HomeMy WebLinkAbout018-1098-14-000
vrs- PRIVATE SEWAGE SYSTEM St. Croix
S3'ePJ 3'.d 3w dine livncic.n
INSPECTION REPORT ''"'la r Per-t Nr
GENERAL INFORMATION (ATTAGI1 -0 PCR1,11T) Sxe Pla o Ne 605189
Petsaral i-for-ator yoo p's:iee mny ne usad •c• senordati Dwnu-,es 'Pn,acy La.; i C4 ;i „m7i 3152916
Pe:-'it Ilolcc, s Nar- CIN Village Tuwrsnlp PaICCI Tax Ne
Billy LaBelle TOWN OF HAMMOND 018-1098-14-000
CST HIM F ev Insp TIM Ell DI.1 Desonpl on. Se. iion+Tcn:: Range ;Mao N0.
(o y0 30.29.17.821
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ,N55 CAPACITY STATION BS FS ELEV.
Sep:c J G~ t/ _ Z t3encPrtark w`S
Dos ng V
Alt. DA9 ~ J S 160 ,7
icr 1-1 Bldg. Sower s.d `f?~-5
Hold rg SCHt Inlet 7-7
g
TANK SETBACK INFORMATION SuHt out et
TANK TO RL VJ[LL BLDG. `iert' Air Ina,e ROAD D: Into:
Sephc 7 Sam/ 57 _ DI Bo,lort
Uosiny ) IleadeaPvlan.
3 - f /oo.
756 57
Awat on DISI Pipe ( /M r
Holding Bw System
4, a '9 /`'9 ' 7
'
PUMPISIPHON INFORMATION Final Grade ' • It 16~r Z
I.1anufactVer I Demand S' Cover / I / p
L.be1 GPM 9~6 3'O 166.7
Model NamDer 19)
1 ~
TDH Friction=ossZ System H TDH 4 't
a IL
rcreomain Len Dia~z r l Iii: to cat
SOIL ABSORPTION SYSTEM
BEDITRENCH V idl•, / 1 _cr•Ath N, Orr -.u ch PIT DIMENSIONS I O Is ns:de Dia q,. J o,~_r
DIMENSIONS G 67
SETBACK SYSTEM TO P:L BLDG + :"JELL IAKF.:STRIEA LEACHING r,Mn raclj1C-.
INFORMATION Type ~fxJ~~. .m CHAMBER T OR PJndel Numter
r r JD.J 96 8l
DISTRIBUTION SYSTEM 60- f
Hedger ML, -III-. 7 Jim finincn x 1nlu S cc x Hnle Sp_ ninL i.a~ n r I•[ake
Lcrnlr uia I ennrl ;5* D a spa-mg I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only t~--~
Deptr Over Depth Over '.x Death u' xv Seedeo+Sacded A M, Iched
BcJ'TICNh Ccnlcr /
-7 1 i!5c!IrEn;r la,as r^psoil --:yes l No --vf!5 '~_No
I -mil
COMMENTS: wdude cote discrepenc es. Persons present, etc/i Inspection rtt ~d r f 3r; It'; $ Inspecion uz
Location: •515 76TH AVE v
~'il~t„
I AL BFA Descr pt or - I-
2 ) Bldg sewer length = V ~ Q'ri
- anrocnt of cove,- l~ St'.~, 1Z CdC 13.E-t Sv!✓fv~9r
~'}2 /0.~ a X~C~ V Q
Plan rev'. son RegLired- Yes )!(No 16 31 too Ip ~37 ~ 5
Use other side for add tional rfo•mation
Jale InseP:t Sigrati Cerf N"
SB7.57'c !R ~ p'I
}U - - - r aqZ -
II\„F I gaiety and B:lhdings
201 t1 •Alasnington Ave,. P. L). Sax 7162 -
I
P -,=MYy' Nlm i Nmmbn ;q• Ix fi:lcd m by) c,
ao SAC , 1 ZA ` Id3d•soc. ':1C 5370, =7162
- uJJd't I stxxT
I'ITJJt a>.v t;on tiamtx:r
Application
r 7~ v A= l udc ' m~ sr r f 11 s J}t!
