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HomeMy WebLinkAbout042-1079-40-430 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix and Building Division OIX INSPECTION REPORT Sanitary Permit No S : GENERAL INFORMATION (ATTACH TO PERMIT) 597354 Personal information you provide may be used for seconds State Plan ID No r y purposes [Privacy Law, S.15.04 (1)(m)] 2945131 Permit Holder's Name: City Village Townshi GEORGE & JENNIFER NIEMEYER g p Parcel Tax No: TOWN OF WARREN CST BM Elev: 042-1079-40-430 Insp. BM Elev: BM Description: Section/Town/Range/Map No: TANK INFORMATION 29.29.18.451A-60 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Hbution s) x Hole Size x Hole Spacing Vent to Airh Dia Spacing IL COVER x Pressure SYstems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over Bed/Trench Center xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Edges Topsoil IS ~ No L--1 Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 752 103RD ST 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes E] No i i Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. County CEIVED Safety and Buildings Division - G(- $ rt 201 W. Washington Ave., P.O. Box 7162 a t c ` PS. $r~ AAadis WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) MAY 3 0 201~i . ' ST. CROD T., G ~ ~ nn~~~/ hermit Applicael, _ State Transaction Number In accord anef~q~~3 2 ] 2) Wis. Adm. Code, is required prior submission of this form to the approx. 1 unit to obtaining a rani rmit. the Department of Safety and Profeo pe l rvNote: Applicaiion forms Personal nformation provide may for you to-owed PObe used for ,,cogdary res in accordance with the Privac Law, s. 15.04 1 m , Stars Project Address (if different than mailing address) 1. Ao lication Information -Please Print All Information Property O erT~ J , - y~ I, L.•~- < X Parcel # Property Owner's Mai Ad 0y / - Y30 e -3 ling l j Property Location a C~ ~ c~ Y 1$ U S/ L) City, State Zip Code Govt. Lot •F. 1 Phone Number C-h Ff , 1 5 LLz'_ ► Y<, Section T pe of Building (check all that al (circle ones pp Y) Lot # T N; R_ E qi } 1 or 2 Family Dwelling - Number of Bedrooms j 41 a ~ Subdivision Name El Public/Commercial - Describe Use OF- • Block # ❑ City of ❑ State Owned - Describe Use _ j CSM Number r ❑ Village of ' - ~ ~ X35 rt • . .,1r'~ own of_~°r~'L~C ~Z III. Type of ermit: (Check only one box on line A. Complete line B if applicable) A. ..21 +r.r;•.. Jt New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued Before Expiration Permit Transfer to New Owner IV. T e of POWTS S stem/Com onent/Device: Check all that apply) El Non-Pressurized In-Ground El Pressurized In-Ground 11 At-Grade tY X14 RT'Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable 4X19 L 3 ❑ Holding Tank ❑ Other Dispersal Component (explain) _ " V. Dis ersal/Treatment Area Information: Pretreatment Device (explain) Design Flow f (gPd) Design Soil Application Rate(gpdsf) Dispersal Area Re aired s e-A l q (f) Dispersal Area Proposed (sf) System Elevation J ,7 U ~>U VI. Tank Info capacity in 11 -76C 1 ' Total # of