HomeMy WebLinkAbout040-1326-16-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 589794
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used +or secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village Township Parcel Tax No:
DCCI Investments TOWN OF TROY 040-1326-16-000
CST BM Elev: Insp.1 E_ley: BM Des~riptSection/Town/Range/Map No:
(//Cy/~ 17.28.19.2208
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic J 3 I ~J Benchmark n f~f~ /06
Dosing Alt. BM
Bldg. Sewer 12', G Ca
I.J.- Li cf,44 _j i)
Holding St/Ht Inlet J3.72-, V c
St/Ht Outlet 1 C
TANK SETBACK INFORMATION J 3 • $9 b ~7
TANK TO , VL WELL BLDG. ent t Air Intake ROAD Dt Inlet ' r Qr~t
w 's v v
Septic 36 All 70 57 Dt Bottom 111, d $al, -C (0
Dosing
/ 7Z~ / Header/Man. 97,4T
11 A* 77 lel_ I
Aeration Dist. Pipe q~
Holding Bot. System ' I I to
PUMP/SIPHON INFORMATION Final Grade Z /ac,
Manufacturer / DP ~and~ St Cover i q~ Z tL~ Z 12 _51" 7
Q J
Model Number
k [ Loll 01
. Zd F.A 61740-DA, z.3 166
TDH Lift .9 Friction Loss System Hel9 TD )A 3 Q /,60
Forcemain ILenV, / Dia Dist. to Well J
SOIL ABSORPTION SYSTEM 7
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION 7t -f System: r CHA LINER OR Model mbe / VIntak
DISTRIBUTION SYSTEM ZZZZ /06JHeader/Manifold Distribution Hole Size Hole Spacing Vent t Air Pipe(s) ~1 ~ o Length Dia Length Dia
pacing ix Ix SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only O
Depth Over Depth Over xx Depth of xx SeededlSodded xx Iched es No
Bed/Trench Center ~5 Bed/Trench Edges Topsoil
JJJJ "Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 415 MEADOW VALLEY TRL ~ i d G ~G c5 d
1.) Alt BM Description
2.) Bldg sewer length = S`
- amount of cover
6 u. p~xX,
Plan revision Required? es sii~ No r 7
Use other side for addition I information.
Date Insep or's S' ture Cert. No.
SBD-6710 (R.3/97)
County
r~18 ti Safety and Buildings Division ± t°
< 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
OCT o Madison, Wl 5 -7162
- ~ sr. cRnix coin ,
A EK15 Stale Transaction Number
Sanitary Permit App1ic4,--__ GRR7F3Cq
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governr emr
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to roject Address (if different than mailing ess)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1) m , Stats.
`s
1. Application Information - Pl rint All Information
Property Owner's Name Parcel #
ProPrt eY_Owners Mailing ddress Property Location J G / Z0-9
1i i. I .\J
T-), Q i I Govt Lot -i State t Zip Code Phone Number f~
Section
( 12
Cm'i, ~ ( ~ 1 1 cle ones.
l- P `t, t .G T f N R E
U. /Type of Building (check all that apply) Lot #
`P1L 2 Family Dwelling - Number of Bedrooms Subdivision Name
dk Block#
❑ Public/Commercial -Describe Use ❑ City of
O ~
❑ State Owned - Describe Use CSM Number ❑ Village of
.i--- own of r
III. Type of Permit: (Check only ne box on line A. Complete line B if applicable)
A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ermit Revision Q Chan ge of Plumber 11 Permit Transfer to Hew Lust Previous Permit Number and Date Issued
Before Expiration Owner f
IV. Type of POWTS S stem/Com onent/DevCheck all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil Mound < 24
in. of suitable soil .
