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HomeMy WebLinkAbout014-1018-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578944 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: Bergmann, Richard & Eileen I Forest, Town of 014-1018-50-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: M / G-s—F 08.31.15.124 TANK INFORMATION ELEVATION DATA g, 2 16 St' 16-0 TYPE MANUFACTURER /if CAPACITY STATION BS HI FS ELEV. /43.3 /66 Septic Ir-N L+,�j /, A Benchmark Dosing Alt.B / ✓ Goy - ,3, S Aeratton Bldg.Sewer' 0 . Holding 4 St/Ht Inlet I�� • S �+ TANK SETBACK INFORMATION St/Ht Outlet TANK TO - P/L_ WELL BLDG. a Air Intake ROAD Dt Inlet Septic d O ? Dt Bottom 3•ZI 1 $'�.?Cj Dosing / X� J f Header/Man. l�, 1113 74 Aeration U Dist.Pipe 163 .7Y Holding Bot.System C.tt''� 16 3. a� Final Grade 73. lw lam,/.7� PUMP/SIPHON INFORMATION �'`1/ Manufacturer 6u� DePmMand St Cover Model Number Z 0, � �i 1 d o � TDH Lift Friction os System Head TDH t 3.1-5 z7, Forcemain Length �� Dia. / Dist.to Well SOIL ABSORPTION SYSTEM Z $. ZD BED/TRENCH Width Length No.Of Tren s PIT DIM NSIONS No.Of Pits Inside Dia. Liqui a th DIMENSIONS r O ",6 �e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Qt$ystem: �� J Z3 / UNIT Model Number: DISTRIBUTION SYSTEM of SQ, Header/Manifold S Distribution `7� Z / x Hole Size /I Ix Hole Spacing Ve o Air Int e Length 3• Di a �� Length ��' '" Dia Spacing v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 4"✓`' Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center t Bed/Trench Edges Topsoil L Yes No es No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: S /_aL 1 7 Inspection#2: Location: 2748 220TH Ar Clear Lake,WI 54005(SE 1/4 SW 1/4 8 T31 R1 5W) 40 acres Lot �• Parcel No: 08.31.1155.11224 1.)Alt BM Description 2.)Bldg sewer length= 14 10 f d-- -amount of cover= n o ! Dj 7 �ZI 1 61-- fs-x•^-. lam, a V.-- Plan revision Required? Fm_1 Yes No Use other side for additional information. - Date Insepctor Signatur Cert.No. SBD-6710(R.3/97) i h:�r`"a�i!i�vaa;t9ta xsr,BS Jury i i ;,^tb?:�.,F.i,#' itUM?'fil'_•r 19zt1:P�n1?3rE,: d a� .� County 00 ,; IV /Safety and Buildings Division • 6A-& -�- h�' 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 7yo M.0 0 8 2015 SI MOIX C01 INIVI Z)� iON�t� State Transaction Number ;,OMNNR9 Application 2�7�4 � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit -is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) 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),Stats. y� �O M v� I. Application Information—Please Print All Information Property Owner's Nam / Parcel# b Z y —/0/ Property Owner's Mailing Address Property Location ' .ti j oo h� FXQ Y � AV C, A Govt.Lot City,StateCC Zip Code Phone Number / S 1/, l,tr( �/,, Section 56 71-� 7 t'i� T 3` N; R (circle one 11.Type of Building(check all that apply) Lot# f ,or 2 Family Dwelling—Number of Bedr, ms Subdivision Name ; �,� Block# ❑Public/Commercial—Describe Use ❑ City Of ❑State Owned—Describe Use 4 CSM Number ❑ Village of 6 x 71 R-Town of III.Type of Permit: (Check only one box on line A. Complete line B if applicable) 2--,. A. ❑New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued / Before Expiration Owner W.Type of POWTS S stem/Com onent/Device: Check all that apply) 6 ✓L Q u ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑ Mound>24 in.of suitable soil A Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) /f V.Dis ersal/Treat ent Area Information: ` Design Flow(gpd) Design Soil Application Rate(gpdsV I Dispersal Area Requir (sf) Dispersal Area Propose sf) System Elevation yso p5 / f,® ys� yso 3� o r/ VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units U .2 New Tanks Existing Tanks GO c a> i j; m/�/Me 6 Septic or Holding Tank /O o Q �^^- �(�O O � Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' tgnature MP/MPRS Number Business Phone Number PlumbeA Addr e ss(S tree i ty,State Zip Code) i VI oun /De artment Use Only Approved ❑D' Permit Fee Date lss ed Issuin gent Signatur Owner en Reason r Denial $ 626 , S/JZ �� IX.Condt� easons for Disapproval 3� r J� ; (t G� r orb v; 1 e � \�_ d t , *TMn 5� "��. by plumbw. P t11 Attacb to complete plans for the system and submit to the County only on paper not less than 8 In x 11 inches in size SBD-6398(R. 11/11) a LAP ° lo 71 ;< t A) ` D Or a 13a- --vvv ol 5 + T '° ' oi ' 33 .