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042-1089-80-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572809 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: Nichols, Stephen & Nancy Warren, Town of 042-1089-80-000 CST BM Elev: Insp.BM Elev: BM Description: - Section/Town/Range/Map No: 32.29.18.494C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I /_ / Benchmark 0 /06,,0 Dosing Alt. BMl ✓ P V3 Aeration �,�/ BId�Sewer - J �d Holding St/Ht Inlet 'W y6 4 1 43 TANK SETBACK INFORMATION St/Ht Outlet .-- TANK TO P..�- WELL BLDG. Vent t to Air Intake ROAD Dt JaW L - i 1y/1 YS . Septic Dt Bottom -f- / �.3 y 7 Dosing Header/Man. p 3 Aeration Dist. Pipe %( p Holding Bot. System / 2 /o. �rJD• PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM ' '74-55,217- S/q Model Number ' { f S-Z Z9 •'4G— TDH Lift Fricti n Lo ss System TDH Ft Q-C 2 3 Forcemain Len / DiaZ �r Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width f Length No.Of Trenches PIT DIMENSIONS No.O Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L B DG W�EL]- LAKE/STREAM LEACHING anufacturer: INFORMATION Ty e Of System: CHA Z aryl 1D,j4_ 5 Zit. 7 (t UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold r Distribution Ix Hole Size Ix Hole Spacing Vent to A/Q Pipe(s)?� I l_Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 7d_ed/Sodded xx Mulched Bedrrrench Center r a LI Bed/Trench Edges Topsoil ❑ Yes L No [ Yes ❑ No tom' COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: M I Zi PgInspection#2: Location: 1057 65th Ave Roberts,WI 54023(SW 1/4 NE 1/4 32 T29N R1 8W) metes&bounds Lot �j, Parcel No: 32.29.18.494C 1.)Alt BM Description=T0�-' Of I t'V W(lWf It�.(y,c� /G�C e �t'L�y�` 2 2.)Bldg sewer length= z0� _ � /iiQ� 10 wtj cz-nV"c�c( �o�Q� STt y� �L`�`i��c✓ �t -amount of cover= � c Z n �,._ / �(� C (/ Z� AQU�(Qr� �1 cL✓ Plan revision Required? ; Yes *'No• -� - I Q ❑ ❑ ? � 6 J Use other side for additional information. /V _ SBD-6710(R.3/97) Date Insepctor's Sig ature Cert.No. PLOT PLAN PROJECT Stephen Nichols ADDRESS 1057 65th Ave Roberts Wi 54023 SW 1/4 NE 1/4S 32 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX SYSTEM ELEVATION 104.6/103.0 /101.4 3.5' below DATE 10/3/14 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE / HOLDING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1125 # of EZ Flowsl BENCHMARK V.R.P. Bottom of garage siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark I C _ 1 74sm = Scale is 1" = 40' � r DW unless otherwise noted A0,, ,�j 15' System is failing— All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Wel ST is not water tight 0" Old system is to ' and f 1 of r t r i D W be pumped and 30 buried Huffcutt Combo Tank 40' '5e4- o v+" k– Existing 2 ChizY411f, Bedroom \ House \ 12, ' 3-3' X 75' cells with>3' spacing 18% Slope Garage 5 102 B-1 150' S' M. 40' 104, -- 6' 50' � 65th Ave B-2 108' 20 Vents B- � . . 300' F94,cQ Vwt� ,, u� 'F° Q0 d g LL'qk) - 2 EK I S ��� � operty Line PER WN"J"I L' tNT AND DEyIATER�N'u FH7EEAD CAPACDTY C6RVL'- EL -z -7 7 1 29*- 50 23� 153 Il , 4 0 3 01 2Y 12 152 44 ;4 2y 42 T 30 V '2 3 20 4 4-1 C,4508 A 60 BO 1/4 GALLONS I -T------------------T LITERS SQ 24C 5 6 FLOW P`:R MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS •Timed dosing panels available. Electrical alternators,for duplex systems,are available and supplied with an alarm. Variable level control switches are availab e for controlling single phase systems. •Double piggyback variable level float switches are available for variable cycle controls.c- level long and short Sealed Qwilk-Box available for outdoor installations.See FNI11420 •Over 130°F.(54*C,)special quotation required. 77 1521153 Series ........... 