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HomeMy WebLinkAbout008-2007-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 578974 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Z Sy3 ~(p Permit Holder's Name: City Village X Township Parcel Tax No: Dickhausen, Joseph & Michele Eau Galle, Town of 008-2007-03-000 CST BM Elev: Insp. BM Elev: BM Description: a Section/Town/Range/Map No: JH?i /0&1.001 1'lf 6'90 19.28.16.562 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER .c^,f CAPACITY STATION BS HI FS ELEV. Septic 5e4-*1 Benchmark Z-32 16Z•3 Dosing P~ Y D 1 O Alt. BM ' L~ y 3.90 8 5.55 Bldg. Sewer Yrf ~2. 52 ~L• -7,(,. 77 Holding St/Ht Inlet * tZ -7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P` WELL BLDG. Vent t r Intake ROAD Dt Inlet Septic Dt Bottom ,k I`- `73.1'? Dosing Header/Man. 91,71 Z$ Aeration '•(1 Dist. Pipe 6 '7$ , Zi Holding Bot. System w•7Z. 97-4.- PUMP/SIPHON INFORMATION Final Grade -364 95t' Manufacturer GP RandSt Cover' kk, Model Number 30, I~ /r /-JZ TDH Lift Friction Loss System ad~ TD" 7~[ ~.3 S /•s~ /S 17,17 L / Forcemain Length Dia. N Dist. to Well Z SOIL ABSORPTION SYSTEM BEDITRENCH Width Length L No. Of T ench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Q 7 ~ • Z7 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type~f~ystem: ~ UNIT Model Number: I IY a U O, IIZ b /\/I+ DISTRIBUTION SYSTEM Header/Manifoldill LL/ Distribution it 1xHoleSize IxHoleSpacing V to Air take jPipe(s) Length Dia'•Z7 Length Dia Spacing U Z7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 8 Bed/rrench Edges Topsoil es No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:Inspection #2: p/,d (.d G.7>. 5 oL~ Location: 217 215th Street Baldwin, WI 54002 (SW 1/4 SE 1/4 19 T28N R16W) Star View Acres of 3 \ .r Parcel No: 19.28.16.562 1.) Alt BM Description 4T f7LP~i M!N • 5fq,41A* k 49LAbbA r e 1910 / GoJu- 2.) Bldg sewer length = 22 S d - ~8 S O r - amount of cover = V 11//~~ Plan revision Required? Fa Yes -V(No ' t ' (O 3 y s l Use other side for additional information. Date Insepc is Sign. a Cert. No. SBD-6710 (R.3/97) aarery ano tsunaings ulvlsion 5+. GCe 3 D R J!JV 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ` S P S ED Madiso 15 07- 62 .3 7015 7 S 17 ST Peymit Application' State Transaction Number :OMft ` In accordance with SP 1 - ubmission of this form to the appropriate governmental unit Z SJ , V4. 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. / Z's 5 1. Application Information - U ease Prin All Infor n l Property Owner's Name 1 / Parcel # 3osi:PH pick Mosi5v ovB _ 7m-7• 03- ooc~ Property Owner's Mailing Address Property Location a172 Qom/ ~ AVe, Govt. Lot (54oZ:~ City, State Zip Code Phone Number t ( y, y., Section a W1 (circle one T N; RI~EorV II. Type of Building (check all that apply) i or 2 Family Dwelling - Number of Bedrooms # 3 Subdivision Name STAR UZE ~ 6k 4.4 ❑ Public/Commercial - Describe Use ❑ City of El State Owned - Describe Use / CSM Number El Village of r / 8 I z / //s✓~cY R-Townof GAtk 661 ,C III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Za A' New System El Replacement System 11 Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner r Q= IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil E Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: a 0 Design Flow (gpd) Design Soil Application Rate( gpd Dispersal Area Re wired (sf) Dispersal Area Proposed (sf) System Elevation 46-0 o4 IIZ?. F IA060 5F `I?