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HomeMy WebLinkAbout026-1294-31-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572896 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: Oeverin Homes LLC, aka Oeverin Pro ertie Richmond, Town of 026-1294-31-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: \per • b S. Ibk Svv-F� 28.30.18.1513 TANK INFORMATION 06". \V' ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /l Benchmark -J S U D.t7 U IoUU . Jbf- I�n2_ �.V Dosing Alt. BM Aeration Bldg.Sewer 2 U f O 1 Holding St/Ht Inlet 3 85 �y • 5 � II TANK SETBACK INFORMATION St/Ht Outlet L4-2- d �' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Bt Te-r _ ou-t rwA Nx 1 I LOS Septic --1 C ` -75 r l S I ZR J Dt Batt°m Destfl�' I J Header/Man. `}5 A ration Dist. Pipe olding Bot.System a 8.S 99•S /`t L 9. .2 4Y.8 Final Grade b �b PUMP/SIPHON INFORMATION ��b Man ufact De M nd St Cove r I 0.9 /]v—7. Mo I Number / TD Lift Friction Loss S Head TDH Ft Force Len Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length 2 1 No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. ILiquid Depth DIMENSIONS SETBACK SYSTEM TO P/ LDG WELL LAKE/STREAM LEACHING Manufacturer: qp INFORMATION CHAMBER OR J Tl Type Of System: I N A_ UNIT Model N �: q`1 p r CUNVEN �NA-L 2i �Zq 5 J7 / DISTRIBUTION SYSTEM be is Ch = `/ Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake A Pipere�dS Length 5' Dia � Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over /// i Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges To s ' w �es fix] No Q'�es No r COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1332 116th Street New Richmond,WI 54017(NW 1/4 SE 1/4 28 T30N R1 8W) Richmond Acres Lot 31 Parcel No: 28.30.18.1513 1.)Alt BM Description= � lic.-r 2.)Bldg sewer length= Otte vT /lis�GA''� -amount of cover= 7 Plan revision Required? es No ZZ 15 1 Use other side for additional information. Date Insepctor's Signature Cert.No. SBD-6710(R.3197) oa atat�T Count}, /' Safety and Buildings Division <—��1 IVj 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) ,. Ma[}�disaon,WI 53707-7162 N �//�,�/� a�°4storFV��`w t a 1 a ! I � L'& 1 i - 7`PP it li: +at�o y��= -�-� State Transaction Number � herm A r-- tjw in accordance with SI'S 383 I( ;Viss Adm Code,submission of this form to the appropriate governmental unit is required prior to obtainingta-&arl permit. Note:Application forms for state-owned POWTS are submitted to PrRiect Address(if different than mailing address) the Department of Safety anaF 11 e'ssional Servies. Personal information you provide may be used for secondary purposes in accordance wi Privac•Law,s.15.04{1 m),Stats. L Application Information-Please Print All Information Property Ow'ner's Name Parcel# Property Owner's Mailing A j� Property Location ( [ J 13 c !i Q C3 I Govt.Lot City,State , I Zip Code Phone Number �� ,,s L_/�, Section 7 cle on T J N, R E o II.Type of Building(check all that apply) Lot# 3 j —� SubdivisioZ e ---� Family Dwelling-Number of Bedroomst`,� i Block it � � i ❑Public/Commercial-Describe LJse ❑City of El State Owned--Describe Use CSM Number I ❑Village of If Sown of III.Type of Permit: (Check only one box on line A. Completelline B if applicable) A. yttem ❑Replacement System ❑Treatment/Holding Tank Replacement Only Other Modification to Existing System(explain) i j B. ❑Permit Renew Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Dale Issued Before Expiration I Owver ���/' (f � W.Type of POWTS S stem/Com onent/Device: Check all that apply) Inn-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of