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HomeMy WebLinkAbout026-1158-00-058 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division Sanitary Permit No: INSPECTION REPORT 600201 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 2994910 Personal information you provide may be used for secondary purposes [Privacy Law, s-15.04 (1)(m)j Permit Holder's Name: L City Village Township Parcel Tax No: WILLIAM MARTIN TOWN OF RICHMOND 026-1158-00-058 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 16D 25.30.18.1193 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ J ry. y~n~ L Benchmark ~ sl X03 • Alt. BM Dosing ✓w"P ~ e"14 7?. Gev~►.~Oo Aeratt6° Bldg. Sewer 9~• ~7 S Holding St/Ht Inlet St/Ht Outlet ' TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. ent t it intake ROAD Dt Inlet Septic /06 A 2-7 Dt Bottom F12 C/ 78, y Dosing 1 Header/Man. Z ( o 166 f'Aeration Dist. Pipe Z . 5 /00 A4- 2-7 1 3(o ~ rep Holding Bot. System r~ Final Grade PUMP/SIPHON INFORMATION A/- Manufacturer Demand St Cover C. 4-10 3 ,e GPM ~Fw 04.0- Model Number 5 Y) 9g y SAJ :TD 11~ Frict ion L ss ystem Hea DH FFoi _n Length IDia. 2 I Dist to weu SOIL ABSORPTION SYSTEM 3. BED/TRENCH Width Length No. O~renc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid De tp h DIMENSIONS 96 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type LSem* /Vff UNIT Model Number: r DISTRIBUTION SYSTEM Header/Manifold Distribution "d y' x Hole Size L x Hole Spacing Ve Air In Pipe(s) f Length~_ Dia Length_ Dia Spacing 3 71 Z- i SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Seeded/Sodded xx Mulched Bed/Trench Center J Bed/Trench Edges Topsoil 101--, No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection # 4, ~ ~ J-06 A, v$ Location: 1440 136TH AVE e.o J~` 40 C"k S Q ✓t 1.) Alt BM Description = 2.) Bldg sewer length = 7-7 - amount of cover O Jam- °tJG~. Plan revision Required? ❑ Yes No "s✓ Use other side for additional information. Cert No. Date In4SSaatturree SBD-6710 ( R.3/97) rU-o1~ _ i aa, x:,t C Md FM IV L_ W I 2sr Q^ Safety and Buildings Division p E ~ *t 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be ed in by Co-) 1 Madison, W1 53707-7162 s (per Zd A ST. CROIX YME~ V35VEPGJJTDJ4 State Transaction Number anitary Permit ~ _ in accordance %ith SPS 383.21(2), Wis. Adm. Code, submission of this form to me app-r„ is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to roject Address (if different than mailing addrc s) the Department of Safety and Professional Servies. Personal information you provide mac be used for secondary .r purposes in accordance with the Privacy Law, s. 15. l) m), Stats. 3 L Application Information - Please Print All Information Property Owner's Name Parcel 4 t!S ' r - Property Owner's Mailing Address Property Location 5` O P 9 vt Lot - City, StateI / ( Zip Code Phone Number - yy Section . \ i ~ / l 3 circle T,~N; R ~ or W U. Type of Building (check all that app) r 2 Family Dwelling-Number of Bedro Stidivis n Namc 8~C pp ❑ Public/Commercial - Describe Use a ❑ City of Oa~~~• G.M. ❑ State Owned - Describe Use CSM Number Village ❑ of Town of C l III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. Zew System ❑ Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (ex lain) R. ❑ 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) ❑ Non-Pressurized In-Ground ❑ Pressurized 1n-Ground ~de ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsaare ent Area Information: Design Flow (gpd) Design Soil Application dsf) Dispersal Area Required (sf) DispWal Area Prop (sf) System Elevation VL Tank Info Capacity in Total # of Manufacturer v Gallons Gallons Units u J New Tanks Existing Tanks d p : a m U n C7 W ~ r .l Septic or Holding Tank Yfr7 Dosing Chamber 7 1 1' VII. Besponsibility State a t- I, the undersigned, mu r ousibility