HomeMy WebLinkAbout040-1304-12-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
506374 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No'.
Grothaus, Jim & Amy I Troy, Town of 040 - 1304 -12 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/ ( 08.28.19.1818
TANK INFORMATION I UELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � 2 � Benchmark s v � 7eAje - I
Dosing Alt. BM O
C� 774 //- ✓ n- --- /.C/
Aeration Bldg. Sewe , �J /
A -/0
Holding t/ t Inlet
6.
TANK SETBACK INFORMATION St/Ht Outlet 14), SC,[� p A -
TANK TO P WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic � 1 / � � � Dt Bottom
Dosing Heade — r/Ma, m' 7—,
Aeration Dist. Pipe_ / ,4 . 1#k
Holding Bot. System $ 119 ✓S�
Final Gr 7,, hUY ��
PUMP /SIPHO FORMATION C7V QQ?? 1�
Manufacturer Demand S Cover 2 3. S
GPM 9a S-
Model Number
TDH Lift Friction Lo System He TDH Ft
Forcemain h Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length / No. Of Trenches PIT DIMEN DNS No, Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO l P/ LDG WE LAKE /STREAM LEACH NG Man u r
INFORMATION CHAMBER OR
Type Of System: \ m / UNIT Model Number:
/ / V / DIS IBUTION SYSTEM '
Bader/ anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
g /I /f Pipe(s) Q71 ,�y lit �b e I-- I 3d t fi°
Len th Dia Len th D ia Z_ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center /� /� Bed /Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:__LL1 / 0 Inspection #2:__/ /
Location: 438 Horizon Court Hudson, WI 5)4'0,1,6 (NE 1/4 SW 1/4 8 T28N R19W) Sunset Valley Lot 12 Parcel No: 08.28.19.1818
1.) Alt BM Description = �r B� �t//(�Y 4xv -
2.) Bldg sewer length = S G / l'K ill _Y QJL Ql
i
- amount of cover = Z,s /
% � r
Plan revision Required? Yes 1 ', No
Use other side for additional information. / P r� - ;7
Date Insepctor's Signat e
C
SBD -6710 (R3/97)
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eommereemi.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 St. Croix
i seo n s i n Madison, WI 53707- 7 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce
✓ b 3 b
Sanitary Permit Application S ransaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the ap N�
governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned ct Ad ress (if different than mailing address)
POWTS are submitted to the Department of Commerce. Personal information provide may be used for 438 Horizon Court
seconds purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats.
I. Application Information - Please Print All Information
Property Owner's Name — � RECE l q
; 040 - 1304 -12 -000
Property Owner's Mailing Address U 1, roperty L cation / 4
408 S. Grove St.
ST. CROIX C LaiTtY Lot
City, State Zip Code Phone Numb , Section 8
Stillwater, MN
55082 651 - 491 -4712 (circle one)
II. Type of Building (check all that apply) OJL C.6 Lot # T 28 N; R 19 AA W
1 or 2 Family Dwelling - Number of Bedrooms 4 12 Subdivision Name
, 5o6 Bloc Sunset Valley
❑ Public /Commercial - Describe Use ___1 ❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
Z � /I ;- I
K Town of Troy
c,._. I?
III. Type of Permit: (Check onl one box on line A. Complete line B if applicable)
A' New System ❑ Replacement System y p y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B. ❑Permit Renewal El Permit Revision El Change of El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
iv�� �S.s,._
IV. Type of POWTS System/Component/Device: (Check all that appl
kNon Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil
❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil ApplicatiotyRate(gpdsf) Dispersal Area Required (sfj Dispersal Area Proposed (sf) System Elevation /
600 0.67 857.2 900 1 --," 902.75/902.35 ✓
VI. Tank Info Capacity in Total n
p ty N of Manufacturer
Gallons Gallons Units . o �„ 2
.
New Tanks Existing Tanks 10 c ti b
n � 0
Septic or Holding Tank k
1250 1250 1 ieser
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for inst lation of the Pip) WTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number
Jim Hurlburt MP 222997 715- 283 -4851
Plumber's Address (Street, City, State, Zip Code)
N 260 CTHW D Eau Galle WI 54737
VIII. County/Department Use Onl
Approved ❑ sappro Permit Fee Date Issued Issuing A Signature
1 O iven eason for Denial 4 166 - /a zZ a 7 Zl�)
IX. Conditio of A r l /Reasons for Disapproval / aJ - 6P fEM �1 � , I)o ySd�C 1 ~
1. Septic tank, effluent filter and n J
dispersal cel must all be services 1 maintained
as per managem plan provided by plgmber.
