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HomeMy WebLinkAbout042-1028-40-000Wisconsin 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 Holder's Name: Jerry & Arrisa Frederick City Village Township TOWN OF WARREN CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MAN FACTURER CAPACITY Septic 1000 Dosing ba QNV 5 Aeration 5'r J TANK SETBACK INFORMATION I _&VS 4 r IA TANK TO A P/L t� WELL BLDG. Ven Air Intake ROAD Septic �• Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer - Demand GPM Model Number ��� T D H L'ft Friction Loss System Head TD Ft �S 3.3 .7 Forcemain Leng1bi Dia. Dist. to Well a SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 657142 State Plan ID No: Parcel Tax No: 042-1028-40-000 Section/Town/Range/Map No: 11.29.18.164 Bld Sewer M01 M� rt r:rb Him., I M11 mmmm BED/TRENCH DIMENSIONS Width ` Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYS M TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typ f Syste 7/6 r60' ?5OI CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM--3�rve r-jj..,n►6d iHeader/M fold ` 1 1\ Distributi Pipe(s) rf '�� � x Hol Size .3 x Hole S Icing Vent to Air Intake Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only.-2A, J....L. Depth Ov r Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/ nch Center 61 60 Bed/Trench Edges Topsoil ly Yes ❑ No Yes ❑ No COMMENTS: (Include coded,crepencies, persons present, etc.) Location: 1054 140TH ST 1.) Alt BM Description =-(iw rW✓ 2.) Bldg sewer length =70' -amount of cover = q;i,! Plan revision Required? ❑ Yes 1� No to Use other side for additional information. 1 Date SBD-6710 (R.3/97) Inspection #1: Inspection #2: / ` V In or's Signature Cent. No. SAN-2024-075 Property Owner's Name TE& y { 14 9XISA AA4E&1X ICK ProrrertY Owner's Mailing Address It +� City, Scate v r Zip Code Phone Number IL Type of Building (speck all that apply) Lot q V I or 2 Family Dwelling - Number ofBedmo= 3 11 PublidCormaercial - Desenbe Use Block # Department of Safety APR 0 4 2024 & Professional Services, lr C�c c •x- s 4� .'z !# St Croix Ca�rltyCommurlily Ge eirapmel� Industry Services Division Sanitary Permit Number (to be filled in by Co.) �' `•---- �" S 2 Sanitary Permit AFF %, iar� 7f T ion Niirober In accordance with SPS 393-21(2), ems. Adm. Code, SUbmtSSLOn of this foam to the app� is required prior to obtaining a sanitary permit. Note: Application forams for stetaowned POVITS are submitted to Project the Department of Safety and Professional Services. Personal informeIIon you provide may be used for secondary purposes in accordance with the Privacy Law, s. 1.5.04(t )(m), Ststs. I. Application Information - Pteatte Print All Informatina I /r 3 "40 /y6 LW S Parcel # Property Location Govt. Lot ,S E t, rtlE v., s"lion T a7 N R / (if different th= mailing address? ❑ City of © State Owned - T7escnbe Use CSM Number Q Village of �E Y b(Town of III. Type of PO''Pi"I'8 Permit: (Check either "News or "Replacement" and other applicable on Elise A. Check one box an Ihn B. Complete line C appltieable l A' ❑New System Id1 R emcrn System ystem ❑ Other Modification to Existing System (explain) Cl Additionsl' Pretreatment Unit (explain) B. ❑ Holding Tank ❑ in -Ground ❑ At -Grade Mound ❑ Individtuit Site Design ❑ Other Type (explain).. (conveatiwnai) 1 :-2 :'j C• ❑ Renewal Before ❑ Revision ❑ Chartge of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date issued Expiration IV. Ili ent Area and Tank Liformation. D . SD (� , Desigi Flaw (gpd) Design Soil Application Raee(gpd/st] Disperslit