HomeMy WebLinkAbout040-1303-00-068
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
512889
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)]. 2,5 2 / Z -
Permit Holder's Name: City Village X Township Parcel Tax No:
Oeverin Homes LLC, aka Oeverin Pro ertie Troy, Town of 040-1303-00-068
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
22.28.19.1803
14
TANK INFORMATION
ELEVATION DATA
TYPE MANUFACTURER ACITY STATION BS HI FS ELEV.
4" ~ 3.05 /0 3.0
Septic Benchmark
o,GFCvr 1000 2.7 16Z•~ A06
Dosing co V I a~~ Alt. BM
Jam),\ WV 3. loo 0(5
~ I F 1 M C Bldg. Sewer T.
Holding t Inle _ `
U Io4. ?e(. TANK SETBACK INFORMATION STANK TO P/L WELL BLDG. Vent to Air Intake ROA Dt4nlet- _
Septic f A ► I Dt Bottom I / ^ Z ci/- ,
Ju ~Y I
Dosing Head /Man.
Ioz.3S
Aeration Dist. Pipe (0 2 -35
Holdin Bot. System I I 'b / ~JS
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cov ( (bo n
fCh~_ GPMq~ 1 6.1
I
Model Number 'r 'Z "14
/06
TDH Lift Fricti 1n Loss System Head • p~ TDH ` Ft
Forc ain Length) Dia. 1) Dist. to Well
SO ABSORPTION SYSTEM / bv~ ~-2,4
BED/TRENCH Width t Length No. Of Trenches PIT DIMENSIONS No. Of Pit Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type 90QN0 stem: &I UNIT
Model N er:
DISTRI TION SYSTEM QS~
Header anifol n/ Distribution l x Hole Size Ix Hole Spacing Vent Air Intake
Length Dia L en(s) Dia Spacing t 1
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Tr rich Center Bedlrrench Edges Topsoil Yes No ~es No
t
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ Inspection #2: /
ration: fft - " ' ' k~
693 Heritage Pass Hudson, WI 54016 (SE 1/4 SE 1/4 22 T28N R19W) Walnut Hill Farm aka The Trib,,Lot Pairca o: 2.28.1r~19.~`~'
't BM Description= ~
g sewer length =
lount of cover = b t` #-Well 116+ infud LA
in Required? ~Yes No
de for addition information. Date Insepctor's Signature Cert. No.
County
~ 0
5 ro~
~oF? R"r Safety and Buildings Division
201 W. Wash' ton Ave., P.O. Box 7162 Sanitan' PertnitNumber (to be filled in by Co.)
I D S P_ isc~n~V37 2 45~-z
lot, 4 r
State Transaction Number
` tary Permit Application
Irt accordance w~`5~383 X1(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ~2 ~
is required prior td obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Pr ject Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary t
I u ores in accordance with the Privacy Law, s. 15.04 1 m), Stats. 3 / 1
1. Application Information - Please Print All Information Parcel
'
0C. Property Owner's Name Q o t ) -130 -,2 06y
Property Owners Mailing Address j PropertLocation
Govt. L'(
t I\
City, state Zip Code ;Phone Number St ion tion Z
I trcie o~
H. I 7 E ~ Wv1
Il. pe of Building (check all that apply) Lot -~-t~
Subdivision N e i
, y
t 2 Family Dwelling-Number of Bedroo
BI ck rJ"
# ~ ( I q f A
Describe Ilse ❑ City of
l
CSM Number ❑ Village of
❑ State Owncd ecribe Use
x ~/l D ON 1) Lf ~I l Toyrt, of new
III. Typg it: (Check only one bog on line A. Complete line B if applicable) A. ew Systcm~ ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only I u Other
Modification to Existing System (,explain)
i
T_ -rList Previous Permit Number and Date Issued
R. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber I ❑ Permit Transfer to New
Before Expiration Owner r 1
IV. Tv of POV+'TS System/Component/Device•' (Check all that apply)
2 of suitable
f suitable so and < soil
El Mound
❑ Non-Pressurized In-Ground El Pressurized In-Ground 11 At-Grade _y 24 in. o
