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HomeMy WebLinkAbout002-1037-60-100 )erartmem of Commerce PRIVATE SEWAGE Countyr. St. Croix SYSTEM Buiidino Division Sanitary Permit Nc -7 INSPECTION REPORT -!W7 7~/ 0 ERAL INFORMATION (ATTACH TO PERMIT) State Pian ID No: L/ rai intormabon you provide may be used for secondary purposes r-nvacy Law, s.15.D4 (1)(m)] Z 70 ,lit hot Name, nn City V ' ae Township Parcel lax No: dl • n~ 00Z.- - 46-140 BM Description: Sectionrown/Rangeftap No: M Eiev ST BM tev- 4rE Z, ~5 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPA-71 y STATION BS HI FS ELEV. Septic Benchmark 3 ~at hDosing f Aft. BM 4ticm` ..y~j Bidg. Sewer Holding St/Ht inlet c + e iSt/Ht Outlet _ TANK SETBACK INFORMATION 1 \ TANK T O P/L WELL BLDG. Vent to At, Intake ROAD ~Dt inlet S=Pt'c. D Bottom ; f its Dosing Header/Ithan. . r r Aeration Dist. Pipe y folding Bot. System. Final Grade PUMPISIPHON INFORMATION - (Id:anuracturer Demand St Cover h_ . GPM , v. II ^9 rModel Number 3 cl 7 7DH Lift Friction System Head TDH, : Ft iForcemain Length Dia. Dist to Well , SOIL ABSORPTION SYSTEM BED7RENCH Width L enotn No. Of jrenches P7 DIMENSIONS Na Of Pits inside Dka Liquid Depth DIMENSIONS r" SETBACK SYSTEM TO P/L BLDG ;1WELL LAKE/STREAM LEACHING Manufacturer CHAMBER OR INFORMATION _ UNIT Mode', Number i ype Of System: DISTRIBUTION SYSTEM- IHeader/Maniroid Distribution i r x Hoie Size x Hoie Spacing. Vern to Air Intake !Length Dia Lenoth Dia Spa ino a - SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth ova xx Depth of Seeded Sodpec xx Mulched Bzdrrench Center Bed.- ranch =aces - Topsoil Yes 77 No J Yes No COMMENTS: (include code discrepancies, persons present, etc.) Inspection #1:/ ~.p speciipn2: Location: ~ ?PLA. arcel No: " Aft BM Description 2.) Bldg sewer length - amount', of cover Plan revision Required? Yes No Use other side for additional intomnation. J I1 4 } Date nisepmo?s Signature Car. No. SBD-6710 (R.3B7) CGY1- -611 Cb 4f-d ej 11A6~.&-s 45-mi, 1 ~L won* a W Ell-T_ r~~~rq County ` I Safety and Buildings Division P ` " K MAY 3 1 201 t6,' 201 W. Washington Ave., P.O. ox Sanitary Permit Number (to be filled in by Co.) uu Madison, W1 53707-716 / CR O X COUNT '997/7, MY DEVELQENT Sanitary Permit Application Transaction Number In accordance with SPS 383.21(2), Wis. Adra Code, submission of this form to the appropriate governmental unit u j j is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing 7)-) sthe Department of Safety and Professional Servies. Personal information you provide may be used for secondary _LtRoses in accordance with the Privacy Law, s. 15. 1 m), Stats. 1. Application Information -Please Print All Inf on S 1- --s 04l S Property Owner's Name • Parcel # Property Owners Mailing Address ( Property Location ] p Govt --1 C State L~ JZi Code 1 Lot P Phone Number rL a ~ Section gtrcle 11 Type of Building (check al! that ap Lot # T N; R (E7 E~ 2 Family Dwelling -Number of Bedr _ Subdivision Name ok ~ Bloe ❑ Public/Commercial - Describe Use ❑ City of ❑ State Ovned - Describi Use CSM Numberq 7,6 11 Village of OJ 5$a9 9-Townof III. Type of Permit (Check only one box on line A. Complete line B if applicable) A. I~tr- 2( System ❑ Replacement System ❑ TreatmenUHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber 11 Permit List Previous Permit Number and Date Issued Before Expiration Transfer to New Owner IV. T e of POWTS System/Component/Device. (Check all that apply) I _1 o ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ound > 24 in. of suitable soil ❑ Mound Irv 10 ( < 24 in_ of suitable sod , ❑ Holding Tank 11 Other Dispersal Component (explain) 11 Pretreatment Device (explain) / V. Dis ersaareat nt Area Information- Desi Flow (gpd) Design Soil Appli c " at ds ~f) Dispersal Area Requir (s~ Dispersai,Area pro os (s S o o P ~ yste>Elevation 6 -66 1 VL Tank Info Capacity in Total # of Manufacnrrer Gallons Gallons Units New Tanks Existing Tanks m v J =j d N v N Sepric or Holding Tank n - r I Dosing Chamber VII. Responsibility Statem t- I, the undersigned, as a possibility for installation of the POWTS shown on the attached plans. Plum's Name (Print) Plum ` s afore MP/1vtPRS Number Business Phone Number r~.