•~,3 V/ VI. Tank Info Capacity in Total # of Manufacturer U Gallons Gallons Units ©0 1d~ 52- S $ o New Tanks Existing Tanks 1 r o oA p t_x),At bd 000141,90 ,x- - K• - 1% U cn H v) w C7 w ept,c r Holding Tank 1000 Dosing Chamber 00 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number BA-R z6.401tF-ME t' 9 l D '715-- 77 -583'91 Plumber's Address (Street, City, State, Zip Code) 17 17 A 1 V / ett/ !V 7 0 5-3 Z LA , R A . 13 1T lNrv6 lit` 4-476-7 VIII. oun /De artmen Use Only Approved ❑ l`e Permit Flee Date ssue Issuing t Signature <0 en Reason for Denial $ J • ~b (p ~L~ IX. Condit' tyeasons for Disapproval 3 / o-rvfl ~t~~ itp 1,.J. l Ersal till must ad htjjR , es / maintained C~r'✓ ~ L~ ,per 'lldi pit Management plan proti ,ed by plumber. Tpquitemilt Rlttst be mairltain8d Oil pa`s rxldt / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size c >'y -4j-Qz 13 40 ~v vo ILI v acv ~ 1 ~ 411 425 IN. BARRY BIGAOUETTE Page 2 5/26/2015 Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 stars 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 4rard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.switn@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm ~kyaii7.~ DIVISION OF INDusTRY SERVICES yti~', ro{ 3824 N CREEKSIDE LA HOLMEN WI 54636 31 $ K Contact Through Relay P http://dsps.wi.gov/programs/industry-services S ,?y w~ www.wisconsin.gov O ,YG C` 0 'sf s ;tisw Scott Walker, Governor Dave Ross, Secretary May 26, 2015 CUST ID No. 921620 ATTN: POWTS Inspector BARRY BIGAOUETTE ZONING OFFICE PIERCE PLUMBING INC ST CROIX COUNTY SPIA N7053 CTY RD BB 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/26/2017 SITE: Joseph Dickhausen Identification Numbers 217 215 Ave Transaction ID No. 2543556 Town of Eau Galle Site ID No. 812548 St Croix County Please refer to both identification numbers, SW1/4, SETA, S19, T28N, R16W above, in all correspondence with theagency. Subdivision: Star View Acres; lot 3 FOR: Description: Three Bedroom Mound System / 10% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1535522 Maintenance required; 450 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter 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. GONDITIO The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code APPRO requirements. DEPT OF SAS No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.0OROFESSIONA stats. OF INDUI DIVISION The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the C R ; requirements of Sec. 145.19, Wis. Stats. SEE • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approve flans 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 BARRY BIGAOUETTE Page 2 5/26/2015 Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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. + The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 4yard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerTy.swixn@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm r INDEX SHEET L N x Q) PROPERTY OWNER: JO Se {1 (J t'<- k h a.c S eti n PROJECT NAME: Z'os~ D i c k h at~S L►~ PROJECT LOCATION: 6 L4 c f SE ~ Se c, 19 T Q 8 m R 16 u) J , MUNICIPALITY: tau ~~1 COUNTY: ST; C 6 DESIGN: PRESSURE DISTRIBUTION MANUAL VERSION 2.0" SBD-106706-(N.01/01) MOUND COMPONENT MANUAL VERSION 2.0" SBD- 10691-P (N.01101) IALL.Y CONTENTS: JED ETY AND Page 1: Plot Plan L SERVICES 3TRY SERVICES Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout DENCE Page 4: Septic Tank and Pump Chamber Cross Section and Specification Page 5: WLP lDd0/. p6_JA_&.. Tank Specifications Page 6: Pump Specifications Page 7: Observation Pipe Detail Page 8: POWTS Owner's Manual & Management Plan- Pg 1 Page 9: POWTS Owner's Manual & Management Plan- Pg 2 Name: ~rycg avuee Signed: Address: A) 7053 (f 1Y Rd. B,8 Credential Number: 9~ 16.