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HomeMy WebLinkAbout042-1090-20-610 PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 600277 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No 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: Roscon Properties, LLC TOWN OF WARREN 042-1090-20-610 CST BM Elev: Insp. BM Elev: BM Description: ~ Section/Town/Range/Map No: no .,if^0 32.29.18.497A-70 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -r- 3 Benchmark /d Nc1~~,~ P: t +r 16c-,n ~y /C) . dosing / Alt. BM o /d (o t"~, I l-.ti L.r ~-t.~ .•-L~ Imo' [ 1-~-~ da_.c~.-. Aeration Bldg. Sewer r 63 /6 Z Z, Holding St/Ht Inlet /,o TANK SETBACK INFORMATION St/Ht Outlet /b r TANK TO P/~ WELL BLDG. ent t Air Intake ROAD Dt Inlet ~tt ~ 9 Septic r Dt Bottom Z/ 7~7 Dosing Header/Man. Aeration Dist. Pipe /66 Cv /o.7 /Op Holding Bot. System 7 Final Grade d % 1 PUMP/SIPHON INFORMATION Low, emand St Cover Manufacturer D GPM Model Number; ° • ! ~'J TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width : Length No. Of Trenches j PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer— INFORMATION CHAMBER OR Type Of System. ~I UNIT Model Number: 162- A v`Je DISTRIBUTION SYSTEM /(04-'f6 ~ j2 d-aL Header/Manifold /I Distribution Ix Hole Size Ix Hole Spacing Vent to Airlntake Pipe(s) (.JC a 1 Length Dia ~ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over Tx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 7 Bed/Trench Edges ° Topsoil C Yes C No l Yes No l COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 688 104TH ST `4- 1.) Alt BM Description = / 2.) Bldg sewer length = 76 / - amount of cover 7 Use other revision de for additional Yes No information. Date / Insepctor's Signature Cert. No. SBD-6710 (R 3/97) F vm County 2~e Safety and Buildings Division tI 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 1 Madison, W1 53707-7162 r~ ~ry~w 1X COVN~ / p Lp E A~ S cR PM ,oM anitary Permit A iCa* 0,X Stale Transacts n number in accordance with SPS 38321(2), Wis. Adm. Code, submission „ X' v 'ltal unit iff - is required prior to obtaining a sanitary permit Note' ' 2f ?.9 _ aomiued to Project Address (if different than mailing address) the Department of Safety and Professional Servies. 1 ~tSN~ -.•.r ce used for secondary ~ purposes in accordance with the Privacy Law, s. 15.04 BX77 [l` 1. A lication Information -Please Print 1. v -1011 Property Owner's Name Parcel # _ / r a te; ~ 20 -Af 60 Property Owners Mailing Address Property Location -1 /3' A V_,~Govt Lot City, State Zip Code Phone Number ~/y Section T N, R ar w H T pe of Building (check all that apply t # amily Dwelling - Number of Bedr Subdivision Name 11k Block # ❑ Public/Commercial -Describe Use V ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of~ Q wtL III. Type f Permit: (Check only one b ix on line A. Complete line B if applicable) :Z X1, A- ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal eimit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued ' Before Expiration Owner ' A IV. Type ofPOW TS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground 11 Pressurized In-Ground El At-Grade El Mound > 24 in. of suitable soil ❑ Mound ,2 in. of suitable soil S ❑ Holding Tank ❑ Other Dispersal Component (explain:) ❑ Pretreatment Device (explain) V. Dis rsaVrreat ent Area information: Des' Flow (gpd) Design Soil Application dsf) Dispersal Area Required (sf) Dispersal Area Proposed System El on / VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a i m v U hew Tanks F_xisting Tanks Septic or Holding Tank Dosing Chamber - VII. Responsibilint- I, the undersigned a e responsibility for installation of the YOR TS shown on the attached plans P, 's Name (PignMP/MPRS Number Business Phone Number .7 Plumber's Address (Street, C State, Code) ( l VHL,CountvfDepartrnent Use Only ?1~ pproved hermit Fee Date t~ufed Issuing t Signature er Given Reason for Denial 1 I D I ` 1 IX Con ' / nti1bC ~~f~o'rir I?' approval L~ as• § r'"o /A 1. ye. `rk, vftt:1'tnv k (j Sper _,i cell MUSt dll be s°I :k:?s !mein / -is per :;gar icemen ,)i n lyr<i ,ideri Uy plumber. n' 2. All wt.bark re.ctjr.~!