Loading...
HomeMy WebLinkAbout008-1050-70-000 (F,C 22 30 30~ AVE. PRIVATE SEWAGE SYSTEM nt: St. Croix Wisconsin Department of Commerce Safety and Building Division Permit No: INSPECTION REPORT 597432 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No 2976505 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: STEVEN & DEBRA SYLVESTER TOWN OF EAU GALLE 008-1050-70-000 CST BM Elev: Insp. BM Elev. BM Descri oni Section/Town/Range/Map No: 17.28.16.260 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~O Alt. BM wvu~ Dosing DT. Aeration Bldg. Sewer ( ! ~ 3- !S OZ.SD Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 5 ; ~ y sue! Dt Bottom ~/.Sd ~ gOl Dosing Lt LA L, ~ tr Header/Man. Aeration Dist. Pipe : / spy Holding Bot. System 55S D / _ - 00 , gIJ K, C-41 Final Grade j PUMP/SIPHON INFORMATION N' Manufacturer D St Cover ~T- 3•/P /~Z PM Model Number TDH Lift Friction Loss System Head Ip(p,-2n :4.6 1 O ,a t (0.1) Z, b0 ~-jLi 1 a 1 3A Forcemain Length I Dial Dist. to Well SOIL ABSORPTION SYSTEM 2- 3 3 'f' BED/TRENCH Width Length No. Of Tr ches PIT DIMENSIONS No. Of Pit _ Inside ia. Liquid _Depth DIMENSIONS SETBACK SYSTEM TO v P/L BLDG WELL LAKE/STREAM LEACHING Manufact~reF: INFORMATION CHAMBER OR\ 111 Type Of S t I2 t L UNIT Number: DISTRIBUTION SYSTEM I , I J Header/Manifold Distribution x Hole Size F Hole Spacing Vent to Air Intake ( It Pipe(s) Q , / / 17 Length Dia Length 1 ~a ' is Spacing ~ta SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over Tx-x pth o f xx Seeded/Sodded xx Mulched Bed/Trench Center Bedrrrench Edges oil J Yes No J Yes I` No COMMENTS: (Include code discrepencies, persons present, etc.)) Inspection #1: Inspection #2: Location: 2230 30TH AVE Ca, r `tc /cto- sYo~,4e_0' a-j /Jee-?~ 1.) Alt BM Description r 1.4-j~awS-~-K ~eM_ jh4wzW_) 2.) Bldg sewer length = t 9 8/ - amount of cover = I! Gd w~ ` 3) ~P'^'n~ I'KGstil iL~e I`~'nf..~• ~1'1.~~2' ~ ll~j~'~ a 4 ~ d !J ! ( 3. ~ ~ Plan revision Required? ❑ Yes No d0 a Use other side for additional informat(on. O ! ate Insepctor's Signature Cert. No. SBD-6710 (R.3/97) / RECEIVED— -ac- 1? - ~b $si AUG } / } Safety and Buildings Division 8 K G 4! I 2011 201 W. Washi ton Ave., ROn Box 7162 Sanitary Permit Number (to be filled in by Co-) r'$ A C:ROIX COUNTY Madis X07,362 I± MNTY®EVELOPME 41DJGFSE68 RDq l Z 'v State Transaction Number Sanitary Permit Applicatwl_.t c In accordance with SPS 383.21(2), Wis, Adm. Code, submission of this form to the appropriate governmental uhf J) 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 secondary ~~_30 purposes in accordance with the Privacy Law, s. 15. 1 m , Stats. L Application Information - Please Print All Information Property Owner's Name .l ' Parcel 4 Property Owners ailing Address ll~ Property Location a 8 • 14. d6 C~ Govt Lot City, State l• Zip Code Phone Number ✓ Sectiiw r 4' l S f ~a 7 1 (circle e) L/ -4 II. Type of Building (check all that apply) Lot # T L N; R E 1 or 2 Family Dwelling-Number of Bedrooms I> 01C 0- Subdivision Name PVC R01AX PigK Block# ❑ Public/Commercial - Describe Use ( ❑ City of ❑ ❑ State Owned - Describe Use CSM Number Village of i t rlg Town of F.=zt.t~ '~~i! III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A- System ❑ Replacement System ❑ : reatment/Holding, Tank Replacement Only ❑ Other Modification to Existing System {explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) rl ❑ Non-Pressurized In-Ground ❑ Presswized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil d < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsanreatment Area Information: Qft~av Desi Flow (gpd) Design Sot? Applic dsf) Dispersal Area Required Dispersal Area Proposed f) System Elevation r VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units r D~ 1~~. ao3, New Tanks Existing Tanks t 2 (t iW SU izV s - i Septic or Holding Tank I t i Dosing Chamber x ti `,1 L VII, Responsibility Statement- c undersigned, assq&~ responsibility for iustahation of the POWTS shown on the attached plans. Plur be~'s Name Tn Plumber' ignature MP/MPRS Number Business Phone umber 7,7_-,,` 's ddress (Street, City, State, Zip Cod Gam-- e ` C-) A~1./ ~~C l C~~f /`t_~ •."y ! 