HomeMy WebLinkAbout040-1320-00-005
i.-.n>m l4p:n'r.rn'. of Cmm~amc
PRIVATE SEWAGE SYSTEM St. Croix
oa4Y,y ir";1 Cloild "P C> vi5ir^
INSPECTION REPORT sancai Permit r,u
GENERAL INFORMATION iATTACH TO PFRMIT: State Ian UNo 615320
P c•si: n a l IWor W,C you Finaide ,,1 ::•e 11, rxoo nr. al o..rptnos'O•vac: . ax,:: I` i0 'p,r
Perm: Ho hers%,i ',mlagc -crosho Parcol Tax N,,
Nick Jackson TOWN OF TROY 040-1320-00-005
t9 Vt i Ica mq~ ? e. 9t.1 Oesc°.bn _ _ 5,,t aMTOxn RUn6e Va Ao
a 24.28.20.2152
TANK INFORMATION ELEVATION DATA
TWIF f.VANIJ .ACT-RFR CAPACITY SIA I-N P.S HI FS E_EV.
l ~
Septic Benchmark
Dosing C) Z All HIv1
crn _ ti~uv ~r..:~ q.lO ~ly.ao
.~k -E ~ t~,~ ~ ,7J II8•l~U
HoIrfing S:'•..t mla IZ`37 I~O-a`~'O
vl,l o.nirl
TANK SETBACK INFORMATION I L, IIU. jfj
'ANK It) WL LVrII LLU(3. 'vent:o NUrta.«e ROAD -t Inlet
Sept c 1 1 G 1 A I n I 7112 UI BoIIOm ~2- 01
"1 I V r- ~
::vts ny Headcutvlan. >
- f{ 107. li
r'reration Dist Pile
5 10-7.1 G
Ho ding Bol. System
701 nA 3 > 19.80 ~Ol i
L' ral Grade
PUMP/SIPHON INFORMATION L. I gyp.
PAarutactur: 1 Cerland :i:amr ~.k,, W.
tduccl \ur)Uer v' r/a'~ 2~ t.V`i~~ t UN~ 4.~1i Il/~ • to
TDH Lit[ I I Ficlion Loss J r Systerl l lean! TDH r FI - - -
J
FCroeman Lengthe 1 Cia -Z rl Dist o'6o _
.~C
SOIL ABSORPTION SYSTEM
BED:TRENCH Aidtn 7 Length rl I NO. C' PIT UIMENSIONS Nn of Fds nside Tin L'.: uid Copt-
DIMENSIONS 12 I CV Of C\ _
SETBACK $-$-EfIl TO 1`8. Oct' . lit; ',^:H L L.AKC:STREAh1 LEACHING Lfa^.ul_clu•e[ 0. j r o
INFORMATION ^ CHAMBER OR V~x/l 1- h L
TYPc Cd Sysl°'~ r I I, / UNIT N:., uer.
DISTRIBUTIONS STEM
Ilc I - M... if. ~j 1 U .r h.:io' x Hale Size x H L, t,Pacin; Van: to A:r intake
Pip
Lon,! . :La, Spacmy
SOIL COVER x Pressure Systems Only xx Mound Or At-Grado Systems Only
I:ePd 1' t Rcpt L cr xx Uep:O of x s d J :•x ituiched
ruc vrs No
COMMENTS: paGutle catle tliscrepen:des, pr:rsrrs puscrY., etc.; Inspection #1 Inspection #2.
Location: 783 cROix RIDGF DR Plow dtL
1.; All 8411 Des::nphon = y i f Per it - Vt U& J
2.; Bldg sever length = ~ it
amount or cover Li ~ I
Plan revision R ad Yes No
Use other side' 'is or add tonal nlcnnahan. ({~S / l / ~fIL( j1
Cattl I^s 's Signature Cor.. No.
lPWC
SRD6T1a lfi ?Ji: i
y_)C6
oro'"anreM ^r\ 1 l [ _i t nrny _ _ 1
Safe! and Ave. Box
2r. 11`. Washington Ave., N.O. ,1~2 L
Sanitary Pcnoit Numb, (ro be tiea m by Co.)
$PS ZQlg wtadlsor., *04 53707-7162
- i 153 2C)
Sarutar 1)~mit Application uunN wb, _
.n wrcan-c with 6Pa 3kt'1 in ,n r r:,ruf :h's rnu:rodeappr. W, 1 SL 1 ~05?)7=~
i" required ruv to ..h.a. un a am rt P=W NWc .AFpb a tram, fot tale owed pUWlS a:e suanin.a'.:u Prolrr .4kkesS ;n CiHarnt76~maiiing add sr
m.h:pamnort : Sai2h and Pr n ^aoual h.-rr ts. Parnu uvurtnaunr nw -nor iJc tax} be ucrd fa sc .'dary -
Z.npcau, and We Pr rails
LI Application Info, maooo PI a Pr nt All Informatfp~~~-- Ulf-
P:<T=Iy Crw= s Namc
t `Y Y
r wpem imnars blading AeMess
l ?'rrywn}' L.aatiou i f c 0 a
in', Stnm Zip C.'dc :
, hwx "i S m
~ _ 15 i
IL Type of Building Iuhc'ck all that applyl V- ? L(~ P i~• J
41, r : }amip'!TvcWn_- VavFic: ,,1 b......ams
ok koa Boo - L C
'~]i'ublic~Wnnnerc:al-)c~-.i.^.til.< '1
- C:cSathr C5 .
