HomeMy WebLinkAbout038-1105-40-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
578911 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:
Francois Family Farm LLC Genevieve Trust FStar Prairie, Town of 038-1105-40-100
CST BM Elev: Insp.BM Elev: BM Description: Sectionrrown/Range/Map No:
t db to 26.31.18.440A-50
TANK INFORMATION ELEVATION DATA
TYPE MANUFACT R k CAPACITY STATION BS HI I FS ELEV.
d Benchmark A
Septic v V � (0)cc) apt 0'� M) ID03 MID
Dosing Co Y�'0bb Alt.BM�Alkrtbvu r t' '
Aora4i6ry t n r Bldg.S�w +r�S — Loi
� 5 q 3 1J
viva mum St/Ht Inlet W 5j.q I O C 1
S"Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent Intake ROAD
Septic >50 ' >Li)' >50, �5 I >I^'`1 Dt Bottom
Dosi .J--- ✓IVJ (vV Header/Man. 9 y. 8
Aeration Dist.Pipe G 9, Q
U
4 1
Bot.S stem O,
Z Z I
9(g.17-
PUMP/SIPHON INFORMATION Final Grade
Manufacturer ZQ e 1 _ Demand St Cover f 9(0
GPM ~►
Model Number GN 2 1 Z I
TDH Lift�.3 Friction Loses System Head TDH i�.3Ft
Forcemain Length 1S.1 I Dia. 2„ Dist.to well J
` OQ
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length Na�A€-Frenchi=S PIT ALWENENSIONS No. its Inside Dia. Liquid Depth
DIMENSIONS 6� V.C�� 6 ED
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer: 1
INFORMATION CHA OR
Type Of System: t �W " goo t !N/A-
` UNET Model Number:
DISTRIBUTION SYSTEM
/Manifold Distribution ' Z x Hole Size x Hole Spacing Vent to Air Intake
g � t 2 Pi 9s GI,( 2 P 9� I /tJ
Len th Dia Length -J_I is S acin V
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over /1 , Depth Over xx Depth of I xx Seeded/Sodded jxx Mulched
Bed/Trench Center - / y Bed/Trench Edges �_ Topsoil (� es BE No Yes 0 No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 5 Inspection#2:
Location: 1976 CTY RD CC New Richmond,WI 54017(NE 1/4 NE 1/4 26 T31 RI 8W) NA Lot 1 �rPPP-'' ,voM Parcel No: 26.31.18.440A-50
1.)Alt BM Description= -r �- �� C A,1L4XS A US ed * R16 -6Ji('
2.)Bldg sewer length= U C0 Dt!� / vrt ix S-hnq SY f� 0,10anC1,0AA 6/
-amount of cover O'k
cDeu
Plan revision Required? Fs-1 Yes No W j 15 A*
�
Use other side for additional information. �✓ 1
Date nsepctor's Signature Cert.No.
SBD-6710(R.3/97)
PLOT PLAN
PROJECT Genevieve Francois Trust ADDRESS 1241 200th Ave New Richmond Wi 54017
NE 1/4 NE 1/4S 26 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX
SYSTEM ELEVATION 94.2 3/31/15 3
DATE BEDROOM
COVENTIONAL 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 wood post ASSUME ELEVATION 100° Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR 30/34, within 10' del
of tank,piping shall be Schedule 40.
Scale = 1 /4'1 = 10'
Tanks are to be
Property Line pumped and buried
10 Acres
Driveway Existing 3
Dl�'
Bedroom ST DVS
Brea 15' below system House O O
is to remain
undisturbed
9292.5' 9393.5' C18'
B- 1
4 Slope Tank is to be properly
bedded and provided with
lockdown covers with
approved warning labels
B.M. 1c
300'
B-3
To be i ns u I ated as pe r code
150'
B-2
Huffcutt Grading is to be done
Combo to divert run-off away
Tank from system
93.2'
Cty Rd CC
County
r) �" Safety and Buildings Division f� 1
201 W.Washington Ave., P.O.Box 7162 Sanita Y Permit Number(to be filled in by Co.) I
-Va iison,WI 53707-7162
U lv`l-Y
ELOPMENT°
Sanitary Permit Application State Transacti tber 0-5 Q
In accordance with SPS 383?1 2,Wis.Adm.Code,submission of this form to the appropriate 0 L v 3 !