area Required (sf) Dispersal Area proposed (Si) System. Elevation 5'S0 / d , 5',SO 5'SD r/G70, G 6.! /®d. / Lo,,rr,,.x Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units °' � New Tama Existing Tanks QrA `e/ 18r[ L L a n. U w w C7 ca Septic or HaddiegzrankAnd © / Dosing Chamber / 4p - GDD F Larr 3d •- V. R&Spo utility StItteMmt- L, the andersigned, ssmme butlPtion PO'I TS shown on the attached pram Plumber's Name (Print) Piuntber's 'gnahire MPA7445"rNumber Business Phmte Number Plamber's Address (Street, City, State. Zip Code) F i-d. 160x A0. e!�a Z F.ox 4) � 7117.10 VI. County/De artment Use Oa r Approved z Permit Fee Data Issued Issuing Agent Signature r _ n for Conditions o Apptav e] SYSTEM OWNER: 3) � � C��'�-cB+IS 1M flS�S � Bt .10— 1110- t.'in. - urC- 1. Septic tank, effluent fitter and dispersal cell must be serviced 1 maintained as per t11 ,, , Qa,,,1 _ ^ n s aoCE management plan provided by plumber. / a `.'Y"`" J �ntl�n2dJ CD{u�.Ci 2. All setback requirements must be maintained as per applicable code i ordinances. Attach to complete p7sas for the sastem and submit to the Caunty only an paper not less than a In s t t turtles in aide SBD-6398 (X 03/22) fwl 0177/>1 t a v7cp a9dMv �3rcgrby�6' �� vl rtrro,,/ vrits/x.� � y Ys p ph/ hso/ 5LO-VZOZ-NVS I / Yo/ - '7-7 'pNI :1 67 Ynolro7J/'a%! rvri'00/-'v3'Sds' s1 r' od prnoW � ,� pb X 8 8/ , 59h r7Vw i�v car ® S77P ->n,/ zo 97307 VI)VI.40 'd'd ivvw 0 E dNiviv-d I ppwp;p ,scot >nt/ h "o,r /o NOl t OS/ 0 OQ/ - "W 9' , r v o'8b 1 c+� Xior�ls' rl+3YDry� Yo -1 8/ `A/ 6 r "// '3/v 3 S 1S N1 Qi�/ v r 1 -°O/ AdOO ,�� r ns ra,F.tiT SAN-2024-075 Wisconsin Dg)artment of Safety and Professional Services �_� Phone: 608-266-2I I2 Division of Industry Services / .l Web: 111q'. J,p, 4822 Madison Yards Way = i Email: o,:), : •. ,.. rr.. R PO Box 7302 Madison, W1 53707 I�%. �# Tony Evers, Governor Dan Hereth, Secretary March 26, 2024 C11ST ID NO.: 224199 KENT HOKE PO BOX 10 COLFAX. WI 54730 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/26/2026 MUNiCIPALITY: TOWN OF WARREN ST. CROIX COUNTY SITE.: JERRY FREDERICK 1054 140TH STREET ROBERTS, WI 54023 SE 1/4 NE 1/4 SEC I I T 29 N R 18 W FOR: Design Wastewater Flow Value: 450 Bedrooms: 3 Limiting Factor(s): 32 Inches Maintenance Required: Effluent Filter Identification Numbers Plan Review No.: PWI'S-032400502-C Application No.: DIS-03241 1732 Site ID No.: SIT-128059 Please refer to all identification numbers in each correspondence with the Department. Condir,mafly APPROVED DEPI OF SAFETY AND PROF€SSIONAL SERVICES DIVISION OF ITRY SERVICES 1 I i � I SEECORRES7OHD CE Mound Component Manual - Version 2.1 (May 2022-2027) Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) SITE REQUIREMENTS A full size 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. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: • A sanitary permit must he obtained from the county where this: project is located in accordance with the requirements of Sec. 145.19, Wis. Slats. • Prior to the construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. if it rolls into a'/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. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Slats. • A state -approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacturer's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per the approved plan. SAN-2024-075 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 and Wis. Admin. Code § SPS 383.54(l). • 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. 