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HomeMy WebLinkAbout024-1008-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 600205 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2995331 Permit Holder's Name: City Village Township Parcel Tax No: WILLIAM PEABODY TOWN OF PLEASANT VALLEY 024-1008-60-000 CST BM Elev: Insp. BM Elev: BM Description: SectionrFown/Range/Map No: /db 1; '1~1 )f,06.28.17.44B TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r, 3 Benchmark Dosing Alt. BM rHolding~& Bldg. Sewer / 3 ~y St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO ~PL WELL BLDG. Vent it Intake ROAD Dt Inlet I Septic , Dt Bottom 8 It z W . 6 Dosing 7 Header/Man. ? 97. Z Aeration ~ Dist. Pipe , Holding Z ~ 5-11 Bot. System PUMP/SIPHON INFORMATION Final Grade Z. Manufacturer Demand St Cover Z'O GPM r► / ~O y O Z 'G Model Number 1021 TDH Lift Friction L s.97 System Head TDH AA ./A F 3.9 I Forcemain Length fDia. r 11 Dist. to well 43 L 56 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. pt,Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~`J /~f) SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR TypSystem: UNIT 0 J `7 Model Number DISTRIBUTION SYSTEM 0 Header/Manifol) / Distribution x Hole Size , ( x Hole Spa Vent o it Inta Pipe(s) GL~] LL' Length /f Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded odded ulched Bed/french Center 1 Bed/Trench Edges Topsoil _ 1 ` - s I ' No lyx Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspecti #2: t/ Location: 1528 CTY RD N of ~p eL1 s III~VORL...••~~r/// 1.) Alt BM Description = 4:114-11 - ~GyC 3 O 2.) Bldg sewer length - 15 GL~ J~J -amount of cover= ~ ^ ^ Plan revision Required? [ji Yes No 1.1 Use other side for additional information. SBD-6710 (R.3/97) Date Insepct*ature- Cert. No. Coun 1 Safety and Buildings Division 8 K 201 W. Washington Ave., P.O. Box 7162 sanitary Pettnit Number (to be filled in b}' C Madison, WI 53707-7162 Sanitary Permit Applicatio, State TraasacrtionNnmber In accordance w~ SPS 383.21(2), Wis. Adrm Code, submission of th ental unit is required prior to obtaining a sanitary permit Note; Application formawned POWTS oveare submitted to Project s (if different than mailing ress ll/ the Department of Safety and Professional Servies. Personal information you provide tt for secondary ) f RLrrposes in accordance with the Priv Law, s. 15. 1 m), Stars. I 43 , v L Application Information - Please Print All Information Property Owner's Name ` Parcel C70q 77( Property Owner`; Mailing Address l Property Location City, State J Govt. Lot Zip Code Phone Number Section + I y~ tit c C, J- 'Z circle one)"~ Ll- Type of Building (check all that apply J Lot # T N; R ~ E br W ) or 2 Family Dwelling - Number of Bcdro s Subdivision Name # ❑ Public/Commercial -Describe Use lock ~ D City of ❑ State Owned - Describe Use CSM Number O ❑ Village of 49 P C ?9LIv_wn Of. 111. Type of Permit: (Check only one box on line A. Complete line B if applicabI A ~New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (extyiain) B• ❑ Permit Renewal 11 Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued -q ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS SVStem/Com onentMevice: Check all that a XI I - Non-Pressurized In-Ground D Pressurized In-Ground ❑ At-Grade d 12244 im of suitable soil D -Mound < 24 in. of suitable soil D Holding Tank D Other Dispersal Component (expt ) D Pretreatment Device (explain) V. Dis rsal/Treat ent Area Information- De/sign Flow (bpd) Design Soil Applicati dsf) Dispersal Area Requir st) Dis rsal Pro ~f(s S em Elevation 3 VL Tank Info Capacity in Total # of Manufacturer - Gallons Gallons Units New Tanks E ..v; g Tanks m J Septic or Holding Taak Dosing Cbambcr VII. Responsibility Statement- the undersigned, asst esponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber Sim e MP/IvtPRS ?number Business Phone Number } Plumber's Address (Street, City, State, Zip Co I VIII. unty/Department Use Only Approved - PennitFee MM Date sued Issuing. Signature 'v eason for Denial $ ~0 • "[J /7 DL Conditi pproval dM artbi i lit !'it?Et d~ bB s . !c as I n, . into'," eC' V~ 1 ~f I t/~ In pQr 7larsK0"MM plzn p u ,ided bV plumbe.. i p fLr 1 A 2, '~tnal~i~( tec~e~lens mu~tpE t:-K~;rt,.use RT'E' ~ IwJ~~'A-t 3 as pK 1V'krbW cod,- J ,xdina11r.P3. J Attach to complete plans for the system and submit to the nun onl on pa ' L tyl y per not less than Sir z 11 inches m SLZL SBD-6 1 'S 6 G 398 (R- 11/I1) ~ y 1 ~ I i System PLOT PLAN PROJECT William Peabodv ADDRESS 1528 Ctv Rd N Roberts Wi 54023 SE 1/4 SW 1/4s 6 /T 28 N/R 17 W TOWN Pleasant Valley COUNTY ST. CROIX SYSTEM ELEVATION 96.8' DATE 8128/17 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 XXX HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION no, Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 10' 1.2' Acres Q Tank is to be properly bedded ov.; ed and provided with lockdown covers with approved warning Existing 3 fST O l abels Property Line Bedroom W e I I House B.M.* Old system is to be pumped and buried ffcutt Combo Tank B-3 96.5' 95.8' 95.5' B-1 B-2 94.5' Area 15' below system is 5% Slope to remain undisturbed Grading is to be done to divert run-off away from system Cty Rd N it DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 Contact Through Relay P http://dsps.wi.gov/programs/industry-services ?y~ 4 www.wisconsin.gov Scott Walker, Governor Laura Gutierrez, Secretary September 20, 2017 f ti b^,; pew 0 NJ CUST ID No. 226900 ATTN POWTS Inspector 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: 09/20/2019 Identification Numbers Transaction ID No. 2995331 SITE: Site ID No. 842965 William Peabody Please refer to both identification numbers, Cty Rd N above, in all correspondence with the agency. Town of Pleasant Valley St Croix County SE 1/4, SW1/4, S6, T2 8N, R17W FOR: Description: Mound System (3 Bedrooms - Replacement) Object Type: POWTS Component Manual Regulated Object ID No.: 1727877 Maintenance required; Replacement system; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/O1, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • 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. • Abandon Existing System per SPS 383.33 • Pump Floats to be set and verified per approved plan. Anv changes may result in pump resizing to meet TDH and GPM Specifications. • 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) • • SHAUN R BIRD Page 2 9/20/2017 • Tank Installation to follow all manufacture's recommendations. • 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. • 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 mound 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. 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 con struction/instal lation/operati on. 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 Submitta1l. W Payment S Private Sewage Plan Reviewer, Division of Industry Services code` . 7633 (920)492-2214 , Monday - Friday 6 am To 3:30 pm tim.vanderleest cr wisconsin.gov • SHAUN R BIRD Page 2 9/20/2017 • Tank Installation to follow all manufacture's recommendations. • 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. • 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 mound 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. 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 S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer ,Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest(~.wisconsin.gov Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 % - Date: 8/28/17 Owner:Wiliam Peabody Location: SE1/4 SW1/4 S6 T28 N,R17W 1528 Cty Rd N Pleasant Valley Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specifio*i s and cross section Attachments: Soil Te Shaun Bird° Signature License number 2~2 900 Page 1 of 9 IN101JSTRY SERVICES System PLOT PLAN PROJECT William Peabodv ADDRESS 1528 Ctv Rd N Roberts Wi 54023 SE 1/4 SW 1/4S 6 /T 28 N/R 17 W TOWN Pleasant Valley COUNTY ST. CROIX SYSTEM ELEVATION 96.8' DATE 8/28/17 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK r MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark I Scale = 1/4" = 10' 1.2' Acres Tank is to be properly bedded Failed and provided with lockdown covers with approved warning Existing 3 ST OW labels Property Line Bedroom O Well House o B.M.