-)o PM 5'-/ c L,/ T o Y ~ ~ .4 04 ~J ao _ g- N AQ J 14- U 4e Q- U ~ 1 l^ Y p 0 ~ ~ O ~J S 13 fy, ~r bbd CN- 5 i )LU o a IN. ~n Synthetic Covering AST'M C 33 Distribution Pipe 621- ISX Medium Sand H G s~ 7 Topsoil 3 I D E I; Coy► foc~~lev 9s~ Slope Ci~U0f 2»- 2 Force Main Plowed Aggregate From Pump Layer D 83 Ft. E ~ Ft . Cross Section Of A Mound F e Y6 Ft. G S Ft. AFt. H /.a Ft. Signed: B ~~,Sft. License Number: K l2./ Ft. Date' L O,y t. J Ft. ~c~h y l 7 Ft. W Q q, Ft. L. Observation Pipe TJ B K D", puc ~pi'C2 Nl a~ h _ T „ Distribution Pipe Aggregate r D' Observation Pipe Plan View Of Mound Perforated Pipe Detail Cleanout Access % 1-4 Threaded E n d v i s Cleanout (PoflolQ,id / ~ PvC Nivt End Manifold 10 Holes Located on Bottom Are Equally Spaced R ` / Force Main From Pump S~ First Hole Next to Manifold X / Cleanouts Distribution Pipe Layout P R K~ Y ~i S-3 ~:)t X Y D7 „ Hole Diameter Inch Lateral " A Inch (es) Manifold " Inches Signed: Force Main " Inches License Number: Invert Elevation 9, 1-3 Date: Holes Per Lateral Number of Laterals Total Holes 1 Page ~Of SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" fiX-VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE - WITH CONDUIT MANHOLE COVER W/ PADLOCK 5 WARNING LABEL 6ek) P 4' MIN. 2y r, 18" IN. r. D. ~•~l 18~~ M1N. INLET WATER TIGHT SEALS GAS- TIGHT i VAPPROYEO FILTER } SEAL ; JOINTS WITH APP~o ( ALM APPROVED PIPE PIPB : ON 3' ONTO ONTSOLID SOIL C SOI PUMP OFF ELEV . 73.SrFT. OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: W)) 1 es e r 3'5- gc;' TANK SIZES: SEPTIC /000 GAL. DOSE VOLUME INCLUDING dp GAL. 37.gg,6ul -,-FLOWBACK: 97. 3y GAL. DOSE 400' ALARM MANUFACTURER: S`r nk,,LbLic CAPACITIES: A = _Iff INCHES = d •(cgGAL. MODEL NUMBER: O I SWITCH TYPE: av.tCB = 2 INCHES = 3 GAL. PUMP MANUFACTURER: ZO~LL C = INCHES = GAL. MODEL NUMBER: /S/b _ SWITCH TYPE: _)c'fl_ I 1~ 6N,«T Fjocc+ D = _LO INCHES = 1 7GAL. REQUIRED DISCHARGE RATE ..3®•7S'GPM PUMP 6 ALARM WIRING AS PER I LHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE -)416.3 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 6., FEET + ->-30 FEET FORCEMAIN X a,07 FT/100 FT. FRICTION FACTOR y,7 FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTH 14.7 b 63. Pep- P/eks e 5e- -e- /~tik- ,Sf 'c., S~ eef" SIGNED: LICENSE NUMBER: DATE: 1/88 a ~ I ° wC Z ~ ~ < °o M _j WQ~CO NCL L) -.q- Of Cn 0 t Z w o f~ o c)o 2 _ vj Q Q F- x FCL En C°7 I cia N 10 Z (L o ~s W o Q o0 op -n% a ~-~2~ \(v C 'u cm ~Q zz o_ I oUa- o i o ow ~ a a s Q ~n~~ Q a.. aV' c°~ z l - t~J x 00 O 0 01 1 J W w LAj 0 0 I-I I I I I yr In 0 > O U 1--I O W m . D C-4 CD m F- L~ 0 (n 00^ no J Q in < mwW Ilco 0 a. -O0 .}M co o L ° W 0 y, 0 F= J C) I- ~V) 1- N~ N ~ I~ O Q o > Z in O Q Z-J11-(~o~°o o _ o m (n D OH Q ao0QWZ~WaW Za Q Z U CD J J -Q 0 O M Z Z CD V) O S C J Z s M 1 1 '•r I I I 1 W _ II 6 .,9-V LLI =II 1 1~ „ .1 I e S p 1 I 1 I I I L1J L;j I 1 1 I LL 11 ' 1 I O J I I J rL, f^ Ln :1 I I V/ I I • I 1 1 I V) •1 I j Z I i I I .1 1 i 1 ' L iJ- 0 .6C „95 ~I I ( (A Sin w •w HEAD CAPACITY CURVE TOTAL DYNAMIC HEAD/CAPACITY 3 7/e 6 1/4 Weight Seal 4 PER MINUTE MODELS "140/4140" EFFLUENT AND DEWATERING 4 5/8 Ft. Meters Gol. Ltrs. 14 45 5 1.52 91 344 0 0 3 7/8 10 3.05 84 318 + 40 15 4.57 76 288 ° ° 12 (14),4140 20 6.10 68 257 1 1/2 - 11 1/2 NPT 35 25 7.62 59 223 10 30 9.14 49 185 3035 10.67 38 144 40 12.19 21 79 8-- 25- 45 13.72 5 19 12 5/8 c9 Lock Volvo: 46' = 8 20- Q 4 5/16 r 15 SK1624A 0 J 4-- 0 10 2 3 7/8 6 1/4 - 5 + 5/8 --L 0 O 3 7/8 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 0 LITERS + 1 80 160 240 320 400 ° 0 FLOW PER MINUTE ° 010904 1 1/2 - 11 112 NPT CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied with 16 13/32 an alarm. • Mechanical alternators, for duplex systems, are available with or without -T alarms. 