Z AN h n iquirements must be maintained
as c" coft / adiMoc". (e
Attach to complete plans for the system and sub tt to the 7Dunty only on paper not less than 8 1/2 x 11 inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
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.: RECEIVED
Wisconsin Department o rr OIL EVALUATION REPORT Page 1 of 3
Division of Safety and Bu ng s v T 2
i 2004
in accordance Comm 85, Wis. Adm. Code
ST. CRO Cow ST. CROIX
Attach complete site an on p -6y1/2 x 1 inches in size. Plan must
include, but not limit pad' and Parcel I.D. (pending)
percent slope, scale or dimensions, north arrow, a n�
r- Date ne
Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) t D Q
Property Owner Property Location ❑
ARTHUR & MARIYLN FEYEREISEN Govt. Lot — NE 114 SW 114 S 8 T 28 N R 19 E (or) W
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
420 Townsvalley Road 12 — Sunset Valley
City State Zip Code Phone Number village ElTown Nearest Road
Hudson, WI 54016 ( 715 386 - 2122 TZGY I Townsvalley Road
El New Construction UseEI Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement Pu bfic or commercial - Desenbe:
Parent material outwash/sandstone Flood Plain elevation if applicable NA ft
General comments Conventional In -ground trenches - to be designed by installer
and recommendations: loading rated s on d location of tram has - rofi dra m be uired
PB- Boring# ❑ Boring 0D k-s 4 6�f irL� 9S
El Pit Ground surface elev. 905.92 ft. Depth to limiting factor 96 i Sol Rate
Horizon Depth Dominant Re�dox Descri Boundary Ro
ption Texture Structure Consistence Boundots
in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. 'Eff#1 'EfW2
1 04 10YR2/2 — l 2f -mabk mvfr cb 3vf-m 0.6 0.8
2 4-11 10YR2 /2 — I 2f-mabk mfr c i 2vf-m 0.6 0.8
3 I1 -19 10YR3/4 E l — fk 11 sl If -msbk mfr as 3vf-m 0.4 0.7
4 19-45 10YR3/4 — 3 cs & gr osg m cw — 0.7 1.6
5 45 -83 10YR5/4 �p d c ml cw — 0.7 1.6
6 83 -96 1 10YR4/4 — fs Osg ml as — 0.5 1.0
7 6 0YR4/6 _ I00 TI c2f 1 / fs (0)s9 ml — — 0.5 1.0
F 111 Boring # O BOO 903 �O' �Qd Y pit Ground surface elev. 1nr Depth to ammn9 factor in. Sol Rate
Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Mu�ti Qu. Sz. Cont Color Gr. Sz. Sh. 'Efl#1 'EtftF2
1 0-4 10YR2/2 — sl 2fsbk ds cb 3vf-m 0.6 1.0
2 4-8 10YR2/2 — sl 2f -msbk ds ai 2vf-m 0.6 1.0
3 8 -12 10YR2/1 — I 2fa&sbk mfr ai 2vf-m 0.6 0.8
4 12 -21 10YR3/3 — 1 2fsbk m f r cs 2vf-m 0.6 0.8
5 21 -27 10YR3/3 — A 2fsbk ds cs 2vf-m 0.6 1.0
6 27 -102 10YR3 /6 — cs & gr Osg dl — -- 0.7 1.6
Effluent #1 = BOD > 30 220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = B013 30 mglL and TSS < 30 mg/L
CST Name (Please Print) i nature CST Number
Mary Jo Hollister 224832
Address balle Evaluation Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 01 - 13 & 07 - 08 - 04 (715) 426 - 1775
j
Arthur hur (Lot 12 (Pendin 2 3
Pro perty Owner ) Parcel ID # g Page of
❑Boring 906.56 O� -q v cam
Boring #
Pit Ground surface elev. ft. Depth to limiting factor >108 in.
Sal Applica Rate
Horizon Depth Dominant Color Redox Description Texture Stnxiure Consistence Boundary Roots GPDW
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 '002
1 0 -3 1OYR2 /1 — I 2fabk ds cb 3vf-m 0.6 0.8
2 3 -11 1OYR2 /1 — I 2fabk ds ab 2vf-m 0.6 0.8
3 11 -19 1OYR3 /3 — 1 2f -mabk ds as 2vf-m 0.6 0.8
4 19 -24 10YR3/3 - sl 2f -mabk ds as 2vf-m 0.6 1.0
5 24 1OYR3 /4 7 r s Osg dl cs 2vf 0.7 1.6
6 30 IOYR5 /4 , s Osg d1 I — 1 — 0.7 l.6
orizons 4 & 5 have some A, Horizon 6 has 20- 25 %gr.)
