HomeMy WebLinkAbout040-1327-32-000
v':rswrsin Depadmerl of Comme'^r. PRIVATE SEWAGE SYSTEM cc,"Itr St. Croix'
Sa'ety and &uldm9 Division
INSPECTION REPORT S.,n 1."v Pc r„rt No
GENERAL INFORMATION (ATTACH TO PFRIOlT) Pia r ID No 605087
S:nle
Personal iOY rmaVOn y0U cncade nl3Y Ct• u9C'd Ior se:'on Cary, pW pOSCS IP'iVary I Xu S p-0 ;111m)]
Pcnud Hc:,e s NaMP, C.ty V Mane Ipwlu-'dp Parcel Tax Nc
DCCI Investments LLC TOWN OF TROY 040-1327-32-000
IJ WA I ICV In dp. Bh1 L C:'. Hlvl Uri> p'-' .
Ses:v,n: I r:IL:nye~ Ma, W,.
1466 1 Am I G6r 17.28.19.2230
TANK INFORMATION ELEVATION DATA
TYPE !o1ANUFACTl1Rl-R s CAPACITY SfAI ION BS HI FS ELEV
t
Septi;: t 7r- -i Benchmark
J , / Zia / / Z.7f~ 107. /e6
Dosing CO AI: BP.9 f 1 1{a.~. 9. 9349
Rldg Sewe
I
!✓ZS 1-7117 '76 59
P6L41 15
Holding SIMI Inlet
Z, -641.51
TANK SETBACK INFORMATION SCHt Outlet
IANK TO W-LL BLDG. :re cAir Intake ROAD Ot Inlet
.,et ti_ D' Bottom /4&(p (o . t 8
Dosing Z-7 q IS~ Z7 ! Header.'Man. `r' 97
Aera'on ►C` Dist Pipe 7
1121ding ( Bct Sys'r-r
L^4z 9(.•3
45 yo
PUMPISIPHON INFORMATION Final Grade 3• `
manufact.ner Demand it Cove I (00 'Al s 111PNI r! 9.3 93. V
r.4adel Nt.rlbcl 6:06 /76
I DI I L r~/ Friclicn oss System H TDH / • ~t -
r
Forcemain I Length Dia.Zi Disf to ",'w
~
SOIL ABSORPTION SYSTEM
DFDtTRENCH uVw4' I en ,r° Ne. Of Tre I I PIT DIMENSIONS Nn O' P. b: msicn Dra t dud I]CpP
DIMENSIONS 3 176 2 "f' `
SETBACK SYiTENI TO 7 PiL BLDG WELL LAKFiSI RrArA LEACHING f.~aru'at'urer
INFORMA11ION CHAMBER OR Ez FO .j
T, pr :)r titt.lc:".r~t I~ ~~/~f A
UNIT lmlaol
Num
K
DISTRIBUTION SYSTEM
t 9 = ~ fa
Heade^Msn Inky f Oisrnbdnc•Q e r Hole S ^e .Hale >cp,;cmg M I e
RpC;4', r _
V•ngln~ C a _ Lcnga ~ Do Spac ng__
, It
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
DcaPl Cver DeptF O'uer .:a GeprC i:1 ax Sec ded+sodded Liu _'-Cd
3ed+Trenrl-:,, nwE' Fied+'•erPi Lcces I,rpsJi
Z•~ Yes Ac ~`es J.
COMMENTS: ;Include code discrepenc:es, persons eresent, etc . Inspechcir f ' Inspeciion #2:
Location: 347 MEADOW VALLEY TRL
I A9 BM Description = F:.1 4,~ C.-BJQJ~
2. i B!dg sewer length = Pr ~l r / S D
- amount of cover _ Q. I\ aS
~
I o GaUe,~, ab5 /a r'- A ~ecaj ^ +-a
Plan revision Required? Yes >("No g7 I 1 ll~,
Use other side for additional in'mmalion. ` T I 'I 67
Dare Ir'sepdc' Signalr.re ::ert N:
SBD-3?' C rR ?,.';r 6
County
~y
"UN t Safety and Buildings Division St Croix
O`er 201 W- Washington Ave., P.O. Box 7162 Satin ary. Pawn Number (to be filled in by Co.)
tit 1' 1 3 2 Madison, WI 53707-7162
Sanitary Permit Applica State lnNuseher
In accordance with SPS 30 ,21(2) \A is Aden. Code, submtssinn of if,, turn it, the appropriate goverrrmen I Mt A -
is is required prior to obatatmg a sanitary Ixnnit Note: Application forms for stateowncd PON'TS arc submawd to Pmjat Address (if d;fferent then mailing address)
dec Derarirnern of Safav and Professional Scrvres. Persoool utfotmehnn you provide may be used for secondary
purposcstnaccor dance with die privacy Law, s. 15.04(1 un), Staus.
