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Home My WebLink About020-1100-90-000 'Aisccnsin Depa-tnerl of Ccrrmerce PRIVATE SEWAGE SYSTEM Coun*y. St. CrOIX Saferi and Bwlr.uiq C'ivison INSPECTION REPORT Sar fay Permit No (ATTACH TO PERMIT) 584791 GENERAL INFORMATION state an ID Pro Personal infornatior you prcwde may be used for seconcary purposes I-nvacy Law, x 15.04 (',(m;Q y( Pe mit Ho der's Name T Village -ownship Parcel Tax No Kelly Klimek TOWN OF HUDSON 020-1100-90-000 CST BM Ele'v Insp. BM Die,, BM Descnptior n ' 11 SectiorTcwn'PangciNap No: F2 ~'I 34.29.19.403E TANK INFORMATION ' ELEVATION DATA TYPF MANUFACTURER' 1 iPACITY STATION BS HI FS ELEV. Septi.- J Benchmark Dosing Alt. BM Aeration _ Bldg, Sewer ~ D ~ 6kS S (1,1 27 Ho ding i St'Ht Inlet TANK SETBACK INFORMATION SUHI Outlet TANK TO F!1. V EL- BLDG Vr_,)t to Air Intake R-,7 DI Inlet Septic Dt Bottom L i DositV Ffeadrar!Nlan. r Y t(i Aeration Dist Pipe !ioldinq Bot. System t PUMPISIPHON INFORMATION Final Giadu Manufacturer Demand St Cover' ; Model Number% li 1 inv~ ~1 V LAId I I~( TDH T 1 Friction LosSystem Head TD F Forcemain Lengtfl - ' Dia.. ! r: Dis to '✓vell SOIL ABSORPTION SYSTEM / BEDITRENCH Width iJ I jLer,jth No. Cf Trenche PIT DIMENSIONS %u Of ° Is Inside D w I iyuid Depth DIMENSIONS `jam] t SETBACK SYS] F-M TO P!L RI DG WELL LAKEiSI R(=AM LEACHING rdsnuracturer INFORMATION CHAMBER OR fi Type Ot System t UNIT Model Number rt DISTRIBUTION SYSTEM He tle Aanifo d D stributior x Hole Size x Hole Spacing Vent to A 'make Lenylh__j_r~_ Ma Length Dia Spnr.inq SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only _7 7eolh '7ver Depth Cve" :cr Depth e` 7ec.~Scdded xx Mulched 2edrTrench Center 0. Red:T-ench Edges Topsoil J as ] No Yes No COMMENTS: (Include code discrepencies, persons present, etc) Inspection #1 Inspection #2: r Location: 652 CTY RD N1 I , T{ J i~^ a l" 1.j Alt BM Description - 1 i l~y 2.1 Bldg sewer length = I ,l) - amount of cover Plan revision Required? Yes t-)(No U~ti~ Ia Use other side for additional information. Z Ili Date Inscpctor's afore ^e-t No. SBD-Ei tU (R2,9;" N116 W18455 Morse Drive Germantown, WI 53022 `t~Y 262.253.1353 1800.234.5490 IM m u R n inc. Fax 262.253.1248 Yuur oor!nerv in pum nin,G si:ce 255N , www.jimmurrayinc.com Commercial Grade Submersible Sump Pump Model PVL-ES-MAN-20 Features • Cast iron pump housing for quiet operation ■ Oil-filled motor housing for lifetime lubrication and rapid heat dissipation . 1/3 HP permanent split capacitor motor with thermal overload protection Commercial grade epoxy coating for corrosion V;'= p and rust resistance • Stainless steel screws, bolts and handle • Mechanical Seals (stainless steel spring, nitrile i - parts, carbon and ceramic faces) Upper & lower sintered sleeve bearings - oil lubricated for smooth operation & extended life ■ Effluent Rated - passes limited amount of 1/2' spherical solids ■ 1-112" NFPT discharge ■ Manual operation. Requires switch for automatic operation. ■ CSA Certified Specifications 3-year limited warranty Horsepower. 