❑ Holding Tank El Other Dispersal Component (explain) L7_ Pretreatment Device (explain)
V. Dis rsaV Tre meat Area Information:
Design Flow (gp Design Soil Applicati Rate(gp Dispersal Area Requ` ed (sfl Dispersal Area Pro osed (sf) y e v og~
41 1 41,y- 6 z'9 - A)
VI. Tank Info apacity in Total # at Manufacnt
° v
Gallons ~ Gallons I Units a p d
New Tanks Existing Tanks ;
i W 1. W r. U L
j
Septic or Holding Tank
Dosing Chamber 63 a l
VII. Responsibility Statement- I the undersigned, as esponsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Priam) Plumb i ature MP ~RS Number Business Phone Number r
ress (Street, City: Zip Code J y~
Plumber's Add
-1 Z 12-
VI ountv/De artment Use Onl -
Pe 't Fee Date sued Issuina n t Si a
Approved roved I S / p~ n
❑ r Given
IX. Conditions of ApprovaVReasons for Disapproval n ^ ~ n
3 f~v e to pe,~ M vS v~ d~
SYSTEM OWNER:
1. Septic tank, effluent filter and
dispersal cell must g _etyiP@_ / maintained
as per management plan provided by plum csr1 ~~1~ I I~ S1DTc
81 to the County oniv on paper not ess than 8 it 1 11, inch in smi ; r 1
as per applicable code/ordinances. G,,r Q CC -I V,1 IV`
SBD-6398 (R 11111)
PLOT PLAN
PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 101.4' 1.2' sand lift! DATE 3/12/15 BEDROOM 3
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none
BENCHMARK V.R.P. Top of 1/2" steel pipe ASSUME ELEVATION 1001 Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR 30/34, within 10' Cale _ 1/4'1 = 10'
of tank, piping shall be Schedule 40.
Heritage Pass
Property Line
WeiI is to meet alI WDNR setbacks
Area 15' below 99'
system is to remai n 9 5'
undisturbed 100'
100.5' Pro 5
Bedroom
4% Slope B-3 House
B-2
H uffc utt Co m bo
Tank is to be properly
bedded and provided with
lockdown covers with
approved warning labels
Grading is to be done to C()P
divert run-off away
100.2' B-1 system
B * Property Line
L:
ST. CROIX COUNTY -
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer d ey e r)
~
Mailing Address 73, Ce A&-to Property Address y_ 7j L`re`✓ ►_e E,
(Verif-g Sk ication required from Pla uin T.-
g eP f new canstrucrion.)
City/State Parcel Identircation Number _QL~ 0 30 6~
LEGAL DESCRIPTION
Property Location S A , 5° E V4, , Sec. 2"Z 7' Z ~ N R W Town al`
Subdivision
Lot #
Certified Survey Map # Volume
- - - Page
# . - -
Warranty Deed # 0-0
Volume Page # _
Spec hous ye mto l.ot lines identifiable y s ~
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 sYstein 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.
T/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system witlr 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.
l/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owners of
property described above, by virtue of a w arty deed recorded in Register of Deeds Office. the,
Number of bedrooms=
;IGNATU OF APPLICANT(S) - DA,
~TF
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
rnclude 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)
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SHAUN R BIRD Page 2 3/23/2015 -
is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145,
Stats.
• Maintain well and waterline set backs per SPS 383.43(8)(1). Consult the Department of Natural Resources for
well setbacks and other regulations and exceptions.
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,
Copy With Your
Patricia L Shandorf PY
POWTS Plan Reviewer, Division of Industry Services PPa ya seInclude Include Submittal.
