HomeMy WebLinkAbout036-1031-20-000
v'dscorsir Departr ent c` Gomrie•ce PRIVATE SEWAGE SYSTEM t' St. Croix
Safety anc m ildinc Division
INSPECTION REPORT Sanitary Perm it No:
584781
GENERAL INFORMATION ,ATTACH TO PERMIT] State Nlar ID No
Personal infornatior you provide nay oe used for seccncary purposes [Privacy Law, s 15 04
Pc-mit Holders Narie Villa!1e -own .hip Parcel Tax Nu
Wayne Ailts TOWN OF STANTON 036-1031-20-000
CST Bli Elev.
1 /66 6P Irsp. Bbl Flev RM 7)esrf firm Section/Towr Rarge Mau Nc
14.31.17.197B
TANK INFORMATION ELEVATION TA
TYPE MANUFACTURE ` CAPACITY STATION BS HI FS ELEV.
Septic j~ 4J /b Renrhmark
Dosing t ,
t Alt 8h4 69 160
Bldg Sewer
52 f i 17
Holding SjHt Inlet IZ ~b{ -73, 7-
SUHt nutlet ~
TANK SETBACK INFORMATION
TANK TC' P!L N1ELL BLDG. vent to Air intake ROAD Dt Inle. `
Septic t If DI Bottom 1 134 Ali
t, ~0 T
Dosing ~e ~ r I ~ Header/Mari. ~.b~ cad' B
J ~f I
Aeration v Dist. Pipe q c'~ e7
Holding Bot. System 9r ~Z G , ~1
Grade
PUMP/SIPHON INFORMATION Final
"anufacturer Derland St Cover -5. 166
O J S GPM eJ`. 7 cr
Model Number I
7U TDH 1-7,.-7Friction Loss Syste He TDH6 F
i
Forcomain -enlb Dia. 't r it to 1AV1
SOIL ABSORPTION SYSTEM 10
BED(TRENCH VVdth _cn0th No Ot Trenches PIT DIMENSIONS No. O` its Irsiec D` Lauid Depti
DIMENSIONS 3 I fee-
SETBACK ,~5^SYSTEM TO Y P!L ELDG bVFI l LAKEiSTREANI LEACHING Manufach.rer
INFORMATION CHAMBER OR
Type C`oystrrtr _ ! UNIT 6"odel Number
NJ tL Y `iT"J $ ~ ~ A
DISTRIBUTION SYSTEM ~s • s fa~
HcadeiWandold Dis'ributicn Ix Hole Size x role Spacing Vent Air Irtaag,
Pipes; ` t✓ w~hL//'
Leno[h_~ Dia Length Dia Spaciny
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Mulched
Qrpth Over Dep:h Civer za Dep:h of xx Seeded;Sndded r
, ' tied -rencr Edges Tcosoil -Yes L No Yes No
Bed Tr?nch Ccrtc 5
COMMENTS: (Include code discrepenries persons present, etc.) inspection #1 Inspection #2'
Location: 1881 220TH AVE 1b J~~ 64 $
U
1) All BM Description = rf ~r 6h r t ~
e ej ' a
2.) Bldg sewer length l.itJ ~}Q
- amount of cover
7 !o d G3~,SL.~ o & G.l k a.T C '0
Plan revision Required? Yes >No I ~d~ O3
Use other side for additional information
L'ate Insepctor's Sign a Cert . No.
SBD-C71C fR.2!C7.
County
f- 3R Safety and Buildings ion ST. CROIX
r ; DS 201 W. Washington Ave., .O. B 62 Sanitary Permit Number (to be filled in by Co.)
AP rl MAY 2 6 20 6 Madison, WI 5370 2
75
ST, CAW COUN ~ IJNJTY br= .
