HomeMy WebLinkAbout016-1012-30-025Wisconsin 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)I
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
7- Z
1 Z.51R
Dosing
%oo Lo v
7 b
gwcr
�f k Ili
Holding
TANK SETBACK INFORMATION /,r_ L5 Ci ainc
TANK TO
5
WELL
S,BULUDCp.
v t to Av y�take
ROAD
Septic
Dosing
3(' / ,
>40-
-7 1 t
N 95 t
Aeration
Holding
PUMP/SIPHON INFORMATION AA) ,V 1;'vgr Lit
Manufacturer
/ �r
LI
Demand Y
GM
Model Number
Q�
LI 6j
TDH
Lilo 0�;
Fri ion4T
LL--
System Head
3,6
T H Ft
P6 , y 7
Forcemain
Lengths .
Dia. .I
Dist to Well >50'
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
! -7
lof.7
�QO
AltP B r (oyLr-
9.3
)D5.
Bldg. Sewer
L)7
SUHt Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
1Z,6
97. 7—
Header/Man.
.L45
%a% Z5
Dist. Pipe
z �`
107 Z-:C'
Bot. System
3.157
104.55
Final Grade
St Cover
BED/TRENCH
DIMENSIONS
Width
975
Length t
N&-Q4 relres)4
2-1Q.�
l-r
PIT DIMENSIONS
N Of Pits
ida Dia
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L5'
BLDG
WELL
LAKE/S R M
ILEACHJKG
HAM R OR
NIT
M nufac er.
yp%/lOvtnf
�y�
35
116'
>so,
1. ..061Number'
DISTRIBUTION SYSTEM
Header/M�aJndold a
{
Distribution 77
Ppe(s)7Z Z' ill
'7
x Hole S¢e ! ��
'i
x Hole Spacing
�
Vent to Air Intake
�0 `x
Length Do
Length Dia Spacing
3 Z
`L
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Dee`l' r"' r
r
Depth Over
xic Depth of
x Seeded/Sodded
xx Mulched
r
Bed/ Trench Edges`
Topsoil > 1 z
�/�L.
l� Yes No
[ -_ Yes No
Q linter
1
COMMENTS: (Include code discrepencies, persons present, etc.)) Inspection #1. r)atJ Vz �L l Inspection #2:
Location: 1781 CTY RD D 1 ,/1 * /tcv".'d SA�I-N UPsref G MR _I
1.) Alt BM Description = F 14fr COYYC- 140 k,(4 avJrp r � ktL IIJ I�l„s d- SeCCI
2.) Bldg sewerlength=Izi (&(eq
-amount of cover=751Z w7 iyt5.fIy}i/r] Uv6tj- J.41V'tWWj1/�W4l 3" i)+5vI�1'�'ieA. I
Plan revision Required? ❑ Yes I No � r _ ? f7 1 ;! � 1 r0o � /
Use other side for additional information. li7 J ` l 1�.. J'fV (
Date Insepctofs Signature Cert No
)41
SYS
1.$
di
a
2 Al
courly
Safety and Buildings Division //f/1111
201 Wr'Washington Ave., P O.snx 7162
g mr}• Pennrt Number (m be filed in by Co.)
.,
Madison, WI 53707-7162 33
-_. _.... -Sanitary Permit Applizatlon
State Tramucnoo Namber
In accordance with SPS 383.2112), Wis. Adm Code, submissieu of this form a {vIt
.. z.l oO-+j 1
is required prior to ob "n+ g a sanitary permit. Note' Appbcanou forms for start-o cd PO W[S are submined to
the Department of Safety and Professional Serves Pers:mal uformation you provide may be used for secondary
PmJ� Address (if diSercm than mailing address)
ses m accordance with the Pn law, s. 15.Wl m), Stars.
�.