113 RPM: 1550 Volts: 115 Full Load Amps 6 0 Power Cord: 20' Weight. 28 lbs. Performance Curve Dimensions (H x L x VV in.;: 9.90" x 8-80- x 8.50" 25 h LIGHT FLOW-GPIA Construction Cover Polycarbonate 20 LI Motor Housing Epoxy Coated Cast Iron Impeller Type ! Material Vortex t Nylon 1 a Volute Epoxy Coated Cast iron 10 Power Cord SJTW_A 'n *7L F=-I tY Mechanical Shaft Seal Nitrile w/ carbon and ceramic face 5 Fasteners Stainless Steel Shaft Cold Rolled Steel U U 10 30 40 50 Upper & Lower Bearings sintered sleeve bear-rigs Flow- (Gallons Per Minute) Specifications subject to change without notice PVI -FS hgf~V.112'13 PW PAM AFIWWWRY - ! C` K" .a.Y ALKLIAS /Z i1C1" M. +iaB ; WJ-- w IR* A,A Art Ctxxx wimm no" Tan ft, TDrdw dF #IL" sr. cmx fouay Aw 11" lJ 1 " o -~i~uw 'Per- ~3a e~ A,G fl ) t AXR A( 9` SW Locadox-D j J~ ' Safety and Buildings n County C 2o1k ~p$ r=1~1{+I ~1f 41t', z 2Q1 N/. WdSlling F Q Box Madison, VVI 5 ? Sanitary Permu Numl er (to Ix filled in by Co j -OT CROIX COUNTY UOYDEVELOPMENT anital'V Permit /application SlateTransacdon, In accordance mth sps 34, 2 1 1 x I( ) tl taten r 1 I rf ;bcr --I , is.:1drn C u~r ti=_ion > this 'orn to the apl r pnete --.errnnertcal 1,nrt N/T}I• s required p or o o7t.Worta . role 3r = p~mi' Nut,_ .q I the D q cV PP t,lon tone, 'or s[ te-o~uicd PtJ~6"I'S arc scbrnat °rl to P r ie stunal Series Person,n nfbnn•hon p~u rotidc mati Prol ct Address( fd;t3 rent than mailingaddressi n. ec.cidanC. v"it i ill I -r,te. Law. s 5.U4i I ir,n). Mats. u,:J lor..econdar~ - 1. A hcation Information - Please Print :\II Intnroi ation , I it,pe.n lh,n_'rs Naar r n!1 Parcel C_ Property' Owner s blalling Atidrss t4 c) Es 10~ ^ ~9j ~','1 _~O L_ C '1 e( 1 Prop<m' LocationJ7 1 I l. '7 b 3 I f a_;. Sale r t C Zip Code Phone Numher (iot tt 1Lnt t _,C Seclwn I1. Type of Iluildio acle on (check all that apply) / Lot f N; R ! C I or 2 Lanti ~ D,t; lhn.• - Ncrnher of Bcdroont,. 7 Subdivision Name 1 Pabl u'Com nercial I)cscrihe Use C-tA Block t; ~1A Clh of J Stale Owned - Describe L; e CAM Numher 'Townof ~'-~-mow G(~a ❑ c? II1. 1 ype of Permit: IC heck only c hor on line . .Complete line 13 if applicable) D -I I Ci Nca S•.slem KRcplac,•rnrnt S~=shun _ Tr:annert'Ilrtldt'tc lank Rer accrnerr Only' ❑ Other klodiltcauon to Fsrsung Systevt (explain) B. L] Po4mlt Renewal Ptrmit Ret isiun ❑ Chan'e ul I'lunthcr List Previous Permit Numher and pale Issued Bcf;are 7:ytirattort i F' Pen ti' l r,mslcr to Nc,a --LL (;tt ner W R. Tv ~ op tP0%VT5 tiy~sterni('nmpn,renl Check all that appl}) i C Nor-Pressnnzcd In-Gruunc' ~ I'r uri;•cd h~ Ground Fj ;at-Gra,i, L- Mound 24 in. of s:utable soil Q klot:nd < 21 in of'stlitahlc' sod ❑ I Ioldim• I ank Lr~ Other Drnr sal t „ n x,nent !,plain l _ S ~ispersaUfreal ent;\realnformation: - CPretreatntentDevke(.xplainl_ Design Fluw(gpcl Design tiuil anli:aGon Rut' t l ~ - p e(c.ld: Disperse' Ar:t,r Kcc t.irec (sr) Dispersa re a Pr used tsfl tiystem GlevaUon ,~"(x) c~ , 5 I y IV V1. "Lank Info 1r- Capacit~' m