HomeMy WebLinkAbout020-1363-01-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 592212
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2 doll%
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Permit Holder's Name: F City Village Township Parcel Tax No
White Pine Inc. TOWN OF HUDSON 020-1363-01-000
CST BM Elev: Insp. BM Elev: BM De ption: j~aG Section/Town/Range/Map No:
M # P If .F p•~jw,1 27.29.19.2138
TANK INFORMATION ELEVATION DATA v, ell l
TYPE MANUFACTUR CAPACITY STATION BS HI FS ELEV.
1R /Nb-5
Septic /AI: I Benchmark / /~D
Fa6TI.: 2 r
Dosing 1 I Alt. BM
Aeratio Bldg. Sewer ip• r/ J7~
Holding Ht Inlet r
!o • 9q q7.3/
TANK SETBACK INFORMATION Ht Outlet 17.17
TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet
rfur
Septic •F U C / Dt Bottom
Dosing ead r/Man.
9.7y 9L(.s7o
Ae ion Dist. Pipe 9.7y 9y
Holdin Bot. System
o. ` R3. `3
9gs3
PUMP/SIPHON INFORMATION Final Grade 5.17 Manufacturer Demand St Cover
~L~ /bo+
Model umber
TDH Lift Friction Loss ystem Head TDH Ft
Forcemal ng h Dia. Dist. to well
SOJL ,AjWqRPTION SYSTEM V T5
BE Width 3~ No. Of Trenches PIT DIMENSIONS No. OfRits Inside Di~ Liquid Dept
DIMENSIONS it I I /
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer,11A~
INFORMATION CHAMBER OR /r
Type Of System:
CeyVvr*vn#ffnL l0' t5Ut -*20b' UNIT Model Number:FL W-/o' /111 DISTRIBUTION SYSTEM C(~ n rti
~nce - PL 1 J vS~ V-e X t~ .
Header/M nif Distribution x Hole Size x Hole Spacing Ven to Air Intake
Pipe(s)
Length Da Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only /a,
Depth Over a Depth Over ` xx Depth of - ❑ Yes ❑ No xx Seeded/Sodded xx Mulche
Bed/Trench Center 1 Bed/Trench Edges 1/n Topsoil
+ / G ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 615 BRAKKE DR O1R- bil h be In~/110
1.) Alt BM Description = ~ 1+c, /
2.) Bldg sewer length = `A I
- amount of cover = r
718„ b n a l (liv 2111~1~~~~") r
Plan revision Required? ❑ Yes ii
' Q'
Use other side for additional informa ion. r 201 0
SBD-6710 (R.3/97) Date Insepct ignature Cert. No.
County
ry Safety and Buildings Division S' • Crc)
201 W. Washington Ave O. BOX 7162 Sanitary Permit Number (to be tilled in by Co.)
I 537-71
Madison.'
P ,
1 CROIX COON ~Jr Z Z Z
MMUNITY DEVELOPMENT
Sanitary Permit Application State Transaction N"tuber
in accordance with SPS 38321(2), Wis. Adm. Code. submission of this form to the appropriate gmernmental unit Z'9'74960
is required prior to obtainin_ a sanitary permit. Note: Application forms for state-owned POINTS are submitted to Project Addr (if different than mailing address)
the Department of Safety and Professional Servics. Personal information you provide may be used for secondary 0-
purposes in accordance with the Privacy Law. s. 15.04(1)(m), Stats. ~
1. Application Information - Pleas t All Information
Property Owner's Name , Parcel "
r.1 W-a,c ' ; 1,n C. 0 2 o-13ce 3 - o t - ooc~
Property Owner's Matting Address Property Location 3
0 Govt Lot
City, State Zip Code Phone Number Section 2_7
1~K z C ~ I[ circle one
~(1 t ~ 6 L{01,1~ (0 12~ J~,7 ^ 22~ ( T Z- "1 , N: R ~ ol~ \y'
II. Type of Building (check all that apply) Lot 4
N
El I or 2 Family Dwelling - Number of Bedrooms Subdi vision ame
'0 ,
Block ;1
~Public lCommercial -Describe Use ~Or~tf & l1~'rnt1
- U ❑ Citv of
CSNI Number ❑ Villa ue of
❑ State Owned- Describe Use 9 Town of CJLd rj O~"n
Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable)
❑ Replacement System ❑ TrcatmenGl folding Tank Replacement Only Other Modification to Existing System (explain)
ANew System
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS Svstem/Component/Device: (Check all that apply)
XNon-Pressurized In-Ground [I Pressurized hi-Ground El At-Grade El Mound - 24 in. of suitable soil ED Mound <-4 in. of suitable soil
❑ Holdimr Tank ❑ Other Disperal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Ti eat ent Area Information:
Design Plow (gpd) Design Soil Application Rate(gp ) Dispersal Area Required is Dispersal Area Propose stl SysteC,Llevation
.~0 . o~ / 02 5-0
VI. Tank Into Capacity in Total 9 of Manufacturer
Gallons Gallons Units
c
EvistingTonhs New funks a
Po Ia
Scptic or Holding Tank
7
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, a e responsibility for installation of the POINTS shown on the attached plans.
