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014-1045-30-000
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)] Dawn Cress TANK INFORMATION TYPE MANUF URERiz;Y,,s CAPACITY Septic 5 ka F 14cr 3 � Dosing A to PK 1p 3Alicalil&m 1000 fr.)f LI' Holding TANK SETBACK INFORMATION LoC b:S tf- TANK TO ?I WELL BLDG. Vent to Air Intake ROAD Septic ,y 30' 36t Z I I Dosing V-- 30• 35, Z 7 r Aeration Holding PUMP/SIPHON INFORMATION fiJ4 ►%gjl Z?.�j3 Manufacturer Deman Zo GP o� Model Number X 152- _ 5g TDH U117 16 dcton Loss System Hea�i G� TDy �q Ft 11 I Forcemaln Leny{p. t Dia2 • Dist to Well 3 B SOIL ABSORPTION SYSTEM TOWN OF FOREST ELEVATION DATA STATION BS HI FS ELEV Benchmark 3 AIBM L (uva� 3. 1 1`9 z BZo , er 7. St/Ht Inlet 7- t�• y SUHt Outlet Dt Inlet Dt Bottom p.15 fref" Header/Man. 3 - 117. 5 Dist Pipe 7 Bat. System , /• L q/' p Final Grade St coverr7 Z /4/• BEDrrRENCH DIMENSIONS Width 7,5 Lengt�J r ((IQ N ^t T �� ) 2-1A'f'[M GS PIT DIMENSIONS No Of Pds Inside a Liqu pth SETBACK SYSTEM TO P/L F BLDG WELL LAKE/S EA L ACHING Manufa Curer INFORMATION Ty Of System 'S I r 85 � V �r t CH MUBER NIT Model umh r DISTRIBUTION SYSTEM Header/Manifold 2 Length 3, 75 Dia ' y Distribution r 1 �' Pipe(s) C r� / 2 Length J"'" Dia I" Spacing . x Hole Size u 1(� x Hole Spacing 1 Z ,3X VAv Intake r / 7.¢_, j"4yt SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Lr V r,, VWM-lJV--r Depth Over xx Depth of xx Seeded/Sodded xx Mulched c i e r '7 Z Q r ed/Trench Edges �_ 4 4 Topsm Z w r�' Yes Fj No A I Yes i`I No 1 yl COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1. %%/e W G/Z� Inspection #2: r[ Location: 2007 280TH ST 1' _ I�k`�,� ri Cove ,Si/} [ G S 1.) Alt BM Description = 6 Per 2 ) Bldg sewer length = xK P�Vvy=t{r pyp (qt� /� l -amount of cover= n V') U i[� Seu�� 7i� (' 7 ` J '7-T po'xn ✓ 7 7��'• "OU44 7 Plan revision Required? ]Yes No I Ise for � � 121 p� p I— other side additional Informati 710 (R.3197) n. Date _ Insepctors Signature Cert. No Industry Services Division County S'r CROIX sla' i 1400 E Washington Ave P.O. Box 7162 Sanitary Permit Number(to be filled inby Cii. ) 3 0 2020 Madison, WI 53707-7162 �' r� dlb hb'nt` rMit Application State Transaction Number �;arw;��rf:�tt ea In accordane yJ14 e, submission of lhi, (omit to the appropriate ntal�j —Q 2a0 O'o'C- is requited prior to obtaining a sari permit Note: Application form» for state-0u'ne µ'Ts are sir Il-- the Deparinrcnt of Safch and Prufcsswnal Seniee,. Penonal infinnwlion )ou provide nla) be or na.ou ar. Prn/ect Address tifdiRerenr than madmg address) purposes in accordance with the Privacy Law, S. 15.04(1)(m), Slats 2W7 280"' ST 1. Application Information - Please Print All Information PfopeivOwners Nanw fares( DA%VN CBUSS 014-11145-30-000 �•v Property Owner's Mailing Address Property Location \ 2007 MOTH ST (iovt Lot Cm. State Zip Code Phone Number NW 'e. SW I+. Section 21 EMERALD, 'A 1 54013 (circle one) 131N R15EorW 11. Type of Building (check all that apply) r Lot" __ .— © I or 2 I wink Dwcllmg Nuniberof Bedroom, _ Nubdn uion Nance II • k f ❑ PubhGC'ommerenal - Describe Use Block I Clr reCsN a -_— � [I City of ❑ State Owned - Describe Use ❑ Village of CSM Number ® Town of FOREST 111, Type of Permit: (Check only one boa on line A. Cmnplete line B if applicable) A ❑New Sy,tnn _ Replacenwnt S),tam 0'1 realnwnVl folding I ank Replacement OnN ❑ Othcr Moddicuoonto Fyisting S)stem(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Lisl Previous Permit Number and Date Issued Before Expiration Plumber I Owner IV. Type of POWTS System 'ComonentlDevice: Check all that apply) ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in of suite,le soil ® Mound <24 in of suitable soil El Holding hank ❑ Other Dupersal Cumponrnl icsplaun ElPreireauncnt Nt ice Icsplamt r� i / n/ .n\ `//M/l) (r/r0rJ , V. Dis"ersal/Treatment Area Information: i n Design Flow IgpJ) DesignSod, Application 450 Rate(gpdsf) Dispersal Area Required t,l) Dispersal Area Proposed t,f) ystem Elcva[wi --) 450 450 95.4 CONTOUR d �� /� 7_5� VI. Tank Info Capacity in J i /•_ ,G t.L_- fit'" E a ons 'total a {. h�Ct Manufacturer . L " U New Tanks Em,ung I,mk, Gallons it Units = a '.i e 'm w rn ii C t T II Semitic wllollina'r.mk 1000 1000 1 SKANN' El I El i Doane Chamhcr 600 6(10 1 SKAXN IEL VII. Responsibilitv Statement- 1, the undersigned, assume responsibility for installation of the Powrs shown on the attached plans, Plumbers \ame (Pant) Plum atur MPS IPRS Number Business Phone Number ROBFRI HARDINA / 824a25 715.491.5039 Plumber's Address (Street. Cny. State, Zip Cadet 477 170TI'AVI.-I'URI-LF. LAKE WI 54889 Vlll. County/Department Use Only_ Approved ❑ Disapproved .1in I-ec Date 6bu alIssuing Agent Sign' m ❑ Owner Given Reason for Denial �in $ V60 • 17Q IX. Conditions of Approval/Ressons for Disapproval 3) p.(,t ' S N.. YSTEM OWNER: w .(�,+ i Septic tank, effluent filter and utsrersal cell must be serviced /_maintained f �� l!�� f � s prpl. Q, tiewr+ "T RtxAA be-� a-v as per management plan provided by p'iumcer 2 ft set { ac to comp ere p ens or Ihr •, vrem d wbmir e Covn iA ov pajre�r�n�ulrlw, thain A ±, 11 inches in site oa Jc ar ✓i�...i..; Cw..'J�...L...... S Pibi9 �DOO/�t490 60Mb6 44,nk- Wl N54_ L W. g SBD-6398(R03.'14) l'`algvTVM-v �•!?�£� frb, wt I M CHECK BOX AS APPLCABLE, CHECK BOX AS APPLICABLE SOIL EVALUATION g Scale: aD 40 so eo © SYSTEM PAGE 2 OF SITE MAP PLOT PLAN PROJECT NAME: (ig n gel 102 DESIGN FLOW: 450 GPD CRESS Attach design flow calculations for commercial plans. PROJECT ADDRESS: 2007 280TH ST Pipe Material / ASTM Standard (Tables 384.30-3`&� 384.30-5) N Sanitary Sewer. Al / 3U3�-r BM Symbol: + BM Elevation: 100 Fi Face Main: 7-/ SC-9 �(J BM Descdptlon: TOP OF PROPANE TANK Slope Oradlenl (-A)Indicare north by IMPORTANT' of Tested Area: 2 well symbol (I/appgrahleX O arewlag enartox on the appmprlle qm Show ground elevation contours at suitable intervals. T T • : � he�exisi. PQWTS s i -- - ro . r ti*� abartdotiedhalr be l i � � t •- pC - _ 5 PS 3 3.33,+WA s i A �.. , 7 k,_ i { t �p'v" t �= t��0a-cvre0 --r-avk_3:BRj. _ eft' - } I I • I , � {XI I 1 } __ • t � 1 : I i 1 t i t , _ • , t ' � I 3 r l , 1 1 I � / I • y , ; -eerarx+ev r0 DIVISION OF INDUSTRY SERVICES 2850 MIDWEST DR STE 104 I o v ONALASKA WI 54650 S �l Contact Through Relay ` \ PS http:lfdsps.wi.gov/pmgrams/Defaukaspx rOFLssrov w .wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary September 9, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES 2022-09-09 Plan Review: PWTS-092002040-C BOB I HARDINA 477 170th Ave Turtle Lake WI 54889 SITE: Dawn Cress 2007 280th Street Town of Lincoln St. Croix County SW, SW, S21, T31N, R15W Total Amount: $250.00 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES =ri SEE CORRESPONDENCE FOR: Description: Three Bedroom Mound System \ Sloping site Mound Component Manual — Ver. 2,0, SBD-10691-P(N.01/01, R. 10/12), Pressure Component Manual — Ver. 2.0, SBD-10706-P(N.01/01, R. 10/12), 450 GPD, 16" depth to hniting factor from original grade, Maintenance required, Effluent filter, Replacement construction The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.0100), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. 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. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892 — voice \ (608)785-9330 — fax icrry swun ro rci. eov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: CRESS Owner's Name: DAWN CRESS Owner's Address: 2007 280TH ST EMERALD WI54013 Legal Description: SW.SW,21,31N-R15W Township: FOREST County: Subdivision Name: Lot Number. Parcel I.D. Number: Plan Transaction No.: ST CROIX Conditionally APPROVED DEPT, OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE 014-1045-30-000 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Filter Maint. Page 10 soil test Page 11 tank specs Designer: Robert Hardina License Number: 824825 Date: 08/26/20 Phone Number. 