'ap > Z /
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C Sl .ia. St- tr ;Y.:..n ! n]].I..:fIIJn ))L pIJYI:IC n'.a\ he U$N 'rX.' nn•.:14
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I AlppliraUOU Informahr n Pkaae Pnnf 411 In13 uuetion J ~ " ``t ,yJl
:r a 0/8-1048- wooo~o
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t 2 ~ CC"(!//J// - I >rrry:aaann R
ua : :,ic 'hme ytnbq Its 4. -tic
- ~Yot I T e1~J
ti. ,
t
A~' /!Tvpe of BmldmR Ichclk all that apply
ol ? Furu]v Uw< line,-Na:ntx• ti I,ku'::<aTU 3 Q -
I ~utdum •.amhl_ a N•
I _ I. 8... /Z--
faJCI::'['nmlCnr:r:a;-IhS'IF,e _kf
r_ Scale Uuard - i letenbc tte cSm Num. r ❑ 'v il)n fc o'_
❑I. Tv a fCbttk Duly one box ou line A Complete I ne $ if applicable)
• r - - _a- - -
S anal n 12eptaceo:enl iyztrn: r.-avnrrl:N Idmq'~ aM R pl\ quen, ;ialy _ hn:o yfodt5ca :n to Existmg! $~~telu +cxplam~
~~i'rJUUt Rcncwa iI-1 -mn'dc'cua i.n ,c of !'tun'+r ,,w ~Lts: rcviou: :-mn`aminel mlt (1alr Lasuei7.J
f¢'cre Fxp,r.mm emrt 1mclfer r: Sew
d,Yyd _ 1 l lCl
l1 T~~c of [ UW f~ Cvs1m.Coin mn,ntUevlcr. tf.'hea all That y pl_'i__ k
❑ \u- Pramr a h: ;rounc L Y r-ssw 1 a -nu-d ~I •tliFr.,cr 1 - - -
unu> 1^ tstiJd oa ~i.lt found -s.. cfnfl lMc asi; i
HI Imp' d. L lctrn 1FcA..I -rv r zt yIaunt
- nRrt;s -ICIt CxYa'<;explu
v LLc reatmtnt 4re4 JOIN matnn
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i Dll"rJ lr fc. ca i:.IJ- It _;~rsal nlca. to c~ i jy.l ~'F cva~oo le//
an In(o C 7, ,;IV .u ~ Ibti e ul I
MLmni3cnner
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C Rmponslbilnv Ctatem I I, me undersigned, ass rrspmmbrblt 1br iusullatiao of the POta fS shown na the attaehrll plain -
Iw b^ s\aclc P.~11 L
A
P.tmh mac;. -
Iff N1Pc' a;uuCc B,tcln~;;lmtle Nl bm
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-XIO
_ -numv_ Department Lsc f1_u1 _ - - I
App m•cd ~ Li :rov T~~n Fcc ~ -hus suN .,',rc_ ._vl Sl~awwe - - -li
70-.d- I /v4~d 91Z1o/1S
U ltot~1el~F,lsonc for lllcapproval
lgept tank elltcn IiRor n1
u :1 Abe _to s'ra intai,-
p r :lal s ..ten plan c tine) Lv ~Iwnge:; a.... 1 e..~/ D~+~v
2 All Whar.ly
apFNcreel it ^emc mutt to ¢a,rt ir.t 4
as pefnWt uN'i:l:Minaicet. y ~e _AAAAAA. 4,~ LLB
n raea m SumpL•a ylarta fm the mrrm and b
>umrt le (bong volt na~ra Iht clue b w r ;1 Iaean ur
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Svstem PLOT PLAN
PROJ6t`r Kerner Bast ADDRESS 948 L aBarae Road Hudsor Wi 54016
SW 1:4 NW 1!4S 30 'T 210 N:R 17 y',"rO~tN Hammond COUNTY ST. CROIX
SYSTEM ELE%ATEON 996' ''..1' Banc li`t 8'2 418 BEDROOM 3
DATE
CONVENTIONAL. AT-GRADE: CONVENTIONAL LEFT HOLDING TANK
INfOUND XXX SEPTIC TANK SIZE '.000 gal ons LIFT 'TANK SIZE DOSE TANK SIZE 630
- HOLDING TANK SIZE. LOAD RATE 1 C ARSORPTION ARE'.A 456 # of chambers none
BENCHMARK V.R.P. Top of pvc pipe ASSUME LLI'.V ATION 100' Filter Lifetime Filter
❑ BOREHOLE 0 AVP:I.1. » It. R. P. same as benchmark
Property Line
Scale = 1/4o = 10'
To 75th Ave
Well is to mee' all WDNR setbacks Pro 3
Bedroom
House
kte' V-1
I 1
I ~
B.M.°
5 Acre Lot t 4 uffc it Combo Tank
E] ❑B-3 <
99'
98.5' Q
Grading is to be done to divert
run-off away from system 97
Area 15 below
g r", El 4% Slope system to
remain
undistu bed
?roocrty Line g-2
~.y
V
f1
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7 JNJW3SV33NOI1V3N339
m Itr
a~r•.i,,,. DIVISION OF INDUSTRY SERVICES
' 10541 N RANCH RD
IIA"bVARD WI 54843-5462
i S Contact Through Relay
~ P hllp rdsas •eegovipregrams;industry serv '.rzs
w.wv •nisccrsin gcv
Scott Walker, Governor
Laura Gutierrez. Secretary
September 07, 2018
C1.ST ID No. 226900 A17 A': ]'Off TS InsPeeAu
SHAUN R BIRD 70NIN(i OFFICE
BIRD SELF SI ORACF=. SI- C ROIX COUNTY SPIA
143'_ 12110 111 Sd'- - 1101 CARMICI IAH. RD
NEW RICHMOND WI 54017-6409 Hl1DSOS WI 54016-7703
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09:07,20.20 Identification Num'o_ers
Transaction ID No. 3152916
SITE: Site 11) No. 853399
Kernon Bas Please rclir to butt idenlificaucw numbers,
-61 If Arc above. in all correspondencc with the agency.
