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HomeMy WebLinkAbout026-1048-50-100 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 597429 GENERAL INFORMATION State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2960673 Permit Holder's Name: City Village Township Parcel Tax No TAMMEC LLC MATHY CONSTRUCTb TOWN OF RICHMOND 026-1048-50-100 CST BM Elev: Insp. BM Elev: BM Descripti n Section/Town/Range/Map No y 7 Ala,"( , At,~- 16.30.18.243 c TANK INFORMATION ELEVATION DATA " TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 'QD Septic Z Benchmark stp mg -760 fr', ~ LAA 0 I a ~ ~Z~`l Alt. BM r~ Aeration Bldg. Sewer -17(,,-( Holding St/Ht inlet `l-7 TANK SETBACK INFORMATION St/Ht Outlet rj • 3 975 , -7 TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet Septic Dt Bottom zz a Dosing Header/Man. 7" ~ 9 7 3: 4 Aeration Dist. Pipe 7.69 'L Holding - Bot. System 7% -1 7 Z q~ 14 PUMP/SIPHON INFORMATION Final Grade 7 I0b h4 Manufacturer Demand St Cover / GPM {r+'~ Z 97 Cf Model N r T Lift Friction Loss System Head TDH Ft A P, & 7Y. V9 Forcemal - Dist. to well 0!I J J SOIL ABSORPTION SYSTEM N'v BED/TRENCH Width Length / No. Of / Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS --3 s _ + r~ ~ a SETBACK SYSTEM TO 10 P/L !BLDG WELL LAKE/STREAM LEACHING Manufacturer: EZ INFORMATION Type f System: r~ CHAMBER OR ~ J _ r f '~Qa ~b S A, UNIT Model Number: b l ;5 DISTRIBUTION SYSTEM OJt v EZ /O Header/Man'rfold ID stribution Ix Hole Size Ix Hole Spacing Vent to Aire Pipe(s) / Length _ Di\ Length Dia Spacing - G SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systerns Only Depth Over Depth Over 70 Depth of xx Seeded/Sodded xx Mulched Bed Trench Center Bed/Trench Edges psoil No ~+ti Yeses C, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1180 CTY RD G i rj I d ^1. r, I P,-~ 1.) Alt BM Description = i ~J VU L^O 1,.6 2.) Bldg sewer length = 22 \J / y , 9 / - amount of cover 3z a v` ~ 50 I Plan revision Required? Yes Y No Use other side for additional information. Date Insepct ignature Cert . No. SBD-6710 (R.3/97) t~ ~1 5 C. q,w pQ~q J C/ - Sh" c-2 0-7 ai;T'"'Ra , County ~a Safety and Buildings Division C' 201 W. W ngto Ave O P x 7162 c , Sanitary Permit Number (to be filled in by Co.) p ` S Ma W V537 -7 - _ ` uNrr H3X030K3KY4DT 5 / ~7 Z~ ~p~~ ermit Application State Transaction Number In accordance wN83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 3 - 25w is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondan ur oses in accordance with the Privac Law, s. 15.04(1)(m), Stars. ~0 C'4,~ ~ 1. Application Information - Please Print All Information Property Ow9gr's Name Parcel Property Owner 'svlailingA~ress Z~ Qr ©Z~- 169g- 5-,0_140,6 43 9z0 Property Location/ . 3e. / O~ i/ II 1 City, State Govt. Lot Zip Code Phone Number A Section ~~(circle one II. Type of Building (check all that apply) Lot # T 3o N:/f--R- F o JT5 El I or 2 Family Dwelling - Number of Bedrooms Subdivision Name c KPublic'Commercial - Describe Use ,it f BI ❑ City of ❑ State Owned - Describe Use G) CSM Number ❑ Village of I ` Viri ~OLw~ i. Town of /P~ C✓~Q70^ 0 Ill. Type of Permit: (Check only on box on line A. Complete line B if applicable) A. New Systcm ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing Systcm (explain) B. ❑ Permit Renewal [I Permit Revision El Change ofPlumber E. Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owuer IV. Tv e of POWTS System/Component/Device: (Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound? 277- 77 4 in. Of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required ~ (,s Dispersal Area Proposed (s System El _tion l ~ ASS / eAr L 6 (P Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ° n c ° u New Tanks Existing Tanks G _ W ✓ VV G C: r Vi CL li `L Septic or Holding Tank ✓ ~ ~ ' Dosing Chamber I~ VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shoes n on the attached plans. Plumber's Signature Mp fPRS Number Business Phone Number Plumber's Address (Street. City, St ip Code) 3.7.1 w- J'ce VIII. ounty/Department Use Only Approved isapprove Permit Fee Date -sue ISSLH gent Signature w, e • i Reason for Denial S g6'. bo S 17 IX. Condit n isapproval UiS er :sn cell must all be spr.•tces'nl !n ~;R 3) a~4.>✓11~ Q^(~ As per.nar:agement plan pfcrtioed by pluinbe!. 2. All setback rechirer; en~s.~lust;:t~ ► 2airtt, it e~i as per aWlicabls co& / tirdinancea, Attach to complete plans for the system and submit to the CountY only on paper not less than R 1- x 11 inches in size SBD-6398 (R. I I/I I) r 3 _ Q \ J 2' L:- SQ ~ ME . _ _ '.r r _ ~ L u- _ :rx,, - .rte - O = In W 11 I . F- Q~ ~ Q N S- LL s W = a Z U M - w cc n - J k Fx 4~,. - _ U W a < - Q ~ : ~ - 1 Q r = Co - - - - - - - - - - - - - - - - - v - ~ Z L In z 5 ,v :mac - _ m - r Q U w LL) j - 0) v~ 0 r n _ - x _ , 3s O \ . _ _ . (1) - > f z - N ~ - : aM rte . 0 a s y t~ ~ - - - ~ ~ - ~ - ~ ,.~~t ~ o N C) _ - ° ~ - - ~ ~ ~ ~ . . ~ - - z " ~ X E r t 0 . , . It ~--i _ _ - ~ c - rF y . - - ~ I . , - . 4~7 ~ - ~ . ~ , I : - - - f , . . 7- - - - - ~ ~ .1, p- c 1 s - 7. . - - - I . . . . . . --l- - - - - - - - -1 - . f - V -A--~K-: , ~ ~ s ~ F ~ "I I- 11 - : x e € x n ~ I..:: .4. ~ k . - ll~ . - - ._i : . F _ r It ~ ~1 Tomas IW -w p F 11 - ti~ x a ~ . \ : ria Y...~k 2 1 Y 1 . w Jetr ,].t 4. N tt ~ f = I r C y ct s: _ _ _ v^I Y l 3IVDS JO IIVAA NO MVA HJN38 TIWAA i N1:11ANAI~'Y `~9tie',xrnlp~ DIVISION OF INDUSTRY SERVICES To 3824 CREEKSIDE LN 1P HOLMEN WI 54636-9466 a Contact Through Relay I S P http://dsps.wi.gov/programs/industry-services v~ Gw Jul 3 1 2017 www.wisconsin.gov 4 ~0 SIONP, Scott Walker, Governor Laura Gutierrez, Secretary July 27, 2017 CUST ID No. 225410 ATTN: POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING & HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/27/2019 SITE: Identification Numbers Tammec, LLC /Monarch Paving Transaction ID No. 2960673 1180 County Road G Site ID No. 839113 Town of Richmond Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NE1/4, SE1/4, S16, T30N, R18W FOR: Description: Commercial Non-pressurized In-ground POWTS \ Filled area Object Type: POWTS Individual Site Design Regulated Object ID No.: 1711818 Maintenance required; 116 GPD Flow rate; Filled area; System(s): Non-Pressurized In-ground; 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. 4. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code rMDIT requirements. AP P I" No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, T)FPT C' stats. r~ F ESS' The following conditions shall be met during construction or installation and prior to occupancy or use: OF ' Reminders • This POWTS has been reviewed and approved as an Individual Site Design due to the fact that the existing onsite fill material will be excavated, removed and replaced approximately 14' of sand that conforms to A Standard C33 for fine aggregate. The system shall be constructed in accordance with the approved plans and c . SPS 383, Wis. Adm. Code. • The fill material used shall be verified as sand conforming to ASTM Standard C33 for fine aggregate as per SPS 384.30(6)0), Wis. Adm. Code. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • 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. PAUL R KOEHLER Page 2 7/27/2017 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. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/install ation/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. Sincerer Fee Required $ 250.00 This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. PAUL R KOEHLER Page 2 7/27/2017 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. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 chances 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. Sincer , Fee Required $ 250.00 This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiR/LNRT code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "'Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. RE~E/V JUN r 2 2017 ~._NDUs T-RY S i CONVENTIONAL COMPONENT DESIGN V/c~~ Residential Application ~`-°-W~ INDEX AND TITLE PAGE Project Name: TAMMEC LLC Owner's Name: TAMMEC LLC MATHY CONSTRUCTION CO. Owner's Address: 920 10 TH AVE N ONALASKA WI Legal Description: NE1/4SE1/4S16T30R18W Township: RICHMOND County: ST CROIX Subdivision Name: Lot Number. of IALI Y /ED Parcel ID Number: 026-1048-50-100 ETY AND _ SERVICES Page 1 Index and title `TR'H Page 2 Page 3 Page 4 Page 5 Y c. sd./ Page 6 diO fe,r-\, Page ? hz ~.oec Page 8 Page 9 Attachments: Soil Test & House Plans Designer/Plumber: PAUL R KOEHLER License Number: 225410 Date: 06/07/2017 Phone Number (715) 246-2660 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 :;BD-10705-P (N.01/01). Page 1 4- Septic System for Monarch Paving, Located at 1180 CTY RD G New Richmond, WI 54017. This System Will be Serving a Building Used for Testing the Products of the Company. It Will Have 4 Employees Working from this Faucility, & a Floor Drain that Serves the Mechanical Room. The Sink Used in Testing Products will go to its Own Holding Tank. For Others Approved Methods of Disposal. The System is Sized as Follows: 4 Employees x 13= 52 + 1 Floor Drain 25= 77x1.5=115.5/.7 Loading Rate= 165/30 for Square FT Credit of EzFlow Dispersal= 5.50 or 55FT x 3 Wide. Proposed is a System 60x3 FT or 180 Square FT of Disposal. The System is to be Installed After all the Old Fill Material is Removed & Replaced with ASTM C33 Sand. The System is not Expected to be Used Full Time as Testing is Done Seasonal. As Weather Permits. r~ 2-- . # t J w w , ~ I ~N , - Q ° m v ° r W o ~ - Li:i.-- 4 W Q LL k a z . ~ . . t- Q Q ti : w of ~a , m _c 1 - n. j 3 2 vi M r~s t Q ~ Q ^ I = Sa _ w ui z zIs m v~i J LL f £ z ~ m rte, LL 7 Frt U 0 , ~ L1 - cr w Q (10 ~a, c cl~ N w Q v) f~ a ~ t ~ I-,-- - I ~ ,-,-1, CY) f _ i m - - ° C I S f a - O ~f B- .T.a~e,f - - n < F 1 3~ a\ O , 4- I LiJ D ° N W , O , I-I... . - ~ ~ ~ - . - - - . - ~ Li ? c M . IM , M= r+'~ v X o i m, lp ~f C N: 3 . 7 4 , x - ~ y., , C . . CL as - "cF u . . , £ 3 ~ I Y - ~~I 8 ~ t cn < j ^'Y°~' \'Qv ry Via, g :FS,A ~~f... . :3 . - , ;i i_ r z . . -.1 - I. 1.11, I 1.1-11, -1- -.1- - - . - ~ ~ - ::7:~:~:~:~~.