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HomeMy WebLinkAbout004-1010-40-100Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may he used for secondary purposes [Pnvacy Law, s.15.04 (1)(m)] Permit Holder's Name. City Village Township Dean Davis CST BM Elev: Insp BM Elev IBM Description. . ®` CID . r ram - TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing 7 W B t04nLo gR� Aeratio oldin TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air intake ROAD Septic / e Dosing +A Vt VOL Aera ' Hold' PUMP/SIPHON INFORMATION (�Q Mamifarh lrorI — _ i _.,.__. g,J ls2_ TDH Li ,3 Frictio `Loos System Head -� TDH it.S t Forcemain Length L Dia. r t Dist. to Well SOIL ABSORPTIOW SYSTEM ' TOWN OF CADY LV% ILCr ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer 0.S / SUHt Inlet .Go g3,go� St/Ht Outlet Dllnlet H er/Man. B.tios Dist. Pipe 9 J 3,3,0 3 p Bot System 3J7,. t+rF'. dl Grad 9t tl 12 Cover b,r. 3r$C IMENSIONS Width / Len l h y jNo. Of Trapehes Z � PIT DIMENSIONS No Of Pits Inside. De. LiaLlid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LA E/STREAM LEACHING CHAMBER OR UNIT Man rer: Type Of ASystem :- f^, ( i ULlmtp.r. Llillllt lJ■L-I Clan nm ON VA a✓. ��.�-rr.CtlC!�wT7 Headerr/M:�pld / I t1 DisteYsution ( ( (( x Hole Size x Hole Spacing Vant to Air Intake4 ' Length3 Dia L Z Length) ,-]I, Dia Z Spacing ( V VIL V V GF% V Vmecum SvNnmc nnl.. -- RA -..-A A. A. Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsail O Yes 0 No O Yes O No COMMENTS: (I1p�clCu(de code dis re6enct s, rs s p es neLc.) / Inspection #L r'l ? ZZInspection _#2L: LJlocca `�0 290TH S I p,�� f �Q ate, 1.) Alt BM Der le lion = Z LS 76 z/4, 4,- ry �, - C,}� 2.) Bldg sewer length = w �19s• 7 �,�y�,o�+.� 6" 'frs.+.� t "`+^een--� r�^�-- amount ofcover = PLAMW-541*A. w (zc-}I GefeJtl 6 QUAjer Q1 ` ' . `""9s oueseoQ • 3 •a "Qa 0im- �lAw h Cc—Aw. ,6&,+ c�itlhe �r Plan revision Required? Yes % No 4 Z l �_ Use other side for additional informati n. ELDy1Date Insepctor's Signature Cart o. J7P+ �°�c cos �fA - �vo . I 39 W. 11 $afety and Buildings 'vision County. S 0 8 Washington Ave., P.O. BOX 7162 P$ Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) ` MAY 2 7 �21 63311 t. Croi our,ty ,1 S� �r)�%�t4 lication r Stare Transaction Number y In accordance with SPS 383. ( is. A m. Code, submission of this form to the approp overnmental unit O S2 0 0 4. _ Project is required prior to obtaining a s nary• permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safely and Pro ssional Services. Personal information you provide may be used for secondary Address (if different t mailing address) purposes in accordance with the PrivacyLaw, s. 15.04(1 m , Stals. e� 570 1. Application Information _ Please Print All Information Property Owner's Name Parcel # IDEA 004- io�o-ya -ioo Property Owner's Mailing Address Property Location Govt. Lot /._l!4 Section 05 City, State ZipCode Phone Number Kofto wit. y u ,1 IS_1"{yip-( M&4 (circle one) T 2$ N; R !� West 11. Type of Bu ing (check all that apply) Lot k I or 2 Family welling — Number of t Subdivision Publi ! rcial Describe Xtim � Block <� # ❑ City of State owned — Described useP No CSM Number v,3p dlage of CAA4 Qrt�rta� Town of wt-S — o— SL 1 ' Ill Itl. Type of permit: Check only one box n omp ere (applicable) A. New System Replacement System Treaument/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) -- r Non -Pressurized In -Ground ❑ Pressurized In -Ground At -Grade Mound > 24 in. of suitable soil Mound < 24 ' of suitable