715-491-5039 Signature: ri( Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 4.0 (R. 04103) Page 1 of 11 I CHECK BOX AS APPLICABLE. ❑ SOIL EVALUATION SITE MAP PROJECT NAME: CRESS CHECK BOX AS APPLICABLE. Scale: 1°=40' © SYSTEM PAGE 2 OF ao so i ao PLOT PLAN (tO tt gdo) 10' DESIGN FLOW: 450 GPD Attach design flow calculations for commercial plans. PROJECT ADDRESS: 2007 280TH ST Pipe Material I ASTM Standard (Tables 384.3M & 384.305) BM Symbol: BM BM Elevation: 00 FT N Sanitary Sewer: Al 1 30 3q Force Main: 2 BM Description: TOP OF PROPANE TANK Slope Gradient (%) of Tested Area: 2 Well Symbol (Irapparabley, 0 Indkam north by drewing an arrow IMPORTANT: Show ground elevation contours at suitable intervals. on the appropme Ine. ; j' Mound and Pressure Distribution Component Design Design Worksheet (r or c) Site Information Residential or Commercial Design Estimated Wastewater Flow (gpd) Peaking Factor (e.g. 1.5 = 150%) Design Flow (gpd) Site Slope (%) Contour Line Elevation (ft) Depth to Limiting Factor (in) In -situ Soil Application Rate (gpdtfe) R 300.00 1.50 450.00 2.00 95AO 16.00 0.40 (c or e) Distribution Cell Information 60 00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 11 Influent Wastewater Quality (1 or 2) Pressure Disribution Information Center or End Manifold Lateral Spacing (ft) Number of Laterals Orifice Diameter (in) (e.g. 0.25) Estimated Orifice Spacing (ft) _ Forcemain Diameter (in) Forcemain Length (ft) Pump Tank Elevation (ft) System Head (ft) x 1.3 Vertical Lift (ft) Friction Loss (ft) Total Dynamic Head (ft) e 3.75 2 0.188 2.91 2.00 40.00 85.00 N3.25 Lateral Diameter Selection in. dia. option choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000.00 Septic Tank Capacity (gal) skae IManufacturer nNote: Sand fill (D) calculations assume a Table 8344-3 in -situ soil treatment for fecal coldorm or <- 36 inches. 7.50 Cell Width (ft) Are the laterals the highest it in the distribution network? Enter Y or N If N above, enter the elevation (ft) of the highest point. 10.71 fe/orifice Does the forcemain drain back? Enter Y or N 6.52 Forcemain Drainback (gal) 53.77 5x Void Volume (gal) 60.29 Minimum Dose Volume (gal) 27.53 System Demand (gpm) Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) 642.001 Total Tank Capacity (gal) 39.00 Total Working Liquid Depth (in) 16.461 galrn (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) lifetime Filter Manufacturer 16.46 Dose Tank Volume (galfin) Petite Filter Model Number skew Manufacturer Project: CRESS Page 2 of 11 Elevation Mound Plan View ii L Mound Component Dimensions Down slo a toe extension made. A 7.50 ft E 21.80 in H 1.00 ft K 1 10.60 ft BI 60.00 ft F 9.50 in I 11.25 ft L 1 81.20 ft DI 20.00 in G 0.50 it J 8.37 ft W 27.12 ft 450.00 (ft2) Dispersal Cell Area 1125.00 (ft2) Basal Area Available 7.50 (gpd/ft) Linear Loading Rate 6.00 (ft)1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area ®' .: 95.40 (ft) Contour Elevation 2.0 % Site Slope Shading Key 'a Q, 1Q Topsoil Cap a 1.5 ft Subsoil Ca '(0.0 I❑II m ASTM C33 Sand 5 IgJ Tilled Layer d o Ho ft ITTT © Aggregate a Geotextile Fabric Cover Dispersal Cell See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally r Typical Lateral F spaced from the ® distribution cell's centerline in the distribution cell (AxB). A ♦ Project: CRESS Page 3 of 11 Project: End Connection Lateral Layout Diagram Laterals centered over the A&ttmmensron --__--fie Turn-upwdballvalveorcleanoulplug E P All Wterals are identical IEX—)I Moles dried on the