(715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633
pat. shandorf@wisconsin.gov
cc:. Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
o~rART.KF~ DIVISION OF INDUSTRY SERVICES
5~~' ion 10541 N RANCH ROAD
P HAYWARD WI 54843
31/ D S < Contact Through Relay
P S http://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
o~~'ssroNAy' Scott Walker, Governor
Dave Ross, Secretary
March 23, 2015
CUST ID No. 226900 ATTN.• POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 03/23/2017 Identification Numbers
Transaction ID No. 2521279
SITE: Site ID No. 810922
Oevering Homes Please refer to both identification numbers,
693 Heritage Pass above, in all correspondence with theagency. CONDIT
Town of Troy APPS
St Croix County DEPT OF S
SETA, SETA, S22, T28N, R19W PROFESSION
FOR:
Description: Mound, 3 bedroom residence DIVISION OF IND
Object Type: POWTS Component Manual Regulated Object ID No.: 1528137
Maintenance required; 450 GPD Flow rate; 22 in Soil minimum-depth to limiting factor from original grade; System(s
Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manua
Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter
iSEE COR';
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s)
• 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. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
Reminder
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per SPS 383.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
• Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material,
device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it
Cover Page
Shaun Bird ~EC)IFrvr<D
Bird Plumbing Inc. MAR 16 2015
1432 120th St. INDUSTRY SERVICES
New Richmond Wi 54017
715-246-4516
Date: 3/ 12/15
Owner:Oevering Homes
Location: SE1/4 SE1/4 S22 T28 N,R19W 693 Heritage Pass Troy
Manuals Used: Mound Component Manual Version 2.0 (01/31)
Pressure Distribution Manual Version 2.0 (01/31
6LLY
Page# OVED
1. Cover Page AFETY AND
2. Mound Plot Plan ES
3. Mound Cross Section
4. Pipe Cross Section/Pipe Layout
VNDENCE
5. Pump Chamber Cross Section 6. Pump Curve
. Maintance and Contigency plan /J 7
7-8
9-11. Soil test
12. Filter Specifications an cross section
Shaun Bird r
Signature
License number ,2200
PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
SE '1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 101.4' 1.2' sand lift! DATE 3/12/15 BEDROOM 3
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none
BENCHMARK V.R.P. Top of 1/2" steel pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
All piping shall be SDR 30/34, within 10' Cale = 1/4" = 10'
of tank, piping shall be Schedule 40.
Heritage Pass
Property Line
I
Wel l is to meet all WDNR setbacks
Area 15' below 99'
system is to remain 99.5'
undisturbed 100'
100.5' Pro 3
Bed roo m
4% Slope B-3 House
B-2
Huffcutt Combo
Tank is to be properly
bedded and provided with
lockdown covers with
approved warning labels
Grading is to be done to
divert run-off away
100.2' B-1 system
IV B.M. Property Line
Mound System Cross Section and Plan View
" " - - ' - - - - - - - ` Dimension Feet
J I I B
• .1
1 1 1
• t • 1
. M1 1 L L 1 L 1 L •
. . . L•L•L•1 L f f
L M1 L.M1•1 M1 • • • • • • } .r f•f •r•
r r ••1
. . . . • • 4r4 L • . . • .
I . . • . . . . . . . • . •M1 L•L L 1 M1f1 M1rLM ti L:L•1: . • . . r r l r r E
. KLLLrM1• M1M1LM1 . •L . • • f•:: rr.
. • . • . . • . . •r : :M11y:{:1:M1•~•1•{?11'1 . . : :r
. r' 1rhf4f:. .ryrti +r.f~':~
. . . . M1fti:1.1 1 • f
. . . . • • L 1f\flr4rti l'•4f• . . . :M1:1r .
L .r.f.:.r.f.i}::1i1i1iM1F1i1•r11.
. r.r.r.r _
..r•r•r•r. •.r:•.f•r•r.:.r•r r: r r r r r r f f r ,1 1 .
A I ?1111.. 1r I
i:}:i}ij:r:F}i}}:r.r:asr:i}isr}f:r:r}~}r:r:r.}:i}::}}i.:•:r• •F:r}r} i.' r r/
I r f Lr r r f:fLrLr LrLf4•••} M1 t L ljM1ltrl Lr} L 1ft 1 1 L ~••1 1 ••rM1 L 1• •
Nam.
W I 1 I G -
I T I 1-1 v
I I r
I
1 I 1
K
W
Z~;7
K B Z /0--
L Slope
aggregate 4 in. sch. 40 pvc
Clean
- 1 = Topsoil = ASTM C->3 E
Cap Material sand fill to 2 `i2 in. dia. 0 observation pipe
A
Geotextile G H
Fabric f.r1r : f1f1r r
1f L•1•M1•M1• .r~
' 4ry .rtir.:.:.r.f• U
D
L
' Plowed Surface
,rte, t Contour
Slope Direction
GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing
vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or
chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/4 inch soil wire
when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately
after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or
is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot
thickness to minimize compaction of the plowed surface. After the topsoil cap is placed. the entire mound
is seeded and mulched ulched to promote vegetative growth, limit erosion and protect from freezing. The
observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange.