❑ Holding Tank Q Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersaVrreat eat Area Information: )
Dlpsign Flow (gpd) Desip Soil Application Rate(gp f) Dispersal Area Required (sf) Dispersal Area Pro osed System Elevanon
VL Tank Info Capacity in Total # of Manufac-ttuer
Gallons Gallons Units J T
r U
New Tanks Existing Tam a m m
Septic or Holding Tank
Dosing Chamber
L
VII. Responsibility Statement- I, the undersigned, ass a possibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' ature MP/MPRS Number Business Phone Number
_e, 6
Plumber's Address (Street, City, State, Zip Code
4A).4 Lz
VIII. unty/De artment Use Only
Approved ❑ Permit Fee Date Iss ed Issuing. t Sigpn
l QA eke,
eason for Denial
DL Condittfns.~j R e~ ~ I r approval
ciisperrs,i cell must all be seiic-?s ! m int~`'ec
-as per maragement plan pro tided by pluinbet.
I.
2. AM ~*egWrervnts must,.be rnairdt ir'ed
as per aW loW code / zrdinanm.
Attach to compiete plans for the system and submit to the County only on paper not less than 8 to x 11 inches in size
SBD-6398 (R. 11/11)
Soil Test and System PLOT PLAN
PROJECT DCCI Investments ADDRESS P.O. Box 445 New Richmond Wi 54017
NW 1/4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 96.9/4k65 ! 10/3/16 BEDROOM 4
J DATE
CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK
MOUND SEPTIC Tj SIZE 1255 gallons LIFT TANK SIZE800 gallons DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Property Line
Sc AL- LVen = 10'
B- Vents
>6" uick4 Standard
2-3' X 90' cells with aching Chamber
>3' spacing of Cover h 20.0 ft2 of Area
ft^2/pair of end caps
1°Io Sloe 4' Long
90' p 4Grade at System Elevation
10. 3411
-3
B.M.* f5l
Meadow Valley Trail
Z IF 15'
B-1 30'
Pro 4
Bedroom
House
80'
75'
T
LT 4'
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County ~
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
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. 67r - „3Z~o - A0 `
A r
Please print all information. Red by Date LL
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location f
~1 -r ~ 414 ) "a Y1 Govt. Lot f lJ, r 1 /4 1 S T . R E (or
Property Owner's Mailing Address Lot # Block # Si bd. Na or CSM#
City , ;Mate Zip Code Phone Number ❑ City ❑ Village Town Nearest R
ew Construction Use: Residential / Number of bedrooms Code derived deign flow rate c i) l; GPD
❑ Replacement Public or oqTmercial - Describe:
Parent material 0 r. ~ r _srt Flood Plain elevation if applicable ft.
General comments
and recommendations:
System Type "zAv 'T System Elevation ~6
Boring # E] Boring
pit Ground surface elev. j ~ . ft. Depth to limiting factor 1-77 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
r /
A
W~ , I
W 1~ rt
Boring # Boring
,m
Ground surface elev. / a_- ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence FBoundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
K' f Y
7 G
r~
Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD. < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) nature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St New Richmond, WI 54017 ! 715-246-4516
Property Owner Parcel ID # Page of
❑ Boring 29
Boring # pit Ground surface elev. ft. Depth to limiting factor L 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 ff#2
1
❑ Boring # ❑ Boring
❑ Pit 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
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ 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 = BOD5 > 30:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L 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.
S13"330 (RAM)
Property Owner _ Parcel ID # Page of
a Boring # ❑ Boring f
Pit Ground surface elev. eft. 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 ff#2
6
❑ Boring # ❑ Boring
❑ Pit 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
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/t. • Effluent #2 = BODS < 30 mg/l- 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.
SBD-8330 (R.6=)
Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer 4 . Minimum Pump Performance Required
Tank Model Number o GPM @ Ft TDH
Total Tank Capacity
Max. Bury Depth
Total Dynamic Head (TDH) - Feet
Pump Manufacturer Elevation Head E
Pump Model Number
IDistal Pressure
Alarm Manufacturer Network Pressure Loss
Alarm Model Number i Force Main Pressure Loss
Switch Type ! Total
Manhole Min. 4" Above Grade
With Locking Device
Vent Min. 12"
Above Grade Weather-proof FAN
With Cap Junction Box
Finished Grade -
Depth of Cover Ft Disconnect
1 Means
r r ] } } > Y > s } > r r r > > } r } r r r s r > r ] : > r > r : r > > > > r > s > > > > r s
{ i { { { { { i { { < { < i { t t { { { i { { { S { i i < { { { { i { { { < > { { i i i < i { t i
Y } y
}t t
' Outlet
i
Inlet Y` Switch Settings and Reserve Capacity II
{
y` Tank Volume= j GPI - - t'<-----
>
{ t
' Dimension Inches Volume Gal. A }
si
< (reserve) A T f a_ '/4»
i (alarm) B 2 - B > i Weep
Hole
t (dose) C 'tt
L Off Elev.