� r it 3© 3y f ' - _ 7y9 BRADY J UTGARD Page 2 11/6/2014 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis.Adm.Code. 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 Fee Received$ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer,Integrated Services WiSMART code:7633' (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m. -4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Utgard Plumbing&Heating Note: Effective January 1,2012, all codes under the jurisdiction of the Division of Industry Services(formerly " Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. AxrNg DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD HAYWARD WI 54843 4 � 3 1,M„ k Contact Through Relay www.dsps.wi.gov/sb/ �' ow www.wisconsin.gov 'SSION SF@ Scott Walker,Governor Dave Ross,Secretary November 06,2014 CUST ID No. 220357 ATTN.-POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING&HEATING ST CROIX COUNTY SPIA PO BOX 413 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/06/2016 Identification Numbers Transaction ID No.2475036 SITE• Site ID No. 807671 Richard Bergman Please refer to both identification numbers, 2748 220TH Ave above,in all correspondence with the agency. Town of Forest St Croix County CONDITION SE 1/4,SWIA, S8,T3 IN,RI 5W APPRO FOR: Description:Mound,3 br res DEPT OF SAF Object Type:POWTS Component Manual Regulated Object ID No.: 1511106 PROFESSIONAL Maintenance required; Replacement system; 450 GPD Flow rate; 12 in Soil minimum depth to limit��i�r5t��4"bF INDUS original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12), ressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12), SSWMP Pub.9.6; Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Cod _ and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructe EE CORRESP 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 BRADY J UTGARD Page 2 11/6/2014 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis.Adm.Code. 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 Fee Received$ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer,Integrated Services WiSMART code: 7633 (715)634-7810, Fax: (715)6314-5150,M-F 8:00 a.m. -4:45 p.m. pat.shandorf @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist, (715)634-3484,Monday-Friday 8:00 am To 4:30 pm Utgard Plumbing&Heating Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. 1� 7 Ll r ° r 0 p 33 5 3 � f.3o3`� a �yg - r g�b ��.= MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project N ame RICHARD BER MAN I R Owners Name: RICHARD R CH BE GM AN Owner's Address: 5500 LAJ(if ELMO AVE. N LAKE ELMO MN. 55042 2748 220 TH.AVE. Legal Description: SE/SW/S8/T31/R15W Township: FOREST County: ST. CROIX ALLY Subdivision Name: �D Lot Number: Block Number: TY AND bERVICE Parcel I.D. Number: 014-1018-50-0000 RY Plan Transaction No.: Page 1 Index and title )NDENCE Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank , Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN Page 9 SOIL EVALUATION Designer: BRADY UTGARD License Number: 220357 Date: 10/29/14 Phone Number: 715-760-0946 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N.01/01),and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81) Version 3.11 (R. 06/01) Page 1 of 9 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor(e.g. 1.5= 150%) colifom,of<=36 inches. F-7450-0-0-1 Design Flow(gpd) 5.00 Site Slope(%) 101.09 