HomeMy WebLinkAbout030-2141-00-028
Caunt
E76~ § Safety and Buildings Division
;t
a 2(I1 W. Washington Ave., P.O. Box 7162 t • 1 1 x
Madison, W1 53707-7162
a Sµ7lturt•t alt Nu,n6~r (iu bn nrruA n by L-. , -
~3 IT nIt erpp~eation state Trrunssaction E't .21(2}, Vuis.aA(lriy ission of this torrn to tl>N uPPr~priare governmental Z S
ning a sla
Note; Application form for state-owned POWTS are Project Address (if diileretd than flf Co Personal intbnnation you provide may be used for secondary
Privac Y:aw, s. 15.04 I m), Scats. DR,
ion Information - Please Print Au Information 03 7 vl
Property Owner's Name v ~al
Parcel #
Property Owaer's Mailing Address
Property Location
City. State Govt. Lot 2-0
Zip Code Phone Number 1 /
Section ~b
)l ® Cie one
IL Type of Building (check all that apply) Lot # T~ N; It t a r
Z Fy Dwell' of Bedroom - Subdivision Name
Block #
Q Public/Comntercial- Describe Use
Q City at'
❑ State Owned - Describe Use CSM hiumber U Village of
' awn
III. Type of Permit: (Check only one box on line A. Complete line R if applicable)
!A
New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Uisting System (explain)
R• Q Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Ile it Number and Date Issued
Before Expiration Owner
IV. Type of POWTS S stem/Component/Deviee: C a ra
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground t-Grade Mound ? 24 im of suitable sail ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) Q Pretreatment Device (explain)_
V. Dispersal/Treatment Area Information: -
Desi Flow (gp4) Design it Application Rate(gp st) Dispersal Area Required sbo Dispersal_ Area PtpPosed (st) ysiem Elevation
VI. Tank Info Capacity in Total # of Manufacturer S
Gallons Galion! Units
New Tanks Existing Tanks U°
Septic or Holding Tank y y
I Josulg Chumbe r 6 l
IVII. Responsibility Statement- 1, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans.
Plumber's N (Print) Plum ature MP/MPRS Number Business Phone Number
~ tlumber'oddress (Streat, City, State, Zip Cod
r
2- ZA"A ~s 417
j11 Count /De rtment Use Only
Approved 13 Disapproved Permit Fee l1 V Date Issued Iss ' g Agent Si ature
i'f
❑ Owner Given Reason for Denial Z S J I ( 21 (Z G Gi ri G(tiYVtir _
K 9Alf RO OWNER rovaUReast►ns for Disapproval
1. Septic tank, effluent filter and dispersal cell must be serviced / maintained
as per management plan provided by plumber. J ,a8 " ' U
2. All setback requirements must be maintained
as pef applieable co e planet for flee system end submll to the ly only ou per not less then a t12 x I t iuebes in Size
,iW-6398 (K 02/09)
p~FP,Rra N Safety and Buildings
o~~ ~QS 141 NW BARSTOW ST FL 4TH
WAUKESHA WI 53188-3789
• y m Contact Through Relay
P www.dsps.wi.gov/sb/
www.vAsconsin.gov
~OsstoN~•v5 Scott Walker, Governor
Dave Ross, Secretary
I
November 15, 2012
CUST ID No. 226900 ATTN: POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 11/15/2014 Identification Numbers
Transaction ID No. 2176065
SITE: Site ID No. 786060
Shaun Bird Please refer to both identification numbers,
Natalies Ridge Lot 28 above, in all correspondence with the
Town of Saint Joseph agency.
St Croix County
NE1/4, SWl/4, S36, T30N, R19W
Lot: 28,
FOR:
Description: At-Grade, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1401863
Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade;
System(s): At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution Component
Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter ,
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
This system is to be constructed and located in accordance with the enclosed approved plans and with the At-grade
Component Manual, Version 2.0, SBD-10854 (N.03/07), and the Pressure Distribution Component Manual - Version 2.0,
SBD-10706-P (N.01/01)
In the event this soil absorption system or any of its component parts malfunctions so as to ci~~rr
l~, ^e aa% hazard,
the property owner must follow the contingency plan as described in the approve Tans. itit a owner
must comply with the operation, maintenance and monitoring duties as described i e ion`s I o the at-grade
component manual. A copy of this information must be given to the owner upon co ofgte project.
