HomeMy WebLinkAbout026-1108-10-000 (2)
sm Dcaan-er. r.•fc' -cL.c PRIVATE SEWAGE SYSTEM C"'rry St. CfOiX
INSPECTION REPORT su ntt"' P_,n`m Nu 605115
GENERAL INFORMATION Ire I I ACI I I U PERMIT) Slate Pan ID No
Pers„'ra rfo-^'atit .u f......Ie rra he 1,1 euc'rJmj pcrp..;1,,a Li I. s. I! J4 i I'dmil
Pc it II:11cer; Na- City Village 1CV..rSh D Paine' Tax No
Ryan and Lindsey Stewart TOWN OF RICHMOND 026-1108-10-000
CS- %4 Fev M<o UNI Llev. BP•1 Dec,.,.inn .Cie.-lion, Tovr!Ran". Mao No
~dD IE7a fit} a YT a~ 04.30.18.600
TANK INFORMATION ELEVATION DATA
TYPF MANUI-ACTURER CAPACITY STATION BS HI FS ELEV
.p' c~ Benchmark
Dtm"Q V An BM
VA, .5 /Lb V 15
Aeration Bldg. Sewer
~ ~s •5
I loldrlg SUHt Inet ,5 17,
S" Ht Oatle;
TANK SETBACK INFORMATION G . 7 1
TANK IO P!L WELL BLDG. Veal +ir1l_n:aa,e ROAD D11nle! \
~1rEE''
Septic I D! Boaem
Dosing Header 'Man
7.9 9
Aeration Dist Pipe
'9. 13
Holding Be:. System
9. 1Al 3
PUMP/SIPHON INFORMATION F nal Grade q,
P.1anc'acturer Dernard St Cover 1
GPPA FIBd5 I~.S
Model Number
TUII I Fr C.10') Loss S)*stm Hewe~ TDH Ft
Fvuz:ma r '
1ar:p:n _ Uut.:c 4:'etl
I __r4
SOIL ABSORPTION SYSTEM
BEDITRENCII "1;19r Ie-Irll Nc 0YT1,1.11-r. PIT DIMENSIONS No isi I,Sole Di' Lc,c DJ p'h
DIMENSIONS .3 Z. CAC
SETBACK SY8TEr,1 TO P'L BLUG WELL lAK[rSTRt-Aid LEACHING P.I.In t;nauin
INFORMATION
L_ CHAMBER OR
Type Of Syst-rn UNIT
C/~ hRl' I . lY- Mr.~°{ NUmt r , I `
AVM? ld rZ• CW~'Y c7 ~ec
DISTRIBUTION SYSTEM 14i 7- 3Z 7-J
• Ir_aocrvManJOly /I UiSt r_I,,r' xlltlc5m, xHole Spat ng VaetbAi; Inla c
PI~.o,31 N
Lencth D a T Le-3th_ Ura Soacn-q d /
SOIL COVER A Pressure Systems Only xx Mound Or At-Grade Systems Only
Decd CIDrr Lk'i Over :a Depth of xx t vu0ctl; Soddej xx h!ulched
L-rtll lu_nctl Ccr[e' BeaTrencr Poces Tn uprl
p..
_ x'e5 No Yes No
COMMENTS: Include r:ecte d-screpencies, persons present etc Y Inspection #L inspection #2.
Location: 1197 1'4TH AVE ~'I~ Ca J G~a r~ / / / p O
1.1 Alt BPA Des::np,lon = x V All c j i ` aJ&" e
2.1 Bldg sewer length = ',3 5 Y 11 LO 34 • S
- amount of cover
n r
Z arm ~ PJJS 4 Z
Plan t revisior Required? 'Yes ~CNIO C I/) _ 1 Q / ~[y~
Use other !hcr sde 4a additional information l U 1Q 1 v ill„ T /d
SBD li: to tld 3r~J'Date Insexlor' S pnalure Le' Na.