4 5/16 • Control alarm systems are available for 1 phase pumps used in simplex SK1524B system. See FM0732. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. SELECTION GUIDE • Sealed Qwik-Box available for outdoor installations. See FM1420. 1. Single piggyback variable level float switch or double piggyback variable level float • Over 1307. (54"C.) special quotation required. switch. Refer to FM0477. • Refer to FMO806 for 200° F. applications. 2. Mechanical alternator M-Pak 10-0072 or 10-0075. 3. See FM0712 for correct model of Electrical Altemator E-Pak. 4. Variable level control switch 10-0225 used as a control activator, specify duplex (3) 140 Series - 53 lbs. 4140 Series - 73 lbs. or (4) float system. 14014140"' MODELS Control Selection Model Model Volts-Ph Mode Amps Simplex Duplex N140 N4140 115 1 Non 15.0 1 or l &5 2 or 3 & 4 E140 E4140 230 1 Non 7.5 1 or l &5 2 or 3 & 4 A CAUTION BN140 BN4140 115 1 Non 15.5 1 or l &5 2 or 3 & 4 All installation of controls, protection devices and wiring should be done by a qualified BE140 BE4140 230 1 Non 7.5 1 or l &5 2 or 3 & 4 licensed electrician. All electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 ` Louisville, KY Cane 40256-0347 Manufacturers of. . ~ SHIP T0: 3649 Cane Run Road ® ® Louisville, KY 40211-1961 r=lrr/-!/MP6 4piYCF +9.Js9p ( http:/Avww.zooller.com PUMP !O(502) 7 FAX (502) 7740 PUMP 3624 © Copyright 2001 Zoeller Co. All rights reserved. Water tight cap 4" min. dia. Piping material can be ASTM D2665, D1785 or D3034 Slo# 6`, min. min. Infiltrative surface Water Closet Collar BarP/8" min. dia.) 0bservatl6rT-pipes must: 0 be located such that there area minimum of two Installed In each dispersal cell at opposite ends from one another • be located near the dispersal cell ends • be at least 6 Inches from the end wall and sidewall • be Installed at an elevation to view the horizontal or level Infiltrative surface within the dispersal cell Observation pipes may be located less than 6 Inches from end walls or side walls if spedfied In state approved manufacturers`Installatlon Instructions. . 1 Page ~of~ START UP AND OPERATION For new construction, prior to use of'the.POWTS check.trestmgnt 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 bedischarged 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)prtortovistoring .power to-the pump or cor"ct 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 drjn (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting product's, pesticides, sanitary napkins, solvents, tampons,'and water softener brine discharge. ABANDONMENT. When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned In compliance with s. Comm 83.33, Wisconsin Adniinistraj:14a bodei • 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: 0 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. .0 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 p The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement.area is available a holding tank maybe installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS,`AN6VHOLDING TANKS MAY CONTAIN POISONOUS GASSES-'OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY. CIRCUMSTANCE. DEATH MAY ffl=Sf~' ~S~APE=OR=i~GESGkf~:FROM.'R'F1)+'IflTERi13.R~1v1F' ~FfiANK'I~! 