HomeMy WebLinkAbout040-1250-80-000 (2)
SroL;consir eeparmem or Commerc° County
PRIVATE SEWAGE SYSTEM St. Croix
3clety anc Bu id ng Drms On
INSPECTION REPORT serltary Peunl: rvc
GENERAL INFORMATION (ATTACH TO PERMIT) slatePan,CNC 6051441
Persc •,a nh-matier you pr-'woe m3q pc used for secondary p. poses iPnvazy Law, s 15.34 r, irm;; 3144355
Pe•mit F-c Je, s N.;me Ccy Vi age Township parcel lax No
Thomas & Susan Vik TOWN OF TROY 040-1250-80-000
CST RM Fe, 'nsF. 3V L c sM Oescr ptlo.-' sccbc-Y1vanlH3nge^.lip No
19.28.19.1310
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION Bs HI FS ELEV.
Sep:ic EyIf !
l ?,\~'i ~.rUrBe~ I.c10 BenchmarR J ~ ~o I IJ~',tJ
Dos ro R- At BM Q
Aerani; / Bog Sewer
t r`< ~~~-t I rX~ - C X I S
Hold rg SYH1 Inlet
TANK SETBACK INFORMATION SUHt Outlel_ -
TANK TO PiL VVELL. BLDG. V, nt tonir lna.e ROAD Dt lrlet
L✓ w - -
Sep:c . , Dt Bottom r
Dos rg Header.Man.
Ae,atior _ Dist. Pipe r
Pot. System
PUMPISIPHON INFORMATION Final Grade
~ Jt~ 7 "
Manulac.urer Demand l S7 Cover
' e r GPM .jc:) O
Model Nurrber L-1 _0
TDH IM M r1 Fr c:~on LOSS System Heatl TDH Ft
Forcema,n Lcrg'n DIa r Dis. to bvell _
SOIL ABSORPTION SYSTEM
BEDlTRENCII O isl- Len 1•i I No. OI ^ercres PIT DIME DNS NF O' P Is ',ns de Dia. _ G. J
DIMENSIONS J t 1 a) f~.
SETBACK SY51 EPA TO P+L BLDG WELL LAKE:STRFAM LEACHING Ivlan.lad.,c'. r
INFORMATION rU CHAMBER OR ( D
.r De O` Syste _ , r _
f~ UNIT Idede'. NmI1C+:•I
J J 7 !'v
DISTRIBUTION SYSTEM
learn P tan lolc DIsutitio- x Hoe situ x Hole Spaang VP1, to A r I" lake
Pion' c t' 2, ~ L t' I
crgm_ r a Leng I 3a spacng -
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only _
Depth U' e- OcaP. Over xx CeFI- of xx SecceGSoddeo xx (A-1che7
BP.C."etch Center ) r l 9anlTrennh i lines - lopaOl YOs No Yes _ No
COMMENTS: rlnclude code d. screpencies. persons prosert. etc; Inspection #1: Inspection #2.
Location: 332 ST ANNES PK'V,'Y
1.j A't SM Description
2 j B'cg sewer length =
-amoanto`cover=Ck~jl~'~ 1
Plar revision Required? Yes No L t, -
Use other side for adult ora' rnlormahoc.
SBC-e713 (R 3+97i Date Insexlor's Signal re Cer.. No
.
SAn?-2s~ t~-2~
;iafeiy and Buildings Doaslon ~ Dl
c, -
1 I p s. ~ _ 201yK. u4'ashin9to' Ave.. Pi,i. B%'102 iarurar,pcrmii Numhe im be tilled in hg Cn j
r p - \ Is4ad1. Vd: 707 162"11]
I
-s ~ l~
Sa itarn PC-111it AppllCa loll sax e~~
s id:u i h ~r. i t}: 1~), Wr q n \ od. t i ~I ,fi t I:.m :o the apprc~-iate uw<raan I.d unit
I .i.. a I 1 lvamwl P=in V x.. pr t .tt.-.T umt tnr A= CHner. N UW 't wr an:xrtimf: to ETac... :G di3nent dean mai'icg mn=si
m. Irq,vt m t $r,d-iv s I§ tr'sionat ul Pe al a I.. m..vnn sma prou:lc mat be uieZ lot sd..cmdan'
u novcti in YUtlwc'w:W lilt Prn a-, Ie ra.l filar. Q,•.t, ~~.t e
I Application Informauu~o llJJ~~,9aaak Pam all lnfnnna/tiuo _
tcpCicr thri 'S 1.xnr Illv'~ ~ S~~Q.~ I inr .lam
}T )P i a•x. s Mathne, address i :qr n I,:aricu U
n
ten, Swtc 7.i .vf i PhoneRmbcr
t For pe of Bui ditir is wk all that ap } „C, - d- y -V -
I m i a-rt ' i7wdline Vombo of Bcc rn;ti Su:'idrvtsrw Kane
011
i':,badt:xrenecial I+.-..crax t,';e
:5141:uvMr I\lla cni
1 160
111. 'T'ype of permit: lChm e:\. Cmnplete line B if applicable}
C La Tcw Sys:c cA%n2t is Cys+c-o 1 7rc M1tm a. arc nf'1- k Ri.: 2-m iA iu \qi~y&&.Ja t: ExiS^..ng Sysfim ta)ila:yl
84 Pcrmn Ra %a1 -1Nim,t RCtsi<, ~1_..r1 cul.n.mZ4277 ElFrn i_-...tila niVew Lice one, taus Pu-\mt.Numberan I ua
rl r %JITaItCK.