L Application Information Please Print
- All Information
Properly Owner's Name Parcel #
Property Owner's MMgailing Address °roperty Location
" ( Govt Lot
City, State ip Code I Phone Number /
7rn� �l 424
TJ(J N. RZJ _F W /
' IL Type of Bnildiag (check all that apply) t # I `/
Family Dwelling -Number of Bmrooms Subdivision Name
�71
BI #
PubadCo�iercial-Describe Use CS
A\V ��� ❑ City of
i
CSM Number
❑ State Owucd-Desmbe Use V. j r � •Village of '
of
III. Type of Permit (Check only one box on line A. Complete line B if applicable)
System lacemerit Systm
❑ TreatmenVdoldiag Tank Replacaoeot only ❑ Other Modrfx,anon to casting System ( am
�P1 )
B.
❑ Pemvt Renewal ❑ Permit Revision ❑ Charge ofPiumba
'��. Pamn T:aysfQ m New L'st Previours Pwmrt Number and Dale Issued
Before Expiration
i
Owver
�ptic
.� 7von-Pressiamsd In -Ground ❑ Prmsunzcd In-& and ❑ AI-Cr de C Mound > 23
LI
m of sortable soil and <24
m table soil / /1
[/ r
Holding Tank ❑Other Disperse! Component plan)
PreoYannrnt a (cxplam)
( /
V. Dis rsaUTreaorn t Area Information:
G 10 O
Da pba2 ) Dest� Soii Applcanw f) l Dispersal Area Requ" (Sf)
Du A. Pr d (sf) System Elevation
r
ISb 6
OS,
VL Tank Info -ity m Total
# of
Manta
G�>o� Gallons;
Umrs
New T.W. F., inn TaW¢-
g
u a v o
.. V y m h
= -
Septic � Ho18mt 7aak
i
I .
i
VIL Respoasibility Statement- t, a undersi as not responsibility for installation
of the POVJ rS shown on the attached plans.
Plumber's Name (Prmt) P 'c Signanue
W/MPRS Number Business Pbone Number
_
Pt®bef�� �, S� �p
Countv/De artment Use Only
roved ❑Di
Permit Fee
Date lssu
s/9
],,sums eat Slgnanne
`
❑ for Denial
yea
z
IX. Conditions pprov
nET
r
tank.EM
ffluent fllter and
per cell must ticCedprove I maintained
�`
t plan bplumr
per management plan provided by plumber,
m
setback reouirements must be maintained
as per applicable code/orddv0MtiYaandne pimfort
398
i,Q`/SdC-ace, 7��1S ooe 4,,s tWD�f7��'LI.Q"i/'�C 6aQ-tiVL
6). � a4-1+ tlbx T514- x,4GPD
ukkAw- .
u
System PLOT PLAN
PROJECT Mike Maes ADDRESS 1781 Ctv Rd D Emerald Wi 54015
1/4 INN 1/4S 6 /T 30 N/R 15 W TOWN Glenwood COUNTY ST.CROIX
SYSTEM ELEVATION 105.4' 1.4' sand lift DATE 4/10/21 BEDROOM 4
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of Chambersnone
("NCHMARK V.R.P. Top of survey Iron ASSUME ELEVATION 100' Filter Lifetime
❑ BOREHOLE O WELL «H.R.P. same as benchmark
LB�M:
1 03' Cty RD D
1 04'
B-1 105'
7% Slope ` CO
A
Area 15' below system is y
to remain undisturbed
B-2 Scale =114" = 10'
O
0' 40' 80'
Grading to be done to
divert run-off away
from system
0
-3
Huffcutt
Property Line
Old tank is to be
C)'L' pumped and
buried
Si Existing 3
bedroom
house
Tank
2-D4�
Well
O
April 29, 2021
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2023-04-29
Plan Review: PWTS-042100712-C
SHAUN R BIRD
1432 120th St
New Richmond WI 54017
SITE: Mike Maes
1781 Cty Rd D
Town of GLENWOOD
St. Croix County
Total Amount: $250.00
FOR:
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL
GREEN BAY WI 54304-5211
Contact Through Relay
http://dsps.wi govlprograms/industry-services
www wisconsm gov
Tony Evers - Governor
Dawn Chin - Secretary
Mound Component Manual — Ver. 2.0, SBD-10691-P
(N.01/01, R 10/12)
Pressure Distribution Component Manual — Ver. 2.0,
SBD-10706-P (N.01/01, R 10/12)
Description: 600 GPD (4 Bedrooms —.Veiv Construction)
Maintenance Required
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s 145 06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use
• 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 drams 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 I/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)
• "'ell 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 with rock fragments, nee roots, stumps and boulders reduce the amount of soil
available for proper treatment, 11 no other site is available, trees in the basal area of the mound must be cut off
at ground le\el. A larger 1-ill area is neces.mry �dhen am of the abode conditions are encountered. to pro\ade
sufficient infilu'attve 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/installation/operation.
