Loading...
HomeMy WebLinkAbout024-1029-40-100Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)] TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Die. Dist. to Well SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SVHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDrrRENCH DIMENSIONS Width Length No. Of Trenches PR DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type OF System: P/L JBLDG IWELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dla Length Dia Spacing SOIL COVER x Pressure Svstems Only x Mound Or At -Grade Svstems Only Depth Over Depth Over m Depth of xx Seeded/Sodded xx Mulched Bedrrrench Center Bedlrrench Edges Topsoil Q Yes Q No X Yes Q No COMMENTS: (Include code discrepancies, persons present, etc.) Location. 258 CTY RD T 1.) Alt BM Description = 2.) Bldg sewer length = • amount of cover = Inspection #1: Inspection #2: Plan revision Required? 0 Yes A No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctors Signature Can. No. ety and BuiJungs Division County"Wiscons St Croix AY 2 8 MOI W. on Agsm e., P.O. 7162 Sanitmy Pemlrt Number (to be fillyd in by Co.) Department Saf and �12 Professional S 'ces st. croix C unty ant a State Plan I.D. Number POWTS-052000913-C ak mmun State Sa ermit Appii8. In accord with SPS 38121 (2) Wis. Adm. Code submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note application forms for state-owned POWTS are Pm1tMs�dn r mailing address /d'1�� er 4 I T submitted to the Department of Safety and Professional Services. Personal info lion you provide may be used for se in accordance with the PrivacyLaw, s . 1)(in), stukA I. Application Information — Please Print All Information 4-g2iiW6 A) Property0wreer's Name Lee Jacobson CLYo£ '� Awlic q-ow-o soN Parcel N 420da9-yo,l•d Pmft Ow°w"s Mailing AddesT1_7 Qw-++.� Q.C.. Property iuwion 1850 County N Gon. Lot NE Vs N E Y., section 21 City, Stale Zip Code Phone Number Baldwin, WI 54002 715n60-0652 T 28 N/R 17 W Il. Type of Building (check all that apply) Lot p Subdivision Name X I or 2 Family Dwelling -Number of Bedrooms _Fora Block M city Public/Commemial - Describe Use CSM Number Village of X Town of Pleasant Valley State Owned - Describe Use In. Type of Permit: (Check fine A. Complete line B if applicable) A.70,titmewal em Replace is ❑ TreahrwoNHolding Tank Replacement Only ❑ Other Modification to Existing System B. nsion Change of ❑ Pemdt Transfer m New List Previous Permit Number and Date Issued tion Plumber Owner f'_ _ 1 /� I 7 r /. IV. of POWTS System: Check all that apply) Is'l—N _ Non —Pressurized In -Ground Pressurized In -Ground _ At -Grade _ Mound>24 in of suitable soi omd <24' of suitable mil — Holding Tank _Other Dispersal Component (explain) Pretreatment Device (explain) r V. DispersaVirreadhatent Area lnformation: Design Flow (gpd) Design Soil Application Disposal Area Required is') Dispersal Area Proposed (sf) Systern Elevation 600 0.4 1500.Osq.ft. 1551.Osq.ft. 93.98' VI. Tank Info Capacity in Gallons Total Gallons Number cfunns Manufacnlua (''' �, gTp{aa,ry� d-- Prefab Concrete Site Constructed Steel Fiber Glass Plastic ©� New Existing T.W. Tanks septic or Holding 1200 1200 1 Weiser Concrete X Tank Dosing Cheaber 800 800 I combo X VII. Responsibility Statement- 11 the undersign time blliry for lesnllation of the POVM shown can the athtehed planer Plumber's Name (Print) Plum MPlAtPRS Number Business Phone Nttmbtr Kent Hoke 9 715/962-4155 Plumber's Address (Street, City, State, Zi ) 200 Bremer Ave., Suite D. Colfax, W1 54730 Vill. Conn /De artment Use Only Approved ❑Disapproved Permitt Fee [Date Issued Issu' g Agent Signature ❑ "Gi for $ffSCF f ZOZO Dent "#(1 R fZApprovs /Reasons for Disapproval 7J) ig I Ad 1. Septic tank, effluent filter and ' coke — dispersal cell must 4g_serviod I mount@fined 41�t tn� _ _ _ ` rw by as per management plan provided plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. (y Rjw.6dr D raves S Much moPIMC pram tie the a:onsry omY) rime aYa P a .w.m a..n o...... to aeur 1c*K SBD-6398 (R. 01/03) NE,NE,21,28N/R17W Pleasant Valley township St. Croix county LEGEND 1 BM: 100.0' center of X within orange painted circle *pApits , contour No DSPS 383 setback problems Scale I" — 40' except where indicated System Elev. 93.98' on contour 92.9" SITE PLAN 8 �CQp1t 93k�t �j g1 d 2" M tU eS-) 1. Ail L/L}100,4?0+s�S trio kc :- =_ - I, project: JACOBSON �c IC O r *4 page 10 of 10 PROJECT. ,lac�b so„ — 1-1&r n mavwl . DATE: TIME; INSPECTION TIME: COUNTY'§ PHONE: TANK TIME: Materials: PH: vr,13a s— Sf45 May 22, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-05-22 Plan Review: PWTS-052000913-C Loretta Larrabee N2089 Cnty Rd Y Menomonie, WI 54751 SITE: Lee Jacobson 258 County T St. Croix County Town of Grow NEY.-NEX-S21—T28N—RW FOR: DN610N OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 Caead Through Relay hdpJhN*.wi.gov/WoVamsWuabyaervices www.w onwn.gov Tony Even - Governor Digialy signed by Joshua Rowley DN: C=US, Joshua Rowley �e�1ue�@wLe&n�, Over, 202DA6.22 11:39:35051W Description: Mound Component Manual — Ver. 2.0, SBD- 4 Bedroom Mound — 600 GPD — 10691-P (N.01/01, R 10/12) Replacement - 23" to limiting factor— Pressure Distribution Component Manual — Ver. Effluent Filter - Maintenance required 2.0, SBD-10706-P (N.01/01, R. 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders e The mound site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. e A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. 0 Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter isrequired. • A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a con,, of this latta, M. ners shall also receive a copy of the appropriate operation and maintenance man (s) a ;ible for ensuring that POWTS is operated and maintained in accordance w :his chappter an ie approved O'OWly signed by Joshua Rowley management plan under s. SPS 383.54(1). DN: c=us, Joshua Rowley E-jWhua.roxby@wis nsin.gov, • In the event this soil absorption system or any of its component pa mal owe 4A0�02j7A&%ggoa health hazard, the property owner must follow the contingency pl; is described in approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ,%MhUa11?0U Y Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)813-9111 Joshua.rowlev@wisconsin.gov Private On -Site Wastewater Treatment System (POWTS) Replacement resident system Mound and Pressure Distribution Component Design Index and Title Sheet Conditionally APPROVED Project Name: JACOBSON DEPT. OF SAFETY AND PROFESSIONAL SERVICES Owner: Lee Jacobson DIVISION OF INDUSTRY SERVICES Location: 258 County T Legal Description: NE.NE.21.28.N/R17 `__mgtatRaned WafflftMey Township/County: DN: C=US, Pleasant VJ& t p1rRCM1EqY CN S.rOSTa ley," is nsin.gov. Date: 2020.05.22 11:38:35-05'00' Contents: Page 1: index and title. Page 2: general inform � `;_ _ 'am Page 3: mound drawings Page 4: dose tank Page 5: pump information Page 6: septic/pump tank detail Page 7: septic filter information Page 8: management plan Page 9: contingency plan Page 10: site plan Designer's name and license no.: address: phone: cell: e-mail: Attachment: soil test to state plan Loretta Larrabee license# 1872-007 N2089 Cry Rd. Y Menomonie, WI 54751 715/664-8184 715/505-1628 lanloerctestingeawt. net Designer's Signatu�%_ /Y May 19, 2020 I the undersigned submitted these plans under my authority Mound component manual for POWTS Version 2.0 SDB-10691-P (N.01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) page 1 of 10 g 6008a1 4.0"0% n DWF 0.4 soil. system yea GENERAL INFpgIKATIpN PPLcatio 1200/8 tg g soil facI coin tmore �� co 82 ser tonk septic filter Lateral do laterals 4 Lateral Lateral spacing (P) 46.2 511 Manifold2 didia g (S) 3.25ft' Force main dia. 1 !