- ri CS M1f 4crt;ber _
L i State uww:l h thar c''
III. Type - k only one box on Imc 4. Complete line B if applicablel
System kep,.M.m,: Syse¢a L 'r..ur.:o 3- R fm:k Fr - .neat ~4r!v Jdlm Sh ztilix:roa to Exiaciog Syg:-. (neplaU,:
jl R.
aril N,cnew°I 1 : Par..v. Hsu ts'..n. k:nrora Pcfmle Nmnbv and -)ale Isau~
1 i .et~e nt I r usrr ❑ •'emvl f raga t \cw'
kc rc tcp r i a I Owns
ry oft UWTS Svslemr(:om~iopent Tln ice IChe _T hl - -
m LTC .n..a.d ,n v2Lnd -I Ftc. r <a L . nmd~
' -(iriu l hf.uv c:,: ~fsci,.tbl vua UM1fou.•rt-?i m, of sairg'IC sod
I i-.Idm r A [ <M J µ.n -I C u n ,1 _ ❑ Net Cs ¢v. Dni. ;expiain'._
1 DispenalTrea ent (re. (oformauun. -
h ny bleu T-;fc ) .-pb m y F c:)rydS Doycrs I lr r 4cyr..red isf Dty+e>,d area hop',. - ed 1. " .rm
17. Tank Infu - - q>n min 7 ta. z ul I b!s:mtvcr, r.• E' ~ -1
' (.a.x nq 'tilvtr. Jars
hew'an:. -~.;'Tsn.... ° V 3 _
♦at tx trulu:J: Twk - ` - - T-II
II RGipr n5tbdin Statement- L the uadcnign umc respnusrbrbry Ibr insGllariuu of We POW T-1 sbnwn ..the attached plans
t u m s Va.tw 'tut' - - cr S. mare - .P,1+fPR5 Vranbx 3us;uxs %wne N bcr
I I1Wnber S.AildfeC r;lUYe1•CUU Stae, Co
,
VIII. Counh Uepanment Use f Inh,_
opnvca r. szyat ~ '-sswn +enr S:ynaturc
LY. Cunddi s~~g a . E! ~CS str,C U^japl-xoval rl-t o_- I h
ji . R' C..trv~.~ eft
v:+per. .cell must all 4t2 s r, H_. e 3
~ ~
4S per mar3Semem plen ioe'I uv;llumbe
2 Adl aNl»rAl nlr,UrRrwsy m'ut vu r..a.rt: i:.l i C~
M PW Pprftw3 cxy".! ! ad-arse. J
- -ACCVCL vmp4v plain rep rLe ~.erem acd zoruu ro<r_,unp ,.I, ue Panes :r<.~ k-> than s 1 ] ::wLC. m .uc
PItO.IEC'r Nick Jackson System PLOT ITAN
ADDRESS 39T caale 3luP 2,our. H-dson Wl 54018
NE 1;4 NE 1145 24 -r 28 Nrrt 20 \r'rOtVN Trot cntrNTY ST CRCIY,
SYSTEM ELEVATION 919.0' S~3l.9
BEDROOM 4
nnTu
CONVENTIONAL AT-GRADE )OOC CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE .255 gallons LOT TANK SIZE DOSE I.ANK SIZE 765
HOLDING TANK SIZE LOAD IL,ITr .E ABSoiIPTION AREA 1000 a or chambers
BENCHMARK \'.R. P. Top of s.lroey iron -
ASSUME ELEVATION 100' Filter Lifetime Filr,r
❑BOREHOLE WEI,L •II.R.P, same aeoencn--ark
2eB' Property Line
Croix Ridge Drive
Well is to meet all ~NDNR setbacks
Property Line
f IJficGL Combo
Tank Property Line
i
Pro 4 Bedroom
House 4 -4
Area 15 below system is i;; re:nair undisturncd 5-5C
15%b Slope I I I B-5A
Grading is tc )a done to diver: I I
412' Property Line run-o!* a% ay from systern `
3-56 I B.M.'
