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010-1021-40-000
(IX) Service Visit Form 0/Q -#b 000 ~.30,/~, /3l3 White Knight Microbial Inoculator/Generatorrm Service Visit Record r.. ~ + t,~ Owner Name Ila_ vri kti r Unit Serial Number Date Visited f Field Technician Purpose of Visit Routine Maintenance Customer Concern _ 2 Week Spot Check Tank liquid appearance; iTranslucent Clear -Other (specify) Liquid odor: None -Perfumed i Noxious Other (specify) Bubble Pattern: Normal Abnormal (describe) Unusual observations: Effluent Filter: V In Place Housing to outlet pipe secure Cleaned ' Hair/ Lint buildup Notes: u White Knight: Biological Growth Visible Color Ample flow through unit ~ Unit Clogged with Inoculant replenished X-- Unit removed & cleaned Notes: Air Supply 'wv"fie ~ Pump: Outdoor )L Indoor Hour Meter Reading Pump Operating Properly Air Filter Clean _X Alarm Operating Properly Notes: 30 Soil Absorption System Weather: Precipitation previous 48 hrs Time of inspection I I Surface Condition: Dry & Firm Soft & Spongy Saturated Breakout / Location(s) ~\j r Monitoring WellPort: Not Applicable Inches deep from surface Dry Inches static water N otes: Repairs or Modifications Performed: Additional Comments: Service Visit Report Left With Property Owner Technician's Signature - i Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Safety and Building Division Sanitary Permit No: INSPECTION REPORT 592122 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2766545 Permit Holder's Name: City Village Township Parcel Tax No: Dayna Hennessy TOWN OF EMERALD. 010-1021-40-000 CST BM Elev: Insp. BVlev: BM Description: ,i!`J1 n „A Y~ ` Section/Town/Range/Map No: (1J1 09.30.16.131 B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS FS ELEV. all 174S Septic ~ ~ -166 Benchmark ~ y'' ~L ~I1• it 9 ~ L~,,,J, b Q o (1t ( 7 1/ V 05;11, 00 Alt. BMj~~ ~ f Gn~c~ Igo a~'v~t,~ AaLatia" A) Bldg. Sewer ~t T 7a 16z • 3S eL Holding 7Sa St/Ht Inlet %.455 7-5 co ~bo 7 c. St/Ht Outlet TANK SETBACK INFORMATION 19 TANK TO P/L WELL BLDG. Vent Air Intak CAD Dt Inlet Ct 5 v Dt Bottom .1f# qD Header/Man. 4, 4 1 qe~ Septic /65 165 Z-13 L i13 Z3 / ~ Dosing - ' Z Aeration Q Dist. Pipe ` 9c! , Holding Bot. System gq~Lr 1 _ Final Grade /'yr/ ` PUMP/SIPHON INFORMATION f~C~'S ' a7 CCJx~/~ Manufacturer z&e/ I Demand St Cover t q~ Z GPM ~d1~1/ I Model Number ✓ 3 TDH Li , a,9~ Friction ,os System H ad~ 00, Forcemain Len th / Dia. / ( Dist. to Well Z Q - SOIL ABSORPTION YSTEM BED/TRENCH Width Length _ No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. ....~Liquid Depth DIMENSIONS 3b t(&Xc N___ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR CSG Ty~fSyste . UNIT Model Number: o~ P ~J DISTRIBUTION SYSTEM of Header/Manif~ld if Distribution Ix Hole Size x Hole Spaci~n~g~y+ Ve o Air I e Length is Length ~ • • Do Z6 Spacing__,4_ wN SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 1XX Depth of xx Seeded/Sodded T Mulched Bed/Trench Center / / Bed/Trench Edges Topsoil Yes ❑ No Yes No COMMENTS: (Include code discrepencies, persgns present tc,.) I spection #1: Inspection #2: 5 V Location: 2336 160TH AVEyy~ {J J~ ~ . to ,ti ~J~'S o r- 1.) Alt BM Description - -ra _ Ga 2.) Bldg sewer length = ZOO b bse r✓~ o~. - amount of cover = a- J% 75 S Plan revision Required? Yes No Use other side for additional informationnJJJ ~C - on. Insepctor's nature Cert. No. Ar - - SBD-6710 (R.3/97) r l:~ afety and Buildi~tgs Divisn St, Croix } `tt~ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 SRO Sanitary Permit Applicat ZAMVgEASZG State Transaction Number in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropi1- HBR it is required prior to obtaining a sanitary permit. Note: Application forms for stale-owned POWTS are subru tteu to Project the Department of Safety and Professional Services. Personal information you provide may be used for secondary Address (if different than mailing address) Ave, purposes in accordance with the Privacy Law, s. 15.04(1)pn), Stats. ~y 2 2 1 _ ~y~ 1. Application Information ease Print All Information G JJ `P V Property Owner's Name j Parcel # Dayna Hennessy CIC) - 10'),i ~6 e~4 Property Owner's Mailing Address Property Location 2336 160t" Ave Govt. Lot City, State Zip Code Phone Number SE y,, NW Section 9 Emerald , WI 54012 715-688-9319 (circle one) T 30 N; R 16 West Lot # _ II. Type of Building (check all that apply) X I or 2 Family