1..~ VIII. CountV/De rtment Use Only pproved ❑ D rove Permit Fee ate Issued Issuing 4grn Signattre I El er! riven Reeso . or Denial ICJ C7D. DC Conditions of Approval/Reasons for Disapproval ~lCl P Lester a.~e, SYSTEM OWNER: (f l ~hts PeM - 1. Septic tank, effluent filter and 11 U+S-~, r f~ Lv„ -1 ) C/'.eU dispersal cell must be serviced /maintained '7 r" 1 1 '►Z/' / U ►f [ 1C j Q - ;..r6rs is sits - ,cubm t to the County 0131? OR PAW not 1-1 2. All psetback p requirements must maintained as per raplicable codeJordinance ces. rL(J~U t~i"1~t /Q~ SBD-6398 (R. 11/41) / SHAUN R BIRD Page 2 8/1/2017 the site is too wet to prepare If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(l)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan Any changes may result in pump resizin2 to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at -round level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services WiSMART code: 7633 (920)492-2214 , Monday - Friday 6 am To 3:30 pm tim.vanderleest@wisconsin.gov /~RTeT , pro?`. ~.~r DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 ` m GREEN BAY WI 54304-5211 (5 I', Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~Ossio.~L7~` Scott Walker, Governor Laura Guti6rrez, Secretary August 01, 2017 PPRCM-D ,,,F SAFETN CUST ID No. 226900 ATTN: POWTS Inspector rck+ 1' L 3, SHAUN R BIRD ZONING OFFICE° BIRD SELF STORAGE ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/01/2019 Identification Numbers Transaction ID No. 2976505 SITE: Site ID No. 841158 Steven Sylvester Please refer to both identification numbers, above, in all correspondence with the agency. 30TH Ave Town of Eau Galle St Croix County SE1/4, SW1/4, S17, T28N, R16W FOR: Description: Mound System (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1720242 Maintenance required; 450 GPD Flow rate; 19 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area • Divert surface water from POWTS Area. Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire Y Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/10/17 Owner:Steven Sylvester Location: SE1/4 SW1/4 S17 T28 N,R16W 30th Ave Eau Galle Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan r 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specifications and cross section Attachments: Soil T st Shaun Bird Signature License num 226900 FIECENSO JUL 19 W? Page 1 of 9 JUL 13 2017 ,NQ IND ~~l INDUSTRY SERVICES System PLOT PLAN PROJECT Steven Svlvester ADDRESS 2475 210th St. Luck Wi 54853 ,SE 1/4 SW 1/4S 17 /T 28 N/R 16 W TOWN Eau Galle COUNTY ST. CROIX SYSTEM ELEVATION 100.0 1.5' sand lift! 7/10/17 3 DATE BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 galloons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none 66 BENCHMARK V.R.P. Top of 1/2" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter -E ]BOREHOLE O WELL *H.R.P. same as benchmark 1320' Property Line Area 15' below system is B•M.