152JI53 MODELS control Selection I/s Du x Volts.Ph Mode SKN A. SiT C� Model es .1ed N15` 2 Non I AulAuto 85 Inclu 1 2 or' 8N1521 115 1 FE1521230 1 Non 3 43 2.1—3 SE152 230�� 13 "N153 115 17Ncll 2 105 i 1 1 SELECTION GUIDE ---------------------I-- —A 2 of 3 1 ,,, 1 105 1 lnclu;ea level float switch of double piggyback variable level Moat LBN153' 115 1 Single piggyback variable I E 153 �"5V' 230 1 --+— 2 of 3 t^ . t Non 5 5.3_i ndu Refer to Ff,1047T L11E-1�3L 230_1 s t cn. R i i emajor E-Pak. F, CAUTION—] 2. See' for correct,model of Electrical All nuolactivator,specilfy duplex(',': g should be done by a qualified 3. 'v'ariable level control switch�&0225 used as a cc, All installation of controls,protection devices and wirin licensed electrician. AD electrical and safety codes should be followed including the Most or i4)float system. lic recent National Electric Code(NEC),and the Occupational Safety and Health Act(OSHA) % RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO P.O BOX 16347 0,3-17 facia fals of�fan i Louisville.KY 40256_ SHIP TO: 3649 Cane Run R03d ijrr OWA5 Sl*rz- 1EF Louisville Ky 40211 1961 (502)778-2731.1 8401 925-P1-!MP FAX(5421.7430"24 http.11www,zoeIIer-c0m OC Copyright 2000 Zoeller Co.All sights reserved. S County S t afety and Buildings Division 4 ht^( 201 W.pWas ton Ave.,7P�O.Box 7162 Sanitary Permit Number(to be filled in by Co.) State Transaction umber p4 Sanitary Permit Application ' In accordance with SPS 383.21(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(ff different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary put oses in accordance with the Priv Law,s.15.04(1 m,Stats. L Application Information-Please Print All Informa 'on Property Owner's e t Parcel# 1st.✓ �� � � ��°' �U °-v� � Property Owner's Mailing'Address Property Location L�/Z `j Govt.Lt City,State Zip Code Phone Number Section ,'P a r C. n -� T�N, R� E V II.Type of Building(check all that apply) � Lot# Subdivision Name t 2 Family Dwellin-q-Number of Bedroo /J J 7`4-'tt 1"LL�( '. ]1 r^i' r /ll(S l�xj Block# ❑ Public/'Commercial 1D.cribe Use �' r -/ -� ❑City of i CSM Number ❑Village of ❑State Owned--Describe Use V.- of -.&ZC.{ III.Type of Permit: (Check onl on line A. Complete line B if applicable) A' ❑New System placement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New �r „ � Before Expiration Own / 50- OA) W.T e of POWTS S stem/Com onent(Device: Check all that apply) Non-Pressurized In-Ground ❑Pressurized In-Ground ❑ t e ❑Mound?241in,.ofssui Mound<�2,41 is off suitable soil�X y �..tr ' [7 r' att� DIM,lI. �1 ; ❑Bolding Tank ❑Other Dispersal Component(explain aTti V.Dis rsaVTreatment Area Information: ' Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area uired(sf) Dispersal Area Proposed(s System Elevation VL Tank Info Capacity in Total #of Manufacturer u c Gallons Gallons Units n ? U B New Tanks Existing Tanks �.Z 1 Pn L L -•i o m A w U Septic or Holding Tank ✓ ' V Dosing Chamber VII.Responsibility Statem t-1,the undersigned, u responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Pl ignature MP/MP1tS Number Business Phonc N her _ a r JJ '{ Plumber's Address(Street,Ci ,State,Zip Cod VIII. ounty/De artment Use Only Permit Fee Date Issued Issuing Agent Sign ure pproved ❑Disapproved 7(,) r')„ Oil ❑Owner Given Reason for Denial IX.Conditions of Approval/Reasons for Disapproval jr4 , 1 6C- ��.� � Z C�l�G� L �� SYSTEM OWNER; 1.Septic tank,®ftlu®nt filter rand dispersal cell must Ja¢_envig0d/maintained as per management plan provided by lumber. p and submit to the County only on paper not less than Sir.z 11 inches in size as per applicable code/ordinances. SBD-6398(R- 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/3/14 Owner: Stephen Nichols Location: SW1/4 NE1/4 S32 T29 N,R18W 1057 65th Ave Warren System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. EZ-Flows Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Se ion 9. Pump Curve 10.