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008-1057-30-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safely and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m)] David Pettis TANK INFORMATION TOWN OF EAU GALLE TYPE MANUFACT RER QIi CAPACITY Septic 2 ' Dosing f � Holding TANK SETBACK INFORMATION GOf-kS e- %L&%,r I TANKTO /L WELL BLDG. Vent to Air Intake 9ItDosing JROAT)Septic Aeration Holding PUMPISIPHON INFORMATION U4 ()jf pr 07 JIl Manufacturer G )j r{ &,G r 1 Demand GPM Model Number R '} / l�Dl TDH LJt �S Fria ; Lgss Sf-ysternjiead TDz Ft Forcemain Lent V7 t Dia.2 7-Dist to Well 7 SOIL ABSORPTION SYSTEM ELEVATION DATA County St. Croix Sanitary Permit No. 624993 State Plan ID No Parcel Tan No 008-1057-30-100 Sectionfrown/Range/Map No 19.28.16.285A STATION BS HI I FS ELEV. Benchmark '7 2 J lo7r iii Alt BM ro 01 7-o a5.3 Bldg. ewer U ` n 91, `� I St/Ht Inlet nr J Si Outlet Dt Inlet Dt Bottom Header/Man. 1 �� Dist. Pipe 5, Joi,y Bot. System / Final Grade St Cofer' r 7.Z loZ• 1 Con�O�r 7.3 l oo Cc�Lr• r,u�,�„Id BEOITRENCH DIMENSIONS Width , Length x 7 yp_OL.Trernhee ir11s PIT DIMENSIONS No. Of Pits Inside DaLiquid Depth SETBACK INFORMATION SYSTEM TO IP/LW BLDG WELL LAKE/RE LEAC ING CLEAC ROR UN Ma factures Typ ,q g $DV m �6 , I t 5 5 , Model Number' U15TRIBUTIUN SYSTEM Header/Manifold Lengih�0i— IDistnbution (I I ,. Pr+ eogth)�•3 Die / Z spacing �- x Hole Size .3 „ 16 x Hole Spacing 2- L Ve(f�)t to Air Intalke- ✓�Si• SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Ae- Plr i 1,- Oerytir6ver--- en AL / q y 1'O k IDepth Over ed/Trench Edges xx Depth of Topsoil I s t J xz Seeded/Sad d Yes No xx Mulched V Yes No mot, - -- .�I [-] COMMENTS: (Include code discrepancies, persons present, etc.) Location: 2180 20TH AV -Er 1 1. ) Alt BM Description = ! 2.) Bldg sewer length = 151 - amount of cover = 7'q - Inspection 91 flo0 %/ Z I Inspection u2. I q:W /Q B Plan revision Required? [,' Yes i I No I Use other side for additional information SBO-6710 (R 3/97) Date Insepctoes Signature Cert No e A A I �. 4 n_ 7) f In E LE��vy I - - Industry Services Division County 0 MAY 27 2 2t 1400 E Washington Ave T. �a0/X nary PerNumber (to be filled in by Co.) PermitMadison, '•';,,- P O Box 7162 S St. Croix u WI 5370 t•� 7 2 - j inment j amtary Permit Application ction NumMx In accordance with SPS 3832] (2). Wis. Adm Code, submission of this form to the appropriate governmental unit �Tolmu p r pW l.r,is required prior to obtaining a sanitary permit. Vote: Application Forms for state-owned POWFS are submitted to the Department of Safety and Professional Services. Personal information be for Project Address (if differem than trailing address) you provide may used secondary ✓ u oses in accordance with the Pnec vLaw, s. 15.04(1)(m). Stou- W /so a?O ram' uE. 1. Application Information- Please Print All Information Property Owner's Name Parcel 4010 &Tr/S �� 669- 657- 36-166 _ Properly Owner's Mailing Address Property Location 6 3 93 78 rN S i r Gow. Lot NE SeS /,, Section 19 Ity, Slate Zip Code Phone Number / , l Z,4ki!U/Lt Ef 5501/V /z/V T a8 N; R /((curl.l. on. II. Type of Building (check all that apply)- Lot x ® I or 2 Family Dwelling- Number of Bedrooms c7 I Subdivision Name Block ❑Public/Commercial - Describe Use # ❑ City of I Stale Owned - Describe Use CSM Village or Nlumbertlil.Z _ ®Town of EAu 17,411E ^°C t• 7 IQ �^ Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. Ncw stem S y ❑Replacement System ❑ TrcatmcnUHoldmg Tank Rcplaecmcnt Only ❑Other Modification to Existing System (explain) B. Permit Rmcwnl ® Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS Svstesu Com onenUDevice: (Check all that apply) — ❑ Non-Pressu ,,,d In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound> 24 i . of suitable sod 9 Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component xplain) I _ Pretreatment Device (explain) V. Dis ersallpreatment Area Information: Design Flow (gpd) Design Sod .4pphcaf Ra dsf) Dispersal Area R fired (s0 Dispersal Aria P oposed (sf) System Elevation _ 3oo / 0 0. 300 300 /O o S /o7.�'% /do.ocd.rraretl VI. Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units rk-'dK-0 v o9 Ncw Tanks Ell" une Turks p D Io4u, u Y gyo 1 L/iESEc Ladc<. Scpnc or �_'^�T�rt Syo - DoiinK Chamber 500 — .J 60 � Lo/rrdo t' VII. Responsibi6h' Statement- 1, the undersigned, assume respor 'billty for igAlation of the POWIS shown on the attached plans. Plumber's Name (Pont) Plumber's igna MPlMPRrg Number Business Phone Number �/EN r Welxie, o?.?y/ 9 9 7/5 911- 1//5 ' Plumbers Address (Sweet, City, State, Zip Code) IS4X /oi in1FOX/CJr SY730 VIII. Coon /De artment Use Only W Approved ❑ Di roved Permit Fee Dale Issued Issui¢ Agent Signature ❑ (),site von Rcas Denial S 90n---/u/�Z r IX. Conditions Approv Reasena-fariaappravel 3) K-�1/U51 9n'6 f f YSTEM OWNER. �^ �^ 1 Septic tank, effluent filter and � �t ?--� dispersal cell must be serviced / maintained � ^'�'� 5 as per management plan provided by plumber. �� 00i, plans for the system and submit t the County only oa paper rat less than a firs x 1r inches in sire as per applicable codelo��i'rf rSo�c�°' y) PLC -(Z- fillu /l k sap- w •a+I =e t SBD-6398 (R- 08/14) 5_) A.J / y- p._4 Iw OSr�> l ctn2 r,.., 4elp WI Ili, )GYO/ -'73 'nr/ fa7 yn°1 no7 0'00/ ry t' /o/ -''3 .rUs s1"d 71"111, S6 x t /,- 7r37 x 78610 F y3S31� ,o 0 77 q u k °4 �pelr �060% ✓rl p -07 r,oy71Y r3r7vq "Y7 JO `9 M71`NSl°`6/3S`F :fnd rl oY OS/t' -S/113� p,nYd JY*l sdS 71N N 1v7 3yfY0� Jvpf �avv7_x `il/d = q I o/ yr O i,pb d VIOU p3Nj Ve pe ove Td d " RECEIVED D 9,1 `Sp MAY 2 7 2021 S e ST. CROIX COUNTY CDD May 17, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-05-17 Plan Review: PWTS-052100986-C KENT HOKE PO Box 10 Colfax WI 54730 SITE: David Pettis 2180 20th Ate Town of EAU GALLE St. Croix County Total Amount: $250.00 FOR: Description: 300 GPD Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay httpa/dsps.vA gov/programshndustry-services wwwmisconsin.gov Tony Evers - Governor Dawn Crim -Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES t/ 'LA.2l4.I,4 Gf/.A�ICI.f SEE CORRESPONDENCE Mound Component Manual — Ver. 2.0, SBD-10691-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 to accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 1 OL01(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: • It is rec o m mended 10 I, oce oil dkovisaI area prior and duri., .,lion to amid dislnrhanee. compaction and use of the .ill. • NN ith ness construction, it is recommended not to actisate the pomp in the dose tank until the tanks are pumped pi for to homcross ner occupancy. NA astessater'enermcd from conh'actors cleaning of equipment and lnnls and'01' left oser construction products shall not be discharged into the drains discha r;:,mg to the I)iisale onsite sits l cssater Iry atnlcnt sy stem (I'( AN TS). NN asle genermud shall be properh disposed of on -site or oft site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet sod will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • It is recommended to cut as short as possible and remove ground cover prior to tilling the ground surface for the dispersal area. • Remove and maintain woody vegetation on or near the dispersal component to minimize root infiltration into the dispersal cells • Electrical connections shall comply with SPS 316.300 and NEC 300 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewers beyond 30 feet per SPS 382.30 (11)(c) • Well shall be located 50 feet from drainlield and 25 feet from treatment or pump tanks. A copy of the approved plans, specifications and this letter shall be on -site dunng construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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. Inquires 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, r/ 7nr f.G liflaV&e) Travis Wagner POWTS Wastewater Specialist, Division of Industry Services (608)598-0715 travis wal wLQOI, RECEIVED MAY 2 7 20 V p _ APPLICATION FOR REVIE*T CRON COUNTY CDi; Private Onsite SP ' -complete all pages- Wastewater Treatment S _ NOTE Personal information you provide may be used for secondary purposes [Privacy Law s 15.04(1)(m), Suitst