1. A licatlon Information - PILWripit A4 Information 347 Meadow Valle Trail
Ptttp osr (tuner's Nam, f Parcel p
DCCI Investments LLC ( 040-1327-32-000
Property Owner's Mailing Address
MttPertY Locadrm
PO Box 445 /
Croat w, 32
City, State Zip Code Finnic Nuenba
.SiE___ N, NW 'a, Section 17
hmond WI I 501E 7115 - 4 - ((eQrleene) 9-120
of Building (cheek all that apply) t.a N T 26 N; k 19- j(oe W
filly. TN -
10.1 m 2 Family Dwelling - Nun16ct of Bediatms 32 Subdivision Name
CaiD Bloc Meadow Valley of Troy
0 Pubtir'Cummacial - Describe, Use -
1M1~ ❑ City Of
LJ State Owned Describe Use CS-NI Number ❑ vdlegc of
Z w q 6 zC Town of Troy -
al.'lype of Permit: (Check only on box on line A. Complete tine B if applicable) A&_
A
New System Replacemrnt Systan 0 Tteatment-Votdtog Tank Replacement Only 0 Other Modification to Existing Sym m (explain)
B • ❑ Pceran Renewal 0 Prnnit Revision 0 Change of Plumtcr C Permit 1 ransf r to New List Previous Permit Number and Date Issued
Before F.xpiratiun Owner
IV. T e of POWTS S stem/Com onenUMNice: Check all that apply)
s
~.NomPrcssurixcd In-Ground 0 Presstuved ImGround 0 At Gradc 0 Mound > 24 in of suitable wd ❑ Mound , 24 m. of stulabie wil
❑ Holding Tank U Other D;spcrsel Component (explain I ❑ Ptetreaottcru Deuce (explain)_ _
V. Dis anal?rca ant Area Information:
Design Plow (gpde T Iesipn Soil Appliufion Rath sq Dispersal Area Kcqu aQ Dispersal Amer Pro (sr) System Elevanoo
600 1 7 857 900 1117.5
\'1. Tank Info ('apxiq• in Total a 0 Manufacturer
(iallons Gallons Units
New Tanks E.nfing Tanks / yg t
w/Polylock 525 a. J n it-
1 a
Sepik or Botdinx Tank
1 Wieser X
[bring Clamber
VII.umRtapom1bilih' Statement- 1, the undersigned, assume respupsibility for installation of the 1.O W1S shows on the attached picas.
Plber's Name (Print) Plum Si at MP/S1PRS Number Business Phone Number
Countryside Plumbing 8 Heatin 664713 715 246-2660
Plumber's Address (Su«E City. State, Zip Code) -
321 Wisconsin Drive New Richmond WI 01
VIII. C unto/De artment Use Orris 720
Approved isapproG'Pd. permit Fee faro' sued 1 (ssuin ISignatum
I IN'na ert Rcavnl tot ai JP57,
IX. Condi ap casons for Disapproval
" tw*, ett xm IRW tv.( ,7) /a7✓• d~ ?CA
o P. s' CO St 411 be sn31~a ' t{if~.'g5. 1 tArt4.~AlY~
as per „vrayemeM. plan 2•o noen by tilwnbet. ktw A. O t"A .
2, Allee(Mck re5uesraan;s mrr't tro rna,nt in d n
~ypxllrpN~el.ntr,~/:rd'urxt %/l.+~DPrn..~~ro,n
.Anneh to tompkn pheax for at sy non and nbmlt to flit Coo aey ody ON paper xor son A. .1t tQ x 11 Wrt. W dxe
SBD 6398 (R. I L 11)
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: DCCI Investments I,I,C
Owners Name Derrick Const.
