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HomeMy WebLinkAbout040-1200-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: ;t~4 / (ATTACH TO PERMIT) 589791 Ye'6NERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2745255 Permit Holder's Name: City Village Township Parcel Tax No: Ronald & Deborah Schock TOWN OF TROY 040-1200-20-000 CST BM Elev: Insp. B Elev: BM Description: Section/Town/Range/Map No: 0-~- w e t 1 28.28.19.920 TANK INFORMATION 1DU,p ELEVATION DATA TYPE MANUFACTU E `V' ti \ CAPACITY STATION BS HI FS ELEV. c, '-I - Septic 00 0 t• / Benchmark E~ Dosing Alt. BM 14' Aeralien 1 Bldg. Sewef F I L 191d 111 X fy, F~elg _ r Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION - TANK TO ~y J WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 t 715- I Dt Bottom J2,11 M. 2y Dosin i Head r/Man: - r? g , I 1~'S. . Aeration Dist. Pipe Holding Bot. System 145 it)21 Final Grade PUMP/SIPHON INFORMATION Manufacturer bul rp Demand St Cover I ' r GPM Model Number fi~ • TDH Litl n ~ Friction Loss,, System Head C~ TDH F.t Forcemain Length ,r Dia. , Dist. to Well t ~ SOIL ABSORPTION SYSTEM BED/TRENCH Width f Length No. O1~Frerrelacs PIT DIMENSIONS No. Of P' Inside Di Liquid Depth DIMENSIONS f) 1 SETBACK SYSTE TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION 5 CHAMBER OR TYA tst UNIT Model Nu gr: ~r DISTRI.B-UTION SYSTEM Heade ManifQI / t T stribution ' x Hole Size x Hole Spacing Ve to A' pe(s)Len th Dia n9th Dia Spacing 2 9 -1 =a i hz 17 SOIL COVER , x Pressure Systems Only xx Mound Or At-Grade Systems Onl y Depth Over 1 Depth Over xx Depth of. xx Seeded/Sod II I C f' Bed/Trench Ce \ Bed/Trench Edges Topsoil I 0% ded J / /~es No fir' ~es No COMMENTS; (Include ode discrepencies- persons present, etc.) Inspection #1: J W Inspection #2: r A i l tC~,1 `~tl CI, ~x'r. c! c r~rP (l.o 0 C h o -hi Location: 597 SYKORA LN i Y 60 Ood N, 1.) Alt BM Description 1'ttq/ ll}tI - ~,L y Mt(~tM(ti~ ~ ~vllq h~ l~l~ rV~VJ('h~ •L„ L~i~N t~~, ,mot T 2.) Bldg sewer length = W, 1 f y + l t tl DO r~ - amount of cover - W '1 t~~ 1~ T~ ~l p t Plan revision Required? Yes No Use other side for additional information Date t sepctor's Signature Cert. No. SBD-6710 (R.3/97) lr IVED ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT 14 x,010 AND OWNERSHIP CERTIFICATION FORM ST. CROIX COUNTY /2 i O VyeTM DEVELOPMENT /r A/ till i)~L ~ Mailing Address - Property Address K 0 L4 (Verification required fro Planning & Zoning Department for now construction.) City/State 17) ^ 1 Parcel Identification Number 1 U - J (}0 c,? U u LEGAL DESCRIPTION Location 1/4 , 1/4 , Sec. , T N R_a_ ~ w, Town of Property Subdivision Plat: , Lot Certified Survey Map # , Volume . Page # Warranty Deed # (before 2007)Volume , Page Spec house 0 ye4no Lot lines identifiable Oyes 0 no SYSTEM ffiNTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF AP ICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Tr nett-,i -5A N - do 61 County MP Industry Services Division D Q)1 1400 E Washington Ave F~ Pti5 AU 1 16 P.O. Box 7162 Sanitary Permit Dumber (to be filled in by Co.) ESQ ST CRC?1X CO NTY Madison, WI 53707-7162 ~j' zS„ox P_-,.AAAAAI INITY DEVF~OPMFNT 45 T7 anitary Permit App1_ieation State Transaction Numbere In a ordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Z7 Y 5 , 5 S is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than trailing address) purposes in accordance with the Privacy Law, s. I5.04(1)(m), Slats. ~ I. Application Information - Please Print All Informatio ~ ~~7 )6 Tl Z4 4 Property wner's Name Parcel # Property Owner's Mailing Address Property Location, 1S e q a O i Govt. Lot Ciry, /~tate Zip Code Phone Number / 1/4,/VA,~ '/4, Section c~ 7 _ circle o N R / E or II. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use 'a(,Q. Block # ~ ) rn .1 1 S ❑ City of ❑ State Owned - Describe Us CSM Number El Village of X 75 /fia J J 6&~ ® Town of 4e, 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit umber a and Date Issued Before Expiration Plumber Owner .~7 t IV. Type of POWTS System/Component/Device: (Check all that apply) Q h p ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil J2 Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatme Area Information: AA, Design Flow (gpd) Design Soil Application Dispersal Area Required (s Dispersal Area Propose s'f)n System Elevation Rate(gpdsf) ~.1/ 7 1/ VI. Tank Info Capacity in c Gallons Total # of p t? ° 1 .2 M ufacturer o U ti New Tanks Existing Tanks Gallons Units ) J~ 7 °U i;i h rn iz 0 a. Septic or Holding Tank I 16 E El El El El Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Responsi lity Statement- I, the undersigned, assume responsi lity for installation of the POWTS shown on the attached plans. Plumber' me (P ' t) Plumber's 'a e MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) _ n VIII. unt /De artment bse Only Approved tsapp Permit Fee Dat Issued A01 Is suin gent Signatur7IX. Condi 1 )1 oP e f Disapproval 66 ^ t % e n? 0spemrAl cep must all a set kes !_rtiairtt as per tna .agement plan provided by plumber. GfZ'CC~ Wt r"`' 2 q recOrements W code / must. MziryEd 6& '6 6V'e. , r.~l.r ~t►IDtvt.i~0y1R~ dry Attach to complete plans for the system ands mit to the County ly on paper not less than 8 112x I I inches in size SBD-6398 (R03/14) c_ , r J 1 j p , v ryD j' / . / 1 4 5Q5 ~5$~. 33 ~vtiPpR7 fEti'r DIVISION OF INDUSTRY SERVICES c~~ s PO BOX 7162 MADISON WI 53707-7162 a S' Contact Through Relay P http://dsps.wi.gov/programs/industry-services y S www.wisconsin.gov ~"f Es'sioti_~ j Scott Walker, Governor Dave Ross, Secretary August 08, 2016 CUST ID No. 224263 ATTN: POWTS Inspector KIM A OCONNELL ZONING OFFICE KO CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020-8173 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/08/2018 Identification Numbers SITE: Transaction ID No. 2745255 ID No. 827105 Ronald and Deborah Schock Site Please refer to both identification numbers, 597 Sykora Ln above, in all correspondence with the agency. Town of Troy St Croix County SWI/4, NW1/4, S27, T28N, R19W FOR: Description: Three Bedroom Mound System / 4% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1615696 Maintenance required; Replacement system; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-I0706-P (N.01/O1, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 10 1.01(10), Wisconsin Statutes, is responsible for compliance with all code C requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEVI stats. PROFESS The following conditions shall be met during construction or installation and