( ) pp opriate governmental unit I
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
u oses in accordance with the Privacy Law,s.15.04(1)(m),Stats. f¢ J ^
I. Application Information-Please Print All Information ( ` (•�
Property net's Name Parcel k
i ! ` 0 3 S IDS
Property Owners Mailing Address Property Location Q,
Govt of �(
City, I lip Code Phone Number Section
le ory�
T -N; R E of W/
II. pe of Building(check all that apply) Lot#
ily Dwelling-Number of Bedrooms Subdivision Name
Blockil
Public/Commercial-Describe LJse
City of
❑State Owned--Describe Use/ CSM Number
I Q�v ;3 w5 ❑Village of
. — _n
wn o
III.Type of Permit: (Check iv one box on line A. Complete line B if applicable)
A. Q N+r
i
ew System D14oement System)' ❑Treatment/Holding Tank Replacement Only � � Other Modification to Existing System(explain)
I
B. ❑Permit Renewal ❑Permit Revision I I Change of plumber El Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV.Type of POWTS System/Component/Device: (Check all that a I —
❑Nan-Pressurized In-Ground ❑Pressurized in-Ground ❑At-Grade d_>24 ia.of suitable soil Q Mound<24 in.of suitable soil
i
Folding Tank ❑Other Dispersal Component(explain)_^ Pretreatment Device(explain) f
V.Dispersal/Treat] _ent Area Information
Design Flow(gpd) Design Soil Applicati ate( dsf) Dispersal Area Require sf) Dispersal Areapopg6ed(s Syst Elevation
VI.Tank Info I Ca aci
ty in
P I Total 4 o Manufacturer
Gallons Gallons I Units I g
New Tanks 2
xisting Tanks I o a '
i
Septic or Holding,Tank
Dosing Chamber �
VII.Responsibility Statement- I the undersigned,assume onsibility for installation of the POWTS shown on the attached plans.
Pl er's Name(Print) Plumber's a e MP/MPRS Number Business Phone N bar
L� �t
Plumber's Address(Street,City,�S7tatte-,,ZipJ e) `
Z 4 V Fit S
VIM Countv/De artment Use Only
9pproved t Permit Fee Date sued Issuing, nt Signature
en Reason for Denial
DL Condlti �sons,for Disapproval `
f iSeptic'tank,effluent fifte►and' . 3\ o�,5 / A, 5d w (`O V 64e-0—
dispemal cell•must all be servtces/'maintained
aaper management plan provided by plum ber. a(tL j ti w �^�•
2 .�d'a0*k tep�remeMa must aintatiiesl
as P�+ �clade%or�llnes: 6L
Attacb to complete plans for the system and submit to the County only on paper t less than R a 11 inches in size
Cl.V) W� r
SBD-6398(R 11/11)
Lk 6e u
K-0 b¢-
SHAUN R BIRD Page 2 4/8/2015 +
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 3 83.3 3 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
This Amount Will Be Invoiced.
When You Receive That Invoice,
Patricia L VSandorf Please Include a Copy With Your
POWTS Plan Reviewer,Division of Industry Services Payment Submittal.