Contour Line Elevation (ft) 12.00 Depth to Limiting Factor(in) 0.50 In-situ Soil Application Rate(gpd/fe) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour(ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/fe) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? C Center or End Manifold 3.00 Lateral Spacing(ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point 0.188 Orifice Diameter(in)(e.g. 0.25) 3.25 Orifice Spacing(ft)= 10.23 fe/orifice 2.00 Forcemain Diameter(in) 165.00 Forcemain Length(ft) Does the forcemain drain back? Y 86.00 Pump Tank Elevation(ft) 3.25 System Head(ft)x 1.3 26.91 Forcemain Drainback(gal) 17.09 Vertical Lift(ft) 29.97 5x Void Volume(gal) 2.97 Friction Loss(ft) 56.89 Minimum Dose Volume(gal) 23.31 Total Dynamic Head(ft) 28.84 System Demand(gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x X 1.00 x X 1.50 x 1.25 x 2.00 1.50 x 3.00 J 2.00 x 3.00 x Gallons/Inch Calculator Treatment Tank Information 600.00 Total Tank Capacity(gal) 1000.00 Septic Tank Capacity(gal) 36.00 Total Working Liquid Depth(in) weiser Manufacturer 16.67 gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity(gal) POLYLOK Filter Manufacturer 16.67 Dose Tank Volume(galfin) PL-525 Filter Model Number weiser Manufacturer Project: RICHARD BERGMAN Page 2 of 9 Mound Plan View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J 1/10 B . . . . . . . . . . . ion Pipe T.K A . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ­ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... J L Mound Component Dimensions A 6.00 ft E 27.60 in H 1.00 ft K 11.70 ft B 75.00 ft F 9.00 in 1 2.53 ft L 98.40 ft 12 24.00 0.50 DEflin G Aft J 8.48 ft W [A27.01 ft I 450.001(fe) Dispersal Cell Area 1 1389.711 (fe) Basal Area Available (gpd/ft)Linear Loading Rate 1 7.50 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 104.84 (ft) H 2 Ifffllflr. G ................ F Dispersal Cell 103.59 (ft) Lateral . . . 103.09 (ft)—Mo►l . . . . . . . ... Invert Dispersal Cell D . . . . . . . . . . Elevation E 101.09 (ft)Contour Elevation 5.0 %Site Slope Geotextile Fabric Cover Shading Key a a — T Dispersal Cell See lateral details on Topsoil Cap CL 1.5 ft Page 4 for number,size, C ....... a 0 and spacing of laterals. Ci -*0 Subsoil Cap 10 0 T ASTM C33 Sand T3 t F Laterals are equally PJ Tilled Layer m 0.5 ft Typical Lateral spaced from the Aggregate distribution cell's 0 9 centerline in the A distribution cell(AxB). Project: RICHARD BERGMAN Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are ldentic at IE P S •=Tura-up valve or X-4�,J2 212- Laterals&face main of PVC Sch 40 ctesnoutplug tplug ` perCOMMTable84.30-5 rtes drilled on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.00 in Orifice Spacing(X) 3.50 ft Lateral Length (P) 36.75 ft Orifices per Lateral 11 Lateral Spacing(S) 3.00 ft Orifice Density 10.23 fe/orifice Lateral Flow Rate 7.21 gpm Manifold Length 3.00 ft System Flow Rate 28.84 gpm Manifold Diameter 1.25 in Total Dynamic Head 2131 ft Forcemain Velocity 2.94 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and -�► Comm 16.28 WAC 4 in.min. Disconnect Tank component is properly vented y � Alternate outlet location Forcemain diameter weiser Manufacturer _t 2 in. Ca aci 600.00 Gallons Volume 16.67 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 24.58 409.75 B 2.00 33.34 C Pump off_elevation(ft) C 3.41 56.89 86.50 D 6.00 100.02 D Total 35.991 600.00 Dose tank elevation(ft) 3"Bedding un er tank. 86.00 Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULDS Pump Model Number EP05 Pump Must Deliver I 28.84 gpm at 23.31 ft TDH Project: RICHARD BERGMAN Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name UTGARD Phone 715-268-6995 POWTS Regulator's Name ST. CROIX Phone 715-386-4680 System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years INSPECT FILTER ONCE A