HomeMy WebLinkAbout040-1249-90-000
WisconsnDepartment of Comnere PRIVATE SEWAGE SYSTEM County St. Croix
safety and Building Division INSPECTION REPORT Sanitary Permit No.
582059
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No.
Personal information you provde may be used fur secondary purposes [Privacy Law s 15.04 (1'.(m;,)
Village "ownship Parcei Tax No:
Prrrnd Holder's Name: City
Jim & Ann Green TOWN OF TROY 040-1249-90-000
CST BM Elev, Insp. BM Elev BM Cescr of on I e~ .GCB SecticniTownlRangwmap No:
1 6D W pe L: 19.28.19.1301 , , "n cl
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ; S CAPACITY STATION BS HI FS ELEV.
Septic y~ Ab l _ Benchmark
N~ l 1 /
~V T 3 Alt. BM 7 .4
o IJ d 6v C , G~ L a
wefatiarr Bldg. Sewer `~,3 T
Holding St/Ht Inlet 4x
TANK SET AC INFORMATION S1iHt O utlet
TA.N C TO WELL BLDG. Vent t Air Intake ROAD Dt Inlet
Septic 1 y3 DI Bottom JZ . 3 . Z-
Dosing HeaderlMan. --J
53 117'
Aeration Dist. Pipe
-75 `l.
Holding _ Bot. Systern '55
S
PUMP/SIPHON INFORMATION Final Grade 3. Cl F.
Manufacturer Demand St Cover
C~Ph1 r 'F+~- '1
Model Number
Tf3H Lift Friction LQJ~ Sy m Hei~cj, TDH Ft
Forr:emain 1 Length Dia. y ( F DM to well /
5(, Z 13
SOIL ABSORPTION SYSTEM
BEDITRENCH 'A lwth Length No. Of Trenches PIT DIMENSIONS No. Cf Pits Inside Dia Liquid Depth
DIMENSIONS -
SETBACK SYSTEMIC P;L 6LD(-, VVdFLL LAKE/STREAK' LEACHING Manufanturer~
INFORMATION CHAMBER OR ~A r L
ype Of System UNIT Mcdel NJr)
Ja4-~ a 9 3,' a, ,:Irz. 4 24
plr
DISTRIBUTION SYSTEM cI' •f- 1 (C --7.32-
Heade'iManifo)d I D stritillorl Hole Size x Ho e Spacing Vr to Air Intake
c{I Pipets)
L! Lengtt• C a V Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Deptn Over _ TT Depth of xx Seededl8cdded xx Mulched
Bed/Trench ;e-der EedlTrench Edges Dsoll yes _ No Yes Na
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: S ~1Q 1('0 Inspection 92:
Location: 271 TROON CTS' a -/z- 5 27
1.) Alt BM Description = r ' t v~ i~ S
2.) Bldg sewer length = Z'7
amoun
' Z7;
t of cover Plan revision Re uired? Yes No Use other side fo addition I in rmation. ~1 Date Cert. No.
vDD-6710 (R 3!)7)
~ro;\ Safety and Buildings Divisior ,
1~ € MAY 23 Z o i 7 201 W. Washington P. Box 7162 Saai[arY Permit Number (to be filled in by Co.)