* to remain undisturbed 234' 4% Slope 660' B 3 B-1 ~ Pro 3 Huffcutt Combo Tank bedroom house 97' Grading is to be done to divert 13- 2 98' run-off away from system 98.5' 99' Well is to meet a WDNR set s Tank is to be properly bedded and provided with lockdown covers with approved warning labels 40 Acre Parcel ll Scale = 1/4" = 10' 30th AVe Mound System Cross Section and Plan View .r - - - - r - Dimension Feet a A g J B I '.;.;.ti.y4VK-L •1:L:1.L:ti:Y1:4:ti:L:4ti:1:1:ti:ti:L.Y4:L:L•L•L D T _ I;.. Kii i~i.r:'L•'^^•`.isiw•=i•iy.r.J•r•J.J.J.f.f•f.i:•bf.J•r•r.J.J.J•r•f.J•f.J•r.r•J•f•f•f•J.fY r4mJ' YL•L•L• 1Y•L•YL•L•L•YL•L•L.YYYL•L••.•Y4YY .L'L•L.L.L•L.L.YY\rµ L•YYYL•YL L• t ~y r•rvvr vw•JV•r•r•r•r•r•f•r•r~ LJ A I~,_ YYYYYti•YYL•1•L•YL•Y.•L•'..L•L•Lrti•M•YL•ti•Y1.1L.L.L~Y~•Lµ•L~`iL• YYL.L~L _ rvYL~~~Y~YtN1LV•J.rNJYWYV•r1 •Jifvvr•J•J•J•FJ•r•J•rYV.J•JVJVVM~JV.f•f - •YL•L•\•L•Y •L YYYM1•L•L•4•L•L 1.YYL+.. .I : MY•NV Y•J•r•f.1.J:J~r•JM.r+••J•ryvf:r~J~J~M•J•N•f•rJ•J•fMMM•N.f•J. f•J•r•rY.JV _ ~ ~1 N 1 fYJh•1•Y1•Y~•YLNYVL•Y4•N•L•YYY'L•L•YL•YYYYWL•L•LK•L•YL•L•YL L•L•YYYL• I::: •JYYV•1v J•r•rvJ•JWJ•fvJ•J•f•f•J•r•r•JY•JV•J•J•f•JYY•MJY•f•rY•f• ; W F G iii .i.... i i=: i ::i:i::i i :::i i:....•.-1•.•: 1•.•.•........ . _.I H 1 r. I I ~ r; T T- 1 K w K B Z L Slope 7 = Topsoil = ASTM C-33 L:J = Clean aggregate = 4 in. sch. 40 pvc Cap Material sand fill` '/2 to 2 1/2 in. dia. observation pipe a Geotextile H Fabric Nv YL'NrW Jtit•F F :.D E Plowed Surface j - Ft Contour Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page J of • Pressure Lateral Layout Two Laterals - End Manifold f Threaded Cleanout Lateral Turn-up -0 Plug Manifold M X I L Long Force Main 1> Sweep j 90 Bend Distribution Network Specifications Pressure System Construction Lateral Diameter 2- In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice S acin s_ In. the pipe with a sharp drill bit and face down. L (Lateral Len Ft. Lateral turn-ups terminate with a threaded M anifold Len Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter in. diameter lawn sprinkler valve box accessible from finished grade. Farce Main Length Ft. L • • • • • • • • • • • • • • • • • • Grade 6-8 Inch Lawn Sprinkler Valve Box Page 03/05 lg; i Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manuficturw Pump Manufacturer 2,., Tank Model Number ; Pump Model Number 5 Alarm t< Total Tank Cacity 7-2 rMax.Buiy Depth Alarm Model Number 4 i~ Switch Type :-r Filter ManufactursF 's m Total Dynamic Head (TDH) - Feet Filter Model Number i Elevation Head Distal Pressure Network Loss D < a-. Minimum Pump erfonmaace Required Force Main Loss GPM Ft TDH Total e ~o Outlet Manhole Wm. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Securely Mounted I;ocl~g Device < Below Grade Sealed RTatertip t Weather-proof Junction BOX FirAshed Grade _ r. Vent Mm. 12" Disconnect Above Grade Means With Vent Cap >><a a,> ><,,~a a a a a a a. a. i sr<' •,•,i;{ r°.'<'rL': d?< v'.;a;•;~s; i s Outlet Filter Inlet .t Baffle t i. Inle A I Switch se4t~ ap and Reserve C ►aC1t5' Weep Tank Volume GPI Hole B a; > Volume Gal. ' Dimension: Inches (reserve) A; S 3 b 7 Off Ele on C (alarm) B : 2 Ft Bottom rr, D evation ' Total : > . . <•<>< > 9717, -7 'Ii <>Isa<'•'i <y<'i <'<ialai <aa'aia<'<'<'<a<'a ii'ta<'P<'<'a>fai <i;.;<.<;•'i ;~s!x<'°~'>• <'i s>a < i .'<'s'.'.'<': < <i'sa<'i rai i :y.a !'~'<a<>a'<'r'a'a°<'<> accordance with the $TppsovalION:. The. dose .tank is bedded. and bwk filled in ~ r may not G~~RAI, PSTt.gVV " al gific ations. Maximum ~:pth of bury as. SpeoiW . by .the manufactwre y ) manufacturer's Pte. have an ewe Iccdcing dMce (Padlock be exceeded without piricu' Mat&oie covers exposed ° and installed. Piping at tp inlet and outlet is' of approved material, coimec~ to the tank with watertight fittings, 'fhe forme ihain is sleeved with 4? Such. 40 PVC to bridge the tank laid on stable soil to present settling or sagging- c.al wtnpl with NEC 300 and Comm 1623. excavation and the.sleeve,is sealed atertigbt. of 0210 LJ TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING Ln MODEL 152/153 r 2 ~ ~ MODEL ;52 t5., w t W 54 Feet Meters Gal. Liters I Gal. Liters 153 5 1.5 69 251 77 291 10 3.i 61 231 70 265 12 40 1 15 4.6 53 201 61 231 20 .1 6.1 i 44 167 52 197 ~ 30 25 7.6 34 129 42 159 Z 8 30 9.1 I 23 87 I 33 125 35 7 85 20 i o I 40 12.2 11 42 4 Lock 'dcive: 138.0 Fi_ (11.6m)I44.0 Ft. 1. 