fouil ,i of hl Gallons aru;ae rer halloos (lilts New Tanks Il I[zisnnt: T;u;ks rr r Sepec nr oldin-, lank 7 ~Ll u - ~"I 8 lQ nnsnig CFanrbc- V IL Responsibilih Niatement- L the under.i„ned, assume respornilrilithfor ,lallation of the P0%% I*Sshuns I Plurnher s'~:un; i P-,nt ~ ~ non the atlachcvf plan.. Rumxr's S(,,vatarc ~iPrbll'RS Namber Business Phone Nwnhtr la, ~ L C_ 1 r~ ,~1 L l ~t L N~ Plmnher'.:1ddress (.4rrset. Cin. Srttc. Ill, Codei J?. L/ 7~s S i f 2~s ~t I c7~ V Ill. Ctntnlv!Uc artntent [ sc Ooh pproccd ❑ Pc-lnrt Fe,,' I Date suet 4 Ic,uutg ent Sil;natt:rc L :r (:r:rr Reason Ibr -vial I r oa ~ ~P IV Condit axons for. Disapproval 1 GMUW4 Nor wid low awpw" 00 must eA kipg ykas I mdin aLm, , u61' 1 -oW ~ Q~rlanl plan pravxIed by plumber. ('~+~1a~r~;tlttus!•p~h>etirtt¢it7ed PA^- GOOG.~ , ft W► SPFNCtlbi6 taode ! ordnatim. l uarh u, rnn ydlrl pea n. (br Ih1 srs tem :md whmir to 1111 C'ounh- ooh nn paper nor Inc than (i V2 i l l inches in size 513 D-6_-,9X i R. I I' I i f CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: KELLEY M. KLIMEKISHEILA M. HOBBS Owner's Name: (same) Owners Address: 652 C.T.H. N Hudson, WI 54016 Legal Description: NW 1/4 of the ICE 1/4, Sec. 34, T29N, R19W Township: Hudson County: St. Croix Subdivision Name: NA Lot Number: NA Parcel ID Number. 020-1 100-90-000 Page 1 Index and title gC0N Page 2 Plot Plan NNI • Page 3 System Sizing & Cross-Section MARY JO Page 4 Filter Specs * HUPPi RT ' * = Page 5 Maintenance Information D 1859 ? Page 6 Management Plan ;RIVER FALLS.- Page 7 St. Croix Cty Septic Tank Maintenance Form W1 g Warranty Deed SlGN Page 9 Sll C /V^p Attachments: Soil Test TAA1K'P 5cc-1 i c.ti' lc_ Designer/Plumber. Mary Jo Huppert License Number: 1859-007 Date: 05/24./2016 Phone Number (715) 426-1775 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Owaf KAY A.KuAOkgd EMA A +%MDS 1"sOft .."M..Sama . it Nl. IWA) f it~cn6ea -Sr. c MK gcrcOR -I- a -1 1 P& . l~''~#~-mss )EpdD., ZW Cdr IIAO qs TV z ~ ago :ENDS'S e.T.,N A ~iNIEs • - - etc Axe 90" Gr.~r. = PAGE 3 OF 19 U 0 Z +t, W w A U t -i z U O =W Q p Q C Cl) U> m U~z E Z Z U c a N U •c ~ - (A C5 T, 4)E ° ? C U fW Z > _CO ~ ° 7 t i Q LD 216 < CL CL - U) m W s ~o m Z ES ~ U y g ra; ~.WE v Q) U Q Ir al ~ C 9 r 5 s c f~ J " D , I E ~j co R i , I a Vl u QO li ■I Chi II II CL co U) U) .0 0 L cc a . II /1 - H p aD U o I I ~sQ v CT) U) •(A `n c ( ~v mCL T-N ~ ~o ~rn~ ~J II (V n M M c N L a I co z ELI _ II II II x O~ V a I n z.2 M 0 m +r w b I 0; O I U C w I I ~ Ln a) o co (D w ( I = W @) w U I ~ Z E I, I w N CL 12 W U ~ ■ ~y N C W T I■ ;I W O 11 s ■ sc w d rn 3 Ir 'I Y i . J a 2 I~ .I i o ,l ~ a I► cn t 1 Z .I a 1 - ~~J r • ® f Filters PL-525 EFFLUENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of amity Accepts PVC the largest commercial fihers in its extension handle class. It has 525 linear feet of 1/16' filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16' removed for cleaning, the ball will filtration slots Rated f+orover float up and temporarily shut off 10,000 GM the