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002-1026-30-025
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety 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)) Permit Holder's Name City Village Township John E and Mary E Rivard I TOWN OF BALDWIN CST BM Elev. Insp BM Elev. BM Description. I� % A �fJ/,. i l nN P t TANK INFORMATION TYPE MANUFACTU ER 2' CAPACITY Septic 1 Dosing C��6o boo F7I`�r Ore d;d�vlti Holding TANK SETBACK INFORMATION Ti L-- i-E 1 r s ! TANK TO P/ WELL BLDG. ROAD Septic 3G`IV (P5Dosing38, /`! �� + EtoAir Aeration Holding PUMPISIPHONINFORMATION MjI54-D,!1,Pcr ZS.De Manufacturer , i, Dema I f 7rt 1'I� GPM Model Number TDH Lif4 D Friction L• Is System He d TDH Ft 7 1 Forcemai(np Lenl , Dia. ++ Z Dist to Well of SOIL ABSORPTION SYSTEM Agof (,e /( TION DATA STATION BS HI FS ELEV Benchmark JG 3 l D:5,3 j o Q AIt.BM G q DA von�ct b Ib Bld .Sewer 5 't9 `7 SVHt Inlet I I Z ?.7 [ > St/Ht Outlet Dt Inlet Dt Bottom Header/Man.-(os y61/•bs Dist. Pipe p p/ Bot. System 9.35 9S. 95 Final Grade St Cove -' ) Y' f -Yf r / / l0 CP '?B. y BED/TRENCH Width Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS Z SETBACK SYSTEM TO P/L - BLDG WELL LAKE/STR M LE CHI anufa r INFORMATION CHA B OR Type Of Syste D el Num r VA 30 S5' N� DISTRIBUTION, SYSTEM Header/Manifold I 3 Distribution +t Pipets) —7 I Z x Hale Size 3 x Hole Spacing r Vent to Air Intake •./l-,� �" Length Die Leng[h / Dial_ Spacing 1 L n SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only DEptlTT7�T� +' Depth Over ed/Trench Edges > I l t m Depth Topsoil of t xx SeededlSodd�11ed``` 'I xx MUlchedt,/ tenter O 17 Yes No y Yes F No COMMENTS: (Include code discrepancies, persons present, etc.) Location: 2661 CTY RD E / G 1.) Alt BM Description=� �1� /ov,,J41 -i 2.) Bldg sewer length = 7Q' - amount of cover = Inspection#1: 001 !/zo/ ?-I Inspection#2: Its 4=oo /p. Af' N O v-j, I ® I h5 P t C'i"t d'1 Plan revision Required E Yes R No bl -Z ` Z Z�� _ /�3 Use other side for additional infonnatio _ Date Insepclofs ignature Cart No. AM% 91KJed ad — 3si �7Syii: l; 'T-i � - In stry Services Division Cowry 9"� 0 1400 E Washington .Ave S7, Lao,x -St. Croix COUnty P.O. Re, 7!62 i Sanitary Pemit Number (la be filled in by Co.) S�pihrnunity Development Madison, W153707-71fi2 �33 y5 0 Sanitary Permit Application�,�-(oZDoZ333- Sm mnsacnon Number In acconlenee with SPS 3 83 2]Wis. (2), Adm. Code, suhmisiton of this forth m the appmpnam go%emmmed wit is required prior to obtaining a sort permit. Note Applmabon Toms for swe-owned POINTS arc submiucd to the Department oFSurery and Professional sm:ces Pnsonal infitrmation you provide may be used far secondary of et Address (if different than marling address) / -7 I n ran in accordance with the Pmac Lan•, s_ UD4(I l(m), Sims s0 •% µ rt zo, X'0. E i. Application Information - Please Print All Pn_fo_rm_ a(ion Property Onmer's Name Parcelg T J O//r /UAGO OO.i' /O)( - $O -OHO\O Property Location Property Owner's Mailing Address Z$foCo-7 PaIbo 0r. Ill Govt. Lot �'/.. /VE '/., Seeman /3 C^,n, State Zip Cod. I 1 I Phone Number f�T, t-/Q.Z O (ride one)_ v J i a °I N; R /G j o IU R. Type of Building (check all that apply) Lot P Subdivision Name ® I or2 Family Dwcllmg-Number oFBedromtu ,3 I ❑Pahllc/Commercial- Desrnbe Use Black El city of ❑Smtc Owned -Describe Use_ ❑ Valaee of CSM Number jD /V' _ ZOA'L �/. (IM0I I\ �. 6 Tonnaf boGour ❑[. Type of Permit: (Check onI) a boti on line A/-� .omple[c line B if applicable) A I __ ANew System ❑ Replacement System ❑ TreattrumfHolding Tank Replacement Only ❑ Other Modification to Existing System (evplainl B. ❑ Permit Rcnaval ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Change of Plumber ❑ Pcrmi[ Tmnsicr [o Nov l 1 Relore Ezpimtwn I Cvmer S �t l - By Qr �I iV. Ty c of PORTS Svstem/Component/Dc-.,ice: Check all that a plv) py`irov r3 Nri -Pressari,ed In-Grouneseurm d ❑ Pril In-i,.eund ❑ Al -Grade ® M1lound 1 21 in. ofsuuable su'dj Mmma 121 im of suitable suit I] Holding Tank ❑ Other Dispersal Component (cxplam) LJ Prc[rmtmcnt Deane (csplain) i _Vvte ersal/I'rca[mtion: entkrea informa Design Flow (gpd) Design Soil Appiican° RaI(gpit Dispersal Area Requir (s0 Dispersal Arca Pr uste�d (sf) System Elevation Cod t..A I %So Y50 �011 %,595/ad 9S.>St Vi. Tank Info Capacity rn TatA 6* of ib!mmfacmrer Gallons Gallons Units Lt1� brL11C0 Fi�<r ' 66 _ c c ? U o B Ncw Tanks TPvvwit Tanks _ _ Scrim or Nwdme'Tank FOOD - /000 I ! - LJ/ESE< COAIGR. ✓ Uosmg Clumbcr I /� 60 _ ,LOO �o '� ViI_ Responsibility Statement- 11 the undersigned, aseumc responsib' ' or instal!atia OR?5 shmsn on the attached plans. I Plumber's Name (Print) I Plumbe - Business Phone Number K.