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HomeMy WebLinkAbout038-1203-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 597475 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 2988643 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: ERIC & KELLY KRAMER TOWN OF STAR PRAIRIE 038-1203-80-000 CST BM Elev: Insp. BM Elev: BM Description: ^ Section/Town/Range/Map No &6(w 23.31.18.1090 TANK INFORMATION ELEVATI DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. 'o Benchmark L7(o L_ Septic 1 1 Fj t-~ M`P: 2 t t 5. Dosing comIQ,\ Alt. BM l/ Q// Bldg. Sewer r, S t Inlet cfJ/, St/Ht Outlet 'J TANK SETBACK INFORMATION G4i/1S -f TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet eh~r Septic Dt Bottom Dosing v I 1 Opirntion (J Dist. Pipe H Bot. System li/ ~(J Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover !n g GP Y~ (P Model Number N Imo'") 1 f}~'~ t )D 3, TDH Lift Fricti n s System Head J o~ TDH, Y t y, Forcemain I Lent I Dia. I i Dist. to Wel v N SOIL ABSORPTION SYSTEM BED/TRENCH Width Lent NPIT DIMENS NoOf P is Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING Manufacturer: INFORMATION CHAMBER OR Ty f S ste I / I? UNIT Model Nu er: DISTRIBUTION SYSTEM JD PW IL. 19(put'N Lin 1a ed AVM N 1 ' -Prom Coeir/; le to Air Int a J~ ~n 'l x Hole Spacing A Header/Manifold Distribution , 1 Ix Hole Size A I Pipe(s) 5 'C Length Length Dia Spacing SOIL COVER Pressure Systems Only xx Mound Or At-Grade Systems Only DO Depth Over Depth Over n xx Depth of xx See /S xx Mul hed Bed/Trench Center Bed/Trench Edges Topsoil ) „ Yes No Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: fol~~ Phi or , Location: 1258 202ND AVE SLOW: 0411 MDW-Cd F) W C Iva_ 0-! 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = > 1'~'' e~ Co~~ on Pll ! Plan revision Required? I Yes y J0 O Use other side for additional informatiolti. _j Date Insepct ignature Cert. No. SBD-6710 (R.3/97) Count3~ <1 Safety and Buildings Division : r o, t ~ `M1 , v 1 201 W. Washington Ave,, P.O. Box 7962 Sanitary Permit Number (to be filled m by Co.) S COUNTY Madison WI 53707-7162 ST CROIX State Transaction Number Sanitary Permit In accordance with SPS 383.21(2), Wis. Adm. Code, submissi, 8Z1 GBQ74FRJZ6 -4/3 is required prior to obtaining a sanitary permit Note: A.pplicabon tornrs rva to Project Address (if di Brent than mailing address) the Department of Safety and Professional Servies. Personal informatioc. you pr ovide may be used for seconds.y L oses m accordance with the Priv Law, s. 15.04 1 m , bo T :AA lication Information I Print All Infor~~ f✓~ 2 Property Owners Name Parcel f ` Prop Owner's Mailing Address - - Property Location 01 .31 . ig, 11546 City, State Gon. Lot ~ -7 Zip Code Phone Number /4>P- y~ Section I ( . • /)(circle ) II, ype of Building (check all that apply Lot # _ T ~/-tL_ or W l.,or 2 Family Dwelling-Number of Bed, cot f Subdivision N c J ck Y_ ~ ~ i ❑ PubGe/Commercial - Describe Use i ❑ City of ❑ State Owned - Describe Use / CSM Number ❑ Vrllage of Z X 3 r Qovn of f C III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement S - Yam ❑ Treatmr nt/Holding Taal: Replacement Onl} ❑ Other Modification to Existing Sys= {explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber n Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / i I - I 0_5 of PO'WTS System/Component/Device: Che -k all that apply) %1~~ tt'=Pressurized In-Ground ❑ Pressurized In-Ground .Tirade ❑ Moturd > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) - _ Pretreatment Device (explain) V. Dis rsaUTre ment Area Information: Design Flow (gpd) Design Spil Application dsf) Dispers p rea~lnsed (s Dis Area Pro sed (s Elev VL Tank Info Capacity in l- Total # of Manufacturer Gallons Gallons Units u New Tanks Existing Tanks m U ~ E c 2- a u W, 1 a - . 