(715)634-7810, Fax:(715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMARTI code:7633
pat.shandorf@wisconsin.gov
cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm
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.
o�rAxTU � DIVISION OF INDUSTRY SERVICES
10541 N RANCH ROAD
HAYWARD WI 54843
3 t f
Contact Through Through Relay
F http://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
�O`�'s'sfor�LS Scott Walker,Governor
Dave Ross,Secretary
April 08,2015
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: 04/08/2017 Identification Numbers
Transaction ID No.2529283
SITE• Site ID No. 811484
Genevieve Francois Trust Please refer to both identification numbers,
1976 Co Rd Cc above,in all correspondence with the agency.
Town of Star Prairie
St Croix County
NEI/4,NE1/4,S26,T3 IN,R18W
FOR: COI°1�1T1
Description: Mound,3 bedroom residence
Object Type:POWTS Component Manual Regulated Object ID No.: 1530845 APP
Maintenance required; Replacement system; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor fro fP-' OF
original grade; System(s): Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure P'OFESSIO
Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter �N
®IV1SJON OF
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 SEE CORD
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
SHAUN R BHZD Page 2 4/8/2015
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
This Amount Will Be Invoiced.
When You Receive That Invoice,
Patricia L S an dorf Please Include a Copy With Your
POWTS Plan Reviewer,Division of Industry Services Payment 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
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
A Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 3/31/15
Owner:Genevieve Francois Trust
Location: NE1A NE1A S26 T31 N,R18W 1176 Cty RD CC Star Prairie
Manuals Used: Mound Component Manual Version 2.0 (01/31)
Pressure Distribution Manual Version 2.0 (01/31)
Page# )A4ALLY
1. Cover Page 3VEp
2. Mound Plot Plan 3,FETY AND
AL- SER\110E CES
3. Mound Cross Section OUSTRY
4. Pi Cross Section/Pi a Layout
Pipe C p y
5. Pump Chamber Cross Section
6. Pum p Curve
;ESPONDE►�10E
7-8. Maintance and Contigency plan
9-11. Soil test
12. Filter S ecificat sand cross section
Shaun Bird
Signature
License num a 226900
PLOT PLAN
PROJECT Genevieve Francois Trust ADDRESS 1241 200th Ave New Richmond Wi 54017
NE 1/4 NE 1/4s 26 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX
SYSTEM ELEVATION 94.2 3/31/15 3
DATE BEDROOM
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
Ilk BENCHMARK V.R.P. Top of wood post ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR 30/34,within 10' w
of tank,piping shall be Schedule 40.
Scale = 1 /4" = 10'
Tanks are to be
Property Line pumped and buried
Existing 3
10 Acres Driveway
Bed roo m ST D
DVS
A rea 15' be I ow syste m House O O
is to remain
undisturbed
92'9 5' 9393.5'
B- 1
4% Slope Tank is to be properly
bedded and provided with
lockdown covers with
CO approved warning labels
B.M.*
300'
B-3
To be i nsuIated as per code
150,
B-2
Huffcutt Grading is to be done
Combo to divert run-off away
Tank from system
93.2'
Cty Rd CC
Mound System Cross Section and Plan View
- - — — — — — — — — — — — — — — — — — — — — — — — — — — ` ` ( Dimension I Feet
i t A �
i ( B
I ( r r {;:':;{LJ{{{:{�::i?Sr•�'i:r;':•:'r�r':i:} JM1r _—
.M1rM1 M1 M1 M1 M1r1JM1 M1 M1r •J•r•r;,:i:'J r r J JyryJ::::::::1J�.f.~J �-- —_�-. .
A ( J
M1f~:�i:tir: fM1 M1J. J f J M1�1:1j:J•:flrtir\rti�';:±�yj1jM1::f.'• - 1• r.�
r:r JM1r M1J M1 tint M1 M1 M1JM1 M11M1 J M1 ••f JM1rM1JM1JM1Ji J r J r J r J . ( ----r
W
( ( G
H L
( 1
i
I �
I ( K
t L ;S,
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ..� w
K --- B Z I `
Slope
L
C
( — 1 = T'opsoil = AS`I M C-33 :_ = lean aggregate 0 = 4 in. sch. 40 pvc
( ( '/to 2
'/ in. dia. observation pipe
Cap Material sand fill M1 M1'
Geotextile G H
Fabric r:? �•;•:::.::;? . --�_
�r:rr F ,
:iM1•: ... r r r
�V�L: tirM1
J.r •J;J•r•r;r;f., .
D E
a �K
y `> >.