system so the effluent won't , leave the tank. No other fifier on the marilrat can make that claim/ Accepts 4- & V SCID. 40 Pipe PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years ~ under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be di5ic done by a certified septic tank Automatic shut-off pumper or installer. tall when fitter ' is removed 1. Locate the outlet of the U.S. Patent No# 6,015ABS septic tank. 6,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing tc 4 tank. Make sure all solids fall or fi outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. Technical Specifications PL-525 EFFLUENT FILTER EX~TSC8IDA 1~ KRKETEXE11 M 11.9 - - OUIETrA4M8E7®R flN ~----lam - -I 1 _ I S31 tea. - ae ~ I 1134 j PL-O FLTER HOUSING PART NO. - 3014225 MA7M&' &58ALL -HOPE $MTOCM3F"T91CAT1 1fl00 F'AiNNClEEX1E1" 'I- . r wainrim *A 90CWT EK" Le 904 NLLFWAM CPO= [-1 F-. k Tic -s An l ' 4~ s { k _ F POLILOK PLSZ<iFILTER CMTWM PARTNO.- 3M41-0 . IF MATRA- -PMWROP11 ENE AN Technical Specifications PL-525 EFFLUENT FILTER I I - c'7f8TSS5tDtl I J/~ij~ ' ' FOR WLET ET" IM r f%IIlETFA151ieGE7~TS _ _ rsMe0a6•sae0 ~ als' r II r-+ ~ _ rase A i~ - - t,--- `mil I ! I I PL4ZFLTMHOUSING PA12T ha - 30142325 - / MATERIAL HOUSING-POLYPROPYLM - WTLETBIISHMG-OW ' UBALL -HDPE soa;lrE>ca'ISFeaiswla+ Z~~~<<`~ ~ IL23 E167:a75 , t h ! r tpEt ` FIx?XMO(EOM EXtE11T10N ---53J OF1~F9LOIS -$1mI xc&rs as ~ ;:;~:~.t< III firuvuse+~o ('-av~wc ~ _ ~eyr o a t -71 -1 xl r. 170.71 $ ~F _ sa zu = zt r POLYLOK PL-5b FLTER GARTRIG( t _ PARTNO.- 30141-513 7: 7, MATERM POLYPROPYLENE - 1,7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner c- LSE K u'"EK' st1 L.I o tiosa S Septic Tank Capacity al El NA Permit Septic Tank Manufacturer !PSjEK ❑ NA DESIGN PARAMETERS Effluent Fitter Manufacturer P0L_ Lt, ❑ NA Number of Bedrooms ❑ NA Effluent Fitter Model :6Z S ❑ NA Number of Public Facility Units IVNA Pump Tank Capacity JL al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ~_k&SEK ❑ NA Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer ' ~}(fG ❑ NA Soil Application Rate al/day/ftz Pump Model I _ ES- I P+ ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Flier Biochemical Oxygen Demand (BOD6) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD6) 530 mg/L (gravity) ❑ In-Ground lpressurized) Total Suspended Solids (TSS) 530 mg/L [3 NA X"n-Ground At-Grade ❑ Mound Fecal Coliform (geometric mean) 5`[W &U/100171111 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Oft- ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cellls) 1 At least once every: ❑ month(s) (Maximum 3 ❑ NA year(s) years) Clean effluent filter At least once every: ❑ month(s) ❑ NA Year(s) Inspect ❑ month(s) pump, pump controls & alarm At feast once every: p year(s) ❑ NA Rush laterals and pressure test At least once every: ❑ month(s) ❑ NA yearls) Other. At least once every: ❑ month(s) ❑ NA ❑ yearls) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be 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, 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 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 (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with 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 months, shall 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. 