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Home My WebLink About018-1082-10-040 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 605027 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3098411 Permit Holder's Name: City Village Township Parcel Tax No: Edwin Frank/Christine Johnson TOWN OF HAMMOND 018-1082-10-040 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Oz> S c J L-o~-- Go f30.29.17.567 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER s CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing S Alt. BM C e ~ 7 /d2.9 ~ernEiea ~ ~ Bldg. Sewer Holding SUHt Inlet \ TANK SETBACK INFORMATION St/Ht Outlet TANK TO A L WELL BLDG. ent t Air Intake ROAD Dt Inlet Septic *JA- X33 Dt Bottom Dosing 56 NA- 33 1 39 Header/Man. y V T• L O Aeration Dist. Pipe 'F, z /d 3 8 Holding Bot. System T - °f O3! ~ PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover zilig GPM s • /dZ . Model Number TDH Li16rZ Fricti/•L~s System ~ TD /f, Ft Forcemain Length n IDia.Z Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. O rench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S7 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of em: I (06- J UNIT ~Q Model Number: tJ DISTRIBUTION SYSTEM Header/Manifol Distribution / x Hole Size x Hole acing Ven Air In e Pipe(s) -7/ / Length Dia ]Length v f Dia_ Spacing--*-- to Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/ odded jxx Mulched BedlTrench Center Q Bed/Trench Edges Topsoil El No Yes ❑ No LL!! rJ . COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 ///Z//Y Inspection #2: Location: 722 160TH ST ~ ~ 1) 1.) Alt BM Description wa~L; ^&I- I ^ , In 2.) Bldg sewer length = 3 Vd~ - amount of cover = it / zz '4Z. Plan revision Required? ❑ Yes o -7 1 7- ( 0 Use other side for additional information. /rr's SBD-6710 (R.3/97) Date Insure Cert. No. County _ Safety and Buildings Division 2 1" - 201 W. Washington Ave., P.O. Box 7162 Sanitary permit Number (to be filled in by Co.) S ` _ K Madison, W1 53707-7162 ~T MAY 2 5 2018 State Transaction Number u, F~ it Application In accordance w2th SPS 383.21(2), Wis.~ de, submission of this form to the appro ate govemmenta unrt is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project -Address if different than mailing address) / the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ores in accordance with the Privam Law, s 15. 1) m), Stats. - '2Z L Application Information - Please Print All Information Property Owner's Name r Parcel # Property Owner's Mailing Address Property Location 0 7 Govt Lot C C~ C' Sty Zip Code Phone Number_ l; v-'/., Section 1 ~ r -~'7 cycle e) M; l T N; if E r W II. Type of Building (ch all that apply Lot # Subdivis nn~NamI n or 2 Family Dwelling-Number of BedroLo 2 - ~.t ( J B~ Block QQ// ❑ Public/Commercial -Describe Use ❑ City of 3l 46 v J CSM Number ❑ Village of ~ t . State Owned - ❑ - D wn of -A'Al (W.110 III. Type f Permit: be Use (Check only one box online A. Complete line B if applicable) A' System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El PermitRenewal Permit Revision El Change of Plum Transfer to New List Previous Permit Number and Date Issv~d ❑ q~owueart e/ 1A 72- Before Expiration i Q evice: Check all that a 1 , v ofPOWTS Svstetn/Com onentll? _ IV T 1 ❑ Non-Pressurized In-Ground El Pressurized In-Ground ❑ At-Grade ound ? 24 in. of suitable soil ❑ Mound < 24 in. of so le so ❑ Holding Tank ❑ et Dispersal Component (explain)__ ❑ Pretreamrent Device (explain) V V. Dis rsai/Tre went Area Information: Design Flow (d) Desi Soil APP li on dDispers Area Req ' Of) Dispersal Area opose s System Elevation gp VL Tank Info Capacity in Total # of Manufacturer o I _o Gallons Gallons Uy i nits U New Tanks Existing Tani y Yv o v m ~ G n. U rn :n L Septic or Holding Tank Dosing Chamber 'on of the POWTS shown on the attached plans. VII, Responsibility Statement I, the undersignetas:ponsib~il)itl,sibility for instaliah Plumber's Name PluMP/IviPRS Number Business Phone N her I Plumber's Addresss) (Street, City, State, Zip Code) VIII. County/Department Use Only - Permit Fee Date ued Issuing . ent Signat e roved ❑ sappy pP E] S I Reason o ial • O er / - - DL Couditi&W6Wf RdW asons for Disapproval e t (h 1 1. ':l ieot c tark, a fIt.en- lifter e,irt 3, G~'r~ a~ / I , ~1 a b ~ s•;perqale cell rs!ust W. all be pro s ! r ntm s per ;p 3Seme plan pro ridect by plu nbet. ~J+%" W L iA. 4.