I _
Madison, VVI , 67 2
ST. CROIX COUNTY
OMMUNfTY DEVELOPM N O ~v J 1
Sanitary Permit Application "TramsactinnN
In accordance ntidt SPS X83.2; 2), Wis Adat. Code, subrussion of this fern; to the appropriate govermnental unit
is requited prior to obtaining a sanitary pecmlt. Note. Application forms for state-owned POW. S are swinitted to Pnjea Address (if different than mailing address)
the Departmct of Safey and Professional Servies. Personal information you provide may be used for semndarv
pumses :n wzordanee with:be Privacy Law, s.::.04(lk'm), Stats. 1 _
1. Application Information - Please Print All 1nf6rrn2tio ! C4~f I
P:(_)pmty rrvnes's Name / Par_eJ N
I, ~J c 0~1C - I ot-~ 0 -OZ7V
Prapetty Owner's Mailing Address Pmperty Locanon / 3 V
Govt Lot L ~
City, stare Zip Code PtomeNumber Section
f`cuc
e' L1 --2 N. R ^ l
T ~ w ~
n. Type of Building (check allthat appl - - O Lot b -
yZ-3-at2Faintly Dwelling -Number ofBcc~ Subdivision\amc f
lock ff7 V j I
PabliuCommercial - Describe Use
I I ❑ City
7 I
"St4 N umber ❑ 4 tllage of
t9w
G State Ouned Desmbe Use
Town of /
TH. Type of Permit: (Check only one box on line A. Complete line B if applicable)
Fw Sysu:m r Replacement System r ; rwtu=t,1ioldmg Tank Replacerneat Only ❑ Otha Modi5cal;on to Existing System f explain)
B• r❑ Pemtit Rem ! Permit Revision Cunge ofPlltmb°r ❑ Patctit a3sftt o New List Previous Permit Number :md Date Lssued
Before Exp on Owns
iV. Type ofPOWTS SystemlComponeotmevice: (Check all that applyh
Non-Pressurized In-Gimund ❑ Pressurized in-Ground G At-(made G Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
L Holding Tank ❑ (-Xba flispets:il Component (explain) - LPretreatment Device (explain)
V. Dis rsanrea ent Area Information: I
Design Flow (gpd) Design Soil Applicati Lne(gpdst) Dispersal Area Required f) Dispersal Area Pro sf)
System LleyaSoo
\Z Tank Info Capacity in Total it of Manufacturer
Gallons Gallons Units = e
^tiew Tarp _ i , _ I 1~j~ t I ~ ~ ? ~ •
Sgxic a Hording Tzaic T ,
Lensing Ctamba L
VII. Responsibility State nt- f, the undersigned, responsibility for inttalhtinn of the POWIS shown oo the attached plans.
pmrnoa s ?game (Ptwt) Pi Signature %1F,MPRS Number B¢sitttss Phone Number
G
-
Plinnber's Address (Street C Star„ Zi. , `~1
Couatv/Departmeat Use Only
App-ad C U' ScrmitPu_ Date sues Issuing. Si~lature
r - i Reason for Jena q~
DL Coadi "n's approval
tlisper ,l cell mull all be srtt)i 1 3Wh§Irk ` e V p
as per maragernent plan prali by plumber. J
2 AY setback regttitietxmrtts g4rtlatrtttirsd
ae per opFkcable cods / xdinanm.
Attach to oomple places for the s~stew and submit w The Count!; only on paper par less than > 1^ x 11 inches in sift
SBL1_6348 (R. 1111'.)
Septic-Dose Wank Cross Section And Pump Performance Specifications
Tank Manufacturer - Pump Manufacturer
Tani; Model Number Model Number
r P -
PUMP
I Total Tank Capacity Alarm Manufacturer
17
Z
NMax. Bury Depth Alarm Model Number
Switch Type
Filter Manufacturer - - Total Dynamic Head ('TDH) - feet
filter Model Number Elevation %Head
Distal Pr_Network
Minimum pump performance Required ; Force Main Loss
Ft TDH j Total
2---_ GPIv=,/ L i
Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade
Locking Device. inlet Manhole With Locking Device
< 6" Below Gri de Sealed Watertight Securely Mounted
Weather-proof 1
Junction Box - -
Finished Grade * `
1
Vent Min. 12" Disconnect
Above Grade Means
With Vent Cap
Outlet Filter
Wet -
Baffi =s
Inlet
1 A
Switch Settgs and Reserve Capacity
Weep
Tank Volume GPI B Hole
Dimension Inches Volume Gal.
