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HomeMy WebLinkAbout040-1318-00-044 (2) County ` Pi-V S ty a Bu s Division s K P.O" Box 7162 Sanitary Permit Number (to be filled in by cc) Madison, WI 53707-7162 ~S rr7,3 Sanitary Permit Application State Transaain Number 1 In accordance with SPS 38321(2), Wis Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a Sanitary Permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing addre~ the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15. 1) m , Stats. L Application Information -Please Print All Information Property Owner's Name Parcel t$ Property Owner's Mailing; Address Property Location -7 / ) f -511 city, state Zip Code Phone Number ! Section IL Type of Building eck all that apply} "?n-4 TG N; I~ E 05 u r/" Subdivision N c Family Dwelling -Number of Bedrooms ok C-A B o - L2 r.► i ❑ Public/Commercial - Describe Use ~G ❑ City of i El State Owned - Describe Use 1 CSM N tm 11 Village of / I of l z III. Type of Permit: (Check only one boz on line A. Complete line B if a ) Q~ A. System ❑ Replacement System - Treatment/Holding T neat On. ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ ange o i ❑ Permit tc New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POW FS System/Component/Device: k a at a lv is ❑ Non-Pressurized In-Ground ❑ Pressurized ln-Ground Grade G - 24 in. of suitable soil d < 24 in. of suitabie soil ❑ Holding Tank ❑ Otber Dispersal Component (explain)`^ a Pretreatment Device (explain) V. Dis rsal/Treatm;e~t Area Information: t Design Flow (gpd) Design Soil Application Rate f) Dispersal Area Requir (sf) Dispersal Area ProFo sed (f) yst s S ~ cm Elevation 10 1701 .0 VZ Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c o u New Tanks Ex st rig Taals ` ` + P W Septic or Holding Tank- Dosing Chamber I VII. Responsibility Statement-,?,)the undersigned, assume risibility for installation of the POWTS shown on the attached plans. j Plurn s,Name (Print) Plumber's e MP/MPRS Number 1 Business Phone Nufn r~, Plumber's Address (Street, City, State, Zip Code) VIII. ouotv/De artment Use Onav Approved isapprove Permit Fee Date sued Issuing , t Signature $ ~Z5 p en Reason for iii, IX Conditi on gor Disapproval 3 ~Ae~ 1. Septic tank, effluent it er an dispersal cell must all be services / maintained II,A as per management plan provided by plumber. t ' 3. AN setbactc requirements must be maintained as per WpkAble cods / ordinances. Attach to mmpku plans for the system and submit tDaly paper Dot less tban 8 1,-z l l inch jn svF SBD-6398 (R. l 1/11) PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Drive Suite 410 Woodburv Mn 55125 NW 1/4 NW 1/4S 11 /T 28 N/R 19 W TOWN Troy COUNTY ST, CROIX SYSTEM ELEVATION 1061.0 2' sand lift? DATE 5/3/1 5 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK. 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND )OOC SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none IL BENCHMARK V.R.P. Top of spike in ground ASSUME ELEVATION 1061.76'Filter Lifetime Filter tJ BOREHOLE (D WELL -H.R.P. Same as Benchmark . 13% dope All piping shall be ASTM SDR 30/34, within 1056' B-1 09D 10' of tank, pipinlg shall be ASTM F891 ❑ 1058' 1059` 1060' 322` Property Line B-1 09B B-A2 Huffcutt Combo Tank B- 1 09A Area 15' below system is to Not to be used for design purposes remain undisturbed nd outside of Bstem area B- 1 09C 3 Tank is to be provided B room with lockdor'n Gove Ouse with ;approved war- n9 L labels s to be Oredi ng i 'tajei! i3 to meet al i tLt R Setbacks done to divert run- off away from system 1/4" = 10' Scale 1 .5 {acre Lot 340' Propert;, Line Crest Curve otiE~ DIVISION OF INDUSTRY SERVICES f~~\ 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304 Contact Through Relay j S http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Dave Ross, Secretary May 26, 2015 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/26/2017 Identification Numbers Transaction ID No. 2543792 SITE: Site