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 10I.01(I0), 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. I45.06, stats. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval, the Division of Industry Services reserves the right to require changes or additions, should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, A:Gxt4 Katie Petzel Division of Industry Services Phone: 608-574-1189 Email: katie.petzel@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 SAN-2024-075 Cage 1 of Private ansite Wastewater Treatment System Index and Tine Page Project Name: Owner's Name: Owner's Address: Legal Description: Municipality; County: Lot Nurnber: Subdivision Name. Parcel I-D. Number, Page 1 .Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Name of Designer Signature: 4,[E'. 4J y CJT SYa/G 7/.S 688� gCQf E NE To wg4o, City of z C�to.x -�--- dock Number: _� CSM Number /0 SY /Yo '—'`` r 5',?-/0078 ooa Index and Title Page Plot Plan Cross -Section & Plan View Pipe Lateral Layout Septic Tank / Pump Chamber Cross-section & Specifications Pump Performance Information POWTS Owner's Manual & Management Plan POWTS Oamer's Manual & Management Plan Filter Information License #:,� Date: 3 - /.? - 1.?0.7 y `Mound Co - �",. ' ,� ,.1 ' �.am anent Manual and DSFS 381-38 mpon t Manual fbr POWTS" Version 2.1 (May 2022-2027) "Pressure Distri tion Component Manual for POWTS" Version 2.1 (May 2022-2027) AttachmcnL it Evaluation Report Co+ cfaiom*jfy APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDIZ5TRY SERVICES _ 1 x ' SEE CORRESPOND CE t jr/a I-Y,VJ 0177/>1 t av7cp a9dMh� F3rcgrby�6' � y Ys p ph/ j,SO/ 5LO-VZOZ-NVS I / Yo/ - '7-7 'pN/ :1 67 Ynolro7J/'a%! rvri'00/-'�3'Sds' s1 r' od prnoW � ,� pb X 8 8/ , 59h r7Vw i�v car ® S77P ->n,/ zo 97307 VI)VI.40 'd'd ivvw 0 E dNiviv-d I ppwp;p ,scot >nt/ h �ro,r ,ro NOl t OS/ 0 OQ/ - "W 9' , r v o'8b 1 c+� Xior�ls' rl+3YDry� ea -1 8/ `A/ 6 r "// '3/v 3 S 1S N1 Qi�/ v r 1 -°O/ SAN-2024-075 n .5 ft .8 ft F = .9 ft G = . Si ft H = �!�_ ft GEOTEXTILE FABRIC COVERING ASTM C-33 SAND FILL ,-Z— TOP SOIL -- TOE --,,,_ .,sc1111Lr�: • F ,/t e�.: CROSS-SECTION OF MOUND Page 3 of 9 il, PTURNED LATERAL a ACCESS BOX I TOP SOIL OBSERVATION PIPE & WATERTIGHT CAP ^.� DISTRIBUTION LATERAL ( IY? in, sch. 40 PVC D2665) Lateral Invert El.= a! ` G / System El. = ao, ft r' -S % SLOPE •FORCE MAIN (2" sch. 40 PVC D2665) DISTRIBUTION CELL = Lw" ft x 7S ft = 'MO ft (0.5"- 2.5" aggregate) Min. Required = fXO + /, O = jIS,6 ft2 A = d ft $ = _— 73' ft z 7.8 ft 5 .1 J = Jr ft K = 7.7 ft L = 90.11 ft A W = 8.8 ft /8.81W 4" sch. 40 PVC observation pipe a� .� s ° 1.5 ft 2" Force YMain o5 � m 0.5 ft d.a8� PLAN VIEW OF MOUND Observation pipe _� Bsi Observation pipe 1/6B = Distribution Cell ��� 1 1/6B = 78 1 1.7 S ft (0.5"- 2 b" aggregate) � Distribution pipes /,?.,S' ft I G x 75 ( In, sch,40) ContourEl,= /aa./ ft 7.7 .K— OX= Upturned Lateral with Access Box Prohibit disturbance and vehicle traffic within 15 ft of downsiope toe, L 90. Y I Basal Area = /3 8 ft x %j ft = /O 33 ft2 Min. Required = YY.S6 + 7s6 ft2 SAN-2024-075 PIPE LATERAL LAYOUT OF M UND (End Manifoid with Aggregate) ROLE DIAMUR, - � in. LATERAL DIA. = !!A in. MANIFOLD 'DIA. = -_ %y=� in. ($ch. 40 PVC aed FORCE MAIN DIA. = pipe D2665) r�0® e in. Neta�vGS�eJ P = S ft. uQPu9���B� x y ft. � � %�� toa X„\ y ft. (LEW In. sch. 40 PVC D2665) FORCE MAIN W sch. 40 PVC D2665) Page of Access f Box S� \\O \r,x y• y Yam' �Na �p%� HOLES LOCATED EVENLY ON BOTTOM OF PIPE. Minimum Number of Holes = SY.Sd ft' + 12 = 38 Holes Holes/Lateral x 2 Laterals - 38 (3/16") Holes x 0.66 gpm / (3/160) Hole = ? 