In granting this approval the Division of lndustr} Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state slats 101. 12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe budding, 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,
% eLJ�
,lf 4, oC"eelf
POWTS Plan Reviewer— Wastewater Specialist
Department of Safety & Professional Services I Division of Industry Services
email. tim.vanderleest(a)wisconsm.gov
Cell: 608-516-6134
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St,
New Richmond Wi 54017
715-246-4516
Date: 4/9/21
Owner:Mike Maes
Location: NW1/4 S6 T30 N,R15W 1781 Cty Rd D Glenwood
Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12)
Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7. Filter Specifications and cross section
8-9. Maintance and contingency plan
Attachments: soil test ✓\
Shaun Bird
Signatu
License number
Page 1 of 9
System PLOT PLAN
PROJECT Mike Maes ADDRESS 1781 Ctv Rd D Emerald Wi 54015
1/4 NW 1/4S 6 /T 30 N/R 15 W TOWN Glenwood COUNTY ST.CROIX
SYSTEM ELEVATION 105.4' 1.4' sand lift
DA'1'E4(10/21 BEDROOM 4
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of Chambersnone
"NCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime
❑ BOREHOLE WELL *H.R.P. same as benchmark
7% Slope
B-2
11
A
1 0 3'
1
B/
3
Cty RD D
1 05'
Area 15' below system is
to remain undisturbed
a
Grading to be done to
divert run-off away
from system
Huffcutt Combo Tank
Property Line
Old tank is to be
pumped and
buried I —
Scale =1/4" = 10' �,
ST Existing 3
it bedroom
Y' house
2 D �q
IS6y
Well
O
M
Mound System Cross Section and Plan View
t
t
17 -.1 = Topsoil = ASTM C-33
I Cap Material sand fill
k.-
/n vl. 0
= Clean aggregate
%a to 2'/2 in. dia.
Slope Direction
Dimension I
Feet
A
7J
B
D
E
G , S'
H
I a,
J +�
K
L (o
W
Z
(�
sloe
O = 4 in. sch. 40 pvc
observation pipe
GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing
vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or
chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a''/. inch soil wire
when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately
after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or
is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot
thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound
is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The
observation pipes are slotted in the lower 6 inches and sec in place with rebar or a closet flange.
2
10/07lgj Page ' of
Pressure Lateral Layout
Two Laterals — End Manifold
Man
I
.>/ Or, h
Distribution
Lateral Diamei
L(Lateral Len `7
M(Manifold Len 67
Force Main Diameter
Force Main Length /Ir7
03/05 lgj
In.
Ft.
Ft.
In.
Ft.
Aed
lout
g
ig
Sweep
90
Bend
Pressure System Construction
Laterals are constructed of Schedule 40 PVC
pipe. Orifices are drilled perpendicular to
the pipe with a sharp drill bit and face down.
Lateral turn -ups terminate with a threaded
cleanout plug and are enclosed in a 6-8 inch
diameter lawn sprinkler valve box accessible
from finished grade.
