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Home My WebLink About032-2176-08-000 Wisconsin Department of C' mmerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600297 GENERAL INFORMATION 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: Anthony & Jessica Holland TOWN OF SOMERSET 032-2176-08-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: dp 'deh 0 G~T- 12.30.19.1493 TANK INFORMATION t ELEVATION DATA TYPE MANUFACTUR V tCAPACITY STATION BS HI FS ELEV. Septic Benchmark ~r r,~ l r w c" 'y, 7 /66 aSin°g AIthBM N~,r/! 9y- ell Aeraiiotl 221 ,.AJ- lit Bldg. Sewer S At Ti ' St/Ht Inlet 93-a Hokkrtg Pi We ! TANK SETBACK INFORMATION i J S s~ St/Ht Outlet " is C12-915 TANK TO Al WELL BLDG. e to Air Intake ROAD Dt Inlet A 1t Septic 1 l~ , _QP i Dt Bottom i > ~0 Zo Dosing Header/Man. a - /Z . 6,9 Aeratior►~ Dist. Pipe /Z 9Z . 011q Holding Bot. System 7 13.0 9/, o Z ql~ t, q PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM /Z. G G '4.5 1s. Model Num TDH Li Friction Loss System Head TD~t Ft Force main Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -z i 7 eYLCl~p~ 1~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact~': t~-fa>t-tom. INFORMATION CHAMBER OR Type Of System --.7 5t~ UNIT Model Num ' C~K CdAjeji S_ :54 ' I 6-J DISTRIBUTION SYSTEM 1116+4 (0 c 3'Z ~•''S Header/Manifold p/ Distribution Ix Hole Size re Spacing Vent to Air Intake Pipe(s) Length_ 6 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of r7ed/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No ~_Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: Location: { t 1620 83RD ST 1 J 1.) Alt BM Description= L ~ il ~ 2.) Bldg sewer length t~• - amount of cover = y / Cjswt. rL~ox S~ a`X. ` Q 2 Plan revision Required? Yes No NJ 1% ~ Use other side for additional information. L_- Date Insepctor's S nature Cert. No. SBD-6710 (R.3/97) - 3 Se ~ County oEe~~r ~ ~ 1 ~ y-, , [E zsfi Industry Services Division $ 1400 E Washington Aveiy pemtit Number (to be filled in by Co.) i S 1$ P.O. Box 7162 Madison, WI 53707-7162 YIOi`1A "late Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this TZ9 RTQ4XSMAJ 8 AU4 is required prior to obtaining a sanitary permit. Note: Application forms_ Project Address (if different than mailing address) j the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Slats. f- i 1. Application Information - Please Print All Inform Property Owner's Name 2 Parcel # L Property Owner's Mailing Address Property Location Govt. Lot city, state/ Zip Code Phone Number Section circle l n 7 T N R E oone) / 11. Type of Building (check all that apply) Lot # lot 2 Family Dwelling - Number of Bedrooms 4 Subdivision Name X;l ❑ Public/Commercial -Describe Use G✓, t5f' lock # e ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number i' ;r h 1 lD 3- Q Town of ~.5 III. Ty a of Permit: (Check only orie box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration - ° Plumber Owner ; ► t 5 IV. T e of POWTS System/Component/Device: (Check all that apply) tj Non Pwssurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Molding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreatment.Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed Of) System Elevation 9 v,' Rate(gpd5f) Vt. Tank Info Capacity in B S Gallons Total # of Manufacturer o H - U q Gallons Units o 2 ~ New Tanks Existing Tanks l D a U v rn cv V C- Septic or Holding Tank , C~ ❑ ❑ ❑ ❑ Dosing Chamber _[00 ❑ ❑ ❑ ❑ VII. Respo sibility Statement- I, the undersigned, assume respon ' lity for installatioppf the PON'1TS shown on the attached plans. Plumbe ~ ame Plumber's S' re MP/MPRS Number Business Phone Number S - Plumber's Address (Street, City, Sta e, Zip Cod 9 Q VIII.Coup /De artment Use Only Approved ❑ Du~ Permit Fee Dat Issued Issui p Agent Signalu $D ❑ Owner Given Reason for Denial l 1 IX.Condi o j Disapproval Gt:d-tor+b ~l~ Q Iii - ~(O3 a~C, i ~ (iil~f:'al Cttll!~ttit dp ~~~t!(n~.•ffi: ~ 1 P.