� ,Plowed Surface
y� 7i Ft Contour
Slope Direction
GENERAL INSTALLATION: The mound area is staked out along the design contour. Existinti'
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 ality sand is placed immediately
qu
inches of sand under the tracks or
after plowing. Sand is placed with a tracked machine keeping 12 or more
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 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.
10/0719j Page of
Pressure Lateral Layout
Two Laterals — End Manifold
4-- Threaded
C leanout
I-ateral Turn-up Plug
Manifold
R
ivl
1 I
X
Long
Sweep
Force Main ; 1 qp
Bend
Distribution Network Specifications i Pressure System Construction
Lateral Diameter In j
_ In. ✓ Laterals are constructed of Schedule 4y) PVC
Manifold Diameter____ _
Orifice Diameter ����� In. � pipe. Orifices are drilled perpendicular to
PY
j—i�._!, the pipe with a sharp drill bit and face down.
X(Orifice S acin ) 7 -- Lateral turn-ups terminate with a threaded
L (Lateral Len Ah � � �'t—
I't. cleanout plug and are enclosed in a 6_8 inch
M (Manifold Length)__ In diameter lawn sprinkler valve box accessible
Force Main Diameter -- from finished grade.
C
Force -_
• • • • •
Grade • • • • • • • .:�:::::....::::::: :�
6-8 Inch Lawn
Sprinkler Valve
Box
Page ----vf ---
03/05 lg)
Se tic-Dose Tank Cross Section And Pump Performance Specifications
p .
Tank Manufacturer
Pump Manufacturer " —_----�
Tank Model Number v , c Pump Model Number �--
Alarm Manufacturer __aLC-Ar G
Total Tank Capacity s Alarm Model Number - t/
Max. Bury Depth � '"
Switch Type
Filter Manufacturer P, 2714
(� Total I}ynamic Head{TDH)- Feet
Filter Model Number *Network Head
ssure _- +U
Loss
r— Minimum Pump performance Required Force Main Loss
GPM:
Ft TDH Total
Outlet Manhole Mina 4"Above Grade With Manhole Min.4"Above Grade
Locking Device, Inlet Manhole Securely Mounted With Locking Device
<b"Below Grade Sealed Watertight _ Weather-proof
Junction Box -
r Finished Grade
Vent Min. 12" Disconnect
Above Grade Means
With Vent Cap
outlet Filter
Inlet Wet Baffle X.
A 1/a„
Switch Sett%n and Reserve Capacity Weep
r:
Tank Volume GPI B Hole
Dimension Inches Volume Gal.
(reserve) A „^r - S ✓ S Off Elevation C
(alarm) B % Ft, ;: Bottom
(dose) C •�' D Elevation
(dead) D ` -� `�; Ft
7 ..:::::a•i.•:.>r
Total
..,.. ,
'.'•':>•••;.•.• with the
TION: The septic/dose tank is bedded. and back filled in accordance
GENERAL
INSTALLATION: asspecified by the manufacturer may not
' Product a roval specifications. Ma�cimum o of bury affective locking device (padlock)
Manufacturer's P Pp fittings, and
be exceeded without prior approval. Manhole covers expo grad with watertight
led.
piping at the inlet and outlet is of approved material, connected to the tank
instal P or gging. The force main is sleeved with 4" Sah•40 PVC to bridge the tank
laid on stable soil to prevent g Electrical service complies with NEC 300 and Comm 16.25.
excavation and the sleeve is sealed watertight.
Of
Page
02105 U
7�
FH77
1 52
z-
j
40
�2
Z
4
J
0
CAL1,ON'S
7 7,V
C _-V
CONSULT FACTORY FOR SPECIAL APPLICAT IONS
•Timed dosing panels available
Electrical alternator s;for duplex systems,are available arid sjpplied v;�h
an alarm
Variable level control switches are avaiiat;e for controlling single prase
systems.
