HomeMy WebLinkAbout040-1312-06-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
578905 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: Village X Township Parcel Tax No:
City
Delta Construction, Inc. Troy, Town of 040-1312-06-000
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No:
9*2.7 4 (3 aj g 04.28.19.2036
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ;A,� CAPACITY STATION BS HI FS ELEV.
i
Septic Aj ( r G, J Tl 7, 1 16 Benchmark ��Z 3 7
�'Ir—
Alt.BM `lov. fy
Aeration Bldg.Sewer
Holding St/Ht Inlet (e- t 5 1 7 T
Q
TANK SETBACK INFORMATION St/Ht Outlet 7• C�S• J 3 47/
TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet \
4 �
Septic 1 Z A)4— L45 D/ Dt Bottom �
Dosing Header/Man.
Aeration Dist.Pipe 7• `J • If
7.(P 4t4_4-
Holding Bot.System T• .7 3 ."RY
3. 24 c7
PUMP/SIPHON INFORMATION Final Grade 4, 0 3
Manufacturer Demand St Cover c/
GPM t':l�-+� Go J --
Model Number 3• Z 45. T
/3�
TDH Lift Friction Loss IT DH Ft
Forcemain Le ia. Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width i Lengt No.Of Trenches ' _ A PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS ? 4to Z �f l.�G�U SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type Of System. ,�+ A , w J CHA UNIT OR Model Numb r: r' `�� us
DISTRIBUTION SYSTEM e k -1—I L = 3;7 G ,Jo.-(°S
Header/Manifold Distribution x Hole Size x Hole Spacing VenAt�Air Int ke
Pipe(s) /v 6
Length 7 Dia l Length `-- Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over /// Depth Over xx Depth f xx Seeded/Sodded xx Mulched
Bed/Trench Center N (./-� 5 Bed/Trench Edges \` Topsoil Yes 0 No Yes �] No
COMMENTS: (Include`code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 520 Olivia court Huds n,WI 54016(NE 1/4 SW 1/4 4 T28N R19 IW) Cottage Meadows Lot 6 Parcel No: 04.28.19.2036
1.)Alt BM Description= i✓��� C V li� �- � �a���- O V%'
2.)Bldg sewer length=
(00-amount of cover= / 64 J 6��`'�- 1%'� u-"-"' S�•%,,-
Plan revision Required?
Fiol
Yes No
--
Use other side for additional information. �Oe�
Date Insepc is Si ure
SBD-6710(R.3/97)
PLOT PLAN
PROJECT Delta Construction ADDRESS 206 2nd St. Hudson Wi 54016
NE 1/4 SW 1/4S 4 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX
SYSTEM ELEVATION 95.5/95.1 4.5' below qrade 4/7/15 BEDROOM 3
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 RAT 6 ABSORPTION AREA 771 # of chambe 38
IL BENCHMARK V.R.P. Top of 1/2" iron pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL -H.R.P. Same as Benchmark
153' Property Line M.
40' 10' 67'
B-1
Scale = 1 4" = 10'
V en4
0 82' �
2'5' X 78' cells with
>3'spacing
B-3 10
4% Slope �._
7� 1
jE- Quick4 Standard 20 1
eaching Chamber
Of ith 20.0 ft2 of Area v
12" .6ft^2/pair of end caps S
Grade at System Elevati on
3 430'
Pro 3
Bedroom
House
307' Property Line
All piping shall be SDR 30/34,within 10'
Olivia Court of tank,piping shall be Schedule 40.
vp+r.Rh447.
§,I Safety and Buildings Division Coon r
D 201 W.Washington Ave., P.O.Box 7162 �'
'' Sanitary Permit Number(to be filled in by Co.)
P {�'' Madison,Wl 53707-716? Trio
') " A -14 77) 5 7 =7 05
,ts.:4: ,_____ _ _ ,_
s-c. � c aanitary Permit Application 0 b
In accor.. ,. 'it�t°$PS 383.21(2),Wis.Aden Code,submission of this form to the appropriate governmental unit
is req'Dlr 1+rior to obtaining a sanitary permit. Note:Application forms for stale-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Sert'ies. Personal information you provide may be used for secondary'
purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. .. 5.�yt
U.J t t
I. Application Information-Please Print All Information / t✓�.q. �J r
Property Owner's Name
I/ / Parcel#
/ A /� .L: .�,4JA 4�
Property Owner's Mailing AT dress - ■
,,cc---� Property Location j)�
Z,V (� Sx Govt.Lot Zb _ J
City, Zip Code I Phone Number
+, /., Section
..//t. li_s/ ./ 15 i ■ Q /(Qrcle o
II. ype of Building(check all that apply) L. -- T 2, t7 N; R / / F',c.
1 or 2 Family Dwef(ing-Number of Bedrooms I Subdivision Name
dic ea, kb rs2_ : • /
0 Public/Commercial-Describe Use PA L A • 1
��
°— ❑city of ,
CSM Number ❑Village of State Owned--Describe Use 2 of
Z. L .. Cell-5 will i-1 1 WWC :4
III.Type of Permit: (Check only ne
box on line A. Complete line B if applicable)
A / � ++ 7 vA-42__.ystem ❑Replacement System ❑Treatment/Holding Tank Replacement Only I ❑Other Modification to Existing System(explain)
R. ❑Permit Renewal ❑Pemtit Revision i ❑Change of Plumber 1 List Previous Permit Number and Date Issued
Before Expiration g Owner Permit Transfer to New
i � j 1
IV.Type of POWTS System/Component/Device: (Check all that apply) • t��-tt& A V`
7r-Naa:I'ressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil CA.A.A.
Bolding Tank Other isp sal Component(explain)
❑Pretreatment Device(explain)
De Design Flo (gpd)reatment Area Information: L.,S�i� f� J�� D
Design Flow(gp I Desi Soi pplicatton Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) 7System Elev on lt,v
VI.Tank Info i Capacity �1 / j�
1 P nth Total #of Manufacturer / S 1 G7�' Z
Gallons Gallons Units °? �
New Tanks I Existing Tanks �+� em u J = =
Ati !^t ti 2 U P , 3 - C
Septic or Holding Tank I ? / _-_1 ^'"
Dosing Chamber �'7�G/t I
I 1 1
VII.Responsibility Statement-I,the undersigned,assn" , ponsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber' •_ azure MPMIPRS umber
Business Phone N ber
c_5/ ;5 i 2�7 -7/< :'a2/( /''
Plumber's Address(Street,City-State,Zip Code)/ ,
`3 7-. - /Z) NNE `i , GCI) S Vi / 7
VIII.County/Department Use Only
roved isapprove Permit Fee Date sued Issuing. t Signature
even Reason for Denial S / '' 41p Q is
IX.Condit$11f$ Q1Aitasons for Disapproval �tJi ^e� pro
I." Septic tank,effluent filter ant • 3) u /�,
dispersal cell must all be servIces I maintained „
as per management plan provided by plumber. R..O W W.�� r .1- 0A,Q,JA
2. M **requWements must Ostnaintafned;
as per applic khade I ordinances. j et Parok.a `e,y1, .
Attach to complete plans for the system and submit to the County only on paper not less than 8 7,..2 z 11 inches in size
SBD-6398(R. 11/11)
PLOT PLAN
PROJECT Delta Construction ADDRESS 206 2nd St. Hudson Wi 54016
NE 1/4 SW 114S 4 IT 28 N/R 19 W TOWN Troy COUNTY ST.CROIX
SYSTEM ELEVATION 95.5/95.1 4.5' below grade 4/7/15 BEDROOM 3
DATE
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK IZE
HOLDING TANK SIZE LOAD RAT` .6 ABSORPTION AREA 771 # of chambe 38
BENCHMARK V.R.P. Top of 1/2" iron pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
. 153' Property Line B.M.*
r 40' 10' 67' 111 I
,B-1
Scale = 1 4" = 1 0'
,Vents
- I
A 82' 2-3' X 78' cells with
>3'spacing
B-3 b100'
4% Slope
alp Vent 11-• B-2
Quick4 Standard
>6" Leaching Chamber 20'
of Cover with 20.0 ft2 of Area
5.6ft^2/pair of end caps
li
4' Long
Grade at System Elevation
34" 30'
Pro 3
Bedroom
House
307' Property Line
All piping shall be SDR 30/34,within 10'
Olivia Court of tank,piping shall be Schedule 40. ,
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 4/7/15
Owner:Delta Construction