~ 7 6 Crc'j 7/1 -p-`'I 0 Plumber's Address (Street, City, State, Zip Co C~i Lo Couutv/De artment Use Only Approved ❑ r Per/mitt FFeeeA /D-at Issued Issuing, t Signahne en Reaso ial $ (P TV ' to DL Condifi ' ous for Disapproval 1 rs'tark, efthtent filter and 3 c,6&. 4,'wA it CJ~i► "0sieresd cell must all be sprvl`cPS ! n.~int~rec' ss,per management plan pro sided by plumber. ) Ck-/ei It^ % 214- lb~ Irr UjVemeMs must, be maintzined r LL r n per swft" / 4 rdinanM. Attach to complete places for the system and submit tot Countyun y onper not s than 8 la x I' es, ar SBD-6398 (R. 11/11) PLOT PLAN PROJECT Randi Dunn ADDRESS 950 230th St. Baldwin Wi 54002 SE 1/4 NE 1/4S 17 /T 29 N/R 16 W TOWN Baldwin COUNTY ST. CROIX SYSTEM ELEVATION 99.3' DATE 4/25/16 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 1/2" pipe next to lone oak ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 1 169' Propert} Line Scale= 1/4" = 10' 18.5' acres A rea 15' be I ow s}ste m i 3 to remain undisturbed 6% Slope 300' 95.5' B-2 El B-1 97 5' Huffcutt Combo Tank .5' 9 8 21 5' p 1!~- 3+ Grading is to be done to divert run-off away from sVsterr,°{ Tank is to be properly bedded and provided with lockdown 1 covers with approved-warning labels Pro 4 Bedroom House Well is to meet all %AeDNR setbacks 230th st. 738' Property, Line Ic CO ~~~a~enxTn~ DIVISION OF INDUSTRY SERVICES T 2331 SAN LUIS PL STE 150 o~ I v GREEN BAY WI 54304-5211 0 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov RO ssIoNScott Walker, Governor Dave Ross, Secretary May 20, 2016 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/20/2018 Identification Numbers Transaction ID No. 2703355 SITE: Site ID No. 823812 Randi Dunn Please refer to both identification numbers, 950 230TH St above, in all correspondence with the agency. Town of Baldwin St Croix County SEI/4, NE1/4, S17, T29N, R16W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1600146 Maintenance required; 600 GPD Flow rate; 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.01/01, 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 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01/01). • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.01/O1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(N01/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". A copy of the 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. 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. SHAUN R BIRD Page 2 5/20/2016 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 This Amount Will Be Invoiced. y When You Receive That Invoice, Matthew A Janzen Please Include a Copy With Your POWTS Lead, Division of Industry Services Payment Submittal. (715) 340-0407 , WiSMART code: 7633 matthew.janzen@wisconsin.gov Cover Page K' 28 z0, iNDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. CONDITIONALLY New Richmond Wi 54017 APPROVED 715-246-4516 DEPT OF SAFETY AND PROFESSIONAL SERVIC':'S RVICES D.VISI , DF INDUSTRY SE Date: 4/25/15 fi Owner:Randi Dunn SEE CORRESPONDENCE Location: SE1/4 NE1/4 S17 T29 N,R16 W 950 230th St. Baldwin 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 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specific tions and cross section Attachments: S i Test Shaun Bird Signature_ _ License n ber 226900 Page 1 of 9 PLOT PLAN PROJECT Randi Dunn ADDRESS 950 230th St. Baldwin Wi 54002 SE - 1/4 NE 1/4S 17 /T 29 N/R 16 W TOWN Baldwin COUNTY ST. CROIX SYSTEM ELEVATION 99.3' 4/25/16 4 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 1/2" pipe next to lone oak ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 1 169' Property Line Scala = 1/4" = 10' 1 B.5' Acres Area 15' below system is to remain undisturbed 6% Slope 300' 96.5' B-2 ❑ B-1 97.5' Huffcutt Combo Tank 98.5' 215' ❑ B-3 Grading is to be done to divert run-off away from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 4 Bed roo m Ho use Wel I is to meet al I WDNR setbacks 230th st. 738' Property Line Mound System Cross Section and Plan View - - , ~ ~ Dimension Feet J A B J I D U 1 L ti: ti:ti:ti:ti:• L ti:tititi:ti%: T I .r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r.f.r.r.rFF'isr~~+rsr~r'rYLvrrY .r•r•f•r•r•f•r•r•r•r•r•f - •f1jLf4j4j4• •L•L•1•L•Y1.1•YYYYYYI.1.1.1•L•L•4 4 L-L•L•YYYYYY•YL.L.L•L•L•L• I •1•L•L•L•' •?•r•r•r•r-r•r•r•r•r•r•r•r•r•r•r•r•r•r•}.i•!•r•r•r•!•r•r.r•r•f•f•r•f•r•r•rvr E+ L L•L.L•L•L•L•L•4.4.1.L•1.L-YL•L•L•1.L•1•L.L.1.4•L•YYYYYI•L•L•L•1•Y1•Y A I r•f•r•r•r•r•r•r•r•r•r•r•r•r•r•r•!•!•!•r•r•r•r.r•r•r•r•r•f•r•r•r•r•r I `,{}~J'+~• 1 4.L•4.L.4.1.1.L.L•L•1•L•1.1•Y1.1•L•YL•L•L•YL•L• 1rti~ti:ti~1. L•L•L•1• i r.f•T•f•f~iylyJyr:J~•~{~x~(F~', - f•r•!•f.r•I•J•!•!•r•r•r•r•f•f.r.f.f•f•f•r•f•f•f•r•r•r~J•!~rL 1 1.1•L•L•L•L•L•L•1• . ?111:ti: I 1 1:L •f t 1:1.1.4.4.4.4.4•L•4•L•L•L•4.4.1.1.1.L•L•L•L•L•L•YL•L•L•L•L•L•1.ti.L.ti. •r•r•r•r•r•r•r•!•r•r•r•r•r•rvr•r•r•r•rv!•r•r•r•r•r•!•r•r•f•r•r•r•r•r•r•r.r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r W I I F I j ; t:. i' G J ..:....:.Z H v L I I F~ J 1 - i K Co L 3. ` ----------------------------------W ^s g K- i B Z 4L - L Slope 160161 i - -1 = Topsoil = ASTM C-33 4f1 = Clean aggregate = 4 in. sch. 40 pvc I I ryr•i Cap Material sand fill?? 1/2 to 2 1/2 in. dia. 0 observation pipe Geotextile G H Fabric F L.L. 1.4. . r1.h. 1.4 4.41L1L•L•L• . . . . . . . . . . . . . . . . . . . . . . . . D E Plowed Surface • ~ ~ ~ ~ Ft Contour 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 1/4 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. 10/07 lgj Page 3 of Pressure Lateral Layout Two Laterals - End Manifold 4 Threaded ` Cleanout Lateral Turn-up --0 Plug Manifold M X L Long Force Main Sweep 90 Bend 3, U/i - - ~el _9 Distribution Ne ork Specifications Pressure System Construction Lateral Diameter Z In. Manifold Diameter l In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M (Manifold Length) 1 Ft. ceanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main Length G Ft. from finished grade. Grade 6-8 Inch Lawn Sprinkler Valve Box 77\ L n Page of 03/0519) Septic-Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Tank Model Number Z o -b Pump Model Number t~j /,S- Total Tank Capacity i s J'3 S Alarm Manufacturer UU S c Max. Bury Depth Alarm Model Numbers Cr r/ /-)7 C~ C 141~ ~-r G Switch Type Filter Manufacturer ; e- h`nv~ Total Dynamic Head (TDH) - Feet Filter Model Number ? j Elevation Head /C 7 Distal Pressure Network Loss / Minimum Pump Performance Required Force Main Loss / U GPM; Ft TDH Total , outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Deice. Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted Weather-proof 1 L Junction Box r► ► tnr as Fined Grade t- t~ tts t~ r r aa~ s tau. Vent Min. 12" Disconnect Above Grade Meads ' With Vent Cap Outlet Filter Inlet a----,Wet Baffle " - >ta` A. and Reserve Capacity Switch Setgngs Weep Tank Volume = l GPI B Hole Dimension Inches Volume Gal. (reserve} A 2 6'- 1- X77 Off Elevation C B : 2 ' - _F» Bottom (dead) D D Elevation ~0 Ft Total a Y>>>> >Y > 7•<~ a •ai i i i >at<i i s<. < a< GENERAL INSTALLATION: The septic /dose tack is bedded and back fithe inanufa~cturemay of manufacturer's product approval specifications. Maximum depth of bury as specified by be exceeded without ptior. approval. Manhole covers exposed to grade have an. effective locking device (padlock) r tank 'onnected to the with wdert installed. Piping at the inlet and outlet is of approved material, with 4 Sch. 40 PVb edge the tank laid on stable soil to prevent settling or saWng. The force main is slee,ved excavation and the