10/071gj Page of
Pressure Lateral. Layout
Two Laterals - End Manifold
4 Threaded
Cleanout
Lateral Turn-up - Plug
Manifold
M
1. - Long
Force Main ~ / Sweep
J LAS 5/ AI tom. 90
Bend
Distribution Network S eciticdtions Pressure System Construction
Lateral Diameter _ In
Manifold Diameter Inln• Laterals are constructed of Schedule 40 PVC
er In. ! pipe. Orifices are drilled perpendicular to
Orifice Diameter ~j
X (Orifice Spacing) _ ce i In the pipe with a sharp drill bit and face down.
L Lateral Len th)e Ft. Lateral turn-ups terminate with a threaded
M (Manifold Lenth) Ft. Cleanout plug and are enclosed in a 6-8 inch
- diameter lawn sprinkler valve box accessible
Force Main Diameter Z In.~
Force Main Length 156 from f finished grade.
Grade •
6-8 Inch Lawn
Sprinkler Valve
Box
Page of
03/05 lg;
Septic-Dose 'dank Cross Section And Pump Performance Specifications
Pump Manufacturer
Tank Manufacturer r~ Pump Model Number Y 7
Tank Model Number /G G Alarm Manufacturer c
Total Tank Capacity ! trez? v Alarm
Max. B' Deptil Model Number "
/ Switch Type ' r -
Total Dynamic Head (TDH) -Feet
Filter Manufacturer Elevation Head v
Filter Model Number ' Distal Pressure U
Network Loss
Minimum Pump Performance Required Force Main Loss
Ft TDH Total
GPM
Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade
Securely Mounted With Locking Device
Locking Device. Inlet Manhole
< b" Below Grade Sealed Watertight Weather--proof
Junction Box -
- Finished Grade
Vent Min. 12" Disconnect
Above Grade Means
With vent cap
> i : a t ..oaf
Outlet Filter
• Inlet Baffle
Inlet A 1l<„
Switch S and Reserve Capapity • Weep
GPI Hole
Tank Volume = B
Dimension. Inches Volume Gal.
35
Off Elev 'on C
(reserve) A
B 2 n ca Ft (al
b ; a Bottom
{dose) c l' a D Elevation
f~
Ft
(dead) D *-,~-~------Total z 6, C)
yi i•.t> .•i faY f~>,f~ ifi)<>iY: iY a`{Yt>: i if.Y <f <Yi of <Yia .•if{:.•a :::i•<•<•:a '
M accordance with the
The septic/dose tank is bedded and back filled ufacturer may not
GENERAL INSTALLATIaN:
roduct approval specifications. Maximam depth to of a bury as have an effective by ective the manlocking device (Padloc
manufacturer's p royal. Manhole covers exposed g~ the tank with watertight fiitings, and
be exceeded without prior app roved material, connected
installed. Piping at the inlet and outlet is of app The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
laid on stable soil to prevent settling or sagging ice complies with NEC 30(~ and Comm 16.2.
excavation and the sleeve. is sealed watertight. Electrical sere
P
02/05 U ,
tw T r1, [4"r'P~ t;Nv
-
Air CAPA~ ~Y -
2-~ 43 r
r '
30
-
8
z _ -
2u
4-.
1v_
I
1
I
40 C 'uC
0 I
ZG
Ttpc ~r.
_
CONSULT FACTORY FOR SPECIAL APPLICATIONS
a ;
v
. Timed dosing panel's available. a n^i'ed W,,F e L
Electrical alternators, for duplex systems, are ava,tat! a~~ s,~""
an alarm. phase
Variable level control switches are availab e for centroihng sln9'e
.
Systems
• Double piggyback variable level float switches are availab+e rcr varia'c'.e
level long and short cycle controls. -
Sealed Qwik-Box available for outdoor ins al'at'.cns See 1''42'
Over 130°F. (54°C.) special quotation reG y red
1521153 Series - - $ s<
1511153 MODELS
r - -j _ 'wpm s SlmF;rx Durex _
Model ; volts Ph s Mods - - -1 t- sK2oe4
1 1152
nc ue -
8.5
BN152 i 115 _1 flute . cr 3
I Et° 223G Non 43 -I
BE15: 230 _.~N 2°-+ tG 5 ' , _ or ? SELECTION GUIDE
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2 EPe for correct nod--l of Electncal Alternator E-Pak-
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p CAUTION used
rotecdon devices and wiring should be done by a qualified 3 ,?n3De e+ ! co^,tr', Switch "0-0225 as a control activator, sped
cluding the moe
Ail installation of controls, P .
licensed electrician, All electrical and safety codes should be followed in i.4j 'Ica" SySteT
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.