for installation of the POWTS shown on the attached plans. N um 's Name (Print) Plumb s i e MP/MPRS Number Business rieNLupbu Plum 's Address (Street `City; State, Zip Code) / AA_ VIELJe-ounty/Department Use Onlv Approved sapprove Permit FeDsued Issuing t Siven Reason wl S y1'') DL Cond' ons orDapproval 3, GOV1. b/•i-ti jeAJ~ Attach to complete plaw for the system and submit to the ounfy only on paper not less than 8 in x 11 inches in size I SBD-6398 (R. 11/11) System PLOT PLAN PROJECT William Martin ADDRESS PO Box 382 St.Croix Falls Wi 54023 SE 1/4 NW 1/45 25 /T 30 N/R 18 W TOWN Richmond COUNTY SYSTEM ELEVATION 99.0' DATE 8/23/17 BEDROOM 3 CONVENTIONAL AT-GRADE XY~ CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 1" steel stake ASSUME ELEVATION 100' Filter Lifetime Filter BOREHOLE O WELL *H.R.P. same as benchmark B M 0% Slope B-2 ° town road ~ J o Tank is to be pro e bedde ad o J provided with loc o n cove with approved wa in labels p B-3 'r Pro 3 t Huffcutt Combo Tank Bedroom House ❑ B-1 well is to meet all WDNR setbacks Scale = 1/4" = 10' 136th Ave Cut P x7:~,~T DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 o'/, GREEN BAY WI 54304-5211 Contact Through Relay p http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~~ssro * w~ Scott Walker, Governor Laura Guti6rrez, Secretary September 18, 2017 PT OF S~ CUST ID No. 226900 ATTN POWTS Inspector S 10 ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD - NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 - CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/18/2019 Identification Numbers Transaction ID No. 2994910 SITE: Site ID No. 842869 William Martin Please refer to both identification numbers, 136TH Ave above, in all correspondence with the agency. Town of Richmond St Croix County SETA, NWIA, S25, T30N, R18W FOR: Description: At-Grade (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1727480 Maintenance required; 450 GPD Flow rate; 72 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(] 0), 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. • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 SHAUN R BIRD Page 2 9/18/2017 • 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 changes 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, Tim Please Include a Copy With Your Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services (920)492-2214, Monday - Friday 6 am To 3:30 pm WiSMART yment code: 1. 7633 tim.vanderleest@wisconsin.gov SHAUN R BIRD Page 2 9/18/2017 • 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 changes 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 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/install ati on/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 a>wisconsin.gov I . Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St.. New Richmond Wi 54017 715-246-4516 Date:8/23/17 Owner:William Martin Location:SE 1/4 NW1/4 S25 T30 N,R18 W Lot 58 136th ave Richmond 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 Contigency plan 9. Filter Specificati Attachments: So' T t Shaun Bird Signature License m er 226900 -7CEIVED \0, 2 8 7017 PI)STRY SERVICE.: Page 1 of 9 System PLOT PLAN PROJECT William Martin ADDRESS PO Box 382 St.Croix Falls Wi 54023 SE 1/4 NW 1/4S 25 /T 30 N/R 18 W TOWN Richmond COUNTY SYSTEM ELEVATION 99.0' DATE 8/23/17 BEDROOM 3 CONVENTIONAL AT-GRADE )OOC CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none 66 BENCHMARK V.R.P. Top of 1" steel stake ASSUME ELEVATION 100' Filter Lifetime Filter -0 BOREHOLE O WELL *H.R.P. same as benchmark IP. 0% Slope B.M.