* Old system is to be pumped and buried Huffcutt Combo Tank B-3 96.5' 95.8' 95.5' B-1 B-2 94.5' Area 15' below system is 5% Slope to remain undisturbed Grading is to be done to divert run-off away from system Cty Rd N Mound System Cross Section and Plan View Dimension Feet f A A t 1 1 ;E B 1 J1 / •YY4•'4•YYYW4.4.4.4•Y4.4.4•Y4•YY4.4.4•YYYY C r.r.J•J•J.r_-J- r•f•r•rw.r-r~-r-r•f.N•J~' .JrMi~i:r"•:'':'-••'.•.••••'n:.:':.:' D : rvrwwv-r-r.J.r.rwy-~~ v'v - A •4.4•Y'4• 4.4--.:Y1n •4•Y4•YYYL•4M•W NYY•4~•4K•YY4•L•4.4.4.4•YY4j4•Y j4~ 1 ~rYMhrYNJ-r Li 4•YL•4.4 ti•4•YY4.4•"••Y4.1•Y4..4.4.4•Y 4.4r'.•4:WYYL.1.4.4~4.1.4•Y 4 Yti•4.4.4J V~~Yf•NYYwM•f••••rtilY•J•rV• YYY•JY•!•N•J•J•J•r•rY•r•r•fY M•fi•JY•J•f ~YY •4.!Elm W •Jy.•K~ryf•f• LJ•! Yr•4f•4•rtifY rKKhN~~N~-i-1N.f 1 N.rµ Y F -r-r•J•J•r•r•r•i r•r-r-}•r•r•r•r•r•r-r•i•nr•r-rvvr•r:r 1 1 Z . G '!1 a 1 r' ii::~i~i i i'i i:: i•i'i~:~;.i...•.• : , H /10 1 - I I cc 1 J Z r; 1 K l ~J0f w [o ! J (9 K $ z ! Slope L 41 L I -:71 = Topsoil = ASTM C-=33 ;Y:Y = Clean aggregate = 4 in. sch. 40 pvc 1 Cap Material sand fill %2 to 2 '/2 in. dia. 0 observation pipe Geotextile H Fabric N• 4.4 44 •1YY ,_4, ~Y4 ,~Y4 r F~ • 4 fi ••rY Y• ` D E i Ft Contour Plowed Surface Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x V) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6!inches and se~jcured in place with rebar or a closet flange. 10107l9j Paige 0 f Pressure Lateral Layout Two Laterals - End Manifold 4 Threaded Cleanout Lateral Turn-up No Plug Manifold M X L Long Force Main Sweep 90 Bend Aali Distribution etwork S ecifications Pressure System Construction Lateral Diameter "Z In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC In. pipe. Orifices are drilled perpendicular to Orifice Diameter 3/4 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 M anifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main Length Ft. from finished grade. Grade j 6-8 Inch Lawn Sprinkler ' Ialve Box Page of 03/051gj i Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Tank Model Number Pump Model Number j- Z Total Tank Capacity Alarm h4anufact= S Max Bury i A.W m Model Number Switch Type n i G Filter Manufacturer Total Dynamic Head (TDM - Feet Fitter Model Number ? Elevation Head Distat Pressure Network Loss , Miziimmn pump performance Required Force Main Loss 7 &P-41 5. Ft TDII Tout S' outlet Manhole MiiL 4" Above Grade With I ' Manhole Min. 4" Above Grade Locking Device. Inlet Manhole u unt(d With Looking Device < 6" Below G *de Seated "Watertight SecrelY Wend=-proof Junction Box E-FWsbed Grade " s ~ t. s t. a: Vent Nim. l2" Disconnect Above Grade Means With vent cap Outlet Filter - Inlet t t Bade >ta A. a Switch Sat*gs and Reserv Capacity 40. Weep > GPI f<• Tank Volume B Hole Dimension Inches Volume Gal. ' (reserve) A 3 7 . . > Off Elevation C t 2. {alarm) B 0 Ft Bottom Elevation (dead) D / 3 D Sr- Ft Total aZ.~ 3 b. •afa :•:.:'i .f.'.•a'•• f•a•i f a. t aaa < a a~ a <.a ! ! a. s a!< f i< <i a aka a t< s a< p s a'a•:: i <ifs:•<fi <>.:a:<ai i tas tats: <'t•i <at:aa:'<•i si i a a::: ! i°i <ai iait: ~ia::a:'t::at•talaa:ai a :a::asaisai i :ati`i a s ra . Wlth the ' GENERAL INSTALLA'`ION: The;. septic/dose.talc is bedded. and .back filled it aCCOIda[iCe r may al specifications. A+Mmimum depth of bury es. specified . by the ~ufactute lo not ck) manufacturer's product. appManhole covers exposed to grado have as effective locidng device (pad be excealed without prior dpproval. fiffi and installed. Piping at tl~ inlet and outlet isf approved material, connected to the tank w sagging. The force mWn. is slaved with 44. Sch. 40 PVC to bridge the tank laid on stable sort to prevent settling or lies ritlu NEC.300 and Comm I62S. Eteetrical:sei mp . . f excavation and the .sleeve. is Sealed o Page J of 02105 U TOTAL DYNAMIC NEAD/CAPACiTY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING Ln MODEL 152/153 MODEL i 152 t53 ti 50 Feet meters Gol. Liters I Got. Liters 5, 1.5 69 251 77 291 153 10 3.i 61 231 1 70_265 12 40 15 15 4.6 53 201 61 231 ° 20 - 6.1 1 44 167 52 197 z 30 25 7.6 34 129 42 159 a 8 30 I 9.? 