HomeMy WebLinkAbout038-1109-60-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No 597405
:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holder's Name: City Village Township Parcel Tax No:
Anthony & Kimberly Hennings TOWN OF STAR PRAIRIE 038-1109-60-200
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
T . ; 27.31.18.461A-20
TANK INFORMATION EL VATIO
TYPE MANUFACTURER CAPACITY ST I BS HI FS ELEV. -b 4 Septic d` r) Benchmark !,036 0406
Dosing ~ Alt. 4(J6l~ 15 cue_ q.qq 17
Aeration Bldg. Sewe [~.t
. 7
Holding - - r St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet (3.915
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom AS z
Dosing ,U ' Y t Header/Man. 30 !b
r o n 1. O
Aeration Dist. Pipe 3•,3r6 ~0(.a
6
Hol Bot. System
Final Grade
PUMP/SIPHON INFORMATION , did, 3-7
j
Manufacturer Demand St C v r / ~o I
GPM
Model Number 17 1
T D H LiIt Frictti Los Syste ea ! Tq
H Ft
Forcemain Length r
I ;P_ Dia. t~ Dist. to W It
(Iv,4W
SOIL ABSORPTION SYSTEM
BED/TRENCH Width 67/ Leng
DIM t No. Of T nch PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Aept~~
ENSIONS 11
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM) LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type System: ~q t \ UNIT Model Number:
10150A )D 1 ~ )6 I-A
DISTRIBUTION SYSTEM
Header/Manifold Distributiioon-7 ? f x Hole Size F -le Spacin Vent to ntake
Length/ Dia _ Length [ f ..h Dia_ Spacing
f2 7'
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over i __TB Over \ xx Depth of xx Seeded/So93cd N~
Bed/Trench Center , rench Edges Topsoil
Ye8 , No F1'-Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspe tl~_on #1: C9p_ Inspection #2:
Location: 1937 110TH ST ~p k~ _ ~
1.) Alt BM Description = l.,~ GViz . ~
eN~ Q` W e ea~ O-C Pw 1. v Ir
2.) Bldg sewer length- X-4 W- %-0nbtkbK#-00
- amount of cover = x~ ~t~5
12ts~r. ~ ~ i►tis~ett(t~
i other side Required? Yes No
for additional i J [ J
Use
information. J~e - - Date Insepctor' ig Cert. No.
SBD-6710 (R.3/97)
~o
G, U
c„ ~ £ t Q ~
P C oa L.
I
7~ L(.J r a y a
fl
Industr} Services Division Cotmry
U 1400 E Washington Ave sr- 6zel/X
S PS ~/KOIC XWQRV 1060 P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
iNIadison, WI 53;W,-7162
Sanitary Permit Ap n StateTransactinnNnmber
n accordance oath SPS 3S3 21(2)• Wts Adm. Code, submission nn to the,}p(~~te governmental unit
2.9y6 79o
required prior to obtaining a sanitary permitNotes Application r its for s - le + e t 7~a)tied to Project Address (if different than mailing address)
he Department ofSafehr and Professional Services, Personal information oZide secondarv+
~uToses in accordance with the Privact Laws 1 a.t040 )(m), Stats_
1. A t )iication Information PI -e Pr•nt AI Information ~i
j Property Own 's Nan e = g Parcel k j
109 Cc L
`Property O++aier's Mailing n dress _Propert} Location?-1 . 3
~r ~ 9.35 ~/D ~ ci r Gov[ Lot _ p
City, State Zip Code Phone Number IVs/ 1A 5a 1/~, Section 47 7
_ ~l,1 ~GN/+~O.vp ~r Sy0 (circle one
"o, T M, R
11. Type of Building (check all that apply) Lot _
Subdivision Name
l or 2 Family Dwelling - Number of Bedrooms
lock P .
