HomeMy WebLinkAbout004-1022-60-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15 04 (1)(m)]
Permit Holders Name I City Village Township
Ken Cook
BM Elev.
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
r
Septic
f L�
Dosing
o yt
co
A on
Ho I g
TANK SETBACK INFORMATION ) Ar L, �- e ( 11A; ,
TANK TO
P/L Q((
WELL
BLDG.
Vent to Ai ntake
90AD
Septic
y -�-4.
715�
S ,
Dosing
7�
-7 ��
t
Aeration
Holding
PUMP/SIPHON INFORMATION" f1A
Manufacturer
Demand
Z&A Of V
GPM
Model Number
+ I1
lJ
TDH
L'
Fnctio L ss
System ead.
TDH/ Ft
S
Forcemain
Dia. Ik
Disc to Well /
ILerl,%K,
I 7
SOIL ABSORPTION SYSTEM
TOWN OF CADY
County St. Croix
Sanitary Permit No
633994
State Plan ID No
Parcel Tax No:
004-1022-60-000
Sechonrrown/Range/Map No.
10.28.15.154A
ELEVATION DATA f 94 /A/_9< IAA n
STATION
BS
5
HI
9
FS
EV.
Benchmark
d
1. BM
L
g Sewer
"� ki
4f-7
`b 5 25
St/Ht Inlet
SUHt Outlet
DtInlet
Dt Bottom
7
c� I l]
Header/Man.
-76
3
Dist. Pipe
D 0
I Y.!�
Bot. System
Final Grade
St'Cover
�f✓
l
T. v
BED/TRENCH
DIMENSIONS
Width ,
Le ` 1
S
ND_ Of es
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L 5
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer:
Typ System_
IV
t
I
✓ O V
Model Number.
DISTRIBUTION SYSTEM
Header/M itOk1 r
1
11-englh—�---Dia I I
Distribution 7
Pipe(s) ,�%
Length 4 Dia Spacing �/
x Hole S e
x Hol acing
,L--g�
r
Vent to Air Intake
SUIL C:UVtK Y Pressure Svstems Anly vY Mnund nr At arada Svstoms nniv . 1-4....t11/a.
Depth Ov
^
Depth Over
xx Depth of
xx SeededlSodded
xx Mulched
Bedrlr h Center
Bed/Trench Edges
Topsoil �� G�
yes No
1* Yes No
COMMENTS: (Include code discrepencies, persons present, etc.)
Location: 439 HWY 128
1.) Alt BM Description
2.) Bldg sewer length = �5'
- amount of cover = zf 8
Inspection #1: l� �l ;IJ K3 Inspection J#2�zO t5151a �p
homEf�Dtron�+✓IGiCO(/)it,vtrrhl�Arlp'11
tJ1A SfV�r �}v1 . Se j�rh . ail (> GL4aQ of 13 nq /
Plan revision Required? Yes 1� No �`(j yn� / I }M r /
Use other side for additional information. (I V / `� 1 54 C/U,
Date sepctors Signature Cart No
SBD-6710 (R.3197) �'
11"�7t— ��! l�—D� ?Y�A•I rt t� �d ,7llIV— 3 131,
._ HT 12 2 2021 Industry Services Division
L,
County
4822.Madison Yards Way
G
$
Salivary Permit Number (to be filled inby Co.)
q
jp
Madison, WI 53705
p5 St. Croix County p O Rox 1
Community Development Madison, WI 7
33 Iq
Sanitary Permit Applieatio
StateTransactionNumber
In accordance wdli SI'S 393 i 1(11. 1&,, Ada Code• submission of this to,m to the appri •ntal unit
is required Prior :u obtaining a sanitary permit Nitta Application fonts for stateownud POWTS are ed t o
Project Address (if diffat eri dun ress mailing add)
nt
the Depanent of Sa fciv and P:uressi onal Sen ices. Perwn al :n lnrma lion you provide may be used for seco a
purposes in accordance with the Privacy Lan, s. 15.04(I)(m), Slats,
1. Application Information - Please Print All Information
Pioperry Owner's Name
Parcci p Pa _1 p s
----��Ev Co6K
Coy- 1o.1a- Zen -vb0T
Property Ownci's Mailing Adds;
Proper, I i,o
E"
I Goy. CCIJJot
Coy, Sale ', 7,p C +de � Phone Number --—�
AQ alG 0,414Er GJ� St/747 d/2 34Z- 383/
I rib N R /.S F
11. Typeof Building (check all that apply) Lot r
�I of _' Panul) Dwelling - NumberofRedrooms J G�
5ubdiwsion Name
II lock k
Dublic;Commmial - Dcs.nnheUsc--
❑City of
❑State O%vncd - Describe Lsc CSM Nuruber
Village of
Z� J�Cown
of
Ill. Type of PONVTS Permit: (Check either -.New" or -Replacement- and other applicable on line A. Cheek one box on line B. Complete line C if
a ticable.)
