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HomeMy WebLinkAbout018-1099-50-000 7~g ~ 9~o Prow Wisconsin Department of Commerce 7,'00 /NA t; PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. CirOIX INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 584794 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2-75015S Permit Holder's Name: City Village Townshi Oevering Homes LLC p Parcel Tax No, TOWN OF HAMMOND 018-1099-50-000 CST BM Elev: Insp. BM Elev: BM Description: /H~ / Section/Town/Range/Map No: 1 ~ ~r l v Sow 09.29.17.860 TANK INFORMATION ELEVATION ATA ' TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM X10 r~ ~o Aeration Bldg. Sewer Holding SUHt Inlet ~o. 9lo.SS TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 Dt Bottom A111114 1~~ Dosing Header/Man. Aeration Dist. Pipe Holding ~ ~ ~~l • Bot. System ~:7 lay. 'sR PUMP/SIPHON INFORMATION Final Grade ManufactureryA Demand St Cover GPM 104-2. Model Number TDH Lift Friction Loss System Head TDH Ft 9 s. 75' Forcemain Length Dia. Dist. to Well Z yid SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS O s SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR M_-~P UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold x Hole Size pacing Vent to Air Intake Pipe(s) Length Dia Z Length Dia Z Spacing 7 7L z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Be /Trench Center ! Bed/TreOnch Edges TopsoPlth of xx Seeded/Sodded or xx Mulched (i i ~ K Yes Ej No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: l~p 7- 7-44~, Inspection #2: Location: 1011 174TH ST .er-141 n- 1.) Alt BM Description = -,dd Gt1E-(r~ ArT ~NSPEZj?O~ 77~~ M//~ -r1 {'cf(~6'/ Pa- a(,( s ,P- 2.) Bldg sewer length = - amount of cover = s' _ S S ' T11 1 r F~oN1 /L, o;~.i, r So GS r Nd~ ~I"i~ (G r~ (~-T ~P % L"(1Q~ Qc ~SuPPW67-P-0471~ 4*4,10 ve(LtFY~ 3w~ f~C(Z- ~Ert.J~cPP+~ v~~`(5 Plan revision Required? ❑ Yes [ No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. System PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 114 SW 1/4S 9 IT 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.2' 6/19/16 BEDROOM 3 DATE CONVENTIONAL AT-GRADE 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 culvert ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 174th ST. Property Line (not to scale) Well is to meet all WDNR setbacks Scale = 1/4" = 10' Pro 3 Bedroom House 2.5 Acre Lot Grading is to be done to divert run- away from S sy$t #4 11B - 1 << Huffcutt Combo Tank o' 0P * _10 c B-2 100.5 Tank is to be properly bedded • and provided with lockdown ` covers with approved warning 99.5' labels / 6% Slope 3 8 9.5' Area 15' below system is to i remain undisturbed Figm WK'S 14 law St UNW. KR816 'County 4 1-- 2t1r JUN 3 a safety DEZDGHVMET2A0 fl CRakx COUNTY 201 W. Wash.,.-_-. Sanitary permit umber (to be filled in by Co.) T UNIT( oEvE~_OPMF Madison, Wl 53707-7162 AL~ Sanitary Permit Application SSatcTransactionNnmber Q In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Z 7 3 013 U is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordancewith the Pr yac Law, s. 15.04(1) m), Stats. a't / 1 I 2 t/ Y / / y~ L Application Information - Please Print All Information V <6 Property Owner's Name Parcel 4 P :J 4P a,. L 0/9- - ,Sb Ono Property Owner's Mailing #ftms Property Location Govt Lot City, State de Phone Number ~ (~y., Section IL Type of Building (check all that apply) Lot # j1r J T N; R or W or 2 Family Dwelling -Number of Bedrooms S bdivision Namc Block# Public/Commercial - Describe Use J ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of own of .",y 14', III. Type f Permit: (Check only one box on line A. Complete line B if applicable) A/O G IA) _4~ ew Sy;,- 11 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B- ❑ Permit Renewal Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Datq Issued Before Expiration Chvner IV. Type of POWTS S stem/Com onent/Device: (Check all that apply)- El No-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade and 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: 6 5A I LI Des" Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfl Dispersal Arpa Proposed (sf) System Elevation VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units F, ^ B CJ New Tanks Priding Tanks U t%i P cn Ci Septic or Holding Tank i Dosing Chamber I VII. Responsibility Statement- 1, the undersigned, ass*" esponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb s ature MP8.4PRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) AVD VVf C unty/De artment Use Only Approved ❑ Disapproved Permit Fee Date Issued T Issuing; Agent Signature ❑ Owner Given Reason for Denial G 7- 7- CY DL Conditions of Approval/Reasons for Disapproval C NSe"D F(LvM l 4&1V Tn 7 -hw5r pwma !