(`nn..7h°' . per inw.3g~. Platt pso Aded by plwmbc% 4" 2. "All atll er:k tri :ir~trler s truxit,t~t inaliltt, ir:r i Attach to complete plans for the system and submit to the Count)' only on paper not less than 8 1/2 ill inches in size n r~r~ ~•+no mn„~ o t 3 V, 16; ti - ~4 - - - - - - - - - - - - ~ y 17 -S, .rs - - - - - - - l: ! J 0 ~ t kmom c VMI c dr~1e40 Poe ? Learning - C Chamber Sys t IeUabon ~~j~ ~sca Kett Strs€ fi~att W 1 }c3 itrtg Trench ft Vent or Obs-4va€icn Pr Chambers 11] JJ Header Trersd~ 2 Arlanufaturer And M.del - ` EISA Racing f Perchamber S~} ApgtieatiOn Labe , gpd/.S gpd Design FIOW Soil APplicaiia€t Rabe EISA = _ ' J a er rows of d anhem each- Page or Wis. Dept of Safety and Pmfe 1241m SOIL EVALUATION REPORT Page _ of Buildings 1 ` Division of safety and° in ac,~ordan with SPS 385, Wis. Adm. Code Wit. ;n~ ~ County Roach complete site,ptandm;peperyw54 11 inches in size. Plan must include, but not timit6d-tD'veTffcai-and horizontal reference point (BM), direction and Parcel tD. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Dat L Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 0 ~Z✓ g Property Owner Property Location 114 ? 114 S -4 ~ T N R C' E (or Govt. Lot Ali, t' I Property eras Maifeng Address Lot # B # Subd. Name or M# City State Zip Code Phone Number 0 City []Village Town Nearest Road New Construction Use. I] Residential / Number of bedrooms Code derived design flow rate ~ GPD ❑ Replacement Public or commercial - Describe: Parent materials uTl J,~st~ Flood Plain elevation if applicable ft. and Boring # tl Boring Pit Ground surface elev. 5 ft. Depth to limiting factor>in. Soil ticadon Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft s in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 tf#2 r S y i- Y 9 it ❑ Boring I~i Bonng # ® Pit Ground surface elev. 9-)-." 22Z ft. Ddpth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure istence Boundary Roots GPD/R z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.. ' ff#1 if#2 LI? 5' 4 t/ v E t #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 =1301 < 30 mg/L and TSS < 30 mg/L CST NamlQP6s e P nt) ~ j Signa CST Number Address Date Evaluation Conducted Telephone Number `7 _ 77 l_ "Xi SBD-8330 (R11/11) Property Owner Parcel ID # Page of Boring # Boring ❑ Pit Ground surface efev. ft. Depth to limiting factor in. Soil Gcation Rate z Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsefl Qu. Sz. Cont_ Color Gr. Sz. Sh. * ff#1 ff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ApplicationRate - s Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GpD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * if#2 o 130""9Boring Ground surface elev. ft Depth to limiting factor in. ❑ Pit Soil A licati on Rate Roots GPD/ft : Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD s < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (RI 1111) .iLY ~ !'i G ~S ~ O /Ifj.~ti1CJ.. - _ - - _ l_ ~ ~ ~ _ - _ _ / ,F 1 s 5 i1 1 l - - - _ \ `1 -1-777 AaTl(~,r~.n r County Industry Services Division % 0 S ~G 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P P.O. Box 7162 Qft, M n, Wl 53707-7162 ~0 5 1. ermlt A~►r vGG State Tr cti Number In accordance with- 383.21(2), Wis. Adm. Code, submission of this fon.. Ct0 ^~vvemmental unit IVA is required prior to obtaining a sanitary permit. Note: Application forms for s[afcw. ea, y -bmitted to the Department of Safety and Professional Services. Personal information you provide nt., I secondary Project Address (if different than retailing address) purposes in accordance with the Privacy Law, s. 15.04(i)(m), Stats. 1. Application Information -Please Print All Info - rmatiJ I' C Property Owner's Name Parcel # f r Property Owner's Mailing Address Property Location 1 a • 3 G - 19 'Ali Govt Lot City, Sta " I Zip Code Phone Number Section ,q circle oV4 N R II. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name v ❑ Public/Commercial - Describe Use Ce ~r t Block /./OUSE IN Ate ❑ City of M Number ❑ State Owned -Describe Use U ❑ Village of C G S F Town of Ill. T k only one box on line A. Complete line B if applicable) NAO W-Mb Tr ydin- Tank Rep] ly [I Other Modification to Existing System (explain) A.. ~ New System ❑ Replacement System [I it Transfer to New List Previous Permit Number and Date Issued B. ❑ Permit Renecvai ❑ Permit Revision ❑ of j 7~ Before Expiration Plumber caner IV e o PO om onent/Device: (Check a ply) LNo,Non-Pressurized In-Ground Pressurized In-Ground ❑ At-GraX ❑ Mound 124 in. of suitable soil ❑ M d < 24 in. of suitable soil in Tank tspersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsaUTreatment Area Information: ! L la/ :Design Flow (gpd) 'Design Soil Application Dispersal Area Require sf) Dispersal Area Proposed (s System Elevatio 1 . ` j VVV VI. Tank I Capacity in Gallons Total # of tv/P10 t/Wafnufacturer U y v Gallons Units c m New Tanks Existing Tanis c U n y cn L V G Septic or Holding Tank ❑ ❑ ❑ ❑ Dosing Chamber - ❑ ❑ ❑ ❑ ❑ VII. Res o ibility Statement- I, the undersigned, assume res 'bility for installation of the PONYTS shown on the attached plans. Plumber' ame ( nt Plumbe MP/MPRS Number Business Phone Number C -2~ - Plumber's Address (Street, CiVS Zip Codes, i VIII. County/ eartment Use Only proved ed Pe it Fee Date Issued Issuing Agent Owner Reason S zd /7 IX. Condition PIoproval/Reasons for Disapproval 3 Cpfi f ~n U Zol ~(P3 rvC SY` T n{ ) /M r 7 ~n et`lue,t filter and 4441) r. muc,t be serviced /maintained provided by plumber. A! n~wents must be maintained for the system and submit to the County only on paper not less than 8 to x 11 inches in size 17 Taw 1 ~ Anc _11-h-A Mid CONVENTIONAL COMPONENT DESIGN Residential Application IND X AND TITLE PAGE Project Name: Owner's Name: Owner's Address: - Legal Description:;' Township: County: Subdivision Name: Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed page g CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: J J License Number: = z 7 Date: Phone Number 722 Signature f' Designed pursuant to the in-Ground Soil Absorption component Manual for POWTS Version 2.0 SBD-10705-P (N.01l01). • 7 I ce, ; L i ~ ; ~ l Ano ~ 0 OKEQW UDR pv c vent Pi e wy-A) vent cap Leaching s fie Chamber" oElevabon ®jl A~S~ iQtt $VS£ FtE pd aw w; lading 3ch yr"t vent or O@sen-- ian Ptpe Chambers Mr I . ~l, x Header Tn:nci, 2 &ROMM Co w / IbiattufacWrer And Model yo,~ EISA Rafing - Sq it per chamber Soil Application Rate J 91 gpd Design F-IOWt : SOD Appr[Caf on Rate EISA _ Chambers 2 Mvis of charn&ws each- J/ J Page - or ....3 1p w w ta` l t' PL -525 FLUENT FILTER 4 - 5 ...rr..y..-u"F^_'-s'•a._:.._. -....':?F '.a,.'..em. F.T"^'^. :r"'4~.'.^_~A .....r..Y..........5..~'R^:^.R'_. 5S'=:.^_.' :.+s`m',T.:.,.ern~T^.""' Polylok, Inc is pleased to add its new commercial filter to its existing line of duality effluent filters. The PL--525 is rated for over 10,000 GPD Alam, Accepts PVC (gallons per day) making it one of accessibility extension handle the largest commercial filters in its class. It has 525 linear feet of 1/16° filtration slots. Like the Pofylok' PL 122, the new Polylok PL-525 has =Y an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1116" removed for cleaning, the ball will filtration slots Rated for over 10,000 GPD float up and temporarily shut off" the system so the effluent won't leave the tank. No other filter on - , _ the market can make that claim! f Accepts 4° & W, -•0. PL-525 Maintenance: The PL-625 Effluent Filter should operate efficiently for several years a under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the. installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs -Gas deflector servicing. Servicing should be done by a certified septic tank Automatic shut-off pumper or installer,` : ball when filter is removed 1. Locate the outlet of the U .S. Patent Nog 6,015,483 septic tank. 5,371,640 2. Remove tank cover and pump tank if necessary. 0g _5-~ aA€_q 1. Locate the outlet of the septic tank. 3. Do not use plumbing when filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6" outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter, the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover, 5. Replace the septic tank cover. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -5--.f FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: ❑ NA Permit # Q Septic ❑ Dose ❑ Holding Volume: (gal) rid DESIGN PARAMETERS Tank Manufacturer: l / -5 e' ❑ NA Number of Bedrooms: ❑ NA ❑ Septic 0 Dose ❑ Holding Volume: e6,% (gal) Number of Public Facility Units: NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): J (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal/day/ft2) Effluent Filter Manufacturer: /Yo 16"1 El NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: l Fats, Oil & Grease (FOG) <_30 mg/L Pump Manufacturer: C, s Biochemical Oxygen Demand (BOD5) <_220 mg/L ❑ NA ❑ NA Total Suspended Solids (TSS) x150 mg/L Pump Model: _ - 1-~ High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L NA NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other: (BOD5) <_30 mg/L Soil Absorption System (TSS) <_30 mg/L NA Fecal Coliform (geometric mean) <_104 X In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA Maximum Effluent Particle Size t/e in dia. ❑ NA El At-Grade El Mound ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) R When combined sludge and scum equals one-third (%3) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: 1 month(s) (Maximum 3 years) El NA ear s Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA year(s) Flush laterals and pressure test At least once every: ❑ month(s) El NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (%3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) 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, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code 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 required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 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. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INST LER POWTS MAINTAINER Name Name Phone - Phone ,/7 31 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHO TY Name Name Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I 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, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, - gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code 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 required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 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. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INST LER POWTS MAINTAINER Name l Name Phone - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHO TY Name Name Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance Requi ed Tank Model Number GPM @ , 7(0 Ft TDH Total Tank Capacity Max. Bury Depth Total Dynamic Head (TDH) - Feet Pump Manufacturer Elevation Head Pump Model Number Distal Pressure Alarm Manufacturer - s Network Pressure Loss Alarm Model Number It"I Force Main Pressure Loss Switch Type f Total '~w l Manhole Min. 4" Above Grade With Locking Device Vent Min. 12" Weather-proof Above Grade Junction Box With Cap Finished Grade - - - Depth of Cover Ft Disconnect 1 Means j r r a: > r> r r> r> r r> s r r s s> r r r r r r a r r> r> r r: r r r>> s>>>> i S i i i{ i<< i< S L i S t i{< i t< t i<< t i; t i{ S< S<< t C{< i t i S i i S >t r r i y }t t Outlet { Switch Settings and Reserve Capacity _ ` C Inlet Tank Volume = GPI ' > 3 ' }`r Dimension Inches Volume Gal. A ' { 1/4'17 t ~t? (reserve) A ` Wee 3- t>t p > (alarm) B 2 Y_ -4 B - > < Hole t > ' < (dose) C Off Elev. C { > t > < t (dead) D Ft► ` ms { a ' Total r r ` D { Bottom of Tank Elev. t a t y i i< S L S i{ a r s r ~i c a r > a a > > > > a > > > > r r > > a > > > > > > r r > > > : a > a > r r > > > r > > r > a > > : > a a > a S i t S<< C K<< t<< t t i t< t< t t i t t i<{{ i t +i C G S< S S<< S t S t t t G< S K GENERAL INSTALLATION: The 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 excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05lgj Page of GOULDS PUMPS Submersible Effluent Pump I PE tFF1-UENT pump SPECIFICATIONS MOTOR FEATURES Pump - General: General: t Corrosion resistant • Discharge: 1'/z" NPT • Single phase construction. • Temperature: 10411' (4010 • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and fully submerged. • Built-in thermal overload ~ cover. • Solis handln: '.4° tection with autornatic reset ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil-filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • Manual models available. shaft u~cat for extended following uses: • Pumping range: see PE31 Motor: ~ powered for continuous • Mound Systems performance chart or curve. • .33 HP, 3000 RPM operation • Effluent/Dosi Systems PE31 Pump: • 12.0 Maximum amps ng ■ All ratings are within the • Low Pressure Pipe Systems • Maximum capacity: 50 GPM • Shaded pole design pe working limits of the motor. • Basement Draining • Maximum head: 25' TDH PE41 MOtbr: m Qum disconnect power } • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM mod, 20' standard length Dewatering • Maximum capacity: 60 GPM • 7.5 Maximum amps heavy duty 1613 S1TW with • Maximum head: 29' TDH • PSC design NEMA 5-15P, three prong, PE51 Pump: PE51 Motor. 