HomeMy WebLinkAbout038-1119-80-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: ,
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)j
Permit Holder's Name: City Village Township Parcel Tax No
Susan Cronick TOWN OF STAR PRAIRIE 038-1119-80-100
CST BM Elev: Insp. BM Elev: BM Description: ' Section/Town/Range/Map No:
/ D L 5 ( 29.31.18.495A-1
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER lei A1,5 CAPACITY STATION BS HI FS ELEV.
Septic y J . o Benchmark
r-" -I Z, Off' ~T v ~d~
LAAL t 0 l.1 6z` J Alt. BM 3 L
;
Aeration Bldg. SewerIA
5k el(V
Holding SUHt Inlet
TANK SETBACK INFORMATION St/Ht outlet
TANK TO A PIL WELL BLD en Air take ROAD Dt Inlet
k{- 'b
Septic 50 0 / Dt Bottom
7 ~7 /eo
Dosing Header/Man. 5 ~~Z • s
Aeration F Dist. Pipe /Z
Holding Bot. System
I -Z
3.S o
PUMP/SIPHON INFORMATION Final Grade 13 7
Manufacturer Demand St Cover La 3•e/~,
GPM
Model Number
TDH Friction Loss System H TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS -3 1 W, I Z 14
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR A-L + o.
Type O System: O 7,~ 64 ' ~4D 1 UNIT Model Numbew J • / S
T L4/ •IJL+
DISTRIBUTION SYSTEM / ~-I(y
Header/Manifold ( Distribution x Hole Siz~ '7 pacing Spacing Vent to Air Intake
Pipe(s) E~+-e
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx D h of xx Seeded/Sodded 1xx Mulched
Bed/Trench Center S, L Bed/Trench Edge3~ Topsoil Yes ❑ No s ❑ No
COMMENTS: (Include code discrepencies, persons pprresseentt,, etc.) Inspection 1: Inspection #2:
Location: 996 192ND AVE ~ Gt "s VL- " *L,%--
1.) Alt BM Description = J W OOP .A-
2.) Bldg sewer length = $ 5 ff,~.~d(/)
- amount of cover = Gtr ~p r Ga,fl~ $G w '
Plan revision Required? ❑ Yes ~<No
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor's gnature Cert. No.
s (r c~ Y ' X
Safety and Buildings Division c;
RECEIVED
1 w 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
pS h PR 2 4 ZU ~ Madison, WI 53707-7162
ST. CROIX COUNTY
HMV 51 it Appl State Transaction N ber
In accordance with SPS 38321(2), Wis. Adm. Code, submission of this ivuu w Luc appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PORTS 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. C /
1. Application Information - Please Print All Information ` '1 6~ 1! -,P-
Property Owner's Name Parcel #
C_.ji
Property Owner's Mailing Address Property Location 9 I
3--5 0 y/~ ; AC ' ` Govt. Lot
City, State Zip Code Phone Number 1/4 I 1/4, Section -Z cir
(circle one
411 T/ N, R Eo W,,
II. Type of Building (check all that apply) a Lot #
1 or 2 Family Dwelling - Number of Bedrooms / Subdivision Name
OIL Bloc
❑ Public/Commercial -Describe Use
❑ City of
J T
State Owned - Describe Use G~ CSM Number 11 Villa--e of
❑ ~
Z ~S ~ l~-' C ::e ~c 1.2t3 C ~ c )9 Town of
III. Type of Permit: (Check only o e box on line A. Complete line B if applicable)
A.
New System El Replacement System ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System (explain)
B. ❑ Permit Renewal El Permit Revision ,9Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration V Owner $T 73
I 1117- -9
IV. Type of POWTS System/Com onenVDevice: Check all that apply)
Nr Non-Pressurized In-Ground 11 Pressurized In-Ground ❑ e 17111 _ 4 in of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (ex 3 rryc l r c . y L~ Pretreatment Device (explain)
V. Dis ersal/Treat nt Area Information:
Design Flow (gpd) Design Soil Application ygpdso Dispersal Area Required Dispersal Area Propose f) em vation
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units 0 E5
New Tanks Existing Tanks p o
' 014:~, a U rn v iz, C7 C,
Septic or Holding Tank + r
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the PORTS s wn on the attached plans.