72 U ~ Z15 i Septic or Holding Tank - _ i Dosing Chamber ~ 7 ~ - VII. Responsibility Stateme t- I, the undersigne ds responsibility for installation of the POWTS shown on the attached plans PI 's Name (P~4t) Pl b mature MP/MPRS !lumber Business Phone Cr Z, i ber's Address (Street, City, Sta e, 7i - - / 7 0/ VIW. tCounty/De artment Use Oniv II approved I Lsapproved Permit Fee Daissui ng t $i~ratrur, ~ Ov, sr Gi Deni 1 ' 4 7 DL Condi ' WHY . - ~ ° • or ~pproval '(1K gW.AgerroW plan pro rided by piu,rrbe(. ) _ t ♦ r J1A 2. 'A WM" regL&Grv ms must bt; r-airdrir.Ed .1•~, / L_~ as W~, / crtipnanccs. elk", Attach to complete plans for the sysu n and snhmir to the 0"'Y only on paper not less than 8 1n_ z 11 inches in size 31-1_--6398 (R. I 1/'l ) System PLOT PLAN PROJECT Eric Kramer ADDRESS 1258 202nd Ave New Richmond Wi 54017 SE 1/4 SE 1/4S 23 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 96.8' DATE 8/3/17 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .4 ABSO TION AREA 1130 # of chambers none Ilk BENCHMARK V.R.P. Top of steel fe ce pot a ASSU ELEVATI N 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P, ame s be r r-.,o 11 9A Town Road ~"12'Acres 'J v t~ t Grading is to be done to divert run-off away from system Scale = 1/4" = 10' B-3 tt~, d ❑ Well is to meet all WDNR setbacks 97' v 96 B. M. * Huffcutt ❑ ❑ mbo Tank 96' B-1 B-2 5% Slope ~ i Area 15' below system is to $ remain undisturbed Pro 3 Bedroom House 202nd Ave Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line r DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 0 ~A GREEN BAY WI 54304-5211 3 t ®~J Contact Through Relay P, httP//dsPs.wi.9ov/Pro9rams/industry-services 9 ~ y, www.wisconsin.gov X °ssior w~~ Scott Walker, Governor Laura Guti6rrez, Secretary August 29, 2017 APPROVI -PT OF SAFE CUSTIDNo. 226900 ATTN: PO WTS Inspector FESSIONAL ..:!CAN OF IND'UST ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708•,•l CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/29/2019 Identification Numbers Transaction ID No. 2988643 SITE: Site ID No. 842284 Kramer Please refer to both identification numbers, 1258 202ND Ave above, in all correspondence with the agency. Town of Star Prairie St Croix County SEI/4, SEI/4, S23, T3 IN, RI 8W FOR: Description: At-Grade (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1724729 Maintenance required; 450 GPD Flow rate; 100 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), 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. • 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. SHAUN R BIRD Page 2 8/29/2017 • Divert surface water from POWTS Area. • 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) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan. Any chanj4es may result in pump resizing to meet TDH and GPM Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • 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 at-grade must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • 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. 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 Wyment S code: 1. 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest@wisconsin.gov SHAUN R BIRD Page 2 8/29/2017 • Divert surface water from POWTS Area. • 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) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan. Anv chances may result in pump resizing to meet TDH and GPM Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • 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 at-grade must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • SPS 383.54(1)(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 borizontallv from where the servicing pad is located. 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, Tim Vander Leest Please Include a Copy With Your 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 Cover Page Shaun Bird S'.'i'`3k; Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 zlel ~ 715-246-4516 Date:8/3/17 Owner:Eric Kramer Location:SE 1/4 SE1/4 S23 T31 N,R18 W 1258 202nd Ave Star Prairie Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Conti cy plan 9. Filter Specifications Attachments: Soil Test Shaun Bird Signature ,i License number 22690(a li: 217 AUG 07 SERVICE1 Page 1 of 9 System PLOT PLAN PROJECT Eric Kramer ADDRESS 1258 202nd Ave New Richmond Wi 54017 S E 1/4 SE 1/4s 23 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 96.8' DATE 8/3/17 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 130 # of chambers none BENCHMARK V.R.P. 