HomeMy WebLinkAbout018-2011-73-000
. Croix
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 6"7Z -/4~~) 592158
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)].
Permit Holder's Name: City Village Township Parcel Tax No:
Kernon Bast TOWN OF HAMMOND 018-2011-73-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
O I~ G_J 30.29.17.1088
TANK INFORMATION ELEVATION DATA *t ~Jl v &4 /dam S ,?.'d1.o
TYPE MANUFACTURERrJdNil;-S CAPACITY STATION BS HI FS ELEV.
Benchmark 161 .3 /66
Septic
dvf~f
0/ Alt. BM -1-60 7,6 g
Dosing ONE
( /vMP- i.5' u
g~tatian \ 1F1d_9_
. S w r ~ .1 C61.1
Ht Inlet (d , /L 16' v
St/Ht Outlet V
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. ent ttc Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosi g Header/Man.
Aeration Dist. Pipe
15
Holding Bot. System
PUMPISIPHON INFORMATION Final Grade 17-$'
77
Manufacturer Zoe /1 „ Demand St Cover i3 79.3
..e Uki fn ai
Model Number y~ J / 15 GP a K~~v ~ rj , `T 7 f
y~ • ~Ft 6 4 G~rZ
TDH Lift Friction Logs System Hea TDH(ii
l.~ w v
Forcemain Length F~ Dia. o Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of nc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 14,10
SETBACK SYSTEM TO P/L qLDG, W ELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION I CHAMBER OR
TyOf Syst O UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution / ix Hole Size / Ix Hole Spacing Ve Air Int ilk
Pipe(s) tG/ y
Length- Dia Length Dia Z Spacing Z
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center / Bed/Trench Edges Topsoil Yes L] No s E] No
COMMENTS: (Include code discrepencies, persons present, etc.) -InjsN'pection #1: IZ- 5-1 (Q Inspection #2: J//~~~~~$ J 7
' nk- only h
Location: 154578THAVE In
/ n ~i^.iJ4_U
~.l l
1.) Alt BM Description G aje~ 0y%,
2.) Bldg sewer length = / O w
-amount of cover = 32, d~C
7 LiZ" 0-~ C OVty 0 o\\\ L° R-i no.N r
Plan revision Required? ❑ Yes No d ti 3 ~
Use other side for additional Informal n. L5 i I
Date 'rinsepctorl's ignature Cert. No.
SBD-6710 (R.3/97)
County
~bJ Safety and Buildings Division
< r. 201 W. Washington Ave., P.O.. Box 7162 Sanitary Permit Number(to be filled in by Co.)
Madison, Wl 53707-7162
K
t~Th~F q23 Ki 5 g ZZ ~b
CSY
State Transaction Number
Sanitary Permit Application -a % l
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Ls
is required prior to obtaining a sanitary permit Note: Application forms for stale-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secon 1
purposes in accordance with the Privacy Law, s. 15.04(1) m), Stats. l -
nAca nformation - Please Print All Information §
ame Parcel #
Mailing Address Property Location C ~ q7 ` i69Y
I
Govt Lot
Cy Zip Code ~_Phlne Number ~t/t{~ Section
N> R / E W
U. Ty o Building (check all that apply) ~ Lot #
Ty 2 Family Dwelling -Number of Bedroo Subdivision Name
~~yy Bloc F /r r' f
❑ PubliclCommercial - Describe Use VIA 44 ❑ City of
on 1W,
CSM Number Village of
A1 ❑
El State Owned -Describe Used
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A_ ew System ❑ Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issu -
B. El Permit Renewal Permit Revision El Change of Plumber Permit Transfer to New t
Before Expiration
,
IV. Type of POAITS System/Component/Device: Check all that apply)
❑ Non-Pressuized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 t. of suitable soil ❑ Mound < 24 in. of sui soil (`1
❑ Holding Tank ❑ Oth Dispersal Component (explain) ❑ etreatment Device (explain) II
V. Dis 7(gpd) nt Area Information:
Design Design Spplication Rate(gp f) Dispersal Area Required f) Du ersal Area Proposed Sy em Elevatioig-
21
VI. TaCapacity in Total # of Manufacturer
Gallons Gallons Units m j =
New Tanks Exisan Tanks r C ( m ro
Septic or Holding Tank ;4 I~"` r !