prior to occupancy or use: 0i~~ ON OF Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. EE O • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on site durinsz construction and open to inspection by authorized representatives of the Department which may include local inspectors KIM A OCONNELL Paac 2 8/8/2016 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Tiffany Marshall Wastewater Specialist , Division of Industry Services WiSMART code: 7633 (608)267-9378 , tiffany.marshall@wisconsin.gov KIM A OCONNELL Page 2 8/8/2016 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 C41 Balance Due $ 0.00 Tiffany Marshall Wastewater Specialist, Division of Industry Services WISMART code: 7633 (608)267-9378, tiffany.marshall@wisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGI4p Residential Application I " / INDEX AND TITLE PAGE ✓u 1016 Project Name: Ronald & Deborah Schock Sl ~AV~C Owner's Name: Ronald & Deberoah Schock Owner's Address: 597 Sykora Lane River Falls WI 54022 Legal Description: SW-NW-sec27-T28 R19W Township: Troy County: ST Croix Subdivision Name: Sundown Hills Lot Number: 13 Block Number: Parcel I.D. Number: 040-1200-20-000 DITIONALLY "PIRILOVED Plan Transaction No.: F SAFETY AND ZONAL SERVICES Page 1 Index and title NDUSTRY SERVICES Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications _ZA1 ~F + Page 6 Management and contingency plan ,fZES NIC.I~ Page 7 Pump curve and specifications Page 8 Plot Plan Page Soil Evaluation Designer: Kim Oconne g' License Number: 224263 Date: 07/27/16 Phone Number: 715-381-7917 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design [design Worksheet Site Information (R or C) "=1 Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.001, Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 450.00 Design Flow (gpd) 4.00 Site Slope 101.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.401 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information r~ 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) -E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 7.50 ftz/orifice 2.00 Forcemain Diameter (in) 50.00 Forcemain Length (ft) Does the forcemain drain back? Y 93.10 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 8.16 Forcemain Drainback (gal) 9.23 Vertical Lift (ft) 67.32 5x Void Volume (gal) 0.68 Friction Loss (ft) 75.48 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 24.72 System Demand (gpm) 16.41 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 _ 1.25 x 1.00 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information '__'10_050 .00, Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) Wieser_ Manufacturer 27.78 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) Plo I~ ock -Filter Manufacturer 16.761 Dose Tank Volume (gal/in) PL 525 Filter Model Number WeiserManufacturer Project: Ronald & Deborah Schock Page 2 of 9 J Mound Plan and Cross Section Views T . J 1/10 .6 Observation Pipe . . ; : . K O A W B . . I : : : : : : : : : : : : : : : . . . L Mound Component Dimensions ft B ft F 9.50 in z ft L ft A A18.00 ft E 20.88 in H [Aft ft K [Aft D in G 0.50 ft J W 450.00 (ftz) Dispersal Cell Area 1225.14 (ftz) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 104.29 (ft) - 0 ..r;,. ♦ H 2 G j 103.00 (ft) Lateral F Dispersal