I r
- - - -
I (J Public/Commercial - Describe Use
it X _IV
~'drHaeOf
_S CSMNumber
❑ Sta e Owned - Describe Use
~va
,t p v y( ` .?7 ~ . ~ToNm of ..srriPrC
111 Type OW - ersuit~ (Check only one box on line A. Complete line B if applicable)
}Q ~c++ S+steni_ ❑ Replacement System ❑ TreatmenUlioldina Tank Replacement Only ❑ Other Modilication to Existing System (explain)
t3• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number Date Issued
Before Expiration O+wter d W~
-IV. Type of POWTS System/Component/Device: (Check all that apply)
Non-Pressurized ht-Grotmd ~ Pressurized In-Ground ❑ At-Grade ❑ Mound >24 in. of suitabI oil .9 Mound <24 in of suitable sod I /
I-! Holding Tank ❑ Other Dispersal Component (exPlain _
) ❑ Protrca}ment Device (eapTatn-11
!
V. Dis ersal/Treattn Area Information: _
Design Flow (gpd) Design Soil Application te(gpdst) Dispersal Area Requir (st) Dispersal Area Prop d (st) System Elevation Go ✓Ta~~ t.
Gco a boo G6 a l60. s' / 99.3
VI.Tank Info i apacit) to Total ' # of Manufact r
Gallons Gallons I Units A P 0 b„
New Tanks Existing tanks
W t//Y~J^~ n/ U n n c
Septic or Flaldme -fnn
Dosin^Cha'nb, 7S
7Sy
_VII. Responsibility Stateme - I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
PI_lutnber's Name (Print) VAAt I Plumber's $ignat Wffi RS Number Business Phone Number 11 e
Plumber's Address (Street,, City, State, Zip Code)
VIII. County/De epartment Use Only
SLAA pprovcd sapprovrd Permit Fee Date Issued Issuing t Signal e
a.Llmrer" .c.a ti,r ne~iaL._
IV Conditions of, Approval(Reasons for Disapproval ~Nill
da 9 ►d/tr~ ~ivr
SYSTEM OWNER: ~n
1. Septic tank, effluent filter and
dispersal cell must be serviced / maintained t
as per management plan provided by plumber. - I A
Z. All se aC fegUlf@Y7#~Bt$ t7t6f t{aQl i} ttygem and sub it th County only on pape not less than 8 [11 x II inches in size
as per applicable code/ordinances. ~,C~ iiln y►~r ~ ! po - ~1/lens ~
SL)-6398 (R- 0314) ~ ! ~ • ;
DIVISION OF INDUSTRY SERVICES
°r 10541 N RANCH RD
HAYWARD WI 54843-6462
Contact Through Relay
1 P http://dsps.wi.gov/programs/industry-services
www,wisconsin.gov
o
ti Scott Walker, Governor
Laura Guti6rrez, Secretary
June 02, 2017
CUST ID No. 221889 ATTN: POWTS Inspector
EDWARD J BERGH ZONING OFFICE
ED BERGH CONSTRUCTION ST CROIX COUNTY SPIA
N4050 CTY HWY H 1101 CARMICHAEL RD
ELK MOUND WI 54739 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/02/2019 Identification Numbers
Transaction ID No. 2948790
SITE: Site ID No. 838239
Tom Hennings Please refer to both identification numbers,
1935 110TH St above, in all correspondence with the agency. CONE
Town of Star Prairie
St Croix County AP
NW1/4, SW1/4, S27, T31N, R18W01
FOR: z:ZOFESS
Description: Mound, 4 bedroom residence
of
Object Type: POWTS Component Manual Regulated Object ID No.: 1707051 [>aViS10N
Maintenance required; 600 GPD Flow rate; 23 in Soil minimum depth to limiting factor from original grade; System(
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
E G
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:
~
Key Item(s)
• 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 addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
~ ."e._Per scale, the slope appears to vary. The bottom of the distribution cell shall be level per the Mound
Component Manual. The "D" dimension shall be a minimum of 13". The maximum finished slope of the
mound surface shall be equal to or less than 3:1 per the Mound Component Manual. The mound shall not be
placed with greater than 1 % slope along the length of the mound.
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.
EDWARD J BERGH Page 2 6/2/2017
• 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.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Please Include a Copy With Your
Patricia L Shandorf Payment Submittal.
POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633
(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
I
EDWARD J BERGH Page 2 6/2/2017
• 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.
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 ranting 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.
Please Include a Copy With Your
Patricia L Shandorf Payment Submittal.
POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633
(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
~G. ~ o F 9
Ons~ 77~&ewater Treatment System
i'
'SAY 17 2. 01
~`°~,r, ~u~ a.v y ~E',voi.✓z 5 - Y- ~n ..wo ~~o ~ r.S C(.v~'l,,t ~j ~ , ,
Clvs Name:
/~/E .QecN.so ~v L~-Z S5'o f 7
La IV (,-J -5 -W 7
AORAVED
SAFETY AND
Of4AL S RVI
reia~onaa c Set 0o4..? 7 4133
ERA l
4pE ~N?t IV CE 4
f ~j L GAGE
2 LoT f-lA~l /
Pap,? ~/L05S- SEG 1/o.JI pLRN !1lEl,J of lVee ig,
Page 4 z ft r,5.:-A44 zw yoo r
~EPT-/G YA~~ f~t/i~lj ~iY~'~relE4 G~iQoSS- .SEcr/ate
Page ~U~1/° ERFo/1MA.JGE_ ~U.PdE
Page ~acJ I-S Dc✓niBa `s /~galyyc 1'~ArJGE~r~~ l' Ax,.;
11 d! rr er
Pam
page Fi4 r~~L /„/Fo,yAl7a~1
sigRstwe.- Dair,< S-11- 7o17
Designed. _ ffie F61lmwing POWTS Companeal dual and vsn s 811-2
Aae" G d 06,v " r ~ .lrs re ~E"it s/sa 0 SBD -106 g!-t° 6&l. -0//O l )
_ _ A"~G~3S~2~' llLf~~:.r,~•6,''~v~'~L+.z? -~~as~Ps~vt'~~ ir!<snt 1~,4 ..2'3Y6.> ~se~~»/d?~~!°~ cfMf.:~.*'"f'G r'.;~
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U 3 C .q~D o b
O
?i
-`s Vent Pip i e
e
>-10 7i from
Building Electrical must comply 11h
in_ or 2.0 $ above SPS 396 and NEC 300
sig. !ish=d 1=(gad Elevation ~Kend manhole, riser as nece..ssmv.
Wealhemroof
`typical) Approved Junction Bo
Approved Locating Manhole
y- Vent Cap %nth Warning Label Attached
(typical)
n~hcr `lr~kc(s) as necessary -
-Conduit
;~UI'S~.~anC io SPS 383.43(8)(g) a° r4in. or 2.0 abo,fe
Established Flood ElevaCcr'
(typical)
- f -Airtight Seal
.fished Grade J.
Quick Disconnect I
18° Min.
0
gallin
Depth On) I Volume (gal)
_ 9.S x/73, 5 Weep ` \_Ap c c~ :!r
l Hole ! Approved Pho , J onto
II 2.0 3 g.7. / a`~d
7, ,S /10, y Alarm.
p.0 f /a78. J a On
} _ (c) Pump i 0- i- ~ ELEVATION _ 1 ry L J/
In
I?
- Concrete ( INSIDE BUTTGI
Block ELEVATION 3" Approved Bedding tlatenal Beneath Tank
Vertical Head f
-
aume S.m? gal ,
Sr . /6 3 4 + Min, Supply Head = fi
Dose Volume (TDV - f
~ gal/dose a o 9.0.15"
FM Friction Loss = /.3 -R
a eral void volume <TDV <0.2k design tow)
(force main drainback volume; Fitting Losses = g ft
7.5 ,;(min. supply head x 0.3)
MiNi. PUiyi= DiSCHaRGE RATE TOTAL DYNANPHO HEAD
„3 5! 3.7 9P
PUMP TANK: SEPTIC TANK(S'
Volurne = 7S y gal Total Volume = aS41 gal
m.
j Manufacturer: ,SxAe.1 6 R'F4'46 Manufacturer(s): SKAw f"/1EG~sr
Dump Manufacturer: ZC5 E l L elL
install approved effluent Ater at the septic tank outlet
Rump Model: /3d immediately upstream of the Pump tank inlet,
(See attached pump curve.)