di We soil I ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersaVTreatment Area Information: l De tgn Flow(gpd Design Soil Application Rate(gpdsf} Dis ersal Area Requjaed(sfl Dispersal Area Propossf) System Eles n �� ,� .) ✓ VI.Tank Info I Capacity in I 7otal #of Manufacturer Gallons Gallons Units tvew Tanis Existing Tanks ��- j ...U I Septic or Holding Tank A07,M7 X1 Dosing Chamber VII.Responsibility Statement-1,the undersigned,assum es risibility for installation of the PORTS shown on the attached plans. Plumber' Name(Print} Plumber' ure MP/MI'KS. umber Business Phone Number GLA._. Plumber's Address(Street, t ,State,Zip Code) 3 1Z04& , A /�,02,u� /(-/ °7 VIII. untvlDe artment Use Only Approved Disap Permit Fee na Date Is ued Issuing Agent gna e Li weer Given Reason for Denial �S. 23 Zb IX-Conditions of Approval/Reasons for Disapproval 00dj')�'WS 6-� Attach to complete plans for the system and submit to the County only on paper not less than R in.z I1 inches in size SBD-6398(R. 11/11) a4bjvti Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 2 30 18 Richmond COUNTY ST.CROIX NW 1/4 SE 1/4S 8 /T N/R W TOWN SYSTEM ELEVATION 99.5/98.7/98.0 5' below qrade 4/21/15 DATE BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 45 hk BENCHMARK V.R.P. Base of lath on lot line ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. 513' Property Line Scale = 1 /411 = 10' �s Pro 3 Bedroom 116th St. House 30' 16' 111 S / 20' B-1 ✓ tB- 6 5'Area of poor soils 20 20' Area of Vents 30' Poor soils 156' Property Line 10% Slope ✓/It B-3 10' 20' 12' 520' Property Line B * 100' Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" Grade at System Elevation 34" V Property Owner_ Parcel ID# Page of Boring# ❑ Boring (� / 9L pit Ground surface elev. v t ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 a �6 All F-1 Boring# E]E]❑ 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 E] Boring❑ Boring# Ground surface elev. ft. Depth to limiting factor in. 11 pit Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30 1150 mglL 'Effluent#2=BOD5<30 mg&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. Sao-8330(RAM) F � Wisconsin Department of Commerce' a SOIL EVALUAn-ON'R€PORT Page of DiAsion of Safety and Buildings � Irf a ccQrdAttba.tark)t t;omm 85,Wis. Adm. Code ._ County Attach complete site plan on paper not 1"'iiha�$� x 11 inches in size.Plan must include,but not limited to:vertical and horlaogW reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions;north airow,and location and distance to nearest road. D Z G— 1 2. -- 31' Peas#%piint all information. Reviewed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location O e►7c,r I; t? � Govt.Lot J 1/4 1/4 S ��j T �() N R E(or Property Owner's Mailing A ress Lot# B lock# Subd.Name or CSM# q33 A- t City State Zip Code Phone Number ❑City ❑V lage own Nearest Road O-New Construction UsOET-Residential/Number of bedrooms Code derived design flow rate y-i V GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Flood Plain elevation if applicable All A ft. General comments and recommendatims: System Type (-y n Z i>e."7f- Z System Elevation r , r 7/ IBoring# Boring pit Ground surface elev. ' ft. Depth to limiting factor I L, 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 ot, 31-L o-Z0 10z" V }'�,� rn �Lys 5 1� V Boring# C] 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. Munsetl Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 M J— Y= -� Effluent#1 =BOD.>30<220 mg/L and TSS>30<150 'Effluent#2=BOD,<30 mg/L and TSS<30 mg/L CST Name(Please Print) Sigoure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 o Count}J� /11ro ANC TT���t f)L ,�� :..