921'019 917'
r
-K, CIVISION Or INDUSTRY SFWICLS
2331 SAN L UIS PL
GRDDN DAY WI 543C4-5211
0 S . Contact Through Relay
PS hllp:uesps.wi.gov/progranis+indus9y-sew COs
vnvw %viswasm.gov
Tony Evers - Governor
Dawn Crim - Secretary
%tay 6, 2019
CON DI I IONAL APPROVAL
PLAN :APPROVAL FAPIRhS: 2021-05-06 i AND
RvtG£S
Plan Review: PAVES-0519005}7-C
S
SI1:1I_.A R BIRD
1.112 120th St
New Richmond W1 54017
SITS: Nick Jackson
Lot , C:oi-. Ri.._:
l o"n ofTroy
Saint Croix County
I
Total Amount: 520.00
At-Grade Component Manual - Ver. 2.0. SBD-108 4
l\.03 07• R. I!12i
Pressure Distribution Component Manual Veer. 2.0,
S110- 10706-11 1N.11I!O 1,R I0121
Deveriprion: 600 GPD (4 Redrown%-:Verv Comiroclion)
\1ailLe1una: Rcu1li1e,1
'I he cuhminol described above has been reviewed liar conlirrtntntce with applicable \Visconsin Adntinisliatice Codes
and \4'isconsin Statutes. 'I he submittal has hecn COMM I'IONALLY APPROM). Phis syslcm is to he
constructed and located in accordance \vith ;L•e elclosed x!proveJ plans and with any component mmllaalls)
referenced aho\c. I he o\ener, as defn;:d irl 101 .01i ]lot. \V ixonsin Sitowes, is responsible Ibr compliance
with all :.ode reyuirenens.
\o person nlay engage in or work of l-,limhil:" in (kc star. vdess licensed to do so ny the Departine-11 per s.145.00,
stall.
I lie lallowing e\» naitions shall be met during crmslruoion or installation and prior to occupancy or use:
• Presenr dispersal area prior anJ Junin, cons-.rue:on to avoid disturb-once, compaction and use (11,01C site.
T\ ith new construction; it is recommended not to ncliv,rte the pump in the dose lank until the tanks are
pumped prior :o hunieomier occupancy.
•
\Vaslewater generated from contractors cleaning of cquipmenl and tools ands or left over construction
products shall oI b: etch n'ged in the drains drsch wing, to the private onsitc wastewater treatment spstru
i pOR I S1 \%asle •ecm.ra\d shall h p.opM) haposed of o-n site or off site
• \np tall grasses, leaves and shrubs shall he cut sltorl and rrcmoved prior to tilling the surlace. lix insto0al.o❑ to
prc\en manirg under the dispersal area. All loose organic material to be remoucd frorn doe POW IS Dispersrl
m:a.
• Prior to construction of the dispersal area, check the moislure content of the soil to a depth W'S inches.
Snnearing and eon:aacting of w'et soi. wih result i I reducing :he infiltration capacity of the soil. Proper soil
:nuiNlur~ runte:11 can be dOernI ined I,v rollia_ so:I sample he,seet the hands. If it rolls iruo,t 1:A- inch wire.
tine site loo ,set to prepare. If it crumble.. Nile prep aatioil can proceed. If the site is too ,oct to prepare, do not
proceed until it dries.
• Divert surface water Font POWTS Arco.
• All piping shall confirm to SPS Fable 384.30-3 and SPS Table 38.1.30-5
• Insulate building sewer beyond 30 feet per SPS 38230 (11)(cl
• Tank Installation it, tbllm% all manufacture's recommendations.
Pump I- mats In be scl and I erilierl per approv c•d plan. \ns shames nay result III puogl resi>ill; to meet
I IAI and (:PNI ~pecificatiuus.
• Vcrify pruper(v line(s) priur to installation.
• Well setbacks to meet chs. \R 811 & 812.
• Arr.n that ate ocnipied t I roe 11.:re..m.. Is • root':. lttunrs,md 'ould. ~ IcJur- I.W .m.:•unt of soil
~i L: 1 _ 'q':r I '.ircit_ I[ It.'. I ie~ 'i do. vor.;n Il~c i~.~:al ,aN.a a.l ue <i •vedr rxasl be a.-::;T
IN Ir.r A i.aecr III nI u'. of tl i,•n ic n ,a.. •rr:' I 1d:
• SPS 383.54(1)(e) The management plar. Ior a POW S shall specilicaCy address the servicing mechanics of an
aerobic or anasobic ircamtent tan:., or a kilding tank %Owre either ul'the tbllov,ing conditions csist:
I . I he bosom of the tank is located more than I feet helow the elevation trhere the Nero icing pad is located.
2. 1lie bovonn ol'the tank is located more than 150 feu horizontally front olierc the sen icing pad is located.
Owner Responsibilities
• -fhe current owner, and each subsequent menu, shall receive a copy of this letter including instruction; relating
u, ;'roper use and nnrnlc mace ul'Ihe Nstem. O,enms :hall receive a copy of the appropriate operation and
• rn umenance manual and or owner's manual for the 11OW TS described in this approv- l SPS 383.54(1).
In the evenl Illu sail absorption cyst ~m or any of its component parts malfimctions sot to create a health
wm/ard. the property m\Eel, mu]t till lmr lire cor:l:mcncy 1) !an as cescrthed in the approved plans.
A copy ol'lhe approved plans, specilication% and this letter shall be on-silt during conslruetion and open to
inspection by mithori/ed rcpli.c a tires oftllc Deparu t •nu whist may includ local in.~..;aors. A:I psml:s
raµ.In•d by the st:dc or the lose nn.aic:I. olity .hall he obrame:: Arlo- to a?minuumcm o
eun.h uet iolll i Ilslal!at ion!operat ion.