* B-2 town road Tank is to be properly bedded and provided with lockdown covers with approved warning labels ❑ B-3 Pro 3 Huffcutt Combo Tank Bedroom House ❑ B-1 well is to meet all WDNR setbacks Scale = 1/4" = 10' 136th Ave v i Q W W U ~ a U3 Q o J w I i Q . y I o I o I I W I I I W a~ co (0 I I `L I > W = I ( w i I Z ~o cu N O D I I Q a l = a I cu C U c) /rY ! I I ~ a I W t../ U w I C/) z\` _ ' o I 0 C/) s Q r ! I i U E cn I I ! Of Nw I I i ! ~ I I ~w a \ U) Nww I r d .s I E \ w D \I I N3 1 co ¢ a a` I I LIJ I I i I I I w a ro c7 w •Y t o w ! I L Q y ~ °m cn CL a cc \ x o l 0-0 5D co y 0 o ! I I I z I I I I _ w r Pressure Lateral Layout One Lateral - End Manifold .4 Threaded Cleanout Lateral Turn-up Plug Force Main X L Long Sweep 90 Bend Pressure System Construction Distribution Network S ecifications Lateral Diameter In. [Latterals are constructed of Schedule 40 PVC Orifices are drilled perpendicular to Orifice DiameterIn. X (Orifice Sracin) ..c r 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 Len th, ' Ft. diameter lawn sprinkler valve box accessible from finished grade. Grade Q. 6-8 Inch Lawn Sprinkler Valve ----60. Box 03/05 lgj Page Septic-Dose Tank Cross Section And. Pump Performance Specifications Tank Manufacturer Pump Manufacturer I an _ Pump Model Number/_,` Tank Model Number Total Tank Capacity Alarm Manufacturer zlt'- Max. Bury Depth Alarm Model Number Switch Type!' Total Dynamic Head (TDH) - Feet i Filter Manufi~eturer Filter Model Nt f 7 ° Elevation Head Distal Pressure - Network Loss Minimtun Pump performance Required Force Main Loss ~ - GPM: @ Ft TDH Total ' Manhole Min. 4" Above Grade Outlet Manhole Min. 4" Above Grade With ~ Locking Device. Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely.Mounted Weather-proof i ` Junction Box. Finish-d rade " ` " s 1 Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet idet Baffle - • %a Giwitch Setra;ngs and Reserve Capacity :<< Weep 40 GPI , << _Tank Volume = B Dimension: inches Volume Gal. Hole X (reserve) Ai y, 2Off Elevation C 3 p- (alarm) B ?Ft (dose) C s `s 7 Bottom < (dead) D D Elevation Total Fr I-~ti S~T~T~ T a i a e < < < i < a < a a s R <,<,a, < < <'<'< . < < . • < . < < < . a ..•a'`• r s 1,Y; ,l . I<••I;,Y,,•I•. • / Y 1 i >•Y<>•.<>`;i•i•Y<;Y<.•T•1 a<,<,<;< a +•<;,,r~ , < i•ay< i•<•< < 1 l;f~<;1+< ~<<< < < ya t < a < <•<< < l t t , 1 i < l < a•<'S•a',',•Ia r,•1•<+i a•a•V•<•1•<•i i < i 7.S • LI• r1. - GENERAL INSTALLATION: The septic/dose tank is bedded and track filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and'outlet 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. ]Electrical servi compiles A th NEC 300 and Comm 16.28, r 02/05 LJ Page 01 f _ - TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAL CAPA.CI ~y CURV" EFFt.UENT AND DEWATERING r MODEL 152/ 153 153 L MODEL jl 152 r I ti I eet ! A1eters I G caters I Gal. T L ters 50 -5 69 251 77 291 153- F 10 I 3. i 61 I 231 1 70 265 t5 4.6 53 1 201 61 231 12 40 52 --t 20 1 6., 1 44 167 52 L 197 159 7 25 7.6 34 129 42 30 30 9.1 23 j 87 33 125 ~ 20 ~ ! , v 1 Il 11 ! 42 i 40 12.2 j Lock 'vciv 13B.0 t- (11.6-n)144.0 Ft. ('3.4,n) 41 10 j j 0 20 40 60 80 100 GALLONS - r• 5 !4 i LITERS 0 80 160 240 320 - 3 27/32 FLOW PER MINUTE ' 3 27/32 1 CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. lied with B 1 Electrical alternators, for duplex systems, are available and supplied an alarm. • Variable level control switches are available for controlling single phase I systems. le level float switches are available --j- Double piggyback vanab for variable level long a ,i nd short cycle controls. j • Sealed Qwik-Box available for outdoor installations. See FM1420. I I 1 I • Over 130°F. (54°C.) special quotation required. 12 1/5 1521153 Series h~ 1521153 MODELS Control selection 7 5 1/8 Model Vohs•Pfi Mode Am 5 Sim lax Du lax 1 2or3 I sKZOSa N152 115 1 Non 8.5 ~ 8N152 115 1 Auto 8.5 Included 2or3 1 Non 4.3 1 2 or 3 E152 230 BE152 230 1 Auto 4.3 Indut* 2 or 3 N153 1t5 t Non 10.5 t 2or3 SELECTION GUIDE 10.5 Included 2 or 3 bade variable level float BN153 tt5 t Auto 1 2 or 3 1. Single piggyback variable level float switch or double piggy E153 230 t Non 5 3 Included 2 or 3 BE153 230 1 Auto switch. Refer to FM0477. 