- ; Safety and Buildings Division 74'r" r - i 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be tilled in by Co.) P r K,,,,,._ �� ��� � Madison,WI 370T' 1 CRc\, � L —_ State T;ansaaiv umber r ,,,Av Sanitary Permit Application �. in ac40'N''' e with SPS 383.2l(2),Wis.Adm.Code,submission of this fora:to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address if different that mailing address) I the Department of Safety and Professional Servies. Personal information you provide may be used for secondary* purposes in accordance with the Privacy Law.s.15.04(1)(m),Slats. /3 3 2- i! D` ` I. Application Information-Please Print All lain:4111\ Parcel Property Owner's Name 4. Q� O —31-- /11 Property Location / /�/ Property Owner's Mailing.q ess (/ n ,e < f , City,State j Zip Code , I Pbone Number ! - g. '4.,. Section 17 {V- Q circley II.Type of Building(check alit at apply) 1r' I Subdivision.'are ❑I or 2 Family Dwelling-Number of Bedrooms, ❑Public/Conunercial-Describe Use c. ;=J Gips of pl 0 V' - — CSM Number ❑ Village of ILI State Owned--Describe Use - ,��pwm of III.Type of Permit: (Check only one box on line A. Complete line B if applicable) _t, Na- A I f'w System ❑Replacement System a Treatmenu"tiolding.Tank Replacement Only 1 Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision Eli Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued IBefore Expiration I Owner "t+i --i IV.Ty e of POWTS System/Com.onent/Device: (Check all that a .lvl 'I. i .4 ■ Non-Pressurized In-Ground Q Pressurized In-Ground ❑At-Grade E Mound?24 M.of suitable soil J Mound<24 in.of su ..r.le soil ❑Holding Tank u er Dispersal Component(explain,) Pretreatment Device(expl. I ill l�7 q V.Dispersai/Trea it Area Information: 4j t GL«� //rte Desj w(gpd) ,I Design Soil Appli at on Rate(gpds i Dispe � Required{stl Dsp°rsal Are piled js� II�`G31'ley bon J/ 15(W. VI Tank Info Capacity in Total I s of Manufactur r I �.Sj Gallons ' Gallons Units m `ii . ' II v 1 F ¢ 7 Nov Tanks Existing Tanks 1— g- I` v i '° i J J Septic or'Holding Tank i i K./au-3 j: .4,-.7_,s, � y .r'� _ Dosing Chamber I 1 . VII.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumbir's Name(Print) 1 Plumber's Signature 1 MP/?vtPRSCNumber ' Business Phone Number ii /'I) r29 Plumber's Address(Street,City,State,Lip ode/ ( i 2,0 ‘5, qi 1 i/ , ViI County/Department Use Only — r i Permit Fee I Date sue Issuing nt Signature pproved sapprove $ ���' OD � wrier riven Reason for Dental IX-Condift$l asons for Disapproval Q_ 1 e( o • ■ - ' t. Septic tank,eftluient filter anil, . 3) 1h1 /' , n �,• dispersal cell must all be Seri/tees/maintained `5 I/V►a..` a 42.., a l rya j°''n W►u.... as per management plan provided by plumber. �� r 2. Al ck OciOrements!rust. mauntained. J`J� �- 2 r tX 1 D as per applicable code/ordtnzinces. ,•o•.. Attach to complete plans for the system and submit t the County lily on pa per not less than R iC z II ichci in size a � �Cc." . SBD-6398(R 11/11) 1 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 S E 1/4s 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 96.7/96.2/95.7 2.8' below grade 3/31/15 3 BEDROOM DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE r•4 ABSORPTION AREA 1 137 # of chambers 57 BENCHMARK V.R.P. Top of 1/4" 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' of tank,piping shall be Schedule 40. B-2 B.M.