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i r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
al ❑ NA
Owner Septic Tank Capacity
t
Permit # Septic Tank Manufacturer ❑ NA
Effluent Filter Manufacturer ❑ NA
DESIGN PARAMETERS
[3 NA Effluent Filter Model ❑ NA
Number of Bedrooms
NA Pump Tank Capacity b~ 3 U al ❑ NA
Number of Commercial Units
Pump Tank Manufacturer ❑ NA
'mated flow average) aUda
Estt (
ted x 1.5) 2 J gal/day . Pump Manufacturer ❑
stima NA
Design flaw (peak), E (
y
Model /✓l J
Vda /ftz Pump A
Soil Application Rate ) a ❑ NA
Monthly average' Pretreatment Unit
Influent/Effluent Quality ❑ Sand/Gr'4vel Filter ❑ Peat Filter
Fats, Oil R Grease (FOG) 530 mg/L p Mechanical Aeration ❑ Wetland
Blochemical Oxygen Demand (BODs) 5220 mg/L ❑ Disinfection ❑ Other.
Total Suspended Solids (TSS) 5150 m /L Manufacturer
Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s)
Biochemical Oxygen Demand (BODS) 530 mg/L ❑ In-ground (gravity) ❑-9round (Pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ At-grade and
❑ Other.
Fecal Conform (geometric mean) 510' cfu/100m1 ❑ Dri ine
Maximum Effluent Particle Size Y. inch diameter Values typical for domestic (non-can+merclaQ wastewater and
septic tank effluent
Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE Service Frequency
Service Event
Inspect condition of tank(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume
Inspect dispersal cell(s) At least once every ❑ months ear(s) (Maximum 3 yrs.)
J❑ months year(s)
Clean effluent fitter At least once every
At least once eve ?0 months-Uyear(s) ❑ NA
Inspect pump, pump controls & alarm ry At least once every ❑ months ar(s) ❑ NA
Flush latprais and pressure test'
Other: At least once every ❑ months ❑ year(s) ❑ NA
Other: At least once every ❑ months ❑ year(s) ❑ NA
MAINTENANCE INSTRUCTIONS of the following licenses or
Inspections of tanks and dispersal cells shall be made by an individual carrying one
certiflcatlons: 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 level or ponding of effluent on the ground surface. The dispersal
cell(s) shall be visually inspected to check
the efft effluent
on thes uent
in the observation pipes and to check for any ponding of effluent on the ground surface. The Po lg o authority
ground surface may indicate a failing condition and requires the immediate notification of the local regulatory When the combined accumulation of sludge and scum in any tank equals
one-third (Y3) 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. retreat ment components, and any
The servicing of effluent filters, mechanical or pressurized POWTS components, p
other maintenance or monitoring at irifervals 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.
Page of
ainting products or other chemicals thr
of f th,
START' UP AND OPERATION of for the presence p
h concentrations are detected have the contents o
For new construction, prior to use the POWTS check treatment tank(s)
process and/or damage the dispersal cell(s). If hig
may impede the treatment pr operator prior to use.
tank(s) removed by a septage servicing op
rrx bas
System start up shall not occur when soil conditions are frozen t at the infiltrative surface. excess
in is the backup or surface discharge ofr over effito ue the
result power
'
power outages pump tanks may ;ill above normal ghwater levels. When
dischgarged the dose, overloading the cell(s) and may icin Operator prior to castorrestoring p ! IeVE,s
one large age Servicing e norms
discharged dispersal cell(s) in
re
emaved sist in by a Sept manually operating the pump controls to
To avoid this s situation have the contents of the pump tank
effluent pump or contact a Plumber or POWTS Maintainer to as
within the pump tank. not drive or park over, or otherwise disturb or compact, the area with!"
Do not drive or park vehicles OvW tanks and t grade soil absorption lcells. Do
area.