7-116
11I Ty of POIi'TS S •t _ - .
,Sr - tern (.nnqu n,m7yc ae:
L. in"nnd D N'a-" a - 1 cn - zde I Moss 2 n olsoh olc sw U M1l not N In of<aivhic W
7 `nF a ~ (et r I i u: D n to rtm z ~ + nape n`/" -
pt rval rr/.. Bent area fuformatton
^s -T Fk I,pcIJ' l; ,~1, d :v}•h au..i va )T'1 6v7~cr,..l .\tor l.ewe.,uhf .f: Ii: ~.,ul ..m_ ei~ p ..yh S v a.r iiiwaliop
1. bank Into _ _ ra.a•. is '.at Jr fww-'km.G
ba.iant : aI ns 7niu I \ - v v
~.fM TNkt 'LLSL114 -Saki. T J
kl.l n Ank - i~ r y
- T
\'Il. Respnnvhility Start empqt- hr uudrnrKn sumr r slronubrhty for imulluuoo c POK' 1~, h ixc r u the attached plant
11 v4'N cnuc~Ft om~ Yhcrw V rpbn ~
ICS 1 Pnnll 4x/ Q S S r it:Cr `t~
ku-mbc; \Sirc>•OIrtc1 nr .I - _ - ~ C ~ rt
~7 1.1C
VIII. Cuuntr Dcpartmcut Uec Onlr _
Irma I cc - Daft sat: is,uiuq ti Ji e~a[mc -
IX Coudttu p 'coos for Disapproval
(*4w C*4 rnltal all hu-LAW ' mk mtk tr ✓ rf /yam r
a per aMf.>1QR11U pIM p10 40erl try ylu.ntx:. All 2 AiMft&li*%#wtramidtirrsritesra4 ~GOF o-li. f C O
M pM sppk" 0061 / mIMM". r
onkwpopa unr lmxlhaua C:r li tocboasue--
-ena:~m;umplr[cP~iar rM :yxmm and soamivw T'
~3U-ti393 i~11r1 t;.
S v;tcm PLOT PIA N
1'Rr)I t'i : Jrr Vik ADDi:t:SS 332 Sl. Armes Pa'kwav H.ufson Wi 54016
l i 4 NW I i 4S 19 !'I' 28 N!R N- To`%;~ Troy COUNTY ST. CROIX
SYSTEY9 ELEV'AT'I0A 96.5 DATE ?!29!' 8 G
BEDROOM
c'ONVENTIONAI. 1'I-GRADE X)o: CONN I:N1'10\4I: LIFT HOLDING I A\K
MOUND SEPTIC '1'aNK SIZE 1200 gallo-is LIFT TANK SIZE DOSE TANK SIZE 849
- HOLDING TANK SIZU LOAD ROTE .6 ABSORI"t'1()\ ARI'.A 1000 ,h of chambers none
kk BENCHMARK Y.R.P. Top of air conditioner ASSUME LLFYATION I410'
Filler Liletlme f ii[c
BOREHOLE NVELL
H.R.P. surne as bencnrnarK
°rDperty L:ne
I
Existing System
area, faiiing Scale = 1/4" = 10'
Va!vc to use olc system
St. Annes Drive ST
Huffcutt Dose Tank
existing 4
b F: Bedroom House
,y B 1
1.2 Acre Lot
5 ",,,slope
.^J e I
B_, Grading is to be one t, divert a+va~,mr sy:;tern
95 og B-c p, ra 15 L~ioad sgsterr is to
rcriain undisturbed
St. Annoy ?arkevay
~~-~'~r•+t:~;. DIVISION OF INDUSTRY SERVICES
a`.. 2331 SAN LUIS PL STE 150
GREEN BAY WI 54304 5211
s Contact Tn•ougi Relay
1-"' P S httP11t:sPs.wi govlorogramsAndasny-services
WAW wucans r. gov
i Scott Walker, Governor
Laura Gutierrez, Secretary
Aueust'_0, 2k) Is
I I:ST ID No. "6900 A/ IPoll 1:C lrcc; V~; l~u7.ONIAC, OFFICL
SHAI!N R BIRD ST CROIX COUSI'N' SPI.A
1-131 1'0111 tit 1101 CARMICIIAFI. RD
NIAN+RICHMOND WI ;4017-6409 111 DSON WI ;4016-7708
CONDITIONAI. APPROVA1.
