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HomeMy WebLinkAbout030-2038-50-050 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 600317 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: Rick & Lynette Ballis TOWN OF SAINT JOSEPH 030-2038-50-050 CST BM Elev: Insp . BM Elev: IBM Description: Section/Town/Range/Map No: f 0(7 Cy2 T ~,,,rJ-A C&),n 25.30.20.481-A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark Septic /Z ooaf Au~ 904E419 (3 Alt. BM r fTp GVk mP.o Aera _ Bldg. Sewer , O A 7 (f St/Ht Inlet l 7- TANK ~ l SETBACK INFORMATION St/Ht Outlet T(/ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ot _ Septic f 7j Dt Bhem .C. Dosing Header/Man.~~ AerajLacL_ Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATI Final Grade O Manufacturer Demand St Covey Cvp- Model Number TDH Lift Iction Loss System Head TDH Ft F remain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length i No. Of Trenches PIT DIMEN NS No. Of Pits Inside Dia. \ Liquid Depth DIMENSIONS (/D_ d/(I \ SETBACK SYSTEM TO P/L BLDG WELL LA S M LEACHING Manufacturer: y, INFORMATION CHAMBER OR Yi /C Ito, Type Of System: UNIT Model Num ~pwti~ ~-1 47 S>^ s4c2 S~' DISTRIBUTION SYSTEM 7-R t tLp Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ( Pipe(s) 1Length ~ • Dia Il Length ~ Dia Spacirf-g""" SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only s Depth Over Depth Over xx ©epth of x eeded/Sodded xx Mulched ' _N o Bed/Trench Center Bed/Trench Edges Topsoil ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1396 25TH ST / 1.) Alt BM Description = cwkr u 13Vl V 2.) Bldg sewer length= 3a - amount of cover = 7 4 jr Plan revision Required? [_II Yes No Use other side for additional information. Date Insepctor' onat~r Cert. No. `f , SBD-6710 (R.3/97) - ounty Industry Services Division F lled in by Co.) 140 Sanitary Permit Number (to be illed in by Co.) ®S P.__,~~ U S Madi n, 6 1416 W63 r ~~ossto~wvs~ State Transaction Number Sanitary Permit Applic tion A4 ~,tmental t In accordancewith SPS 383.21(2), Wis. Adm. Code, submission of this fo to the ~ 'StYbmitted is required prior to obtaining a sanitary permit. Note: Application forms f st~AWt~f{e= ~d project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you grout /i{ j j u oses in accordance with the Privacy Law, s. 15.04(I)(m), Stars. J C L 1. Application Information -Please Print All Infor / n Parcel # Property/91vne7same Property Location Property Owner's Mailing Address ~~l• / . Govt Lot Phone Number /Y~ N~ Section Zip Code (circle City, State T 3C N ~ E otW/ Lot # II Type of Building (check all that apply) C_ Subdivision Name ill or 2 Family Dwelling - Number of Bedrooms J O f. tt ock # 64f AS F1 Public/Commercial - Describe Use ❑ City of ❑ Village of ❑ State Owned - Describe Use t _ CSM Number of W ltod' ~~O -1, c Town 1 III. Ty a of Permit: (Check only o e box on line A. Complete line B if applicable) O Z Modification to Existing System (explain) A. ❑ New System F1 Replacement System Treatment/Holding Tank Replacement Only ❑ ❑ Permit Renetival Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued B. Plumber Owner Before Expiration IV. T e of POWTS S stem/ComponentJDevice: (Check all that apply) Mound <24 in. of suitable snit Non-Pressurized In-Ground ❑ Pressurized in-Ground ❑ At-Grade ❑ Mound > 24 in_ of suitable soil ` , Pretreatment Device (explain) C] Holding Tani: Other Dispersal Component (explain) ❑ V. Dis ersaUTreatment Area Information: Dis rsal Area proposed (s System Elevation Desi Soil Application Dispersal Area Required (sf) Pe / / (2 ✓ Design Flow (gpd) G Rate(gpdst) Capacity in VI. Tank Info L s b Gallons Total # of Man1f,tureT Gallons units ~ New Tanks Existing Tangs v Septic or Holding Tank ❑ ❑ ❑ ❑ ❑ Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume res onsibility installation o t lie PORTS shown on the attached plans. Plumber's Sim MPlMPRS Number Business Phone Number l -7 Plum r". Nam f IL Plumber's Address (Street, City, Sta , Zip Code) VIII. Coun IDe artment Use ©nlt' Approved isappr Permit Fee Daat Issue , I Issuin- pent Sign W iven it for Denial w( 3 coo. 0AA p IX. Condi d a`~nF f Disapproval V . , .~t+t c~ !rust all be s~►_ki^ s`' ►s+,t / afsyemen. plan p+c liderl by A: > ilG1t rect..