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010-1058-90-000
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 IPnvacy Law, s.15.04 (1)(m )] TANK INFORMATION ELEVATION DATA TYPE MANUFACT R j vyo CAPACITY Septic /4 - �lkr .5 /Z5o Dosing OP pa r'a3.5 756 r"L Holding TANK SETBACK INFORMATION LC�c Ls nS. TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic >SD SO Dosing igo i 50 ` �50 ` 7S0 Aeration Holding PUMP/SIPHON INFORMATION PeAI rCC' 26.g3 Manufacturer Demand L i � G�M Model Number a C) L Z TDH Li(1/ S Fnctto Losts z `7 Syls/tem Heads IT . / Ft 1. Forcemain Leng;5,1 , �7 Dia. „ z Dist to Well SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No. 633840 State Plan ID No. Parcel Tax No 010-1058-90-000 Section/Town/Range/Map No: 25.30.16.370 STATION r 'J ✓v 1 HI. aFS ELEV.00 Benchmark �. O )�• /� Alt. QM / Bld 9 Sewer 8. Z D 7 SVHt Inlet z 98.36 SUHt Outlet Dl Inlet Dt Bottom 15. l_ `4 Header/Man. g.%4 i6�.18 Dist. Pipe R.� p 1fl•1B Bat. System u,K4-ey ,li- 't St Cover I n Cvv t� 9.1-7 /12. 6.1 03. Z12 BED/TRENCH DIMENSIONS Width / t /„ Length 100, )) -� Z °r7T/b! /S PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth SETBACK SYSTEM TO P/L / BLDG WELL LAKE/STR M L CHING Manufactur . INFORMATION AMBER OR UNIT O TypeSystem DunV,,I >:7o r >10� '��i ' Uiofffl Number DISTRIBUTION SYSTEM Header/Manifold // f 1 Z DistnhutionXn , ! ,, r Z/ Length f / Z x Hole Size? x Hole Spacing / y./ f vannjJ,to tAir,I,ntake A� Length Da / . Dia Spacing J Z ) K SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only /)"' A., an rg r % l Depth Over edlTranch Edges xz Depth Topsoil f 1 xx Seeded/Sodded xx Mulched a I'D(J I Q ries No 14, �I No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1. Inspection #2: Location: 1377 260TH ST _ M 0 J P-d C2 L) JISV LvI �- JG YIGJ 1.) Alt BM Description - /„ 2.) Bldg sewer length- - amount of cover = >Lll Plan revision Required? L Yes IZ No I v ! - Use other side for additional information, ( mil► (y Date Insepcloes Signature Cart. No -� S—�� -�, " � wat,Jrstey , - County / I ram; \�J __ �� Industry Services Division - St Croix ja 1400 E Washington Ave Sannarc Permit Number (to be lilted in b) Co.) Ps AUG 17 2021 P.o Box7162 a' Madison, WI 53707-7162 % �3D 4ah,Na�' - Count 6 V C V men Application State Transaction Number YY In accordance with SPS 383.21(2). V. is .Ado Code. submission of this tomn to the appropriate governmental unit PW75- 4)92la9os- —L— is required prior to obtaining a sannan permit Note Application forms for state-owned POW S are submitted to the Department of Safety and Professional Services Personal information you provide max be used for secondary Project Address ut different than mailing address) purposes in accordance with the Prrvacv Lau. s 15 04(I )m) Stats � ZGbfi� 1. Application Information - Please Print All Information Propen} Owner s Name Parcel d Brent Wrink 010-1058-90-000 Property Owner s Mailing Address Property Location 2447 130"' Aso Gust Lot C ay. State /m Code Phone Number RWi, 01.0 • Section ;6 G lemvood Cm. 'A 1 S4013 Ili-684-9231 (circle d 1 30 N R l� Eor II. Type of Building (check all that apply) Lord ®1 or 2 Farrah Dwclhn@ -Number of Bedrooms Subdwision Rams 40 acre parcel ❑ Public/Commercial - Describe I se Block a ❑ Ciq of ElState Owned - Describe Use _ CSM Number ❑Village of Zo y� x ® Town of I merald III. Type of Permit: Check only one box on line -k. Com r lute line B if applicable) A ®New System ❑Replacement S}stem ❑ T reatimmUlloldmg Tank Replacement Onl} ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of FE Pernui Transfer to New List Previous Permit Number and Date Issued Before I xpimtion Plumber ner { L "++ : / b is IV. Type of POWTS System; Component'Dev ice: Check all that a hI a t Gb ❑ `Jon-Pressurzed In -Ground ❑ Pressurized In -Ground ❑ At -Grade U Mound > 24 in of suitable so it ❑ Mound <24 in of suitable soil ❑ 1foldmg Tank ❑ Other Dispersal Component(ckplam) ❑ Pretreatment Device (explain) '. Dispersal/Treatment Area Information: v { sign Flow Igpd) Design Sod Application Dispersal Ar-a Required (0) Dispersal Area Proposed (sfl System Elevation O0 Rmclgpd+O 600 iSGO 232143 23Z 16050 40 V1. Tank Info Capacity in Gallons I oral R Gnitof Al s �, uLinks an facuimr (ialloru - y o = ,' Lew tanks Fxnnc banks./�It-' 1 �, i z_ Septic or Holdme lankI ly$D 1 1250 1 I I luffcutt Concrete oN@;C� Z ❑ ❑ Dosing Chamber 75U W/ Lifetime Filter El ❑ VII. Responsibility Statement- I, the undersigned, assu responsi tv for nstallation of the PORT S shown on the attached plans. Plumbers Name I Print) Plumhcr s 1 na[ \111!MPRS Number Business Phone Number Todd Sinz 139462 715-235-2644 Plumber's Address (Streit, City. State. Lip Code) 115609 708i1' Ave Menomonie WI 54751 Vill. County/Department Use Onh Approved El Disapproved Perttin Fee Da Issu Issuing .Agent Sienaturc ❑ Owner Given Beason Cor Denial $ L/O O �s IX. S9cfE�Aii7 pproval/Reasons`for�is'adprov al3 fl,W+ r �b [p/�jV !M IkAi/h bt GIKCL 1 Scat-c Doti, effluent filter and f y� µ.l 6, ta-. i77 dsoorsal toll mutt be fervlrerUmeintavud //'' /' �1 s� p as tier management plan prcadded by plumber. 