Gontrois/Alarm IVianufactu e~ r: ,S:,T E IZ~Yo v -s - :
i Filter ManUfacturer 'd'eAR
Controls/Alarm Model: L"X ate. 7- 1
Filter Model: /lL -3
Float switches containing. mercurtit are prohibited. I
_ TOTAL DYNAMIC HEAD/FLOW 11)4
G 9
PUMP PERFORMANCE CURVE PER MINUTE 0~-+-
MODEt 159/1521153 EFFLUENT AND DEWATERING
` I I
5.- -53
I
i I MODEL , 151 _ i 52 153
I i I 1
Feel ,e er Gal. Liters Gal.. ~ Uters Gal. TLiter
50 189 69 ! 267 77 j I 291
7
a I I !i ( f0 3.0 46 770 j 6123'. j 70 26
3a
15 4.6 36 144 53 20' 61 23'
8 25- 151 - - 1 I 20 I 6.1 ~29 110 j 44 j 767 52-- j 19
25 7.6 16 Et 34 I 11 42 j i~9
6
- zo 30 9.1 - - 23 87 33 125
i 35 i0. - i - - 22 85
15 ! i 40 179 1 ( - - 11 I
IL -
Shut-off Head 30 ft. (61m) 38 ft. (11.6m) 44 ft, (13,4m)
I ~ I ~ j Ot4&3P..,
-I 5 1 ~i- ~__i~1- •
Model 151 Models 152115
1o is ~a as ~a sa 7a s'o sa soa
'-%1oNS ; 6 7132
6 t
/ 3718
. r . r 3118
• , ir,tuc u: si to panels
Electrical alternators, for duplex systems, are available and
supplied with an alarm,
`triable level control switches are available for controlling
sirlgle phase systems. y
Double piggyback variable level float switches are available
,or variable level long and short cycle controls. t- ; -m== i'
Sealed Qwik-Box available for outdoor installations. See „ t„;6 12 Ire
l I
-i011420. _ - -
s 1 a,v,ei T ~fJl l
SK2444
15111152.1153 MODELS Control Selection
"iodel Voll4•f'h . 69ode Amps Simpfex_j Duplex
01 ! 116 1 Non a 60 1 T 2or3
RN151
115 1 Auto 6 0 Induded I 2 or 3
230 Non 1 3 1 2 or 3
BE151 230 1 Auto T 3.2 Induded 2 or-3
„Easy assembly"
- - \ N152 NS 1 Non BS 1 2or3
- - 7• (pump S discharge Poe
BN152' 115 1 i Au o 8,5 ! Included 2 or 3 not included.)
1,12 230 i- Non 4.3 i 2 or 3
'.Q
r i 52 230 1 Auto 43 Included 2 or 3 '
~ a 115 1 J-Ncn ; lo .5 1 2 or 3
1 1103 115 1 _ Auto 10.5 _ Included 2 or 3_
,7 t A
53 230 0 1 Non 5.3 1 2 or S,,ae ; 4yyuack ` arlnv'c bVc o ::!vu !C r . Syi uc~O,e I
goat switch Refer to FM0477. Reduces potential clogging by debris.
Replaces rocks or bricks under the pump.
See FM0712 for correct model of Electrical Alternator E-Pak. Made of durable, noncorrosive ABS.
a. Variable!evel control switch 10-0743 used as a control activator, specify duplex Raises pump 2" of; bottom of basin.
Provides the ability to raise intake by adding sections of 11/"
1A CAUTION or 2" PVC piping.
Attaches securely to pump.
Accommodates sump, dewatering and effluent applications.
'NOTE: v'i'ne sure float is tree from obstruction.