[ .s^.errs mir.it Le 6Miet4 Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size G n~ Itk- A, ° - - - - - ll ~4 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX ARID TITLE WAGE -A-, _IT' Project Name: Owner's Name: Owners Address: - o -y J i Legal Description: - Township: ~"Scf~ County: 7 Subdivision Name: Lot Number. Parcel ID Number. Page 1 Index and title Page 2 Plot Plan ur Page 3 System Sizing & Cross-Section ,six - Page 4 Filter Specs Page 6 Maintenance Information CF, ~ fj Page 6 - Management Plan - Page 7 St. Croix Cty Septic Tank Maintenance For Page 8 Warranty Deed page g CSM or Plat / Attachments: Soil Test & House Plans - License Number: Designer/Plumber. Phone Number Date: Signature Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SSD-10P7 5-P (N.01io1)_ v n ~ Sj ~n0 Tlk Y Q M. C1 y a o y pkfC Vent Pipe C= 7 chamber t 1 it Egli AbSO 6011 € ~Ft ~y HUPITITA l } Z _ 3`-nrsr ~ Gfrdmbecs Vent Cr Obssr pipe -4-ft E,JI~ F.lt-~5 s l t4' MEL Ttd~ 2 14eader t 11facturer And Mode! -chamber dog Apptir on R ` gpdi,-4 it swig pff~On ' RatI3 gpd }design ROW 2 revvs of pag5 of ~ C of wis / f 3 Dept. of Safety and Professional Services SOIL EVALUATION RE Page Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code County ~ J Attach complete site plan on paper not less than 81/2 x t 1 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distence ickn-karest road. - ? ; •L Please print all Zed by Date Personal information you provide may be used fors ~rposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Properb/ Location fid1 AR _ Govt. Wt 114 1/4 T N R ~ E (ol~ P Owner's Mailing Address #ot r Block # Subd. Name o#CSM# City State Zip Code Phone Number ❑ City, ❑ illage ElTown Neare oad 10 New Construction User Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: Parent material z f] S'W Flood Plain elevation if applicable ft• General comments and recommendations: F t Boring # Boring pit Ground surface elev. ft. Depth to limiting factor 5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz t Color Gr. Sz. Sh. ff#1 * fW2 r r 6 t L - i 9 9 Boring # Boring ~CTi( Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture structure aonsi.stence Boundary Roots GPD/fr 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' tf#1 * fi#2 ^3 r X) q ~ S I~ ilk * E "t #1 = BOD > 30 < 220 mgt- and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Na ~ n l(; Signatu CST Number Address Date Evaluation Conducted Telephone Number SBD-8330 (RI 1/11) Property Owner Parcel ID Page of --:'5 Boring Boring # 0 Pit Ground surface elev. /Z'A ft Depth to limiting factor in. Soft Asx3fication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munselt Qu. Sz. Cont Color Gr. Sz. Sh. tf#1 * ff#2 - c u ~ It rl n Boring Q Boring # pit Ground surface elev. ft. Depth to tmiting factor in. Soil AppAcation Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPDIft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. + ff#t * N#2 1 1 Boring# Boring Ground surface elev. ft Depth to limiting factor in. t_._ J ❑ pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots * tfi#1 GPD t 2 *1 -02 in. Munseil Qu. Sz. Cant Color Gr. Sz. Sh. Effluent #1 = BOD b > 30:< 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = SOD 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 608-266-3 15t or TTY through Relay. M-8330 (R 11711) Property Owner_,~ Parcel ID # Page ~ of goring # F1 Boring 0 Pit Ground surface elev. /Z t~ ft Depth to limiting factor ~/~?C) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistenc® Boundary Roots GPD/ft 2 in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 $02 IYZ i - l~5 7 i it Q Boring Boring # t-i Pit Ground surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2 Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 E * tti#2 J BO°ng # Ground surface elev. R Depth to limiting factor in. in. El Boring 11 7~d ~ Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure orusistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ` ff#2 * Effluent #1 = BOD 6 > 30:E 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD a < 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. SM-8330 (Rf U! 1) I rn ~ vv) -tee n 4 M Q O h ~ I _D - County / s XR o~ L Industry Services Division j 9400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) D'S t JAN 2 2 2018 P.O. Box 7962 $i Ma ' , WI 53707-7162 Croix County f tyw °~ss~o•a~ r nit ne A if , • State Transaction umber sanitary ment Permit ;'is. Adm. Code, Submis.'