15 feet down slope of f any any Mound or at-grade
stream may improve the performance anrsinfecta s nts~ fa~ foundat oOn d!
condothems; cotton swab ' wastewater tae floc; diapers, d rnd min
following den it, painting p
of the
Reduction or elimination tn
~ s degreasers; lion , o (sump pump)
antibiotics; baby wipes; cigarette butts; from
water; fruit and vegetable peelings; gasoline; grease-, herbicides; meat scraps; medics
pesticides; sanitary napkins; tampons; and water softener brine.
be taken to insure that the system is propeSlY
shall
steps
When the ABANDONMENT POWTS fails and/or is permanently taken out of service the following
coo
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin pipeAdministrative C openings ode'
sealed.
• Ail piping to tanks and pits shall be disconnected and the abandoned
The contents of b a Septage Servicing Operator
of all tanks and pits shall be removed and properly disposed o by
the void space filled with surii,
•
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and th
gravel or another inert solid material.
and cannot be repaired the following measures have been, or must be taken, to provide a code complOn
CONTINGENCY PLAN
If f the the POWVVTS TS falls
replacement system; replacement soil absorption system
the location of a rep
C3 A suitable replacement area has been evaluated and may be utilized for
wilt reupon
protect and the should not be replacement area infringed
rsult in th pier e'
wells. and Failure to compaction
The replacement area should be protected fremof lines and disturbance
setbacks from existing and proposed structure,
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comp Y S technologN
effect at that time.
[I A suitable replacement area is not available Qu et set a k and/POSWTSmitations. Barring advances In PO uaf'c
c
holding tank may be installed as a last resort p
-Es~,. he site has not been evaluated to identify a suitnt able area. it no replacement area. replacement Upon area is failure of the available a POWTS holding a tank soft
and may be site eve installed!
~ must be performed to locate a suitable replacem
/a last resort to replace the failed POWTS,
and and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiitralit
surface. Reconstructions of such systems must comply with the ruses in effect at that time.
RESCUE OF
<<WARNING>>
INSUFFICIENT PUMP AND OTHER TREATMENT TANKS MAY CONTE ANY C L GACUMSTANCES ES AN DEATH MAY RESULTYGEN.
SEPTIC, LETH
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UN
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS MAINTAINER
7POWTS INSTALLER
Name ;,E. f - -
Name ,77--
Phone
Phone
~
LOCAL REGULATORY AUTHORITY
SEPTAGE SERVICING OPERATO PUMPER Name
=Name,
ne 96
Pho
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
3
ftooramDepwWatolCawneroe SOIL EVALUATION REPORT Pape /of
pfrWarolBaMyand Bu~dY~pe
in acaada= *0 Comm 85• W Adm code- T Gd' e/ 1-- ny
Attach aaRate slide plan on paper not IM OW a In x 11 kwhm in size. Plan muu -
hr 407- /r I
EROSION W not knited lo: vwdo i r
naa.d.bP.:aeie«drnme.ar. Pc•c~oi~ tL-
EROSION CONTROL PLAN must be oete
completed before sanitary permit issuance "
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CST Name (Pleeee P" R • ZI LB R i G kT` Ogn*- WA- 3rw
Adds Ulbricht & Ass9ciates D Edw
715- 7 3
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2812 10th Ave.
Spring Valley, WI 54767
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The Department er Comnwrcc is an equal opportunity service provider atM employer. if yon need asstmnceto at:cese Servttxa or
need material in an skmmx format, plcm coatact the department at 60&266-3151 or TTY 608-261-8777.
OD4Mt LG"
• PLOT PLAN WALNUT HILLS FARM. LOT # 9 Pg. 3 of 3
Q = Contour elevation lines.
0 = Backhoe Soil pits.
O = Benchmarks set, maRKED WITH FLAGGED V
lathes. 1/2" steel conduit pipes. i
I
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"'71LTER CARTRIDGE INSTRUCTIONS
l i- 1
Installation
STEP Dry fit the filter case onto the rid of the outlet p pe to ensuree`t is
p into the
centered under the access opening. if not, then either Insert more p
tank through the outlet or solvent weld (clue) additional pipe onto the outlet
pipe.
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3/4-inch optional suppplemen needed side support. If side supportkmeth G a ls+notiutili edl,2
proceed to step four.
STEP 3 For installations utilizing the optional supplemental side support: r
solvent weld the 3/a-Inch pipe onto the filter case. If side support method is not i
utilized, proceed to step four.
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
a..
the case,
STEP S If a VRS switch is utilized: insert into the filter and lock by turning
clockwise 90°.