Location: NE1/4 SW1/4 S4 T28N,R19 Lot 6 Cottage Meadows Troy
Manuals Used: In-g round absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifica ons Sheet
Signature
License n - •er#226900
PLOT PLAN
PROJECT Delta Construction ADDRESS 206 2nd St. Hudson Wi 54016
NE 1/4 SW 1/4S 4 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX
SYSTEM ELEVATION 95.5/95.1 4.5' below grade 4/7/15 3
BEDROOM
DATE
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK I E
HOLDING TANK SIZE LOAD RAT' •6 ABSORPTION AREA 771 # of chambe 38
BENCHMARK V.R.P. Top of 1/2" iron pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
153' Property Line :.M.*
gl 40' 10' 67'
•
:-1
•
Scale = 1 /4" = 10'
Vents
82'
2-3' X 78' cells with
>3'spacing
B-3 t 100'
4% Slope
Vent
%i11132
>6„ LQuick4 Standard
eaching Chamber 20'
of Cover ith 20.0 ft2 of Area
.6ft^2/pair of end caps
4' Long
Grade at System Elevation
34" 30'
Pro 3
Bedroom
House
307' Property Line
All piping shall be SDR 30/34,within 10'
Olivia Court of tank,piping shall be Schedule 40. ,
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above rade
5.6ft^2 pair of end plates g
Finish grade elevation
Typical Installation 100.0'
Vent Grade Vent
3'I 4„ 3,
• ��30/34 Septic Tank
Long 5
5' Lon glibk- 5' S 1"Long Grade at System Elevation
3 6" Grade at System Elevation
Spacing 5'
2-3' X 78' ' Cells
Same on other end Observation tubeNent
At end of cell
A
B
19 chambers per cell
System elevations:
A_95.5'
B 95.1 '
Si. CROIX COUNTY
SEPTIC TANK MAINTENANCE /UG8EEM]TNT
AND
()07y4El{S/{lP CE[lTTFqC/\TiGN FORM
Owner/Buyer Val-cc,---
/ m��'-p._ - --'------- --- --------------- - �
Mailing Address_ '7 7 / 5/-^ �
) /
_ __ - __-_--_~~ == ^_ . +�'_--_-
Property Address f1- �!- l-_'
_---------'�-~^-~ =� ".�s��� "
(Verification required from Planning& Zoning D:pxit.ono for new construction.) ----- -' -- -
City/State '_ ___ ____ Puzrn) Idcu1Ji "�uu ��nziknr �� _ _, -Cu�Z)
---
LEGAL DESCRIPTION 6 ���L
_ r
� �,nnpedyLucu�uo A/ �� 1/4 , Sec _ , ] _^ _/ INK / / Y, To�on[
Subdivision Lot #_/ - ,
Certified Survey ��mp #_'______ ---- ______.___ __ _._, \/o1/uuo___' -_____` Page#_ -----_ __
��lh[. 0 � J
Warranty Deed ��
"m��m"� __-����/�����']L �� ____________ , \/o|ucu0�` "���« y��x# ���_y
Spec bvuvr vo
0 J*/line, identifiable /�pr no
~�
SYSTEM MAINTENANCE AND OWNER CERTIFICATKON
lr�ro per uuouudmaiueouucoof you zaopticxys1eocouidrxuuUiuis prmatxofaUu,xb`hand}o�"uvtvu Pnop",
��mumnaococ"ovistxofpuupng"u, he xrpticaokovecytb,ovy"aroorav"u"c, hovvdud. hyulixen;nJpu,opo, 'ko/yvn put inw
t6oxyo1�m nuoufe:1d6e ffiocdoovfc6oxnydrta6cunxrxuuuext sta0e iutbr*xx.rdixyovoJayotvoc 0vmorzuu� 'uozso
,00pooaihddiexmospncifiodim§Cvoou. 83 5%(1) audin(%';pm, l2 St. Cx.ixCouutyS^ndury0rdinxoo` '--
The property owner agrees to submit to St. Cioix County Planning &Zon ing Department a certification feint, signed by the
owner and by a master plumbex,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site
wastewaler disposal system is in proper operating condition and/or(2)after inspection and pumping(if'e:rxouzy) �eanphctank is
less bdlo[sludge.
~ ^
u�^uuuruI^w"�heundersigned h *nread the above rvy"o u
"u�^ auuug/nc/vm�o�iuo/on/,,ato ,,°ug,dbvynxxlny,t*'uv'id, o^`
xset zo,o, uucu/o, as set by the Deparntient vfComuu/cou udUheD, ?urtzou'^fNatvzul8xxvouxu- Stale o[Yi^:«ua/
u.Cuuifi,udouamtiogi6atyonoop/icoyrtuobuu6cnomuimuioodumot6ocooplxx,|uodznoo,md1»1&»St. umix C mm County
&&
Zoning I)cpartiriont within 30 thys of the three year expiration date.