i-Ot uP,usul ; clon it!on a rsseFt w S3'f°.[; [k,, c, s o clineeIerei into Hite QP,51~1. u5 eVa
.vner- ri/i✓
1AJ 4 i { Septic Tank Capaci' gal ~ N: j
-eimti T Septic Tani: manufacturer i SXA~ ~tGASr 1 NA
Effluent rilEeriliaPUfBCtLrzr i=E \A
Number o Bedrooms (I00--pd/bedroom) I 4j/ Effluent Filter Model
I G 3 C Ty ~
,:umber of Commercial Units , !Pump Tank Capacity 2al C Nrk
Estimated flow (average) + 3/op gal/day ~ I Pump Tanl:'Manu?acturer ~ ,Cq~,l AFG~1" ❑ !`.A'
!resign flow (M F)_ estimated x 1_~ o ,lj Pump lyianufacturer i Z4-,-z ~ i lA
Goo caday
Pump ivlodel i /S1 El NA
Soil Application Rate ci/dcY !r -
Preire8tmeil't U_ NIA)
1n uentiE:Iue-itQuality (cn N, MontbivAveraae Ilit i i ❑ Sand/Gravel Filter Peat Filter
afs_ Qii Grease (rOG) S 30 M&L R n iviechanical Aeration M Wetland
Siochemica? O,\yi;en Demand (BODs)
Total Suspended Solids (TSS) 2120 ma /L C! Disinfection Other
i Nianufacturer: \'iodel_
! < 150 ma/L
j Soil Absorption Component nA)
- retreated Effluent Quality (;K NIA) Montlily Averaue i
G In-ground (gravity') ` in-wound ;pressurized}
Biochemical Oxygen Demand (BOD;) j < 30 ma." L { n At_arade
Total Suspended Solids (TSS) I found
1 30 m2I G Drip-tine -i Other:
Fecal Co Harm (geometric mean)
- S 10 cfull oomi { ! Vertical Distance Tank Bottom, to Service Pad:
i
:'Ia., i.um E luent Particle Size f 1/-. inch diameter ! j Horizontal Distance Tank(s) to Service Pad: /1010
Dis33ersn Jn- 1'.! Fem./l ,oc'ei rdumba .
latfo s:
Soil Dispersal End Crap (Dispersal Unit EISA) or
- A imlication rate = Area Required - E S - (1 rencli Width) = = Units or Total ! ,enath of-, renchi s
n "-Desicn of Pressure Distribution Networks for Septic Tani:-Soil Absorption Systems-' Publication 9.6 (SSV-0jvLP Manual)
0 'ICC Plowtech Mound Component Manual" Version 1.2
i "EfFlow Mound Component iWanual" Version '0/20/2007
C SBD - 101;5-!-P (R-M2, ) "Aid Grade Component ;Manual Using Pressure Distribution" Version 2.0
i ! SBD - 10705-P CN.0U0 1) "In Ground Soil ;absorption Component NdanuaI'- Version 10
ZSBD- 10591-P CNi.0i/oI) "NIound Componentjvianual" Version2.0
❑ SBD - 106557-P (R_6199) "Drip-line Effluent Disposal Component ivianual"
, SBD - 107 6P (i`i.01M) -`Pressure Distribution Component i2anual" Version 2-0
Cs Ober -
ltee em=,:`
_-,in,p,`inspect tank(s)_ inspect dispersal cell(s): clean filter ! At least once every: ;913 months ~I'J j'ears ❑ Other -
saect pump & pump controls, alarm, preir eatment unit ,At least once .a. lerlV; [j _ months $ 3 years 0 itiiA j
F!us't; and pressure test laterals i At least once every: L months W 3 years -L] NA
- ~R-- ':Iw = _ For new COIIStrtlCtlOn. prior i0 use Gf tree o0WTS CheCl: ii 28imcnt tank(s) for the presence of
11ainting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s)- If high concentrations
-l re detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Sy steri s=ar up sha?I =_iat uec
,Ue Soil coiiditUoss a-e ffOzer- a tine intlitrat!ve sue face.
T:iC property owner is responsibie oi- tide operation and maintenance of the PO "\tiTS and submission of required reports- The quantity
::nd aualitv of the wastetVatc:r stream ,;'ill affect the periomouice and lon°evity ofyour POW T S. ' Ile installation of water-sayin-
as.3m;antes and Y-Wmres along with prompt repair Ot leans reduces the -,vastewater volume- Also the brine or waste nom water
softeners. iron removal units. other clear v,,alter treatment devices and foundation drains should be discharged to the ground surface
':'Jlienever possible. mote: this does not include laundry waste. sllo%vers, dishwater, etc_
! his svstern is aesiQaed to handle domestic sireng-th wastewater, however, tthe disposal of ;ood based greases and oils; vagetablel= _i
peels and seeds, bones. and food solids such as those produced by a garbage disposal should be minimized- Toilet tissue is the enl:
paper that should be discharged into the system- Other non-biodegradable itenns such as baby wipes, tampons, sanitary napkins
condoms. ci;at-me butts, dental floss, and cotton Swabs should not enter file system. Chemicals such as petroleutrl products, pain:,
Page Z of 9
i-3r nev:r construction: prior to use of the POWNTS 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 o 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 till above normal highwater levels. When power is restored the excess wastewater :rill 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,
-o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to 't'he
effluent pump or contact as Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
A,ithin one 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.