-12. Soil Test Signature License numb 26900 PLOT PLAN PROJECT Stephen Nichols ADDRESS 1057 65th Ave Roberts Wi 54023 SW 1/4 NE 1/4S 32 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX SYSTEM ELEVATION 104.6/103.0 /101.4 3.5' below DATE 10/3/14 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZ� I 4 AREA 1125 1 1 =5' HOLDING TANK SIZE LOAD RATE ABSORPTION A # of EZ Flows BENCHMARK V.R.P. Bottom of garage siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Scale = 1 /4'1 = 10' Scale is 1" = 40' unless otherwise DW noted 15' System is failing All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Wel Old system is to ST is not water tight 20' D W be pumped and 30' and full of roots T buried 30' 30' Huffcutt Combo Tank 40' Existing 2 Bedroom House 12, 3-3' X 75' cells with>3' spacing 140' Garage 25 18% Slope 102' B.M. B-1 150' 5' 55 40' 104' 106' 50' 0' 65th Ave B-2 108' 20' Vents B-3 '! 300' Property Line C Q ',U— O LL _ w 0 ? X 0 ♦.+ N N = c �a C7 cn (1) E O 0 IF CL _ O u > t�La Q. . . . E N m E' ii cu 'a cn cn ; U �f a 0 _ .�1'. ; 'a vi v d' : 'Soa •.c. a > tai UL LO CL Q ° 0 -0 W °• • �o o � o >o ,°o cn o � W V . . . . . ti p E '2 Yu1 LL. V � � o. — .n '•'•'•'' • ' • •'• o 3 F-- . . N LL O o a .— 1L o d cu a cy) U ii cn U) O Lm I•-0 i ormance Specifications Sep tic-Dose -fai* Cross Section And Pump Perf Tank Manufacturer Pump Manufacturer Tank Model Number Pump Model Number Gv Total Tank Capacity Alarm Manufacturor 1/e Alarm Model Number B De th ax. P M Bury jTotal otal Dynamic Head(TDH)- Feet Filter Manufacturer Head Filter Model Number essure Loss Minimum pump performance Required ain Loss ' C� GPM, Ft TDH ' outlet Manhole Min.4"Above Grade With Manhole Min.4"Above Grade Locking Device. Inlet Manhole Scowely Mounted With Locking Device <6'Below Grade Sealed W aterhlzht Weather-proof ---► "�'°� Junction Box -- '. .. Finished Grade -► Vent Min' 12" Disconnect Above Grade Means With Vent Cap putlet Filter ----- - ------ Wet Baffle Inlet ;•: Inl A. 'A" and Reserve Capacity ': Weep Switch Sett;ngs :: .•: ;.° .;• Hole Tank Volume= J GPI B Dimension Inches Volume Gal. e)A ?3.S Elevation C (resew r;; off El (alarm) B 2 ;: Ft Bottom (dose) C D Elevation J ' �2L--9—Ft (dead) D �' >:a: >':::.•: X. Total , a a.a a a,a,<i r':>;r•>•':a>::'''::''::::i'a ii':::::::I+'a':::a+•a r�>�«`>�>ys��>iaY�::�Yai:i:iF a•:a>a•:i'::::::a.a.a a . and beak filled in accordance with the 'NERAL INSTALLATION. The septic�dosc tank is bedded ified by the manufacturer may not G royal specifications. Maximum dept'of bury sPee . device (padlock) manufacturers product app have an efPoctive locking t fit(padlock) mval. Manhole covers exposed to�e to the tank with watertigh g be exceeded without prior app approved material, connected installed. Piping at the inlet and outlet is of appr 16.2:1. t � or sagging- '�force maul is sleeved �C 00 and Comm the tan laid on stable soil to proven g hi Electrical service complies with excavation and the,sleove is sealed waterti8 of Page — 02/05 U SNOILVIOOM 31383NOO BMW NISNOOSIM N 1VNOIIVN uo�}fro f3nt{'MMM x III1-£2L (SIU XVJ U •31]tl 0 U 0 0 NNtll 3I1d3S MO dWnd (U 30 2l38W3W 9191426 (008) 9W-UL (SIU N(111b9 009/000'I � 62L4S IM 'Slltl! tlM3ddIH3 � iNVid 031311838 'V'D'd'N 133KS P1621 b91ti 1133f'❑dd 13uno I I ' II m I i I i o� v i i .6£ .6£ I I .8L in n � i (U ^ Z n LLI WC CL r:t m Cl) Ja 1 ~ _ d � Q' C3 0- C I I I .L9 .8L LO z z w o„ _ ' -J Q Q A�U+ d (U v I 131N1 F-------------- w I I I I I ^ I D C I � r I � � I D I I m y I � M (V7 J I --I frl °�` z I. I I a r m� r 55' j y R° f'0 r = m --- - 47' 8' n D �o r 3' 44' ut I D rte. i z - I O"Tl mA D A. UI N N PTT z 0-1 O n Ln 0)C Imo'_ O Z m I --- - w I ww L--------------------- a 20" 12, r m D z o 7C r D c� rr,to cy� f*1 V1 n E3 _ - � 0D z A N aA r Ll m m C3 N N N ❑ y T< A LZ'1 O; 'O < 0 0; d = d b