Systems Division of Industry Services ❑ Plans io be F_filcd G....aw,, cw___r,_:_.. •_ i _ - --- • _-•�� •- ==�vv �r maser name oelow. i For plan status, check our website at httnJ/dstu yA ooy ! Email technical code queslions to 1ta:OSPS56PcwtsTlechOM LSeveral counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those counties and their designation check our websi a at h`n /(dsas wi.aov 1. Project Information -Fill in all known information. Confirmation of assignment to a rernewer. PmjecUSite Name: DAu1A IE rr/S Transaction ID: Location, Number & Street of pmiect (f unkrrovm, indicated nearest road) Previous Related Trans. to: p41 TS - Q 91no/%B%' G AJE Estimated Completion Date- Legal Description: rVCC SE /4r dB N, //a y/ Assigned Reviewer: 1 Count Y T. �,fo a< I (_l GtY [_l Village rail Assigned Of -rice: _ Town of F,lu G,IILE ( 2- After plans are reviewed, please: (check all that apply) you: office cf GhaEca bebr�: LaCrosse, Green Bay ❑ Call customer 1, 2 (circle number)` ❑ Requesting party will pick up - NOTE We reserve the right to rrWistribute plans to another office if needed to reasonably balance turnaround �} Mail plans to c1J5t0me6 2 (circle number)' times- Check haa:lldsos.wLecy for next available review date -Refers to customer number from below. i 3. Complete ihe`miowing designeriowner/requesting information. Ddr¢e the check boles when Castanet, owner or requesting party is the same to avoid repeating irrrarmatioa Designer lnfartnaiion (Customer l) Fir[ Name DSPS Other Please Specify Below (Customer 2) DSPS Last Name Customer Number First Name Name Customer Number NT /YadE /�P- d.7H/99 DAd10 Company tlarme E M3 Company Name ` P Y Auul ass Add es, o. hex /o G343 /7B t� 5r 4) City State Zp+4 (9 digits) Ql 2pT4 (9 dig6s) LOLFAX 41T JY730 y ZACEVIZLE /%n/ta SSd yy Phone Number Etnail address Cell phPone Phone (area code) Number E-mail address Cell hone 7rs (area code) 9G.7-H/ss tis.Jb f/oerbrde cell' XWj'© Check itapplicable ❑ Owner �r7or 1. can Ctretlr rt appkcabte or specify relationship ® Owner ❑ Other -s eci relationship Information and Plan Submittal Checklists. Ta request electronic plan review complete fhe appropriate application iortn and e-mail it, along with your registered SharePoint usemame toDSPGSBPIanSchedule(al+Nsconsin oov_ If plans are being submitted via paper, they will be assigned to a reviewer after receipt at a DSPS office. Submittal checklists can be found in each applicable component manual appearing on the POWTS em9rant Page under Publications PO!MTS 22Wj2MELIS Manuals HolmentOnalaska Area DSPS 2850 Mdwest Or Ste 104ab Green Bay DSPS Onalaska, 54650 2331 San Luis Place 3 Green Bay, W154304 F608-785 Far 0B-7e5 F-9330 920-492-5601 Email: DSDs$bPlanSchadulr wi Gov Fax 920-492-5604 Email: LisasSbP1an khedule0nini o Make Checks Payable to: Division Industry Services OR ❑ Check box to invo- designe and sign below OUNT DUE Designer signature Review Code 7633 SHD-10577 (R 3119) 10 W W U W X 6. POWTS SUBMITTAL (check all that apply - Incomplete forms may result in Processino delovsl ® NEW ❑ Aerobic Treatment Unit(s) ❑ Chlorinator ❑ Tank Replacement Only ❑ REPLACEMENT ❑ commercial system ❑ UV Disinfection Unit Cl Add Effluent Filter SYSTEM TYPE(S) NOTE: Submit separate shests for each system If submitting multiple systems on the same site Enter Fee ® Revision to previously approved plan $86.00 Q5, rD ❑ Miscellaneous Review (i.e. replacement of a septic tank, addition of an effluent filter or pretreatment device to an existing system, etc.) $80/hr Component Manuel Design All treatment components are previously approved ElAt-GradeComponent Manual -Vac 2.0, SBD-10854 (N.03/07, R. 1A2) Wastewater Flow In under s. SPS 384.10 2 O or (3): ❑ In -ground Component Manual - Vec 2.0, SBD-10705-1" (N.01101, R 10/12) Gallons Per day Mound Component Manual - Vec 2.0, SBD-10691-P (N.01101, R 10112) Design wastewater flow of the proposed system: rI Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N,01101, R 10112) 1,000 gpd or less $ 250 00 ❑ Other - Please specify GPD 1,001 - 2,0Do gpd $ 325.00 0 1- 2,001 - 5,000 cod $ 400.00 [ Sall Based Individual Site Design" One or more treatment components are not c ❑ At Grade previously approved under s. SPS 384.10 (2) or (3): x (Individual site design/deviation from component O ❑ Non -Pressurized In -ground Design manuals and use of components without product � C) ❑ Pressurized inground Wastewater Flow in approval): j : ❑ Mound Gallons Per day y ❑ Drip-Ilne Design wastewater low of the proposed system: ❑ Constructed Wetlands GPD 1,000 gpd or less $450.00 ' Documentation must be provided to support treatment and dispersal claims. In a separate 1,001 - 2,000 gpd $600.00 statement, provide rationale for the project and attach supporlIng documents (code sections, test 2,001 - 5,000 gpd $750.00 reports, technical papers, research articles, etc.) greater than 5,000 gpd $900.00 plus $0.08 for each gallon over 5000 gpd Slate -owned facilities: Design Holding tanks previously approved under s. SPS ❑ Holding Tank Component Manual, Vec 2.0, SBD-10855-P (N 03f07, R1/i2)' Wastewater Flow in 384.10 (2)(3). Design wastewater flow of the proposed system: Gallons Per day " Non -stale owned Commercial and Residential Holding tanks that completely utilize this manual 5.000 gpd or less $ lkom and have an estimated daily flow of less than 3000 gallons per day must be submitted to the GPD 5,001 - 10„000 gpd $150.00 appropriate governmental unit for review Instead of the Depanmenl. [see SPS 383.32(3)(a)) greater than 10,000 gpd $225.00 ❑ Holding Tank Individual Site Design", (re, site constructed, <5 day holding capacity, Co- Design Holding tanks including site constructed tanks NOT led wastewater, elc. min 9 ) Wastewater Flow In previously approved under s. SPS (3). Please specify: Gallons Per day Design wastewater flow of the proposeposedd s systst emm : ' Doe must be provided to support the rationale for the project, Ina separate statement, 5,000 gpd or less $180.00 5,001 - 10,000 gpd $300.00 _ include al please include all code sections, test reports, technical papers, research articles, etc.) GPD greater than 10,000 gpd $450.00 ❑ Soil Saturation Determination Report (using observation pipes) ❑ Interpretive Delerminalion $240.00 ❑ Experimental System (One time additional fee). Submil fee for individual system as per appropriate above system type) Experiment Number _ $400.00 ` SBD-10577 (R 4118) Priority Review (oiler same amount as normal review fee listed above) $ _ Enter Total (rounded to the nearest dollar) $ 85, ' RECEIVED MAY 2 7 2021 SL CROIX COUNTY COD Page I of 9 Private Onsite Wastewater Treatment System Index and Title Page Project Name: OAU/a f"E Owner's Name: Owner's Address: 6393 /78 Sr w APPROVED L aKEu ttE iry S,,,,gEPT. OF SAFETY AND PROFESSIONAL DIVISION OF INDUSTRY SERVICES Legal Description: E 6 /9 8N fit/ Municipality: Town, V41age, Eity of EAw GALLE County: 5� E�,,x SEE CORRESPONDENCE Lot Number: / Block Number. CSM Number: ,77- 7 9G Subdivision Name: o7/8d W6 & wo.- Parcell.D_Number: 008 /0S7-36-/do Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Name of Designer: Signature: Index and Title Page Plot Plan Cross -Section & Plan View of Mound Pipe Lateral Layout Septic Tank / Pump Cbamber Cross -Section & Specifications Pump Performance Information POWTS Owner's Manual & Management Plan POWTS Owner's Manual & Management Plan Filter Informatioul -11 License#: /70- ,77s/99 SBD-10691-y(N.01 ound Component Manual" Version 2.0 ✓ - SBD-1070 j!P (N.01/01) Pressure Distribution Component Manual- Version 2.0 Am�h.no..t coil GvuJuutimt RcYmt N 0 t aON 7 r oi x�Yl y35711 7 OOSIo�g L'/v/ -'og nr/ JV7 xnvl ro7 O'OVI ry t'%O/-'�3 s.(S shod vrn°N S6 7 C'lC 7v37 xvoy SL x b � t ai71d 78610 � � a1% �-6(� M7✓7� (� r7 V J� o•oo/-'N�/ 9�v° e na,r s ^a/,� v� ,7s r°% ESN o,sod°y(1 rV'r 07f0Y°Y� •07 xtvV;l 1y 3170'17 "Y3 jv a /a71`NSp`6/3f`3N goy r%1 or 0,81r -ctaa3cl vl^vd J7N f�+°Y p13S Ch'f8F s'dS 77d 1a7 7v7Y06' JoNf 7aY°7=% �fl/e = [7 It a19lJ 008 XoY//, o3NS Avn3nivd F n m K N n D 71 z < o m o � � O O VIc,a5rta` D = / a ft E= /, 5 Y ft F = 9 ft G = ,5 ft * = /"/ ft LJ `" o - U X � � v A = `i ft B = 7S ft I = /d,Y ft .T = 42 ft K = /O ft L=eft W = ;4.7 ft 4" sch. 40 PVC observation pipe m` o Nn �1.5 ft y � � Y M 0.5 ft a=02 � asp CROSS-SECTION OF MOUND Sr I TOPSOIL GEOTEXTILE FABRIC COVERING ASTM C-33 SAND FILL 511 TOPSOIL H TOE.Q1 F r- Page 3 of `i UPTURNED LATERAL A ACCESS BOX OBSERVATION PIPE & WATERTIGHT CAP DISTRIBUTION LATERAL ( IIa In. sch. 40 PVC D2665) Lateral Invert El.