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HomeMy WebLinkAbout008-1092-10-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 597441 GENERAL INFORMATION State Ptan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2976098 Permit Holder's Name: City Village Township Parcel Tax No: TYLER & KELLI SCHLEGEL TOWN OF EAU GALLE 008-1092-10-100 CST BM Elev: Insp. BM Elev: BM Description: SectionrTown/Range/Map No f; 6b C,(\ fw32.28.16.487A-10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE 'I CAPACITY STATION 13!5 ` HI FS ELEV. . C 1. 164 Septic Benchmark D , qS- ' TO IC)( Dosing ~w ~ J,_p • ~ Alt. BM ~ q 1`r'1 1 ~d, S O ration Bldg. Sewer _ 7 /3.Cv 10.85 Fjplditag r~ L p ~D' b 1~ 6Ls St/ Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 0' ' Dt Bottom /t 0 2 -7 Header/Man. Dosin + b l -7 01 1-7, Aeration ___r_ Dist. Pipe g ` Holding Bot. System 73 PUMP/SIPHON INFORMATION Final Grade S `f ~v Manufacturer Demand St Cover ~Q dit~ GPM V # Model Number 6AJ TDH Lift Friction Loss System Head TD J + /3 + /5 3 , 0) & _ z Forcemain Length Dia. Dist to Well "76 - SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. PIT DIMEN IONS No. Of P s Inside Dia. Liquid Dept DIMENSIONS 66 2;s SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION T f stem: ~s CHAMBER OR Yp 0./ ti u , L UNIT Model Num DISTRIBUTION SYSTEM E 1'~ o Air Inta e Header/Manifolpt I Distribution I of r l x Hole Size 1 Ix Hole Spacing + 1 ILA19 J Pipe(s) l ' Length Dia ` Length I Dia J ' 6 Spacing • L tj S OIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / Bed/Trench Edges Topsoil e • / OL, Yes No `yes i, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection ;1 : 2~ ~ L spec ion #~2: " r Location: 2264 PIERCE/ST GR IRDl-OW 1.) Alt BM Description = i~N CoV~~ - 0 ~t D Ct cel II , 2.) Bldg sewer length - amount of cover S er 7 Plan revision Required? Ji Yes 5`~No I 17 Use other side for additional information. l `"1l r_ SBD-6710 (R.3/97) Date Insepct r' Signature Cert. No. 1 rx a SAN,90 7 - ) SS County 4F X 8C3KWY9YBMJCR ter r p v ~i vvdsnmgton mve 4 Sanitary Permit Number (to be filled in by Co.) p U U 20 111 P.O. Box 7162 ~ S~ Madison, WI 53707-7162 741Y1 ~,ROIX COUNTY ST. P (E opM NT State Transaction Number Sanitary L Permit Application / 7 ~9 In accordance with SPS 383.21(2), Wis. Adm. Code, submission ofthis form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted t r 'ect Address (if different than mailing address) I-P the Department of Safety and Professional Servies. Personal information you provide may be used for seconda purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. , - 1. A lication Information-Pleas ri All Information l L 5~~~~ Parcel Property Owner's Name 1 Property Owner's Mailing Address , Property Laelb n '1$ g'l A Q A / l t7~ y~ d'~ dl !L~ ~ ~ 7 ( ' ~r~~k1 Govt. Lot City, State Zip Code Phone Number- y, Section 3 (circle one), '511.1 T_-Z_N; R_E rW' V_.Y, pe of Building (check all that apply) Lt # 2 Family Dwelling - Number of Bedrooms 1 Subdivision Name l Block # ❑ Public/Commercial - Describe Use ~Aoo 11 ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use x I . / 10577 /V x W J own of .1 III. Type of Permit: (Check only one box on line A. Complete line if applicable raw O ^4-' 'Ne A' New System El Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) Er' List Previous Permit Number and Date Issued B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner O v IV. Type of POWTS System/Component/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Ot r Dispersal Component (explain) ❑ Pretreatment Device (explain) 0-0 V. Dis ersal/Treat nt Area Information: Q ^d64 b. t• Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Propos (so System Elevation I S /Loe /_3 9'/ ly- 77 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units E t j New Tanks Existing Tanks 1 ( C o n 2 tl r Q !1 p 1L`✓/ a U w n w C7 0. S t~ [ Septic or Holding Tank ~L L r / --e Dosing Chamber 1 -7 c-,' VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's 'nature = MP/MPRS Number Business Phone Number Plumber's Address (Street, Ci , State, Zip Code) VII oun /De artment Use_Only 17 Permit Fee M/ Date ss`ued Issuing t Signature Approved llbv d ° • $ / r W ' J ' Reason for Denial IX. Condit ~e~k, E. Ix. I e~ctit~sapproval • I . w r r O~ e t v~~ / diswt ai cxll must all be _?I is s ' r nt~°; ec , as per igtarzgemeM plan pta ndert bV Nlwnbe,: 2 .A tck neqWrecasM must-burwrt.lr.ed as W lfffttlble code / ~fdiflA1 u. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD-6398 (R0313) P/®f PiaV, /00.~r e- -Ic q of 0 , ~T `ry/ L Z~ VI Ile r' c~ 3JJ ` R ih QJ r►e ~ jo ra m DS i^©t:~er P~i~ ~ P gilt , -0 Prbf>oSEc~ qll a~ Sl~~ r1 f 193 [S/op Qe-, S i ~ 1 3 ~ a a le- 13. !-1 q q i 0 '7' c cti~ ~ 4+C lz2l _e6-C--e Sf CRG~/X /\c(, ' ~ti~~RrbtF:,yT DIVISION OF INDUSTRY SERVICES 3824 CREEKSIDE LN HOLMEN WI 54636-9466 Contact Through Relay ~S P http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~rFSSioNP~ 4/ Scott Walker, Governor Laura Guti6rrez, Secretary August 03, 2017 CUST ID No. 220292 ATTN: POWTS /nspector BENNIE W HELGESON ZONING OFFICE HELGESON ENTERPRISES ST CROIX COUNTY SPIA N7649 STATE ROAD 128 110 1 CARMICHAEL RD SPRING VALLEY WI 54767-8709 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/03/2019 Identification Numbers Transaction ID No. 2976098 SITE: Site ID No. 840661 Tyler Schlegel Please refer to both identification numbers Pierce St above, in all correspondence with the a enc . " Town of Eau Galle ply St Croix County ~pI C S W 1 /4, SE 1 /4, S32, T28N, R 16 W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1717860 Maintenance required; 600 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -1069 t~-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: • 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. • 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, 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. • Abandon the existing system components per SPS 383 .33 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewers beyond 30 feet per SPS 382.30 (11)(c) • A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. BENNIE W I IELGESON Page 2 8/3/2017 • In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due S 0.00 Travis J Wagner Wastewater Specialist , Division of Industry Services WiSMART code: 7633 (608)598-0715 , Monday - Friday 7:00 am To 3:30 pm travis.wagner@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Helgeson Enterprises 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. BENNIE W HELGESON Page 2 8/3/2017 • 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 y, 7 Fee Received $ 250.00 Balance Due $ 0.00 k Travis J Wagner Wastewater Specialist , Division oflndustry Services WiSMART code: 7633 Monday - Friday 7:00 am To 3:30 Pm (608)598-0715 travis. Wagner@wisconsirn.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Helgeson Enterprises 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. r INDEX SHEEN' j.._ PROPERTY OWNER: 7 le r ?01? ~ 17 d. ` y I - till ~f7 PROJECT NAME: j 1-,, PROJECT LOCATION: 5 b-l 1- cy f 5Z ti sc ,3 MUNICIPALITY: eL LL COUNTY: .5 i,~ O l k DESIGN: PRESSURE DISTRIBUTION MANUAL VERSION 2.0" SBD-106706-(N.01 /01) MOUND COMPONENT MANUAL VERSION 2.0" SBD- 10691-P (N.01101) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank and Pump Chamber Cross Section and Specification 1e1-Y Page 5: 5-0 7,5-0 -,P1 _ Tank SWiPns L SERVICES Page 6: Pump Specifications JSTRY SERVICES Page 7: Observation Pipe Detail Page 8: POWTS Owner's Manual & M.,-'- emo A;EPg 1 Page 9: POWTS Owner's Manual & Management Plan- Pg 2 Name: Bennie Helgeson Sign d 4 / Address: N7649 Hwy 128 Spring Valley, WI 54767 Credential Number: 220292 / vi-le r T, kc (A 1 4 H--PJ Ct C~ V\, VL cc.) f Pi' -SecQ It 1& ca- 1a5~~ 7SL ~v.j, ~ie.M~ boo.