bottom of the lateral 3 egtsapg spaced y Force main connection via tee or crow to maafoid at ang pouts. Latest, & (tilde mainof Ptic sch i0 {oer SPS Table 384 30-5) Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head 2 1.50 in 58.60 ft 3.75 ft 13.76 gpm 27.53 gpm 15.64 ft Orifice Diameter Orifice Spacing (X) Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemaln Velocity Dose Tank Information Electrical asper NEC and Comm 18.28 WAG Disconnect Tank component Is properly vented skae Ca aci 600.00 Volume 16.46 Manufacturer Gallons gauinch Dimension Inches Gallons A 20.79 342.19 B 2.00 32.92 C 3.66 60.29 D 10.00 164.60 Total 36.45 600.00 T A =B C Alarm Manuafacturer Isie rhombus Alarm Model Number Itank alert Pump Manufacturer Izoeeller Pump Model Number Jbn152 Pump Must Deliver 27.53 gpm at 1 15.64 ft TDH CRESS 0. 1881 in 2.93 ft 21 10.71 ftZ/orifice i 7F ft 1.50 in 2.81 ft/sec Locking cover with warning label and IoWng device and sealed watertight 4 in. min. Alternate outlet location Forcemaln diameter 2 in. Weep hole or anti - siphon device Pump off elevation (ft) 85.83 Dose tank elevation (ft) 85.00 Page 4 of 11 Mound System Maintenance and Operation Specifications Service Providers Name —�- �-eM_wf r - -+r F — Phone F7 ;-387—8 POWTS Regulators Name 'holcr Phone System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in EstimatedFlow-Average 300 gpd MaximumBOD5E:220 mg/L Septic Tank Capacity 1D00 gal Maximum TSS150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform10E4 cfu/100 mL Septic and Pump TanM Effluent Filtei Pump and Control: Alarm Pressure Systerr Mounc Other Service Frequency Inspect and/or service once evM 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test month) Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ..,••......... ............... Grade yr 6-6" Diameter Lawn --_> . Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution �► r-t� Long Sweep 90 or Two 45 Degree Bends Same Diameter as lateral Project: CRESS Page 5 of 11 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82.94 Wis. Adm. Code, and shall maintained in accordance with its' component manuals jSBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be Inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-Inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of In accordance with NR 113, Wis. Adm, Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filer shall be cleaned as necessary to ensure proper operation. The fiker cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter Is equipped with an alarm, the filter shalt be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an Impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance Is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce - Pump Tank The pump (dosing) tank shall be Inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be Inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction In the winter will promote frost penetration. Cold weather Installations (October -February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOOS, 150 mg7L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD" 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/1 00 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed It should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mcund,component bits to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in lts' present location by Increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: CRESS Page 5 of 11 MODEL 151/152/153 50� OMEN 46 NONE 4o- 130" MOMMEM 254 INS, ME 2 i�� 10-1 7b 810 9( 10 20 30 40 50 60 �T 200 240 280 320 WARNING DEATHMAYOCCURIFTANKISENTERED WITHOUT PROPER EQUIPMENT VOTE SEE INNER WALL PHOTO ON THE "EXCLUSIVELYAT SKA WS" PAGE 3.00 4.00 27.00--1 I--27.00 �27.00 24.E 24.00::::j 5.00 2.00 IN�� S 41NCH PRES SEAL GASKET INSTALLED 200 `--BAFFLE FILTER SECTION VIEW OF TANKAND COVER Model Number: 10001600 Approved for. SEPTIC/SEPTIC,SEPTIC/PUMP,SEPTIGt Weight Inlet Jm. Ut a Dim. Liq. Depth 13,050lbs. AA- A'. 