= /o/. 7 ft ^rrr11U1yy. a %d/In.�o\Irv/O�\\\Vu/piatl�Pi�Iy/1.1���/L _ l PLOWED SURFACE = • - G %SLOPE FORCE MAIN (2"sch. 40 PVC D2665) DISTRIBUTION CELL = fix 76 ft = 306 R• (Y,"-2Y," aggregate) Min. Required = 300 + /"o = 360 ft2 PLAN VIEW OF MOUND 2" Force Main Observation pipe r Observation pipe r 75 /d B—K- _ I I Manllold'Tea' I c 1/68- DlsldbWonCell (�Insch. Dlslribu�Iion 1168 /i.S It Y x75 pipe( /%a In. /Is ft 40 PVC sch. PVC 5) D2665) 0266 OX= Upturned Lateral with Access Box Prohibit disturbance and vehicle traffic within 15 ft of downslope toe. L 45/ Basal Area = /y Y ft 0 x 75 ft= 80 ft2 Min. Required = 300 + 5/ 7so ft' a PIPE LATERAL LAYOUT OF MOUND (Center Manifold with Aggregate) HOLE DIAMETER = 3/4 in. LATERAL DIA. A in. MANIFOLD TEE DIA. in. (sch 4t pipe FORCE MAIN DIA. _ �_ in. P = 34.3 ft. X = j. ft. Y — ?.i £t. 0 z o HOLES LOCATED EVENLY c> x ON THE BOTTOM OF THE PIPE. CC Q K U F= C9 �51 L 3 N° Minimum Number of Holes= ado ft' + 12 = d5- Holes Page 4/ of _ /7_ Holes/Lateral x .2 Laterals = 3s' (3/16") Holes x 0.66 gpm / (3/16") Hole = VY GPM = SYSTEM FLOW RATE PIPE VOLUME = M 4 ft. Laterals (total) x . 0 92 gal/ft. = G. 7 x 5 = 33. 5- GAL = MINIMUM DOSE VOLUME PIPE INVERT ELEVATION = /o1.7 ft ss MAY 2 7 2021 ST CROIX COUNT( coo Page S of 9 COMBINATION SEPTIC/DOSE TANK CROSS-SECTION (DRAWING NOT TO SCALE) FINAL GRADE MANHOLE RISER & COVER [per SPS 3842SM & (8), approved (slope gntuno surface away from locking device, & mrntng label: Extend manhole(s) for proper drainage) manhole rtser as necessary.) 4" Men. Sch. 40 PVC Tank Vent 4' Min. SC1L 40 PVC Tank Vent BUILDING SEWER localend IT above grade or 24- ELECTRICAL JUNCTION BOX located 12'above grade or 24• above Regiorul Flood Elevation flier SPS 382.30(11)) above Regional Flood Elevation (comply with SPS 316 and NEC 300) FORCE — MAIN rr >4' OPTIONS Ise'cnver .,. ._ .. >te' ruNnD�E _— `>te' Force .'.'...-r.'.''.'. ..'. ..'.'...... /V /'� Main .. PATTOYOF INLET (mxrttlevaLwl FbU Tree— II Neap INl_R— ET lirlc I -- (wSleeiLCrlevtlj--(— �-` \11 Oti✓co p aFscEmx I+ary roam r''F nOi ""°'" au Ya Fr08 ]7- C Flaal / On Flaal <'INLRPI'c aPprovad ENYenl Rler Paede Sze B Rehired On O .l On Float >:. A :� 937fl MINIMUM OF 3" OF SUITABLE BEDDING BENEATH TANK & MAXIMUM BURY DEPTH OF W Anchoring of lank may be required per SPS 383.43(8)(g) Tank Manufacturer: GI/ES,54 Loaf CcEre Daily Wastewater Flow (DWF): 3o0 GPD Septic/Pump Size: 19 Y415,66 gallons Number of daily doses: 5..1 i /9 / % /l Alarm Manufacturer. SEPIRoalyc s Model Number. /Y,;'T1 Switch Type: /Y 4,6~1cll. Effluent Pump Manufacturer. // rric /7/Adr Model Number. 9Ec Minimum Discharge Rate: ,/Vr/V GPM Vertical lift (pump off to lateral invert)............ 8.0 ft System head (distal pressure a7. 6 x 1.3 ft): 3.3 ft 15 ft Force main x /.3 1100 friction factor 3 ft Filter friction loss ................................. _.... — ft Tolol DynomiIa ll.d (rDI-1) //. G R Z Force main volume:,75 It x . /L3 gal/ft = Y / gal Actual dose volume: L/S gal - Y. / gal = S7.'/ gal (total dose volume - volume of 'force DOSE TANK CAPACITIES: Reserve above alarm 17. 8 in = 3d8. C gal (D) Alarm float above on float 47 in = 13.4 gal (C) On/Off float measurement S.7 in = C/. S gal (B) Off above tank bottom 8 in = 9f. L gal (A) DOSE TANK DIMENSIONS: Length //Y in Width 93 in 0v0et h�i'ht 413 i. /,' 97 RE(,LIVLD MAY 2 7 2021 ST. CROIX COUNTY coo ENGiNEDRM DATA. etc-cl�-us I�I��I r4 �rrr_nrns ��• -9i11 PERFCRMANG DATA II I I I I 1 I I n n M N in sn rn in m APM-61M 0, Franklin Eiaatrie ftft Bn 79941 inn 4*WCM 0N,Tpu TION A. L of cl EFFLUENT PUMPS cam Eao*-mated cast iron/ Thermo lashc Motor Housing Eppxffo#ed cast iron Impoer MaterW Thermoplastic elastomer Impeller Ta Nan -do Volute Epoxy -coated cast iron Motorshaft Steel Mechanical shaft Seal NiMle with carbon and ceramic faces Fasteners Stainless steel Uppersintered sleeve and lower ball hearing Pne Cord SJTW--SITOw RECI 't111;=D POWTS OWNEWS MANUAL AND MANAGEMENT PLAN MAY 2 1 mi FILE INFORMATION Owner 7AurA f rT11 Permit # DESIGN PARAMETERS Number of Bedrooms I00 d/bedroom) Number of Commercial Units - Estimated flow (average) ,lee gal/day Design flow (DWF), estimated x 1.5 japgal/day Soil Application Rate /.0 aVda fl Influent/Effluent Quality (O NA) Monthly Average Fats. Oil & Grease (FOG) S 30 mg/L. Biochemical Oxygen Demand (BODs) < 220 mg/L Total Suspended Solids (TSS) 5 150 mg/L Pretreated Effluent Quality (® NA) Monthly Average Biochemical Oxygen Demand (BODs) 5 30 mg/L Total Suspended Solids (TSS) 5 30 mg/L Fecal Coliform (geometric mean) <10 efu/100m1 Maximum Effluent Particle Size 118 inch diameter ST. CROIX COUNTY CDD SYSTEM SPECIFICATIONS Septic Tank Capacity 8 0 gal ❑ NA Se tic Tank Manufacturer 411,Fsr1 Le.le. O NA Effluent Filter Manufacturer ,try 40 ❑ NA Effluent Filter Model rr6872- /YQ ❑ NA Pump Tank Capacity Sao gal ❑ NA Pump Tank Manufacturer GI/,FSS.a Gea", ❑ NA Pump Manufacturer L/rrts blab ❑NA Pump Model 9 EG ❑ NA Pretreatment Unit ( ® NA) ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑Wetland ❑ Disinfection ❑.Other. Manufacturer. Model: Soil Absorption Component (O NA) ❑ In -ground (gavity) O In -ground (pressurized) ❑ At -grade ® Mound ❑ Drip -line O Other. ❑ Dispersal Units — Manufacturer ❑ Aggregate Cell(s) Model Calculations: Soil Dispersal EndCap (Dispersal Unit EISA) or LP-Aoolication rate = Area Required - EISA - (french Width) _ # Units or Total Length of Trench(s) 75r ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publication ❑ "TCC Flowtech Mound Component Manual" Version 12 ❑ "EzFIow Mound Component Manual' Version 12115/2017 ❑ SBD - 10854-P (R.1112) "At -Grade Component Manual Using Pressure Distribution- Version 2.0 ❑ SBD- 10705-P (N.OI/OI) "In Ground Soil Absorption Component Manual" Version 2.0 M SBD - 10691-P (N.01/01) "Mound Component Manual' Version 2.0 ❑ SBD - 10657-P (R.6199) "Drip -line Effluent Disposal Component Manual" ❑ SBD- 10706-P (N.01/01) "Pressure Distribution Component Manual' Version 2.0 MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT Manual) Service Event I Service Frequency Pum /in ect tank s , ' ect dispersal cell(s), clean filter At least once eve ® 13 months M 3 eats ❑ Other - d um & um controls, alarm pretreatment unit At least once every:- months M 3 ears ❑ NA mush and pressure test laterals _. _ _ At least once every: months ®3 years ❑ NA START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations ate detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water -saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, hones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that chould be discharged into tho y.tem. Oche• no., biodegradable arms such es baby wipo, is puns, snitaty napkitvs condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page 7 of 9 RECEIVED MAY 2 7 2021 ST. CROIX COUNTY c D Page $ o= 9 drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over al I system components. Compaction of snow over the dispersal unit may cause it to GCCZC up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware. identify any cracks or leaks. measure the volume of combined sludge and scum and check for any backup or pending of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings grcatcr than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (I /3) or more of the tank volume, the entire contents of the tank shall be removed by a Scptagc Servicing Operator and disposed of in accordance with Ch. NR 113. Wisconsin Admin. Code Specific servicing mechanics must be provided if vertical is>I5 feet or if horizontal is>l50 feel and instmclions to be provided below The outlet filter(s) shall be inspected and cleaned to remove any accumulated solidsaccording to manufacturer sspecifications. Solids washed from the Filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to service P OWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 38333. Wisconsin Admin. Code: ° All 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 4fter pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel. or other inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of replacement soil absorption system. 