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HomeMy WebLinkAbout040-1318-00-013 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 589703 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)t. 2716820 Permit Holder's Name: City Village Township Parcel Tax No: Creative Home Construction LLC TOWN OF TROY 040-1318-00-013 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 11.28.19.2088 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J Benchmark Dosing Aft . 000 .i Q . 4 B ,'4JAA. Go 3•~ M74 9 t • Bldg. Sewer i 1 Holding St/Ht Inlet -7, Gf Ad 7b, 474? TANK SETBACK INFORMATION St/Ht Outlet TANK TO ' j% P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S /jk Z-7 Dt Bottom Dosing Z7 (0 Header/Man. b 167 Aeration Dist. Pipe Holding Bot. System -7 1671(8 PUMP/SIPHON INFORMATION Final Grade 3.6 /075, Manufacturer Zo ~t_eo,4 Demand St Cover / GPM ,7 ^ /674/,W Model Number ILA TDH Lift Friction t,os,'7 System a TDH Forcemain Length Dia. Dist. to Well I , SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. O9Tcheg) PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dep DIMENSIONS SETBACK SYSTEM TO v P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Typ ystem: UNIT Model Number: 4 14 (03 DISTRIBUTION SYSTEM Header/Manifoll Distribution x Hole Size ' Ix Hole Spacing Ven Air Int Z Pipe(s) " ~Z 4 V Length Dia Length / Dia Spacing 0 z - fj Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of //yy xx Seeded/ odded xx Mulched Bed/Trench Center 1 , I Bed/Trench Edges ` Topsoil I Yes ❑ No Yes No 1 9 COMMENTS: (Include code discrepencies, persons present, ejcj Inspection #1: 7 i Z(,,, Inspection #2: 1 CI+e•Irvt.3 Location: 743 MOUNT CURVE CHASE W /6 /fi g f S 1.) Alt BM Description 4 "A J4' 2.) Bldg sewer length = /~Z Sv(vi dill - amount of cover = ! n n ~ SAW d r-, Q t~ A At, ~-o ba-47, an Plan revision Required? El Yes 1X10 7 / _ Use other side for additional information. ~P SBD-6710 (R.3/97) r Date Lnsepctor's i nature Cert. No. RECEIV va' Coun e r) r Safety and Buildings ion 'J K Ulm 201 W. Washington Ave.; P. 62 S 'tart' Permit Number (to be filled in by Co.) Sgt Madison, Wl 537 -7162 G 7 cKOIX COUNTY UNITY DEVELOPMENT 5 F .5 Sanitary Permit Application s Transacts°(nN"mbber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental emit ~ ~ - , 0 is required prior to obtaining a sanitary permit Note: Application forms for stare-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may used f dary pHToses in accordance with the Priv Law, s. 15. 1 m), Stars. L Application Information - Please Print All Information a Property Owner's Name/3 Parcel if Property Owner's Mailing Address Property Location I C~; C 7 ;T ✓?,~1 fly f'r"~. Govt Lot City, State Zip Code Phone Number Section 7 cycle o If r TN; R _E W II. Type of Building ec all that apply) Lot -s or 2 Family Dwelling-Number of Bedroo / Subdivision 'are d~ B ock. ~J/ S - ❑ Public/Commercial - Describe Use p u- p F ❑ City of ❑ State Owned - Describl Use I CSM Number ❑ VU age of 7 Town of _MG o- i - t, ai 60- IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 54ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Othe1946 r Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type ofPOWTS System/Component/Device: Check all that apply) 0 , ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank El Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: Design Flow (gpd) Design Soil Applicati Oral. dsf) Dispersal Area Requ- s Dispe s al Aosed System Elevati n VL Tank Info apacity in Total # of ~ a & rer Gallons Gallons Units o ~'r New Tanks E ishng Tanks 4 t m o y m ~~~.