7/1/A-1 C �yfC/Y �Y !15 ;k, /-era �' "' ' ` 2. All fPtbalk rEyUIYln?enlS mU9t b! Irlaifll✓tlllad ✓ /�l //� /� } ) as parapplicable todeybrdtdylklil. "u'L !h C hWt Attach to complete plans for the s}s and xuhnot to the County on I} on paper not less than a in x 11 niches in size SBD-6398 IR(13:14) S NO 1gnrJ //S/vrbiotr,t vt'Z nt�p�C� \Atf-laid! Attach to complete plans for the s}s and xuhnot to the County on I} on paper not less than a in x 11 niches in size SBD-6398 IR(13:14) S NO 1gnrJ //S/vrbiotr,t vt'Z nt�p�C� \Atf-laid! L,�4 NW1321,jo ! Z y 0 N , 5y c'9� �, Joss Ir� i' ^ ®"n 7 aEf (/bl.� loo ,.o y N gwa+o"a'd 9'an tr>RT�Ii -, DS PS August 12. 2021 CONDI'f IONAL APPROVAL PLAN APPROVAL EXPIRES 2023-08-12 Plan Review: PW TS-082101905-C TODD L SINZ E5609 708th Ave Menomonie WI 54751 SITE: Brent Wind 2buth St Town of EMERALD St. Croix County Total Amount: $250.00 Description: 600 GPD (4 Bedrooms —New Conwructionl Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay htlp lldsps wl govlprogramsfindustry-services www wlsconsln.gov Tony Evers - Governor Dawn Conn - Secretary Condifionalfy APPROVED DEPI. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Pressure Distribution Component Manual —Ver. 20, SBD-10706-p(N.01I01, R 10/12) :Hound Component Manual — Ver 2.0, SBD-10691-P (N.01%01. R 10.12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component 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 stork at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance. compaction and use of the site • With new construction; it Is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite ssastewater treatment system (PON'TS) 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 sod. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 i4- 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 (t 1)(c) • Well setbacks to meet chs. NR 911 & 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. • Arca, that are occupied ,%nh rsi. Irdgnrcnh uca 100h_ ,twnp, end hOn1JCI1 rcdu.X the ❑MOL111t 01 111 ,n ai abi: fw Ill „pa t1,a0nah1 11 no odtn >n� n a,a,ldhl—. i:., in th; ba,al ei-L „f dt, mound inu�tbc �utoi7 at around lC.,l A Ln _a t::l ,ne,i i, ns.:.an_ ��hcn am ofth� ahoy; e1 nJiu,Ql, are er Ce1unta:d t, 1110%idc Nullirient mliliieu%e then Owner Responsibilities • The current owner. and each subsequent ow ner. 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 andtor 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 `installationioperation 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 budding, structure, or component Inquiries concerning this correspondence ma} 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, IT", VQ�a1 911j POWTS Plan Re%iewer— b�asteNNater Specialist Department of Safety & Professional Services I Division of Industry Services Cell: 608-516-61 34 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN ICaticr INDEX AND TITLE PAGE Project Name Brent Wink Septic System Condmonally Owner's Name. Brent Wink APPROVED ,SAFETY AND PROFESSIONAL SERVICES Owners Address. 3447 130th Ave DIVISION OF INDUSTRY SERVICES Legal Description Township: County: Subdivision Name. Lot Number. Parcel LID Number: Plan Transaction No: Glenwood Citv Wi 715-684-9231 ""CORRESPONDENCE NWt/4 NW1/4 S25 T30N R16W Emerald St Croix Block Number Na 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 Septic Tank/Pump tank. Page 9 Effluent filter Page 10 Plot Plan r Designer: Todd L Sinz License Number: MP139462 Date 07/22/21- Phone Number, 715-235-2644 Signature: D/Igned Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R 10/12), and both SSWMP Publication 9 6 Design of Pressure Distribution Networks for ST-SAS (01181) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10112) Version 7.0 (R. 11/12) Page 1 of 10 Mound and Pressure Distribution Component Design Design Worl(she- (R or C) R Residential or Commercial Design 400.00 Estimated Wastewater Flow (gpd) 1.50' Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) 17.001 Site Slope (%) 100.00 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ftz) Distribution Cell Information 1 100 001 Dispersal Cell Length Along Contour (ft) _ ( 1.001 Dispersal Cell Design Loading Rate (gpd/ftz) Influent Wastewater Quality (1 or 2) Pressure Disribution Information (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) 2 Number of Laterals 0.156 Orifice Diameter (in) 4.00 Estimate Orifice Spacing (ft) _ 3 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) �/ 90.00 Pump Tank Elevation (ft) Ji5� System Head (ft) x 1.3 q Vertical Lift (ft) l Friction Loss (ft) In -line Filter Loss (ft) Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o lions choice 0.75 1.00 { 1.25 1.50 x x x -_ x 2.00 3.00 Note: Sand fill (0) calculations assume a Table 383-44-3 in -situ soil treatment for fecal coliform of <= 36 inches. 