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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600313 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3042722 Permit Holder's Name: City Village Township Parcel Tax No: Dennis & Rhonda Malecek TOWN OF HAMMOND 018-1099-38-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 9113 -,3 GS! 09.29.17.848 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,'A-~ L CAPACITY STATION BS HI FS ELEV. Septic y~• /•6 zJb Benchmark /~Z a qe, 3 F:'( . b t O Dosing Alt. BM / ~ Aerattvn Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet ~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ J Septic 1115 ^ V& _ Dt Bottom /Q ~ ~Z• Dosing ~ ` r gO 1 Header/Man. 9 4 Aeration J Dist. Pipe pQC~ Holding Bot. System ~ q~ -]7 Final Grade 3. C/ 9 PUMP/SIPHON INFORMATION Manufacturer r Demand St Cove)/ ~ ~ Z Z- 16D - 7 l GPM rf ~'i~t,~ q -7 Model Number Zs~ ? 7 GO r✓r 5. q/ / / TDH Lift Friction Loss System Hea TDH Ft Forcemain Length Dia. 2 t l Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width f Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 /it7l r ` SETBACK SYSTEM TO !•V P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of,$yste G /C /Do UNIT Model Number: ` DISTRIBUTION SYSTEM J Header/Manifold Distribution J If x Hole Size 1/ Ix Hole Spacin.9 Vent to Air Intake \ \ Pi d ! Length pe(s) Dia Length 9 o Dia Spacing 'NN 1 Z. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 1XX Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Z Yes No Yes n No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: n~ r~ g Inspectio (/TL, Location: 1040 174TH ST/ P/0 C) r r GO✓~ 1.) Alt BM Description = 2.) Bldg sewer length = ~t 1 - amount of cover = ~L 11 DN Plan revision Required? n Yes No - - I [ v 1 L ~57 Use other side for additional information. L ✓I~ ~'~I SL4 BD-6710 (R.3/97) Date Insepcto Signatur Cert. No. ~~r aarr ` County `s r =sl ' 1 Safety and Buildings Division 201 W. Washington Ave.; P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P :=J.~LZS J X ~I~. Madison, Wl 53707-7162 Db3/3 Sanitary Permit Application StareTransactinnNt~ber In actor S 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental emit ~ d- is a sanitary permit Note: Application fors for state-owned POWTS are submitted to Project dress (if different than mailing address) 0 of and Professional Servies. Personal information you provide be used for secondary 16 accordance 'th the Privacy Law, I5. 1 m Stars. 7 A lien ' Infor ation - Please P i All Info ation Q Pro~er ftAName Parcel # 1 j~ Property _dress Property Location Govt °t Co< 2S 1 Zip Code Phone Number ~ r/4e A, Section lc "PI T z`__ N' R/ W II. T e off Building (check all that apply Lot Family Dwelling-Number of Bedroo SubdiName OIL. ❑ Public/Commercial-Describe Use ❑ City of ❑ State Owned - Describe~]se MAO CSM Number Li Village of of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) System S 5' Y~ (exP ) A. 11 Replacement S System El Treatment/Holding Tank Replacement Only D Other Modification to Existing S lain 13 List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Tra~fer to New Before Expiration Owner W. Type of POV S stem/Com onent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized ln-Ground A o- ❑ Mound > 24 in_ of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ 9ffier Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVl7rea ent Area Information: De)go Flow (gpd) Design Soil Application f) Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation lair Rl) .12 ZMV VL Tank Info Capacity in Total # of anufacturer u Gallons Gallons Units o g New Tanks Existing Tanks . / o a, a m ~v V) C7 Septic or Holding Tank Dosing Chamber ✓7~ VII. Responsibility Statement the undersigned, assum r ponsibility for installation of the PORTS shown on the attached plans. Plumbey's Name,Plumbe;'-s ghee MPIMPRS Number Business Phone brr all hzpber's Address (Street, City; Sta Zip Code), t ounty/De artmeut Use Only _ uing . t Signattue Approved isapprove Permit Fee /Da ~stl Iss 'v easfor Deial lfr 11 ,.f 1 IX Conditions, , E oncl or DrOpproval 2 tt~att.ni crN mu$t aq ~h.