HomeMy WebLinkAbout020-1102-40-300In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Index & Cover Sheet
Plot Plan
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Dispersal Area Cross-Section & Plan View
Attachments:
Pump Curve
Pump Tank Specifications
Management Plan
Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
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Project Name / Description
OwnerName{s): TERRANCE R. & RI TA A. WERTH Phone: ____ -__ _
Zip: 55014Owner Address: 153 EGERT LANE, LINO LAKES, MN
Project Address: 661 GILBERT ROAD
Govt. Lot: NA SW [3_1/4 of NW 8114, Section 34 , T 29 N-R 19 EOorW�
Township: HUDSON County: _S_T _. C_R_O_IX _____ _
Project Parcel ID #: 020 -1102 -40 -300
Designer Information
Remarks:
.*#.
Signature: _...t,_...:._...i::.,:.:._:_!::�::::::L-L-.f!� ;;._4-----Date: 05 - 26, 2023
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-gravity 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 = _______________ gpd; BOD5 ≤ 220 mgL-1; TSS ≤ 150 mgL-1; FOG ≤ 30 mgL-1
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o 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 extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.)
o electrical components - if applicable (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 dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) 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 filter(s) 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.
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: ________________________________________ Phone: ________________________
Local government unit: _______________________________________________ Phone: ________________________
Local government unit address: _______________________________________________ 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.
Contingency 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 in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
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*(min. supply head x 0.3)
( < 0.2X design flow + force main void volume)
Vertical Lift = ____________ ft
GRAVITY-DOSED
SITE
150ft100500
DISCLAIMER: This map is not guaranteed to beaccurate, correct, current, or complete andconclusions drawn are the responsibility of theuser.
Community Development Department – Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov
SANITARY SYSTEM
OWNERSHIP/ADDRESS FORM
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
Mailing Address
City/State/Zip
Phone Number (required)
Email Address (required)
Parcel Identification Number (found on the property tax bill)
Property Location _____ ¼ , _____ ¼ , Sec. _____, T _____N R_____W, Town of .
Subdivision Plat: , Lot # _____.
Certified Survey Map # , Volume , Page # .
Warranty Deed # (before 2006)Volume , Page # .
Number of bedrooms Spec house yes no Lot lines identifiable yes no
New Property Address (Verification of new address required from Community Development Department for new construction.)
/ / (Staff Initials) (Date)
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.
NEW SYSTEM: LEGAL DESCRIPTION
File #: ______________ Office Use Only Created 2/2021
OFFICE USE ONLY
OWNER/BUYER INFORMATION
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