6.00 Cell Width (ft) Are the laterals the highest point in the distribution network? En,er Y or N If N above, enter the elevation (ft) of the highest point. 12.00 felorifice Does the forcemain drain back? Y Enier Y or N Forcemain Drainback (gal) 5x Void Volume (gal) A Minimum Dose Volume (gal) System Demand (gpm) Manifold Diameter Selection in. dia. o lions choice 1.25 x 1.50 x 1 x 2.00 3.00 Gallonsflnch Calculator Treatment Tank Information —I Total Tank Capacity (gal) 1250. 00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Huffcutt concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 758.00 Dose Tank Capacity (gal) ILifetime i Filter Manufacturer 16.851 Dose Tank Volume (gaUin) LT 1/8 Filter Model Number Huffcutt concrete (Manufacturer Project: Brent Wink Septic System Page 2 of 10 Mound Plan and Cross Section Views Observation Pipe K O B. A 6.00 ft B 100.00 ft DI 6.00 in L Mound Component Dimensions E 18 in F 9.50 in G 0.50 ft 600.00 (ft2) Dispersal Cell Area 6.00 (gpd/ft) Linear Loading Rate —t JI` A I H 1.00 ft K 8.41 ft z 17.21 ft L 116.81 ft J 3.56 ft W 26.77 ft 2321.43 (ft) Basal Area Available 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.29 (ft) —% T ❑ \ H G + 1 '101.00 F Dispersal Cell ft Lateral ( ) 100.50 (ft)� — _ Invert Dispersal Cell © t Elevation D ❑ 4 � a 100,00 (ft) Contour Elevation 17.0 % Site Slope Geotextile Fabric Cover Shading Key m o T Dispersal Cell See lateral details on 1❑ 0 Topsoil Cap p ° 1.5 ft Page 4 for number, size, 2❑ Subsoil Cap c a © Q — and spacing of laterals Laterals are equally ASTM C33 Sand 0 / F ®� Tilled Layer Y ©0 Aggregate d 2I 0.5 ft Typical Lateral © spaced from the distribution cell's Tre centerline in the ♦I A distribution cell (AxB). Project: Brent Wink Septic System Page 3 of 10 End Connection Lateral Layout Diagram -- .. c ""'•"-"" •=Turn-u P'citall ••u hrn Or clean Out Glm P.IIlirenL-x.id.rnt it —X—.I Hiner dulled On the b.,rrom 01 the l it oral iag1A.r spa•:-d Fri, v ni im corineeticn vl i Ieu jr �ro Ip rr, irnlCdd i! roil bomr Lat?I 51! f,,,-emain .rh 40 Pv-. per -.r` Tstdr" b24 Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head 2 1.50 in 98.40 ft 300 ft 13 46 gpm 26.93 gpm 15.27 ft Orifice Diameter Orifice Spacing (X) Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity Dose Tank Information Electncal as per NEC 300 and SPS 316 300 WAC Tank component is properly vented Huffcutt concrete Capacityl 758.00 Volume 1 16.85 Manufacturer Gallons gal/inch Dimension Inches Gallons A 26.24 442.14 B 2.00 3370 C 5.75 9681 D 11 001 185.35 Total 44.991 758.00 --Tl— A i B C D Alarm Manuafacturer SJE J6ombus_ J —.. i Alarm Model Number ,Tank Alert Pump Manufacturer IZoallerL, Y— — Pump Model Number i 0N451 Pump Must Deliver 26 93 gpm at 15 27 ft TDH Locking cover with warning label and locking device and sealed watertight 4 In. min. E Aftemate outlet location Forcemain diameter 2 in Weep hole or anti - siphon device Dose tank elevation (ft) 90.00 Nee e &.witches con'airrne mercury mej not i, used ir this system Project Brent Wink Septic System Page 4 of 10 Mound System Maintenance and Operation Specifications ---- - ---- _ Service Provider's Name T- L Sinz Plu---mbin-9 - Inc----. Phone 715-235-2644 POWTS Regulator's Name St Croix County Zoning Phoner715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle SizeM>10E4 in Estimated Flow - Average 400 gpd Maximum BOD5mg/L Septic Tank Capacity 1250 gal Maximum TSSmg/L Soil Absorption Component Size 600 ftz Maximum FOGmg/L Type of Wastewater Domestic Maximum Fecal Coliformcfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Service Frequency Inspect and/or service once every 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 3 years Inspect for ponding_and seepage once every 3 years Call T L Sinz Plumbing for your service needs_ _; Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384,30-1, have a watertight cap, and are secured in as shown in the mound component manual 2 Dispersal cell aggregate conforms to SPS 384.30 (6)(1), Wis. Adm. Code. 3 All gravity and pressure piping materials conform to the requirements in SPS 384, 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 6-8" Diameter Lawn Sprinkler Valve Box Distribution Threaded Cleanout Plug or Ball Valve Sweep 90 or Two )egree Bends Same Diameter as Lateral Project Brent Wink Septic System Page 5 of 10 Mound System Management Plan Pursuant to SPS 383.54, cos. Adm. Code General This system shall be operated In accordance with SPS 382-84 Wis, Adm Code, and shall maintained in accordance with Its' component manuals [SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver 2.0 SBD- 10706-P IN 01101, R. 10/12)] 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 SPS 383.33, 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 sepbc tank shall be maintained by an individual certified to service septic tanks under s 281,48, Stars. 