-Ivr /CE J.7 P9 7rs P-12- yrsS I Plumber's Address (Surest, City- State, Zip Code) lox I-V73a II U. Co /De ar[ment Use On {��V.. D( Approved / \ ❑ Disapproved ❑ Orvncr Given Reason for Dcmal Permit Fe 1 '0 Jil Date I'sJsued 7(� Issuing Aec itmamre I� L�`�- IX. Conditions of ApprovaVReasons for Disapproval 3 �is�a S rov C (}{ 5 �/S rat WlA! Vl V�QVLC STEM OWNER I Septic tank, efilUent filter and iLO � 1•/' O W (.LCr dispersal cell rnuat be sewlced / maintained Iti'4" -q&4 T%orol � /..g4er- as pet nianagenlent plan provided by plumber. - 10 I tu t ` A#'5 P rm 4 . -1 i�h'' "pffi'ii p'tiWIM, m., mona-b—It to -the eaunry only an Paperout hose thank rr_x it rather insize as per spphcab4 ro: /orA n-n.,^-s LS K SBD-6398 (R- 08114) EKE F Alq r � ' JoNJ „ltrJAAd- Ca. /1d.yE " /V41,/V6, 13, d9N/ Id T of .4,9LAw/,J/ S,r e"toly za, N /V A 1ST So/ �= P/r3, A.ce�esca SAe.r carLF�i<al A[[ 393.Y9 ser H // Le, ad. E / AO, sirl AAlvewy FAA,l Pl6cA 0 Hit loly q7.o 1.156/ ro F OM! Le. /to. E Ail,rsfA. /000/Ldd , /i0A/Aa r.4d4 ,taPJL ScA•yo 14J/ FOALf rlA/J C8d/� g3.Z5 I 07(a s'4a a / '06s rA� m F'yd / F fld G "%S /I bCK GE[L ,16.2 /° 9a, 2 / NeaJd ,aow r3 I i YS. Ec.' %5. 95/aJ 95, .T5 �O„irO�A L a r. S GS I � C!j,/l. - lda,o r40 of P/1 0✓4 FIiE �o�IL �SP� October 5, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-10-05 Plan Review: PWTS-102002333-C KENT HOKE PO Box 10 Colfax WI 54730 SITE: John Rivard XXX Ct< Rd I__ I: Town of BALD W IN St. Croix County Total Amount: $250.00 Description: 450 GPD I3 Bedrooms — New Construction) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http //dsps m.gov/programs/Industry-services vww.wsconsln gov Tony Evers - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES � %/--L z SEE CORRESPONDENCE Pressure Distribution Component Manual — Ver. 2.0. SBD-10706-p (N.01/01, R 10/12) 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 in accordance with the enclosed approved plans and with any component manuals) referenced above. The owner, as defined in chapter I01.01(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: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated 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 beset and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with 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 orthe mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. 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(1). • 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 construction/instal lation/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, O POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: dm_vanderlcegagikconsin .. Cell: 608-516-6134 Page 1 of 9 Private Onsite Wastewater Treatment System Index and Title Page Project Name: TONn! QlVA60- Owner's Name: " Owner's Address: �jQLEI t�(�Irh MY(1�1�' (1 n a vl • LU 5( 4 k30 ontltbonell Legal Description: APPROVED g P — / �' �' NE 13 .7 9 /V �� (,J DEPT. OF SAFETY AND PROFESSIONAL ERtltt-Es— Munlc] all Town, Wlage, of DIVISION OF INDUSTRY SERVICES Municipality: Sity �ALO/r/.r County ST. ",toi1( �r % d z .f., 11 Lot Number: SEE CORRESPONDENCE BIock Number: CSM Number: Subdivision Name: / !. Parcel J.D. Number: 00,Z - /O,i6 - iO - 000 (AhAr oF) 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 Chamber Cross -Section & Specifications Pump Performance Information POWTS Owner's Manual & Management Plan POWTS Owner's Manual & Management Plan Filter Information 9i�M License#: ^0- ,7.?�Y199 SBD-10691-P(N.01/01)"Mound Component Manual" Version 2.0 W SBD-10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 Attachment: Soil Evaluation Report • ,7020 YY,C7S' YLHN IV&),/vE ia, a9//, /tw of �A40wi,J/ ,ST, T l=So O ?o` q= bre, A.Go�efcE Spc.E eer `f «a� ALE SF5 tax in 5er u w fie. aE 0 /404 fE 6Rtufwdr A ; of 9 GJO ` re 1441 'S. Ae, d Afit /6/.8v` rm a< 'Ocs ram w F'y6 A. O sEd�% %9 4I/ES fA 90ly � /000 Loa LONAe rAJK ,7 Pot .fG// Yn jj /43 Fa{Gf /'IR�JCSd J JOAN q�,xs y7.a zrQ i s9, / POP G %7s QeGK [E(G �d•2 �� 9J,d� iHauJO Oow rS � i rs.EG. 9s9s`eJ 95:,?S4aJr�A Lnr. , al 9sls L5� ��" a" owc PiVE D .7 ft ft ft G = ft H = /. / ft A = In ft s = 75' ft _ = 8.4 ft J = 54 ft K = 8.6 ft z = 9.7• 2 ft W = ?0, 2 ft 4" sch. 40 PVC observation pipe 9 � n UI o � ° 1.5 ft N y m - � M Y 0 0 3 O.S ft I.c1 m m W ao� Page 3 of 9 CROSS-SECTION OF MOUND UPTURNED LATERAL & ACCESS BOX S/ TOPSOIL // OBSERVATION PIPE & WATERTIGHT CAP ' GEOTEXTILE FABRIC COVERING J DISTRIBUTION LATERAL ( AR in. sch. 40 PVC D2665 ASTM C•33 SAND FILL Lateral Invert El.= 96, ft 6I TOPSOIL . ,. Toe -� a... �Y. r�G SystemEl.= 9595 ft ....,A_,.. l� ,, .71'r`,.•` ,�Y�`"'/-�`\CC�!/ �f % C�7„ Contour EL= 95, f{ _ '.. :. -. _-, •. , ,_ . - .. � . , :,,. ,: PLOWED SURFACE P/o SLOPE - FORCE MAIN (2` sch 40 PVC D2665) • - DISTRIBUTION CELL = _�_ ft x 7-5 ft = y4O ft2 (%%2Y," aggregate) Min. Requited = S'SO + /0 = 'P.fd ft= 2" Force Main Manifold r ( //7 inW sch. 40 PVC D2665) PLAN VIEW OF MOUND I Observation pipe 5 L J 7S B - Observation pipe 8.6 -K- o ox i 1/68 = Distribution Cell Distribution pipes "I/GB = s It ('i -2h" aggregate) /Z3- it OX= Upturned Lateral with Access Box Prohibit disturbance and vehicle traffic within 15 ft of downslope toe. L 9.),,2' Basal Area = I y% ft x%s__ft = 10 95 ft' Min. Required = - , � = 75-0 ft2 PIPE LATERAL LAYOUT OF MOUND (End Manifold with Aggregate) HOLE DTAMCTER LATERAL DIA, ODIA. (S a CF RCG MAIN DIA.