••••• Grade ••••••
6-8 Inch Lawn
Sprinkler Valve
Box
Page q of —
Septic -Dose Wank Cross Section And Pump Performance Specifications
Filter Manufacturer
Filter Model Number
Minimum Pump Performance Required
�/ GPNL Qa 7i Ft TDH
Outlet Manhole Min. 4" Above Grade With
Locking Device. Inlet Manhole
< 6" Below Grade Sealed Watertight
— — —/ — Fi tiaimd Grade
outlet Filter
Inlet I� inlet Baffle
Switch Sett p and Reserve Capacity
Tank Volume = 7 GPI
Dimension: I
Inches
Volume Gal.
(reserve) A.
(alarm) B
2
(dose)ED
(dead)
S
Total
S
6
.., .e�*r.ltr.:a
Win
IMM
Total Dynamic Head (TDH) - Feet
Elevation Head
Distai Pressure
Network Loser
Force Main Loss
3,
Total
%
Manhole Min. 4" Above Grade
Securely Mounted
With Locking
Device
Weather-proof
I
Junction Box
i
_i
t� _
Vent Min. 12"
Disconnect
Above Grade
Means
With Vent Cap
3Z
----
55
A
Weep
B
Hole
Off Elevation C
~, Ft Bottom
D Elevation
4 s. I Ft
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior Villwal. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical servioa mplies with NEC 300 and Comm 16.23.
02/05 U Page � of
280-SERIES
112 hp Submersible Effluent/Sump Pumps
The Liberty 280-Series provides a cost effective "mid-
range" pump for on -site waste water systems, liquid
waste transfer and commercial heavy-duty sump pump
applications that require higher head or more flow.
Designed around Liberty's unique "Uni-Body" casting,
the 280-Series will provide years of reliable performance.
All Models Feature:
" Vortex style impeller permitting passage of solids
up to %W
• 416 stainless steel rotor shaft
• Permanently lubricated upper and lower ball bearing
• Epoxy powder coat finish
• All fasteners - corrosion -resistant stainless steel
• 1 yz Discharge
• Stainless steel bottom screen - easily removable
• Maximum fluid temperature:140' F.
280-Series Cord Lengths
Model 10' 25'(-2) 35'(-3)
50'(-5)
280 Standard Optional Optional
Optional
281 Standard Optional Optional
Optional
283 Standard Optional Optional
WA
287 Standard Optional WA
WA
10' cord length standard on all models. For optional lengths,
add "-2, -3 or -5" suffix to model number.
Example: for model 280 with W oord, order 280-4
Motor Specifications
%hp 60 Hz 3450 RPM
Oil filled, thermally protected
(PSC) Permanent Split Capacitor
8.0 amps (115V)
4.0 amps (208/230V)
ON
Model 281
Wide angle
float switch
with quick -
disconnect
c us Certified
Sr�.1<+»a..n.gxt m cringe Oman roac..
35
30
25
LL 20
v
15
= 10
U.S. Gallons Per Minute
0 38 78 114 158 192 228 270
Liters Per Minute
Dimensional Data:
Weight: 29lbs.
Height:13"
Major Width: 10" (model 287)
Minimum Sump Diameters:
Model 281, 283... 14"
Model 287 VMF... 100
Factory switch
Model 281, 283
Model 281
setting s
VMF
Turn on level
13"
9.5"
Tum off level
7"
4.0"
The Model 283 features a fully adjustable wile -angle float Differential
adjustments can be made easily by tedwrkV the float to the dis-
charge pipe or other mounting point Venial float model 287 Is not
adjustable.