i Holding Tank ❑ Other Dispersal Component (ex p in) — ❑ Pretreatment Device (explain) V. Disperssl/Treatmeat Area Information: o +ti (o•O Design Flow (gpd) Design Soil Application Rate st) Dispersal Arco Required (st) Dispersal Area Proposed (s� System Elevation L{So 1, 450 4170 q1.1 V1. Tank Info Capacity in Total » of Manufacturer ff ^ Gallons Gallons Units ([y y�,�' Q 'C "l �"l'� g v I n. New Tanks Existing Tanks (>�t1(.O t � U Septic Tank 000 4. WWL Lift Tank %t r` AC VII. Responsibility Statement- 1, the under ed, ass t re ility r installation of list POW"1 S shows on the attacbed plans. Plumber's Name (Print) Plu Der' i MP/MPRS Number Business Phone Number Lewis Bork �253976 715-231-7375 t Plumber's Address (Street, City, State, Zip Code) E7818 Count Road E Menomani 54751 Vill. Countymepartment Use Only Approved ❑ Disap rov Permit$�ssued t uim Agent Signature ❑ Owne Given Re n for Denial J24 IX. Conditions pprov aMa lit" ohappronal 3) STEM OWNER: Septic tank, effluent filter and �,Q Q� spersal cell must be serviced I maintained Cf\ A 5 �� DS(� +�ll� o"tp_wv' - +k&4 wt s per management plan provided by plumber. J) /'gyp �r II setback re uirements m T n► S at�ti a n 2 �e wedol �l 171T) --s,'u 4 rra�...••..aa n.svc-w— '.�% Luv �tT( �► &019- F V W t V r �l� . ^ . - . _ r °19 � QS ,,u ui.0 I� 0V� ©tFW CHECK BOX AS APPLICABLE, CHECK BOX AS APPLICABLE. COOT 3 01.3 SOIL EVALUATION Scale: V=40' 'SYSTEM PAGE 2 OF6 SITE MAP ° 40 60 60 67 PLOT PLAN PROJECT NAME: 10, DESIGN FLOW: �" io GPD �� ��►�_ ( Attach design flow calculations for commercial plans. PROJECT ADDRESS: 2404% 1 IN i�BM mbE15Md: ww �'BMElevatiorc FT e 1 SM Descriptlon: -M t lS k (�Is.mkti. Pob� Slopa Gradl" ('h) wee Symtd (uapplicable): 0 la rWlln�p %n+hno�,v of Tested AMa: on the approprhe I rw MwEc Rtk* (L-i 2534�6 4w113 �o�r�': m a"k" iI,,t Pi,rc. k)SP,5 Cock Z iDi4% DPwE.wt� E4 Flow 30o I?A F D C-A Zs 50 300 Eye -,-Oa Pipe Material / ASTM Standard (Tables a64.30-3 & 3&4.30-5) Sonttory Sewer.,^/ S4JA4D f20(. Face Mal): _ 0 M N l22HANT: Show ground elevation contours at suitable Intervals. f- 1 1066IQv D- 9.1 Z� 1&LZ, PAA 87, q „ „t t90 �oDSQS sFr 13ACL4. `-'sueC L-7(CO 61tow May 21, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-05-21 Plan Review: PWTS-052101073-C LEWIS C BJORK E7818 County Rd E Menomonie WI 54751 SITE: Dean Davis's shop 290th strcct Town of EAU GALLE St. Croix County Total Amount: $250.00 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http J/dsps.wi.govlprogramshndustry-services www.vAsconsin.gov Tony Event - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES 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) Description: 450 GPD (Workshop — Domestic Wastewater Only — New 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, stars. The following conditions shall be met during construction or installation and prior to occupancy or use: • Only waste that is categorized as domestic waste is Permitted to enter a POWTS unless a letter of concurrence from the DNR that permits commingled waste accompanies the plan. • 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 leftover 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 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, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger till 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/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. 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, c�,enr 7/,aird�t � P.