PLAN APPROVA1, EXPIRES: 08+20;2020 Identification Numbers
Transaction ID No. 3144355
SI'Z'E: Site ID No, 852553
Vik I'lear c reler to both identification numbers,
332 St Annes Parkway above, in all cu_rrespoodence with the agency.
Town of Tros.
St Croi> C ounly
SL1•1, N%V1;4. SI9. 128N. R19W
FOR:
Description: Replacement Residemial At ;evade
Object hype: PO%VI S Component Manual Regulated Object ID No.: 1790918
Maintenance required: Replacement system: 600 GPD Flom rate: 40 in Soil ntininuun depth to limiting factor from
orieinal trade; Systenlfsi: At-crado Component Manual. Version? 0, tiRD-I0854-P iN.0:0', R. 1 12). pressure
Distribution Component Manual - Ver. 2.0, SBD-10706-11 (N.0101, R. 101'1: F111LICnl t'ilter
The submittal described above hat been reviewed fox conformance tsith applicable \Visconsin Administrative Codes
and Wisconsin Statutes. I he submittal has been CONDI IIONALIA APPROVLD. 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 file Department per s.1.15.06.
star'.
Ilse fullowim_ conditions shall be met during construction of installation and prior to occupancy or tee:
Key' Items- PONVTS Design Approval
• This system is to be constructed and located in accordance with the approved plans. and the "At-,trade Laing
Pressure Distribution Component Manual fur Private Onsilc Wastewater S.swms Version 2.0'• SBD-10854-p-
P(N 0_ `o?).
• Provide surface water diversion around the treatment tanks and at-grade dispersal component.
• The owner is responsible for the operation and maintenance of the private onsile wastewater treatment s•stent
(POWIS) in accordance all SPS 3.93 and the approved management plan
• The owner of a POW'TS shall be responsible liar cnsurins that access opening covers remain locked or
seculed except Ibr lnt pzelwn. c~ehmGuu, utaic:c:+,uxe ar •c:ricieV
~ pc..l,u.c.-
• Owners shall receive a copy of the appiopri<tlr operation and maintenance manual and or owner's manual for D
the POW I S described in this approval. PRD
• Provide a copy of the approved POWTS plans and this letter to the owner. ON
IrLII
s~ ~
A copy of the approved plans. speeilicntions:md thn leucr'hall he on-site durin_c eon>trnct ion al:d Upeo to
in.pcclion by authorised rcpresenlalivcs of the DQpartment. %%hieh nrq include local ilspectors. All per ui6
rcquircd by the state or the local nttloieipality shall be obtained prior to COulnencemcnt of
con,nvction.'installation opcration.
In granting this approval the Division of lu6stiv Services reserves the right to require cham-es or additions should
condiliono arise making them necessary for code compliance. As per state slats 101.12121. nothing in this rcu wv%
I:all relieve the desivner of the responsibilip for designing a safe building. aruclm'e, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed hclo\v. or at the address
on this letterhead.
I he above left addressee shall provide a copy of this letter and the POW TS management plan to the owner and anv
others who are responsible lux the installation, operation or maintenance of the PO\V I S.
S:Mcrely. I'ee Required S 25 0.0n
']'his Amount Will Be Invoiced -
When You Reccivc Ihaa Invoice
Mark S Pincer Plcasc Include a Cope \1 ilh Your
POW 1 S Wastewater Specialist . Division of Industry Services Payment Submittal.
i6U81 I 1 189 \ion fri. 7:00 a.m. 3:45 p.m. WISM.ART Code: 76:
nark.ha_et iin\i._ov
cc: Ldw:n ;A I aylor. Wash•w;der Spcciah~l. l? I `1 6:4 1,484, boon-fri, 8:00 A.M. - 1:±0 P.Al.