-ems mwt LET t: r nt it E.Y ~i I V as per sppfiWbl-i c nr,s / : rdimanG.11. Attach to complete plans for the system and submit to County only on paper not less than 8 in x 11 inches in size SBD-6398 (R. 11/11) Soil Test and System PLOT PLAN PROTECT Richard Stout Roscon Properties ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NE 1/4 NW 1/4S 29 /T 18 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 96.2/96.8/ 4' below quad 12/20/17 3 DATE BEDROOM CONVENTIONAL XXX d v NVENTIONAL LIFT HOLDING TANK irk MOUND SEPTIC TANK I E 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 676 # of chambers 33 ,BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale is P = 40' unless otherwise 104th: St noted 7% Slope B-2 lop' a 90' 30' 490' Property Line 3' X 4cells with >3' spacing B-1 5 Replacement area ~ S Pro 3 Bedroom 10 youse 7 All pipin shall be ASTM SDR 30/34, within f 10' of tan , piping shall be ASTM F891 I IJ Vent' >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 12" Long Grade at System Elevation A » ew. s w Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings 1 t I~ i ,itj, dahceYvl~h Comm 85, Wis. Adm. Code f- ~ tnty Attach complete site plan on paper notaeA~1'"ti!$cww"~AN size. Plan must include, but not limited to: vertical an ' ~ {a rte/ direction an&* '15* ~ LD. percent slope, scale or dimensto rrow, and location and distance to P Please print all information. a Z Review y Date Personal information you provide may be used for secondary purposes (Pr;- G~V m)). Property Owner r V~ ,,erty Lox ' Govt. Lot 1 / 1 /4 S 12-T ~ N R Z Property Owner's Mailing Address Lot # Block # Subd. Name M# c'- uly, State Zip Code Phone Nu ber ❑ City ❑ Ylla~ge.~~Town earest Road New Construction Use~esidential / Number of bedrooms t`S Code derived design flow rate GPD ❑ Replacement CC ❑ Pu c or commercial -Describe: Parent materialL/ 2 c J Flood Plain elevatio a icable General corrvnents and recorrxnendations: l/' )r f.L t/~ = F System Type L fit' System Elevation_ 'Y 7 a Boring # Boring pit Ground surface elev./?0 L ft. Depth to limiting factor l in. T 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 ...E 0 ~ J, rl Boxing # ❑ Boring pit Ground surface elev. f 7O+ ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. ~~M}}unsll Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 6161-1 ~L"J r it Effluent #1 = BOD. > 30 < 220 mg/L and T >30 < 150 • Effluent #2 = BOD. < 30 mg/- and TSS < 30 nxyL CST Name (Please Print) ture CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 540 %r r' - 715-246-4516 Parcel ID # Page of Property Owner ❑ Boring Z- Boring # & Pit Depth to limiting in. a I+~Pit Ground surface elev. 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 A 0" r n -V A k) Z l~ 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 E] Boring E-1 Boring # F1 pit Ground surface elev. ft. Depth to limiting factor in. 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 EEI Effluent #1 = BODS > 30:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/- 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 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6/00) Property Owner Parcel ID # Page of Boring #❑~ryry Boring 2 t,Pit Ground surface elev. 0 31 Z' ft. Depth to limiting factor _ in. Soil lication 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 ~3 ter Z A k--1 ti ,t ~ I I I ❑ 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 Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ 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 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, i 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 (8.6/00) Soil Test and System PLOT PLAN PROJECT Richard Stout Roscon Properties ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NE 1/4 NW 1/4S 29 /T 18 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 96.2/96.8/ 4 4' below ade 12/20/17 3 ^ ? DATE BEDROOM CONVENTIONAL XXX NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK I E 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 676 # of chambers 33 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale is 1" = 40' unless otherwise 104th St noted I o~ 1% op, 7% Slope B-2,, l 10 .4 90, 30' / 490' Property Line M * /3"-3' X 46' cells with >3' spacing B-1 15 Replacement l B-3 area / 10' ST Pro 3 Bedroom 10' House 11 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long „ Grade at System Elevation S rv -a~ t~ - 3IS County Pecel M Safety and Buildings Division t " 201 W. Washington Ave. P.O 7162 Sanitary Permit Number (to be filled in by Co.) a y'1, r n, 53 -7 VA Q1'~ X277 r~ 4~s N~~~ ~t Stale T Number ;onnM ~ 1" N,~GFN In accordance with SPS 383.21(2), Wis. Adm. Code, submissio; Lo the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Applicatio,...