l }
' ` (dead) D - t
F i
Y Y
t
> { Total ~ ~ - - '
> t
Bottom of Tank Elev. FS D
> >t
< ; i t< S< t{ < S
? > > > > T T T > } > T T r Y > > ] > > > T J T T Y T > T T T > > } > > > } T T > T > T ] ] } > > > > J J T > > >
<< L i t< S S S S S S L S S t t S i< i t<<{ t L t t{ S t i t< S i<{ S L< L S t t i< S S L S{<< S< S
GENERAL INSTALLATION: The 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) installed. Piping at the inlet and outlet is of approved
material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or
sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed
watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code.
03/05lgj Page of
TOTAL DYNAMIC H'=AC/CAPACII
w -LEAD CAPACITY CURVE °ER MINUTE
MODELS 53/55/57/59 EFFLUENI AND DEWATER~NG
25
I ! Model I 53~55~57~59
6 20
o Ft. Meters Gal. _trs.
1 5 1.5 1 43 '63
i5 0 1 3.1 34 29
a 4 v mr
z
5 4.6 1 g 72
i
10 i S"ut-off Head 19.25 ft. (5.9rr)
2 5 3 ~/16!----6 5/32
5/5 r,
/2 - /2 NF-
11
U.S. GALLCNS 0 2lO 30 40 5C
LITERS 3 15/16
80 100 _ t
aI
FLOW PER MINUTE 009897 p
4 1/16
l
A, A
Variable level float switches available.
Variable level long cycle systems available.
Available with special cord lengths of 15', 25', 35' and 50'.
Alarm systems available. 0 6
Duplex systems available.
I~ 3 3/32
SfC858
Single Seal Control Selection Listings
Model Volts Phase ' Mode j Amps Si013or4&~5 CSA UL 1. Integral float operated mechanical switch no external control required.
M53155 & M57/59 115 1 Auto 9.7 Y Y 2. Single piggyback variable level float switch or double piggyback variable level
N53/55 & N57/59 115 1 Non 9.7 Y YYy float switch. Refer to FM0477.
BN53 115 1 Auto 9.7 Y Y 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075.
BN57 115 1 Auto ! 9.7 N Y
_ Electrical Altemator.
4. See FM0712 for correct mode o
BE53)57 230 1 Auto 4.8 Y YY~
f D53755 &D57/59 230 1 Auto 4.8 1 Y Y 5. Variable level control switch 10-0225 used as a control activato , with Electrical
E53/55 & E57/59 230 1 Non 4.8 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system.
Single piggyback switch included.
O CAUTION
For information on additional Zoeller products refer to catalog on Piggyback Variable Level Floal Switches, FMO477;
Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FMO487; and Single Phase - c
Simplex Pump ControVAlarm Systems, FM0732.
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
- MAIL TO: P.O. BOX
Louisville, KY 40250 Manufacturers of..
a ~ SHIP TO: 3649 Cane Run Road /
Louisville, KY 40211-1961 'awITY POMPS FNL'E /a9-7~9
® f= (502) 778-2731 • 1 (800) 928-PUMP
http://www.zoeller.com PUMP !O. FAX (502) 774-3624
0 Copyright 2002 Zoeller Co. All rights reserved.
SINEW _ - - 0() /t -
o~ FCaounnttyy
1
2 q Safety and Buildings Division 201 W. Washingt
on Ave., P.O. BoX 7162 r (to be filled in b}' Co)
b Madison, WI 537D7-'16 l /
CROIX COUN` Y
MUNI'i'Y PVPLOPMEN G
6G~ - ,action Number
Sanitary Permit V,PTQS
V
Application Pw~
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govemmental unit IV A
is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project , dress( di$ercnt mailing address) r Pti the Department
of Safety and Professional Servies. Personal information you provide may be used for secon Z / r!
