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HomeMy WebLinkAbout040-1303-00-034 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 584766 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2699195 Permit Holder's Name: City Village Township Parcel Tax No Oevering Homes LLC TOWN OF TROY 040-1303-00-034 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: AM 15~ /aQ. DO TvP 6F OcAfjER P&:M /•!1 AIW 22.28.19.1769 TANK INFORMATION ELEVATION DATA C b L TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic qre~ /vV9 Benchmark ~aZ • 7 BCD. ~ Dosing j ir Alt. BM Aeration Bldg. Sewer lz•7 Po.cr Holding SUHt Inlet 11 f.+3 Q!Q~ r V/• - TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom ~ llo, 8~ 1 Dosing u Header/Man. Aeration rO~ Dist. Pipe Holding Bot. System d i7 ZS zf 9 Sa PUMP/SIPHON INFORMATION Fina -IV l Grade 4o 7 lLJ.~, Manufacturer Demand St Cover GPM iwrz 9Gf, Model Number YS qt~QQ TDH Lift L Friction Loss System Head TDH Ft 1q•s' S 99 . If z~ 39 Forcemain Length Dia. Dist. to Well 17 SOIL ABSORPTION SYSTEM BED/TRENCH Width V ` Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S SETBACK SYSTEM TO P/L BLDG WELL ILA STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR c sir UNIT Model Number: modem, Ft DISTRIBUTION SYSTEM Header/Manifold N Diseris ition " x Hole Size IX Hole Spacing Vent to Air Intake p() Length Dia Length_ Dia 7i Spacing D• 7Z Z ~ 3v' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Led/ Over Depth Over J-P Depth of ded/Sodded Mulched ench Cen er y Bed/Trench E ges / u so il N 0 (Q 3% Yes ❑ No ❑ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: -ZZ Location: 238 LEGACY CT iC<_ 1.) Alt BM Description = APC A 2.) Bldg sewer length = 2_71 t - amount of cover = NtL f, -AV i Plan revision Required? ❑ Yes t No Use other side for additional information. L I!~„ I~ ! n SBD-6710 (R.3/97) Date nsepctor's Signature Cert. No. RECEIVED ~ I County Ay 8 20°i 8 Safety and Buildings Divisi G 8 K 201 W. Washington Ave.; P. Box 7 am Permit Number (to be filled in by Co.) PSa ° f OIX COUNTY Madison, Wl 53707-71 ~ NITY DEVELOPMENT ~ 54M A~ Sanitary Permit Application S Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 0 C' 1 / is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Proj ess (if different than mailing address) the Department of Safety and Professional Servies. Personal infomnation you provide may be used for secondary oses in accordance with the Priv Law, s. 15.04(1 m), Stats. L Application Information - Please Print All Infor ti IC A Property Owner's Name Parcel # PLOP/r Property Owner's Mailing s P ~J I Property Location 1769 D 6"', , g V~ 6"', j , I 14 Govt Lot city, state Zip Code Phone Number s 1 ® '/4 , 1/4, Section l V ci/4J- L. C/) TZ-(circle op ~ ~3 II. Type of Building (check all that apply) Lot # N; R E dr W / or 2 Family Dwelling-Number of Bedroo Subdivision N C a 01C OA Blo ❑ Public/Commercial -Describe Use 1 44.- 4 11 City of ❑ State Owaed - Describe Use CSM Number ❑ Village of Town of c2 C ~ X5 a") ~DL III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. cw System ❑ Replacement System Q Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision Q Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soilound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Informatio J Design Flow (gpd) Design Soil Applicati Rate(gr f) Dispersal Area Requir f) Dis Area Pro f) S em Elevation y~ /o o ~J,> VL Tank Info Capacity in Total # of Manufactiner Gallons Gallons Units S New Tanks Existing Tanta m u U v O c E re Septic or Holding Tank Dosing Chamber VII. Responsibility Statemen a undersigned, assu res nsibility for installation of the POWTS shown on the attach plans. Plumber's Name (Print) , Plumber' i e MP/MPRS Number Business Phone N bee G ~ ~ ~ /.J✓ ~ Pless (Street, Cd3': Zip untv/De artment se Only proved rsapprove Permit Fee Date sued Issuin- ent Signature ner Given Reason for ial S 44 0 ' 23 1&o DL Condi . 1 axons for Disapproval n 1, 5eptim tank, a must all be srlvic,?s V-6 disper-:.1i cell m roust all b be sra•ic,?s r nr (rifare~; ~ V-6 -w~~ w,► ~1A~J~~ ~ as per management plan provided by plumber. 