~rms for state-owned POWTS are submitted to Project Address (if different than trailing address) the Department of Safety and Professional Servies. Personal informattion you provide may be used for secon oses in accordance with the Privacy Law, s. 15. 1)(m), Stats. I A lication Information - Please Print All Information p~ Properr Owner's Name , ( e Property Location Property Owner's Mailmg Address Govt. Lot ---T City State Zip Coded Phone Number N I/,,~ 1~J'/+ Section s O Y ) t (circle cs ! -1 T N; w pe of Building (check all that apply) Lot Subdivision Name 2 Family Dwelling-Number of Bcdroo fJ~ B1o ❑ Public/Commercial - Describe Use ❑ City of VWV CSM um Q 'village of ❑ Sta Owved -Describe Use Z +oA-- Gad. - W. Type of Permit: (Check only on box online A. Complete line B if a I' A. New System ❑ Replacement System Treatment/H eplaceruent Only ❑ Other Modification to Existing System (explain) • list Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision I Cha n g er ❑ Permit Transfer to Hew Before Expiration IV. T of PORTS S stem/Com onent/I)evic h %hpl that apply) _ Trion-Pressurized In-Ground ❑ Pressurized In-Gro At-Grade ❑ Mound > 24 in. of suitable soil ❑ Motmd < 24 in. of suitable ❑ Pretreatrnent Device (explain) Holding Tank ❑ Otb ispersal Component (expl , V. Dis rsaVrreat ent Area Information: pr posed (sf) ystean Elevation (ripd) Design Soil Application f) Dis ersal P rea Required f) Dispersal Area Design Flow Tank Info Capacity in Total # of Manufacturer VL I P o Gallons _ Gallons Units , J y c ar p m .a New Tanks Existing Tanta • t U cn P Ln Septic or Holding Tank /l Dosing Cbamber ~.y C~ VII. Responsibility Statement- the undersigned, assume r o ibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumnbec's Si ''.0 S Number , Business Phone Nurn Plumber's Address (Street City: State, Zi Code VIII. ounty/De ar'tment Use Only Per~m/it Fee Dale sued ) ~J Issuing . t Signature Approved t v yg y. eason for Denial I - 1 DL Conditipns R' Pt 'g1~8i PProval (jss ,i bR?~ cell must dll ~~;-fcs ! r; rat 'r 3~ ~'.r i as per .7mr.agement plan roru liaeh Vv NIwnbe . 2. A reqW S,inuut.tie 1 'aintF i1 a;i as W #pFalba tong / WtdiIlamai. Attach to w®plue plarcs fur the system and submit to the County orals un page' not leas than 812 z t l inches in sift SBD-6398 (K 11/11) System PLOT PLAN PROJECT Roscon Properties ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NE 1/4 NW 1/4S 29 /T 18 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 110.0/109.0 4' below grade 11 /13/17 BEDROOM 3 DATE CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE 0 WELL *H.R.P. same as benchmark Scale is F = 40' unless otherwise 104th St B.M.* noted t ji Quick4 Standard 75 Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 1 0' 490' PropertyLine 3 4 Grade at System Elevation Vents All piping shall be ASTM SDR 30/34, withi 10' of tank, piping shall be ASTM F891 -3 75' 12% Slope 40' Pro 3 Bedroom House 2-3' X 66'cells with >3' spacing B-2 30' 15' 110' 90' Huffcutt Combo Tank 112' 104' ro 7. 07 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11/13/17 Owner: Roscon Properties Location: NE 1/4 NW 1/4 S 32 T29 N,R18W 688 104th st. Warren System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan r 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Section 9. Pump Curve Signature License numb #226900 System PLOT PLAN PROJECT Roscon Properties ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NE 1/4 NW 1/4S 29 /T 18 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 110.0/109.0 4' below grade 11/13/17 BEDROOM 3 DATE CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale is 1" = 40' unless otherwise 104th St B.M.