Sn~,.1•. 3Aru-Fork
Yi rJ.. i~~ Cotmn
i r ~I ti ` Saiet• and 3uildmgs Division ITY
a 201 VJ. Washington Ava P.O Box 7162
~D= P
II said", Ycmin Number ite be 51ied in ;n Co
PS• Q~ 20~$ Madison,WI 5a70i- 162 j
Saa4a y v6,TrLLlt .Appli _ smrc T;an a~~y nmhe
U ac:;:rni:ml;r w•tth.SPF=rE?=1 1 Win Ad:u wa, submassior o this form to the appmpr;aic eovemn_nral unit ,o+
I' =Wrcc jug: n ob:a nlav L u i m NM Nis Apph a.ior. tunic fIx slat,-owned PCM-IN are Subm11LG to Yro w. AdllM (if dlfferew than III:n1Llg BddIC51)
UK- Dcpsnnicte of Saki a T ,fe siuul S ,.m Persona iofurcumon yov provide may be used for secu.a- , I ,S
purf+ns it =orasncc w:tli the umaec Law. W'I I;mi Sou;.
1. A bcation Information - Ylcase Print All Information If J',, -4"
Z
f'rup:rty' Crtvtler's Name. 1--> Parcel #
uI?N Ft , n 'Ify UL) -/iOd lc - Gv47
Rm We , Ow:u;r S Nisding Ad ms , .yr. t - Yropczn Location L q /lY7 /iY r'vC
cunt slier. Cmt¢. L<rt _
Zip Coae Poll Number
~K I'~ (!`1 ./,1j^ JN~~ ~ti• SY,117 _(wctr or
_ T N, R
11 Type of Budding icheck all that apply) Lo:
--X
-X at Fwnc. Dv Uinp.- Numbs of Bear,, s J / SubUPISIM N-=c V, 0 l: k
11 u,y hJCma:nercii - Draritx: Use
L~ Cm o`_ -
Ll S= 0,,md - Lxac--ihe Use C:SM N=Iwr rrL %Uaec. of
7- O~ ~74-r7~ wTnwr. of_
iTI. Type of Permits (Check o e,A.. Complete line B if applicable)
1 Nrw Sysrem {arArptueemen; Sys[cm ':Ieam:ene<:Ioldalg 7:cd: Rrpi.L:nrcn: Oil}' Other MoSi(;ation tc Ixsnnf, Systcn i meptav.
B. - Permit l:enewal i~ Pemlt Re.•i;un Q Ch:;nec n- "h,m,. uermr. T:wsfu
71 [n New Lac "emus Peruut NuIllrrr~~t ti s~•••-ttt Dare !SsuBefore l:zpaatiou _ Cl~,rrcr 21% V/ /r,7b
B
-L. rCnmpnnent'Devicc: ICbrck all that apple) /ry
or )-1--ea in-Ggood ".::.:d U Grow,d .;-(;adc r' Mornd _?4 it; n` cycubk Sur: Mound < 4 in o: su midi Sol Ri
~Hohlbrg :aru 7,-r* w; .>sperta Tin neot texplahii - 11'rrwtm- rsi,e(exrau:j_ .
V. Dis crsal`I real nt :Area Information: 07 ! / -1 ` . h 3 •i o--,- 1,, " 5
Design Flow (~,dj SuC ?.;>hccm+r Rat.i ds: Lis r• r- 5
I" S'P r~ers'al Arca Rrquu ( D'spe - Area , IO ar System Dm•anon
L/ d
~9 y z
\'L "tank Info ~Crlwc:p m Tmal k or ]1anuacuara •
i.allo Whom Unm 9
Ne Saws
%a=5'inF -ankx I {A r .T1^~ /ci c ` ~ Y d i
ipu. m. iniAinf, Tsuk ~
itnam II
uaur bc .J
\',ta, Res onsihilin' Statement- L the umdersigne
_ d, sssamc recfamsibiht}' for iaseaila lioa of eke PONTS shon•o 09 the attached plane
Idnlter s ~amc IT;mtts Purrul it's Sigraure NPI KgNuruhc flusmec<Phone Numtw
'wpillw's Ac
City. Smi.. 2iF Cndc
l11A <,l( ti Y 13
\7It. Cnuntv~le aliment Use Onh
. .4ppro,•w ❑ Pemlitt Ior QI1a iWi gcn: Sigma
rvci~Ttc.•_wr-f al
s `I'S 5. U lB
LX. Cnndi - ~r]tcasous for Disapproval -
1. tack, l! -ue Rico-, end
(ihper: ; crV >t all be - s r s t + 1tts.1 e;
_ 3> 6~
u per ,.tar ayemen plzr• u n v,7)00
2. AY t ftwk rKOUn en i mu t Le r.. t t
YPMwtwwlrtyr /:rd ar,.T O~c~ atc_a~
Amcb m warpiert phis fay the system and submit w ebt Count' udf ae paper nor ie. dun h^ I I iaaet ¢ sin
' 4 Wa" nG' (b 1)J i
SBD-6198 (R. 1111)
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CONVENTIONAL COMPONENT DESIGN
Resident al Aoolication
INDEX AND TITLE PAGE
pro;,ect Name - -
Owners Name a eJ w_,~
~T,1 i•h
owner s Address: 1 1 17 7 e,~t yi.