2 Ap atfteick requirements must be rnaintzikr.I W per Vp iadA Code / ordinance3. ti Attach to complete plans for the system and submit to the County only on paper not n 8 In z 11 inches in arw SBD-6398 (R 11/11) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 997 1.7' sand lift 4/14/16 BEDROOM 3 DATE CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of power box 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 Scale = 1/4" = 10' 1 R M yk W.1 1. 301 ' Property Line 98' 97r' B- 1 Scale = 1/4" = 10' Huffcutt Combo Tank 1 acre lot 4% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels B-3 Pro 3 Bedroom Ho use al I nut B-2 Hi I I Way Grading isto be area 1 S' below Wel I is to meet al I WDNR setbacks done to divert system is to remain run-off away undisturbed from system Legacy Co u rt okiTM~N DIVISION OF INDUSTRY SERVICES ro 2331 SAN LUIS PL STE 150 fc D GREEN BAY WI 54304-5211 Contact Through Relay S http://dsps.wi.gov/programs/industry-services 2a www.wisconsin.gov nRo~`~sS1ON"'Scott Walker, Governor Dave Ross, Secretary May 11, 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: 05/11/2018 Identification Numbers Transaction ID No. 2699195 SITE: Site ID No. 823331 Oevering Homes Please refer to both identification numbers, 238 Legacy Ct above, in all correspondence with the agency. Town of Troy, St Croix County SE1/4, SE1/4, S22, T28N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1597913 Maintenance required; 450 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(N01/01) "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/installation/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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. SHAUN R BIRD Page 2 5/11/2016 i 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. 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 matthewjanzen@wisconsin.gov Cover Page Shaun Bird V pR 1 2015 Bird Plumbing Inc. "rYR1!i 1432 120th St. New Richmond Wi 54017 715-246-4516 , If S.a. Lfl li~ IGt:c i APPROVED Date: 4/14/15 -PT OF SAFE fY A~ ,RUFESSIONAL SERVI`- Owner:Oevering Homes "TON OF INDUSTRY SL Location: SE1/4 SE1/4 S22 T28 N,R19 W 238 Legacy Court Troy T.._ " 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 Specifications and cross section Attachments: Soil Test C Shaun Bird Signature - License numb 226900 Page 1 of 9 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 99.7' 1.7' sand lift 4/14/16 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of power box 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 Scale _ 1/4" _ 10' B.M.A 301 Property Line 98, 97' B-1 Scale = 1/4'1 = 10' 4 Huffcutt Combo Tank 1 acre lot 4% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels B-3 Pro 3 Bedroom House WalInut B-2 Hi I I Way Grading is to be Area 15' below Wel I is to meet al I BNR setbacks done to divert system is to remain run-gaff away undisturbed from system Legacy Court O~ Mound System Cross Section and Plan View - Dimension Feet . J t; t ' 't B j 1T a D YL•ti: L L•1.1•L•4. 1 1.1.4•L•L•L•4.i:r.r.fti{{+, •r.J4J.J~iir~ f.hf•J.J.J•J,JYY1.1.1.1.1. 4.4.4.4.4.L.1•Y4.4•YL.1.L.Y1K.4.1..• 4f••f•1•f•J•J•J~JiJ~t~f~l.f~JLl~J•fiJir~J~f•JYtiJ`J~J~J•J•JY•fyJy •J•J ' A 4 4 i r ri J:JL.r.~:>~r:f J K 4 4 li, E / t, •:•.•:•.411 •:tir r6jti1~:•V.\•YYL.YYYY1.1.4.4.1K:4:{:4:tiJ L Y41 4 41ti•L?tifl:S:~ 1 {:YYL Yl O II L L L tfl• J•hrY•f•J•J•J•.••l•JY•f•J•f•1.J.f•f•r•f•f•f•J•J•J•r•hhhf•f•J•f VM•J•r• l 4•,Y:J:f4j1~4.L.1.YL.YL.L•L•L.1.Y1K•Y L.L•L•Yl•4.1.1. J•J . ' ~Y1~4 f•J•J•f.f•J•JJ•f•J•J•J•J•fMyf•J•J•J•f•r•f•f• 4.1.L•4•L.4.4.1.Y1.•]]}~~:4.1•L•HL.Y t Yl•Y4.1••.1.1.4•Y1.4•YY4•V4.4.4.4.1• f•J•r•f•hhJYY•f•f•fR•lMMM•f•f•J ; t J•J.J•f•f•f:J•J••WJ•f•J•l•hJY•J•hJ•JY• K•4.YY4YYYl•1•L•L•1.1•L•1.1K•4.1.4K•4.4K•1• ` W F fM J•t•fY• J•J•f•J•f•f•J•J•d•f•J•f•J•f•JY•J•f•J. . . .f•f•f•J t t G t ZH v 1 r ~ 1 J!! - J i D t K L 9J K B Z L Slope 40 10 - "1 =Topsoil = ASTM C-33 ~1? i = Clean aggregate O = 4 in. sch. 40 pvc J•J4f4 Ca Material 1 P sand fill /2 to 2 /2 in. dia. observation pipe Geotextile G H Fabric 111+1!1!1! ~.,1f.: J~r•f :41zZlir•" f.f .1111•J. . f f4J4h F l ZR Z. litii.