A. ®\css S•nmm ❑Rcpluccmem Sy stern ❑Other .Modifrcariun to Exisune System (explain) ElAddittonal Pietreatincoll that Ieaplain)
I
is
Holding Tank In-Grountl �21Mound III +r lndn idual Site DesignOther Type (explain)
(wnvenuonol) I i �� J
C. ❑Renewal Relon: �Revislon ',�l'hangc of Pl u;nbcr l�franster m New Owner Lim Previous Permit Number and Date issued i
I xp,ration
IV. Dispersal/Trestment Area and Tank Information: O -e! pin
_
Design Flow )gpd) Design Sint Appbcan�o Ratr(gpdYl brsT persal Area 2csquired Dispersal Area Pru (sf) System Elevation
,/56 Via_ /_0. S'so zjjZ-S 1—yso /Z�0 19a.Srod 9/.S�coarOMA
_avae,ty in Total I -of Q eta laf c'luref T
rank fnlonnauun r:+!Lass Gallons I Unitsf�,a�j ;� is I U o
S� -
x'os Tanks i Faro n�Tani� _ 2
se c nr �
M � �406_ �__ I �060 ) i✓/f S f.t Co.rc.s . V _—
db Goo / Ca.+ao Q
V. Responsibility Statement- L the undersigned• assume responsibility, for installation of the POWTS sboten on the attached plans
Phnnbcr's Name i Print) P'um bcr' re MP/Iii Number Busrttta Phone Number
oNv. t�xE = ,��iarc 1~<s c7�-lace
Plumber's Addresss (Street, City, State, Lip Code)
N LJ 98 Sr. A Y. S //uCf}vt7 GJI-sY7iL
VI. County/Department Use Only
Approied ❑ Disapproved Petmn Fee 7 Date imued Issuing Agent S ture
s L /
Ll Oamer Gwen Reason for Dcnml 6—! 7J• o 0 1
Conditions of Approval/Reasons for -D,-VP muaL_3.i/oYL$ l V` Q•
SYSTVAOWNER: �I C to e Ft e f !.✓f�� rs Inntvt rt
1. Sepik tank, effluent filter and t L.(r'
dispersal cell mist be aarv'cedlmaintairied L'
by ✓S`T-
al per management plan provided plum
2. All setback,equitements must be maintal 1�J r�a�/+eh
r0
us pop aiipli(dble ibdelotdlhatitdg.
S
.1'ol4 frog e,
Attach in complete plans for the munin and When it to the Cosa, only an paper aW le`ssss tha s a Ins rt lissher to sire
SBD -(,398 (fo
R. 03121, `) c. �� �'"e4"`- "je S � S-)e4 -e /"I- LK % e_k1t� tan
410✓KC) Crass S1t.C7/Jp,-. 1
FIAT P7.1
Y39
fll,,r. /?a
i
leE.J t-106K - f 39 lllrvY. 128
N4✓/ S4d, /o, .?8 n/, /5,
or C,foy, Sr. eAa.,x Cd.
IJodo5
r
N
0 10' Yo
X= 4dlr5/ !9 4CAE � ..tAcfL
X L L Vs 383. Y3 SEr ^44xt n'er
`OA
y
PRo/eifd M
® IJEct .1 Pat SW. f'o
O,ccF &4mi J 5- )
�.toPo3s0 �/ESf� � 1�
,QRfJEIaLY �006/Ldd Lo,yBO Q�E`� E�fcO
rfAIX �— 89 s'
On \ 13.,*1. 140, o .JAIL AJ
90 --�4 9rc
i
G x 75,fO<K c Etc
Oe,Jrs
r �
LAr. /✓✓. Et.- 93.o,
/C. a dr 9
September 20. 2021
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2023-09-20
Plan Review: PWTS-092102345-C
JOHN PE LIIE
N6298 State Ihghway 25
Durand WI 54736
SITE: Ken Cook
Town ofCADY
St. Croix County
Total Amount: S500.00
Description: 450 GPD (3 Bedrooms — A'ew Construction)
Maintenance Required
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL
GREEN BAY WI 54364-5211
Contact Through Relay
http /ldsps.wi gov/programs/industry-services
www.msconsin.gov
Tony Evers - Governor
Daum Crlm - Secretary
Conditionally
APPROVED
DEPT OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
SEE CORRESPONDENCE
Pressure Distribution Component Manual — Ver. 2.0.
Hill-1117n6-p I\ (11 III. R 111 12)
Mound Component Manual — Ver. 2.0, SBD-10691-P
(N.Oli0l, R 10 12)
Tlne submittal described above has been rep iewcd for conformance with applicable \k isconsm 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 manuals)
referenced above. The owner, as defined in chapter 101.01(101, 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,
stals.
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
pniducLs shall not he diuhal ed into the dl.uns dlschalone to the pli\'Ilc onsilc �%astekkalci (IenuneW sysiem
tPONN FS). NN ante generated shall be properly disposed of on -site or otI site
• Any tall grasses, leaves and shrubs shall be cut short and remos ed 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 [he moisture content of the soil to a depth of 8 itches
Smearing and compacting of wet Sod will result m 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 act 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 394.30-3 and SPS Table 394.30-5
• Insulate building sewer bevond 30 feet per SPS 392 30 (11lie I
• Well setbacks to meet chs. NR N 11 & R 12
• 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 CPNI Specifications.