Model 283
Wide angle
float switch
with series
(piggy -back)
plug
-sue
Model 287
VMF-Series
Vertical mag-
netic float for
smaller pits -
will operate in
a 10" diameter
sump
Liberty Pumps " 7000 Apple Tree Avenue " Bergen, New York 14416 " Phone 800-543-25M Fax (S85) 4944839
www.libertypumps.com ConyNht o uwry Rvrgx I 2017
All rVft rawrwE. D.r 2100 FAA M7
m
20140048A
SECTION A -A
1.I921
h
9.8/64 93759 ��
9 3156 �-
1
-t�
POWTS OWNER'S MANUAL $ MANAGEMENT PLAN pa9e��or—
S SPECIFICATIONS
FILE INFORMATION
YSTEM
Owner
Septic Tank Capacity
al
❑ NA
Permdt
Septic Tank Manufacturer
eff NA
DESIGN PARAMETERS
Effluent Fkw Manufacturer
k
❑ NA
Number of Bedrooms
❑ NA
Effluent Filter Model
i
❑ NA
Number of Commercial Units
1LNA
Pump Tank Capacity
l al
❑ NA
Estimated flow (average)
Pump Tank Manufacturer
NA
Design flow (peak). (Estimated x 1.5)
6n pal/day
Pump Manufacturer
❑ NA
Soli Application Rafe
0 gal/dayffePump
Model
❑ NA
InfluenVEffluent Quality
Monthly average'
Pretreatment Unit
'
Fats, Oil 8 Grease (FOG)
00 mglL
❑ SardfGnivel Filter
❑ Peat Fitter
Biochemical Oxygen Demand (BODJ
:s220
❑ Mechanical Aeration
❑ Wetland
Total Suspended Solids (TSS)
5150 /L
❑ MaDisnufacturer
Manufacturer
❑Other.
Pretreated Effluent Quality �A
Monthly average"
Dispersal Cell(s)
Blochemical Oxygen Demand (BODJ
530 mg/L
❑ In -grand (gravity)
❑ In -ground (pressurized)
Total Suspended Solids (TSS)
530 mglL
❑ At -grade JudLound
Fecal Col form (geometric mean)
5104 cfu/looml
❑ Drip -line
❑ Other.
Maximum Effluent Particle Size
Y, Inch diameter
valms tplcal Im cl esdc (noo-wrranerWl)
wastewater and
�• values typical for pretreated wzstawater.
MAINTENANCE SCHEDULE
Service Event
Service Frequency
Inspect condition of tank(s)
At least once every
❑ months
ear(s)
(Maximum 3 yrs.)
Pump out contents of tank(s)
When combined sludge and scum equals one-third ($) of tank volume
Inspect dispersal cell(s)
At least once every
O months
r(s)
(Maximum i yrs.)
Clears effluent filter
At least once every
, ❑ months
years)
Inspect pump, pump controls &alarm
At least once every
❑ months
ear(s)
❑ NA
Flush la*als and pressure test
At least once every
❑ months
earls)
❑ NA
od"C '
At least once every
O months
❑ year(s)
NA
ogler:
At least once every
❑ months
❑ year(s)
NA
MAINTENANCE INSTRUCTIONS '
Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the folkywtng licenses or
certifications: Master Plumber, Master Plumber Restrictgd Sewer, POWTS Inspector, POWTS Maintainer; Septage
Servicing Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken
hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up
or pondlog of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels
in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding oteffluent on the
ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum In any tank equals one third (Y,) or more of the tank volume, the
entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR
113, Wisoonsin Administrative Code
The servicing of effluent fitters, menlcal or pressurized POWTS components, pretreattment components, and any
other maintenance or monitoring at irlervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A sevicd report shall be provided to the local regulatory authority within 10 days of completion of any service event
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of paindr)y products or other
chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concegtrations are
detected have the contents of the tank(s) removed by a septage servicing operator prior to use.
page —of —
START UP AND OPERATION
For now Construction, prior to use of the POWTS check treatment tank(s) for the presairm of painting products or other chemicals thElt
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.
System start up shall not occur when soil conditions are frozen 0 the Infiltrative surface.
During pourer outages pump tanks may fill above normal highwater levels. When power is restored the stows wastewater will by
discharged to the dispersal cal(s) In one large dose, overloading the cell(e) and may result in the backup or surface dfscherge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring powar to the
effluent pump or contact a Plumb or POWTS Malntalner to assist in manually operating the pump oontrols to Motors normal lehrels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cols. Do not drive or park over, or otherwise disturb or Compact, the area within
15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the fife of the POWF$:
antiblotice; baby wipes; cigarette buts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; W foundation drain
(sump pump) water; fruit and vegetable peelings; gasoline; grease; harbWdes; most scraps; medications; oil; painting produces;
pesticdes; ssnitwy napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS falls and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is Properly
and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• Al piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shell 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 sail,
gravel or another Inert solid material.