Boring # ryBoring
J Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNF
in. Munsell Ou. Sz. Conti. Color Gr. Sz. Sh. '001 1 'Eff#2
r Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '01#2
' Eflkrent #1 = BOD > 30 < 220 nxYL and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer_ If you need assistance to access services or
need material in an alternate format, please comet the department at 608- 266.3I5I or TFY 60&2644rM.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer J t rA anok ,Q v 4
5
Mailing Address �7S15 :54' 51 � Si :55
Property Address 30 Q vi 4vL• G� wCA 5 Cr" t,.) � b 5
(Verification required from Planning & Zoning Department for new construction.)
City /State Aft, IJ'ok Ux,6yoTt,, Parcel Identification Number
LEGAL DESCRIPTION
Property Location _Q_L 1 /4 , SCO '/4 , Sec. , T Zs N R I CA W, Town of �jr -,eA
Subdivision 54v� �� U o , f lee., , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 4
4 /
Z S NATURE OF PLI S) DATE
rmation that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
I111111IIIIIIIIIIIIIIIIillf11111II llIINiIIIII1111
* 8 6 2 7 3 7 1
State Bar of Wisconsin Form 1 -2003 862737
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI
RECEIVED FOR RECORD
10/19/2007 03:10PH
THIS DEED, made between Scott L. Feyereisen and Galeen K. Feyereisen, WARRANTY DEED
husband and wife EXEMPT A
("Grantor," whether one or more), REC FEE: 11.00
and James Henry Grothaus and Amy Jo Grothaus, husband and wife TRANS FEE: 330 .00
PAGES: 1
( "Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ( "Property ") (if more space is Name and Return Address
needed, please attach addendum):
David J. Estreen
Lot 12, Plat of Sunset Valley in the Town of Troy, St. Croix County, Wisconsin. 304 Locust Street
Hudson, WI 54016 rJl I`lb�
040 -1304- 12-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Easements, restrictions and rights-of-way of record, if any.
Dated October ' 2007
,
(SEAL) (SEAL)
* " co e ' n
(SEAL (SEAL)
* * Gale n K. Feyereisen
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
r•.,
T , STATE OF WISCONSIN )
T i-�oT r ..SM A'f ) ss.
authenticated on r, .'` :' St. Croix COUNTY )
* Personally came before me on October J / W� 2007
TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Scott L. Feyereisen and Galeen K.
(If not, Feyereisen
authorized by Wis. Stat. § 706.06) to me known to b e person(s) who executed the foregoing
�tn,nqd, d e same.
THIS INSTRUMENT DRAFTED BY:
*
Attorney Doug Berg MA
1200 Hosford Street, Suite 201 Hudson, WI 54016 Nota Public rate of Wisconsin
My Commissi (is permanent) (expires: - 6) )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003
• Type name below signatures.
1 of 1
POWTS OWNER'S MANUAL MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 0 V1 to rcTt a Septic Tank Capacity gal ❑ NA
Permit # Septic Tank Manufacturer w' a,l-v ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer e' ❑ NA
Number of Bedrooms 100 d/bedroom A ❑ NA Effluent Filter Model ❑ N.A
Number of Comme�JeUnits NA Pump Tank Capacity al ® NA
Estimated flow (average)* 7 ��gal/day Pump Tank Manufacturer m NA
Design flow (peak), estimated x 1.5* t, j-o ' gal Pump Manufacturer p NA
Soil Application Rate <o � al /da ft Pump Model z p NA
Influent/Effluent Quality (NA❑) Monthly Average ** Pretreatment Un CD N,q
Fats. Oil &Grease FOG ❑ Sand/Gravel Filte ❑ Peat Filter
(FOG) S 30 mg /L ✓ ❑ Mechanical Aeration C] Wetland
Biochemical Oxygen Demand (BODs) 220 m
`� ❑Disinfection
S 250 m L ❑ Other:
Total Suspended Solids (TSS) V Manufacturer: Model:
* ** Dispersal Cell(s)
Pretreated Effluent ality Monthly Average
Biochemical Oxygen nd (BODs) '62-In-ground (gravity) Q In- ground (pressurized)
5 30 mg /L El At -grade ❑ Mound
Total Suspen lids (TSS)
Fecal Colifo geome mean) < 30 mg /L ❑ Drip-line ❑ Other:
10`cfu/100m1 ® Leaching Chamber Manufacturer 6.0 Rt uavn
Maximum Effluent Particle Size 1/8 inch diameter V Model OV- Approval Stipulation
"Wastewater Flow Verification on and calculations: Soil Application Rate 0, - - gpd/ft 2 Area Req `3S r't'
(Other than bedroom based) Absorption Area Credit per unit 3 6
Minimum Number of Chambers
❑ Aggregate Desi n Flow/Loading Rate = ft - m,r.