/2 in. Zo im 9.0 1.62' (191/2") i Miect: JACOaSON di center spelsfal� llstetn w/4laterals linear rate ell es�8n 1 orifice o&Im9rate 1.0 et}lcen WX 7.89 quality #1 LATERAL LAV OUT DIAGRAM Ceater Fed System `** seepage 9 of10 box - of to scale) 0WWnr s Rowle t�loshu""sgw Joshua P.,Y 5/.. �CM�a��,qy�y 0**@wmco sm go., 30in. f2`l W�_06� 11 3935 os p0 19 10.23gpm Mis Construction for tum_np detail finish grade S 3.25' orifice Joshua Orifice e iSce '.ngX) orifices Per lateral lateral di total syste Ike rate m tale F.----- P Orifices loc ated on bottom of lateral Y Lam Orifice next to fitting Fomc main 2" dia. ftezofl0 PLAN VIEW OF MOUND (not to scale) A = 6.5' D= 1.08' (13") J = 6.5' required bed 600sq.ft. B = 94.0' E= 1.39' (16 3/4") I = 10.0' proposed bed 611sq.ft. F= 0.83' K = 9.0' required basel area 1500sq.ft. G= 0.50' W = 23.0' proposed basel area 1551 sq.ft. H= 1.00' L=112.0' observation pipe @ 9.5ft. W 23.0 ~� QK Finished grade elev.95.78' Lateral invert elev.94.48' Observation pipe �. 6 DN:C=US, 0xx5 Joshua Rowley CWJ;� RM sea' ♦— L-112' Mound Cross Section View (not to scale) Dispersal cellelev.93.98' - - 4 dispersal cell = 2" ------ - --- Or -lateral — --- -- - --- ----- ---- - Aggregate bed 6" --- --- --� - ---- - - - --- - - - -- ---- ----- --- --- --- --- tilled layer Numeral Key 1 topsoil cap 2 subsoil cap 3 ASTM C33 sand 4 synthetic cover over cell 5 aggregate Closet flange secure observation . Rowley H — D - --- ---- --- --- -- tilled layer contour site slope elev. 92.90' 1.5ft. I0.5ft. 4in. dia. observation pipe with 1/4in slot project: JACOBSON page 3 of 10 Septic/pump combo cross section (No Scale)rt ri .Approved Locking Manhole CoverWith Warning Label Attached 4Weatherproof ApWarning label Junction Box 1pcK�Wq„ v �mum e-\ , 'I Quick 18" Minimum oa.i s,.aw�"11aaGpnnect Jo u - Ro D►t c leyE s. ".mw*@M�s".9oV. ua s• 1 /4" Weep Hole Baffle Approved Joint 1 ' r V/q"---:40 Pipe 1 A Extending 3' Alarm Onto Solid Soil On 61, B Approved Joint w/y' SdW ll" 1 C Extending 3' Faev. 7, C ' Onto Solid Sed Off 61 r. Conc. Block 3" of Bedding Under Tank wnt.- Pump and Alarm Are On Separate Circuits 207e owe — ze, Cr' Tank Manufacturer: r-SE i�.�nc kcf t 'A. 44 c s, kSM,� 133.9 Tank Size-Septic/Pump: 12-- / scn Gallons Alarm Manufacturer: S.T' hornb� 5 e«w p� Model Number: NSF ,i Capacities: Ate^ inches or'/y`/BcGallons Switch Type: C-he.,,l + B 2, inches or�q Gal l ons Pump Manufacturer: -:11-W ,V-\,N + C ,5 inches or It1.2JGal Ions Model Number: SE - So A _ _ + Dom_inches or;-; « Gallons Minimum Discharge ate: 40 GSM Total ..... = winches or j?t c Gallons Vertical Difference.Between Pump Off and Distribution Pipe:10,)O feet gaV'j' zz. z Minimum Required Supply Pressure:.?,A3 #:.:3 5 ..... ........y feet Feet of Force Main x 4,lk friction Factor/100 Feet: +3�1 eet 2 Inch Diameter Force Main Total Dynamic Head:...