¢f POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleetitiawisconsiu.eo� Cell: 608-516-6134 PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01101, R. 10/12) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross -Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Attachments: Enclosures: Pump Curve POWTS Application for Review Tank s) Soil Evaluation Report & Site Map Effluent filter instruction Project Name J Description Owner Name(s): UkP,.► LNA%J1S Phone:- Q- z14 Owner Address: E19LB Ai AN h uriAda WT Zip: 541 49 Project Address: z1go ''"O Govt. Lot: 5E 1/4 of NE 1/4, Section 05 , TZ-6 N-R L S_ E []or WZ Township: CAAq County: S+. Cro1 X Project Parcel ID #: �= H - (D I D- &t o- Wo Designer Information Designer Name: Lewis Bjork Designer Address: E7818 County E Menomonie WI E-mail: lewisbjork@yahoo.com License Number: 253976 Remarks: Phone: 715 _231 _7375 Zip: 54751 Conditionally APPROVED DEPT, OF SAFETY AND PROFESSIONAL SERVICES OIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Signature: Date: �-Z3-Zo7 Original signature required on each submitted copy. CHECK BOX AS APPLICABLE, I CHECK BOX AS APPJCABLE. (' OT 7 01.3 10 qSOIL EVALUATION Scale: '"=40' SYSTEM PAGE 2 OF6 ° 40 60 Bo SITE MAP PLOT PLAN PROJECT NAME: to' DESIGNFLOW Lisci GPD Djulo D'" I Attach design flow calculations for commercial plans. PROJECT ADDRESS: 290 j% Pipe Material / ASTM Standard (Tables 384.303 8 354.30-5) N �I Scd�4D 20L Sanhary Sewer BM Eavatton. �� FT ' • ^ Force Meln:___3.- •• K K BM Descripaon: Nkif, PO4 Slope Gradient ('hl NMI mad {n s In "16 Donn oy IMPORTANT: of Tesled Area: � PPAcodef O °re"u`o ran op ft I' Show ground elevation contours at suitable Intervals. on w appropAte Mr. 25 3q?� Z9� 28S e o Pex 3S945 Cork �('wrwAy PA srr CY Flow 30o IrA VoA F D Cal Zs 50 2A UgY4b o r96 a twt9� �S� & 1066Qa C a- 9 O DSPS SET i3ACLI- -:T'sSuE. t-I Lr 7 A 61to. Pl W=Le(lft 0.5' TO 2X WASHED AGGREGATE (min. 6.0" beneath distribution pipe - min.2.0' over distribution pipe and cowered with approved synthetic fabric) ASTM C•33 SAND FILL min. 0.5 ft T tts r D Plowed Surface 1p OL $ ��SINGLE -CELL MOUND DISPERSAL AREA MIN. 6.0' OF TOPSOIL COVER min. 1.0 ft -- r--o _9 -- c I , f� A = ft --i I Surface Contour ^ Elevation = _ ft (Show force main, manifold, and flush valve locations on plan view.) 5 % Slope , D = "_1 ft E= 2 ft System Elevation = 19-1-1 ft Lateral Invert Elevation = , 7. ft CROSS SECTION VIEW (No Scale) PLAN VIEW (No Scale) �iwe dacl /� 1J J = ft � ft (typal) + trrvic�) r-------- —---------------------------;-----� ----------------------- ooaervedw --- L— — — — — — — — J ------------------------------— — — — — — — — — — — — i— B=1ft Q f �•I8 K= Bend as necessary to follow contour DOWNSLOPE TOE L - 14• t It Prohibit disturbance and vehicular traffic within 15 feet of downslope toe. Reset Page Wk* ft ( DISTRIBUTION NETWORK SPECIFICATIONS FLUSH VALVE DETAIL (No Scale) Orifice in � — — 11 Valve Box Center of Threaded Cap (insulation optional) for Head Testing (optional) \ r � \ 1 \ Ball Valve � (optional) / \ (No Scale) Lateral Spacing S= A Shield orifices for gravelless applications I) *11, .11 Lateral Length (P) = Z it Orifices equally spaced: ( �— (dred¢ ) OR b) below) a) along bottom of lateral b) ebng top of lateral with every _ th hole facing down Flush Valve Assembly (typical - see detail) LATERAL INVERT ELEVATION = _s (typical) Lfl (rise► pipes optional) Z 1 '0 Schdl40 PVC Manifold 7'0 Schdl 40 PVC Force Main (slope to pump tank r— for drain -back) First Orifice (typical) Laterals to be level r Schdl 40 PVC Lateral 0 = . J in (typal) Number of Orifices per Lateral Orifices equally spaced along bottom of lateral (typical) On ce pacing (X) _ (typical) OBSERVATION PIPE DETAIL (No Scale) Screw -Type or .