Celli 102.50 (ft) - Invert Dispersal Cell : Elevation .E D : 4 4 101.00 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key n I - Dispersal Cell See lateral details on 0 Topsoil Cap c 1.5 ft Page 4 for number, size, 2❑ • Subsoil Cap m o _*Q and spacing of laterals. ©0 ASTM C33 Sand ea R / Laterals are equally ®0 Tilled Layer N 0.5 ft Typical Lateral F spaced from the distribution cell's ©0 Aggregate o centerline in the A * distribution cell (AxB). Project: Ronald & Deborah Schock Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the E: dirnen_ ion • = Turn-up •m' ball vaKee or clean out plu g I P All laterals are identi._ 31 If X I Hc~l es drilled on the bottom of the lateral _ equally spaced main conneeri ri ui3 tpe or cross to manifold at -3nV point. Later als .36. fon_ernain 40 PVC per 3P Table 324,30-6 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 7377 ft Orifices per Lateral 30 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ftz/orifice Lateral Flow Rate 12.36 gpm Manifold Length 3.00 ft System Flow Rate 24.72 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.41 ft Forcemain Velocity 2.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -i SPS 316.300 WAC 4 in. min. Disconnect _ Tank component is properly vented F- Alternate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 600.00 Gallons T Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 21.30 356.92 B 2.00 33.52 C Pump off elevation (ft) C _ 4.50 75.48 ~ 93.77 D 8.00 134.08 D Total 35.80 600.00 IF ' -Dose tank elevation (ft) 3" Bedding under tank. 93.10 Alarm Manuafacturer 'SST , w~ Note: Switches Alarm Model Number ~tUr` ~T containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number PE-5-1 Pump Must Deliver 24.72 gpm at 16.41 ft TDH Project: Ronald & Deborah Schock Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Kim Oconnell Phonel715-381-7917 POWTS Regulator's Name ST Croix CTY Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 f:2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Oth ~ Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade \Jo 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Ronald & Deborah Schock Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 11/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. HGOULDS PUMPS Submersible Effluent Pump PE t~ ' ~IFLUENT PUMP SPECIFICATIONS MOTOR FEATURES Pump - General: General: ■ Corrosion resistant • Discharge: 1111" NPT • Single phase construction. • Temperature: 1040F (400C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and os,..r. ` . fully submerged. • Built-in thermal overload pro- cover. r • Solids handling: 'k" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. ° Class B insulation. heavy duty ball bearing • Automatic models include a • Oil-filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • Manual models available. shaft. lubricated for extended following uses: • Pumping range: see PE31 Motor: service life. performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Mound Systems • 12.0 Maximum amps operation. • Effluent/Dosing Systems PE31 Pump: • Shaded pole design ■ All ratings are within the • Low Pressure Pipe Systems • Maximum capacity: 50 GPM P 9n working limits of the motor. Basement Draining • Maximum head: 25' TDH PE41 