L
SaIlltarylpe )plication ransactio Number
In accordance .vtth SPS 38:.21(2), Wis. Adm. Codc, submission of this f tim to the appropriate go, ernntental unit
rs reyunrd prior to obtaining a sanitan permit. Note: Applt.:ation tcrns ldr state-owned POWTS arc submitted to Project Address (ifditlcrcnt than mailing address)
the Dep,unn(-',t ul Salety and Professional Servics. Personal infbrmati n ,.,u provide may be used for secondary 1 im nr,e 119
, it) accu owe with the Pnracv Law. s 1 5.04; I)fjn). Stats. JF{rli 91, rLlue-
1. Application lnforntatior ase Print All Information
Propert;, ( )caner s Name Parcel e
WAYNE AILTS036-10312-0000
Property Owner's Mailing Address Nuorerty Location
1881 220TH AVE Govt Lot / C~
(1 r I7 800)
ity, State Zip Code Phcne Number NE NE Section 14
DEER PARK, WI 54007 N/A circle one)
T 31 N: K 1 ~ F or 0'
[I. Type of Building (check all that apply) Lot a
1 or 2 Family Dwelling - Number rd Bedrooms N/A Subdivision Name
Wock 9 N/A
❑ Publicr'Conunerciaf Describe Use ❑ City of
N/A
❑ Statr. Owned Describe Use CSNI Number ❑ Vdlagr of
n ~;b~ ~G~~~ ~~/'~1~~ N/A *1Town of STANTON
1141. Type of Permit: (Check n one box on line A- Complete line B if applicable)
A. tiIstem Replacement System
❑ Treatment-Holding Tank Replacement Only ❑ Other Modification to Existing System (r.xpl:un)
K. (J Permit Rearwal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Nmnrrer and Date Issued
Retore Expiration Owner
IV. Type of P0%%"I S System/ComponenUDevice: (Check all that apply) /O 4J~ t
IX Non-Pissut i/Ld In-Ground D Pressurized In-Ground ❑ At-Grade L Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable sod
❑ Wei nq lank ❑ Other Dispersal Component (explain) ❑ Pretreatment Dcvice (explain)
V. Dis rsalrl'reat nt Area Information:
Design Flew (gpd) Design Soil Application Ratc(gpdsf) )isl)ersal Atra Required (sO Dispersal Area Proposed System Elevation
642 650
VI. Tank Info Capacity in Tntal of Manuracturcr
Gallons Gallons t fair, E c to
u
New Tanlcs Cxisting Tanks o uLJ'
~l✓ ~d ,~z a C n v: J o.
Srpticor Holding Iauk 1000 1000 1 W ESER 1 I~ X
n~xinr ('hamper - 600 600 1 T
VII. Responsibility Statement- 1, the undersigned, assume respunsibility fur installation of the PO\Y TS shoart on the attached plans.
Plumper s Name (Print) Plumber' natug N1P, MPRS Number Business Phone Number
PAUL KOEHLER 225410 7_1_5-246-2660
Plumber's Address (Strcct, CoN, State, 7ip Cude)
321 WISCONSIN DRIVE, NEW RICHMOND, WT 54017
VI . County/De artment Use Only
Approved Permit QFe~ej DD~at Iss d Issu' Agent Signa re
XNlwi,v cn Reason nial ~tJ ' "L/ iIt V 3 I (o
E
Ix. Condign tbk a casnn for Disapproval
Sept . ar a t,k n, t e : •t, l~ --L ~v Y e-r' ~-atQ
uisper, cull all he s-i:_k~s. rnainta:Cec Q
as per fnar.agement plan pro tided by plumber. I `I F
2 R1l ~NbtiCk f1~U1MQf 11Mt5 fry}t6t. f+e tndlM~ ir.ed P~` l d IrNfl t~,,
as (Jl Al l~ Y1
pK wpib" a*& / ~f di ums3.