39" I II 10.00 OUTLET END VIEW OF TANK OUTLET V� 4 /NCH PRESS SEAL GASKET )NORHOLDING SKAW PRE -CAST Phone:(715)967-2277 26255 1051h Street, New Auburn Toll Free: 1-800-924-8625 Gal. / In. Nom. Cap. Wisconsin 54757 Fax: (715) 967-2707 16.47 1642.33 gat www.skewprecast.com APPLICATION FOR REVIEW -Complete all pages - be for NOTE. Personal information you provide may used secondary purposes (Privacy Law s. 15.04(1)(m), Slats.] Private Onsite Wastewater Treatment Systems Division of Industry Services ❑ Plans to be E-filed. Provide SharePoint User name below: For plan status, check our website at htto://dsi)s.wi.gov Email technical code questions to mailto: DSPSSBPowtsTechawi.aov Several 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 websfte at htt :/Ids s.wi. ov 1. Project Information • Fill in all known Information. Confirmation of assignment to a reviewer. Project/Site Name: Transaction ID. Location, Number & Street of project (b unknown, indicated nearest road) Previous Related Trans. ID., &0 -) d i�n4 4Y- Estimated Completion Date: I Legal Descriptlon, SE-U, Siy o`� i 3 N _ l.sl� y Assigned Reviewer: county ST, e):/j� Assigned Office: Mail to your office of choice below: ❑ City ❑Village ®Town of rrd7jT 2. After plans are reviewed, please: (check all that apply) La Crosse, Green Bay ❑ Call customer 1, 2 (circle number)` NOTE: We reserve the right to re -distribute plans to another office If ❑ Requesting party will pick up needed to reasonably balance turnaround times. Check htto:Rdsosmi.00v for next available review date ® Mail plena to customel(9�2 (circle number)' 'Refers to customer number from below 3. Complete the following deelgnedowner/requesting Information. Utilize the check boxes when designer, owner or requesting party Is the some to avoid repeating Information. Designer Information (Customer 1) DSPS Other Please Specify Below (Customer 2) DSPS First Name Last Name Customer Number First Name Last Name Customer Number ROBERT HARDINA 824825 Company Name Company Name HARDINA SEPTIC SYS, Address Address 477 170TH AVE City State Zip+4 (9 digfs) City State Zip+4 (9 digits) TURTLE LAKE WI 54689 Phone Number T E-mall address Cell phone Phone Number E-mail address Cell phone (area code) (area code) robert2372mnturvteLnet 715.491.5039 Check if applicable Check if applicable or specify relationship ❑ Owner ❑ Owner Other — specify relationship Information and Plan Submittal Checklists. To request electronic plan review complete the appropriate application forth and e-mail it, along with your registered SharePoint usemame to DSPSSBPlanScheduleC-Wisconsin.goy. 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 program page under Publications POWTS Components Manuals HolmerdOnalaska Area DSPS Green Bay DSPS 2850 Midwest Or Ste 104 2331 San Luis Place Onalaska, WI 54650 Green Bay, WI 54304 608-785-9334 92DA92-601 Fax: 608-785-9330 Fax 920-092-5604 Email: DsosSbPlanSchedule(dlwi.eov Ema1L• DsosS6PlanSchedule®wi oov Make Checks Payable to: Division of Industry services OR ❑ Check box to invoice designer and sign below TOTAL AMOUNT DUE $, Review Code 7633 Designer signature ��%,l_! a SBD-10577 (R 3/19) 5. POWTS SUBMITTAL (check all that apply - Incomplete forms may result In processing delays) ❑ NEW ❑ Aerobic Treatment Unit(s) ❑ Chlorinator ❑ Tank Replacement Only REPLACEMENT ❑ Commercial System ❑ UV Disinfection Unit ❑ Add Effluent Fitter SYSTEM TYPE(S) NOTE: Submit separate sheets for each system if submitting multiple systems on the came site ❑ Revision to previously approved plan- -_- S86.00 ❑ Miscellaneous Review (i.e. replacement of a