* B-1 90, 175' 219' 27 100' � 20'ST Vents 30' 0+ 98' 0I 3-3' X 78' Cells with >3' spacing °)C) 60' -3 0 4 40' Pro 3 96' Bedroom Scale = 1 4" = 1 0' House A Please note: a new soil test is to be done to find a more suitable location with 156' Property Line better soils. • 520' Property Line a•Vent >6,, L Quick4 Standard of Cover eaching Chamber with 20.0 ft2 of Area .6ft^2/pair of end caps 4' Long (..„1 .,x, Grade at System Elevation 34" Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/31/15 Owner: Oevering Homes Location: NW1/4 SE1/4 S28 T30N,R18 1332 116th St. Richmond Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Co III ngency Plan 7. Filter Specifications S Signature J' License numb #226900 (1 PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/48 28 IT 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 96.7/96.2/95.7 2.8' below grade 3/31/15 3 BEDROOM DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 1 137 # of chambers 57 BENCHMARK V.R.P. Top of 1/4" 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' of tank,piping shall be Schedule 40. B-2 B.M.* B-1 175 219' 7 900 100' Vents �—, ST 30' 0+ 98' 0 3-3' X 78' Cells with >3' spacing 6°)() 60' ❑'4 40' Pro 3 96' Bedroom Scale = 1 4" = 1 0' House A Please note: a new soil test is to be done to find a more suitable location with 156' Property Line better soils. 520' Property Line a"Vent >6,, LQuick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area .6ft^2/pair of end caps 4' Long v 34" Grade at System Elevation Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99.5' Vent i Grade ► Vent 4' 4" 4' X30/34 Septic Tank 4' Long 1 5' 4' Long 1 Grade at System Elevation 3 4" Grade at System Elevation 3 4" Spacing 5' 3-3' X 78' Cells Observation tube/Vent Same on other end To be located on end of Cells c ..„,, _____. \ A System elevations: C A 96.7' B 96.2' 19 chambers per cell C 95.7' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer_ (/eiL.)e)71c ger,‘-&) ---- _______ Mailing Address /f. �, /,I)/!67-(../(,e9 i �� � �/�,�.' l C d � ,- I Property Address / 3 3 7.., //67 91• //'_ (Verification required from Planning&Zoning D- e-nt for new construction.) -� City/State _ Parcel Identification Number ' 6 ' 3/'( LEGAL DESCRIPTION aL___ei_ Property Location/ Y4 ,..<E %a, SecZ. g 130 N It/g W, Town of / r - Subdivision X, e" / - - - Lot#-,__ Certified Survey Map# — -- - Volume , Page# _______. Warranty Deed# i 31 ,Volume _, Page#____________ . Spec house - yes no Lot lines identifiabl ye. 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 owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper veri •signed by the fying wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(ifnecessar the onsepe less than 1/3 full of sludge. necessary), the septic tank is 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 ear expiration date. I/we certify that all statements on ' form are true to the best of my/our knowledge. I/we am/are the owners)of the property described above,by virtue of a w ty deed recorded in Register of Deeds Office. Number of bedrooms----3 ________ IGNAT OF APPLICANT(S) -- 3f V/i-) 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. (REV.08/05) pOWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of SYSTEM SPECIFICATIONS SYS ,.,c ❑ NA FILE INFORMATION li Tank Manufacturer: cL tat Owner p {�/i/'� (9x11 _, Septic ❑ Dose ❑ Holding Volume: r � NA • Tank Manufacturer: DESIGN PARAMETERS , Volume: (gal) Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding NA Vertical Distance Tank Bottom(s)to Service Pad: /� (n) Number of Public Facility Units: // (gal/day) Horizontal Distance Tanks)to Service Pad: ( Estimated(average)Flow: Specific servicing mechanics must be provided if vertical is>15 feet or