• kreas Ihal are occupied ::Ill, I11,1. li n:: i,l,li'. ,I unh-..il:,l h,nl ,I.i- id,' It [lit' .un,r,nit Ill It'll
n .ili,l Ian n�al 1;"u n', i,l li In a :. ,I1 .0 .Ii)iL. ii", lu illi i'.i,.il ''I"'" lilt ['I"" tic L,it 011
:it, .,J: ,, ' ri..ur, 0 ;LL L1l'M; .nndlLum, .oc Cn1(lIJ tCIe,1. to 11111%Idc
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 PONVFS 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 m the approved plans.
A copy of the approved plans, specifications and this letter shall be on -sue during construction and open to
inspection by author17ed 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 Seri ices reserves the right to require changes or additions should
conditions arise mak ing them nece's,us Ihr code c(attpl lance As per .tale s1,us 11)1 2(2). nothing in this Ies leo
shall relle%c the designer of the responsibility for designing a sate 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 Division of Industry Services
rn.i.l: _
Cell: 608-516-6134
n'.ac o:'r.
{11-1 � � c r) ♦-i`Ti�7'1�
_ _ �A . �• / i : � 1 : '. n � l l � . �. � ' t 'w l •ti ." \ \ V la l i : �. . i ,i �. L V 7 .
(_n,cnel � `,ill:"_.• '• - K - . ._ CmiJtlwnnlly
APPROVED
DEPT OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDLSTRY SERVICES
SEE CORRESPONDENCE
Ir
I �
I
�'rt EC li "G{I;' I''�1"it I!!�ial l': S.: V":'.c l;• :.
tif',U rlr'.!-P I \,11', II I "\ r tr•' � � ,m " _
PIOT El:1 ]
AIE-) �oor- Y39 Awr. 128
/V41, S4J /e a8 N /S�l
of C,rAY, Sr Cceir Co.
' A//,cep.
am �
Qf
,C/U ® NEct
1 /�RoPooiJ
1 ,QA�JEdIY
-aa�—� /
Y39 O/
8
r
„ N
0 10� yo
G7= aiTS, /9 ,f c.cF �O,Ia eEL
�9CL 503 383.113 sereAc.r1 /YET
�OOC�LOd �'�Ilo
I ANx
Put 5C.4. y0
FO,c(F ryA,✓�3 S')
/ -� UOEJ Fir'c0
c%D
70
G x75 Roz cLe
a?. 8 x 9Y. Y I /-ro ., J 16IJ
SYS. E,. - 9� s ` 915ro",<
D = /.o
ft
E = /, y,?
ft
F = `)
ft
G = s
ft
H = /. /
ft
A = ft
B = 75 ft
I = /o. 8 ft
J = G ft
K = 9.7 ft
L = y, y f t
W = .77.8 ft
GEOTEXTILE FABRIC COVERING
ASTM C-33 SAND FILL
S11 TOPSOIL -
Page 3 of 9
CROSS -SECTION OF MOUND
UPTURNED LATERAL & ACCESS BOX
TOPSOIL OBSERVATION PIPE & WATERTIGHT CAP
DISTRIBUTION LATERAL ( /A In. sch. 40 PVC D2665)
Lateral Invert El.= 93.40 R
TOE a'1 F OD
% °h SLOPE FORCE MAIN (2" sch. 40 PVC D2665)
DISTRIBUTION CELL = G ft x 75 tt = - Y$6 ft2 (0.5"- 2.5" aggregate)
Min. Required = '114 _ / D = 'ISd W
4" sch. 40 PVC
observation pipe
m m
0
o u a 1.5 ft
'
N CO
3 0
00 3 L:, OSft
w 0
PLAN VIEW OF MOUND
/ T Observation pipe
C J
tox� --
A
OX
i
75
B -
Observation pipe
H I
- 11
TI 1168 = Distribution Cell
Distribution pipes
]. S ft (0.5"- 2.5" aggregate)
L C /s 7.f'
( �� in. sch 40)
I OX= Upturned Lateral
with Access Box
�Proh bit disturbance and vehicle and vehicle traffic within 15 ft of downslope toe.
�L
I? y'
System E1.= 97.5 ft
Contour El.= 9/. 5 ft
9.7r
—K-}
♦fAuif.cd
\ 2" Force
Main
Basal Area = /w/, 8 ft x 7S ft = /.?:o W Min. Required = 115d + I '/ = //7.S ft2
r,ige -3 of
D ft CROSS-SECTION OF MOUND
E ft UPTURNED LAI ERAL &ACCESS BOX
OBSERVATION PIPE& INA] ERTIGH I CAP
ft (E):-Cfl E FABWC C, uVERING FC)p SOIL DIST kIRLMI-IN LME�;.'Al i
C, f C- 93.0'
A%S TM C-11 SAND ['It C %92.5'
G
TOPSOIL
r7l
91 51
F, )1"•:.F U AIN
/5
4
f
W
A
,e f I
I(
PIPE LATERAL LAYOUT OF MOUND
(Lnd Manifold wth Aggregate)
HOLE DIAI,1ETER �/� in.
LATEPs1L DIA. II2 in.
MANTEOI.n DIA. _ _&2 in. (spipeD40 �'VC <ea6J
FORCE MA��I7N DIA.= _�� in. PvGS�ee
f t .
N
s= 3 ft. JQ P0y
as
X = _ y . ft.