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 renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 6i The site has not been evaluated to identify a suitable replacement area. Upon failure 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 tank may be installed as a last resort to replace the Failed POWTS_ 9 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconsrructions o fsuch systems must comply with the ru Ies in effectat that time. \YARNING!!!! SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTIAN LE"FHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP. OR OTHF,R TREATMENT TANK TINDER ANY CIRCUMSTANCES. DEATH NIAYRESULT. RESCUE OF.A PERSON FROM THE INTERIOR OFATANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER POWTS MAINTAINER Name: T 1oKE /W- z// 9 Name: .,uiviSi..rL Phone: / G)- wsr I Phone: 6 - SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name: Name: Sr.CtaiX �opvva,trrr ilEutt. Phone: Phone: 715' &- y180 F;L- ,! IVED MAY 2 7 2021 �6 9 .af, 9 Maintenance InstructionsUNTMcDD CS .- t•eaa366-sBA3 Biotube�- Effluent Filter 'V ial e a=z—ty4S - �So How to Clean Your Effluent Filter _o en>:.-e vac' e iLe !;liter i; i —c.on ne Dropariy, -t srouio aE .-soac every yea-. Ulcer normal corditions, yaLr o>ivr: 172, unc"Dr.. or several years Demo clear ;rcis -ecessary. T re `itet should be cleared wb=r it becomes doyced =_rove tD resrict worm=_j'IcLvs er a.:ne seO:;g tari-.4: a •T�r.:-um. T.e Fifer should he cleared wherever :hE tact Lies! Vac -le eraser fD rave a septic tan: service prcv.ce"sae care or Ster ma .nterarce. ana cleanireyou cen'.no =_ -acre s=_•v ce c'ovde' it ;he Yellow cages. L-Der SaD:-c r=_^<s 3 systems • Or you tar .o-t/act ` cu• r ry p DJ. ealt. 7EDa:;re^:IJr a LEi. vna w,s^ :D lnsc=_c! ano+or clean voo, ache:;':Its--r•ourseir. oa s�_- , cr=_s; proper'y, k.Vea• `.ail -ikon^'; pa••ts ace s^:n. - 1uzs. _loves, and goggles or classes. T-er fellevr these ns:rLcvc-<_ Remove rile access lid tc your septic :Erik uy uncrEL+:- mc tte stainless sleet iic baits wry; hex nead ovrenCr p:ct,:ded. If ymu lio is ebove groupie, .t will he easyte •nd. It i; is bure,: be ow around, find the marker the-, .r_•:ca:es 1-ts location. Remove ihE Site- cenndge by graspiro tie tee handle e-8 1: irg it Ou: of its nousinc !seE DhOF0 ]', Sorav :^e car,nog= tubes LL9i'- E nose remove a .y Llten! fs6E Jro'0_l Enstra "tees :r ;he opncnai floev ^ Dd:ila; on plate in.sice ::^.a rite! are ^;ear o' any aebns. A-0_ke sure the rinse .rater ^n-s oac; mm the'arx, bet do not allow solids material !D rat; into the open. F,Iter housing. - �'rn'iy_._�c :1E Cart4C'yE 6Eck .nt0 t}1@'Curti Sum- e-,ftoemt filters come Lkfth all diarrit that acuvales .rZer' ime filter needs cleaning. if ycu have an alarm. chec, iD matte sure H is working Dy lif ing the flea; t A-7h a stick An audible hom should sound. The aierm pane, is ^armally n?Dunted on the side or :he cruse Or .i trE _ 2De. Note: 1 your effl ent;her doasn': have ar alartr: s `r_ ar- .2^.d yDL w'JLIL like We, Call your IOCai SepUc system ;Steller. Record :he pate that you inspec:eC andior cleaned on the form that `.ollows. Ii you checked 1PE aierm Or made any other observ2ddlns aboLr, the tank or sysem, include that iniomtaaor. under-Alrtes. AIIacn access tic oy placing it on the riser.: -etching the On hogs in the li= vmth the bob catches. Insert 6d bell:nto cet0es and tighten vvth hex head wrercb crowded. Photo 1. Remove the *ii,ercartridrre dylininn it ourDiars reusing. ?horn_ $Gray d;E CEl`..nd'CE :'Chas :r,in Sore. At � : \ � . � \� Zvi\ \:� 4" CAST -A Mini a III= I .I I VENT W840/500— MR TANK SPECIFICATIONS DIMENSIONS: CAST -A -SEAL WALL: 2 9/16" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 59 1/2- LENGTH: 9'-5 3/4" WIDTH: 7'-9" BELOW INLET: 48" LIQUID LEVEL: 43" WEIGHT: 11,150 LES. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 19.61 GAL/IN (SEPTIC) 11.82 GAL/IN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP, OR SEPTIC/SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) OUTLET I. N I ^ V I I a f PUMP PAD CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: 1 OF / 1 N �- N Z p N U LIVING I 11 0 ° KITCHEN!' �D DINING ,R4 ,NG AND PIMENSION9 ARE FOR REPRE9ENTATIOR _ LNiT PLEASE CCN&.L' I.R LO A. g 1IG INSPEC•OR NJ OR CONTRACTOR. ALL HEADERS TO BE 44XI0 UNLESS OTHERWISE SPEGIPIED UTILITY rl JSy' 3 CAR ARAGE I 0 9 LIVING ARE4i ],585 BO. Fi. a u fK O Y b N b Q J LL J Q LLJ > r 'N H �p m F m u�m b ST. CRo ,LJNTY SANITARY SYSTEM File ce Office Use Only OWNERSHIP/ADDRESS FORM Created2/2027 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. RECEIVED OWNER/BUYER INFORMATION MAY 2 7 i117f Owner/Buyer Mailing Addre City/State/Zip Phone Number (required) --i I )' 56u - Owt n Email Address (required) Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location h& , SR — '/a , Sec. 1.9 T C4000 N R1(QW, Town of EQ.. J JSQ I (p% Subdivision Plat: [ t , Lot # �. Certified Survey Map # i d 1 O L� �'1 Volume Z `� Page # LOL 9 Warranty Deed # u(-A Sl'{ S (before 2006)Volume Page # Number of bedrooms _e�2 Spec house O yes'0 no Lot lines identifiable O yes Ct no OFFICE USE ONLY New Property Address 21 � zf1 /t '• eiU (VerificaU n of new address required from Community Development Department for new construction ) �0 2l o / (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.aov -: ►*-dud o — `�; 11 SY 1.! 2. - I Industry Services Division County ) B 1 4 rL�Z� - �C1 1 1900 E lVasbin� on Ave s r CA e17( Sanitary Pane Number(ta be filled i nby C.) PS .Box 7162 Croix county Nla R 707 -162 -z ) p-7 St. menf _jop . ? G J ° anitary Permit Appiic - X State Transaction Number ere In ccordanwith SPS 383.2) (2), Wis. Adm. Code, submission of this form t" the -pp o note on it Q (/ t W t/ 1 ,s required prior to obtaining a sanitary permit Note Application fortes for state-owned POWTS are submiuq to Project Address (ifditferent than mailing address) the Drpanmcnt of Safety and Professional Services. Personal information you provide may be used for secondary `` u uses in accordance with the Prnree Law, s. 15.04(1)(m), Suits. // li 1. Application Information — Please Print All Information SMili� Propert wncr's Name N.6 tel 0 1 — Cog— 1� 1Vv Property 01"cl-5 Moiling Address Property Location _t /y U I� I 1 ✓ fJiv� Govt Lot Section City, Suite Zip Code Phone Number A 'q' l 44 _�'/.,��__'/., (nrcic o hI. Type of Building (check all that apply) Lot Id(I or randy Dwelling- Number of Bedmoms 7 - Subdm ivision Na. Block ❑PubadCom nil -Describe Ilse [I City of e CSM ❑ Stoic Owned- Dr\..-c ❑ Village of // Non -6CTown of,Ir.OALL,CIII- Type of Permonly one box on line A. Complete line B i pplicablea if Neww Syste❑ laccmcnt System ❑ TreatmenVHoldi Tank Replac nt Only ❑ odier a ation to Existing System (explain) At B. ❑Permit Rrn❑Perini cvision ❑ Change of P b 't cr to New ='u PRehire Expim0, IN g1L nrT c of Iiion'Ca- one evice: Check al at a❑ Non-Prescuriecd I ❑ Pressuri,c -G and ❑ ,mdc ❑ Mn > v_4 in sun hie �1 Mound <v a of sui le soilHoldingTank iipcmal Component pl nrj ❑ cur De""'cxlaV. Dis ersai/Trearea Information: DesigryFfow (gpd)n Sod Applicat n Rate( Dispersal Area Rcqu d (so Dis rsal Area Pro d (10 S cm ation Lod_/.O D. �SOO f/OooVl. Tank Infoapacity in Total : or Manufactu Gallons Gallons Units Fir✓ ! o 1 Noe Tanks Evstin anks - U rn H rn :7 U S.puc or lbhfing7Tnk /s700 — 00 411eff< Co..lcA�rE posing Chamber 80d — 8 I I za w6_e VIL Responsibility Statement- 1, the on iuned, ssuAryespona4ilhAv installation of the PON'I'S shown on the attached plans. Plumber's Name (Print) Plumber' m ktt LkS Number Business Phone Number KENY f14,nr ,1,7 Yi 99 715 91.?