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HomeMy WebLinkAbout028-1040-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 572836 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: Monicken, Timothy & Denise Rush River, Town of 028-1040-50-000 BM Description: Section/Town/Range/Map No: BM Elev: Ins p.BM Elev: p CST p 34.28.17.252 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE X/, 'S CAPACITY STATION BS H - FS ELEV. .' /. z J _ � /aa "V, Septic 1A, 3 Benchmark 164- 05 n a . 7 e,r' Boa 3. z Ge� Alt. BM �/� Dosing .r� � Bldg.Sewer Holding SUHt Inlet 91 4�5"?SUHt Outlet \ \ TANK SETBACK INFORMATION TANK TO I �P` WELL BLDG. Ven to Air Intake ROAD Dt Inlet 1 Septic 7 ZS $7 3 Dt Bottom /Z.$t� Cr<. Z Dosing g� 3 0 1 AlZ I _ Header/Man. 3 c/ ?5j, S LS Aeration Dist. Pipe 3, 44-7, v . 5 Holding Bot.System Final Grade 1.?. 447 9 3-D2 PUMP/SIPHON INFORMATION Manufacturer GPM nd St Cover' 4A— . 3 5 Model Number s (o •`� TDH Lift-7 �� Friction Loss System Head TD i `5 it Forcemain Length Z Dia. 1 Dist.to Well �7 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Tren s PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS ,(�p L 4 SETBACK SYSTEM TO �l P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ,may/ �� �x � //L UNIT Model Number. � 1 0_64)V%X DISTRIBUTION SYSTEM U o.f-- r ader/Manifold H Distribution / 3 I I x Hole Size ( x Hole Spacing // Ven o it Inta pO 7 d� Pi e s [�ngth Dia �'Z`5 Length 5 I Dia /'ZS Spacing 3z Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/ dded xx ulched Bed/Trench Center ' �2 Bed/Trench Edge\ Topsoil I Yes No Yes No � J \ COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: /Z- / /OP Inspection#2: S / !$/ Location: 1825 Cty Rd M Hammond,WI 54015(NE 1/4 SW 1/4 34 T28N R17W) 40 acres Lot �' IL Parcel No: 3 128.17.25 1.)Alt BM Description= - LaJe�_ G�,a.t Let, b ZS v,, P/°`j 2.)Bldg sewer length= '56 -amount of cover= > !IZ 11 T 6►�- Plan revision Required? [:] Yes XNo 5 15 t0 Use other side for additional information. Date Insep toes Sign re Cert.No. SBD-6710(R.3/97) C�V-\ .4-L c; /t ,U 70- u-V o� ccs f:rc1ea- if CrH r r r Y A�UDOL 7 S a 14 1606 PIP 7R TV. E.1'1. GL, cis r-d,`( Property Owner �d�h M l'LI C kev� Parcel ID# O.8l_Y O�06 5-0 Page of F3-1 Bonng# ❑ Boring ❑Pit Ground surface elev. ft. Depth to limiting factor Q in. –90-11APPIloation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •011#1 •Eff#2 - 60 v 3 O C2 D to Boring# ❑ Boring ❑ 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 F-1 Boring# ❑ Boring 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/fP In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 •Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD,<30 mg/L and TSS<30 mg1L 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. San-8330(R.mroo) elf� � e-k-e, I'� I I '"� Monl RECEIVED Whcenim . ofCernme"f�1 SOIL EVALUATION REPORT page�_of 3 Division of Se"and Build(nga �1 U� 2 8 in accordance with Comm 85,W e.•Adm. Code ST.CROIX COUNTY comer C,Po/tC Attach complete site p. p�g�p jpIll Inches In size.,Pianmust include,but not iimite'li :veifioaf and rizontal re#erence point(BM),directldrt and parcel l.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Q ©-) SO •'2 �j Please-ptfnt all InforMatfon. viewed b Date Personal iMonnation you.provide may be.used.for.secondary purposes lPrlvacy Low,s,15.04(1)(m)). Property Owner S0 kh N1 a rt I c ke t1 Property Location er i cr. Govt.Lot E 1/4 S)c)'i/4 S 3 T 8 N R Property Owners Mailing Address Lot# Block# S�AW.Name or CSM# City State Mp Code Phone Number []City [3 Village qTown Nearest Road Naw,moti�l I WE I SS�d! .r'?/ i fl -3sv7 ey" :Rd. 44 aKN9wGonstrucWn Use: Residential/Number of bedrooms 3 Code derived design flow rate 15;'5_0 E]Replacement 11 Public or commercial-Describe: Parent material Les sc 00e, 7�/! Flood Plain elevation if applicable _ AZA General comments LGSM /-)" SCc lit d urrejee- t ype, Pcf y o f and recommendations: DLCN b Boring# ,0-,/Boling L_LJ L"J pit Ground surface elev. ��� R Depth to limiting factor in. Soil Applicollo,n.Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WWII! In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Etf#1 *Eff#2 D- oYr2 3 b w (o 1, v a : /�� /a p -41 ' L rwv 6 Fir W Jft �• 3 -3 (eye 1-- -'If (0-4 Ll 38-S6 .