" Values typical for domestic (non commercial wastewater Materials: all materials must comply with u'I Adm Code
and septic tank effluent. COMM84 and be installed per manufacturers specifications
'•'Values typical for pretreated wastewater. and approval letters.
DESIGN CRITERIA
❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990)
❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler.
Publication 15.22
• "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6
• "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manua! -
Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980
❑ SBD - 10570 -P (R.6/99) "At -Grade Component Manual Using Pressure Distribution"
❑ SBD - 10567 -P (R.6/99) "In Ground Absorption Component Manual"
-SBD - 10705 -P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0
❑ SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual"
❑ SBD - 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual"
❑ SBD - IOS72 - P (R.6/99) "Mound Component Manual"
I ❑ SBD - 10691 - (N.01 /01) "Mound Component Manual" Version 2.0
❑ SBD 10595 -P (R.6/99) "Single Pass Sand Filter Component Manual"
❑ SBD - 10657 -P (R.6/99) "Drip -line Effluent Disposal Component Manual"
❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual"
❑ SBD - 10706 -P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0
❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units
I ❑
MAINTENANCE AND MANAGEMENT
MAINTENANCE MONITORING SCHEDULE
Service Event Service Frequenc
Inspect condition of tanks At least once every S ❑ months Q ears Maximum 3 v7s i
Pump out contents of tanks When combined sludge and scum e uals one -third 1/3 of tank volume --
Inspect dis ersal cells At least once every 5 ❑ months [W ears Maximum 3 vTS
Clean effluent filter At least once every b a months ❑ year (s
Inspect 2umP Pump controls & alarm At least once every ❑ nths ❑ ears 9 NA
Flush laterals and pressure test At least once eve months ❑ ears ®N.A
Valves At least once eve months CD ears ® NA
Other At least once ever ❑ m hs ❑ ears - NA
6
Page z of 3
START UP --
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that
may impede the treatment process and/or damage the dispersal ce ). If high concentrations are detected have the contents of the
tanks) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
OPERATION c
The property owner is responsible for the operation'arid`rrraintenance of the'POWTS and submission of required reports. The quantity
and quality of the wastewater stream will affeathe performance land lorigevii' 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.,.
i
This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetableifruit
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 - biodegradable items such as baby wipes, tampons, sanitary napkins
condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint,
disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS
and contaminate your drinking water supply.
Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components.
Compaction of snow over the dispersal unit may cause it to freeze up. L-�
❑ Valves
Valves shall be operated in the following er:
❑ Alarms
Alarms should be tested on a regular basis by t ome o r. if an alarm sounds, contact an individual licensed to service
POWTS, There is normally a l day reserve der regular oper 'ng conditions, however water should be conserved until any
problems with the system are correcte prevent back -tip of sewa intothe dwelling or surfacing.
INSPECTIONS
Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master
Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule).
RSeptic Tanks Component
Tank inspections must include a visual inspection of the tank 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 backup or surfacing of effluent .
Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any
defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective
locking device to prevent accidental or unauthorized entry into the tank.
I
When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents It
of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR 113, Wisconsin
Administrative Code.
The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's
specifications, Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more
frequent intervals than stated in the maintenance schedule to keep the system operating.
❑ Pump Chamber/Treatment Tanks Component
The inspection must include a test of all electri uipment such as pumps, alarms and floats. A visual check must be
made for leaks, backups, surfacing ,* 'inissi or bloke -... ecurity devices and other hardware and the condition of the filter.
Any service needs or repairs shall be mptly taken care of.
Page I of 3
stn- Ground Gravity Component Dispersal Cells
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence
of surface seepage
or discharge,
An dischar
e
to the round surface promptly must b tl re orted to the t ors
e ere regulatory
Y g g P P Y P g
authority. Pondin
ry gat depths greater than 75 of the height of the component may indicate overloading or impending
hydraulic failure necessitating more frequent monitoring.