YEAR Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal';cell aggregate conforms to Comm 84.30(6)(i),Wis. Adm. Code. 3. All gravity;,.and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral 'y -- Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: RICHARD BERGMAN Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54,Wis.Adm.Code General This system shall be operated in accordance with Comm 82-84 Wis.Adm.Code,and shall maintained in accordance with its' component manuals[SBD-10691-P(N.01/01)and SSWMP Publication 9.6(01/81)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce. I Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. I Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5,30 mg/L TSS, 10 mg/L FOG,and 104 ofu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: RICHARD BERGMAN Page 6 of 9 ��Gt)U�,DS PUMPS Submersible Effluent Pump EP04 & EP05 Series APPLICATIONS Fttlt}(submerged in high ■EP05 Impeller:Thennoplas- ■Bearings: Upper and lower Specifically designed for the g e turbine oft far tic enclosed design for heavy duty ball bearing following uses: lubrication and efFitent improved performance. construction • Effluent systems heat transfer. 0 Casing and Base:Rugged • Homes Available for automali Md thermoplastic design provides AGENCY LISTING • Farms ,A11ltt� superior strength and corrosion • Heavy duty sump tmatk models 1tKkW* resistance. f, M Canadian LR S ^S:«'�„,^ • Water transfer - �#��� • Water t rin Medumikid Fkwt SdrM1�Cl1 a Motor��g:Cast iron g assembled and presets at the for efficient heat transfer, P'"Ps K ISO 9001 Regntwed factory. strength,and durability. SPECIFICATIONS ■Motor Cover:Therrnoplasuc •Solids handling capability: FEATURES cover with integral handle and Y-l"maximum. float switch attachment points- •capacities up to 60 GPM. 6 EP04 Impeller Thernioplas ■Power Cable:Severe duty 0 • Total heads:up to 31 feet, tic semi-open desert w t rated oil and water resistant. •Discharge Size: 1'h"NPT. PUMP out vanes for meefiartical •Mechanical seal:;carbon- seal protection. f ota ry/ceramic-stationary, BUNA N elastomers. • temperature: 104 F(40'r)continuous 14,0 F (60()intermittent. METERS FEET •i JM(nets-300 series to 5taailc ys steel. +� a • Capable of funning 30 ;��� dry without damage to t t omponNnts 25 Motor: •FP04 Single phase:0.4 HP. v_ 6 20 115 or 230 V, 60 Hz, 1550 q } RPM,built in overload with ? 5 i ,Iutomatic reset. 4 ?si- •EP05 Single phase.0.5 HP, o 115 V or 230V, 60 Hz, 1550 EPO5 3 i0.. M t � .. _. ... r �. RPM,bu+it in overload with automatic reset. EP04 1 i •Power cord: 10 foot standard length, 16,_3 SJTW with three pronq grounding plug Optional 20 (J,. 00 foot length,16/3 SJTW with to za _io 40 o GPM three prong grounding plug - ------�_----T_1__ /� 1 - - (standard on EPt?`)) 4- jrJ r 6 8 10, rrrta� l CAPACITY Goulds Pump~ � ,,•,,,,- sr ,! �/ ITT Industries` V J ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i Owner/Buyer Mailing Address ..��dC, �,oc/� -y— �4 U� � Property Address a 7 y p l�a A /C . (Verification required from Planning&Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Locations C /4 , 5U? /4 , Sec. , T 3/ N Rj �EW, Town of Subdivision Plat: , Lot# Certified Survey Map # , Volume , Page# Warranty Deed # �? 3'T C-y (before 2007)Volume , Page# Spec house❑yesgno Lot lines identifiablek yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION ' Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS. 383.52(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. Uwe,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 Safety And Professional Services 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a warr7ty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF PLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning-&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. 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