•Double piggyback variable level tjoat switches are available f0i''/3rlac
level long and short cycle controls. :nsiallat:o-,; See 42"
Sealed Qwik-Bcx available for outdoor i
•Over 130°F.(54'C•)special quotation required
152J153 Series
1521153 MODELS control Sei
Model Volts-Ph Mode
_
~ J152 115 1 , N111 1 8�� __277,
to inci
1 BN152, 115 ed
��4.'3 —2 c,3
2,
�C7�1 4-3 2c,
521' 230 o
2
i 11115_1 �,5
�j 105 SELECTION GUIDE
1"5 _� 2
uto 1,05 lnciu;eo float switch or double pi�lgyback variable level float
3N 3; Sin.gle piggyback V31`131DIF level
Nor. 5-3
5 3 e-,to utoy Re.
I
¢E1531 2K
2, ee 2 for cc,rect model of c:iactncal A,iternator E-Pak,
p CAUTION ch 1,j-0225 used as a control act;vator,specify duplex',.
es and wi ring should be done by a qualified 3. va',;a0le level-0,'ArUr svi'l
All installation of controls,protection devices ri
codes should be fojjc�ed including the most -4)noal systeM
licensed electrician. Ali electrical and safety and Health Act(OSHA).
recent National Electric Code(NECt and the occupational Safety
RESERVE POWERED DESIGN
d into the desig,,,of every Zoeller pump.For unusual conditions a reserve safety factor is engineere 1 17 -
MAIL TO: P G aox �63,
SHIP TO J
nY 40
775-17,31
923 PLV
774-3624
http.11www.zoeller.com
Ail oqts reserved.
2000 Zoeil". Co
1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
SYSTEM SPECIFICATIONS
FILE INFORMATION Septic Tank Capacity al ❑ NA
Owner .,�
Permit# f Septic Tank Manufacturer HA
Effluent Filter Manufacturer ❑NA
DESIGN PARAMETERS Nq Effluent Filter Model ❑NA
Number of Bedrooms
Pump Tank Capacity �� al ❑NA
Number of commercial Units Aim Estimated flow(average)
aUda Pump Tank Manufacturer ❑ NA
k (Estimated x 1.5) < 7 aUda .Pump Manufacturer �E, �ti ❑NA
Design flow(peak), � ❑NA
/, [� aUda /ft2 Pump Model �/�l�^
Soil Application Rate q
Monthly average' Pretreatment Unit
Influent/Effluent Quality ❑ Sand/Gravel Fitter ❑ Peat Filter
Fats, Oil&Grease (FOG) 530 mg/L ❑Mechanical Aeration ❑Wetland
Biochemical Oxygen Demand (6005) S220 mg/L ❑ Disinfection ❑ Other
Total Suspended Solids SS) 5150 m /L Manufacturer
Pretreated Effluent Quality -- Monthly average" Dispersal Gell(s)
530 mg/L [3 in-ground(gravity) ❑ In-ground(pressurized)
Biochemical Oxygen Demand (BOD5) ❑At-grade � r.
und
Total Suspended Solids (TSS) 530 mg/L ❑ Othe
Fecal coliform (geometric mean) 510`cfu/100m1 ❑ Dri ine
Maximum Effluent Particle Size Y inch diameter Values typical for domestic(nog-commerclao 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 ar(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 feast once every ❑ months ar(s) (Maximum 3 yrs.)
At least once every ❑ months ear(s)
Clean effluent filter ea s ❑ NA
Inspect pump, Pump controls& alarm
At least once every ❑ month Y r( )
At least once every ❑ months ear(s) ❑ NA
Flush laterals and pressure test ❑ NA
Other At least once every ❑ months ❑ year(s)
Other. At least once every C3 months ❑year(s) ❑ NA
MAINTENANCE INSTRUCTIONS one of the following licenses or
inspections of tanks and dispersal cells shall be made by an individual carrying
Septage
certifications: Master Plumber, Master Plumber Restricted Sewer
POWTS Inspector, POWTS Maintainer,
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
or pondtng of effluent on the ground Ic surface. The ong of effluent cell(s)
on thelground Visually pond ng of effluflentnon then
in the observation pipes and to check Y Po
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 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 componetsp by a certified POWTS Maintainer.
other maintenance or monitoring at irervals of 12 months or less shall be performed
A servtcc 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 he treatment process rdamage the dispersal cell(s).
lff high concentrations ns are other
chemicals that may impede
detected have he contents of the tank(s)removed by a septage servicing operator prior to use.