Plumber*s Name (Print) Pill per's ign ur, MP MPRS Number Business Phone Number
? w C3 S teen 225,4 S I (7l`5)4z5-55'1Y
Plumber's Address (Street. City, State, Zip Codc)
Nl,23o g14S111111 Skrtvt_ ~~,Il s ,Gds 5 4022-
VIII. ounty/De artment Use Only
Permit Fee Date k ned Issuing -at Signature
approved Disapprov S
t % cI- C °t Reason for Denial
lY. ConditiYris c .~fivV o•,~i Qr`ti•jsapproval ) / J,c t ~~i► r0✓ ke.
disper :sv cell must all ~ ?s; e 'tlt ; (~Qx rn L ~f ~
a!u ape of n, Q,i-~e C7r T""''
+;per management plan purr+iaarl W
2. Ail aftwdl raguioomm m!aut.wl Ir a,r?tt )F E
as pw vpplc" co$* / ~udiluxsj,
Attach to complete plans for the '),stem and submi o the County on _ on paper not less than s t!' . I I inches in size
SBD-6398 (R. I I I I 1 v
Plot plan Page ~qr
l'r~Peny f~wrser yv 4f TPiAi
Legallmesc m J t T ,f,,~ 1 = 40
:PRl: { where noted}
a~ NWit OF T~StN{ ~ 5~~.. 27' TZ4a3
- -5` C i- ~ Li~tSGDwSS[t3. Pit
~Zp- [ 3ro3 - -
North
~G171t~r
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~ptisT gw4lct LJB1 i ~ ZIO ~l ``,4 5*~v D 1'7 SS Se?r, p `v3ko Q•l 2
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.site Location:
WBhDt}~i ROPtD
SSG.
V
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL STE 150
~c' GREEN BAY WI 54304-5211
Contact Through Relay
http://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
ti
\n o ssro Scott Walker, Governor
Dave Ross, Secretary
December 16, 2016
`*A
CUST ID No. 224832 ATTN: POWTS Inspector
MARY JO HUPPERT ZONING OFFICE
HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA
28497 KING ARTHURS 1 101 CARMICHAEL RD
DANBURY WI 54830 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 12/16/2018 Identification Numbers
Transaction ID No. 2874900
SITE: Site ID No. 834084
Hudson Storage Please refer to both identification numbers,
615 Commerce Dr above, in all correspondence with the agency.
Town of Hudson
St Croix County
NWI/4, SW1/4, S27, 1-29N. R19W
FOR:
Description: In-around System (office - New Construction)
Object Type: POWTS Component Manual Regulated Object ID No.: 1677410
Maintenance required; 150 GPD Flow rate: 120 in Soil minimum depth to limiting factor from original grade;
System(s): In-ground POWTS Component - Ver. 2.0, SBD-10705-P (N.01/01, R. 10/12); Commercial System, 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 101.0I (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.
• 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-
• Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches
below the system elevation Smearing and compacting of wet soil will result in reducing the infiltration capacity
of the soil Proper soil moisture content can be determined by rg 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.
• Divert surface water from POWTS Area.
• All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5
• Insulate building sewer beyond 30 feet per SPS 382.30 (1 l)(c)
• Tank Installation to follow all manufactures recommendations.
f
• MARY JO HUPPERT Paee 2 12/16/2016
• Verify property line(s) prior to installation.
• The approval of this private onsite wastewater treatment system (POWTS) serving this facilty is based on the
quality of influent discharged into the PO WTS treatment or dispersal components being equal to or less than all
of the following:
L A monthly average of 30 mg/L fats, oils and grease.
2. A monthly average of 220 mg/L BOD5.
3. A monthly average of 150 mg/L TSS.
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
333.54(l).
• 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/instal lation/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.vanderleestnwisconsin..,zov
• MARY JO HUPPERT Page 2 12/16/2016
• Verify property line(s) prior to installation.