~sngc>bef
VII. Responsibility State ent- 1, the undersigned, assn a esponsibility for installation of the POWTS shown on the attached plans.
Plumfber's Name (Print) Plumber' ~S' azure f MPlMPRS Number Business Phone Number,
Plumber's Address (Street, City, State, Zip Cp
!
Countv/De artment Use Only
Permit Fee Date ued Issuin ent Signature
proved S 90 7- L?
iven Reason for enial
LX. Conditi ~sous.or Disapproval nr
ep. ank, et t,bm It e* tern 3
dispert:to Celt must all be sr-4 icas ! r«inta '-ti
as- .per ~rtairayement plan pro Tided by plumber.
2. 'AM ;6j "l lfe wtsMust barla intfrined (~~1
as pet ~ c4& I zrdinance3.
Attach to complete plans for the system and submit to he County only on paper not less than R `n x ] 1 inches sib
5 `a
4 cam: A- h
~~J W/ PefAA+-;
SBD-6398 (R. hill) caQ. ;r,
System PLOT PLAN
PROJECT McCabe Homes Inc. ADDRESS 935 OSDrev Drive Bavoort Mn 55003
NW 1/4 NE 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 96.2' DATE 11/27/16 BEDROOM 4
CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE •6 ABSORPTION AREA 1000 # of chambers none
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
78th Ave
Scale = 1/4" = 10'
2 acre Lot well is to make all WDNR setbacks
Pro 4
Bedroom 240'
House
Huffcutt Combo Tank
Tank is to be properly Area 15' below
bedded and provided with system is to remain
lockdown covers with undisturbed
approved warning label
8% Slope
94.5'
B-2 B-1 95.5'
96.2'
96.5'
75'
B-3 B.M.*
Grading is to be
done to divert
run-off away
from system
Property Line
Property Line
DIVISION OF INDUSTRY SERVICES
,o%RT.~tE~r 2331 SAN LUIS PL STE 150
( o s GREEN BAY WI 54304-5211
C D. Contact Through Relay
3 P { http://dsps.wi.gov/programs/industry-services
vrww.wisconsin.gov
ssro'N' Scott Walker, Governor
Dave Ross, Secretary
December 08, 2016
DEPT O
CUST ID No. 226900 ATTN: POWTS Inspector
SHAUN R BIRD ZONING OFFICE 2 N C, f i 3
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICFLNEL RD
NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708
CONDITIONAL APPROVAL Identification Numbers
PLAN APPROVAL EXPIRES: 12/08/2018 Transaction ID No. 2865611
SITE: Site ID No. 833633
Mccabe Homes inc Please refer to both identification numbers,
1545 78TH Ave above, in all correspondence with the agency.
Town of Hammond
St Croix County
NW1/4, NE1/4, S30, T29N, RI 7W
FOR:
Description: At-Grade (4 Bedrooms - New Construction)
Object Type: POWTS Component Manual Regulated Object ID No.: 1673282
Maintenance required; 600 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original Grade;
System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution
Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department, per s. 145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site.
• With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped
prior to homeowner occupancy.
• Wastewater generated from contractors cleaning of equipment and tools and/or left over construction
products shall not be discharged into the drains discharging to the private onsite wastewater treatment system
(POWTS). Waste generated shall be properly disposed of on-site or off site.
• Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to
prevent matting under the dispersal area. All loose organic material to be removed from mound area.
• Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches.
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 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.
S
SHAUN R BIRD Page 2 12/8/2016 ,
• Divert surface water from POWTS Area.