2. See FMO712 for correct model of Electrical Attemator E-Pak- 3 p CAUTION qualified should be done by a duplex odes should be followed 'mclud including the most 3. Variable level control switch 10-0225 used as a control activator, specify licensed electrician. All All installation of controlls~otec ionde ic g 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 Manufacturers of. . SHIP 70: 3649 Cane Run Road !I P„MPS ,i NCf 9,79 O o Louisville, KY 40211-1961 [GIUTY Z pq ® (502) 778-2731. 1(600) 928-PUMP / ~MP L"O FAX (502) 774-3624 htip:/hy~,N,.zoel ler.com © Copyright 2000 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner (,~_~,f r., :!r7 l Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA )ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity al NA j Estimated flow (average) gal/day Pump Tank Manufacturer r ❑ NA Design flow (peak), (Estimated x 1.5) aVda Pump Manufacturer 13 NA Z Soil Application Rate al/da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) <_220 mg/L ❑ NA D Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other. !Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L >-4t,-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size 36 in dia. AONA Other. ❑ NA (Other: Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other 0 NA IAINTENANCE SCHEDULE Service Event Service Frequency !inspect condition of tanks At least once every: month(s) (Maximum 3 Years) ❑ NA f- ars (Pump 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: [I month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: El onth(s) ❑ NA - ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ear(s) 1 lush laterals and pressure test At least once every: ❑ month(s) NA year{s) Dther. At least once every: ❑ ❑ year(s) month(s) NA ~7ther: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must !include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of _ combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipas 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 I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of }: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, And any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. r 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 thEit may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of tho 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 bye discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundations drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following, steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with sq)il, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirjed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neied for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruI0 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. ft~-.The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluai~ion must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. l Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Namur Phone f Phase SEPTAGE SERVICING OPERATOR PU ER' LOCAL REGULATORY AUTHORI r Name f~~(n . Name i'-~ - -7 Phone E41 Phone document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. :u • ;W 77N P m D - 1 ~I t ~ ~lilliil` 1 ~ 1 ~ i IL-j ~O O ~ J J a Q o y f 7 O Q i co 3 0 ° f i i i I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE ,'AGREEMENT AND OWNERSHIP CERTIFICATION FORM. Own Buyer f-,7 7 l ~_~L1.,c - Mailing Address O` 7 _ 2:) 1'!cFUAz Prop rt y Address Verification required Y { red from Planning & Zoning Department for new construction.) City/Mate Parcel Identification Nur:aber LEGIAL DESCRIPTION Prop rty Location r/4 , 1/4 , Sec. t S , T L) N W, Town of Sub vision /f' ,t'~ j c , Lot #D" Certified Survey Map # Volume__,, Page 9- War anty Deed L~ )J ,Volume , Page # Spec house yes Lot line, identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION I 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, ii 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 wastev ter disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less th n 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 Departrr. mt 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. 