Maintenance information must be given to the owner of the tank explaining that periodicQleaning of the filter is
required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions.
A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
SHAUN R BIRD Page 2 11/15/2012
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. Stats.
Owner Responsibilities:
• SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under
s. SPS 383.54(1).
• SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. SPS 383.54(4) shall be considered a human health hazard.
• SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the
address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sin Fee Required $ 250.00
i
This Amount Will Be Invoiced.
When You Receive That Invoice,
Julia Lewis-Osborne Please Include a Copy With Your
POWTS Reviewer 2, Integrated Services Payment Submittal.
(262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633
j ulia.lewis@wisconsin. gov
i
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be
modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the
relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety &
Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future
reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366.
ECEIVED
NOV 13 2012
Cover Page SAFETY & BUILDINGS
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 11/8/12
Owner: Shaun Bird
Location:NE1/4 SW1/4 S36 T30 N,R19W Lot 28 Natalies Ridge St. Joseph
System type: At-Grade
Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07)
Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01)
Page#
1. Cover Page
2. At-Grade Plot Plan
3. At-Grade Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7-8. Maintance and Contigency plan
9-11. Soil test
12. Filter Specificatio
Shaun Bird ~;ot1
l
Signature
yq `
License numb r 126900 e
F ~
sAo ~o~y
'LO cs
Ftic~ gill
PLOT PLAN
PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017
NE 1/4 SW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
SYSTEM ELEVATION 95.3' 3
BEDROOM
CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none
BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H.R.P. same as benchmark
124th Ave
80th St.
3 Acre Lit
Tanks are to be properly bedded and
provided with lockdown covers
Seale = 1 /4„ - 10, with approved warning labels
Huffcutt Combo Tank
B-2 fl f
Pro 3
Bedroom
House
B-3
B.M.*
7% Slope
B-1 Area 15' below system is to
94' remain undisturbed
96' 95.3'95' Wel I is to meet al I DNR setbacks
Grading is to be done to divert
run-off away from system
At-grade System Sloping Site Cross Section and Plan View
-lip SSA +11P fW.. •I• RA. sTJl9r7fi e~Sm~ S,f,,.eer m~:,.r .w~::'"~!;. T1. ~,f~ .!R-*, +r.:: nw ~+n:;~!.w .n+~ wq.,: n.. .w.:;.
E
G, A
• •
~ Dimension Feet
y r■j' i~' y~i . Flit i~if~y,i~i. i'. r7-;•~•'~f'. ••'li 4r•7 ~
1 r ti% };r3~r:: r rye r; ~3
~.F1',~'r tir r A Z..
7j ~•r■r 4'"y '~'4 ; S}: r~ ~'~~i!':"y1} `{•.~:rY;y 'i'~'~jy}y 1 B
ti ■t■~'ti. I
r ■ r•F•~1~~,~~ r3'j ~.~ti~,}~•~ r ~ ~.j.3~ ~r•r 3~~ ~ i 1/6 B
~~`i%~~ .~il~~'+ ■r7~' • ~`fy r'•.~ry s }~•••■y •ti .;■'I~•'~ S•~iy
1J ~y~y` yf}'~~ ti•ti'C'4{a•~L.~C~•~e:. y■ ,~j :~,~y~yrtdyrti r.r. r. 7j~ 1
A y.R y L•j■L y jS7f S'ti~ • s~~;:■Tyr r~y :"S r ■'r'r ~•.'.+ri ~.fy ~~Yr'■ •~~'r~
j. ■ . T.,,1~'~ ; y■ ■'~•'~•y~■■y •~r ~'~L,~.r y I 'C
ti '.T■ '..5 S yyiL r '~I r4R, r r ri~■ r,~'rrl.,f ■r~ rr■yy~ ■J' ~P ~.rri / 4/
■~'•r'.~~' r■ ~r~r• ~pi',"~'~`~i • . i,e■'L•~{y.y'L'y.yS ~y~~,.~■~''jr~-..~'.y.'~.