Leaal Dcscnct or: /Sf - S t 5f 1. y -7-.'O )I) Tnwnship: 1l c1-., r c/
1
County. J~ . a. Y-
S,ibdivision Name
Lot Number
Parcel ID NL rmber (1-lo - //00 -too 0
Pace 1 Index and tike
Pane 2 Plot Plan
Page 3 Svst=_rn Sizirg & Cress-Sec_i_ion
Page < Filter Specs
Pace 6 Ma -tenance 1rf0rn2ti0,n _
Page 6 Manacemem Plan
Pace 7 St. Croix Ctv Septic Tank Maintenance Form.
Page 8 'vVarranty Deed
Pace t~ CSN. or Plat
Attachments: Sol; Test 3 House Plans
Deslgner/Plar•_`)e ~'i Gti k i gwFi ti 5 License Number: L L Z 0
Date: F`icneNumber 7/J 119/ "5588
S~gr.a:ur
D_•s,gned pUr56dr th'.he Io-C3w~•id So I A:;su•p::,v comF evert Mal.n! it POW l n ve'sio'1 2.0 S6')-10705-P iN.01+01 i.
Pa3e 1
D~
Y ~ S
i 3 J
o ~ 3
m V..
l
S
C ~
~ `\F nl
_ o
VJ I\ J 0 W .Q '
r
00
Soil Absorption System Cross Section
~I c
4 -4'Saieaule!a rha;Grade
?VC VerdPip_ 1
zz"
'vViti''velt. Cap I I ~J • Z ft
Chpim'Der
Sys'em El=vafion
y
Soil Absorption System Plan View
~ t.
tl
L t ~ 1~ lI T ~j ~ il7nTM
I
' J R <I Ve.l: Or Obsr-yaiion Pipe Leac`~inl~ng L Trench 1 1 I ~
Cnambers -
_II 7111iIILI 71'HIll~7
_I! L~JR\
F 4' Da
_I 'Each `Z J Header
I - - - - - - - -Leaching Chamber So=^ificafi^ns - - - - - - - -
1%4anufa-Mrer P it fl4odal _
EIS.A :Rating Zv L) sq fl per chamber Soil .Appficacion Rave 7
f) J gp: sq ft
gPd Design Move -7 SDIf Application Rata Z o . J
- - er E,aA = 1 Chamber
2 rows o` -!-7 - chamber- earn. I
Si
page-- of
I \ 'yam `~`:i?p
Installation and Maintenance Instructions
Installation
Step 1 w fit the filter cave onto the outlet pipe going to the drain field. Ensure it is centered directly undo- the
access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added)
Step 2 if utilizing the additional single side support and the tvvo bottom supports: While the case
is still di fit to the outlet pipe, measure and cut '_"schedule 40 pvc pipe to the length needed to extend fro•r, the
hubs that are pre-molded into the, ase to :he side wall and the inside floor of tank. solvent weld pipe into thn
hubs that are pre-molded olio the case.
Step 3 Solvent weld the case to the outlet pipe. Insert the filler cartridge into the case pressing down on the
cartridge until it locks into place at the bottom of case.
Step 4 if utilizing a vertical read switch: Insert svach ir•to the hale ore-,nolded into the top of the filter. Press
straight down until it locks into place
Maintenance
1) Remove the access lid of the tank. Nose: 10 ensure undesirable solids do nut grit the lank a;.d into the
drain field, the tank should be pumped opt W. til the IeVei of cfr1uent is below the ouJet level of the tank.
2) To remove the filter cartridge from the filter case, pull up fir?liy on the handle of the cartridge dislodging
it from the case. (if utilizing a vertical read switch, removal of switch is optional)
3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is rerroved.