septic tank, addition of an effluent filter or pretreatment device to an existing system, etc.) $801hr ❑ Component Manual ❑ AtGradeComponent Manual - Ver. 2.0. SBD-10854 (N.03/07, R, 1/12) ❑ In -ground Component Manual - Ver. 2.0, SBO-10705-P (N.01/01, R 10/12) ® Mound Component Manual - Ver. 2.0, SBD-10691-P (N 01101, R 10112) ❑ Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) ❑ Other - Please specify ❑ Soil Based Individual Site Design' ❑ At Grade ❑ Non -Pressurized In -ground ❑ Pressurtzed In -ground ❑ Mound ❑ Drip -line ❑ Constructed Wetlands ' Documentation must be provided to support treatment and dispersal claims In a separate statement, provide rationale for the project and attach supporting documents (code sections, test reports, technical papers, research articles, etc.) State-owned facilities: ❑ Holding Tank Component Manual, Ver 2.0, SOD-10855-P (N.03107, R7/12)' ' Non -state owned Commercial and Residential Holding tanks that completely utilize this manual and have an estimated daily flow of less than 3000 gallons per day must be submitted to the appropriate governmental unit for review instead of the Department. [see SPS 383 32(3)(a)] ❑ Holding Tank Individual Site Design*, (Le site constmcted, <5 day holding capacity, Co_ mingled wastewater, etc.) Please specify: ' Documentation must be provided to support the rationale for the project. In a separate statement please include all code sections, test reports, technical papers, research articles, etc.) Enter Fee All treatment components are previously approved Design under s. SPS 384.10 (2) or (3): Wastewater Flow in Gallons Per day Design wastewater flow of the proposed system: 1,000 gad or less $ 250.00 GPD 1,001 - 2,000 gpd $ 325.00 2,001 - 5,000 gpd $ 400.00 One or more treatment components are not _ previously approved under s. SPS 384.10 (2) or (3): (Individual site design/dewaton from component Design manuals and use of components without product Wastewater Flow in approval)_ Gallons Per day Design wastewater Bow of the proposed system: GPD 1•0W gpd or less $450.00 1,001 - 2,000 gpd $600.00 2,001 - 5,000 gpd $750.00 greater than 5,000 gpd $900.00 plus $0.08 for each gallon over 5000 gpd Design Holding tanks previously approved under s. SPS Wastewater Flow in 384.10 (2)(3)- Design wastewater flow of the Gallons Per day proposed system: 5.000 god Or less $ 90.00 GPD 5,001 - 10„000 gpd $150.00 greater than 10,000 gpd $225,00 Design Holding tanks including site constructed tanks NOT Wastewater Flow in previously approved under s SPS 384 10 (2) or (3). Gallons Per day Design wastewater flow of the proposed system: 5.000 gpd or less $180.00 5,001 - 10,000 gpd $300.00 GPD greater than 10,000 gpd $450-00 ❑ Sal Satraabon Determination Report (using observation pipes) ❑ Interpretive Determination $240.00 1 _ ❑ Experimental System (One time additional fee). Submit fee for Individual syslem 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 3/19) $ 250 • Z0140048A installation and Maintenance Instructions �1 aryn�a��ao�o�a�ra4�w�co�,.m�►��u.►K�a�reaa,�ru� pfwwptpstifsaftwInaRaw pot addtd APIsamyoeedtobea►bled} tihp2lfug1sln�d►e►sU+�asideat�patandthetwob�baattatyppatts: ttiMgWad,acaga � �t dry titYo ibe os►4teY gfpa< a►�uro and out s"ldfa�#ti� 4Q fn+c ld� W �felenRth nceded to esd 6om the babe dwt ate p►s�nalated ftdo ceae to du s* rw aad tha tralde #aor tam aohMa+twekE pfge ale d+a i�tlatmeptw►tfnMadotNet4esaae. , �P S SaWeet �aldtAera►ae w dts oWtet Wpa kmtE rate tNgn•a►t�e N�a tla sass ptgep;{da� an dw aWAdNr�Rtoc�akrtophoeatdte6otta►tolaast. $"a N► oftaVero lt+ead t,:uwtswAlntothatofuk4atluwp4tdteoa+hw t�mu�6ttt6�piu� VAWOOM dab *WAtWPVWsit ~hWWpte"WWWofdietL*' � To refit+adtliq�+aetHJtMenDtpdteP��YondtEhtlndNoftNaartrid� it Ratty the sale; pf 40mg a v Ucg read ssv*k removal ofsvitt Isoptlanel) Si ilelag as ate +Nnsa th8 ARas anawtng vtelbla sapt8ye Meeeifel a re►90Yad !j Pi�MtAa�tartl�Ch�toihal�erslcepraednB�wtft#t►tlrerwdgltNadcstntoptlme. a} ta�ao.aeaaca�oeaakenad�ae RECEIVED SEI{ M $ OU!