4.-n) cr+soa 10 1 2O 0 60 80 100 GALLONS 6 t/a LITERS 0 80 160 240 320 - 3 27/32 FLOW PER MINUTE i ! 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. J ® 3 27/32 I • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. I 12 1/e r„ L 1521153 Series (~--C- 152H53 YODELS Control Selection I I 1 I Yodel Volts-Ph Mode Sim ex Du im i 5 1/8 N152 115 1 Nort 8.5 1 2 or 3 I sxz~s BN152 115 1 z1b 8.5 included 2 or3 t _L E152 230 1 Non 4.3 1 2 or 3 0E152 230 Auto 4.3 Inc 2 or 3 N753 115 1 Non tot, 1~ 2or3 SELECTtONGUiDE BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 . 1 Non 53 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer 1o FM0477- n CAtmoN 2. See FM0712 for correct model of Electrical Alternator E-Pak Ali installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisvils, KY 402560347 Manukctixersof SHIP TO; 3649 Cane Run Road y n £LLr,.j) Louisville, KY 40211-196t Q~1/TY / 11MP9 ~hCF ~i9i~i9 "Y rQ (502) 778 X (502) (800) PUMP 24 Pff httpl/wwwzoeUer.com FAX (502) 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. 17 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_ o{ FILE~FORMATION SYSTEM SPECIFICATIONS Owner P Septic Tank Capacity al NA Permit. Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer t -M NA Number of Bedrooms NA Effluent Filter Model ❑ RA Number of Commercial Units 4 Pump-Tank Capacity 46 al E3 NA Estimated flow (average) aLiPump Tank Manufacturer ❑ NA Design flow(ppak), (Estimated x 1.5) J gal/day - Manufacturer 0 NA Solt Application Rate 0 Ud M2 Pump Model 0 NA Inffueht/Effiuent Quality Monthly aiyerage' Pretreatment Unit Fats, ON & Grease (FOG) 530 mg/1- 0 Sand/Grevel Filter 0 Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L 0 0 Mechanical Aeration 0 Wetland Total Suspended Solids (T S) 5150 m 1L Disin fection ❑ Other. Manufacturer Pretreated Effluent Quality Monthly average'' Dispersal Cell(s) Biochemical Oxygen Demand (BODS) 530 mg/L 0 In-ground (gravity) 13 ground (pressurized) Total Suspended Solids (TSS) 530 mg/- 0 At-grade ound Fecal Cordorm (geometric mean) 510` c fu/100m1 0 D ' ne 0 Other. Maximum Effluent Particle Size Y Itch diameter Values typical for domestic (noncommercial) wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every .3 0 month ' ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume r(s) (Maximum 3 yrs.) inspect dispersal cell(s) At least once every ! !months' Clean effluent filter At least once every onths ear(s) Inspect primp, pump controls & alarm At least once every 0 months r(s) 0 NA ❑ months r(s) 0 NA Flush lat;6rals and pressure test At least once every Other: At least once every 0 months 0 year(s) 0 NA other: At least once every 0 months 0 year(s) 0 NA MAINTENANCE INSTRUCTIONS Inspectioris of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifmtions: Master Plumber, Master Plumber RestrictQd 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 tie 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 notification of the local regulatory authortty. ground surface may indicate a falling condition and requires the immediate When the combined accumulation of sludge and scum in any tank equals one-third (X) or mote of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 