Plumber's Name (Print) Plumber's Signature / J~vTRS Number Business Phone Number
1~ L his-IzI -~9t A4:.-.4--t/f C. t- C'L L. 7Q ~ Plumber's Address (Street, City, State, Zip Code)
l G S . c /~'cl~ < C i<< LL c<
. CountyTe artment Use Only
XApproved ❑ Dl~ Permit Fee Date sued Issuing t Signature
$ tb Z(~ I7
tven Reason for Denial U
IX. CondiSM10APWWWReasons for Disapproval VP„ Zol(e- ~7
1. Sepbo tank e+flmnt fldte vM
uispews,i Cell must dll be s-1 leis / m nt~'rec ~ P~~
As per;par.Agement plan u=owned by plumbei. e.Cr u T,'
2. AN •k mgwimi,-Ants must be m irrt, lrEd J
as pot rpFilc wa w de 1 vMinaXV1. it,510i G U le-
Attach ~to complete plans for the system and su omit to the County only on paper not less than 8 1rz x 11 in es in size
SBD-6398 (R. 11/11)
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CONVENTIONAL COMPONENT DESIGN
Resfdontla{ Appllcatiorr
INDEX AND TITLE PAGE
Project Nan1t :
()wnpr's Name: f'T' )10- 6_3
Owner's A~grPSS: -
I_.egal t)escrlptir~n i c~
I ()1NfR5{111") ~dT'`
Gotatlly; ,
~tlt]d!}IiS1cJr1 Name;
rat Rlumhsr'
Parcel 11) Number: Q~ I ! l CT ^ .rR cr
v
Page 1 Index and title
f~ap _.-Plot flan - - -
Page a ; st:An1 Si7-h1 & Cross SertT ~ jai T--
Page 4
F`llter Specs
Page " ~ Maintsnartcr~ lnfarma#ian
page
iu►aneement Plan
Page 7 St, Croix (_tv
Ss.Ptlc: wank
- JV~a
page H I'^- Zanarace forth
y 1Narranc eed
k'age g 11A or, Plat
- - e
Attachments; St,i1 Ts t House flans
Oesimeo'll 0T) her.
cc .lcensP Numher: a.?7~P9 0
il~one Nurntber ~S ~'T y Y
51r~ t1z~t► rre
I ~`'"r`lrr~`t ""';uant (n the in-(' round Solt Absorptlotl ~L,+hpon~ nt JU1on,r~t gnr Po1HfrS 1/er-goon 2.0 SSR-10701i.P (N.071fl1).
Page ?
5e' a _ q0
6 ry~~
~e .3
w`
Y .~.-:max
4del
2~ y33
~j
Soft Absorption System Cross Section
16-7 ft
4' Schedule 40 Final Grade
PVC Vent Pipe `off,
With Vent Cap ft
Leaching
Chamber % 66f ~b
ft
' System Elevation
ft~ ft
Soil Absorption System Plan View
ft
I aft
{
-a=ft Vent Or Observation Pipe Leaching Trench 1
Chambers
'In
4° Dia.
Trench 2 Header
Leaching Ghamber Specifications
F urer And Model e!4 "C-IV ~
sq ft per chamber Soil Application Rate -7 gpd/sq ft
w r 7 Soil Application Rate IVT~v EISA Chambers
2 rows ofchambers each.