Owner's Address: PG Box 445
New Richmond WI 54017
Legal Description: SE 1/4, NW 1/4. Sec 17, T28N RI 9W
Township: Troy
County: St Croix
Subdivision Name: Meadow Valley of Troy
Lot Number: 32
Parcel ID Number: 040-1327-32-000
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing 8 Cross-Section
Page 4 Filter Spers
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St, Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test 8 House Plans
Designer/Plumber: Countryside Plumbing License Number. 664713
Date 07!06/2018 Phone Number (715) 246-2660
Signature
Deigned pursuant to the In-Ground Sal Absorption Component Manual for PGw'rS Version 2 0 SB0-10i'o3~1J {N OVOt)..
Page 1 .
I . .•1rr 49
DCCI INVESTMENTS
SE 2/4 OF THE NW 1/4 S77T28NR19W
TOWNSHIP OF TROY
r BENCH MARK TOP ELECTRCIAL BOX
NW CORNER 100
SM 2 TOP ELECTRICAL BOX SW COR-
NER 98.65
II TWO TRENCHES 40\ T
TWO TRENCHES dT'EZ FLOWS 90 FT
EACH
' WIES' 200/800 COM TANK I
POLY LOCK 525 FILTER I
LOT 32 SYSTEM ELEVATION 97.S
j
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w
0
I O
PROPOSED !
w
HOME
I I
PROPOSED' TELL
~ O
i TESTED AREA FOR DRAIN FILED l
i
_fT
MEADOvd VgLLE1 TRAIL
DCCI INVESTMENTS
SE 1/4 OF THE NW 1/4 S17T28NR19W
TOWNSHIP OF TROY
BENCH MARK 1 TOP ELECTRCIAL BOX
NWCORNER 100
BM 2 TOP ELECTRICAL BOX SW COR-
NER 98.65
SCAL't`1" = 40 FT
TWO TRENCHES 0f EZ FLOWS 90 FT
EACH
\~I
WIESER 1200/800 COMBO TANK
I
POLY LOCK 525 FILTER
LOT 32
SYSTEM ELEVATION 97.5 I
I
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I O
I v
PROPOSED 1
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W
' HOME I
I
PROPOSED ELL
I
f f ~ ~ I
O I
I
O I
I
TESTED AREA FOR DRAIN FILED
1 ~ I
> I
l -----1
MEADOW VALLEY TRAIL
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT P,go_a_
Project Name: Derrick Const. / Kunshier
No. of Cells 1 Per Cell n
3 it Cell Width Total No of jj~
~Q it Cell Length SO sa it EISA Per Cell
J it Cell Spacing ?00 sq P. Total EISA
Manufacturer Model La In Lan th EISA Rail
1203H-5ft 5.0' 25.0
Q
t Infinrator
EZ1203K101t 10.0' 50.c
Gravelless Leaching Unit Manufacturer. F7® f.!
C-/-,
Gravelless Leaching Unit Model: t! 2 / n, 0 D {vr -'10A
Typical Cross Section
Finished Grade it
Observation Pipe with
approved cap or vent
,........e...
T
..~~QQ , jSoll Bac~ll
-L~ in t~
~Geotextile Fabric
T 1i4 Infiltrative Surface
12 in i
it Umrdng Factor
in I Slotted and Anchored Vent/
yl Observation Pipe with Cap
Plumber/Designer Signature: Countryside Plumbing & Heating
License a: 664713 Date: 07/06/2018
{
F DOMAI W ft tat
mrorar inns in Precast Dra+mpr -I Taber PL-525 Effluent Filter
8 YienrH'atrr Proaiers A pvnee of rayae M:.
PL-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL- 525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning. the ball will float up and temporarily shut off
the system so the effluent won't leave the tank.
Features: 1/16" Filtration Slots
Rated for 7(1,000 GI'D (gallons per day). ' Alarm S,vikh
10(>ilO.GPD: (optional;
• 525 linear feet of 1/ 16' filtration i - .
• Accepts 4" and 6" SCND 40 pipe. Fxler ! ` pvc
Exteminsion ! landlc
• Built in gas deflector
• Automatic shut-off ball when filter is removed.