- s'rss Plumber's Address (Street, City, Smtq Zi ode) L J 7- 6Y730 \rll/. Court /De artment use Approved ❑ Disapproved Permit Date Issued wny' nt Signature ❑ Owner Give cason Far Denial tFFee S W 50 w 00 � � o (j IX_ Conditions of Approv easons for Disapproval R S bus at. 1 r• TEM OWNER: O I + eptic tank, effluent filter d t Ispersal cell must be se Iced / maintained p t;. rM a s per management pl provided by plumber, .� I t II setback re ulremen s must be main er applicable ode/ordMbYr2ls;."mP' ," Pla,.s so. the s ste �C2 vCruuntySo yWgin, l�9v11tp t a "'1nc l/ss" I%Vt YIQYIinF 1 `� P Nr C LvL`ely. 3A&64A. 8r4) .�) A -I( 6c.,d14i-,s ;re,M x4ak CW, 1 In e4t ec� w 14, tfwA 14 V/^e 7/dtt'. PLAT PLAN ao T// q�E. r '� g0O Ya S/fL0 ALL SPS 383. Y7 1s rd�uKs erL•r f/A u,O `- 6 Pr,5 - ,?o rN lwwo C j CIL rh, �jSL q- b� O^I I I 9A A�nsd 1,1L 30 r n rAELi PL Gl/fscA laoe�8ao Lonbo YbJ'r p /Dl.a ,�"puL ScA.4o 30 � n 3 � @y�® 1 Lip b 9go / 8 K%S Ra[/L CECL � 076.8/K oaurs SYs. Eu• - /o/? o✓ /aa.o ca,, /er, /do, Et. - /O/.7 1 AND - OWNERSHIP CERTIFICATION FORM Owner/Buyer U tRy I D { i 1 S / \�A >U 5 0 rixt- MailineAddress �,3c/ %7�f� ST (�ci L,gketJr%�-'✓ /1//V 5509�1 Propem, Address 1 `ay t; fTr(�. �^j��{}1� ►�� Gi �( � (Verification required from Planning & Zoning Department for new construction.) City!State �W�tlutrl,u�C Parcel Identification Number MR- LEGAL DESCRIPTION ( / Property Location -fl— V. , � /< , Sec. ICI , T ALN R _L�p W, Town of Subdivision Plat: Lot 4 �. Certified Survey Map # I bilOrov _ Voltune _ % 7 Page r b Warranty Deed # I �( Q 54L (before 2007)Volume Page Spec house0yescam Lot tines identifiiable[IyesEjno SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. 383.52(t) and in Chapter 12 - St. Croix Cowry Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the 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 pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the uandards 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. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Ilwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owiler(s) of the propem• described above, by virtue of a warranty deed recorded in Reeister of Deeds Office. �1121- C?0 DATE 'f *Any information that is rn srepresented may result in the sanitary permit being revoked by the Planning & Zonin&Depanment. Include with this application a recorded %"a my deed from th= it ci t r of n==d. r >=y o,..r Jr reference is made in the warranty deed. (REV. 041I2) September 3, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-09-03 Plan Review: PWTS-092001987-C KENT HOKE PO Box 10 Colfax WI 54730 SITE: David Pettis XXX 20th Ave, Balu�� Town of EAU GALLE St. Croix County _ Total Amount: $250.00 Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY IM 54304-5211 Contact Through Relay http //dsps.M.gov/programs/industry-services www.wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES t71VISION OF INDUSTRY SERVICES 40' 2 CORRESPONDENCE J' ressure D' ution Component Manual — Ver. 2.0, SBD-10 p (N.01/01, R 10/12) QComponent Manual — Ver. 2.0, SBD-10691-P /01, R 10/12) The submittal described above has been reviewed f c\oved th applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal 7the NAPPROVED. This system is to be constructed and located in accordance wlosens and with anycomponent manual(s) referenced above. The owner, as definedr 10nsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at pluhe ssed to do so by the Department per s.145.06, stats The following conditions shall be me/during construction or installatioNnd prior to occupancy or use: • Preserve dispersal area pri and during construction to avoid disturban compaction and use of the site. • With new construction; i Y,recommended not to activate the pump in the Ne tank until the tanks are pumped prior to homeow r occupancy. • Wastewater generate rom contractors cleaning of equipment and tools and/or left over construction products shall not be Pcharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste ifiterated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied s� ith rock fragments. tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available- trees in the basal area of the mound must be cut off at ground Icvel. A larger illl area is necessary %0en anv of the above conditions are encountered. to provide stffflcient infiltratoc arca Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(t). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of constructs on/instal lati on/operation. 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. Thanks, POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services entail: ti_m anderlcesi a \+i,, i_ Cell. 608-516-6134 Page 1 of 9 Private Onsite Wastewater Treatment System Index and Title Page Project Name: _ /,)ALip v ±hS Owner's Name APPROVED -2EP-T FF FAFGTY ANO 1Dh, J� `' �I� /� _ SERVICES Owner's Address: Y Z l l'tJf DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Legal Description: n; I v Q 1 G T .:2V n 1 11 n I A/ Municipality: Town, ge, C4Y of Cotmry: Sr. Y Lot Number: �_ lock N r: _ Subdivision Name: {{�� Parcel I.D. Number: 0 09- Page I Index and Title Page Page 2 Plot Plan Page 3 Cross -Section & Pla iew of Mound Page 4 Pipe Lateral Layou Page 5 Septic Tank / Pu Chamber Cross -Section & Page 6 Pump Performan Information Page 7 POWTS Owner's Manual & Management Plan Page 8 POWTS Owner's Manual & Management Plan Page 9 Filter Informatfon Name of Designer: Signature: CSM Number: License #: /V- .72'// 99 !_ SBD-10691-P (N.01/01) "Mound Component Manual" Version 2.0 SBD-10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 Attachment: Soil Evaluation Report D = /..2 ft =Z 7 ft F = 9 ft O = 5 ft H = /./ ft A = S ft H = 75 ft I = 1,2_ ft J = 6.8 ft K = /o.Y ft L = 95.8 ft W = 74.8 ft 4" sch. 40 PVC observation pipe m Dda s o A $gym �1.5It s� s 3 0.5 ft tyi a 8 � Page 3_ of 9 CROSS-SECTION OF MOUND UPTURNED LATERAL & ACCESS BOX 51I TOPSOIL �/ OBSERV N PIPE & WATERTIGHT CAP GEOTEXTILE FABRIC COVERING / DIST 13UTION LATERAL ( r Yw In. sch, 40 PVC D266* ASTM C•33 SAND FILL _ - W Lateral Invert El.= /oi.7 ft $rl TOPSOIL 1}Tnh:c).:'�7'.lH �G System EL= /a/,2 ft TOE '' ;' 3 ' ' ... y ./ . , : / .,. '., Contour El.= /04.0 ft I "•:... - _ _ PLOWED SURFACE:; %SLOPE _-; FORCE MAIN (2" ach. 40 PVC 02865) " DISTRIBUTION CE _� It x 7J' ft = d6d ftZ ('W-2'`/" aggregate) Min. Required = 406 + /. 0 = COo ft° PLAN VIEW OF MOUND y Obse 'on pipe r 75 OX` SA . .P1.9 W I} V68 = I Distribution Cell R (''A"-2%" aggregate) Dishlbutio SIX Xs ( /.Ya in, OX= Upturned Lateral with Access Box Observation pipe Prohibit disturbance and vehicle traffic within 15 R of downslope toe. IE L 95.8 ` Basal Areafix 76' it= /T60 fP Mln.Required= 60 + ,'y = /SOo Its 2'Force Main Mangold (/Y? In. sch. 40 PVC D2665) Page —,/ _ of 9 E'9EL= LATERAL. LAYQIJT ®F N QUIND (End Manifold with Aggregate) HOLE DIAMETER = y/6 in. LATERAL DIA, = MANIFOLD DIA. = /Xa in. r (sch 40 PVC AG6 J pipo D26G5) �r"a j6 /' cess FORCE MAIN DIA.= in, Va e�apJ�g\ee V ox n = 7.7 ft, t0�0 \' S = 5x f t . 1P Q �a5`N°\e has �0 �Y3 � r 3� 5 N°e / x a y x� 3 Y3 0,. ANIFOI_D ( /r.2 In. sch, 40 PVC D2655) 3 (2" sch/0 PVC D2665) 3 F �StN°fie IDLES LOCATED EVENLY INU BOTTOM OF PIPE. Wrinlm Um Number of Holes = G 00 _ ft' 12 = Sd Holes --gZsl-toles/Lateral x 2 Laterals = Sd (3PI6") Holes x 0.66 gpm / (3/'16") I -tole = 33 GPM = SYSTEM FLOW RATE PIPE VOLUME = /yV k Laterals (total) x 0,092 gal/ft. _ /3. JS x 5 = 1. G..zS GAL = IVIINIMUNI DOSE VOLUME PIPE INVER'r ELEVATION = /a/. 7 ft, Page S of 9 COMBINATION SEPTICIDOSE TANK CROSS-SECTION (DRAWING NOT TO SCALE) FINAL GRADE MANHOLE RISER & COVER Qer SPS 384 25(7) S (8), apprmeo % (slope ground surface awry from looking device. S waming IaW: Extend manholes) for proper drainage) manhole riser as necessary.)` I A' Alut. Sch. ao PVC Tank Vent ELECTRICAL located 12' above grade or 24' 4' Pdin Sch. 40 PVC Tank Vent above Regional Flood Flevauon BUILDING SEWER loaded t2'above grade or2a• JUNCTION BOX (pg(SPS 382. 