C] Mound, At- Grade, In- Ground Pressure
The inspection shall include recording the leve s f ponding, if an a observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any disc rge tot round surface must be promptly reported to the regulatory
authority. Ponding greater than 75% of the height of %ae y indicate overloading or impending hydraulic failure
necessitating more frequent monitoring.
The pressure distribution system is provided rth an of each lateral to be used for flushing. The laterals
should be flushed at least once every thr 3) years. systems with multiple laterals should be done to
ensure that equal distribution of of nt is occurring gevity of the system.
REPORTS
Reports for maintenance, inspection, and monitoring s all be submitted in accordance with COMM 83.55 Wisconsin Administranve
Code,
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is
properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative 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 properly disposed of by a Septage Servicing Operator.
After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled %� ith
soil, gravel or other 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 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.
p A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technolog\ a
holding tank may be installed as a last resort to replace the failed POWTS.
O 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.
p Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrati% e
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 GASES AND /OR INSUFFICIENT
OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES.
DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR
IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name t�-t Name
Phone -+ - Phone
SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY
Name Agency ST, G 20 x C_ok H-t\ oN I, N
Phone Phones - 38(x- 4bg0
Standard Erosion Control Plan
for 1- & 2- Family Dwelling Construction Sites
According to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, soil erosion
control information needs to be included on the plot plan which is submitted and approved prior
to the issuance of building permits for 1- & 2- family dwelling units in those jurisdictions where
the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard
Erosion Control Plan is provided to assist in meeting this requirement.
Instructions:
1. Complete this plan by filling in requested information, completing the site diagram and marking
appropriate boxes on the inside of this form.
2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and
after grading. Water runoff patterns can change significantly as a site is reshaped.
3. Submit this plan at the time of building permit application.
PROJECT LOCATIO [)pA z t*-% <L+ Ncd5m W- 5 y 1 0(o
r , Please indicate north
BUILDER I{�S C� a&tm,4 4WVNER by completing the arrow.
WORKSHEET COMPLETED BY �� .NL41+LT DATE — _ 7
——
SITE DIAGRAM scale 1 inch = _ N
feet I
EROSION
CONTROL PLAN
LEGEND
PROPERTY
LINE
EXISTING
-� DRAINAGE
TD TEMPORARY
DIVERSION
FINISHED
-� DRAINAGE
'I A
LIMITS OF
GRADING
_ SILT
FENCE
�♦ STRAW
BALES
GRAVEL
O VEGETATION
SPECIFICATION
TREE
PRESERVATION
STOCKPILED
SOIL
W
. m
EROSION CONTROL PLAN CHECKLIST
a
Check (10 appropriate boxes below, and complete the site diagram
a with necessary information.
F-
u 0 Site Characteristics
North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways.
❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells.
Location of storm sewer inlets.
Location of existing and proposed buildings and paved areas.
The disturbed area on the lot.
Approximate gradient and direction of slopes before grading operations.
Approximate gradient and direction of slopes after grading operations.
[� Overland runoff (sheet flow) coming onto the site from adjacent areas.
Erosion Control Practices
j❑ Location of temporary soil storage piles.
Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide
vegetative strip, or should be covered with a tarp or more than 25 feet from
any downslope road or drainageway.
Location of access drive(s).
Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide
and 6 inches thick. Drives should extend from the roadway 50 feet or to the
house foundation (whichever is less).
❑ Location of sediment controls (filter fabric fence, straw bale fence or 10- foot -wide
vegetative strip) that will prevent eroded soil from leaving the site.
❑ ocation of sediment barriers around on -site storm sewer inlets.
of diversions.
Note: Although not specifically required by code, it is recommended that concen-
trated flow (drainageways) be diverted (re- directed) around disturbed areas.
Overland runoff (sheet flow)from adjacent areas greater than 10,000 sq. ft.
should also be diverted around disturbed areas.
CI Q Location of practices that will be applied to control erosion on steep slopes (greater than
12% grade).
Note: Such practices include maintaining existing vegetation, placement of additional
sediment fences, diversions, and re-vegetation b sodding or seeding with use
e9 Y 9 9
of erosion control mats.
[ Location of practices that will control erosion on areas of concentrated runoff flow.
Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected
from erosion through use of such practices as in- channel fabric or straw bale
barriers, erosion control mats, staked sod, and rock rip -rap. When used, a
given in- channel barrier should not receive drainage from more than two acres
of unpaved area, or one acre of paved area. In- channel practices should not be
installed in perennial streams (streams with year round flow).
Ch Location of other planned practices not already noted.
. J
. m
a Indicate management strategy by checking (V) the appropriate box.
4' Q
I o Management Strategies
Z
D' Temporary stabilization of disturbed areas.
Note: It is recommended that disturbed areas and soil piles left inactive for extended
periods of time be stabilized by seeding (between April 1 and September 15), or
by other cover, such as tarping or mulching.
Permanent stabilization of site by re- vegetation or other means as soon as possible
(lawn establishment).
• Indicate re- vegetation method: MrSeed Q Sod Q Other
• Expected date of permanent re- vegetation: lyla.,% t
• Re- vegetation responsibility of: 0 Builder M 01 0 wner /Buyer
• Is temporary seeding or mulching planned i e is not seeded by
Sept. 15 or sodded b Nov. 15? 0 Yes No
P Y
0 Use of downspout and /or sump pump outlet extensions.
Note: It is recommended that flow from downspouts and sump pump outlets be routed
through plastic drainage pipe to stable areas such as established sod or pavement.
Trapping sediment during de- watering operations.
Note: Sediment -laden discharge water from pumping operations should be ponded
behind a sediment barrier until most of the sediment settles out.
Proper disposal of building material waste so that pollutants and debris are not carried
off -site by wind or water.
( Maintenance of erosion control practices.
• Sediment will be removed from behind sediment fences and barriers
before it reaches a depth that is equal to half the height o f the barrier.
• Breaks and gaps in sediment fences and barriers will be repaired imme-
diately. Decomposing straw bales will be replaced (typical bale life is
three months).
• All sediment that moves off -site due to construction activity will be
cleaned up before the end of the same workday.
• All sediment that moves off -site due to storm events will be cleaned up
before the end of the next workday.
I
• Access drives will be maintained throughout construction.
• All installed erosion control practices will be maintained until the
disturbed areas they protect are stabilized.
For more assistance on plan preparation, refer to the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site
Best Management Handbook, and UW— Extension publication Erosion Control for Home Builders.
The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through
the State of Wisconsin Document Sales, (608) 266 -3558.
Erosion Control for Home Builders (GWQ001) can be ordered through Extension Publications, (608) 262 -3346 of the
Department of Commerce, (608) 267 -4405.
I
EROSION CONTROL REGULATIONS
Erosion control and stormwater regulations can be complex. Local, state and, in
some cases, federal regulations may apply. Before construction make sure you have
the appropriate permits.
LOCAL ORDINANCES
Check with your county, city, village, or town for any local erosion control ordinances including shoreland zoning require-
ments. Except for new 1- & 2- family dwellings, local ordinances may be more strict than state regulations. They may also
require erosion control on construction projects not affected by state or federal regulations.
UNIFORM DWELLING CODE (DEPT. OF COMMERCE)
CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT.
• Silt fences, straw bales, or other approved perimeter • Local building inspector
measures along downslope sides and side slopes. . Department of Commerce, Safety and Buildings Division,
• Access drive. P.O. Box 7969, Madison, Wis. 53707, (608) 266 -2128.
• Straw bales, filter fabric fences or other barriers to
protect on -site sewer inlets.
• Additional controls if needed for steep slopes or other
special conditions.
STORMWATER PERMIT (DEPT. OF NATURAL RESOURCES)
CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT
• Erosion control measures specked in the Wisconsin Department of Natural Resources, Storm Water Permits,
Construction Site Best Management Practice Handbook. P.O. 7921, Madison, WI 53707 -7921, (608) 266 -7078.
• Measures to control storm water after construction.
This publication is available from county UW- Extenslon offices or from Extension Publications, 45 N' Charter
St., Madison, WI 53715. (608) 262 -3346 or toll -free (877) 947 -7827. A publication of the University of „w
Wisconsin - xtension in cooperation with the Wisconsin Department of Natural Resources. E M�kV7
01999 by the Board of Regents of the University of Wisconsin System. Send inquiries about copyright permission to: Director, Cooperative
Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Dr., Madison, WI 53706. University of Wisconsin- Extension is an EEO /Affirmative
Action employer and provides equal opportunities in employment and programming, including Title IX and ADA requirements.
GWQ001A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites
V* Pelnua on
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