••►►►+fif w n. U cn J) Septic or Holding Tank r aJs Dosing Chamber , ~j m VII. Responsibility Statement- Ijpr undersigned, assume onsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's e MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) u 1416~ /2 1 l L~< VIII. County/De artment Use Only pproved Permit ~Fe/e~ D'awle sued Issuing, tSignature kO- en Reason enial $ tp t Y~ ' IK Condit I axons for Disapproval ~J Q L J i 1 W" tank, effluent fi ter and rb letn;al cetl must all be sel:'Icws f_ntgiritalr.e9' W r ^tA, "per,Rlragement plan provided by plumber. 2. Ak "lt4".`*tiirerrrents must,ba maintEivied l / _ _ n •~t tom c' c7r'd, ~ppraAlcode / .rdinar icea. q) F!„ ~ G Attacb to complete plans for the system and submit to the County only on paper not 1 S ri~`z ] I inches/fin SBD-6348 (R. 11/11) PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Drive Woodburv Mn 55125 NE 1/4 NW 1/4S 11 IT 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 1074.5' 1 .5' sand lift 5/27/16 BEDROOM 4 DATE - - CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 7E HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 1.25" pipe ASSUME ELEVATION 1069.52 Filter Lifetime Fi, ❑ BOREHOLE e WELL *H.R.P. same as benchmark All piping shall be ASTM SDR 30'34, within Cale _ 1{f 4n = 10' I W of tank, piping shall be ASTM F891 Mount Curve Chase rtSi Line _ 1'~ 11 = 01 P rope . Property Line Wei I is to meet! Pro 4 1 Acre Lot all WDNR Bedroom setbacks (b House ~b Grading is to be do o divert run off away m s~~ste m Huffcutt Combo Tani, I B-A B-G ❑ Area 15' below system is to remai n Tank is to be properiw bedded and undisturbe provided with lockdown covers witf 13% Slope approved warning labels 1 0?4' ❑ Tank is to p, iperiV 110 75, bedded an pr ided with B- El lockdow c rs with B-B approu d ni ng labels 1 G 7 2' B.M.* 1070'/IF Pr e v Li ne ~ A VO DIVISION OF INDUSTRY SERVICES o\\ PO BOX 7162 MADISON WI 53707-7162 D I Contact Through Relay P s http://dsps.wi.gov/programs/industry-services l /=:r www wisconsin.gov u~,t »ro~ Scott Walker, Governor Dave Ross, Secretary June 06, 2016 OUST ID No. 726900 AI TN: P0117,S hrspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC S"l CROIX COUNTY SPIA 1432 120TH ST 1 101 CARMICHAEL RD NEW RICHMOND Wl 54017-6409 HUDSON WI 54016-7708 CONDITIONAL. APPROVAL PLAN APPROVAL EXPIRES: 06/0612018 Identification Numbers Transaction Ill No. 2716820 SITE: Site 11) No. 824774 Creative Homes Please refer to both identification numbers, 743 Mount Curve Chase above, in all correspondence with the agenc Town of Troy St CroiX County NEI/4, NW 114, SI I, "1 28N, R19W FOR: Description: Four Bedroom Mound System ! 130/,o slope Object Type: POWTS Component manual Regulated Object ID No.: 1605164 Maintenance required; 600 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-10706-P (N.01i01, 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 101.01(10). Wisconsin Statutes, is responsible for compliance with all code ~►©NjF requirements. AP No ()F No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.U6, ~ ~ A stats. V, 0FESSIC~ The following- conditions shall be met dUrin« construction or installation and prior to occupancy or use: Reminders / • A sanitary permit Must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. t- • 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. • 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 ofthe approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/27/16 Owner:Creative Homes Location: NE1/4 NW1/4 S11 T28 N,R19 W 743 Mount Curve Chase Troy Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01 /01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section N'D 6. Pump Curve VICES SERVICES 7-8. Maintance and Contigency plan 9. Filter Specifications and cross section f Attachments: Soil Test t, f ,r Shaun Bird Signature 1 License nu r226900 Page 1 of 9 PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Drive Woodburv Mn 55125 NE 1/4 NW 1/4S 11 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 1074.5' 1.5' sand lift DATE5/27/16 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 7( 1. HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none Ilk BENCHMARK V.R.P. Top of 1.25" pipe ASSUME ELEVATION 1069.52 Filter Lifetime Fig ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark All piping shall be ASTM SDR 30/34, within Scale _ 1/4'1 _ 10' 10' of tank, piping shall be ASTM F891 Mount Curve Chase 10 1 Property Line Scale = 1/4 ° - Property Line We I I is to meet pro 4 1 Acre Lot all WDNR Bedroom setbacks House Grading is to be done to divert run off away from system Huffcutt Combo Tank B-A B-C ❑ Area 15' below system is to remain Tank is to be properly bedded and undisturbed provided with lockdown covers witr 13% Slope approved warning labels 1074' Tank is to be properly 1073' 13 bedded and provided with B- B- B lockdown covers with approved warning labels 1072' B.M.* 1070' Property Line Mound System Cross Section and Plan View ~ Dimension ion Feet J t - - t t l B T I t D - t i L h i h h h h L h L h h rr f r frtr firL Lii rrrr 4 i L i L L h•1• A I i i L L 4 L L i i•L - f f f r r f r f r+ r Lr`iti: if`r•rti ~rtir; ryr;+•r•r r+ r - r•r~+, f.r.r I E' L 4 i h L L i i 4 i L• r r rrt + r•r r r r r r r• f r f+ r r r r r r ii~r•i:i~i•r i•hrhlLj.','•{~~.-L~.~[+ irL•Ljh•4•i•t•1•hth•i•yhjLfhrh 4 L h h h h i i h L h h h•i•h•i+h•Y?h•h•i•i•[Va~{°~~!~i~`hji;hlhf y :rr~f}fy++J~l }:f• ~fM1•\~:lv~ti1\~1.1+\1\.ti•1. ti.\ L.L.i h i+1~i.h.i.h h irirl~\11~~\r1~i 4~1~" \.1.y.} 1ty t F • / I W I rrryr r+r+•r4r{rrfr•rLr r~r f+r~++rrrr~r r+r•++f rrr.r•rr+t rv 1 CJ t I G S~ Z . t H 1 I t I K I I f~ i L 1 ` W KT B 1 Z Sloe l% L t - 1 = Topsoil = ASTM C-33 = Clean aggregate = 4 in. sch. 40 pvc t I ,h .1ji••jL Material sand fill I/2 to 2 '/2 in. dia. 0 observation pipe Cap ~_.A Geotextile G Fi Fabric ---T S ~•L.rtiftirtirtirtii F ri S ij1{ijhjtirLfLfh it •S•tiriyl•L• D E - 10-k', 0 Ft Contour Plowed Surface Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07lgj Page J of Pressure Lateral. Layout Two Laterals - End Manifold 4 Threaded Cleanout Lateral Turn-up Plug - Manifold AM- M I L - Long Force Main ` Sweep 90 Bend Distribution Network Specifications ~ Pressure System Construction Lateral Diameter In. Manifold Diameter 1 In. Laterals are constructed of Schedule 40 PVC Orifice Diameter r I pipe. Orifices are drilled perpendicular to In. X Orifice S acin In. the pipe with a sharp drill bit and face down. L Lateral jLen Ft. Lateral turn-ups terminate with a threaded M (ManifoFt. Cleanout plug and are enclosed in a 68 inch Force MaiIn. diameter lawn sprinkler valve box accessible Force Mai" 1, Ft. from finished grade. Grade •••••••.:d • 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 Igj Septic-Dose Wank Cross Section And Pump Performance Specifications Pump Manufacturer Tank Manufacturer Tank Model Number Pump Model Number rJ t > Z- Alarm Manufaadirer Total Tank Capacity Max Bury Depth Alarm Model Number I- Switch Type c Head (TDH) - Feet Flter Ml Total Dyaami j Elevation Head , Distal Pressure Network Loss Minimum Pump f erformance Required Force Main. Loss f ~ Ft TDH Total ` GPM, Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade `Locking Device. inlet Manhole - With Locking Device < 611 Below Chide Sealed Watertight Securely Mounted V _ Weather-proof Junction Box -m s Finished Grade _ Vent Min. 12" Disconnect Above Grade Means • With vent cap Cutlet Filter _ _ _ - - - - - 'Wet Baffle Inlet - In `'i' A 1/s» switch settlugs and Reserve Capacity Weep Tank Volume GPI Hote Dimension Inches Volume Gal. B (reserve) A p Elevation C B 2 [7Fty Bottom (dose) C : ; D Elevation Ede) D Ft Total . filled in accordance with the is bedded and back GENERAL INSTALLATION: The bury as specified by the manufacturer may not manufacturer's product approval specifications. Maximum depth of have an effective locking device (padlock) be exceeded without pirior $pproval. Manhole covers exposed to grade the tank with watertight fittings, and at the inlet and outlet is of approved material, connected 4" Schw 4q PVC to bridge the tank installed. Piping The force ~ is sleeved with ifle laid on stable soil to prevent settling ors . Electrical ice complies with NEC 300 and Comm r16.23. excavation and the sleeve is sealed avatar i$ltt . Page of 02/05 U DYNAMIC. HEAD/CAPAC;TY TOTAI PER VINUTE CAPACITY CURVE EFFLUENT AND DEWAIE~ING DEL 152/153 ! I ,s3 FHEAD U1 MODEL ! 152 W U-1 C Liters 50 1 Go Liters I ol. I I Ee Meters ~ 5 T 1 5- 69 I 25" 77 291 153 f In 3 i 61 231 11, 70 ~ 265 ~ 12 40 15" V 5 4 6 53 I 201 ~ 61__ i 231 ` r- --r-'- I + 187 52 _97 L- i 6,1 , 0 34 129 42 r 159 x 30 _ 23 8' 33 'I 175 Z 8 ( i 3G I ~ _ ~ __-2i I I - 0 _ 4- 40 1 42 l i I l~_ 20 I 17,2 i ^ (11.6m 144.0 Ft. 4.r,) i _ck vov 13?~ 4I I oJssoa 10 I I I 0 20 4 60 80 100 GALLONS LITERS 0 g~ 160 240 320 5j5 - I FLOW PER MINUTE ( \ ~ 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 + Timed dosing panels available. available and supplied with - • Electrical alternators, for duplex systems' are ava 1 I an alarm. • Variable level control switches are availabe for controlling single phase systems. - sue' • Double piggyback variable level float switches are available for variable level long and short cycle controls. - f g • Seated Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 12 1521153 Series 152 3 5 1/S Cotrol Selecj1on 1153 MODELS t7~'-" lex I rdode1 ! volts-Ph Mode I Sim .ex I+-D_u - --r- 9.S t I_ 2 or 3 sK2064 t{--N1-52 1151 Non 1 t BN152 115 1 I Auto 8.5 Inclined 2 or 3 _ E152 230 1 Non 413 1 2 or 3 I--"- Auto 4 3 Included 2 or 3 BEt52 230 t 1' 2or3 SELECTION GUIDE N153 115 t Non 10.5. SN153 115 1 1 Auto 10 5 lncluieo 2 or 3 back variable level float 1 Non 5.3 1.? or 3 1. Single piggyback varia0te level float switch or double piggyback 230 2o(3 I BE153 230 1 Auto ' S.3 Inclu_ded iT switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Aftemator E-Pak. duplex (3) 3. Variable level control switch 10-0225 used as a conVOi activator, specify P , p CAUTION All installation of controls, protection devices and wrong should be done by a qualified or (4) float system, cluding the most nsed IrecentNation lElectric Code (NEC)randth Occupational SafetyandHeaithAd(OSHA)- RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO, P.O. BOX 16347 r !V~ Louisville, KY 40256-0347 Manufacfurersof. . SHIP i0: 3649 Cane Run Road app Louisville, KY 40211.1961 QUgL/TY PUMPS ✓1NCf ~JJU Z~ r (502) 778-2731.1(800) 926-PUMP "l r / 7LJlY!` L O FAX (502) 774-3624 httP;//www.zoeller.com 0 Copyright 2000 Zoeller Co. All rights reserved. 