Dwelling - Number of Bedrooms 4 This proposed system will serve ooi~e`` room residential Home. Block Na ❑ City of CSM Number ❑ Village of - 1 / X37 X Mown of Emerald III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System Replacement System Treatment /I folding Tank Replacement Only ❑ Other Modification to Existing System (explain) X List Previous Permit Number and Date Issued B. El Permit Renewal El Permit Revision ❑ Change Of Plumber ❑ Permit Transter to New Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) ~ Non-Pressurized In-Ground • X Pressurized In-Ground At-Grade Mound > 24 in. of suitab .oil Mound < 24 in. of suit Ie j oil Holding Tank ❑ Other Dispersal Component exp am _ Pretreatment Device (explain) V. Dispersal/Trey ent Area Information: Design Flow (gpd) Design Soil Application Ra gpdst) Dispersal Area Required Dispersal Area Propos (sf) System Elevation 600 y~d 8 1750 1,200 D 89.25 ft VI. Tank l fo Capacity in Total # o Manufacturer Gallons Gallons Units ° New Tanks Existing Tanks X_ - I 1A, 1 Septic Tank 2 1 2650 all Le is Bjork Wieser X Lift Tank 1 750 1 ieser L'o X V11. Responsibility Statement- 1, the undersigned assume resp nsibility r inst II tion of the POWTS shown on the attached p ans. _ Plumber's Name (Print) Plu s Siam MP/MPRS Number Business Phone Number Lewis Bjork 253976 715-231-7375 Plumber's Address (Street, City, State, Zip Code) E7818 County Road E Menomonie, WI 54751 VIII. ount /De artment Use Only I ermit Fee Date sued Issuin~~ A nt Signa re Approved $ ,5 I i ~ A 'eason for Denial &37 IX. Condill~l(~Q 7Reasons for Disapproval 1 ~eOr, tank, erfluent filter and disper-si cell must all a swvices I mmaintair,gj~ as;per management plan provided by plumber. n 2. 1 A~I~aetbjck requirements must be mainte ined Q ~MD J~n.b~ ~ 6, as pw q*kaW code / crdinanca O` SBD-6398 (R. I l/I t) 4 Y, a 13 Fdt , z 1 ~ " r~ 1+ ~ 2 b 4A 4.. eim M. o a Jz~ 6r) o~paxTtF~ DIVISION OF INDUSTRY SERVICES 0 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/programs/industry-services ~ www.wisconsin.gov n ice, F~~L~a Scott Walker, Governor Dave Ross, Secretary CrONDITIC August 31, 2016 APPRC s -T OF SA CUsT TD No. 25,976 ATTN PO WTS Inspector P["". OFESSIONP DIVISION OF INDU LEWIS C BJORK ZONING OFFICE LEWIS WORK LLC ST CROIX COUNTY SPIA / E7818 COUNTY ROAD E 1101 CAR 41CHAEL RD MENOMONIE WI 5475 1-663 7 HUDSON WI 54016-7708 SEE CC)ki<ESI CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/31/2018 Identification Numbers Transaction ID No. 2766545 SITE: Site ID No. 828056 - Davna Hennessv Please refer to both identification numbers, 2336 160TH Ave above, in all correspondence with the agency. Town of Emerald St Croix County SE 1/4, NW 1/4, S9, T3 ON, R16W FOR: Description: White Knight Pretreatment - Inground Pressure (Replacement - 650 GPD) Object Type: POWTS Individual Site Design Regulated Object ID No.: 1620297 Maintenance required; Replacement system; 650 GPD Flow rate; 35 in Soil minimum depth to limiting factor from original grade; System(s): Non-Pressurized In-ground; Aerobic Treatment Unit, 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: • Cells may need to be stepped. Maximum Depth is 11 inches below grade. • Laterals to be 1.25 Inches • Orifice Size = 5/32 Inch • Total Dynamic Head = 14.91 Feet • Gallons -eer Minute = 54.4 • Dose Tank- "A" Dimension = 28.83 Inches = 464.7 Gallons • Dose Tank - "C"' Dimension = 8.7 Inches = 140.2 Gallons • Installer is pumper and stated that he can pump the tanks. • The department may require metering or monitoring of the effluent from this product to evaluate the operation and compliance to SPS 383.44 effluent quality parameters, • A valid maintenance/servicing contract is required for the life of the system. A copy of the initial warranty or contract must be submitted to the county prior to issuance of the sanitary permit by the permit issuing agent. • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. LEWIS C BJORK. Page 2 8/31/2016 • • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches below the system elevation. Smearing and compa~tui~ of wet soil will result in reducing the infiltration capacity of the soil. Pro er soil moisture content can be determined by rolling a soil sam le 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. • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS 'T'able 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) Tank Installation to follow all manufacture's recommendations, • Verify property line(s) prior to installation, • 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 servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. 