4) Place the "PLer cartridge back into the filter ca::e;;re%, no clown on the cartridge until L lo-.s into place '
5) P:,1Ce t6c access lin back onto the tank ensuring it is secure.
tif,e!Me fi'tc' hac a I.frti'ne:i.^iitr-J •.varranTV
Lfefimv lilt:-r!Ii; trans tir~-'liter util'be lreP rf ruan~`ar.L:ri.~~and wog V.rsm.Inp J.~rr[!<AUling nnrr. .il u;e'cr the F`-'rind ;.f
toot. Lhe ori(,na purch;ser ovens h p:odoct. IifU rn~ ti'tcr ;sl nr J¢ a r n a'~mer, ?iau Ir. the ree•it i-at tic ori,:iral fllt" tees
no: daruted during the instmatinn, mehhcuan e! rocu.s. Ja n,ry- to this proms~ catccd byaccadenr, ci so>e or abuse win rot
be covered u0aler this barraols•. Impraper care of rnelfen„ions re-um ne from prodict not b^_ing Irstalied, operat^.d or IntaiFCj
Properlyw,l!void tF.i; wariaoty Lf rims Sheratwmes nn •e;pominhty for labor chargPC, ruvoral ch,mgcs, ins:a!laT:or~ xetF Cr
incidental or censCquen;ial coats.
('.cotta::'. rt,ikr-Cel': tirt"I 17r9!r r_in t vhone: h02 ?a •
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
~ v',.ef u/~ / erg' _
_ j t ~ v N ~ ~ .S { ✓ ' ,'V-U A, ! -m' I I NA
Sarti 1 I 'Dust. - ' I lold:rg Velum-o. /!/0O (gal;
DESIGN PARAMETERS T,-:
_!r.•r r:^r :r; 5edroc'it s: } lJ K:'. h Septic n Dose ❑ Holding VOIUMe: (ga.)
Nurrhrr of Fub,ir Paclfty Units: -ht-TIA wnical Distances Tack Sollcm(s) to Service li i'tl
Est,rtrt_. i fn orate} Flory: Y~~j y,,y;ta,I Harr; crh Ustarco Tank(s) to Serino Pad:
c s rr :Peak; ! low (estimated x 1 5} pe aic M.'x'l y wee.lAn` rust he provided 'ver foal is 5 -tar
3.7 f I criasrtal is 1.,8 fed. Spec ric instN-trio=: to to prondvd on hack.
In Situ Soil r np IcaCcn Rate: -7 (y-I r r,'l EfIlUent Fi: Nlanufacturec
lardxd!Dcrle;'.ic) InfUenVI.ffluen( P.lonfh'yaverace Ef9t.ec Filter Voecl: ❑ NA
Fv cmzis,
rfiri s3o mC+L Punn1cm1 rer:
d::mha T I UzrUer m:n~ t& D>v '228 nig:L 1 Tj^.
_ Toga S,rsF=p ,.1 v:I _i: iT..51 Si) r. ~iL -'C'ilp 7v'Cdel.
H_c 5t2rytr•'n"uenV_ttl::~ P.4coth~ya•;eragc- Pretreat'nentUot
:rOGj >30 r,ya. V Manufar-:urer.
'.I:::r'x -22C mgrL y(Flr. .
i 7SSj >;50 n:g l I- I Mconarica, Aera[i Dn El Peat ril:er r,
Pretreated Lr`L!~:'I'- P.•ien:hly avera7:: ❑ Di-.in'ealon ! ! eNand
❑ snnd'Graver Haar ❑ CIIICl.
i3ODsl ••-30 n'gfL Soil AF
.-C mg:; SafpGCn System
(I SS; .