� • - • Sip Cap (loose) r -+ .. Finished Grade (rnuiched & seeded) 4"0 PVC Pipe Topsol Cover Top of pipe to terminate , ` (min. f foot) at or above finished grade (4) 114'-l/2- X 6- Slots db apart Anchoring Device Infiltration Surface Orifice Diameter = (typal) Orifice Discharge Rate = ' w gpm Number of Laterals = Z' Lateral Discharge Rate = �2'S gpm TOTAL DISCHARGE RATE = ZS- 68 GPM First Orifice (typical) 17 i---- xEND MANIFOLD (typ"ml) CONNECTION box. Manuold First Orifice (riser pipe optional) (typal) I---- x -- E--xrz xrl x --I (typical) (typical) Manifold CENTER MANIFOLD (riser pipe optional) CONNECTION Check applicable PAGE 5OF6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) d`(d lle..r 0:.... IMPORTANT: vent cap Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES @ � gallin J must comply w/th SPS 318 and NEC 300 �TI Weatherproof Junctbn Box Extend mannoie user as necessary. Approved Locking Manhole with Warning Label Attached (typical) Conduit a' Min. or 2.0 A above � 2 Established Flood Ekvebon (MDkeO �Airtight Beal D Ouick D,sconneG s Pump Tank Liquid Level =0�b_in Pump 0 Force Main Diameter in Force Main Length = ?z ftn'�^ppDVeasE Force Main Void Volume = 3. l.(/ D gal [C] Total Dose Volume T� DVS = SJ gal/dose i (5X total lateral void volume < TDV 50.2X design flow) + (force main drelnback volume) MIN. PUMP DISCHARGE RATE = 2S,O'8 gpm 18' Min. �A ( �aq Weep �— Approved Joints with Mole Approved Pipe 3 tl onto Sold GrounC (typical) Alarm al on PUMP -OFF Q >_on ELEVATION =y q ft Concrete Block INSIDE BOTTOM ELEVATION = O / • � ft it Beneath Tank O 9 Vertical Head =�oft 2' s + Min. Supply Head = ft + FM Friction Loss =��ft + Fitting Loss" _ �-i s- ft (min. supply head x 0.3) mo��_ = TOTAL DYNAMIC HEAD = I Z. 1 5 ft Electrical PUMP TANK: SEPTIC TANKS Volume"gal Total Volume =_ 000 gal Manufacturer: �3SCSI.I(l+ Manufacturer(s): �I�rDT�.✓Z- Pump Manufacturer. Zoeller Install approved effluent filter at the septic tank outlet Pump Model; N152 (saaettac,aepump cuiIIe.) immediately upstream of the pump tank inlet Filter Manufacturer: Orenco Controls/Alarm Manufacturer: SJERombus Controls/Alarm Model: AB Filter Model: FT-0822-14B Float switches containing mercury are prohibited. PAGE 6OF6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal)1Area Operating Limits: '1 Design Flow = '50 gpd; BOD5 5 220 mgL"; TSS 5150 mgL"; FOGS 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) c neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s1 shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. o Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Lewis BjOrk Family Septic Service Phone: 715-231-7375 -7(s-36- y�Yy Local government unit: (,""" ,,f � �Phone: !! Local government unit address: No+Py" Co 4v**^ �►'� w t WL ZIP: Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. I50 Series E ffluem Pumps ! Zoeller Pump Company https:Nwww.zoel lerpumps.conUen-nai productsisump-eflluent•pu m ps'ef... 0 �W W W LL cl 14 45 1 „ 12 40 o -- 10-35 152 30 a 0 8 26 151 J 6 20 15 a 10 2 5 0' GALLONS PUMP PERFORMANCE CURVE MODEL 151/152/153 L IN t 10 20 30 40 50 60 40 80 120 160 200 2d FLOW PER MINUTE 280 320 360 2 of 5 2/21!2018, 10:05 AM Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm, Code Attach complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan must County St. Croix include, but W limited to: vertical and horizontal reference point (BM), direction and Parcel I D O(A-101040-000 percent slope, scale or dimensions, north arrow. and location and distance to nearest road. Please print all Information, Reviewed by Date Personal Information you provide may be used for secondary purposes (Privacy Law. S. 15.04 (1) (m)). Property Owner Dean Davis Property Location �y e Govt. Lot SE 114K ►- 1l4 S Or T2,S N R E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# E pj city I AP Zip Cafe Phone Number ty Village • Town Nearest Road KN ft tlo I UT I t'y 41!nj (ill . KAQUZgp C nNew Construction Used Residential ( hLumber of bedrooms Code derived design lbw gate 450 GPO 11 Replacement a Public commercial Describe: iW,8+9 6111)14.6WO Alf j• Parent material A! SS ea1t Flood Plain elevation if appl' ble , r iA ft. t+ General comments In my opinion there is _ min of non -saturated , non consolidated soil above limiting factor , I would and recommendations: propose a standard component manual , install after county and state approval of an mound treatment dispersal system ❑ B-1 Boring # 0 Boring QPit Ground surface elev. ql � ft. Depth to limiting factor �� In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell O . Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 RP as 1041L s t St i z+4 a YV%A #q. C.s Z r _ e- _ A 021til•�L:OW .7f1n1•���• f�fita l 1'+Al�:i`C�<e�i:Ca�1�Q�1•Q''I E Boring # a Boring lo %Ija c El Pit / Ground surface elev. 9J • yQ ft. Depth to limiting factor_ in. Cll1I �flrltlr`AfIM Q>rG Radox Description Cont. Color III j iMEM M. . i 11 mmm® mmman M l!, L v." Mmmm ' Effluent #1 = ODD > 30 < 220 mglL and TSS >30 < gl •EVTMIEtBoD,Ii3OmgkandTSS130mgtL CST Name (Please Print) na CST Number Lewis Burk 253976 Address Date Evaluatlon Conducted Telephone Number E7818 County E Menomonie WI 54751 -7-2.4_ZO -zo 715-231-7375 Dean Davis Property Owner Parcel ID # H Bonng # O Poring Q Ground surfaceelev. 95•q ft. 004-101040-000 Depth to limiting factor —1:7— in. 2 3 Page oF_ Cnil Annlirnfinn 0.4. Redox Description E., r A IUMWI l., . �P��'�fl'/��11M®N "Irm rim M .• I .. ❑Boring # Boring • pit Ground surface elev., ft. Depth to limiting factor in. Snll Anntlrsfinn RatA Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#f •Eff#2 Boring F-1Boring # ■ oa Groundsurface iting face elev. ft. Depth to Ilmfactor in. Horizon Depth in. Dominant Color MunseA Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP ON 'Eff#1 'Eff#2 Effluent #1 = BODY > 30 < 220 mgft. and TSS >30 < 150 mg1L ' Effluent #2 = BOD, < 30 mglL and TSS _< 30 m4L The Department of Commence 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 T'I'Y 608-264-8777. sao.5330rot to w-oot CHECK BOX AS APPLICABLE. CHECK BOX AS APPLCABLE. 9 SOIL EVALUATION Scale: 1°=40' 'SYSTEM PAGE 2 OF6 ° 40 so sD SITE MAP PLOT PLAN u PROJECT NAME: t0, DESIGN FLOW: Li��—D GPD QA%J►b Attach design now SAID calculations for commercial plans. PROJECT ADDRESS: ISO* Pipe Material / ASTM Standard (Tables 384.30-3 & 38//4.30-5) N Sanitary Sewer SCJA 4b e L BM Symbol. BM Elevation: n: �FT _ / Q {� Face Main, 2 f N t N ILl a�w� escdptlon: tlsss6. C��" ob BMDp y,} Slope Gradlerlt C Iodka4 nolh ey IMPORTANT: ( _'Ll— well Symbol (d appucable): O ��o m snow Show ground elevation Contours at suitable intervals. of Tested Area: on des approprhs Wo. iAhs{Ec�2539'7f 2 4a4r► e O J. a- Z Pled S7. q Flow 30o 9 pd F 0 