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 fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation The filter 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 shall 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 Infittratwe 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 BODS, 150 mi TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS 10 mg/L FOG, and 104 ofu/100 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. Conti npencv 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 mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced In its' 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. Pretreatment Units The Information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system Project: Page 6 of 10 BbFgrty'Pumps 0 40 + 30 R m1d 0 i 0 2811_PI H010,/72n15 LITERS PER MINUTE 50 100 150 200 250 10 20 30 40 50 60 GALLONS PER MINUTE cCopyiight 2n15 Liberty Pumps hs All nghta served Slxmhcatmw sublcct to change wuhout n,nuc 6= 10 1-m 4 2 10 70 II I I I i OUTLET (TANK Bo 01 'HUFFCUTTI 1,250 750 I UN, 5' DIA F O U a z 44 QdM6 m NOT KCXDmMlfV mi u mwmf ifetj me f IteF The Best dust Gat Better The most efficient, the lowest maintenance, the most economical effluent filter! • Nearly Twice the Filtering Capacity • Estimated to go 3 Times • Longer Between Cleanings • • Cleaning Made Easy • • Does Not Retain Solids Between Plates • • Lowest Price • ® o Eliminates the collection of solids inside the cartridge. - Nearly twice the filtering capacity of any other filter. - By eliminating solids between plates drastically reduces the need to clean. - Cleaning made simple and efficient. Og t LT 1 /8: 3500 GPD/Residential Strength Filtration 1 /8" - LT — 1 /16: 3350 GPD/ Residential Strength Filtration 1 /16" - LT — 1 /32: 3000 GPD/Recommended for Commercial use with Residential Strength - Filtration 1/32" - IT — 1 /64: 2500 GPD/Recommended for Commercial usage with Residential Strength - Filtration 1/64" a /D - 2700 Inches of Linear Filtratinn (Naarw T{.,i�.a +L... !`.....,..�.,a[i[� A REQUIRED Jo .mwEy2 APPLICATION FOR REVIEW -Complete all pages- ��al NOTE: Personal information you provide may be used for secondary purposes (Privacy Laws 15.04(1)(m), Slats.] Private Onsite Wastewater Treatment Systems Division of Industry Services ❑ Plans to be E-filed. Provide SharePoint User name below: For plan status, check our website at http,//dsos wi.ogy Email technical code questions to mailto DSPSSBPgwt Tech(Cwi.gov 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 website at httJPo s.wi. ov 1. Project Informations - FFiiilll�inm all known Information. Confirmation of assignment to a reviewer. ProjecUSke Name: krt A:) ( ['0 1 L) K. Transaction ID: Location, Number 8 Swt of project i unknown, indicated nearest road) Previous Related Trans. ID: ds Cp�' �T Estimated Completion Date: Assigned Reviewer: t�1GW I NOW At 5Z5_Tr6 N el � L, Legal Description, County Assigned Office: ❑ City []village ®'Town of Mail to your office of choice below: LaCrosse, Green Bay 2. After plans are reviewed, please: (check all that apply) ❑ Call customer 1, 2 (circle number)* NOTE: We reserve the right to redistribute plans to another office If ❑ Requesting party will pick up needed to reasonably balance turnaround times. Check � ❑Mail plans to customer 1, 2 (circle number)' htto:rldsos.wi.gov for next available review date 'Refers to customer number from below. 3. Complete the following designerlownertrequesting Information. Utilize the check boxes when Designer, owner or requesting parry Is the same 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 Todd Sinz 139462 _ Company Name Company Name T. L Sinz Plumbing Inc. Address I Address E5609 70841 Ave City State Zlp+4 (9 digits) City State Zip+4 (9 digits) Menomonie WI 54751 Phone Number E-mail address Cell phone Phone Number E-mail address Cell phone (area code) area code) 7152352644 customerservloeAtlsinzplumbing corn Check if applicable Check if applicable or specify relationship ❑ Owner 0 Owner D Other —specify relationship Information and Plan Submittal Checklists. To request electronic plan review complete the appropriate application form and e-mail it, along with your registered SharePoint usemame to DSPSSBPlanSchedule@tWlsconsin.gov. 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 appeanng on the POWTS program page under Publications POWTS Components Manuals HolmeNOnalaska Area DSPS 2850 Midwest or Ste 104 Onalaska, VIA 54650 608-785-9334 Fax 608-785-9330 Email: DsosSbPlanScheduletMN Make Checks Payable to: Divisior E:111heck box to invoice Designer signature SBD-10577 (R 3/19) Green Bay DSPS 2331 San Luis Place Green Bay, WI 54304 920-392-5601 Fax 920-492-5604 Email DsosSbPlanSchedule(Uwi gov Services OR sign below I TOTAL AMOUNT DUE s� Review Code 7633 5. POWTS SUBMITTAL (check all that apply — incomplete forms may result in processing delays) E NEW ❑ Aerobic Treatment Units) ❑ Chlorinator ❑ Tank Replacement Only ❑ REPLACEMENT ❑ commercial system ❑ UV Disinfection Unit ❑ Add Effluent Filter SYSTEM TYPE(S) NOTE: Submit separate sheets for