(reserve) A
{alarm) B 2 J Off Elevation C -3.0 X
(dose) Ft Bottom
_Zzl
{dead) D D Elevation
Ft
Total
. septic/dose tank is bedded and back filled in accordance with the
GENERAL INS'rAI,LATIOspecific Zhe specified by thB manufacturer may not
manufacturer's product approval ations. Maximum depth of bury ass 1o device adlock)
vksttgght fit ings, and
be exceeded without prior approval. Manhole covers exposed to grade have as effooti
installed. Piping at the inlet and outlet is of approved omateria ;Since 4 h 40 PVC to bridge the tank
laid on stable soil to prevent settling or sagging. The ce
excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.23.
Page of
005 U
_ I
Variahle Ievpi fi,)at switches available.
Variable level long cycle systems available. `
Available with special cord iengths of 15'. 25', 35' anc 50'.
Alarm systems available.
Duplex systems availab a _ 1
Single Seal Control Selection Listings
Model Volts Phase Mode Amps simplex Duplex 'CSA U_ r l r r,. r
1 11
float G19g`ReEv`n1blu ~r 5tY11Ch 0l tl
]5i56N5-F 71 - - M1._ 3„r455 I
oat r I' Fr,104
Phl5 tL 1 Acto 9 ,
3- Filer a,co. alterrator'"A-Pak' 1C-C+)!2 or t0.OC"
ET i b I Acto o 7.
•l model of E eclacal Allen-
_ . Se `-h1{x,'1 2 or ^orre^t
. .
C_53_7 230 1 Arlo 48 1
- - - r 1, : , i' . .
D53 55c05'59 2K t &!o 48 ,c 1, a
r c,t 55 8_ E.,, 59 230 f t Non 48 2 3,7r4&5
`,I'ye CHjQ/03Ck SW~Cn IrCI.IdCC
=onnlormahtronaadihonal?oelerprod r c _ I ;,t
Fleclrca Alternator. F"d0485: %lechanicai
Sirrp;eA Purnp Cort,CLAlarm Systems, F'.'
For unusual cond ticns a reserve safety lactor is engineered info
MAIL To: F.0 BCIX
Z \ C am' _ Lo:,,s0,e KY J02 0 4,c.' "'1"s ur
/ 54rP 7t7 7649a, c Hu
~~l r 1 ~ sr!re K." ~'J2r! C' ~;~/TY!'UM.~S ~/+N E ~Ir~J
PUMP !O. ~.z~ I.7 (890; 926-PUVP
hlip:&W~zoeder.com Z_, A%t5921 7'4-_624
r', Ccpy~iy^t 2002 Zoe'ler Co. All ~ights reserved.
Property C)v`re• Parcel ID # Page of
Bon # ❑ Boring L'' -1
❑ Pit Ground surface elev. / 0 ft. Depth to limiting factor L~ in.
Soil lication Rate
Roots GP D4
Honzon Depth Dominant Color Redox Description Texture Structure FTt',d
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
l o -1 j z iI~
ing
Boring # ❑ Bor
Pit Ground surface elev ft. Depth to limiting factor in.
L] Soil Iication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in
❑ Prt Soil icabon Rate
Horizon -iepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD1ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2
' E`tiuenl 41 = HvD, > 30 < 220 mg/L and TSS X30 < 150 mgfL ' Effluent #2 = BOD, < 30 mg'L and TSS < 30 mg1L
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, plea5c Contact the department at 608-2ti6-3151 or TTY 608-263-8777.
sao-siio rR a+x1
Property Owner Parcel ID ar page o.
Bonng # D Boring -
1 Q pit Grouna surface elev. L~ ft Depth to limiting factor t L/ in.
Soil Act lication Rate
HDominant Color Redox DesStructure Consistence Boundary Roots GPD/ff
Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 •Eff#2
1
-1 0 V,
r'
f ❑
LJ Boring # Boring
❑ Pit Ground surface elev ft. Depth to limiting factor in.
Ski p6caiio7 Rate
FHorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PDlff
in. Munsell Qu Sz Cont. Color Gr. Sz Sh. 'Eff#t 'Effi42
Boring ❑ Boriny-
F-1 ❑ pit Ground surface elev. h- Depth to limiting factor in.