&J 2'!!lC143Y IA/li5 MINJt3t,Gf f ~.t tk.l! E~ n cold I Cftri11 acts. Attach to complete plans for the systam and submit to the County only on paper not less than 8 in z 11 inches in size SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Edwin Frank ADDRESS 1125 Norton St. Hammond Wi 54015 SE 1/4 SE 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 104.0' 4/18/18 3 DATE BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. SW lot stake ASSUME ELEVATION 100' Filter Lifetime Filter Q BOREHOLE O WELL *H.R.P. same as benchmark 100+' Property Line Scale = 1/4" = 10' 5 Acre Parcel ( 160th St. Grading is to be done to divert run-off away from system B-1 Huffcutt 9 C bo Tank Pro 3 B-2 0. Bedroom House 3% Slo 103' B-3 Area 15' below system 1 02' is to remain undisturbed 4...~P _ B.M.* 330' Property Line DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 S' Contact Through Relay P J http://dsps.wi.gov/programs/industry-services S wwwmisconsin.gov 'su»N Scott Walker, Governor Laura Gutierrez, Secretary May 10, 2018 I% APPROVED CUST ID No. 226900 ATTN: POWTS Inspector OF SAFE,'Y ZONING OFFICEi ~t I$~"►`?t1Sy SHAUN R BIRD ST CROIX COUNTY SPIA 1432 120TH ST 1 101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/10/2020 Identification Numbers - Transaction ID No. 3098411 SITE: Site ID No. 849041 Edwin Frank Please refer to both identification numbers, 722 160TH St above, in all correspondence with the agency. Town of Hammond St Croix County SE1/4, SE1/4, S30, T29N, R17W FOR: Description: Mound System (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1761041 Maintenance required; 450 GPD Flow rate; 35 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/O1, 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 mound area. • Divert surface water from POWTS Area. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil Proper soil moisture content can be determined by rolling a soil sample between the hands If it rolls into a 1/4- inch wire the site is too wet to prepare If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 i SHAUN R BIRD Page 2 5/10/2018 • Insulate building sewer beyond 30 feet per SPS 382.30 (1 1)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan Any changes may result in pump resizins! to meet TDH and GPM Specifications. • Areas that are occupied with rock liagments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off Lit ,round level. A larger fill area is necessary when any of the above conditions are encountered. to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal Iation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 Zm This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services Wyment S code: 1. 7633 (920)492-2214 , Mon- Fri, 6:00 a.m. - 3:30 p.m. tim.vandcrlcest~rrhvi.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/18/18 Owner:Edwin Frank Location: SE1/4 SE1/4 S30 T29N,R17W 722 160th St. Hammond Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency" Ian 9. Filter Specifications and cros section Attachments: Soil Test j` 6 Shaun Bird Signature License number 6900 Page 1 of 9 System PLOT PLAN PROJECT Edwin Frank ADDRESS 1125 Norton St. Hammond Wi 54015 SE 1/4 SE 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 104.0' 4/18/18 3 DATE BEDROOM i CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. SW lot stake ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 100+' Property Line Scale = 1/4" = 10' 5 Acre Parcel 160th St. Grading is to be done to divert run-off away from system B-1 Huffcutt Combo Tank Pro 3 B-2 Bedroom House 3% Slope 103' B-3 Area 15' below system 1 02' is to remain undisturbed B.M.* 330' Property Line Mound System Cross Section and Plan View 77777 ~ ~ Dimension Feet J A r i ~ B 1 ~ T Lti fLJi~1fyr4! D S?11;14!: 1 S 1414%414.4 L•1•L•~ L L iJ414l4l4•i~?il1fiYirir•r L L?•? L L?1?L?L•1. 4f•f•f• L 1 L - riiii1r4i •r•f.f. . L i?•? r r• L i?•? L • • r•r•f• 4 L?1?S?•r r r4?: L i r r4?: F4i4s4 L i •1K• L h?ti•L~ L•1•L• f•fY• r.•4• S?ti. L?•? :4r4,4r4:4~ E v.r•r• rv4f4'4 fL.{?1?'?4r I L•L•L? r r f1?1?S? fLf.{{ti?f:4? r i4}4.4 L L 4f L 4 r i4i4r4 Lj4? . L•L•1•L•L: ? i4i4i4?4 r.r.r`r1}4'4 7 r•f:Jf.r i•r•r L•L•L? ? L S?5:1?1?