30(11)) above Regional Flood Elevation {=reply vrith SPS 316 I and NEC 300) J 5 w eover LN TOM Or Z'J,,enelevaecnl- v iat='T pr_ Approved Effueni Fit Uroudl4l -%: Pend^ Size leTrad On O,dw, MINIMUM OF 3' OF SUITABLE BEDDING Anchonng of tank may Tank Manufacturer: Septic/Pump Size: Alarm Manufacturer: Model Number. Switch Type: Effluent Pump Manufacturer: Model Number. Minimum Discharge Rate: FORCE MAIN 1 <i 2 i,a• OPTIONS I >ta• � 11 Fen a Men ..Float Trn_— I I Wr_p I 1 Rae 1 I___ 4 ' roar= Flow, fa a OlrFlmi A EIe = aT ANK & MAXIMUM BURY DEPTH OF 96- I 0 r SPS 383.43(E)(g) ZO-J CAtrAC Daily Wa water Flow (DWF): GOO GPD 00 aallo Number of lv doses: S.2 /9.2 7.) %VOrr,6u5 Rlfsr / Force main volume: V0 fix . /63 gallft = V. 9 gal Actual dose volume: gal - '/. 9 gal = //S.2 gal (total dose volume - 011K of force main) /TILE Z7LiJT Vertical lift (pump off to lateral inven/ .......... 8.0 ft System head (distal pressure 8.5" x 1 3 ft): 3.3 ft 30 ft Force main x .7.'Y /100 friction factor . 7 ft Fiiterfriction loss ..................................... — ft Total Dynamic Head (TDH): /.2-00 ;t 8.1 gal (D) Alarm float above on float d in 5'Y. S gal (C) On/Off float measurement S. y in = d e.l gal (B) Off above Tank bottom 8 in = /77. 9 gal (A) DOSE TANK CAPACITIES: DOSE TANK DIMENSIONS: Length /6 rl in Width 9L in Outlet height 3L in Gallonslnch .77. �'/ Reserve above alarm Y5 , � Cl/ �._I,'Pal 9E"A-SfS ram. 9RNGM ry LK1 i� 9 li0 m9 50 W S 6 e r 9 9 i 6 �i I � 9 w m m <9 m m ie I mvum-GR I I i I Franklin ie V.au Zlwmuzm I rm inn EFFLUENT PUMPS di 9 9ER-WIRF Cmmi tdotneHousing Epary-coaied cast iron/ "ihermowastic Epoxy -mated cast iron e0e1'Maze9iat 17hermoolastic elastomer t Type Non-rlo9 I Yo[ute Epoxy -coated cast iron t9omr50e I Steel Mec6ardcat Seat Nitrite with carbon and ceramic 11 1 faces Fasteners 5tawesssteel Bear,s Uppersintrjed sleeve and lower ball hadno L ruwel Cora 15im-sow .. m 90� ti+-a�-aru-a 9.5:-an ncazc Page 7 0f 4 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTI;NI SPECIFICATIONS Oumer dlyio rrrrs I Permit," I DESIGN PARAMETERS NlumberofBedrooms(100gpolbecirooml y !NumbcrofCommercialUnits Estinaied flow (average) ` yad -al/day Design flow (DWF) = estimated x 1.5 Cdti gal/day Soil Application Rate /.0 gaVdayln' j lntluentf6ffluent Quality (❑ i iA) Monthly Average I Foes. Oil S Grease (170G) I S 30 mg/L Biochemical Oxygen Demand (BODs) 5220 mall Total Suspen d Solids (TSS) ,I ( < Igo mJL Protreated Effluent Quality ( \A) Monthly Average Biochemical Oxygen Deman OD,) 530 ngIL" Total Suspended Solids (,) S 30 mail - Fecal Coliform (geometric mean S I O cfui i00niL Maximum Effluent Particle Size I inch diameter c Dispersal Unit Mfg.1TVVdel Number: Calculations: Soil Dispersal DN'F - Application Rate = Area Required Z66 - /.O = G00 _ 7 "!CC Flowicch Mound Component \•)anal" Ve ❑ "EZ Flow Mound Component Manual' Version ❑ SBD- 10354-P (R.1/I3)'.at-Grade Compone CISBD- 10705-P (N.0lZ)_.,In Ground Soil 19 SBD - 10691-P (N.01101) "Mound Comp e. ❑ SBD - 10657-P (R.6199) "Drip -line Effl it I CgSBD - 10706-P (N.01 i01) "Prcasure Distr utio Septic Tank Capacity 7o gat O NA _ Septic Tank Manufacturer I ldl"ex 6mc4. ❑NA Effluent Filter Manufacturer 04Edca ❑NA Effluent Filter Model fT0 .7.7- 114 ❑ NA _ Pump Tank Capacity Bad a] ❑ NA Pump Tank Manufacturer e La.,c... ❑ NA Pump Nlanufactu_rer Pump Model 6,rrr ll/A.r r O NAI % EN O NA{ Prctreenn of Unit (® A) O Sand/Gmvel Fill ❑ PeatFiltcr ❑ Mechanical • t A ion ❑ Weiland (7 Disinfection ❑ Other. Manufacturer Model: Soil Abs ion Component (❑ NA) ❑ in Caro d (gravity) ❑ In-ground(pressurized) Q At it ® Mound O Dr• line ❑ Other. VcrAfc.il Distance Tank Bottom to Service Pad: 9 @ —ft 1 ,izontal Distance Tank(s)to Servicc Pad: /— d0 Cap ,fY(Dispersal Unit EISA) NA ^� 4 ,� or (Trench VVidthl = ;? Units or Total Length of Treneh(si \YO 8 r 73' `Tank-S bsolption Systems" Publication 9.6 (SSWMP Munual) 1.2 )007 tual UsingPres eDistribution" Version 2.0 m Component ual" Version 2.0 Manual" Version 2.0 Component Nlanual' i Flush and pressure test laterals I At least once evon': U irtontns R9 J years U rw„ I START UP AND OPERA T10Ne Fo new wnstmcuon, prior to using the PO)i?S check treatment tank(s) for the presence of painting products or other chemicals that may i edc the Rctltmem process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks) removed b; septage sen•icing operator prior to use_ Sys[ems[artppshall noioccunvhen soil conditions are frozen at the infiltrative surface. The propettg owner is responsible or lie operation and maintenance of the POVVTS and submission of required reports. The quantity and quality of the .wastewater stream � 1 affect the performance and longevity of your POWTS_ The installation of water -saving appliances and fixtures along with prompt repair leaks reduces the wastewater volume. Also the brine or waste from water softeners: iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater. etc. This system is designed to handle domestic strength wastewater_ however, the disposal of food based greases, oils, vegetabledfruit peels, seeds,bones, and Food solids, such as those produced by a garbage disposal should be minimized_ Toilet tissue is the only paper that should be discha wed into the system. Other non -biodegradable items, such ns babes ...+oe-s..e^'P^^-'• `"^•'"•y �"r'' ^e •e^aon,a, cibut nie mats, dental floss, and cotton SWabs, Should not enter the system. Chemicals, such as petroleum products, paint. disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into thesystem lxcausethey can seriously damage your POWTS and contaminate your thinking water su I Maintain a regular steady flow by spreading laundry washing _ Facie —$ e 9 supply ry c throughout the week. Avoid vehicle traffic over all system components- Compaction ofsnow� over the dispersal unitmay cause it to freeze up. INSPECTIONS $ liAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber. Master Plumber Restricted Sewer, POIWFS Maintainer_ or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection mthe tank to identify any missing or broken hardware. iderti any cmchs or Teaks, measure the trolume of combined sludge and scuof m and check for any backup or ponding of effluent to the ground suri-ace and test all electrical equipment such as pumps and alarms- Any defects shall be promptly corrected_ Exposed openings greater than 9 inches in diameter shall be secured with effective locking devices to prevent accidcnmal or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (I!,) or more of the tank volume, the entire contents of the tank shall be mmovcd by a Septage ScrA-icing Open [or and disposed of in accordance with Ch. Alp. 113. Wisconsin Admin. Code. Specific servicing mechanics must be providcd if vertical is>I i Ices or if horizontal is>150 feet and iostmetions to be provided belmy. The outlet filler(s)sI Ilbeinspected and cleaned to remove any accumulated solids accor g to manufacturersspeciNcations.Solids washed from the filte shall be retained in the tank. Filter cleaning may be neccss i more frequent intervals than stated in the maintenance schedule t\rc.aul� the system operating. Alarms should be testedegular basis by the home owner. if an alarm scum , contact an individual licensed to service P OFVTS, There is normally a 1 de under regular operating conditions, however pater should be conserved until any problems with the System are corrected to t ck-up of sewage into the dwelling or sw faABAiNDONIM"EPlT: Wp0 S fails and/or is permanently taken t o1'service the following steps shall be taken to ensure that the system is properly aly aban tied in compliance with Ch- SP oS3.33. Wisconsin Admin- Code: - All piping to tankits shall disconnected and the aba oned pipe openings sealed. • The contents ofalland pits sh be removed and proper] disposed of by a Septage Servicing Operator. • After pumping, aland pits sha be excavated and re oved or their covers removed and the void space filled with soil, gravel, or other inmaterial_ CONTIINGENC 1 PLAN: 1- dle POWTS fails an cane code compliant replacement system: A suitable teplacement area has been evaluated replacement area should be protected from distnr from existing and proposed structure, lot lines and systems must comply witih the rules in effect atth 0 A suitable replacement area is not available du holding tank may be installed as a last resort to p JSf The site has not been evaluated to identify a su b. be performed to locate a suitable replacemen are I esort to replace the failed POWTS_ befpaired the following measures have been, or must be taken- to provide a y be utilized for the location of a replacemenr soil absorption system. The -e and compaction and should not be infringed upon by required setbacks Is Failure to protect the replacement area renders it unusable. Replacement TIN f replacement. se it and/or soil limitations. Barring advances in POWTS technology a :e th fled POWTS- cplacc tit area Upon failure of the POWTS a soil and site evaluation must If no rep ement area is available a holding tank may be installed as a last w Mound and at -grade soil absorption syste may be reconstruct m place following removal of the biomat at the infiltrative surface.Reconstructionsofsuch systems ustcompl} withtherule effectat that time. 1VAANLNC!!'