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HomeMy WebLinkAbout040-1104-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574395 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: UWRF Board of Regents, c/o Mann Valley Lab I Troy, Town of 040-1104-40-000 CST BM Elev: Insp.BM Elev: BM Description: /� Section/Town/Range/Map No: �(7 G5 26.28.19.410 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV._ £i. 10D'3d D . � Septic �, S Benchmark Dosing Q e3��' v '� Alt. BM r,•� L, �Q�rs �• l) Z AQn Bldg.Sewer F e l 2. SZS Holding SVHt Inlet /o. z W, 3- TANK SETBACK INFORMATION SUHt Outlet 6,Z 73, -L"I TANK TO P/L - ri ELL BLDG. Vent to Air Intake ROAD Dt Inlet 04 d its __f- Septic 1 Dt Bottom ,>16b' ICX� GEC/ �� c � .s �g -7,Jib Dosing / , r r Heade an. lib / ��'�� AV 3 3i ) Aeration 'F� Dist. Pipe -2" Holding I 11,p ot. System 03 ', PUMP/SIPHON INFORMATION Final Grade' �rZ _ �/ G�� ,7 / Manufacturer /_o g GPM Demand Co�f'i GOJ `/ Z Model Number o4 ,`OJT 7' �✓ / ✓ TDH Lift— Fri ion o System Hem DH Ft 1-5° ' (0 - 5 l Z- Forcemain Le th i Dia. Dist.to Well 67 h SOIL ABSOR TION SYSTEM c BED/TRENCH Width )r Length f No.Of Tre h s I IMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAftHIhId Manufacturer: INFORMATION Typ System: r CRAM OR �; ) � �' � �� � NI Model Number: DISTRI ION SYSTEM ltk (kV c" � Head 16M anifol Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia Length Dia A Z g Spacin � f Z 7 7- , 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 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#a: & nspection#2: �/ �' / 1 Location: 129& 131 S.Glover Rd.-Mann Valley Lab Farm River Falls,WI 54022(SW 1/4 N�1�6 T19W) a Parcel No: 26.28.19.410 1.)Alt BM Description 2.)Bldg sewer length= �fr' t �lvvr�i:%�t11� Cf �v�� =�'h S/� �� � • 7 -amount of cover= >142" ecf ]„'k , Plan revision Required? El Yes No Use other side for additional information. L_i SBD-6710(R.3/97) Date Insepctor's Signalure Cent.No. A. a40 i"� I i "Vz k� Ib3 : I r,• ! • ,..LaTt 4 CiG4h ou7 d;Sc..sraect ek,sr.n�t¢a� �c �eC /,he i t � � �x.S7•rw aI � /1(ejJw 1 z.s-o/Gr�o—�„�;s"c�(irf;�•/c t�7fi{.� �-ee'f�Rrp.(� Q���^ovcC✓�a•a"V�lc" focat`"o., a.� cC�'�'giN � �ui 4V,,'es Pt Cw ac r- ^e a O 1 j- o .�# =7-14 © 3c3 7k45 oV IV „dxfik-es x i�j 6 y W,,Csc. Con c t d! to k V L Safety and Buildings Division � D 201 W.Washi on Ave.,P.Q.Box 7162 , '� � � Sanitary Permit Number i u:be filled an b���c�. s o yl g 1� Madison,W 53707-7162 GoV��rAE A 15 7 3 S x P y 9 State Transaction Number twlary Permit Applicat d In accordance with3.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note.Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies, Personal information you provide may be used for secondary s in accordance with the Privacy Law,s. 15. i m),Slats. Some- 1. i 1. A lication Information—Please Print All Information Property Owner's Name Parcel# Propedy Owner's Mailing Address Property Location --' � '-S jd�er ( �fia� 1 �/, 1 !? City,State Zip Code n Phone Number y.,�%'o, Section y`4 3 K0 ry n�l ,vcirele one, _� 1 -- T t�; R E ! II.Type of Building(check all that apph) Lot# .91 or 2 Farm Dwelling—Number of Bedrooms 157] Subdivision Name 1 # Block€ YD / Q Publi dComutcrciai—Describe Use ❑City of i 0 State Owned—Describe Use t Slv Number Y iifaec of Town of } } 111.