Town of*] lammond
St Croix County
. SA, 129N. R17W
FOR:
OhicctType: POWTS Component Manual Re!•.datctl Ohiect ID No.: 1-95112
Maimcnance required: 450 CPU) Plow rare; Systems): Mound Componenl Manual - Vcr. 2.0. SBD -10691-P (N.01!01,
R. 11) f_), Pressure Distribution Component M4 srual - Ver. SBI)-10706 P (N.01!01. R. 1012): C[Iluent I iltei
'I lie submittal desmbed ahocc ha hecn reviewed for Coofill mance with applicable W isconsin Administrative Codes
and \l'isconsin Statutes. The submittal has been CONDITIONALLY APPROPGD, This syacm is lobe constructed AI
and located in accordance with tare enclosed approved plans and with arty component manual(s) referenced aU'~~T OF SAFETY AP
The owner, as (Mined in chapter 101.01001. Wisconsin Statute;, is responsWc for complia nce with all code
requirements. DIVISION OF
i
A cops of the approved plans. -pecilications and this letter shall by on-site dtlnt construction and uper"
inspection by authorized rc•pres' nl illvcs of the Department, which way incladc local in-I eetors. All permits t
required by the statc or the Incal mw.icipnhty shall be obtained porn to commencement of
constructioniinstallationloperation. ' -
In granting this approval the Division of Industry Services reserves the right to require chanpcs or additions should SEE CO
conditions arise making them necessary for code compliance. As per state stets 101.12(2), nothing in thys review
shall relieve the designer oft the responsibility for designing a sate building. structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed helow, or at the address
on this letterhead.
I he above Ieft addressee shall provide it cop of this letter and the POW IS management plan to the owner and am
utters who are responsible l6r tio: inslall:aion. operation or maintenance of-t)ic POWYS.
Sincerely, Fe:: Required S 250.00
I his Amount Will Be Invoiced.
When You Receive That Invoice,
Gch n a' ' ,Joe Pleaw Inckide a Copy With Your
Wastewater Specialist . Division of Indr:strv Scr\'ice, Pag l:lent Submittal.