Page of
POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ~ ~ ~ ~ ~ ~j c7✓~ Septic Tank Capacity ~BQC~ al ❑ NA
r
permit # Septic Tank Manufacturer D NA
Effluent Filter Manufacturer 1041111,OC,& 13 NA
DESIGN PARAMETERS
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units *NA Pump Tank Capacity at El NA
F.,stimated flow (average) _ elide Pump Tank Manufacturer 0 NA
De9ign flow (peak), (Estimated x 1,5) llda Pump Manufacturer rA NA
Soil Application Rate alldff /fts pump Model ❑ NA
Standard Influent/Effluent Quality _ Monthly average* Pretreatment Unit 13 NA
f=ats, Oil & Grease (FOG) S30 mg/L ❑ Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (RODfi) 5220 mg/I. 0 NA 0 Mechanical Aeration ❑ Watland
Total Suspended Solids (TSS) 5150 mg/t_ C7 Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Piochemiral Oxygen Demand 48013j 530 mg/I_ IR In-Ground (gravity) ❑ in-Ground (pressurized)
Total Suspended Solids (TES) S30 mg/l_ n NA El At-Grade la Mound
Feral Conform igeometric mean) s1W cfulI 00ml ❑ D Tip-Line ❑ Other:
Maximum Effluent Particle Size `_m _ Ye in dia. O NA Other: ❑ NA
nNA Other: ❑ NA
flthPr:
*VRlues typical for domeAtic wastewater and septic tank effluent. att,er. D NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
lnspect condition of tankis) At feast once every: A month(s) (Maximum 3 years) ❑ NA
3 Q ser(a)
nlamp out contents of tankis) When combined sludge and scum equals one-third IY,) of tank volume DNA
Inspect dispersal ce(lls) At least once eve Q month(s) (Maximum 3 Vestal ❑ NA
ry: 3 13 yearial
- 0 e months ❑ NA
Clean effluent filter At least once every: ~ ar(e}
--1.1-1 -
Inspect pump. Dump controls & alarm At least once every: ❑ l month(s)
earls) El NA
13 Y
'13 monthis)
f=lush laterals and pressure teat At least once every; 13 year(s) ❑ NA
❑ monthis) ❑ NA
At least once suety: ❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
insperti(inn of tanks and dispersal cells shall he made by an individual carrying one of the following licenses or certifications;
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage 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,
rneniure the volume of combined sludge and scum': and to check for any back up or ponding of effluent on the ground surface.
The dispersal cellis) 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 tank equals one-third (Y3) or more of the tank volume, the entire
rontents of the tank shall he removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113.
Wivconnin Adminfatrative Code.
All other services, including but not limited to the servicing of affluent filters, mechanical or pressurized components, pretreatment
snits, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall he provided to the local regulatory authority within 1 0 days of completion of any service event,
START UP AND OPERATION Page of
For new construction, prior to use Of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal collfs), If high concentrations are detected have the contents
of the 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 hI hwater levels, When bri
discharged to the dispersal cell(s) in one large dose, oVerlo din~ the cell(s power restored the excess wastewater will of
P#fsuent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
pump or contact a Plumber or POWTS Moir tslner to assist in manually operating the pump controls to
restore normal levels within the )rump tank.
Do not drive or park vehicles over tanks and dispersal cells. 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 arch
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; crtndomss cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable paeiinoo; galtnline; grease; herbicides; meet scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons and wat+gr e' ftenor brine.
ABANDONMENT
When the POWT S 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 chapter Comm $3,33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
w I'fre contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
After purnping, 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 treasures have been, or must be taken, to provide a code compliant
replacement system:
G A suitable replacement area has been evaluated And may be utilizers for the location of a replacement soil absorption
systarn. The replacement area should he protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot linos 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 that time,
❑ A suitable replacement area is not available due to sethack and/or scii limitations. Barring advances in POVdTS
technology a holding tank may be installed as a last resort tp replace the failed POWTS_
N ~ The site as not en evaluated to identify, a suitable replacement area. Upon failure of the POWTS a soil and site
,lbilf
N evaluation be performed to locate a suitable replacement bras. If no replacement area is available a holding tank
may -in one s a last resort to replace the failed Ps;3WTb.
Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface, Reconstructions of such systems must dortlply with the rules in effect at that time.
< WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN UTHAL GASSES AND/OR INSUFFICIENT OXYGEN, DO O
ENTER A SEPTIC, PUMP OR OTHER TREATMENT 'SANK ONbER ANY 610CUMSTANCES. DEATH MAY RESULT, RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY Be 011:rlat,p T OR IMPOSSIBLE.
ADDITIONAR COMMENTS
-
POWTS INSTALLER
Name pC?W INTAINER
I,Iaams
Phone 7,r _ `3 - - -
1 / Phone
aEPTAGE SERVICING OPERATOR (PUMPER) L!p AL ~ ~ULAtORY AUTHORITY
Name
..._Phone ~ ~ I+Satne ;
~~w f
!?bane / 810 " `T ~ri8
his document was drafted incompliancy with chapter CornM 8122f 1(wilfitwit) end 89,54(1), (2) & (3), Wisconsin Administrative Coda.
ST. CROIX COUNIYY
SEPTIC TANK MAIMFENANCE AGREEMENT
AND
OWNERSHIP CERTIFIC ATIC -N FORM
Owner/Buyer
Mailing Address <m f t i7 lu- 4
Pr~wy r -
Addrm
(Vca' fi tion required from Planning & Zoning Department for new c `cm.)
City/State Parcel Identification Nwnber
LIGAL DESCi2SMO.N
Property Location, V, ~ n/4 , sm. 'x 1' N R ~4" W, Town
Subdivision .Lot#
Certified Survey Map Volume ~ page # Warranty Deed , volume , Page #
Spec house yea uo i.ot line, identifiableyes no
SYSTEM MAINTENANCE AND OWNER CERTMCATION
Imp ore and main=&= of your septic system mould result in its premature failure to handle wastes. Proper
rnaxntcnanze consists of pumpmg out the septic tank every three years or sooner, it needed, by a licensed pum;xx. 'What you put unto
the system can affect the function of &te septic tank as a treatment stage iu the wasw disposal Mt= Owner mamteaance
responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix Casty Sanitary thdinance.
The property owner agrees to submit to St. Croix County Plann, g & Zonmg bcpartaxmi a certification f=4 signed by the
owner and by a master pluuxber, jtuneyman phnnber, 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 (it necessary), the septic tank is
less than 1/3 fall of sludge.
I/we, the undersigmd have road the alxjve roquiratuLmls, and agree to maintain the private sewage disposal system with the
standards set fortlx, hmin, as set by the Department of Commerce and the Department of Natural Resour=.s, State of Wisoonsin.
Certification stating that your septic system bas been maintained rmW be completed and returned to the St. Croix County Plamurig &
Zoning Department within 30 days of the three year expiration date.
liwt certify that all statements an tbi form ara true t4 the best of mylour knowledge. I/we amlarc tlw owucr(s) of the
property described above, by virtue of a warAnty treed recorded m Register of Deet.{s Office.
Numbs of bedr ems
/
SIGN TCTRI? OF,AI'PUC (S) DATE
**'A.nk sufwrn~faai that is ni srepresented may result in the sanitary Perrin being, resvoked by the Plarming & Zoning Department.
Include with this application it recorded Warr ty deed from the Register of Deeds OfFiice and a copy of the certified survey map if
reference is made in the warranty treed.