• Alarm accessibility. = Haled l,.r
• Accepts PVC extension handle. 70'~ cru
I'L-525 Installation:
Ideal for residential and commercial waste flows up to --1 5251.hnar Ft.
10,000 gallons per day (GPD). "I I; mo'
Filtration Slots
1. Locate the outlet of the septic tank.
f
2. Remove the tank cover and pump tank if necessary
A 6'
'CCet IS a" k
3 Glue the filter housing to the 4" or 6" outlet pipe. If Sc
Hn 4u pipc e '
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter. - -
4. Insert the PI: 525 filter into its housing.
tiff 5 Replace and secure the septic tank cover. r
N cer ad 5 FIgN 5I Stand
dard 46
I'1; 525 Maintenance:
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
'y
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 servicing Servicing should be done by a certified eas +k. for
septic tank pumper or installer. nm"mahc
'chub Oil Fall
L 1 ovate the outlet of the septic tank.
2. Remove tank cover and pump tank if necessary.
Do not use plumping when filter is removed.
4_ Pull PL-525 cartridge out of the housing. '
i
5. I lose off filter over the septic tank, Make sure all
solids fall back into septic tank. i 44I
A'
0 Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserlt~ci N,hl i'l"K Lab` F ±t 1 b ltcns rs a cc aepl rx Eacdu 'Ify i inst, Y taall,
lls
i . Replace and secure septic tank cover. Ihr SmanlAterTii s.sitch and alarm inlo'mtstmg tank,
Polylok, Inc. 3 Fairfield Blvd. Wallingford. CT 116492 Toll Free: 877.765.9565 Fax: 203.284.8514 AmutpoIVlok.com
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L LGRAWN BY: NCP SCAI FPRE-POURSEPTIC MANUAL 371D US -,V, i, II DEN ROCK. VA 54750 , CO 00 00 DATEPOSI-POUR~ CC jz;-8456 "20D/8"
L GOULDS PUMPS Submersible
Effluent Pump
MODEL 3871
EP04 & EP05
'A Series
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
Specifically designed fort he grade turbine oil for tic enclosed design for heavy duty ball bearing
uses: lubrication and efficient improved performance.
following
heat transfer construction,
• Effluent systems ■ Casing and Base: Rugged
• Homes Available for automatic and thermoplastic design provides AGENCY LISTING
• Farms manual operation. Auto- superior strength and corrosion
• Heavy duty sump matic models include resistance. Sp• r;ie ~ r ^utT8549 nad Standards ass«aeon
_ yty
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron
• Dewatering assembled and preset at the for efficient heat transfer, GouldsPumps is ISO 9001 Registered.
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic
• Solids handling capability. FEATURES cover with integral handle and
?ol maximum. Float switch attachment points.
■ EP04 Impeller: Thermoplas- ■ Power Cable: Severe duty
• Capacities: up to 60 GPM. tic semi-open design with
• Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant.
• Discharge size: Vb' NPT. seal protection
• Mechanical seal: carbon-
rota ry/cera mi c-stations ry,
BUNA-N elastomers.
• Temperature:
104'F (40 Q continuous
140 40'f (60`t:)intermittent - METERS Feel
• Fasteners: 300 series 1
stainless steel.
• Capable of running e 30 + 5Gwn
dry without damage to 8 4
components. 25' zs n
Motor: J
• FP04 Single phase: 0.4 HP, zo'
115 or 230 V, 60 Hz, 1550
RPM, built in overload with i s
automatic reset. ° is
• EP05 Single phase' 0.5 HP, e 4
115 V or 230V, 60 Hz. 1550 0 EPOS
RPM, built in ovedoad with
automatic reset.
z ; I Poe
i
• Power cord: 10 foot Si
; - - '
standard length, 1613
t
grR nding lug. Opti prong
grounding plug. Optiona120 o
o to - 20 3a.. 40 so GPM'.
foot length, 10 S1TW with
three prong grounding plug -
(standard on FP05). 0 z 4 F R 10 -
17 myh
CAPACITY
Goulds Pumps
C 2003 4ouldz 1'vmpz
rkrrti':r lul y. 1 Pf
<& ITT Industries
HGOULDS PUMPS Submersible
i-A Effluent Pump
4 EP04 & EP05
Series
3--
2 -
COMPONENTS DIMENSIONS
(All dimenswns are in inches Do rim use for consvuction purposes J
item D•SCnMlon
1 Impeller I
2 Base
3 Pump Casing
4 Mechanical Seal
5 Ball Bearings_ _
6 O-Riogs 11 MAX
7 Power Cord - 2'15 A - l0'A 1' NET
B Oil filled Motor
9 Motor Housing,
Stator Assembly
10 Motor Cover o 3'A
4V 7.