1-1715)61-1-3-18-1 , Mon-fri, 3:00 a.m. -4:30 p.nl. WISMAR"I' code: 7633
cdw i n aavlorliwi. eov
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8!24/18
Owner:Kernon Bast
Location: SW1/4 NW1/4 S30 T29N.R17W 1515 76th ave 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
--ESS?Oi';AL SERVICES
3. Mound Cross Section RY SERVICES
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve L
7-8. Maintance and Contigency p an ittLS 0, DENCE
9. Filter Specifications and cross ction
Attachments: Soil Test
Shaun Bird
Signature
License number 22690
2 Page 1 of 9
System PLOT PLAN
PROJECT Kemon Bast ADDRESS 948 LaBarge Road Hudson Wi 54016
SW 114 NW I /4s 30 /'1' 29 NIR 17 W TOWN Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 99.6' 1.1' sand lift 8/24/18 BEDROOM 3
DATE CONVENTIONAL AT-GRADE, CONVENTIONAL LIFT HOLDING 'TANK
MOl \U XXX SEPTIC TANK SIZE 1000 gallons LIF U TANK SIZE DOSE TANK SIZIi 630
HOLDING TANK SIZE LOAD RA'11% 1.0 ABSO RPTION AREA 456 # of chambers none
BF,NCIIVL%RK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑BOREHOLE 0WELL xI1.1t.P. sameasbenchmark
Property Line
Scale = 1/4" = 10'
To 76th Ave
Well is to meet all WDNR setbacks Pro 3
Bedroom
House
B.M.`
5 Acre Lot Huffcult Combo Tank
B-1
❑ ❑ B-3
9 9'
98.5'
Grading is to be done to divert
run-off away from system 97,
Area 15' below
system is to
96' ❑ 4°-o Slope remain
undisturbed
Property Line B-2
[7 4 tl
Mound System Cross Section and Plan View
---------Dimension Feet
xt t A
JI 1 I - ~ j
T t p 1
1 7 j I H ~j
I r iJ 1 IF_ H ~ C~~777
11 1 I d
1 1 ~ .r
L
_ Z
Slope 0/1)
L
T
- 1 - Topsoil -;1S [_A'1 i Clean acre,,atc q in. sell. JO p%c
ap Nlaterial IL sand till to in. di a. observation pipe
H
(iculcx[iir ~
L)
li
PhmulSUiflcc a L3
~J > > Pt Contour
Slope Direction
GLNERAL INSTALLATION: the mound area is staked out alontr the de ign contour, Fxistinc
vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldhoard or
chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a inch soil xwire
\Oien a sample is rolled between the palms of the hands. AST1vl C-33 quality sand is placed immediately
after ploxa ing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or
is placed overhead by a backhoc. 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 freer.ing. The
observation pipes are slotted in the lower 6 inches and see red in place with r6ar or a closet flange.
lt)WY 1gj Page of
Pressure Lateral Layout
Two Laterals - End Manifold
f- fhrcadeti
Cleanout
I alerai '1 urn-up Plug
'Manifold lnJ
\1
. X
Force Main Sweep
90
13end
Distribution Network S iecifications Pressum System Construction
Lateral Diameter In.
Manifold Diatnel.er pLI~~ In. Laterals are cou5ttnctcd of Schedule 40 PVC
Orifice Diameter i ~ In. pipe. Orifices are drilled perpendicular to
X_(Orifice S mein 'I In. the pipe with a sharp drill hit and lace down.
L (Taaral Length) Pt. Lateral turn-ups tcnninate with a threaded
clcanout plug and arc enclosed in a 6,1 inch
) _ Ft.
M ( ~ ih
~`laml< ld Luis
Force Nlai Dian cter ~di rmrter lien sprinkler valve box accessible
~iorce \I u❑ Len„th Ih ~ hr m iinish~d s!ratle
• • • • • t iradc • • • •
6-8 Itch Lawn r i,
\
SprinklerValve / -0• t-I
Box
1
L:f-s
C'
}'age of",
03105 lgt
Septic-Dose Tank Cross Section And Pump Performance Specifications
fartk Manufacturer Pump Manufacturer
_ Pu!3,,er
del Number r _
Tank Model Number ^c Alarm anufact
urer
~Tota Tank Capac ity _Alarm Model Number
j tvfmt. Bury Depth -
- Switch Type
Total Dynamic Head (TDH) - Feet
(Filter Manufacturer ~ ,
Filter "Numb Elevation Head ^ U
Distal Pressure - ~J
Network Loss f _
~
M- mumPuPerformance Required- Force Main Loss
-
ini" ma
- L ) GPM S' Ft TDH [ [ Total I S - -
Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade
Locking Device. Inlet Manhole With Locking Device
< 6" Below Grade Sealed Watertight Securely Mounted
-proof 1
► Junction Box
_ r
Finished Grade • . • •
Vent Min. IT, Disconneet
Above Grade Means
With Vent Cap
outlet Filter
u let I41 'Inlet Baffle -
TA r/4"
Swttcb Se*P and e ty Weep
Tank Vohune~/~'_ GPI B ';j Bole
Dimension Inches Volume Gal.