* noted ic Quick4 Standard 75 eaching Chamber ith 20.0 ft2 of Area .6ft^2/pair of end caps B-1 0' 490' Property Line Gra de at System Elevation 34Vents All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 -3 75' 12% Slope 40' Pro 3 Bedroom House 2-3' X 66'cells with >3' spacing L J4- B-2 30' 15' 110' 90' Huffcutt Combo Tank 112' 104' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation ~ 114.0' Vent Vent Grade 3' 4" 3' ,A ~,~30/34 Septic Tank 5' Long 1 5' S' Long 1 15 36" Grade at System Elevation Grade at System Elevation Spacing- 5' _ 2-3' X 66' Cells Same on other end Observation tube/Vent At end of cell L-'7~ A B 16 chambers per cell System elevations: A-1 10.0' B-1 09.0' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _P Mailing Address [ vE~ ~2 St Yc 1 Property Address t Sf (Verification required from Planning & AZD"t for new constrai;hion.) City/State P=ei Identification Number _ ! (7 _ (7 LEGAL DESCRIP, TION Property Li7Li7ilon T L `I 1`f R I VY, Town of 1,Vqr Subdivision , Lot # !5- Certified Survey Map # ? VcAume page # Warranty Deed # Vo:ume , Page # Spec house l ` no Lot linm- identifiable no SYSTEM MAEMNANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mamknance consists of pumping out the septic tank every three years or sooner, ii needed, by a licensed per. Wbat 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 SL Croix County Planning & Zoning Department a certification fob signed by the owner and by a mash plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is im proper operating condition and/our (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full. of sludge. I/we, tbo undecsigncd have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by ft Department of Commerce and the Department of Natural Resources, Stye of Wisconsin. Certification stating that your septic system has been man=ned must be completed and retained to the St Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all stets on - vein are true to the best of my/our knowledge. I/we audare the owner(s) of the property described above, by virtue of a deed recorded in Register of Deeds Office. Number of M SIGNA OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Inchide 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 fire warranty deed. M". ow POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer Cl NA 3ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms O NA Effluent Filter Model 0 NA i Number of Public Facility Units a-NA Pump Tank Capacity C? a( 0 NA j Estimated flow (average) Pump Tank Manufacturer gal/day p ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer 0 NA Soil Application Rate aUda /flZ Pump Model - 0 NA JS i Standard Influent/Effluent Quality Monthly average" Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L 0 NA O Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection 0 Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BODs) 530 mg/L jl~ n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L 0 NA 0 At-Grade ❑ Mound Fecal Coliform (geometric mean) 6104 cfu/100ml 0 Drip-Line 0 Other: MMaximum Effluent Particle Size Ya in dia. 0 NA Other 0 NA (Other. ❑ NA Other: 0 NA `Values typical for domestic wastewater and Other ❑ NA septic tank effluent IAINTENANCE SCHEDULE Y-~ Service Event Service Frequency (inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA L ea s (Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume 0 NA _1 7' (Inspect dispersal cell(s) At least once every' 0 month(s) / }[,year(s) (Maximum 3 years) ❑ NA moh --lean effluent filter At least once every: ye ar(s)s} ❑ NA nspect pump, pump controls & alarm At least once every: Q month(s) ❑ NA l7lush laterals and pressure test At least once every: ❑ month(s) 0 NA 0 year(s) Dther. At least once every: 0 month(s) 0 NA ether: ❑ year(s) D 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 ioumbined 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 Pegulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (f) or more of the tank volume, the entire contents of j:he tank shall be removed by a Septage Servicing operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. INI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer- A service report shall be provided to the local regulatory authority vAthin 10 days of completion of any service event. pop of START UP AND OPERATION presence of painting products or other chemicals that For new construction, prior to use of the POWTS check treatment tan ,s) high are detected have the contents of thO . may impede the treatment process and/or damage "dispersal concentrations 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. vr it. During power outages pump tanks may fill above normal highwater levels. When power the restored backup or surface excess discharge wastewater will ill b bie discharged to the dispersal tea(s) in one large dose, overloading the cell(s) and may result in is r to