• The approval of this private onsite wastewater treatment system (POWTS) serving this facilty is based on the
quality of influent discharged into the POWTS treatment or dispersal components being equal to or less than all
of the following:
1. A monthly average of 30 mg/L fats, oils and grease.
2. A monthly average of 220 mg/L BOD5.
3. A monthly average of 150 mg/L TSS.
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
L"4 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.vanderleestnwisconsin.gov
In-Ground Gravity Plan PAGE 1 OF 4
Index & Cover Sheet
Component Manua! Design References:
Version 2.0, SBD-10705-P (N.01/01, R. 10/12)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View 0
P g of 4
9 Management Plan
Attachments: Enclosures:
1AAK sPEt5 POWTS Application for Review
~-iLISK !3PEC5 Soil Evaluation Report & Site Map
EZ Lei, is
Project Name / Description
1+VtSCA: ST-OPIA E AFFIC7
Owner Name(s): W+ttTE ('ENE, yam.. Phone: 07- -~z6- 2z.'
Owner Address: PD. Bee 5c4, NuD-.oN ~ ~,~z 540 t t, -i'DJto
Project Address: Tara Co-"t-Kc,F,- pRtv>r N u D , var sLt tai to
Govt. Lot: NA I NW 1/4 of sw 1/4, Section Z7 , T 2,1t N-R iq E❑or W
Township: Hv b60AJ County: nL RorX.
Project Parcel ID 620 -15L- 6 - Ei - C06
Designer Information
Designer Name: AAAt y -~M 4w9p&izi- Phone: -2)5 - 821 _ 114q 0
Designer Address: zs4q-i KiatyAP-ri+ufis cT, t>AAzWzJ- ;,vim Zip: ~y8
E-mail: t~ t C r s t-~1e s; ~~n t~ ~+u-~ l c c K ecm i his space re k~' : i _ ,t-a1 stain
License Number: A,
Remarks: •
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2 ~U16 : f,~~=m , ,
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Signature: U- Date:
Origi ignature required o ch submitted copy.
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In-ground Gravity Management Plan PAGE 4 OF 4
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow = 150 gPd; BODS 5 220 mgL"; TSS 5150 mgL''; FOG !5 30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Steiner Plumbing, Electric, Heating phone: 715-425-5544
Local government unit: St. Croix County Community Develop. Phone: 715-386-4680
Local government unit address: Hudson, WI ZIP: 54016
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
in the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
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The 1625 filler is ideal for grease trap applications. The 1/32" filtration has been shown to reduce fats, oils, and
grease (FOG) by as much as 60% to 98%1 The filter may be used in onsite wastewater systems that require a finer
level of "SS removal. Whatever the application, Polylok has the filter for you!
Rated for 8,000 GPD (gallons per day).
625 linear feet of 1132" filtration. Alarm Switch
Accepts 4" and 6" SCHD 40 8,0(?0 GPD pipe. (Optional)
Built in gas deflector. " Accepts 1" PVC
Automatic shut-off ban when filter is removed. Extensim Handle
Alarm accessibility.
Accepts PVC extension handle. Rated for
w 10,= GPD
Ideal for residential and commercial waste flows up to
8,O0 gallons per day (GPD).
625 Linear Ft.
1. Locate the outlet of the septic tank. of 1/32`"
Fe7tratrort Slots
2 Remove the tank cover and pump tank if necessary.
3. Glue the filter housing to the 4- or F outlet pipe. If
4° & 6"'
the filter is not centered under the access o use a Accepts
Polylok Extend & Lok or piece of leg SCHD 4o pipe
Pipe to center filter.
4. Insert the P"25 filter into its housing.
5. Replace and secure the septic tank cover.
" = 5 i
The PL-625 Effluent Filters will operate efficiently for
several years under normal conditions before requiring
-cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
TR
.F
Years- If the installed filter contains an optional alarm,
the owner Will be notified by an alarm when the filler
needs servicing. Servicing should be done by a certified
septic tank pumper or installer."`-,, Gas De@ector
1. Locate the outlet of the septic tank
Automatic
2- Remove tank cover and pump tank if necessary. Shut-Off Bali
3. Do not use plumbing when filter is removed.
4. Pull PL-625 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all
solids fall +<I' "
back into septic tank.
6. Insert the filler cartridge back into the housing making
sure thefitteras propedy aligned and t-.
mmplebetYinsetted-
7. Replace and secure septic tank cover. in1.z
Potytok 7abei &
Best filters accept Easily installs
the SmartFIltero switch and alarm. into existing tanks.