Fecal Cn'iror lyeam='rio maani s'I J` -Cr. Und (,ra•vaii FI h :nand ipra5~.~rra I Nr'.
t la;<irn um f"t. ,.,•-t i'rrt _I'.- is `I din - PA I At Wade „~a.rd
I i_r:~ Lice ❑ nrF er -
'_I AA Oti
❑
MAINTENANCE SCHEDULE
Service Event Service Frequency
I'~rtq o_t ac-tcntsof ta~ln; •flen comb.; -+:!agc.=nd=; r;um cql a's one'h:rl 'c taro-, v^lume
❑ b^~rr- 11-:1110 sva:er a:acn is activatcd
Inspect conditior. of tnr.krsi - A.t le_s Dote ovE: : J r-:onu'i:=i
- - _ ~ _ ~ (Maximum 3years) El NA
Inspect d`soersal Oaiks) At ors: -,rice r,:er : °rnnir,(51
Z + sari::l (Maxirnum 3years) 1:1 NA
C.can effluent fii;or - At cast once evr_ry. ! 'n::atiust _ -
/ / tF scan Lf NA
I F,c : PUMP pump COr:rols & aiann rl )gin t, n e~erv. LI men s' ..e .VA
iL..r laterals and o-CSSLAd lest At least once everd' ❑ mcn:n• _ - -
_ J Yean'sl ,7NA
r East ores, r.'•: el y: a /A.
El
MAINTENANCE INSTRUCTIONS
r...irrtg of tank -rr ca nl. ,:rp 1.1I be rr r t ;:n in.-I 'I vuu rnr r e c h. t .I y h I.
r 'r Pium r P1„te ILI:IL r ^e n tr 1 Se er f(:.:'TS I t t.r :.6:. I O..TS t 1 utt .ut.r a 4r - . ScI I u (r r t,I .u' Ir-r;
kin Oe;.h mtat it h Ic visun~ I ctx: n or the Lin kl,c :o i.1.:ntIF, any rr s;rn I or Lradil f crG i re c r r. „ cr' hs.
r P m - c( Imt'.c.budge all semi and a :-,hock to any back ur or ( ndir g of effluent o:•r t e crcuiiJ sur`ij2n The ~ciI
rr he
r poor s st m shall be s,My insocraed to deck the et ucn, levels it the orsc vatlor Pipes and In che~ for ary pondlrg of eftdr.-nt
f grUl-J e surface. The ponding of e"Lunt on the ground surface m:y'ndlcate a failing condition and. recuires tee immeo::t:r raitication of tic iota. regulatory aut'oi
'V,
- yen :he ccrnt•' ed cc nUatl. x of sl,!dge and scum Ir any trea-mert Ian< cq:!als o. e third or moro of the lark volurr e, the e r.i e
contents of th Ink shn I I ierro.;eri by a Scrtage Sr~Aring Oporatci (p imoell and disposed o' in acr-n'ca•r;a ;riti• rhnrtcr NR
hViscons'n Adrninistrat •v:: Code.
'
All o:hel sera e,,. C L;'11-9 OU' net 'imree to t-e ser i ing of e=fi,.rnt fi't r men%).:n:c I r rressunzad rltiL.ni:f..
r,c a,-.y serve r g at :^lervsis o' :12 r Icnths, shall be pe formed by a ce•-tlf PUa,?S I,:mt~'nec
A servr,r.. repor shop ye rr +;idrd to IhIe Ica,I reg lafo-r .a'~rhnrii iD,io i! aa~s c= =nIrtiun of n • "rvh:, -,-It.
Faga „t
START UP AND OPERATION - - -
For new construction, prior to use of the POWTS check trealinent tank(s) for the presence of painting products or other chemicals
that may impede the treatment process andror 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.
(luring power outages pump tanks may fill above normal highwater levels. VVIien power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
eifluent. 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 P0:1ITS 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 disUub or compact, the area
within 15 feet down slope of any mound or at grade soil abscrpticn area.
Reduction cr elimination of the follnw.ing from the wastewater stream may ircurove the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; far,
foundation drain (sump pump] v:ater, fruit and vegetable peelings; gasoline; grease; heihirides; meat scraps; medications; c!F,
painting products; pesticides; sanitary napkins; tampons: and v:ater softener brine.
ABANDONMENT
'thin the PO`aVTS fails andror is permanently tak:m out of service the following steps shall be taken to insure tnat the system rs
omperly and safely abandoned in compliance vJ*h chapter Comm 33.33, VJ scmisin Administrative Code:
• Ail piping to tanks and pits shall be disconnected and the abandoned pipe cpen!rgs sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Ope:iatur.
• After pumping, all tanks and pits shall he excavated and renrnved 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, cr roust be taken, to provide a code cemp!iant
replacement system:
❑ A suitabla replarenw.nt area has been evaluated and may bo 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 well. 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 mot
comply with the ruses in effect at that time.