sleeve is sealed watertight. Electric :service complies with NEC 300 and Comm 16.213. C Page J of 42105 U TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING cn MODEL 152/153 MODEL 1I 152 153 cr_ WW i 50 ~Feet -it Meters Go!. Liters I Col. , Liters S 1 5 I 69 261 77 291 153 10 3. i 61 231 70 265 12 40 152 15 4.6 53 201 61 231 ° 20 -I 6.1 44 167 I 52 197 i ~ 30 25 7.6 34 129 1 42 159 I 23 87 1 33 125 Q $ 30 I 91 3 - 22 85 o ~ 20 11 42 r 40 I 12.2 I - - I ---L o i 4 Lock Voivz: 136 ' .0 ('3.4m F 014505 10 I i 0 20 4 60 80 100 GALLONS Imo- 6 1/4 LITERS 0 80 160 240 320 _ 3 27/32 4 5/8 I i FLOW PER MINUTE-'-I-~ 3 27,/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ I --t- 0 3 27/32 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with e t an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. I I ~ 1521153 Series „--T ~.I I I I 1521153 MODELS Control Selection I Lj Sim !ex Du lex Model volts-Ph Mode Am s N152 115 1 Non e.5 1 2 or 3 SK2064 BN152 115 1 Auto 8.5 Included 2 or 3 t E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Inclined 2 or 3 N153 115 1 Non 10.5 1 2or3 SELECTION GUIDE SN153 115 1 Auto 10.5 lncluded 2 or 3 E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1_ I Auto 5.3 Included 2 or 3 switch. Refer to FM0477. A CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (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 Louisville, KY 40256-0347 Manufacfurerso . . F s° SHIP T0: 3649 Cane Run Road Zp 4~ ® Louisville, KY 40211-1961 Q(QUTY~UHPS aJ/NCf /~9,9j9 f'VMP !O (502) 778-2731.1(800) 928-PUMP FAX (502) 774-3624 http://www.zoelier.com © Copyright 2000 Zoeller Co. All rights reserved. 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_._,_of FILEINFORMATION SYSTEM SPECIFICATIONS Owner I ru- L y Septic Tank Capacity ~o~ S S al ❑ NA Pemtit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer - ❑ NA I Design flow (peak), (Estimated x 1.5) r!J gal/day: Pump Manufacturer ❑ NA Soil Application Rate /0 avda /ft2 Pump Model NA Influent(Effluent Quality Monthly average' Pretreatment Unit A Fats, Oil & Grease (FOG) S30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 420 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m /L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD,) 530 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade and Fecal Coliform (geometric mean) 510' cfu/100m1 ❑ Dri ine ❑ Other. Maximum Effluent Particle Size Y. inch diameter Values typical for domestic (non-commercial) 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 ❑ months ear(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 - ❑ mon .year(s) (Maximum 3 yrs.) Clean effluent filter At least once every , ❑ month gear(s) Inspect pump, pump controls & alarm At least once every ❑ months ear(s) ❑ NA Flush laterals and pressure test At least once every ❑ month year(s) ❑ NA Otfier: 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 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 ch_ NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechinlcal or pressurized POWTS components, pretreatgment components and any other maintenance or monitoring at irlervals of 12 months or less shall be performed by a certified POWTS Maintainer- A servlc;g 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. - 0 Page _ of STARTUP AND OPERATION painting products or other chemicals th~lt sence concentrations For new construction, prior touse e of at~d'~ check dispersaltcell(s)s) If for high the pre are detected have the contents of the of may impede the treatment process operator prior to use. tank(s) removed by a septage servicing op System start up shall not occur when soil conditions are frozen at the infiltrative surface. the will be and may When result power in is the restored backup or the surface excess discharge wastewater of power to fiv effluenlt. During power outages pump tanks may fill above normal highwater levels. di discharged