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018-1099-46-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592220 GENERAL INFORMATION 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: Devering Homes LLC 7 TOWN OF HAMMOND 018-1099-46-000 CST BM Elev: Insp. BM Elev. BM Description. Section/Town/Range/Map No: 60 IV\ I G S 09.29.17.856 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / /ea Dosing Alt. BM Bldg. Sewer 1_ 7. <J IT • 6 .7 Holding SUHt Inlet St/Ht Outlet TANKS TBACINFORMATION 1 TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet ~o Septic Dt Bottom 2q f1-7 1' '64t Dosing Z 17 Z Header/Man. 44 5~ 7 3-t Aeration Dist. Pipe 13.1 <1$ Holding Bot. System 3 . O C~l _ Final Grade 2A 9 / q PUMP/SIPHON INFORMATION I Manufacturer Demand St Cover 2-6 e I GPM C 't e- T. T 3 Model Number 13 A J i TDH 14, Friction sg System Head o TDH , t Forcemain Length / Dia I Dist. to well Lo Z SOIL ABSORPTION SYSTEM BEDITRENCH Width Length NPIT DIMENSIONS No. Of Pits Inside Dia. - Liquid Depth ~ DIMENSIONS -3 67 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type O System: Z, 7-9 . / UNIT Model Number: a_ a~~ N DISTRIBUTION SYSTEM o(aA- Header/Manifol / f Distribution x Hole Size If I x Hole Spacing/ Ve o Air Intake Pipe(s) ` Length / "7~ Dia Length J~_ Dia Spacing ici X~D SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /G'' I tel (7 nspection/#~2: Location: 1029 174TH ST / 4&0' ~ 1.) Alt BM Description = 1 = `7 ` a ( P16 W 2.) Bldg sewer length / = C a I 33 - amount of cover 3 a u. ~-a ln.) t Plan revision Required? Yes o Use other side for additional information. ~P Date Insepctor's nature Cert. No. SBD-6710 (R.3/97) Ste' t 00 I=n Count r Safety and Buildings Division <I t K JAN 2 O 201 ( 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) I Madison, \Ul 53707-7162 T. CROIX COUNTY ZZZC) MUNITY LOPMENf' / State Transaction Ntunber Sanitary Permit 7, f in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application fors for stake-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information yo rovide e used for secon purposes in accordance with the Privacy Law, s. 15. 1) m), Stats. I _ L Application Information - Please Print All Informs on Property Owner's Name steel ii LPL. C> ~ ~ ` • ~ Property Owner's Mailin dress Property Location , (p i~ l - f ac..~/t i J +1k A ~ Gnvt Lot State ~ Z~inCodbe Phone Number a~L Section ~i~ a, `T~N;R 1 /lEoW U. Type of Building (check all th p Lot 7~ amily Dwelling-Number of Be 0011 ~ Subdivision Nam. / P4~_zz q 6 - , L Bloc Ct -5 - f \ d'!Z ❑ Public/Cormnercial - Describe Use t.,lL ❑ City of of CSM Number ❑ Village of ❑ State Owned -Describe Ue of i14 ,J J~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B- ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Petit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of PORTS System/Com ouent/Device: (Check all that apgjy) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade and > 24 in. of suitable soil ❑ Mound < 24'n. of suitab soil f ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Trea ent Area InformatiojrO . Des' Flow (gpd) tDesign Soil Appl'c A gpdsf) Dispersal Area Requir sfl Dis al Are~~PrX111,14 Sy em Elevation,- VL Taak Info Capacity n Total # Manufacturer Gallons Gallons Units U New Tanks Existing Tanta Septic or Holding Tank Dosing Chamber VII. Responsibility Statemen - 1, the undersigned, assu r ousihility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Pltmtb7'" rgr e MP/MPRS Number Business Phone Nurnbor Pitnnb 's Addresseet, City; State, Zip Code ountv/De artment Use Oniv Approved Permit Fee Dat Issued Issuing. t Signature 00 ❑ Osvatr tven Reason for ial S JA DL Conditi oas,ggor Dis pproval 1 _ terk, etfltx:lr 1tRer i+rn~ 3 f~?J ~ I tihcper`wUi cell -:lust dll be sPCic s ! r; lnt.~` gr,lgement plan pt a nded by plumbei. 1 PK 2. ' m 1Tlust.kw r airttr ined P ('e ~e o n pW ""was 11 1* / adiimatlw. Attach to complete plans for the system and submit to t County only on per not less thau 8 it x I t iucbes in size SBD-6398 (R 11/11) P611A. System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 98.4' DATE 1/1/17 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX 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 B. M. 300' Property Line 98' B-2 97' 96' 5% Slope uffc tt Combo Tank Area 15' below system is w 3 i At. to remain undisturbed _ Grading is to be done to divert P run-off away from system Pro 3 Tank is to be properly bedded and Bedroom provided with lockdown covers House with approved warning labels Well is to