+ i• ~rM =r.`s.s:r.r. t rt D B (0 K 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'/a 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 Plug Manifold M X --T L Lon Force Main Sweep p 90 Bend c~ t Distribution Network Specifications Pressure System Construction Lateral Diameter 'Z_. In. Manifold Diameter 2t In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice S acin Tn. ~ the pipe with a sharp drill bit and face down. -~7 L (Lateral Length) Ft. Lateral turn-ups terminate with a threaded M Manifold Len Ft. ceanout plug and are enclosed in a 6-8 inch Force Main Diameter- In. diameter lawn sprinkler valve box accessible Force Main Length ( Ft. from finished grade. Grade d 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 lgj i Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump ManufitcUm Tank Model Number hi~ 1A 910 Pump Model Number NOJ-3 Total Tank Capacity a Alarm ManufaGdaer Ile- r S Max. Bury Depth i Alarm Model Number Switch Type Total Dynamic Head (TDH) -Feet Filter Manufacturer I Z,1 Filter Model Number i Elevaxion Head A Distal Pressure 3.0 Network Loss Minimum Pump ~erfbmuncc Required Force Main Loss 3,_3 v GPM! -Z Z- Ft TDH Total 2 Z outlet Manhole Ntin. 4" Above Grade With Locking Deiice. Inlet Manhole Manhole Min. 4" Above Grade < b" Below Gr~ie Sealed Watertight Securely Mounted With Loclang Device weatl~ proof Junction Box . _ Finished Grade Vert min. 12" Disconnect Above Grade Means With vent Cap . • > . <r~a > . >;<'.;<~ . <ai :~:.YS : s :iii :<i i <:.<~ i a<aa • > Outlet Filter Inlet Baffle - a;,-- Inlet a; < Y is •i A. Switch Sctt p and Reserve Capacity ; Tank Vohmm = GPI Weep Hole Dimension; Inches Volume Gal. B -1 r reserve) A ( (alarm) B 2 . Off Elevation C (dose) C 10 Bottom ' (dead) D f D E1 4vati 'on g Ft ' Total • ><>< i•<< a a a s •Y<Y Y . > > s , s ..<a • a a a . > <a:< a < • < a < < s < a s < < t s < < a•:t'a . < a • • { s : t a < < t < t a < < < < s a <a: i t•i t•<•: <>a•i i <•a•: is :>;:a<a GENERAL INSTALLATION: The septic/dose tank is bedded and bade filled in accordance with the manufacturer's product gproval sQecificadons. Maximum depth of bury as, specified by .the mulufacturer may not be exceeded without P~iw appmval. Manhole covers exposed to g<'ade have an effoctive locking device (padlock) t fittin -gsand installed. Piping at ft inlet and outlet is of approved material, connected to the tank with. w , The force main is slecvexi wilt 4" Sch• 40 PVC to bridge the tank laid on stable soil V provent settling or sagging. excavation and the s1mve.is wiled watertight. Ele lzical:seivice complies withNEC304 and Comm 16.2:3. Page. of 02/05 IJ TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING Ln MODEL 152/153 52 I t5~ MODEL 1 U- 50 Feet I Meters Go!. Liters i Gol. Liters 5 1.5 i 69 251 77 291 153 10 3,1 61 231 70 I 265 12 40 152 15 4.6 53 201 61 231 20 -1 6.1 1 44 167 52 197 30 25 7.6 34 129 ~ 42 159 . U 8 30 9.1 1 23 I 87 33 125 o 22 85 3 20 i 11 42 F¢- 40 122 CD L Voi: X38.0 =t. (11.6m)I44A Ft. (13.4m) ve J i LoCk 4I G1450a 10 I 0 20 60 8,0 100 II GALLONS l-- a 1/4 LITERS 0 80 160 240 320 - 3 27/32- ~1-----~'4 5/8--41 FLOW PER MINUTE I 1 V ~ ! 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. - OO 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable -r - - lI level long and short cycle controls. i • Sealed Qwik-Box available for outdoor installations. See FM1420. I I • Over 130°F. (54°C.) special quotation required. 