Manufacturer Gallons Gallons New Tanks Units Existing Tanks o Septic or Holding Tank J ~ t✓ R. U ~ N ~ ~ ~ GL, Dosing Chamber / e 3 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe 's Signature r „ a MP/MPRS Number Business Phone Number Plumber's A ress (Street, City, State, Zip Code) --7~~ Cr_C, Zl - - lc ~ yVVIIL-Court /De artment Use Only I~ Approved ❑ Disapproved Permit Fee Date Issue Issuing Agent Signature ❑ Owner Given Reason for Denial t C IX. Condi ~reasons for Disapproval J/ ~ia T7~01AL i ' .u cell "ItltlE 4N i _n^ec J Is per managemmd prlo sided by plumbs;. / A G tf"" j~ Per t1plIft bts Ig" / --A!tul/t+. ` Attach to complete plans for the system and submit- the County only on paper not les than 8 12 x 11 i chews in sizze SBD-6398 (R. 11/11) PL D T PL- c0 - LC~T I NOT Td SGFlLE - CxCETT 70 M6UQ0 I Cj 13M'5 SET': Tops e,-F o~ ya" F145JEy cotitl~N~r PES ~J d' = BAC~k4ot. ?iT cn 5 - L 300, 17 /Vo. Z-4 7" L d= CowtouR LhQE5 5 u Rve y6 (0 :EtzoN) I3AR5 - o N 0Te- 131 SEW,E R NOTE : 13106. I T~}.v k s i se E -to com[3D w cl0 J CDDE fDMp~~~t~ I ExT~R/bR , 3 I o j [3E FROAi HomE ` w 5 u L-ATi5 ~l UG 1 / PP, o pos ED F}II C/o GIcAN u~5) WELL 5khM Br- FRosT FRoof \ S~,y I \ \ 3` cl o - I The area 15 It. below the downslope edge of the Soil Absorption System must remain undisturbed. NEuj w tESr-k 5o PRE cHST CNAOD 5F-PTI C, I u M p i I l P~Nk S~1 0 ot7 /ono 6;> 50 G c(o \6 \ ~ ~ Ni~oRM (07. A ~o~ ~ coN ou R 14 • ~ 3oo,lB ` 13Z So, LOT Liot~ \ 25 WIDE SEPri f )3m l - A5~ mod, o' - I f ~N c L, E arc z, as --y- -1c- - -IC - - -x- - -K- - -X- - -x- - - - _{4 ~Y 4RTt.~F DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 Contact Through Relay 1 p s w; ; http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Laura Guti6rrez, Secretary May 18, 2017 CUST ID No. 226375 ATTN: PO WTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767-9102 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/18/2019 rabove, entification Numbers ID No. 2945131 SITE: 37866 George & Jennifer Niemeyer to both identification numbers, 103RD St correspondence with the agency. Town of War ren St Croix County NW1/4, SW1/4, S29, T29N, R18W FOR: Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1705146 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter 'The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. CONDIT No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, APPR(' stats. s DEPT OF SA The following conditions shall be met during construction or installation and prior to occupancy or use: PROFESSIONA Key Item(s) DIVISIO IN U' • 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. In additio ,#$p owner must insure that the operation, maintenance and monitoring duties as described in section VIII mound component manual are complied with. A copy of this information must be given to the o upon SEE CORD completion of the project. • See corrections in red on the plan. • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 12". The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component: Manual. ROBERT W ULBRICHT Page 2 5/18/2017' ' Surface water drainage shall be diverted away from the system area per Mound Component Manual. Materials shall conform to the requirements of SPS 384. Maintain well and waterline set backs per SPS 383.