�v `I Mat' 7.5 1-§9 5 Fa-1 Boling* R!PitIng Ground surface eiev. 9 7. ft. Depth to limiting factor 3s in. go(I A I�kcatton Rate Horizon Depth Dominant Color Redox Description Texture Structure jrWste,nce Boundary Roots GPI in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1' *Eff#2 0 `l l2 L �r -3 'lo Yt2 `-' sbk /f "' y (� S owl 2 C 3,p + 6 6 (60 5 b s ✓-It- 'Effluent#1=BOD >30<220 mg/L and TSS>30:5 150 rr!g/L 'Effluent#2=BOD <30 mg&and TSS 5 30 mg/L CST Name(Please Print — _ Sig CST Number 0-2I eso� nature -2 a 0 a 9 2 Address Date Evaluatlon Conducted Telephone Number [.Tt\M9/1 TIME Mn\ Sy76 7 36-578 ACR C—s �,- k. bti Mors icken �T, C�PG/X C4C�,tJTj� �GCY,��. �� fir.-►-t /�o�i� �e�. TDc,vK �_�i�s� ��yer Iq e.S in A/A47o��wTs4-rasu tz 1��,✓ /Ba 27 _ J �D W fi L l_ o7T 17N �rc� 3.�edL �)c,c, ,e c� �0f:) a PUC- aP,Q 13l r ct BA loo.8 y � C,,141 h Tor PW- Pry free;J RECEIVED , county . =Di L 7o q T s�?:: :>:::.... ''`�.�,� Industry Sery �sl 1�0 1 4 �/ < '` ? A 1400 E Washin ton Ave> v'•>:.:<. .;::;< i COUNTM Sanitary Permit Number(to be filled in by Co.) P.O$�o Madi$4dI�A IJNWL�1� LOPMEN Z<6 Sanitary Permit Application State Transaction �7Number .D 7 In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit Y4 0 d 3 is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to -Project Address(if ddferent than mail' ad ess) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ZS h` oses in accordance with the Privacy Law,s.15.04 1 m,Stats. I. Application Informatio -Please Print ormation Property Owner's Name & 1 IA—, Parcel# vo ,-5,0-00) I, e, Property Owner's Mailing Address /'� Property Location 3� f'1/ I l�/ �i/'C�. �/, Govt.Lot City,State Zip Code Done Number �r Y,-5 iJ Y., Section / ltA WT /is o� ^7/S-�at�-,6V30 (circle one T �N; RE W IL Type of Building(check all that apply) Lot# Nr 1 or 2 Family Dwelling-Number of Bedrooms Subdivision Name 6k 4A Vim• Block# ❑Public/Commercial-Describe Use El city of ❑State Owned-Describe Use CSM Number ❑Village of Town of 44-d IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) 20 x A. View System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑ Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued / Before Expiration Owner IV.Type of POWTS System/Component/Device: Check all that apply) J ❑Non-Pressurized In-Grou ❑Pressurized In-Ground ❑ At-Grade Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil El Holding Tank ❑ er Dispersal Component(explain) ❑Pretreatment Device(explain) V.DispersanreatiAent Area Information: IX Design Flow(gpd) Design Soil Application Ra gp f) Dispersal Area Required(s Dispersal Area Proposed(sf) System Elevation �S'0 e � 7 Sv t t25 /.E 5-�. 6 a -7 7 9 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units n u b New Tanks Existing Tanks I a� �� po vV N y ran w C�h Li. Septic or Holding Tank Dosing Chamber VII.Responsibility.Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's ignature MP/MPRS Number Business Phone Number 9a) ?/5)77d-3a7� Plumber's Address(Street'City,State,Zip Code) f j/ L/ N 76Y/ H"J /`-)f r/n VQl It wr- s 76 7 V111,Counn /De artment Use Only Approved ❑D' Permit Fee Date sued Issuing A Signature �Z `� / en Reason for De ' �' I N IX.Condi' easons for Disapproval / e//_ 61 6161 ek,effluentMer and' 3> lei� 'O�5 (A_ ✓c'� 44e?- Atlp fUl ed must all be-Servteas/maintained ��� as pet rhaRegement plan provided by plumber. A#600ack>egitirelnentsMust�e:maintained Attach to complete plans for the system and submit to the County only on paper not less than 8 I x 11 inches in size SBD-6398(R0313) BENNIE W HELGESON Page 2 10/7/2014 Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The 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. 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 Fee Received$ 250.00 Balance Due $ 0.00 4erard M Swim POWTS Plan Reviewer,Integrated Services (608)789-7892,Mon-Fri, 7:15 am-4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm �9 p,RTUp DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA o�y HOLMEN WI 54636 Contact Through Relay http://dsps.wi.gov/programs/industry-services p w www.wisconsin.gov SS10111 5� Scott Walker,Governor Dave Ross,Secretary October 07,2014 CUST ID No. 220292 ATTN.-POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON ENTERPRISES ST CROIX COUNTY SPIA N7649 STATE ROAD 128 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/07/2016 SITE: Identification Numbers Tim Monicken Transaction ID No.2464083 County Hwy Y Site ID No. 806762 Town of Rush River Please refer to both.identification numbers, St Croix County above,in all correspondence with the agency. NEIA,SWIA, S34,T28N,R17W FOR: Description:Three Bedroom Mound System/ 11%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1506276 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s):Mound Component Manual-Ver.2.0,SBD-10691-P(N.01101,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 and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed CONDITI 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 APPRIC requirements. DEPT OF SA No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.1 PROFESSION stats. UMSION OF INDU The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with the PLAtECOR S requirements of Sec.145.135 and 145.19,Wis.Stats. • 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. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384,Wis.Adm. Code compliant. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. BENNM W HELGESON Page 2 10/7/2014 Owner Responsibilities: The current own e r,and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The 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. 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 ' Fee Received$ 250.00 Balance Due $ 0.00 erard M Swim POWTS Plan Reviewer,Integrated Services (608)789-7892,Mon-Fri, 7:15 am-4:00 pm WiSMART coder 7633 jerry.swim@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm a I r ) INDEX SHEET PROPERTY OWNER: TIM MONICKEN 323 HILLSIDE CIRCLE DR. BALDWIN, WI 54002 PROJECT NAME: TIM MONICKEN PROJECT LOCATION: NE '/4, SW '/4 , S 34, T 28 N, R 17W MUNICIPALITY: TOWN OF RUSH RIVER COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL VERSION) �'L SBD-106706-(N.01/01) LY MOUND COMPONENT MANUAL VERSION 2.0" 10691-P (N.01/01) AND CONTENTS: TRY SVICES Page 1: Plot Plan ERVICES Page 2: Cross Section and Plan View of Mound ' 3a cE Page 3: Distribution Pipe Layout Page 4: Septic Tank and Pump Chamber Cross Section and Specification Page 5: WLP1000/600—MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: Observation Pipe Detail Page 8: POWTS Owner's Manual &Management Plan-Pg 1 Page 9: POWTS Owner's Manual &Management Plan-Pg 2 Name: Bennie Helgeson igned Address: N7649 Hwy 128 Spring Valley, WI 54767 Credential Number: 220292 Date: 09-24-2014 ec �I -e7ouYJ off; 4 R� c� Swi r� A�y cU-)m 7 r dOonS�cQ! � s Balk f3.M, too.ov , � c t�,�, R,"bbo•. 94 y i 4 Poe- Tb� of 1 1JL l � �ea,-es ,app- —� 1 n-t r buy 7.w,: ryL,. Page 0r9_ Synthetic Covering 4 S-rM 3:3 Distribution Pipe Medium Sand Ffev H _ G Topsoil . .J � E 0 3 . b e oA't % 'Slope ,CULOf i"- 2 !�2 Force Main Plowed Aggregate From Pump Layer D / Ft. ' E Ft. Cross Section Of A Mound F . YO Ft. G . S Ft. A Ft. H _ / Ft. Signed: B �g.Z-Ft, License Number: — K g 7.,?, Ft. Date: L Ft. j Ft. T Ft. Acrc-e- .!Ma,H W �`�J Ft. • I•Y'G�m �lc-✓� L Observation Pipe KB �---�— _..I ----------- Distribution 6_LL_ Of 2 2 z Pipe Aggregate Observation Pipe aaso-1 Areo­ I Plan View Of Mound Perforated Pipe Detail Cleanout Access 0 Threaded End vll� Cleanout Pat i of Olt d PVC Pip( End Manifold • `�� Holes Located on Bottom R Are Equally Spaced Force Main From Pump X�, S First Hole Next to Manifold Cleanouts Distribution Pipe Lavout P R S X Y _1��7!�� Hole Diameter Inch Lateral" Inch(es) Manifold" Inches Signed: Force Main" Inches. License Number: Date: Invert Elevation Holes Per Lateral Number of Laterals 3 Total Holes 76 _ SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS Ofj IONS 4' PKVENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF _ 251 FROM DOOR , WINDOW OR FRESH AIR INTAKE JUNCTION BOX APPROVED WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 'Ne0 e, WARNING LABEL ---_ — ---4" MIN.11 1 8�� 2y" .. r.a. INLET 18 MIN. WATER TIGHT SEALS GAS- TIGHT Fib?ER A SEAL PPR4V.ED APPROVED �p --1— JOINTS WITH ALM PIPE 3' � _ .. B APPROVED P.lP, ONTO SOLID "T— ON 34 ONTO SOIL C SOLID SOIL PUMP OFF ELEV • �. Q•FT. OFF D 3" APPROVED BEDDING UNDER TANK ' SPECIFICATIONS CONCRETE PAD SEPTIC / DOSE TANK MANUFACTURER: A-0 e5-- TANK SIZES: SEPTIC C�CJ GAL. DOSE VOLUME INCLUDING DOSE G nc� GAL. �/o � , FLOWBACK: .S7q GAL. /'Miv� ALARM MANUFACTURER: ,�J'F `�' � �ic�S CAPACITIES: A MODEL NUMBER: _ �p.