1 23 87 i 33 125 o ; 22 55 3. ; 20 1 11 42 0 40 12-2 - 6.m) 144.0 Ft. 11.1.4m) 4 L ck Voive: 138.0 Ft. 014506 10 I 0 20 4 60 80 100 GALLONS e 1/4 LITERS 0 80 160 240 320 _ 3 27/32 s 5/8 FLOW PER MINUTE I I 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. - = ® 3 27/32 I ~ Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable I 1~ level long and short cycle controls. • Seated Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. ,21;8 L- ! ( --r 1521153 Series' 1521153 YODELS Control Selection ) I I I Model Volts-Ph s Sun ex Du Iex I 5 1/8 Mode I i N152 115 1 Non 8.5 1 2or3 y~06~ BN152 115 1 Auto 8.5 Included 2 or 3 { -L E152 230 1 Non 4-3 1 2 or 3 SE152 230 Auto 4.3 Inks ed 2 or 3 NM 115 1 Non 10.5 t 2or3 SELECTION GUIDE Ei53 2 115 30 1 1 Auto 10.5 tndu:ed 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float E 153 Non 5 3 1 2 or 3 BE153 230 1 Auto 5.3 Included _2 or 3 switch. Refer to FM0477. p CAt171oN 2. See FM07I2 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 acWat0f, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most Or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. kWL TO: P.O. aOX -6347 Louisville, KY 40256-0347 Mandacturersof.. F Z SHIP TO: 3649 Cane Pun Road ~ Q Q Lwisville, KY 40211-1961 JjuQUrr'P PS /NCF X999 ¢ P)ff,11Ar fQ (502) 778.2731.1(800) 926-PUMA r-AX (502) 774-3624 httpJlwwwzoeUer.com © Copyright 2000 Zoeller Co. All rights reserved. ~o 9 • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Fil-F..ZNFORMATION SYSTEM SPECIFICATIONS Owner y Septip Tank Capacity 4#2al l3 NA' Permit Septic Tank Manufacturer NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms p NA Effluent Fitter Model ❑ NA Number of Commercial Units NA Pump Tank Capacity al ❑ NA Estimated flaw (average) al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) J2~ gal/day- Pump Manufacturer ❑ NA I ~j2 Some Application Rate aVda /ftZ PumP Model ❑ NA influent/Effluent Quality Monthly average' Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Weiland Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids ([SS) 5150 m /L Manufacturer Pretreated Effluent Quality . ❑ NA Monthly average' Dispersal Cell(s) round (pressurized) Biochemical Oxygen Demand (BOD5) 530 mg/L ❑ in-ground (gravity) A3,0191 Total Suspended Solids (TSS) 530 mg/L ❑ At-grade nd al Coliform (geometric mean) s1W cfu/100ml ❑ D ine er. Fec Maximum Effluent Particle Size Y inch diameter - Values M*a! for domestic (non wTMnemlal) wastewater and septic tank effluent Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ month year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume Inspect dispersal cell(s) At least once every ❑ months ar(s) (Maximum 3 yrs.) Clean !effluent fitter At least once every ~l ❑ months -fiear(s) ❑ months ear(s) ❑ NA Inspect pump, pump controls & alarm At least once every Flush laterals and pressure test At least once every ❑ months year(s) ❑ NA other. At least once every ❑ months ❑ year(s) ❑ NA other: At least once every ❑ months ❑ year(s) ❑ 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 strum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be'visuaily 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%notifcation of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals trine-third (X,) or more of the tank volume, the entirecontents of the tank shall be removed by a Septage Servicing operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters. mect-qnical or pressurized POVVI S components, pretreatVrnent components, and any other maintenance or monitoring at i4ervats of 12 months or less shall be performed by a certified POWTS Maintainer. A servicg report shall be provided to the local regulatory authority within 10 'days of completion of any service event START UP AND OPERATION products or other For new construction. prior to use of the POVVTS check treatment tank(s) for the presence of painta)g p chemicals that may impede the treatment process and/or damage the dispersal cell(s)- If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior.to use_ Page of START UP AND OPERATION or other chemicals thElt For. new construction, prior to use of the POWTS check treatment tank{s} for the presence of Caren deter have the contents of th If high cones may impede the treatment process and/or damage the dispersal cell(s). 