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HomeMy WebLinkAbout020-1017-90-030 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No, (ATTACH TO PERMIT) 592176 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2794856 Permit Holder's Name: City Village Township Parcel Tax No: C % C Shaun Bird TOWN OF HUDSON 020-1017-90-6" CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 13.29.19.83A - TANK TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER: ` CAPACITY STATION BS HI FS ELEV. Septic s Benchmark ;ter Dosing Alt. BM 4eration Bldg. Sewer „ 1 '4 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet ` TANK TO P/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet Septic r. Dt Bottom t 1 Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System 10410 Final Grade PUMP/SIPHON INFORMATION Manufacturer e, / Demand St Cover GPM Model Number L~ ((Y4 7 TDH Lift Friction Loss System Head TDH Ft U lt-lC ' Forcemain Length Dia. Dist. to well I SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches, PIT DIMENSIONS No. Of Pits Inside Dia. Ld Depth DIMENSIONS SETBACK SYSTEM TO P/ . BLDG WELL LAK /STREAM LEACHING Manufacturer: INFORMATION Type Of System 'Yt_ CHAMBER OR X % UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution T. Hole Size X Hole Spacing Vent to Air Intake / t 1 Pipe(s) k / - _ Length Dia ff- Length Dia Spacing__( ✓ iSOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over T Over xx Depth of xx Seeded/Sod - Muhed Bed/Trench Center 'z rench Edges Topsoil '1✓~l'"/ es o ° Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 920 CHIPPEWA PATH 1.) Alt BM Description = C I 2. Bldg rsewe length - - amount of cover = l~ Plan revision Required? E Yes ❑ No / /J 1 Use other side for additional information. ( _ / t~ 01 SBD-6710 (R.3/97) Date Insepctor's Sf nat're Cert. No. ~'OQ county, t <18 Safety and Buildings Division r 201 W. Washingto e., P.O. Box 7162 Sari t tary Permit Number (to be filled in by Co.) T S; Madison, 70 718 0592 /7G tL' S ST, CH C 1 2 71 ' 6R8BH State 8AQ6 Transaction Number Application g In accordance with SPS 383.21(2), Wis. Adm Code, submission of this form to the appropriate govemmenu_ is required prior to obtaining a sanitary permit Note: the Department of Application forms for state-owned POWTS are submitted to Project Address (if erent thawmailing address) Safety and Professional Servies. Personal information you provide may be used for secondary oses in accordance with the Privac - Law, s. 5. 1 m , Stats. T / /t -L-Application Information - Pleas r' LAAInformation Property Owner's Name Parcel # I d RO _10V - I - FE, oPerty Owe s Mailing Address Property Location 1 :a 2 e/ u City, state Govt L)ot Lot Zip e - Phone Number Lov w ,~~1~ .Section typyp ) ~C I (J~,~/~ C OV le IL e of Building (check all that aply) Lot T ~ N; R 11 E W Family Dwelling -Number of Bedroo Subdivision Name d ~ ` w Block # ❑ Public/Commercial -Describe Use V PTV ❑ City of ❑ State Owned - Describe Usk f CSM Number ❑ Village of 4,1 7-1 III. Type of Permit: (Cbeck only one box on line A. Complete line B if applicable)`vv 1 A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal 11 Permit Revision El Change of Plumbez ❑ Permit Transfer to New List evions Permit Number and Date Issued/ Before Expiration Owner W. T ofPOW IS System/Com onent/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade X-AMound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable Soil . ❑ Holding Tank ❑ Other Dispersal Component (explain) - ❑ Pre 8'etment Device (explain) / V. Dis rsal/Trea ent Area Informatio r Design Flow (bpd) Design Soil Applic ' Ratlt(gpdsf) Dispersal Area Requir sfl D persal Pro d System J~ f,~ Q I l l7i ~J VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanis m v J °r m' ra co tr n c C Septic or Holding Tank Dosing Cbamber VII. Responsibility Statement the undersigned, assu risibility for installation of the POWTS shown on the attached plans, Pi Name t)t Plumber, e MP IZ$/I Tumber Business Phone N Plumber's dr StreeLcity. Sta p ) unty/De artment Use Only proved ❑ D_ Permit Fee Date ued Issuing t Signature S ) A Reason for Denial I /d I ~0 IX Conditt~ons5o p~ K . ~It <t approval 3 Uisper .,i comust all bebe aw,.ic.?s intairxc' ,as per rrlat>li invent plan providod r plumber. 