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 0 New Svstem . System Re lacement S ,� p } 0 TreattnentlHolding Tank Replacement Only ❑Other Modification to Existing System teaPiain} � 1 B. ❑Pemrit Renewal 0 Permit Revision D Change of Plumber 0 Permit Transfer to New List Previous Permit Number and Date Issued } Before Expiration Owner IV.Type of POWTS S stem/Com nentWevice: Check all that apply) 0 Non-Pressurized hi-Ground 0 Pressurized In-Ground 0 At-Grade 0 Mound>_24 in of suitable soil '7 Mound<24 in,of suitable soil 0 Holding Tank 0 Other Dispersal Component(explain) t 0 P r nt Devitt xplain) V.DiwirsaV17reatment Area information: D-Z Flow(gpd) Design Sod Application Ra e(gpds Dispersal Area Requir (sfl Dispersal Area Pr ed(WSysteE1cvation/TV VI.Tank Info Ca ty in Total of Manufac turer Gallons Gallons Units Nesw Tasks Existing Tanks Saptic or Holding Tank +ti N X Dosing amber VII.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. P tuber's Name(Print) Pl s Signature MP/MPRS Number Business Phone Number a� P1u s ddress(S et City,Stott,Zip Code) � VIII ours /Ue kartment Use Gw Permit Fee Date Issued UQ lss ' Agent igna Approved ❑Disapproved �j } 0 owner Given Reason for Denial S"' �• ' % 3 v M Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: t 1.Septic tank,effluent filter and lol k �JC% filiA-4--e 512.E 3P,3 3 x dispersal cell must be serviced/mainlined s as per management plan provided by plumber. ` V Xn4w,2 4 4d as per applicable CI1°clla-for the system and submit to the County only on paper not 1 n 8 trz x 1I itches' SBD-6358(R. i 111 1) CHARLES L WEBSTER Page 2 9/18/2014 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. • Abandon the existing system components per SPS 383.33 • The system was designed to meet the influent quality defined in SPS 383.44(2)(a) The quality of influent discharged into a POWTS treatment or dispersal component consisting in part of in situ soil shall be equal to or less than all of the following: 1.A monthly average of 30 mg/L fats,oil and grease. 2.A monthly average of 220 mg/L BOD5. 3.A monthly average of 150 mg/L TSS. • SPS 383.54(3)(b)(b)The servicing frequency of an anaerobic treatment tank for a POWTS shall occur at least when the combined sludge and scum volume equals 1/3 of the tank volume. • The inspection,maintenance and servicing reports shall be submitted to the governmental unit within 30 calendar days from the date of inspection,maintenance and servicing. • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS)in accordance with SPS 383 and the approved management plan • The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or secured except for inspection,evaluation,maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. • Prohibit vehicle traffic and soil disturbance within 15 feet of the downslope edge of the mound pursuant to "Mound Component Manual Version 2.0" SBD-10691-P(N.01/01;R. 10/12). • Insulate 4"0 conveyance pipe pursuant to SPS 382.30(11)(c),W.A.C. 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 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. 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. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Edwin A Taylor Please Include a Copy With Your Wastewater Specialist,Integrated ices Payment Submittal. (715)634-3484,Monday-Friday 8:00 am To 4:30 pm WiSMARTjcode:7633 edwin.taylor@wisconsin.gov oOpARTUB DIVISION OF INDUSTRY SERVICES 5� row 10541N RANCH ROAD HAYWARD WI 54843 Contact Through Relay 3 �� K Cr VED http://dsps.wi.gov/programs/industry-services Y www.wisconsin.gov �° p 2g 2W4 A�ossror�+tiS� SEf Scott Walker,Governor COUNTY Dave Ross,Secretary Eta ,OMMUNITY DEV September 18,2014 CUST ID No. 220673 ATTN.•POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER SOIL TESTING&DESIGN SERVICES ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/18/2016 Identification Numbers Transaction ID No.2456961 SITE• Site ID No. 653358 Uw River Falls-Dairy Science Teaching Center Please refer to both identification numbers, 129 S Glover Rd above,in all correspondence with the agency. Town of Troy, 54022-8282 St Croix County SETA, SWIA, S26,T28N,R19W FOR: Facility: 744436 UW RIVER FALLS DAIRY SCIENCE CTR FARM#2 4-BDRM HOME 129 S GLOVER RD RIVER FALLS 54022 Object Type:POWTS Component Manual Regulated Object ID No.: 1502897 Maintenance required; Replacement system; 600 GPD Flow rate; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes P.Q. 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. condr 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, DEPARTMEN stats. OF The following conditions shall be met during construction or installation and prior to occupancy or use: SEE_ CORR • A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. Changes to the approved plan must be submitted for review and approval. Failure to properly attach the approval and index page to plans that match the copy on file with the Department may result in enforcement action under s. 145.10, Stats. • This system is to be constructed and located in accordance with the approved plans,and the"Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.01/01). • This system is to be constructed and located in accordance with the approved plans and with the'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01/01). • Prior to construction of the dispersal area,check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil.Proper soil moisture content can be determined by rolling a soil sample between the hands.If it rolls into a 1/4-inch wire, Webster Soil Testing & Sewer System Design Charlie Webster, Owner N5815 770th Street Ellsworth, WI 54011 WI Licenses: MP220673, ST220673, D 2110 P Telephoni(715) 273-3430 POWTS Index Sheet Page 1 of 9 Mound System for a 4 Bedroom Residence Property Owner/Project: University of Wisc-River Falls NW1/4 SW1/4 S26, T28N, R19W 129 South Glover Road Town of Troy, St Croix County Parcel I. D. 040-1104-40-000 Page 1 Of 9 Index Sheet Page 2 of 9 Plot Plan Page 3 of 9 System Cross Section Page 4 of 9 Distribution Pipe Layout Page 5 of 9 Septic Tank & Filter Detail Page 6 of 9 Pump Chamber Layout Page 7 of 9 Pump Performance Curve Pages 8 & 9 of 9 Management Plan ``\`\`````` ►u N i u n q b 7///Z �SGONS �/ - onc�lly p2�10P _ CE CO 0 ELF` O TY C B ILDI GS E'S{G - E c Component Manual Used: Name: Mound Component Manual for POWTS Version:2.0 SBD-10691-P Dated: January 30, 2001 Name: Pressure Distribution Manual for POWTS Version: 2.0 SBD-10706-P Dated: January 20, 2001 a o � N VY c ll leh � ?s y3ot7v�n � 's�.r.'af,o•� fit. t Lead a * ry c—tieCf 10ihe r � 3 C/eqa �f isc�.nrec7- e�r,Jr,r�.fiQ.