= a Pipe D 665) in. eJeCess Box \ea\.tJoo S = 3 f t . 09 \og \Ao\e "A �\ Y 11 -- �.�Y ��X Y' T s..3' y X Y' YT\` r P -7.2 ` MANIFOLD (Z& In / D26a� PVC D2GG5) 5) x vw\e FORCE MAIN (2"sch40 PVC D2665) Minimum Number of Holes = S�,9 ft' r '12 = 3$ Holes Page _ 1 of _ `� HOLES LOCATED EVENLY ON BOTTOM OF PIPE. -Zf Holes/Lateral x 2 Laterals = 38 (3/16") Holes x 0.66 gpm / (3/16`) Hole = ,25-08 GPM = SYSTEM FLOW RATE PIPE VOLUME = _ ,4Y ft. Laterals (total) x 0.092 gal/ft. _ /J. ?.r x 5 = a. as GAL = MINIMUM DOSE VOLUME PIPE INVERT ELEVATION = 9C. YS ft Page 5 of COMBINATION SEPTIC/DOSE TANK CROSS-SECTION (DRAWING NOT TO SCALE) MANHOLE RISER & COVER NAL GRADE (per SPS 3B4.25(7) & (8). approved ope ground surface away from locinng device. & wamirg label; Fideitd anho4e(s) for proper drainage) manhole riser as necessary.) 4' Aaai. Sch. 40 PVC Tank Vent ELEGTRIGAL lom1ed 12- above grade or 24' 4" Mm. Sch. 40 PVC Tank Vent above RegiorW Flrrotl Elevation BUILDING SEWER located 127 abovegrade or 24• JUNCTION BOX (per5P538230(II)) above Regfmat Flood Elevation {wmply vriM 5PS 376 and NEC 300) / I t FORCE ......... -..........- MAIN _ `72 OPTIONS >a Ise -rover 23' mn. NB' - MANHOLE _ {TI Face '1 .� INLeZ—— BOT—OM OF INLET QnvM alevatlon) 1 r3' F tTree ba weV I I Hole Ivaarewalx lavN} - Q.4F,u4o wAa raala0 It f Te9)7-/46 - On Rest Y 7 / O <,IWET ML Approv4a [ntuent HIMe T/. Partide Eta, - V.-ta e) RegvkenOnO ffet ea Float .;.-.. A ... Fl4v. _r ... ...... . ... ...... ... _ .......... MINIMUM OF T OF SUITABLE BEDDING BENEATH TANK & MAXIMUM BURY DEPTH OF 96' Anchoring of tank may be required per SPS 383.43(8)(g) Tank Manufacturer: /.J/ESke 1' 6011L. Crf Daily Wastewater Flow (DWF): ys0 GPD Septic/Pump Size: /000 /6 c o gallons Number of daily doses: S. Alarm Manufacturer: ,iEOT.aert/cs Model Number. /Yxrl Fomemain volume: 8o ftx_/G3gaUft= /3.0 gal Switch Type: /%� �NArrc. t Actual dose volume= /oo. L gal - /3.n gal = 874 gal (total dose volume - volume of force main) Effluent Pump Manufacturer: 1/mg- hlf or DOSE TANK CAPACITIES: Model Number. 9 Reserve above alarm _ .?o in = 335.1 gal (D) Minimum Discharge Rate: J? 5. od GPM Alarm float above on float l in = 33. S gal (C) On/Off float measurement G _ in = /ao. C gal (B) Vertical lift (pump off to lateral invert)............ /0 S it Off above tank bottom 8 _ in = /3'/. ! gal (A) System head (distal pressure ?. S x 1.3 ft): 3.3 ft So ft Force main x /.Y 1100 friction factor 41 ft DOSE TANK DIMENSIONS: Fitter friction loss ...................................... — ft Length _--Z.So in Width $`/ in Total Dynamic Head (TDH): /Y. 4 ft Outlet height .JG. in Gallonslinch 14.74 9EN SERIES - 4/10 HP a I I �o � g"i / t4T_TII�I=7f7;t,> >�1! � sPPll II 9EN{IA-SFS 9EN-0A-RF EFFLUENT PUMPS Pe. /, df? fle7' ]0.49 on '� 9EN-0A-SFS 1076' 2733an Ul54' 2654 rm 9EN-CIA-RF 915- 9.8' 6 B' 7314rm N%an 1717cm 9EN-UM 9.15' 96' E.8' ZI.24 an 2430 an 1727M Epoxy -coated cW iron i0 100 t;o 200 251 �0G 1 Cow 'ihermo lactic t� I I 1 9 " Mntor Nnuc6no I Fnn ,UE l r.d e al m 40 So 60 v C fFi Franklin Electric HANIMIDI MIw Jdumkmn rI-m-pel� Ier Material _ Impeller type Thermoplasbc elastomer Non -clog volute _ Epoxy -coated cast iron___) motorman Steel ; MechaMcaI Shaft Seal NiMle with carbon and ceramic faces Fasteners Stainless steel Bearhigs Upper sintemd sleeve and lower ball bearing I Power Cord j_SJTW" SJTOW MX SGWV rard 9EN-UX mnacB Page 7 of 9 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner Permit' DESIGN PARAMETERS Number of Bedrooms (100-polbedroom) _ 3 N umber of Commercial Units Estimated Flow (average) ?pp gal/day Design flow (DA+F) =estimated x 1.5 -lSo gal/day Soil Application Rate gallday/ft= In OuenifEffluent Quality (O NA)Monthly Avemge Fats_ Oil & Grease (FOG) 5 30 mg/t. Biochemical Oxygen Demand (BODs) 59M mg/L L Total Suspended Solids (TSS) 15150 mg/L Prerreatcd Effluent Quality (®NA) i onthly Average Biochemical Oxygen Demand (BODS) 1530 mg/C' Total Suspended Solids (TSS) S 30 mg/L Fecal Col(form (geometric mean) S 10 cW1100ml- Maximum Effluent particle Size 11/8 inch diameter Dispersal Unit MfgJModel Number: SYSTEM SPECIFICATIONS Septic Tank Ca acity 1400 gat 0 NA Septic Tank Manufacturer 411KSEA Co,dew. O NA Effluent Filter �ganufacturer p, "40 0 NAJ Effluent Filter Model f rds81- /06 0 NA Pump Tank Capacity Od al 0 NA Pump Tank Manufacturer GIJESEA C�4, 17 NA Pump Manufacturer Li rr&r Zmgr 13 NA Pump Model cJ EN O NA Pretreatment Unit (®NA) 0 Sand/Gravel Finer 0 PeatFilter 0 Mechanical Aeration 0 Wetland ❑ Disinfection O Other. Manufacturer. Model: Soil Absorption Component (0 NA) 0 In -ground (gravity) 0 In-ground(pressurized) I ❑ At -grade ® Mound 0 Drip -line 0 Other: Vertical Distance Tank Bottom to Service Pad: // fi Horizontal Distance Tank(s) toService Pad:_//W I, NA Calculations: Soil Dispersal End Cap (Dispersal Unit EISA) DWF Application Ram = Arm Required - EISA — or (Tsench Width) _ ,'t. Units or Total Length of Treneh(sl fs0 - /.o — Yto — tit = 75' 0 'Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publicafion 9- 0 "ICC Flowaech Mound Component Manual" Version 12 0 "EZ Flow Mound Component Manual' Version 8/20/2007 0 SBD -10854-P(R.1/l2)"At-Grade ComponentManual UsingPiessure Distribution" Version 2.0 0 SBD -10705-P (N.OI/01)"In Ground Soil Absorption Component Manual" Version 2.0 1� SBD - 10691-P (N.Oli01) "Mound Component Manual" Version 2.0 0 SBD - 10657-P (R6/99) "Drip -tine Effluent Disposal Component Manual' ® SBD - 10706-P (N.01101) "Pressure Distribution Component Manual' Version 2.0 MAINTFNANrF Mrovurnumr.8rmvniR.F.