Y = ` ft. �- N
h,
MANIf ow
i1/I� !n sch 4f
PVC, Dzfis5
No ,
.r If �5l
FORGE MAIN
(2" soh 4Q PVC D2665)
\NONe
LaSr ��
Box
Minimum Number of Hodes = y' O Nt _ 12 = 3•9 Hoes
Page __ y--of _ 9
HOLES LOCATED EVENLY
ON BOTTUM OF PIPE.
—_Z? Holes/Lateral x 2 1 ate,als = 38 (3/16") Hales x 0.66 gpm / (.VPI6") Hole = _ . d8 GaM = SYSTEM FLOW PA E
PIPE VOLUMF- _ ZL� ft ;-aterals (total) x 0.092 gaVft. _ 11.15-x 5 = CC.-7 _ GAL = MINIMUM DOSE VOLUNIE
PIPE INVERT ELEVATION = 93, 0 ft
Page _ S of `?
COMBIN i iON SEP T iGJQ08E ?kAMK CROSS-SEG c ION
(DP,AV,rING NOT TO SCALE'l
MANHOLL RISER. & COVER.
=1NAL 3RADE (Del SPS 384 zs(;) c (81, approved
/(slope ground surface array from loc%irxj cuv,pe, n remmg label Extend
manholefs) for pmPFJ drainage) / „anholu riser as mca3sary.}
4" ivlln- Sth 40 PVC 7artk Pent
located 12-abovz ride or 24-
4- :,m Sch 4C PVC (an', lent ELEC'RICAL 9
j BUILDING SEINER / locked • above gmde of 2t JUNCTION BO:`' aUove Regional Rand Elevation
-.2
` (psr SPS 3B7 3o(; ;)} aoove Hanional .%I n Elevation IcnmWY cviln SPS 318
/ )) and NEC 300) /
J
I j
NI/ I�
i
(iJse
II a Tze—
`_
1 I
I I I
I E
I i
'.� ='t= n°2
j Frv_o: !�'.P.l
^C]'S12J o:1•. xn'Fd;er
Pantle one
-
5
.I�
>4
FORCL
MAIN
OPTIONS
1
»p jl
=ro•i I
I.tain
Alerm Flo.,
----- L Flan:
• On 71oa:
iu,NI,',Qiv, OF 3" Or ,3UITARLE BEDDING BENEATH TANK a Iv)AXIMUfvi BURY DEPTH OF C"o'
,,nctonnq of taNc may be required ner SPS 383.43(M(M
i
Tank Manufacturer � L✓/c'5 E+: L oni ci E i � Daily bilamewater, FloY,v (D1}LI{-): Z156 GRD
SepficlPUmp Site: /ooa f600 aalluns u ,ijer oi' dail asses , 53 /J,8 s%)
Alarm Manufacturer
Model Number. 74,0K AL E/ T / Fulce main volume 3S rt y, , l!J galltt = 3. 7 gal
Switch Type ^1 e4tVW/ue. Actual dose volume: 90. S gal _5.7 gaf = 8 Y. 8 gal
(total dose volume - volume of force main)
Effluent Pump Manufacturer. Zd EL tE,:
Model Mumbe.. /SI
Minimum Discharge Rate: o?so 2 __GPrvI
Vertical lift (pump oft to iateral invert) ... - 11.6 f,
System head (distal pressure -7• S 1.3 tn:) _ 3, 3 it
3I- ft Force main x / y /100 friciion faro_x 5 q
Filter friction loss .. . .--_.._ _-_ft
't otal Dynamic Head (TDH) ���✓ g
DOSE i ANIK CAI�AC_ t IES:
Rr�serve above alai �O. In = _ 3 r1S.3 gal (D)
Alarm float above on float a in = -__ 33.5 gal (C)
On/Of floai measurement S. '/ in = 9G. 5 gal (B)
Oft aoove ;ark botcom 8 in = /3 y 1 gal (A)
DOSE TANK DIMENSIONS:
Leng>h 16-0 in
Ouilei 'neight ��?l_o in
Width 8 `f in
Galionslinch /6.76
PUMPPERFORMANCECURVF
MOCEL 15'152153
I
o •.ryn
• Timed Dosing panels avai able
• Electrical alternators. for duplex systems are available at d
supplied with an alarm
• Vanable '.evel control switches are available for control mr
single phase systems
• Double piggyback variable level float switches are available
for variable level long and short cycle controls
• Sealed Qwlk-Box available for outdoor Installations See
FM 1420
• Over 130'F (54°C) special curial required
1SIMS2/1S3 MODELS
Control Selection
Model
Volts -Ph
-
Mode
-
Amps
S&mpiex
Duplex
1,1151
115
Non
rid
^
2nr,
FN'5'
Auq
5l%
InUuJe'
<c'
c15t
231,
Non
; 2
or
5E 151
230
AulaInc
uJea
2or ,;
N152
7'S
Nan
E5
3or 1
614152
its
Ad1G
E5
Inc,,JeU
.n-
E152
230
Non
13
2x
BE 152
23C i
A"
:o
IncWeC
2o,'
N153
.15
No-
'G5
2n
HN'cl-
'1c
A,rr
'Oq
r„rdw
--u
E 153
23C
No-,
S 1
BE153
23C
Auto
5 i
:rdr,Uec
1 Single nlggyhaC.K variable level float snitch or dounle plggyCacK variable ievo
float swilc'1 Refer to FM0477
2 See FM0712 for rorrerl mode! of Electrical .Allernator F-Dak
3 Variable lEvel control swilrl' 10.W,13 used as a cenlrg ac!lva:ur speclfv auple)
13, o• (4� Real system
4 CAUTION
TOTAL DYNAMIC HEAD/FLOW
PER MINUTL
EFFLUENT AND DEWATERING
MODEL
151
152
153
r c': Llcl^r,
i_d Leers
cell
LWS
Cir
' L,wm __
"
Sr 169
65
26t
!7
291
F.