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date:7/29/18
Owner:Tom Vik
Location:SE 1/4 NW1/4 S19 T28 N,R19 W 332 St. Annes Parkway Troy
Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07)
Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12)
Page#
1. Cover Page
2. At-Grade Plot Plan
3. At-Grade Cross Section
4. Pipe Cross Section/Pipe Layout "OMONALLY
"",'ROVED
5. Pump Chamber Cross Section
k SAFE7'YAND
6. Pump Curve ,NAL SERVICES
7-8. Maintance and Contigency plan ' Y SERVICES
9. Filter Specifications
1
Attachments: So I Te
Shaun Bird ENCE COAD/T/ON
Signature gPIZO 4q)o,
License number 26900 SSS~FS ;e y
AL SrygNG
T SE Cd
f3FCF JLn ~ R~
1
JUL 3 0 e'ii18
!n
INDUSTRY SERVICES Page 1 of 9
I
Shy st cn, PLO •I' PLAN
1'ROJEC'I' Tom Vik ADDRESS 332 St. Annes Parkwav Hudson Wi 54016
SE .114 NW 1145 19 /'T 28 N/R 19 W TOWN Troy coUNTy ST. CROIX
SYSTEM ELEV VI'ION 96.5' 71129/18 4
DATE BEDROOM
CONVENT IONAL AT-GRADE XXX CONVENTIONAL IAFI' IIOLIIING TANK
MOUND SEPTIC' TANK SIZE 1200 gallons LIFT TANK SIZE DOSE TANK SIZE 849
IIOI.DING 'TANK SIZE' LOAD RA'I'N .6 ABSORPTION AREA 1000 0 of chambers none
BENCIINIARK V.R.N. Top of air conditioner ASSUME. ELEVATION 100' Filter Lifetime Filler
❑BOREHOLE O WELL +H.R.p. Sameasbenchmark
Property Line
Existing System
area, failing Scale = 1/4" = 10'
Valve to use old system
St. Annes Drive ST
Huffcutt Dose Tank
Existing 4
B.M Bedroom House
❑B-1
1.2 Acre Lot
6 g0slope
O Well
B-3 Grading is to be done to divert run-off away from system
95' 96' B-2 Area 15' below system is to
97' remain undisturbed
96.5'
St. Annes Parkway
~ r
At-grade System Sloping Site Cross Section and Plan Vie«
♦fi-
F: i ~
t t Dimension Feet
t r Vic:- i°.:.::,::•: •T t A r/T
t
1
16
t
t
i
A C
t
i
t D ..0
n
t
E .0
t _ -
t
F 0.-
.
t
t
Ci _ 1.0
L s 1hB-0 r /O
W
-4_4-~ -
1 L o Slop
t - 1 - Plowed NZ ti. Clean ae«regale 4 in. sch..10 pvc
i t
basal area •ti• to
_ in. dia. observation pipe
Lateral with topsoil Cap
aggregate over pip,:
6corextilc Observation Pipe
- t' With Can
Fabric
~ I l 17tCPa~ ~tlte'l.
.:::•iii:•c; I opsoil Cap
piT
Lt (~mtutu
i I, 1A ~I Surli(c R
Shope Direction
GENEPUL tNSTALLATION: the at-grade area is staked out along, the design contour. Existing
vegetation is mowed and raked off the site. The basal area (I x w') is staked out and plowed with a
moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to
form a './i inch soil wire when a sample is rolled between the palms of the hands. The A x B area is
covered by clean aggregate deposited overhead by a backhae. Special care must be used when
placing the aggregate to minimize compaction of the plowed surface. :Mier the topsoil cap is placed,
the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect
from freezing. The observation pipes are perforated in the lower G inches and secured in place.
03'0 Igl Page of /
Pressure Lateral Layout
One Lateral End Manifold
4 l htcaded
Cleanout
Force Main Lateral LLin-11-111) No plug
L - Long
Sweep
9(1
Bend
Pressure System Construction
/ Distribution Net ork S ccifications
lateral Diameter z_ In. Laterals are constructed of Schedule 40 PVC
Orifice Diameter -515 Z- In. pipe Orifices arc drilled perpendicular to
X (Orifice Spacing) In. the pipe %kith a sharp drill bit and face down.
L (Lateral Lcngth) Ft. Lateral turn-ups terminate with a threaded
Force Nlain Diameter 2 In. clcanout plug and are enclosed in a 6-8 inch
Force Main Lenoth , Ft diameter lawn sprinkler valve boa accessible
lrom finished ;rack.
• • • • • tirade
6-8111ch Lawn
Sprinkler Val%c
Box \
03;os lri Page- or~
Dose Tank Cross Section And Pump Pertormance Specifications
Tank Manufacturer ~ CuLt Minimum Pump Performance Required
Tank- Model Number - UPV'1 !a. Ft 1'llll
Total Tank Capacity
blax. Bury Depth Total Dynamic Ilead JIM) - L'eet
Elevation head
Pump Manufacturer
~ Distal Head 1 .