each system if submitting multiple systems on the same site Enter Fee ❑ Revision to previously approved plan $85.00 ❑ Miscellaneous Review (Le. replacement of a septic tank, addition of an effluent filter or pretreatment device to an existing system, etc.) $80/hr [Component Manual All treatment components are previously approved ❑ At -Grade Component Manual -Ver. 2.0, SBD-10854 (N.03/07, R. 1/12) Design Wastewaterater Flow in under s. SPS 384.10 (2) or (3): ❑ In -ground Component Manual -Ver. 2.0, SBD-10705-P (N.01/01, R 10112) Gallons Per day Design wastewater flow of the proposed system. [Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 1(/12) / n� _7M ❑ Pressure Distribution Component Manual — Ver 2.0, SBD-10706-P (N.01101, R 10/12) 1,000 gpd or less $ 250.00 ❑ Other - Please specify GPD 1,001 — 2,000 gpd $ 325 00 2,001 — 5,000 gpd $ 400 00 ❑ Soil Based Individual Site Design* One or more treatment components are not previously approved under s. SPS 384.10 (2) or (3): ❑ At Grade (Individual site design/deviabon from component ❑ Non-Pressunzed In -ground Design manuals and use of components without product ❑ Pressurized In -ground Wastewater Flow in approval) ❑ Mound Gallons Per day Design wastewater flow of the proposed system ❑ Dnp-line ❑ Constructed Wetlands GPD 1,000 gpd or less $450.00 ' Documentation must be provided to support treatment and dispersal claims. In a separate 1,001 — 2,000 gpd $600.00 statement, provide rationale for the project and attach supporting documents (code sections, test 2,001 — 5,000 gpd $750 00 reports, technical papers, research articles, etc.) greater than 5,000 gpd $900 00 plus $0.08 for each gallon over 5000 gpd State-owned facilities, Design Holding tanks previously approved under s. SPS Wastewater Flow in 384 10 (2)(3). Design wastewater flow of the Elast Holding Tank Component Manual, Ver. 2 0, SBO-10855-P (N 03/07, RIM 2)* Gal' lons Per day j proposed system Non -state owned Commercial and Residential Holding tanks that completely utilize this manual 5,000 gpd or less $ 90.00 and have an estimated daily flow of less than 3000 gallons per day must be submitted to the GPD 5,001 — 10„ 000 gpd $150.00 appropriate governmental unit for review instead of the Department. [see SPS 383 32(3)(a)] greater than 10,000 gpd $225.00 ❑ Holding Tank Individual Site Design*, (i e. site constructed, <5 day homing capacity, Co- Design Holding tanks including site constructed tanks NOT mingled wastewater, etc.) Wastewater Flow in previously approved under s. SPS 364 10 (2) or (3). Please specify' Gallons Per day Design wastewater flow of the proposed system. 5,000 gpd or less $180 00 ' Documentation must be provided to support the rationale for the project In a separate statement, 5,001 — 10,000 gpd $300.00 _ please include all code sections, test reports, technical papers, research articles, etc.) GPD greater than 10,000 gpd $450 00 ❑ Soil Saturation Determination Report (using observation pipes) ❑ Interpretive Determination $240.00 ❑ Experimental System (One time additional fee) Submit fee for individual system as per appropriate above system type) Experiment Number _ $400.00 Pnority Review (enter same amount as normal review fee listed above) $ y( Enter Total (rounded to the nearest dollar) $ Z Ob SBD-10577 (R 3/19) )� j QQ,A 3 MJ' a9� ��'PPray� :�Q tSa� cYr�� YYo° Pon P&QVtNs t °:\4' &W-W " lank 3 Lly7 /30 Rua G' &A&) CAL 1 0 Z'D Jbi /Oo.a pfpofa&k� fw-DC.O - koM 05 �,C•7,r , t�� ST CRo NTY SANITARY SYSTEM File #: OWNERSHIP/ADDRESS FORM ��taty 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 Mailing Addre Phone Numbe Email Address Parcel Identification Number 61 t) -- IbS$ -Ro-D oo (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location IV W th ,"%, Sec. _.L T 3N R_Lb W, Town of J�mv UAd Subdivision Plat: b j4 k Li U 14Cr e P=,P Lot # AIA Certified Survey Map # b Volume Mk- Page # N �i (before 2006)Volume Page #P-A Number of bedrooms Spec house 0 yes,Wno Lot lines identifiable *yes O no OFFICE USE ONLY New Property Address ) 3 7 7 Ff. (Verification of new address required from Community Development Department for new construction,) F fly 47 i ;?6 i 2/ (staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St Croix County Government Center 715-245-4250 Fax rddCwcwi l; 1101 Carmichael Road, Hudson, WI 54016 w m ccwioov couHrr#-8d�) NO, 633840 STATE ANIT�IR PERMIT isv� ado Sr.� I-JX-111 A4NS-P-N-R%Jx L PREY UB NO. - 1Ell IM&L"i'L PLU BER00" TOWN OF -i SEC�,T AND/OR LOT lNa LIC.#. jyj%2. N, R_/" BLO SUBDIVISION CHAPTER 145.139 (2) \VIS05NSIN 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 the permit, please contact the county gpthority. ISSUING OFFICER - DATE PERMIT EXPIRES -114& /ZQZ-KUNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (Rl1/20) +meconalnlI 1!