1 POWTS OWNER'S MANUAL 8, MANAGEMENT PLAN Page - ot FILE INFORMATION SYSTEM SPECIFICATIONS rPem er Se tic Tank Capacity p tic ❑ NA it Se ptic Tank Manufacturer / r _ ❑ DESIGN PARAMETERS Effluent Filter Manufacturer' k' p NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial UnitsNA Pump Tank Capacity ? - al ❑ NA Estimated tksw (average) /c 1 gal/day Pump Tank Manufacturer t r ❑ NA I Design flow (peak), (Estimated x 1.5) c c ~ ' gal/day' . Pump Manufacturer , ❑ NA Soil Application Rate z al/da Ke Pump Model ❑ fjA Influent/Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mgJL ❑ Sand/Grevel Fitter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 420 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m /L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality EIINA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD5) 530 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade .13~AAQund Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Dri ine ❑ Other. Maximum Effluent Particle Size Y. inch diameter Values typical for domestic (nmrcornmercialj wastewater and septic tank effluent Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ monthsyear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every ❑ months Ayear(s) (Maximum 3 yrs.) Clean effluent filter At least once every / ❑ months , year(s) Inspect pump, pump controls & alarm At least once every ❑ months year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months, -dyear(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA I Other At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or ceftific ations: 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, miectVnlcal or pressurized POWTS components, pretreatgment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servicO report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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. C page of Painting pacts or other chemicals th~lt START UP AND OPERATION For new construction, prioc to use of the POWTS check treatment tank(s) for the presence of ant Process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the may impede the treatment 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• abler is restored the excess wastewater will be uena. During power outages pump tanks may fill above normal highvaater levels. When power to the dispersal cell(s) In one large dose, overloading the cell(saand Septa g result in the backup or surface d~'rg ormal levels discharged raiar prior to restoring power to thle T avoid controls to restore e this situation have the contents of the pump tank removed by effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump pact, the area within within the pump tank. area not drive or park over, or otherwise disturb or com IrFe of the POWTr Do not drive or park vehicles over tanks and dispers llrcells. 15 feet down slope of any mound or at-grade foundation drape Reduction or elimination of the following from the condoms: cottonaswabs; degreasers; d ntaef loss; diapers; and prolong t disinfectants; fat rating products; antibiotics; baby wipes; cigarette butts, medications; oil; pa (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out f 33i a the f sinAing sist s shall) be taken to insure that the system is prope y Code: and safely abandoned in compliance with chapter Comm • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly 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 U,~nt If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code comp li' replacement system: ►acement soil absorption systelm. ❑ A suitable replacement area has been evaluated and may be utilized for the location of a rep aired should The replacement area should be protected from disturbance and c u pacti n act the c placemen infringed upon by the nHed setbacks from existing and proposed structure, lot lines and