231
70
2E5
53
20'
51
271
]
r 11C,C
44
ti
C2
197-
75
42
159
2--
U
33
125
JS
--
42
It ^tml -
°5ft
6nl
- 4it 034ni .-
Model 151
I "
t Wr-tl
tir o-4:
m4 CBP
Models 1521153
I
l 1
"Easy assembly"
5
1,
y\ -'X11,
�t ,'J tl,s;Nme PWe
not .•uLxJrs1
1
•t11.
r�.-�7.
_e
Reduces potential dogging by debris
Replaces rocks or bricks under the pump
Made of durable noncorrosive ABS
Raises pump 2" off bottom of basin
Provides the ability to raise intake by adding sections of 1'>'
o' 2' PVC piplrg
Attaches securely to pump
Accommodates sump dewntenng and effluent applications
NOTE: Make sure float Is free from obstnrcbon.
For unusual conditions a reserve safety factor is engineered Into the design of every Zoeller pump
c:r Copyr l 2008 7oAlle• Co All rights reserved
POWTS OWNER'S MANUAi A,N'D MANAGEMENT PLAN
HLE INFOR IATArois
Oi-_ wner /< EAl LoG K
Permit F
—J
DESIGN PARAMETERS
I Number of Bedrooms (I OOgpolbedroom) 3
Number of Commercial Units - J
Estimaicd flow i averagei _ - __;
_1Do ,al,'day
Design flow (DWF). estimated x 1.5
1Y0 al/day
Soil Application Rare
Dgal/day fr
influentlEffluent Quality (❑ NA)
Monthly Average
Fals- Oil & Grease (FOG)
< ,0 mJL
Biochemical Oxygen Demand (BODS)
< ' 20 mg/1
Total Suspendtd Solids (TSS)
`
5 :�0 mL'1, _J
Preticated Effluent Quality (M NA)
Moothly Average
Biochemical Oxygen Demand (BOD.)
s 30 mg/1
Total Suspended Solids (TSS)
'; < 30 me/L
Fecal Coliform (geometric mean)
-
Maximum Effluen
Calculations:
Soil
DWF - Application rate -
fa
_1U cfu/10011"l
1.18 inch diameter
cvc--caa cvFt-ruts-A-rrnhic
Septic Tank Capacity
QOQ gal [DNA
Septic Tank Manufacturer
Ce.u.
NA
Effluent Filter Manufacturer
s4i c5 r
❑ NA
Effluent Filter Model
Gf-/O
❑ NA
Pump I ank Capacity(-'apacity
OQ gal
❑ NA
Pump Tank Manufacturer
!l/E,iE_ Lase...0
NA
~Pump Manufacturer —�
2,o czzrX
❑ NA
Pump Model
/S!
❑ NA
Pretreatment L]nit NA)
❑ Saud/Gravel Filter
❑ Peat Filter
❑ IvIcchanical Aeration
❑ Wetland
Cl Disinfection
❑ Other:
ManufacturcC
lt'lOdC1: _
Soil Absorption Component (❑
NA)
❑ in -around (gravity)
C In -ground (pressurized)
C At -Trade
R Mound
O Dui line
❑ Other
L Dispersal Units — Manufacturer
n Aggregate Cell(&) ylodel
Dispersal HridCap (Dispersal Unit EISA) or
Area Reeuired - EISA (Trench Width) ="Units or Total Lenvth ofTrench(s)
G' - 751 --
❑ " Desiari of Pressure Distribution Netwotits for Septic Tank -Soil Absorption Systems" Publication 9.6 (SSNVMP
❑ " iCC Flowtech Mound Component Manual" Version 1 1
❑ "EzFloty NIOUnd Component Nlanual" Version 12115/201:'
t❑ SBD - 10854-P (R-UL) `At -Grade Component Manual Usiug Pnssuic Distribution" Version 2.0
❑ SBD - 10705-P (N1.01101) "in GrUtrnC Sntl Absorption Component Manual' Version 2 0
rX SBD - 10691-P (N 01101) "Mound Curnpoaent Manual" Vcrsmn ^_-0
G SBD - 10657--P (R.6i99) "Drip -line Etfiuent Disposal Component Manual"
❑ SBD - 10706-P (N.01/01) "Pressure Distribution Component Manual- Version 2.0
❑ Other -
ANCE MONITORING SCHEDULE - iWAiNTENANCE AND MANAGEMENT
Service Event Service
ct tarik(s), inspect dispersal cell(s;, dean filter At least once every 1 ® 13 mo
it) & oumo controls. alarm, pretreatment unit At least once every: (7 me
Oder -
START UP AND OPERATION: For new construction, pnor 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 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 shalt not recur when soil conditions are frozen at the infiltrative surface -
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity
and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water -saving
appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water
softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface
whenever possible. Note: this does not include laundry waste, showers, dishwater, etc.