~'! rna ~n~a`rg4, 36 I per .7w. . plant pro ikwi by plurrbe . l- W as per liptllbb co& I ""fit11 w'S. E. Attach to complete plans for the system and submit to the ty-ofily on paper of less than 8 La z 11 inches in size SBD-6398 (R. 11111) System PLOT PLAN PROJECT Dennis Malecek ADDRESS 1759 102nd Ave Hammond Wi 54015 NW 114 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 97.5' DATE 12/15/17 BEDROOM 4 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE •6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of 1/4" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE (DWELL *H.R.P. same as benchmark do-1k J /4 111 J /'11 Z5 c a 1 e = ~i.. _ u 102nd ave B-4 was dug to extend tested area and to 2 acre parcel 457' Property Line design at-grade, contours were verified and county plat map also added to show contours, original soil test was incorrect Grading is to be done to divert run-off away from system Well is to meet all Pro 4 Bedroom WDNR setbacks House B-4 B-3 Property Line B-2 Huffcutt Combo Tank 6% Slope B-2 is not to be used for design purposes Area 15' below system B.M.* is to remain 220' 98, undisturbed B -1 97'97.5' 96 ty Line 414' Proper l p Y~+?Fyr DIVISION OF INDUSTRY SERVICES on 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 Contact Through Relay 31 f t" a y ' +r http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~~ssroN*l'~`/ Scott Walker, Governor Laura Guti6rrez, Secretary December 28, 2017 PP 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: 12/28/2019 Identification Numbers Transaction ID No. 3042722 SITE: Site ID No. 845492 Dennis Malecek Please refer to both identification numbers, 1759 102ND Ave above, in all correspondence with the agency. Town of Hammond St Croix County NW1/4, SW1/4, S9, T29N, R17W FOR: Description: At-Grade (4 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1741024 Maintenance required; 600 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from the POWTS Dispersal 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 a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Divert surface water from POWTS Area. SHAUN R BIRD Page 2 12/28/2017 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installat ion/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 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 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm SHAUN R BIRD Page 2 12/28/2017 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan Any changes may result in pump resizina to meet TDH and GPM Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tapk or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer ,Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm RECEIVED Cover Page DEC z o 2017 INDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. " f`' New Richmond Wi 54017 715-246-4516 Date:12/15/17 Owner:Dennis Malecek Location: NW 1 /4 SW 1 /4 S9 T29 N, R 17 W 1759 102nd Ave Hammond Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specifications Attachments: So7Tes, Shaun Bird Signature License nurtber 226900 Page 1 of 9 System PLOT PLAN PROJECT Dennis Malecek ADDRESS 1759 102nd Ave Hammond Wi 54015 NW 1/4 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 97.5' 12/15/17 4 DATE BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 r HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of 1/4" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE (DWELL *H.R.P. same as benchmark Scale=1/4"=10' 102nd ave B-4 was dug to extend tested area and to 2 acre parcel 457' Property Line design at-grade, contours were verified and county plat map also added to show contours, original soil test was incorrect Grading is to be done to divert run-off away from system Well is to meet all Pro 4 Bedroom WDNR setbacks House B-4 B-3 Huffcutt Combo Tank Property Line 0 B-2 0 6% Slope B-2 is not to be used for design purposes Area 15' below system B.M. is to remain 220' B 98' undisturbed 97.97.5' 