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 or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). 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 highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cellist and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump 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 area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTS. antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; 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 property and safety 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 property disposed 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 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 that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 0 alua " ~OtVS7~v«ng dank be " e R al-/ l 8 pN ❑ 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ~jl LL EAFL\/ Name 3j LL 6'-~< Phone Phone -7! S 4Lt I - 2-3S ( SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone 1 S- 3 ~Cv- ~O This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&ff) and 83.54(1), (2) & (3), Wisconsin Administrative Code. In-ground Dosed-Gravity Management Plan PAGE j OF4 IMPORTANT: The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 600 gpd; BODE 220 mgL"'; TSS 150 mgL"'; FOG :5 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) e Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Early Plumbing/Heating Phone: 715- 441-2351 Local government unit: St. Croix County Phone: 715-386-4680 Local government unit address: Courthouse, Hudson, WI ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code No product for chemical or physical restoration of the POWTS may be used unless approved by the department i accordance with SPS + Continaencv Plan In event that any t a plan submitted to the component may appropriate agency for review and approval. A failed in-ground dispersal be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. 15 ~ a Aft - RE a; 4.6 og~ t O tk. 6 ASS {M `r{._ ~~~i 4.7E r, r i ~ c .71s N A_ 1-00 AV Alt LLJ ai' -21 KLIm (-ATt y4C ANT } Septic-Dose Tank Cross Section And Pump Performance Specifications Tank lv ut+ez 1 E P®p M suer <:~;QLU--o Tank Model Number WLP i200 80b- Model Number fe Total Tank Capacity )zoo/ ?00 Alarm Manufacturer i"1r Rt+d.M 9 u.S MaL Bury Depth Alarm Model Number A g A LP-w-1 Switch Type 0 16.4 L- -Filter Msnu urer Total Dynamic Head (TDM -Feel Filter Model Number Elevation Head 5 Distal Presque Network Loss - Minimum Pump Performance Required Force Mein Loss o gG , GPM Ft TDH Total e Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole With Locking Manhole M4" Above Grade < 6" Below Grade Sealed Watmtigbt Securely Mounted Device weather-proof,W Fed Grade ittac tia® inish Beat tt ~ tt. ~ Depth of Vent Mm. 12" Cover Disoonnect Above Grade Ft with Vent Cap means > Outlet Outlet Filter Inlet Inlet Bade r< A ' Switch Settings and Reserve Capacity s` Tank Volume= ?