A D ❑ D D £ N o WA O r eye 6" o� N Z A m c:D D m n A.Z-. r t a t7� D ci C7C -mlm n D 3 °° m D n c) m c o r = do m m ot" n u H ;a -1 <m ti n mr ❑ n am oi ;u° cz 'gym a w N A mA am c- m tJ ty cy O m D£ Nm 45' 10' A _= Hey 42' d o m za o0 A m � r W D ;u m A r m =� A❑ £ o <<i o A ti c �p D d Ul D D z -1 O Z N PR❑JECTI HURCUTT 4154 rd STREET �� N.P.C.A. CERTIFIED PLANT CHIPPEWA FA FALLS, WI 54729 a��� & 1,000/600 GALLON MEMBER OF: N PUMP OR SEPTIC TANK I C 0 A C R E T E. I n C. (715) 723-7446 x (800) 924-1516 �r FAX (715) 723-7111 w www,huffcutt.caro g NAPONAL k PASCONSIN PRECAST CONCRETE ASSOCIATIONS W w TOTAL DYNAMIC HEAD/CAPACITY �I HEAD CAPACITY CURVE 3 7/6 6 1/4 4 PER MINUTE MODELS "140/4140" EFFLUENT AND DEWATERING 4 5/8 Ft. Meters Gal. Lt's. —� 14 45 5 1.52 91 344 0 3 10 3.05 84 318 INS 40 15 4.57 76 288 12 20 6.10 68 257 1 9/2- 11 1/2 WT 140,4140 35 25 7.62 59 223 I 10 30 9.14 49 185 35 1 10.67 38 tai 40 12.19 21 79 9 25 45 1332 5 19 12 5/8 Lock Vat": 46' 6_20— --}_ S2 4 5/16 z SK1524A i 15 a J 4 Q F 0 10 2 r t • - �' 3 7/6 6 1/4 5 4 s/a O 3 7/8 U.S. GALLONS 10 2 30 40 1 50 GO 70 80 90 100 1 1,0 1 + L LITERS 1G0 240 320 400 0 FLOW PER MINUTE 010900 tp 1 112-11 1/2 MR CONSULT FACTORY FOR SPECIAL ,APPLICATIONS • Electrical alternators,for duplex systems,are available and supplied with 16 13/32 an alarm. • Mechanical alternators,for du*x systems,are available w th or without -� alairm. 4 5/16 • Control alarm systems are available for 1 phase pumps used in simplex _ � sK,u4a system.See FM0732. • Variable level control switches are available for controlting single phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. SELECTION GUIDE • Sealed Qwik-Box available for outdoor installations.See FM1420. 1. Single piggyback ybadc variable level float switch or double piggyback variable k • Over 130*F.(54*C.)special quotation required. switch. Refer to FMO477. • Refer to FM0606 for 200*F.applications. 2. Mechanical alternator M-Pak 10-0072 or 10-0075. 3. See FMO712 for correct model of Electrical Alternator E-Pak. 4. Variable level control switch 10-0225 used as a control activator,specify duplex(3) 140 Series-53 lbs. 4140 Series-73 Ibs. or(4)float system. 14W4140•••LIDS _--control Selection Model Model Yofls Ph Mode Mips UM A- M4140 115 1 Non 15.0 101&5 2 or 3&4 E140 E4140 230 1 Non 7.5 1 or 1&5 2 or 3&4 o CAUTION BN140 BN4140 115 1 Nan 15S 1 or 1&5 2 or 3&4 All installation of controls,protection devices and wiring should be done by a qualified BE140 BE4140 230 1 Non 7.5 1 or 1&5 2 or 3&4 licensed electrician. Ail electrical and safety codes should be followed including the most recent National Electric Code(NEC)and the Occupational Safety and Health Act(OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 5 �— ~MAIL TO:P.O.BOX 16347 _— LOtirsv*,KY 40256-0347 MmullactimOf.. L� Sires TO:3649 Cane Run Road Lolesvdfe,KY 40211-1961 Qusurr1911mve SNAF/9.39" ® PUMP !O_ (504 776.2731.1(800)928-PUMP Mgo//www.zoeJJA com FAX(5M4774-3624 ©Copyright 2001 Zoeller Co.All rights reserved. µ Property Owner_ Parcel ID# Page of 0 Boring Boring# ❑ .Pit Ground surface elev..L' ft. Depth to limiting factor-f in. 5*Eff cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Dlff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#2 0- 3 1 Z C All, ) ' , F-1 Boring# ❑ 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/ff " in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 F-1 Boring# ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 I 'Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5 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. SBD0.8330(8.6/00) �� 022a1� � Wisconsin Department of Con'(merce CpUN MENT SOI E -REPORT Page_L of 3 Division of Safety and BuildiT C '0\J JevoP � kj� in accordance with Comm 85,Wis. Adm. Code County Attach complete site74Q on