�' e T•'e fu,v se •c *ba r p S Ptio $`ci o.,ddr p eN code v occt O 0 A STis! D.2-C6-S- A oh d -rrM v 303¢ f-il �ba..�''.�'� Etdoyz � by k,/,"CS"cF ev•�ewe.�'e ! ii Yid � i c,wh v ItS O-L a � ' r qz ' ! o d v 3 �yStel� C'1•�-^r �c T� o /� Pag'e..aOf Approved Synthetic Covering FtSTM C 33 Distribution Pipe Medium Sand N G Topsoil _ -s�_ _ F Elev q - _1 E 1 D 3 . 8 % Slope Bed Of j- 2 Force Moin Plowed Aggregate From Pump Layer D 3 Cross Section Of A Mound System Using E z/ ill• ��• 7P-0 A Bed For The Absorption Area F G d-! Ft. A Ft. H /• O Ft. Linear Loading Rate=(?- 0GPD/LN FT B 7'- Ft. ,esign Loading Rate=o KTGPD/SQ FT I IS Ft. 74cccs7 X ,? Ft. K /Q Ft. llfer.t 1 S' / L � Ft. TyPicJ/ �dtc..t/tn d W 3 ® Ft. L Observation Pipe AI -------------------- � - Mdsr Fo/� ps jr e G '�� ► Q - ------------- ------------------- F7 wVA 14.- T-- __.--_- -------� - Distribution ed Of 2r— 2% Pipe Aggregate 4 4 I f Observation Pi e ICl` (Anchlor securely) OLrchvd f%oK /J.��s 7 ° lE1l�C d /s//,la(1•H.� w. /�.'�1E+,efrr o/� '[ iHa�f� �t/ P�ov 9fe�w,l d �dC'r l ,G CcJ� �a(/ � 7�lCPo�f6li+s 6i�+C�iCSS/atftAF�G ScC4ceJ� Q�h^�oia�. Plan View Of Mound UsYkg A Bed For The Absorption Area Pq Perforated Pipe Qeto)) n End Yi�r per I oral ed PVC Pipe o e / Jota�.o°` a� Holes Located on 801,0,, sec de�a• l Are Equally spaced /g dt � QishiJutian / Pipe dcfid.l P / Distribution Pipe Layout S Ft. X ?6- Inches Inches Hole Diameter g Inch i Lateral " [ Inch Manifold Inches Force Main inches _ — — — — # of holes/Pi Pe _�7q al c e ess d.x tkre'd c%d per, Invert Elevation of Laterals rt- r �____`YP��� l �. �acs-•►�e�d __._ �/ Place 1st hole,l8;n. from sMde► 'd;�*}►{>�+e �a/� with succeeding holes at3 4�'I'n.intervals. w Pi v c a, Fct; //s. N o re : 4n a cc cejtq.j6`c Q 't�iiS cbi/c+- cz6c,vE �hta(� AP�•a�c� �ac�i',�*� ��hyi�'C corcil , lv A a ICICItol, cover c 7.0 �u� , a 4"Y4 4"Y4� 17C w.�i...h� l��e�r dttdc�► ef� 3 i Po/y K f-4a- SAS eF'fl/uek �` I, { 4 d a. t� c ;�h aP�Fnre d 'O"Pe 3 pt- cKl a r. �.'� po"..t Gf 3 ihel�e� u�6 a F I-er �4h M/Ct t'�4 �- Tah k s: e / S o J. T,i ci e e•. t 4 l0 I f>`n c e S I i PUMP CHAMBER CROSS SEC T IOI•J ANG SPECIFICATIONS B F N11 piP h$ To 44,1,74". �oliit.tG��irt 07 VENT GAP hall vo Covc, tv ptovVe d cccS'.S To r '"" 1 C,1. ap,xjed-90 APPROVED LOCKING � P/dttTC%k4t/% WEATHERPROOF JUlJCTION BOX WUJDO MAMHOLE COVER Oft .FROM DOOR. W OR FRESH IZ°MIU. AIR IMTAKE I GRADE 'V CONDUIT le•Mw• �� � 41 .0^ PROVIDE I INLET AIRTIGHT SEAL ( I11 ' a A * ' III f H _ i 11' ALARM 8 I 1 *APPROVED ou 0 JOINTS, WITH APPROVED PIPE 1 ELEv 2 °� T 3' ONTO PUMP-- oFF D SOLID SOIL GOAICRETE GIOCK __ RISER EXIT PERMITTED OQLy IF TAIIK MAIJUFACTURER HAS SUCH APPROVAL. 5� ck / z 7(:9 C- /4-.3)= /��4 SEPTIC /- SPECIiFI•CATIOAI$ E DOSE 4iv."eSc- C—o a c--c TAWKS MAQUFACTURER. (JLIMBER OF DOSES: " PER DA-1:1 TANK SIZE : 7-!�-O GALL0IJS DOSE VOLUME f cis t� S J. - �Lm 6u INCLUOING BACKF4.OW: GALLONS }4LARt'1 /'1Al.lUFACTURER: — MODE.L 1.1UMl5ER: Tar'/ ' ��� � CAPACITIES: A= ICHES OR CALLOUS SWITCH TyPt' McGha"' c `? / B tUCHES OR 1� �\ GALLOQS �`� Cs ICHES OR ` °� GALLOQ5 PUMP MAW UFACTURCR: �' MODEL NUMDE.R: f D-6-—FICHES 0R• z� CALLOUS SWITCH TJPE: MCC fa q rd, r `" f MOTE: PUIiP AUD ALARM ARE TO OE � ,` - W5TALLED ON SEPARATE CIRCUITS MINIMUM D15C�ARGaE RATE - GPI VERTICAL DIFFEREAICE DETWEEA! PUMP OFF A1J0 DISTRICUTIQN PIP .. ?