=ISzoy�ee.t project: JACOBSON page 4 of 10 SE-50H Series 1/2 HP Manual Submersible Effluent Pump - High Head, 3/4" Solids 0 a x FLOW - UTERS/MINUTE 0 50 100 1s0 200 250 0 10 20 30 40 50 60 FLOW -GALLONS/MINUTE 9 Specifications SE-50H 16.0 14.0 Cons I1Ct4 "CaTplly siwW 6y Joshua Rowley SOS IRQ ey ENS.p. ec.I=b�u�s. "Iron "'> • l�I 12.0 Impelle itedal '.., oeb os2ytl Ipc Iron 10.0 W r Impelle T9 8.0 °a Volute Epoxy, Coated Cast Iron 6.0 Power Cord SJTW-A 4.0 Mechanical Shaft Seal Nitrile with Carbon and Ceramic faces Fasteners Stainless Steel 2.0 Shaft Stainless Steel 0.0 Bearings Ball Bearings 70 it 5 '3 lI D 82.0 atio 43 =�L O N II 4" C� A—Ig-M III II Woo it m TYP /� It C III � � f FILTER I I BAI J I I I I L •' J WLP1200/800-MR TANK SPECIFICATIONS DIMENSIONS - WALL 3' BOTTOM: 5' COVER: 6" MANHOLE: 24" I,D. PRECAST CONCRETE RISER HEIGHT: 5:" O.D. LENGTH: 10V O.D. MOTH: 96' O.D. BELOW INLET: 43" O.D. 4" CAST -A -SEAL LIQUID LEVEL 36" WEIGHT: B(1TTOM 14,800 LBS. COVER 6,170 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIP, SEE DETAIL #10 (OTHER SPATES SEE CHART) LIQUID CAPACITY: 33.46 GAL%N PUMP)) LOADING DESIGN B' 0" UNSATURATED SOIL s 0 TANK CAN BE WED AS: SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTA:/SIPHON O 4' VENT aJ1II COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESI(N #9 (SMALL FIBER) rl e CUSTOMIZED TA IKS: � FOR CUSTOM TANKS CONTACT WIESER CONCRETE IJ INLET — _ _ _ OUTLET � II 3tl PUMP PAD DRAWINGS SUBMITTED in SIDE VIEW FOR APPROVAL APPROVED BY: APPROVAL DATE: TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: W W C DO 0�DO u7 N r7 o I O Do r ra F 9 1z 1 OF FicuaE4. SIZINGButmEErr"hum These charts show the relationship between Biotube fitter size (diameter), design flow, and mean time between cleanings. The larger the filter and the smaller fire flow, the longer you can go between cleanings. For example, a typical three-year cleaning frequency would require an 8-in. fitter for up to 2,500 gpd, a 12-in. fitter for up to 5,000 gpd, and a 15-in. fitter for up to 8,500 gpd. Assumes a property sized watertight tank and residential strength waste. See Orenco document NDA-FT FT-1 for more information. 1250 a 1000 v 3 750 0 lL 625 C) 500 Z 0 375 4ii 125 0 Residential Applications -- FT0822-14B FTB1824 w--•-- FT0444-36 FT0436-28 FTJ0418 FTi-0418 3 4 5 6 7 8 9 10 11 12 Mean Time Between Cleanings (years) FT -Series Base Inlet Effluent Filter 8000 7000 0. 0171/l/ to v 3 0 5000 LL C 4000 fA 3000 m 0 2000 1500 1000 500 0 Commercial Applications FT fiu4 T254 DII: ad ._ _. a Rowley E"hua rowWy®wisconsin.gov, CN=Joshua Rowley Date: 2020.05.22 11:39:36-05 W 3 4 5 6 7 8 9 10 11 12 Mean Time Between Cleanings (years) FT Series Base Inlet Model NOMENCLATURE -14B�Options A = Boat bracket FSO = overflow plate Bast inlet model Cartridge height: 14' standard Housing height 22' standard _ Filter diameter (inches) 08 = 8' Blank = 1/8• filtration P = 1/16" Btiration Bictube effluent filter writs Mound System Management Plan Pursuant to DSPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with DSPS 382-384 Wis. Adm. Code. and shall maintain in accordance with the component manuals and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with DSPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes risers, access risers and covers should be im :ted ' ' 'ness and soundness. Access openings used for service and assessment shall be sealed watertight up the w...N,........ service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed a, ;s openTjsiiFr9d sr tIina>� !pYdiameter shall be secured by an effective locking device to prevent acciden or nautllp se oN: OUT I or component. osgua flow e`, E=joshuar ieygwis sin.gov. SepnCT 1 CN=Joshua Rmley The septic tank shall be maintained by an individual certified to service set tanks u0Yle?W.902M, ;38W.'W he contents of the septic tank she be disposed of in accordance with NR 113, W ` nde The. nne ng condition of the septic tank and outlet filter shall be assessed at least once every 3 years by ins_ The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slip off the filer when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personal shall advise the owner of when the next service needs to be done to maintain less than maximum scum and sludge accumulation in the tank. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings maybe made around the mound's perimeter and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since compaction may hinder aeration of the surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations dictate that the mound be heavily mulched as protection from freezing. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral and it is recommended that each lateral be flushed at least once every 18 months. When a pressure test is performed is should be compared to the initial test when the system was installed to determine if orifice clogging has occurred, if clogging has occurred orifice cleaning is required to maintain equal distribution within the cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner and any levels above 6" considered impending failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or components shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank or its components become defective the defective components(s) shall be immediately repaired or replaced with a component of same or equal performance. If the mound fails to accept wastewater or discharges wastewater to the ground surface, it will be repaired or replaced. Increasing basal area if toe leakage or by removing biologically clogged absorption and dispersal media and related piping and replacing components as deemed necessary to bring the system into proper operating condition. See page 9 of this plan for the name and telephone number of your local PO WTS regulator and service provider. project: JACOBSON page 8 of 10 Mound System Maintenance and Operation Specifications POWTS Regulator's Name: St. Croix County Zoning Dept. Phone: 715/381-4382 System Flow and Load Parameters Design Flow —Peak 600gpd Maximuminf ntP_.-._._ ._ 1/8in Estimated Flow — Average 400gpd Maximum BC 20 m gfL Septic tank Capacity 1200gals Maximum TS m u lr s igrwd by MVrr oN: c=uS, rn Soil absorption component Size 611 s ft.bed sir Po q• M�Eif Wa(Rowle+ , ua r-Joshm1ey@wiswNv CN=JoshuaRowley 5 Type of Wastewater residential Maximum Fe( : oliivnBple2D* 06.22" , Service Frequency Septic and Pump Tank -----Inspect and/or service once every 3 years Effluent Filter ----Should inspect and clean at least once every ] - 3 years Pump and Controls ---------Test once every 3 years Alarm ----------------Should test monthly Pressure System ----------Laterals should be flushed and pressure tested every 1.5 years Mound -- -------Inspect for ponding and seepage once every 3 years Other ----------------Initially filter should be checked yearly to determine service schedule Avoid surge flows of water. try to spread laundry throughout the week Avoid winter traffic such as sliding or snowmobiling which might lead to mound freeze-up Miscellaneous Construction and Materials Standards I . Observation pipes are slotted and materials conform to Table DSPS 384.30-1, have a watertight cap and are secured as shown in the mound component manual. 