•. L.L. . S 4f r.f•r.f• Lr4f4J4J4.4 4?4 ti?ti?i?ti?4: l4l:r4i. . ff' i F i Z i J r G I J i i I i J K 7 7 7 1 7 i ° L - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - W I ni K B -----T~ Z P L Slope - 1 = Topsoil = ASTM C-3 } Wiz C'leati az e ate 4 in. sch.U vc Cap Materiasand fill'/2 to 2 '/2 in. dia. 0 p observation pipe Geotextile G H Fabric err .rrrrr: F L11• rLr4•~?~l4r / ~ G~ 4r. l/ [ Ft D _.E Ft Contour Plowed Surface • Slope Direction GENERAL, INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/071gj Page Oil' Pressure Lateral Layout Two Laterals - End Manifold 4 Threaded Cleanout Lateral Turn-up Plug Manifold I M \4 J1, X t L Long Force Main Sweep ` 90 Bend Distribution Network S ecifications i Pressure System Construction Lateral Diameter i In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter lIn. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M (Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main Length <; 4,? Ft. from finished grade. Grade 6-8 Inch Lawn Sprinkler Valve - Box Page of 03/0519) 111 Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer - Pump Manufacturer i Tank Model Number Tp Pump Model Number 2 Total Tank Capacity Alarm Manufacturer Max. Bury Depth Alarm Model Number Switch Type Filter Manufacturer Total Dynamic Head (TDH) - Feet Filter Model Number j t j~ Elevation Head Distal Pressure Y_ U Network Loss Minimum Pump performance Required Force Main Loss i ` E GPNf Ft TDH Total _ Outlet Manhole MuL 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grr~de Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box am Finished Grade ~ •m ..e Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet 4-------' Inlet Baffle - ===r - t A Switch Settngs and Reserve Capacity Tank Volume = GPI Weep Dimension: Inches Volume Gal. B Hole (reserve) At A/" l _j (alarm) B - 2 ff Elevation C Ft 1-1-5 X. (dose) c • J° I, Bottom Elevation (dead) D D Total Ft > •a'i : •.'i a'<'a '<>i'i syi i <'<'<>:i <':i i<>:<'i : <'s'a><'. :<'< : i .•i ~•o~ '.'i ><><'~' 'i i < :>i i a'~~: i: a: GENERAL INSTALLATION: The septic/dose tank is bedded. and back filled in accordance with the manufacturer's product. approval specifications. Maximum depth of bury as. specified. by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effoctive 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. 44 PVC to bridge the tank excavation and the sleeve, is sealed watertight. Elect=°ical.service complies with NBC 30.0 and Comm 16.28- Page of 42/0 U 280 SER/ES 1 /2 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- Performance Curve: 280-Series range" pump for on-site waste water systems, liquid 40 12 waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. 35 11 Designed around Liberty's unique "Uni-Body" casting, 30 9 the 280-Series will provide years of reliable performance. ~ 25 8 ;n LL Q 20 6 All Models Feature: • Vortex style impeller permitting passage of solids co 15 5 upto%" = 10 3 • 416 stainless steel rotor shaft 2 • Permanently lubricated upper and lower ball bearing 5 • Epoxy powder coat finish 0 0 • All fasteners - corrosion-resistant stainless steel 0 5 10 15 20 25 30 35 4 45 50 55 60 65 70 U.S. Gallons Per Minute • 1 1/2" Discharge i i i i • Stainless steel bottom screen - easily removable 0 38 78 114 156 192 228 270 • Maximum fluid temperature: 140° F. Liters Per Minute 280-Series Cord Lengths Dimensional Data: Model 10' 251(-2) 351(-3) 50'(-5) Weight: 29 lbs. 280 Standard Optional Optional Optional Height: 13" 281 Standard Optional Optional Optional Major Width: 10" (model 287) 283 Standard Optional Optional N/A Minimum Sump Diameters: 287 Standard Optional N/A N/A Model 281, 283...14" 10' cord length standard on all models. For optional lengths, Model 287 VMF...10" add "-2, -3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Factory switch Model 281, 283 Model 287 settings VMF Motor Specifications Turn on level 13" 9.5" '/2 hp 60 Hz 3450 RPM Turn off level 7" 4.0" Oil filled, thermally protected (PSC) Permanent Split Capacitor The Model 283 features a fully adjustable wide-angle float. Differential 8.0 amps (115V) adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point. Vertical float model 287 is not 4.0 amps (208/230V) adjustable. ,7 rT-I-- Model 280 Model 281 Model 283 Model 287 Manual, Wide angle Wide angle VMF-Series no switch float switch float switch Vertical ma9- with quick- with series netic float for disconnect (piggy-back) smaller pits - - plug - will operate in a 10" diameter sump ssP~ alus c Certified Specifications are subject to change without notice. Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com Copyright @ Liberty Pumps, Inc. 2017 / /n All rights reserved. LLIT 2000 R05/17 ! POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 'or FILEINFORMATION _ SYSTEM SPECIFICATIONS Owner `A Septic Tank Capacity Permit # r C~ al NA Septic Tank Manufacturer NA DESIGN PARAMETERS Effluent Filter Manufacturer tics NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units, Pump Tank Capacity C~ al ❑ NA Estimated flow (average) < aUda Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) aVd Pump Manufacturer ❑ NA Soil Application Rate A aVda /ft-' Pump Model ,l ( ❑ NA Influent/Effluent Quality Monthly average' Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m /L ❑ Disinfection O Other. Manufacturer Pretreated Effluent Quality A Monthl average" Y Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-ground (gravity) ❑ 1 -ground (pressurized) Total Suspended Solids (TSS) 530 mg/L 13 At-grade ound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-line ❑ Other. Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non-commerclao wastewater and septic tank effluent k Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months - year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every ❑ months a-fear(s) (Maximum 3 yrs.) Clean effluent filter At least once every jF~/o months ear(s) Inspect pump, pump controls & alarm At least once every ` j ❑ _Ji6ear(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ear(s) ❑ NA Other: At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Sertriclng Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mnlcal or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at irttervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s)- If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. , r 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 or other chemicals thElt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. 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 the excess wastewater will bie discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to tlye 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. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTr: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producl~s; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm x3.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space 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 compiiipnt replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should 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 neied for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technologN a holding tank may be installed as a last resort to replace the failed POWTS. 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 last resort to replace the failed POWTS. Round 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>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS - POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY UTHORITY Name 4-7 Phone f Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. - - Ilk M ~W y N + i - I i 'O t ~ I v r. a 00 1 -1 i z o Q a 0 a , co C Q ' U Z ~ Q Q E.._ 1 u f I i i E ST. CROIX COUNT'S SEPTIC TANK MAINTENANCE .AGREEMENT ANT) OWNERSHIP CERTIFICATICjN FORM: Owner/Buyer _ fi r co r" - - Mailing Address `A6 Property Address Y. (Verification required from Planning & Zoning Department for new constriction.) City/State - Parcel Identification Nurlber D/S'- 6.6Z7 LEGAL DESCRIPTION Property Location,j 1/µ 5.2 1 /4 Sec. O, T N R.~ W, Town of Subdivision - , Lot # 1 Certified Survey Map # - Volume Page # - Warranty Deed # Volume - , Page # Spec house yes no Lot line:; identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION improper 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, ii 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 wane disposal system Owner maintenance responsibilities are specified in §Comm_ 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zon ing Department a certification form, signed by the owner and by a master plumber,,journeyman 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 sludge. Vwe, the undersigned have read the above requirements and agree to maintain 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. l/we certify that all statements on this f m are true to the best of my/our k nowledge. 