1/we certify that all statements o4ns,, form are true to the best of my/our knowledge. 1/we arrilare the owner(s) of the grope described above, by virtue of a ty d eed recorded in Register of Deetk Office. Num er o edroom 'k, SI A O APPLICANTN DATE ***An 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. 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Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 77 Please print all information. tewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Oakwood Land Development Govt. Lot SE 1/4 NW 1/4 S 25 T 30 N R 18 W Property Owner's Mailing Address 1141 Lot # Block # Subd. Name or CSM# Spring Lake Park ✓ 58 na Red Pine Corner Second Addition City State Zip Code Phone Number City Village V Town Nearest Road MN 55432 749180-4996 Richmond 136Th Ave New Construction Use: Of Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Pitted Glacial Drift Flood plain elevation, if plica"RECEI ED General comments C and recommendations: Mound Design, system elevation 99.55ft based on contour line 98.55ft JUN 1 1 2002 ❑ Boring # Boring ST. CROIX COUNT 't' r! Pit Ground Surface elev. 99.25 ft. Depth to limiting factor 72 1 in ZON I.e~tion Rate ~ ~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft- * " Eff#1 *Eff#2 1 0-20 10yr3/3 none sil 2msbk mfr gw 1f .5 .8 2 20-40 10yr4/4 none sicl 2msbk mfr gw 1 of .4 .6 3 40-72 7.5y4/4 none ms osg ml cs na .7 1.2 4 72-96 10yr7/4 fractured limestone na na na na na np np _ 1-1 Boring # Boring u 1ri Pit Ground Surface elev. 99.25 ft. Depth to limiting factor 75 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 1 *Eff#2 1 0-51 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 ,to 2 51-67 7.5yr4/4 none sicl 2msbk mfr gw 1vf .4 .6 `f< 3 67-75 7.5y4/6 none cos osg ml gw na .7 1.6 4 75-96 10yr7/4 fractured limestone na na na na na np np horizon 3 was wet * Effluent #1 = BOD s' 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS =30 mg/L and TSS < 30 mg/L CST Name (Please Print) natvrf: CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG. New Richmond, WI 54017 6/5/2002 175-246-5085 Property Owner Oakwood Land Development Parcel ID # pending Page 2 of 3 r-~ $ I Boring # Boring I~ ✓I Pit Ground Surface elev. 98.95 ft. Depth to limiting factor 75 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-34 10yr3/3 none Sil 2msbk mfr gw 1 f .5 .8 2 34-53 7.5yr4/4 none sicl 2msbk mfr gw 1vf .4 .6 3 53-75 7.5y4/6 none ms osg ml gw na .7 1.2 4 75-96 10yr7/4 fracturedlimestone na na na na na np np Boring # ; Boring -f 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/ft' *Eff#1 *Eff#2 11-LIL 107 r- Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. I Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <_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 L Page 3 of 3 i STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM New Richmond, Wl 54017 Lic. # 248956 06,,k u>oo l.i n ~e uc loe r-e h (715) 246-6200 5'~ Y l , Iv tJ % <Seo ZS, T30 N,1~ 18 W (715) 246-5085 "Fow /1 D~F S-4 cf?0" -Ce , Z'ed lei n e Corner` Seoo~~ f'e? Act- Sy 140 .10 ~ /I/or 4~ A°l-, laz- Qc 7a' N O ~ 1731 ~0 13 3 1 Z- l25~~ lj.!'J f /e✓oc~ •orl~/fL.' roP o-~/ ~S:GeQ./ ~f~k•e oFF/QC~ic~eS~ d= For'i n 55 130~I rL y i7e d. / 99,2S' ~ 2 = SS zs' _ 3 0, o•~ 111 !orn .t r (7ASe c