ID No. 812594 Creative Homes Please refer to both identification numbers, 708 Crest Curve above, in all correspondence with the agency. Town of Troy St Croix County NW1/4, NW1/4, S11, T28N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1535673 Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-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: • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • The mound area must be deep chisel plowed to help break up the platy soil structure that was reported at the site. The county may, at their discretion, request verification of the plowing prior to continuation of system construction. • The POWTS dispersal component and septic system shall follow all setback parameter requirements as per s. CO SPS 383.43 (8)(i), Wis. Adm. Code. • As per the Mound Component Manual, activity is limited in the mound area. Vehicular traffic, excavation, and DE" soil compaction are prohibited in the basal area and 15 feet downslope of the basal area. pROFES DnnSION OF 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 U construction/installation/operation. SEE C SHAUN R BIRD Page 2 5/26/2015 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 4q)) This Amount Will Be Invoiced. When You Receive That Invoice, Ra hael E Huempfner Please Include a Copy With Your POWTS Plan Reviewer, Division of Industry Services Payment Submittal. (920)492-7726, M-f 7:45 am To 4:30 pm WiSMART code: 7633 rachael.huempfner@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. TYPICAL OBSERVATION PIPE DETAIL The required observation pipes must have slots on the bottom 6 inches of the observation pipe. Installations of all observation pipes include a suitable means of anchoring. See Figure 5. Water tight cap 4" min. dia. Slot b.a 6" min. min. Infiltrative surface,x Water Closet Collar flar(3.fi" min. dia.) * Piping material may be either ASTM D2665, D1785 or D3034 Observation pipes must: • Be located such that there are a minimum of two installed in each dispersal at opposite ends from one another. • Be located near the dispersal cell ends. • Be at least 6" from the end wall and side wall. • Be installed at an elevation to view the horizontal or level infiltrative surface within the dispersal cell. Observation pipes may be located less than 6 inches from the end walls or side walls if specified in the state-approved manufacturers= installation instructions. r ' WiisconsinDepart'nentofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code CcxsntY tf.~ Attach complete site plan on paper not less than 8 1t2 x 11 inches in size. Plan must r include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ? 66. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. V Please print all information. Reviewed by Date Personal information you prowds may be used for secondary purposes tPnvacy Law. s. 15.44 (1) (m)). • Property Owner Property Location z Govt. Loot , 114 l /4 S/ T N R E( } W Property Owner's Mailing Address lot # 8iocic # Subd. Nape or CSM If 0 City State I4p Code Phone Numbe Q City Q Village To ` Nearest R ad, GPD ;!1' NeW Ccnstruiton Use £?esidential 1 Number of bedrooms Code derived design flow rate > 7,:) [3 Replacement Public or commercial - Describe: Parent material ~~Z/0 Flood Plain elevation if applicable Z . General conrrnents mac' and recornrnendatims: /t°seG System Type System Elevation- Boring Boring # C] Pit Ground surface elev. ? 1 ff. Depth to limiting factor in. Soil Ap ircation Rate " Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPott4 in. Munseii Cu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'E (77 TZ- Boring # Boring lF~ Q Pit Ground surface elev. ft_ Depth to limiting factor in. Soil Application Rate Honizcn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Cu. Sz. Cont, Color Gr. Sz. Sh. 