- 02P4SOPFC2BP6 ~ unit In accordance with SPS 3$3.21(2), fitted to is required prior to obtaining a sanitary permit. Note: Application forms for stay-u--- - - ject Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary ' i t^ r rt purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. J 1. Application Information,- Please Print rmatton Parcel # Property- Owner's Name Property Location Property Owner's Mailing Address Govt Lot,/ Phone Number X,E N~ Section ' City, State Zip Code (circle 9pe) I T3 N R E oL Lot # II. Type of Building (check all that apply) ~ Subdivision Name JQ I or 2 Family Dwelling - Number of Bedrooms 4-_ ~ stock # F1 PubliclCommercial - Dsscribe Use CJ'SC ❑ City of ❑ State Owned -Describe Use Village of CSM Number L Town of III. Ty a of Permit: (Check only one box on line A. Complete line B if ap licable) A- New System ❑ Replacement System ❑ TreatmentlHolding T R acement Only ❑ Other Modification to Existing System (explain) Permit Ch ae of P Transfer to New List Previous Permit Number and Date Issued ❑ Renewal El Permit Revision 13 V Before Expiration PI be a 15 IV. Type of POWTS System/Component/Device: { C ply) > M,,--1d u<24 in. of suitable soft e- Mound - 24 in. of suitable soil ❑ Non-Pressurized In-Ground ❑ Pressurized In ❑ 'Q='I'an tner vispersal Component (explain) ❑ Pretreatment Device (explain) Holdtn-lc"~v V. Dis ersal/Treatment rea Information: Dispersal ea Pro posed (s System Elevation D(gpd) Design Soil Application ispersal Area Required (sf) P Rate(gpdsf) VI. T" Info Capacity in o E Gallons Total # of Manufacturer ° U y _ Gallons Units a c U 'vi v C 0 C. New Tanks Existing Taroks rf/j El Septic or Holding Tank ❑ ❑ ❑ ❑ ❑ Dosing Chamber VII. Resp sibility Statement- 1, the undersigned, assume respon ' tC'Yfor installation of the POMTS shown on the attached plans. Plum Name( n re MP/MPRS Number Business Phone Number Plumber's Plumber's Address (Street, City, State ip Code) VIII. County/ De artment Use Only Approved Permit Fee Dat Issued Issuing nt Signature even Reason for Denial $ g'6 ' IX. Condi ~ IWA-Reasons for Disapproval 3, D 1` ~c EiAt;tn: t~ Ic~i ✓ ~ / c i;ww.-. ct*must r9 t~g1E~!`>)~Ei ts~il~li 9 W P6r :Ylarayemen! plsn p!trtidwl try Nlujnt e . 2. _*A ee*#~* twq„h's MwM Lo r;tattttrll E*t iR W Wftr6h1 C46l 1 •:rifum3it1'- Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x I1 inches in size _ l~ ~ _ . _ \ ~ - - - ,-t, - -i . n l~~ - _ - ~ ~ ~ T ~~C,,~ _ ~ ~ ~ ~ ~ ~ \ \ r ~J • ~ ~ ~ ~ _ ~ . ~ - _ _ -r ~ _ ~ .r~ ~ _ ti _ _ ~ ~ / ~ ~ - ~ i l _ I - e, ~ a - i - ~ s r _ ~ _ _ ~ _ CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name*. Owner's Name: Owner's Address: Legal Description: / I Township: County: Subdivision Name: f 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 j Attachments: Soil Test & House Plans Designer/Plumber. License Number: Phone Number Date: - Signature r Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705--P (N.01/01). ~ ' ~ ~ \1 c`1~I( g ~ i o ~ ~ ~ _k ~ ~ ` ~ ~ ~ U c ~ ~ \ t ~ ~ ~ _ _ _ ~ , ~ ~ _ ~ ~ --moo ~ O i - ~ _ M, ~ - ' ~ ~ ~ _ ~ _ ---~---tea ~ ~ ~ ~ - ~ ~ ~ - ~ i J ~ ^ ~ \!I I PVC vot Pipe r-vftVe;-t cap Leaching Y C > Chamber Elevabon Roll AbSoM On € Plan l i MTRIIIII n „7 i dnng 3 ch I =,t Vent Or Obse;va~iM P"tpe Cftambecs 4~ Dla. t Tre~scS~ 2 Header Manufacturer And Model EISA Raiingzz per chamber SoO Application Rate _ 901'A ft sq it EI~A umbers i gpd design Ico~r soil Application Rate -E, ? mars of~_ enambem each- a~ page f~ : J 1 _ 525 EFFL VENT FILTER (7' {lok, Inc is pleased to add its Poi, new commercial filter to its existing line of quality effluent fitters. The t PL-525 is rated for over 10,000 GPD Alarm 4 ; Accepts PVC gallons per day) making it one of accessibility extension handle the largest commercial filters in its Y class. It has 525 linear feet of 11-15°~ filtration slots. Like the Polylok 4 PE-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" filtration slots . Rated for over removed for cleaning, the ball will 10,000 GPI float up and temporarily shut off the system so the of !cent won't leave the tank. No other filter on the market can make that dairrrt Accepts 4° & 0" SCHD. 40 Pipe i_ PL-5'~ga aFff The PL--525 (Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is re( mended that the filter be cleaned t' 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 bas deflector servicing. Servicing should be done by a certified septic tank=- Automatic shut-off pumper or installer. ball when filter 4 is removed 1. Locate the outlet of the U.S_ Flatent Nog 6,01S,483 septic tank. 2, Remove tank cover and pump _ n r tank if necessary. D:: E y~l 1. Locate the outlet of the ~ v.