___ _ FEET MIUIMUM NETWORK SUPPLY PRESSURE . ;'.°� L I3'o FEET 1 FEET OF FORCE MAIIJ X Ti�00 FxFKICTIOU FACYOR. �' FEET TOTAL Dy1JAMIC. HEAD FEET _ 4517 3 G OF TA►JK' L-,&444 '-H ;W�i �1 ;LIQUID DEPT H 11JTERtJAL DIME1JSlO1J `` e k 1� U r 7'e�rr� 7o- ET T � � Erin 3871 EP04 EP05 APPUCATIM •Fasteners:300 series Fully submerged in high ■Motor Housing:Cast iron Specifically designed for the stainless steel• grade turbine oil for for efficient heat transfer, following uses: ' Capable of running lubrication and efficient strength,and durability. •Effluent systems dry without damage to heat transfer. ■Motor Cover.Thermoplas- components. Availl"for and tic cover with i •Homes Moor integral handle •Farms I and float switch attachment •Heavy duty sump • EP04 Single phase:0.4 HP, Moak 110611111011111 points. •Water transfer 115 or 230 V,60 Hz,1550 f� and ■Poor C�Ale:Severe duty •Dewatering RPM,built in overload with rated oil and water resistant. automatic reset. M�° • EPO5 Single phase:0.5 HP, ■�riws:Upper and lower SPECffICATigI11S 115 V,60 Hz,1550 RPM, FEATS heavy duty ball bearing Pump:EP04 built in overload with n EPE4 kqwllw.Thermo- construction. • Solids handling capability: automatic reset. plastic Semi-open design 3/+'maximum. • Power cord:10 foot �Y with pump out vanes for UVW • Capacities:up to 55 GPM. standard length,16/3 SJTO mechanical seed protection. t •Total heads:up to 24 feet. with three prong grounding _ madow �` • size:11/2"NPT. plug.Optional 20 foot pl BM 'Thermo- Discharge (CSA listed model numbers • Mechanical seal:carbon- length,16/3 SJTW with improved porn f0f end in"F"or"AC".) rotary/ceramic-stationary, three prong grounding plug BUNA-N elastomers. (standard on EPO5). Chu'.pugged •Temperature: thermoplastic 104°F(40°C)continuous superior strength and 140°F(6(rC)intermittent. corrosion resistance. • Fasteners:300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 components. I Pump:EP05 6 • Solids handling capability: e 7 Pty Y4 maximum. W • Capacities:up to 60 GPM. s 20 ID _ •Total heads:up to 31 feet. • Discharge size:11h'NPT. O z 5 ' '� • Mechanical seal:carbon- 0 1 rotary/ceramic-stationary, a 4 BUNA-N elastomers. c I •Temperature: 3 10 104°F(40°C)continuous 1400F(60°C)intermittent f 2 i 5 ° 10 20 30 40 so GPM 0 2 4 6 s 10 12 Wth CAPACITY ©1995 Goulds Pumps,Inc. Eff6ctil/e May,1995 RIA71 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page F of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 6t t�L/ "Ve,, F Septic Tank Capacity / ISO al ❑ NA Permit# 3 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer fin/ /, k ❑ NA Number of Bedrooms ' p NA Effluent Filter Model ❑ NA Number of Commercial Units NA Pump Tank Capacity 7-5—Ogal ❑ NA Estimated flow(average) [aVday Pump Tank Manufacturer W.!,e c r ❑ NA Design flow(peak), (Estimated x 1.5) 6-0 CJ gaUday Pump Manufacturer C11, / V ❑ NA Soil Application Rate j,, , 6 p, aUda /ftiz Pump Model Lc--J°Ca ❑ NA Influent/Effluent Quality Monthly average` Pretreatment Unit NA Fats, Oil &Grease (FOG) 530 mg/L ❑ Sarxi/QraveI Filter ❑ Peat Filter Biochemical Oxygen Demand (BODa) --220 mg/L ❑ Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODE) 530 mg/L ❑ In-ground (gravity) ❑ In-ground(pressurized) Total Suspended Solids (TSS) 530 mg/L ❑At-grade Mound Fecal Coliform (geometric mean) 510`cfu/100m1 ❑ Drip-line ❑ Other Maximum Effluent Particle Size Y.inch diameter vases typical for domestic(non-oommemiao wastewater and septic tank eflluant. +* values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every ❑ months �ryear(s) (Maximum 3 yrs.) Pump out contents of tanks) When combined sludge and scum equals one-third() )of tank volume Inspect dispersal cell(s) At least once every 3 ❑ months �(year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 3 ❑ months ,Kyear(s) Inspect pump, pump controls&alarm At least once every ❑ months ❑year(s) ❑ NA,0qrmc%,Ve Flush laterals and pressure test At least once every ❑ months ❑year(s) ❑ NA 4 s e dt' Other. At least once every ❑ months 13 year(s) P(NA Other. At least once every ❑*months ❑year(s) XNA Nr� fceo,r.r.e, did}/CAM+h� JIte), 01 cc vet - .�Ye�ls.�veLecwanr,sdt/iN MAINTENANCE INSTRUCTIONS yoa.rclu+n P1/-M� every P.+ to V0,0V d! R--4/&� d% .6407jt -}he wl".je+°- Inspections of tanks and dispersal cells shall be made by an individual carrying one of tip 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 to 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 ch. NR 113,Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreat9ment components, and any other maintenance or monitoring at intervals of 12 months or less 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 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 cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. • (� L� fiery F_ r^ �� Page-of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwatsr levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose, overioading 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 power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. 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 life of the POWTS: antibiotics; baby wipes; cigarette butts;condoms;cotton swabs;degreasers; dental floss; diapers; disinfectants;fat foundation drain(sump pump)water;fruit and vegetable peelings;gasoline; grease; herbicides; meat scraps; medications;oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONt4 ENT When the POWTS faits and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safety abandoned in compliance with ch. Comm 83:33,Wisconain"Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shelf be removed and property 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 another 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 stucWre, lot tines 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 affect at that time. ❑ A suitable replacement area is not available due to setback and/or 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 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 of such systems must comply with the rules in effect at that time. <<WARNING>> 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. ADDITIONAL COMMENTS POWTS INSTALLER '�r v v POWTS MAINTAINER Name -7—a Name Phone _ -7/5— Z s — Phone SEPTAGE SERVICING OPERATOR PUMPER aot4 sus LOCAL REGULATORY AUTHORITY Name Agency .S`t lip'., cT Phone Phone 71j-%-- 9,6-— his document was dratted by the staffs of the Green Lake,Marquette and Waushara County Zoning