Ili graining this approval the Division of Industry Services resrrovs the right to :oquire changes or iddilioa> show,t li
conditions arise making them necessary liar code contpli;nuc. As pa: sGac tau I01. 121'_'1. nothing in this review
shall relieve the cosigner of the responsibility fo:' designing, a sat, building. structure. or component.
Inquiries concerning this correspondence may he made to me an the telephone number listed below. or at the address
on this letterhead. li
I he above loll addressee shall provide a cop) of this letter and the POWTS management Plan to the toner a:Id env
others who are responsible tier the installation- operation or maintenance of the POW I S.
Sincere];,
171311 ia1/t.- 81e.11
I kin Vander Lecst
Private Sewage Plan Rev ieaer . Division of Indusu'p Services
(920)492-2214 , Mar Fri. 6:00 a.m. - 3:30 p.m.
ItU :u1:.a Cl' i Cpl tl V1 L u„ '
it
l
Cover Page
PROVED
- f,`.FF.TY AND
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date:5/1/19
Owner:Nick Jackson
Location:NE 114 NE1/4 S24 T28 N,R20 W Lot 5 Croix Ridge Drive 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)
Paged
1. Cover Page
2. At-Grade Plot Plan
3. At-Grade Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7. Filter Specifications
Shaun Bird
Signature__
License numb 226900
Page 1 of 9
System PLOT PLAN
PROJEc`I' Nick Jackson ADDRESS 397 Eaule Bluff Court Hudsor. Wi 5»016
NE 1/4 NE 1;45 24 I'r 28 N/It 20 W TOWN Troy coLNTv ST. CROIX
SYSTEM ELEVATION 919.0' 5;3,19
Dn'rE T1F:DRUOM 4
CONVENTIONAL AT-GRADE )00C CONVENTIONAL. LIF"f HOLDING TANK
MOUND SEPTIC TANK st"/.E 1255 gallons LIFT' TANK SIZE DOSE' 'T'ANK 517.E 765
HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # or chambers
SENCIINTARK V.R.P. Top of survoy iron
AssLrvu; ELI•:vnTtoN uw' Filter Lifetime Filter
❑BOREHOLE O WLLL "ll.R.P, samoasbenchmak
Croix Ridge Drive 289' Property Line
NJell is to meet all WDNR setbacks
Property Line
Huffcutt Combo
Tank Property Line
Pro 4 Bedroom
House B-4'
Area 15' below system is to remain undisturbed B -5C
15% Slope B-5A
Grading is to be done to divert
412' Property Line run-off away from system
B-58 B.M,*
921' 919' 917'
~ 1 i /
At-grade System Sloping Site Cross Section and Plan View
y t-------------------------------------
E i
tl - - - - - - - - - - - - - - - - t UimensionTlrect
A
1 /L
I _
1
1 B
J
E --1-
116 B
1 C
1
I
~.0
I
I
E
5.0
i
L t i._: 1 I F 0.5
~ II I
W
-
- Plowed .1a = Clean aggregate
basal area I in. sch. 40 fwe
L-,
t, . to 2 'm. dia. observation pipe
Lateral with Topsoil Cap
aggregate over pipe /
Geotcxti!c - - Observation Pipe
Fabric With Cap
_
.i:: t. v _
"topsoil Ca
Contoar i:.l;:::•..:.,
Slope Direction t
GENERAL INSTALLATION: The at-grade area is staked out along the desigl contour. Existing
vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a
moldboard or chisel plow. Plowing ma}' not proceed if the soil is wet enough at the plow depth to
lorm a V, 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 backhoe. Special care must be used when
placing the aggregate to minimize compaction of the plowed surface. After 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.
111 03J05 Igj j
y~ Page - Of/
Pressure Lateral Layout
One Lateral Lnd Manifold
4 Threaded
Cleanout
Force Main Lateral Turn-up Plug
L Long
Sweep
90
Bend
I Yressurc System Construction
Distribution Nchvork S ec fications J
Lateral Di ureter _ Z_ In. Laterals are constructed of Schedule 40 PVC
Orilice Diameter ~
L I Pipe. Orifices are drilled perpendicular to
X (Orific acin _ In. the pipe with a sharp drill bit and face down.
Lateral Length) Ft. , Lateral turn-ups terminate with a threaded
Force Main Diameter -I- In cleanout plug and are enclosed in a 6-8 inch
Force Main Leneth ; S } diameter lawn sprinkler valve box accessible
from finished grade, -
• • • • • Grade • • • • • • • :.may • • • • • • •
6-8 Inch Lawn \
SprinklerVahe
Box
03/05 lgj Page
of ~
Septic-Dose Wank Cross Section And Pump Performance Specifications
Tank Manufacturer -
tf t1JU _ Lump Manufacturer it -
I'nnk Mvdel Numherj~ - _1 I Pump Model Number 7
/ - -
Total'I'ank Capacity r 5 S L '-7 for I Alarm Manufacturer
'Bury p~~ 1111 i Alarm Model Numher
Switch T'---/y/}
Fdtcr Manuft ettuer l 1i --1 Total Dynamic Head ('IDH) - Feet
j Filter Model Number
Lievation Head
' Uisuti Pressure ~
Network I vss
Minimtun Pump kerformartce Required_ Force Main boss
(iPM -~S,--1 t TI)H~ Tbtttl
Outlet Manhole Min. 4" Above Grade With
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade
t1t
< 6" Below Grade Settled Waterti T t Securely Mounted With Locking Device\J1
\
Weather-proof
- Finished Grade - Junction Box
Vent Min. 12"
Above Grade Disconnect
With Vent Cap Means
Outlet Filter
Inlet I y- -Inlet Baftlc
9wrtch Settings and Reserve Capaci TA
fy
Cane Volume
_ Weep
mension InchesVultane (jai.