T3, VYtsconsin Administrative Code. The servicing of effluent fitters, m nical or pressurized POWTS components, pretreatfinent components-, and any other maintenance or monitoring ate i ervals of 12 months or.less shall be performed by a certified POWTS Maintainer. A setvlce report shall be provided to the local regulatory authority within 10 days of completion of any service event START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of paintin products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high conodktrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page of START UP AND OPERATION or other chemics th`It For new construction, prior to use of the POWTS check treatment tank(s) for the presence of paintingdetected products the contents of the may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are have 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. will ble During power outages pump tanks may fill above normal highwater levels. When power backup the excess i surface discharge to w e will discharged to the dispersal cell(s) in one Large dose, overloading the cell(s) and may result in the to To avoid this situation have the contents of the pump tack removed by a Septage Servicing Operator prior to restoring power 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. the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, 15 feet down slope of any mound or at-grade soil absorption area. fife of the POWT : Reduction or elimination of the following from the wastewater stream may improve the performanceand prolong the ~ foundation T$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; dralln (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producils; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT shall be taken to insure that the system is propeify When the POWTS fails and/or is permanently taken out of service the following steps 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 falls and cannot be repaired the: following measures have been, or must be taken, to provide a code compii*nt replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the mThmment area will result in the ns{ed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulej in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baiting advances in POWfS technologN a oiling tank may be installed as a last resort to replace the failed POWTS. site has not been evaluated .to Identify a suitable replacement area. Upon failure of the POWTS a sop and site evaluation m e performed to locate a suitable replacement area. If no replacement area is available a holdiing tank may be installedi 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 suffal ReeDmtructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TA14 . KS 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 Ol A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER dame ~ ^ . Name l / - Phone J SEPTAGE SERVICING OPERATOR U R LOCAL REGULATORY AUTHORIT)j Name ~ Name Phone Phorie J This document was drafted in compliance with chap r SPS 383.22(2)(bX1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. a P Em, M S _ i i N m p P _ o ~I J m I. C1.1 i { l 'j I .