4 GPM = SYSTEM FLOW RATE PIPE VOLUME ft. Laterals (total) x 0.092 gai/ft. = .j..T ..x 5 = Cl• aJ' GAL = MINIMUM DOSE VOLUME PIPE INVERT ELEVATION = Z61 / ft. SAN-2024-075 Pew --S_ of 9 T FINAL GRADE MANHOLE RES'ER & COVER t dr*k&& } � f 'srMk 5Qd.40 PVC'rw*�V2WSUILDINGSEWER VW LEC7RMAt az!i iessY 9 sP83x [ fnd NEC300} • t� n �t u �t it r Alarm Aftnufthgw f .�6Pree r�r Mal Number: 1 ---�- &fth TypalBbw Plano m- -- 1 rr Gll�r AbW Number-.9jF,,c M rnum O ge a�IS-......�.—d*_.,Gplwl V Wt(PtMVoffto WONurveWo.,__------ .D ft -13.3-ff Force mob y ft on Total Dynamic Head ft o-Y 4-L- _ft II, FORCE PMN OPTIONS 18' 11 _�, ,.� ti c7nF1M 9�a DWyW8dwmtwFlow toWF?= Y3o Number of da7y dog S 3. GPD ForcemNmvaEumec� 5 tx ACW dweWkww %7. 2 gW - 7 3 t ai dose _ cones vZ) � _ $_.., y 9 • _ gal IM SAP MQ. Reoww above algm ------- �O S in = Y3. G g d (p) Alarm am above an floor"� in O+---j� ow (C) NOff tka� meaeursrnea�t--,�g5 to = Off above teak t _._,.._ �,. Lenom In Outlet tt _34 in VVkhh 8 coonslinch 76 SAN-2024-075 EFFLUENT PUMPS 4- d ax C? 11~llr,� 9Ef-OA-SFS 9E(-aA-RF i. �;i ��i�4 E�.T■Th�Il�ll���', qK-nM 9EE CISFS R8'(3ilD mrr �i 7"(Iil mml 4 mm] 9ECCA-RF 1.0" Cao mm] 89" (2m mm} 9.4' t21d mm) 9EC_ aM n.a• aaa mm] s- crls mm] aa• [:l4 mm] Lh4'� d » ✓ �I, i .�sw,'�,a'www'd:,daaie�G rv�d.,,.°. Onv99 A FmW-fIH morals w �u w 60 70 90 GPAM - CPX Franklin. Eleotrlc HoaCuaeie�i70L714f 15rww.t pirtcam SAN-2024-075 POWTS UVn'fERIS MANUAL AND MANAGES PLANa+� 7 of 9 l�,lr li�i Ullll�rATYi]N 7wnt=r [fIJERICfC SY'SnMSMCMC -RONS P�.tt �r tiC iaAlC Canaci ^ESIGN PARAMTM�I 4enrir sir n s . �QG eel 0 toa k■wj.=„ea ul D =01M hFvmber cf Commercial Units l 11 l?ffiuent Ft isrMan c went Filter 1}q �a�trR' 11 - Ew Co C13 EStimated flow [Ave) (100 �hedroorat) L7t7 Tam frD�l3w l / Dc' sign ODW �wg? = estimated � t.s Aso � � 'rank t�dD �,� d Soli )Oplia t o Rate tz /.a d Mar, irrtE G�.�,r Trsfluent/E�lttettt tY (❑ NA) Ctaesse wG) Mon%IyAvemp model�•� tTeneatment Unit (o RA) d Biochemical en Bid (BDDS) Total � 30 arg(L. 220 to �' B sandl�vel Filter Q &lechanicad Awation ❑ PeatFiitt r ❑ Suspended Solids (TSS) G 150 aaglS, Cl Disin on W eda:td a ogre' Pretreated Efl ent tat ty (�l NA) ) Mtmufachat�r Model: Biochemical Oxygen IS Monthly Ave¢agc Sate Ad7sarption Cofagnncat d NA Tat'] S-Vended ems) Fecal Coliiarna (geometric � 30 � 30 M&g L ❑ In -gm fgrav ty) t3 At -arose ® "--g d �} � mean} Ma:timuxn Effiuetl>t gatticle � 10 cfulltlUmi I18 Moamd d Drip -line ❑ Other. Vertical Disfan TapnlcBaf3ttm inch, diameter ba Harizcmtal . ServicePad: Calcudatlona: Dispersal Unit I Model Nsmlrer: D rsT a toServicel'ad —`" ft soil " © NA Dt�F A�nUM � End CaP PiVersal Unit EISA y 'n W-�+ or I.en I)ESI{GN CRrrEaUA G 75 ❑ "At�uttade Cvtngot] Matte ® "Design cfPressmDis�ttibra ouNe a metre or Gravity. Versicn30 ( Y2022-2tn� (3 ,"Design Fltnv Mcund Compoamt Manual" Ve�va I2JIS/ auk- °Tuog 6 � c Tank -Sail Ahs ystems-" Publication 9.6 (S SWhe �-Gmund Soil Absorption C�nentM for 201 (Apal.24I8.2023) �) "Mmmd Componnt Manual frrr PGV OT'S Neuron 21 - Version 2.1 (May 20222027) ❑ 2027) � Dis 'Idon Compcnerlt l =aW for PUWn." V n 2.1 May d Other (may 20Z2-2027} Plush and test 13 At tarsi once . (� months � 3 Q l•n FART i7P dtvn nn� ..,.,.._. � prod" of other altar: ma For IWW cnnKftCd % prim' to using the FUWTS check the cctnt$rtts of'the Y cede the teat pt and/or damage thetxe�nt tanks) for the p of painting If high cmcmtmfi ar