-zit z GPI weep Dimension Inches Volume Gal, $ Hole a~ ' r r (reserve) A 2D, 9 ~/~v5. ~5 t (alarm) B 2 ~frf, OfrElevabion C Ft < (dose) C v oil (dead) D zf Zy D Bottom < r Elevation Total 36, 00 .4 , Ft , r s► a► s s a s s s►>> r, s► s►> s s r a s: r a s r s► s s a,• a•> s a> r s s► a a, s a s s• s GENERAL U I'ALLATTON. TLC m"c/dose tank is bedded and back filled in acoordBcee with the •s P rOdud approval SPecMC260M Maumum depth of bury as VeCified by the mamufec WW MZy not be exceeded without prior approval. Manhole covers acposed to grade have an effective locking device (padlock) instsnea. Piping at the inlet and outlet is of wroved mamerw comwod tV the tank with wamaftht fittings, and laid on stable soil to prevent settling or sagging. The force mm is sleaved with r ScjL 40 PVC to b idge the tank ex=mhou and ffie sleeve is sealed w6fffighL Electrical service complies with NBC 300 and Comm 16M WAG 02x05 LJ Page of ST. CROIX COUNTY SLPT1C "T:A.?\K MAINTE?\ANCE AGREEMENT AND U\~___'\_LRSHIP CERTIFICATION FOR NI Mailm~! address PrL- rt\ AJjrCSS J IY1 (Verification required frum Planning K Zoning Department for nevr construction., t Cit% 'State~v`;~,~ Parcel identification Number LEGAL DESCJPTION Property Location. ✓ `J 1~ Sec• j T vZ~ - ~N RW. To~,vn or' Z4E = fi i L?-T =C; j o Subdi~ ision Prat: Lot C ertified SurveN Map ;4 _ Volume Pa_Qe - 1N arrant- need n i1 t"beior~ ~00 %i~ oltune ~J PaR ' e Spec house yes no Lot lines identifiable - Ves - SYSTEM MAI\TENA CE AND OWNER CERTIFICATIO-N ltt;p-oj,p -r u; acid maintenance of your septic system could result it, its prcmarure failure to handle ~kastes. Proper maintenance consists of purtpin` out the septic tank everN three ,ears ur sooner, if needed. b} a licensed pumper. What VOL! pu'.:nt- zhv s tern can affect the function of the septk tank as a treatment stag. in the waste disposal system. : h ner mai:rtcnanl e re:.pon ihihties are specified in §SPS _183.52(1) and in Chapter 12 - St. Croix County Sanitan• Ordinance. The property owner a_r;:es to submi: to St. Croix Count% Planning & Zoning Dcparttrent a certification form si- nez b, t:-ie ox-\ net rd bv a master Plumber. journeymar. plumber. restricted plumber or a licensed pumper,erif`,in- That (It the on-site wastewater disposal systern is in proper operating condition and:'or (2) after inspection and pumoin ;if necessar% the septic tank is less than 1'; fall ofslud2e. 1 we. the undersigned have read the above requirements any a_rce to maintain the prn at, sekA aRe dtsvosai s., st;rr. a ith the standard., set forth, herein, as set by the Department of Safety And Pru1'essiona: Ser ices and the Departmen- of Na;urai ResOarccs. State of «iscorsin. Cerrifrca:ion stating that N ,our septic s}stem has been maintained must be completes and -eturn.d to the St. Croi.: County