Di (reserve) B Hole
(dose) C I 2 Off Elevation C
T_ 7. s n , Ft
(dead)
Bottom
row
D Elevation
C.'ENF,RAI, INSTALLATION:
The
manufacturer's product approval sep[icJdose tank is bedded and back filled in accordance with the
be exceeded without sp. Mda le Maximum depth of bury as specified by the auutafacturer may not
prior approval. Manh hole covers ex m to grade have an installed. Piping at the inlet and outlet is of a
laid on stable soil to prevent settling or sagging taneffective locking device fittings and
Pproved material, connected to the tank with watertight fittings,tank
extavaticn and the sleeve is sealed watertight. Hi force main plies sleeved with 4" Sch. 40 PVC to bridge the
02/05 IJ and
fShtElectrical Electrical serve complies with NEC 300 and Comm 16.28,
Page ..-J ol~
280-SERIES
112 hp Submersible Effluent/Sump pumps
The Liberty Pmvklos a cost effective "mid-
range" pumwaste water systems, liquid Performance Curve: 2&)-series
waste transfer and commercial heavy-duty sump 40 12
applications that pump
require higher head or more flow. 35
Designed around Llberty's unique "Uni•Body" casting, 30 - 11
the 280sedes win Provide years of reliable Performance. d 9
All Models Feature; 120 25
8
• Vortex style impeller permitting passage of solids ~N 6
UP to d 15 S
• 416 stainless steel rotor shaft = 10
•P 3
emlanertUy lubricated upper and lower ball bearing 5
' Epoxy powder coat finish - 2
• All fasteners - corrosion-resistant stainless steel 0 0
• 1)4" Discharge 0 5 10 15 .S 20:25 3D 35 40 45 60 rr 60 65 70
• Stainless steel bottom screen Gallons Per er Minute
aeon-easily removable ---i--i--~~.~
• Maximum fluid temperature: 14(' F. 0 38 78 114 156 192 226 270
280-series card Lengths Liters Per Minute
Model 10, 2s t.2) 35, Dimensional Data:
260 ~
standard 0 tional optional OpU.y wo19hC 291bs. Hel9ft 13'
6tandard o+>e! Optional Optioriy Mayor V dth: 10" (model 287)
moo- al ---Optional WA
2a-7 standvd dntionm -W-A-wA - ""mum Sump Diameters:
10•cordlanpthetanda,,,,, nW o_FOroptlonal lengths, Model 281, 283...14'
add'-2, 3 «d" ol2 to rtwdd nu mmber. Model 287 VMF...10"
Fxampkr, ler rnotlN 280 with 35' cord. order 00-3
Factory switch Model 281, 283 Model 287
MotorSpecircations settin s Mod VMF
Y. hP 60 Hz 3450 RPM Turn on level 13"
Turn off level 9.
Oil filled, thonnaily protected
(PSC) Permanent Split Capacitor
8.0 amps (1 1 tha he tto tai reawree a hYN ad
5V) T ha dcl &i 2 ju-1sWe Mde glo float D'merentw
4.0 amps (208(230V) can feat
made charga pipe or other Gaa* by tact-i lg the float to the dis-
adj amble ng Point Ver6oat float model W7 Is not
Model 280 Model 281
Manual, Wide angle n Model 283 Model 287
no switch float switch Wide angle VMF-8sriea
with quick- float switch Vertical mag-
disconnect with series notic float for
(Piggy-back) smaller pits-
plug will operate in
a 1
0' diarrleter
a sump it
co
c US Certified
sw..+"em....mr a a..v"rowu<mm.
uGerty Pomps • 7000 APP/e Tree Avenue • Baryon, New yord 14416 • Phone Boo__
43.25M Fax 5) 494.1839
www.llbortyprrm pS. oom
C-P`O1euh•rt PwrP 1 -2017
All rgf-neewd LLn 2000 ROM7
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - of
rILE INFORMATION
Owner SYSTEM SPECIFICATIONS
Oen er# LJ Septic Tank Capacity_
.-,.L~.-- al ❑ NA
Septic Tank Manufacturer
.)ESIGN PARAMETERS C _ 0 NA
Effluent Filter Manufacturer NA
Number of Bedrooms
_ O NA Effluent Filter Model otlel ❑ NA
Number of Public Facility Units
_ ;"A Pump Tank Capacity ❑ NA
Estimated flow (average) T al
y~ G gaUday Pump Tank Manufacturer C C {yNA
Design flow (peak), (Estimated x 1 5) , C' aUda Pump Manufacturer
Soil Application Rate _ & I 0 NA
-____gaUdav/ft` Pump Model` RNA
Standard Influent/Effluent Quality Munlhly average- Pretreatment Unit
Fats, Oil ii Grease (rOG~ 0 m /L
9 ~ Sand/Grave! Filter ❑ peat Filter
Biochemical Oxygen Demand (SOCs) 15220 mg/L ❑ NA
O Mechanlwl Aeration ❑ Weiland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection
Pretreated Efluent Quali --I ❑ Other
ty Monthly average Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) 530 m L ❑ NA
g' ❑ In-Ground (gravity) O Mound rid (pressuhzed)
Total Suspended Solids (TSS) ~0 mglL ~-NFy At-Grade c Mound
Fecal Colifonn (geometric mean
S10° ctu/tlbml D Drip-Lino 13 Other.