2. Dispersal cell aggregate conforms to DSPS 384.30 (6)(11 Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in DSPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration 6. Lateral Turn!W to finish at grade or above, enclosed in a 6-8" diameter lawn sprinkler valve box or similar product (lateral turn -up consists of a long sweep 90 or two 45degree bends same diameter as lateral) 7. Lateral Turn -up on end of distribution laterals after the last orifice. project: JACOBSON page 9 of 10 SITE PLAN NE,NE,21,28N/Rl7w Pleasant Valley township a s w iry i St. Croix county ^� LEGEND I BM: 100.0' center of X within orange painted circle ^its — contour No DSPS 383 setback problems Scale I"-40' except where indicated � to+1- ' System Elev. 93.98' Y }` on contour 92.9" s9.3a34 }iouu..Awk.6 ka 5soW-,Q °b ,sic, 93� g1 DighaRy ugned by Joshua R DN: C=US, Jw0a Rowley E-josh.. i-aawux vn. CNaoshua Raaney 4�• y,; d Date 202006Z 11:39:37 y r C -" "16,10 (IAsTMLbbS) 1— — trio A.-C 1 e .L- avt_ project: JACOBSON page 10 of 10 Ms. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Division of Safety and Buiklirlgs Page 1' of 3 - h, to a dunw whiz 5r, aw, vws. ,tom. lave ._... �^�� Attach complete site plan on peeper rptss than 8 1/2x 11 inches in size. Plan must include, but not limited to: venlcal and horizontal reference point (BM), direction and percent slope, scale or dimensions. north arrow, and location and distance to nearest road. Please print all information. Personal informaUM you provide may be used far secondary purposes (Privacy law, s. 15.04 (1) (m)). - - County o . Parcel I.D. Reviewed by Date Property Owner E- J Property Location r, Gov. Lot N G 114 N Ct/a S Z. j T 2-$ R (1 K(or W Property Owner's Mailing Address' (f' Lot 1 Bbo; 9 Subd. Name a CSW �o �1 --/-� City SWW Q tip Code Phone Number ❑ City ❑Ulage I Town Nee Road ROAV2 YN I VITI 54002k H'G Is) 60-06S l�� c �s V oN: ❑ New Canstrultion Use: Residential l Number of bedrooms N Code Ur 7 ��°Mg11ey@"" s'" gOV• GPD Replaceanent `� Public w currallerrial - Oesonoe: N . rq fMl 7 2020.05.22 11:39:37-05W Parent materiel _ �cdA.a.er_.a._� Flood Plain elevation if ar ^'^ N A - fL eecome and recommendauons, R 2. , and recommendations, him. ZS S T i Boring s 1�] Bores IEI Pit mound surface elev. 93, a R Depth to iirniung factor a in. Soil Application Rate Horizon Depth in. Dominant Color I Munsell Redox Oescrlpaon Qu. Sz Con. Color Texture Structure Gr. Sz. Sh. Boundary Roots IS g!2 -S a - `7, G M a6k 0 ' -1(v 7.6Y * S(c- 4.vvx. 1 Qjk S 'v ,b 3. Irv- ZSV r g e- a m (�r tndr S \vt -9 06 `l 2.4-3j '7,s le. 113 0 .7 S/ t 5 cl S. 31-yo 'I.SU'A 7S YR `4o`5/: S C, A•oZ Boring* ❑ Boring Pit Ground surface elev. 92,1 ft. Depth to fimiling factor a 3 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Desorption Ou. Sz. Cont. Color Texture Structure Gr. Sz Sh. onsstence 0ourIdary Roots GPM - 1 Rig -L- - O 1,5 3/ m a6K S If /, 0 a. ln.iR ri.SV `// c� f+ intr lo{ 3. I8-2.3 V�YR 1/-It -M(flr S 6 a, �. HE EMuem fit = BOD ,> 30 c 220 nryL and TSS >30 c 150 mg1L - Efterd 02 = BOO c 30 mglL and TSS c 3D ^r8& CST Name (Please Print)Signature CSTNuypty Address a Evaluation Conducted T Numbar tJZe 'tat. 4 I -�z� his �64 -818Y CARxhin la l III I 1 Property Owner Le-,(e- J0,toParcel ID 3So�1 # �Boring If F4�� 2�_ ' pit Ground surface elev" g. R Depth to lambing factor 2Y in. Page 2, of 3 . Dominant Color Munsell Redox Description Du. Sz. Cart. Color Texture Saucture Gr. Sz. Sh. insistence ndnnry Roots GPOMt M#1 11#2 t'-Ily sigrd 1J. DN:c=^ h C Q y WJ it NVoshua Ra DoMi2a2a. , 0,I.SYQ ti 9.54Ry/3 S 6 '�8 !� T t 5 u R eyl, amnsin. ley ov. ❑ Boring # ElBoring ❑ Pit Ground surface elev" M" Depth to limiting factor in. Sol peon Rate MIT Qu Boring # El Baring ❑ Pit Ground surfaceelev. M" Depth to limiting factor in. Gvl A�ivr •Ef uenl#1=BOD ,>30c220ng&andTSS>30 <150mA 'Eflkwt#2=800,<30notandTSS <30mgR The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format. contact the department at 608-266-3151 or TTY through Relay. 