Planning Zoning Departmen/~a,- ut 30 days of the three year expiration date. 1 we certify that all staternen*.s is form are true to the best of my nu- knowlec3_=e I w: am art 'W cat pert., or the grope; described abos c, b, virtue of ant\ dee r :ci riles in ; ehiste- ctf Deeds c r°ti.c. Number of bedrooms SIGN" ~ l VLRr, c_]l- APPLIC'ANT(S ) 1>^~TE 'An% infornraLior rf at is misrepresented may result in the sanitarx permit being revoked by the Planning L, Zonin, ~~~;,;irttrient ' Include with this app'ication a recorded wa:rrann deed from the Re-ister of Deeds Office and a copy of the certified surve\ map if reference is made in the warrant deed- (REV. (RED'. 04'12) E K 3 0~ w r b ~ NNW e-~ } v v '`i~•'HS~- Y N v1s yc~ "sue "s: _ way. - 'A _ Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer U✓ 1 t I=ti - - Pump Manufacturer Tank Model Number iQ<r L i Z C'/ SSC r - Pwn Model Number Total Tank Capacity G+ t? i _ . Alarm Manufacturer _`Zj Rr1 vk tt5 Max. Bury Depth Alarm Model Number _ Switch Type v t Cc + IC t-. 1 Filter Manufacturer ^L YLGK r-- - Total Dynamic Read (TDI1) - Feet Filter Model Number~f%~ Elevation Head Distal Pressure _ Network Loss_ - Minim Pup Performance Requircd~- Force Main Loss ~%GPM 239 Ft TDH [Tot„~ Outlet Manhole Mitt. 4" Above Grade With - - Locking Device. Wet ManholeianlirJle Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted with Locking Device weather-proof - ► Junction sox ± ' F'nished Grade Depth of 1 Cr { Vent Min. 12" Disconnect Above Grade Ft With Vent Cap Weans a > a r a r < [ [ < t t t t t c t t tic t t < t t < < [ < < < t < '<I Outlet Outlet Filter Inlet Inlet Baffle Y e~< > < f ' Switch Settings and Reserve Capacity A ` a[• '4 1/41. a[a I a< < a♦a Tank VolumC- ? CPI a[ - Weep Dimension Inches Volume GaI. }3 < Hole (reserve) A ZG',,ly4s Y tfs , (alarm) B 2 G)fCElevation C , dose) C 4J7 '7' ' ° ~ Ft > ZZ, 214 • ~Bottom 't (dead) D - - D Elevation Total 3 i. ) s'_i}' . > :L F77. f f a M. a a a> a>>> a> a a> a f r> a>> a a. i t t t t u t{ t< i[ t t[♦ t t t t{{< t♦ l[♦ t t t.{ i<< t{ t[ t< t 1 S</ a t a < f a l<< t'4 f> a f a a a s a a a a a> f f a a>. a r>>> f a> f r> a s a>> a r a> f ass f a a s a a f> f GENERAL INSTALLATION: The septiddose tank is bedded and back filled in accordance with :t manufacturer's product approval specifications. Maximum depot of bury as specified by the manufacturer may n-, be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlee installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight Electrical service complies with NEC 300 and Comm 1628 WAC. OV05 Li Page of Wastewater METERS FEET 40 PE51 1 MODELS•. PE31 PE41, PE51 HP:.33, .40, .50 35 } 1 - 10 I - 2 GPM J -y 30 PE41 1 FT a PE31 x 25 ' -T r 1 T z 20 O - : ~I 0 0 0 10 20 3 40 50 60 _ _ 0 GPM 80 L i , 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 PE41 _ PE51 Total Head Total Head --fie- (feet of water) GPM GPM Tote) (lead GPM (feet of water) (feet of water) 5 52 8 61 10 10 42 _ 10 57 15 5y It 29 15 46 Z0 50 z0 6 20 i 33 0 25 25 34 16 30 26 35 if~~y~~: j~(~t.Ll:`~ f•11--i•~'~~~~.