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. Insulate building sewer per SPS 382.30(11)(c). 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 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf WiSMART code: 7633 POWTS Plan Reviewer, Division of Industry Services (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm ROBERT W ULBRICHT Page 2 5/18/2017- • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per SPS 382.30(11)(c). 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 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf WISMART code: 7633 POWTS Plan Reviewer, Division of Industry Services (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm ULBRICHT ASSOCIATES CO. 2812 10th Ave. • Spring Valley, WI 54767 14 - Reg. Designers of Engineering ; ystem 715-772-3442 017 Private Sewage Consuttants F; ~;Y 0 8 2 (,.!y- USTRY SERV{_;f=_ PROJECT INDEX Plan I.D. # Date APRi L Z y, 2017 Owner GEoP,(1;L v Te.1Jx)i -FER N/ E/tj, ye Phone 110 ~!S Z zz I c~~ JC r Address 75-~ ~Q3 ~D. $T• 120 _ i3E~Ts 101 . 5~{6z3 ' Legal Description LoT - ~ /vw Sw s T ll 5m lo359g7 Vol. 27 ?J. (.o2 ~s~cR~s zq , '-1,,> i w Town of piN o q l - 1071- yo -OR(, _ .__wR2E~? County C.S.T. ~o RT- t,cGt3Ri GIST- Installer ffe,JR-y ?to- &71-E2 Local Authority/ ioervision ST• CRo,X PROJECT DESCRIPTJON 715- I S - 36 ( -y (v o o ~E-►v c605-r2u.CT'10,j J FOA A 3 T3EnR~Lt. 5i zEn ~otic~ A 0 ff-kAS L_ P14i L-y WASTEF10 0 'D i 6-~ Flo U3 y5-0 got I-PA-~. e 5OiL5 ARC 501TAB1I~- FoR A Con~v~~Tio,~f}L ~io~~d SYS~~~ us/P6-- 1~_ " AA-) u _y . y AND RVIC>rS ~Y SERVICES KOBE ULDS 1 ~C o , 1 JUD& ,SI.G` Pg,l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) Pg•3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OUTS) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg•5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg,6,OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the fo approved manuals: "Mound Component Manual For Private Onsitewing Wastewater Treatment Systems 11 _ and "Pressure Distribution component1Manual0 ForD PrOivate(Onsite Wastewater Treatment Systems,, (version2.0) SBD-10706-p to (NO1/01). PL D T- PL o LC~T I NoT TO 5C)9LE- 6~Xcu~E'PT Mo~ I p Co) 13m 'S SET-: To ps ~ f f o~ ya" Ffh5JEll (oNL)L)"r f'1PES ~1 IN = 13ACkko~. 'PITS 3pQ, 1'7 No. DoT L d= C6,3tcuR LWE5 5 2~~ ya R `s ~o BARS ~ 0 N 07C' r3~D S~w~R N°TE ; 131,06I-- T .vk s sw~2 c o = o -to coM130 rs 13E CDDE' c0^~p~i~4~ I 6xT~aroR , 3 FRoM coo ME pj 5 V l-ATE~p sG~ y~ 3 l~~ ,3 PROPOSED W ill C/o C~Iff au-ts> \ WELL u. W shRJI 8~ FRos~' Roof \ S°~,~ ( rt13 o U R o urv p \ 90 ~q~ Q~ (~fc-. cp ( \ 3 c(° The area 15 ft, below the downslope edg of the Soil Absorption System must remain undisturbed New w ~ESER 50 PRsc,AST Carlo SERr~ I ~u M F I P~Nk gCt 0 o va /ooo 6250 POSD \ \ ~b r C(o (o7. y~ NtbRM I `~l9 ~ ~ ~ CON OU I \ . L( f D! ` I a 106.0 \ b r \ ~ ~ I 3oo.IB ` f3Z so. LOT WrJr wIOi5 SEPTIC - - --)3 4v J00.0 r C~ L,A)E t3M CZ `y~ X- -X- - _ ' C:pOss SEC 10&J of mouAjD wirti T3ED BF!D OF 7-o M Vi STRi(3u'Tjn,u ~55~~j`'ATE' r lti i G kns F S 9 p J P w (-r- or- r°P s o i t. w/ TE,P~ritifz- s Ys r+~M Vui FORM 70 E7 Ir lob qO, 3 P -r- MaD. oil SAmj> PIo w r v Top S o l' / q ('fGCuTRA~ Cv2ue D cc Nov v2 Cv °Jo 5 t oPE FoRce" vu i F'oRM Mho ~1EVATOQ OJUMR Rev> /0 7, / o q` / ~ ~ ~ Fr. Z J\ ESE v~4r~ o,J s u Fr. 1 / I"vERr of )ATE A( j~g• la 5 Fr" To p o f R tick 10. H 1.0 FT. ' Top °F l ly 9. b IATERA IS FPL Vt~w o;F= Mov,j D wiri~ 13~D a%' 081010 A t_ FoRcE MAiN • p T K _ F r w - - - - - - - - ~ l ~ ►s ° - Fr \31 w ~T- f3En of %2" Pvc. cAPPEd Ta 1 ''-y" ~qy 2EG TL" dt3sERVhria,v n r~T'. p'pEs /oc.4r%at/s : t5 FRdM D(Y~" o CIL& PERMA,j t--,JT M A P kERS (716PS o RECquiC2ED J s o t t, 10-f rRATW E' - CApAcj r P~ y Yft2 64. Fr, PR,op o s E V BAS A4 Me4 B X( A+ z ~5 x ~ i~ ~ 575 IR. rT. L^`, ~ f~/J..-.f' ..s~' '--..,r ~ 6~f t~ f__! ' sJ• 4' t ~y~'~~ L a.:- ~ " ~ `~f..P .1 Observation pilre - f---Distribution cell ~-Cover rr►aterial f=ill material-•~._ (ASTNI C3fine = aUC regate) Titled area Slope -f=orce t1laiil Figure 6. Cross-section of a Mound System ` Water tight cap Tap of 4'° cnin. dia. leaching Repair couplings chambe / Sot- . 6" mill. mill. Infiltrative surface., Water Closet Collar! 1Sar(3f8- mh ilia.) Figure 8 - Observation Pipes s ~ 20 7 -,e -D15,TRl,i3UT Io,Nj 'PI PE LAy6u1° J-1 I C~~T FORCE MAIM 3~ 2S~ log ° of c To-rAL V0`0 VOIuME of NET-ujoRK ` i. 5 g ~I s 3• o a5 - T017\L ~JDID VDIUM O F ~ MAN ~ ~ la8• yo IMVERT Z. EVNTiO~ flow t3AG K +-~T~~ ~l5 ~~~e~ Pl METE 3/ c~R~ ~~09~ Zamoue X49 I-. ATE R~ L. ° ° ~ 5 Mfg*®Poi-L) ~a A~~~~~ l®~~~-~® Z FORGE MA w iN ckt e, y3 aTrom, eVP-Q .y 5PAc~~ ROUE 5 PER l ATr-PA L /3 ~~sr~lc~ur~a,u call AR~~ 2- TvT-PrL li D lCam- PER ~o(E : (o SQ, ~T'. SSE ~E\)I-RSE 510E FOR °rE BWNL ~/g~ D~-tA'lL PER 07 j,5 Y F®~, 3~lCe ®gES ~'fl SC~~R t~ yMs. Pr-k 6 INL,TE PER Hol ® ~L6s~'~u9'JL)-r10fj Pe5c-kAR~E RP9~ FOR EiAck JATecp~~9 `~'l~°~'~~. PI.$T~20 ~3OTI0~J ~~SC-~~~~~ RfiTff b~~~ p,~®64(x' 3 5 A9 ° ~i3of~ All G~ ~ ~c ~ f -CAS %~✓~1 ~~j~'Q ® ~.S'~~~~ d 5c, CAI p r~ - P4 14E-- Ce _ SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 e ' lU' FROM DOOR, WINDOW OR WEATHER PROOF JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER' 4Ov) 9R. W/ PADLOCK 6 WARNING LABEL 4 " MIN. ~.-4" 1 GAS- l i ~r✓~`;T P p Ly L~ G~ 1,~• I -T- T I G H T i ffA i3AFF~ A I SEAL PROVED INTS W / t~VG ~'1 p~' u_ PE 3' ONTO ' 1- o 'jo SOLID b C SOIL LID SOIL ~ PUMP OFF ELEV. 1:'1'RISER EXIT D RMITTED ONL TANK NUFACTURER K 3" APPROVED BEDDING UNDER TANK HAS APPROVAL aN -riJ (.:r- CONCRETE PAD 13r, PO _SPECIFICATIONS ~r ~S~R P~~c}t5T' `;EPTIC / DOSE q '.TANK MANUFACTURER: CD►`~I/Il+-~ LO NUMBER DOSES PER DAY: C OA4 a( 9o~ TANK SIZES: SEPTIC GAL. DOSE VOLUME INCLUDING SEPE i&jr5- GAL. yg,jFLOWBACK. I GAL. ALARM MANUFACTURER: GtVt~I A►ltf2M Cp ' CAPACITIES: A = INCHES = 3UV GAL. MODEL NUMBER: SWITCH TYPE: F/0A-~---_ B = 2 INCHES = ~_G A L PUMP MANUFACTURER: ®~LI.IrTZ 