purposes in accordance with the Privacy Law, s. 15. 1) m), Stars. y
L Application Information - Please Print All Information 1 V, 02h /V
Property Ownc>is~e
Pro nets ailing dress Property Location 17, ~j X „ Iq
1 Govt. Lot ) )
City, state ' Zip Code Phone Number A/t,,;' i,, f✓l t/'1/ Section /
circle o
C 1/144 ~V T N; RlC E W
II. ype of Building (check all that applKt -7 j Lot #
or 2 Family Dwelling -Number of Bcdroo ubdivmsion N7 i All,
6V_ dha Block# r ` .CL
❑ Public/Commercial - Describe Use
❑ City of
❑ Statue Owned - Describe Use CSM Number 11 Village of _
Z ~J i`` Z,7, ~-ZZ r own of_~_.~ i.
i
III. Type 'Permit: (Check only ne box on line A. Complete line B a licable)
A. ~ew System ❑ Replacement System ❑ Treatment/Holding R lacement Only ❑ Other Modification to Existing System (explain)
B List Previous Permit Number and Date Issued
❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Transfer to New
Before Expiration
IV T of POWTS S stem/Com onent/Device: hec all thafta
Non-Pressurized In-Ground El Pressurized In-Ground t Cm nand > 24 in. of suitable soil [11 Mound < 24 in. of suitable sod e
❑ Holding ank =7;,, Dispersal Component (explain) ❑ Pretreatment Device (explain) J
V. Dis ersal/Treat ent Area Information: L A - t"'t
Design Flow (gpd) Design Soil Application Rate dsf) Dis s Area R aired (sf) Disp area Propo d (sf) System Elevatio
< f 0 ` 6
VL Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units 44 II w U °
New Tanks Existing Tanks o y m
Z U rn E Z ~ ~L
Septic or Holding Tai: r
Dosing Chamber
VII. Responsibility Statem t- I, the undersign , a sume responsibility for installation of the POWTS shown on the attached plans.
Mbcr's Name (Print) rs Signature MP/IvfPRS Number Business Photo Num er
d.
U
Plumber's Address (Street, City; te, )Zip )
Z~V~,a
VIII County/Department Use Only
pproved ❑ Permi Fee Date ued Issuing. ignature
g5 • g Z5 ~G
eason for ial
tik~F
IXConditi9 pproval ~d d~' S r
. ns fix
, ti
disper. ..i cell, must all be ti, iic?s.'rll. _ty'ne
per management plan pro ndedbyby plumber.
as
Z ip'selbilk FSquiments must be l tairtL~irjed ro►1
as per *p cock / ordinances,
Attach to complete plans for the system and submit he CoQQnty only ogpaper no leAthan 8112 : 11 inches
SBD-6398 (R 11/11)
4a, qk AA t.5L. 5 ewlj! 1
~j, Ia U. aAtPM~
mAcal- 6C /111e~
System PLOT PLAN
PROJECT DCCI Investments ADDRESS P.O. Box 445 New Richmond Wi 54017
NW 1/4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 98.0/96.5' 4' below grade DATE 8/2/16 BEDROOM 4
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
66 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Scale = 1/4" = 10'
Meadow Valley Trail
91'
B.M.*
2-3' X 90' Cells with >3' spacing
20'
8'
ST 0, B-1 80'
Pro 4 44'
Bedroom
House B-3 14% Slope
105'
39'
~h B-4 64'
Vents 0-4111 5'
bf nt 100' 98' B-2 54
>6„ 10 Quick4 Standard
A ing s R 30/34, wi in eaching Chamber
--~0'..ef to e AST of Cover h 20.0 ft2 of Area
ft^2/pair of end caps 53'
qt) 4' Long 12 „
r Grade at System Elevation
Property Line 4"
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/23/16