Page-of
START UP AND OPERATION for the presence of painting products or other chemicals th:'.t
st(trCtlon, prior to use of the POWTS check treatment If high concentrations are detected have the contents of tf�,:
For new�con Process andlor damage
may impede the treatment P operator rior to use.
tank{s)
removed by a septage op p su
System start up over is restored o Surface d'scha ge ofrefflulent.ss
shall not occur when soil conditioV�normal highwater levels, When P
tanks may fill ab nor to restoring power to b le
During power outages Pump operator p
um tank removed by a Septage Servicing P"
e operating the pump Controls to restore normal IevN s
to the dispersal cell(s)in one large ldose,ovperiaading the cell(s)and may result 9 the pas
discharged
To avoid this situation have the contents o S Maintainer to assist in manually op
effluent pump or contact a Plumber or POWTS act,the area within
within the pump tank. ark over, or otherwise disturb or come
Do not drive or park vehicles aver tanks and dispersal cells. Do not drive or p the fife of the POWl 3'.
15 feet down slope of any mound or at-grade sail absorption area. rove the performance and prolong
diapers; disinfectants; fat; foundation drain
Reduction or elimination of the following from the wastewater stream may improve
meat scraps; medications; oil; painting P
raductis;
wipes: cigarette butts; condoms; cationol neb grease$herb' dental floss;
antibiotics; baby p
(sump pump) water; fruit and vegetable Peelings; ga
pesticides;sanitary napkins;tampons; and water softener brine. ro t 'l
ABANDONMENT permanently taken out of service the following steps shall be taken to insure that the system is p p�i Y
When the POWTS fails and/or is perms Y
and safely abandoned in compliance with chapter Gomm 83.33,Wisconsin Addm'n�tQpen'Code:sealed-
*
All piping to tanks and pits shall be disconnected and the abandoned
d of by a Septage Servicing Operator.
• The contents of all tanks and pits shall be removed and properly
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with s{•ail..
gravel or another inert solid material. I,i
CONTINGENCY PLAN not be repaired the following measures have been, or must be taken, to provide a code comp 'i n
If the POWTS falls and can system
replacement system: on by require(
❑ A suitable replacement area has been evaluated and may be utnidzecdompaction and should not be infringed t result'in the nEe
The replacement area should be protected from disturbance a with the rui€ i
setbacks from existing and proposed structure,a lot
uitableaepiacelme taalrea.t Replacement sylstems must comply
for a new soil and site evaluation to esta advances in POVVTS technologl/
effect at that time. to
❑ A suitable replacement area a last vaesole tau replace tthe failed/POSWTSmitations. Sarnng POWTS a sail and site evaluHt,i<
holding tank may be costa
The site has not been evaluated to identify a suitable replacement area. Upon failure aft e
ormed to locate a suitable replacement area. it no replacement area is available a holding tank may be installed
must be pert
a last resort to replace the failed POWTS.
at-grade soil absorption systems may be reconstreuctee n effect at that tgn1e removal of the biomat at the in i tra
�nd and 9 with
surface. Reconstructions of such systems must Comply
<<WARNiNG>> R TREATMENT TANKS MAY CONTAIN LETHAL GASSE
CES, DEATH MAY RESULT. RESCUE O
SEPTIC, PUMP AND OTHES AND/OR INSUFFICIENT OXYGEN. DO �'t
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTAN
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
--- POWTS MAINTAINER
POWTS INSTALLER Name <'
Name , Phone 4'
Phone 7 _ -a-i -s.
LOCAL REGULATORY AUTHORITY
SEPTAGE SERVICING OPERATOR P I Name
Name
,� ir^i✓° � G�
_ Phone
Phone f - ? s ! 2 & 3 iNisc;onsln Administrative Code.