1/we an/are the owner(s) of the property described above, by virtue of a warr~ty deed recorded in Register of Deei is Office. V/ Number of bedroo 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 reference is made in the warranty deed. (REV. 08/05) i ♦ f IC ;5.87' 60.28 297.00' 33.6d 1 ~7 I O D 0 LOT 5 1 m 0 ti N m O I:z w ( 1.90 ACRES 0D o n a) 1 r_ 82,547 SQ. FT -D•I 0 O') 1 y ok S 00 m .A 10 rn I LOT 6 U o o I I rn cy A 2.00 ACRES m 1 I I U) 87,120 SQ. FT. N89°53'18"E 297.00' -f I-~ a 1 r' 1 11 ~ U v, Iri w u Cn 1-~ I C? \ N bo CD 1 ~ L7 N NI I I m co LOT 4 N - 17°39'07"W 293.89' y -4 w 1.90 ACRES m 82 , 547 SO. FT. A T A W ;D r n LOT 3 ' W I I I' 2.00 ACRES rv ~ 297.00' 33.00 87,123 SO. FT. W CD S89°58'06 "W 330.00' I N 66 w 0 P1 AT I OrA-rlr%Al cv r= N ~ II u~ I I l II) l l ~II I i l I I I;;II'+i 1, I I '~lil' ~ III l,illl III ~ ! ~ 77 I i l~ V I I I, ~II {I ' ~ I'i I II'~ v~ ~ !II ; ,II III ~ !~~I ~ li'Irl n ~ i li{ l III 11; ~ I I I II'I I I~I'III I;I III l ~ i i II ~"I~ I l!I„I~ ~ih I,II ' I I !Il I I III Irl ~~I~I~ ~ I il'I I I a lhi l I~~I ! ~ ~ i III I.'I I ,I,n II ij ~ I t III j~ ' ~ I i 14 III ' ! III I' ''I ~i~ III jl I O I• III ~ I l I ~ I II i' I I I I~ III l ~II it { l ! I~~i II Ill III li'llll 11 h It l ,Il ~I I ~ (I Li.l~ll I i i I I I I I! I I ~r ~ ~ ~I I I ~~Ii l~ l (III I ) II F (i l!I ICI I !Ili I~l~~ I ~ I Ill ,II~ ' I 'III, ~ ' li,i~ ~ I I I ~1~ ; I I ~j i,ll~ IIII~i ~ I III}II In, I'! I I I li I i I i n I i I'II'I I I~! I~ lilt' I III i ' li!'ll,i Ills .III l ~ III I, I ~ ~l ~ I'll' II I I It II j it i III ' li il~i it~I lii ;I I Ii! ill iillll~ l I1, ~ I ~dl 111'1 I Ill~lli~ l I I~ id ,L l,li! III I II i l { ill li I~ ! , I,! I~ i. ;l I l lli I I I I'I III I I I I III'I' i { I ~ !I I ~I~'I I i ills II ~ i! Q ~ ei~ -,a I I~ ~ ~ I I ~ ~ I I ~ ~ I I I j ! I I ! ' I 1 I. I i i I i - 1 I i 'v I ~ - I ~ I I s0 o• _ I -L .G N Q I O a0r N - I h KT- i O J I ~=11m O~ _O _ I 1 I ~p Al I I ' I 'o I I I. N L- I I _ I f ov I N I 44 4i M ~ rd 1 „z ~ _ I N I i I I I A~ L I i i I, li o ~ i I 4 i I i i I ' I 0 I i Q-,Z Q,zz nQ z nom', I Wisconsin Department of Commerce SOIL,E.\6MV REPORT Page of If Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code t, ? r r County Attach complete site plan on paper not less than 8 1/2 x 1es in size. Plan mu's include, but not limited to: vertical and hohzflr►tal reference point (BM), direction and Parcel I.D. y (r percent slope, scale or dimensions, north arrow, and location andrillst ifa~il~rf WNT(}ad. / ~1 1 1 u c C Please print all information. - Reviewed by Dat r / Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Ow er N Property Location 40 1 1 e Govt. Lot J 1/4s 1/4 S' T" N R E( ) W E 42117 Prop Owner s Mailing Addre Lot # Block # Sulk. Name or CSM# C* State Zip Code Phone Number ❑ City ❑ Village 44 Town Nearest Roa New Construction Use: Ill Residential / Number of bedrooms -y Code derived design flow rate T~M GPD Replacement ❑ Public or commercial - Describe: Parent material 4 + VI VI A 4: 6GiIil Flood pPlain elevation if applicable General comments 5-4 0. 6, r -7 5 ' d f tl' w r fvl (J u ► e.."( - 9 7 s., r and recommendations; ~ ~ Cba5~ -L o r\ c.Z ya Q ►1~ l7 V Boring # Boring f 5 1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate_ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 24-J I , ❑ Boring t Boring # ® pit Ground surface elev. Depth to limiting factor 9-7 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 D-13 0l,~ h - I a 13 -31 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L ame (Please( Print Signature CST Number AUdress ..t ate Evaluation Conducted Telephone Number ( 17-b Io a - Property Owner Parcel ID Page e--", of ❑ Boring t j .x Boring # `1 , tp 3 ' 4 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 , 1 b 7 L t v~ `i yit- Iii`, t~ W R YdI i'v'ilf f f_r w ? tip 4,5 A- 0-19- 611 6 ~ r. . ❑ Boring Boring # ® pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 'Eff#2 ® ❑ Boring # Boring Ground surface elev. _ ft. Depth to limiting factor in. ❑ Pit 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 ' Effluent #1 = BODS > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L Tile Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8370 (R.6/00)