� INCHES = GAL SWITCH TYPE: � / � B = 2 INCHES = �'3,S` GAL. PUMP MANUFACTURER: cdd _ MODEL NUMBER: C. _ ) INCHES = = GAL. SWITCH TYPE: _.L1=.stiau�_ c �r�o D _ /0 INCHES = /�7 �O GAL. REQUIRED DISCHARGE RATE Q,. GPM PUMP E ALARM WIRING AS PER I LHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE + MINIMUM NETWORK SUPPLY PRESSURE `j, b FEET * _ FEET FORCEMAIN X ,07 FT/100 •FT. •FRICTION FACTOR • . FEET • .l3 FEET TOTAL DYNAMIC HEAD = ZZ 73_FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH LIQUID DEPTH' WIDTH DIAMETER SIGNED: LICENSE NUMBER: DATE: 1 /88 D o cr OU JP cr ENO . Y p n D t7 [�p In O F fn Q �0p p� V)CL O\F O ZZ nnnoO 0Uw 00 Ora -Iv -I_j < nO �a� c4 ILL. M N W F-w 0 0 z I=JCJ x 00 w w D V) N!(f) r 'COO. ° m 01 w o cn 00�o ix mil/ 0 0 NmJ tna ml\ ° 0 � J Q o O o'�M,n m w w 1� co ° F. 0 D I C5 .- J O Y �w� DDoZwT �uj �`) M •• J.. zo U ° a °�zuz ° zmQ z�� a o En z�mUM=JAS mJ Sti Z LLJ J Ld J O z z V) o J z ° M 1 I . I I i I I I • I I � � W II W °O ^ W L.L. I I U V) In ' I 1 z -------Q I 1 W J� O u�g p K6C 91 ,�95 � MODEL . P0 I. EPOS Submersible Effluent Pump 'a ` t . t M •.y i i � f• ;{µy yet, � L MITI I FEET ! MODEL:3871- o IO - ,; 0 2 I : 1 10 ZO oL 0 IO UK"• 1 CAPACITY Pump:Specifications. .Features and Benefit's '/10 and 1A HP •b•PO4 impeller-semi-open design Up•to 60 GPM . with pump out varies.to'protect' Maximum head to 32' Pmechanicalseal. Discharge size 1'!:'NPT •�EP05 impeller.-.enclosed design' ' Solids:I/.maximum for improved performance. . Motor •Rugged giass-f1led herrgplistic All motors feature ball casing and base design provides i bearing construction. superior strength and corrosion Single phase:,115V resistange. Materials of Cohstruction "Cast iron motor housing-for Cast iron efficient heat trahsfer,sfrength., Thermoplastic and-durability. Stainless steel *Corrosion resistant threaded stainless steel shaft. •Available for-automatic and manual operation. •CSA listed.,models available. 09eration and/dature stainless steel hardware r t o . Water tight cap 4" min. dia. . Piping material can be ASTM ' D2665,D1785 or D3034 6" min. min. Infiltrative surface Mater Closet Collar Bar(3/8" min. dia,) Observation pipes must: 0 be located such that there are a min/mum of ends from one another two Installed in each dispersal cell at opposite 0 be located near the dispersal cell ends • be at least 6 Inches from the end wall and sidewall • be installed at an elevation to view the horizontal or level Infiltrative surface within the dispersal cell Observation pipes may be located less than 6 Inches from end walls or side walls if specified in state approved manufacturers'installation instructions. p I Page 9 of 9 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) 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 Servicing 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 soil 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,sanitary 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 soil 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 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 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 THEtNTERIOR OF A-TANK MAY NOT BE POSStBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name k e_[ �2.►7 rj c 2,. Name 6 O� p p„ Gael , Phone Phone '�l S -o� 7 3- S I SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name tt a h Name + &-p•►iL Zr�-r•� h h h �� i '71'� Phone .r/ rJ _ 7 _ 'S fS Phone 1 '7 2>u — 4 �a d 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. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Of 9 FILE INFORMATION SYSTEM SPECIFICATIONS Owner �-, 1 Tank Manufacturer: /,J f car ❑ NA Permit# ® Septic ❑ Dose ❑ Holding Volume: /000 (gal) DESIGN PARAMETERS Tank Manufacturer: Cv 1'24w, ❑ NA Number of Bedrooms: `t ❑ NA ❑ Septic Q0 Dose ❑ Holding Volume: 1v00 (gal) Number of Public Facility Units: X NA Vertical Distance Tank Bottom(s)to Service Pad: /3 (ft) Estimated (average)Flow: �1 (gal/day) Horizontal Distance Tank(s)to Service Pad: 40 (ft) Specific servicing mechanics must be provided if vertical is>15 feet or Design(peak)Flow=(estimated x 1.5): t/,D (gal/day) if horizontal is>150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal/day/ftZ) Effluent Filter Manufacturer: Poly([a Ic ❑ NA Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model: �b( (6(•� $o? Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer: 6�0 U I Olt Biochemical Oxygen Demand (BOD5) s220 mg/L ❑ NA ❑ NA Total Suspended Solids(TSS) sM mg/L Pump Model: .- High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BODS) >220 mg/L ❑ NA ❑ ❑ ® NA (TSS) >150 mg/L Mechanical Aeration Peat Filter ❑Disinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other: (BOD5) 5_30 mg/L Soil Absorption System (TSS) 5530 mg/L 04 NA Fecal Coliform(geometric mean) s101 ❑ In-Ground(gravity) ❑ In-Ground(pressure) ❑ NA Maximum Effluent Particle Size 1/8 in dia. ❑ NA ❑At-Grade Mound ❑Drip-Line 0 Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) m When combined sludge and scum equals one-third('%)of tank volume ❑When the high water alarm is activated Inspect condition of tank(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NA year(s) Inspect dispersal cell(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: f�J month(s) El NA year(s) Inspect pump, pump controls&alarm At least once every: month(s)1 E3 year(s) ❑ NA Flush laterals and pressure test 'At least once every:. ❑month(s) ❑ NA year(s) Other: At least once every: ❑month(s) ❑ NA ❑year(s) 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 ('f3) 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 but not 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 30 days of completion of any service event. GMW-005(02/05) Page ,? of 9 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 Servicing 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);pdor 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. following from the wastewater stream may improve the performance and prolong the life of the treatment ' ination of the fo Reduction or elimination 9 tanks and soil 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,sanitary 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 soil absorption systems 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(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 compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the.locabon 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 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. I 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 FI;EEULT.-ESCAPE OR-RESCUE FROM 11qE'tNTERIOR OF A—TANK-M-AY-NOT BE-POSSIBLE. _ ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. /. Name H e.1 _—,-_4-,v, �ev,n 112— Name d� h Get SG r�i Try.-+to Oki Phone Phone l 1,rj 9-7 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name V h m G r� i -F'r s / Name �- liY p'►1G Phone -7 Phone [Cj 3$ — y t, �K q 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. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer v-1 .Mailing Address i d e.t r Gt 1 3 Property Address N q but; kda M 11-F2 5 4 (Veri ation required from Planning&Zoni g Department for new.constru 'on.) Cit y/State 4&04 W' cd tSf r Parcel Identification Number J J LEGAL DESCRIPTION Property Location /11 F 1/ , SW 1/ , Sec.2�4_, T,,g�N R t'j W,Town of Subdivision , Lot# Certified Survey Map# A)4 , Volume ,Page# Warranty Deed# /DV.�S--7 t. Volume Page# Spec house 0 yes R/no Lot lines identifiable Byes 0 no 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. I/we,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 Commerce and the Department of Natural Resources,State of Wisconsin. 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. I/we certify that all statements on ' form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a w anty deed recorded in Register of Deeds Office. NuWqf ooms 3 SIGNATURE OF APPLICANT(S) DATE ***Any information 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. 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