1BD jM),RrtH11 r Lee Jacobson NEB/4 NE'/4,S21T28N/Rl7 Pleasant Valley township St. Croixcounty G&"- CSTM224588 LEGEND i BM : 100.0' center of X within orange painted circle X — backhoe pits I - contour No SPS 383 set back problems Scale r- 40' Soil Evaluation Site Plan i IV & V il OWURy signed by Joshua R oy DN: C=US, Joshua RowleyE QN-Jush�s RaRley ns Dale' 2020.O5.22 11:39:37 X i x ql-.I UU QT.os.— _0 page 10 of 10 project: MAST ST. CROIX COUNTY SEPTIC TANK MAIN7ENANCE AGREEMENT AND OW NERSBIP CE•RTiFICATION FORM Owner/Buyer Mailing Addn Property Adds City:'Starr j&t/IUI477di Identification Number 6 i-�� r/- Z%-1,06 LEGAL DESCRIPTION Property Location .eXC.r�hr Salto t ieth Plat:_-f� v,A[6 i+,Sec_o2/ .T.29 NR 17 W, Page M Spec house Elym 1�Fm Lot lines identifiable ❑ MIAn" SYSTEM ,MAINUNANCE AND OWNER CERTIFICATION S1( Cro.K Cc), le 4 '0.z9z/ ) Improper use and maintenance of your septic system could result in its premature failure to handle wastes- Proper maintenance consists of pumping out the septic tank every three years or sooner. if needed. by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 353.52(p and in Chapter 13 - St. Cmix County Sanitary Ordinance. Tlhe property owner aerees; to submit to St. Croix County Planning & Zoning Department a uriifietuion roan, signal by the onacr and by a master plumber, jotune.man plumber, restricted plumber or a licensed pumper verifying that it) the on -site ,,Wt wvter disposal system is in proper operating condition andlor (2) after inspection and pumping (i F necessary), the septic tank is less then 15 full of sludge. Inrc. die undersigned have read the above requirements and agree to maintain the private sext'age disposal cyst mt with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources. State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Cmix County Planning & Zoning Department within 30 days of the Wee year expiration date. Iarc cerCfy that all statements nn thls form arc true w the best of my/our knowledge. Uwe am/are the otrncr(s) of the propeny %lc=ibcd above. Iry virtue of wananty deed rccordul in Register ofDeeds Office. \uub_erro ms S , ATURE OF APPLICANTS) DATE '"Any "'Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Dcpartmont. "' include w iLh this application a recorded warromy deed 8om the Register of Deeds Office and a copy orthe ecrdricd survey romp if reference is made in the %%- rmn v deed. (REV. 04/12) Parcel #: 024-1029-40-100 Valid as of 06/09/2020 02:59 PM Alt. Parcel #:21.28.17.180A TOWN OF PLEASANT VALLEY ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: Co-Owner(s): CLYDE S & JOANNE TR JACOBSON 1850 CTY RD N Physical Property BALDWIN Wl54002 Address(es): ' 258 CTY RD T Districts: Dist# Description Parcel History: Date Doc # Vol/Page Type 2422 SCH DST CROIX CENTRAL 1700 1 WITC 07/08/2004 1 768175 2612/059 OC Abbreviated Descriptio 3,5.000 SEC 21 T28N SE N EXC 1 SM 15/4134 Plat Tract (S-T-R 401/41e01/4 GL) Bkx*/Condo Bldg ' N/A -NOT AVAILABLE 21-28N-17W SE NE 2020 Valuations: Values Last Changed on 05/28/2020 Class and Description Acres Land Improvement Total G1-RESIDENTIAL 12.0001 16,300.001 87,800.001 104,100.00 G4-AGRICULTURAL 1 27,0001 4,600.001 0.001 4,600.00 1215-UNDEVELOPED 1 6.0001 10,800.001 0.001 10,800.00 Totals for 2020 Totals for 2019 2020 Taxes Taxes have not yet been calculated. Key '- Primary MAY 08 2020 -ji S+ WI Ws. Dept. of SafettlinciPmileg SOIL EVALUATION REPORT Divisiono Sa�.