Pump Model Number Network Head Loss
Alarm -Manufacturer Force Main Head Loss
Alarm Model Numher Filter Head Loss
A.1 4
switch ly 1
Total
Pe r/ ? e 4.7
Manhole Min. t" Above Grade
With Lucking Device
Vcm Min. 12"
W
Above (;rode eather-proof 1
Junction Box
With Cap 0
- - - - - - finished Grade - - - - - - - ~ J
I`
Disconnect
Means
i
Switch Settings and Reserve Capacity j
Inlet }
I ank Vol unc - CPI
Dimension Inches Volume Gal. A
(reacrvel A
^C7- -
Wee
(alartnl B 2 B p
Hole
(dose) C
S = l-~ 6- Off Elev.
L (dcad) D C
Total
Z-Pt D
Bottom of tank Elev.
GENERAL. INSTALLATION: The dose toile 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 excavation and is sealed
watertight. Electrical scrvicccomplies with NFC '00 and Conini 16.28.
l r)
10'07181 Page of
I
280-SERIES
112 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 J 17 77 1
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 280Series will provide years of reliable performance. d 25
N 8
All Models Feature: LL 20 6 m
• Vortex style impeller permitting passage of solids 15 5
up to fl" ) 10 3
• 416 stainless steel rotor shaft _ f
• Permanently lubricated upper and lower ball bearing 5 2
• Epoxy powder coat finish 0 0
All fasteners -corrosion-resistant stainless steel 0 5 10 15 20 25 30-35 40 45 50 55 60 65 70
• 1 Discharge U.S. Gallons Per Minute
• Stainless steel bottom screen - easily removable ~ ' 11 1 ~
• Maximum fluid temperature: 140" F. Liters Per Minute
280-Series cord Lengths
Model 10' 2~~ 5' - _3s -3 Dimensional Data.
- ~i 50'-- Weight: 291bs.
280 Standard Options]. Optional Optional Height: 13"
281 Standard Optional _ Optional Optional Major Width: 10" (model 287)
283 Standard Optional Optional WA
287 _ Standard Optional WA _ WA Minimum Sump Diameters:
10' cord length standard on all models. For optional krxJtirs, Model Model 287 28 VMF..14"
add"-2--3or-5"suffixtomodelnumber, ..10"
Example: for model 280 with 35' cord, order 280,-3
Factory switch Model 281, 283 Model 287
settings VMF
Motor Specifications Tum on level 13" 9.5"
hp 60 Hz 3450 RPM Turin off level 7° 4.0"
Oil filled, themtally protected
(PSC) Permanent Split Capacitor The Model 283 features a fully adjustable wide-angle float Differential
8.0 amps (115V) Auctmentc can be made easiy by tedlenng the float to the di
4.0 amps (20$/230 charge pope or other mounting point Vertical float model 287 is not
adjustable.
Model 280 Model 281
Model 283 Model 287
(LVI
Manual, Wide angle Wideangle VMFSeries
no switch float switch float switch Vertical mag-
with quick- with series neticfloatfor
disconnect (piggy-back) smaller pfLs-
plug will operate in
a 10° diameter
sump
c uS Certified
sw~ac•e"rn art,+v+lt<.ru O.».ywgww "ww.
Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839
www.libertypumps.com coplmglawlrbaty pumps, Ire:. 2017
M nMis,eaen ed. LLn2DOORDSrl7
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_of_ _
=1LE INFORMATION SYSTEM SPECIFICATIONS
Owner
Septic Tank Capacity %
❑ NA
Septic Tank Manufacturer ❑ NA
)ESIGN PARAMETERS Effluent Filter ManufacturerV
_ z O NA
Number of Bedrooms - O NA Effluent Filter Model ~n
❑ NA
Number of Public Facility Units LNA Pump Tank Capacity
_ I CNA
Estimated flow (average)
~16 i caUda Punt
y P Tank Manufacturer C O NA
Design flow (peak), (Estimated x 1.5) -
_ '~i _gal/dal Pump Manufacturer i ~ O NA
Soil Application Rate / -
_r gaJday/R1 Pump Model D NA
Standard Influent/Effluent Quality I ' Monthly average' Pretreatment Unit
Fats, Oil & Grease (FOG) 530111 D Sand/Gravel Filter D Peat Filter A
Biochemical Oxygen Demand (BODO 6220 mg/L G NA ❑ Mechanical Aeration C Welland
_ 7olal Suspended Solids (TSS) <150 mg/L ❑ Disinfection _ O Other:
Pretreated Effluent Quality
Monthly average Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) <30 m/L NA
9 ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Tota.'Suspended Solids (TSS) <30 m9/L At-Grade
-
~llA _ D Mound
Fecal Colifonn (geometric mean) 51.0° cful100m1 Drip -Line ❑ Other
Maximum Effluent Particle Sze in dia. D NA Other -
Other ❑ NA
A Cther: - -
_ D NA
*Values typical for domestic wastewater and septic tank effluent. Other - - - -
NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tank(s) At least once eve - F1 month(s)
- ry~ ,__~ear s (Maximum 3 years) p NA
(Pump out contents of tank(s) - -When combined sludge and scum equals one-third (k,) of tank volume D NA
!Inspect dispersal cell(s) At least once every. - D month(s)
_ - f~year(s) (Maximum 3 years) C ..\A
lean effluent filter _~Al least once every: ( month(s) -
year(s) _ D NA
nspect pump, pump controls & alarm At least once every: C7 month(s)
22 year(s) 0 NA
I:lush laterals and pressure test At least once every: G month(s) - -
15ther - year(s) D NA
)Ihe• I A; east erica every: a~~S~s) C NA
D NA
MAINTENANCE INSTRUCTIONS
,nspections 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 Irspecto, POWTS Maintainer. Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to identify any m,ss:ng or broker- 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
disually inspected to check the effuent levels in the observation pipes and to check for any ponding of effluent or the ground surface.