Attach to compete plans fvr the s)slem and sub to the (wanly ooh ol, W r nut I n :1 x 11 inches in sin
t~a Got~.~- ~
SBD-61,98 (R. I 1 11 ~y
. S
46
WAYNE AIL T" SEPTIC RFP~- ~-Fl l---NT
5YSTEIA SYSTEM ELEVATION
BENCHMARK 100 FOR BCT-! 1 AND B,JT W OF SIDEING OF S iEC OR
HOME
SYSTEM ELFVTION 95
,20TH AVE 66 FT
LL DRAIN
0
~o
i
WISER 1,600 COMBO TANK
3 BEDROOM SHED
POLY LOCK 525 FILTER HOME
Q H 4C
L5 TRENCH
TWO TRECHES OF EZ FLOIrv' t5 F I LONG
S F 1
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND I ITLE PAGE
Project Name: WAYNE AILTS
Owner's Narne. WAYNE AILTS
Owner's Address: -1881 220Th _e1VF,___
DEER PARK, WT 54007 -
Legal Description: NE 1/4 NE 1/4 S 14 T 31 N R 17 W _
Township: STANTON
County: ST. CROIX
Subdivision Name NIA
Lot Number: N/A
Parcel ID Number 036-10312-0000
Pagel Index and title PG 10 SOIL TEST
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
t
Page 4 Filter Specs
Page 5 ---------P1N- P
Page G PUMP CHAMBER CROSS SECTION
Page 7 COMM TANK P-'-'Fr
Page 8 PUMP. CONTROL
Page 9 MANAGEMENT PLAN
I
Attachments: Soil Test & House Plans
i
Designer/Plumber. PAUL KOEHLE.R License Number: 225410
Date: 5/25/16 Phone Number 715-246-2660
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POVITS Version 2.0 SOD-10705-P (N.01101)
Page 1
WAYNE AILTS SEPTIC REPLACEMENT
SYSTEM SYSTEM ELEVATION
0 BENCH MARK 100 FOR BOTH 1 AND 2 BOTTOM OF SIDEING OF SHED OR
N1 HOME
SYSTEM ELEVTION 95
220TH AVE 66 FT
WELL DRAIN
Q ~
0
1.0
WISER 1,600 COMBO TANK
3 BEDROOM SHFD
POLY LOCK 525 FILTER HOME
30 F SCH 40
Q
n
25 FT L5 TRENCH
TWO TRECHES OF EZ FLOW 65 FT LONG
25 FT 4=ff~
SOIL ABSORPTION SYSTEM DETAIL! GRAVELLESS LEACHING UNIT Page_ol_
Project Name: /
No. of Cells ~s Per Cell
ff Cell Width 5 Total No of 13n
n Cell Length
sq fl EISA Per Cell
It Cell Spacing GS fl sq ft Total EISA
Manufacturer Model Laying Length EISA Rating
InfilUato' EZ1203H-5ft 5.0' 25.0
c712031-i 1:Jft 10 01 5U 0
Gravelless Leaching Unit Manufacturer:
Gravelless Leaching Unit Model: Z eLy
Typical Cross Section
Finished Grade `d)
_ Observation Pipe with
approved cap or vent
•
--Soil Backfill
in • y~
Geotextiie Fabric
--V {
" ft Infiltrative Surface
12 i,,
3.~ft Limiting Factor
---,Slotted and Anchored Vent/
Observation Pipe with Cap
r.•
PlumberlDesigner Signature:
License a#:/~~, J ~J~Lf Date.
~'~I✓ ?S d~~
PALOMlnc
,4g C~t
PL-525 Effluent Filter
(I7,04d(l'Jl1S !R i'te~351, n!anay:: ~ Z2tK t'
& tfastewa(er Ftojutts b 6.izon c' Pol.+nk Inc.
PL 525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
ti25 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PI.-525 has an automatic shut-off hall
installed with every filter. V%Ihen the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tank.
Features: 1/16" Filtration Slots
:'alarm Switch
• Rated for 10,000 GPD (gallons per day). (Optional)
• 52-5 linear feet of 1/16" filtration. T~~~OQP
Accepts
4'" and G' SCHD 40 pipe. . v cepts 1" PVC
•
Extension Handle
• Built in l;as deflector.
• Automatic shut-off ball when filter is removed.
Rated for
• Alarm accessibility. 10,(W GPD
• Accepts PVC extension handle.
P1-525 Installation:
"
Ft.
Ideal for residential and commercial waste flows up to of Linear
of l/1G
10,000 gallons per day (GPD). Filtration slots
1. Locate the outlet of the septic tank. -gap
2. Remove the tank cover and pump tank if necessary.
Accepts " 3. Glue the filter housin~~ & r "
b to the 4" or 6" outlet pipe. If SCSI In ao pipe
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the P1-525 filter into its housing.''"" - -
Certified to
5. Replace and secure the septic tank cover.
0 NSF/ANSI Standard 46
PL-525 Maintenance:
The PL-525 Effluent Filters will operate efficiently for
77 e- .