• All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5
• Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c)
• Tank Installation to follow all manufacture's recommendations.
• Pump Floats to be set and verified per approved plan Anv chances may result in pump resizing to meet
TDH and GPM Specifications.
• Verify property line(s) prior to installation.
• Well setbacks to meet chs. NR 811 & 812.
• Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil
available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be
cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to
provide sufficient infiltrative area.
• 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 ad is located.
2. The bottom of the tank is located more than 150 feet horizontal) from where the servicing ad 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 t11is 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
cons truction/instal lation/op eration.
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,/ Required $ 250.00
This Amount Will Be Invoiced.
Tim Vander Leest [Fee
When You Receive That Invoice,
lease 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.vanderleestOwisconsin.gov
SHAUN R BIRD Page 2 12/8/2016
• Divert surface water from POWTS Area.
• All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5
• Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c)
• Tank Installation to follow all manufacture's recommendations.
• Pump Floats to be set and verified per approved plan Anv chanties may result in pump resizing to meet
TDH and GPM Specifications.
• Verify property line(s) prior to installation.
• Well setbacks to meet chs. NR 811 & 812.
• Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil
available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be
cut off at trround level. A larger fill area is necessary when any of the above conditions are encountered; to
provide sufficient infiltrative area.
• 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/op eration.
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.
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 WSMART code: 7633
tim.vanderl ee st(.@wis cons in. troy
Cover Page
Shaun Bird
ERV
Bird Plumbing Inc.
1432 120th St. .1_
New Richmond Wi 54017
715-246-4516
Date: 11/27/16
Owner:McCabe Homes Inc.
Location:NW 1/4 NE 1/4 S30 T29 N,R17W 1545 78th Ave Hammond
Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07)
Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12)
Page#
1. Cover Page
2. At-Grade Plot Plan
3. At-Grade Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7-8. Maintance and Contigency plan
9. Filter Specification
Attachments: Soil T
Shaun Bird
Signature ~ _
License number 900
ECEIVE®
UEC 0 1 2016
INNSTRY SERVICES
Page 1 of 9
System PLOT PLAN
PROJECT McCabe Homes Inc. ADDRESS 935 Osorev Drive BaVDort Mn 55003
NW 1/4 NE 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 96.2' 11/27/16 4
DATE BEDROOM
CONVENTIONAL AT-GRADE XX)< CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none
hk BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION loo' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
78th Ave
All
Scale = 1/4" = 10'
2 acre Lot well is to make all WDNR setbacks
Pro 4
Bedroom 240'
Huffcutt Combo Tank House
Tank is to be properly Area 15' below
bedded and provided with system is to remain
lockdown covers with undisturbed
approved warning label
8% Slope
94.5'
B-2 B-1
95.5'
96.2'
96.5'
75
Grading is to be B-3 B.M.*
done to divert
run-off away
from system
Property Line
Property Line
At-grade System Sloping Site Cross Section and Plan View
-
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aggregate over pipe
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GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing
vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a
moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to
form a'/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is
covered by clean aggregate deposited overhead by a backhoe. Special care must be used when
placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed,
the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect
from freezing. The observation pipes are perforated in the lower 6 inches and secured in place.
03/05lgj Page 2 of /
Pressure Lateral Layout
One Lateral - End Manifold
Threaded
Cleanout
Lateral Turn-up ► Plug
Force Main
i
X
L Long
Sweep
90
Bend
Pressure System Construction
Distribution Network Specifications
Lateral Diameter Z In. Laterals are constructed of Schedule 40 PVC
Orifice Diameter In. pipe. Orifices are drilled perpendicular to
X (Orifice S acin) In. the pipe with a sharp drill bit and face down.
L Lateral Length) Ft. Lateral turn-ups terminate with a threaded
Force Main Diameter In. ceanout plug and are enclosed in a 6-8 inch
Force Main Length Ft. diameter lawn sprinkler valve box accessible
from finished grade.