restoring power l then t To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator to restore rower levels or contact a Plumber or POWTS Maintainer to assist in manually operating the pump effluent pump within within the pump tank, disturb or compact, the area Do not drive or park vehicles over tanks and dispersal cabs. Do not drive or park over, or otherwise 15 feet down slope of any mound or at-grade soil absorption area. ( POWT$: Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of four the tion drain * butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants. fat; sump pump) baby wipes; cite ns; oil; painting products; (sump pump) water, fold and vegetable peelings; gasoline; grease; herbicides; meat scraps; medkiatlo pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT shall taken to insure that the system is properly When the POWTS faits and/or is permanently taken out of service the following steps and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed, e The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. e 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 code conmpiiant If the POWTS fans and cannot be repaired the following measures have been, or must be taken, to provide a replacement system: -~L,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 riot be infringed upon by required structure, lot lines and wells. Failure to protect the replacement area will result in the neled foror a new sob from and site existing and proposed toestablish a suitable replacement area. Replacement systems must comply with the rule:[ in f a 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 sail and be nstabed# oars[ must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the Mitrai ve surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING>> SEPTIC, PUMP TREATMENT AND OTHER PUMP OR OTHER TREATTANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. Do NC)T MENT TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE ENTER A SEPTIC, 0 A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name > c. Kj Name J l e, Phone - C. Phone _ - f SEPTAGE SERVICING OPERATOR (MiMpEg) LOCAL REGULATORY AUTHORITY Name Name Phone - c Phone 7 J S . C~k This document was drafted in compliance with chapter SPS 3e3.22(2)(b)(1)(d)W and 383.54(1), (2) & (3), Wisc or" Administrative Code. I ~W • ri+I Ilr ; a III., ?I ~I ~'lIG 1 I I ( ~y I r 1;1 ~ i , 1 - _ ttl(~~I; ;I ~ v ~ i f I i 1 l' I lL_ i ~ I J tea; ~ ~ i Coo I I \ v v J s z. c / I c ~ F= 1Lu `.l i Septic-Dose 'dank Cross Section And Pump Performance Specifications Tank Manufacturer - Pump Manufacturer ^lc~ Tank Model Number c; Pump Model Number 1 Total Tank Capacity, Alarm Manufacturer (x Max. Bury Depth Alarm Model Number Switch Type Filter Manufacturer Total Dynamic Head DH) - Feet Filter Model Number Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM; @ ft TDH Total - Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box r. - Finished Grade - - - Vent Min. 12" Disconnect Above Grade Means With Vent Cap .,1 Outlet Filter - - - - rnlet Inlet Bade ' - - Switch Setongs and Reserve Capacity A 1/a„ Weep Tank Volume GPI ; 1 1 B Hole Dimension. Inches Volume Gal. (reserve) A 1) " Off Elevation C (dose) C r Bottom (dead) D ; D Elevation r Total ; L _ Ft rl ~t•.;t t t I t <,1, l t 1>t>i : t f t f t•<. t f, t t•i .>t t< t` t; t , t l/ t>< . 1.1 <It>l 1>f>/>f•1><•f•f>~ f•1•~ 1.1 GENERAL INSTALLATION: The septic/dose tank is bedded and back 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 service complies with NEC 300 and Comm 16.28. 02/05 U Page of TOTAL DYNAMIC HEAD/CAPACITY u 'w HEAD Cr/~FCRITY CURVE PER MINUTE g ~ MODELS115-z/55/57/59 EFFLUENT AND DEWATER'!NG 25 Model 53/55/57/59 20 I ~ I Q 6 i Ft. Meters Go!. I i trs. = 1 5 1.5 43 j '63 I v 1,5 0 3 34 29 a 4 15 4.6 19 72 4 10 S ut-off Hecd 19.25 ft. (5.9rr) F- 2 r: 5 15/161 --6 5/32 i 45/9 /2 -1': /2 NFT 0~ P U.S. GALLONS j 10 2 30 40 50 1 'LITERS 3 '5/16 80 160 a - ! FLOW PER MINUTE W9897 4 1/16 h Variable level float switches available. Variable level long cycle systems available. Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. Duplex systems available. 