the pending of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
-egulatory authority.
fJhen the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of
he tank shall be removed by a Septage Servicing Operator and disoosed of in accordance with chapter NR 113, Wisconsin
4dm nistrative Code,
All other services. including but riot limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment urnts,
'and any servicing at intervals of s:12 months, shall be performed by a certified POWTS Maintainer+
k service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page _ of
START UP AND OPERATION
the]
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
may impede the treatment p•ocess andlor damage the dispersal cell(s). If high concentrations are detected have the contents of the
:auk(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 till above rormai hlghwaler levels. When 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 effluent.
To avoid this situation have tine 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 leve s
within the pump tank,
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or pa k over or otherwise disturb or compact, the area with n
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 POW 'I is
antibiotics; baby wipes; cigarette butts; condoms cotton swaps; 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 taker, out of service the following steps shall be taken to insure that the system is propeliy
and safely abandoned in compliance vrth chapter Comm 83.33, Wisconsin Administrative Code:
• All pipltg to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and p'ts shall be removed and properly disposed of by a Septage Servicing Operator.
• Ater pumpirg, all tanks and pits shall De excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the PUNTS 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 De atilizeo for the location of a replacement soil absorption system.
The replacement area should be protected from disturbaice and compaction and should not be infringed upon by requhled
setbacks from existing and proposed structure, lot tines 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 rule, in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a
holding tank may be installed as a last resort to replace the `,ailed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaVualpon
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 infdtalive
surface. Reconstructions of such systems must comply with the rules in effect at ;hat 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 OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS _ -
_ -1..~
POWTS INSTALLER POWTS MAINTAINER
Name Name /<<r<_
Phone Phone
SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATOR AUTHORITY
Name / Name
Phone Phone
This document was drafted in compliance wth chapter SPS 383.22(2)(b)(1)(d)&d1,, and 383.54(1), (2, & (3). Wisconsin Administrative Code.
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Ob1'N~L1tSHI}' CE72'fTl-')1.1'1'1_ N FORM
Owner/Buyer
MatlinYAddress~j 5 2- An eto~e Aet4 czj_
Property Address
(e'er, leation requited iron: i'l lMiol; & Zourrr Dapa:m:ent tornew construction.) -
Citv'State - - - - _ Parcel (tic~tlicaion VutaberQ~~O =1~J-~(~ ~n~
I.EGAI. DESCRIP-f'ION -
Propcity I.ocaGoti-~,6 f,/Lc,/`ia , Sc;c.l ; 2 Y N 1~ t\', Town of iz~
Subdivision
- ~ Lot #rJ~
Certified Survey d'lap 1;
- - b't tun±e Pale ti
r.
R'arrantY Deed 1: - ~J
- - , Voiuntt% - - Page. ,l
Spec house yes uc t m iinr. i+leuttiiabie~ no
SYSTEM MAINTENAN( AND O NEI2 (-'ERTfTICA I'IO!S
I rtq+ropur use and araurrenanec of Your. Sepflc system Couhl result ni its pr,•mature failn:e w handle wastes. Proper
ntaintcuauec cpnsists of puntpulp out die scpuc tank eve.rv three vean, or 5onncr, ti oeedtrd. by a license,,] pumper- What you put into
the system can atlect the hurctiorr of the septic rank as it lrcahncnt stage 6n the wasic disposal system. Own--r maintenance
respousroili6is arr. speatficd in ,]Comm. S ~.';2(1) and m Chapter 1 - St. l:roix County Sanitary t hdinancc.
The property owner agrees to suiunit to st. (-:o 1x 1(111111; Planmuz Z on af; Department a cerrrlieallon tirrtn signed by the
owner riot by a notate: plumbcr,,jot¢ueyman ptunrire. restrn.t, c plt:mbu or a 1weiised pumper serityinft that (1) the on-site
r stawaler disposal sysicra is ra proper opera nig condition aucior Q) .Ater io.;pee.;: ion arld pturytmg (if -accessary), the septic taro n:
I ss than 13 [till of sludge.
L'wc, the rmd.:ratgtted ha,c rca<i inc. flbnve ic9nircmi nL: aad aezvc to mit tmu: the pnvare sewage disposal system wul: rfv:
snodurds set forth, herein, as Sri t)' the Deparnnenr ofl. moniiaco au: the Drpantr t:nt of Naiuad Rcsmuccs, Sratc of w'iscoosm.
< cn fica tiort srntmg this }nor Sept; cvsteia has been nratntamud aarsi he. complew-f and ienrrned to the Sr. Croix Cotm y Plaatme &
!o nag llepartmcn( wuhm 30 nays of rLe wree year expiration date
Uwe certify that all s[atrmcros on ch ;roan an enn o uu hest of nn'nur knowledge I •mr au✓a a the of;ter{si of the
propcny described abocr by vu hue of a w" anhdecd :euuuir.i ri Rc,.utc: of Der ds OBrs:e,
/,,,b bedro nn 17
SIC;: 'A111IR OF APPI IC 1N'1'lS) ~
llA'fF.
•*Any informaiwn that is tvstepresenled may, result in the samina y net nut hriog o-volced by the Planning & Zonate Departrne u.
i noiurie with this application a i morded wartattfy deed from the ReKistr i u~ Dre;is ;:Vier and a copy of 'he cci liked survey nap if
reference Is nradc in the warranty deed.
(KU V. 08105)
1'^IA.}IX !•'pR COUN'PY I,ON.iNC, OFF.ICF
JT3.L.1LA7.Tolq F `1'ZON 5TA4'$MEpIq'
AN EXIS"SC SEPTIC 'DANK
r~,ln Y that r, have-inspected
ht/_ the sei,r ic: task pr~scn•
/c7 c- - - sect-ion - resi e ee
/ ~ -
lUCt3:ecl-.
- TZ__
1nd
r k a- baffles tcUpc~rt .inspection, ;ow,
T certify that l have
>unotion_" be In good
g properly, condition, :uurd
and it appear., to be
'.,~i s t f l:nc
se,rv i ced :
- br,",4 uccllr/ :urFabsorption system? - - - -
UpCnximate volume " no, "lip next We).
j:u:ir- or lony;it of time:
"'ruction: Prefab
CortCretej0
s: " utact Steel
urcc-: (If known):L~~~ CL-r,et
- T (1r known,
a
ture) - ~'r
as
t (Name) Plee print
i r,.t.lej ~
~ / 6 ;umber) -
(t•rense rJ--
ta -
Latuto he comp.let:ed by licensed
es) or L].c ensed Dispose
ude} r NH piumbe,- (,;.14~ 0!
( l.3 W"'COnsin ~i'"":r;•in
- - Adnt]uEstr.: I- ,VF,
r':! weber (appl y i.n - - - - - - - - - -
g for sanitary Permit) Certific;at:ior,; .
ecce t'
p lnrJ the above at.emenL
=oncl.it.io i
n 1 certify thatstthe tank to t
cun.r.orm regardng Pxistim
iilspeCti,ert the requirements opnnin best of 3 `L1'(1c tanl.
over outlet ILHx 8 Wi' Adm.
deowKe
N wry c baff]. C (except. 101
e-
Signat
----------_141J/Mpyy 7 j~
@(~ i!1s
Wisconsin Departmenlb)'CcA4rW SOIL EVALUATION REPORT Page of
Division of Safety and BuildINS
in accordance with Comm 85. Wis. Adm. Code
county complete site plan on papernot less than 8 1R x At inches in size. Plan must include, but not limited to vertical and honzontal reference point (BM), direction
and Parcel LD.
Percent SIOpe, scale or dimensions, north a"", and location and distance to nearest road.
Please print all information. Renew oy Date
peoenal ndarmauon you provide may be used for secoMery purposes (prlvaey uw• a. 15.04 t/) (m)). /
Property Owner Property Location
Govt. Lot 54 1f4 !a $ r T N R E to v%.