.:~:'ry`rr':3' ~s yty. j;;~•,~r,r7ra•.r. I D 2.0
.'!'}i.`d'.}.,'7'=.~' "~}'r•~'•r~ • a I
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yti ~rn~5 } y,~ti'sf{~;:~,ry,~y~,~Cy~~~y~"';; ;■ti.~3'y.~, E
I . , 3~ .j~ 7jRj~ ~j~ 'G.~ ~ $ ~ y ~tf'f4-•Lt'y. I 5,0
1 I r~~} `fi'r ' y~•ryr 7 t-'~; ,■y~y3'"C" ,.:4.t.f':;~ ;~i■ I F 0.5
~ti ~ti ''~ti ~::~r~,1i ;~r~~,t{•r r,~•~r~',~,~ 7r'~ rry~ R,~.. yr 'J G 1.0
1/6 B 4 W
E •-1 13 L
L % Slo e 7
1`1 = Plowed MIR Clean aggregate
basal area %z to 2 Yz in. dia. - 4 in. sch. 40 pvc
` observation pipe
Lateral with 2" Topsail Cap . Is.
aggregate over pipe
Geotextile G Observation Pipe
Fabric With Cap
9 SA Ft Lateral Invert
y r>:fy.yd~ Topsoil Ca
r • r~ ~ rrr t p
ti■~ J Ft Contour
r •r ;
D Plowed Surface's
C
Slope Direction
GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing
vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a
moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to
~
form a /4 inch soil wire when a
sample is rolled between the palms of the hands.. The A x B area is
I
covered by clean aggregate deposited overhead by a backhoe. Special ;Care must be used when
placing the aggregate to minimize compaction of the plowed surface. After- the topsoil cap is placed,
the entire at-grade is seeded and mulched to promote vegetative groom, limit erosion and protect
from freezing., The observation i es are perforated in the lower 6 inches and secured in place.
03105Igj Page of
Pressure Lateral Layout
One Lateral - End Manifold
4 Threaded
s Lateral CIeanout
Force Main Turn-up 0 plug
i
X
L Long
Sweep
90
Bend
Pressure System Construction
Distribution Network S eeifications
Lateral Diameter -z- In. Laterals are constructed of Schedule 40 PVC
Orifice Diameter 312- In. pipe. Orifices are drilled perpendicular to
X Orifice Spacing) In. the pipe with a sharp drill bit and face down.
L (Lateral Length) 8 Ft. Lateral turn-ups terminate with a threaded
Force Main Diameter c In. cleahout plug and are enclosed in a 6-8 inch
Force Main Length cj Ft. diameter lawn sprinkler valve box accessible
from finished grade.
• Grade •••••0
•
6-8 Inch Lawn
Sprinkler Valve
Box
I
03/05lgj Page of
Septic-Dose 'tank Cross Section And Pwnp Performance Specifications
Tank Manufacturer Pump
Model Number
-
Tank Model Number _ PL -
Total Tank Capacity Tp (p Alarm M um
-
Max. Burry Depth Alam Model Number
Switch Type
Filter Mantuhuctluer Total Dynamic Head (TDD) Feet- -
~Filter Modal14wnber _ Elevation Head
Distal Pressure - -5
Neetwwork Loss
Minimian Pump ferfortumm Required Force Main Loss
_S [FPM J S Ft TDH
outlet lmknhole MIn. 4" Above Grade With Manhole Min. 4" Above Grade
Looking Devioe. Inlet Manhole With Looking Devioe
< 611 Below (imp Sealed Waterrtlaht securely MUL111tB[1
Wdathar-prof
Junction Hots k-
Finished tirade ~ VAN r Im VA MW rr ►r►1
'Vent: Min. 12" Disconnect
Aborts Grade Means
With Vent Cap
I Y f 'f. f .Y 7.Y,f,>tYi ,f,f,/•► flf l•y 1! YI{If1,Y>,1,I,Ir111,I,Y,1,•,~fY,11,I,1>1`Y rf;,Y +1/
1!•► I r 1'1•r S'/ 1/> I V t V l l >'1
11+'1 1 fJf'/ • i
:iJ '11
Y~
Cutlet Filter
law Baffile - - , J
Inlet
/,•1 , ,I I,1,
Switch S n~s Reserve 1.~ ty
1 J
> I
:S+r; 7 i,., > 1 w
' Tank Volume ~ ' GPI 11 f ;:1 Weep
a;1{ YID .