-yTA1NTRNANCF. ANt) MANAGFMF.NT Service Event Service Frequency �umplpspect dispersal cel(s) clean filter At least once every: ® I3 months ® 3 years ❑ Other. Inspect pump & pump rnatrots, alarm, pretreatment unit At least once every: 0 months 0 3 years ❑ NA Flush and pressure test laterals At least once every: ❑ _ _ months ® 3 years ❑ NA START UP AND OPERATION: For new construction, prior to using 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 are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Systemstartupshallnotoecur when soil conditions are frozen' at the infiltrative surface. tMe 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, oils, vegemble/fruit 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 discharged into the system. Other non -biodegradable items, such as baby wipes, tampons, sanitary napkins condoms, cigarcne butts, 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 the system b= they can seriously damage yourPOWTS and contaminate your drinking water supply. Maintain aregularsteady flow byspreading laundry washing throughout the week. Avoid vehicle traffic over all svBtem components. Compaction o fsnow- over the dispersal unitmay cause it to freeze up. INSPECTIONS & NJAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer. or Seplage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware. ;dentify any cracks or leaks, measure [he volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings -,rooter than 3 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 (113) or more of the tank volume, the entire contents of the tank shall be removed by a ScptaSe Servicing Operator and disposed of in accordance with Ch. NR 113. Wisconsin Admin. Code - Sp --cif ic servicin t mechanics must be provided if vertical is>13 Feet or ifhorizontat is>1i0 leet and instructions to be provided belott. The outlet filter(s) shall be inspected and cleaned to remove any accum u lated solids according to manu tacturer's specifications. 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 keepthesyslem operatinn. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service P OWTS, There is normally a I day reserve under regular operatin_ conditions, however water should be conserved until any problems with the system are corrected to prevent back-up ofsewage into the dwellina or surfacing. A t3ATAIDOMMENT: When the POWTS fails and/or is permanently laken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, 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. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with suit. gravel, or other inert solid material. CON T INGENC:I PLAN: It the POWTS fails and cannot be repaired the iollowing measures have been. or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for Elie location ofa replacement soil absorption system. "file replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks fi,mn existing and proposed structure, lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement s}'stems must comply with the rules in effect atthe time of replacement- 0 .4 suitable reoiacemeat 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. y 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--Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of -such systems muAcomphy with the rules in etfectat that time. NVAIiNLvGE!'. SEPTIC, PU13P, AND OThTR T.REAT}iENT TANKS bLs-, CONTLAN LF,'IHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP- OR OTHER TREATMENT TANK TINDER Ali-)( CIRCUMSTANCES. DE.ATIi YcAV RESULT. RESCUE OFA PERSON F RON-1 THE iNTERIOR OFA TANK r'YLSY RE Ui FF ICULT OR. IMPOSSIBLE - ADDITIONAL COMMENTS: POWTS INSTALLER Name: E,r %KE /,%a- .?311 Phone: i/S 9e,2- '//S _ SEPTAGE SERVICING. OPERATOR (Pumper) Name: Phone: POWTS MAINTAINER Name: WA Phone: YTS 9L?-5'!5S -- LOCAL REGULATORY AUTHORITY q Name: ST. etd1X' LOr/NU+L17 /)FUEL. Phone: 7/,$- 384- yL80 ' Oc, 9af9 8-in. to 15-in. Dia, Biotube Effluent Filters J Applications Standard Models Orenco° 8-inch to 15-inch Biombes Effluent Alters are designed to r70854-36, Fi 1254-35, 171554-36, FT0822-14B, Fr1254.36AP remove solids from effluent leaving commercial septic tanks. They can be used in new and existing tanks. Product Code Diagrams General FT L 0 0 - 36 n Or=_ncea S-inch s 15--1nch Bietuoe¢ Effluent Fillers' are used to improva = r iaa�+v»uLLx�n the quality of effluent exiting a commercial s:.ptic lank TheBiotube cartridge Ilfs snugly in the vault and is removable for maintenance, the handle assembly snaps into the notches in the top of the vault, and the rasarcP,r:uwM tee handle can be extended for easy removal of the cartridge. A `base I ,° - ,° nz« mle.' model see 2 is available for low -profile tanks. An 0 onal slide `' �` i P ) Pd � sP-satr>u: rail system, available on larger models, simplifies installation antl provides zE - 45"a`""" tank access for servicing. N qnM �"°`[�P"°` Handle assemblyI R1�a4T •o+°m umc:nV dam, nsm,e: ,s�rm ilcat assembly a.wox:�,s,�P-�veeue s=>ni ordered se aratel '�lima.rylmgnM. 