• • • • • Grade • • • • • • • Q ; • • • • • • •
6-8 Inch Lawn
Sprinkler Valve
BOX
0 3/05 lgj Page _ of
Septic-Dose Wank Cross Section And Pump Performance Specifications
Pump Manufacturer _ '
11
Tank Manufacturer
Ta_nk. Model umber 30 Pump Model Number il) J Z
Total Tank Capacity Alarm Manufacturer e C
Max. Bury Depth _ Alarm Model Number
Switch Type C Xc
Filter Manuff-- err , ~s2 Total Dynamic fIead (TDH) -Feet
Filter Model Number Elevation Head
Distal Pressure . _
Network Loss
Minimum Pump V rformance Required Force Main Loss too
GPM: @a, Ft TDH Total
utlet IS+Ianhole n. " Above Grade With Manhole Min. 4" Above Grade
evice. Inlet Manhole With Locking Device
< 6" Below Grade Sealed Watertight Securely Mounted
Weather-proof l
Junction Box t-~
Finished Grade 1-Mft
Vent Min. 12" Disconnect
Above Grade Means
With Vent Cap
mss,., YiYal<I<I .a1<.•.a1i )<r<><.<.{. a.a
Outlet Filter .X-------
Wet . Baffle - - - - -
r.;
;•1
Switch Settings and Reserve Capacity A V4"
<'r< _ Tank Volume = j GPl Weep
Dimension ; Inches Volume Gal. B Hole
(reserve) A; N. 4D6
(alarm) B 2 Off Elevation C
~t
'4(dose) C. g 13 Ft -
Bottom
(dead) D' j j} Eleva;6011
Total .:1
r Ft
~-~i? 1~f; T rTiTfFS-f'; ; ; Y~1; ~>•i.; ~i-t . • . . . a . . < . a <
1 i 1 t 1 <1 I l < i l I t i 1< < . a< < .
'a t 1 . . i s > > > •ai 1) 1 5 \It ><i4)t1 a) >11<)<'a;tl<,< a i>•I .
at< a11 t l t Itt l t IIi It111.t /1 1{IV<Ia
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
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 tank
excavation and the sleeve is sealed watertight. Electrical service rgmplies with NEC 300 and Comm 16.28,
02/05 U Page of t-_
TOTAL DYNAMIC HEAD/CAPACITY
PER MINUTE
HEAD CAPACITY CURVE EFFLUENT AND DEWATERING
NI MODEL 152/153
CK,
w MODEL 152 153
I
50 Feet Meters j Ga!. Liters I Gol Liters
a 5 I 1.5 j 69 261 77 291
0 3.i 61 -23-,- 70 265
12 40
152 5 45 53 I 201 61 231
20 6 1 44 167 , 52 1,97
c~ 30 25 7.6 34 129 42 159
z 8 30 9.1. 1 23 87 33 1 125
2 2
8 5
J 20 - 1---~
p 40 j 122 11 42
4- LocK Voive 138.0 (1L6m1144_0 Ft. 14-n)
crosoa
10- i
I
0
20 4 60 80 100
GALLONS
LITERS ~ 80 ~ /LL ---a
160 240 320 3 27/32-~--~*
FLOW PER MINUTE 1
3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Timed dosing panels available. 0 3 27/32
Electrical alternators, for duplex systems, are available and supplied with e
an alarm.
• Variable level control switches are available for controlling single phase
systems.
• Double piggyback variable level float switches are available for variable T- -
level long and short cycle controls.
• Sealed Wk-Box available for outdoor installations. See FM1420.