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned;
every tirne the tank is pumped, or at least every three
years. If the installed filter contains an optional alarnt,~
the owner will be notified by an alarm when the filter
Gas Deflector
needs servicing. Servicing should be done by a certified
septic tank pumper or installer. Automatic
Shut-Off Ball
1. Locate the outlet of the septic tank.
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL-525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all l `
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
Outdoor the filter is properly aligned and completely inserted. Sn, lk t Alain F ttend4 I t,k
Pi,lvhik, 7al el & & [lest filters accept Easily installs
7. Replace and secure septic tail: cover. t1,e SnnartFiltervJ SWitch and alarm. into existing tanks.
Polylok. Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free; 877.765.9565 Fax: 211,.254.8514 w%rtiV.polylo - com
GOULDS PUMPS Submersible
Effluent Pump
MODEL 3871
AOF-
EP05
EP04 &
'.f
Series
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: tipper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses:
• Effluent systems heat transfer. ■ Casing and Base: Rugged
• Homes Available for automatic and thermoplastic design provides AGENCY LISTING
• Fauns manual operation. Auto- superior strength and corrosion sR Canadian StandardsAssoaation
• Heavy duty sump matic models include resistance. _ File # LR38549
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pumps is ISO 9001 Registered.
• Dewatering assembled and preset at the for efficient heat transfer,
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
'/d' maximum. ■ EP04 Impeller: Thermoplas- N Power Cable: Severe duty
• Capacities: up to 60 GPM. tic semi open design with rated oil and water resistant.
• total heads: up to 31 feet. pump out vanes for mechanical
1 • Discharge size: 1'12" NPT, seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
1041 OWC? continuous
- - - - -_-r T--
140-F (60:Q intermittent. METERS FEET - - t
• Fasteners 300 series 10- J
- f
stainless steel. y 30
-
- - - - 56pm -
• Capable of running ! -
dry without damage to s I i 2.5 FT
~ -
components. 25 ! - - - - - r
0 7
Motor: W I -
zo
v o ;
• EP04 Single phase: 0.4 HP, _ ~
- -
115 or 230 V, 60 Hz, 1550 a - - _ . -
i
RPM, built in overload with o 5 15
f
automatic reset. a
• 110 V Sinor 2 30V, 60 gle phase H 5 1P, ° 3 - - -EPOS _ i
RPM, built in overload with
- - - - EP04 -
automatic reset. 2- i
i
• Power cord: 10 foot
- - - -
standard length, 16/3 t - - - r - - t -
SAW
undinh three prong
20 0 0~--- ~o -
20' -
9ro g plug. Optional 30 40 so GPM
foot length, 16/3 SJ 1 W with
i three prong grounding plug
o a 6 to 12 m';n
(standard on EP05).
CAPACITY
Goulds Pumps
EF 2003 U°u'~5 P`,R'PS ITT Industries
t'e~t~~„ lady, :acii
83371
PUMP CHAMBER CROSS SICTIOIJ AND SPECIFICATIOU'
--VCIJT CAP
`l" C.Z. VENT PIPE WEATHERPROOF APPROVED LOCKIKIG
JIJIICTIOIJ BOX MAIJHOLF. COVER
25' FROM DOOR.
WIMDOW OR FRESH 12~MIU.
I
AIR IMTAKE
GRADE
FE
`IMR1.
18rI'SIU. II
GOIJDUIT -
18 NW .
PROVIDE _ I
INLET AIRTIGHT SEAL i III f
I III
* I III
II ALARM
i II
Is I 1
*APPROVED I I oKl
C JOINTS WITH j i
F_LEV_ FT. APPROVED PIPE PUMP-` J
3 ONTO OFF
D SOLID SOIL
C011CRETE DLOCK -T
KiSCR EXIT PERMITTED OULy IF TAWK MAUUFACTURZR. HAS SUCH APPROVAL
SEPTIC E SPVC.IFICATIOMS
DOSE:
TA/JKS MA►1UFACTURER: 4/e, 4c, IJUMBE:R OF DOSES:-PER DAS
TAIJK SIZE: ll,LfP CALLOUS DOSE VOLUME .~a(
ALAKM MAIJUFACTURC-R: si INCLUDIMG 15ACKFLOW: GALLONS
MODEL klUMBEK: CAPACITIES: A= 4; IuCI►ES OR !1L= CALLOUS
SWITCH TyPL: _ IMCIJES OR 1'5e ALLOWS
I IP~~
~
~y`r, .LOE1L
Cpul~ C 2~ INCHES O )
I PUMP MAAIUFAGTURCR: r
I MODEL LfUM6ER: c- _ INCHES OR uALLOAI`_
j SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE
MIMIMUM DISCHARGE RATE GPM INSTALLED OIJ 5EPARATC CIRCUITS
VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AUD DISTRIBUTIOM PIPE.. FEET
FEET i
+ MIMIMUM NETWORK SUPPLY PREITSSURE ~
. 17 1'2S
I } t~ FEET OF FORCE MAIN X FTiooKFRICTIOW FACTOR.A`L., ~ - FEET ~IZ'3
TOTAL DyWAMIC HEAD = 0 FEET Z5
IIJTERIUAL DIMEI.ISIOMS, OF TAUK: LEKIGTI/LL--.;WIDTH ~--;LIQUID DEPTH
l 1y1 f Q 2 S-1/0
SIGIJEO~ LICENSE HUMBER: ` DATE: ~a~~
94-Oos/ooou 3113 9578--5Z~-008 z \
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S,117-Rhombus SES Cnntrals Balld A Panels
bx., "w A: BAP Product lnfc
Femums r~
1.tode: t 11
• Moder 11.= spots
• 6t,xirl 3 t?