47.0 a ft4:-;.=,M ( P �� �1 �e.usz�..s�,,�tPrz�eu.e�a •, � sr.:.tlsv4„�,f n°c:y lsuudes„_r. R,san°:sP„ O� ��,avm rs�px nPSIsuGmy.�+4Ywm '., i� �-'tMa3tssaaPYt°asefure,xv I FTC 22-148 C� IT Fi 9R16::WNi6S1 iv'OP.L'b::pL'^WS.'-6' o U , pe couolin9 ! I A ' ! •' Bioluhes ww ! � � CuaWii GE.9.L.iamad rli lLlm�9�MXIiIC4tP�} Vault - 11 = n G'Flsada,l r=a ewwcn°.m_ �l� L lei holes ¢vim _ 4!c p-Rro, rya R.�•t. — Support coupling — Iplin Materials of Construction II i Vault _ PVC v�SJpPort oradcei Pipe coupling PVC Handia (mnpmems PVC Cutaway view Side view Support coupVm9 W bracket PVC &olube®corhidge Polypropylene and polyethylene 'G=�c,�'6btro f.�x:=•,!kY.svc[o�a-ca uv;s. mWvtL V.S. ud nkmsavl x1mis. We We.'9Rga[[rapkny arcl sPw¢tda'i`; z2 arzaaERan 72a'rtl,ao¢ tii#, rIDtvs ¢xv urenca Systems° Inc., 914 Pamay Ave, Sulherrm, OR 97479 USA • 600-34&-9843 •54t-059-4449 • wsuw.amnco.com mo-rT-rT-2 nevi 2.0, 9 mn] Page 1 of 2 •S S£?±L EVALUAnQf+t REPORT f2o3= p .�'.Z[43'n'{7G _ 5. r �- S a.ordar,� wah Ca::m 3 . ;lw. Adm...�__ _ P�IsSE�tc SBiRi06. _- - - - SUmitt Sail Tsaenq, In_ 'ac^ cmp!eiu site Aran or, paw not less Shot. 8:f % t t !notes in size. Ran mu5 cony St. Croix frauds, buYr;� i @ed Yo: ..^,'SIDS end hodzonta! r_re;= .,t paint 18M). diseecn and _ __ percent scope, scale cr dimersio�is rmrth - mw. and location and distance in nearer, road. Farce) ID 002-1026-30-000 Please print all information. - --- ----- - Revravrd By Date P=:dna! }iu _niY;d- s_Y ^` cSEd =r � ;;=±"y Ci rcx; tPnvac;-iar. s. 75.04;f) (rn1 I t L S_'"Mo-. Dgvrd & Rita lco'L Lot NW1/4. NE114. S113. 129N. R16VV )Pro:eT+ carers fdatry rddr-ss Lot` 64oc;. Suec-Name or=IV 25? i Gt" Rd E �., ^ CStvt Pending P.pproval -_--_—_..__-....-_—.� _ jCSC: Sate Z CJ:e PhGn2 Nl.'r`Sar A —city �41:-g_- -cam ^ eazst Road i Woodville V;i 54028 Beitdwir: CYY Rd E i N", Corsauction Uss: RMz-oenlall NumbercfbedMQmS_ 3COda derived dsign glow tale 450 GPD i .. �epla .-+an+. Publcar cvmmeral-Desr�b=_: (I Pe--nt = a; Ou,twmh iOna-O Series) _ -r1act Affair alavatn. if ap- _ M? ✓�pticab7e R General cor;xnen5 ',^rat;;£ii?at)`-ICfamduti sysla-_Sy_+-^.taarioa_3S.Fa bz ciihz �ntoo�lne:Sta4lishs; at 952 ;'. SF .+a v: eaBaic i ;and racomrrprgafidrt5:e^!ftiMlaEl3rlS 2W. 4�'na ' Pc avuna surace ebv. _ ; ti.:n l]em to wmitting i2por 24 in. 'Soil AopliCMion Ra1e� � Ha,=on Oepth ' Gominact Color F.edox Dscripnon : Tadure L Structure Consistence Bmmdary - Roots GPQ_rll' in. ?Are,:-b aa- SL can. CVcir ' Gr. Sz St.. _ - 0-I3 10yr3/3 Mile -----none --- SL 2FSBK tNFR tc 2VF 0.6 1.0 13-29 IrnSr3 SL 2MiSBK MFR GW SVF 0.6 1.0 7 29s_ 1G'Tris -T2d 7.51, u1`c 7. 2 Si L .� 2MSBK_-__----MFP. C'YV --- 3.6 0.8 ' '1 ---c ---� 4i-52 !.5'fryf5 _.--_ m3p _-i r6,T is 2 LS SCSBK MVFR G --- 0.7 1.6 76 Syr�/4 `n2o 73yr6(8 SL om MFR --- , -- 0.2 0.6 x Epn^g : __ = onrg Fit Ground su.4ace elev. _ 93.75 � Depth to lirttitmg Tacmr 2B Soil Application Rate, Honzon' Deolh Dominant Cdlor Redox Descdptlon Taxbrra: ' Structure ;Constslence8uundary: Roots GPDR' ;Aunse^ Qu. Sz Cunt Colo Gr. Sz. Sh. - •Pftt 'kff' none SL 2FS8KM' .iS 2VF 0.45! 1.0 _ 2 - 19-28 10yr4? none SL 2MSBK MFR - Gtv iVp 0-6 1.9 - -_ 28 34 ? Oyr5; 6 — m2d 10vr6ili 2 LFS iCSBK MNFR (AV ---- +. ,.syrsf6 run i SvrS/a SL'._._ OM MFR -- r'=BOO,.3o<220mg+Land TSS>30<150 mgfl. 'Erfiuen[x.2=a^OD�<30 mg/L end T$$� 30 trig/! Name _Please Pnrrrt Signature: r' CST Number 227429 ss S %7 Soil Testing, Date Evaluation ConduCsd a=nt+�ne M.- ssS�zM1:se.wr...Pmnmen=�., 41-to120z0 715-760-1978 PmPvy G.ver Swarson. David Fi Pit -----__ PzrcellD� DO<102G3aQOD 3 'coring-- tl0"n5 = _ F? Cro i l4irzre d a 9535 f Depth to hm0mg favor 32 i2 Page -Lot 4 lior¢on Depth = Dominant color Redox Description Textu2 -: Struciure Consistance. Bounds I�11 NPP�Bon Ralel o P,00tS i GPDt, c1. Mttnse8 Qu. 5z- cant. Color Gr. Sz Sh. 1:M IOyr3/3 Mile SL 2FSBK MVFR AS 1VF 0.6 1.0 �14-225 10yr4/3 none SL 2MSBK MVFR GW 1VF 0.6 1.0 3 25-32 1Dyr414 D3nc SIL 2FSBK MFR GW SVF 0.6 0.8 - 4._ 32.-47 1 e 0Yr4/ • nad 7Syr6y8 7.SoW2 SiQ 2MSBK MFR GW _ 0.4 0.6 i 5 47-TL 10yr4/6 mZp 7sv-c)S SIL 2MSBK MFR -- _- 0.6 1Mrfiii 0.8 f� I- 4 Selina 80"^5' = _ Pa Grouno suriam elev- 103.55 SL Dow.:a Urnahg factor 28 in. ISoil Application Rau Honxon Dapm Donin9nl Color Red. Desuplun ' Texture Slnr4ure Commence; Soundary Roots GPD/o' in. Munsell Qu- 5L CmL Colo: Gr. 37 Sh -_0-4 myr3/3 none SL 2MGR MVFR AS 2VF 0.6 1.0 j 2 9-20 i0'gri(3 rtcvle SL 2FS13K MVFR _ GW SVF 0.6 0.8 3 75yT4/4 acne SL 1FSBK MFR C;r.