7 C = INCHES = GA L MODEL NUMBER: SWITCH TYPE: RoA-r D = 45 INCHES = x-2- 2 GAL REQUIRED DISCHARGE RATE 35 GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WA( VERTICAL DIFFERENCE BETWEEN PUMP OFF' AND DISTRIBUTION PIPE 70 FEET + MINIMUM NETWORK SUPPLY PRESSURE 2 FEET + Z _ FEET FORCEMAIN X 2.5RFT/100 FT. FRICTION FACTOR.. FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP 'T'ANK: LENGTH WIDTH DIAMETER,,~ s E E- 13 cfc S/De- LIQUID DEPTH SIGNED: _ LICENSE NUMBER: DATE: P/C ,SPECS ! V df Dep & 1-7 dv-. Q SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device. Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a an oss/ooo~u+ 3~Id 95-b9-5Z2-009 z o5ctis IM ')4=J N3L71VIN Ol IAH sn 9LL2M anod-lsod 3LVa 00/00/00 ado 1bnNdW OIld3S ~0~ W 3138O 'A'38 i8n0d-32ld wo-,L=~V L :3~VOS doM 10 NMVao dri-059/00OLd-H U) 0 w Ha mo o Z) rl~ ix ~ w W d m o U Q U.. Li L.n Q o 6r L= o. fly ~°I W F m w I:e F ° Z ¢ w U J o o z Q ~0L w a ~W H O > L.L ~C z Q °*-Q zz m~ o Q d o C z C) L O W OQ QJU JJ [n Wp U ¢ d O Q a° O N mUn J W W UU W Z Z Y Q o. U) O w ZQ O U O ° ° m J Q W to N p ° U) Ln W p z N F- M LIJ N O U C-4 Of--WJO~i ljQ U a W~F~- N W U 0Z <F-V) o O LiJ LO-'0, 7- ~V) ~(n~ - ZU Oda wUS °O O "~J.. m?J- pQW OZOW Q W m FN NU O Z ..O~0=0O5 C) I= °U~ °~F Q ° Z W a xX ~O Y ~QOOQWw°w°' Q t Q+° U 0 Q (nO o W Z 3rmumm-jim p Z U D waw p Q W J J Q z > z U Z Z J 0 O~ J Q W N I 4. Q ~ W Cf) Q - FI Q U W ° d s a F- > g z d W W ~ tY 0 CY LLJ svo ~ „ot do N i : I U W W W _ Q J ° 0 LJI Q o f O w LLJ wQ o Q J m „5 I „ 9~ F- L~ Q svo ,zti do a \a cr cy a J Lr a~3~J „~'8 sV-,~ „~5 Z Z(1LLER EFFLUENT ]DUMP MODEL 98 HEAD CAPACITY ct'j"VE Morin. A ~ V.i alleaNS ►o LrTER~ -?o 30 _ na ?a ea act t 6o 240 ROW Pr;n klmlrf., TnTAI F,y1rAAr10 NF f~j-~~7~-_ w-~-•- FiFII/f Ht AHO Flm'P Poll llrllaTe ,'°-'-.^==Z-~ M[A! Cu'Arify ` N 1161 cYAll,~c arna - - ' t0 i,a} rN era of 111 r.pT 271 to N.10 Oft tin 4. 25 04 C O NS(. LT -Acl,on1` FC?p SPECIAL APPLICATIONS A ptectrk et etterrtelom tof duplex systems, ere evallablo find ATIONS la>pp#Fri wllh art nlttrrtT• '&*&l Merr wtlhoaA *WM hYMr, ury float &wllchas errs avellabla for can r 1 Alsct eNemelore, tc~r dup►ox evnlefne ere ovalleblrf wllh or ti three phnsa t my8lM8. F44rtA, tr.llllrl9 single arid Double plggyhack mercury lloal switches NO nvsRabltt for Verlat" level long rycle confroln. nlendord Rlt Modell, _ Wet -_01 l4i lb A.. +/1 l~ tTw In@.gralMost O p[!_1 r;Th()N nlgbF MadNt _ }~graled?pale Fn4criy,:llcatAwlrclt,rwaxtomals-c•ntratrayulrerl. V h" hh__ Mod@ Am _ ~aphol 9al.cllon 1 • fiin ewrtnhgf, p bark mercu . fur ler to Fkitf4)e ,q, Float *wlrch or doubh radgyhsck menu ulo p- UuPI.N 9. ~fadtAnld rJ Fm(or 10 t?OIq N. 