CIA Zs 50 2µ Pi`A Boqys (5) %�-'`_ __ t96 Spa cS� Brt96' \vvo (�5a p _ -TNL 3 4- FloosPs 51ET aACV-'65Le L[L. 7100 s�tcwpJ a � m U) cy 146" F4' CAST -A -SEAL i411 I i111 I I 02.47 / II 1 I FILTER OR II II i BAFFLE III( I 4" CAST -A -SEAL 4" VENT TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP1000/650-MR TANK SPECIFICATIONS a DIMENSIONS: WALL: 3' W rc o BOTTOM: 3" a. COVER: 5' MANHOLE: 24' I.D. PRECAST CONCRETE RISER HEIGHT: 54 1/2' O.D. e LENGTH: 146' O.D. WIDTH: 84' O.D. BELOW INLET: 43' O.D. LIQUID LEVEL 38' o WEIGHT: 14,940 LBS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL a g GASKET, CAST -A -SEAL BOOT OR EQUAL $ INLET AND OUTLET BAFFLE AND FILTER: r m 8 WISCONSIN. SEE DETAIL flO H (OTHER STATES SEE CHART) W LIQUID CAPACITY: 26.32 GAL AN (SEPTIC) 0 o c o W 17.00 GAL/IN (}SUMP) LOADING DESIGN: 8' 0' UNSATURATED SOIL ® z 00 TANK CAN BE USED AS: U N 1 SEPTIC/SEPTIC, SEPTIC/ PUMP OR SEPTIC/SIPHON Q COVER: MIX DESIGN #8 (NO FIBER) = W ,n DO TANK: MIX DESIGN #10 (STRUCTURAL FIBER) IIIIIIIIIIIIIIIn o CUSTOMIZED TANKS: 3 FOR CUSTOM TANKS CONTACT `MESER CONCRETE Oc -i � Q o Z UCi Q o U o F a DRAWINGS SUBMITTED w,) FOR APPROVAL APPROVED BY: $HEFT N0. APPROVAL DATE: PRODUCTS NEEDED BY: /� 1 Ca Maintenance Instructions „ft,,,m. -aaa.ata-seas Biotube® Effluent Filter How to Clean Your Effluent Filter To ensure your effluent filter is functioning properly, it should be inspected every year. Under normal conditions, your effluent filter will function for several years before cleaning is necessary. The filter should be cleaned when it becomes clogged enough to restrict normal flaws out of the septic tank. At a minimum, the filter should be cleaned whenever the tank is pumped. Most people prefer to have a septic tank service provider take care of filter maintenance and cleaning. You can find a septic tank service provider in the Yellow Pages, under 'Septic Tanks & Systems.' or you can contact your county health department for a list. If you wish to inspect and/or clean your effluent filter yourself, be sure to dress properly. Wear full-length pants and shirt, shoes, gloves, and goggles or glasses. Then follow these instructions: 1. Remove the access lid to your septic tank by unscrew- ing the stainless steel lid bolts with hex head wrench provided. If your lid is above ground, itwill be easy to find. if it is buried below ground, find the marker that indicates its location. 2. Remove the filter cartridge by grasping the tee handle and lifting it out of its housing (see photo 1). 3. Spray the cartridge tubes with a hose to remove any material sticking to them (see photo 2). Ensure the three orifices in the optional flow modulation plate inside the filter are clear of any debris. Make sure the rinse water runs back into the tank, but do not allow solids material to fall into the open filter housing. 4. Firmly place the cartridge back into the housing. 5. Some effluent filters come with an alarm that activates when the filter needs cleaning. If you have an alarm, check to make sure it is working by lifting the float with a stick. An audible hom should sound. The alarm panel is normally mounted on the side of the house or in the garage. Note. If your effluent filter doesn't have an alarm system and you would like one, call your local septic system installer. 