Motor: ■ Quick disconnect power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM Dewatering Maximum capacity: 60 GPM • 7.5 Maximum amps cord, heavy 20' duty 16/3 standard d length, SJTW with • Maximum head: 29' TDH • PSC design NEMA 5-15P, three prong, PE51 Pump: PE51 Motor: 115 volt grounding plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compact. • PSC design s Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless 40 MODELS: PE31, PE41, PE51 Steel. PE51 HP:.33, .40, .50 ■ Stainless steel fasteners. 35 10 2 GPM _ AGENCY LISTINGS 30 PE41 1 FT _ _ . _ PE31 us w 25 C~p U Q 20 Tested to UL 778 and o CSA 22.2108 Standards By Canadian Standards Association File #L.R38549 O H - - = - - - Goulds Pumps is 150 9001 Registered. 5 0- 0 0 10 20 ' 30 40 50 60 70 GPM 80 0 5 10 15 m3/h Goulds Pumps CAPACITY n r + t f ~6 ,r / I ' l \ Z-13 33 8w-009/0001d-M:3ll3 99-b8-SN-008 90OZ 'NV 'A38 o\ p t00a .taVnNVP :31V0 05Lt9 IM ')400M N301VW 'OUMH sn 9tL2M 'vnNVH Olid3S Z 1MS Aa NMVaO 31313013 B3331M m p° :RV0 'ON A381=.V/t :31VOS dw-0090001d1M \ w ~ ~ w z J Ir W z Z Of O it w > O vwi w _ ~ w_ z V) J > O J _ Q N w p a r a F V U N o w o C DP cv J Lu a o z a Ch o 00 F- z o _ o W a V a o Q O Q= (u J J N > \ O LLJ O WF W 00 z z O L) N O m v o i W w O w 3 a w W m N ro cn > r w Z Q U 0 V) O O NUJ Q W - N O F- X o4MO ~ m W W (l, (D O Z> Q = D W 0 O O Oto f- N 00 o a v a o Y "'L.;~`-~zw~ ~a ~uZiU) > _j V) tom-- Inm o J Q Z 0wO=~=00= OQ Qzpw Q V) Z 3 w U w ZQ _QJI->z0Z~JO D °U Z-, Q O Y-j m a v' EaV o Q OQQwwOWC1 W O U U z W 0= F- 3mU:2 J?i 0)J ?i Q Q~~ Z z3:Q Q N O pY LLi F O V W Z O N W J J O z z O Z Z J J Q O F-- N U I' D a U z Q W Q !n Y z H H F z w Ld -j > t ,6~ o I ~ ~ I ~ II I I.I I, I I i I „8ti Li_ 5 5 LLJ 0- J 0 J w I 0 v i U) cap W I' V wom I. wS I I I _ I I i I\ j I - I I w J z .,ti8 .,95 ay' G -\0 'k o g y N$9'1820 E ? .1 17 11. P A' \a°+ 83.7 L' m 92.17' to \ v ab aA" \ 4~ 52 59'40" S 19, c~9 a rte` ?0 Vol ; \~Q 7 152°59'40 1 ~ 4.02 ACRES w o,~pfl 100°004d' 21 C1 s3a ~ -~n OS ~ o / if oy0 ~~3•5e P a0 t q0 / ~8 e ! \ w rON69 UNPL.A"ED BANGS i 9500 V LCRES 30 /S,5* ! ; N / u` N N'i .fl , N 0 ~~jj f^ 0 9 to G 2.60 ACRES ~ /08a 2.01 ACRES \ _ 50 00 11° °0 ~ S Svc N NOR7 NEk 2 3~, c~7_ M ` RIGHT-Oc 9 \0 cv $~a -ate Ego 2`~ aN 3 z69° Q ` 155.00' emu'' 145.00' f`10 (ro S U~1Pt-P~ ~a„ 300 00, ~Z0A S 89018'2 0 W D 6 :RES _ 0 3 ~N?LA*J T.E ` RECEIVED S? -~c ~ S s Wis. Dept. of Safety and-Prztessinrial$ervirac sOI~l tb , ON REPORT Page of Division of Safety and E K5PFTAZ5PJ7MA ice~with t§,Af~'~SSNTYb )b~iFCCpORT-f ode County Attach complete site plan on paper not less than 8 1/2~Mi'1n~ttP~`ir1 s~zeVAWiR&WNT include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. i Re ed by Dat Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). $ ZZ Property Owner Property Location Govt. Lot awl 1 /4 1, / 1l4 S T ' N R c? E (or)b Property Owner's Mailing Address Lot # Bloc # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village fOTown Nearest Road F-1 New Construction user Residential / Number of bedrooms j Code derived design flow rate GPD Replacement ❑ Public or commercial -Describe: materialFlood Plain elevation if applicable ft. Parent General comments .;y,, and recommendations: 0 Boring # Boring ® Pit Ground surface