'Eft#1 'Eff#2 ALLY PR ED SA TY AN ' Effluent #1 = BQD. > 30,5 220 mcYL. and TSS >30 < 150 n q& 1 ' Effluent #2 = 800, < 30 mr,JL, and TSS < 30 mgiL CST Name (Please Print) Si ` re CST Number VNDEN PRY Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Nu1432 120th St, New Richmond, WI 54017 ' ` 715-246-4516 Old, PLOT PLAN PROJEC'T' Creative Homes ADDRESS 707 Commerce Drive Suite 410 Woodburv Mn 55125 NW 1/4 NW 1I4S 11 IT 28 NIR 19 W TOWN Troy COUNTY ST.CR©IX SYSTEM ELEVATION 1061.0 2' sand lift! 513115 3 HATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XX)C 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 spike in ground ASSUME ELEVATION 1061.76'Filter Lifetime Filter BOREHOLE (DWELL -H.R.P. SameasBenchmark All piping shell be ASTM SDR 30/34, within 105 6' Slope, 8-10'~09 t~' D 10' of tank, piping shall be ASTM F89I 105c~' 1059' _ 32 " Proper#y Line B-109B _ Nuffcutt Combo Tank B-1 09A Area 15' beIow system i3 to Not to be used for design purposes re main undisturbed and outside of stem area B- 1090 Pro 3 Tank is to be provided Bedroom with lockdown covers House with :approved warning labels Grading is to be Well is to meet ail done to divert run- off away, from system 1/4" = 10' Scale 1.5 acre Lot 340' Property Line Crest Curve Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/ 3/15 Owner:Creative Homes Location: NW1/4 NW1/4 S11 T28 N,R19W 708 Crest Curve Troy Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) 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 Contigen y plan 9. Filter SpecifijoilTes s section ,VICES Attachments: SLS Shaun Bird Signature_ License numbe PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Drive Suite 410 Woodburv Mn 55125 NW 1/4 NW 1/4S 11 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 1061.0 2' sand lift! 5/3/15 BEDROOM 3 DATE CONVENTIONAL IN-GROUND PRESSURE 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 spike in ground ASSUME ELEVATION 1061.76'Filter Lifetime Filter ❑ BOREHOLE e WELL - H. R. P. Same as Benchmark All piping shall be ASTM SDR 30/34, within 13% slope Ina shall be ASTM F891 1 056 B- 1 09[7 10' of tank, PiPa 1058' 1059' 1060' 322' Property Li ne B-109B Huffcutt Combo Tank B- 1 09A B.M.w A rea 15' be I ow sx ste m i s to Not to be used for design purposes remain undisturbed and outside of s stem area B-109C Pro 3 Tank is to be provided Bedroom with lockdown covers House with approved warning labels Wei I is to meet al I Grading isto be done to divert run- 1~,rDtaF~ Setbacks off away from system 1/4" = 10' Scale 1 .5 Acre Lot 340' Property Line Crest Curve Mound System Cross Section and Plan View ~~-----------------------------------Dimension Feet J I i B j l I I ~ ---r T 1 i 1 - " " 1 D 1y F }S A 1 1~ 1 4- z -'-1 1 1 T i i - ,1- - ' 3 - K 10 • K - 7 B 1 - 1 C? - I. Slope / Y. - -1 = Topsoil = ASTM C-33 Clean aggregate 4 in. sell. 40 pv c I I Ca Material - , p sand fill to 2 % in. dia. observation pipe L El Geotextile G 1l~ f 1~ abric 1' l D E Z K4. `4 ) ) 1J - l l ,l ) ~ ~ i L Plowed Suitace r Ft Contour- Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design c011t0L11-. I'Aistin-1 vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard c)r chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a inc11 soil 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 track,,, w is placed overhead by a backhoe. Special care must be used Nvhen placing sand of less than one 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. 'HI observation pipes are slotted in the lower 6 inches and secured in place rebar or a closet flange. 10/071~j Page `-7 of t Pressure Lateral Layout Two Laterals - End Manifold Ihreadeci (Aeano w I ateral -l urn-up - 1'ltl Manifold M - - - ( Lon- Force Main Sweep n 90 Rend i.l Distribution Network Spe~citications Pressure Svstem Construction Lateral Diameter ? In. Manifold Diameter - -h~ I Laterals are constructed of Schedule 4t) PVC -----t Orifice Diameter (In~~ pipe. Orifices are drilled perpendicular to X_(Ori_flce Spacing) .