¢q'gt4F lrfdl(:gotdFl�nel 8arvloea m4sionotl —Sarvlcn 1 2��2) SOIL EVALUATION REPORT Iih accordance with BPS355. We Adm. Cade Attach complete site plan ate psf fldtlpia }hart a 112 x 11 Inches in size. Plan must Induds, but not emttad �: o t o ffi'As%fenmolnt (W, dirsotton and percent elope, scale or dimene one, north Arrow. and location end distance to nearest road. Please Print all Informa4on. Property Owner Property Pape/of 2 County s/Iita7/�/ri Property Looadon �n GovL Lot /3 L-� Y. ✓JAY. S.5L5 T SO N R n Lot# j alobk# I Subd. N�eje or CSh#1 Code. Phone Number ❑city Dwell Town NewConstruaeon Use:aRsaldendW/Numberofbsciroomis code derived dell flow rAl OPD RaptAcement Publl or ommeratI D cribs: Parent matedal 'L tS �.+•— Flood Plan elevation If applteabaNA ft. General comme no racommendatbns:. r d4 ` � /a reabn tir t e�. OSCL4P, � 04 fnD"�ec� J U n9 Sorinp Bad # 117 1 Pit Ground surface alAv.Q��'_'ft. Depth t4 amgina i AM Annllcstfen Rate Is WMM SWAM At W�Mlfflzi I W— M W !M �4 9 � M- M- ; , Boring # Bonne U a �( Ph Ground surface siev. [ ' lit. Depth to 11m1d a factor_.- �11. Sall Application Rate Hodtan Depth In. Dominant Color Murrell Redox Deaoripdan ' Qu.Az. Con! Color Twdura Structure Or. St Sh.. Consistence Boundary Route OPD1Ff 'Ea#2 6— Y Ord 'S I� i7 �. 9— I 5 r.� 2C o• I � c rn i ISO moIL—u sso s > 6 COT Name (Piamm Prinp n CST Number / U Address ill Heidt Soil Testing D 6v aeon Conducted Telephone Numb ' S$Y W:�bV3 nci r r,,,,,,... _ dnuaaao ttwafa/ 547 M (7 6) 679'5 9684 er .'�L Isoftg0 Borng PR Ground eurlm egvlMv-2 R DOM !a ARd ft � lm { SW Awfialkift Rot �WIMWW©MWVF� PRO= PERM a' © i I Sannp 0 ❑ Boring F] PR Gmund autism elev. _ ft. Depth to MonA tta f _+ IrL tJ String $ Boring Pik Ground eurlem elev. _ R' Depth to balor,_ In.- 'EtRuent010SOD,>30S220mg/LendTB8>30S150mg(L 'Efluent#2= SOD, >30S220mg/LendTSB>3D9150ftWL gr..". 1):V".1 3 °l97 I30 Auer e(onwOA C,} tJlSY&3 Pro a a /b oh 3o SC l Will Heidt Soil Testing W3503 HeMIO 5 Road Mondow (7179-8584 6) 5 Atpo� - ab21/��/Jyy �Q{.MFTy r�,1 A ``�� ount) In try Services Drvion t [ rots �dv� 9 O 1400 Ave — on Sennury Pennrt Number (to in b} Co) P 0 Box 71, Madison, WI 53707-7162 6 33 0 ink "use I u62action sc. F-t ° ermit Apppplication stale -06210142Snn,ber R YY -C Ia accordane w� - _ 1�I Wix. Aura Code. ,umu,sion of this Conn to the a n required pr obtaining a+:mean per in Not •Application forms for state-owned OW I S are submnlcd to the Department of -Safety and Professional Services Personal i lormation you proved- may be used for secwndan Project Addle" (if ddlerent than mailing address) purposes in accordance whit the Prnacs I.aw. s I 04(I )(mu Stan 260"' St 2 �/ ,,-H~ y 1. Application Information - Please Print All Information NG -t 260 Property Owner's Name Parcel k Brent W mA Propem Osene � Mailing Addrex Propem Location 2447 130" Ave Go%t I of Cdy, State ! Lip ode Phone Number SW (, NW C, Secti i Glanward Cm 1YI i4013 'L-6R4-9231 I' le one) 1 N 16 1 orin II. Type of Building (check a at apply) 4 Lot k ® 1 or21amd} Drsellme-Auniber droonts �--- Subdis nName ❑ Public Commercial — Desenhe Lae Block a � City of El State Owned — Describe t w - ❑ b(llage nl CSMNumber ® Ioon of I,MLRALD Ill. Type of Permit: o Check nl one box on line Com fete line B if applicable .A New System ❑Replacement System eatinenCI loWme l an6 Repla rent 0nls ❑ Other Modification to Fxistmg System (explain) B. ❑ Permit Rcnewal ❑ Perms Rev'IVOn ❑ Chdttgc Penn Trmsfer to New I ist Presious Permit Number and Date Issued Before Fxpuation Plumber sorer I 1V. Type of PO4�TS System; Component De vice: (Check all th Iv ❑ Wn-Pressunred In-(ImunU ❑ Pressunrcd In -Ground ❑ AI-Gra found - 24 in of suitable suit ❑ Mound <24 in of suitable sod ❑ Holding lank ❑ Other Dispersal Component plain retrca ent De ice(explami A Al V. Dis ersal/Treatment Area Information• X owvW .00 Design I low (gpol Design Soil Apphcat n Ispersal Arc Required hl) Dispernal Area Proposed (s0 System Flesation 600 Raw(gra]O) 600 «� 162i 10050 40 VL Tank Info Capacity in 0 dons total rz Ot Gallons (nits Min acWrcr o 2 v s "m ucw TnnAs mime I ai s CL Scpticnr l folding l ank I Hurt-cutt Qmtbo ® ❑ ❑ fAxinra Chamber 1 A A 4 750 V ❑ ❑ ❑ ❑ VII. Responsibility Statement- 1, undcrsignc , as um r ponsi lity installation of the PON IS shown on t'h1sviltrictred plans. Plumber. Namc (Print) PI mb sa re MPrMPRS Numb hosme" Phone Number Todd Sul/ 139462 715-235-2644 Plumbers -Address (Street Cm late. /ip Code G5609 70811 Avc Menm oonie N'I 5475I Vlll. CountN/Depbment Ilse Onh- tW Approved Ihsapproved Pennnt Ic, Dtae I u 'ig Agent,Signamr 9llssue Al Own senReas forDemal $ 6T,J� IX. Condi as o ppr UReasex9-far�isapprmal •3� k S SYSTEM WNE f y✓ Q b e 1. Septic tank, effluent filer and eGt CA CLl@ e l dispersal cell must r eed 1 malntalned �_ a�a�Q2 � +� � 4a•„� tbe plan provided by plumber. r�Y�S+V�K— n 4 ��- n ,� as per management plan �C 2 All <athark requirements must be maintained Ya.1Tt De•ndC ems. rust y-� ()/,,e ^Q,t "�„�, �d ( fi g p arts tnr the s�.tem anJ Arpit-ta the (n�rlh snl, o I�er not IcsLtDh'n x 1 cl�e�n sizy��1 ,, �6 ve .i J Nr�H`�NX6 ,, P�� ^ rY-1,L����(R�- S� �G��"( l( 02. _"SIT \I-Y e �I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Brent Wink New Septic system Owner's Name: Brent Wink Owner's Address 2447 130th Ave Glenwood City Wi 54013 715-684-9231 Legal Des iption NW1/4 NW 1/4 S25 T30N R16W Township. Emerald County St Croix v Subdivision Name: Lot Number Blo Number Na Parcel I D. Number. 