This document was drafted in compliance with chapter SPS 383.22(2){b}( }(d)&(f)and 383.54(1),O O,
k ILA` CARTRIDGE INSTRUCTIONS
Oa 'w
Installation I
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
of 3/4-inch pipe needed to brace the filter to the tank end wall if utiliz!ng the.
optional supplemental side support. If side support method is not utilized,
proceed to step four.
STEP 3 For installations utilizing the op tianai supplemental sloe support:
I
_
solvent weld the -inch pipe onto the filter case. if side support method is not +-
S4/ P p
utilized, proceed to step four.
B-
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
the case.
STEP 5 If a vRS switch is utilized: insert into the filter and lock by turning
II
clockwise 90°.
Maintenance
1, The effluent filter should be cleaned every time the septic tank is A ...-
serviced.
opening to inspect the tank and filter. j
2. Open the outlet access op g
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.
4. Once the effluent level has been lowered below the invert of the
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.
6. if a VRS switch connected to an alarm is present, the switch
should be removed by turning counterclockwise 90° and cleaned N_
with water only.
7. While holding the cartridge on its side (large flat surface facing
down) over the access opening, rinse off the cartridge with water * ,
s
only, making sure all septage material is rinsed back into the tank. t
g. If VRS switch is utilized, replace by inserting into filter and V �
turning clockwise 901.
9. Inser the filter cartridge back into the case, pressing down until «
the fitter locks into the bott om, of the case. •
10.Replace and secure the access opening on the tank.
BEAR ONSITE-FILTER CARTRIDGE-FIVE-YEAR LIMITED wARRAN7Y .. .. -
SEAR OPt51TE`Filter Case-Lifetime Limited wasran-y
..„_ .._ _
t- d$S� 4vCf � Y 9a �
S �
ST. CROIX C OUNT-f
SEPTIC 'TANKMAINT NANCE j iGRt,FIMENT
ANL►
OWNERS14IP CEIMF1CAT1(--;N 1-'ORM
Owner/Buyer i Qj e
Mailing.Address_.
Property Address .____ -_-- -
(Verification rc aired fioru_Planning& Zoning f)ep r anent for new conti(incrion )
Parcel Identification Nur lber e939'— J
- - -- _.__... .._Il
LEGAL DESCRIPTION
Property Location ✓ '/� , Sec.��j S J '�} is �W "Town of ` / Pt ---
Subdivision
___��----------- ---- [sot At
Certified Survey iVlap # -- \/c ltune Page ft (�
Warranty Deed #— ----- h U V"c:lume �� Page#1
Spec house yes no l,oi liner identifiable 0 no
SYSTEM MAINTENANCE AND OWNER CERTIFICAIJON
Improper use and rnainte:nance of your septic system could result in its pr:,m ture faillue to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, it needed,by a licensed pumper what you put into
the systern can affect the function of the septic tank as a treatment stage in the wasic disposal system. Owner maintenance
responsibilities are specified in§('orrnn. 83.52(1) and uc Chapter 12 -St. Croix County Sanitary t_)rdinance.
The property owner agrees to submit to St. Croix County Planning &Zoning Department a certification form, signed by the
owner and by a master plrtrnber,journeyman plumber,restricted plumber or it licensed pumper verityiug that(1)the on--site
wastewater disposal system is in proper operating condition and/or(2)after inspec.ion and pumping(if necessary), the septic tank is
less than 1/3 full of sludge.
T/we,the undersigned have read the above reyuirenrctits and argue to maintain the irrivate sewage disposal systerza with t'hc
standards set forth,herein,as set by the Department of{::ommercc and the Departtr-ent of Natural Resources, State of wiscousirn.
Certification stating that your septic system has been rri<tintained must he complete,l and�enrrned to the St. Croix County 1'lanuing&
Zoning Department within 30 days of-the three year expiralion date.
Vwe certify that all statements on this form art, true to tlxa best of illy/our k uowledge. 1/we arrL/are the owner(s) of the
property described above, by virtue of a warranty deed recorded ill Reg;ist of Deerls office.