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L•1.1.1.5.5 S+5.5••.• - 1.1 r r=r~r r r~r•r•r•r•r.r•r•r•r+r r•r .-^.+-.•4. S•1•5 5.5+5•5•5•1•L•5•L••( , s•rr{~r r•r•r•r r•r LaL~S~!1.5• D - %,Plowed Surface ® Slope Direction ""--5► GENERAL INSTALLATION: The at-grade area is staked out along the desigri contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize cow -rpaction of the plowed surface. After-the topsoil cap is placed, the entire at-grade is seeded and nu,idbed to promote vegetative growth, limit erosion and protect from freezing. The observation pips::. perforated in the lower 6 inches and secured in place. 03/051gj page of Pressure Lateral Layout One Lateral - End Manifold 4 - Threaded Cleanout Force Main Lateral Turn-up Plug X L Long Sweep 90 Bend / . v l Pressure System Construction Distribution N ork Specifications Lateral Diameter. In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded Force Main Diameter In. cleanout plug and are enclosed in a 6-8 inch Force Main Length Ft. diameter lawn sprinkler valve box accessible from finished grade. Grade 6-8 Inch Lawn Sprinkler Valve Box 03/051gj Page of / Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer , i Pump Manufacturer-;,-v, Tank Model Number ` 0 0 Pump Model Number Total Tank Capacity f7: . ~7 Alarm Manufacturer UL. Max. Bury Depth Alarm Model Number Switch Type -C<<--14 Filter Manufacturer Total Dynamic Head (TDff) - Feet Filter Model Number Y Elevation Head 7 Distal Pressure j Network Loss r- - Minimum Pump'erformauce Required Force Main Loss GPM: @ Ft TDII Total S Outlet ).Manhole Min. 4" Above Grade With Locking Deice. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof 1 Junction Box - - Finished Grade MW Wft - - Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet Inlet Bade - - - - - - - Switch Se*gs and Reserve Capacity ' ` A. > %a" a Tank Volume = GPI _ Weep Dimension, Inches Volume Gal. B Hole N. 06 (reserve) A; Off Elevation C (alarm) B 2 (dose) C `j Ft (dead) D ( Bottom _ D Elevation Total S,T~a > > > . >,f . , T Y > > . r 3 ! T > . of •Y •1 > I") 1•><I•>•i<>•i >~Y"1 1.1<! <•>•>•Y i t >•Y >•1•>•i •>•>y •'<•<. • ~ `'<T • : 1<••}ia<LL L'•' u-a~•i<• <,<;a~.aa><~... < a a < . < < . a < < a < < e < e 1 < t a a a < " . f . < v . GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufact"rer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior 4pproval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and'oudet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Eleetricservie omplies with NEC 300 and Comm 16.28. 02/05 Ll Page of i_ TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING MODEL 152/153 ~---T 1152 15 MODEL I 52 I Cc!. liters i Col. Liters w j Feel Mete,, 50 5 1,5 69 251 1 77 291 1 1 10 3,; tit 231 70 265 12 40 1 1_5_ 4.6 I 53 1 201 61 231 o I 20 11 6 44 167 I 52 197 30 25 7.6 34 129 42 159 :2 1 8 30 1 9.'• 1 23 87 1. 33 125 r ! 185 0 35 j 20 I i L? 1 42 40 12.2 o 4 j Lock Vcive: 33.0 Fi. (11.6m)j44.0 Ft. 4m 0 014506 j 1 I 0 100 20 40 60 80 GALLONS e LITERS 0 80 160 240 320 - 3 27/32 I 4 5/8- 1 FLOW PER MINUTE ! j 3 27,/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ 3 27/32 • Timed dosing panels available. ! • Electrical alternators, for duplex systems, are available and supplied with I i 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. 1 • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54T.) special quotation required. -I 12 1/5 _T 1521153 Series 15 I f J' I ! 