}.�;IM4 ►IAtl�NihC veaha�theAtmrvdbeheedw�Bmswo+ddrtbd�ntuom�ma4►rtAas+a eta,eue�puxDaeua+rsANx,ur�.eae� w0ep�ldoetfMr4�au mrauan�lhsed�taleraec .... .. ..._._.....u... �.—•..._-_r�rwr.11wuMMINNMdWttlYTdtN�.tl'ahWaY+�NO\ Q� t�ai�ete•ta4� -fru Owner/Buyer ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM DAWN CRESS Mailing Address Property Address City/State 2007 280TH ST EMERALD 54013 SAME (Verification required from Planning & Zoning Department for new construction.) Parcel Identification Number 014-1045-30-000 LEGAL DESCRIPTION 21 Property Location SW SW /4 ,Sec. T N R 15 Subdivision Plat: Certified Survey Map # W, Town of FO R EST M Volume , Page # Lot # ((�c2dQtt7r"S ` ; _r4i ' ) c /0 2Co 9' 1 arranty Deed # 3 Z 1 33 3 (before 2007)Volume 5-09 Page # Sip Spec house ❑yes[Dao Lot lines identifiable ❑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 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 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. I/we 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 Regtsrer of Deeds Office Number of bedrooms 3 r SIGNATURE 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) Parcel #: 014-1045-30-000 Valid as of 03/08/2018 02:48 PM Alt. Parcel #: 21 31.15.331 B TOWN OF FOREST ST. CROIX COUNTY, W ISCONSIN Owner and Mailing Address: CARLTON J & DAWN CRESS 2007 280TH ST EMERALD WI54013 Co-Owner(s): Physical Property Address(es): ' 2007 280TH ST Districts: Dist* Description Parcel History: Date Doc If Vol/Page Type 1127 SCH DIST OF CLEAR LAKE 0038 CLEAR LAKE FIRE DIST 07/23/1997 509/566 1700 WITC _ 8020 UPPER WILLOW REHAB DIST Legal Description: Acres: 2 350 SEC 21 T31 N Pit 5W 2.35A S730' OF W 140' OF SW SW Plat Tract (S-T-R 401/41601/4 GL) Block/Condo Bldg ' N/A -NOT AVAILABLE 21-31 N-15W 2017 Valuations: Class and Description Acres land Values Last Changed on 10/10/2014 Improvement Total Gl-RESIDENTIAL 2.350 13 10000 113,100.001 126,200.00 Totals for 2017 General Property 2.350 13,100.00 113,100.00 126,200.00 Woodland O.C)001 0.001 0,001 0.00 Totals for 2016 General Property 2.350 13,100.00 113,100.00 126,200.00 Woodland 0.000 01 0001 0.00 2017 Taxes Bill # 460657 Fair Market Value: 137,700.00 Assessment Ratio: 0.9162 Amt Due Ann Paid Balance Installments Net Tax 2,180.56 1,033.02 1,14754 End Date Total Special Assessments 0.00 0.00 0.00 _ 1 01/31/2018 1,033.02 Special Charges 0.00 0.00 0.00 p 07/31/2018 _ 1,147.54 Delinquent Charges 0.00 0.00 000 Private Forest Crop 0.00 0.00 0.00 Net Mill Rate 0.018704625 Woodland Tax 0.00 0.00 0.00 Grass Tax 616.46 2,2553 Managed Forest Land 0.00 0.00 0.00 School Credit 9 Prop Tax Interest 0.00 0.00 Total 2,36060 53 Spec Tax Interest 0.00 0.00 First Dollar Credit 65.44 Prop Tax Penalty 0.00 0.00 Lottery Credit 1CIaimS 180.53 Spec Tax Penalty 000 0.00 Net Tax 2,180.56 Other Charges 0.00 0.00 000 TOTAL 2,180.56 1,033.02 1,147.54 Interest Calculated For 0310812018 (Posted Payment Payments) Date r Receipt# Type Amount Note 01130/2018 563 T T ',033.02 d dress ck 6845 St. Croix County 1062671 Page 3 of 3 C- T-,?oao- ass Wisconsin vision n Kt ,f�S �f at Services Page _ of Division of In t i s NOV 04 2020 SOIL EVALUATION REPORT I accordance with SPS 385, Ws. Adm. Code Countyr ST CROIX Attach complete ite plar�n � ❑�@i9 than 8 12 x 11 inches in size. Plan must include, but not limited to v&lld81r8rM' dint (SM), direction and percent slope, Parcel 1 D scale or dimensions, north arrow, and location and distance to nearest road. 014-1045-30-000 Please print all information. Revved by r 7 y Dah 111 Property Owner Property Location ❑ DAWN CRESS 1 Govt. Lot SW % SW % S 21 T 31 N R 15 E (or) W rProperty Owner's Mailing Address Lot # Block # Subd Name or CSM# City State Zip Code Phone Number I [:]City ❑Village ® Town Nearest Road ❑ New Construction Use: ❑ Residential/ Numberof bedrooms 3 Code derived design flow rate 4LO GPD ZIDN E j( ® Replacement []Public or commercial —Describe: _ l Parent matenal OUTWASH Flood Plan elevation if applicable N/A ft. General comments and recommendations: RECOMMENDED SYS MOUND // 6 "'N �riL 1❑ Boring # vev' �zd ❑ Boring ® Pit Ground surface elev 95.0 ft Depth to limiting factor 17 in q +5 l ; tq-54 // (o/z' jz / B# I _ SoJ Annhcahon Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az Cont. Color Texture Structure Gr. Sz. SIT. Consistence Boundary Roots GPD/Ft' 'Eff#1 'Eff#2 1 0-12 10YR3/4 -0- SIL 2MSBK MFR GW 2M .6 .8 2 12-17 10YR5/4 '0' SIL 2MSBK MFR CW 1M 6 .8 3 17-30 10YR5/4 F2D1 1 SIL 2MSBK MFR N/A NIA 6 8 4 30-46 10YR4/6 C2D5YR4/4 SCL 2MSBK MFR N A N,A 4 .6 2❑ Bormg # ❑ Boring ® Pit Ground surface elev � 6 ft. Depth to limdmg factor 1 in Qnil AnnIirntmn Ra}c Horizon Depth In, Dominant Color Munsell Redox Description Cu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 'Eff#1 -Eff#2 1 0-10 10YR3/4 '0" SIL 2MSBK MFR GW 2M .6 8 2 10-17 10YR4/4 'V SIL 2MSBK MFR CW 1M .6 .8 3 17-32 10YR4/6 C2D5YR4/6 SIL 2MSBK MFR NIA WA 4 6 CST Name (Please Print) Si CST Number 1 ROBERT HARDINA 524825 r Address Date Evaluabon�nducted Telephone Number 477 170TM AVE TURTLE LAKE WI 8/24/2020 1 715-491-5039 Boring # ❑ Boring ® Pit Ground surface elev 95.6 it Depth to limning factor 16 in Soil Application Rate Horizon Depth In Dominant Color Munsell Redox Description Qu Az. Cont, Color Texture Structure Gr. Sz Sh Consistence Boundary Roots GPD/Ft2 'Eff#1 'Eff#2 1 0-8 10YR3/4 -0- SIL 2MSBK MFR GW 2M .6 8 2 8-16 10YR4/4 -0- SIL 2MSBK MFR CW I 6 .8 3 16-30 1 10YR4/6 C2D5YR4I6 SIL 2MSBK MFR NIA N/A .4 6 Boring # ❑ Boring ® Pit Ground surface elev —it Depth to limning factor _ In. Snil Cnn irnfinn Rnte Horizon Depth in. Dominant Color Munsell Redox Description Qu Az. Cont. C01or Texture ii Structure Gr, Sz Sh Consistence Boundary Roots GPDlFt' 'EfF#1 'Eff#2 I i I i I 7 Boring # ❑ Boring ❑ Pit Ground surface elev it. Depth to limning factor in. Rnil Cnnlirahnn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz Sh Consistence Boundary I Roots GPD/Ft' `Eff#1 -Eft#2 i i i Effluent #1 = BOD, > 30 s 220 .mg/L and TSS > 30 5 150 mg'L ' Effluent #2 = SOD, > 30 _< 220 mglL and TSS > 30 6 150 mg/L 3❑ Boring # ❑ Boring ® Pit -Ground surface elev. 95.6 R Depth to limiting factor 16 in. Soil Aoplication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FF 'Eff#1 'Eff#2 1 0-8 10YR3/4 -0- SIL 2MSBK MFR GW 2M .6 .8 2 8-18 10YR4/4 -0- SIL 2MSBK MFR CW I .6 .8 3 16-30 10YR4/6 C2D5YR4/6 SIL 2MSBK MFR N/A NIA .4 .6 ❑ Boring # ❑ Boring ® Pit Ground surface elev. —ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/W 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. _ ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 'Eff#1 I •Eff#2 ' Effluent #1 = BOO, > 30 5 220 mg/L and TSS > 30 5 150 mg/L " Effluent #2 = BOO, > 30.5 220 mg/L and TSS > 30 s 150 mg/L `+:r3Ee j4Nb x1•4 h 5 CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. ❑ SOIL EVALUATION sale: t° =40' © SYSTEM PAGE 2 OF SITE MAP 0 40 Bo 80 PLOT PLAN PROJECT NAME: to, OESiGNFLOW: 450 GPO (fongnd) CRESS Attach design flow calculations for commercial plans. PROJECTAODRESS: 2007 280TH ST Pipe Material! ASTM Standard (Tables 384.30-3 8 384,30.5) BM Symbol: BM Elevation: 100 N FT Sanitary Sewer. / Main: / BM oescripWn: TOP OF PROPANE TANK Force Slope Gradient (h) Weil Symbol (If applkable)' O 2 Indicate north by drawing an arum IMPORTANT: Show ground elevation contours at suitable intervals. of Tested Area: on the approprhe rna