©a ~P ! Y~n fah 71~. l y oS qt J k7eL; NI K urc Sl~ l /83 GhE~gh~ ~ f / l ~r o WALL ? w 6/-P e- i 1 I I ~z 1 Ilu r i q` 13M' ~tyf ~ ~a.l. i ~ j l +t PC) i e5ccL 70 Synthetic Covering A5?M C 33 Distribution Pipe Medium Sand F.:Js~re~, e Topsoil 3 E 5 Slope. J CirL IL Of iy- 2 %Z Force Main Plowed 1~ Aggregate From Pump Layer D 7Ft. Cross Section Of A Mound E Ft. F Ft . G S Ft. A /0 Ft. H / Ft. Signed: B 60 Ft. License Number: K / 3 Ft. Date: Q,6 Ft. J 7,q Ft. Ft. w 300 3 Ft. Observation Pipe 16 - - ~I W - T------- Distribution Of 2- 2 i Pipe Aggregate i Observation Pipe Plan View Of Mound Py Perforated Pipe Detail Cleanout Access Threaded Ed V 1- w Cleanout Perlor0 iro PVG Pip( End Manifold 4ot`0°`~ Holes Located on Bottom Are Equally Spaced R Force Main From Pump X S First Hole Next to Manifold e Cleanouts ; Distribution Pipe Layout P 7 i R S 7 ow X Y Q f A0 Hole Diameter Inch Lateral " Inch (es) Manifold " Inches Signed: Force Main Inches License Number: Invert Elevation Date: Holes Per Lateral Number of Laterals Total Holes Page ! Of SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" PLY-VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER tpwn~X1'J _ WARNING LABEL qq 0 MIN. 2y" 18" IN. - .x. D. u INLET WATER TIGHT SEALS GAS- , \ /APPROVED TIGHT VAPPROVED FILTER - A SEAL JOINTS WITH APPROVED PmQt~ fo k A LM APPROVED PIPS PIPE 3' SAS -B ON 3' ONTO ONTO SOLID SOLID SOIL C SOIL PUMP OFF ELEV . ~3, S_FT. _i_ OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE . Yo to l Cc4.1 s 3;r. L~~",e rs•~ i x TANK MANUFACTURER: /~5-ev < ~C3~• TANK SIZES: SEPTIC 0 GAL. DOSE VOLUME INCLUDING DOSE 7.5' n GAL. 1'7,1,) 6,a 1--F LOWBACK : GAL. ALARM MANUFACTURER: ,I C fL,, jx CAPACITIES: A = ~ S_ INCHES = GAL. MODEL NUMBER: d SWITCH TYPE: C /p B = 2 INCHES = 3D,_ VGAL. - PUMP MANUFACTURER: :Z D-e Ile-, C = INCHES = //.a, Sy GAL. MODEL NUMBER: L SWITCH TYPE: Me. l~, Sh~icQLi~/©a D = 13 INCHES = ~ S~GAL• REQUIRED DISCHARGE RATE YA VGPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE '77 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . ~5= FEET + 10FEET FORCEMAIN X ~7FT/100 FT. FRICTION FACTOR . , FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID n-P TF_ 7aKk-Spe sti~ef SIGNED: LICENSE NUMBER: DATE: 1/88 o P-RJI o D o -j 0 LJ < C) LO cn D F--Zg * C0 F- L,j N Z Z F ~ J (~U NLLJ 10 EE) OR 00 -r O a- 12-91 W F-- V) p W Q CV 1 O OJ J 2 ZZ Imo- C;_ I O\Uw O Z 1-1 LO . ° L` w a -I J a I~ r~ I~ n O CL N a u) c-4 p co Gi f- w Q a w I-JU ~W p p (nQ ~pN (D~ fl fl-I~ 3CL I 0 o 0- _ p O p Ln 4- LO I W w cn O) L0fl (n (n Q \s NOUOF- ~Q mNQ C4 O ~n Z 3 LL, N Y N"'`°J(~MZW- -JW~ N ~ Q O z C, 0 a: (n _1 F- LLJ 3 p 2 ~ DOW O M Y 00 = Q (n ZJF->Z j OZO-JDO °s Q a Q LLJ O~i..I OQOOQw OO Z 0 0 O En- ~m 0 ~ 2 J ~MLJ Z Q ZV) W F- F- ° p J J Q p Z Z O W ....~Z ~x-KV N r-Hl I I I I I I I I ~ I I: I I ~ II ~ I. W x I II I . 5 W LO I 5 I a , I Li.l OJ W I I- v _Q ~ C) r rl N Fes- 9 £ I ~ I i ..LS i is x I I I ~ I I 0 F- JW F- D 0 „99 „09 „99 TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE MODEL 152/153 ,I EFFLUENT AND DEWATERING N Li X MODEL 152 153 50 Feet Meters Cal. Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 70 265 15 4.6 53 201 61 231 X 20 6.1 44 167 52 197 30 8 25 7.6 34 129 42 159 A OL 0 30 9.1 23 87 33 125 20 J 35 10.7 22 85 40 12.2 11 42 4 10 Lock Valve: 38.0 Ft. (11.6m) 44.0 Fl. (13.4m) 014508 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 6 1/4 3 27/32 174 5/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. I o • Electrical alternators, for duplex systems, are available and supplied with e 3 27/32 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 152/153 Series 12 1/8 1521153 MODELS Control Selection Model Voles-Ph Mode Amps Sim lex Duplex N152 115 1 Non 8.5 1 2 or 3 5 1 /8 BN152 115 1 Auto 8.5 Included 2or3 E152 230 1 Non 4.3 1 2 or 3 BE162 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN163 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. e CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. All 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 recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. 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 Louisville, KY 40256-0347 Manufacturers ol.. SNIP T0: 3649 Cane Run Road ® 4 ® Louisville, KY 40211-1961 QvazirrPu 1,167 SINCE /9,9JN http✓Awww zoeller.com PUMP !O. (502) 778-2731. 1(800) 928-PUMP FAX (502) 774-3624 © Copyright 2001 Zoeller Co. All rights reserved. C/ Water tight cap 4" min. dia. T Piping material can be ASTM D2665, D1785 or D3034 Slot V min. mein. ' Infiltrative surface Water Closet Collar Bar @18" min. dia.) ObsdMifidn pipes must. - • be located such that there are a minimum of two Installed in each dispersal cell at opposite ends from one another • be located near the dispersal cell ends • be at least 6 Inches from the end wall and sldewall • be Installed at an elevation to view the horizontal or level lnflltrative surface within the dispersal cell Observation pipes may be located less than 6 Inches from end walls or side walls If specified in state-approved manufacturers' installation Instructions. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~S of~ FILE INFORMATION SYSTEM SPECIFICATIONS Owner ~ i- C f'1 ! I Tank Manufacturer: 1,x) i,:~Ser ❑ NA Permit # VeSeptic ❑ Dose ❑ Holding Volume: /_95O (gal) DESIGN PARAMETERS Tank Manufacturer: W i eSA?t' ❑ NA Number of Bedrooms: ~f ❑ NA ❑ Septic U'Dose ❑ Holding Volume: 7,570 (gal) Number of Public Facility Units: eNA Vertical Distance Tank Bottom(s) to Service `Pad: (ft) Estimated (average) Flow : OQ (gal/day) Horizontal Distance Tank(s) to Service Pad: (n) Design (peak) Flow = (estimated x 1.5): Specific servicing mechanics must be provided If vertical Is >15 feet or 460 0, (gal/day) if horizontal Is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal/day/W) Effluent Filter Manufacturer: 0 ❑ NA Standard (Domestic) influent/Effluent "Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer: C! C/ f-C f Blochemical Oxygen Demand (BOD5) s220 mg/L ❑ NA ❑ NA Total $uspended Scilids (TS$) sY5A mg/L - Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) 220 m/ Manufacturer: (RODS) g/L .NA IdA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter Pretreated Effluent Monthly average El Disinfection [I Wetland ❑ Sand/Gravel Filter ❑ Other: (BODE) s30 mg/L Soil Absorption System (TSS) s30 mg/L ,I(NA Fecal Coliform (geometric mean) s10' ' ❑ In-Ground (gravity) . ❑ I Ground (pressure) ❑ NA Maximum Effluent Particle Size %s in dia. ❑ NA ❑ At-Grade round El Drip-Line ❑ Other: Other: ❑ NA Other. [I NA MAINTENANCE SCHEDULE. Service Event Service Frequency Pump out contents of tank(s) NT'When combined sludge and scum equals one-third (i/s) of tank volume ❑ Wheh the high water alarm is activated Inspect condition of tank(s) -At least once every' El month(s) c. Plear(s) (Maximum 3 years) ❑ NA Inspect dispersal-cell(s) At least once every' ❑ month(s) -1). P Year(s) (Maximum 3years) ❑ NA Clean effluent filter At