a ' _
(reserve) A 1 > > ' Off Elevation C
Oialarrii) B 2 , C7i Ft Bottom
dose) C D Elevation
(dead) D Ft
I- Total
` ` • . • • • , • is bedded and back failed in accordance with the
GENERAL INSTALLATION: The septicldose tank
th bury specified by the manufacturer may not
manufacturer's product approval specifications. Maximxum depto gr radeashave an be exceeded without prior approval. Manhole covers eposed locking device (padlock)
t fittings, and
inlet and outlet is of approved material, connected to the tank with watertight
installed. Piping at the • 40 PVC to bridge the tank
The force main is sleeved with 4" Sch
on stable soil to prevent settling or sagging- lies with NEC 300 and Comm 16.23.
excavation and the sleeve is sealed watertight- Electrical service` trip
Page of
02105 ,
LJ ,
280-SERIES
112 hp Submersible Effluent/Sump Pumps
The Liberty 280-Series provides a cost effective "mid- performance Curve: 280-Serves
range" pump for on-site waste water systems, liquid 40 - - 12
waste transfer and commercial heavy-duty sump pump
41
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
LIL CD
All Models Feature:
20 - I- - 6
W
• Vortex style impeller permitting passage of solids 15-
5
up to f;" = 10 7 - 3
• 416 stainless steel rotor shaft
-LIN LL
2
• Permanently lubricated upper and lower ball bearing 5L- t
• Epoxy powder coat finish p - - _7 - 0
• All fasteners - corrosion-resistant stainless steel 0 5 10 15 20 25 30 35 45 50 55 60 65 70
• t'/-_" Discharge U.S. Gallons Per Minute
--Y- - I -.1- 4- I -
• Stainless steel bottom screed - easily removable 0 38 78 114 156 192 228 270
• Maximum fluid temperature: 140 F. Liters Per Minute
280-Series Cord Lengths
Model 10' 25'(-2) 35'(-3) 50,(-5) Dimensional Data:
- Weight: 291bs.
280 Standard Optional Optional Optional Height: 13"
281 Standard Optional Optional Optional Major Width: 10" (model 287) -
283 Standard Optional Optional _N/A
28.7-_ Standard Optional WA N/A - Minimum Sump Diameters:
10' cord length stwidard on all models. Foroplwnal lengths Model 281, 283...14"
add "-2,-3 or-5" suffix to model number. Model 287 VMF...10'
l3xample: 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"
X 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 u1 be made easily by ludroring the float to the dis-
charge pipe or other mounting point. Vertical float model 287 is not
adjustable.
-r
i
Model 280 Model 281 - d' Mode1283 Model 287
Manual, Wide angle Wideangle VMF-Series
no switch float switch float switch Vertical ma
4 with quick- y with sones netic float for
disconnect smaller ts-
(piggy-back) P
a ~ plug will operate
' a 10" diameter
sump
ss rr, $ Al-us Certified
${X:ifgaLOR. arc su:, al tc is,rcm wmnoa,uticc.
Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-25W Fax (585) 494-1839
www.libertypumps.com Cu1,yngM lAtmrly Pumps, Inc. 2017
alt Roots "-".~.d. urt loop Roan 7
i
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE TNfOF2MAT10N SYSTEM SPECIFICATIONS
Owner Se tic Tank Capacity
-S--- - ag_I_ U NA
Perm t ffi Septic Tank Manufacturer ~u U NA
DESIGN PARAMETERS Effluent F lter Manufadurcr U NA
Number of Bedrooms [j NA Effluent Filter Model i A
Number of Commercial Units ;gj!A Pump Tank Capacity at 0 NA
Estimated flow (average)) ) gaVday Pump Tank Manufadur ( A
Design flow (peak), (Estimated 1.5) ' L altda Pump Manufacturer I 1 0 NA
Soil Application Rate l~~ aVda /ft= Pump Model n J ❑ NA
Influent/Effluent Quality Monthly average' Pretreatment Unit zj~
Oil & Grease (FOG) 530 mg/L U Sand/Gr~ Mechanical Vel Filter O Peat Fllter
Fats.
Wetland
Oxygen Demand (BODS) 420 mg/L 0 Disinfection Aeration ❑ O Other:
Total Suspended Solids (TSS) 5150 m /L 0
- - Manufacturer
Pretreated Effluent Quality O NA Monthly average'' Dispersal Cell(s)
Biochemical Oxygen Demand (BODS) s30 mg/L 0 In-ground (gravity) (71)n-ground (pressurized)
Total Suspended Solids (TSS) ,30 mg/L U At-grade Mound
Fecal Coliform (geometric mean) 510' cfu/100ml U Drip-line Other.