~15Jzi Nmf A) W'W'D. -K L C~Mr<vj Sf~~ F gs r l(K-WIF Attach to complete plans for the system and submit to the County only oa paper not less than 8 t2 z 71 inches in size SBD-6398 (R. 11/11) a BTU DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 ( D Contact Through Relay http://dsps.wi.gov/programs/industry-services V y. a www,wisconsin.gov \F~•55[OV3 Scott Walker, Governor Dave Ross, Secretar•a w ITIC APPRC June 28, 2016 DEPT OF SA P rr. %)FESSIONA CUST ID No. 226900 ATTN: POWTS Inspector Dli vi L k~N OF I N D U 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 SEE CURRESI CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/28/2018 Identification Numbers Transaction ID No. 2730138 SITE: Site ID No. 825864 Oevering Homes Please refer to both identification numbers, 1011 174T14 St above, in all correspondence with the agency, I Town of Hammond St Croix County SE1/4, SW1/4, S9, T29N, R17W FOR: Description: Mound System (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1610021 Maintenance required; 450 GPD Flow rate; 30 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.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 durinc, construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compactinc, of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. i SHAUN R BIRD Pa.-e 2 6/28/2016 • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizin2 to meet TDH and GPM Specifications. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicin(pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicimZ pad is located. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered. to provide sufficient infiltrative area. 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 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. 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. 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 S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Private Sewage Plan Reviewer, Division of Industry Services Payment Submittal, (920)492-2214, Monday - Friday 6 am To 3:30 pm WiSMART code: 7633 tvanderleest a wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm Cover Page ALLY Shaun Bird 'ED =ETY AND Bird Plumbing Inc. ? SERVICES 1432 120th St. .TRY SERVICES New Richmond Wi 54017 715-246-4516 1ONDENCE Date: 6/19/16 Owner:Oevering Homes Location: SE1/4 SW1/4 S9 T29 N,R17 W 1011 174th St. Hammond 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 an cross section Attachments: Soil Test F Shaun Bird Signature License number 2 6 0 b W N 2 1 i( Page 1 of 9 System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.2' 6/19/16 3 DATE BEDROOM CONVENTIONAL AT-GRADE 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 culvert ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 174th ST. Property Line (not to scale) Well is to meet all WDNR setbacks Scale = 1/4" = 10' Pro 3 Bedroom House 2.5 Acre Lot Grading is to be done to divert run-off away from system B 1 Huffcutt Combo Tank 100 B-2 100.5' Tank is to be properly bedded and provided with lockdown covers with approved warning 99.5' labels 6% Slope B-3 89.51 Area 15' below system is to remain undisturbed Mound System Cross Section and Plan View Dimension Feet J 1 I - B 1 ~ t T D •f~r~J~f•r.1.fYY.J.+.+.r.+.+.+.J.+.f-lyJ1!~!~~yl~J:-1- -Z 1.Y1.1.1.1.1.1.1.1.1.1.1.1.1.M1.1.1. L. L. I / Y +1r~ ':i i .L.1.1.1.L.Ln•L 1 i:{r{ri:i?.':~:i'{{ir1i •+.r..r1+.+.+.+.r.r A I +1.i L y 1i r: ! !•J1. J1l1rLr1.1• - ~Lr1iiJ 1 if .L E _ 1 aryl J 1 ti ti 'J 1tit~1~!~!~'~f L•tf r ! J•!•f.rY.+.+•f•r• \ ML•L•,•1.1~1.1 ltirl•LL. . L•1.1• . !•lYYY. . I lYY:f:isJ:%~':'1'1'-1.1.1.111~ti:tiK:4:ti~ rl:\:4~ti14L.L.1.L.1. : : r.l.f•!.+ . F I i G I H l7 I - I I _ c' I i i J 1 - 1 K r . L K 1 B W 1Z6J0 T z lo. L Slope (o =Topsoil = ASTM C-33 = Clean aggregate = 4 in. sch. 40 pvc Cap Material sand fill1/2 to 2 %2 in. dia. observation pipe Geotextile G H Fabric tij1rL~11ti4ttifL'.'' L•1• 1 ,•1.1j1. E . 