--0.4 ----- 0.7 ` a 78-37 L.�._ " 75bT4/4 rtZd 7a'yt6JS 7,,7 GRSL 1MSBK _ MFR GW -- ' 0.4 0.7 j 5 37-772 Syr4/4f SL OM MFR - 0.2 0.6- i 5 Boring # Sainc -- eg Ground sutfaceelev. 9455 ft. Dep:h to remitirg iaetor 21 i^- j501l Npplir2tion Rate Florimn D99h Domm ns Color Redox ➢^_scriplion Texture Stru4ure !Consisterim Boundary; Roots GPDlfte in. - Meneall cu. Sz. •,ont. Color Cr. SL Sit. .may .F 10y.3/3 none SL 2FSBK MVFR ` AS - 2VF 0.6 1.0 t < 5--3 1Gyr5/3 nonr SIL 2FSBK MVFR GW - 2VF 0.6 0-8 � ' 23-27 7.5yr m2d 10gT6l65l6 1%7&2 SL 1CSBK _ MVFR GW 0.4 0.7 4 27-76 Syr4/4 m2d 7.Syr6f8 ?SwS/2 SS oM MFR i 0.2 ; 0.6 I, Eiiruent9l = BCD_> 301220 na/L and TSS >80. 1S0 mglL ' Effluent 42 = ROD,' 30 ma1L and TSS too my1L TF.z A-paranwu efCommere is an squat opponunih. saritt yrvridcr and emplm'er- If_'ou need anLgssm so acmS Services or 11Led TWICfial in an 111=211i fOMMI, pleMe eOntact the depurmem at 60S-26&3)iI or M 60&264-87,7- 5 o0. -.R u.-A Sda:itt Sol Teem.:ti SYCroix ICounty, �•• ,•�:r+I>I,r � Conducted For: David & Rita Swanson I_e mld 2661 Cty Rd E Woodville, W154028 U J 1 m a.eculy if Part of PID: 0021026-30-000 lunm NWI A NE 1/4 5131-29N R16W Township of Baldwin ;I IYI,ra, D3• I)rllYr f,11r111111Y 1 Lll r., mvl Itn u:c p ' l 1 95' •1 y\•\ 1U(i Fuers ar.e ::Ln:nnf �.. 1t �•1 Ian. ,In _ Iil) 1 t i ui v.11'.11 �: lllv�,lur /3 nn' Cnnlnur Lmu�9 U5.Z5' ` }•. glapa, 'I '100.00' \5i !iU' BM top of 2" "VC Pipe ` •� 1 t BM 2 101.84' fop of telephone pedestal no. WP48 \ 43 Contour Line EL.• 95.2 \ \ 1•lot- !� t \ \ \db- U11R7 ,I N j •\ '1 \ \ ar •� � 1 \ o an �o mu Ifs '\ •15' WYLIAl1,IFk lhb mnVru vl rryw ,:na WLn 'na�r.wrnrl cu rupl. iv uup14, nM nnOra f Conducted by: Ihprtias ,1 Scfut ill oeY,Maml mo uw rus Pnrea It n!no CST 2 7429 4-15-2020 ,: •� � 'e' r � �� Yn.�'i �,' i .rye, I(p` :v I: ' I or9 f* 3A, , i I Jt WI:UI _ 'gs APPLICATION FOR REVIEW -Complete all pages- - P 3 NOTE Personal information you mrovide maybe used for secondary purposes -- _- [Privacy Law s. 15.04(1)(rni Stats.) Private Onsite Wastewater Treatment Systems Division of Industry Services Lj Plans to be E-filed. Provide SharePomt User name below: For plan status, check our website at hM:/1dscs_tn.aov Email technical code questions to meitto_DSPSSBPmli :1 ech0wi aov Several counties have been delegated certain authority to review plans in lieu or Division of Industry services, For a current list of' hose counties and their desi na5on check our webs"rwe at hana/dsos.vri-oov 1. Project Information - Fill m all known infnnnation. I Confirmation of assignment to a reviewer. Pmjec69te Name- J O/4V /1 UAL,1 I Transaction ID_ Location, Number & Streeter project (if unknown, indicated nearest mad) Previous Related Tans. ID: fin. Qd, yE - Estimated Completion Date - Legal Description_ Aa. N Er /3 19 /V /6 CJ Assigned Reviewer: County SE erte/X Assigned Office: ❑City ❑ Village YTown of 19A4ALalw __ rer^w gf cF.nice Wit,, ._ La Crosse, Green Bay 2. After plans are reviewed, Please- (check all that apply) ❑ Call customer 1, 2 (circle number)` NOTE: We reserve the right to redistribute plans to another office r ❑ Requesting party will pick up -- needed to reasonably 6atance turnaround times. Check 2}Mail plans to rusiomer©2 (circle number)- rw,aaldsos_vri_oov far next available review date -Refers to customer number from below. 1 J '. Compiefe ihefaimwing designeriownerimquesdng information. Utilize the check boxes when designer, owner orrequesting party is the same to avoid repeating information. I I Designer information (Custon i) DSPS ' First Name Other Please Specify Below (Customer 2) DSPS Last t Name Customer Number I<S/wr7- /Yo KE Hist Name Last Name Customer Number if Company Name 9 6'�A6/06�C�rQ IImerra fir Address Ad ress City State Ztpr4 (S digits) City Slate Zp+4 (9 digits) Phone Numb er E-mait address Celt phone (area code) Phone Number E-mail address Celt phone j 7/5-9G1-H/SS nv d�iG�uP:6rd6 C %n Km/ (area code) r� Check ❑ applicable 9Nor1- can Check it applicable or specify relationship ❑Owner ® Owner El Omer —specify relationship information and Plan Suomrttal Checklists. 1 o request electronic plan review complete the appropriate application form and e-mail it. along with your registered SharePoint usemame to DSPSSBPIanSchedule(clNflsconsin.aov. If plans are being submitted via paper, they will be assigned to a reviewer after recept at a DSPS office_ Submittal checklists can be found in each applicable component manual appearing on the POWTS program pace under Publications FOA!TS Comoon nts Manuals HolmenfOnalaska Area DSPS Green Bay DSPS 2850 Midwest Dr Ste 104 2331 San Luis Place Onalaska, WI 54650 - Green Bay, WI 54304 608-795-9334 920-4925601 Fax: 608-785-9330 I Faz 920-492-5604 Email: Dsos5bPlanSchedulc-fdrrn.eo`! Email: DspsSbPianScheduletfilwi.gov Make Checks Payable to: ❑ Check box to it Designer signature SBD-105T7 (R 3119) Services OR and sign below TOTAL AMOUNT DUE S .?SO." Review Code 7633 e premre m i oesiTTA i idnamr nil mar gouty- Incomplete forms may result )it process Inn delays) Unit(s) ® NEW Aerobic Treatment Unit W ❑ REPLAC@MENT ❑ Commercial System memo._..--,___-__._______._ ❑ Chlorinator []Tank Replacement Only ❑ UV Disinfection Unit ❑ Add Effluent Filtor SYSTEM TYPE(S) NOTE: Submit separate, shoats for each system if submitting multiple systems on the same site Enter Fee ❑ Revision to previously approved plan $85.00 i ❑ Miscellaneous Review (f.e, replacement of a septic lank, addition of an effluent filter or pretreatment device to an existing system, etc,) $11l Component Manual Design All treatment components are previously approved ❑ At -Grade Component Manual -Ver. 2.0, SBU-10054 (N.03I07. R. 1112) Wastewater Flow in under s. SPS 384,10 (2) or (3): ❑ In -ground Componen(Marxial - Ver, 2.0, SBD-10705-P (N.01101, R 10112) Gallons Per day Design wastewater flow of the proposed system: © Mound ComponentMilWal—Vef.2.D,SBD-'IDBOI-P (IV.01I0'1, Ri0112) ysd ® Pressure Distribution Component Manual -Ver. 2.0, SBD-10705-P (N.01/01, R 10/12) GPD 1,000 gpd or less $ 25000 ❑ Other -Please specify 11.001 - 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 384,10 (2) or (3): ❑ At Grade (individual site designidevialion front component ❑ Non -Pressurized In -ground Design manuals and use or components without product approval): ❑ Pressurized In -ground Wastewater Flow In ❑ Mound Gallons Per day Design wastewater flow of the proposed system: ❑ Drip -line _ ❑ Constructed Wellands 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 2,001 - 5,000 gpd $750.00 statement, provide rationale for the project and attach suppoi liN documents (code sections, test greater than 5,000 gpd $900.00 reports, technical papers, research articles, etc,) plus $006 for each gallon over 5000 gpd State-owned facilities: . _ Design^� Holding tanks previously approved under s, SPS 384.10 (2)(3). Design wastewater now of the ❑ Holding 'tank Component Manual, Ver. 2,0, SBD-10855-P (N.03107, R II'12)* Wastewater I°low In Gallons Per clay proposed system: ' Non -state owned Commercial and Residential Fielding tanks that completely utilize this manual 5,000 gpd or less $ Dal 5,001-10,A00 gpd $160.00 and have an esllmated daily now of less than 3000 gallons per dayndiusl be submitted to the appropriate gcvertsuantal unit for review Instead of the Depsubnerd. [see SPS 383.32(3)(a)) GPO greater than '10.000 gpd $225.00 ❑ Holding Tank Individual Site Design', (te site constucted, <5 day holding rapacity, Cc - Holding tanks Including site constructed tanks NOT Design previously approved under s. SPS 384,10 (2) or (3). I mingled wastewater, etc.) ng Wastewater Flow in Design wastewater now of the proposed system: Please specify: -._ I Gallons Per day 5,000 gpd or less $1 B0,00 • Documentation must be crowded to support the technical pa for the project In l separate statement, great - han 10 gpd $450.00 please include all code sections, lest reports, technical papers, research articles, etc,)-- GI°D greater than 10,000 ppd •1450, 00 I ❑ Sall Saluialion Delonnlnalion Report (using observation pipes) Iderlvciive Delennination - $240,00 - --[71 ❑ Experimental System (Ono time additional fee), Snbnid foe for Individual systenn as per appropriate above system type) Experiment Number $400.00 _y— AT _ Piiorily Review (enter same amount as normal review fee listed shove) $ Eli to Total (rounded to thn nearest dollar) n SB1D-10577 (R 41'18) 1 r BD YONATION PLAN_ - ROOF FRAMING PLAN- 2 \ Tl, _- psi' w.ra I YA 3!a'SOM 'lam iMBwaa¢Bmg �axuapp' d cV N 3xL NN @NNE O Q A � t I 1 Ai ❑ � tr t$ M tr e ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AC AND OWNERSHIP CERTIFICATION Owner/Buyer "JD h A, 4- fflu'r-y k + V Mailing Address 1;?i Property Address 2 (: required from Planning & Zoning City/State Parcel Identification Number LEGAL DESCRIPTION VIE 01ECE M M M OCT 13 2020 St. Croix County Communit Devel new concoction.) Property Location &1.J '/4 , 0 @-% V4 , Sec. _1J T #2 9 N R-,& W, Town of -6& LA vuil +A Subdivision Plat: l Lot # t. Certified Survey Map # / V 0 (q(Q /7 Volurne 30 Page # —9KyS--. Warranty Deed # / j ybJ (before 2007)Vohune Page # Spec house Qyes*0 Lot lines identifiablef(yes[]no 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(1) and in Chapter 12 - St. Croix County 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 I/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system 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. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms re�� d2r2n2,(7 SI NATURE OF APPLICANT(S) DATE •""Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. •" Include with this application 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. (REV. 04/12) HE __ ED Depa ent of A .�Sps Saf and MAY 27 Z(RPIlda cewR Oomm85,Wis. Adm. Code Professio al Services �r Croix County C5T -acx - lob #2032 Page 1 of 4 Schmitt Soil Testing, me .attach complete site Ian on a p p fl5�lAhlse#th�l in s¢e. Plan must include, but not limited to: ve nzontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s 15.04 (1) (m)). y St. Croix Parcel I.D. 002-102530-000 KKKK....ewed &/y' Date N l 1 at Z 8 70 �444f'fLLL. Property Owner Swanson, David & Rita Property Location Govt. Lot NW1/4, NEt/4, S13, T29N, R16W Property Owner's Mailing Address 2661 City Rd E Lot # Block # Subd Name or CSM# CSM Pending Approve V- 3O P City State Zip Code Phone Number Woodville I WI 1 54028 1 715-688-9216 City Village ``i Town Nearest Road Baldwin Cty Rd E !` ] New Construction Use. '�`._; Residential! Number of bedrooms 3 Code derived design flow rate 450 GPD ,! Replacement J Public or commercial - Describe. Parent material Outwash (Onamia Series) Flood plain elevation, if applicable NA _ ft General comments Area is suitable for a mound system. System elevation is 95.95' based off the contour line established at 95.25'. Slope of area is and recommendations. 5%. Depth to limiting factor is 28". ❑ Boring # ._�' Boring J Pit Ground surface elev. 94.75 ft. Depth to limiting factor 29 in. Soil Application Rate Horizon Depth 1 Dominant Color ! Redox Description in Munsell Cu. Sz. Cont. Color Texture Structure Gr Sz. Sh Consistencel Boundary ! Roots GPD/ft- "EH#1 •Efr42 1 0-13 10yr3/3 none SL 2FSBK MVFR AS 2VF 0.6 1.0 2 13-29 10yr4/3 none SL 2MSBK MFR GW 1VF 0.6 1.0 3 29-41 10yr5/3 m27svd 7.Syr6/6 r6lz SIL 2MSBK MFR GW 0.6 0.8 4 41-52 7.5yr5/6 map 7.5yr6/8 10yr6/2 LS j 'teWcim MVFR lS ------ 0.7 1.6 5 52-78 5yr4/4 m21Mr6//r16/8 SL j OM MFR ---- -- 0.2 0.6 2] Boring # _ Boring { �Pit Ground surface elev. 93.75 ft. Depth to limiting factor 28 in. y Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ConsistenceBoundary Roots GPD/ft2 *Eff#1 'Eff#2 1 0-19 10yr3/3 none SL 2FSBK MVFR AS 2VF 0.6 1.0 2 19-28 10yr4/4 none SL 2MSBK MFR GW 1VF 0.6 1.0 3 28-34 10yr5/6 m2d 10yr6/6 10yr6/2 LFS i SW C> MVFR GW ----- 0.5 1.0 _._ 4 34-71 7.5yr5/6 map 7'5y 6/8 10yr6/2 SL DM MFR ---- ------ 0.2 0.6 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St New Richmond, WI 54017 4/15/2020 715-760-1978 SBr19330 (R 011W) 16) Property Owner Swen5onlDavid&_Rita PafcellD# 002-1026-30-000 -- Page -2 of 4_ 3 Boring Boring # Pit Ground surface elev - 95.35 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color in. Munsell Redox Description Qu. Sz. Cont. Color Texture Structure jConsistence Boundary Gr. Sz. Sh. Roots GPD/W •Efr#1 Eff#2 i 0-14 10yr3/3 2 14-225, 1 r4 3 / none SL 2FSBK MVFR j AS 1VF i 0.6 1.0 none I SL I 2MSBK MVFR GW 1VF 0.6 1.0 3 --- 25 32 1 r4/4 none SIL 2FSBK --- MFR GW 1VF 0.6 -- - 0.8 32-47 ' 10yr4/4 m2d 7.5yr6/8 7.5Yr6/2 SICL 2MSBK � MFR ', GW I -- 0.4 I 0.6 5 47-72 - 1 -Oyr4/6 - -- m2p 7.5yr6/8 -10yr6[1__-.-' SIL 2MSBK --f MFR 0.6 - - 0.8 i«- - - yin. _--' Boring Boring # -, Pit Ground surface elev. 103.55 ft. Depth to limiting factor 28 - - Soil Application Rate Horizon Depth in Dominant Color Munsell Redox Description Qu. Sz Cont. Color Texture Structure Consistence Gr. Sz. Sh. Boundary Roots GPD/ft' 'Eff#1 -Effn2 1 0-9 j 10yr3/3 none SL 2MGR MVFR AS 2VF 0.6 1.0 2 9-20 10yr5/3 none none m2d 7.5yr6/8 7.5yr6/2 m2p 7.5yr6/8 1 r6 1 SIL 2FSBK MVFR GW 1VF 0.6 0.8 3 20-28 7.5yr4/4 7.5yr4/4 SL 1FSBK MFR GW 1VF 0.4 0.7 4 28-37 GRSL 1MS8K MFR GW ------ ------ 0.4 0.2 0.7 0.6 5 37-72 5yr4/4 SL 0M MFR ---- Boring Boring # ' Pit Ground surface elev. _ - 99.55 ft Depth to limiting factor 23 in. Soil Application Rate Horizon Depth in Dominant Color Munsell Redox Description j Qu Sz Cont. Color Texture Structure 'Consistencel Boundary Roots Gr Sz. Sh. li GPD_ W 'Ert#1 -Ert#2 1 l 0-9 10yr3/3 none SL 2FSBK 1 MVFR AS 2VF 0.6 1.0 2 9-23 ', 10yr5/3 none SIL - -' - 2FSBK MVFR ! GW 2VF0.6 - 0.8 m2d 10yr6/6 5yr5/6 SL 1CSBK MVFR GW '� �� _ 10yr6/2 3 23-27 7.---- 4 27-76 5yr4/4 I m2d 7.5yr6/8 SL 0M MFR 7.5yr6/2 -- 0.4 ---I- 0.2 - - - 0.7 0.6 - - --- ------ -- -- ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or 7TY 608-264-8777. SBD-83301R 07/00) Schmitt Soil TesUN, Inc. v 0 CM a fO a St Croix County, WI r' Ro E Conducted For: David & Rita Swanson 78, Legend BM 2661 Cty Rd E Woodville, WI 54028 Site Address Tax Parcels Tawns Part of PID: 002-1026-30-000 Foes NW1/4 NE 1/4 S13 T29N R16W V"'a9P5 Township of Baldwin Sections ❑StCmmC. 98' Other Counties 1 Lakes antl Rivers t 195. Rivers and Streams 95, t •\ 1 a.eIn ; conveyance Division 97,—. —. —. —.` 13 �.`ez 7 � 99' ` Contour Linti 95 5' t 5°o Slope 53' BM 1 100.00' top of 2" PVC Pipe t �'� 1 BM 2 101.84' Top of Telephone pedestal no. WF4B t 1, 83 t 58' Contour Line EL. 95.25' •` •\ ` 101' 46' \ ` N 131 \ z7' 1 65, I \ •� 0 20 60ft _ 1 BS 'V OI This map is of be of guarartecomplem 45' 3ouuate C t accurate. corracl. current or complete and and wndus Diva drawn are the ees[,onvbJ,ty of the Conducted by: Thomas J Sc i \.\ 3M 1 °ter CST 227429 j89 4-15-2020 114 0 v D 01 m a 'r f 1 € _ ..'"" RAN CTY RD E]� e M S. . 1.1,•2. 93 i-; 912/637 0 1Q4, zoo soon DISCL/.IME11 TNi� usp n M5tpuareMppBBd 19 Ds , quat�, tarre¢S, axrnN, Pr %mplalB,,gqqq Wnl7uei9lp WaM1 ba tllaMpor�siDififyp/IM' , I 10 r