Maximum Effluent Particle Size Y. inch diameter Values typlt l for donnx.G~. (nont nerriar) wastowater and
septic tank eftluent
Values ly "It for prebeatee. wastewale'r
MAINTENANCE SCHEDULE
Service Event ! Service Frequency
I-] months ac(s) (Maximum 3 yrs.)
Inspect condition of tank(s) At least once every
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 O rnonths ear(s) (Maximum 3 yrs.)
Clean effluent filter Al least once every 0 monthsar(s)
Inspect pump, pump controls & alarm At least once every = ❑ months r(s) U NA
Flush IaNrals and pressure test At least once every -,,U months-LYyear(s) ❑ NA
-ort,ec At least once every 0 months 0 year(s) n NA
otnor. At least once every Cl months ❑ year(s) U 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 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 (Ya) or inure 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, rn"meal or pressurized POWTS components, pretreattrnent (xrrnponents, and any
other maintenance or monitoring at dervals of 12 months or less shall be performed by a certified POW I-S Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any servi(~e event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatinent tank(s) for the presence of painting products or ether
chemicals that may impede the treatinent 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.
Page_ of
START UP AND OPERATION of the po
, WTS chi tanV ~ or the presence of painting products of For ni impede construction, the treatment prior
and/or damage the drspersaltCell(S)if high concentrations are detected have the other eon chemicals
ent process
may
tank(s) removed by a septage servicing operator prior to Lisa.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Uunng power outages pump tanks may fill above normal highwatei levels. When power is restored the excess wastewater will be
to re ischargP of of flo a i1e
dlsc!targed to the dispersal cell(s) in one urge dose, overloading the cell(s) and may rIli ithe a surface prior
To avoid this situation have the rxtntents of the pump tank removed by a Soptag Servicing Operator effluent pump or contact a Plumner or PONTS Maintainer to assist in
maxi operating the pump controls to restore normal leve s
within the pump tank. the area withlr
Co not drive or park vehicles over tanks and dispersal cells. Do not drive o, park over. or othenwse disturb or compact,
15 feet down slope of any mound or at-grade soil absorptior area
Reduction or elimination of the following from the wastewater stream may sdenth rerf or is nce nd prolong the li:eof the Oi an
antibiotics; baby wipes; cigarette butts; condoms: cotton swabs; de9
;sumo pump) water; fruit and vegetable peelings: gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pestades; sanltary napkins( tamnons; and water softener brine.
ABANDONMENT
When the POINTS fails and/or is permanently taken out of service the following steps shall be taken !o insure tnat the system is properly
and safely abandoned in compliance with chapter Contra 83.33 Wisconsin Administrative Code:
• Ad piping to tanks and pits shall be dlsconrected and the abandoned pipe openings sealed.
• The contents of all tanks and pi's shall be removed and properly o:sposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall ne excavated and removed or tneir covers removed and the void spate filled with soil.
gravel or another inertsolid material.
CONTINGENCY PLAN
If the aOWTS fads and canrot be repaired the 'oncwing measures have been, or must be taken, to provide a code comp) r)nt
replacement system:
❑ A suitable replacement area has heart evaluated and may be uhllzed for the location of a replacement soil absorption system.
The replacement area should be. protected from cistrubance and compaction and should not be infringed upon by required
setbacks horn existing and proposed structure. lot lines and wells. Failure to protect the replacement area wNl result in the neied
for a new soil and site evaluation to establish a suitable. replacement area. Replacement systems must comply with the n/leri in
effect at that time.
❑ A suitable replacement area is not ava table due to setback and/or soil limitations. Barring advances in 1i technoi a
holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been evaluated to'dentify a suitable replacement area. Upon failure of the POWT S a soil and site evacuation
ihust be performed to locate a suitable reptacerneri area. if no replacement area is available a holding tank may be installed as
a last resort to replace the failed PONTS.
Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infi!tra--live
surface Reconstructions cf 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 DIFGICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER PONTS MAINTAINER
Name
Narrie Phone '7y Phone -/j
_ r-rT
SFPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY AUTHORITY
Name _
Phone ~~J [ l/ Phone - 6
rh:s document was drafted in cornpl:ance with chapter SPS 3e3.22(2)(1;i)(')(d)&lf~ and 183 54(1), (2) & (3), Wis.-orrsm Adrnlnisrr We Code.
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ST. CROIX COUNTY
SEPTIC TANK MAFV'FLNANCV riCiRP.F,I~lI 0
AND
OWNERSHIP CEiCflFICA FR N WIW $FN 1 2 Zpl$
Owner.•13uyer / , -
iviailing Address 5/
Property Address .1 1 L'
ui'ica ton acquired (tam I'lanmue rl•. Guning Department fol new crntsutlchon.j /
7
City,'Slale_ Parcel IdentificationNulaber O oar
/_n?