'Maximum Effluent Particle Size/~ in dia. NA Other.- -
Olter. ❑ NA
NA Other
:J NA
'Values tmica' for domestic wastewater and septic tank effluent at
- -
C NA
MAINTENANCE SCHEDULE
Service Event
Service Frequency
[hispect condition of tank(s) At last onto every: 7 month(s)
?a_ ears (Maximum 3 years) ❑ NA
p out contents of tankO 6 ~~Whon combined sludge and scum equals ono-Lnirtl of ta tank volume
NA
ed dispersal cell(s) ~~.-At least once every: ral r(s) YS4ear(s) (Maximum 3 years) ❑ VA
n effluent finer At least once every: n,/ronlh(s} -
r4 year(s) O NA
nspect pump, pump controls 8 alarm At least once every: year(s(~) q NA
i=lush laterals and pressure test
At least once every o t at ear(sjs) _ tNA
t (east once every_Year(s) MAINTENANCE INSTRUCTIONS
tnspectons of larks and dispersal tails shall be made by an individual carrying ore 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 identfy any missing or broker hardware, identify any cracks or leaks, measure (tie volume of
combined sludge and scum and to check for any back up or poncing of effuont on the ground surface. The dispersal cell(s) shat be
~✓isuatty inspected to check the effluent levels in the observation pipes and to cheat for any pending of effluent on the ground surface.
The ponding of effluent on the ground surface may incicale a failing condition and requires the immediate notification of the local
regulatory autncrity.
AMhen the combined accumu.ation of sludge and scum in any tank equals one-third (h) or more of the tank volume, the entire contents of
he 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 fillers, mechanical or pressurized components, pretreatment units,
tend any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
4 service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page _ cf
START UP AND OPERATION
For now censtructon, prior to use of the POW T S check treatment tank(s) for the presence of painting products or other chemicals theft
may impede We treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of this
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at Pie infiltrative surface.
During power outages pump tanks may fill above normal hlghwaler levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the ce'I(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 Soplage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Malntalner 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 with it
15 feel 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 pro:ong the life of the POW7l3:
antibiotics; baby wipes: cigarette butts: condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) water: fn.it and vegetable peelings; gasolne. grease; herbicides; meat scraps; medications; oil; painting products;
oestlcides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails antllor is permanenhy taken out of service the following steps shall be taken to insure that the system is propefly
and safety abandoned in compliance with chapter Cemm 83.33, Wisconsin Administrative Code:
• Al! 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 properly disposed of by a Septage Servicing Operator.
• After pumping, ail 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 taker., to provide a code compliant
replacement system:
❑ A suitable replacement area has been ovMuateci and may cc utilized for the location of a replacement soil absorption sysleyn.
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 ruler) in
elect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding lark may W installed as a last resort to replace the failed POWTS.
The site has not been evaluated to Identify a suitable replacement area. Upon fahure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area, If no replacement area is available a holding lank may be Installedl 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 infiltrative
surface, Reconstructions of such systems must comply with the mles in effect at that time.
<<WARf,l
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 POWTS MAINTAINER
Name\(t, 1~ t a ' Name
Phone Phone
SEPTAGE SERVICING OPERATOR PU ER) LOCAL REGULATORY UTHORITY
Name Name l ,
Phone/lJ Phone -
This cocumenl was drafted in crxnpliance wdh chapter SPS 383.22(2)(b)(l;(d)&(f( are 383 54(1), (2) &;3). Wlsconsur Admn natrarve Code.
I
N4smrain Depa,bned ofCmnom ) t1 E1lALUAIIQN REPORT f,pa i d 3
Dretsm orse" and mAd+ns I "
In omm 85. Adm.
~b ST. CROIX
A > K eR PAW nQj 3m ram. 0
ir~cl,de. but poi i:,red eo: wni®i and na;ronim Point i rurcW fo.