at the in�rat ive vexd by a septage scevicing OPmw rpriar to use. rnstartttpshall when sail +qua The proptaty is amble fur t}te opemt'oo s FXUM maim�e of the YOU- -PS and sub tt� gttattt ty and along w� p oiVtrqw of �s mftoss thy, c and /tang y your PDi�VT3. The ro an otbw clear w"w Ue t m= ,devices and f indation dta hm Anuld tune. Also the brine or waste from watl5r_ include latmdty , showt:ts, etcbO &schmgBd to the grmund sulbm wh=1M Possible. Notm this � trot Brio syatmm is dts red to hamilo tic sd� ■ , sarifood BOWhas �, however; the digwW cif fond bawd cbt & a euL Othea.. le- ftns� such as baby hammmmi�ed Tsat'lett is theme vnd let at ft mil' not y am, Y P, cig abet shoos, °+SdOh'�m, s�dWt ® aatrez the p� Y a�drma condoms, ei8atetio butts, ie at t'bcOtODn iy�heeir�t, m �tamieeis, such as p�Pim, ,� ckMftwaftrm 1Y- Ma�a.t�g Wsteadyficvr� � c9ns-m-ualyd cYawPd'9 TS and contr g' °°��• mart rxfsnativat�em � Out� we+ek. Avoid vehicle rra.ffic over SAN-2024-075 drinking water supply. Maintain a regular steady flow by spreading late[throughoutPage 8 o- 9 allsystem components. Compaction ofsnowoverthedispersal unit ay cause tto[&ethe week. Avoid vehicle traffic over INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or g p certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Se toe Servicing O erator (per the attached Maintenance Schedule). 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 check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicinz Operator and disposed of in accordance with Ch. NR 113, Wisconsin Admin. Code. Specific servicing mechanics must be provided if vertical is>15 feet or if horizontal is>150 feet and instructions to be provided below. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keepthe system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a I day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into die dwelling or surfacing. ABANDONMENT- When the POVVTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is proerly • pand safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Admin. 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 with 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: 0 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 renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technolo holding tank may be installed as a last resort to replace the failed POWTS. gy a 65 The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions ofsuch systems mustcomply with therules in effectat thattime. WARNING!':' SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AMID/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THEINTERIOR OFA TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER POWTS MAINTAINER Name: r '16&e /1lP— 1?Yi99 Name: f Phone: � u^r ir6 15- 6,7- w5X I I Phone- SEPTAGE SERVICING OPERATOR Pum er 7 LOCAL REGULATORY AUTHORITY Name: Name: <Sr. 4edlx Orlyu,+itr e 6l/EY. Phone: Phone: 7/5- 86 — Ygso SAN-2024-075 4, ? ffc 9 Maintenance ca eroneo TyaYrin$• U�'iCmin4 t•aoo-sae-s�ls Biotube Effluent Fitter How to Clean Your Effluent Filter To ensure Your efff uent filter is function;ng properly, it should be inspected every year. Under normal conditions, your effluent flier will function for several years before cleaning is necessary. Tf.e Filter should be cleaned when it becomes clogged enough to restrict normal flows out of the septic tank. At a minimum, the filter should he cleaned whenever the tank is pumped. Most people prefer to have a septic tank service providertake care