1 2. Alp'stetFaPCiC'Filersenks must be rnaint ..ine:d as per ebbs code 1,: r(; tan c^cs'. Attach !o cnmplete plans for the system and submit w the C ty only os paper not less than 8 1f1 x 11 inches in size SBD-6398 (R. 11 111) System PLOT PLAN PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017 SW 1/4 SW 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 101.0' 10/20/16 BEDROOM 3 DATE CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 2.0 acre Lot Scale = 1/4" = 10' Chippewa Path Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 3 Huffcutt Combo Tank Bedroom House B-2 r' l 7 Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away from system B-3 B.M.* 6% Slope 240' - ~ 100.5' 00, 99.5' 450' Property Line 8. t DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 i GREEN BAY WI 54304-5211 \Si Contact Through Relay http://dsps.wi.gov/programs/industry-services timrvl.wisconsin.gov OAF sro? Scott Walker, Governor Dave Ross, Secretary t 10f N November 0%, 2016 -rPPROVI 8 OF SAFE ~°,L COST I.D No. 226900 ATTN: P0WTS Inspector 0N N I~~UiT S F A1JZq R B IRD ZONING OFFICE -F BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND W.1 54017-6409 HUDSON WI 54016-7708 SF E COf~RLSP01 CONDITIONAL APPRO\IAL PLAN APPROVAL EXPIRES: 11/02/2018 Identification Numbers Transaction 11) No. 2794856 SITE: Site ID No. 830495 Shaun Bird Please refer to both identification numbers, Chippewa Path above, in all correspondence with the agency. To,Am of Hudson St Croix County SW1/4, SWI/4, S13, T29N, R19W Lot: 3, FOR: Description: ltilound Systeni (3 Bedrooms _New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1632631 Maintenance required; 450 GPD Flow rate: 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBDt"10706-P (N.O1/01, 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. i 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 riot 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 tali 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. • Divert surface water from POWTS Area. • Prior to construction of the dispersal area check the moisture content of the soil to a death 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 114- inch wire, f S SHAUN R BIRD Pase 2 1 1/2/2016 the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to Drepare. do riot proceed until it dries. • 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) • Well setbacks to meet chs. NR 811 & 812 • '.Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Anv changes may result in pump resizin2 to meet TDH and GP]YI Soecifications. • Areas that are occupied with rock: fratrments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A lartrer fill area is necessary when any of the above conditions are encountered to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a. copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 Zea~ This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Private Sewage Plan Reviewer, Division of Industry Services Payment Submittal. (920)492-2214, Monday - Friday 6 am To 3:30 pm WiSMART code: 7633 tim.vanderleest T,~wiscc!:sin.Eov Cover Page ~Y Shaun Bird Bird Plumbing Inc. Y AND EWCES 1432 120th St. SERVICES New Richmond Wi 54017 715-246-4516 tJEI~GE Date: 10/20/16 Owner:Shaun Bird Location: SW1/4 SW1/4 S13 T29 N,R19 W Lot 3 Chippewa Path Hudson Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance andr Contigency plan 9. Filter Specificatid s and cross section Attachments: Soil T Shaun Bird 7 7 Signature License numb6 6900 Page 1 of 9 i System PLOT PLAN PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017 SW 1/4 SW 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 101.0' 10/20/16 BEDROOM 3 DATE CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 2.0 acre Lot Scale = 1/4" = 10' Chippewa Path Tank is to be properly bedded and provided with lockdown covers with approved warning labels I Pro 3 Huffcutt Combo Tank Bedroom House B-2 Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away from system B-1 B-3 B.M.