Oercad slope, scekadtn,valap,rprU, arr ow, nd distanatone Mad. S
`C~%CCU,Vr~
Please pAnt all I rmaf70n. Re M Gate
vr.a as+a w rwa. n .r e...w a.«~.a.r w v..ssl S 17 0
PmpMyOw Property Location y .a • z/s ❑ ❑
BOMAR HEIGHT'S, LLC (Buyer: Brum Llnm n Ifornes) Govt Lot - NE IX E 1a 24 T 28 N 20 E (o0W
•al"M1O-^•i 4n-i' W'./ii1i1ip_`° _ot f Block I Su6d None or CSW
6810 Brookhill Drive 5 - (Pending)
SUIe eirjQgg
20 Code, NuMa LF&Y ❑v"Je own Nearest Road
Salt Lake City, UT 84121 1 NK South, Cove Road
Q NewComevgbn llm0 ReerOaraiel!Nunbwolbrvboorm 4 Code dernmd design lbw rat 600 GPD
(U] Replaoamra -n-i'0tri wDe:
,.a metarW till Food Plat, elevation N applicable NA t
ymr b Bofi+-y,\ clt%pLk'cw. CmZt IIn-ground mcb. 0.6 ading me I
old borm.
!~`"Y- J~<~At~ l~.~CeU{~!~ Sr(Fi~/ P.~Q JO.~ipv~ /N r/ ~ r~OA GO A#OCi / L
5 v1C~ v~JO~ N4JC 12-
O-GOJJp~J J ✓~~(L 7Z~4/
lkvay f O
E) Pit Ground Wfdea elev. 17. R Depal to Wnifing factor 50 " R
WAvokslon Role
Horton Depth Dorn►wrd Redoe Dcsalpaon T-1- S Sr Consua rre Bourdary Rook
o_ We ou. Sz Cart cola Gr. Si Sh_ 'Eflf1 'EM
I 0.5 IOYR2/I - sl 3fgr8abk mvfr rs 3vfco 0.6 1.0
2 5-18 IOYR2/1 - sl 2f-ma&.sbk mfr
_ ci 2vf-co 0.6 1.0
3 18-35 IOYR3/3 - sit 2fsbk mfr cs 2vf-co 0.6 0.8
4 3540 7.5YR3/3 - sl 2fsbk mvfr lvf-m 0.6 1.0
5 40.50 7.5YR4/6 - fs Osg dl cb - 0.5 1.0
6 50.
B ❑ RatK1
g Pii dfsune lu m e18v: -914.x.. A: Dull 1e InMatO low - Q _ h,
Horlron Depth Domturv Redex Desorption Tmmre Seivaae Comatenca Boudmy Rona GPDAC
h Muoea Du. St Can. Color Gr. Sz SA 'Fall 'EM2
1 0-6 7.5YR2.5A - 81 3fgr&sbk mvfr ci 3vtoo 0.6 LO
2 6-20 IDYRy1 - sl 2fsbk mvfr cs 2vfco 0.6 1.0
YR
A53 LU-SV #100"
3/3 it lshk mtr .o u.a
4 30.5YR4/6 - 1s Ifabk mvfr cb lvf-m 0.7 I.fi
54 - - Isbr - - - -
EILa4M.EIOD >30<220 mgt and TSS>30<150 ng4. •Efb/era 82 =ODD 30 myL and TSS < 30 rnWL
CST Name "eel, m" / CST Numbs
maxy Jo Hollister
224832
44 6 (41
AdAi'es Dean Evsk" n Gunck.cbrd Tek pho w NurOp
B'9@75 OM Avenue, Kim Falh, W1 14022 11=17=03 (71;)426=1773
I
I
EOMAR HEIGI ITS, LLC (Lot S) pares IO t (Pending) paw 2 of 3
Proparb Oaar
C
Bong It I El pit Groudttataoselav. qiq-10 M. Depth a1 lla factor S2 ✓it Sol Appkmkn Rate Biv Hortaon D" DosiwtM Peter Redox Dama"on Tmmre
Structure Conbtence Bot►Nary Roofs - GPDW !i
Yf MWYA 9u U 6111,1 1, 4 fih. _ 1 10W
1 0-6 7,SYR2.5A - st 2f-msbk muff cb 3vf-oo ^ 0.6 1.0
2 6-18 I YR2/I It 2fa&sbk mfr ci 2vf-m 0.6 1.0
3 18-30 7.5YR3l3 sil 2fa&sbk mfr u 2vf-co 0.6 0.8
4 30-52 IOYR416 Is Ifshk mvfr cb 2vf-m 0.7 1.6
5 52- - Isbr - - -
Bodrpt 1 'Borkp
u Urn _ _ - Sol Irotign Rate
Hgisat Depth Donsnra cow Redox Deagiptron Texsue Sl ugwe . Carm+stentoe BotadatY Roola GPDm
inj ssu sel tau. SL coat color G. SL Slt '001 'EW2
Bodrg
Pit Gra'nd slafeee obv - fl. Depth b Yrilan.7 hgor in.
F-1
~ ~
$d Avokabon Rate
IIMmn Depth DaNwa Colo, Red" Drglsban Teztrse Structure Canter ce n0u darY Row GPQffl
in, Afisool Do. SL Curl Color Gr. SL Sh. 'Eta1 'Etp2
i
F.Mera t1 • BOD.> 30 < 220 mgVL ad TS.S >33 a 150 myi ' Eflsrtns 02 • BOD, 130 nv& aM TSS 130 mg4
he Department of Commerce is an equal opportunity scrvioc provider and mployer. If you need assimarnce to acceu services or
neat materiel in nun allmmue format, ply contact the department al 608-2W3151 or TTY 609-26048777.