meet all WIDNR Scale = 1/4" = 10' setbacks 218' Property Line 174th st. 300' Property Line cop I p~y~It7ag~ DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 o~ 9F GREEN BAY WI 54304-5211 3 D S a Contact Through Relay http://dsps.wi.gov/programs/industry-services q ~ S www.wisconsin.gov \~ssroN*LS Scott Walker, Governor Eric Esser, Acting Secretary January 17, 2017 TOF' CU ST ID No. 226900 ATTN: POTVTS Inspector F E S S 5 C: SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 w . CONDITIONAL APPROVAL - PLAN APPROVAL EXPIRES: 01/17/2019 Identification Numbers Transaction ID No. 2893988 SITE: Site ID No. 834819 OeverinQ Homes Please refer to both identification numbers, 1029 174TH St above, in all correspondence with the a~ene . Town of Hammond St Croix County NE1/4, SW1/4, S9, T29N, R17W FOR: Description: Mound Svstem (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1687979 Maintenance required; 450 GPD Flow rate. 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component 1\lanual - Ver. 2,0, SBD-10706-P (N.01101, 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. • Divert surface water from POWTS 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. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 SHAUN R BIRD Page 2 1/17/2017 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • 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 serviciniZ pad is located • 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. Any changes may result in pump resizina to meet TDH and GPM Specifications. • Areas that are occupied with rock fi•agments, 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 larger 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 This Amount Will Be Invoiced. J v 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 tirn.vanderleest a,wisconsin.2ov SHAUN R BIRD Page 2 1/17/2017 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • 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. • 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 Any changes may result in pump resizina to meet TDH and GPM Specifications. • 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 mound 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. 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 $ 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 WiSMART code: 7633 tim.vanderleest a wisconsin.gov Cover Page Shaun Bird AND Bird Plumbing Inc. `'ICES 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 1/1/17 Owner:Oevering Homes Location: NE 1/4 SW1/4 S9 T29 N,R17 W 1029 174th ST. Hammond 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 and Contigency plan 9. Filter Specifications and cross section Attachments: So~ Test l Shaun Bird Signature License nurryl er 226900 Page 1 of 9 „ ti} RY SERVI 'ES System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 98.4' DATE 1/1/17 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX 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 B. M. 300' Property Line 98' B-2 0 -4' 97' 96 3 5% Slope Huffcutt Combo Tank Area 15' below system is to remain undisturbed Grading is to be done to divert Pro 3 run-off away from system Tank is to be properly bedded and Bedroom provided with lockdown covers House with approved warning labels Well is to meet all WDNR Scale = 1/4" = 10' setbacks 218' Property Line 174th st. 300' Property Line 4- Mound System Cross Section and Plan View Dimension ` Dimension Feet J A 8 i i B l i S 7 T A ' fLrtirti.' .L~LrLjljLfLjLj fyjtii'11:L~i.1 J L L. 1 5 Jy.1.~.5.' LJ.J.J.f J f 1 1 00 1j1r1•L•L~LtLJ J J f L JLJL L 1 L~~: JtiJ•f11. J1f1fLiLjLf1'1r1. S. S. Lr1:ti.ti.L.L:L:L:L stir J J f L. L L.LJti: E L 41ti.S.L~ti.ti+M1-ti?4rLr1.l.ti~ti~lrti~ti 1l1! `rtit?; ;rti: f:l}J:J.J:f~J~f:Jyr:r:t:r:r:j:r1r:'1~i 1:y:1: L:ti:1:t~i.L~t?11ti:ti.4:4~ti.1: •J .J~f W J•J.J.f.J.f.J.J.J•J•J•J.J•J.f•J•J•1.f.JtiJ1it.%hrtrtrhr1iyr:rii1i:i~ftir:'':i? ' _ 77 F t G Z I i H i I l i i J t i ♦ K •2- -----------------------------------W .7~ K B Z L Slope % ~ - 1 =Topsoil = ASTM C-33 I'l Cap Material =Clean aggregate 0 = 4 in. sch. 40 pvc sand fill r %2 to 2 %2 in. dia. observation pipe Geotextile G H Fabric aril r~r.