`~±i t_-tt- ' t-¢t 1-~1:- ~{•tt/41t=`'~ +++O OIOZ 'NVr a3SU\38 0 ~21n ISO 31YO Oioz 4kwnww 31V0 D94l4 ox oa ►pOtvw Ol lMN sn 9T./97M z ~af14d- _A-,l=_f l 3'iN~S ,dnNVw Oud3s W 5W -75 MYaU 31311111 z o z ~ v H j a °v Q z W p~ o ~O ag 80 U7 U W r- _j F z O F- vi ° m < m LL cr- Z m m ~Op ac 0 9x m a z W 0 a vi Q o< z z ~ z a w H g, a° m a O -j V a U Q fn O \ LD J O 2 W 6 ;r m Q Q a 0 0~ m In }y c~ C? z ~z~ a O m z > 0011 -oOo~KS 1 <wm 4: cl = z a 0 V) C4 ~D C) W ~..,"n'•°- wmv F°ZV~i z w = u ~4 ~~a z0 CJ- Ir ~ -3: WA - M<o o<ww Q'y-I3 a` v0 a ° O Y ~ x <((A0 3momm-j ]J z Sr4 ~y w U k< N t d r z ,6£ a O a a ~ a t Sb0 .9£ do cr h I N N U cD V) ` d W LU W t W F.v < w £ V i @ 4 ! r: ci S a ¢ c 1 Q„ Q Y Ok do U M ~ F- ~ z d it z 003a m 96 SV < .£S m Y z H Wisconsin Department of S344EI1r811g-ices o l J 1(Q - S Division of Industry Services M1 ~M 3 1 Z(~11b SOIL EVr1UJP. 'C:?N REPO '~'Z' Pege 1 of 3 3!. GR004 C)p 3f~fitlzSPS 383,Wis. Adm Code p p r~/g EffVV County ST. CROIX Attach com fete site Ja F'tldt'le `tflan 8 112 x 11 inches in size Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D 020 1100 - 90 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . A' '4 Please print all information. Revie y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location w KELLEY M. KLIMEK & SHEILA M. HOBBS Gov Lot NW 114 NE 114 S 3 T 79 N R 19 E❑(or)W Property Owner's Mailing Address Lot # Block # Subd. Name or M# 652 C.T.H. N City state zip Code Phone Number ity ❑Mllage own Nearest Road Hudson, WI 54016 ( ) C.T.H. N ❑ New Conslnxtion Usel] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD D Replacement ❑ Public or commercial - Describe Parent material Sandy oum ash Flood Plain elevation if applicable NA ft General comments Conventional In-ground trenches 0.7 loading rate required and recommendations: pumping System Elevation - 96.00 ft. Boring # Bonng 171 a Pit Ground surface elev. 100.10 ft Depth to limiting factor 90 in. Sod Applicat on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 22 10YR2r2 - I 2f-msbk mvfr Cs 2vf-co 0.6 0.8 2 22-27 10YR31 sl 2fsbk mvfr cs I Vf-co 0.6 1.0 3 27-90 IOYR4./4 - s Osg dl - 0.7 1.6 Horizon 2 has some gr 20-25% 2] Boring # Boring 98.77 96 Pit Ground surface elev ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-20 10YR2%2 - I 2f-msbk mvfr cs 3vf-co 0.6 0.8 2 20-29 10YR-31 - Is If--msbk invfr Cs 20:-Co 0.7 1.6 3 29-96 10YR4i4 - s Osg dl 0.7 1.6 Horizon 2 has sonic gr 30-35% Effluent 01 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign l / CST Number MARY JO HUPPERT Hollister's Soil Testin &Desi 14 x ' ~ 224832 Address Date Evalu Conducted Telephone No timber 28497 King Arthur's Court, Danbury, WI 54830 05- 17 - 2016 715-326-1775 5 Rf )•R'i 30 i R0?r I ; t PW PIM PAC 3of'3 KG"y Nt.KUMEKI.*C1l-A A +i6085 40ft ~ AGC.. la1 TtfE A11A~'/~/ ArF T~1~ A~ ~ 1~ .sw.,m-.~, lemgi -malA) OF fft,ID" -,Sr. CJMK ewamf, pir North ¢Z ~ off; 4ftw 1 pe - Oil gtTV C ~ s) ggt~r ~r.~. of • SSW LOCAKt MO d=tf- At