.! SEPTIC, Pli3"Y, AND OTIMR _REATIiElT T.iNIiS 3tAV NTLAN LETHAL GASSES AAID/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, Pit P. OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEAN M_AYRESUiT.R1r,SCu-EO APERSON FR-ITHEiNT-E RiOR OFATANK MAY BE DIFFICULT OR HVIPOSSIBI.E. ADDITIONAL COMMENTS: POWTS INSTALLER POWTS VAINTAINER I Name: /CENT l>/414E Name: /9 ,/E L urorS/dL Phone: %!S 9.1,2- yiss Phone: y/,S 96F-595S SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name: Name:_ Phone: I Phone: 7/5- 38G- y�8o D 9 a� 8-in. to 15-in. Dia, Biotube Effluent Filters Applications Standard Models Orenco° 8-inch to 15-inch Biotube° Effluent Filters are designed to FT0854-36, Fr1254-36, Fft554-36, Fl0822-14B, Frl254-36AR remove solids from effluent leaving commercial septic tanks. They can be used in new and a"sting tanks- Product Code DiaaramS General Orenco� 8-inch to 15-inch Biotube- Effluent fiilers+ are used to improve the quality of effluent emung a commercial septic tank- The Biotube cartridge fits snugly in the vault and is removable for maintenance, the handle assembly snaps i o the notches in the top of the vault, and the tee handle can be extende or easy removal of the cartridge A "base inle!.+ model (see p. 2) is aval le for low -profile tanks. An optional slide rail system, available on larger Vets, simplifies installation and provides tank access for servicing. .idle assem '� n float assembly led separately} e coupling — abes t- holes POW Cutaway view - 36 1 I i i raaswanvcw m,->::!,za� jn �xm.vanr QW., yj[I.nr v a . afi ryi4A:smm I19 gnT1'.n IB = 48 PTg 54 a Sa USRI W+6]IIW Gn rrs�Tna'® bTu a4 = W p6o r z_�zyq K- sp)a mT.an . a4ra =wn pr+[imn�6 Y.0 lf4mep M1Y no,: B[11'L" M� G9F ' a'✓:1`): [T Maafen PWl+xam+euc 49:n (I]19mry IKWq to Alta 1F46 n rJfO i fE9 root 54-+-11]R-mTI R]OvJ la`Altla)b}n (119i iWamN K`..n5x+-niMmcla A5t tl a n a itf.[&x[][ m-1 W nll6)6 mg1®,gb 4LL tl a5112 n. R[ax26[5 root r ra ix- a4ISn pD7� ztl]T>mq utl � 4Ee rJ cpsN of T M/ 4+[ l� 5 i21ya[ b 0[ IM Cutls FT0�22 148 l: trot nx-Adsma�v i rso = rsnnv W's asaMn em[axlm-e 6uu[194k41iv ad 4^ f 4 = 14 p56 a[reaa � romy xgaT .nn ' i w„m:Lvom � P c'Mi[ilLxm l[v� F41L' TfW,6av Materials of Vault PVC Poe coupling Copplinq PVC Side view Harde Components PVC Support coupling and nraCkel PVc BMW cartridge Polypropylene and polyethyLerm 'a--mca761oPu0+=Err,Ux1 RM are on-ee Wild, M!dVe ru aW.Wn vbl[[lylm4 Nale:51,ppM mq!kg arrtlsgAwr6'rJxtaa aiir7a64 w 12-irchaxd 15-axa stay Grenco SystemsO Inc., 814 Airway Ave, Suthedin, OR 97479 USA = 800-348-98A,3 -541-459-4449 • wwWprenco.eom NM.FYF7-2 Riw.Z%Coolly Pagel of Wisconsin Departrnent bf Safety and Pmfesslonal SeMces Oh"lon of Industry SwvIces SOIL EVALUATION REPORT Pape 1 or n a=rdenca Whh SPS 385. V& Ad n-L Coda County -- S� Ct'b^ Attach cmnPiet sit plan on paper not leas than 8112 x 11 inches In size. Pion must include, ` Parcel I.D. but not 8n71fed to: wdicai end horiwnt,l rateenoe point MW, ditWon and pereent ebpe, scab or di nansions, north surrm. and bmTbon and dhhnos to ne meat road_ Please print all Into ... W on. Ravhu2d by papa Personal lydomsnon You PmvZe maybe used foraecdnd S. 5. 1 m . Pmpety Owner Property Lacafiw ❑ ❑ 11 � I�� � Za- ��(�. 1'GCT\r] C�O t�4kS�'ott hO�p.o j, GcvL Lot Ya Y. S T N R E W (Or" Property Owners MWm Addreas Lot# Bbtlr# bti6d. Nene or MW City Stets Zip Code - Phone Number ❑ 0ky ❑Visage ® Town Neuot Rded S'5G- o6? 1 �NewConetruenon 11=1MR yiNumberafbadmome . Code dwMiddaip WerMM!o-GPO ❑ Replacement ❑ Pubik or commgrchl-Desarme: = Parent materiel 10' -- �'-- ��\ Flood Plan 0WOWn B applicable N 0. R . General comments and tecwnmendetbns: . r l , Borinp0 Boring Pft Ground surface day.lf:�R Depth to Ilmalnp factor? min. Boll Acolicatan Rate- Harr'Em Depth In. DOminam Color Munson Reds' Desalptlen 'Qu.Az. Cont. Color Tmdttre &&dune Gr. $ Sh. Cona{etance Boundary Root GPDIW /�, Zf `r s'��+. �Zr.s"af' r,•LEt- � Il_ d-�i o-� Yr L. t`?l _. NZ 0 c-9 -E Bodrtg # ❑ Boring g Pn Ground surface mev.?0o-.=R Depth to limiting factor ` In Son AmI{dedart Rafe Horizon Depth Dominant Color Redox Deaonptbn • Tedure Structure CorolafWnm Boundary Roos OPDIFP In. YWrnell Qu. Az. Cont. Color Gr. sz. Sh ?i- k J(_ z- . L I Sguemli BOD >30 S > 309 led MWL 220 and TA�: 1ep CST Nerve (Plem Print" q / CST Number y G Address Willel01 IoCk Road 611[4s E5re11e11M CWWUMo - ' Telephone Numexu r Mondovi, WI 541DD SBD433p(Rp41t5� 1715) 579-9584 1=! ®pit tee Gmwdalafrtoedw8r _ft 040 to "ft fecto(L in, HOrfmn DwM In DomtnertCobr tduneeh RedoxDesalpttan Ou. At Cord, Color Tuna struaurs Or. St Sh. Conafstenp Boundary ROote wu n�auvu nruo OPWFtr e '3-.'Z� �ST" '3 cif"a-5YL' r Scc cSn._ n t{�:- J,. 6'7— p•'( iC GQ5 ',�, ❑ Borhv ® Ph Ground wrkm Depth to limiting factor la Hortmn Depth In. DorninerR Color Munssil Radox Daevlptlon CAL Az. Gaut Cater Tenure Structure Gr. St Sh. Consistence Boundary Rooht ....... GPO/R2 .Y ,am ,Ow r� g 66 o V ztir z _.zfrj C�C c . .-'J j` ijo /• ,�U .f�/' SG /'-2� rNl� � Is- Z-_ (1'� - Boring (] Ph Ground e+ufam elan. _ R.' Depth to rm*4 hwwr _ �.n. eMmt#I - HOD, > 30 5 220 mgfL and TSS > 30 i 1&0"L • ERluant02 - 8OD, a 30 s 220 mplL anti TES > 30 s 18D myL 'vr I Will Heidt Soil Testin(i W3503 Hemlock Road Mondovi, WI 54755 ( l 5) 579-9584 ,00 o,2 CJ r.er• a4*' APPLICATION FOR REVIEW ,p = ' ;Sp - -Complete all pages- S .. NOTE Personal information you provide may be used for secondary purposes [Privacy Laws. 15.04(1)(m), Slats.] Private Onsite Wastewater Treatment Systems Division of Industry Services El Plans to be E-filed, Provide SharePoint User name below: For plan status, check our website at htm;//dsos_wi.ouv Email to code questions to mailtd:DSPSSSPowltTechi@wi,00v Seven counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those counties and their designation check our webs -re at hiciiij9ldsos-tvi_aov _ _ 1. Project In Formation - Fill in all known information. Confirmation of assignment to a reviewer, I Projecusite Name: mod 1 P � 1 Transaction ID: i Locaao Number Sa�ayey[�of rojrU (d,,u/pknwm, indicated nearest road Pmvious Related Trans- lO: 1)`� l �f-� ( Estimated Completion Date- Assigned Reviewer: -. Legal Description: L [ r S f- County %felt ' Assigned Office: _ (_) City M Village FITovm -1a Ile of .l_t.( Wall ayou. -.mt .._� .