96 414' Property Line D At-grade System Sloping Site Cross Section and Plan View E Dimension Feet L L•S S•S L•S L S L S S SL S L L L L L L•S L S L•L S L•L•L L L•S•L L L•L•L L L LI A •J J J• L J•1•J J•J ••J• J•.r•J j j j j j j J j j J j j j J J J J J•J•J J J•J•J J•J•J•J J L•L•L•L•L•L•L•S•L•L•L•L•L•S L L•L•S•S•'L•L•5i•L•S•L•L•L•L•S•L•L••L•L S L LLL L S L S ■S•S •S•S.J••.j.J•J,r,„j,•j.l•J•J•l•J•j.j.j.j.j.j.j.j.j■j.j.j.j.J.j.j.j.J•j•J•J•J•J•J•J J : S•S•S••S■L•L•S•S•S•bS•S•S•S•L•S•S•L•L•'L•S•L•S•LK•L•L•L•L•L•L•L•L•L S L S I J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•J•j•j•j•j•j•j•J•J•j•j•j•J•J•J•J•J J J L•S■,L,L■,L■,L■S■L,,L■L•L,L•L■,L,L■L•L■L■S■L•S,•L.S,■L•L•L•S•S•L•~yL••.•L•L■L•L•L•L•S L L L .J J•J•d'•J•J■J•J•J•J•J•J•J•J•J.J•J•J•J•J•J•J•J•J•J•j•j•J•j•J•J•j•j•JM•J•J•J•J•J J J L•L•S•L•S•L•S■L•L•bL•S•S•S•S•L•L•S•S•S•L•L•L•L•S•'L•L•'L•L•L•L•L•L•L•L•L•L•L•S L L S=I r•l'•.7 f.r,r.r, J, J• J• J•d~, f. f. 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L•L S L S•L S L L L L L•L L•L•L•S S S L•L•L■L•L•L S•LK•L•L•L L•S•L•S S L L L E c` 1/6B y' W Z Z~ E -1 B 1 L % Slope I = Plowed :~a = Clean aggregate O = 4 in. sch. 40 pvc _ basal area Jtirti 1/z to 2 %Z in. dia. observation pipe Lateral with 2" Topsoil Cap aggregate over pipe Observation Pipe Geotextile G With Cap Fabric J J•r•• .Ft Lateral Invert S S•S•L ~qr t,, ,rar p'ly' J J r•r•J.J•r• JIFJ•J~r:rWr:r:r:J• Topsoil Cap r•J•r•J•r J•J•J•J•J 1•j•j•J•j•r•J•.f'•r•J•r•J• ' ti•S•L•S•S•L•S•S L•L•L•L•L•L•~•L•~•~•;•S•L L•'L S•L 4•LKA•S P Ft Contour ~ •r•J•J•J■J J•J■J•. J r•J•J• r J, J,1'. r. r r, r, J, J; _ _ S L•S•L•L•1.•L L•L L• S•• yr"'jtij•j•j•j~•~•. _.'j r.r• - - Ft Contour ;rLjL'L'L S"L"S• L•S•L•S•L L•S•L•L•L•L• ":.+w-.!j..r:j:J:J:j:J.j.j.j.J•J•J•J•J•j•J•J -s, •L•L•L•L•L•L•L•L•S•S•L•S• ••_tw.. • •j•j•l•J•J•J•J . • y Iy'V~`I'~fr f y~'Y D Plowed Surface _ C Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the desigd contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands.. The A x B area is covered by clean aggregate deposited overhead by a backhoe.. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative gro►h, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/051 "I gl Page of Pressure Lateral Layout One Lateral - End Manifold .4 Threaded Cleanout Lateral Turn-up Plug Force Main X L Long Sweep 90 Bend r, ~z ^ ~ti tu- Pressure System Construction Distribution Network S ecifications Lateral Diameter In. FLat,e ls are constructed of Schedule 40 PVC Orifice Diameter Z In. . Orific es are drilled perpendicular to X (Orifice S acin In. the pipe with a sharp drill bit and face down. L (Lateral Length) Ft. Lateral turn-ups terminate with a threaded Force Main Diameter 2 In. cleanout plug and are enclosed in a 6-8 inch Force Main Len Ft. diameter lawn sprinkler valve box accessible from finished grade. . . Grade •••••••:;Q • 6-8 Inch Lawn Sprinkler Valve Box Pa e of 03/05 lgj g e Septic-Dose Tank Cross Section And Pump Performance Spec'f cations Tank Manucfacturer Pump Manufacturer Tank Model Number S Piunp Model Number Total Task Capacity 02 S' Alarm Nfanfacturer Max. Bury Depth Alarm Model Number G- Switch Typo ~ ~ _ Feet Filter Manufacturer . TotaftHed Filter Model Dumber Elevation HDis tal PressNetwork LoMinimum Pump Performance Required Force Main GPNt Q Ft TDH Total Outlet Manhole W. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole With Locking Device < 6" Below Griide Sealed Watertight Securely Mounted weather-proof 1 . Junction Box Finished-Grade raw Vent Min. 12" Disconnect - Above Glade Means With Vent Cap Outlet Filter -.