{ L L.L.L.L.L.L. . . . . . . . . . t "t D E '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 1/4 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 tracks or 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 of Pressure Lateral Layout Two Laterals - End Manifold .4 - Threaded Cleanout Lateral Turn-up plug Manifold M Force Main l' Long Sweep 90 1 f Bend i 2 ` L. Distribution Network S ecifications Pressure System Construction Lateral Diameter Z In. Manifold Diameter.. In, Laterals are constructed of Schedule 40 PVC Orifice Diameter 1 In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M (Manifold Length) Ft. ceanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main Length Ft. from finished grade. Grade 6-8 Inch Lawn Sprinkler Valve BOX Page of 03/05 lg; Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer j_z~ Tank Model Number p~ Pump Model Number j Total Tank Capacity Alarm Manufacturer 5 c Max. Bury Depth Alarm Model Number i Switch Type e Filter Manufacturer ~nr Total Dynamic Head (TDH) - Feet Filter Model Number r Elevation Head J Distal Pressure 3 . Network Loss Minimum Pump Performance Required Force Main Loss - GPM! Ft TDH Total Outlet Manhole h in. 4" Above Grade With Locking Duce. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device ~i Weather-proof Junction Box - - - Finished Grade ~ ~ , 7,r ~ Vent Min' 12" Disconnect Above Grade Means ' With vent cap Outlet Filter Inlet inlet Baffle - : A 14" Switch Settings and Reserve Capacity GPI Weep Tank Volume = Hole B Dimension Inches Volume Gal. (reserve) A Off ev 'on C (alarm) B : 2 30 Ft (dose) C " . > Bottom {dead) D D Elevation Ft . ' ' . , ' Total 30 GENERAL INSTALLATION: The septiddose 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 $pproval. 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 maul is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve. is sealed watertight. Electrical service complies with NEC 340 and Comm 16.2:1. Page of 02/05 U TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DE1"fATERING 1n MODEL 152/153 X r I I - ~ MODEL i i52 153 50 Feet A.1eiers j Go!. I Liters I Cal. Liters 153 1} 5 j 1.5 j 69 ~ 261 77 I 291 12 40 I- 10-~1 --1! r 61231 -j 70 ~ 265 152 i5 I 4.6 I 53 I 201 61 231 7p6.1 44 167 I 52 97 j i 30 25 7.6 34 129 42 1:)9 z $ 30 I 9.1 23 I 87 33 125 20 35 1 22 85 o _ 40 12.2 I j I 11 42 ~ 4~ _cck VCive. j38.0 (1L6m1144.0 Ft. 1.4m) 10 010503 0 20 0 6,0 8,0 100 GALLONS LITERS r- 1/a p gp 160 240 320 ' 3 27/32 FLOW PER MINUTE* i i '/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS Timed dosing panels available. = 27/52 Electrical alternators, for duplex systems, are available and supplied with e i an alarm. I • 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. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. I I I 1521153 Series 152153 MODELS Control Selection ' =iNon de Am s Sim lex Du n 8.5 1 2 or 3to 8.5 Incuded 2or3 samosa n 4.3 1 2 or 3 to 4.3 Included 2or3 on 10.5 7 2 or 3 BN153 115 t 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 BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. D CAUTION 2. See FM0712 for correct model of Electrical Aftemator 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 16347 Louisville KY 40256-0347 Manufacturersof SNIP TO: 3649 Cane Run Road LL: p Louisville KY 40211-1961 15w-7Tr f'UA1F9 ,1o4'Cf 19,7 " \ ac ~L/MP !D (~2) 778-2731. 1(600) 928-PUMP httpJ/www.zoetier.com FAX (502) 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. f0(~ 1 POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page_ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Ayn~f Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer L ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units, Pump Tank Capacity j al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) _j 22 aVda Pump Manufacturer ❑ NA Soil Application Rate ~Z? aVda /ft2 Pump Model j' ❑ NA Influent/Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/GMvel Fitter ❑ Peat Filter Biochemical Oxygen Demand (BODJ 420 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m 91L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality A Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODS) 530 mg/L ❑ In-ground (gravity) ❑ 1 -ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade und Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-line ❑ er. Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non-commerclaQ 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 ❑ months'-J*year(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 ar(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months r(s) Inspect pump, pump controls & alarm At least once every ❑ months r(s) ❑ NA Flush laterals and pressure test At least once every ZS ❑ months ear(s) ❑ NA Other At least once every ❑ months ❑ year(s) O NA I 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 SeMcing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a 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, mectWnical or pressurized POWTS components, pretreatgment components; and any other maintenance or monitoring at Rervals of 12 months or less shall be performed by a certified POWTS Maintainer. A serviaj 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. n n page of START URAND OPERATION For new construction, prior to use of the POWTS ah he disaersaltceil(s)} If for the presence of high concentrations are deed have then antentcesl of the may impede the treatment process and/or damage the 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. the restored kup oh excess iwastew to willlebnig of . During power outages pump tanks may fill above normal overloading the levels. and may result power discharged to the dispersal cell(s) in one large dose, power to thle r prior to ring To avoid this situation have the contents or POWTS Ma staintank er to assistdinymanuap y operating the ppumpocontrols to erestore normal levels effluent pump or contact a Plumber within the pump tank. compact, the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or comps 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 t llif fof the oOn drab antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degrasers, dental floss; diapers; disinfectants-, fat gasoline; grease; herbicides, meat scraps; medications; oil; painting producils; (sump pump) water; fruit and vegetable peelings; g 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 propcq y and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail 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, ail 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code comp lion 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 requitjed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result the rut ~(en for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at that time. ❑ A suitable replacement area is not available due to setback and/or soli 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 evaiualpon 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 urface. 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 O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER e-71 Name F17 Phone l Phone L SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY41 Name Name ~f Z22 Z Phone j j Phone f L-' 6 This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(t) and 383.54(1), (2) & (3), Wisconsin Administrative Code. 1 ~ {1 w o. j P tit;, n M , ~ a i Ifl tt~ i 7'i t ~L ~iltti~H~ I ! I i I ( i v I rf a 1 ~ _ i _ o0 l c °o Q N h ~ a 0 ~ Q c Q N ) , Z ~3 0 w r-- I i ST. CROIX COUNTY Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 2 ~t l Mailing Addres ILI 1 Property Addr s V` (Venncauon required from Planning & Zoning ll el? nt for new construction.) City/State i Parcel Identification Number LEGAL DESCRIP'T'ION ~ ' Property Location Y 1 J V4, Sec~j n T NR W, Town of _ Subdivision. IN c~ - - Lot # _ ( . Certified Survey Map # Volume page # Warranty Deed # - Volume Page # Spec house/' y~es no Lot lines identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION .improper use and maintenance of our maintenance consists of u y septic system could result in its premature failure to handle wastes Proper p mping out the septic tang every three years or sooner, if needed, by a licensed the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Ownermer What you t responsibilities are specified in Co Pu alto § mm. 83.52(1) and in Chapter l2 - st. Croix Coup Sari mamtenance county tary Ordinance. The property owner agrees to submit to St. Croix county Planning owner and by a master lumber oty lannung & `Coning Department a certification form, p Journeyman Plumber, restricted plumber or a licensed pumper verifying that (l) the n s geed by the wastewater disposal system is fn proper operating condition and/or (2) after inspection and pumping (if necessary), the se tic less than 1 /3 full of sludge. P tank is I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposals stem standards set forth, herein, as set by the Department ofCOmmerce and the Depar~,mem of Natural Resources, State of Wisconsin. the 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 ye expiration date. Uwe certify that all statements on s form are true to the best of my/our knowledge I/we am/are the owners property described above, by virtue of a w anty deed recorded in Register of Deeds Office. of the Number of bedrooms IGNAT OF APPLICANTS} 1 7 / 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. 08/QS)