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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 3 of 4 FILE INFO'; A-1I N SYSTEM SPECIFICATIONS Owner •/e f) /�y►, . ( Tank Manufacturer: ❑ NA Permit# t' '` p-3eptic ❑ Dose ❑ Holding Volume: 85(j (gal) DESIGN PARAM ERS Tank Manufacturer: umber of Bedrooms: 0 NA ❑ Septic 0 Dose ❑ Holding Volume: (gal) Number of Public Facility Units: ❑ NA Vertical Distance Tank Bottom(s)to Service Pad:3 (ft) Esti ated(average) Flow: (gal/day) Horizontal Distance Tank(s)to Service Pad: 24 (ft) Specific servicing mechanics must be provided if vertical is>15 feet or Design(peak) Fl.w=(estimated x 1.5): G r6 0 (gaUday) if horizontal is>150 feet. Specific instructions to be provided on back. In Sit Soil Application Rate: a 6 (gaUday/ft2) Effluent Filter Manufacturer: gitn.o J ❑ NA Standard(Dorn ic)Influent/Effluent Monthly average Effluent Fitter Model: ft 515 F Oil&Grease (FOG) s30 mg/L Pump Manufacturer: Biochemical O. •en Demand (BODO) X120 mg/L ❑ NA g2-44A- Total •uspended Solids(TSS) <_150 mg/L Pump Model: High Strength Intl ent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 p 0 mg/L 'NA ❑Mechanical Aeration ❑Peat Filter ❑ NA (TSS) >150 mg/L . Pretreated Efflu- t Monthly average ❑Disinfection an Sand/Gravel ❑Wetland IY 9e ❑Sand/Gravel Fitter ❑Other. ((oos) 0 mg L PICA Absorption System Fecal C•iform(geometric mean) s104 12.1 xa//round(gravity) ❑In-Ground(pressure) ❑ NA •Maximum Effluen Particle Size '�in dia. ❑ NA ❑DriGrade ❑Mound Other: ❑Drip-Line ❑Other. Other: ❑ NA Other: - ❑ NA MAINTENANCE HEDULE Se ce Event Service Frequency Pump out conten s of tank(s) hen combined sludge and scum equals one-third(36)of tank volu e ❑When the high water alarm is activated �j EF qdd►r/o N�4L TnlSt eo Inspect condition of tank(s) At least once every: ❑ ear(s)S) (Maximum 3 years) ❑ NA [t�-9ear(s) Inspect dispersal cell(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NA � Fr:}-years) Clean effluent 9ft r At least once every: ....e tn(s) ❑ NA 3 M-1/6r(s) Inspect pump,pu p controls&alarm At least once every: ❑month(s) ❑ NA ❑year(s) Flush laterals an pressure test At least once every: ❑month(s) NA ❑year(s) Other: At least once every: ❑month(s) ❑ NA ❑year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall:be made by an individual carrying one of the following.licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 he local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (f6) or more of the tank volume,the entire contents of the tank shall be removed by a Septage.Servicing Operator(pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of<12 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) •