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POLYLOK PL-S15 FILTER CAR1R W I :S2.6an), _
PART NL:- 301414!.~}
MATERIAL-POLYPROPYLENE - OOLOR-GREEN
TOTAL FILTRATION - 610' OF 1032' SLOTS (1.80 Sq )
(189 METERS r a o e f:
9 an)6 5 sq pn)
TOTAL FILTER 9.58 SQ.FT- (8900~~M.78 SL sq. CM)
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80WTACC@~FSf243an'
8A1LPU91f100 L75.4an'
7.16
{ ! 1182sm_
?244 -
1 _ 57Dan1 s = f. _
c l-
- 19.OZ - i
f=
AU cm]
PanoxPL-62'►ALTER~ s~ r Iff
Ala - 3MI.625
E r = - ~ 2
WERAL-POLYPROPYLENE
i-m
COLOR-GREEN
TOTAL FLTRATM- GW OF 1W SLOTS (1.80 sq ft,)
(169 METERS OF-BW SLOTS)(14r,5 sq cm) _ - a` a it
TOTAL FILTER SURFACE -9-58 SQ.FT (8903.78 4 Cm)
jD/~ SAD AND BUILDINGS olvISION
mbin9 Produet Review
Nvi P.O. Box 7162
` tMadson, Wisconsin 53707
Department of Commerce
Jim 0oyte, Governor
November 21, 2003 Cory L Neuhw, Secrebry
RING INDUSTRIAL GROUP, EZFLOVV
BEN BERTEAU
65 INDUSTRIAL PARK RD.
OAKLAND TN 38060
Re: Description: LEACHING SYSTEM, POLYSTYRENE AGGREGATE
Manufacturer. RING INDUSTRIAL GROUP, EZFLOW
Product Name: EZFLOW DRAINAGE SYSTEM
Model Number(s): EZ1203H (3-12" bundles with pipe in center bundle in 5 ft- or 10 ft 1
12" bundles with pipe in each bundle in 5 ft. or 10 R le ePgth), EZ1203HP (3-
pipe in 5 ft. or 10 ft. lengths), tZ1201A 1-12'
bundle }n containing aggng agg a (1-12" bundle with
EZ0601A (1-6" bundle containing polystrene regate may} and
aggregate (EISA of EZ1203 H or EZ1203HP in 5 ft lengths only}.
EISA of in 10 ft. ! gths = 25.0 sq. ft./)roduck EISA of EZ1203 H or
Max. depth of btxy = $engths =50.0 sq. ft./product, Width = 36 inches, Height =12 inches,
Product File No: 20030515 ft.)
The specifications and/or plans for this plumbing product have been reviewed and determined
with chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160 winscocompliance
Statutes. rrtsin
The Department
and the Wisconsin hereby issues an
ative Code. Th~o~ to s. Comm 83.44 (4) ofNov based on the Wisconsin Statutes
approval is valid until the end of November 2006.
Theis approval supercedes the approovat issued on June 2, 2003, under product file number 20030127.
This alternate approval is contingent upon compliance with the following stipulation(s):
• This product must be installed in accordance with the
plan approval. If there is a conflict manufac~er's printed instructions, pnxW approval, and
plan a the between the man
approval. product approval and/or plan approval yvr uke Pr and the product approval andr'or plan
' When this product is installed in a di
black of the product approval letter, dispersal tell that is sized based on the EISA rating stated in the regarding
fts
220 mg/L and a TSS value be
product must receive wastewater having a GODS value between 30 and
tween 30 and d 150 150 mglL.
• When this product is installed in a
block of the product dispersal cell that is sized based on the EISA rating stated in the regarding
des approval letter. this product must be installed in individual excavations that create a
Persal cell that is horizontally separated from other dispersal cells in other excavations
3-1oot measurement is measured between the closest outside edges of the
by at least 3 feet- The
of the product approval letter. product listed in the regarding block
• When this product is installed in a dispersal cell the design of the dispersal in the product without baddlow, of wastewater into the drainpipe that discharges into this product-
-
Sty^^.
EZ1203H
c . vvvvwpl
Vitvvvv
:56 IWVVV VV
wv It
wvw 12
2 is
4.625vv vvv
vvqr 1 t,
v
vv ya' I/2 Ciro. = 18.84"
f
IP v
vaW .