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 POW TS 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, Tim Vander heest 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 t.ian,vander Ieest ci~wisconsirhgov LEWIS C BJORK Pane 2 8/31/2016 • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches below the svstem elevation Smearing and compacting 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 114 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. • 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) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • SPS 383.54(l)(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 servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. 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/install ati on/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 $ 250.00 This Amount Will Be Invoiced. f✓~~✓✓/ 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 tim.vanderleest@wisconsin.gov pressure with tier 3 -treated effluent, individual site design In-ground EIVED 'ECE Residential application ,~,~IIG ~ 5 X016 Index and Title Page Dayna Hennessy - replace mound with in-ground system 4GVSTRY SCRUIcF4 Project Name: NALI_YY` Owners Name: Dayna Hennessy <J`ED ETY Owner's address: 2336 160t~' Ave Emerald WI 54012 L SERVIC 31 TRY SE)Fi'v`a~::E. Day time Phone: 715-688-9319 Project Address: 2336 160`h Ave Emerald WI 54012 SE NW 9 30 16W _iuC E Legal description: Township and County: Emerald , St. Croix DSPS Site ID No.: Parcel ID No._010-1021-40-0000_CSM # 389770 Plan Transaction No.: Page 1 Index and Title Designed Pursuant to Page 2 Plot Plan Following manuals Page 3 Plot Plan Legend Design Criteria and Sizing Publication 9.6 Pressure distribution Page 4-5 Data entry, Page 6 System cross section Plan view , Lateral detail Page 7 Page 8 Pump tank exit detail Page 9 Pump curve All materials must comply with Page 10-11 Contingency Plan / system management Knight treatment DSPS 384 and installed with the Attachments: ,Soil Test Manufactures specifications Enclosures: Manholes, Filter Drawing, Tank Drawings, ATU - WK-40 service inspection forms Designer an nsta • g Mas r plu ber: Lewis Bjork License # 253976 Page 1-11 Signature r,~ a S 0 ~o _ .T cr s M O r0 RAT..".b t,o ca r w- ~ft 4S CL ~ . may` ti. f r vl ~ tt ~ \ Vi/ kn t' i Plot Plan Legend 1 4" PVC ASTM D 3034. 42"Min. Cover where snow is not removed. 2 24" inside diameter concrete manhole brought min.4" above surrounding grade. Concrete covers chained and padlocked . 3 Precast concrete septic tank. 4 Effluent filter location. 5 Building sewer clean outs with frost sleeve 6 Precast concrete dose/pump/filter tank. 7 10-2 OF-B Power conductor . 14-2 OF-B alarm circuit conductor. Both wires are UL listed A-2057 g 2" PVC ASTM D-2665 -09 Schedule 40 Pipe Force main. 9 4" PVC ASTM D-2665 -09 Schedule 40 Pipe . Entering and exiting concrete tanks min 10' in length. 10 Carlon All weather pvc junction box. UL listed # A-241 11 Aggregate Cell treatment/dispersal cell 12 Inspection wells 13 "kW-40 ATU and its air supply blower Data entry, Design Criteria and Sizing Site information Residential Design / utilizing aerobic per-treatment d Design Flow 400 Estimated water flow ( GPD ) Four bedroom Home /600gp 5 % Slope across system area /90' Design counter elevation based on BM 35-37" Depth to estimated seasonal saturation .8 In-Situ Soil Application rate for type 2 effluent (gpd/square foot) / designing for .5 Distribution cell Information (3) @ 3' cell width, & 130' in length 600/(3x130x3)= .5 gpd/design loading rate Waste water quality Anticipated residential strength waste water <30ml FOG <220MG/L'C15e0MGeatmen Bo 5 feet of anaerobic treatment tank and from dose to~ank after nit Tier 3 to treat waste water to 30/30 BOD TSS Knight model WK 40 installed in a 1250 gallon Pressure Distribution Information Center Connection manifold 1.5' from edge of cell to Lateral /one lateral centered in cell (6 ) laterals total 64.19' in length / Force main drains back to tank 126 Orifice Diameter (in) Laterals are the highest point in distribution network 3.75' Estimated Orifice Spacing (ft) = 11.78 square foot/ orifice 2„ Force main diameter - S tank 6:S°system Head X ' 100' Estimated force main length 86" elevation in pump ' 3 +47--r2' Vertical lift . ion loss in force main (ft) ft) 13~ Force main drain back (gal) .50 In-Line pressure effluent filter ( 6 3 78.25 5x Void Volume (gal) 89.30 Minimum Dose Volume (gal) 42.02 System Demand (gpm) Lateral Diameter Effluent filter information 1 " sch 40 PVC 1) Orenco - FT082214 Model Manifold diameter 2) Simtech - STF 100 4-11 2" sch 40 PVC Anaerobic Treatment tank information (2) 700 gallon precast concrete / LB 700 / Lewis Bjork LLC Aerobic treatment tank 1250 gallon Wieser precast concrete with a Knight Treatment systems WK-40 Dose Tank information Dose tank gallons per inch 750 gallon Wieser dose tank capacity Distribution Network Specification &Diagram Diameter 3.89' Orifice spacing 6 Laterals .74" Lat. End (Z) 64.19' Lateral Length (P) 17 Orifice per Lat. 1178 Orifice Density (ft2nd) 3.08 'Lateral Spacing (S) 12' Manifold Length Ygpm Lateral Flow Rate 2 "Manifold diameter - Orifices .94-25 C,~s 3139pm Each Cell discharge rate System flow rate 42gpm TDH force main Velocity 4.29 Ft/ sec ' - i Sb 100 ebb 0 KGt! yo 5-11 I O-LJL M NO'S ,L" k s r^ Y i 1 t hv' i II 3 ~S Ate, ~II~~ l f IZI, LT f -7-fl Dose Tank Exit Detail Tank Manufacture -Wieser Electrical as per NEC300&SPS316.300WAC Gallons 750 Locking cover with Warning Label and sealed water tight. Gallons per Inch_16.12 Tank is properly vented. Force main (2"is.163 per length_100' of _2-sch 40 pvc. Void volume _16.30__ foot) Friction loss is relative to amount of gallons per minute of pump / no orifices or min head. Maximum dose size is <19% of the of the DWF plus drain back . Dimension Inches Gallons +90, Ground surface A B= 2" 32.24 6+ C= 9 2YO.11- weep hole D= 112.84 Totals 46.53" 750 Alarm Manufacture SJE-Rombus Alarm model Number 520-002A A Pump Manufacture Zoelher B Pump Model # 153 rLf~ q C 86.58' off pump must deliver 42-M GPM At 3 -fit of TDH I'Y. i I 3" Bedding under tank 86' bottom No mercury switches r 14 SS L - Page 8-11 Project uj PUMP PERFORMANCE CURVE ~ ODEL 1511152/ 50 14 5 153 12 4 35 152 I 10 U 30 8 25 151 C I~- 6 20 15 10 2 5 40~~ 70 80 g0 100 10 20 _ GALLONS 280 320 360 LITERS 0 40 $0 120 160 200 240 014508 FLOW PER MINUTE 8/15/2016 https://fdn.gleapahead.com/rtp/tools/93928-63.gif POWTS OWNER'S MANUAL AND MANAGEMENT PLAN 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 service operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of the water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwashers, ect. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins and others of this kind shall not be introduced to the system for they may cause premature failure to the POWTS. INPSPECTIONS AND MAINTENANCE: Inspection shall be made by an individual carrying one of the following license or certifications: master plumber, master plumber restricted sewer, POWTS maintainer or Septage service operator (per attached maintenance schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry to the tanks. The ATU or more specific the WK -40 has a check list supplied in the enclosures. When the combination of sludge and scum in the tank exceeds one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage service operator and disposed of in accordance with chapter NR113, Wisconsin administrative code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufactures specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When a POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPPS 383.33 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 service operator After pumping, all tanks and pits shall be excavated and removed or their covers removed and Page the void space filled with soil, gravel or other inert solid material. t be repaired the following measures have been, or must be CONTINGENCY PLAN: If the POWTS fails and cannot taken, to provide a code compliant replacement system- the site has not been evaluated to identify a suitable replacement are If Upon failure oft a eao availasoil and no replacem site evaluation must be performed to locate a suitable replacement area The holding tank may be installed as a last resort to replace the failed POWTS. Specific service information 700 precast tanks Septic / anaerobic -separation chamber --1400 gallons , (2) LB effluent filter , there are 2 - one gravity filter serving the out let of septic tanks - Orenco Ft082214 second filter is a pressure filter serving the outlet of dose chamber and last line of defense before the drain field Treatment tank -1250 gallon wieser concrete tank with WK -40 installed with in pump and floats 153 ent System dose tank 750 gallon wieser concrete tank with Zoeh;e~Bii need it0 be registered on the deed of This ATU requires service on cycle of six months , sanitary permit from st. Croix county this property, this must be done prior to issuance of y p WARNING: SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES R OTHER TRATM NT TANK UNDER ANY INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP O CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MY BE DIFFICULT OR IMPOSSIBLE. All system maintenance will need to be recorded with St.Croix count on there new Laserfiche System r , y Noi Full Service Plumbing Foretng needs., pumping ns, 715-231-7375 caI1715-231-7374 f oraJJYour plumbing and se `s Pagell-11 Tuf-Tite makes a full line of Risers and accessories for Pre-Cast applications. "ilk ON, ,Y Riser Lid - with Molded-in gasket. Available in 12", 16", 20 and 24 diameters. Green Only. Concrete Lid - with handle. Use the Safety Pan to cast your own concrete lids. ` Safety Lid - May be used in place of concrete lid. Fits 24" Riser Pan only. ,t Black Only. 16", Safety Pan -Safety PanTM available Only. 20" and 24" Risers. Green y 6" Tall Riser - For septic tanks. Stackable P in 6" increments. Available in 12", 1620 and 24" diameters. v# 12" Tall Riser - For septic tanks. Stackable in 12" increments. Available in 20" and 24" diameters. Black Only. Tank adapter Ring -For mounting riser or lid to tank when casting-in is not an option. ~ 1 II'P'CI'://\1'\1'\1'.OItE\GO.CObI/I'1[lll)Ut;r clA u-1,..,..,i„■..~ )rl1JBE*-FT SERIES BASE INLET EFFLUENT FILTERS (FT) Home About Products Distributor Locator Internatwnal 1, Documents i, Contact i y° j.: ra R Or c our e n-~ Literature Re ulat^^~ es c s » rtes » C Product talo s Techn!,_al Resou s » o » Mr~rke~ ca a H me About rent or orate - D ~ FHli~ont Filter H m » Product Catalogs » General, Onsito Products _ Coroora~_ to o e Biotube° FT Series Base Inlet Effluent Filters OrencoO Biotube® FT Series Base Inlet Effluent Filters remove about two-thirds of suspended solids from effluent, helping extend dralnfield life.; They have the flow area of a full-size filter in a small package for short septic tanks. Biotube FT Series Base Inlet Effluent Filters are installed on the Schedule 40 or Type 3034 outlet pipe of a new or existing tank. They come with a filter cartridge, PVC housing, and an extendable PVC handle. An optional overflow plate is available for 8-inch (200-min) models, to prevent effluent from bypassing the filter if it clogs. 8-inch (200-mm) nominal filter diameter * 14-inch (356-mm) filter height, standard 22-inch (559-mm) housing height, standard 1/8-inch (3-mm) or 1/16-inch (1.5-mm) filter mesh available * Corrosion-proof construction Y~l Extendable handle . Easy to clean z Ala-MM w Optional overflow plate available a optional float elbow available for high-level alarm assembly High-level alarm assembly ordered separately (see -Float Switch Assemblies' in the "Product Ordering Information" section of this catalog) • Sample Product COd@5'K 6loTUjj0 T.SERIE.SRASE LNUT EFFLUENT FILTERS F70822-14B - Biotube FT filter, 8-inch (200-mm) diameter, 14-inch (356-mm) filter height, base inlet FT0822-14B-FSO - Biotube FT filter, 8-Inch (200-mm) diameter, 14-inch (356-mm) filter height, base inlet, overflow plate installed * For the full range of available product options, contact your local Orenco Distributor or Orenco. Technical Data Sheet Product Sheet - - © 2015 orenco Systems ® Inc. Follow us: 0 6/2/2016 4:1 It Pill I OF I -,a Webslte: :x mtech c(;➢ e Sim/Tech Filter' imtech.com = Email: sales@gaab_s 1455 Lexamar Drive _ Fax: 231-582-7324 MI 49712 Boyne City, Toll Free: 888-999-3290 Office: 231-558 82--1020 1020 Sim/Tech Filter's Last Line of Defense The 10Q Series Pressure Filter For more info and to The Sim/Tech pressure filter, with its unique design see videos, visit and mounting location, allows the filtering screen to Aww.simtechfilter.com be scrubbed during pump operation, providing maximum maintenance intervals with unmatched NI performance capabilities. The filter screen is a type 316L stainless steel with .062" (1/16") diameter holes. Optional socks are available for finer filtration. The screen is 3 inches in diameter and 18 inches long, with 41% open area. This large open area (69.52 square inch- es) allows the filter to operate at up to 83.8 gallons per minute at 1 psi. With features like these even a 95% plugged screen will keep your pressurized sys- tem well protected and working properly. This performance product assures quality effluent with lower TSS levels, keeping your pressurized systems functioning at 100% efficiency. Engineers and designers can specify the Sim/Tech pressure filter to safeguard and assure systems will Vortex Action function as designed now and in the future. The Sim/Tech pressure filter is perfect for both residential and commercial applications. High flow-rate manifold. Multiple filters can be assembled into a manifold to + 13 v accommodate high flow-rate or high strength effluent systems. _ 3 At the max flow-rate of 83.8 gpm, headloss for a clean filter is .21 psi or 1 /2 foot and head- loss for a 95% plugged filter is .85 psi or 2 feet. 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~ y na Kenvle ss'• Mailing Address &e . Property Address Q, p 140 Avc (Verification required frcm Planning & Zoning Department for new construction.) City/State Ernpr&W Parcel Identification Number Q1( - ~1(-~( -~t~c © LEGAL DESCRIPTION Property Location SC '/4 , Sec. T 'SG N R6W, Town of r,- Subdivision Plat: Lot r; Certified Survey Map # Volume Page # Warranty Deed # (before 2007)Volume Page # Spec house ❑yes* Lot lines identifiablegyesE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and r2turned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on t is 6rm are true to the best of my/our knowledge. I/we am/are the owner(s) of the property scribed above, by virtue of a rtdnt deed recorded in Register of Deeds Office. i , Num er f bedrooms ' LCA C N ATURE OF PPLINTt); AT Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Lewis Bjork, LLC MAINTENANCE CONTRACT FOR AN ON -SITE ATU TREATMENT SYSTEM Customer: D AV ,\Ie N V{ M , Phone: '-7i5- 4%8 -9 3i 9 EmailAddress: Address: 336 iI GO HA dif City: ZipCode: 5q C13 Subdivision: e~ Installing Plumber: L Brand/System Name: _y( ,~,~v{- Model#: V.~ LIC> Serial#:_ Install Date: _ Permit _ Lewis Bjork, LLC will inspect and service your aerobic septic system once every 6 months for the duration of your contract. For a new single family dwelling, this date is the date of installation, required by state guidelines. For an existing single family dwelling, this date is the date the notice of approval is issued by the permitting authority. The effective date of this maintenance contract, shall be, the date the license to operate is issued. Before this service policy expires, the owner of the ATU - P.O.W.T.S. is required to have a new signed maintenance contract. A copy of the new contract shall be submitted to the permitting authority at least 30 days before the current contract expires. If the property owner or maintenance company desires to discontinue the maintenance contract, the new maintenance company shall notify, in writing, the permitting authority at least 30 days prior to the date the service vvill our company will cease. If a maintenance company discontinues business, the property owner shall, within 30 days of the termination date, contract with another approved maintenance company and provide the permitting authority with a copy of the newly signed maintenance contract. SELECT OPTION: Additional Service Calls are $75.00 per hour - call; this includes any visit that is not regularly scheduled MIN--- [ ] 2 Year Initial Contract (New Construction Only) 3 Year Contract Renewal [ ] 2 Year Contract Renewal [ ] 1 Year Contract Renewal TESTING & REPORTING Lewis Bjork, LLC shall test & report on this system as required by the rule on the following: 1) An inspection every 6 months, which includes inspecting, adjusting, & servicing of the mechanical & electrical component parts as necessary to ensure proper function. 2) An effluent quality inspection every 6 months, consisting of a visual check for color, turbidity, scum overflow & an examination for odors. 3) If required, a sample shall be pulled from the aeration tank every 6 months to determine if there is an excess of solids in the treatment plant. If the test results determine a need for solids removal, the user will bear the cost & responsibility for doing so. r 4) If improper operation is observed, which cannot be corrected at that time, the user shall be notified immediately in writing of the conditions & the estimate date of correction. 5) The IOS - 500 inoculants exchanged on a 6 month basis 6) All system maintenance will need to be recorded with St.Croix county on there new Laserfiche S. stem Lewis Bjork, LLC who has been certified by the manufacturer of your system, will be responsible for fulfilling the requirements of the maintenance contract, as well as responding to any complaints and/or addressing any concerns by the owner of the system. Concerns and/or complaints will be addressed within 72 hours, excluding weekends & holidays, of the initial contact. Upon expiration of this policy, our company will offer a continuing service policy as mandated by state regulations. VIOLATIONS OF CONTRACT WARRANTY include: shutting off the electric current to the system for more than 24 hours, disconnecting the alarm system, restricting ventilation to the aerator, overloading the system above its rated capacity, or introducing excessive amounts of harmful matter into the system, or any other form of the unusual abuse. AI included in Violations of Warranty are, not keeping grass & weeds trimmed around the electrical box, as well as keeping ants from infesting the electrical box. . NOTE: This policy does not include pumping sludge from unit, if necessary. The service company & the owner agree to abide by the service policy as stated above. Maintenance Company: Start of Contact Date of Expi ation: _ System Ow er/Homeowner ture: E7818 Couhty Ro d 2 n' WI 54751 Today's Date: _ Iewisbjork@yaho com (715) 1.73-7t~vis,B} A thorized Signature: Date: Service Company Operator Name ti License Number: Lewis Bjork, MP253976 SELECT PAYMENT: Credit Card payment via (select one) Phone Email Standatr] Mail Contract Verified (Office Use Only) Check Payment Check# RECEIVED IIIII IIII II I !I 1~~ I~I~ I I ~ IlII 6 5 Document Number Document Titl SEP 15 201 8 TX943311 9 627 St. Croix County 30MMUNITYDEVEL PMENT 1035703 BETH P'ABST AEROBIC TREATMENT UNIT (ATU) REGISTER OF DEEDS SERVICING AGREEMENT ST. CROIX CO"" WI RECEIVED FOR RECORD 09/14/2016 11;51 AM State Plan Transaction Number - EXEMPT ~ REC FEE: 30.00 _DAN a,-N ~C 55 COPY FEE: 2.00 Name - (Owner) Typed or pri ted PAGES: 1 Being duly sworn, states, under oath il,at _ ,He/she is the 0w11er/pa#10wTM-rr of the following parcel of land located in St. Croix COUnty, Wisconsin, recorded in Volume Page Document Number/629 Zc3S St. Croix County Register of Deeds Office: Recording Area A parcel of land located in they. '/,of the N`,A)/, of iSection j9 Name and Return Address Tc--) N - R _ W, Town of--~I+nti~ St. Croix 93a3(; 16oxh Ade County, Wisconsin, being duly described as follows (include lot no. and / subdivision/CSM or detailed legal description): ,A0 I -F 5~-(101 ? c-4 C~(O ID21- yD -oc~o 65 1)7 .397-7-70 VC l~ /378 Parcel Identification Number (PIN) Agreement Date: As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Aerobic Treatment Unit on the above-described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of SPS 383, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System) technology. If the owner fails to have the POWTS and ATU properly serviced in response to orders issued by the governmental unit or the Department of Safety & Professional Services (DSPS) to prevent or abate a human health hazard as described in s. 254.59, Stats., the governmental unit (St. Croix County) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. The owner agrees to maintain a contract with a licensed POWTS maintainer for the life of the system. The POWTS maintainer will perform periodic inspections and maintenance as required by the manufacturer and the DSPS, including, but not limited to: the blower, electrical controls, and treatment unit operation and sludge depth. These inspections are to be scheduled every 6 months for the first two years of operation and yearly thereafter. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit so as to not create a human health hazard as described in s. 254.59, Stats. 4. The owner recognizes that the county, DSPS, or POWTS maintainer may make periodic inspections of the components to complete performance monitoring of the unit. 5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection, maintenance or -servicing event in a manner specified by the department or designated agent within 10 business days from the date of inspection, maintenance or servicing. 6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the aerobic treatment unit no longer serves the property. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined by reference to the property where the Aerobic Treatment Unit is installed. Owner(s) Name(s) - Please Pri t Subscribed and sworn to before me on this date: Notari d Ow is Signature(s) r Notary Public Itr 69 'sa;n;e;S uisuoosiM aa11)u!paooaa aq; o; oo Z$ pue;uawnoop..)no f o; abed auo sppe 95edaanoo s;q; Jo asn :a;oN ;uawnoop ay; }o sated leuoipppe uo paoe;d aq few ao;uawnoop aq; }o a5ed;s-q4 s;q; uo peoe;d aq few .o;a `uo;;duosap;e5a; `sasne;o 5upuea6 au; se qons uogewao}ui aaq;0 (paainbai;i) NId pue 'ssaappe uan;aa 12 @WC-u 'api;;uauinoop :aG)pLugns Aq pa;a;dwoo aq;snw uo;;ewaoju; sail ,3AOV0 lON 04 - 1N3Wf100a -lbJ3-lSIHl JO 12ldd SI 30dd SIHl„ -JU 3fS13~ ~ t7, )(6)ti0 S el (Denod] sasodind /iepuooas ao pasn eq (e me u ewJo u! uosaa j 6 nn / - d d ,kb v n 0 ~C''~ 7 f . C~l G'2 (q pa~}e-Ir] a eu6!g le!o!}10 I, e~uawwano0 ~O n saa!dxd uo!ss!uawoo /W u!ad aseald - ell!1 WEN le!o!}}0 , ;uaua n O Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O l 0- 021-40 000 Please print all information. Rev ed by Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location if Ef n Dayna Hennessy Govt. Lot SE 1/4 W 114 9 T 30 N R 16 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name r CSM# 2336 160th Ave - Part of 3.8 acres / CSM 9389770 City State Zip Code Phone Number City 11F Village Town Nearest Road Emerald WI 54012 ( 7)5-688-9319 160th ave Fmer2ld New Construction User Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: NA Parent material Loess over till Flood Plain elevation if applicable NIA ft. General comments Using high] treated effluent install and recommendations: b b y (3) cells 3' x 130 installed 9" or .75' below surface contours /utilize pressure distribution and cover with top soil 12" above system IGHAL 171-1 Boring # Boring Pit Ground surface elev. 90 ft. Depth to limiting factor 35 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10Yr3/3 sl 2fgr mvfr gs 2f .6 1.0 2 4-8 10 r3/2 s1 2fsbk mvfr cs if .6 1.0 3 8-13 7.5yr5/4 sil 2fsbk mvfr gs l f .6 .8 4 13-35 5yr4/6 grscl 2msbk mvfr s - 4 6 5 35-45 5yr4/6 flfI0vr6/2 scl Imsbk mvfr gs - - 6 45-56 5yr4/4 f2dI0yr6/2 scl O,n mfi p2 Boring # ® Boring 89 35 ® 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/3 sl 2fgr mvfr us 2f .6 1.0 2 4-11 10 r3/2 sl 2fsbk mvfr cs 2f .6 1.0 3 11-27 7.5yr5/4 sil 2fsbk mvfr gs if .6 .8 4 27-35 5yr4/6 grscl 2msbk mvfr as .4 .6 5 35-46 5yr4/6 flfIOyr6/2 scl lmsbk mvfr gs - - 6 46-58 Syr4/4 12dI0yr6/2 scl 01 11 _ * Effluent #1 = BODS > 30:< 220 mg/L and TSS >30 < 150 m * ffE" I A I -T--1 lue #2 ODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Lewis Bork C!Z~~ 253976 Address Date Evaluation Con cted Telephone Number E7818 County E Menomonie WI 54751 7-15-2016 7 15-23 1-7375 Property Owner Hennessy Parcel ID # 010-102 1-40-000 Page 2 of 3 p3 Boring # Boring ® Pit Ground surface elev. ft. . Depth to limiting factor '6 ❑ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2 1 0-5 10yr3/3 - sl 21 gr mvfr gs 2f 6 1.0 2 5-9 10 r3/2 - sl 2fsbk mvfr cs 2f .6 1.0 3 9-26 7.5yr5/4 - sil 2fsbk mvfr gs ]f 6 8 4 26-36 5yr4/6 (>rscl 2msbk mvfr as - 4 6~ 5 36-48 5yr4/6 fIfIOyr6/2 scl Iin sbk mvfr - - - 6 48-55 5yr4/6 f2dIOyr6/2 scl Om mfi - F p4 Boring # Boring 91 r7 Pit Ground surface elev. ft. Depth to limiting factor 37 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fly in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-4 10yr3/3 - sl 2fgr mvfr gs 2f .6 1.0 2 4-9 10 r3/2 sl 2fsbk mvfr cs 2f .6 LO 3 9-28 7.5yr4/4 - sil 2fsbk mvfr cs If 6. 8 4 28-37 5yr4/6 - grscl 2msbk mvfi• cs - .4 .6 5 37-52 5yr4/6 fIfI0yr6/2 scl Imsbk mvfr cs - - 6 52-62 5yr4/6 f2d 10yr6/2 scl Om mfi - - ❑ T-1- Boring Bonng# 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/fig in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Effluent #1 = BODS > 30 < 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 e nployer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3 15 1 or TTY 608-264-8777. S E3 D-8 , , O I est (R.07/00) I~j 7 C7 M -y ~ O 7 r0 y, %S o J r Al J m.. s 51 LJ 3 i .z J ) Ix,