2!153 MODELS Control Selection lex t/o I Model Volts-Ph Mode A" s Sim lex Du 1 2 or 3 I I N152 115 1 Non 8.5 r BN152 115 1 Auto 8.5 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Inclo-;ed 2 or 3 N153 115 1 Non 10.5 1 2or3 SELECTION GUIDE BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 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 to FM0477. o cAUT1oN 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. AU 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 70: P.O. BOX 16347 Louisville, KY 40256-0347 Manulacfurerso . . SHIP 70: 3649 Cane Run Road ~ Opp Zo Louisville, KY 40211-1961 Q/TY PUMPS /NCf ~i7c/iJ 4 a (502) 778-2731.1(600) 928-PUMP 10111A107 FAX (502) 774-3624 pttpJ/www.zoell er. corn © Copyright 2000 Zoelle Co. All rights reserved. 77 ,t' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner t 1 0, ermit # Septic Tank Capacity al ❑ NA P Septic Tank Manufacturer ❑ NA )ESIGN PARAMETERS Effluent Fiter Manufacturer ti y~ a , ❑ NA Number of Bedrooms ❑ NA El NA Effluent Filter Model Number of Public Facility Units al )a -NA Pump Tank Capacity ❑ NA Estimated flow (average) `J V gal/day Pump Tank Manufacturer ❑ NA I Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate aUda /ft2 Pump Model l 1 L ❑ NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit J tNA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 420 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection O Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) S30 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L j4A J;jfAt-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. jj Other. ❑ NA Other: Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency lInspect condition of flank(s) At least once eve ❑ month(s) every: ears (Maximum 3 years) ❑ NA IPump out contents of tank(s) When combined sludge and scum equals one-third (X) 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: earth{s) ❑ NA / t (s) Inspect pump, pump controls & alarm At least once every: month(s) W-year(s) 13 NA ti rnorith(S) I=lush laterals and pressure test At least once every: ❑ NA ether. ,yearar(s) At least once every: ❑ month(s) ❑ year(s) ❑ NA tither. ❑ Na MIAINTENANCE 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 ic:ombined 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. I,Nhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 1411 other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land 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 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 thElt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thj; 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 ble discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt. 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 POWI:$: 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 33.33, 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 compliiont 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 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 ruled in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology/ a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation Lust be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWfS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltralive ace. 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 Name Phone / ` Phone SEPTAGE SERVICING OPERA'1 PUMPER LOCAL REGULATORY AUTHORITY Name Ii t}r~ Phone Phone This document was drafted in compliance with chapter 3PS 383.22(2)(b)(%d)&(f) and 333.54(1), (2) & (3), Wisconsin Administrative Code. fry ' W N I' a ~t O. 11~t1 SI t f i .j I f b t I v i - a o v CD cq O I Ci; 00 t ~ Z 1 a T i i a a I N N M N 0 j 61/ C j ~ 3 o I W 1 i I- i i. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIHCATKrN FORM OwnerABuyer Mailing Address ( 5 ~g _AV Jj j 1 S`~ 1 Property Address ► C J~,;~.c,,--% (VerifY.Zf n required from Planning & Zoning Department for new construction.) City/State Parcel Identification Numbexf~ C~)'Md LEGAL DESCRIPTION r~ Property Location 12 I 1/4 , 1/4 T N RU_W, Town ot5lz, P : C'Q/L'C( Subdivision Lot Certified Survey Map # Vc:'lume Page # Warranty Deed # Vo lume , Page Spec house yes o Lot line` identifiable 3--ym no SYSTEM MADTENANCE AND OWNER CERTIFICATION Improper use and mam=auce of your septic system could result in its premature bibrre to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, it needed, by a licensed pumper. What you put into the system can affect the fanctwu of the septic tank as a treatment stage in the waste disposal system Owner mamftnance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St Crow County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification foam, 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 ism proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 frill of sludge. Vwe, the undersigned bavo road tbo above requirements and agree to rawa m the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificationstatthat our s uig your septic system has been mamtamed must be completed and retanved to the St. Croix County Plaaamg & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this fo are true to the best of my/our knowledge. Uwe am/am the owner(s) of the property described above, by vntaeAf a wa7 deed recorded in Register of Deeds Office. Number f b _77 V J SIGN J UR,E OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. 1whide with this application a recorded wmmty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. OS/05) . UNPLATTED LANDS SW 1 /4 OF THE SE 1/4, SEC. 23 -869.83' - 66.00' 293.72' 278.00' = 2 . I --66'- 33' 33' co oc O T 24 LOT 23 I Lc 557 SO. FT. W 85, 666 SQ. FT. 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Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. -~f o-0 'r Xj lJj) Please print all information. Revs ed by ' Date Peramal information you provide may be used or segondary purposes (Privacy Law, s. 15.04 (1) (m)), f~ Property Ownapp / Property Location Govt. Low ~S 1/4, 114 T N R E (o Property Owner's Melling Addres ~ Low#~ Block # SubdOt+lame or CS 0c) M# X r City Stag Zip Code Phone Number ❑ City ❑ Village Town Nearest Road 5 Yaz ) r ~~11i~/ ew Construction Use-)OeResidential / Number of bedrooms Code derived design flow rate GPD Replacement ❑ Publi comet - Describe: Parent material _,o ,qtd ~r Flood Plain elevation if applicable ffl General comments and recommendations; ® Boring # Boring I - - - W Pit Ground surface elev. J ft. Depth to limiting factor _ i y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP01fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a ©-a Y 10 5 S ( r Boring # ❑ Boring ? ff-Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlf? In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 V 3 rte s l -D ry, r Ft2 LS drh S 9 Li ? O o S/ g-,-L1- S l T a e- -7 L J00 1/4. Effluent #1 = BOD } 30 :E 220 mg1L and T§0,40;< 150 mg/L ` Effluent #2 = BOD 5 30 mg/L and TSS 30 mg/l. Number CST NameXPlease Print) Ignature X 906) Address Date Evaluation Conductea Telephone Number ~~d~ % L'.~ °~cJ i~~ G/1 G✓ 7 ~4 Property Owner Parcel ID # Page --of a Boring # f❑7T goring t-I pit Ground surface elev. _22-L ft. Depth to limiting factor - 1 y in. Soil ication Rats Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-L7 e _s 0 61v S_ l 7 ~I l6 % l U r I f Boring # ❑ goring u ❑ pit Ground surface elev. ft. Depth to limiting factor in. gel Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu, Sz. Cont. Color Gr. Sz, Sh. 'Eff#1 'Eff#2 a Boring # ❑ Boring - ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 Effluent #1 = SODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = SODS < 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 TTY 608-264-8777. SBD-8330 (RAMO) Soil Test Plot Plan,: Project Name Ronald Wohlers Shau 'rd Address 1282 200th Aver N ew Richmond WI 54017 M #226900 Lot 23 Subdivision Wohlers Estates Date 8/16/00 SW/SE 1/4 SE 1/4S 23 T 31 N/R 18 W Township Star Prairie El Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon System Elevation 92.3 *HRPSame as Benchmark Alt. BM Top of Steel Fence Post with Orange Ribbon @ 99.5' Pro Town Road (Center Line) 98' 80' 0-41 97' a°. B-3 40' -01 tB-L4F1.M lt M. 30' o h go, 96' 5% Slope a 0 r 308' Property Line