This system is de3igned to handle domestic srreneth wastewaier, hrnvever the dsposai of food based greases and oils, vegetahle/fruit
peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only
paper that should be discharged into the system Other non-hindegmdahle items surh as baby wipes, tampon&, unitary napkins
condoms, cigarette butts, dental floss, and cotton swabs should not cater the SVStem. Chemicals such as petroleum products, paint,
Past: 7 of 9
disinfectants, pesticides, antibutttcssolvents, etc-- Should not oe flushed into the system as they can Seriously damage your POWTS
and contaminate ,your cinnkine water suppl}
tvfauuam a regular steady lots I,% spreadw n iaundwashing throughout the week. Avoid vehicle traffic over all system components.
Compaction of -snow over the dispersal unit tna" cause n to freczc uo
INSPECTIONS Sr hLAINTEN ANCE: Inspection shall he made by an individual carrying one of the following Itcuirses or
certifications: Master Plumber. Master Plumber Restricted Sewer- POW'I-S Maintainer or Scptage Servicing Operator (per the attached
�lauticnanct Schedule). lank mspecnons must include a visual inspection of the tank to identify any missing or broken hardware.
tdenutv any cracks or leaks, measure the volume if combined sludg,: and scum and check for any backup or pending of efllueut to the
ground surface and test all electrical equipment such as pumps and alarms Any defects shall be promptly corrected Exposed openings
greater Char. Y Inches in diametei shall be secured with efi.ctive locking devices to prevent accidental or unauthorized entry the tanks.
\': hen the combination of sludge ane scum in any tank exceeds one-third i I%3) or more of the tank volume, the entire contents of the
tank Shall be tCtuored hp a ieplaile Scrvicing ( P, oratar and disposed of In accordance a Idi Chapter NR 1 13, Wisconsin Administrarin e
Code
The outiet Filler(q) shall be inspected and cleaned tU retno,•c any accumulated solids according to manufacturer's specifications Solids
washed from the filter shall be retained it,, the mill.. Illter cleaning nia\ be necessary at more frequent intervals than stated in the
maintenance scheduie to i ccp file system operattrs.
Alar:,ts should be tested on a reintlar basin b) the home owner If an alarm sounds, contact an individual licensed to sell ice POINTS,
There is norinallI a I dad nscn e under regular ,rperannL condition,, however water should be conserved until any problems wi tit the
system We ctrrceled to prevent back-up of sctvagz into the duelling or surfactne
ABANDONMENT: 1'r hen the PON'• CS falls andor is permanently taken out of service the tollow'me steps shall be taken to ensure
that the system is properly and safely abandoned in compliance with Ch SPS 3S3.33, NNISLniSin Administrative Code.
All ptputg to tanks : nd ill's shall he Lsconuccicd anti the abandunrd pipe openins scaled.
- The contents of ai! tanks and pus shall be removed and properly disposed of by a Scptage Servicing Operator.
- After pumputg, all tanks and pits ,hall be excavated and removec or their covers removed and the void space filled tt ith
soil. gravet or other inert solid mate ial
CON''TINGEN'CY PLAN: If the POWTS falls and cannot be repaired the following measures hat c been. or must be taken, to orot-idc
a code conlpltant Igllaccment systci.i
A suitable replacement area_ has been evaluated and may he un Iized for the location of rep laccme tit soil absorpt roll s•. ste In
The replacement area should he protected from distwbance and unnpacuon and should not be infringed upon by requited
setbacks from existing and proposed etructure, lot lines and wells Failure to protect the replacemcnt area render it unusable
Replacement systems must comph with the rules in effect at the unrc u? replacement
❑ A suitable Iculac.enlent aree is not available due to setback and/or sal limitations Rarring advances in POINTS technology a
holding tank may be installed as a last rc,ort to replace the failed POWTS.
X The site has not been evaluated to idurtry a suitable replacement area. upon I -allure of the PO\VTS a soil and site eva!uamon
must he performed to locate a ,unable replacement area If no replacement area is available a holding tank may be installed
as a last iesort to renrace the failed POWT S
X :Mound and at-,,rade soil ahsorpdou syucros ma} be iecuustnrcted in place follow Ing Ienlutal of the hromat at the infiltrative
surface. Reconstructions ofsuch systcm> must nnnply with the rules in effect at that time
<<WARNING>>
SEPTIC. PUMP AND OTHER TREATIUFN,I IAVKS MAY CONTIAN LETHAL GASSES .AND/OR INSUFFICIENT
OXYGEN. DO NO'I ENTER A SEP"1 IC, PUNIP OR OTHER TREATMENT TANK UNDER ANN- CIRCL'11STANCES.
DEATH MAY RESULT. RESC[:E OF A PERSON FROM TIIF INTERIOR OF A TANK MAN BE DIFFICULT OR
IMPOSSIBLE.