PERFORMANCE RATINGS 91/ '
6" MINIMUM WATER LEVEL WHEN
Gallons Per SUPPLIED WITH FLOAT SWITCH
Total Head Minute
(ft. of water) EP04 EPoS
5 53 -
10 46 62
15 36 55
20 21 46
-25-0 33
30
MODEL INFORMATION
Float inimum Minimum Minimum Maximum Shipping,
( Minimum M
yle Cord Discharge
Order No. HP Vohs Amps Circuit Phase Style Length Connection On Off Basin Solids Weight
Breaker Level Level Diameter Sim Ibslk
EP0411 Plug l No Switch 10 1'/1 Manual Manual _ 15' _ 20/9.1
kP0411A PI gyWck!Wide An le 10' 141 12" _ 6" 15' 2119.5 i
F P0411I--1 4 I1S 12 10 Plug ;No Switch 20 1'A Manual Manual 15' 10/9.1
EP0411 AC Piggyback! Wide Angle 20 1'/." 12' 6" 15' 2119.5
I.
EP0412 1 Plug f No Swtch 10 1'/,' _ Manual Manual 15' 'A' 20/91
EP0412F 230 6 10 Plug 'No Switch 20 1'/,' Manual Manual 15' 2019r23; 1
EPO511E I 115 13 20 Plug. No Switch 10 1'/,' Manual Manual 15' EP0511AC .5 Pig gyback!WrdeAngle 10 th' 12' 6' 15 41
EPOSI2F 230 65 10 Plu ; No Switch 10 1 Al Manual Manual Goulds Pumps
Gonrds Pumps and the ITT Fnrincrrid 141ncks Symbo: art
registered Uadcmarb and uadccamo of ITT Induarrics. www.goukls curl
PRINTED IN ti 5 A SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. t/ ITT Industries
Septic-Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacture
Tank Manufacturer WIESER Pump Manufacturer GOULDS
Model Number 1200/800 Pum Model Number EP04
Total Tank Capacity 2,000.00 Alarm Manufacturer SJ RHOMBU
Max. Bury Depth 8.00 _ Alarm Model Number PS PATROL
Switch Type FLOAT
Filter Manufacturer POLY LOCK Total Dynamic Head (TDH) - Feet
Filter Model Number 525
Elevation Head 10.00
Distal Pressure
Minimum Pump PctfotTttancc Required Netw2rklns;~ -
,2.00 GPM 10.00 Ft TDH Force Main Loss 0 . -
DJa~- .00_
Outlet Manhole Min. 4" Above Grade With
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade
< 6" Below Grade Sealed WatertiRlit Securely Mounted With Locking Device
Weather-proof I~
Finished Grade Junction Box 1
I Depth of f `
Cover Vent Min. 12"
Above Grade Disconnect
Ft Means
With Vent Cap
a s a a, a,a . , a„ T„ t a a a a a a
Outlet Filter Outlet
Inlet Inlet Baffle
}
Switch Settings and Reserve Ca 'tyact A
. > ~4„
Tank Volume = GPI
Weep
Dimension Inches Volume Gal.
p >a Hole
(reserve) A 18 400.32
(alarm) B 2 44.48 Off Elevation
01 (dose) C 6 133.44 F4 ;
(dead) D 10 222.40 _ Bottom
14, Total
1
36 800.64 D Elevation
> > > , Ft
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
'
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 1628 WAC.