LFGAI, DESCRIPTION
c
Property L)atGotlSCj 2'?N Itt-~ W, Town of
777
Subdivision _ F,np n Lol
Certified Survey .Alap # - V( ]little Page k
Warranty Deed # Q 1(7 t? 3 V'oiumc Page"i
' -
Spec house yes :u Lot ;imp identihab.c yes no
SYSTEM MAINTF.NANC'E AND OWNLIt CERTIF)C ATION
G:tpruper use :wd nraauenancc of your septic system could i"ith m its pr,miature failure to handle wastes. Proper
nwirnenance consists of pumping out Iho septa :a nk every three years or snirecr, a needed, by a licensed purrrper, Wbat you put iu(r)
the system can affect the lhnclion of the septic tank as it treatment satgc in the wasie disposal systcnL OWner mamtcnance
responsibil:ues are spt:c:_ted in Wonun. 8352(1) and ci Chapter 12 - St Croix Co mty Sanitary Ordinance,
'The property owner agrees tit submit to it. Ciom County Piantm:g & Zon ng Department a c'crtdlcation form, signed by the
owner and by a uraster pitrrrtber, jonrneyrnan plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
was!ewater disposal system is in proper operatirm condition and,•'or (2) after irtspcc,ion and pumping (L! necessary), the septic tank is
]css that 13 fail of s]udge
i -v, the undersigned have read the above reymrcim-iii: aed agree :u :nnm Gaut the private sewage disposal system with the
shrndards set frnTh, herein, as set by the 1)epa'Z1ren1 w COnmlelce aa. Qnc Dapartir'-w of Nutu: al ResOW cee, Stale Or Wisconsin.
Cernfrcation sorting that your septic syite:u has been atanvanicil must be, comp;et_:d and returned to the St. Croix County Plaarwg &
Zoning Deparaneut w;tl.n 30 days o! the. three y r expiration date.
Uwe cu:tit' that all stalcmen LC nn s futin arc true to die best of myrour kuowledge. Uwe inniace the owner(s) of the
ptouerty described above, by vii fur. of a w• anty riecd recorded ur Register of Dec.'s office.
V
Number of bedrooms"
1UNATURE OF :APPLICANT(S) ~ DATE
-"Auy wrintna ion tha: its nas.,quescated nwy result m the stritary pei nut being wvoked by me Planning & Zonrmv, Deparr ncnt....
Include with lius app;ication a .corded warranty deed from the Registcn A Dceds i.iffice and a copy of the certified survey map of
teference is made tit the .warranty deed.
(REV. 08/05)
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Wisconsin Department d Commerce SOIL EVALUATION REPORT r Page / of 3
Divis,)n of Safety and Buildings
in accordance with Comm 05, Ws Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inches in size, Plan must County 4 Oto/ Y -
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LD.^ (O
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. v / UUCP
Please print all information. Reviewed Date
Personal information you proaup mpy be usod for wcurWary purposes (Privacy Law. S tfi 04 (t) (ill)) '1/ dJ l ~J
Properly Owner 1 Property Location
~l1,,~, L.lll-6 Govt. Lot SGJ 1.4 t)uj V4 S 3U T~ q N R! E(ur)
Property Owner's Address LnLti BlockD d. rmaWd Acr"f'S
City State Zip Code Phone Number ty Village
Nearest Road
"t 1,01 •Y-lOl IP 0 ) 10-6 ~3f m vmon c( I / -D =7 s7 /
New Construction Use: M Residential / Number of bedrooms Code derived design flow rate 71S-Cl O U GPD
Replacement TAI Lj Public or commercial - Describe:
Parent material r - Flood Plain elevation if applicable it.
General comments S Y 34-C W\ f I tJ • / 9 /U x
and recommendations: 00 ,l r c(n~ 5itJ• 9`d• r,,a~.
L.o 9kso
ring Q /
Haring 10
F 71 I
It. Depth to limiting factor
® pit Ground surface elev. _96 9G Soil Appll,at:on Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bdyndary, Roots 01);fR
in. Mansell Ou. Sz. Cont. Color Gr. Sz. Sh. `L-f F#1 'E'1#2
fZ O L- ill LIY)~ rn r' rS /V~
/Z-73 ilo t h/ Sir 2.m. bk
Boring # ❑ Boring
® p;t Ground surface elev. C76,7-0 it. Depth to limiting factor w in.