and Sanitation agencies. This document meets :he minimum requirements of ch.Gomm 8322(2)(b)(1)(d)&M and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS_ GMW(2/01) F�ECEIVED P I ,J 7Q1� g�,o Al 1 3 Wisconsin Department of Co SOIL EV PORT Page of Division of Safety and Buildings �ci n oK q with Comm 85,Wis. Adm. Code County Attach complete siteW ape not less than 81/2 x 11 inches in size.Plan must COUn �f C` �' include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. R Y y Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Prrop'erty Ownerp Property Location &wa.Alet A/W 114 s W 1/4 S oZ CT o2(F N R &W)W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# City State Zip Code Phone Number ❑City ❑�V7illage Town Nearest Road / J?; l°'-t Ar cdZ- S40 ' ( ) U!- CC-all) 5- l leYCA- �rtw ❑ New Construction Use Residential!Number of bedrooms Code derived design flow rate G y GPD Replacement Public or commercial-Describe: Parent material e s f Flood/Plain/elevation if applicable ft. General Comments s r f C Q did( e s 1' ,'� ! ? Sa*��N �/oY C i R. and recommendations:r� �, S, fe w/'!�k( , rC. 2 •� 5;1 s/e c c L Sf e�n •�"e 7`"� Q b7,ig,n14r✓I Ol C o jn S 4�e �� /I ,� to w 7 C Q�•r 7 a. 1u.7� t�.l7" f'a f to►- IA Boring# Boring Pit Ground surface elev. 76'b ft. Depth to limiting factor �'3 in. Soil Appkation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GMT in. Munseil Qu.Sz. Cont.Color Gr,Sz.Sh. -Eff#1 -Eff#2 s !o ¢4? 4 6,� /L Ai a L)k ✓t I'r' w l vf' �-p �•�3 ® Boring# (� Boring Q ? �I Pit Ground surface elev. `0) ft. Depth to limiting factor ✓ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. "Eff#1 `01#2 l o -9 !o YiC 3 SS Z 3. ,6 K .y, h cc _V .Z C,6 �- G S 'Effluent#1 =800 >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature CST Number Cf a,/CS we/ a-._0 6 73 Address Date Evaluation Conducted Telephone Nurroer 770-t 411rwo k12-3-4 of I e16�.2Dt/4 7/S-Z73' -3 30 Property Owner u' l't fa "' � Parcel ID# 040—//0 4 - 4 0—OO O Page a of 3 Boring# ❑ Boring 1Z Pit Ground surface elev. �S ft. Depth to limiting factor �j in. Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu.Sz. Cont.Color . Gr.Sz.Sh. •Efr#1 •Eff#2 o- 11-17 v Yet't/ 2 P 0.d o_ S L- _57 S yr QS 2 YT 0-7 A t5' C,w - V.7 A 9' F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 17 Ong# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lion Rate .Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu.Sz. Cord.Color Gr.Sz.Sh. 'EfF#1 `Efr#2 •Effluent#1 =BOD,>30<220 mg/L and TSS>30<ISO mg/L 'Effluent#2=BODS<30 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. SBD4330(R.07100) Y uti//VEK sIT r OF rIll-tS TvoY +o ,It) 0 0 2 0 t„ite.re•. s',+PP� Fir.,. �. F��..► vY a I/ b t I� � t z I p�p /fit c -It- Cr� L, d ( eJeY� t0 9'os 1 d RksST�w� J u ' v iii t 5.�1`hGlo�.er Rd r I � a rv..,.1. Z Cyr loan iy 4s { 93 4z _fbaut d-�.S`i.T,. to y ' L ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ,0. Mailing Address� �'5 — <;la)per 1 aY Propertyy Address /c � -- Qo pej, P_ (Verification required from Planning&Zoning Department for new construction.) P 1 City/State r,�A 1 c Parcel Identification Number LEGAL DESCRIPTION Property Location '/ , '!d, Sec. -o(21 , T VY N Rj/y Town of � L Subdivision , Lot# Certified Survey Map#n Volume ,Page# Warranty Deed # C ` U 3 , Volume ZIA �#Pa s Spec house yes no Lot lines identifiable 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. Uwe.