\eduction or elimination of the following trom the wastewater stream may improve the performance and prolong the cite of the POV ; &
_~<<tibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tat; foundation drain
:r, rp pump) water, suit and vegetable peelings; gasoline; anise ~iC Ges; ea S::=_S'; •Mr _GicauGns; li!_ ?J tirp `ni!U -i ;
pesticides; sanitary napkins; tampons; and water softener brine.
S.ti, WDONWIEN T
\/Vhen the POWTS fails and/or is permanently taken out of ser lice -LhG _oliw'ing steps shall be ai:.e^ c incur= `hm' ; a s;%sta S : c,;e
and safely abandoned in compliance with chapter SPS 383.313, Wisconsin Administrative Code
Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings saGlad-
The contents of all tanks and pits shall be removed and properly disposed of by a Septage ServicinG Ores: r.
After pumping, all tanks and pitF
gravel or another inert solid mats-
-"'i -iNGENG'f PLAN
`.f the POWTS fails and cannot be rel.
ren!~_Lernent system:
suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
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
c a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
~_Tect at that time.
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 POWVTS.
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 POVVTS.
% ?;iound 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.
<r<i`~aR'stiING»
S-PTIC, PUMP AND OTHER TREATMENT TANKS MAY COW AN, Ai, LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO MOT
= tiTER ASEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUiii+ES T AMCES. D ;ATE `c D AN REST. L T . ?ESC-UE O_ F A'
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE=
ADDITIONAL COMMENTS
POkfVTS INSTALLER POVTiS MAINTAINER
E- ,QE~tN
Name E/I E2GN !!S- d/S8 i Name!,
Phone /S S 77 - 9,705 1 Phone /S 7- .w-
SEP T AGE SERVICING OPERATOR (BUMPER)- ? LOCAL REGULATORY AUTHORITY
Name Name'
~ Jlr Liaa.x ~o. Za,Ji,Jt DfF/GE
a
Phone j Phone 715-
~8L - yG 84
This document is intended to meet the minimum requirements of ch. SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative GocJe-
Use of this document does not guarantee the paporm2nce of the PC!VdTS_ Rev. (3i 13)
• ~L . o r Cf
yi ON
x ?i ¢ f
Enstallation
Dry fit the filter case onto the end of the outlet pipe to ensure it is
~r i~ f
centered under the access opening. If not, then either insert more pipe into the _
ank through the outlet or solvent weld (glue) additional pipe onto the outlet q
pipe.
While the case is still dry fitted on the outlet pipe, measure the length t
of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the
optional supplemental side support. If side support method is not utilized,
proceed to step four.
~c T
For installations utilizing the optional supplemental side support:
'
-olvent weld the 344-inch pipe onto the filter case. If side support method is not
utilized, proceed to step fours
Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the filter locks into the bottom of
the case.
r
y..
.
If a VRS ; - ; r
~:c:i_ mac,
clockwise 900.
AaintenanC
The effluent filter shouic Le cieaneu eve.y
- dmc die sepUc tank is
serviced.
Open the outlet access opening to inspect the tank and filter.
r +
Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and efFluent.t
Once the effluent level has been lowered below the invert of the
outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case.
3
Slide the cartridge up and out of the case for cleaning.
z
o. If a VRS switch connected to an alarm is present, the switch
should be removed by turning counterclockwise 900 and cleaned '
with water only.
'While holding the cartridge on its side (large flat surface facing t : q
down) over the access opening, rinse off the cartridge wit'n water i
only, making sure all septage material is rinsed back into the tank.
S. If VRS switch is utilized, replace by inserting into filter and , k
s
turning clockwise 90°.
Insert the filter cartridge back into the case, pressing down until
the filter- locks into the bottom of the case. i
10. Rcplace end secure the access orning cn the tank.
n r Is n +t ~1 ~«r , tr fr , n~ 6r F r ~
.}e c" 3 c cd;rc: _ J b + i J_r- o.».:_ L. ..a*r?~t•, :rr ; i
> sn~~f~n-t:or= r_~ + i.r ;ro„ .r,o'_ t-3d_,F. ..-,I, r n s. t n~ - ra.~ : r.r ; •wCCCr s' l a f:. =_d '
no ev_nE s; t._ Eiz i . c. 3,- _ ...red
= purci:a__ of 'd:a Pr-odur.,.