r,1+M
' Dimension inches Voltm►e Gal. B •;1 1401e
Y ; 1
1`I+ 1 11
1 1 1;1
'P(reserve) A. y. S 6 ~1, 1,1
Off Elevation C
► ,1
. + alarm) B 2 30
(d°w) c 9 ' s (dead) Bottom
JJ D Elevation
Toted _ ;1, 1' 1 S 1 C~
►i It. ;11
I'>/ Y't"CT1-s"1'Y'Ti7'~i'Y{TC'L'i'i'TTT7TriTl-i-v'TST's'fTf->' ;I'' •If I1 1 1 1 1 1. 1 1 I,f t 1 I l f I V I I f J I I f t J/ 1 f f J 1 ~t t Y J I f 7
/ 1/~1 J 1 1 1/ 1 I I V I I I V I t i t+ 1/ V I Y. t 1> I t J 1 t ,
>>I>1>r Yr F>f>rYi }f1Y YY~ / >f•>Y>•>tTY Y>•>> ••/13Y11fYf1'!1.11 tY{V11•/Y/r•Y{111lI'••r11 •YI.11•r1 /11• '
I I J/ l t+1 I l r 1.1 { 1 1 1 1 1•/ t J l 1 1'1 t'f f f t i f J J t f// I J// 1 ~ 1/ 1 1 1 1 1 1{ 1 4 1 1{ I f t l l I t/ I I f 1 1 i 1 1 1 1 f f f 1 T I f 1 i 1 t t i+ 1>I
GENERAL INSTALLA'T'ToN. The septic/dose tank is bedded and back Riled in accordance with the
manufactumr's product approval speciitaations. b a imum depth of bwry as speoitlod by rise manufacturer may not
be exceeded without pxior Approval. Manhole covers "Posed to grade have an effective locking device (padlock)
installed. Piping at they inlet and outlet is of approved materlsll connected td tM tank with watertight fittings, and
laid on stable soil to prevent aettlin or gagging. The force main is sleeved with 4" Soh. 40 PVC to bridge the tank
excavation and the sleeve is SwJW v &UWgbt. Electrical service complies with NEC 300 and Comm 16.28,
02/05 U Page of
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90wm 508380 UM 4-0 115 914 13.0 10M 70 64 55 41 32 18.8 2U 24 9.111111.64XU4
2Wu 508340 MCA q:0 280 34 0.5 1000 70 W 55 41 32 13.9 20' 24 9.11 M 1 A x A.94
im-ew" 598850 om 410 115 ON 1.0 IWD 70 24 55 41 32 110 20' 27 SAIIKrAY0.94
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Man -SM W& as in 7A 20 Caa611uous 6utyRIMe4 -"1.9lkGiertWlwtewrurPumpsann6stlcoM4tuous:BnYaslon0asthaparerunwNltln9a0tmliNrotl~I~fatMaepluflae:
FLOW- LITERS/M11UR rMrQnotruction
0 1606 2000 3000 Motor Hour, iE~oxy Coated Cast Iran
11 - A Impeller Material _ Poly Carbonate
t0 Impeller' c Closed Vane
30 Volute AB"
7.5 Power Cord . , SJT A
- W m0cluanicial Slir4ii Seal Nitrite with carbon and
ceramic l'acOS
NJ 5
4 rt Fasteners Staitileu Steel _
t0 Shaft StaInlq Steel_
a.s Hearin!3s Upper Sleeve and Lower
Bail Hastings
0 80 40 60 80
FLOW- GALLONSol"INUTE
PUMP PERFORMANCE -CURVE Little Glant Pump Co.