least once every: 13 ❑ ye nt(S(s) ❑ NA Inspect pump, pump controls & alarm At least oncevvery: Elyear month(s) E3 NA 13 (s) Flush laterals and pressure test At least once every:. ❑ nth(s) ❑ NA ` year(s) Other: ❑ month(s) At least once every: ❑'NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an Individual carrying one of the following .1Icenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to Identify any missing or broken hardware, identify any cracks or teaks, measure the volume of combined sludge and scum and a check for any back up or pon'ding of effluent on the ground surface. The soil absorption system 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 treatment 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 (pumper) 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 30 days of completion of any service event. GMW-005 (02/05) START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the p ice of painting Products+ solvents- or other chemicals or sediment that may impede the treatment process'and/or damage- the so sorption system. If high concentrations are detected have the contents of the tank(s) re. noved by a Septage Servicing Operator (pur ) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failure Start up or restoration of power under these conditions is not recommended, as the exc +ss wastewater will be=discharged to the soil )rption system in -one large dose causing an overload that may result in the backup or surface discharge of effluent. and damage 3 system. To avoid this situation' have the contents of the pump tank removed by a Sr -itage Servicing Operator (pumper) prior to r ng power to the pump or contact a Plumber or POWTS Maintainer to assist in manually 1-perating the pump controls until normal effl, ~vels are restored within the pump tank. System start up shall not occur when soil cc, nditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks c the soil absorption system. Do not drive or over, or otherwise disturb or compact, the area within 15 feet down slope of any mou or at-grade soil absorption area. Reduction or elimination of the following fr n the wastewater stream may improve the r Dance and prolong the life of the treatment tanks and soil absorption system: acid ,ntiblotics, baby wipes, cigarette butts, cc s, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundatipn dr (sump pump) discharge, fruit and vegetal slings, gasoline, greases, herbicides, meat scraps, medications, oils, painting product pesticides, sanitary napkins, solvents, tamr nd water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps sh taken to insure that the system is properly and safely abandoned in compliance with s. Comm -83.33, Wisconsin Administrative God • All piping to tanks, pits and other . absorption syste, Bali be disconnected 'ie abandoned pipe openings sealed. • The contents of all tanks and pits II be removed an' operly disposed of by aL, ,Servicing Operator (pumper). • After pumping, all tanks and pits :II be excavated ,and emoved or their cc rn iv:-,i and the void space filled with soil, gravel or another inert solid mate CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has b evaluated and _ ,a utilized for the l~ of o replacement soil absorption system. The replacement area should be,i tested from dlstu,' once and compaction . , hood not be Infringedupon by required setbacks from existing and propose , ucture, lot,line: wells. Failure to pr „ . , _.cement,area will result in the need for a new soil and site evaluation t, lnblish a'suitab! r -cement area. 'Re, nt w'tems must comply with the rules in effect at the time of their permit isst e. .p A suitable replacement area is no, vailable due to setback and/or soil limita::. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank maybe k ed as a last resort. El The site has not been evaluated to identify a suitable r,,,.':, ,ement area. Upon t : of the POWTS a soil and site evaluation must be performed to locate a suitahle replacement are "no replacement area ilnble a holding tank maybe installed as a last resort to replace the failed POV. ,,/last and at-grade soil absorpti- stems may be :trusted in place t .gal of the biomat at the infiltrative surface. Reconstructions of s_,ch s •s must comply. ,e rules in effect' WARNING TREATMENT TANKS, PUMP NKS, AND HOt_DING TANKS MAY C It, !'OISONOUS.GASSES OR LACK SUFFICIENT OXYGEN TO SU. 1-N LIFE. NEVF't ENTER ANY TANK U At. CIRCUMSTANCE. DEATH MAY RESULT:"-ESCAPE-OR RESCt C.Fi.OMTHepflTE. ' ..OF"A-TAI41KIMAY ru6SIBLE - ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINT,` Name r I - c , Name 18 e-el Y% Phone / S) -2 7 .2 .1. SEPTAGE SERVICING OPERATOR PUMPEF. LOCAL REGULr ')RITY Name ;-0 Vk S v ,et,-, 1C- 4 Name Phone '7 i - 7 3 J S I I Phone This document was drafted by the staffs of the Green Lake, Marquette ; ~ushara County PO'.. letc)ry agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54 (1). (2) & (3), W - nsin Administra' START UP AND OPERATION Page of ..For new construction, prior to use ;of the P.OWTS check'. treatment tank(s) for the p- ence of painting products, solvents or other chemicals or sediment that may impede the treatmentprocess'and/or damage-the sc :sorption system. If nigh concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator_(pur, prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failure:. Startup or restoration of power under these conditions is not recommended, as the excess wastewater, will be=discharged to the soil - orption system !none large dose causing an overload that may result in the backup or surface discharge of effluent. and damage , system. To avoid,this situation`-have the contents of the pump tank removed by a Septage Servicing Operator (pumper) -prior to re ng power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effl L eveis are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks c- the soil absorption system. Do not drive or over, or otherwise disturb or compact, the area within 15 feet down slope of any mow- or at-grade soil absorption area. Reduction or elimination of the following fr^m the wastewater stream may improve the p --nance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, cc s, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundati©n tlr';, (sump pump) discharge, fruit and vegetaF dings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tamp nd water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps sh, taken to insure that the system is properly and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative.Cod • All piping to tanks, pits and other ~I absorption syste;,s shall be disconnected - he abandoned pipe openings sealed. • The contents of all tanks and pits all be removed any' properly disposed of by tape Servicing Operator (pumper). • After pumping, all tanks and pits all be excavated and removed or their co. moved and the void space filled with soil, gravel or another inert solid mater... . CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or t be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has b-,en evaluated and r ,-y 'ce utilized for the loc of a replacement soil absorption system. The replacement area should be _r tested from disturbance and compaction hould not be infringed upon by required setbacks from existing and propose tructure, lot,lines _ wells. Failure to pr e r_,~:acement.area will result in the need for a new soir and site evaluation tc ,ablish a'suitabl re?lacement area. 