1/we certify that all statements on thi io n are true w the best ofmy/our kvov,)odg". |/v,c uuuamdm owner(s) of the
property described above, by virtue of a nmma deed recorded in Register of l)eet Is Office.
,-A.c1,26../. __(}]� APl�T|:iii_.. ------ -- ----
S1GNATURt: Y�� ��-'''/ /�
APPLICANT(S) L)/\7l�
"*Any information that is misrepresented may result in ihe sanitary permit being trNoked by the Planning & Zoning Department. **^
lncludo"vid6ddaupplioutivouzucwrdvd*aoau1ydccd600udbcKnAiuzvrnf!)vodoE'tbcouuducopyofd6vcrrti{irdvmv [
zoieo�cninuzudu(o the vmuruniydeed.
survey
(REV.08/05)
•
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION • SYSTEM SPECIFICATIONS'
Owner (� Tank Manufacturer: LT7 cfv,/,1 ❑ NA
Permit# -Optic ❑ Dose ❑ Holding Volume:/erbe (gal)
•
DESIGN PARAMETERS Tank Manufacturer: 21-■IA
•
' Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: MYNA Vertical Distance Tank Bottom(s)to Service Pad:/�/ (ft)
Estimated(average)Flow: �. 1 (gal^/day) Horizontal Distance Tanks)to Service Pad: !' / (ft)
Design (peak)Flow=(estimated x 1.5): (gallday) Specific servicing mechanics must be provided if vertical is>15 feet or
if horizontal is>150 feet. Specific Instructions to be provided on back.
. In Situ Soil Application Rate: ` (s!7 (gallday/ft2) Effluent Filter Manufacturer: /3'��� ❑ NA
Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model:
Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer:
Biochemical Oxygen Demand (BODO) s220 mg/L ❑ NA • ,Z129A
Total Suspended Solids(TSS) 6150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer.
(BODO) >220 mg/L NA A
- (TSS) >150 mg/L ❑Mechanical Aeration ❑Peat Filter
❑Disinfection ❑Wetland
Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other.
(BODO) s30 mg/L Soil Absprption System
(TSS) 530 mg/L A •
Ground(gravity) In
•
Fecal Coliform(geometric mean) 510' " y) ❑In-Ground(pressure) ❑ NA
Maximum Effluent Particle Size At-Grade ❑Mound
in dia. CO Drip-Line ❑Other;
Other: NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
•
Pump out contents of tank(s) igCWhen combined sludge and scum equals one-third(ii)of tank volume
❑When the high water alarm is activated
Inspect condition of tank(s) •At least once every: '" 0 month(s) (Maximum 3 years) ❑ NA
years)
Inspect dispersal cell(s) At least once every: 3 Ilk month(s) (Maximum 3 years) ❑ NA
year(s)
Clean effluent fitter At least once every: / ,month(s) ❑ NA
/ ear(s)
Inspect pump, pump controls&alarm At least once every: ❑month(s) ❑ NA
❑Year(s)
Flush laterals and pressure test At least once every:. ❑month(s) NA
❑year(s)
Other: At least once every: ❑monin(s) NA
❑year(s)
Other:
❑ A
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third()')or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code:
All other services, including but not limited to the servicing of effluent filters,mechanical or pressurized components, pretreatment units,
and any servicing at intervals of s12 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
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)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,sanitil y 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.
D 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.
O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
holding tank may installed as a
available a of Y
If no replacement area is a 9
must be performed to locate a suitable replacement area. I ep
last resort to replace the failed POWTS.
g
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
ions of such systems must comply Reconstructions y PIY with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN XYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
1
SU
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
Name f�li 4�✓ �/ Name ✓,(fit
Phone 't_�/b Phone /J /� 7
l S
SEPTAGE SERVICING OPERATOR(PU PER) LOCAL REGULATORY AUTHORITY'
Name Tt>C1"� � Name —5 717 �/,��/�-/ �y Gy n
Phone /J��O� /i t / Phone / ) ,� 3 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.
•
/-�►S oa ,
:
r�t ILTER CARTRIDGE INSTRUCTIONS•<F,
+,g. Wdc x, q w t ,•g.
Installation
STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is � �
centered under the access opening. If not then either insert more pipe into the
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length ''',e-
of
3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the
optional supplemental side support. If side support method is not utilized, ,
proceed to step four. .. I
,
STEP 3 For installations utilizing the optional supplemental side support: ,, .''
lir
solvent weld the 3/4-inch pipe onto the filter case. If side support method is not ter '
utilized, proceed to step four.