~.y Inlet Inlet Bale - ` - : ; .t----"_ - , Switch Sett p and Reserve Capacity A Tank Volume = GPI weep imension : Inches Volume Gal. B Hole Dimension,; (reserve) (alarm) B* 2 Off Elevation C (dose) C , s 1 Ft Bottom (dead) D 10,> D Elevation 3 . Total < <•..:•r<:::• Ft z X' GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the : manufacturer's product approval specifications. Nlaximum depth of bury as specified by the manufacturer may not be exceeded without prior *pproval. ManhOic covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and'oudet is Of approved material, connate to the tank with watrtight fittings, and laid on stable soil to prevent sealing or sagging. The farce 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 1623, 02/05 U Page o TOTAL DYNAMIC HEAD/CAPACVTY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING r :n MODEL 152/153 I MODEL I 152 153 50 Feet Meters Go{- Liters I Gal. Liters 5 1.5 69 261 77 291 153 10 3.; 61 231 I 70 26 12 40 152 15 4.6 53 201 61 231 20 .1 6.1 44 167 52 197 30 25 7.6 34 129 42 159 . ~ 30 9.1 l 23 87 33 125 8 1 QS Z i ,2 85 0 35 10.7 i i T a 20 40 12.2 11 42 o r----- I 4 j Lack voive: 138.0 ; t. (11.6m) 44.0 Ft. 1r.. : z 4 m) Dams I 10 1 I 0 20 40 60 80 100 GALLONS 6 '/4 LITERS O 80 160 240 320 _ 3 27/32 _1 j-~-} FLOW PER MINUTE I / 3 27/32 I CONSULT FACTORY FOR SPECIAL APPLICATIONS _ ® i 3 27/32 • Timed dosing panels available. • 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 ` level long and short cycle controls. . Sealed Qwikk Box available for outdoor installations. See FM1420. 1 ~i I • Over 130°F. (54°C.) special quotation required. 152H53 Series' 12 1/8 1521153 MODELS Control Selection j I I 1 5 t/B I Model Votts•Ph Mode S Sim tax Du lex N152 115 1 Non 8.5 1 2 or 3 sK2oes BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Indued 2 or 3 N153 115 1 Non 10.5 1 2 or 3 SELECTION GUIDE BMI53 115 E153 230 . 1 1 Nat Auto t0.5 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float E753 230 5.3 BE153 230 1 Auto 5.3 included 2 or 3 switch. Refer to FM0477. p CAtJT1oN 2. See FM0712 for coned 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 14-0225 used as a control ad+vatx, 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. MAIL 70: P.O. BOX 16347 Louisville, KY 402560347 meow ctrmof. . Lj SHIP 70: 3649 Cane Run Road % Louisville, KY 40211-1961 Q!!rt[JTY~!/A/P9 ✓~dCf ~~~/d r (600) 928-PUMP L4. (502) 778-2731 FAX . (502) 1 774-3624 http://wwwzoeDercom © Copyright 2000 Zoeller Co. All rights reserved. 4-7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ILE INFORMATION SYSTEM SPECIFICATIONS Owner a Septic Tank Capacity i ❑ NA Permit # Septic Tank Manufacturer ❑ NA ESIGN PARIA.METERS Effluent Filter Manufacturer ~ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity / r-- l ❑ NA Estimated flow (rage) d~ aUda Pump Tank Manufacturer i Design flow (peak), (Estimated x 1.5) / auda Pump Manufacturer 1[33N A I Soil Application Rate ai/da /fit Pump Model ❑ NA) 1 Standard Influent/Effluert Quality Monthly average* Pretreatment Unit Fats; Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L PKAL- rode ❑ Mound Fecal Cogforn (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other iMaximum Effluent Particle Size 36 in dia. C1 NA Other. ❑ NA Other. NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent Other ❑ NA AINTENANCE SCHEDULE Service Event Service Frequency Rnspect condition of tank(s) At least once every: 0 o s(s) (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA (Inspect dispersal cell(s) At least once every: 3 4 m~°~)s} (Maximum 3 years) ❑ NA Clean effluent filter At least once every: month(s) E3 NA i Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ear(s) p=lush laterals and pressure test At least once every: 3 month(s) ❑ NA ~tirer At least once every: ❑ month(s) NA ❑ ear(s) ether: 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 linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of icombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be ivisualiy 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 tank equals one-third (Y6) 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 Adminisbative Code. 14i1 other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, hind any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shag be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION products or other cemicaist For new construction, prior to use of the POWTS check treatment tank(s) for the, presence of painting P may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of tho tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored or the surface excess discharge of wastewater will will by le discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup to restoring power to the To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prim, effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. T Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the foundation POWT.