Soil olication Rate
Horizon -iepth Dominant Color Redox Descnption Texture SUucture Consistence Boundary Roots GPD/ff
in. Munsell Qu Sz. Cont Odor Gr. Sz. Sh. 'Eff#1 'Elf#2
I
Effluent 91 = BODS > 30 < 220 nxj& and TSS >30 < 150 mgll- ' Effluent #2 = BODE < 30 rrg/L and TSS < 30 mq'L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need materal in an altentate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
Sen-s3
w(rt.6V0i
PLOT PLAN
PROJECT Jim Green ADDRESS N8405 510th St. Sorina Vallev Wi 54767
NW 1/4 NW 1/4S 19 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 93.5'93.0' 5' below grade 5/16/16 BEDROOM 3
DATE CONVENTIONAL XXX IN-GROt.ND PRI?SSURE CONVENTIONAL 1AFT 11OLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RA'Z'E .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of retaining wall for window ASSUME ELEVA'T'ION loo' Filter Lifetime Filter
❑ BOREHOLE O WELL x 11, R. P. same as benchmark
All piping shall be AS'YNI SDR 30/34, within
10' of tank, piping shall be ASTM F891 Scale - 1/4" _ 10'
40' 80'
Vents S'
30' 40'
2-3' X 66' Cells with >3' spacing
3
j1BS--3
.0'
2?
Pro 3
Bedroom B.M.* 94' 96'
House
Troon Court 52' B-5
B-2
Original soil test to be
replacement area 38'
Vent 12% Slope 23
-3
>6- Quick4 Standard
of Cover Leaching Chamber 3R'
with 20.0 112 of Area
1 5.6ftA2.%pair of end caps 12'
4' Long
Grade at System Clevaii0n B-1
34 ' 15'
90 c B.N1.r
232' Pro erty line
PLOT PLAN
PRC)JI-,CT J,m Green ADDRESS N8405 510th St Sorina Valiev Wi 54767
NW I %4 NW 1/4S 19 /T 28 N/ R 19 W TOWN Troy COUNTY ST CROIX
SYSTEM ELEVATION 87.5/86.5' 3.5' below grade ';3/16 3
DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 galions LIFT TANK SIZE DOSE TANK SIZE
HOLDING; TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 ~ of chambers 32
BENCHMARK ~'.R.P. Top of of SE lot stake ASSI'N1E ELEVAIJON loo' Filter Lifetime Filter
❑ BOREHOLE O WELL * H. R. P. same as berchrrark
All piping shall be ASTM SDR 30134, within
10' of tank. piping shall be ASTM F991 Scale _ 1 / 4n _ 1 01
Please note:
further testing-
will be done to
find a more
Suitable to ion.
tQ
,5 G6 • 9,
I
S'r
lD
Pro 3 y 40'
Bedroom 9 6'
'Hrouse
Z q
Troon Court i2' F3-~ ,J
B-2 y
2-3' X 66' Cells with >3' spacing
38'
Vent 12% Slope. lob
ALo Quick4 Standard n
Leaching Chamber 38'
With 20.0 ft2 of Area 5.6ft^2; pair of end caps Vents Grade at System Elevation B-1 - ;
3 l5'
232' Property Line 4 " 909, B.M.*
RE,"NED.,
t Safety and Buildings D' n~ I' ` 1
l~ 6 Ah, r w l 201 W. Washin on Ave., P. S . q,0Xjk
L-,.s ..t 9t zujserv Permit Number (to be filled in by Co.)