1211/8 1521153 Series (-T 1521153 MODELS Control Selection I 1 Model Vohs-Ph Mode s Sim lex Du lex ' 1 /s N152 115 1 Non 8.5 1 2 or 3 _L 'K2064 BN152 115 1 Auto 8.5 Included 2 or 3 j E152 230 1 Non 4.3 1 2 or 3 BE152 230 Auto 4.3 Inclined 2 or 3 N153 115 1 Non 10.5 1 2or3 SELECTION GUIDE BNI53 115 1 Aura 10.5 Inciuied 4 VI 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 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. p CAU110N 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) All installation of controls, protection devices and wiring should be done by a qualified Licensed electrician. An electrical and safety codes should be followed including the most or (4) float system. recent Nadonal ElectricCode (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 Manufacturersol. . SHIP TO: 3649 Cane Run Road ~7 p Louisville, KY 40211-1961 QirauTY!'ict'PS 5%Hcf /999 s / j%ha !a (502) 7711 FAX (502) X (502) (800) 928 PUMP L 774-3624 http:lAvww.zoelier.com © Copyright 2000 Zoeller Co. All rights reserved. g1-6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of i FILEINFORMATION SYSTEM SPECIFICATIONS v Septic Tank Capacity al ❑ NA Pemtit Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer p NA Number of Bedrooms 3 ❑ NA Effluent Fitter Model ❑ NA Number of Commercial Units )6-NA Pump Tank Capacity b al ❑ NA f Estimated flow (average) [T(~ and Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) / aUd . Pump Manufacturer FJe, ❑ NA' Solt Application Rage al/da /fe Pump Model N -r3 ❑ NA Influent/Effluent Quality Monthly average- Pretreatment Unit 't T4W Fats, Oil & Grease (FOG) S30 mg/L 0 Sand/Grdvet Fitter ❑ Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mgr, ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ((SS) 5150 m /L 0 Disinfection O Other. Manufacturer Pretreated Effluent Quality )XNA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD$) S30 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/. ❑ At-grade Mound Fecal Coliform (geometric mean) 510' cfu/100m1 0 Drip-line ❑ 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 0 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 Z O months year(s) (Maximum 3 yrs.) Clean effluent filter At least once every r ❑ months 'year(s) Inspect pump, pump controls & alarm At least once every ❑ months ear(s) ❑ NA Flush latkrals and pressure test At least once every ❑ months 'tl° ar(s) ❑ NA Other At least once every O months ❑ year(s) 0 NA Other. At least once every 0 months G year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificmtions: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage SerVk* g 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 (n) 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, mechinical or pressurized POWTS components, pretreatgment components, and any other maintenance or monitoring at iritervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servicg 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 painbgg products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high conc,64trations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. R, Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank{s} for the presence of painting products or other chemicals thO may impede the treatment process and/or damage the dispersal cell(s). if high concentrations are detected have the contents of t the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will by discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effiuenlt. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operators prior to o%n gal levels effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump within the pump tank. the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT:$: ' antibiotics; baby wipes:; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting P pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propefly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • Ail 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 If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compNont replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption s em. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by requitled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the noel for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruI0 in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologN a holding tank may be installed as a last resort to replace the failed POWTS. he site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. -~Aound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNiNG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NIOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL. COMMENTS POWTS INSTALLER POWTS MAINTAINER Name i Flame ,cw J Phone 7)J Phone 7)J O`~ - S SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTH ITY Name Name f Phone f Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. D~? rn ~1 i F i 3 t ~J}utt i 1 -o q ~ A C> O v O ~ a00,- A ~J .J i~ EO o Olt, a i c c 0 0. N ~ N V ~ ~ pp ~ U SS, Q Y N o Q 0 uj i, q c!S r- I i C It I I ~Q~ ~ I Ln UNPLATTED LANDS ~Ll.. OWND~Y~THRS Q 841.13' ~ 119.29' 145.19' n I I 7 f" 32s.1 r 222.48' 1'7 '74 37.5' V; CV 0i 0 11 5; LL: c) 00 (f) ven cr, ce) (D L Q!',~n a, u '00 1 .4. MIS ~ L S0.48 LL: 'T 139,94' fV ~i vi a # N 5 W09'39' E 280. S2 g co Q n S 00'09'39" E 279.91"a rZ- r------------ _ o 237.13 12.7$ tA- . 4*- vagh N OD i 010 j Q~ 1 f i M 24~~ V to I - A ap r: r I 'inn I N S 03'07'%" E z •h I I f i a (c.i 224.71 Q,v'N ~ N [ 1 t I f ! r JJ .f9 CLZ 3 „LF. I 140 09.00 N 3: I 1 vi ~O 1 '1 ' 19 N 00'055'18` w 330.38' - N ~I t Q 4. c51 p O 1Cr- 0 / co d 0 ~t A q1t 40 Ul) (A CO r- r r ,,~s~ 1 z N ~axs , T r 9>< ~r 3 .01.0c.10 N zfol ST. CROIX COUNTY SEPTIC TANK MA NTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer V Mailing Address Property Addr :2-732 -'j (Verification r eq ed fr arming & Zoning Departmen r new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location `j L 1 , JC e j SCC. 7 Subdivision T N R W, Town of Certified Surve - Loth YMap#_ Volume r-- _ - Warranty Deed # , Page # Volume Page # MA Spec house 'yes Hot lines identifabl Ye no SYSTEMTNTEIVA.NCE AND OWNER CERTI C ATION Proper use and maintenance of your maintenance cons- the sts of pumping out the se'be system could result in its re system can affect the septic tank every three years or soonerpiftnre failure to handle function of the septi needed, b wastes. Proper es are specified in Co tank as a treatment sta a in Y a licensed pumper responsibilities What you Put into § mm. 83.52(1) and in chapter t2 -St. the waste disposal system. Owner Croix County Sand maintenance The property owner agrees to submit Ordinance. owner and by a master plumber, journeyman to St. Croix County F 'w'astewater disposal system is in Proper Plumber, restricted plu g & Cep Zoning Deparhmnt a certification form, sine less than 1/3 Etta of shed pr operating condition and/ d Pumper veri g d by the the on-site ge. or (2) after inspection and Pumping (if that necessary), the se I/we> the enders- septic tank is rn ed standards set g have read the above re nth, herein, as set by the D quirements and agree to maim Certification statin that ePartznent Of Commerce all' the Private sewage di D 8 your septic system has been maintained the Department of Natural Resour sposals stem Zoning ePment within 3U days of the three ces, State of Wisconsth the ed must be completed and m e ear re expiration tinned to date. the St_ Croix County Planning & '/we certify that all statements on Property described above b v' -s form are true to the best of my/our knowledge. I/we am/are the Y virtue of a w anty deed recorded in Register of Deeds Office s) of the Number of bedrooms r IGNAT OF APPLICANT(S~) ***Any information that misrepresented DATE may result in the sanitaryperrnit being revoked by the Planning & honing Department. Include with this application a recorded warranty deed from the Register of Deeds Office and reference is made in the warranty deed, a copy of the certified survey map if (REV. 08/05) i a~ i Id I I I I x I I ~R Hi3 a I I I I j ` L_; - - - - - - - - - - / I I II I I I ~ a$b I I II i ~ Oi.,l ~ 3S I I h I I x II Q I ~ i 1 ~ I 1 6„ ~~XOi ~-111!y I I i 8 g I i a I I ~ w I I I a j I ~ I~ ~ \d r ~ R I C I S 8d I I a 9 I I I II !B Qb RI I ~ ~ i B , S n I I I I A I I ~ H I _f+'~ ' ~ I' I I 1 T ' L 1L I T' -T 1 I T---T ER _ I L J L J Ia i _ I I 1 1 I l- I 1----- I I=¢ v I i I i G i i ~ I~ I I pp E¢ ' I ill 3 I 1 I I I I II I I I i tl , 1 I vnaxn nrM i „F a m a ~ a .r .ve 8 8 ~b o: