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HomeMy WebLinkAbout032-2174-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 592115 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Oevering Homes TOWN OF SOMERSET 032-2174-03-000 CST BM Elev: Insp. BM Elev: BM Description: /00 8 r Z G 5 Section/Town/Range/Map No 22.31.19.1458 -r 11 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic, 1} Benchmark Dosing Alt. BM R-p 756 !a nBldg. Sewer St/Ht Inlet TANK SETBACK INFORMATION sUHt outlet ` TANK TO YoPpL WELL BLDG. ent )o Air Intake ROAD Dt Inlet Septic / AA- 36 ! Dt Bottom /L @ lr5 Dosing `A' T 3U 7 4Z Header/Man. h~ ~o Aeration Dist. Pipe Holding Bot. System ~41 / Aix- 1 Final Grade I~ PUMP/SIPHON INFORMATION Manufacturer Demand St Cover cGPM ~rIJ.. o all Z.. ys . Model Number J`~~J 1`~ 5•~j 9Y.<P TDH Li /o,cp Friction1L~ s System Head• 4, TDH/~, ~Ft Forcemain I Length r Dia. `I Dist. to Well / /0 Z• /v S . -74.1 SOIL ABSORPTION SYSTEM s FS 91/. 3 BED/TRENCH Width Length No. Of Trenches PIT DIME IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~J - SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:, INFORMATION CHAMBER OR Type Of Syste t j°a.MfE 5 ~J ~yn UNIT Model Number: ✓VAJ.,F J J✓ s DISTRIBUTION SYSTEM of 19 / I i--) Header/Man ifpl Z; 14-- Distribution Ix Hole Si Ix Hole Spacing Vent Air In ke s/~ c~ tf Pipe(s) Length Dia 7 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over jxx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center z -7 Bed/Trench Edges 11 Topsoil _Yes No ~.N, Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2018 57TH ST 1.) Alt BM Description = 2.) Bldg sewer length = - / S /Ija W C.Q_C. V J• - amount of cover = r+ Plan revision Required? ❑ Yes No L( ""I Use other side for additional information. Date Insepctor's Siglature • Cert. No. SBD-6710 (R.3/97) I `ti' ' -E Page 3 of 3 ;1i11e Brian Parnell a idr~~ CST 231314 Date )?-i B ia, 1'1; IV Ynd S~ 74,3 r- Aleyl~- fu NL °tti Lc; icy. le- i LL~~ Soil Borin_ 1- _ 40' S, <il ; I : I $2 13 3=~ dl LzA14' Ii , i _ I I : . , i , b, 1. i i ~ED County Safety and Buildings Division J r K 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit N ber (to be nlled in by Co.) Madison, Wi 53707-7162 016 NTY X MUNITY DEVELOPM&U itary permit Applic,GyFbF~ StillTransacti nNtunber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the app.,., 11140 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned P 1- ZZM roject Address (if different than mailing address) OW the Department of Safety and Professional Servies. Personal information you provide e used for b- may b oses in accordance with the Privacy Law, s. 15.04 1) m), Stats. L A &cation Information - Please Print AllAilliforpidtfill Property Owners Name 3 Parcel # Property Owners Mail' adress _ Property Location Ole C t!~ p !1 / r ~C i Govt Lot City State Zip Code Phone Number IL 14, Section II. Type of Building (check all that apply) t # N; R E ot(W J Family Dwelling -Number of Bedroo 3 ision Name `J 6*- d06 Block # ❑ PublicJCommercial - Describe Use Q ~ ~ ti ❑ City of ❑ State Owmed - Describe Use CSM Number ❑ ViUaae of p of t'~ F 2Li~~ III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) A. s, Q ZM System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal t Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner (3 _ IV. T ofPOWTS System/Com onent/Device: (Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable ❑ Holding Tank ❑ Other Dispersal Component (explain)- ❑ Pretreatment Device (explain) 7~o 1 so V. Dispersal/Treatment Area Information: r ~j Design Flow (gpd) Design Soil Application Rate dst) Dispersal Area Required (sfl Dispersal Ar la Proposed (sf) s em Elevation ill C L J`l/ ( n VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units L ° v 3 New Tanks Existing Tanks = U U rn v cn G Septic or Holding Tank J / Dosing Chamber i f.4 'e) VII. Responsibility Statement- 1, the undersigned, • ' ime responsibility for installation of the POWTS shown on the attached plans Pl s vane (Print) Pi r' Signature MP/MPRS Number Business Phone Number - { 1 j~ Plumber's Address (Street, City; rate, Zip Cq / VIII. County/De artment Use Only D proved Perm ee ' Date TS eQd t Issuing. t Signature even Reason for Dent IX. Conditi' a1Nk. ~ , _ot~'~fnr I?i~approval \ ~X dispoilml Cal "Kmt at J* as pal q0M e 2. AA- Ck I *J ttiwl as Per t1PPA0*11a cock I cnd0doma. ~o ,nr~, a > rV Attacb to complete plans for the system and submit to the County only oa paper not les than R r z I l iucbes in SBD-6398 (R 11/11) , ~ f,~ Iti0{MQ a1 ~ tart er IOW t~ ACA-, septic-Dose Van k Cross Section And Pump Performance Specifications - - Pump Manufacturer Tank Manufacturers - pip Model Number rlJ S 'I ank Model Number 'L S - Alarm Manufacturer Total Tank Capacity ( 7 to l-, model Bury Depth Alarm Number Switch Type P .~Cit Total Dynamit1lead TDH) Feet Filter Manufacturer Filter Model Number Elevation Head Distal Pressure Network Loss ~ Minimum Pump Verformance Required Force Main Loss GPMv @ f C~ Ft TDH Total Outlet !.Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking De~tice. Inlet Manhole Securely Mounted With Locking Device 6" Below Grade Sealed Watertight Weather-proof 1 Junction Box. 1 r ~4 a Finished Grade Vent Min. 12" Disconnect Above Grade Means With Vent Cap ><L Y'1 Outlet Filter Inlet Inlet Baffle r, Switch Settings and Reserve Capacity A 1/411 Weep _Ta[ilC Volatile GPI = Hole Dimension; Inches Volume Gal. (reserve) A li Off Elevation C (alarm) B, 2 3 (dose) C Bottom (dead) D j D Elevation Total GENERAL INSTALLATION: The septicidose 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 41' Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28, 02/05 U Page of TOTAL DYNAMIC i;EAO/CA.PACITY u HEAD CAPACITY CURVE PER MINUTE MODELS 53/55/57/59 E=:TLUENT AND HWAJERING 25 Vcdel 53%55/ 7/59 i 20 6 Ft. Meters o E3 a T i. 5 1 5 I 4„ i5 r C 3 ;4 29 z < 4 15 c E ~ 19 7 2 - - 10 l Shut-off Hecd 19.25 ft. (5.9mi ~ 2- 5 ----13 IE/151,6 3/32---~ Z_ 5/3 /2 - /2 NF 0 % U.S. GALLONS 10 0 30 40 50 TERS 8G or rj 5/t6 0 ' a G~ - t =LGIN PER MINUTE 009697 __T l 4 1/10 Variable level float switches available. Variable level long cycle systems available. Available with special cord lengths of 15', 25', 35' and 50'. r Alarm systems available. Duplex systems available. 3 3/32 III-r Single Seal Control Selection Listings = Model Volts Phase Mode Amps Simplex Duplex CSA UL~ 1. Integral float operated mechanical switch, no external control required. M53/55 & M57/59 115 1 Auto ! 9.7 1 Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53/55 & N57/59 115 1 Non 9.7 2 3 or 4 & 5 Y YY~ 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 j 1 Auto 9.7 N Y BE53/57 230 1 Auto 4.8 Y Y 4. See FM0712 for correct model of Electrical Alternator- I 653/55 & D57/59 230 1 Auto 4.8 1 Y Y 5. Variable level control switch 10-0225 used as a control activator, with Electrical 1 j E53/55& E57/59 230 1 Nor 4.8 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system. Single piggyback switch included. D CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator. FM0495; Sump/Sewage Basins, FM0487, and Single Phase - ` Simplex Pump Control/Alarm Systems, FM0732. _ _ , _ _ - Q For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX `F217 Louisville, KY 40250 Manufacturers of . . u -`r lir7,) / SHIP TO: 3649 Cane Run Road Louisville, KY 40211-1961 QZIAIITY PUMPS SNCE Iq p (502) 778-2731 - 1 http.11www.zoeller-com PUMP CO. FAX (502) 7740 PUMP 3624 © Copyright 2002 Zoeller Co. All rights reserved System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4s 22 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 97.0/96.9/96.8/96.7 2' below DATE 8/30/16 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 .4 ABSORPTION AREA 1542 # of chambers 76 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 10' 30' 99' 5'B-2 45' zq' 4-3' X 78' cells with >3' spacing 50' % Ve is 55' 57th St. B-1 598' Property Line r,,.L 3 100' 30' 3% Slope ST 15' Pro 4 Bedroom House Vent ;4' 6„ Quick4 Standard All piping shall be ASTM SDR 30/34, within Leaching Chamber- 10' of tank, piping shall be ASTM F891 over with 20.0 ft2 of Area 5.6ft^2/pair of end caps Long 12 34" Grade at System Elevation copli, • County -RECEIVEIT s~ Safety and Buildings Division J~. C t- C r r " 20 201 W. W gto Ave. .0. 71621 Sanitary Permit Number (to be Med in by Co.) t 8 ~ K SEP 0 8 1 n Ma 537 -71 ST. CROIX COUNT`( amtary ermh Application StaieT'a `i et In accordance with SPS 38321{2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application formes for state-owned POWTS are submitted to roject Address (if different than mailing address) the Departmait of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15. 1 m , Stan. L Application Information - Please Print All In ati (t 1 J 7i 5V1 Property Owner's Name, I Parcel # 0 t" ~j ,P_ rim. Q 11 1- 3 Property [O~wner's Maitlmg s Property Location C 3,2) (1 7 6t-j Alp Govt. Lot city, state r Zip Code one Number Section 27 T N; R E e II ype of Banding (check all that apply) L/ Lot r 2 Family Dwelling-Number of Bcdroo Subdivision Name ak Block# ❑ Public/Commercial -Describe Use City of ❑ State Owned - Describe Use CSM Number Village of Town of n r.~ IIL Type of Permit: (Check onl one box on line A. Complete line ap 'stable) A.. ew System ❑ Replacement System ❑ Treaanent/Holdin placetnen ❑ Other Modification to Existing System (explain) 101 0lty ® L List Previous Permit Number and Date Issued B• ❑ Permit Renewal ❑ Permit Revision ~-e &b. P ransfer to New Before Expiration Own IV. ofPOWTS System/Component/Device: Chet at 1 % ?Jon-Pressusized In-Ground El Pressurized In-Ground Q At Grade d > 24 m of suitable soil ❑ Mound < 24 in. of suitable soil EHoldmg Tank er Component (explain) ID Pretrce lain) t/ al Trea ent Area Infor mation: 4 17. 0/ 211 (gpd) Design Soil plicatiom Rai Dispersal Area Required (st) Dig oposed ( ^ System Elevation Cb, VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units /J L n o- z AI-/1 \ • . o E CJ . 1~'~G~ a.. U iz vs Septic or Holding Tank j j Dosing Chamber VII. Responsibility Statement- L the undersigned, responsibility for installation of the 110WTS shown on the attached plans. Plumber's Name (Print) Plum s S atuse MP/MPRS Number Business Phone Number ~~<ve ~i ap 4 CL C / J ' fir( Phimbeer's Address (Street ii : State, Zip) r Z_ Ui oVIAJCoun artment Use Only Permit Fee Date su Issuing t 5ianature A.pprnved S ~gl. oa e~ f5 <<i Reason for )x. Conditi ors for Disapproval L ep . tank, eftitit ntfilter and disperaai cell must all be sets es ! maina'r,.g as perlnanagement plan pronded by plumber. n s. MVdb:s~c s *rWnt> kited 3, I PAIA- per sppk tle cods / ordinarim. Attach to complete plans for the system and submit to the County o ly on paper not less than 8 irzF I I inches in size rT~ SBD 6398 (R 11/11) I\ Ak, J ~Ot~ ~ ~ 366 ) J OJV-. 0vVW rt,*\ Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/30/16 Owner:Oevering Homes Location: SW1/4 SE1/4 S22 T31 N,R19W 2018 57th St. Somerset Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Co ency Plan 7.Filter Cross Section, r Signature_ License n #226900 System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4S 22 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 97.0/96.9/96.8/96.7 2' below 8/30/16 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1542 # of chambers 76 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark B.M.* Scale = 1/4" = 10' 30' 99' S B-2 45' 4-3' X 78' cells with >3' spacing 50' Vents 55' 57th St. 5 B-1 598' Property Line B-3 100' 30' 3% Slope ST 15' Pro 4 Bedroom House Vent >6" 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 ft2 of Area 5.6ft^2/pair of end caps 12 4' Long Grade at System Elevation 34" Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 4 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 99 01 Len ACI Grade Vent 41 34 Septic Tank 4' L5' 4' Long 1 40- 34Grade at System Elevation 34" Grade at System Elevation Spacing- 5' 4-3' X 78' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A-97.0' B_96.9' D C-96.8' D-96.7' 19 chambers per cell ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Qe o g ; ' w Mailing Address jLl d~l I ~1~ I Property Address L?( K L (verification required ` l - from Planning & Zoning Department for new construction. City/State Parcel Identification Number 2o1 LEGAL DESCRIPTION - Property Locatioil ~ Y, V4 , Sec. j T N R W, Town of Subdivision Lot #-J Certified Survey Map # _ Volume , page # Warranty Deed # i / - , Volume , Page # Spec house yes no Lot lines identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIR Improper use and maintenance of your maintenance consists of septic system could result in its premature failure to handle wastes. Proper pumping out the septic tank every three the system can affect the function of the septic years or sooner, if needed, by a licensed pumper, s e system, can es are specified in Co tank as a treatment stage in the waste disposal s y Owner rnaintbiliti 'What you put into § nuu. 83.52(1) and in Chapter .l2 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Pla1 owner and by a master plumber, journeyman plumber, restricted plumber nor ai censed pup~ent a certification he on-site wastewater disposal system is in proper operating condition and/or (2) after inspection anudmper veri form, signed by the less than 18 fy~gthat th fall of sludge. Pimping (it 'necessary), the septic tank is 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 commerce Certification stating that your septic system has been maintained must be completed and returned to the St- Croix of Wisconsin. Zoning Department within 30 days of the three year expiration date, 7C County Planning & i/we certify that all statements on this fe n are true to the best of my/our knowledge. I/we am/are the owners o property described above, by virtue of a wary f the deed recorded in Register of Deeds Off-ice. ,r --z Number of bedrooms IGNAT OF APPLICANT(S) DATE E ***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. 08/05) POINTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ILE INFORMATION SYSTEM SPECIFICATIONS Owner P Jt? t n Septic Tank Capacity I -Lru al ❑ NA Permit* Septic Tank Manufacturer ❑ NA 13ESIGN PARAMETERS Effluent Filter Manufacturer 41 0 NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA i Number of Public Facility Units ~,NA Pump Tank Capacity al NA Estimated flow (average) 41 115 6 gal/day Pump Tank Manufacturer NA i Design flow (peak), (Estimated x 1.5) & ~ aVda Pump Manufacturer NA i Soil Application Rate aUda /ftz Pump Model NA i Standard Influent/Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) x150 mg/L 0 Disinfection ❑ Other. !Pretreated Effluent Quality Monthly average Dispersal Cell(s) p NA Biochemical Oxygen Demand (BODs) 530 mg/L ;Kliupround (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <_30 mg/L ANA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: (Maximum Effluent Particle Size 3a in dia. ❑ NA Other. ❑ NA Other: Other: A 0 NA "Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency linspect condition of tank(s) At least once every: v ❑ m artrts(s) (Maximum 3 years) DNA (Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA !inspect dispersal cell(s) At least once eve month(s) D`' ear(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: A year(s)s) ❑ NA Inspect pump, pump controls & alarm At least once every: 0 }moo ~ h(s) ❑ NA f=lush laterals and pressure test At least once every: ❑ month(s) EE4N' ❑ year(s) ether At least once every: ❑ month(s) j?ther: ❑ year(s) MAINTENANCE INSTRUCTIONS !Inspections 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 linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of ioombined 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 i-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of j:he tank shal be removed 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, jand any 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 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals th-t may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thi: 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 be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. 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 POW 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 producgs; 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 propetly 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 properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant repla ment system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requitled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nded for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulet in effect at that time. A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologN a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 installed) as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTA N LETHAL GASSES AND/OR 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 t c % Name Phone - Phone lJ J / SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORITY Name ~ a Name Phone r L Phone This document was drafted in compliance with chapter S 383.22(2)(b)(%d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. E f ! P J I f I ' i a P I ~ P I p I ~ I f,,} LLI TV. 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Q J Y Z I- a -f w' p R O~ s~ osm~o O~i ~ 0: = t Qi ~ O 4 R° ~ ~ g~ al k ~ ~I R g ~ e t N ~I s. ran; c~x~caursoz~ a x.~ - - ° _ I I r - oI I 9 - - ^ e I - r y - 0 - srmr. o-.wezurKOZ~ ~I y ~ i NOE: I aY > LLJ ~o ~ ai of c t c < vN', o I %~~Fy x o!,', m of a 'I II I M~ x Ti I x II i - I ' si g''I f I q s W' z Q a _D Wisconsin Department of Commerce r - )OOIL EVALUATION REPORT Page of i Division of Safety and Buildings in accordance with Co 85, Wis. Adm. Code County Attach complete site plan on paper not less than ~12 11 inch in size. Plan must include, but not limited to: vertfcatand honaoiatal int BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. view y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / t1 Property Owner Property Location Govt. Lot 1/4 1/4 S~ T N R G E (orG Property Owner's Mailing Address, Lot # Block Subd. Name or City Star Zip Code Phone Number ❑ City ❑ Village OTown Nearest Road, New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable lj/G~ ft. General comments and recommendations: I ti'1 L'1 - ~'N✓;Yt G/ ,c t ~t Al Z, yyt Q f _2 (r, F/_1 F] Boring Boring # ~ 1, yZ 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 7 A/Z - - i f i T' ~ ( f I X I Boring # ❑ Boring I I Pit Ground surface elev. l[ ,z, 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 l 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 me (Please Print) I n re CST Number Address Date Evaluation Conducted Telephone Number f" Lt Property Owner Parcel ID # Page of =r Boring #r-1I 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 i X/ J Z, r i S~'' 'c > r - i Bori # Boring N ft. 9 , a Gt nq ng F-1 W W -2h pit Ground surface elev. D p o limiting actor in t- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure C sisten Boundary Roots GPD/ft _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit 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 Effluent #1 = BOD5 > 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 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=) Property Owner Parcel ID # Page of F -1 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 i 1-2 Boring # ❑ Boring 9Lr ® -Pit Ground surface ete~W' V 1{. ~l' D 040 limiting factor t~ in. AN '21 ~ 3 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure C sisten Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 f z r rz IC cL ,4r 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 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 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. SBD4330 (86/00) (J W`NE R Page 3 of 3 aIIle Xs Brian Parnell Address CST 231314 Date f 2 Benchmark 1 /I/D'r` BenCllll113r k ? ~ ' ' ` ~ IV ~~1' tt~ ~L: ~h Lc •rC~."-•rr Soil Boring S~~itable ~:rea 1" = 40' Scale Ad/. Z 8; 3 fj i y ~ ~Or~a _ - I i j I I ~ ! ! I I ; i - - - - - 1- -1 - - ! i i i I l-- 1 7 --T - - - - ' I i I ! I j I 'iT i j - - - 2 \ l~~ \ ` T.7J Vl.f GJ a tr ~ la w Lori J 02t acres ha \ 53 a* .R5 Lor2 z 3.151 acres r: rO O.N. W M o~ rn \ 3.02t res g5~' \ 6 \ rs r0 0. H. \ O = /8l, o\ \ / o t ne ~c~ \ \ f5 \ I Lor4 o \ 02t acres A° D/ \ ~7 03ko9~ \ i / 74. 4 A LOTS J. 0.31' acres rO 0. H. W. M. S34?~