4 Solvent weld the filter case onto the outlet pipe. Insert the filter �a .
cartridge into the case, pressing down until the filter locks into the bottom of ` ,
the case. *3'
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 , , ; , + ,,,' S. f .
serviced. 4 �,
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. i
4. Once the effluent level has been lowered below the invert of the
+tg,,,,
outlet pipe, firmly pull up on the filter handle to dislodge the
cartridge from the case. ` '`
5. Slide the cartridge up and out of the case for cleaning. t µ '
6. If a VRS switch connected to an alarm is present, the switch ; "
should be removed by turning counterclockwise 90° and cleaned :
with water only. 71' a '•,,;.. t ' c �s *ws �3
7. While holding the cartridge on its side (large flat surface facing = ;, .
down) over the access opening, rinse off the cartridge with water °° ,a
only making sure all septage material is rinsed back into the tank. �' 2;' ' �'
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BEAR ON5ITET'FILTER CARTRIDGE FIVE-YEAR LIMITED WARRANTY ,.1,r .
BEAR ONSITE'"Filter Case-Lifetime Limited Warranty
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WamonsinDepartmetrtof«. � '&-if v •IL EVALUATION REPORT Page 1 of-3--Diviston of and accordance • i 85•Wis. Adm. Code
1
J'
�� �� �urty -
Attach complete site plan• paper not i�that;8 a. , in size.Plan must 5?. G�q o )r
kiclude*but ni3t limited q _��ri'• Parcel 1.D. 3
percentsbpe.scaleorbr �� • •41Zii.4r• +!!�, nearest toad• •/0-• / ;-----
l • '-+
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Personal fnforatiionyouproiaemgrr euosuror ..,+ ( /tam s.1so4<t)(n& , ' 6 (E 65
PicpertyOwner Q , Ptopertylocalon • Jr;to .
-Tv 1>P' BJ ERS-re-PT Govt.Lot N0 114 5141" S `t• : N R P9 E or) )
Acpm_VOwner's&berg Address # Block S Subd.Name or++'
S'72 oM4k1* CT ` - { CO7T4-erEMEh'DO'S
City State Zp Code Phone Number 13 City ❑wage ®Town Nearest Road
(-1/f175od WI 540‘. ( ) "7-2o Soi-8eR- tu>
NS Newtbf>sbunlon Useclgi R 1 pit nberorbedrooms 3 -s Code desnred design low rate -1'5 0— 750 GPO
El Replacement ❑ Pubic or commercial-Desert
P a r e n t material L - 6 o t-ov r)-Ns t1 Flood Plain elevation wappscable Y/A- ft.
and comments
das Area. Spot Tested suitable able for 7
a conventional inground system(P.O.W.T.S.) 0, 1'1' (i,
I �P yo°dd�
- 7 i, , V C..�_, 1. • . ,$1 •. • ,.I• _
g p acing .
Q pit Ground surface elev. /-00 OD_ft. Depth to Buffing factor >ci 5 in.
Soil Application Ram
Horizon Depth Da ulaamt Color Redox Description - Texture Structure Consistence Boundary Roots GPO/if
h. Ansel Qrs.Sz. Cont.Color G.Sz.Sh. MINI '
I 0^9 iv VR. /2. — Ise 1 2C bx tr.fr , C5 3• f , • ' • (0
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in. Mumma CM.Sz. Cord.Color Gr.Sz.Stn. 'tit MIN
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CST Name(Please Prim) Signature CSTNumber
J enlnl y u4- a R/Gti-r k'.547 9341-
1lddress Date Eve(uadon Ca;ductsd Telephone Number
2.$ 12 101t Ave SpR,,J0 VA 4.-�t, Wi mkt? (3T* 20e'S (- 1,r) 772-3 42-
For issuance of permits and designing Ulbricht &Associates
Contact: Ulbricht&Associates Private Sewage Consultants
Registered private wastewater consultant and plurnbOO'$ 2812 10th Ave.
2812 10th Ave. Spring Valley, WI 54767
Spring Valley,WI 54767
715-772-3442
ORIGINAL
.
Property owner B -rear Parcel 1D# 6 `iv— /9/4—/0-novo page L of 3
22 Pit Ground stsface elev.41714 ft. Depth to knifing hictor)91 in. soa Appication Rate
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Sol Ammon Rate
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it filmset Qu.Sz. Cont.Color Gr.Sz.Sit - 'tom
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