Owner:DCCI Investments
Location: NW1/4 NW1/4 S17 T28 N,R19W 371 Meadow Valley Trail Troy
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Sectj.on
4-6. Maintanance ar,d ontingency Plan
7.Filter Cross Secti n
Signature
License n rber #226900
System PLOT PLAN
PROJECT DCCI Investments ADDRESS P.O. Box 445 New Richmond Wi 54017
NW 1/ 4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 98.0/96.5' 4' below grade DATE 8/2/16 BEDROOM 4
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
Ilk BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION loo' Filter Lifetime Filter
❑ BOREHOLE O WELL -H.R.P. same as benchmark
Scale = 1/4" = 10'
Meadow Valley Trail
91'
B.M.*
2-3' X 90' Cells with >3' spacing
20'
8'
ST 10' B-1 80' 10
Pro 4 44'
Bedroom
House B-3 14% Slope 105'
39'
B-4 64'
Vents 5
4
nt 100' 98' B-2
>6" 102' Quick4 Standard
All piping shall be ASTM SDR 30/34, within Leaching Chamber
10' of tank, piping shall be ASTM F891 of Cover with 20.0 112 of Area
4' Long 2 5.6ft^2/pair of end caps 53'
Grade at System Elevation
Property Line 4"
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 102.0'
Vent ACI G rade Vent
3' 4" 3'
.A~30/34 Septic Tank
5' Long 5' S' Long 1
36" Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3 X 90' Cells
Same on other end Observation tube/Vent
At end of cell
A
B
22 chambers per cell
System elevations:
A-98.0'
B-96.5'
ST. CROIX COUNTY
SEPTIC TANK MAIN `I ANCE AGREEMENT
AND
0 CERTMCATION FORM
Owner/Buyer k
N,~ L
required from ~ ~ ~ui,g Demt t or consir )
newd6dm
City/S P=el Identification Nmaber
PrvPMtY Location IVLJ V-, LA2 V., Sec. , T % N R_4LW, Town of 1fj
Subdivision o Vl"
Lot#
+ P , Volume page
Warranty btu volume C Fage #
Spec houft e:s Lot Iiner; idew i &blefi ao
Sys= N y AND CERT-M-CATIt"ON
Improper use and umi:>ix== of your septic system could result in its pry failure to ban&-. wastes. Proper
rnawknaw a consists of pu mpmg out the septic tank evay tm years or wooer, if ueeaded, by a licensed pumper. 'ghat you put
thmio
e system cart affbot the f mcd(m of dw septic tank as a truat=nt stage in the was to disposal syat= Owner nubs nee
res pomibilitin are Ypecifwd is § , 83.52(1) and in Chapter 12 - St. Croix Couxty sanitary t hdiua='
17he pmpetty ow= rimes to submit to St. L ro= Co=ty Plate & Zoumg Depar~ it certi lct t fom signed by thD
owner end by a master plumbet, joumirfl= plums, restricted phmVb= or a iice %od pumper verifying ftt (1) tlne ou-szic
wastewater disposal s€ystranx is in Pwar opemting coznaiit ou and/or (2) affirm wapectim and pumpwg (if necessary), the septic tattle is
kess d= 1t3 full ofshtdge.
Vwe, the under igned have road the above requiresmeuts and agrees to maintain the private sawav disposal system with then
scan chards sat forth, .twain„ as set by the Depaztmew of Cotmnerot and the Dapatm=t of Natural Rexowwa6 State of Wiscomim
Cartificatienu stating that your septic sy has been =i=iwd xrnnst be completed and returneel to *e St. Croix County Plawuing &
Zoning DeptsrUa=t with 30 days of the three year expiration data.