Sepn)eralgoigm
I
Plot Plan for Cove Ridge Page 3 of 3
Town of Troy, St Croa County, Wisconsin
CREV~~b: a,-IS-L•L,
Lot > ISoft
Legal Description 1,1404 of n~ I~eYu s 2ft contours
74n1 0 = Backhoe pit
O~
X00 li
JT I
cO,
BENCH MARK:
TOP OF 1 1/4"
RON PIPE
I
1:918.33548-
15
5 ~d
SCALE:1 "=50'
E 91 .1u
I: 91 . 7.
N Q A
n-srs
BENCH MA K: 1' 14.1
TOP OF 1 1/4•'
RON PIPE
Wiscansin Department of Commerce SOIL EVALUATION REPORT
Division of Safety and Buildings Page of
r accordance with Comm 85, will. Adm Code
County
Attach compete sae plan on paper not less than 8 1f2 x 11 inches in size. Plan must ✓ r
include. but not limiluo b: vertical and horizontal reference point (BM), oirerxon and parcel I D `
percent slope, scale or dimsroslons, north snow. and locator, and distance to newest road C)-6 I z V " )0
Please print all Intormation- Roviewad by Date
personal Nfenr,arier, type p~vvroe msY ov v+.a la sawneyy WreMes (prrvery law, s. 15 0/ Il l (m))
PmOenY filer Property Location
rV ! l-L L Go 11 Lot J 1l4 / ~ 14 S,2. J T ~.'3 N R Z-0 E (or III
Pmpemy>B/s Mailing Address Lo Block a S or CSkef
J 7 star JAN yea
_ n
'p Code Number Q city Q VMage own N sl Roao
Cc~0 ( ) 7a, lp 6
Ccnebucaon U, osdential f Number of DWnba11s Code den esign Am rate 0
101 Replacement ❑ Public a commercial - Descnbo. GPD
Parent material _2b6a Flood Plain elevabon if a__
GaMra1 ovnmenls ppliwble _/>!__LLr 2
MW reoon allandaeons.
System Type p
System Elcval.on_.,/-, Ov-
Baring a g Boning
❑ Pit Grouts aruhee else. Depth dfirretrq factor la_
h.
Horizon Depth Dominant Color Rodox Descrlpion Texane Structure Consistence Boundary Roots Sal P~ Rate
In. Mtnsetl ou. St. Cant, color Gr. Sz Sh. '
0-/ / l /U' r L •Eaaz
6 6
6-' 7.s,
Baring a ❑ Boring
❑ Pit Ground svface elev. ____A Depth to limiting factor in.
Horizon Depth Dominart Color Redox Deeariabon Texture Structure Sod lotion Rate
Cortsistorae BorxWary Roots GPO/fP
Monsell cu. Sz. Cant color Cr, Sz. Sh.
'ERat •Eaa2
El fluent pt . SOD, > 30 < 710 myL and TSS >30 < 150 _ • Effluent p2 • BOO- < 30 ng/L and TSS < 30 rrclil
CST Name (Please Print) ure CST Number
Bird Plumbing, Inc. Shaun Bird 226900
ACdrCs3 L~l Date F. va'uation Contluded ?elopnce Number
1432 120th St, New Richmond, WI 54017 S'-~l~ 715-246-4516
ST. CROIX COIlN1'Y
SEPTIC TANK MAINTENANCE AGREEMENT
AND
` OWNERSHIP CERTIRCATICN FORM
Owner/Buyer
Mailing Address , p-
iT Z0. 3 ~rau , Fr,~
Property Address (Vcr&=tion requited from Planning & Zoning artment fen new construction.)
City/State _ Parcel Identification Vuryber _ Q - /3Z0 - - Cp S
LEGAL DESCRIPTION
Property Location ~F. Y. Stx(~ 2 N R,?-OW , Town of' J
Subdivision Lot
Certified Survey Map # Volume Page #
Warranty Deed # Vahunc Page #
Spec house yes no Lot line identifiable ryen~,t~ no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Iproper use and mamtenance of your septic system could result in its premature failure to handle wasbes. Proper
maintenance consists of Pumping out the septic tank every three years or sooner, b needed, by a licensed pumper. What you pm into
the system can of bd the function of the septic tank as a treatment stage in the wasir disposal system. Owner maintenance
responsibilities are specified in §Cbffin. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
the property owner agrees to submit to St Croix County Plaiming & Zoning Department a certification form, signed by tho
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 puffing (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe, the undersigned have read the above rcquuemcnts and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the DLpartm=t 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 Deparwent within 30 days of the three year expiration date.
I/we certify that all statements on this form arc true to the best of my,`our b aowledge. Uwe am/are, the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Dcotis Office.
I
Number f bedroo
I / ~
SIGN OF APPLICANT(S) - J DATE
"•Any mformatio is misrepresented may result in the
sanitary Perm it being revoked by the Planting & Zoning Department
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the cattfied survey trap if
reference is [Wade in the warranty deed.
(REV. 08/05)
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