Design (peak)Flow=(estimated x 1.5): j 7 (gal/day) if horizontal is>150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gaUday/ft2) Effluent Filter Manufacturer: 43 17 ✓ ❑ NA M•nthl average Effluent Filter Model: Standard(Domestic)Oil&Grease (FOG) 5.30 mg/L g Pump Manufacturer: ANA Fats,Oil&Grease (FOG) s220 mg/L ❑ NA . AN Biochemical Oxygen Demand (BOOS) Pump Mode Total Suspended Solids(TSS) 6150 mg/L Pretreatment Unit High Strength Influent/Effluent Monthly average Manufacturer. (FOG) >30 mg/L (BOD5) >220 mg/L 4 NA Peat Filter ❑Mechanical Aeration ❑Wetland (TSS) >150 mg/L El Disinfection ❑Other: Pretreated Effluent Monthly average ❑Sand/Gravei Filter (BOD5) 530 mg/L Soil Absorption System (TSS) , s30 mg/L A Ground(gravity) ❑In Ground(pressure) 1-3 NA Fecal Coliform(geometric mean) s10" ❑At-Grade ❑Mound ❑Other: Maximum Effluent Particle Size 1r6 in dia. ❑ NA ❑Drip-Line ❑ NA � Other: Other: �. MAINTENANCE SCHEDULE Service Event Service Frequency :ii■ hen combined sludge and scum equals one-third(%)of tank volume Pump out contents of tank(s) ❑When the high water alarm is activated ❑ NA Inspect condition of tank(s) -> ! month(s) (Maximum 3 years)• s) At least once every: -c ear(s) 2 ❑,month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: J ar(s) [,month(s) ❑ NA Clean effluent filter At least once every: �jear(s) ❑month(s) U NA Inspect pump,pump controls&alarm At least once every: ❑year(s) ❑month(s) Flush laterals and pressure test At least once every: ❑year(s) ❑month(s) Mel Other: At least once every: ❑year(s) m Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: to a Servicing Operator (pumper). Master Plumber, must include ae visual t inspection of then tank(s)top identify any missing noribroken hardware, identify any cracks or leaks, Tank inspections absorption the volume of combined visually sins ected to check the effluent levels back he observation pipes and to check for any ponding of effluent onsoretion uystem shall be y p on the ground surface. The pondi f effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the of the tank shall be removed sludge a Space S treatment disposed)ofrin more of the accordance volume,the NR 113, contents of the tank shall be removed by a Septage Wisconsin Administrative Code. mechanical or All other services, including but not limited to the servicing of effluent filters, POWTS Maintainer. components, pretreatment units. and any servicing at intervals of 55.12 months,shall be performed by a certified days of TS Maroon of any service event. A service report shall be provided to the local regulatory authority GMW-005(02/05) 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 use If high concentrations are •detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior , 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 g the tdetrel floss tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette'butts, condoms, cotton swabs, 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 repl ement system: Q 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 lt in the the e need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply 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 1 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. Nr ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER Name ���t ct�- )'�> G T Names t c��,.t� y / - ,--, — -, Phone / )j ��_._- 9 j/ �_7 Phone t/� -�7 - �J7 SEPTAGE SERVICING OPERATOR(PIPER) LOCAL REGULATORY AUTHORITY• ,I!, l Name 3-7/11.4:.). /� r.t� �ru� Name /l,-'"�`- ,i t/L9n! ���..-/ 3- .