CONTINGENCY PLAN
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provlde a code comPl*lt
replacement system:
❑ A suitable replacement area has been evakrhtted and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should riot be Infringed upon by requhled
setbacks from existing and proposed structure, tot lines and hells. Failure to protect the replacement area will result In the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with fie rated In
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil IimilloWns. Barring advances In POWTS technology a
1 holding tank may be Installed as a last resort to replace the failed POWTS.
the alto has not been evaluated to Identify a suitable replacement area. Upon failure of Me POWTS a son and site evaluation
must be performed to locate a suitable replacement area. If no replacement arae is evalable 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 blomat at the infiltrative
. Reconstructions of such systems must comply with the rules In effect st that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE O A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER ih
Name
[_Phone]
�
POtlYTS MAINTAINER
Name 24
1_ Phone — y) /
SEPTAGE SERVICING OPERATOR (PPUURP—ER) —i LOCAL REGULATORY AUTHORITY
Name 11n✓ ,,//!� I Name
Prone
Y o2ilw S��d Phone
This documaa was deafled in compliance with chapter SPS 3a3.22(2)(b)(1)(d)8(ry and 383,54(1), (2) & (3), Wla In AdminMtrYhe Cads.
VYLmrWn DeprNrM o(Sd* and Prakssimd Srvfoes
DNelon of trrdkwtry SWA005
SOIL EVALUATION REPORT
Pap 1 of I
Insomrftmwr,h SPS385,Wb. Abe. Code
Altech eaniPlee see plan on ppr not Was Own 8 in x 11 Indmis In ate. Pen must errA+ds,
bulnotbiedm:vrdcWwdtrlrontM.Obwtoe Dotda",axedI endparcedabW
scYs ord4nrrlons, north mow, and location and distance to nearest mod.
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ST CRo rvTx SANITARY SYSTEM File #:
:,rZ,,rFI Office Use Only
OWNERSHIP/ADDRESS FORM Created2/2021
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.
OWNER/BUYER INFQRMATION, >..
Owner/Buyer _75 C
Mailing Address / ?8,
City/State/Zip �n
Phone Number (required)_
Email Address (required)
Parcel Identification Num
(found on the property tax bill)
NEW SYST#,M: LEGAL DESCRIPTION
Property Location _ 1/4 1V t/a , Sec.., T� -ON R/ J W, Town of / 9 �rLLUr/Xt'
Subdivision Plat: /y Lot # L,
Certified Survey Map #_ `7 .i j Volume �2 Page* 570.
Warranty Deed #
(before 2006)Volume
. Page # ,
Number of bedrooms
Spec house O yesx(tlo
Lot lines identifiabledyes 0 no
- OFFICE USi ON& -
New Property Address
(Verification of new address required from Community Development Department for new construction.)
(Staff Init(als) (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(o)sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccw1gov
- C S i -coat - oho
Lk
Wisconsin Department of Safety and Professional Services Page 1 of 3
Division of Industry Se
SOIL EVALUATION REPORT
Inacoordance with SPS 385. Vvis. Adm. Code County
ST CROIX
Attach completh-si[eplan-on paper not less than 8 1/2 x 11 inches in size. Plan must include,
but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.O.
scale or dimensions, north arrow, and location and distance to nearest road. part of 016-1012-30-025
Please print all information. Rev' weQby Da
Personal information you provide may be used for seconds s Pnv Law, s. 15 04 1 m .