* 6% Slope 100.5' 240' 100, 99.5' 450' Property Line 8. Mound System Cross Section and Plan View Dimension Feet J. A l B I T I•JLJL1Lf•tLd:JLlLI:fLf:•1•: •1.ti.1.1.4.M1. M1.Y4.YY4.Y1. D .414!.4.4 L.y 1. J f f.J.J.J.J.J.f.J.f.J.f.J1f~r1j1j4.4.1.Y1.t.4.4.4.4. M1.M1 -:I A I. •f•fY• S•4•M11ti.4•M1•M1.Y4.I.YYY4.4.4•Y1.ti.ti1•J•J•fyfLJ4r1f.J•f•J. - yj f JY•f•! - f•J•J•J• L.1t111f\.4.1: J.J.J.f. 4.4.L.4.M1.4.Y4• 1.4jtir1.4.1. - ::I ~rC.t.;:{.M1 J.J.f.f. 1~11i1ti11:41Yti~1~ f.f.J.JLJ~f~r.r.J.J.1.f.J.f.f.f•f-f ••Y1•M1•4•L• ':ti.1.1.1.Lf1:y: •f• tf-J1~~r~Jar:r~f:J1J:lyr:J•~•1.M1.L.4.Y4.4.4. •J•!•J•f•f.J•f 1 1 M1 M1iti:L:ti:ti:1~1.M1.4.4.Y4.4. ~J r~f Yyr~ E 4.1J:1M1K.4.• J 4 4.4.1.L.M1.4:ti:y~~:ti:'.~ti• J1! - {r i~••.rti J1l:fM1l1r~r:•L1Lt111:ti1ti~ti:1:ti4:1:'•~:\:11•f.f.f1fM1f•f'~"'rLfLr1f4j1 W I f. .J.J.J.J.J.J.J.J.J.f~r~,~ 4 tiJM1 f r. I F - I G , Z I I I H / J I 1 L J .0 i - 7 7 7 7 1 K c 3 7 7 7 7 7 K - W S,~ -_T B 1 Z j L Slo e I =Topsoil = ASTM C-33 r r = Clean a re ate Cap Material L~ Jar' gg g O = 4 in. sch. 40 pvc sand fill •1.4~L;1 `J I/2 to 2 %2 in. dia. observation pipe Geotextile G H Fabric ~ fff fif1f .J1l.r.r.fLj~J,.•., 1~ ) '1 Ft D E `P~ Ft Contour Plowed Surface Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W~ is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tzacat immediately is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07lgj Page 3 of Pressure Lateral Layout Two Laterals - End Manifold 4 Threaded Cleanout Lateral Turn-up - ► Plug Manifold M Force Main L Long Sweep 90 a J~ Bend Distribution etwork S ecifications Pressure System Construction Lateral Diameter Z In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L ateral Len j Ft. Lateral turn-ups terminate with a threaded M (Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter Z. In. diameter lawn sprinkler valve box accessible Force Main Length Ft. from finished grade. • Grade • • • • • • • • 6-8 Inch Lawn Sprinkler Valve Box l~ Page , of 03/05 lgi i Septic-Dose and Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer 1.0 Tank Model Number p b Pump Model Number hJ 1 j Z Total Tank Capacity Alarm ManufacYturer Max. Bury Depth Alarm Model Number ✓ Switch Type M&d4,, VIA Filter Manufacturer Total Dynamic Head (TDH) - Feet Filter Model Number j Elevation Head Distal Pressure 3. L7 Network Loss , Minimum Pump f erfonnancc Required Force Main Loss ~ . GPM, S , Ft TDH Total J S, Outlet Manhole Min. 4" Above Grade With Locking DeWice. Inlet Manhole Manhole Min. 4" Above Grade < b" Below Grade Sealed Watertight Securely Mounted With Looking Device Weather-proof Junction Box Y-- Finished Grade - . Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter ~i Inlet Inlet Baffle ; Switch Seal p and Reserve Capacity `4 Weep Tank Volume = GPI Hole B ` Dimension: Inches Volume Gal. (reserve) A. , j 7. (alarm) B : 2. 3 Off Elevation C Ft (dose) C 7, Bottom (dead) D D Elevation Total 0 Ft >•>>r<r`i> i Y~ i >a ~>~Yti 7t>•~ Y`>ti Y~><,<Y ~t <•.•Y:a . < < t • r.. . ><ti > r i i s s<>.~ . t: < s < a i < e < tit . { < t i ..'s a: aa'< a':a a < a < a . GENERAL INSTALLATION: The sepdcldose tank is bedded and back filled in accordance with the manufacturer's product.approval specifications. Mwdmum depth of bury as specified by the manufacturer may not be exceeded without prior wovai. Manhole covers exposed to grade have an, effective locking device (padlock) iastalled. Piping at inlet and outlet is of approved material, connected to the tank with watertight fittings, and the had on stable soil to prevent settling or sagging. The force main is sleeved with C Sch• 40 PVC to bridge the tank i• excavation and the sleeve is sealed watertight. Electrical ice . mplies with NEC 3fl0 and Comm 1621 Page of . 42/0 LI TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MIME EFFLUENT AND DEwATERING MODEL 152/153 ~lw MODEL 52 t5~ 50 I Feet I Meters I GoL Liters I Gol. Liters 153 5 1.5 j 69 I 251 77 291 12 40 10 3. i 61 231 70 265 152 o i5 4.6 I 53 I 201 61 231 20 6.1 44 167 i 52 197 30 ~ 25~ 7.6 34 129 ~ 42 i 159 r 8 I 30 11 1 23 87 i 33 125 20 3 J - - 22 85 o l 40 17.2 I I 11 I 42 4 _ock Vcive: 138.0 Ft. 11.6m1 44.0 Ft. 10 I r1451W 0i .-T 20 40 60 80 100 GALLONS LITERS 6 1/4 0 80 160 240 320 _ 3 27/32 1 a 5/8 FLOW PER MINUTE 3 27!32 CONSULT FACTORY FOR SPECIAL APPLICATIONS ! • Timed dosing panels available. OO 3 2/32 Electrical alternators, for duplex systems, are available and supplied with B l an alarm- Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls.- I J • Sealed Qvvik-Box available for outdoor installations. See FM 1420. ! • Over 130°F. (54°C.) special quotation required. ( I 1521153 Series 12 1/9 L 1521153 MODELS Control Selection i I- Model Volts Ph mode Amps Simplex Du lez I N162 115 1 Non 8.5 1 2or3 I o /o BN152 115 1 Auto 8.5 Included 2 or 3 t sa2064 E152 230 1 Non 4.3 1 2 or 3 BE152 230 11 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 SN153 115 1 Auto 10.5 Inclu ed 2 or 3 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 SE153 230 1 Auto 5.3 Included 2o(3 switch. Refer to FM0477. p CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. AD electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville,KY 40256-0347 Manulacturersof.. SHIP 3649 KY Run Road Li7 ® Louisville, KY 40211-1961 Qa/TrPuMP~ ONCE /919 o- (502) 778-2731 • 1 (600) 928-PUMP littpJ/www2oeiler.com FAX(502)774-3624 © Copyright 2000 Zoeller Co. All ri hts reserved. 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page- ~ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 5 -y Septic Tank Capacity Permit ~ Rai ❑ NA Septic Tank Manufacturer ❑ DESIGN PARAMETERS Effluent Filter Manufacturer ❑ Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units . 4MA Pump Tank Capacity al [3 NA Estimated flow (average) 3 avda Pump Tank Manufacturer NA 7- 1' Design flow (peak), (Estimated x 1.5) -SV aI/d . Pump Manufacturer -j70 _ , ❑ NA Soff Application Rate C7 al/da /ftz Pump Model qNA Influent/Effluent Quality Monthly average' Pretreatment Unit J Fats, Oil & Grease (FOG) 530 mg/- ❑ Sand/Grevel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) 420 mg& ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m 2 ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality ONA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODS) AO mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At-grade Mound Fecal Coliform (geometric mean) 510` cfu/100ml El Drip-line ❑ Other. Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non-commerc,4 wastewater and septic tank effluent- Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ month ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every r ❑ months ear(s) Inspect pomp, pump controls & alarm At least once every ❑ month ar(s) ❑ NA Flush laterals and pressure test At least once every 'S-- ❑ months ear(s) ❑ NA r At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage SerVidIng Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal tell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mncal or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at irltervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servicx report shall be provided to the local regulatory authority within 10 days of completion of any service event START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thElt cell(s). If high concentrations are detected have the contents of thin the treatment process and/or damage the dispersal cel may impede th tree m P 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 POWT:J;: 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 product0; 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 propeoy 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 fined with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compli<itnt 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 requbjed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need 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 technologl/ a holding tank may be installed as a last resort to replace the failed POWTS. i "ZL,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. osufnd and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infltrajive ace. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNI NG>> 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 O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS _ POWTS INSTALLER POWTS MAINTAINER Name FName Phone Phone ~'-`~l SEPTAGE SERVICING OPERAT PUMPER LOCAL REGULATORY AUTH Name 2- Name x Phone l~ Phone 7iJ~~3~ This document was dratted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administradive Code. (g E4 4- _ Ir a ~ °a -3•t; I E ~ P f t " 00 ~ m P r Dil C C, a Q ~ N v D N ' U ~ 3 Q I 1 1 ~ i 10~ " ST. CROIX COUNT' y SEPTIC TANK MAINTENANCE tkGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -')A" 'I-", _ Mailing Address Property Address (Verification req= ng Zoni om plamu & ng Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location - V~ rS c r 1/. , Sec. T Z7 N RLW, Town of ~ v--J Subdivision , Lot A(~-) Certified Survey MaP# Vc:lume , Page # ~0\ Warranty Deed # Volume Page # Spec hou~y no Lot line-s identifiable( no SYSTEM MAmTENANCE AND OWNER CERTMCATION Improper use and maintenance of your septic system could result m its przmature 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. Vwe, 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 Commerce and the Department 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, bvnitue of a deed recorded in Register of Deeds Office. Number of b SIGNATURE OF APPLICANT(S) DATE ***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. 0805) i y~o gs~ x I o iN* I 8 ~:3 I I .i.... el I I. ~d ~°3~ I' I I I 1 1 I I n3.weo.M.a3nemsxc ~ ~ I I annro~ Grua-w xsz ` I// I I b an 3xnnvx. a3mc _ I I Tr------- -s- - I~ I I I: I I I II yV~' ~ OI i x I I I' II ~ i 1 ~ 1 1 4 I 1 .w, ...s a..r Il a~.iA I .rs~ a I ; I Y i b I I } b Rb RII I W n I ~Kll -__-_JL I F--T 8 = I II I 50 b bb% I ~ F "Vol" Q~ Zii j ~ 3! I~ J ~ I I 1 Q I I---T I ..sa . _ a r _ I 1 I I 7---T 1 i~ ' I I i I I 1 II I _ 1 I L J L J 6i jl I I I _ _ I I ` ~ I I I I i t .E°w i I z I 1 I I I I ~ ~ 307 I I 1 3F~ I' I ~ 8 I I I I I ~b I I 1 I 1 1 ~ I i I 1- b I I I';.i ~ I I .n~~,,,r.a3 I - o g a a a K ' B 8 o J J 6 5~5 r Q~ ~ 3 LL~ 30 ~ Q o~ pJ ~ Z W ~ ...ss U Z m a A~ m I I I I I I I I I I I I Ow ~S~G s i I i I 1 I - I / Rc F ~ ~ e O ■ 1 EE I y UI yy T9 _ 1 1 I - f~ i 0 0 1 F .rcs s s I ~ . I >xn.3>a3txnn ~1 iii .3wnrn,osM~ i I 1 1 ~ ~ ~w ~ 1 1 ] I - ole I iT~~~ III _ ~gg j III 1 ~3 I III Ee ainn>ouvrvn I >xnn>auiMn l 1 I 1 < - I 9 ~ i e U I sa 3a~ i4; i4o I 'gi i&o I ~5 g_, 8 56 S-16~L SCI Wisconsin Departrnentof CgFn SOIL EVALUATION Page of Division of safety and Buildin 2 KV3 P W in accordance with Comm 85, Wis. Adm. Code ST. CIROIX COUNTY County f ('~'J Attach complete dMIFaMER~ x 11 inches in size. Plan must XK# include, but not limited to: vertical and honzon I r ence point (BM), direction and Parcel I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. AAR Please print all information. Revi ed by to Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot i 1/4,51/4 S Z N R E (or Property Owner's Mailing Address Lot # Block # Subd. Name or M# City State Zip Code Phone Number ❑ City ❑ Vill ge Town Nearest Road (J) ~~~1 ( ) r lac 9-New Construction Use: Residential / Number of bedrooms code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: Parent material "~~'"v' Flood Plain elevation if applicable General comments and reconwnendations: C7 System Type m U Gl rL System Elevation X O ❑ Boring F Boring # Pit Ground surface elev.! 4'v '-1 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 Z "7-Z s 5 Boring # ❑ Boring ~ Pit Ground surface elev. ft. Depth to limiting factor 3 D in. Sal Applicabon 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 M.,3rz Al /11 Ail, 1 • Effluent #1 = BOD. > 30 < 220 mglL and TSS >30 < 1 ' Effluent #2 = BOD. < 30 mg& 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 17 , f 715-246-4516 Property Owner _ Parcel ID # Page of n Boring # ❑ Boring ~I I Pit Ground surface elev..? ft. Depth to limiting factor in. n*Eff#l tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 1. 312 _ a c 7 . 6 ~t-s t 10111- 04- 3 Y 1©~ ,~'~l F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODS < 30 mg/- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Property Owner _ Parcel ID # Page of ❑ Boring Boring # Pit Ground surface elev., ft. Depth to limiting factor in. Soil Appfication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 2 1. 5 11-1 Boring # ❑ Boring F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 ❑ Boring Boring # F-1 Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon lepth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BODS 130 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 (R ODD)