Mode • ?.tale? 3
`lude;-1 - PS Patrol®
• F.tode; I I
L1o1el'" Post Alarm With Receptacle for Plug-In Pum
Mode l 1 1 P
Model tr Control
• MOd - e,,.
• ~trin rltr ~afr Post Alarm Provides Convergent Wiring Corneaior and System g
R,,hu Mcrdonng for f'urlp Statior Applicators
• Mc lel O-D The PS Patrols post alarm system features a bulll4n high
• bate F'S wat-r alarm and prnwdrs a -;ajw rmienl Incation to connect all
IFS r° wiring requ red for a pumping station application
• Model r) ~
,
• Model Pp
• JR The PS PalrolO system employs a receptacle to accept either
• U11r3 Nato, a 120V or 230V pump aril/or piggy-barA pwnp switt.h. Vent
• PS Patrol" holes on each side of the post help prevent moisture
• "O '=1'%' conder.sahon inside the post Available n 120V, 230V and 9
• Starter Boxes VAC models-
• C-Leve' ' Std
Ft rn,
• SJt` 5:1 fi+:afte
• ..L a:`
Au'
PS Patrol®
Features-
• Pedestal rated for outdoor use
• Ftrcnplade for 120V or 230V pump and/no piggy-back
pump switch
• Pull out assembly for easy wiring
Contra switch provides alarm a-alivaticn
Testfnormal/silence switch mounted externally for easy
operation
• Separate 120V alarm and pump circuits
Red alarm beacon
• No exte ninl corrls
• US Patent No. 7,218.511
Options:
12GV, 230V and 9 VDC models
• Factory-installed circuit oreake ite urinal block
Factory-installed elapsed time meter (ETV) tc log pump
httr~ ` ttrunv cierhnmhnc rim/cPC-rnntrnlc-hnilrl-a-nanPlc-rlr'tails nhn?T}~-~~ 5,,'7/2014
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner WAYNL AIL'TS lank Manufacturer: WIESER El NA
Permit # ® Septic ❑ Dose ❑ Holding Volume: 1000 (gal)
DESIGN PARAMETERS Tank Manufacturer: WIESER ❑ NA
Number of Bedrooms: 3 ❑ NA ❑ Septic ® Dose ❑ Holding Volume: 60 (gal)
Number of Public Facility Units: ® NA Vertical Distance Tank Bottom(s) to Service Pad: 5 (ft)
Estimated (average) Flow : 460 (gal/day) Horizontal Distance Tank(s) to Service Pad: 5 (it)
- - - Specific servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): (gaVday) if horizontal is >150 feet. Specific instructions to be provided on back. 600 In Situ Soil Application Rate: (gaVdaylft2) Efflu
ent Filter Manufacturer: POLYLOK ❑ NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: 525
Fats, Oil & Grease (FOG) s30 mg/L Pump Manufacturer: GOULDS
Biochemical Oxygen Demand (BODE) x220 mg/L [ NA EPOS ❑ NA
Total Suspended Solids (TSS) _150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >3 mnlglL NA Manufacturer: ] NA
(BODs) 0
(TSS) >150 mglL ❑ Mechanical Aeration ❑ Peat Flter
❑ Disinfection ❑ Wetland
Pretreated Effluent Monthly average ❑ SandlGravcl Filter ❑ Other.