_ IISV 60FIZ n) gax 11010i• a dxh014a1 E t,01C 73157
P4ame MIS:9473511 •Fax:409.210.#
~1. Cpf10R1!!OH'r1~~lt111~1M1AbEl
.com 0 Form 498296- 071103
Www Uttletilil►tlltPiutn
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
Flt..£ odAMATION SYSTEM SPECIFICATIONS
Corner Septic Tank Capacity al ❑ NA
Permit # Septic Tank Manufacturer _ tctlA D NA
DESIGN PARAMETERS Effluent Filter Manufacturer Z _ 13 NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ANA Pump Tank Capacity 3 0 al ❑ NA
Estimated flow (average) al/da Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer G, NA
Soii Application Rate al/da g Pump Model _ 0 /7L. ❑ NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit NA
Fats, Oil & Grease ;FOG) :_30 mg/L ❑ Sand/Gravel Filter D Peat Filter
Biochemical Oxygen Demand (301Ds) :5220 mg/L XtNA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Fretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L At-Grade ❑ Mound
Fecal Coliform (geometric rnean) 510° ctul100m{ ❑ Drip-Line ❑ Other: _
Other: ❑ NA
111CRher: laximum Effluent Particle Size Ya in d{a. ❑ NA
❑ NA Other: ❑ NA
Other: ❑ NA
*values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event Service Frequency ,
At least once ever ❑ months (Maximum 3 years) ❑ NA
Inspect condition of tank(s) y= ear s
Frump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ year(s) s) (Maximum 3 years) ❑ NA
At least once every: % ❑ earth(s) ❑ NA
Clean effluent filter y
❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At feast once every:) .*Ayear(s)
month(s) ❑ NA
1-lush laterals and pressure test At feast once every: year(s)
❑ month(s) ❑ NA
ether: At least once every: ❑ year(s)
❑ NA
Other:
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
combined sludge and scum and tcu check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but nor. limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION Page of
For new construction, prior to use of the PO Schack treatment tank(s) for the presence of painting products or other chemicals that
may-impede the treatment process and/or d mage the dispersal cell(s), If high concentrations tire detected have the contents of the
tank(s) removed by a septage servicing open or prior to use.
System start up shall not occur when soil conditions are frozen at the Infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring p to the
effluent pump or contact a Plumber or POWYS Maintalner to assist In manually operating the pump controls to restore noormal levels
within the pump tank,
Do not drive or park vehicles over tanks and dispersal ceps. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWYS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) water; fruit and vegetable peelings; gasoline;
pesticides; sanitary napkins; tampons; and water softener brine, grease; herbicides; meat scraps; medications; oil; painting products;
ABANDONMENT
When the POWYS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safety abandoned In comppance with chapter Comm 83,33, Wisconsin Administrative Code:.
e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed,
0 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
gravel or another inert solid material. space tilled with soil,
-VONTINGENCY PLAN
If the POWYS falls 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 and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at that time.
❑ A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
-}The site has not been evaluated to Identify a suitable replacement area. Upon failure of file POWTS a soil and site
'must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be installed as
as
last resort to replace the failed POWYS. Y abed
oand at-grade soil absorption systems may be reconstructed In place following rarrioval of the blomat at the Infiltrative
surface, Reconstructions of such systems must comply with the rules In effect at that time.
< :WARNfNG»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES 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, T
A,ODITIONAL COMMENTS
Pt;iWTS INSTALL R
Name , POWTS MAtNTAIAIER
. Phone Name
Phone _
SE F'TAGE SERVICING OPERATO PUMPER
Name LOCAL REGULATORY AUTHORITY
E- ut,. 7
_Phone '7) /c.~ Name
/ 9t!