115 volt grounding plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM S Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compact. • PSC design ■ Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless 40 + MODELS- PE31, PE41. PE51 Steel. T - ■ Stainless steel fasteners. - a... Fes' 33 -40_50 3~ T, ? - - - - GPM 2 10 - --i--1 i - - - -i- T 30 - - ? - -j - - - - 0 - z T ? - - - - - = i--- - Q t - - - - - - - 1 - - - - - PE3 w 25 1 _ L C~p us 1 Tested T - -i -i - - - tD UL 778 and a 20 GA M 108 Statl1laftl5 Fie #LF38549 - + - - i _ -t-{f -i--~`- + - \ -,E_- - t - _ i * ` i G0111ds hwips 1S ISO 9001 Regd. 4 - + -z - -r-j - -'---i-->--}-- --i---+-'- -~-.i-~- -j- °-r-r-}-- --i--i_ t -E-~-; - - -ice - - + - - - 0- 0 0 10 2 30 40; 50 60 70 GPM 80 0 *TS 10 15 m3/+ Goulds Pumps CAPACITY 0 zooz Goulds Pumps Z~ ITT Industries ST. CROIX COUNTY S PT.~C TAN F' ANCl✓ AGREEN `NT A.N • OWNERSHIP CERTiFTCkTTON FORM 0-,;ver.,93uver TOP -,Te 2Y2 &&::3 erZ" Ta-d-h a address %ermcadon required from Plamming & Zoxmg Deparunmt for new consuvMon.) City,'Sta f'lZ Parcel Idea ifica on Number _ ~ Z1 - 11 LP's 4 ICE-SC ~€tl~ Propel 1o~o 1!4 , I1sL V Sec. :.L : T R 1 W, `~ovm of Subdtivision Plat: Lot Certified Survey Map # Volume Page Vv'ar-rau€Y Deed ire 2007)Volume . Page 4 h yes no Lot idertt ~Ayw ll o STEM 1~A7~'TE?YA l`ICE AND OWNER CERTMCATION improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintm mce consists of pumping out the septic tank every three years or sooner if needed, by a licensed pumper- what you put into to system cart affect -Jae Amctiou of the septic =31< as a tre== stagy in the ;gym disposal system. Owwuer mamkizance esponsioiRdes are specified in MS. 383.x"2(1) and in Chapter 12 - St Croix County Sanitary Ordinance t" Ere propem, owner agrees to submir to S€: C mix County P'J g & Zoumg Dapartzent a =Mffcat on farm, signed by !he owner and by a master plumber, journeyman plumber restricted plumber or a licensed pumper vmifying that (1) the on-site wastewater disposal system is in proper opmatn3g condition and/or (2) aib r inspection and pumping (3.faeressmy), the septic tank is less than I/3 fall of sludge. I/we, the unders3med have read the above requirements and agree to maintain the private sewage disposal system with the smnda; ds sec Rzk hmzh , as set by &e Dep eat df Salty And Professional Semces and the T -tmew of'Nat mi Resources, Stare of Wrlis =ate stn s;a f= your ,s is :system has be.33 pied must use completed and returned to the St. Croix Coumy Plaauing & Zoe 1Deparsmena vatia 34 d m. et r&= year capi n tom. Uwe certify that all statements on this.'forni are true to the best of my/our knowledge. Uwe am/are 1he oumer (s) of the pr op--rty described above, by zttue of a •arrauty deed r -tx~rded in Register of Deeds Office. Number of b clrt~4mS V- 1 10 /li7 SIGN W1 U'RE OF AP'PI CA? L(5), DATE : ~ * ny inionnadon that is resented may resin M !he sanitary penurt be]-. revolted by the Plaa=g & Z.am g Depa=eM rice mrith this application a reewded warranty deed from the R of Deeds Office and a copy of the certiffed survey map if eLerencr is made in the warty deed RE /d..:l ~i J t LB.O. 03 N" 521112.39 t ! ! ■ SA, r i LOT r • SEE LOT AREA TABLE bb CNR Np] E 3.00 ACRES TO CW'6W . - ~..8. C~. = d9k9 ' r VDT - - SFF L O AREA 7 & DW N4T - S.0 ACHE' 0 0-M t 2.0 S +1. TO OFMW EXCLUDNG EASEMENT LOT 9 a o- ear 3106 ACM (t*32,701 SUFI) fit- . . . C 5 •4013 W 297 Wr • . R CLEVAI:ON -914 24 . .r .4S 2T8 tJ9 LOT 6 t~ i 1 - - '~T N l Ni O 4 t ' i CY ~ T. _ 2-58.72 620.86, 0 4 ccn m m sy ~ t MO o m o c N °w rn 0 LO _ O m m Cr__l9 P ~~3 a N ' N U°c X160 CD o °