-~~ septictank. 3. Do not use plumbing when filter is removed. Ideal for residential and com- 2. Remove the tank cover and mercial waste flows up to pump tank if necessary. 4. Pull PL-525 out of the housing. 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 5. {-lose off filter over the septic 4° or 6" outlet pipe. If the tank. Make sure all solids fall filter is not centered under the bade 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. 5. Replace the septic tank cover. 7. Replace septictank cover. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: jti-i~='5'~=~ ❑ NA Permit 0 Septic ❑ Dose ❑ Holding Volume: d (gal) CS ; DESIGN PARAMETERS Tank Manufacturer: O NA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) ,ZJ (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Estimated (average) Flow: Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): C ; (gal/day) if horizontal is >150 feet. Specific instructiorys to be provided on back. In Situ Soil Application Rate: (gal/day/ft) Effluent Filter Manufacturer: f- ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NAJ NA Total Suspended Solids (TSS) 5150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L ❑ NA El Mechanical Aeration El Peat Filter O NA (TSS) >150 mg/L Pretreated Effluent Monthly average e El Disinfection El Wetland Y 9 ❑ Sand/Gravel Filter ❑ Other: (BOD5) 530 mg/L Soil Absorption System (TSS) 530 mg/L ❑ NA Fecal Coliform (geometric mean) 510" In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA ❑ At-Grade ❑ Mound Maximum Effluent Particle Size '/8 in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) 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: ❑ month)s) (Maximum 3 years) El NA year(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 controls & alarm El month(s) pump, pump At least once eve NA every: year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ 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 5_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) 1 Page Z 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 INS A ER ( POWTS MAINTAINER Name Name Phone S> 2921 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name u l- 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. ST. C:ROIX COUP= SEPT? C TANK -A.LN=- 4. CE A.GREEN~ Obi--NTERSHEP CERTMCAnON FORM ovMer/Buyer L rQ ti LL~' I iv Address 1~~ /3-96 -T Ca C;~ /1) A.1ddr S 13 5 Sl U~ L Z I o EL V,\ 14 (-verification required from Phoning & Zoning Depamonent for new emMvction.) City/State 4 U 1 L. Parcel Identification Number O I X- &L DFSQH_ t ropeity Lo ion . % , SecvL. T ?vz R- Subdi-iisiou Plat: Lot Certified Survey Map n :S),7 Volume Page Warranty Dead (before Voe .Page house 0 yes~no Lot i eble yes 0 no sySTEM hi& NMNANCE A'-NrD OWNER CERTMCATION uapmper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner; if needed, by a licensed pumper. ghat you put into :he syrsteut can afec► the Cdon of the septic tank as a treatmseut stage in the waste disposal system Owner maintenance responsfoilitie:s are specified in §SPS. 383M(l) and in Chapter 12 - St Croix County Sanitary Ordinance -1 be property owner agrees to submit to St Croix County Pla g & .Zomg flepartrnent a ceaTEfrcation form, signed by to e owner and by a muter plumber journeyman pIumbea, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is m proper operating condition and/or {2) after inspection and pumping (if-necessary), the septic tank i= less than I!3 full of sludge. Tlwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standar-& -set iios& herein, as set by the Dqarmumt of Saiay Aid Profit Semces aw ft Dqmtmmt ofNa=aj Resources, St ft of W-Mcomn- won sutzg that your aerie system has been mambnoed must be camisleted and retuned to the St. Croix County Pls rg Zming t uditu 34 days of the: 4ww yew cpkadw dae. Ifwe certifp that aIl statements on this ftam are true to the best of my/our ltaovdedge I/we am/we the owner(s) of the property described above, by %twe of a warranty deed recorded in Register of Deeds Office. Number of bedrooms C' f l / I SJ Sin A~t1 }P APPLi.CA_N 1 (S, , ~ DATE mformation that is misrepre~d may result in the sanitary permit being revoked by the Planning Sc Zoning Department include mtCh this application a recorded war wrf steed from the Resister of Reeds Office and a copy of the certified survey map if reference is trade in the wananty deed. EV.04 )