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 Coinm6rce and the Department of Naiuusl Resources,state of wiscowin. 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property deserted above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms i � ) AL- SIGNATURE OF APPLICANT(S) DATE ***Any inforaation 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. (1tEV.08/05) DOCLIMENT NO. 278568 va 409 n E346 This Indenture, Made by Herbert Turner and Elms Turner, husband and wife, as Joint tenants and individually grantor s of St Croix County,Wisconsin,hereby conveys and warrants to The Board of Regents of State Colleges-- Madison Wisconsin grantee—of County,Wisconsin, �? forthesum of FiftycEive Thousand and 00/00----DollarA -------(155 .000 00)------------ l? the following tract of land in St. Croix County,Sthte of Wisconsin; '1 The Southwest Quarter (SWI); the South Half (Sj) of the Northwest Quarter (NWJ), i and a part of the Northwest quarter of the Northwest quarter (NWJ of.Nwj), described j as follows: Commencing at a point on the west line of said northwest quarter of the northwest quarter (NWI of NWj) ten rods north of the southwest corner thereof; (� thence south to the southwest corner thereof; thence east on the south line thereof sixteen rods; thence northwesterly in a direct line to the place of beginning, all I� in Section Twenty-Six (26), Township Twenty-Eight (28) North, of Range Nineteen (19) t West. Also, the northeast quarter of the northeast quarter (NE1q of NEJ), and all that 4 part of the northeast quarter of the southeast quarter (NEI of SEJ), lying north I) and east of the Old Telegraph Road which crosses said forty, all in Section Twenty- seven (27), Township Twenty-Eight (28) North, of Range Nineteen (19) West. I ,v I � j i III, I IN WITNESS WHEREOF,the said grantor S he vehereunto set the JJr hand--laud seals this 11th I� day of ee mber A.D,19 64 (SEAL). S NED AND SEA ED IN ESENCE�OF Herbert Turner (SEAL) i James H. Deringer Elms Turner i (SEAL) i Donna Timm (SEAL) STATE OF WISCONSIN, St- Croix county. ss Personally came before me,this llth day of December �, 'jS: R, � the above named Herbert Turner and Elma Turner, husband and wife, f •-;{ii,lttui','��::>: to me known to be the person S who executed the foregoing instrument an aeknow,edged the same. 1.97 Received for Record this thth day of cc e e .D.,19 ak 2 0 o'clock-P—M. .> (SEAL) James H. Deringer AV17 AA otary Public St Croix 67 egister of Deeds. My commission expires At1&r:•?Lb�_•.a2i D S9'r�-� De ut•Register of Deeds. P 1 $i tlir„tu� This instrument drafted by James Deringer, Realtor, Baldwin, Wisconsin -- WARRANTY DEED-STATE OF'MSCONSIN,PORM.NO.9 x.a vuux m..xuwmaa t ~ v O ao > O C c Mi cY o I er m � c a'o ~ o m o N c c'Y m c° L `- c O O m m N . a3a� N € 2 coo .V.Fii' 7 7 N c W N w°c 3 N N O c�v�= D maa' x ° O m.0 a N- in. o c�O •- N N O E c y a m n8 y._ mo ^`S o N E c 2'i a N� N C N d N= O O O T N N c m'O w Z c N'O N 7 d �Ua? ° ym ,� t'i � Z 7 7 N N !n m C Ij 7 N O.a EO m O c c U m 2 - G� CL N O N N O -O N EGO Q 'a N C O m N V >+p m 7 m CO O w L>J D N w N i O U- E c a`o �w > oL s °? 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