Soil Apolication Rate
Horizon Depth Dom-.nanl Color Redox Description Texture Struclure Consistence Boundary Roots GPDtfP
in. Munsell Oil Sr. Cont. Color Gr. Si. Sh. 'Eff#1 •Eff#2
3/z. s; / ZrnsbK n rr s i
z -3G k/ 222 Yl r ~
Filluent 111 = BODY > 30 < 220 mg;L and TSS >30 < 150 mg'L ' Effluent #2 = ROD; < 30 nxl/l. and TSS < 30 mgrL
CS I Name (Please Pont) Signature CST Number
/ cicl c_h makel-
Address Dale Evaluation Conducted Telephone Number
a3 T'`5~_ CTIe 5ef !~)l "`(in ~7- 7-C) (;is)zy~ yao '
- QRI1-Rite r,!!,'!:nn,
Properly Owner Parcel lD#_ Page 2- of
M Boring # Boring
Pit Ground surface elev. ~ 3 8. Depth to limiting factor _ P in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMI
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
~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 GPD4F
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Cff#1 'Effti2
Boring
F] Boring # pit Ground surface elev. -ft. Depth to limiling factor in.
Soil Appl
icauon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ GPDrfP
in. Munsell Ou. Sz. Cont., Color Gr. Sz. Sh. 'Eft#1 '[ff#2
Effluent #1 = BOD, > 30 < 220 mgIL and TSS >30 < 150 mgrL ' Effluent #2 - BUD, < 30 mVL and TSS < 30 mgIL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in all alternate format. please contact the department at 608-266-3151 or TPY 608-264-9777.
son s~~~~,a r2co~
t
property Owner _ _J4 014 Parcel ID II Patio 2- of
❑
p Boring
0orirg I~ 7rj
L'f Pit Ground surtaCO elev. _r n~J ' f1. DepUr'o limiting factor In. Sul: F,p ~hwhcn •!a:e
Horizon Depth Dominant Color Redox Descnphun Texture Structure Coasisleneo Boundary Roots G°Oi!F
In. Munsell Ou. S2. Cont. Caber G,. Sz. Sh, '=ffdr 'F19r7
' 0-1 JCS, 2. Si % ~Z;1C tr c < j
Z 11-3 10v r` A 5 _rr~ShK. r C-
3 y / r/~ L'2f'75 7 `~f.rr, Y)~ri - c
❑ 0oricg q ❑ Dcang -
❑ p;t Ground surface elev. N. DepUt to Ilmliing factrr In.
Soil AppfcaCOn Rate
Horizon Depth Dominant Color Redox Description Texture Struclue Consistence Boundary Roots GPD/N'
in. Monsull Oa. Sz. Cont. Cc'cr Gr. Sz. Sh. 'E"l 'E,ffg2
Borng 8 E] Boring ❑ pit Ground surface elev. r. Oaplh to limiting factor in.
Sell AppliCOGCa Ft a:e
i-onzon Depth Dornivanl Cc of Redox Desalptlon Texture Stmcune ClasI*Ivvice Boundary Roots GPDifF
In. Munsell Cu. SL. Cunt Cclur Cr. Sz. Sit, 'EllRt 'c'10a2
' Ef%Lnt p1 = L'OD, +'W < ,2U mr,1 and 'I "SS 130 < 1$1) rmrvL "F'11.!eu42 = BUD. < 30 rg+t..anG TSS < 30 n-~pr'!
The Department of Commerce is all equal opportc:11ty service pcavidel aad eu:ploycr. If you need assistance to access services ur
aced material in an allcmatc format, pkase cunlart drr. eep:n!nlnn at 608-266-3151 or TTY 608-26447'?
Sill) -IM(FQ,."
PAGE -S 01;
NAME'S i 1,O'1'# I.EGAL D! ~(:RII'TK)N Sw L'o4 'N.& I E(or
scnLe: I"= ~C ~
BM I FLEVATION Z~f.c c
T
BM I llfCCRIP't'ION /o P o j / . 41C
BM 2 ITINATION a-SS
SO
SPG.
BM'DESCRIPION le, oI pvr-
SYS EMELEVAIION
SYjl'IiM 1Y1'li tllU~nul SrS ~t w~
CONTOUR ELEVATION y F.06
v
ti
0
Cj~
sue/ 9~da
c~
SIGMA"I'URI. DATE.
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