$: : antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floes; diapers; disinfectants; fat; water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; (sump pump) pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT is propetlY When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • Alf 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 filled with soil, gravel or another inert solid material. CONTINGENCY PLAN de a code compliant If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to prow replacement system: E3 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption sy telm.. The replacement area should be protected from disturbance and compaction and should not be infringed upon by req (e setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the the rule:t inn for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with 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 ~ iuai as must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may last resort to replace the failed POWTS. 14 and at-grade sou absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone ?j,; ,,c ~-tj Phone ,s yZ/J G LOCAL REGULATORY AUT L D~ SEPTAGE SERVICING OPERATOR MPER EName Name " Phone I/J ~7 This document was drafted in c wMliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. t , W N 1 a s i MOM l t i I .o N fh R f,) 1 ~ F r°s T (t 1._, If ~ s11,.1 EO l C6 i < i- m c 'c • a Q. N ~ {(j N V ~ <L v Q v z p LU 0 ~ N i ~h LOT 39 : ' f,. g 1. 70 ACRE: f V ~ ~ o o , rr, as r $a FT. m► ; ® L OT 43 ` ~ l.eo ,aed y' ~ , F ~ ' ~ ! r. 7e ACRES 3 • Q. 7e, 043 $0. FT. 91 t'6 447• r 'I 313*23' 4 'E 3 try / }L' , Q` 43. or f. K n N r 3.23' 49' , L OT 38 43. aT' 0 33 k• ~f Q1 1 33' 1.07 ACRES ' .1 fXf ? I 06, 753 SO. FT. L 0I 1 teo toed' 1 , f 74,37 ~ ask L OT 53 1.02 ACRES ti 66.017 30.FT. L OT 3 ' r 2.34 ACRES 0 ; ' 110.470 S0. FT ~ q s)r3r L!0 IOW , VJ ~r as"~ 346I d l '!s=E `~1 • 1(/ ~y ~j Js' • r0' ~rt.rw s ' WEN). 1 2 I : ! t ~ 1 • Lu . I L OT 52 L OT 54: .33 L OT 6 sd 1 1. 73 ACRES w 1." ACRES ; ti s_ ~fn s~ l =1 lit ruin Rn eT .a r r+: 7. 4" arb ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMM AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address S . D 44.. VV& Ind 4 -JG A- A 0 J v r Property Address - - 7Sc1 Q (Verification required from Planning, Zoning Department for new construction.) City/State _ Parcel Identification Number it LEGAL DESCRIPTION Property Location i cJ ~/a c t~ 1/a , S , T,-"'/ NR L, W, Town of.4,11 Subdivision Lot # -`~2 Certified Survey Map # , Vc,lume , Page # Warranty Deed # Volume Page # Spec house yes no Lot line-- identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature fuhrre to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the owner and by a magter plumber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of dodge. Vwe, the undersigned have read the above requirements and agree to maintia the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St Croix County Planning & Zoning Department within 30 days of the three year expiration date- Uwe certify that all statements on taus form are true to the best of my/our knowledge. Itwe walare the owner(s) of the property descnbed above, by virtue of a deed recorded in Register of Deets Office. aaa~ty Number of b w7 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if refierence is made in the warranty deed (REV. ones) 4<OILtl.1a'f7 Nt )(bal.Xa ~ _ ~ t "IIINV. iA'i ♦I~+.il.t~3N n w _ +7fll~ P.Yd c I b x "Z 'Z o Eii r is { llt~~~~ 4 s KVId IA11 MIA1U7 NOLI Vfl'\.104 .r t f 1 rWV~t l3) 1 LIHll1alH maenad r I N / ~ r i.