ADDITIONAL COMMENTS
POWJ S INSTALLER
Name JaNN PEKE /N/-,j313YL
L Phone 7/_ s 67-7
SEPTAGE SERVICING OPERATOR Pum erl
Name
Phone I
POW TS MAINTAINER
Name- — --St¢s Larydi✓G- - — —
Phone 715- 47.2- 12d4
LOCAL REGULATORY AUTHORIT! �_
Agency Sr eAO/X L0.'Ifw Jrr 1)fVrgjAwtryr ;
Phone 7i5- 386_f.14o. ---- --
Page 9 of 9
Installation Instructions for the GF10 Filter
Step 1. LQ4. t,! atraf ten uve
rho Septic tank cover, on
the out of side of tank
Step 4 Clue the fine• Lese on10
the oteler pipe, hlse•t ire filtw
canrldgc Into the case Make
sure the "Item it ecrnpl^le;y
hlscrtcJ Into thecascl
J�
BEST
TECHNOLOGV
i
Stop 2 Befo'e I lstallatlon,
plan the title, case on to
theoutictp',pc Makesurn
the case is pon i oned sc
Inc fill. rsds!:e removed
from, the tank fo' maims.
n.ln(r.nwl -.r rvicc
8 e o ar 6_ rm vc re scs 1 :=a r r
Installation of an Same
B existing system. rriI
IT
oI�
Stop ro, 'nrie0zi ons that
rctlulre cr des.re acCoional
suppor:, (if addrelonial support s
not neecwd,go !o Steo 41 Gluca
section of 1'5d: 4C pipe to the
t .191111n1 IUOIICa o" tilehotter•'
of 0wraue and the',Lh la(. led
on the side of the (.ic
Step 70, i^stalWtlons vmere it will
I:e difficult to Icach the ha^ale piece
I -Schedule 40 pipe Into tlr tee on the
Ise Hole and evtend it to 1•.etgnl thal s+ll,
poke it easy ;e rcmose the Mter
LJ r'L -J L� %J1 ..I L'-( '..r r_.
;a new system only the septic tank 3
pumped prim to Installation.
9
— I . Yv J 4'l ._r t.� ", [ _� r.. — F. e-1 L_� _. "I t-J .-- t..
Maintenance of the GF10 Filter
A Uri— Ir.vne in wMch optic taus are sery czd is sec I)y state a , d local Dues
glnwugh U ty may be dr'fc<rY. nnnur,tlalu y ognKc . su B9cst I -is to five
year: vie rreommend the C'!Dfitar bedcaner v: hen the stpt crank l; rorrnal'y R
cfcvned and pumped or as nc.ltd
WARNING: If the liquid level in the tank is above the top of the
filter, pump the tank prior to removing the filter cartridge.
® CAUTION: USE RUBBER GLOVES WHEN HANDLING FILTERSI
Step 1. Remove t'te secrc tank cover
and pump the tank if recesser/ to
preecnt any solids train csca chg to the
fic of vdscr he Is rcr LveJ
e
1�
Step f'Jt We hlte•
handle and side the rllcr
ant of Ille case
`I 3 1
S1ap3 Whdeholdrrglhc
elicit car to dare civet the
„ccess npen'n] of the tank
r h`se thn cartridge off ca4
Irest water. !eke tale to
make sure all solid material
falls bxk into :he lank
BETECHNS7'
GY
3 Fairfield Blvd Wnliinglu,c CT 06M
1.877 7GS-9s66 ra. 2o7 769 b514
Stop 4 lava the cartndge
hack me the case making
sire -.ha! It is proper'y
A tined and complex%:y
"w1ca into the co5c
mr,
011 :...
'� }4 : � �-.�ti.._ . t i; "a"""'�f!"=�i+'�"`.' '� � i ;:}.Guar. �:.=—".--�s•�5..,v,r - _ ` i - , I
4
L
KEN & SARAH
HOUSE
FLOOR PLAN
100
w 0-
]' 101S B0' 8'-or 8' 0' T 11 314" 8 0 114- 8' 0' 8' 0' 8' T B' 0' E'- 0' " 1 1Q'
KEN & SARAH
HOUSE
FRAMING PLAN
101
4
.•4
.v4
".4
1
�
4
--4
KEN & SARAH
HOUSE
EXT ELEVATIONS
110
KEN & SARAH
HOUSE
3D
180
Wisconsin Dad, D
Division of industry v
)N 1 2p21 J-- SOIL' EVALUATION RE PageOf
Attach compbfe sib an on 6►Hel - t t Inches In size. Plan must County n
Include, but rat Ilm to: ve erf0 el reference point (BM), direction and Parcel I.D.
percent slope, Scale d , north avow, end location and distance to nearest road. v y - ,0 �, - �Q - �t�
Please print all Information. Reviewed by Date
Pereonel Infornudon you provide mey be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �y
!L/ C
L
Properly Owner Property Location �\.
4- S4 Yh� �_ J� Govt. Lot 1/4S 1V 114 S D T p N R S E❑(or1
Property Owner's WingOAddreae�
Lo�
Block #
Subd. Name or CSM# p{7 1 rn41
1
cry State Zip Code Phone Number
ity Village own Nearest Road,
New Construction useM Residential / Number of bedrooms Code derived design flow rate GPD
Replacement Pubilc or commercial - Describe:
Parent Flood Plain elevation If applicable
General comments h�1 �YY\J v�'(\ �, r k-y\
end recommandstions:
MBoring Al 0 Boring `'/ f/
Pit Ground surface slsv9 7 ft. Depth to Ilmlting factor 7 O In.