(REV. a8/O5)
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~~y9~'ffhp~ County,
e 3 Safety and Buildings D-
F. 201 W. Washington Ave., P.O. Sanitary Permit Number r((to`be filled in by Co.)
(f ,q 4 201,s-
Madison, WI 5370 2
~a Y T. CROIX COUNTY
MU q73
Sanitary e it -Application "'°ui:~~
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms
for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1) m), Stars. 19(e L Application Information - Please Print All Information
Property Owner's Name ? Parcel #
i ~
Property Owner's Mailing Address Property Locanon 3, i ~cfS
• Govt Lot
City, state Zip Code Phone Number ecuon L ~1
f tt ~-F~
ircle on
II. Type of Sanding (check all that apply Lot
T Subdivision N; Name R E W
"y
Family Dwelling-Number of Bcdr msg.--
Bloc
PAA-
❑ Public/Commercial -Describe Use
~u~ ❑ City of
❑ State Owned - Describe Use CSMNumber UM6 11 Village of
/V 5055 :-mown of.._ ?rt✓ %z• ! f _
III. Type of Permit: (Check only one bog on line A. Complete line B a 1' b
A. Itew System ❑ Replacement System ❑ Treatmen lding T -placement Only ❑ Other Modification to Existing System (.explain)
,~1r
B. ❑ Permit Renewal ❑ Permit Revision 4dt-C-d P1 Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner c1 ~l _ J , t_ 4
IV ofPOWTS Svstem/Com onent/Device: lit t 1 f ~-~i• UCJ~
n-Pressurized In-Ground ❑ Pressurized In-Groun❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank El Other Dispersal Component (explain) ❑ pretreatment Device (explain)
V. Dispersal/Treatment Area Inform?M, << 9 .Y~t
Design Flow (gpd) Design Soil Applicdsf) 711t Area Required (s Dispersal Area Proposed (sSystem El-vafiq
VL Tank Info Co# of Manufacuirer
Units ~ t, 5'2
°
New Tanks Tanks
F! -f U iz P cn C;
Septic or Holding Tank l w
Dosing Chamber
VII. Responsibility Statement- 4thn ned, ass um nsibility for installation of the POWTS shown on the attached plans.
Plumber's (Print) lumber's e MP/MPRS Number Business PhNPlumber's Address (Street, City, Stat
V111 C-&untv/Department Use Only
Approved ❑ rov Permit Fee Date sued Issuing t Signature
en Reason for Denial 2 t~ tQ
IX Condi ro Cason ffor i~ a roval
1. Septn et. m, nlCe~ tihk PP n D
d >rer- cell must all be seiic?s ! nr i-ntalrec' 3) ~.C►~^dc V~'e 1 r'M v
as per management plan pro iidedbyby plumber. I.
2. AV selbef* rell;Wftrjents most oe r aintr.iriEd 14
4Cou.nty IM sA- P e,C as pee appti We cock / ordinance. Attach to complete plans for the system and submit n paper not less than 8 in z 11 inches in size
SBD-6398 (R. 11/11)
PLOT PLAN
PROJECT Matthew Kernen ADDRESS 550 Rilev Ave New Richmond Wi 54017
NE 1/4 SE 1/4s 29 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
SYSTEM ELEVATION 101.5/100.5' 5.5' below grade 4/3/16 BEDROOM 3
DATE
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
Ilk BENCHMARK V.R.P. Top of mid lot stake ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL * H. R. P. same as benchmark
Property Line
.49
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be A STNI F891 Scale _ 1,,-`411 _ 101
Pro 3
Bedroom
House
221' - -
10' 2-3' X 66' cells with >3' spacing
B.M.* S
96' 10' 40' 30'
6' 12'
B-4 B-5
28 Vents
42'
32'
B-3
B-1 12% Slope
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
Property Line with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Long 12
Grade at System Elevation
34"
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 4/3/16
Owner:Matthew Kernen
Location: NE1 /4 SE1 /4 S29 T31 N, R1 8W 192nd Ave Star Prairie
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Conti cy Plan
7. Filter Cross Section
Signature
License number` 900
PLOT PLAN
PROJECT Matthew Kernen ADDRESS 550 Rilev Ave New Richmond Wi 54017