6. Record the date thatyou inspected and/or cleaned your filter on the form that follows. If you checked the alarm or made any other observations about the tank or system, include that information under "Notes" 7. Attach access lid by placing it on the riser, matching the openings in the lid with the bolt catches. Insert lid bolts into catches and tighten with hex head wrench provided. Photo t. Remove the filter cartridge by fining it out of its housing. Photo 2. Spray the cartridge tubas with a hose. e WMT-+ am Wil" ►ya1M4 88) RECENED AUG 1 g 2021 (tO1XOOUN G00 tfGll Jv-VJ v _ .,_A ST. CRQ,[? File #: LINTY SANITARY SYSTEM Office Use Only OWNERSHIP/ADDRESS FORM creoree2l=7 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 INFORMATION Owner/Buyer Dean Davis Mailing Address E1108 Hwy 12 City/State/Zip Knapp, WI 54749 Phone Number (reauired)715-440-0074 Email Address Parcel Identification Number 004-1010-40-100 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SE 1/4 NE t/a , Sec. 05 . T 28 N R 15 W, Town of Cady Subdivision Plat: Certified Survey Map # Warranty Deed # Number of bedrooms Lot # f . Volume^ � Page # — 2006)Volume 1362 . Page # 107 Spec house 0 yes ■ no Lot lines identifiable 0 yes 0 no OFFICE USE ONLY New Property Address 970 2 -i d 74 ST— (Verification of new address required from Community Development Department for new construction.) :1f 19 / / ZI (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Once and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department— Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwigov St. Croix County Accessory Structure Affidavit 0GAh, L Q.jit Name — (Owner) Typed or printed He/she is the legal owner of the following parcel of land located in St. Croix County, Wisconsin, with their deeddg{ document of ownership interest recorded as Document Number 7 r6St. Croix County Register of Deeds Office. This property is described as follows (include lot no. and subdivision/CSM or detailed legal description): OR: See attached deed copy for legal description 1137155 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/17/2021 03:28 PM EXEMPT #: REC FEE 30.00 PAGES: 2 Name and Return Address of yA uqV iS Parcel Identification Number (PIN) 004-/01a- 410 -/00 5 As owner of the above described property, I acknowledge that the Private Onsite Wastewater Treatment System J1POWTS) serves an accessory building on this lot and is sized for a future (� bedroom home, or a design flow of SOgpd. This accessory building may not be used as a residence on this parcel. I also acknowledge that I will disclose this information and stipulation to any future parties interested in purchasing this property. Dated this /74-& day of Ay-tt ,aaL . AUTHENTICATION Signature(s) authenticated this _day of , lC TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFCED BY: St. Croix County Community Development (Signatures may be authenticated or acknowledged. Both are not necessary.) x ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. St. Croix County. ) '3 Personally came before me this /7 day of , the ova named v� �Er; btii_ts to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. n m Notary Public, State of Wisconsin My Commission is ermanent. If not, state Date: -/ - L� r �...