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. ble During power outages pump tanks may flit above normal highwater levels. When power is restored the excess wastewater will will ni discharged to the dispersal cell(s) in one large dose, overloading the cell(s) andl may result in thebackup or io ~ ~ fl To avoid this situation have the contents of the pump tank removed by a Septage Servicing per~ s to restore normal to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump control within the pump tank. the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or perk over, or otherwise disturb or compact, 15 feet down slope of any mound or at-grade soil absorption area. the rife of the POWTG: Reduction or elimination of the following from the wastewater stream may improve the performance and prolong antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers;! dental floss; diapers; disinfectants; f Ong P* (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; 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 property and safety abandoned In compliance with chapter Comm x3.33, Wisconsin Administrative Code:. e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space fined with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have; been, or must be taken, to provide a code compl4o replacement system: O A suitable replacement area has been evaluated and may be utilized, for the location of a replacement soil absorption s 'rrem The replacement area should be protected from disturbance and compaction and should not be infringed upon by 4u setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result IInn the a Jed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with e 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 POW TS. e site has not been evaluated to Identify a suitable replacement area. Upon failure of the POVVTS a son and site evaluagon ust be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed] as last resort to replace the failed POWTS. nd and at-grade soil absorption systems may be reconstructed in place following removal of the blomat 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 IVIAINTAMER Name, 5 ` blame 7 Phone Phone -7 J SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name - ~ Phone Phiorie f J~ E 4 42 j This document was drafted in compilance with chapter SPS 383.22(2)(b)(1)(d)a(t) and 383.54(1), (2) $ (3), Wisconsin AdministrafNe Code. YW'. A I A ~ 1 h 1 jl f, 1 FA ~r cr) v o• pry o 'O O L.Lf L L- a ~ J) S i ~ a EO ov I , a i• ti` m c m c-4 m ~ N g C CC) ~V1I O t o W i C) 1 I I i ST. CROIX COUNT-y SEPTIC TANK MAINTENANCE -AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address - F (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Nuviber LEGAL DESCRIPTION Property Location 1/4 , c %4 , Sec. T NR r~~ r _ I- 7 W, Town of Subdivision _ , Lo t # Certified Survey Map # _ ` l , Volume Page # L Warranty Deed # _ , Voltune , Page # l , Spec house yes no Lot line: identifiable y s no SYS TEM MAINTENANiC'E AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its prc,matttre 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 o~ the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance put into responsibilities are specified in §C'ornm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zon ing Department a certif cation form, owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper ver sign ifying by the wastewater disposal system is in proper operating condition and/or (2) after inspection and Wing that necessary), the on-site less than 1/3 full of sludge. pumping (if'necess septi tank is 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system ith the standards set forth, herein, as set by the Department of Commerce and the Departrnont of Natural Resources, State of Wisco in. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County PI nning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements o s form are true to the best of my/our knowledge. I/we am/are the owner(s) of t I e property described above, by virhre of a rranty deed recorded in Register of Deeds Office. Number of bedrooms y SIGNATMZP, OF PLICANT{S) !I / DATE ***any information that is misrepresented may result in the sanitar II permit being r,^:voked by the Planning & Zoning Depar~ nt. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey reference is made in the warranty deed. p if' {REV. 08/05) RECEIVED UG 3 d 2017 , . Wisconsin Department of Comm rce soil 23 ORT Division of Safety and Buildin%TCROM COUN Page of ,OMMUNITY vvis. Adm. Code Coun Attach complete site plan on paper not less than 8 1/2 x I I inches in size. Plan must ty ? i 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. tV l° 0 Please print all information. Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). iA7// F Property Own r ( Property Location 4, . Govt. Lot - 1/4 t, 4 S T s iJ N R~ E ( rProperty Owners Mailing Address Lot # Block # Subd. CSM# s City S Zip Code Phone Number ❑ City ❑ Village JPJo Nearest Road I L4j" ( Fln-1 ) ma Y&- C ' ❑ New Construction Use'94-Eesidential / Number of bedrooms Code derived design flow rate .fl7> GPD PtReplacement Public or commercial - Describe: Parent material tu "7 Flood Plain elevation if applicable - - ft. General comments and recommendations: System Type n - System Elevation 1 ~'000, 1] Boring # E] Boring Al • ft '1 pit Ground surface elev. . Depth to limiting factor 0 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 'Eff#2 Boring # Boring pit Ground surface elev. - e 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. 'Eff#1 'Eff#2 r_ ~s l C 1 2, , ` Effluent #1 = BOO. > 30 < 220 n-4L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig t CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address to Evalua? ' n Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of Boring # Boring 9 pit Ground surface elev. / b • 2--t. 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. 'Eff#1 'Eff#2 L -50 3~- • - 01. F-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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 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-8730 (R.6/00) i Property Owner Parcel ID # Page of Bonn, # Bonng Pit Ground surface elev. J Depth to I n&V factor 1.~ in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure. Corsistence Boundary Roots GPD/fE in. Munsell Qu. Sz. Cont. color Gr. Sz. Sh. 'Efr#1 '01#2 L el 3 # El Boring ❑ Pit Ground surface elev. ft. Depth t0 linddrQ factor in. Horizon Depth Dominant Color Redox Rate Description Texture Structure Coruistence Boundary Roots GPD/fP in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'EW -EfF#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. fL Depth to Grni" factor in. Sol Appkation Rate Horizon '>epth Donanant Color Redox Description. Texture Structure Consistence Boundary Roots GPQ fF in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Efr#2 Effluent #1 = BODS > 30 < 220 nxyL and TSS >30 < 150 mgA. ' Effluent #2 = BOD5 < 30 nggt and TSS < 30 n-41 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 508-266-3151 or TTY 608-264-8777. SBD4330(RAOD) Soil Test Plot Plan Project Name William Peadbody Sha d Address 1528 Cty Rd N Roberts Wi 54023 C M #226900 Lot 1 Subdivision D 8/28/17 SE 1/4 S W 1/4S 6 T 28 N1R17 W Township Pleasant Valley F Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation 96.8' *HRPSame as Benchmark Scale = 1/4" = 10' Failed 1.2' Acres Existing 3 ST DW Property Line Bedroom O 0 Well House B.M.* B-3 ❑ 96.5' 95.5' B-1 B-2 94.5' 5% Slope Cty Rd N