• Over 130°F. (54°C.) special quotation required. I
I~
1521153 Series 12 1/5 I-
1521153 MODELS Control Selection ;
y ' /5
Model j Volts•Ph Mode Amps Sim !ex 1. Duplex
N152 115 1 Non 8.5 1 2 or 3 i -T
BN152 115 1 Auto 8.5 Included 2 r3 9(2064
E152 230 1 Non 4.3 1 2 cr 3
BE152 230 Auto 43 Inclined 2 or 3
N153 115 1 Non 10.5 11 1 2 or 3
BN153 115 1 Auto 10.5 Inclined 2or3 SELECTION GUIDE
E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float
[B-E1:53 230 1 Auto 53 Included 2 or 3 switch. Refer to FM0477.
A CAUTION 2. See FM0712 for correct model of Electrical Attemator E-Pak.
All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex
(3)
licensed electrician. All electrical and safety codes should be followed including the most or (4) float system.
recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 15347
Louisville, KY 40256-0347 Manufacturersof..
f SHIP 70: 3649 Cane Run Road
Y ~7p
Louisville, KY 40211-1961 r,11AUTr/ LIMPS j1dCE ~-9dd "
(502) 778-2731. 1(800) 928-PUMP
http://Www.zoetier.com FAX (502) 774-3624
@ Copyright 2000 Zoeller Co. All rights reserved.
~7 r
1 t
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
!PILE INFORMATION SYSTEM SPECIFICATIONS
Owner
Septic Tank Capacity al ❑ NA
Permit #
Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model
❑ NA
Number of Public Facility Units NA Pump Tank Capacity 7 al ❑ NA
Estimated flow (average) y V G gal/day Pump Tank manufacturer
❑ NA
Design flow (peak), (Estimated x 1.5)
al/day Pump Manufacturer ❑ NA
Soil Application Rate al/da /ftz Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit
A
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) <220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other.
!Pretreated Effluent Quality Monthly average Dispersal Cell(s)
❑ NA
Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-Ground {gravity} ❑ In-Ground
(pressurized)
Total Suspended Solids (TSS) 530 mg/L 0NA t-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
!Maximum Effluent Particle Size Ya in dia. ❑ NA Other:
Other: ❑ NA
A Other:
❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other. F-1 NA
IAINTENANCE SCHEDULE
Service Event
Service Frequency
inspect condition of tank(s) At least once every: ❑ month(s)
ears (Maximum 3 years) ❑ NA
I
Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA
1 1)
'Inspect dispersal cell(s) At least once every: r ❑ month(s) year(s) (Maximum 3 Years) ❑ NA
Mean effluent filter At least once every: 1~3 month(s) ❑ NA
( X;Lyear(s)
inspect pump, pump controls & alarm At least once every: marts) s) El NA
1=lush laterals and pressure test At least once every: ? 3-year(s)s) ❑ NA
6ther:
11 At least once every: month(s)
ether: ❑ year(s) ❑ NA
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
'Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
!include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
icombined 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 (X) or more of the tank volume, the entire contents of
f:he tank shall 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,
land 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.
~,~i~
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 theft
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will by
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT13:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products.,
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 properly
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
replacement system:
❑ A 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 required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nEled
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule;! in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluatlion
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 CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O1 A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER "el Name Name
Phone Phone 1j-11- t
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHOR!
Name jq , 1117-111, Name Phone f Jam- , , - °L Phone
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
F
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREVI CNT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 4
Mailing Address
Property Addresf .a :1 i 4 E i't _
(Verification required from Planning & Zoning Department for new construction.)
f'a! ]
City/State Parcel Identification Number
LEGAL DESCRIPTION
Property Iacation ~/~jn/4 , W L- n/4 , Sec. f0, T / N R-. /W, Town of
Subdivision l I / ^ Lot # 7
U
Certified Survey Map # Volume , Page #
Warranty Deed # Volume Page #
Spec house no Lot liner identifiable yes o
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result m its premature failure to handle wastes. Proper
maintenance consists of pumping, out the septic tank every three years or sooner, ii= 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 §Comm 83.52(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 (1) 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.
1/we, the undemgnad 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 Commerce and the Departrrtmt of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed corded in Register of Deeds Office.