❑ A suitable replacement area is not available due to setback andror soil limitations. Barring advances in POWTS
technology a folding tank may be, installed as a last resort to replace the failed POWTS.
The site has not been evaluated to identify a Suaable replacement area. Upon fadure of the POWTS a soil and site
evaluation must he performed to locato a ruitaNe replacement area. If no repfacenlent area is available a holding tank
may be installer) as a last resort to replace the failed POWTS.
n Mound and at-grade soil absorption systems may be reconstructed in place following removal of the bionlat 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 AND10R 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 POWTS MAINTAINER
Name Name
Phone ~ ~ j - ~ ~ j 3 flLP Phmm
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Nama Name 6.0 . ,C u.tn.-rte -
Phone '7~7 -')S" v(Ffr1 Phone 7)"S-
141,2r
I llis (Lcunient was drafted in romplianao .,ith chaHtcr Cnnm 83.2212)ihlll lldi&d) and 83.5411), (2) & (3), Wisronsin Administrative Code.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN =a;e r:f_
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Sept;(: .Tank Capacity - gal 0 NA
Permit # Septic Tank Mar•ufactWer 0 NA
Effluent Filter Manufacturer 0 NA
DESIGN PARAMETERS - - - - -
J NA Effluent Filter Model 0 NA
Number of Bedrooms
- - -
-
"J g c,.5er of Public Facility Units 0 `JA P~:alp I ank Capacity al 0 NA
Estimated flow (average( d Pump Tank Manufacturer 0 NA
ga.:ay _
Design flow (fcak). (Estimated x 1.5) Pump Manufacturer NA
JJ~~ gnliday
-
Soil Application Rate gaud aY:fta Pump N-lodel ❑ NA
_ I
Standard Influent; Effluent Quality P.Aunthly a'aeray^e' Pretreatn:ant Unit NA
Fats, Oil & Grease IFOGI a30 rngiL F7 SandiGravel Filter 0 Peat Filter
Biol,homical Oxyy;cn De: land ;ROD;) 1:220 ri) ;L ❑ NA ❑ !.Inchanical Aeration ❑ Worland
Total Suspended Solids IT SSf x'150 mgiL Ll Disinfection - 0 Other:
Pr,lreated Effluent Oua'Ity fslonthly • average Dio-:r;crsal Celllsl NIA
Biochemical Oxygen Demand IBOD~) <30 rngil_ 11 111 Ground (gravity) 0 In-Ground (pressurized)
Total Suspended Solids (TSSI `.30 mciL 0 NA ❑ At-Grade 0 Monnd
Fecal Cofifonn (geomrrrc finnan) '10' cfu1100rn1 ❑ Mip-Line ❑ Other:
0 NA Other. 0 NA
fdlaximum Effluent Particle ovc - qn in dia.
- 0 NA Cther. 0 NA
Giher. _ _
Othr-r. - V NA
x V:;'ura tyPica: for :1• r.eshe aStr-r:aloe arii sCPtic tc:.k etCuent.
MAINTENANCE SCHEDULE
Service Event I Service. Frequency
❑ month(s) (Maximum 3 years) 0 NA
lnspact condition of tar.k;sl At least once.^.~cr•y:_ 6-3 earls)_ -
Pump out contents of tank(s) I When combined Sludge and scum equals one-third IY,1 of tank volume ❑ NA
0 month(s) (Maximum 3 years) F1 NA
nspect dispersal cell(sl Al least Orion every: 0 year(s)
LI monthlsl U NA
Clean effluent filter At least once (,very: 0 Year(s) _ -
0 month(s) 0 NA
Inspect pump, pump controls & alarm At least once (.vcry: 0 year(s)
- - - - I 1 month(s) 0 NA
Flush laterals and pressure test At least once every: 0 year(s)
0 month(s) I I NA
other. - At least once (.very: 0 yearly) _
[I NA
C:Un',rt
M1f AINTENANCE INSTRUCTIONS Licenses or certifications:
'nspecGav of tanks and dispersal cells shill be made by en individual carrying one of the fallowing
fAaster Plumber, Master Pluniher Restricted S(.v.-er, POVITS Inspector; POWFS 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 ilia volume of rombin(•d sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal ce(lls) shall be visually inspected to cheek the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on tho ground surface may indicato a failing condition and requires the
immediate notification of the local regulatory authority.