~ t U - O ~ a a, ,11 R f 31V:)S JO lldM NO MVA HJN38 -11WAA i niainnni-I-i' 41 ~ .ors d' >,t4 ~ Ffi APNIMP, a fi fy- Y z T ~ y ' F l S A f e ~Ji 6 E -a ,,i~~.. CV M G m C°.>~ ~ a ~ ~ £ BUD 4 ~44 ' P"~ O lit 9 C O ~ ~r a e /ppro,rnatly14of fi maeral to be~ re hove , ~a r« ~ 1a ed kith,,'astm`.c3~3 i- # he I ^ (moun'd'sa"nd w, r t ln.su sai# y: Sand #.7 loading rate ~9 E AO At t ft of astric -fie I .Pr sta 16--c f `d r Re t s q t r' : y i Y Ss ^ r a q _ F c y ~ 'Y l e Z _ 8 .l. - F r «n } `r ,rte 5 d` J Wr ~ 6~ A ~ Y 4 ~ t 3 0 ) t n ) 'e4 3 f . ~ a4 t ~ f > !4 h e4 ~ t 7 , 7 dnE :7. aa( 1'1 rats. L`~ 4.¢ k.. ~ R. v fy. - L t t. 5 I SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page_of_ Project Name: MONARCH PAVEING 1 No. of Cells 6 Per Cell r 3 ft Cell Width Total No of 6 60 ft Cell Length C30 sq ft EISA Per Cell( ' D 1 0 ft Cell Spacing 180 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: INFILTRATOR Gravelless Leaching Unit Model: EZ1203H-10 Typical Cross Section Finished Grade 98.6 ft -5ctj f~VC to Observation Pipe with approved cap or vent c 4- ArTia iiL f`~~ 11 ('ac e t ....■.....t--_ ■ Soil Backfill Geotextile Fabric -°s It Infiltrative Surface 12 in Q i ft Limiting Factor 168 in Slotted and Anchored Vent/ Observation Pipe with Cap \ \ \ l ! \ f Plumber/Designer Signature: License v J' S`l4 Date: gJh -r. 1 ~j~ i w Y W = U a O C7 a Of U) p CD -j N w= co Z 0 2~ O ~ B 3 ;S ~n I Q Q~O oM gi55 p O - ' i LEI LLJ ~(n O'er Z ~Z o Via-- M00-1 O~ t~-U O~< u CL O Q U ON U Ch O CO W M M W O U M U E M U (O N co C5 LO N M O (D u u J ~ N U to O to N O U r Q) N ~ O LLJ O O U ~ _ 'Z Q U - U) Z c~ w = ~ F- LLJ Z) ~1 ~ J w Z m _ = U O -LLI j Q C/) U u ~ O m z Z W N CO U cn O > = LO O d W U `N J Z W N U ® ~LL-¢ F- Z W z O J o O 2 a Z w i t L cv-) a- CQ Q>~ CD0007mJ LnZ~ZWQ C%4 LU i m L9 or - = J 0 0 0 Lo 0- a:5i 20co o i/l M-IXLdW :3113 95 8-SZ~-008 0 :anOd-1SOd :31V0 00/00/0 0 :31VO OSLtiS IM '>1008 N301VW OL kMH Sn 9LL£M Z \ Via 313H0003 B3331M ~df1Nb W ~Ild3S w :aflOd-3ad „0-,l=„b t :31V0S d0M *,18 7y -8a w NN-OSLd-M N 0 w Li ~ w Of J U `L H Q Q z } w O J Z 0 0 IoW z a a m N ~,a } N w d w t C) LLI I.- W Q (~no° po WOE Q O L7 m w o U w,2,t OJ QJ O Q mU H IV H O ww Z LL Of Ow QU Q 0) o N a L, D Oz 3 LL o a H O 0-n O m(n ~wW O t`O O~ U \1 Q of > L) o Lr) U o > - vi J a ° cn ao z U) Q N _ m Q = 0 w y. N Q a o C,4 r- ° r- LLI _ a_ s OWNF- mWN 0 O Q? 000 Z a a _ ..O N N~ N Q V 04 << WJ Lo I j Q Q w Q } d J 00 w 0 Z En w~0Z>LLI tp ~~U (-!Nln 1- U= Z D = Nn0 Zo \ Ch Y (V JOF- O-JF- 0QW 0pw Q ZQH V)i w U pW ~v~i Z zJ0 ~==N30= oY U o Q°w w m~ ° Q ozc~F-O~c_~ a z °V,~ Q ° z F- Z3mO°~=0ma Qvc~ Q~° U Zao Z (Q.> N of w F- o o 0 U- L w w H o z z o o Qo Z >Z Z al` J 2 J QO ~ F- U U f Q W N I Q I cn f- z Q W Z U w W a O 0 of Cl. Q :2 w Of a - - N w o I ' Q ~ W I M < 119 "Z i~ LLJ in F- C) \ g j x' ~ ~ I w w w H 0 N W J ° Z W .,Zt F U Q U- „tie 43dino3N sv „bS z Q w of Q N Y z Q F- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION SYSTEM SPECIFICATIONS Owner h! //--e Z L Septic Tank Capacity C gal El NA Permit # Septic Tank Manufacturer to ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer P. ~t Z` 4 ❑ NA Number of Bedrooms NA Effluent Filter Model 152 - 11 NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal 4 NA Estimated flow (average) gal/day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) f f. A gal/day Pump Manufacturer -E;AA Soil Application Rate / gal/day/ftz Pump Model 4<NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) S30 mg/L x ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODB) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) <_30 mg/L kin-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <10G cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 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: ? ❑ month(s) (Maximum 3 years) ❑ NA J year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 0-year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA ayear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ? NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ,)7 NA ❑ year(s) Other: At least once every: ❑ month(s) ONA ❑ year(s) Other: I5-NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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. Page of v 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 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 property 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 fines 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. T aluati a o ding~ank be i e ai e ~R N418 TI'S f7D R- CZ r S77 (JC--A 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 POWTS INSTALLER POWTS MAINTAINER Nae m c~ le X-111 e I /I Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name (SUN 20Al /J Phone V _ - L:j Phone - 3 O l0- (p,YD This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative 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 cellls). 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 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 p}( T N//~1 aluati a o ding~ank be i e ai e ~R D+-f 181T>✓n ~ 2 I.l,~ Cah15TR tJ~t 0 ❑ 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 C~xj/ff v Name 01 Phone 7 `s 3../Z) Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name l 1162i ."4161 ,r /1 S Name l~1~16 [ w_it' I 20/l~l Phone Phone (~j - ~(p- (p This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)Id)&(fl and 83.54(1), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Permit # ~D gal ❑ NA Septic Tank Manufacturer ❑ NA i DESIGN PARAMETERS Effluent Filter Manufacturer 42(NA Number of Bedrooms 4;E-NA Effluent Filter Model a LOG / NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) 22 gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer 411 NA Soil Application Rate 12 gal/day/ft2 Pump Model 11 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) i 5220 mg/L NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand-(PODS) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L1 NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <10' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size %5 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: ❑ month(s) ❑ year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ❑ year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: E3 month(s) ❑ year(s) -9~NA Flush laterals and pressure test At least once every: ❑ month(s) IN NA ❑ year(s) Other: El month(s) At least once every: ❑ year(s) qa'NA Other, ciiii. NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (%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 <_12 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.