l!vt ssfttfY that all eta on aft true to the beat of mylomr 3rnowWV. Vwe ammtaw the owner(s) of ft
iuopeuty dw a flied above, by vixtne of a
deed recorded in register ofDwds Office,
7111Y
NWzber bedxnw=
ATE or APPLICANT(S) DATE
***A,ny information that is mtisrepresentsad may result in the sawtary permit being revoked by the Plarming & Z aiM Dgmtm=
twkWe with thin gMhation a rworcW wars my deed from the Register of Deus Ofte and a copy of the certified survey map if
reface is made in the watrmty deed.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
ILE INFORfIfIATION SYSTEM SPECIFICATIONS
Owner
? 7 Septic Tank Capacity -_j I 0 NA
Penttit # Septic Tank Manufacturer 0 NA
IGN PARAMETERS Effluent Filter Manufacturer 0 NA
rN
mber of Bedraorns 0 NA Effluent Filter Model ❑ NA
mber of Pudic Facility Units A&NA 'Pump Tank Capacity l NA
tima
ted flow (average) gaijday Pump Tank Manufacturer NA
i Design flow (peak), (Estimiated x 1.5) gal/day Pump Manufacturer NA
Soil Application Rate aU /e Pump Model NA
i Standard Influent/Effluent Quality Monthly average Pretreatment Unit NA
Fats; Oil & Grease (FOG) gap mg/L 0 Sand/Gravel Filter O Peat Fifter
Biochemical Oxygen Demand (BODs) 420 mg/L 0 NA D Mechanical Aeration O Wedand
Total Suspended Solids (TSS) 5150 mglL 13 Disinfection 11 Other.
!Pretreated Effluent Quality Monthly average Dispersal Cell(s) 13 NA
Biochemical Oxygen Demand (BODE) Sap mg/l n-Ground (gravity) 0 In-Ground (pressurized)
Total Suspended Solids (TSS) G30 mgjL 716 NA 0 At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml O Drip-Line 0 Other:
iMaximum Effluent Particle Size Y8 in dia. 0 NA Other NA
Otter. Other
;WNA NA
'Values typical for domesdC wastewater and septic tank effluent Other.
NTENANCE SCHEDULE
Service Event Service Frequency
Nnspect condition of tank(s) At least once every: C3 W month( (s) 3
s years) ❑ NA
(Pump out contents of tank(s) When combined sludge and scum equals one-third ()5) of tactic vbhsne 10 NA
Inspect dispersal cep(s) At least once every: Qmonth(s)
c ; j!y Yeags) (Maximum 3 years) ❑ NA
dean effluent filter At least once every: 0 month(s) p NA
Inspect pump, pump controls & alarm At least once every: 0 month(s) 0 NA
Mush laterals and pressure test At least once every: O month(s) NA
O year(s)
At least once every: 13 month(s) O NA
0 year(s)
r.
A
MAINTENANCE INSTRUCTIONS
Ilnspections of tanks and dispersal cells shall be madeby 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 falling 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 (16) or more of the tank volume, the entire contents of
{fie tank shall be moved by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
*A airy servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION duds or other Chemicals tt><1t
For new construction, prior to use of the POWTS Check damage the dispersal) cell(s). If high cconcentrabons are detected have the contents of the
may impede the treatment P~eS andior operator prior to use.
tank(s) removed by a septage servicing
system start up shall not occur when soil Conditions are frozen at the infiltrative surface.
During power outages pump tanks may fin above normal highwater levels. When power is restored the excess wastewater will lj2
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of e l etlun!i;-
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power
effluent pump or contact a Plumber or POWfS Maintainer to assist in manually operating the pump controls to restore normal levels
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. the We of the POWT~:
Reduction or elimination of the following from the wastewater stream may improve the performance d andisinprolong fectants; fat: foundation drafin
antibiotics; baby wipes, cigarette butts; Condoms; Colton swabs; degreasers; dental floss; diapers;
fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produc0s;
(sump pump) water,
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT shall be taken to insure that the system is prope(IY
When the POWTS faits and/or is permanently taken out of service the following steps
and safely abandoned in compliance with Chapter Comm 83.33, 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 property 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 code compCnt
If the POWVTS fails and cannot be repaired the following measures have been, or must be taken, to provide a
rep system:
suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm.
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 prote thereplacement
must comply with in the the rule ten
for a new soil and site evaluation to establish a suitable replacement area. Replacement
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologll 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 POINTS a sal and site evaluaoon
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 POWrS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infittrative
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 ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN 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 1 Phone
SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY
Name c' Name ,
Phone Phone 7iv
r
This daamnent was dratted in compliance with chapter SPS 383.22(2)(b)(%d)&(f) and 38154(1), (2) & (3), Wisconsin Administrative Code.
77
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