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KY~U2.S6 0?j7 (f Liar rot 1 so of 461101; t, Afanulacturors 1-1, xy 1A lYl;5f0 ?74 3624 a !.!f<iYp" /~(r~TC ,S~Yf/' t r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page (D of ~ FILE INFORMATION SYSTEM SPECIFICATIONS -7 jr -7 R Owner eo fz No ~y_ Septic Tank Capacity / al ❑ NA Permit # Septic Tank Manufacturer (N E$~~ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer C(Y` OG j< ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 52 5 ❑ NA Number of Public Facility Units _-e-15A Pump Tank Capacity ❑ NA al Estimated flow (average) ' Pump Tank Manufacturer L 56 i_ ❑ NA © ~I/c~a Design flow (peak), (Estimated x 1.5) gal/day } Pump Manufacturer 0~l ❑ NA Soil Application Rate al/da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Ae ion ❑ Wetland Total Suspended Solids (TSS) <150 mg/L ❑ Disinfectio ❑ Other: Pretreated Effluent Quality Monthly ave e Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (B <30 ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) /L ❑ NA ❑ At-Grade )!L Mound Fecal Coliform (geometric me <104 cfu/1 ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: El month(s) (Maximum 3 years) El NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month)s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: l l monts)s) ❑ NA Kyear( Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA Other: >Kyear(s) At least once every: [I month(s) El NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS c _ Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following lic nses 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 (X) 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 be provided to the local regulatory authority within 10 days of completion of any service event. e Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals 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 POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter SPS 383.33, 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 POWTS INSTALLER POWTS MAINTAINER Name 1~N(Z oR MI c U(W_ Name Phone -71 5 - j -T ' 33i Z Phone 715 ~1 "f q SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY _ Name ON 5 S ~'r1 L V N1 Ilk) Name .00(X C~ 2 ON~,vCr~' Phone 'l y - O 3 Phone 7 JC . ~6 d"D This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(0 and 383.54(1), (2) & (3), Wisconsin Administrative Code. Revised 3/29/13 ST. CROLY COUNTY SEPTIC TANK MANI TI ENA_ CE AGREEtifEfE T AND OWNERSHIP CERTIFICATION FORNI Owner,%Buver Mailing Address 77 0, L' A-Z EC ) r -3 ly /2 " Prope ty Address 4f a}"~ LC ~f c~ i,Verincation required from Planning & Zoning Department for new construction.) d~ City/State > Parcel Identification Number LEGAL DESCRIPTION Propertti Location _ -i4 ,4 Sec. T c N )K R Town of Subdivision Plat: Lot Certified Survey Map r Volume 7 Pace-,,' ~ - . Warraniy Deed # %6114/ 8 Z 7 (before 2007)Volume' . Page - Spec house ~ yes C no Lot lines identifiable C yes no SYSTEM NLATNTENANCE AND 01"-ER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 3&3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form. sunned by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1;'3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources. State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranry deed recorded in Register of Deeds Office. vixw6er,o edrooms GNATLRE OF APPLICANT(S) DATE **Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV". 04/12)