Numbs bedrooms
Z ~ 2-- , -I-
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Tnelude 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
Wisconsin Department of Commerce SLIL tVALUATION REPORT Page of
Division of Safety and Buildings
in`accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
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.
Please print all information. Revie by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
' + C 1 ' rte, Govt. Lot . L 1 /4 ' , 1 /4 ("~T < N R 1 E ( 1N
Property Owner's Mailing Address Block # Subd. Name /
Uty f Dr c~ !c X i ' f ) ~ i
tate Zp Code Phone Number ❑ City ❑ Village Nearest Rod
'Joe
eF;tSew Construction Use sidential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement Public or commercial - Describe:
Parent material ~k Flood Plain elevation if applicable i t✓ ft
General comments
and recommendations: /
System Type System Elevation
IZI 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
4Z
Boring _y C
O Boring
# Pit Ground surface elev. tt. 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
Z .1 x r
Effluent #1 = BOD. > 30 < 220 mg /L and TSS >30 < 1 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) ature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 54 715-246-4516
PIP-
Parcel ID # Page of
Property Owner
E] Boring
❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor _51 _1 in.
Ic ~ I Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EGPD/ffEff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
ell, Ak A/
3
37- q
4
F-1 Boring # ❑ El Pit Boring
Ground surface elev. - ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil lication Rate
Horizon -)epth Dominant color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
Gr. Sz. Sh. 'Eff#1 'Eff#2
in. Munsell Qu. Sz. Cont. Color
Effluent #1 = BODS > 3o:< 220 mg/L and TSS >30 1150 mglL ' Effluent #2 = BOD, < 30 mg/_ and TSS < 30 nVL
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 (8.6/00)
Parcel ID # Page of
Property Owner -
E] Boring ~ ~
E Boring # ;a -pit Ground surface elev. L ! ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff
•Eff#1 •Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r -
D-t Z J ~3~
_ _VV
~ 2'37
137- q 90
a Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in. Soil {igtion Rate
❑ Pit
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
'Eff#1 'Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
❑
Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon ' )epth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPD/ff
Gr. Sz. Sh. 'Eff#1 'Eff#2
an. Munsell Qu. Sz. Cont. Color
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' 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-9330 (R 610)
Soil Test Plot P
Project Name McCabe Homes Inc. n 1
Address 935 Osprey Drive
Bayport Mn 55003
226900
Lot 73 Subdivision Emerald Acres 1st. Add Date; 7/16
N W 1/4 NE 1/4S 30 T 29 N/R17 W
Township Hammond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe
System Elevation 96.2' *HRPSame as Benchmark
78th Ave
Scale = 1/4" = 10'
2 acre Lot
Pro 4
Bedroom 240'
House
8% Slope
94.5'
B-1
95.5'
96.2'
96.5'
75
B-3 B.M.*
Property Line
Property Line
~A
s _ County~~' r~
Safety and Buildings Division
rp,.
201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
1:0 7
Madison, W1 53707-7162
'NTY
~OMMU 11TY DEVE Permit Applicat1C w ~'teTr
dance with SPS 383.21(2), Wis. Adm. Code, submission of this form to M M K W 6 R 73 5 88 N A 7Wbe
In accor
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned e0 W 1'S are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secon
purposes in accordance with the Privacy Law, s. 15.0 11(tn), Stats. -8-112
I. Application Information - Please Print All Inform a ~J^ l
Property Owner''s/Name I Parcel ii
~C1
Property Owner's Mailing Address Property Location,
rt r Z Govt. Lot
qty, S p Code Phone Number r/q y, Section L
r cle o e)