-rte t.d. LU L1_ t l Q % C ~ t. O N N ~ Q I r Q ~ Z 3 O SS 'Q u C7 cn r t i 1 I 70-, ST. CROIX COUN"I'Y SEPTIC TANK MAINTENANCE AGREF,AoI AND OWNERSHIP CERTIFICATION FORM Owner/Buyer k' e Mailing Address ill 1'- Property Address (Verification required from Ph r& & Zoning Department for new construction.) City/State Parcel Identification Nutaber LEGAL DESCRIPTION f~ Property Location " j!F V. ,~~-cJ V4, Sec. , T N R_ LW, Town of it C ~1~ Subdivision Lot # Certified Survey Map # > Volume Page # Warranty Deed # Volume , Page # _ Spec } yeb' Lot lines identifiablo no SYSTEM MAINTENANCE AND OWNER CERTMICATION 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, -d '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 was to disposal system Owner maintenance responsibilities are specified in §Comm 83.52(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 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 Commerce and the Department of Natnral 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 time year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/sre the owner(s) of the property described above, by vjrtug of a deed recorded in Register of DmIs Office, r b oms ,f Z ATLJRE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Departaoent 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. 08/05) ~S N z ~«•M rN► r - r yy 4~ r Cl) co _ co N All r ~*wx 07 C'M m - N ow- I zo in 4zo►~v► 0-4 io co r N O N' CO i r f f RECEIVED 4f i~ - 3 o 17 - 69 MAY 3 0 201.1 Page of Wis. (dept. of Safe`v D!vlslon of Safety ~LOPM _ - ncE rw1,11 SPS ins A n roe - ^OMMUN d .i county ail ch comp° to site plan on paper l-~ ss '2 x nusa uicwde but not limited tc- ven~(a! and n'at eie'_ nc.i on r ! , n n'or a ne. Parcel 1.7. + perr.er,t slope. -;gale, of litre sions. a; a Icr.a lon an ' ~wce o n.,arest road. Date Tease f%€a ~r.t %tfcr' $~.e7e. rR cried b f- .r:.a ,al ir. ,,i ' ~'-r vml umvlae n av _,e r1n-y i r0~n ,V OV,/iILI - ✓r' r liy l OCaiJ0 f1 r ~ 9, T ovr Lot 11ASL,) '114 S 1 ? T ~ce, N R E (0 A/Vt Property Owners Meiling Address Block # Subd. Name or CSPf# qty S,n,_ 7ro .ode "ion _ nimce I ;Ity _I v/illsge i own Nearest Road e I ~ s sic, GPf] gn floarr rate Ne,e1 i .ode derived dc'si Cunsr iU s ; or Seai f~ RPnlac^-mnnt Pubic r , a lc,,,! ?lain elevation if applicabie ft i`'aren material - gtu0 10 1 Iqp ~General comments ce I and recom,nenclations: II-- 1 t) n F Uls er,~i l 0111 vS 1?of e 'd W 1 ris e 1 Bonng 9orinc Ci ou ;d s acre n lw. to Iimitiinq factor in. Soil A lication Rate orizon DeoPh Drnrrinant Color r ~esc~~nto ~.u: ~trucoar . ~;onsistence Boundary Roots GPD/ft u°. I Munsell i Ci S7. Ua,, Colc:r Sh. _ ff k1 fw2 i j j' L -1S ~~Ivt C LC I _ q)y .75 I r~ 1.. Borinq I--~ p r,p ( roand u ` ur nh ,n Iii iiting factor, _Soil Application Pate _J Horizon Dep,h f omurar' Coln; cY Psc, l ui, ~rucwre Y_'.onsistence oundaiy Roots GPD/ft ~ n ~ (t~luns~sll ~ CL~11. Sz. (~c,i t rncr ~ i. S2. oh. Y#1 ~ ff#2 6 75 IAY-Iq Effluent 41 ROB. 3C rqN - S Rfflijent #2 - ROD 30 nag/L and TSS < 30 ma/L - cs Name Please, PI CST Numbe Se - 7 -1 :cam dc('ygess arc lu2t10 n Cnnducted Telephone Nurn~helrJ/ j ei'D-Q33~(1211'111 J •.s: Property Owncr _J~~-~'~~s~ Page bi ! B o ri n c 5onn2 170. C ound d _ cv. th '.o tfrnitlnci factor in. Pit Soil Ap lip cationP.aic:- - 1 Hon -on Depth _ [)Cr man' 'clo' f P,er,p; D -s^.riptic.r. a°c n c'ti:ns ~,.onslstei ,o Boundary Roots GPD/ft 0 i IVur",geil C . Cc C or S%. Sh_ ff#1 ff#2 - s tar t - - off 6 V v 7-d fit ~40 NI If Bor, c Borinc ?f Gmurc s' `2ce e!Lv Oepth c 1Imiiiny factor in. - Soil A lication I ate Horizon Depth DCru'ra`li CO oi , G(7: , i t i ire Tonsis'enc ounda(y Roots GPD/ft lhr s^f z l ; f#1 ff#2 - - - - - I E i - "ice P 9 c'i I7_Ci. . ROrinC ~ . - Soil Application Rate ' i ; lorzoi Dc I j -VCS Ina,,t Flo , c sc pi r. atr ~,t; pure i ,onsistence Boundary Roots GPD/ft v u i_.eli _ nt. Colo- - - - r c. SV . f if#1 --"N) - - 30 mg/I_ and SS < 30 mg/I_ nu need i~,~iStancc io ~ccc r, icrs .cj>r' trncnV zji !~(1<-266 31 i or 1 TS' tau~~u h FZe.lav. 'PI Cale qo-j 9 I 1 4 i-T i'. I -A i FT-F -5kee- L) -t`o - its Q C. It t ~?.'44 I gg~ _