(BOD5) e30 mg1L Soil Absorption System
(TSS) c30 mg/L ® NA
Fecal Conform (geometric mean) <W I3 In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA
- - ❑ At-Grade ❑ Mound
Maximum Effluent Particle Size ~fe in dia. ® NA ❑ Drip-Line ❑ Other.
Other: ❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) At least once every: 3 mo th(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: 3 month(s) (Maximum 3 years) ❑ NA
® year(s)
❑ ❑
Clean effluent filter At least once every_ month(s) NA
I. f] year(s) -
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
3 ® year(s)
Flush laterals and pressure test At feast once every: ❑ month(s) KJ NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: _ ❑ 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 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 <_12 months, 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 (02105)
Page _ of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment 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 be discharged 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 lank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact 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 al-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 drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, 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 Administrative Code:
• 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:
❑ 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.
❑ 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.
❑ 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 may be 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 biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS: -
POWTS INSTALLER POWTS MAINTAINER
Name COUNTRYSIDE PLUMBTNG & HF.ATTNG INC Name PAUL KOEHLER
Phone 715-246-2660 Phone 715-246-2660
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name DARRELS SEPTIC SERVICE Name ST. CROIX COUNTY
Phone 715-425-1025 Phone 1-5- 39
co $Q
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.220fb)(1)(d)&(f) and 83.54(1). (2) & (3). Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CL=RTII.ICATION FORM
O~,vner/Buyer WAYXE ATLTS
Mailing Address 1881 220TH AVE, DEER PARK, WI 54007
Property Address 1881 220TH AVE, DEER PARK, WI 54007
(Verification required from Planning & Zoning Department for new construction.)
('it}''/State DEER PARK, WT Parcel Identification Number _ 036-1031 -00001
LEGAL DESCRIPTION
Property Location NE . NE , Sec. 14 , T 31 N R 17 W, Town of STANTON
Subdivision Plat: N/A Lot # N/A
Certified Survey Map # N/A Volume Page #
Warranty Deed # N/A (before 2007)Volume , Page 4
Spec house ❑ycsElno Lot lines identifiable Q~es❑no
SVSTEN'I MAIN ENANCE AND ONVNER 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 aftect the function of the septic tank as a treatment stage in the \ ante disposal system. Owner maintenance
responsibilities are specified in ASPS. 353.52(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
N astewater disposal system is in proper operating condition and or (2) after inspection and pumping (if necessary), the septic tank is
less than 1: ± full of sludge.
L`we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set tbrth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
Uwe ccrtifv that all statementi on this orm are true to the best of mylour knowledge. I!we anv'are the owner(s) of the
property described above, by virtue of a warn ty decd recorded in Register of Deeds Office.
Number of bedr oms 3
SIGN:\T RE 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 e copy of the certified survey map if
reference is made in the warranty deed.
(RE\'. 04!12)
RECEIVED < I~, - r~~lo
WisconsmDepartment ofCommerce SOIL EVALUATION REPORT Page 1 of-3-
Division of Safety and Buildings MAY q 1 0 LU lln~ccordance with Comm 85, Wis. Adm. Code
County
tr site pla~~n~~QlrY~t', x I I inches in size Plan must St. Croix
(l u e but not livr~l8ffUUN"DEkIfteFa a point (BM), direction and Parcel I.D.
t(~ calc or dimensions. north arrow, ao 3 1 referenced to nearest road. 036- 1,#312-0000
Please print all information Revi , d by Date
Personal infonnution you provide may be used tier secondary purposes (Privacy 1.aw- s 15.04 (1) (m))
Propcrt\ Owner Property Location
Wavne AlIts Govt Lot NE NE s 14 T N R 17 w
Property Owner's Mailing Address Lot # Block # 1Subd.NamcorCSM#
1881220"' Ave
City State Zip Code Phone El City ❑ Village 01'own Nearest Road
Deer Park WI 54007 715-248-7212 Stanton 220th Ave
0 New Construction Use: 0 Residential ; '.Number of Bedrooms 3 Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or Commercial - Describe:
Parent Material _ Loess over Till Flood Plain clevati( f applicable N/A R.