� �elopme-1 ance with SPS 385, Ws. Adm. Code County Attach complete site Plan I than 8 1/2 z 11 irlches in size. Plan must include, but not i Dotal reference point (BM), direction and Parcel I.D. percent sl r i r ow, and location and distance to nearest road. se punt all Wonnation. a by Personal intormadw you provide may De used fa sewndary purposes (Privacy Law, s. 15.61 (1) (mp. ST 2,02,0_ oil Page l-of �- o (C tp� , f /I W.�. D Property Owner L e Property Location Govt. Lot (: 114 N C-114 S Z j T Z$ N R n A(or OW Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# City State Zip Code Phone Number cl S to (lt5) bC-O s21 ❑ City ❑ Vllage Town Nearest Road ❑ Nev, Construction User Residential 1 Number of bedrooms 14 Code derived design flaw rate ReplacemM ❑ Public or commercial - Describe: ry A Parent material �aAaae-�� Flood Plain elevation if applicable General comments a -mo i,.7 0 , W and recommendations: Z. r 9 • 9 :. o O 3 r` GPD ft. ✓ �- Boring # Boring pit Ground surfaceelev. �s. a ft. Depth to liming factor in. Soil iwion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence 3oundary Roots GPD1i' ff#1 102 -L. 127 S YR a -l(c 7.5Y y/ St c mob v `Y 7,sy� 3 � � m r nr ' S. 3i-yo 7.SYR �/311 7 j YR o45/8 cj yv c >� ' Bowing # ❑ Boring x Pit Ground surface elev. 92,1 R Depth to limiing taclor 3 in. Sol Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ons'stence Boundary Roots GPD18 ' ff#i ff#2 r a6K S If O a. 10 18 7.a V y/3 c� rr 0n r Ilf al 3. 18-a3 7.�iR 9/yon. c, r in r QGS b 3-sb 9,54R"/4(Ij C7. - R b/o r �r Ffarwrn a1 = RCM] > 3n < 220 moll and TSS >30 < 150 mo1L - Effluent #2 = BOD • < 30 m32 and TSS < 30 mg1L CST Name (Please Print) Signature CST Nurrr w �o Address ate Evaluaion Conducted T one Number wzc 1)L 4 --1.6210 hts Gb4 -gt8y CRMRIA fRl 11111 Property Owner L.ec. Jckebo 3ovj Parcel 10# Page 2• of 3 . Boring # ❑ Boring 3 elev. 93.t/ ft. Depth to Nrriting factorT Sod Application Rate Horizon Depth in. sell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. nsistence Boundary Roots 1 1 GPDAt I ff#1 ft#2 qc, 4 13 W (f� it �e 3 1 -23 9.SYk V/3 sr, -Wr if Qj 1.0 ti. 2fr-32 9,SVK4/ Sy g tn�r ❑ Boring # ❑ it pGround surface elev. ft. Depth to limiting factor in. ❑ Pit Sod Acclicalion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence undary Roots GPD/fl I MW 02 ' Eftent #1 = BOD . > 30 < 220 mgA- and TSS >30 < 150 mglL ' Effluent #2 = BOD z < 30 mg& and TSS < 30 mg& The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SH04330 IR I 1 I I II 1 . A._J, PropertyOwner Lee J Q CZ"O %l Parcel ID# Paoe Z, of :3 Boring ❑Boring B 1 elev. ft. Depth to limiting factor �_ia. Soil Awlication Rate Horizon Depth in. I Redox Description Qu. Sz. Cord. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/R ff#1 ft#2 1. S i af3 r a - (Q 110 3//3 C -44,r w 1* 0,4 3 1 -LS u 1. SVQ Y3 / &}Sq -4y- ('F Cb (. �I. 2fr-38 9,S4941 S b "5/8 �ir ❑ Boring # Boring ❑ Pit Ground surface slay. R Depth to limiting factor in. god AqXrEcation Rate Horizon Depth in. Dominant Color Munsell Redok Desaiptlon Qu. Sz. Coal. Color Texhae - Structuie Gr. Sz. Sh. onsistence Boundary Roots GPD/ft Z NMI ft#2 ❑ Boring #n Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil ADDlication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh, sistenee oundary Roots GPD/R 2 ff#1 ff#2 `Efkmt#1=BOD s>30<220mWLandTSS>30j150nV1 • Mint 02=BOD a<30mg&and TSS<30mg& The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266.3151 or TTV through Relay. SONN330IRI 11111 Soil Evaluation Site Plan Lee Jacobson NE'/a NE'/a,S21T28N/R17 _ c Pleasant Valley township St. Croix county t- oretta taz abee CSTM224588 LEGEND 1 BM : 100.0' center of X within orange painted circle X — backhoe pits � - contour No SPS 383 set back problems Scale 1"- 40' 1va+ti ^1n.J.� I R All yL } lv0'4° 10 Arc- U. X- --A— vz.9 - project: MAST page 10 of 10