~- YNN9(] Lh((tUd : roe 8 ~ ~ 4 Syy ~ Q ' Y~ o 7 s t : y ~ t G _ AL - r ' U P t r , - , i 1 0 1 . s , " . r i 1 t L• a ~ W o r+~ ! 37f~t~CIIS~2T 3I73 tt W ' d c.~^~~ ~oUVtaavq vk-13 a ~G 1P % tit b ( L a~f ~ H 1~ W i i ; P S. G ' . d L-r i i c IVIJN3NWOJ l.lir~lt•611NY11 a'I~w•IM~IN1lIlAiN (UN ?7/j F ~ v0N011x vA>sNiaa Mm « a#: z W OL 1 1 I i I I « F ~ y f . + i u I . i Vad > ih ® i 1 z, , 1 Wi.-,, r<in bepartment of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must V41 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. G] _ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. eview d by Date Personal information y u rov a may be d for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 6,4404 Property Owner Property Location X11 l 1~ L. Govt. Lot , ilk- 1/4 `~((t 114 S T N R 7 E (or) Property Owner's Mailing Address rt! ` Lot # Block # Subd. Name or CSM# C* State Zip Code Phone Number ❑ City ❑ Village t-Town Neares Road -~U\11a)1GI - GPD New Construction Use: El Residential /Number of bedrooms Code derived design flow rate D ❑ Replacement ❑ Public or commercial - Describe: Parent material Fl od Plain elevation if applicable ft. General comments S~~ i✓1 el-r,- 0 3G and recommendations: ~1 Y i•' c,1 ac . t' I v . 9 Src.Q vh --tic, d~,r ue- es rea Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor _ L__- 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 p IZ i~~ r - I ~~Y 0J rrr Ivy . `j S~l G r, '§j-(c T `l L-C-3 Shy E a Boring # Boring n ~C> !SCJ L Pit Ground surface elev. ft. Depth to limiting factor in. Soil A licabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 r~31 _ J Z)-f~ r yY r 5 1v I n iC) 10 r-9 ILI 2 r k 4 l.Z Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L ' Effluent 92 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur CST Number A&rA S&hv a.kev- 2,533 v<~ Address Date Evaluation Conducted Telephone Number 2.113 SD'l SY. .So er C (7i5 2V 7 ^ `Q6~ ^ Property Owner ~t1 ~_-lt')1 ( ~Y U )f Parcel ID # Page F- 1~ Boring # ❑ Boring 2 7 pit Ground surface elev. J _3b_ 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 C` --IC-. Y~-l--.~,.. iJ 12 -3~j 10 ❑ 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-I Boring # Ground surface elev. ft. Depth to limiting factor Pit in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDH 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 = 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. SnD-x330 (R.07/00) Property Owner !j l~1111 ~~UT Parcel ID # Page of ❑ Boring n 131 Boring # Pit Ground surface elev. 9 ~ • ft. Depth to limiting factor _ U ~ _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ~V-C 12 /d, 5Cm5 ►~~r C - - //2 r s/ ❑ 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/ffz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ❑ 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 GPDH in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ` Effluent #1 = BOD5 > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 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 (R.07/00) PAGE 5 OF 1v1E U A F- d S LOT# 3a LEGAL DESCRIPTION w Y'9'`4 ,S q T cl ,N,R, / E(OrAo SCALE: I" BM 1 ELEVATION ~nQ . O BM 1 DESCRIPTION i BM 2 ELEVATION ~q3U BM 2 DESCRIPTION q SYSTEM ELEVATION SYSTEM TYPE rii o nd 14 - (T ra ~Q t _ - CONTOUR ELEVATION , oc) i, I 5 A70 1 { SIGNATURE c DATE G~ ` PAGE OF NAME LOT# LEGAL DESCRIPTION X,9,yX,S cl T Z`f ,N,R, 17 E(or) SCALE: I°= BM I ELEVATION BM I DESCRIPTION ~BM 2 ELEVATION 3C BM 2 DESCRIPTION SYSTEM ELEVATION SYSTEM TYPE !Yi c > , - CONTOUR ELEVATION I . n r. SIGNATURE ~1~ DATE G~ ` 1093.2 ` ; T clor ' H 1 78' 1093.5 X (113 ' LF r0 A5 5 Q 41 CID Lo v gT CRE 8 _ r s~ r Q H 10 O L F 108 / X i i i D ~Q 7a~ NgGE i a L OT 83 LO 1.52 ACRES + , z 4 CRE 0 (1.8 ~ co s ' Ar i • 35' Sg "E 346, 9, pi - W -Ir 0ti #:,L 1 s LOT 84 ' i 1.58 ACRES Yh 66 r ~ ACRES I i OT 8 Or < z 0 0 B 62 I ti 3.3 3 ACRES M X ~ \ + + N M~ 4 1103.3 + ` c r W~ + lod o O+ ` 10 820 .68' 38'27m 298---- - ' L 65 ~ ' CA 1.74 CRES ` Orr N OT 81: Or I ~ N O ` c4 + 0 1.68 ACRES r ` ~ r