Sop Application Rate
Horizon
Depth
Dominant Color
Redox Description
Texture
Structure
Consistence
Boundary
Roots
GPOIN
In.
Munseli
Qu. Sz. Cont. Color
Gr. Sz. Sh.
•Eff#2
•Eff#1
��
10
MY
C
0 16
�,
A
O.
®Boring # 11 Boring
® G 2l.
Pit Ground surface elev. n ft. Depth to limping factor_ In.
Soll A lostion Rats
Horizon
Depth
Dominant Color
Redox Description
Texture
Structure
Consistence
Boundary.
Roots
GPD/R
In.
Munsell
Qu. Sz. Cont. Color
Gr. Sz. Sh.
I
•Eff#1
•Ery#2
I
CS
3, s y
--
—
O
' Effluent 01 = BOD, > 30 5 220 mg& and TSS >30 < 150 mg1L • Effluent #2 = BOD < 30 mg/L and TSS 5
30 mg/L
7J5 ?90' I
Fa
Boring #
t Boring!. i If
P1t wGroSr� Ur%m elev. � ft.
.a
Depth to limiting factor y q In.
SrJI Annllentlnn Rntn
Worizon
Depth
In.
Dominant Color
Munsell
RedoX Description
Qu, Az. Cont, Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Fe
•Eff#1
'Eff442
1
`\�
10 r 3��
�'
SI►�
d.�nabK
MC!'
• S
4
O.
O.
CW
U
O ti
0 ja
-H�
2,s ,y9
SLi_
0.bk.
3
❑ Boring #
❑ Boring
❑ Pit Ground surface elev. _ ft.
Depth to IlmItIng factor _ In.
Soil Application Ralle
orizon
Depth
In.
Dominant Color
Munsell
Radox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh,
Consistence
Boundary
Roots
GPD
'E
'Eff#2
❑ Boring # ❑ Boring
G d<Ceelev.
❑ Pit_ ft. Depth to limiting factor _ In.
GJI ennlirefinn aafn
Horizon
Depth
In.
Dominant Color
Munsell
Radox ption
4u. Cont. Color
Texture
Structure
Gr. Sz. Sh.
istence
Boundary
Roots
GPDIFtz
'Efi#1
'Eff#2
11
11
11
F�z
7�:
--'1
' Effluent #1 = BOD, > 30 S 220 mg/L and TSS > 30 S 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30:; 150 mg
C'o
J
Homo oA v,s�- Nr639� H�� S7, S ;n� ��11t►� �� 64067
c�htir�-
.
!Ti�
4-v PIP k , n
\r1 6�c.rw �J �t� tt.� — I. p. OOP- IOa�� by - QO
— f �
clt5�
C�Yn�,r
tN
B�- qao
--� E yo
ST file #:
C R iv rY SANITARY SYSTEM office use only
lr�""" OWNERSHIP/ADDRESS FORM
Created Use r
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email.
OWNER/BUYER INFORMATION
Owner/Buyer �Zc__ --_
Mailing Address `" -3
City/State/Zip L. i ,' ,
Phone Number (required) C r' 1721' r
Email Address
Parcel Identification Number ()(' -
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location N —J 1/a , ��1/4 , Sec. / . T Z_� N R/S" W, Town of f_
Subdivision Plat: Lot
Certified Survey Map # f — %O �� J 1Vo ume . Page #
Warranty Deed # (before 2006)Volume . Page #
Number of bedrooms Spec house O yes jrno Lot lines identifiable O yes Cl no
New Property Address
ele
(Staff Initials)
(Verification of new address
1o�2��Zi
(Date)
OFFICE USE ONLY
from Community Development Department for new construction)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form 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.
Community Development Department - Land Use Division
715-386-4680 St Croix County Government Center 715-245-4250 Fax
cdd sccwi.00v 1101 Carmichael Road, Hudson, WI 54016 srcwioov
r
N
2
O
N
_J Y
3 U
O
J
r
w
r
N
0
6TH AVE
4
3 2 1
r
N
F
M 53RD AVE
2
20
50TH AVE
9
11 45TH AVE 12
10
N
N
r
N
rLLb
r
0 1000 2000 3000ft
DISCLAIMER Ttue map is rot guamtesa to be
accurate. cottect current a pate aiW
`-
15 13 "" —._.. N
14ty
. ere or me
contlusIms di the tee�an
use,
,t
Cady Township 28N - Range 15W
Copyright O 2018 Mapping Solution.,
SEE PAGE 37
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Need Additional
Io Plat Books?
on
UnIVSH ty of Wi -Extension
St. Croix County UW-Extension
1960 - 8th Avenue, Suite 140
Baldwin, WI 54002
(715)531-1930
23'
s
S . Cro"ACOUNTY 3
NO. 633994
STATE SANITARY PERMIT
007,
OWNER !fie n
IROA�N9.�\.
PLUMBER. �, NJ ICE LIC.# Z 3 f 3 1I &
TOWN OF fB,JJ
SEC 10 j Z�42 N,
AND/OR LOT Z
CS WI ? 1- 76 45
BLOCK
SUBDIVISION
1G OFFICER
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c). The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
- DATE
vLESS RENEWED
!dUAT
DATE
AIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)