elev. ~ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 3 5 - c Boring # Boring ® Pit Ground surface elev. /1';/,? ft. Depth to limiting factor in. Soil Application Rate Z Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ( ~Wi ff#2 * Effluent #1/= BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ffluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L CST Name (Ple e Tint) Signature CST Number - ~ I Address / Date Evaluation Conducted Telephone Number SBD-8330 (R11/1 1) Property Owner Parcel ID Page of ❑ Boring / Boring # Pit Ground surface elev. ,/fE. Y ft. Depth to limiting factor- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 V f#2 L? ~ 5'12 ZL-Z,2115' } 42 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 * Effluent #1 = BOD e > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD s < 30 mg/L and TSS < 30 m9/L - - - - The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330(1Z I1/11) Property Owner_ ParcellD# Page ~l of ❑ Boring # ❑ Boring I Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ~ G ~ ~ Jam, I i _ J ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 Boring # F] Boring F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ' Effluent #1 = BOD e > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (RI 1/11) - i i J~7 /4` L -T j i T I I ~ ~ I i IiU7 77 If dry„ 16 rn ff~ p 4 ~k Y3 N 4 Pll o" v F a d ' _ o - ~"aT Yr.' ,g $ y. r -:.,9• tl o R 47 4"A cc $ o U 0 CO) • 0 0 D v1 ~ c o m A 0 2 a y T 7! T o o ` J 3 i N O N ~ yet O y ~ O N W W O 0 W A 1 • m 3' c 4 8~ v o _ Q CD OD N O) 7 CD 7 O co N a 7 O to D 7 O O C c, O c (D n O. O O < N Q y T 3 O Ln 00 l11 7 Vi ED O C 40 b'i N 5* D a o m o N a ~ y 3 n m OD O ~ R 0) OD "Wftt m C-) r- cn N co m- 3 r r ti z O O O t~l p a N N N W? V`y a; ~ c O O rev a C cC N <D y N O a ' N N = w N O. Nib, l G (#J7 3 Z ~ ~ N Z co Z o Dom' ti. N N W 2 G ~ Z CC fD t -i cn - a p Z CD v j J IY A z 7 o. c " (n N rp M 00 a z a O s 3 Z M w z A r W ~ D o ~ Cn o' - o m c y az a a ~ y t y a 0 3 a b a ti N a Q ~ c ti s r,, ' rJ rJ ct a A O 7 CD 010 o O ` ~ x a ~ y 00'0 000 00'0 lelo-L soBjeyO luanbulla(] saBjey(] lepedS sluawssesW leloadS lunowy /GoBale(] opo0 leloadS iasn :sleioadS 17Z6 g3le9 :ale(] u01le0 PIA8O 1, :luno(] w!elo :I1paJo Aio:po-l 0 0 0000 pUelpooM 009'98Z 000'9ZZ 005'09 OOE'b Atjadoad IeaauaO :9002 aol slelol 0 0 000,0 pUelpooM 009'98Z 000`922 009,09 00E,tr AtjedoJd IeJaue0 :9002 Jo; slelol ON 009'99Z 000'92.7, 009'09 00£'ti LE) TdI-LN3aIS38 uoseau alels lelol anoidwl puel sei3v sse10 uo!lduasaa 900Zl90!60 : paBuey3 Ise-1 : suoijenIBA 00L'bl£ tr6Z691 :yl!m passassv :amen laMJew ABA II!9 Auvww 1S 9002 9lV;OLL Z66L!EZ;ZO adA.L 06edllOA # 000 ale(] :tiolslH 100Jed :saloN M6L-N8Z-8Z (b!L 09L b!L Ob 6u8-umi-oas) :(s)loeal EL -LO-1 :6P19 opuoomool9 £L iM SIIIH NMOQNns M6LH N8Z1 8Z OAS SIIIH N)%AO(]Nns-ZZSZ Meld OOE ti :sajob :uo!ldijosap !eBa3 H03-LOA AAIIHA dIHO 0040 dS SIIVA 213AI1 I £687 OS HI b OXkS Z69 _ uo!lduosa(] # Is!(] ads _L f, ew ~d . :(se)ssaippy fupadWd leloadS = dS IoogoS = OS :slo!jls!(] ZZOb9 IM SIIVA3 J3AI8 V-1 V'80)iAS L69 f Hd210930 '8 J OI`dNOb ')IOOHOS - O 1IOOHOS f HVH0830 N 9 OIdNOH jau/Ao-oo juajjn~) = D 'jaumo jua.uno = p :(s)ieumo :ssa.ippy xel 0 00 adAjL l!wJad # i!wJad # uolleollddV eeiV sales # deW alep le0!Jols!H ale(] u0lle0J0 NISNOOSIM 'AlNnoo XIOHO '1S X luann(] A0'81 =10 NN%Ol - Otr0 OZ6'6 VIEW laoJed III 6 d0 L 3E)Vd D'dd 170:60 900ZIMZ1 000-OZ-00U-0170 IGOJed A S B U I L T S A 11 1 T A R Y R B P 0 R T 01.