�I)( r / Phone J J " 7" "gL; ( ( L/ Phone / /k1 --CW — 5/e/2 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%-- . 0 n=.. '. STRUCTINS CARTRIDGE t--,4 - , FILTER �. ZOOS '41',` wd ' ? ...:..'i..^ .y: .T Installation e STEP 1 pry fit the filter case onto the end of the outlet pipe to ensu'eetnto the y centered under the access opening. If not, then either insert more p p =� 4` s,x tank through the outlet or solvent weld (clue) additional pipe onto the outlet w `. pipe . : STEP 2 While the case is still dry fitted on the outlet pipe, measure the length i; ,. of inch pipe needed to brace the filter to the tank end wall if utilizing the , A optional supplemental side support. If side support method is not utilized, proceed to step four. .a, STEP 3 For installations utilizing the optional supplemental side support: weld the 3/4-inch pipe onto the filter case. If side support method is not "��T' solvent wed »� r. _ ter•: or utilized, proceed to step four. mks 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 "ryk�,r . the case. •. !: STEP 5 If a VRS switch is utilized: inset into the filter and lock by turning ,:;-'4•:,-;'..,,,,:!, ,. clockwise 90°. Maintenance ,, 1. The effluent filter should be cleaned every time the septic tank is €ms , . «. .a ; serviced. 4" ' " : ," vi,-,..t.,, 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. Once the effluent leuelhas behe filter rhandle o o dislodge he the , ' 41.. outlet pipe, firmly pull _ cartridge from the case. a , �awal".< . and out of the case for cleaning. ° `' ' 5. Slide the cartridge up �"� c -�° ` ��+ 6. If a vRs switch connected to an alarm is present, the switch x ; should water only. ed by turning counterclockwise 90° and cleaned "1 with water only. :y7 � 7. While holding the cartridge on its side (large flat surface facing x-. x r down) over the access opening, rinse off the cartridge with water � only making sure all septage material is rinsed back into the tank. f } 8. If VRS switch is utilized, replace by inserting into filter and a turning clockwise 90°. �� _ Tessin down until - f '" °� ' �, insert the filter cartridge back into the case, pressing % Y gt the filter locks into the bottom of the case. 10.Replace and secure the access opening on the tank. SEAR ONS?TE""FILTER CARTRIDGE-FIVE-YEAR MIT'cB WARRANTY (BEAR ONSITE"Filter Case-L fe.,me L■m,te vva'•a tV .4 s .. x. ^z a: z. x.i,s F, an.+t"�. r ; yr W x 3 3 ' .i � " 4, 9 ,,.....4'.,-.' . i - x M 4 ,,, .?:::'15"i4„.:/.14/41e l'' '' � a . t kuee ms � r A ' Y ,... 0 . ;:3. , . . # u .. :'t. LEI L>1 L .> w c OW IIIiimmiliti 1 .., 1 -,;,- ,"?" I 1.111:111111, II i • t„ ti, I M 1-F--1 111111! 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El <111 ,._._— 1 11,11P-. ____,I,.--,-- r-- „,„ 'er2. , , 1 _ __. .: f y. JL.y...—J1 P -...— ° im l'i r'T 11 plinir ' s a t lar i 1 1 i& „4:it , . __,_! . 11 ,, ,z....11 , 1 r.,_,..,_ 4 'Q-1.-ji_P11.?-D—T-II 7:- I----t ...ruawcznaismwerisprommolow ,.., _ 0 , T I we 4. .• I Ptil I. _1 it : : . 1 _. , ... r-- i r J-740------ ____, 1 r, ..,...........,., •, 1 1 M igi 1 i ,J e,0 gt------ .1 igt 1 , ;•2, :1 §p ' I 1 E g t r e 'te=riretr r 1 ..,-,-,ReiTriete027441 0 1 410 ii 1 .n , • i R' t n ,b ex- V 0 ,► • r- , Property Owner Gera 14 3"; 5p),-.1-1,1 Parcel ID# Page Pl of 4I 0 3 Boring# — Boring p 1•pit n Ground surface elev._?�D, y I ft. Depth to limiting factor a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 'Eff#2 1 0-9 i0YR 3/r21 L 1 PL mfr Gt.4J Ac- i y , 14 •a 3 - 'R /A, —__.. N 1-`i I m 5 lo K mfr; C t,,J 1 .P , LI , 1 3 ,- -' $ -1,5Yr2`-i/+i .. �_.. 5 c.