Maintenance
1. The effluent filter should be cleaned every time the septic tank is
serviced. '
2. Open the outlet access opening to inspect the tank and filter.
3. Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and effluent.
dthe invert of islodge the the
4. Once the effluent level has P obe been lowered below
outlet pipe, firmly pull
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 `acing -4 Z down) over the access opening, rinse off the cartridge w+ ,
th water
only, making sure all septage material is rinsed back into the tank.
8. If VRS switch is utilized, replace by inserting into filter and
turning clockwise 90°.
9. Insert the filter cartridge back into the case, pressing down until A
the filter locks into the bottom of the case. 4r- llvl
10, Replace and secure the access opening on the tank.
BEAR ONSITET" FILTER CARTRIDGE - FIVE-YEAR LIMITED WARRANTY
a:e
SEAR ONSITE" Filter Case -L7te.ime L ^nrtec a zr v
aa;: -iter e
rC -
A 777-MUILTERS (0s3-4s8j'1-3).
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8271016
State Bar of Wisconsin Form 3-2003 Tx:4222004
QUIT CLAIM DEED 1004955
BETH PABST
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI
12/02/2014 3:24 PM
THIS DEED, made between Citizens State Bank, a Wisconsin Corporation, EXEMPT#: NA
("Grantor," whether one or more),and Oevehnn I-Inmes I I_C, a Limited REC FEE: 30.00
Liability Company, ("Grantee," whether one or more). TRANS FEE: 105.60
PAGES: 1
Grantor quit claims to Grantee the following described real estate, together
with the rents, profits, fixtures and other appurtenant interests, in St Croix
County, State of Wisconsin ("Property") (if more space is needed, please
attach addendum): Recording Area
Notwithstanding anything to the contrary set forth in this agreement buyer is relying Name and Return Address
solely on buyer's inspection of the property and buyer acknowledges and agrees tha Title One Premier Group, Inc.
t 706 the property is being sold "as is with all faults" and seller makes no representations Hudson, Street South
warranties or covenants, express or implied with respect to the property. To the fulles Hu, WI 54016
extent permitted by law, seller expressly disclaims any and all implied warranties
representations or covenants with respect to property.
040-1303-00-068
Parcel Identification Number (PIN)
This is not homestead property.
Lot 68 of Walnut Hill Farm, Town of Troy, St. Croix County, Wisconsin. (is) (is not)
Dated November 26, 2014
(SEAL) (SEAL)
Shawn Tyler:Vice President for Citizens State Bank
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin}
)SS.
authenticated on November 26, 2014 County of St Croix}
Personally came before me this 26th day of November,
2014, the above named Shawn Tyler, to me known to be
TITLE: MEMBER STATE BAR OF WISCONSIN the person(s) who executed the foregoing instrument and
(If not, ••''~a!ftsededged the m
authorized by Wis. Stat. § 706.06)
NOTARY'.
THIS INSTRUMENT DRAFTED BY:
Michael H. Forecki '.qP y mitt
of P lic, state/ Wisconsi
Pt E y 01, 2017
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
QUIT CLAIM DEED 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003
Type name below signatures.
File No.: 30116 Page 1 of 1
St. Croix County 1004955 Page 1 of 1
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l~tfzon 5oii Application Rate
Dorrtiuuaxut Redox Description Texture stuck" Consistence Boundary Roots GPDM
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Sol icon Mate
Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDff
ir. Munset[ CLr. Sz. Cont Color Gr. Sz Sh. °Eff#1 'lrfffl2
Boring # t~ Swim '
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Fit Ground surface ft. Depth to rug facer.
PPkSbDn Rate
Soil
Horizon Deptfu Dominant Color R Description- Text m Structure t,ons}stence Soumkwy Roots GPUtft'
In.- Munsell Sz. Court. Color ter. Sz. Sh. 'E##1 'Eff#2
' Effluent #t - Bt713s > 30 < 220 ma& mid TSS >30!E 150 nxllt. ° E#fluent #2 = B006 < 30 mg1L and TSS < 34 rnWL
The Department of Commerce is an equal opportunity service provider and employer. If you creed assistance to access services or
tweed material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-9777.
sear a3ro tRRmo1
Wiscorisin Depwirrient of Conwnerce SOIL EVALUATION REPORT Page j of 3
Division of Safety and Buildings
in acoordance with Comm 85. Wis. Adm. Code county ST G~ G/ x-- 'V
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must L v ?
include, but not Limited to., vertical r
percerasiope•scaleord'me"sM EROSION CONTROL PLAN must be p~tiOf~ Cr•~ b
Please Date
completed before sanitary permit issuance ?p
P--w inrom-*m 7- Provide -r kI
)VA I' GoA Lot 't1 DVq $ IM S ~L TZB N R (or) W
P~ oPP 2311R,5'Te7fl T- 51 0'
Property ownees Mailing Address ' Lot # Block # Sued. Name or CSKW
loot S CA tti LL ,due - ~g WALVO r W 'QN
City _-rMwR State Zip Coda Phone Nurnber ❑ City ❑ Village (Town Nearest Road
Cr oWC Hn MAJ 55-0Wo ( &56 aYk- log f -rR.Oy So. t3100e:R -1~
. o
PL New Conshuctim Use: (A Residential I Number of bedrooms Code derived design flow rate r OZ> GPD
❑ Replacement ❑ Public or corronerclal - Describe: - A
Parent material /o ES 5 o Ut.11L, P~ E~t 47'1/j-- Rood Plain elevation if applicable ft
motions: k
Boring # F7] Boring
®Pit Ground surface elev. /DD _ iL Depth to rarrtug tailor In. ~ Application Rate
Horizon Depth Dominant Color Redox Desaiptim Texture Structure Consistence Boundary Roots GPDff b
In. Mansell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Etf#2
I 0' ll /0 W 31L 214, Sk dS cry 3 • S N
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W O< Z
sYR 741
2 Boring Bor'ng /00-so S S S
2-
pit Ground stxtace elev. ft. Depth to laniting factor in. Sort Appli
Rate t„
Horimn Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPDff
in. Mtmsell Qu. Sz. Cont color Gr. Sz Sh. 'Eff#1 'Eff#2
L t1
z l~ • o S/ z- a O N
3 . Z S"L /fs GS - z• 3
Z • AQW5141 c~ MoT' S/~t_ f' • Z 3
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slA 3V
' Effluent #1 = BOD > 30 < 220 nV& and TSS >3D:5 150 mg& ' Effluent #2 = BOD 130 rngll and TSS 130 n'gIL
Signature a2.G 37 5
csT Name (Please Print) R , -ZIP-B R i G I.TF
Address Uibricht & Assgciates Date Evaluation Conducted Telephone Nu rnber
Private -5 T • - 200 71S- 77A • 3 yy
2812 10th Ave.
Spring Valley, Wl 54767
"
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Pt rty O ner Parcel 10 # pa 3
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131 Boft ~ ❑ 80MV S'S'--5S'S'--5" t Ground surface elev. Sfl. Depth to limiting factor Z Z In.
Soil ieation Rate
Horizon Depth f~ominant Color Redox Description Texture Sumft re C onsistence Boundary RoatS GPDJ f
lrr. Munse Qu. Sz. Cont. Color or. Sz. Sh. 'Eif#1 'E1f#2
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L
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goring # ❑ awrrg
❑ Pit Gtbund surface raiey ft. Depth to Limiting factor rn
Soil wplication Rate
Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary :Roots GPwff
#9 Munsell Qu. Sz. Cont. Color Gr. S.Z. Sh. °Etf#3 'l=tfl#2
# Boring
❑ pit Ground surface elev. ft. Depth to limifi actor In.
Suit Rate
Horizon Depth Dominant Color Redox Description- Texture SVvct a Consistence S wndary Roots G
In, Munson Of. Sz. cont color GF: Sh. 'Eff#l 'Eff#2
% ring # ❑ Boring
Pit Ground surface ei ft. Depth to limiting factor In.
Std Appkallpq Rate
Hort on Depth Dorafnant Cot ReJ& Description- Texture Shuchrre Consistenee Boundary Roars GPQ ff
Munsell Sz. cont. Dolor Or. Sa. Sh. 'Eif#1 'Eff#2
° Effluent #1 48013, > 30 ; 220 nxg(A and TSS >30 < 150 mWL ° Effluent 3X2 = B005 < 30 mg/L and TSS < 30 rnWL
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= Contour elevation lines.
• = Backhoe Soil pits.
p = Benchmarks set, maRKED WITH FLAGGED
lathes. 1/2" steel conduit pipes.
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