paper not less than 8 1/2 x 11 inches in size.Plan must Cr x 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. y'F O J 7- P/ease print all information. !.L) 1/,Z, Reviewed by _ Date,—7 Personal information you provide may be used for secondary purposes(Privacy Law,s.15.14(1)(m)). Property Owner Property Location A//dO/ Govt.Lot .5iO 1 A /(/jC-1 A S 3 2 T Z 9 N R , E(o w Property Owner's Mailing ddress Lot# Block# Subd. Name or CSM# /0J`i - City State Zip Code Phone Number 0 city lage CELTown Nearest Ro d KNew Construction Use• Residential/Number of bedrooms Code derived design flow rate GPD ❑Replacement Q Public or commercial-Describe: Parent material d1`�l[1�L�fN� Flood Plain elevation if applicable ft. General co mments �p m t,2 f1 r✓�S�c�a¢� s `]/ ' 3e and recommendations:_ System Type System Elevation �� F I Boring# Boring / pit Ground surface elev. �2, fit. Depth to limiting factor 9L17 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence LBoundary Roots GPD/fF in. Munsefl Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 0-9 Vz- �„ • 6 /�, GAS ® Boring# Boring pit Ground surfal�elev 7/ /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. I 'Eff#1 'Eff#2 !�/'Z— C Effluent#1 =BOD.>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) Sign CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate Evaluation Cc ducted Telephone Number 1432 120th St, New Richmond, WI 54017 L 715-246-4516 Soil Test Plot Plan Projeet Name Stephen Nichols Shaun Bir Address 1057 65th Ave �^ Roberts Wi 54023 CS #226900 Lot ------ Subdivision --------- Date 9/30/14 SW 1/4 NE 1/4S 32 T 29 N/R18 W Township Warren Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of garage siding System Elevation TBD *HRPSame as Benchmark Scale is 1" = 40' DW unless otherwise noted 15' System is failing Wel 20' D W 30' T 30' ST is not water tight 40' and full of roots Existing 2 Bedroom House 12' 18% Slope Garage 5 102 150' S' B.M.55' B-1 40' 104' 106' 50' 0' 65th Ave B-2 108' 20' B-3 300' Property Line POWTS OWNER'S MANUAL 81 MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: ` ❑ NA Permit# c Z �' eptic ❑ Dose ❑ Holding Volume: (gal) Tank Manufacturer: ❑ NA DESIGN PARAMETERS Number of Bedrooms: ❑ Septie [I Holding Volume G (gal) Number of Public Facility Units:7?71 Vertical Distance Tank Bottoms)to Service P � (ft) Horizontal Distance Tank(s)to Service Pad:Estimated(average)Flow: (ga -?l . speck servicing mechanics must be provided'rf cal is>15 feet or Design(peak)Flow=(estimated x 1.5): J (gal/day) if horizontal Is>150 feet. Specific Instructions to be provided on back. In Situ Soil Application Rate: (galtday/ft') Effluent Filter Manufacturer&_495 -/L ❑ NA Standard(Domestic)influent/Effluent Monthly average Effluent Filter Model: Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer: ; ,L e/C�le-C� ❑ NA Biochemical Oxygen Demand (BODs) x220 mg/L ❑ NA Pump Model: FA--V7 Total Suspended Solids(TSS) s150 mg/L High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L' !u� Manufacturer.. ,e >220 m A ❑Mechanical Aeration ❑Peat Filter "^ (BODs) mg/L SS) >150 mg/L Wetland ❑Disinfection ❑Other. Pretreated Effluent Monthly average ❑sand/Gravel Filter ❑ (BODs) s30 mg/L Soil Absorption System (TSS) s30 Fecal Col'rform(geometric mean) s10'm�LA ' 'Ground(gravity) ❑In-Ground(pressure) ❑ NA �E❑At'-trade ❑Mound Maximum Effluent Particle Size m/a in dia. ❑ NA ❑Drip-Line O Other: Other: A Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scum equals one-third(Y3)of tank volume ❑When the high water alarm is activated ❑month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: years) months) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: ear(s) month(s) ❑ NA Clean effluent filter At least once every: f/ year(s) -a [I month(s) [3 NA Inspect pump,pump controls&alarm At least once°every: earls) ❑month(s) ❑ NA Flush laterals and pressure test At least once every:. ❑yeags) Other: At Least once every: ❑year(s)❑month(s) El Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third (%) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper)and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: All other services, including btA not limited to the servicing of effluent filters,mechanical or pressurized components, pretreatment units. and any servicing at intervals of 5512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02105) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s)removed by a Septage Servicng Operator(pumper}prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and sal absorption system: acids, antibiotics, baby wipes,-cigarette'°butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump)discharge,fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products, pesticides,sanillry napkins,solvents,tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. Comm 83.33,Wisconsin Administrative Code: • All piping to tanks,pits and other sal absorption systems 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(pumper). • 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 com cant 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 o protect the replacement area will result in the need setbacks from existing and proposed structure,lot lines and wells. Failure t for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. �r ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER, Nam� �j,� Name Phone —1 — Phone SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHORITY ;L Name AIZ2 NameU Phone � '' r. L/ Phone 7J-r- "r This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. P 5_ FILTER CARTRIDGE INSTRUCTIONS y$�AM Installation f STEP 1 Dry fit the filter case onto the end 0 the outlet P ipe to ensure it is centered under the access opening. If not,then either insert onto tpi outlet the tank through the outlet or solvent weld (9 } pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. �M STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning j clockwise 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. F'f�p 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making 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 been lowered below the invert of the outlet pipe,firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present,the switch + ' should be removed by turning counterclockwise 900 and cleaned with water only. 7. While holding the cartridge on its side (large flat surface facing down) over the access opening, rinse off the cartridge with water *t, only, making sure all septage material is rinsed back into the tank. S. If VRS switch is utilized, replace by inserting into filter and turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. ; 10.Replace and secure the access opening on the tank. BEAR ONSITE-FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear orssite filter:artridges ar=_warranted to be free of defe'_ts m material and r=orkrnan5hip for five .-arc frorr, dace of Consurner purchase. BEAR ONSITET"Filter Case-Lifetime Limited warranty BE Ons!te warrants the filter case will be free of defects;n matenai ana cEOrkrnasishin dorfnC;na mai use fo!the Period at tone trse or;amai puic;:aser owns the produ.:t. If a defect!s found in na-rnai use. Bear ons!te evil a_'s I ian,r ;�a G'ovltle a replacement Par!o.fProduct,aa*y ImProPef appropriate adjustment,Darnaa`to a product..auSCC by acci0tnt,rr isu5e,o;aUU>e i5 na, covered Ll ;:a e os n:alfUndions resuitmg from units not installed.o?e a ed,or ma ntamed in a;.rar.'an e.v!ih in .u_tuns am ideU u;i11 v;nr,me w•arranry,Proof of purchase icsriginaI sales rece+l m,.