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 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. 10/071gj Page of Pressure Lateral Layout Two Laterals - End Manifold 4 Threaded Cleanout Lateral Turn-up --10 Plug Manifold M X T L Long Force Main / Sweep 90 Bend Distribution N twork Specifications Pressure System Construction Lateral Diameter Z In. Manifold Diameter Z In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 3f~ 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) Ft. cleanout 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 • • C5 6-8 Inch Lawn Sprinkler Valve Box Page of 03/0519) Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Tank Model Number 6 6 Pump Model Ndmber 0 5:' Total Tank Capacity 3 Alarm Manufacturer 5 Max- Bury Depth Alarm Model Number L t/ Switch Type e- a Filter Manufacturer Total Dynamic Head (MM - Feet Filter Model Number ? Elevation Head L Distal Pressure , Network Loss Minimum Pump Performance Required Force Maim Loss GPN€ , Ft TDH Total / > > Outlet Manhole lain. 4" Above Grade With Locking Dc~ ice> Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking vice Weather-proof Junction Box Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet Bale ' A i~a» Switch Settings and Reserve Capacity GPI Weep Tank Volume Hole B Dimension: Inches Volume Gal. W, 0~7 (reserve) A 3 6 (Alarm) B 2 3 J Off Elevation C Ft (dose) C N. $otzom <a< (dead) D D Elevation Total y C > ~t ' < < s < < e><~ > a<>•r~> r<i a >i>~a ~>t>t>t `>,>`>.i 't>s>t>i`> ~>i t ii>i t>t>t>t><'t '•>•>a•>•a a•>•> >~>•1 s~>t>t>t.t~ >~>•1 >t>~)tf t>t>Y. > >t>t> at>< a l i t << t f t. <t << i< t t• i t>< i t t i t <>t>t>i a GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) fittin s and installed. Piping at the inlet and outlet is of approved material, connected to the tank with wate d&t g laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the.sleeve.is sealed watertight. Electrical service complies withNEC 30.0 and Comm 16.2 . 02/0 iJ Page of TOTAL DYNAMIC H.EAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEINATERING MODEL 152/153 I 153 n MODEL i 152 L~j 50 I al. , Liters eel Meters ,a.. Liters I G L'J 1W 5 1.5 i 69 261 77 291 , 153 10 3.1 61 231 I 70 265 12 40 152 15 4.6 53 1 201 61 231 Q 2Q .l 6 , 1 44 167 l 52 197 = 30 25 7.6 34 129 42 159 v Q 8 30 I 9.1 I 23 87 33 125 z i ~ I ' ;2 85 ~ 1 35 20 40 122 I j 11 42 - -1 j Lack veive. 133.0 ;i. "I -4-n) I 01450: 4 1.0 i ~ O 20 60 80 100 GALLONS 6 3 27/32-;-~-----j.~-a LITERS 0 80 160 240 320 I- FLOW PER MINUTE 3 27/3, CONSULT FACTORY FOR SPECIAL APPLICATIONS 0 3 27/32 • Timed dosing panels available. e Electrical alternators, for duplex systems, are available and supplied with f an aiann. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable - I level long and short cycle controls. • Seated Qwik-Box available for outdoor installations. See FM1420. - - • Over 130°F. (54°C.) special quotation required. I I 12 ; 6 1521153 Series MODELS Control Selection )1' 1521153 -----=t7=11rd5 ~ /o I Model VOItS•Ph Mode AMPS Sim lex Du lex N152 115 1 Non 8.5 1 2 or 3 sKZasa BN152 115 1 Aura 8.5 Inducted 2 or 3 E152 730 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 43 Inclined 2 or 3 N153 115 1 Non 105 1 2013 SELECTION GUIDE BN153 115 1 Auto 10.5 Included 2 or 3 bade variable level float E163 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggy BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. & 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 . . Manufacturersof. Louisville, KY 40256-0347 SHIP TO: 3649 Cane Run Road C 7Q ® Louisville, KY 40211-1961 ~LL~LITY 9LWR5 FXL-f O " (502) 778-2731.1(600) 926-PUMP ~vMP `Q FAX (502) 774-3624 httpJ/www•zoeI ier.com © Copyright 2000 Zoeller Co. All rights reserved. I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page .of FILEINFORMATION SYSTEM SPECIFICATIONS Owner ( Septic Tank Capacity kEl Permit # Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms ❑ NA Effluent Filter Model Number of Commercial Units . j&NA Pump Tank Capacity at ❑ NA Estimated flown (average) aVda Pump Tank Manufacturer p NA Design flow (peak), (Estimated x 1.5) 7J~ al/d . Pump