'Re7 Mt :-.,Fterns must comply with the rules in effect at the time of their permit isst. e. A suitable replacement area is no; available due to setback and/or soil limita!! If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be inF ed as a last resort ❑ The site has not been evaluated to identify a suitable replacement area. Upon f of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. It no repiacement.area ! ilabie a holding tank maybe installed as a last resort to replace the failed POV Mound and at-grade soil absorptio stems may be atructed in place f r ^val of the biomat at the infiltrative surface. Reconstructions of such s, ,s must comply, he rules in effect a. WARNING TREATMENT TANKS, PUMP INKS, AND HOLDING TANKS MAY C irl POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SU: T-IN LIFE. NEVER ENTER ANY TANK U At,Y_ CIRCUMSTANCE. DEATH MAY #1E-Sf7ET E5DAPE:OR=RESCUE,:FRONI'fH ,NTE OF Afi K'IViAI' -1 E-t OSStBtE ADDITIONAL: INSTRUCTIONS: POW_fS INSTALLER POWTS'MAINTr,' _ Name Name ~ ~~•2 p 0. 1C7~ Phone f r Z Phone 7 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULA- ORITY Name LJ~11nSC~e.v~f ~efL Name Phone '7 l 7 " f8 i d Phone 7 f,~` • This document was drafted by the staffs of the Green Lake, Marquette I.Vaushara County PO's ilatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wi consin Administral; c:. e. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM + rI Owner/Buyer ` Mailing Address Property Address ~ ~`~E t ~~_f (k ~y (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Nurnberg - f 001 ~ - f -0 00 7 LEGAL DESCRIPTION j } Property Location , 5G 1/ Sec. , T NR W, Town of ~_cc < L- Subdivision , Lot # % Certified Survey Map # Volume SJ , Page # u' i--:)- ~ r Warranty Deed # 2j , Volume N k' Page # (VA Spec house o yes no Lot lines identifiablexyes o 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 into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §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 _a e ~..s t f3<th, herein, as set by the Department of Coniinerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w anty deed recorded in Register of Deeds Office. Number of bedrooms 4 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 in the warranty deed. (REV. 08/05) ~ _0'IHt IL HA15x _ ~T~~ ~ n~~ i n-iu s p~9r e~ NV]dTIM NIVW O I\11NiIlU 4 II'.1114\111C1'l14 •"1\'IINJU1C~11 a a w ~ OJNI37Vd " ~f~iYf{tlia 9DNgGlSg'H IV991HOS n u1 ~ .a ~ h I W ~ d ra ~ a i o, ~o: ~ ty r z r ~ Q o u a r J ~c L L - d. K ~ ? dw Im Lo ' a O = U. R 9 a ® a. V I 9 ~ O UI1 ® 3 m II i I ~I soa .I a z°~ d .I v A ~ k i ~ I 1 ae P o. =1 3 a I , ICIl-R-7 c , w Q~ I v Q e_co-ixc is SNOUVAHIH dO])Illxll u iei~aaivw iu n•ainvv riri~rv•n°u u+aisax DdNlMd - = ~--i L~'~ O '4i iA[DNd ~ 5 F auwm n. p~r6_ L oiaz ~I ?I n• Fi til I p Z ~ O ~ V ' ~ Ul s H e' a u - -i O O Z ® Z Q > w v LU W z_ ~ Q _ oQ ww ~E El a I m z Ww J A fi_~(~ IPL IL-Hd m Hsu a lul c cr~i,~y oznz NV7d NOUVONCIOA 01NI 37Vd v jF\~l i \l I11 II A"I ll~t IIL"1'l IV •"I YII N{UIS~N _ ~ ~ ~ a w o eg a 3 a z o o a~3mad ~ I o ~ d z °~c7 ova a Z - - i i- . `I p ~ - - F q I I~ Q I I ~ e I I 3 J I I f I ~ M I PI I I I I I I I I I I I I I I I ~ I I z I I g I ~ I I I o I I ~ I P I ~ I I ~ I a I I op I I I I I I I I II I II I I A III , y I Y 4 I .3 l\ I ' I - 7 I r , 11 , I , I, , -------11 I III II I I II~ I ~ ~ II I III k I rt I I I I o a ~i s sr~nca oza, NOLIOl4S E)Nlffllflfl/NV'ld-IOOH . , i mv.n-n;inre-~ian Naaisaa o Lug o R ~IN[NUd ~ I ~ s d H-g 50 i ~6 l j~ df St: :i.it -Y uVc ya. 9^.IF 6~ i~_1 3 <1 5 N y3 is ao t;~ i~ E?G T ~ 0 ii ww Z V Q y o qo, Y Ir< tay~ P9a o Z m Q .4 IL O w i~rv'niN aWcnrau _S"IIVSAQ a1~b'219 11 Ntld 11Vh14aJtlNf] O1NI. 39Vd~ °wFOm o !Q C W p l~'1 Ili ~w Elm a W i ~~N~QIS~2I Id~~ IH~S s woi I° e x r i w.. rt~ 'fib y ' " I I 7 I~ I ASR"-`-T~nc ~ 1,1 I 4t G y a r a II _ ~ W W M ;y a x ; rJ - Wt ~sO 2 y t±. I a pQ x l~--_'1 S ~ k• b S I. i I I N a I z Z Q ~z ~s ~a QLL 9 Q ~o m o ~ z~ .