of filter maintenance and cleaning. You can find a septic tank service provider in the Yellow Pages, under 'Septic Tanks & Systems.' Or you dep artment far a list can contaetyaur county health If you wish to inspect and/or clean your effleentfilter yourself, be sure to dress properly. Wear full-length pares and shirt, Shoes, gloves, and goggles or glasses. Then foliowthese instructions-- 1 _ Remove the access lid to your septic tank by Unscrew- ing the stainless steel lid Molts with hex head wrench provided. If your lid is above ground, it will be easy to find. tf it is burded below ground, find the markerthm 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 2). Ensure the three orifices in the optional flow modulation plats 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 effiuentfilters came with an alarm that activates when the filter needs cleaning. If you have an alarm, check to make sure it is working by Iifting the float with a stick An audibfe horn should sound. The alarm panel is normally mounted on the side of the house or in the garage. Note: lfyour effluent filter doesn't have an alarm system and you would like one, rail 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 abautthe tank or system, include that information under "Notes.° t. Attach access Iid by placing it on the riser, matching the openings inthe lid wig, the bolt catches. Insert lid bofra into Lotrhes died nghmn with hex head wrench provided. rrrU10 1. xemove the ffrer cartridge fly lifting it our ref its housing. I from 2 Spray the cartridge tubes with a hose. NIN-FT•FT-1 R6+ 22 7/L4 paAe3ofa LO r- 0 4 N O N i i Wisconsin (Department of Safety and Professional Services SAN-2075 of Division of Ind Lcn�paper '7, � ��SOIL EVALUATION REPORT GS iT- 2 )z0 7 2024 In ccordance with SPS 385. Wis. Adm. Code CountyAttach complete site not lass.than S x 11 inches in size. Plan must include,but not limlted to, vet�tidi b i int(BM), direction and percent slope, Parcei I.D. scale or dimensions,7mrrd istance to nearest road. Q42- 02$- —©0 p Please print all information. Reviewedcy D to Personal information you rnvide maybe used for seconds purposes Pnva Law, s. 15.04 1 m . l<r/2n2� Property Owner Property Location I Q 0 `] P e. fh-' -f' 1 G� Govt. Lot c:3 Y. &k- '/4 S 11 T Z � N R Property Owner's Maifin�Ad re Lot # I Block # Subd. Name or C M# Ci#y Stat Zip Cade hone Number [ Cty ❑ Village STown Nearest Road ihNW a� C~, S r7 gg.� 11 d , � ?ya �w� 41 ❑ New Construction Us : ❑ Residential /Number of bedroorns � Code derived design flow rate �PD ipeplacement ❑ Public o cammer 'al - Describe: Parent material �` 0. c +r� Flood Plan elevation if applicable N d ft.r General comments and recommen ation . '[`�� a r•t n.1,Q�. �� t -fit.. ��.L� f� o c� � D • Y �0. � ��� � S � �-�£.r'`�, S r� `•� `i1 (loct") (� Boring Boning # Pit Ground surface elev a. Depth to limiting factor 2;rr. Soil Applicatien Rate Horizon Depth Dominant Color In. I M Redox Description Texture -Qu. Az. Cont. Color Structure Sz. Sh. Consistence Boundary Roots GPD!Ft2 `Eff#1 .Bff#y 6- - tunnsell S rGr. Y s -- 014 d fo —,�Fy S � G• +f '�-'t s J �G�f r O r5 � 0 ru 2� Boring # Boning Pit Ground surface elev. ���` lft, Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant. Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Consistence Gr. Sz. Sh. h"\ Boundary Roots GPD/Fe S C �`Eti#1 �}.Fff#2 r—rr q-X01 - tmuent iv = CUU, .?U S i[V M 1L. aria 100 1 JU a V "1qJL +Tii WWIn we - ovu. - — m — on 1� au.,a i CST Name (Please Print) i na r r" CST Number cam- I o <3 O Address +`1 1i Date v luau n Carlducted Telephone Number QrC7 fJ r/ 7 t] f r SBD-8330 (R04/15) + :,� C Boring # ❑ 8orinr, Ith SAN-2024-075 iimtng factor �� pg Ground suAaca slay/ R to in• Soil ApplIcaflor, fate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots � GPDIFt� In. Mansell Cu. Az, Cont. Color Gr- Sz. Sh. 'Effi#1 +EfF#2 2*^^dra J . c�� 5 w r►• Fr� Z c3:3 ❑ Boning ` ❑ Boring El Fit Ground surface elev. t Death to ;Imiting factor in. , Soif Anefi,,t n Rate Horizon Depth Dominant Color In. Munseli Redox Description Texture Structure Consistence Boundary Roots Qu. Az. Cant Color Or, SZ Sh- GPD/Fe -EW I -Eff#2 `l ! t I f Boring #' ❑ Boring ❑ Pit Ground surface elev- ft Depth to limiting factor in. And Annlirafihhn Rnfw Horaon Depth Dominant Color Redcx Description Texture Structure Consistent Boundary Roots GPD/Fe In. Munsei! Cu. Az. Cant_ Color Gr_ Sz. Sh- -Eff#1 I i I � , h � _ - I I I r I Effluent #1 = 800, > 30 s 220 mg/L and TSS > 30 s 150 rnVL ' Effluent #2 = BCD. > 30 s M mgfL and TSS > 30 s 150 mg/L M � 'e.'o-w . _11;tv r rr4 �7/6)- eSg 9G64 t 2 I° 76 w-3� --<Y013 „.�b v3 do.7� �;1e, /w-o rat P OL,C,r q,. -�. 3Uc..ti L bt,„.sa 1 SAN-2024-075 . l C i r I W k�-,L `c iN35C13 'Herr lOck ;-IOaCi q 1- 4755 t &. no- ro 0 q$ft, O W800naln DepaArnent of Safely and Professional Services Division of induaby$ervices SOIL EVALUATION REPORT Page_ of In accordance with SPS 385. VYIs. Adm. Code County S Attach complete sde plan on paper not less than a 112 x 11 inches in size. Plan must include, —" Y0 l but not limited to: vertical and hor¢ontal reference point (BM), direction and percent slope, Parcal I.D. scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. I Reviewed by Date ,Personal Infomation u !yvL4e May be used for secondpurposes (EO04 Law, s. 15. 1 m . ' Property Cramer /VQy ` Property Location ❑ ❑ Govt Lot % % S 7 N R E (or) W Property Owner'S,NIdill didM'sC Lot # Black # Subd. Name or CSM# J E eras v ap Gtlde hone Number I ❑ D- ❑ Village *Town I Nearest Road f �2v�AW Qtl �i IGS 5 0 D' e� t 105� 0 ❑New Conshuction U :❑Resid.-Hj.ItNumberofbedrcorns_ Code derived design Flow rate �ry�Ot^pp NO — 1paplacement ❑Publico comme el —Describe; Parent material \�t5� p-Z! 7 (.Lc,Z 4� 141 Flood Plan elevation if applicable tad n. General comments and rewmmenn ation , 0 pp Q (p( .1 .•� �y i`f2,Crvlb(.4, O.� �D..lJ, FT, Boring # Boring ) ^7 Pit Ground surface elev� ft. Depth to limiting factor J - Har¢nn Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots Soil Application I GPDiw Rate I In. I Munseli -Qu. Az_ Coot Color I Gr. Sz Sh. ' I .c�u" rtng Boring I,, ( '` # PB Ground surface elev,r 1ft. Depth to Itmi ing factor Lb in. Horizon Depth i in. Dominant Color Munsell Redox Desor[puon . Du. AZ. Cddt Color Texture + Structure I Gr. Sz Sh. Gonsistance Boundary Rocca5E?WG `i 111 I1Cation Rate lFt� 'Eir#2 ff `� s' zaG a D- D- b s � . effluent 49 B50.>305220 rrlgfL and TSS 30 14R m n. ant 42=SOD. >30 s 220 and SS>30515o. CST Name (Please, Print) C(Please, Numbor �% 19 r Vz— Address VVIii ;till 1'• - -,1 Dale v nConduaed p r /y-c2t Telephone Number c7 t/ C U . -—lRu4rlL `si � CF,6(X COUNTY SAN-2024-075 NOG 10S7 H2, im- N N I h, T 9 0 M-WILI 9MA "9 Jo 54 140 "'-%-QTRA1 ■✓ l . PLUMBE TOWN , , im AND/OR , BLOCK `t&% S.-I � W :� Oki/ M�►�\�� vo.0 awxz& SUBDIVISION III R 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. 916 1 !' -AUTHORIZED ISSUING OFFICER DATE BEFOREIS PERMIT EXPIRES- /0 / 7049 UNLESS RENEWED SBD-06499 (R11/20)