1lfOT:.81c'POtE: ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POW 17 MAINTtAINER , Name _r ' 0- L •G le- Name Phone / -58RE Phone / ' 7 :2 ;2 Zj SEPTAGE SERVICING OPERATOR PUMPER LO.CAL:REGULATORY AUTHORITY Name Name 45^44311C 4MAYX Phone Phone .1, CMZ 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. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page a of / FILE INFORMATION • Ower SYSTEM SPECIFICATIONS c e.h Tank Manufacturer: ❑ NA Permit # X Septic ❑ Dose ❑ Holding V01ume: (gal) DESIGN PARAMETERS' Tank Manufacturer: • ❑ NA Number of Bedrooms:' .0 NA ❑ Septic WDose ❑ Holding Volume 600 Number of Public Facility Units: (gal) ce Tank Bottom(s) to Service Pad: 9 (ft) '.VNA Frizo Estimated (average) Flow : 3DO (gal/day) ance Tank(s) to Service Pad: a~ (ft) Design (peak) Flow = (estimated x 1.5): S--© (gal/day) mechanics must be provided If vertical is >15 feet o r 50 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: 4/ (gaVday/fe) . Effluent Filter Manufacturer: loo Y /a Standard (Domestic) Influent/Effluent onthly average Effluent Filter Model: ❑ NA Fats, Oil& Grease (FOG) s30•mg/L Biochemical Oxygen Demand (BOD5) s220 mg/L• . ❑ NA Pump Manufacturer [~c , Cr Tota).Sus .tided S.plids.(TSS sYgA mg1L Pd;ntp~ Model ❑ NA High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L' Manufacturer: (B.OD5) >220 mg/L NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat-Filter A Pretreated Effluent Monthly average ❑ Disinfection ❑ Wetland ❑ Sand/Gravel Filter ❑ Other: (BODE) s30 mg/L Soil Absorption System (TSS) s30 mg/L CW NA Fecal Colfform (geometric mean) ;10' " 0 In-Grade (gravity) . ❑ In-Ground (pressure) El NA Maximum Effluent Particle Size Vivound /e in dia [I NA ❑ Drip-Line Other ❑ Other: [I NA Other: ❑ NA MAINTENANCE SCHEDULE. Service Event Service Frequency Pump out contents of tank(s).'When combined sludge and scum equals one-third A) of tank volume When the high water alarm is activated Inspect condition of tank(s) • At least once every: ❑ month(s) > year(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) year(s). (Maximum 3.years) ❑ NA Td g Clean effluent filter At least once every: 3 month(s) year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: month(s) 13 ❑'year(s) ❑ NA Flush laterals and pressure test 'At least once every:. ❑ month(s) ❑ NA Other: l~ .ear(s) At least once every:. ❑ month(s) Other: ❑ t'ear('s) ❑ NA ❑ NA 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 (3) 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 512 moliths, 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 (02/0.5) r ~ g r = ' e 12 flail Is a I [If 1110 1 IM, MIMI 4- i till ~s ~4 b - Is liN¢ I a iill I smtm-eal~A~ M~~aucw~w oeuwvlS R YDHIJM A I3 1 It I 9 7 19 I W "rq~~ III I 1 t R'ttt LMtMN11 1 1 ' E { I d I® ` `r I I~ all C ss g Y I 3 I W Awkstae» lL6Vi'~iO A® f f o~ raj.. i v ~ All v II~~,,, g r, ~»wuasnuw~ ~ L I W O i : f3$~~~$Rt4~~~A :':",m .+o'ttcratwaew~w ' 1 - n it on fill %mom R j~ 1gyg~ @x ~ ~k$$AFSS~~ya~afe~§ ~ ~ i e!