--SK rn C1.4 1vc i (0 1, Q I err-y`i`h_ -7,5 0,..54/ cs Ia.kitr3 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 • Boring# Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD/ff 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=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD•8330(R.6/00) . 4 Wisconsin Department of Commerce C .__________.--\\ r ' 4 gilL EVALUATION REPORT Page___I___of Division of Safety and Buildings in ance with Comm 85,Wis. Adm. Code p County 5f, CItoi )4 Attach complete site plan on paper not less than 8 1/2 x 11 inches In size.PI-I rr include,but not limited to:vertical and horizontal referenc point;; Parcel LD. /_ /�G 1-3i,�� percent slope,scale or dimensions,north arrow,and loca on an,' .' - • :. - oad. (a ! 7 Please print all informat n. n(n� R(� Date'�j� " v (4N 1// Personal information you provide may be used for secondary porticoes(Pra s. 5. )). ���� (�� 1 Property Owner t Property Location Gerald 1.• SM•. tk �+ S7(NIN , �F Y IA, 1/4 5 1/4 S CXg T30 N RI 8 E(orn Property Owner's Mailing Addrps o o Subd. Name or CSM# Ill IQO 190 oe. iJW 31 Plat oF R.,chw►owa- Acres City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road Elk R'•iEIR 1 MN ' 553301 cllayW-$S8$ R; ti� v. o N d 1 I1 (oT INS't. (B New Construction Use:(19.Residential/Number of bedrooms 3 Code derived design flow rate_ 4450 0 GPD ❑Replacement ❑ Public or commercial-Describe: Parent material__. 0-LL*wci-S I . 7 I I hi • ) — Flood Plain elevation If applicable V', 0• l AQ eft-*•-' General comments S v 55 s-{- 3—'I-a rct- S C.y') For- -eea e.-t-. S }G and recommendations: 9� T. i ( 9t..�3 ) T. y s .o f /I' , / s i I G) 7.1 (94.,03'1 S;'f` T.5 ( .S ' ma y: 3& 7 G? �/ 7,3 (SS•Ll', T'lO (i y o9') Z' —I Boring# ❑ Boring r vs pit Ground surface elev._!Ob.p0 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 0- V 10YR- 3/a - L '3 cCt 5bK mcr , aw a'C " cV t % oR 9-1K 7,5y24f4 _ _.. "SLR MS O'S rn-Cr cu.) 1 c , t„. 1 , 0 3 I. i c_._.: 5 L 1 5 K 11.-v cr. C w , 14 A ,vc5 1-i• P *1 5M if/e, a teVv■ t., eta 1:,.,s_' , ,/,../...00 ,i /4 S._ L' /� - I r / r 31r 37 If II a Boring# ❑ Boring IA Pit Ground surface elev.'°°'y a' ft. Depth to limiting factor 115 in. Soil Application Rate Horizon' Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 o-i I UYR Sea _._.___._ L. 117M1 r r a ) a- , to , If SYrZ / 1 ceL gill Cw 1 c , t+ , to IMEMIZEMI s1 ,� _..... ... S --- -- 11111._0 „AMU 5 `--- , 5 `(l2 +/4 - "5 1. a ,,;;a..,. •Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L i1 •Effluent#2=BOD,<30 mg/L and TSS<30 mg/L ibi T Name(Please P f Signature r1 CST Nu' `Address a a •�.�, ,S"� sate Evaluation Conducted Telephone Number Ft' -39—ia3 1 I aki$:3-588 S�f' aa.� �Ct'o�e'C��1 �� .510'D A l• Property Owner Gera 1(�C v 5rn A"h Parcel ID# Page �_of__J � 3 Boring# ❑ Boring Ir�� S Q �'Pit Ground surface elev._?�O' y ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/if in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 I (1-C?, ;• `t` t .d` F,`f )'Y. s }^ �J� '.J `° L(•s I\ c�; ,,� X41 : _ _ , r . , i -c G .:. Iv"- , Le ', 0 O 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 -❑ Boring ❑ Pit Boring# Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD/ff 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=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.6/00) E t C10 n x11- F �- 3_ ° �s-,cam, r -,.�s 1 k r∎ cn 4� t — et °4 ° it— Y' I 0 n 'O ' �' j O q r i "4- c �`• 9 le U P I 00 iC-1, lir Y. 1 E t` 1 i 1 I 1 _. /D s 1 W — g so.gsp• r ... ,-' a Sty 4c) _ .D O _ o (/ •< Q _ # • � 9Q 3..) Q Li ' ' .J r I s v . � • o t 6` O V o'bG S ` Lo, � N 4 , C-1 P v. L 1 1 /