010-105 0-000 Plan Transaction No.. Conditionally Page 1 In and title APPROVED Page Data ntry DEPT. OF SAFETY AND PROFESSIONAL Page 3 Moun awings SERVICES Pag Lateral a dose tank DIVISION OF INDi ISTRY SERVICES P 5 System ma enance specifications age 6 Management d contingency plan -� Page 7 Pump curve an peciflcations Page 8 Se tic Tank/Pum nk Page 9 EfFluent filter SEE CORRESPONr,r- Page 10 Plot Plan i Desi er Todd L Sinz License Number MP139462 D 06/04/21 Phone Number 715-235-2644 Signature ft� ✓ /Designed Pursuant to the Mound Component Manual for POWTS Version 2 0 SBD-10691-P (N 01/01, R 10/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) and Pressure Distribution Component Manual Ver 2 0 SBD-10706-P (N. 01101, R. 10/12) Version 7.0 (R. 11112) Page 1 of 10 June 26, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-6-26 Plan Review: PWTS- 062101422-C Todd Sinz E5609 7081h Ave McNQmonie, WI SITE: Brent Wink 2( Street Emerald Township St Croix County NW Y NW Y 525 T30N FOR: Description: 4Bedroom-60 P —32"to limitingfactor- EffluentFllter- tenance required. DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54643-6462 Contact Through Reiay Into!/dsps wl govlprogramslmdustry-services wwvv wisconsin goo Tony Evers 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) The submittal described abov as been reviewed for co ormance with applicable Wisconsin Administrative Codes and Ysconsin Statutes. The submitt as been CONDITIONALLY APPROVED. This system is to be /age and located in accordance with th nclosed approved plans and with any component maenced above. The owner, as defined hapter 101.01(10), Wisconsin Statutes, is respcompliance with all code requirements. No person may r work at plumbing in the state unless licens to do so by the Department per s.145.06, stats. The followiA conditions shall be met during construction or installation and prioNo occupancy or use Remi he site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. 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. Inspection of the private sewage system installation is required. Arrangements for inspectio shall be made with the designated county official in accordance with the provisions of Sec. 145. )(d), Wis. Stats. A state approved effluent filter is required. Maintenance information must be gi n to the owner of the tank explaining that periodic cleaning of the filter is required. Owner The current oNilner, nc and each subsequent owner, shall rece e a copy of this letter. Owners shall also receive a copy o he appropriate operation and mainte e manual(s) and a responsible for ensuring that PO sV,,On and maintained in ordance with this cha er and the approved management plan un 83.54(1). In the event this soil abystem or any fits co p ent p'`s m nt ions so as to create a health hazard, the propr must fol the con nry�l��described in the approved plans.it VVVThe owner is responsibit a maintenance verification report acceptable to the county for maintenance trackie a rts shall be submitted at intervals appropriate for the component(s) utilized iS. In granting this approval the D ision of Industry Se ry s reserves the right to require changes or additions should conditions ise making them necessar or code compliance. As per state stats 101.12(2), nothin/this in this view shall relieve the designer the responsibility for designing a safe building, structuonent. Inquiries concerrrespondence may be made to me at the ephone number listed below, or at the address ohead. The above le addressee shall provide a copy of this letter and the POWTS maNgement plan to the owner an,Any others who are responsible for the installation, operation or maintenance of the POINTS. Since Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)813-9111 Jo,, hua_l oa, l_yL�hvr,con,in no•d APPLICATION FOR REVIEW g -Complete all pages- P S NOTE Personal mbmlation you provide may be used for secondary purposes [Privacy Law s 15 04(1)(m), Slats I Private Onsite Wastewater Treatment Systems Division of Industry Services to be E-filed. Provide SharePoint User name below. For plan status, check our website at hit p 'Ids S wiu ov Email technical code questions to maitto DSPSSBPowtsTech(awi oov Several counties have been delegated certain authority to review plans in lieu of Division of Industry services For a counties and their desionation check our website at http //dsps.wi oov 1. Project Information -- Fill in r i7n all known Information. ProjectlSne Name 6i 9lrk--t ), �t (c- Location, Number 8 Street of project (d unknown. indicated gearest road) Legal Description �% rl`� 1��'S Z.r -f30 tiJ County S; ( f ❑ City ❑ Village _vm of 2. After pl s are