•t.be provided to Bey ansite with all w s rarity Claims.Bear Onsite!;not responsicle for labor cna,ges,removal rha nos: n5taliaticr.,or other i maer:ai 01.arses?u�ntal costs. b�no event shall the l+aoility of Bear Ons!te ex eed the Purchase Price of the product. 5' nowS ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AND OWNERSHIP CERTTFICATIGN FORM Mailing Address Property Address Planning&Zoning Department for new construction.) _�_VcrKc_a&oli r-equ-i-re—d-Fr-o-un-Pia--n City/State Parcel Identification Nur-iber LEGAL DESCRIPTION Property Ucation5.LJ 1/4 N IZ W, Town,of'_LUq Subdivision Lot# Certified Survey Map # Volume Page Warranty Deed# voltinle Page# --------- Spec house yes no Lot line4, identifiable( es no SYSTEM MAINTENANCE AND OWNER CERTUICATION Improper use and maintenance of your septic system could result in its pul-mature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,it needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage III the wade disposal SyStCTIL owner maintenance responsibilities are specified in§Comm. 83.52(l)and in Chapter 12 -St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning&Zoning Department a certification forni,signed by the owner and by a master plumberjourneyman plumber,restricted plumber or a licensed pumper verifying that(1)the oil-site wastewater disposal system is in proper operating condition and/or(2)after inspec�ion and pumping(ifnecessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal systern with the standards set forth,herein,as set by the Department of Conimeicc and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has beery maintained must be complete,t and returned to the St. Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we jityVare the owrier(s)of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. -N umber bedrooms � /OF APPLICANT(S) DATE' *-'**Any information that is misrepresented may result in the sanitary permit being r,7-.voked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) g-. y�p ,y l.•fTLRJ'f�9iir�' 'f 1 'T r = 6 W-man_ :1>,-1:s,sv; zaa:s3 '"asjaar3e Ja33s"=z _ '�.:��✓3`��s ��.. .. .. _ Ued. +f=r RW=Wd times 21sc _ - + Oct A-13. #9' 83 - - '?-=1311 P a Sc. Croa.-= Tae.I'srord\o: That part of W�-, olf SUP,- of RM of Section 32, 'LownshIp19 R ovth, F-vage 18 West St. Crmla County_ . wisconsin Leg Southerly raf the CeoCeei.-ine of rho fora er Town Road a Yv3- 1r1 z4L3d forr-F_ TOGE- W3L-TM a a S:.mpaft Vor a pravate- roar! P-tglst-of-Wav oo and over the Soccherly 33 Ifeec of thaet portion of the SWAz of KE% of Section 32, Township 29 North. I ge 1S West, Sc. Croi-it fCoa nuy. W sea s.in Lying Northerly of the centex"ne of the doruwr Mown road cerowsLng said forty. as �' I is e:ua._rs�xaasvr-gas'- 6�.au'r„^.+:sga aw, c9`si..�"a eF.?:tg.:=. fl •'fl!$i,'a.;�3 +=,w co versn4nts and restrictions of record. If any, and Ro:adfaas Agreem-&ne dated April 21. L'981 -and recorded In Volume 528, page 183, Sc. CroL-% uniLj; Beg:iacer of Deeds Office. 21 L e.; . October 1,983 - b,THAN T11S MARJOR'liE JULL2� AUTEKiMiNTICA7101V! ACSAIO�Vk.LI3GC3FiAe'i, �` SigzsaaEevt4s) STATE OF WISCONSIN Sr. Croix Co aREy --.... ..-_ .founts. X - '..C. asQEc'ttt�.t�I MLA fay, rS ...... ueronslly come. before me this ....:2�sE- rla�•,fff'� .October. __..__..... .......1 19.83__ the TV name.l .. ...... ... . ..... .. _ Mynan ..Julius.-and..Marjorie..Ju-11us.... .. . TITLE: MEMBER STATE DAR OF elf not.. ._ .... ... _.__..... - ga. we Snmcn to he the !"ir=on _. 5.. _.._ who csecafed the otevoer.=_^-i- eurre.f and acnno:rletfre the sari=_. -.._ ;. r-: Rxi;••_.- _ .,-..3 Cm sn--.^.e �L�. ,rte%j^ f 1f c'1Gt0012, CAR Y & -"%-"RR-;Y - -BY Samuel R Cara t G o/r� 22°,--Fuds*n- -W,1 '54at6 . . .-, ._ . r-:' PPtNfir County. Wis- t31G:tatec=%s c_ pn rmanr--nt.i If not, slate a n:ra0o.r a,e not •-a- I ,.,.e m,= O£E.7 - _=TF. aaS OF WIS'C.)5[57%t L�.'c..•:r..+- i.-1-r� 9t:+:.. .,..