~f ln. the pipe with a sharp drill bit and face down. _L (Lateral Length) Lateral turn-ups terminate with a threaded M (Manifold Length) ~ l't. eteanout plug and are enclosed in a 6- 8 inch Force Main Diameter G In. diameter lawn sprinkler valve box acci-,ssibte Force Main Length Ft. frotn 1-meshed grate. 0 CD Grade \ 6-8 Inch Lawn Sprinkler Valve Box Pate ~ Ol 03l05 tgj Septic-Dose Tank Cross Section And Pump Performance Specifications -Tank Manufacturer Pump Manufacturer Tank Model Number Pump Model Number Alarm Manufacturer 'le- Total Tank Capacity t~ - Alarm Model Number L.._ t/ n Max. Bury Depth rSwitch Type .Q- / Filter Manufacturer r? Total Dynamic Head (TDH) - Feet Filter Model Number Elevation Head / C Distal Pressure C Network Loss Minimum Pump Performance Required Force Main Loss J GPM'. Ft TDH Total outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Securely Mounted With Locking Device ~ 6" Below Grade Sealed Watertight Weather-proof, ) ]unction Box Finished Grade Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet Inlet Baffle - - A 1/<,> switch Settings and Reserve Capacity weep Tank Vo Hole lume GPI B Dimension.. Inches Volume Gal. -76 (reserve) A 3 I > Off Elevation C 77 (alarm) B Bottom (dose) C - `I=%• Elevation (dead) D ~D Total r. •'L,ATION: The septic/dose tank is bedded and back filled in accu aane mwith ay of GENERAL INSTALLATION: exposed to gc'ade have pa'~~ by lo the manufacturer manking device (padlock> manufacturer's product approval specifications. be exceeded without prior approval. Manhole covers 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 matncom~es w NEC 3 Q and Comm l ba2~ the tan ~ p excavation and the sleeve is sealed watertight. Electricaservice Page of 42/05 U - A _ u - Ni CONSULT FACTORY FOR SPECIAL APPLICATIONS z T ~ ole. Timed dosing panels aVaila Eectncal a~ternators, for duplex systems.re avaliable and supGilerd wish r an aiarm_ ariabie level control sNitcnes are availab e for eontrolhng angle phase sy ~ ems • Double piggyback variable .ere'. ,oat switches are available 10! ana~: i- leve ~o,",g and short cycle COVOls. • Jeaieo QIA kK-B. GX 3Va.abie -c' o'Utacor Ins a'Iatiul,S. . O:~er',30'r (54°L.} s;:eaa quotation fegl, rec_ 52153 Series ?52 t53 MODELS Control Selection - Model Voits Ph--t_! Mode Amy-- Simi _ Duoiex - - - 2 5 N - S5 - t nc e 2o nN 51 i 115 utc 52 2K ? Non 4 3 c_=- r a3 c edT 2c_ 52 2--K, t~ - - 2 or N 15_ 115 Non SELECTION GUIDE 2 or 5 Ac_OS nc' .ec _ L ,53 230 -~0 3 S' g P','tbacr v 3C12'~V2,'Oa!5;;~[G 0 -ut153: 2, -uto w_ 3 _inc 3- rtC7. P,e_er PD F' p CAUTION L i~ i v f 33e Ot ~r~~cl 8"`la1~f All installation of controls, protection devices and wiring should be done by a qualified 3 D,o c jc licensed electrician. All electrical and safety codes should De followed including the mcst recent National Electric Code (NEC'I andthe Oecupane tai Safety and Health Act ~OSHA,i RESERVE POWERED DESIGN ~r ,;~~sual .,crdtons a reserve sate! ,actor is engineered i.to des~ ~ MAIL T0: F 53 f-- L7 n ,~Fje SMPiO 64 , `u ~I II+r~ii isb` ,n~. _ hG.rl_i7-.~ .`'a: I~'-~~ p http:i/www.zoefler.com - Copyngnt ~L ZJCe :er Co. r _ _ -'C' of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION SYSTEM SPECIFICATIONS 71- owner Septic Tank Capacity at ❑ NA Permit # Septic Tank Manufacturer A Effluent Filter Manufacturer r NA DESIGN PARAMETERS Number of Bedrooms ❑ NA Effluent Filter Model ? ❑ NA Number of Commercial Units A -~M A Pump Tank Capacity all ❑ NA Estimated flow (average) aUda Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) ~j`1 Z_.? aUda . Pump Manufacturer NA Soil Application Rate , L_? al/da /ftz Pump Model 2~AJ NA Influent/Effluent Quality Monthly average` Pretreatment Unit 111,11,14 ❑ Sand/Gravel Filter ❑ Peat Filter Fats, Oil & Grease (FOG) 530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODS) 420 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality NA Monthly average'" Dispersal Cell(s) Biochemical Oxygen Demand (BODs) s30 mg/L ❑ In-ground (gravity) In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade o u n d Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-line ❑ Other. Maximum Effluent Particle Size YB inch diameter Values typical for domestic (non-commercial) 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 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 ear(s) (Maximum 3 yrs.) /mil ❑ month year(s) Clean effluent filter At least once every Inspect pump, pump controls & alarm At least once every ❑ months ar(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ear(s) 0 NA (5ther. 