Number of bedroottrs, _ -- -, o0l -`
SIGNATURE; OF APPLICANT(S)
***Any information that is misrepresented may result in the salutary permit being o-�voked by the Platurirng&.Zoning;Depar-tn3eni_ =`
Include with this application a recorded warranty deed from the Register of'Doeds I-4fice and a copy of the c:ertitied survey map if
reference is made in the warranty died.
(REV.08105)
Property Owner_ Parcel ID# Page of
r' Boring# Boring �
.pit Ground surface elev. ft. Depth to limiting factor .2- in.
a Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF
J in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2
�/
5?-zv , .�' '� 1
20 -
/4� s
F-1 Boring# E] Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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# Ground surface elev. ft. Depth to limiting factor in.
E
❑ Pit Soil Application 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 mg/L 'Effluent#2=BOD,130 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.
SB"330(R.6W00)
own
Wisconsin Department of Carr 3 ` SOIL EVALUATTONREPORT Page of
Division of Safety and Buildings
f''Qe � t Comm 85,Wis. Adm. Code County
Attach complete site plan oo��}},p, k E&VI's than 8 1/2 x 11 inches in size.Plan must X
include,but not limited j�t�YUcal and horizontal reference point(BM),direction and Parcel I.D.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0 3
Please print all information. Reviewed by
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �3 /<tJ� 4/1�5
P Owner Property Location
p� ^ Govt.Lot 1/4 F1/4 S 26T .-, N R JE or W
'Property Owner's Mailing Address Lot)# Block# . o r CSM#
� / IS7 eN7. 7- .533
City State- Zip Code Phone Number ❑City ❑Village XTown Kearest Road fI
oe
❑ New Construction Use:A.Residential/Number of bedrooms Code derived design flow rate y7 GPD
eplacement ❑ Public or commercial-Describe:
Parent material Flood Plain elevation if applicable
r
General comments
and recommendations: Ly
System Type yd?12 u'J System Elevation �!
Boring# Boring
25,f4t Ground surface elev. q3• 7 ft. Depth to limiting factor—32— in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
CJI-, �' s
Boring# ❑ Boring
RPit Ground surface elev,.3 1 1 ft. Depth to limiting factor Z tf in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
2- C-1
r A/
Effluent#1 =BOD.>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD,<30 mg/L and TSS<30 mg/L
CST Name(Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 54017 _- 0 5— 715-246-4516
�
. .
Property Page ___of____
� Lj avnno
Boring surface oe m to lirnitirto factor_ —_ /»
ori
L Y-
ao�ng
i | eonpo* ^~ .
o o m �cm n
Soil Application Rate
Consistence Boundary Roots GPD/ff
Sructure
| | R��� ^� 000�
Fl s d m� / ft Dwpmm/�m��,�r m
Dominant Co4or Redox Description j Textu,e Stiructure Consistence Boundary Roots GPD/fF
in. Munsell
Effluent mI =8OD,>sO<228n«����dTS5>z0 150 mgu `Bnvem*2=aoo,<amrmpl and TSsfxonx-VL
The Department of Commerce is an equal opportunity service provider and ernplover. lf you need assistance m access services or
need nnuodu| in an abcmatc bnvu,, please contact the department at 608-266'}15) or TTY 608'264'8777.
Soil Test Plot Plan
Project Name Genevieve Francois Trust Shaun d
Address 1241 200th Ave
New Richmond Wi 54017 C #226900
Lot 1 Subdivision --------- Date 130115
NE 1/4 NE 1/4S 26 T 31 N/R18 W
Township StarPrairie
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of wood fence post
System Elevation 94.2' *HRPSame as Benchmark
oWell
Scale is 1" = 40'
unless otherwise
noted
Property Line
10 Acres Driveway Existing 3
Bedroom ST D W
House O O D W
92'2.5'9393.5'
B- 1
4% Slope
B.M.*
300'
B-3
150'
B-2
Cty Rd CC