:Vhen the combined accumulation of sludge and scum in any tank equals one-third (Y31 or more of the, tank volume, the entire
contents of the tank shall be removed by a Septagu 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 filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of •:12 months, shall be performed by a certified POW I'S Maintainer.
A service report shad be provided to the local regulatory authority within 10 days of completion of any service event.
G MW (4101)
ST. CROLK COUNTY
SL?_, C --4-N i ].fem. TaN_-kNC`.
k.) mRSr~ CERTIFIC=. IC)l : OR-M
_t.haLing Address H 9 -1
r-- p -R A ddress !7~ r~sz
CV=fiarim reamed om plannct_ Lnai e i p~ men' fb,- new ror_=j ion. y
C 'Sra-t . /Ls'w A ;c k. Pa-:e] Idea :Mti~n N u tb a
LEGAL DESCRIPTION
. T R -W, Teams of
StiD'itizsioaYiarc _ ,L~t=1
Cerrified Sun,ev 1'fap n - ;role . Pan
Warranty Decd ~ ibcio:e O: -7Volume PL--,e _
SDec house = yecynh L.z ines idm :able v_s ^ ]o
SYSTEM NL-k 'F \ANCE ,VND OWNTER CERTIFICATION
-oner u: and maintenance of yoL spa: sgsten CN_'M -e 5I : c: a n7eM:L:•Ire mire. t handle w astc r: m
~aiht~ cz corsics of t a:rlpi= out `-ne sep-ic :xai. nlcn a: et vein X sooner. ;f
r_' a Iiccnszc ptmper. ti'ra vt~U :+:r, mtc
v51em can 0.= in° C' _1e. *a"j: as a 1:'O?=mi stage Ii the WLs-.e [ISp,"al $\'st-cm. ma:.71f,"La'1
r sno sibiL;ies are s?=c5e'_ in (SpS. _-M.5_'. i and it Chanter 12 - S:. CYoir. Cluny Sani an 0-diuznrc.
ae prop , bun a T °s c submit to Sti Cron Cor:~ _'lat u _ & Zon rg DeDL men: a ctiicat on fa s:_ e'
owner znd'ny a =sr.ar piunvcr, lottrneNman nl:.-mbe-, r:>t;acd nictcie: or t li:arsed nUM7)C7 ve-Z-mg tat !:'t tae o] sit° -
u s,cwzter dig*asal s. tem is in D-nper coerwmi alnauon anrJo: (Sj a-re t oa an' -punD n$ = nzcessan'
irspt:_ ( ne se-)c ta.
k
;css mac iu_l of slud_~z.
i'we, the :indwsignzd hzve read the move n:a:icen,_n:s and a== to a:ainmit w::) -watt sew=ag dupnsa' n•s:cm with .e
s:anda-ds s,.far... he: eiu. as set by the Dena m.m: of Sziay And F707essiot2i S=Vj es and tic Depa-mcnt n: Nahral i:cso r;:e ,
S a e of "w scorsin. CzrS aot =_ing drat v" s'c :D re has n_= main<tin ti Must be com;.i>.ed and retuned ;c, :U; it
Cn:mty ;'ia ,rub 8; Zoning Cep a-mien: w iLain SO dzys o.':he a et veal erpi-a:jm date.
I We CCr_'" that Ll s-aemenL o- t4efirm are Sue t0 in_ bER of my 1 ICnpA'led_?e. L'u~e am, it c
proper`, iesc-ioe' a C'Vt, by vi: ue Of z u° ,n-r .9se'_ cordsd in Re is =seeds C'ffice.
Number of bedrooms
n
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DAZE
"•.'-.t i=fxmztmn tha: is s:reprr>cnted :nay . tsu' ¢ be sani zn' ner= bei_ -c.roted Fy *.ht Ylanr.iug Wiz: amen:-
Include w'1,.1 :his 2np5Ca7ot a reCh-dCd w'Pz 3i*' aBej f .-M :ht
aaC z 'vf toe :.,:je7 d-,e.: 77:a: "u
rzfcznce is ma5e in tae wzrari~ d___.
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