Phone
Thi:i document was drafted in compliance with chapter SPS 383.22(2)(b)(t)O d &M and 383.54Ot. O 2 -71J - ~ r
& (3), Wisconsin Administrative Code.
i
i
Wis;onsin Department of Commerce SOIL EVALI C REPORT Page of
Division of Safety and Buildings
~t "f 4 int,adr~rt!ance with Comm 85, Wis. Ad . UoW
4 ty ,
Attach complete site plan on paper not less th ~ 40*11 inches in size. Plan must
include, but not limited to: vertical :is I reference point (BM), direction and pa I.D.
percent slope, scale or dimertSi north arrow, and location and distance to nearest road. -oo -0 a
Please print all information. Revrewe b Date
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). t~/V
Property Owner Property Location
r\~ j t~ ' Govt. Lot 1 /4 5 U-) /4 S 3 6 T D N R / E (or)
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
5 2__. l~~ Z 1? he -5-- TZ is
City State Zip Code Phone Number ❑ City ❑ Village o Nearest R d
VA"
1 ` sya, (2 6 IS'-J-, .Jvs 7 3
,cd
New Construction Use5.X_R-esidential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement Public or commercial - Describe:
Parent material -~ex& Flood Plain elevation if applicable ft.
General comments
and recornmendations:
System Type System Elevation
Soil Application Rate .579 V
# Boring ~
F-11 Boring ~ Pit Ground surface elev. ft. Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf
in. Munsell) Qu. Sz. Cont. Color Gr. Sz. Sh. ^ 'Eff#1 •Eff#2
l li' ' aA.v s
t2 a
~ v-j~ ors S a s6~ -
Z' Jrly Z/ ~0
❑
Boring # Boring s Q
IQ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 ' Effluent #2 = BOD < 30 mg/- and TSS < 30 mg/L
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird ture 226900
Address ate Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54 7 _ / 715-246-4516
Property Owner _ Parcel ID # Page of
Boring # E] Boring
IN J4 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
O
q kit
(LD
E Boring # El Boring
pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
a Boring # Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Akpplicabon Rate
Horizon ' )epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS 130 mg/L 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 contact the department at 608-266-3151 or TTY 608-264-8777.
SBD•9330 (8.6100)
;
Pro'ect Name Shaun Bird Soil Test Plot Plan
~
Sha ird
Address 1432 120th St. r~
New Richmond Wi 54017
QSTM #226900
Lot 28 Subdivision Natalies Ridge Date 11/8/12
NE 1/4 S W 1/4S 36 T 30 N/R 19 W Township St. Joseph
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1" pipe
System Elevation 95.3' *HRpSame as Benchmark
124th Ave
80th St. Scale is 1" = 40'
3 Acre Lot unless otherwise
noted
Scale =1 /4" = 10'
B-2
B-3
B.M.*
7% Slope
96'13-195' 94'
21u 'L ~ ~ ~ ~ W a W o2hlnh~~2lnlnlnh2ln~
,AI4
C5 to
p \
1 `
t 1 \ ♦
Q
31 z
C C b 1 ~~yy~ZN i
b + •Ir ! \
33' 33' if
-t C5 C6 1LMV
m
m - S00'47'44'E 874.59'
F e sw►/4 SW OWE 2657-5W UNPLATTED LANDS
ul
i
~I
F"ILTER CARTRIDGE INSTRUCTIONS
IlnstaiNtion
STEP Y Dry fit the filter arse anto the and of the outlet pipe to ensure it is
centered under the access opening. If not, then either Insert more pipe into the
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
S V rp 2 While the case is Stal Iry fitted on the outlet pipe, measure the length
of %-inch pipe needed to braced the filter to the tank and wall if utilizing the
optional supplemental side support. If side support method. is not utilized,
proceed to step fout_
I
TFP ; For installations utifixrng the optional supplemental side support:
solvent weld the 'A-inch pipe onto the filter case. If side support method is hot
utilized, proceed to step four.,
Solvent weld the filter cake onto the outlet pipe. Insert the filter , h1
cartridge into the case, pressin i down until the filter locks into the bottom of
the case.
If a VRS switch is utili ed: insert into the filter- and iock by turning
clockwise 9116.