~9,3~ ,-om - s' f a :FF I t 9 , t ~ W as- y . g, P5 .k. Wisconsin Department of Commerce ^0IL EVALUATION REPORT Page-z- of -.3 Division of Safety and Buildings Z, ,n ar:=Edarice w.. Adm. Code Attach complete site plan on p4%re6KW*0QblM x 11 inchL must County 'i 7- include, but not limited to*-**9MM int Brn. - C o ( t Parcel I.D. percent slope, scale or dimensions, north arrow, a n~C~o~tibn and dista., ro~tl: ' ~C' Please print all information. Revievied by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04, ✓ u ` ? ` Property Owner 4 i a f c Property Location Govt. Lot 1/4 C- 1/4,,S, T r N R lc? E (or W Property Owner's Mailing Address a Lot Block # Subd. Na or CS&W City State Zip Code Phone Number C3 City ❑ Village (EYTown Nearest Road = T. K C7 NORJ'New Construction Use: 916esidential / Number of bedrooms 0 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial -Describe: Parent material C sS 1, C e. T~ ~I Flood Plain elevation if applicable r tt. General comments n i and recommendations: LG SC r ri,S C: v~ (L u1 LY E'r- ~c~ f~ cf E 1 u-n 5 f 5~e~ti~Ie `01,77 Boring # ❑ Boring ) r t Ground surface elev. V c~ ft. Depth to limiting factor / in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 VR 6 (.1 LL li > y 3 f~ 7. C~ c q@ ll , L? 1 J~iL~C` l ~_`i t T / _ ❑ Boring Boring # G~ / nit Ground surface elev. . ft. Depth to limiting factor 1 7 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 'E02 r, y(~ - l 7 r 0 /7-9l fey C 3P - ' Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = SOD < 30 mg(_ and TSS :5 30 mg/L CST Name (PI ase Print) Signature > CST Number Address Date Eva tlon Conducted Telephone Number n~r~ n~.n /n M1Mnf 1{1 f / ` ( C Property Owner l.~ ~ 1 ~JC ~J _ (f Parcel ID Page. of , 3 Boring # ~ 3 IJ'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. `E01 "Eff#2 -y l~ 62 (C-3,P / P L 7 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rake I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I i i ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soll A I(eaBon Rate: Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots QP /if? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2' I f I_ " Effluent #1 = BODE > 30 < 220 mg/L and TSS >30:5 150 mg/L Effluent #2 = BQD6-_< 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need'assistancle to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777: S 13D-8330 (R.07/00) Property Owner Ll tt Ci wti Parcel ID 06 P_age_ - of ❑ Boring .f 2 Boring # Lam" pit Ground surface elev: ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dorninant Color Redox Description Texture Structure Consistence :Boundary:- :Roots GPDff_ in. Munsell Qu. Sz. Cont. Color Gr.,Sz. Sh. *Eff#1 *Eff#2 C' / -y lC f2 y (C3r' i~Yt2~75-2.1 SL s - ( 7 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *1501 "Eff#2 i i i E:1 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 GP PM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2' j f I Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent-#2 = BOD,. < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity-service provider and employer, If you need assistance to access services or, need material in an alternate format, please contact the department at 608-266-3151 or T"I'Y 608-264-8777. S13D•8330 (0..07/00) e- c. , y3 ~j 1 13. M- i cxn. 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