02/05 W Page - of
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Derrick Consl Septic Tank Capacity x 1000 al O NA
Permit P Septic Tank Manufacturer
Wieser 0 NA
DESIGN PARAMETERS Effluem Fitter Manufacturer P01 Lock 525 C NA
Number of Bedrooms q O NA Effluent Flier Model 525 0 NA
Number of Public Facility Units NA Pump Tank Capacity al PK NA
Estimated flow leverage) 600 gal/day Pump Tank Manufacturer CKNA
Design flow (peak), (Estimated x 1.5) 600 of/da Pump Manufacturer XNA
Soil Application Rate .7 gal/day/ft' Pump Model - X NA
Standard influent/Effluent Quality Monthly average' Pretreatment Unit IXINA
Fats, Oil & Grease (FOG) 530 mg/L C Sand/Gravel Flier 0 Peat Fitter
Biochemical Oxygen Demand (BODs) 5220 mg/L NA 0 Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA
Biochemical Oxygen Demand IBODs) 1530 mg/L ;'In-Ground (gravity) 0 In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L X NA 0 At-Grade 0 Mound
Fecal Cofifonn (geometric mean) 510' cfu!10Dm1 0 Drip-Line 0 Other:
Maximum Effluent Particle Sue Ya in die. NA r: 0 NA
Other' RNA Other: 0 NA
e Values typical for domestk wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspec condition of tank(s) At least once every: 0 month(s) aerial (Me)dmum 3 yews) 0 NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume 0 NA
At
Inspect dispersal cell(s) least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
earls)
Clean effluent fitter At least once every: monthlsl 0 NA
I year(s)
Inspect pump, pump controls & alarm At least once every: 0 monthlsl 0 NA
0 ea(s)
Flush laterals and pressure ter. At least once every: 0 month(s) ❑ P(NA
year(s)
Othe : At lean once every: O yearm(sl RNA
Other:
AS NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or pending 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 pending
of effluent on the ground surface. The pending of effluent on the ground surface may indicate a falling 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 (Ys) 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 chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, 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 Page Z of Z
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 Cegls). 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 be
discharged to the dispersal cell(si in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the 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 straam may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain !sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; 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 safety abandoned in compliance with chapter Comm 83.33, 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 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 ir, 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 siziri has me! been evaluated to id-tify a ..!,able r
alua
0
'3013 Top 11 SphIC011181111 311
b o Ing ank
e ai ~f?DN18 rFEa A6N%1 C061S7RtlC71 Ofv
❑ 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.
< <WARMING> >
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 OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS -
POWTS INSTALLER POINTS MAINTAINER
Name Countryside Plumbing & Heating Name
Paul Koehler
Phone 715-246-2660 Phone
715-246-2660
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
E Name barrels Septic Name s
( AJ 2aJJ~J
Phone F715-426-1025 Phone
-lis- 3Sp- ro
This document was drofted in compliance with chapter Comm 83.2212)(b)(U(d)&(f) and 83.54111, (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwncrBuycr DCCI Investments LLC
Mailing Address PO Box 445, New Richmond 54017
Property Address 347 Meadow Valle Trail V'pv
(Verification required from Planning & 'ng Deparmtent for new construction.)
City/State Hudson %M Parcel Identification Number. 040-1327-32-000
LEGAL DESCRIPTION
Property Location SC' , ''"A , Sec. 17 , T• __2B_N R_JL_W, Town of Troy
Subdivision Plat: Meadow Valley of Troy, First Addition Lot # _ 92
Certified Survey Map # , Volume T_ , Page #
Warranty Deed # (before 2007)Volume , Page
Spec house 0yesao Lot lines identifiable EYyesono
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, if 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 mainenanec
responsibilities are specified in §SPS. 383.52(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 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.
1/we, the undersigned have read the above requirements and agree to maintain the private selvage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services 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 Deparunen: wi n 30 days of the three year expiration date.
Uwe certify that all statements on is form are true to the best of my/our knowledge. I/we em/are the owner(s) of the
property described above, by Virtue of a rranty deed recorded in Register of Deeds Office.