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 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 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, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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 °f START UP AND OPERATION products or other chemicals thr.t For new construction, prior to use of the POWTS check treatment tan`K(s) for the presence of painting may impede the treatment process and/or damage the dispersal cell(s). It high concentrations are detected have the contents of th-. 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 is restored the excess wastewater will t! During power outages pump tanks may `ill above normal hlghwater levels. When power discharged the cell(s) and may result in the backup or surface discharg OWef~oe`',P normal lave s to the dispersal cell(s) in one large dose, overloading lage ro avoid this situation have the contents of the tank to ass saibymat uaplly operat 'g theOp<PmPo~ ptrols p to restoring effluent pump or contact a Plumber or POWTS Maintainer 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 wit ilr 15 feet down slope of any mound or at-grade soil absorption area performance and prolong the life of the POW Reduction or elimination of the following from the wastewater stream may improve the rducis; herbic'destalmea*s;stlrapsrsmedications;t oil;a+patgfoundation rain antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; (sump pump) water; fruit and vegetable peelings. gasoline; grease; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps hall be taken to insure that the system is propel] and safely abandoned in compliance with chapter X83.3 tive Code: sealed. • Ail piping to tanks and pits shall be disconl and the abandoned pipe op Se to e Servicing Operator. • The contents of all tanks and pits shall be removed and properly disposed of by a p g • After pumping, ail tanks and pits shall ue excavated and removed or their covers removed and the void space filled with gravel or another inert solid material. CONTINGENCY PLAN i qnit If the POWTS fails and cannot be repaired the following measures have been, or must he taken, to provide a code comp replacement system: lacem e aosorp ❑ A suitable replacement areh bee protected from disturbance and compaction and shouldenpot be nfringed upontby reion qomen result area will The replacement area should p acement Replacement syistems must comply with the ruleEer the setbacks from existing and proposed structure, suiltable replacement to protect the establish a lot for a new soil and site evaluation to effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS techno oqw a holding tank may be installed as a last resort to replace the failed POWTS. the POWTS soil and fJ The site has not been evaluated identify suitable area. if rio rreplacementpareaailsuavail ble a ho d ng tank may be i n taalua lledl as must be performed to locate a suitable a last resort to replace the failed POWTS. rade soil absor tion systems may be reconstructed it place following removal of the biomat at the inftltrative Mound and at-g p °--surface. Reconstructions of such systems must comply with the rules in effect at that time. RESCUES 01 a<WARNING>> INSUFFICIENT SEPTIC, PUMP AND OTHER TREATIMENT TANKS AY CNTAIN LETHAL GASSES ANDIOR TANK UNDER ANY CIRCUMSTANCES J DEATH MAY RESULTYGEN. ENTER A SEPTIC, PUMP OR ETHER TREATMENT PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS MAINTAINER _ POWTS INSTALLER Name Name - C r Phone/~, /y J Phone , , LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR UMPER Name Name • 7 - - J Phase L Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(")(d)&(f) and 383.54(1), (2) & (3), VNisconsin Administrative Code. 1 'oil 6,x L- 7 LA w VAN in-of St"'PTIC 1~~)~1C_.!V[/11«``L'1';~lf1l~ OWN;FRIS.I11I' C -t_?10,11"I<`"VII!