NE 1/4 SE 1/4s 29 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
SYSTEM ELEVATION 101.5/100.5' 5.5' below grade 4/3/16 BEDROOM 3
DATE
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
Ilk BENCHMARK V.R.P. Top of mid lot stake ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL -H.R.P. same as benchmark Property Line
49
All piping shall be ASTM SDR 30/34, within
Ak- 10' of tank, piping shall be ASTM F891 Scale = 1 " = 1
Pro 3
Bedroom
House
221'
10' 2-3' X 66' cells with >3' spacing
B.M.* S
96' 10' 40' 30'
' 12'
6
B-4 B-5
V ents
42' 28
32'
B-3
12% Slope
B-1
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
Property Line with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Long 12
Grade at System Elevation
34"
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 ,
5.6ft^2 pair of end plates To be >1 above grade
Finish grade elevation
Typical Installation 6/. 107.0
Vent Grade Vent
3' 4" 3'
A/30/34 Septic Tank
5' Long 111 5' S' Long l 3615 Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
7~~ At end of cell
A
B
16 chambers per cell
System elevations:
A-1 01.5'
13 100.5'
POWfS OWNER'S MANUAL & MANAGEMENT PLAN Page of
ILE 1NFOfWAMON SYSTEM SPECIFICATIONS
Owner r'? Septic Tank Capacity
I 0 NA
100-r) oa
Permit # Septic Tank Manufacturer 0 NA
IGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms 0 NA Effluent Filter Model r' 0 NA
Number' of Public Facility Units ANA Pump Tank Capacity I NA.
j Estimated flow (Morage) -:Z-72`2 gal/day Pump Tank Manufacturer NA
! Design flow (Peak), (Estimated x 1.5) aVda Pump Manufacturer NA
Soil Application Rate Pump Model NA
Standard Influent/Effluent Quality Monthly average Pretreatment Unit NA
Fats; Oil & Grease (FOG) 530 mg1L 0 Sand/Gravel Fifler 0 Peat Fitter
Biochemical Oxygen Demand (BODs) 420 mg/L 0 NA Cl Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 mg/L CI Dislnfecfion D Other.
j Pretreated Effluent Quality Monthly average D' I Cell(s) 0 NA
BSI Oxygen Dernand (BODs) 530 mgA_ round (gravity) 0 In-Ground (pressurized)
Total Suspended Solids (TSS) e30 mg/L -4NA 0 At-Grade 0 Mound
Fecal CoGf xtn (geometric mean) 5104 cfuH 00mI Cl Drip-Line 0 Other.
!Maximum Effluent Particle Size X in dia. Other. NA
Other. Other NA
i /1~(NA_~l
'*Values typical for dornes~ wa shrmAer and septic tank effluent Other.
NTENANCE SCHEDULE
Service Event
i _71 Service Frequency
inspect condition of tank(s) At least once every: 0 ,non s(s) (Maxtittta 13 years) 11 NA year Pump out contents of tank(s) When combined sludge and scum equals
one4hird (36) of tank volume 0 NA
Inspect dispersal cell(s) At least once every: ~ mo mordh(s) (Maximum 3 years) 0 NA
Glean effluent filter At least once every:
mYear(s(s) O NA
/I R)
Inspect pump, pump controls & alarm At least once every: 11 month(s) 0 NA
i=lush laterals and pressure test At least once every: 0 month(s) NA
0 year(s)
At leaver once ev 0 month(s)
ery: 0 year(s) NA
r.
NA
MAINTENANCE INSTRUC71ONS
Ilnspections of tanks and dispersal cells shall be madeby an individual prying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer; Septage 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 ponding of effluent on the ground surface. The dispersal cell(s) 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 pondiing of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
WVhen the combined accumulation of sludge and scum in any tank equals one-third (36) or more of the tank volume, the entire contents of
fd,e tank shall be moved by a SepWge Servicing Operator 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, pret eatrnent units,
l3nd any servicing at intervals of 512 months, shalt be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event