.y
a..v v t.vva tv..v v vvv
.vv.v.v a t9♦av.av.avv vttvvta
.yvtvvv af..tlv.Ytty~ vvvvav
24"
BOOMMM
36"
V bid Yolatoe 12-1/2" DIA- (typ•)
Stwt Imtvfacr Area IR to h_ ~ }q
Void C°etficieot in :►8S[eSatc Hives at 5T_a!G Sidewall (2 Si&m-alls) 2* 18.8a►n
tr., ;.14
f
IF
EZ1203H
vvvvvvv vv Vvfvv
VVWVVTW - vvvfvvv
vwirvvvv
wirvvvww
vV vvvvvT
v
71
12
vvv
4.625° vv
VT.
v v V2 Ciro. = 18.84"
vvv
TTT .Tv
VVVV V T.• " vvvvvvvvv ffVVV v
svvvvvv f WVVVTVVTVVVV VfevVVV
VVVVVVV VVVVTVVVVVVVVV WTVVVVV
vTOV1vv VvVVVVOVV►VTVV Vvvv7Tv
~'-24"
Bottom
36"
Void ti otnme S011 lttterfaM Area Ea to Ft sq ~
Void Coefficient in =W.-We aivea at 57_4Y. Sidauall (2 Side..•ails) 2* 11. l =
tY... 3.14
I
i
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner / . 1 I ~QS G Septic Tank Capacity 7 gal ❑ NA
Permit rr Septic Tank Manufacturer r ❑ NA
Ser
DESIGN PARAMETERS Effluent Filter Manufacturer / 1 ❑ NA
Number of Bedrooms NA Effluent Filter Model z ❑ NA
NA
Number of Public Facility Units ~ ❑ NA Pump Tank Capacity gal
Estimated flow (average) gal/day Pump Tank Manufacturer ~NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
Soil Application Rate ay/ft' Pump Model ,WNA
~ 7 gal/d
Standard Influent/Effluent Quality Monthly average* PISSaa a ent Unit ❑ NA
Fats, Oil & Grease (FOG) <_30 mg/L d/G I Filter ❑i ter
Biochemical Oxygen Demand (BOD5) 5220 mg/L )KNA hanical A etland
Total Suspended Solids (TSS) <_1 50 mg/L ection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD5) <_30 mg/L An-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L [ NA ❑ At-Grade ❑ Mound
Fecal Cofiform (geometric mean) 510` cfu/100ml ' ` ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Cl. n dip. NA Other: El NA
Other: El NA Other: ❑ NA
i
Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: year ~ (Maximum 3 years) El NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume NA
i
Inspect dispersal cell(s) At least once every: ye~ (Maximum 3 years) El NA
1 _
Clean effluent filter At least once every: year(s) ❑ NA
E] mo
Inspect pump, pump controls & alarm At least once every: year(s) NA
❑ mo )
Flush laterals and pressure test At least once every: ear(s) ,,'NA
Other: At least once every: El month(s) ❑ year(s) ❑ NA
Other: ❑ NA
i
MAINTENANCE INSTRUCTIONS
Insoections 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 around surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending
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 ('3) 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 chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall he provided to the local regulatory authority within 10 days of completion of any service event.
Page of 2
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.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: 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 products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POVVTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
r Y\ T:+ v t V t v iiy c J 1 a V ITC
aluati a e o a a o ding tank
av be i U e taiteo ~r)gIt ree 1D/2- A/ok1 fz f _S7 ReUc ' L o
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POINTS INSTALLER POWTS MAINTAINER /
Name ~~L°//l~P/ CC 6 ~r~ty Name llO/is
Phone Z ~~'l~/C~ Phone 71,2- , 412 f „✓i- rq-,l
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Z) n Name s~- ~C-6 ( Du~JI 20it(l~tl
Phone / L7 /o;z Phone -7
l - `p- ~(O 8(~
This caocumen- wa_- drafted in compliance with chaprer Comm 83.22(2)Ib)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administra ive Code.
Page Z 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
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.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: 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 products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONhfiENT
When the POW TS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
.Iv T n*~ i, ❑ J d ..i f V il.. .t, . /TC nn V
g
wl ~f~i~l~Unh tin 0~j
ay b b e e r`ZD}-~13 TfS~ h/'5
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
- - - ---infiltrative surface. - Reconstructions of-such systems must comply with the rules. in effect at that time.
< <WARNING> >
SEPT)C, 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 OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POINTS INSTALLER POWTS MAINTAINER /
Name ~L°~I1 ~P/ /C 6 rr Name a !l 0"6
Phone _ Z ~ f'~Y q Phone 12 , 1-12 S el'41
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY /
Name Name ST. ( ~z C~UhJ i ZO/J1~
Phone 713- q2 1~- to . r Phone < I b
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 8u.54(% (2) & (3), Wisconsin Administrative Code.