Property Owners Mailing Address Lot p Block if Subd. Name or Milli
/
/"'Y 11 ht r Cdy Stale Zip Code Phone Number El City ❑ Village own No st Road
/ 11 I st ( ) ru[ 5-n
❑ New Construction Use-7~Pxsidential I Numller 01 bodroums Code derv design flow rate GPD
eplacement Public, or commercial - Describe. _
Pawl material 7, X _ Flood Plain elevation if applicable-- - ft.
General comments
and reoonwnendations_ 4
r
=Z Sys'cm Hova-ion / ~i
Syslert Type
hl/
Boring M Ej @ -Pit
0 @-Pit Ground surface elev. ft, Depth to limiting facia in. Sal lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMP
i in. Munsea Ou- Sz. Cont. Color Gr. Sz Sh. •Effp1 •Effg2
sr 44
BoringM ❑ Bong -
DD11
of Pit Ground surface elev. - - R. Depth to Gmitirg facto n.
Soil IiraGor. Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots Gpo.-F
in. Munsell Ill,. Sz. Cont. Color Gr. Sz- Sh. -Effp1 •Eti
f _
3 2 v Si l
zz, 2t
A~ /J AL z`2 Al,
• Effluent fit = BOO. > 30 < 220 n1yL and TSS >30 < 150 • Effluent 02 = BOD, < 30 mg A. and TSS < 30 rrlp~L
CST Name (Please Print) aturo CST Numbor
Bird Plumbing, Inc. Shaun Bird 226900
Address Date F•.aluation Con uctod Telephone Number
1432 120th St, New Richmond, WI 54017 715-246-4516
Properly Owner Parcel ID Page _ of
Boring ❑ Outing
~ / ~n # PGround surface elev. _L 3it. Depth to limiting factor n.
Suit icalxxt Rate
Horizon Depth Dominant Color Redox Description Texture Stn cture Consisterx:e Boundary Roots GP(17f
M. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh 'Effp1 'Etfp2
7 )7
v. --/Y! S ~7 l L e
❑ Bering
Bo ng p
❑ pit Ground surfaceelev. N. Depth to limiting factor in. Soil Applcation Rate
Horton Depth D<muent Color Redox Description Texture Structure Consistence Boundary Roots GPDlff
in. Munsell Ou. Sz. Cons Color Gr. Sz. Sh 'ENft1 'Efdt2
❑ Boring k ❑ Baing
❑ Pit Ground surface elev. ft. Depth to Wiling factor in.
Soil ication Rate
Horizon "tepth Donunant Color Redox Doscripton. Texture Strucnrre Consistence Boundary Roots GPDfff'
in. Munsell Ou. Sz- Cont. Color Gr. Sz. Sh. 'Efryl1 'ENN2
Ef9uont 41 = BOD, > 30 < 220 mglL and TSS >30 < 150 mg4 ' Effluent N2 = BOO, < 30 ng/L and TSS < 30 r g1L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
tieuaaa,e s~.vi i
Property OT r Parcel ID # Page _ of _
Boring # ❑ Bonng
❑ p'~ !
0 Ol Pit Ground surface elev. Depth to limiting factor -3~f in.
Sail AFOication Rate
Hones Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD#F
in Munsell Ou. Sz. Cont Color Gr. Sz. Sh. -ER#1 -E##2
3 L 7~~ C r - r
i
❑ Bonng # Boring
❑ pit Ground surface elev. ft Depth to limiting fads in Shc Iration Rate
Horizon Depth Dominant Goicir Redox Description Texture Structu i Consistence Boundary Roots GPD/ff
in. Munsell Do. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 'ER#2
❑ Boring
Boring # Ground surface elev. R.
❑ Pit Depth to )inviting factor in. Soil ication hate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/If
in. Munsell Ou Sz. Cont. Cola Gr. Sz. Sh. -E##1 •Eff#2
Effluent #1 = BOD, > 30 < 220 mgrL and TSS >30 < 150 mqL ' Effluent #2 = BOD, < 30 nV& and TSS < 30 mqL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SaPU)O (R 690)
i
Soil Test Plot Plan
Project Name Tom Vik Shakt,v Bird
Address 332 St. Annes Parkway
Hudson Wi 54016 CS'1'M #226900
Lot 68 Subdivision Troy Village Date' 7/29/18
SE 1/4 N W 1/4S 19 T 28 N/R19 W Township Troy
❑ Boring O Well Pl, Property Line County ST. CROIX
BM or VRP Assume Elevation loo ft. Top of Air Conditioner
System Elevation 96.5' *HRpSame as Benchmark
Property Line
Existing System
area, failing Scale = 1/411 = 10'
St. Annes Drive
ST
0
Existing 4
B.M.* Bedroom House
❑B-1
1.2 Acre Lot
6 %slope
O Well
B-3
95' 96' 97' B-2
St. Annes Parkway