Number of bedrooms 4
SIGNATURE. OF APPLICANT(S) ` DAATTE~
***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. 04/12)
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~1Q0~ Roll EVALUATION REPORT
SP S 5VBJ0ESECE9B0IrGe vnth Comm 85 W* Adm. Code Page 1 of 3
•41rm41 Sod Testing, Inc
V:F-
Attach complete site plan on paper not less Ihan BY, x 11 inches in size. Plan must County -
include. but not limited to venicel and horizontal reference point IBM). direction and vll~ fOCa . 14 t&N~
percent slope. scale or dimensions. north arrow, and IoCabon and Balance to nearest road. Parcel I D NJ Lt 0?I`
Please print all information. S~VGR Q ~~L7- Z
eoiso•)al inrnmaba~ yot, Po,-O, 1"y to used for seorrdury purposes iw,racy Lx1. s. 1 r,4 r I i [m;y. Rev l Date
Property Owner Property Location z 1000' it
DCCI Land Planners _ Gov[. Lot Is e4, NW1/4. 517. i28N. R19
Property Owner's Mailing Address Lot If Block # Subd ame or CSM#
1505 Hwy 65 P O. Box 445 32 Meadow Valley Of Troy 1 St Addn
City Slate Zip Code Phone Number City Village Town Nearest Road
New Richmond WI 54017 Troy Meadow Valle 1 rail
New Construction Use. Residential; Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe
Parent material Outwash plain (Pillol Series) Flood plain elevation. it applicable NA It
General comments Areas su.tenle for a fsx1vegIi0va. system wit) a.1 ; gpt.sgtt rate_ Possible system elevation fa A•ea t is gi 2!r. 'lope cd area is
and recommendations 4% -
Boring # Boring
Pit Ground surface elev. _ 99.25 If Depth to Writing factor 98+ in. Sod Apphcation Ralel
Horizon Depm Dominant Color Redox Description Texture Structure ConsistencN Boundary Roots GPD;h'
in. Munsell Ou. Sz. Cant Color Gr Sz. Sh 'Eiritl 'Errsa
1 i 0-5 ' 10yr3/3 none sit 2mgr mvfr as 2vf 0.6 0.8
t
2 5-14 10yr4/'4 none sit 2msbk mfr gw Ivf 0.6 0.8
3 14-19 10yr4/6 none grsl 2msbk mfr ow 1vf 0.6 1.0
4 19-24 1, 10yr5/4 none grts Osg ml gw 2vf 0.7 1.6
5 24-50 10yr6/4 none cos Osg ml as i 0.7 1.6
6 50-98 10yr6/4 none 5 Osg ml 0.7 1.6
P
❑ Boring # Boring q 1 -
Pd Ground surface elev 0.00 h. Depth to limiting factor 98+ u) Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDi 11
in. Munsell Do Sz Cont. Color Gr. Sz Sh.
'En711 'LI•k2
1 0-10 10yr3/2 none sit 2fsbk mvfr as 2vf 0.6 0.8
2 10 -20 10yr4/4 none sil 2msbk mfr gw lvf 0.6 0.8
3 20-27 10Yr5/6 none Is Icsbk mvfr gw 2vf 0.7 1.6
i
4 27-45 10yr6/4 none cos Osg ml as 0.7 1.6
5 45-98I 10yr6/4 none 1 s Osg ml 0.7 1.6 Ilk
' Fffluent #1 = BOD,,, 30 < 220 mgiL and T %30 150 mg;L /~e /'Effluent #2 = HOD 30 mgiL and TSS < 30 mq. L
CST Name (Please Print) Signature . .%r✓~ CST Number
Thomas J. Schmitt _ 227429
Address Schmitt Sal Testing, Inc Date Evaluation Conducted Teiephone Number
1595 72nd S[. New Richmond, WI 54011 6/2212017 715-760-1978
Conducted hy: Conducted For: Page 3 of 3
Schmitt & Sons Excavating, Inc.. Name. DCCI Land Planners
Thomas J. Schmitt. CST 227429 Address: 1505 Ilwv 65
586 Valley View Trail City, State, Zip: New Richmond, W1 54017
Somerset, W 154025
Phone' 715-760-1978 j Subdivision: Afeadow Valley of Troy 10 Addn
s~nnat.re_ Lot No : 31
Date G-1 ,~10 Legal Description: SEU4NW114S17 ,T28NR19W
e Backhoe Pit Township, County: 'T'roy Township, St. Croix County
A Bench Mark 1 El. 100.00' Top of Electrical box in north west lot corner
A Bench Mark 2 El. 98.65'top of electrical box in south west lot corner
Slope= 4%,
Scale 1 60'
00 a y`,
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