S: CROIX COUNTT
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Ai tkok, ~~Z~IDI(r~c~S
Mailing Address f ZC(c 1'Vor.ti.vty ! ; ~e ~nt. c. ~r ~z ur tL~t~oli c~ ~,/T S { o l 7
Property Addrre 3 7 l to SE y,,z~ / u~~ r^•~~" O` W l 3`4 c? 7
e ! (Verification required from Planning & Zoning Department for new construction.)
City/State Ye N r
~ Wr Parcel Identification Number 0 3y l0 `l c,
LEGAL DESCRIPTION
Property Location /1/W Y4 y✓ '4. Sec. Z7 T 3 1 N R t `6 W, Town of
Subdivision Plat: Lot # 1/114.
Certified !Survey Map # t o3Og Y1 Volume Z7 Pa.ge
Warranty Deed # (before 2007)Volume Page'-.' 4~
Spec house DyesKlto Lot lines identifiableKyesE] no
SYSTEM MAINTENANCE AND OWNER 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 Seto
the svstem can affect the function ofthe septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS_ 383.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form- signed I,% fr:
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 i,
less than I/'; full of sludge.
Uwe. 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 P.nd Professional Services and the Department ofNatural Resources.
State of W isconsin. 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/vie certify that all statements on this hi e are true to the best of my/our knowledge. Uwe amiare the owner(s) of the
property described above, by virtue of a wart- v deed recorded in Register of Deeds Office.
Number of bedrooms
zi L7
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made ill the warranty deed.
(REV. 041112)
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START CONSTRUCTION
04- xbd- <3 ° z e n 42 ~~a §v~~q fiy~o
TONY KIMBERLY HENNING6
u ~o T,o D x 32 a 6 m~
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Division of Industry Serv 9@..^ Q
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APR 2016 SOIL EVALUATION REPOR / age / of
ST. CROIX COUNTY APR i I in accordance with Comm 85, Wis. Adm. Code
OMl ~ln ~t9l , County
M Jess ##tpn 81/2 x 11 inches in size. Plan must
Include, but not "WWK is Lkrizontal reference point (BM), direction and Parcel I.D. .
percent slope, scale or dimensions, no'itPt~16tdw,16nd location and distance to nearest road.
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
IX4 - Govt. Lot 1/4 ~.J 1/4 N R E (or) W
Property Owner's Mailing Address Lot # Bloc At Subd. Name or CSM#
City , St to Zip Code Phone Number E]City Village A Town Nearest Road
-1)7 I
( )
El New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD
fj Replacement 0 Public or commercial - Describe:
~l Flood Plain elevation if applicable ft.
Parent material
General comments
and recommendations:
}t'
'I r - • •i~ 1 t
Boring G
Boring #
III III Pit Ground surface elev. ft. Depth to limiting factory in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
VZ-All 5Y;712
Boring # Boring
to pit Ground surface elev. Z ft. Depth to limiting factor- in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
CST Name ase int)) Signat a 1) CST Number
Address / Date Evaluation Conducted Telephone Number
"~L4
/ Xil L~
SBD-8330 (R07/13)
Property Owner S ! Parcel ID # Page of
Boring
Boring #
Pit Ground surface elev. / S ft. Depth to limiting factor in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
6
❑ Boring # ~ Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring i
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
17 Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fiz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
" Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
SBD-8330 (R07/13)
Property Owner Parcel ID # Page of
Boring # Boring 99
F-51 pit Ground surface elev. ft. Depth to limiting fact in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
- m
ly
❑ Boring # Boring
n pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture FGr tructure Consistence Boundary Roots GPD/fg
in. Munsell Qu. Sz. Cont. Color .Sz. Sh. "Eff#1 'Eff#2
Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
F1 Pit Soil :Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Ef#2
Effluent #1 BODS > 30 < _ 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 - - BODS < _ 30 mg/L and TSS < _ 30 mg/L
SBD-8330 (807/13)
1
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