Maintenance
1. l'he effluent filter should be cleaned every time the septic tank is
serviced.
2. open the outlet access opening to inspect the tank and filter,
3. Pump the septic tank cornphitely, masking sure to remove the sludge
layer on the bottom of the tank and not Just the scum and effluent.
4. once the effluent level has keen lowered below the invert of the
outlet pipe, firmly pull up art the filter handle to dislodge the a
cartridge from the case.
S. slide the cartridge up and oert of the case for cleaning.
6. if a VRs switch connected to an alarm is present, the switch
should be removed by turning counterclockwise 90, and cleaned
with water only. n ' y
h
7. White holding the cartridge c:n its side (large fiat surface facing
down) over the access opening, rinse off the cartridge with water f;. .
only, making sure all septagea: material is rinsed back into the tank_ i+
S. If VRS switch is utilized, replace. by inserting into filter and
turning clockwise 90
9. Insert the filter cartridge back into the case, pressing
down until
the filter locks into the bottoen of the case, „ y
10.Repiace and secure the acce:,s opening on the tank.
Y.11:• ri .4?; °~i TM;rt~ ~yt~\i "1 c J,41'.,6: 1b':n vlSld:•.
s
Is.
www beamasitexomii 87?-l~fL ii~TE S (653-4583)
12
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
/ OWNERSHIP CERTIFICATION FORM
Owner/Buyer. ~iL.a w R)
Mailing Address, Z Z-0
, S N
Property Address _ _ Y63 / A
Ac
(Venficatxon required from Planning & Zoning
e Department for new (.onstruction.)
City/State V-~f_ Parcel Identification Number
C~ 1
.LEGAL DESCRIPTION
Property Loca / J
tion k~
4 , Sec. b, T !
N'1? _1j_W, Town of.
Subdivision ii
Z$
Lot #
Certified Survey Map #
Volume , Page #
Warranty Deed # &7 117 N< 1 1 Volume Page #
Spec hous yes no Lot lines identifiabl
yes o
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 li~,ensed 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 (l.) 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 „ewage 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 tr the St. Croix County Planning &
Zoning Department wi 30 days of the three year expiration date.
I/we certify tha 11 statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described abo , by virtu a warranty deed recorded in Register of Deeds Office.
Number of be in
OF APPLICANT(S)
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Pl:!nning & 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. 08/055)
8 Tx:4084924
STATE BAR OF WISCONSIN FORM 3 - 2000 967847
Document Number QUIT CLAIM DEED BETH PABST
REGISTER OF DEEDS
THIS DEED, made between Citizens State Bank, a Wisconsin ST. CROIX CO., W
banking, corporation, Grantor, and Shawn Bird, a single person, Grantee. 11/19/2012 4:19 P
Grantor quit claims to Grantee the following described real estate EXEMPT*: NA
in St. unty, State of Wisconsin (the "Property"): REC FEE: 30.00
TRANS FEE: 84.90
Lot 28 Natalie' , Ridge, St. Croix County, Wisconsin. PAGES' 1
I
Lot is sold "as is" With all faults.
Recording Area
Name and Return Address:
Together with all appurtenant rights, title and interests. 030-2141-00-021
Parce umber(PIN)
This is not homestead property.
Dated this 9th clay of November, 2012.
Citizel ate Bank, aWisconsin banking corporation
* G n Haberman, Vice Chairman
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ST.CROIX COUNTY. ) ss.
authenticated this 91h day of November, 2012 Personally came before me this 9th day of November,
2012 the above named Citizens State Bank, a Wisconsin
* banking corporation, by Gene I-Iaberman, Vice Chairman to
me known to be the person(s) who executed the foregoing
TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledged the same.
(If not,
authorized by 1 706.06, Wis. Slats.)
THIS INSTRUMENT WAS DRAFrED BY *jay P pen -ld
Notary Public, tate I consin
m t my commission is perm ent. (If not, state expiration date:
kG- C~~ .r 4 1. T $172016 )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
'Names of persons signing in any capacity must be typed or printed below their signature =P,.P;7ENF1tLD
in
1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3.2000