I P ^ Madison, WI 53707-7162
NITY OEVELOPMeNT I O( 5~ z 645
i Sanitary Permit Application St=Triusaerron. Number
In ac" dance aiffi SPS 36321(2), ll'is 4dat Code, submssion of this form to the appropnate govemmrntal unit
is requirrd prior to obtar i tg a s- ary petit. Note: A.pphcation fans for state-uwoed POW -1 S ire submated to Project Address (if dill ent thm trying address)
the Dep utmwt of Safety and Professional Servies, uersonal tniormWon you provide may be used for seoon
purposes in wcordmce with the Privacy Law, s. 15.04 1) m), Stats. i n ¢
L Application Information - P ease Print All Information
Property Owner's Narnc._ - Pnrel N
J , oyp-IaKq-qo-ooa
Property Owner`s ailing Addrces Property Location I4 a$. ~R. C
Y r✓ J ' 1 Govt. Lot
City, State Zip Code Phone Number
Section
H: Type of ilding (check all pply) l Lot tk ll
2 araily Dwcl bag -Number o ooros ` i Subdivision Name
6k c.A Inc Blo;k . /
❑ PubliclCotnmercial- Describe use city ki
U stn Ovmcd - Describe U'se CSIM Number ❑ Village of Of Z ;t~- 1 ~,b r - W. Aqw f Permit: (Check only O he box on line A. Complete line
B if app ' b ~ ,
I A.
System U Replacement System envilolld rig eat Only C Other Modification to Existing Syst= (explain)
414
r--
❑ Permit Transfer W New List Previous Permit Number and Dale Issued
B• U Permit Renewal ~ ❑ Permit Revision :
Be°orcEzpitatioa ~ 9'.
0j (?wna , `f„rq jam.,
` • 7 a c~
i,,,,V{{{. Type ofPOWT'S System/Comtwneat/llevicr. (C that apply)
Non-Pressmized In-Ground C Pressurized In-Ground -Gr L Mound 124 in of suitable soi; -I Mound <24 in. of suitable soil
i Holding Tank ❑ Other:)ispersal Component (explain) U ?retremment DeviLz (explain)
V. Ilia VTrea of Area Information:
Dori Flow' (gpd) Desiga Soil Appli:ation n Dispersl-Atea Required (sf Dispersal Ar 3a (st)
CCU 7S
ell) VL Tank Info Capacity in Total ti of Manufacturer
Gallons Gallons Units
New Tacks =aiwng Tanta u c 8 W
Septic or Holding Tank i`
Dosing Cbamba
7T _7
VII. Responsibility Statement- c undersigned, assu ponsibility for inuAlatioa of the POWIS shown on the attached plans.
Plumber's Name :Print) Plum MP(MPRS Number Business Phone Number
Plumber's Address (Street City, State
, Zip.(bde) f
J "Y
T(_1 _~cj_2_
nun '/De artment Use Unl • _
Apparved ❑ Di Permit Pee IM71 Issuing t Sig naaue
~ ven Reason for Lariat I
IX Cond ro lr~its for Disapproval
1. Septr•!ank, fi te• and
disper ceH mu" all berwc~-s I riainlainet /
as per management on proAded by plumber. j
2. All setback regwrerrlen must be inamti tried
as per appk4lAe tom, I : Minanoes,
Attach to eumpior plans for for s, mm and submit to the County only w paper net less tban g in z 11 inches in sift
SBD-6398 (R 1111)
PLOT PLAN
PROJECT Jim Green ADDRESS N8405 510th St. Sorino Vallev Wi 54767
NW 1/ 4 NW 1/4S 19 r u 28 N/ R 19 W TOWN Troy coUNTv ST. CROIX
SYSTEM ELEVATION 87.5/86.5' 3.5' below grade 1/3/16 3
DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL 1,11'T HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of of SE lot stake ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE e WELL * H.R. P. same as benchmark
All piping shall be ASTM SDR 30!34, within
10' of tank, piping shall be .AST-M F891 Scale _ 1/4" _ 10'
Pl ase note:
fu her testing
NN-iIf.,be done to
find ` ore
s le location.