wells. Faire to pro a will result In t systems must comply with the ruler{ in for a new soil and site evaluation to establish a suitable replacement area. ReplacemnYs effect at that time. ace the setback and/or soil Barring advances in POWTS techn oI a ❑ A suitable replacement area is n available resort due to holding tank may be installed as a la The site has not been evaluated i ereplaceneat area. limo reeplaarea. cement Upon failure of the POWTS a soil and site evaluaOon a is available a holding tank may be installed) as must be performed to locate a suitable p Iasi 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. 00 <<WARNiNG>> INSUFFICIENT NOT SEPTIC, PUMP AND OTHER M TREATMENT TANK UNDER ANY C RCUMSTANCES./ DEATH MAY RESULT. R SCUE O~ A ENTER A SEPTIC, PUMP OR OTHER PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER F . - Name Name f Phone Phone SEPTAGE SER LOCAL REGULATORY AUTHORITY VICING OPERATOR P MPER Name > r 7, r Name elf- 7 Phone -77 Phone ~f- This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wirwonsin Administra/ive Code. ~ t l ku+ i i P it 1 11 o., +ii1tiI _ I 1 Qli i I.II L~. ! I i I b ~ j P 1 d 1 -O t a ~ 11 1 ~rf I 21 EO a i °o N ~ Q Go 3 ~5 O 9 ~ u^ W o OA f ST. CROIX COUNT! SEPTIC TANK MAINTENANCE -,kGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address -7 U Property Address-7 0 ~z4- (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Nwaber 0 LEGAL DESCRIPTION Property Location 1=- V4 , /-LW 1/a , Sec. T 2 J 7N R" W, Town of 7f-O c- 1-Subdivision • ` / , Lot # . 2~ Certified Survey Map # , Volume r- , Page # Warranty Deed # j L 6 , Volume , Page # Spec house yes no Lot line,, identifiable 6 no SYSTEM MAEMNANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pre-mature 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 wash disposal system Owner maintenance responsibilities are specified in §Con= 83.52(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. Vwe, 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 Commerce 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 o a deed recorded in Register of Deeds Office. Number of bedrog ATURE 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 a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 3 WTL W 5.080 ACRES uj 221,298 S,F6 uj a f~ )e a IT 4d cvjAse P y aa.e. q'" K C22 W l~« s 9 qp ggx ~ R ~o sE &~qy ;~~_wwy~. ¢ eee~~~ pp~aaey~~e~urd ¢ a a'°a a ~ K a"0 p ° 14066 ACRES 4~K41 7 S°F9 12 r_* bcs g P 1d 4 8^ ° a B F 3" 0 FvN °+R a g :q 1,~,.aa Me P«dsa~ea~»a~ $°qq, 01 16 F A ~~a a 6 R ~ -0 IQ9~ 1.014 ACRES 44,172 S.F. F ~'pp tl ~ K f ~ ~P lea ~ ~ ~ d ~m~n e* pBxx d Mwea a ee.wrx w hvMS~r a aiV 132.00' 131 XO' 85,99, N 90000' 00" E 3778a21 , ~ r ~ 3 1 K@ R8. ,/p+~Qp aoA"~ b p 7 ~~i 3 "'n R B 4d' 6 a 17 1.004 ACRES 43,754 S.F. ES 00 p R. § lea R nrw~.ec w ~4tT9 B aFwea N w1vaM a ewr! a a.w°A a nwawr 6.416 ACRES ae~l 2796480 ,FP 001, c:l 1,0080 18 ACRES 47¢035 S.F. ~~e~ ~ts6~E~~~{~~~~~Et 3>1OO2dfl? ~l~lZ! Lm~~='"' ~ ~ s a 4 El IL # v W ~b LiO~O III b .qFZ~ ' ~L1L O~ Ii i~~ !Y s i ~ t" ! OHO o -j 10E] .,M I 0000 I z Ll O I _ o ~ ; Q ~ OQ q ➢ ti w O i z I I IIIitI 1 lit Q z y n~ ~ Q L, I ~ , lip w Q ~ I 1 y H LL z i „ s 5~IY155 W015(I'J ,,l or ear r" ►...r- ti9s6i~~9is ~>IOOJ~3~lI~l2~ - cv e . < 1 I i y. ~tibj I I bj I I h~;s I I 5 9,. j 11 a I I 1. } ? ~ I I' I 1 I F._____________ 1 1 - r ~ yy W r 5V y I Y~ d LL F I i I R ~ \ I I 5 k-v1 t { I --7 I I I ~ i ' I I I IL 1 i Iv7 1 I C 1 1 f 11 v I I i I f I 1 I 1...... l # ~9APnY1 YCOY R i I 1 ~ ~ t u° ~ I I ~ J 4°t f a I (ry~y W Ffj 1 II o? 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