-...: n N0 e • O e h daig Ir � , fA i i __ __St_Qnjx_Golinty 1]37J55_Page I of2__ - ----_ ut FA" Wisconsin Department of Commei ce SOIL EVALUATION REP 4 r Page 1 of 3 Division of Safety and Buildings MAY 2 7 2021 in accordance with Comrr 85, Wis, Adm. Code c County St. Croix Attach complete site plan on pa r of leis m 4 it inches in size. Plan must h� include, but not limited to: vertic M), direction and Pam I.D. 004-1010-40-W" percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re iewed by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Dean Davis Govt. Lot SS 1/4KVL 1/4 S 05 T ZS N R E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# c U-M "u..A t2 t-4 Nearest Road U New Construction Useo Residential / Number of bedrooms Code derived design flow r to `i5D GPD © Replacement �i Public sentn,ereial Describe i W At 00f Vk 64tor0 7 f aQ (. Parent material ' CSS o.lt� Flood Plain elevation if appli ble U ft. General comments In my opinion thereis min of non -saturated, non consolidated soil above limiting factor , I would and recommendations: propose a standard component manual , install after county and state approval of an mound treatment dispersal system r FB-1 Boring # 11 Boring 10 a Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Q . Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 'Eff#2 14 a8 100jL 3 a �, 6; i Z+ �S Z . %T 8- Ib 104t Z4;. s I Ir. C -18 �.s .� Sc-1 3 msbk K44 I 4s I . G l g �- �• S S, `f2 3 �� �P B-2 Boring # Boring�• NCO %15 Q Pit / Ground surface elev. �' �+ ft. Depth to limiting fact4G_ in. Snil Annliratinn Rat'. Redox Description it. Color HE MIN MMMIS ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < mg/L E ent SOD ,:< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si na CST Number Lewis Bork 253976 Address Date Evaluation Conducted Telephone Number E7818 County E Menomonie WI 54751 1-7,q_zozo 715-231-7375 Dean Davis Property Owner Parcel ID # B-3 Boring # Boring Pit Ground surface elev. • ft. 004-1010-40-000 Depth to limiting factor —0— in. Page 2 of 3 (ZM Annlirntinn Rat. Redox Description Structure ■ R 1�J1& r071W=31. J\ �' A71'1 MMM w M rim M&FITM M�i' i•�i�'R���_-__ ❑ Boring # C Boring M. Pit Ground surface elev. ft. Depth to limiting factor in. Cnil Annlirafinn Pat; Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDHF 'Eff#1 'Eff#2 ❑ Boring # 111 Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Aoolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDff 'Eff#1 'Eff#2 . Effluent #1 = B005 > 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 TTY 608-264-8777. SBD-8330tat (R.07/00) CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. L� Vj Scale: 1ao 40' SOIL EVALUATION XSYSTEM PAGE 2 OF�o o SITE MAP so ao PLOT PLAN c PROJECT NAME: 1D, DESIGN FLOW', � Vv]� GPD DACi design flow for A&I b Attach calculations commercial plans. PROJECT ADDRESS: M 04'M Pipe Material / ASTM Standard (Tables 384.30-3 & 3a4.3G-5) N SyA 40 1"n�'' BM Symbol; +, BM Elevation: W FT Pobi Sanitary Sewer_ / Force Main: 2 / N BMDescriptbn: i MIX, lid: Ca&No- Slope Gradient (%) indicate north by IMPORTANT: of Tested Area: Nell Symbol (ilappllcable): 0 drawing an anon Show ground elevation contours at suitable intervals. on the appmprlte line. &JEL J�vm a. -j 25 3q? Zg� ��SPS W ���WAy PAr.I Q(r 9' f( E4 Flow 30� +pd 1so r- D CZl Zs 2�pA t3q�s (5) t96 300 figs' �S� & /u514 Sfc• � •� 6- 9 s O D<s ps SET --rsq kE. L( L 7 LOD 640WrJ (5ttfn—�4eress, STRucTu.aE +-ft ��v,? �¢! 3i C9W couNn NO. 633877 STATE SANITARY n Clio z70 sue. ) DYMTC79Pf1A�'RE�C�C PREVIO OWNER PLUMBER TOWN OF SEC�,T��N, R_L14 AND/OR OT I B LIC.# 2539I(v PERMIT NO. 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 may be 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 06 : � 0 SUBDIVISION the permit, please contact the county authority. AU HORIZED ISSUING OFFICER -DATE ' a� TTHIS PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (Rl1/20) � � tsw tt 5