Manufacturer ❑ NA Soil Application Rate altda /ff Pump Model 0 NA Influent/Effluent Quality Monthly average' Pretreatment Unit q Fats, Oil & Grease (FOG} 530 mg/L ❑ SandfGr~vel Fitter ❑ Peat Filter Wetland Biochemical Oxygen Demand (BOD.) 5220 mg/L M Disinfection L Aeration ❑ ❑ Other. Total Suspended Solids (TSS) 5150 m 2 Manufacturer Pretreated Effluent Quality 0 NA Month average" ty IY Dispersal Cell(s) Biochemical Oxygen Demand (BODS) 530 mg/L ❑ In-ground (gravity) ❑ p1 -ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade ;9 pound Fecal Coliform (geometric mean) 510' cfu/100ml ❑ 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 --7 ❑ months ar(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 ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ear(s) Inspect pump, pump controls & alarm At least once every ❑ months ear(s) ❑ NA Flush latarals and pressure test At least once every ❑ months ear(s) ❑ NA Other: At least once every ❑ months ❑ year(s) 11 NA 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, mnlcal or pressurized POWTS components, pretreattgment components, and any other maintenance or monitoring at irlervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servic,0 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. 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 thEit may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT,5: 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 productls; 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 propefty and safety abandoned in compliance with chapter Comm 133.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and 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 fails 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 systeim. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulert in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology/ a holding tank may be Installed as a last resort to replace the failed POWTS. The 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 installedl as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following ~h , l i mol ; t the i{ ltnli+y£ urface. 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 NO I 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 Name Phone - J Phone J r SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone / -r 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. tW it N lit all !i tt~ #Il! t 4 l~ - i .f - 1.71... ~qt Ift~tt~ i f a P p ~ - P ~ p f.. O ~ - O' W Oo c c I N ~ U/ Q co o w 1 I IVED C Sfi - c) ~ ~ ~ ?016 - x rr Mj2SXKP Wisconsin q rtn erii of bu,- rSJ3NP REPORT Page of Division 0f S ty drldlbllildirrgs- " OPMENT` in accordance with Comm 85, Wis. Adm. (,vde County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must J~~ 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. 0 1, S - MCI` Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).H~17r Property Owner Property Location l✓ J ~t Govt. Lot 1/4_ /4 S T Z9 N R E (o W Property Owner's Mailing Pe dress Lot # Block # MSubd.CSM# i7`r'C~ ~ " lc j Cfty C State Zip Code Phone Number ❑ City C3 Village Near t oad ew Construction Use esidential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: _/1/) Parent material Flood Plain elevation if applicable 4-- ft. General comments and recommendations: System Type jf vl ( System Elevation V 2 Al - ❑ Boring 4'U16 d : Boring (~ln^ # J F 11 e Pit Ground surface elev. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 e- S- 6 j 3 c 17 J` t Jl ryj I, 1 A G Boring # ❑ Boring gpit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 j ) 14t M ti J f L• r , 4 .i i Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L- • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig e CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Data Evaluation Cord cted Telephone Number 1432 120th St, New Richmond, WI 54017 1- _ 715-246-4516 Property Owner _ Parcel ID # Page of a ❑ Q Boring # Boring pit Ground surface elev. ~cl-- ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/if in. Munsell pi Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 '3 32 l~ s l SC Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:S 150 mg/L ' Effluent #2 = BODS < 30 mg/_ and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SB"330 (8.6/00)