K
yOwner Property LocationAES Govt. Lot part % NW % S 06 T 30 N R 15 E (or) W
y Owners Mailing Address Lot tl Blodr A --Fs-
Prop Name or CSMC
City State Zip Code Phone Number El city 1-1 Village ® Tarn Nearest Road
SPRING VALLEY WI 154767 (715) 781-2737 GLEW400D CO HWY-D-
❑ New Constriction Use ® Residential / Numberof bedroans 4 Code derived design flow rate 600 GPD E x
®Replacement ❑ Public or commercial - Describe: r�r
Parent material GLACIAL DRIFT & LOESS Flood Plan elevation if applicable n_a. ft.
General comments and recommendaho RECOMMEND A MOUND HAVING CENT RLINE LOCA'T1ED O' N`pR NEAR -T�HnE, 104.0' NTOU
<GC. I CgAe" � r,A iwDL zhi ^k3L—PYOC72�V
1❑ Bonng if ❑ Boring - - T ., - -
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CST Name (Please Print)
Signature/
CST Number
CHRIS FREDERICKS
_
1618
Address
Date Evaluation ucted
Telephone Number
499 4 112 Ave, Clayton, Wl 54004
12/12/2020
715.419.0127
Jtllt8J tkmiiz)
a 1 � -�A A,
Boring # El Boring
® PS
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Sod Arntication Rate
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Y =�
3 ] Boring #
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` Effluent #1 = BOD, > 30 s 220 mg1L and TSS > 30 5 150 mg1L ' Effluent #2 = BOD, > 30 5 220 mg[L and TSS > 30 5 150 mg4.
31`�r 1 r r, —Oej
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53a 01 i/I I W
May 19, 2021
RE: Michael Maes property — soil test.
Location: 1781 Cty Rd D; PID: 016-1012-30-025
An onsite inspection of the soil tested area submitted by CST Chris Fredericks, dated 1211212021,
was conducted by County staff on 5/18, 2021. The site was mapped and the soils that are
predominant in this site location of the property are Freeon Soil Series, as per Soil Survey of St.
Croix County, Wisconsin manual.
As mentioned above, the soil test by Fredericks was conducted in December. Special care and
consideration of soil tests conducted during late fall and winter months, due to light conditions,
frozen soils, etc.
A hand -dug verification pit was evaluated about 10 feet north of Fredericks' pit 2
Observations:
One pit was hand dug in this soil tested area. The observations in this report are based off of this
one pit.
The soils were very dry due to the lack of significant rainfall in this area in the last several weeks.
No redoximorphic features were found within the A horizon, (from ground surface to 8-9" below
grade), with granular structure parting to sbk structure. The bottom of the A horizon appeared to
be mixed with B horizon soils. There were distinct, moderately structured peds in the B horizon.
Many peds were found to have silt coatings on them, indicating that water was moving downward
through the soils. There were also many worm casts, and vegetation roots down to around 14-
18" below grade. The mixed soils in the B horizon had soils were colored brown to reddish brown,
but seemed to be the same color as the substratum soils below. There were no obvious
redoximorphic features observed down to 20" below grade.
Conclusion:
Due to the silt coatings noted on the peds in the B horizon, the depth of roots, moderate
structured soils, and the lack of obvious redoximorphic features, it has been determined that the
soil test by Fredericks will be adequate for a mound to be constructed that is designed to require
a minimum sand lift depth of 16" in this location. If any site conditions change, the soil tested
area will need to be re-evaluated by a Wisconsin licensed Certified Soil Tester.
Kevin Grabau
Land Use and Conservation Specialist
l0
/.n - � , . 4 �
kO ?71 J W
i
�5r-WIXCOUN NO. 633353
STATE SANITARY PERMIT
n
�C'fR,i�6FERfl�VEWAL PREVIpCi�➢A8 NO.
IE�
owrrER rn�c►bke� /11�tEs
PLUMBER5MM 91 R6 LIC.#
TOWN OF W6o16
SEC_J,30 _N, R
�V/QOT BLOCK
`` Pa SW HOC . 9/5104:- SUBDIVISION
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and maybe renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
~tj,vuv�A)"ZED ISSUING OFFICER -DATE �„ u (pw
PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)