20'
ST
Pro 3 40'
Bedroom 96'
House 94'
Troon Court 52' B-5
B-2 5 ,
2-3' X 66' Cells with >3' spacing
38'
23
Vent 12`~ Slope
-3
>6" Quick4 Standard
of Cover Leachino Chamber 38.
with 20.0 ft2 of Area
5.6ft^2 pair of end caps Vents
4' Long 1
Grade at System Elevation 13-1
34"
232' Property Line 90' 92 l>,
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 1/3/16
OwnerArn Green
Location: NW1/4 NW 1/4 S19 T28 N,R19W 271 Troon Court Troy
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Core /,ency Plan
7. Filter Cross Section
Signature. i
.l
License number6900
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ftn2 pair of end plates To be >1' above grade
4/ Finish grade elevation
Typical Installation 90.0'
Vent Grade Vert
3 X30/34 Septic Tank 3
5' Long 1 5 5' Long 1
Grade at System Elevation
36" Grade at System Elevation
Spacing- 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A-87.5'
B-86.5'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ( r = Septic Tank Capacity ZTrJ-r dal C1 NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer U NA
Number of Bedrooms O NA Effluent Filter Model ❑ NA
Number of Public FaciJity Units {Z(_NA Pump Tank Capacity al ' "A
j Estimated flow (average) aUda Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) allda Pump Manufacturer NA
Soil Application Rate aJ/da M2 Pump Model NA
Standard InfluentlEffluent Quality Monthly average' Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L Sand/Gravel Filter O Peat Filter
Biochemical Oxygen Demand (BOD5) S 20 mg/L ❑ NA ❑ Mechanical Aeration O Wetland
Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other.
!Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD5) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) s30 mg/L ~lA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size ;6 in dia. ❑ NA Other: ❑ NA
(Other Other: ❑ NA
`Values typical for domestic wastewater and septic tark affluent. Other. ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: Q m anrts(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume E3 NA
Ilns ect dispersal cells I At least once every: ❑~n oath(s) (Maximum 3 years) ❑ NA
P --EJ ar(s
? ❑ onth(s)
(Olean effluent filter At least once every: year(s) O NA
Inspect pump, pump controls & alarm At least once every: month (s) NA
ear(s)
;lush laterals and ressure test At least once every [3 month(s) NA
P ❑ year(s)
5ther At least once every: ❑ month(s) NA
❑ year(s)
Other: NA
MAINTENANCE INSTRUCTIONS
Inspect~ons of tanks and dispersal veils shall be made by an individual carrying one of the following licenses or certifications: Mast
1121umber: Master Plumber Restricted Sewer; POWTS Inspector: POWTS Maintainer, Septage Servicing Operator. Tank inspections mu
iinclude a visual inspection of the tank(s) to identify any missing or broker hardware, identify any cracks or leaks, measure the volume
combined sludge ana scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall b
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surfa
The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the I I
-egulatory authority.
I Nhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents
he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsi
Administrative Code.
:all other services, including but rot limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment unit,
and any servicing at intervals of s12 months, shall be performed by a certified POWTS Maintainer.
IN service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of ,
START 1'P AND OPERATION
of the POWTS check treatment tank(s) for the presence of painting products or other chemicals ths.
, prior to use
For new construction
may impede the treatment process andlor damage the dispersal cell(s). if high concentrations are detected have the contents of thP.
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result hebackup prior sto r urface e ischa pool eftloeal
To avavoi the
To d this situation have the contents of the pump tank removed by a Septage Servicing Operator
controls to restore normal level
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump
within the pump tank.
Co not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area with
15 feet down slope of any mound or at-grade soil absorption area. the performance and prolong the life of the PO11Vl G
Reduction or elimination of the following from the wastewater stream may improve P
iiisinfecta ; oitat; f oun painOngdationproductsdralii
antibiotics; baby wipes; cigarette butts; condoms cotton swabs; degreasers; dental floss; diapers; dmedications
pump) water; fruit and vegetable peelings: gasoline; grease; herbicides; meat scraps;
pesticides; sanitary napkins; tampors; and water softener brine.
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 propel
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly aisposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with so
gravel or another inert solid material.