1 f i I 3 3/32 1 ! I SK858 single Seat Control Selection Listings SEE-E° TIE;N CU:[)E EZModel volts Phase ' Mode j Amps Simplex Duplex CSA U 1. Integral float operated mechanical switch, no external control required. M53/55 & M57/59 115 1 Auto I 9-7 1 Y Y 2. Single piggyback-variable level float switch or double piggyback variable level N5 V55 & N57/59 113 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FM0477. BN53 115 1 Auto 9.7 Y Y 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. BN53 115 1 Auto .7 N Y BE53157 230 1 Auto 4.8 Y Y 4. See FM0712 for correct model of Electrical Alternator. ' I I D53155 & D57/59 230 1 Auto 4.8 1 -Y Y~ 5. variable level control switch 10-0225 used as a control activator, with Electrical E53r55 & E57/59 230 1 Non ! 4.8 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system. Single piggyback switch included. s cnurioN For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches, FM0477; V ,c ` e Electrical Alternator, FM0486; Mechanical Alternator, FMO495; Sump/Sewage Basins, FMO487; and Single Phase sa ° ° a " Simplex Pump Control/Alarm Systems, FM0732. - n= os`eE,'I a-'' r , PIS, EPA, E : W1P i S For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - - - - MAIL TO: P.O. BOX'%6.947 Z - Louisville, 49 KY 40256-L' Manufacturers of O SHIP 70v 3649 Cane ane Run Road pqp ~ Louisville, KY 40211-1961 QV,dL/TYPUMP6 ~,//NCf ~cJJd " ® (502) 778-2731 1 (800) 928-PUMP - PUMP M. FAX (502) 774 3624 http✓/www.zoeller.com - © Copyright 2002 Zoeller Co. All rights reserved. N~2 y w m E o u O w~~OU~~. r Q a.'G b N 8 Eby §w 8 = W o h o o a - W J n o >-NM3 9 ~ 6e0~0Y fiH~ - 656=- 6a~ ~~a ,~~~ao~3 8 s pEg it ,y 77 f I ,a 4 FI - a I qf~ L I ~ ICI. 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Adrn. Code _ County C; ? Attach compeer I7fan on r not less than 8 112 x 11 inches in size. Plan must~~ t 7 J include, buf not it . ertical and horizontal reference point (BM), direction and percent slope, scale cr dimensions, north arrow, and location and distance to nearest road. O 2- `0 p 6 Z~- Please print all information. JUN 26 R~jewed - Date / Personal information you provide may be used for secondary pun (t f G ~^~r / poses (Privacy Law, s. 15- S(1) (m)). Property Owner Property L cu r1 / r irScs/ /V , l r~ Govt. Lot/ 1 /4 %J 4 S i )7 r N R E o Property Owners Mailing ,Address---- r w Lot # Block 4 Subd. Name cif CSM#d / City, ;:;late Zip Code Phone Number IJ~I ❑ City ❑ Villa e To Nearest Road New Construction tJseResidential / Number of bedrooms L Code derived design flow rate ❑ Replacement F1 Public or commercial - Describe; t' - - - GP D - - Parent material G'~ r ~L f' Flood Plain elevate m if applicable j'` tt. General comments and recommendations: System Type, C7-iCr'Lys c Systern Efevatio -i---_ Boring # ❑ Boring a Pil Ground surface elev. 1d± G 2-- ft. Depth to limiting h ctor _ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fit in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 °Eff#2 ILL/ m -M V14 J - w - Boring # Boring Pit Ground surface elev. Depth to limiting fa;Yor K" - in. - Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDft _ in. Munseil Qu. Sz. Cont. Color Gr. Sz._Sh. 'Eff#1 °Eff#2 10 ~3 st a cs 2,),V, .v Effluent #1 = ROD > 30 < 220 mg[L ;and SS >30 < 150y ° Eftluern #2 = BOD5 < 30 rn / and TSS < 30 mg/L CST Name (Please Print) i re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Nurnber 1008 192nd Ave, New Richmond, WI 54 17 d , % 715-246-4516 Lo 5 Property Owner. Parcel ll7 # Page of Boring # ~.Borinlt f Pit Ground surface elev. ft. Depth to limiting factor in. - - - Soil Application Rate Horizon Depth Domina-it Color Redox Description _ Texture Structure Consistence Boundary Roots ~ ~GPDfff~_- in_ Mun::ell Qu. Sz. Cant. Color Gr, Sz.Sh.- _ - _ ,`Eff#1 *Eff#Z A /I t Ii Boring # g~~-~ Boring @_] Pit Ground surface eiev, -Depth to limitind g rac.r :)r in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cor sistence Boundary r Roots CPU/ri in. Mum-ell Qu. Sz. Cont. Color Grr.Sz Sh. 'Eff#1 Eff#'l Boring Boring t~I l_J Pit Ground surface elev. ft. Depth to limiting factor in. _ _ - soil Application Rate_ Horizon -)epth Dominant Color ARedox Description Texture Structure Consistance Boundary Roots GPD/W m. Munsell Qu. Sz, Cont Color Gr. Sz. Sh. `Eff#'l `Eff#2 ° Effluent #1 = BOD5 > 30 < 220 rn9IL and,rsS >30 < 150 mg/L Effluent V. = B OD, < 30 n ign- and TSS 30 nig/l . The Department of Cornrmerce is an equal opportunity service provider and employer If you need assistance to access serviccs or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8730 (R.6100)