to the dispersal cell(s) in one large dose, overloading the e Servicing Operator prior to restoring To avoid this situation have the contents of the pump tank removed by a Septag controls to restore normal levels effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump the area wit n within the pump tank. not drive or park over, or otherwise disturb or compact' Do not drive or park vehicles over tanks and disper f cells. area. 15 feet down slope of any mound or at-grade soil absorption disinfectants', life of the POWT'3: ; fat; foundationdFrpn Reduction or elimination of the following from the wastewater stream may improve improve dental the foss; performance diapers; and prolong antibiotics; baby wipes; cigarette butts; condoms, cettasoli e- grease; herbicides; meat scraps; medications; oil; pal g ~ca~ gasoline-, (sump pump) water; fruit and vegetable peelings; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following sieps halCoeeaken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin • Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. stator. • 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 sell, 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 compiiron ed replacement system: n required of a replacem D A suitable replacement area has been evaluated disrmbac ue utilized tm°paction acation nd should not be infringed upon ion systeim. The replacement area should be protected ffrro result in the railed must area will comply with the the nFl in setbacks from existing and proposed structure, lot lines and wells. Failure to protect thereplacement for a new soil and site evaluation to establish a suitable replacement area. Replacement systems rulett effect at that time. ❑ A suitable replacement area is not available le due to replace setback soil Barring advances in POWTS techno ogl/ a Iding tank may be installed as a The site has not been evaluated to Identify alarea. If no eplarceement aarea isuavail ble a holding t nk may be Installedpas t be performed to locate a suitable le replacement last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative s ace. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> INSUFFICIENT NOT SEPTIC, PUMP AND OTHER TREATMENT TANK UNDER ANY C RCUMS ANCES./ DEATH MAY RESULT. RESCUE O~ A ENTER A SEPTIC, PUMP OR OTHER TREATMENT PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name S~ ~L Name Phone 7/.~ Phone J~ SEpTAGE SERVICING OPERATOR P MP£R LOCAL REGULATORY AUTHORITY / -Z" FM- This Name Phone document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. 01 N llii i i t ,lr~ri! I E M o t 1 it! Q; ti o Q , ~ f II D I ~ ~ r '4 Q III ~C a 4 Q v Q , coo I i ST. CROIX COUNT-Y SEPTIC TANK MAINTENANCE,,kGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ a Mailing Address S-0 Property Address o r (Verification required from Planning & Zoning V-D~ new construction.) City/State Parcel Identification Number 7 - 6 0 Y {t~~ LEGAL DESCRIPTION Property Location ~ Y4,&,- 4 , /'ill Sec. ! , T'~__ _N R/ W, Town of ; &1- Subdivision Lot # s Certified Survey Map # L Volume c~J , Page # F' Warranty Deed # - , Volume , Page # Spec house y no Lot lines identifiable yes ' Yin SYSTEM MAINTENANCE 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, ii= 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 §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property o'w'ner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a roaster 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 1/3 full of sludge. I/we, the undersigned have read the above requiremenis 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 orm are true to the best of my/our knowledge. I/we amlare the owner(s) of the property described above, by of a deed recorded in Register of Deeds Office. V7 ber ANT{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 Uffice and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05)