General comments and recommendations: 1
1 Boring k Boring
0 Pit Ground Surface Elevation 100.6 ft. Depth to Limiting factor =•100 in.
i P_ Munsell _ Soil Application Rate
Horizon Depth l Dominant Color Redox Description Texture Structure Consistence Boundary ' Roots GPDJtt
Qu Sz. Cont. Color Gr. Sz S-h,_ 'Eff#1 'Eff#2
- - - - -
1 0-10 ; 10YR3/4 - SIL 2-m-gr mfr gs 2 f-co 0.6 j 0.8
10-19 10YR5/4 = GRCL 2-f- r mfi - -
cs 2 f-co 0.4 0.6
3 19-27 7.5YR4/4 GRS 0-m mfi gs 1f 0.7 1.6
4 27-35 10YR4/4 - GRS 0-sg ml gs } - 0.7 1.6
5 35-41 10YR4/4 - VGRS 0-sg ml gs - 0,5 0.5
6 X41-100+ 10YR4/4 - GRS 0-sg ml gs 1.6
"Horizon 3 is denser than '
horizon 4 _ V ~f
j
❑ Boring -
72] Baring spit Ground Surface Elevation 101.1 P, l,~ -kp i to Limiting factor tn.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary _
in ~2e
in. Munsell Qu Sz- Cont. Color Gr. Sz. Sh. Roots _SoEff#l E
1 0-9 1 OYR3/3 - SIL 2-f-gr mfr cs 2 f c o 0.6 0.8
2 9-15 10YR4/4 - SCL 2-f-bk mfr cs 1 f-co 0.4 0.6
3 15-25 1OYR4/4 - GRS 0-sg ml gs - 0.7 I 1.6
4 25-40 10YR4/4 - VGRCOS 0-sg ml gs - 0.5 0.5
5 40-105+ 10YR4/4 - GRS 0-sg ml - - 0.7 1.6
g t , 6i Z
' Effluent # 1 = BOD, 30. 220 rng l and ISS > 30 5 t 50 mg1L ' Etllucnt M 0 mgiL and TSS < 30 mg,'L
CST Name (Please Print) Si re CST Number
Mark Iverson 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 1 55 Hammond, NVI 54015 May 2. 2016 715-796-5664
Pro Owner Wayne :dills Parcel ID' 036-1 0 3 1 2-0000
Property Page 2 of 3
❑ Boring
FT Boring RIPit Ground Surface Elevation 100.6 ft. Depth to Limiting factor >105 in.
I Soil Application Rate
_i
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ GPD/ft2
in. Munsell - Qu. Sz. Con-t. Color-- _ Gr. Sz. Sh. I 'Eff#1 'Eff#2
1 0-12 10YR3/2 - SIL 2-m-bk mfr Cs 2 If co 0.6 0.8
2 12-23 10YR414 - SICL 2-m-bk mfr Cs 1 f-co 0.4 0.6
3 23-37 10YR414 - GRS 0-sg ml gs - 0.7 1.6
4 37-56 10YR4l4 - VGRS 0-sg ml gs 0.5 0.5
- - - - j -
5 56-105+ 10YR414 GRS 0-s ~ ml ~ 0.7 1.6
❑ Boring
Boring # Opit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil Application Rate_
Horizon Depth Dominant Color Redox Description Texture Structure Consistence rBoundary Roots GPD/it
in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2
i
I
1
❑ Boring
75 Boring Qpit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2
in. Munsell Qu. Sz. Cont. Color _ r Gr. Sz. Sh. 'Eff#1 'Eff#2
i
• Fttlucnt ;;I - ROD: , 30.- 22il nqL 1. and -1 > 10 _ I ~rl m r'I ' f~f7luent ~'2 - Rrli t ?n 1112r'I. and VY, < 10 mg,[
Chc Drparunent uCCorr.mcr<x i~ an equal opportunir% service proN ider and emploN cr If %ou need a->kmnc(: to acs-esti scrric;a or
~ccd matcria: in an alternate lormat_ pled, contact the department at 60S-_'66-; I ~ I or [ IN 61.18-264-s7"
a ~
(N)
Page 3 of 3
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2
t
S ~r,e.cl
.3 3
g- 3 I
n ) io i i
O
Q
6
0 ft 24 ft 40 ft 80 ft.
C
BM#& Description g_1
Elevation = Bench Mark X U0"',Boring Location & Elevation
Owner: Wayne Ailts Site Information: Completed By: Mark Iverson, PSS #197
1881 220th Ave NE1/4, NE1/4. 314, T31N, R17W 680 Larcom Street
3 Town of Stanton Hammond, WI 54015
zr Per K w Saco 7 St. Croix County 715-684-9125
Phone 715-248-7212 CST# 46672