-N 1,0RN1 1 Owlier/ tttic~r 1►r~,. Mal ink f lddress U_ _ _ ~CCJ " /C /0 Property AddIes,ti -70- ~'ertficttionre.gnrred (~otu Planning d;. 7,>ninlr I)t~pattn<otn litrut•w conSiructian) - ~'ity/State 1'aret;l I(icrttificimott Nin 11w] C Property ISO[ flt10II t X~ , ,rowzi o1 r . v 7122 SubdI isiotl , 71 Certified Survey i`Vl(aI p ~ "g- Warranty heed - - _ Page Spero house yes nn 1 r)i line identilitthl vrsa,, SYSTEM I'V4_g N'I'(+:N.AN E, AND OWNER (TRI-IJACATION' irnl)rooer use and 111tinwilance of your septic S)`stCn] could result in its pl-mature iaitut,: 1O handl, v-rites. l'r))twl maintenance consists Of punipitrlr, out the aepiic tank cvt-ry i-ltrec• ycars or sooner, o needed, by a hecnsr%i tunni rr hat ~ ou pot rote, the system can at3ect the function of the septic tank as it trcatrnettt static in the c~~asic tiisposal~systctu. t)wncr tnaintenanc~ responsibilities ale specified in 011M). 8 3a,td in Chapter 12 ~;t- i',uix C'"rinty araitarv Ordiuancc Hie property owner agn :,s to submit to St. (,oi,c ,runty E'1 tutunr> lor, nli:eparitncnr a ccr(ilic;ati,)n ii)uu, slh,rtccl v flit owner and by a roaster )IumbC1, Ioctrne.yIxlart plurttbet , JCSt1 CtCd I)lnrnhct- or d licensed pumper veri lyinl; that (I } the, oil sit, ,wastewater disposal system is in proper operating eon diiion atidlor (2) alter inspc; ion uud purnpinl', (iCnecrssar}~) the septic r8nl~ Icss than LIJ foil of sludge. I!wc, the undeni,,md road the afro, rCyuircmt ui.: anti u~)c~ u) w ptIvLiu sr,~~at,r (i,~.t~r)s;)i ,v;"it 1), wl(i' iil. ~i,r lant ii standards set lottit, t e;rc.irr, as set t-'v the )epatan,'nt of t:o,ttntctcc aitd ilW ihl) t anent of Natural It ,tioun,, s `auto; of Wist;r.,usut. ( crtificalion staling that })ottr septic system has been tnttiutamcd tmtst be complew't and wmmcd to the ,tit- (_row; (bnnty I'lanu,u~~ ;tc /,otung Department witfiin.io dav:; of the three year expn<tiiori date. l'we certify that all sratemcncs oil thi fo .Ir are ❑uI: to the fxa, of nw:~cm ti ut,u Ic,1e,c 1;,~ r tttidarc the ,m u,°t property described above, by vnhw of a warran deed recorded iu Prt"tster o] i ko is t)trice 1 Nrrrn er o bedrooms a . SK ATUIZOF APPLX ANI I'(S) D A' P I' **Arty inioimaiion that is it list ep,esented Play IeSLIlt iu ilie sanitary perrttit 1)r11 IV o yoked 6V the 1'Lill tt lIg ck: aon ulr f )eIlit)I tc11 ' Include with this application a tecotded warranty de, (i 7.tut,_ ih(° Ileh,n; nl I)~'t its arnt co})1~ of tlu: cr~r[i[ir,f ui~ rv n)al) reference is made in the warranty d,red. (REV. 08/05) CIO 100" Lill 3 1 c ! ~T 6 6° r'°' ,g Oi Lu 1.226 ACRES I 35 I k~°~ , OQ U tea, 53,407 S.F. - I C o ~co 44 4v 1.176 ACRES pny cr) 51,210 S.F. Lp 43 % 'r46 y$ y35.5 y P 36® 1.065 ACRES ~p yS4.8g, 0?• ~3; ` • , 45,386 S.F. ,r' 707 k t2 ~o 1.050 ~ACRES~ / ?SOOP .6- (N 3 r o ! 45,715 S.F. / ?,3j. 4r >p S0. \ >O a^ap c? y . S 6 67 ' .-9.O>P a ° s 710 42 i 41 0 t 0 / SP o; n R=80 t 0 ,00' o ° 001, 9,.0"%~ 1.184 ACRES I o 11.001 ACRE 4♦,0 ry` (g3.8o` 51,553 S,F. _ ° j43,58 S.F. ~iapt~'Sapr 6'S 99~P 65.311591` C.73 ° I Gi An$ ;1170 naP^oP(.1~'65'c~ . ~~w ''T-•°~,._.~ cc ~ I..._.._._.. R J P !4 ry 1 91 ^r~ a®o4 'tea S 8100 0Q" 2147 5' lei . 37,34' x4.45 _ .a at ° "~°I CD, ' ~CO a~ CREST C U RV 46 ^a 5 1.566 ACRES 6x,2222 S.F. 7 ~'t°1 ~O f'ao "aM C 1.109 ACRES f' C79 90.09° i3: i / _Q> .ate n n n P r O" C1• `t I I I it 531?J35 W015f10 ~q~ . ~ ~ ~ ~ T- g`s`a~ Nt/1d 35V8 I L l ooE-1'-7 El El D ~oo°oo III ODOO F] El 0 El E-1 E:l E7 El ~oO °o°oo° III w V c II I I I it I J i o - I j z Q I ~ I I It ~ I I I I I~ w III we fi @@ I III L) I w 9 Q i g + o°