CONTINGENCY PLAN it
If the POW S fails and cannot be repaired the following measures have been, or must be taken, to provide a code compli
replacement system:
~ v' suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption syste$ n.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requh d
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the ne
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the riles in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technolog a
holding tank may oe installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evalua n
must be performed to iocate a suitable replacement area. If no replacement area ',s available a holding tank may be install as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltra ve
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO T
BE DNF ICULT OR CIRCUMSTANCES. DEATH MAY RESULT, RESCUE O A
ENTER A SEPTIC, PUNTR O OF A T TREATMENT
PERSON FROM THE IMPOSSIBLE.
ADDITIONAL COMMENTS -
- 1-
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone Phone ✓~J
SEPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY AUTHORITY
Name
Name
Phone Phone
This document was drafted ir compliance with chapter SPS 383.22(2)(b)(1),1d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Cade.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE ,,'AGREEMENT
AND
OWNERSHIP CERTEFICATIUN FORM
OwnerBuyer
Mailing ' ddre^'
Propefty Ad l
(Verif(cation required from Planning & Zoning Depart men new construction.)
-tc'
City/State Parcel Identification Numb ^ r - I,;, L4 --0
EEGAL DESCRIPTION
Property Location Y4 , %a , Sec./-L T N R LW, Town of 7/-
Subdivision Certified Survey Map # . VcAume , Page #
Warranty Deed Volume Page #
Spec house yes no Lot lines identifiable yes
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
umialananca consists of pumping out the septic tank every three years or sooner, it needed, by a licensed pumper. What you put mto
the system can affect the function of the eeptic tank as a treatment stage in the waste disposal system Owner maintoaaace
responsibilities are specified in §Comm. 83.52(]) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrece to submit to St. Croix County Planning & Zoning Department a cerdfication form, signed by the
owner and by a master plumber, jounwyman plumber, restricted plumber or a licensed pumper Verifying that (1) the on-site
wastewater disposal systea: 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/wc, the undervipl have read the above raqu.irena= and agree to mmataln the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wiscaasim
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 foyfn are true to the best of my/our knowledge. Uwe am/are tine owner(s) of the
property described above, by vines of a deed recorded in Register of Deeds Office.
Number bedrooms,
SIGNATURtE OF APPLICANT(S) DATE
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
referencx is made in the warranty dead.
(REV. 09105)
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L;,F,cr ate ' ~~~na SOIL AND SITE EVALUATION REPORT Paae 1 of 3
L~ a
C- -t)n of Sal` ry a Rr !r~i , in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach cor,plete s to plan o- paper not less than 8 112 x 11 inches in siia.. Plan must include, but St. Croix
~nt limited to vertical and horizontal reference point (BM), direction and % o?'*.pe, scale or PARCEL I.D. #
a 1nensioned, north arrow, and location and distance to nearest road. ` 040-124Y-90 1 3o I
APPLICANT INFORMATION-PLEASE PRINTcA,'tl I Q IKf1ON R Eti"r ~BY ATE
PROPERTY OWNER: PRCPERTY LOCATION
Continental Dev. Corpora ti - ' `GOV SOT nw Ira NW t!a,S 19 T 28 ,N,R 19 X tor) W
PROPERTY CWNER'~S NIAILING A7CRHS LC- # - BLOCK# P OBC NAME OR CSV #
12301 Central Ave. -NE. Suite 230 9 na Troy Villa e
C TY, STA-E Z~ CODF PHONE NU ."?ER ` 1U'j71" rVl_LAGF [TOWN NEAREST BOAC
Blaine, MN. 55,134 (61 ,757-7568 'T
[X) New Construction Use [ ~Q Residential/ Number of bedr-odrnT 4 [ ) Addition to existing building
[ ]Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpdM2 .8 trench, gpd)ft2
Absorption area required B58 bed, ft' 750 trench, ft2 Maximum design loading rate .7 bed, gpolft2_ ~8 trench, gpd!ft2
Recommended infiltration surtace elevation( S, - 93.40 It (as referred to site plan benchmark)
Additional design; site cons'derat ons trenches spaced to code 3.5' below surface grade
Parent material outwash Flood plain elevation, if app icable na -ft
S uitable fosystem -0N.'FV- C1gA1 MOUND IN-GROUND PRF5SUF AT GRADE SYS"=M IN FILL HCLDING TANK
`ors,sten S ❑U FS ❑U ~c]S ❑U 1S ❑U I ❑S ®U 7 ❑S 1341
SOIL DESCRIPTION REPORT
Boring # Horizon Dcp'h Dnmina:it Co ur Mottles Texture Structure Consstence Bounclary Roots GPD%ft
in. Minsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T
i rench
~ i
1 1 0-16 1_Jy-r 312 none Icsbk I 2f .4 .5
mfr -
2 18-30 10yr 4 4 none sicl lcsbk mfr yw if .2 .3
- - - - - -
'b'ound 3 30-34 7.5 r 4/4,_ none _ sl 2mgr mfr gw if 5 .6
elev.