II-,Type of Building (check all t at apply} ` ;Lot T2--1--N; R E
Family Dwelling - Number of Bedrooms Subdivision N e
6K P, Bloc /t' -
0 Pablic/Commercial - Describe Use d~L ❑ City of
0 State Owned - Describe Use CSM Number ❑ Village of
of f
7- Z Zar ZZ
111. Type of Permit: (Check only a box on line A. Complete a applicable) O Mme.
A- stem ❑ Replacement System 0 7reatment/Hold- lank Replacement Only ❑ Other Modification to Existing System (explain)
B. 0 Permit Renewal 0 Permit Revision ❑ Chan ge of ber ❑ Permit Transfer to New List Previous Permit Number and Date Issued y
Before Expiration Owner - _uI *
1
IV. T e ofPOW TS S stem/Com one a e: {Ghee t t app y
essurized In-Ground 0 Pressu ' In-Gr d dirade ❑ Mound 24 in. of suitable soil ~ Mound in- of suitable soil
❑ Holding Tank Other Dispersal Componen pl ) _ ❑ Pretreatment Device (explain)
V. Dis ersai/Trea ent Area Information:
Des- Flow (gpd) j Design Soil Application R e(gapds Disj rsal Area Required (sfl Di~yp aA Pro osed (sf) em Elev 7n r, S.
VZ Tank Info Capacity in To # of Manufacturer
Gallons Gallons Units o
New Tanks Existing Tan} D . o m w
I` ///q J cn v v~ ~ C7
Septic or Holding Tank
Dosing Cbamber
1
VII. Responsibility Statement- I undersigned, assum r ' onsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's e /MPR Number Business Phone umber
,C-s 4. C;,~ b X I - I , (--W -7)
Plumber's Address (Street, City, State, Zt 6ode)
VIII. County/Department Use Only 17 I D
P- approv PermitQFe~e D/a~te sedssuing ent Si~trattne
Reason for Denial $ 60 Al
f 4
WVqgrtaPProval n
IX. ConditjanspK"
disper•.4sti cell must all be set~•~gss!nta;es Jl r a e
as per management plan provided by plumber. wA /y(4 rtsk/trQ.,
2. `All k~egare+entsmusttrmafnt~it~rJ rr
as per spp ic" cade / c4nvm. 4 Ct. ldC..
Attach to complete plam for the s}-stem and submit to the Coup only on paper not leyS~ha. fi.t2 x 11 inclies in size
p solve //l
I
SBD-6398 (R 11/11)
System PLOT PLAN
PROJECT Kernon Bast ADDRESS 948 LaBarae Road Hudson Wi 54016
NW 1/4 NE 1/45 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 93.8/93.2 4' below grade DATE 10/12/16 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
BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
78th Ave
Vent Scale = 1/4" = 10'
>6„ Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Long 12
Grade at System Elevation;
34"
140'
B-3
70, 10' 10'
8% Slope
40' ents 60'
50'
Pro 4
Bedroom B-2
House
96'
B-1
ST
30' 0 98'
2-3' X 90' Cells with >3' spacing
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
Property Line
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 10/12/16
Owner:Kernon Bast
Location: NW1/4 NE1/4 S30 T29 N,R17W 1545 78th ave Hammond
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Sect'
4-6. Maintanance and C nt' gency Plan
7.Filter Cross Section ;
I
Signature
License numbe 26900
System PLOT PLAN
PROJECT Kernon Bast ADDRESS 948 LaBarge Road Hudson Wi 54016
NW 1/4 NE 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 93.8/93.2 4' below grade 10/12/16 BEDROOM 4
DATE
CONVENTIONAL )00( 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
BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
78th Ave
Vent Scale = 1/4" = 10'
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
12"
4' Long
Grade at System Elevation
34"
140'
B-3
70' 10' 10'
8% Slope
40' ents 60'
50'
Pro 4
Bedroom B-2
House
96'
B-1
ST
30' 0 98'
2-3' X 90' Cells with >3' spacing
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
Property Line
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 ~ 97.8
Vent Grade Vent
3' 4'° 3,
~~30/34 Septic Tank
71
5' Long 1
5' S' Long 1
36 Gradc 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
22 chambers per cell B
System elevations:
A-93.8'
B-93.2'