�alow- La Crosse, Green Bay4^ 2- After plans are reviewed, please: (check all that apply) C Call customer 1, 2 (arde number)' NOTE: We reserve the right to re -distribute plans to another office if ❑ Requesting pary will pick up - needed to reasonably balance tuman d times. Check (Nail plans to customeoi 2 (circle moer)` httoWdsnsevi,00v for next available leer date 'Refers to atomer number hum below, 3. Complete mefonovi+ng designer/ownerimqu 9 information. Utilize the check boxes when desi q owner orrequestino party is the same to I i avoid repeating informaaon, I I Designer information (Customer 1) D Other Please Spe Below (Customer 2) DSPS j First Name Las; Name Custom \umber //a,se Fist Name Last Name Customer Number i ,t /JT i'!P- dTVP, Company Name Al Company N Address f q//, O, X. K /Q Address - Coy State Zip+4 (9 digits) ZcLfAX J i`7JO Slate - Zip-4 (9 dgils) GJT i Prone Number E-mail address Cell phone Phon mher E-(nail address Cell phone (aka code) 9d2-111515- Golf xmr A (ar `7/s _ Check it app(irahle RNor/- can _ C k it apple le or specify relationship { ❑ owner J Ov+ner ther -speci relationship in4ortnation and Plan Submittal Checklists- To request electronic an review rnmpl the appropriate application form and e-mail ft, along with your registered SharePoint usemame to DSPSSBPIanSc dule( �sconsm -o If plans are being submitted via paper, they Will be assigned to a reviewer after receipt at a DSPS office. Subm' I checklists can be fou 'n each applicable component manual "appearing on the POWTS prograin page under Publications aOtN Co is I at Is HolmenlOnalasks Area DSPS 2850 Midwest Dr Ste 104 Onalaska, M 54650 503-789-9334 Few 6118-785-9330 Email; Dso58bPtanscttetlule�wi.00v Make Checks Payable to-- Division ❑ Check box to (nvoi Designer Signature SBD-105F/ (R 3119) / Services OR Sign below Green Bay DSPS 2331 San Luis Place Green Bay, WI W04 920492-5601 Fax 920-492-5604 Email: o3ps316PlarS ltedulefht ' o TOTALAMOUNT DUE 5 s2-'Vo o4 Review Cade 7633 eliSM!TTALiciveci, su me+.only - forms may result In oroeeealno delays) NEW Units) ❑ Aerobic Commercial System ❑ REPLACEMENT ❑Commercial System ❑ Chlorinator ❑ Tank Replacement Only ❑ UV Disinfection Unit ❑Add Effluent fitter -- SYSTEM TYPE(S) NOTE: Submit separate sheets for each system if submitting multiple systems on the same site Enter Fee ❑ Revision to previously approved plan $85.00 ❑ Miscellaneous Review (I.a. replacement of aseptic tank, addition of an effluent filter or pretreatment de ' to an existing system, etc.) $80/hr �$ Component Manual Design I treatment components are previously approved under s. SPS 384.10 (2) or (3): Cl At -Grade Component Manual - Ver. 2.0, SBD-10854 IN,03/O7, R. 1/12) Wastewater Flow' ❑ In -ground Component Manual - Ver 2.0, SBD-10705-P (N.O7/01, R 10/12) Gallons Per Design wastewater flow of the proposed system: Mound Component Manual -Ver. 2.0. SBD-10691-P IN 01/01, R 10112) a Pressu ribulion Component Manual - Ver. 2.0. SBD-10706-P (N.01/01, R 10112) G 1,001 gpd or less $ ❑ Other - Please f 325.00 1,001 - 2,000 gpd $ 325.00 2,001 - 5.000 gpd $ 400.00 _ ❑ Soil Based Individual Site Design One or more treatment components are not previously approved under s. SPS .84.10 (2) or (3): ❑ At Grade (Individual site design/deviation from component ❑ Non -Pressurized In -ground Design manuals and use of components without product ❑ Pressurized In -ground Wastewater Flow in approval): ❑ Mound Gallons Per day 1 Design wastewater flow of the proposed system: ❑ Drip -line ❑ Constructed wetlands GPO 1,000 gpd or less $450.00 • Documentation must be provided to support treatment and dispersal claims. I Soper 1.001 - 2,000 gpd $600.00 2.001 - 5,000 gpd $750.00 statement, provide rationale for the project and attach supporting documents de sections, le greater then 5,000 gpd $900.00 reports, technical papers, research articles, etc.) plus $0 08 for each gallon over 5000 gpd Slate -owned facilities: Holding tanks previously approved under s. SPS n 384,10 (2)(3). Design wastewater flow of the ❑ Holding Tank Component Manual, Ver. 2.0, S 10855-P (N.03107, R1112)• We is w in Gallons Per Proposed system: • Non -state owned Commercial and Residential Holdl anks that completely utilize this manual ,000 gpd or less $ 90.00 1-10„000 gpd $150.00 and have an estimated daily flow of less than 3000 ons per day must be submitted to the GPD r than 10,000 gpd $225.00 appropriate governmental unit for review instead a Department. (see SPS 383. 32(3)(a)j gre ❑ Holding Tank Individual Site Design' e. site constructed, <5 day holding capacity, Co- Design HoldingNialis including site constructed tanks NOT previously roved under s SPS 384.10 (2) or (3). mingled wastewater, etc.) 9 Wastewater Flow In Design west ter flow of the proposed system: Please specify. Gallons Per day 5,000 gpd or less Documentation must be provided to pod the rationale for the p(oll In a separate statement, 5,001 - 10,000 gpd $300.00 please include all code sections, test pons, technical papers, research articles, etc.) GPD greater than 10,000 gpd $450.06 ❑ Sall Saturation Determination Report (using observation pipes) ❑ Interpretive Determinallon $240.00 ❑ Experimental System (One time additional fee), Submit fee for individual system as per appropriate above system type) Experiment Number _ $400.00 Priority Review (enter same amount as normal review fee listed above) $ Enter Total (rounded to the nearest dollar) $ SBD-10577 (R 4/18) A�c[�M D s SEP ZO u 1GZ0 zo z p c.c• a-o Q oix Coun ' Community Developm t m w i z A s O y s m i i A Z j S S i ' O — 3 I 1111 11 I O _ _____• n net 0rI I........ a 11 U I6 I d E R. 6 E � c d b nl m � :01111 11 . .. F" o I u,'lil„�i 14 Ao , use' o nLEI �m • -- A EN m O I m rz M mwi LLG PAGE TITLE MAIN FLOOR peLIN BY' Scott Gunnureon qAowKodswwLco" CUENr CaNUCr INFO: - - -� 5CALE: 115-828-1161 NAME. DAVE PETTIS � eghomaaeelgneyehoa.cam I/8°•I�-On OEL- 651-334-55H6 EMAIL. deveonxm / qme L.con I Ii� Vftconsin Departntentof Safety and Professlonal Services Dlvlelon Of Ittdt�&sM�s SOIL FVAI I lAT1ON REPORT c-aoao'a`� of z In accordance with SPS 355, VNs. Aden Code CQUIMIY C ; Attach complate site plan on paper not less than 8 112 x 11 Inches In size. Plan must Include, but not limited to: vertic ll and horizontal reference point jW, direction and percent slope, an scale or dimensions, north arrow, d location and distance to nearest road - Parcel LD. 3 - I 7 -z Z Z 1 Please Print all Infonmallon. Personal information You provide may be used for secondary rive Law. S. 15. m Property Owfter I O_U� 1G i ZCtkS ��JC�9t1�S�'ecY_ 1'o'h`ec� Property Location i'-- GcvtLot Nj� V.15 J�- Y. S I � T Zg N R ��. E (or) iAV Property Owners Melling Address Lat # Blotit # Subd. Name or CSM# Z7- city State Zip Code, Phone Number ❑City ❑Vlllsge ®Town NewsatRoad 15NewConstructlon Use: ®Residential/ Numbsrof bedrooms Code derived designflowrele GPD ❑ Replacement PuI off commercial - Describe: Parent material _� -� w • Z `-T Flood Planelevationif applicable L Rr ZoNF General comments and noom endstldnc {,pic Hw..r74�_ �y S0.vy%�C rrvl�ua\ /`W J �11�1 �GC 1 © Boring # soft Pt Ground surface alevlK! I,L Depth to Btffgrt ffaacct+Ior--'i—n. a Sr ; iCr 0.bo .p 2 iv or tc 5 ih Qi #� VC6 ) � —� art `J 1 of tlA,,.,nl ,•.fll, ao'. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Tmdure Structure Gr. Sz Sh. ConNetana Boundary Roots GPD/FP ivl��.— 6 z-t lvrl C/ Z n d-i l 0- `i L2 YfZ/at`I 5ic c5/ vw� Cr 3o-3 Sy�Y/ E'r S h t6/ Src (cw n.�C: 7 Bodrtg# soft Pit Ground surfaw elsv,�00-Z L Depth to limbV f�actor— N In RNI AI mlirallon Rste Horimn Depth In. Dominant Color Munsell Redox Description Clu. Az. Clint Color Taftre Structure Gr. Sz. SR. ConsNtence Boundary Roots GPD1Ptr 'Efro1 •Efdt4 ( 0 451� i E art s rm .- o �l Z 1k, 04 b`d f77S �-'F - t Emaem Nl-BDD>39%ZZ9 MOILe oT55>395 69 >3R 5279 MOL and Tess >396 Tau CST Name (Please Print) 1 Ignatu,4 CST Number 1, ) z "C- � 17-11� Address vviii i-felUt JUn roou"a Drate(�/vIa�lwr �0Condu�cted TelephoneNumber nC�q \A 5na Hemlock Road SBD8339(R04/15)Mondovi, WI 54755 (715) 579-9584 3 3 j soft# Baring Pit Ground surfaaealay.!_5 ft. P aO I � PAC,�-, Depth to UrnMngfaetof� S in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont, Color Texture Structure Or. SLz Sh. Consistence Boundary Roots GPD/Fe *M .�2 ae � :5 .L YLrI f "�-- 7-5`'e ` 5 2qsY tMt�rec- a'�, O g 3 -3 a e275 ` p. El Boring # Pa Ground surb s el&''_b t Depth to limiting faotor2in. c 11 n....n... ., owe Horizon Depth A Dominant Color Akrnedl RadoxDesm"oo QmA& Cat Color TexWM Structuns Or. Sz Sh. Corshtenoe Boundary Roofs GPDIRZ *EMP1 *EM z f 4,5 c 3 I — ti c -37 SY %L, 25 t2/ Se ❑ Boring # ❑ Boring ❑ Pit Ground surface Slay. _ tL Depth to limiting factor_ In." a I n...a� 1. ff.. * Effluent #1= BOD, > 30 5 220 mg/L and M > 30 5150 mglL * Effluent 02 = BOD, > 30 s 220 mg/L and TSS > 30.,; 150 mg/L [I�S j SIG �AOc ct,�DkbLF-- I�OrNib V� L , 9" c row Will Heidt Soil Testing W3503 Hemlock Road Mondovi, WI 54755 i �715) 579-9584 - j?0- \2;?1 74577 O 7.� Z�LC laq 7�Ym� /Crd.Ci oY2 F.6 �.'h ctiCl v-j���ti��UJ'l Sa'Y ���Q