~ ~ i 115 10 lilt I Ml it it sin~~~~~~ `_J I ®B • • o I ( 1 _ I H d ' ` r~ w~~r err I ~Jl. I,iCVl1~ I.VUl\ 1 Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -SOS 04 b x C~ y h us Exl Mailing Address 2 / 7 713- e- Z"- Property Addrest ra 17 alb , (Verification required from Planning & Zoning Dep ent for new construction.) City/State '9AL&).rAJArl. Parcel Identification Number LEGAL DESCRIPTION Property Location 5W 1/4 , 1/4 , Sec. _L2~_, T _2_1 N R~W, Town of EA( 6,4 S Subdivision Plat: -57, -*R yrciy 44 re , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yes no Lot limes identifiable skyesOno 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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. I/we certify that all statements on is 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 arranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(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. (REV. 04/12) r ~ Property Owner U S L Parcel ID # Kj G Page Z of 3 Boring # ❑ Boring i Pit Ground surface elev. . S ft. Depth to limiting factor -j-9-- in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounds Roots Soil Application Rate In. Munsell n' GPD/ft Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •E02 O-~ 10`123LZ S1 1 Z'~5b1T h1`Fh L° w - . S Z -L9 Lo`tiR 316 Si I 3`Psb►z vnf C1,v . 5 . g 3 l9-~~ ~•S`tQ-yl6 G1~ ~.SLt2 SZZ:, s\,Q- Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor / 11). Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounder Roots Soil Application Rate In. Munsell Qu. Sz. Cont. Color Boundary GPD/ft Gr. Sz. Sh' 'Eff#1 •Etf#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate In. Munsell Qu. Sz. Cont. Color GPD/ft Gr. Sz. Sh. •Eff#1 •EIf#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODE < 30 mg/L and TSS < 30 mg/L Tlie 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. SDD-8330 (R.6/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x l inch County_ x include, but not limited to: vertical and horizontal referen point)~dtln'arfd~ percent slope, scale or dimensions, north arrow, and to lion and distance to nearest road Parcel I.D. Reviewed Date Please print all informs 'on. APR 18 2002 Personal information you provide may be used for secondary p oses (Privacy Law, s. 15.04 (1) (m)). Property Owner ZONING' ocati n 4~ . C "R-IS 1-cV SI L L IT - of 1/4 sJ~ 1/4 S T Z$ N R 16E (or W Property Owner's Mailing Address LC-ity Block # Subd. Name or CSM# I'Al 1" 3S InCW"PUSED TZ Vt~w Etylu State Zip Code Phone Number ❑ ❑ Village ® Town Nearest Road S wI sg0ZzZ (-11':-) uz6 -1--77 SiP" C-3f LA E Zo-rlt-►°rvt--, IL New Construction Use: IQ Residential / Number of bedrooms ' 3 Code derived design flow rate 14 SO GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G L I YF -L - n- Flood Plain elevation if applicable ft. General comments 7 4 - and 'recommendations: Y`'1 ~U 1~ n~ w ' K Sp ~jL l M i~vlMU h1 Zz" QF S P9-~ F1 LL, CCWJ' 0, _ aLN . 10L,Of Y` Boring # ❑ Boring pit Ground surface elev. ~0 b • O ft. Depth to limiting factor S in J Soil Application Rate k Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 Q in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2. T ~ - )oKRj 1 Z - si ~ Z~{-sbl~ YVl'~h Cv..~ - , 5 .8 y Z 8-lS 1D`~1R316 - _ S t d Z-'~-Sbk h~l`~1- C W ~ 5 3 s 3 z -x.51 fZ Lllb f l'~ ~,S~ Q sts s ~1 to-sb k M` p - . Z .3 Fz~ Boring # ❑ Boring l' ® pit Ground surface elev. O 3 • aft, Depth to limiting factor ) 7 in, Soil Application Rate Horizon Depth Dominant Color . Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 l' 1 0 W-t 1ZZ 3-1 Z - ;I Z.'Fs b vy,-R Z $ -Lq xC t 2 316 - S LAC Z. f ao M-f- - e1-3 3 )t1 31 ~SY2 Y(6 '~'F" S`12 SAS sicJ 1 it ' Effluent #1 = BODS > 30 < 220 mg/- and TSS >30 < 150 mgA. ' Effl =BODE 30 mg/L and T < 30 mg/L CST Name (Please Print) gna t a CS Number Arthur L. Wegerer aut4, Lsi 22 254 Address v e g e r e r Soil T e s t i n o, & D e s i g n Service Dal- Evaluation Conducted elephone Number 421 11. 