- ER. : ; ! A Tcwnship ---Ic , Sec.1 Tn. 11, P,// 1 1>.0. ADDFESS. R*&r Cotu:ty, •Tisconsin Subdivision Lot! , I,ot size PL4N =VI Distances dimensions to neet requirements of Sec. F62.20 2-L= I A f _ k.- r N f no rings C' UepL to Cover Dry v.°11 size-.A Type of Anrreoate~L Covered with y Depth of seeiksr ge syste;-, _ Vent caps in place E , number used does nat _ih-ply co pleto I'y D1Sr,_T P ?i ; z: The insp>ction of th-is sys` en by Pierce Coa ' CO olizince Li-it}] St.n `d!i'ini sl1'at1 Ve Codes. 'here are ol.her 2I'C1 i th t it uS 171 5S1blE i 0 ?-11S 4.. c t t}ll his Y}D:LYlt of construction. )?1E=I'CE: CC1t17]1 Yc1:i ; ':L1"l.ty r Sy te~~ operatio:l. PLU2•"BEIZ M JOB: - DAlr;D: %(L~? LICFNSr I:TL? BEIR.- Z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Sani ta,ty Pe,tm.it- State. Septic NAME Township ! St. C40ix County Lacativn 4 v Sectian T N, R W SEPTIC TANK Size ` 9atton.s. Numbe,'c (o6 Compa,'Ltments i Distance Fnvm: Weft ~ 6t. 12% on gneate& stope / 6t Bu.itding 6t. Weteands - 6t. Highwaten 7 6-t. DISPOSAL SYSTEM , 'I Distance Fnom: weft C~~J6t. 12% on g~Leatet 4 tope ~t. a~ $u ctding 7 6t. Gle. hands 1-J Ft. H.ighwaten - 6t. FIELD DIMENSIONS: Width o6 t,te.nch 6t. Depth o6 nock below t,ite ~•Z .in. Length o 6 each tine. 6t. Depth o6 Hoch oven t.ite Z.. .in. Numb en o6 dines . ' ; Depth 06 t.ite below g.tade 340.in. Totat. length o6 tines 6t. Stope 06 trench in pen 100 6t. Distance between tine.s__4~_dt. Depth to bedrock 6t. Totat absohbtion a-tea_81 6t2 Depth to groundwater 6t. Requi,ted a7.ea it 2 PIT DIMENSIONS: Number o6 its Gnavet v ound pits yes no Outside m t 6t. Depth below .inlet 6t. 2 Totat s t o a-tea 6t z _A Area nequined 6t2 INSPECT TIT E APPROVED , SATE ~~i 191 d. REJECTED , DATE 197. l~ r. EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGSANR °€RCOLATION TESTS LOCATION: Scct:u,, T! ?rN, R 1Z F{er W Township or Municipality A - Lot No. 3 Block No. ~:H -County Sub ivision Name - Owner's Name: ` Mailing Address:221~ 5 A 14 TYPE OF OCCUPANCY: Residence No. of Bedrooms - > Other _ EFFLUENT DISPOSAL SYSTEM: NEW - ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS _ J 111.v.Q Z~ PERCOLATION TESTS CA - SOILPAAI'S!ILFT SOIL LYPE `,r_1~ ►I _ _ PERCOLATION TESTS TES- of-T-I' CHARACTER OF 5011 HOURS WATER IN TEST TIME DROP IN WATER LEVE77L, INCHES RATE 'JUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BEN 1ST WETTED SWELLING IN MINUTES PERIOD t PERIOD 2 PERIOD 3 MIN/IN P See '~~-e h r z© 4 D P6 6 l l ~l~ z 8 20 d~4~ 30 lYz , _ 2-113 SOIL BORING TESTS i EST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) ~ lp 861 ~ 7~ e6 Sa wsll~ /W,01 _&a 113-3 I FLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Aicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area 'nreded for building type and occupancy. Indicate scale ur distances. Give horizontal and vertical reference points. Indicate slope. , i i 110 1 i+ 1 I I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. i Name (print) ~~~H Lct~~G Certification No,>~ (3 6 Address tit- i~ QV- Name of installer if known S e 1`4r  rJ CST Signature C("Y A - LOS.-•L A UTHO^1T`( AA