90.2 ft. 4-- 4-82 7.5yr 4/6 none
- ms osg mvfr ~ na t na .7 .8 _
Depth to
limiting ---t{k-- - -
factor
+ -
r
RemarKS:
Boring #
1 0-10 10yr 3/3 none 1 2msbk mfr cs lm .4 .5
2
10-18 i 10yr 4/4 none sicl lcsbk mfr caw 2f .2 .3
- 1t -
3 ,18-24 7.5yr-4/4 . _none 2 mar fr 9'W
_ .5
around g -
elev. 4 24-30 7.5yr 4/6 none is ms; os mvfr_
90.4 It. - ' ! , - - [ gw na • 7 .8
Depth to -5 7- Syr 4/6 -none - _~nl na . 7 ! _ 8
lroitina ~ ✓ t
factor -
-80" V %4r
1; ~ marks:
CST Nano:--Plcsse Print Gary L. Steel Phone: 715-246-6200
.address: 1554 200th e.. New, Ri mon WI 54017
I):1tC' 8-14-~197 CST Number rif D_q2
PROPERTYOWNER Continental V. SOIL DESCRIPTION REPORT Page 2 a`
PARCEL I.D. A 040-1249-90
Depth Dominant Color Mottles Texture Structure Consistence Barry Roots GPDrft
Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
1 0-10 10 r 3/3 none sil 2msbk mfr lm .5 .6
3
i
2 10-17, 10 r 4/4 none sicl lcsbk mfr gt,r if .2 .3
Ground 3 17-24 7.5yr 4/4 none sl 2mgr rnfr T gw if -.5 .6
e ev.
93.4 ft 4 -24-84) 7.5yr 4/6 none ms os ml na na .7 ` . 8
Depth to
limiting
factor
+84 t1
Remarks:
Boring #
1 0-6 10yr 3/3 none sl 2mgr mfr gw 2m .5 .6
4 L2JG - 1 D l0yr 4/4 none sicl lcsbk mfr gw lm .2 .3
3 15-27 7.5 4/4 none - s1 2mgr mvfr gw if .5 .6
Ground
elev. 4 27-82 7.5~r 4/6 none ms -off ml na na .7 •8
96.9 ft. -
Depth to
limiting
factor _
+82"
Remarks: - - -
Borng #
1 0-10 _ 10yr 4/3 none l sl - 2msbk mvfr lm .5 .6
5 2 10-25 7.5yr 4/4 none sl 2mgr mvfr gw lm .5 .6
3 25-80 7.5yr 4/6 none ms osg ml na na .7 8
Ground
elev.
96.6 ft. -
Depth to -
.
limiting _
factor
+II0„ I
Remarks: Grp l~1/tY e t C~rz-rv r~-r~ t'~,
Boring #
round
e ev.
ft.
Depth to - - - - -
Irnting
factor
Remarks: - - -
SBD-8330(R.05l92)