1-iain St. River Falls, 1.11'54022 Z- -o 3_b_pZ 715-425-0165 Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page of 3 in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S include, but not limited to: vertical and horizontal reference point (BM), direction and C 2O x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Ppup ! 6 Please print all information. Reviewed by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` Property Owner C 21.5 1-cU gt L Property Location L Property Owner's Mailing Address -Go* Lot S w 1/4 1/4 S T $ N R 16E (or W' Lot # Block # Subd. Name or CSM# l A t 1'~l 3 s 3 t'~-upn SEDgT'~fZ U ~ S C'ty State Zip Code Phone NumberL S R.t U>~ ~`~LS w I S ~0 Z ❑ City ❑ ~Ilage ®T own Nearest Road Zi (~lS) 14 26-t-1 -2 GfrLL.r-: i Zo -FH-- 10)4j New Construction Use: ~ Residential /Number of bedrooms ' .3 Code derived design flow rate ISO ❑ Replacement E3 Public or commercial - Describe: GPO Parent material G L11";r-L EL ~ Flood Plain elevation if applicable N General comments ft and recommendations: 1'`'1~U1~~ ~ •~S~, bl M O F- S P9,-,t Ft LC.. , C-CJntVOV'L- a V . IOL,pf El Boring # ❑ Boring Pit Ground surface elev. t b • O ft Depth to limiting factor 15 in. Horizon Depth Dominant Color Redox Description oll Application Rate Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. ConL Color 1 Gr. Sz. Sh. 'Eff#1 'Eff#2 f3 toK(Z j J Z - st l Z~sb Z 8 -~S lD`f R 3l6 - ~'L YVI~ e►.`~ - . 5 .8 st I z•'FSbk tn~F>-. cw - ~ s e 3 1S 3 Z -1 .Sy Q X16 l'F -).sLI R, S/8 s ~I 1.CSb k E Boring # ❑ Boring ® Pit Ground surface elev. ) 0 3.3fL Depth to limiting factor 1 y in. Horizon Depth Dominant Color Redox Description I Texture Structure Consistence Boundary Roots Soil Application GPD/ft2 Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ° 1.eq i2.3/ Z. 9 i I Z-' z b vnf C s Z $ -l~ LOK 2 316 _ - • S - r3 s i ~ ~ Z~F sb yn'fr ~ e.t.J - . ~1 .6 3 t~1 31 ~S`f VA, Tl'F Sy2 SAS sick 1~sbk yn~Ft- - . i . 3 Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < ST Name (Please print) - S s_ 30 mg/L and TSS < m er C30 mg/L Arthur L. We>serer igns a CST Number .-.2~`= 3 220254 Address Wegerer Soil Testing & Design Service Telephone Number 421 ld. Iiain St. River calls, [;I054022 Date'ZIuatio-o duct ~-b-OZ 715-/►25-0165 Property Owner k' U S L ~C - Parcel ID )1 G Page Z of 3 Boring # ❑ Boring pit Ground surface elev. . S ft. Depth to limiting factor -LC- In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 lb`•l23L-Z- - St Z`~'sb(T M-fh -S , H Z ~-~9 Lo~R 316 - si 1 3`Psbk. v►~'Fh L°_.f,J - • S - ~ 3 la-~$ •S`1R-~1~6 GLk ').S `tt2 SzS SlC` 1CSbk ylt~~ _ •Z , 3 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. it. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff/12 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I _T Effluent #1 = SODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODE < 30 mg/L and TSS < 30 mg/L Tlie 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. SOD-8330 (R.6/00) PLOT PLAN Page ~ of 3 y0 ' Scale I'= J J LC -r ~uT LiKi ~ LET 3 9.1 3r~~1 h D~,o T 6 $•z lc)C) r,-)L)1' ~M1~ Pt~T `~g`i S cb►.~~z _ X01.0' O 1Z D S~LV Bo TTOw1 OF- StL. J tzL 1.0 Z. g y ' 96 for z '1 tit ~z: l o a> ` _orv 't t L , _3 t DMA Q~ BP~z w! c=t'rN : ~J 2-6-o Z I-6-0 z. 715-425-0165 220254 OI-z~- 3 CST Signature Date Telephone I•Io. CST No. Job NO. nom, ~ I 7 43V Q, oo , , i W(J, „ 1190 r L0 3 AC (3.63 R -2 B- O 130' B_ REC -2 JUL B-3 ST.CRO. ZONIN( :::::::::yam 3+ h~ J{ U3 r r BOO 5? 0 a-0 ~o~o o ~I SURVEYOR: DOUGLAS J. ZAHL S&N LAND SURVE' 2920 ENLOE SIRE su1TE 101 _ HUDSON9 M5401 SE COR. EN43INEER: N88°2cmFMA/ SEC. 19 AUTN CONSULTIN