reviewed, please (check all that apply) ❑ Call cust er 1, 2 (circle number)' ❑ Requesting y will pick up 1 ❑ Mad plans to cu er 1, 2 (circle number)' 'Refers to customer number from below I 3. Complete the following des: avoid repeating Information. Confirmation of assignment ty05 reviewer. Transaction 10. Previous Related Trans. ID: Estimated Completion Data Assigned R viewer: Assigned O ce: Mad to yo ce choice below list of those r the right to re -distribute plans to another office If bly balance turnaround times. Check for next available review data Information. Utilize tbtcheck boxes when desigrwr, owns, or requasdng party is the same to Designer Information (Customer 1) DSPS First tyame Last Name Customs (,D10 _4:)/1J 7— l2t37 Compan Name Address �t`7 city)r�� _ Mate Phone Number `E-mail address Cell phoi (area code r c y Check if applicable - ❑ Owner Information and Plan Submittal Vhecklists. To along with your registered Shar oint usemame to will be assigned to a reviewer rer receipt at a DSI anoearinc on the POWTS o ram pace under Pul HolmenlOnalaska Area QJfPS 2850 Midwest Or Ste 1 Onalaska, WI54650 608-785-9334 Fax 608-785-933 Email Dsv SOP) ,Sched_ul_e Wwi ov Other please Specify Below (Customer 2) DSPS r N be r Fvst Name Last Name Customer Number Company Name _ Address -- degas) City Stale Zip-4 (9 digits)— Phone Number E-mat adWess Cell prone (area code) Check if applicable Of specify relationship _0 Owner F�I Other-s relationsh� j _�+_ Pec fy P �ctronic an review complete the appropriate application form and a -mat it ola ische paW'sconsin go_v If plans are being submitted via paper, they Submittal ch klists can be found In each applicable component manual �(1WTS Como nts kia•wais _ f Make Chee Payable to: D .1.#n of Industry Services OR 7eigner eck box to invoice designer and sign below signature X SBD-10577 (R 3/19) Green Bay DS 2331 Sanws LPla Green Bay, WI 543 920-492-5601 Fax 920492-5604 Email DsosSbPlenSc� TOTAL AMOUNT DUE $:Z) Review Code 7633 S. POINTS SUBMITTAL (check all that apply- Incomplete fors may result in processing delays) © NEW ❑ Aerobic Treatment Unit(s) ❑ Chlorinator ❑ Tank Replacement Only ❑ REPLACEMENT Cl Commercial System _ ys ❑ UV Disinfection Unit El Add Effluent Filter SYSTEM TYPE(S) NOTE: Submit separate sheets for each system If submitting multiple systems on the same site Enter Fee ❑ Revision mviouslyapproved plan $85.00 ❑ Mismilar eou view (Le replacement of a septic tank, addition of an effluent filter or pretreatment device to an et'6ting system, etc.) $801hr — ®Component Manual Design All trealme omponenls are previously approved ❑ AI -Grade Component Manual - Ver SBD-10854 (N 03107, R. 1/12) Wastewater Flow in under s. S 384 10 (2) or (3) ElIn-grouhd1Component Manual - Ver 2 BD-10705-P (N 01/0l, R 10/12) ® Mound Component Manual -Ver 20, SB Gallons Per day Des wastewater flow of the proposed system - 91-P (N 01/01, R 10112) ❑ Pressure Distribution Component Manual - Ver , SBD-10706-P (N 01/01, R 10/12) 000 or less ❑ ether - Please specify GPD 1,001 9p2,000 gpd $ 325 00 2,001 - 5 000 q d $ 400 00 One or more treatment components are not ❑ Soil Based Individual Site Design' ❑ At Grade previously approved under s. SPS 3S4 10 (2) or (3) ❑ Non-Pressunzed In-grourd (Individual site design/deviation from component manuals Design and use of components without product ❑ Pressurized In -ground tewale9 Flow in approval) ❑ Mound Gallons Per day ❑ Drip -line Design wastewater flow of the proposed system ❑ Constructed Wetlands ' Documentation must be provided to Su p Support treatment and dispersal claims In a separate GPD 1.000 or g� $45000 1,001 -2,000 d $600 00 statement, provide rationale for the project and attach supporting documents (code sections t 2,001 - 5,000 g $7501b reports, technical papers, research articles. etc) greater than 5, $900 0D plus $0.08 fore VVn over 5000 gpd State-owned facilities Desig ks Holding tarprewou proved under s SPS ❑ Holding Tank Component Manual, Ver 2 0, SBO-10855-P (N 0 R1/12)' Wastewater FI in 384.10 2) (3 Design ater of the proposed system Gallons Per day ' Non -stale owned Commercial and Residential Holding tanks that c tely utilize this manual 000 gpd or less $ 90 00 and have an estimated daily flow of less than 3D00 gallons per day t be submitted to the 5, 1 - 1 Q,000 grid $150 00 appropriate governmental unit for review instead of the Departm jsee SPS 383 32(3)(a)j GPD grea than 10,000 gpd $225 00 ❑ Holding Tank Individual Site Design', (i a site co acted, c5 day holding capacity, Co- Holding t s including site constructed tanks NOT mingled wastewater, etc.) Design Wastewater Flow in prevously a oved under s SPS 384.10 (2) cx(3) Please specify. _ Gallons Per day Design waste er flow of the proposed system ' Documentation must be provided to support the rationale for the project In a separate statement, 5,000 gpd or less $180.00 please include all code sections, test reports, technical po papers, research articles, etc ) 5.001 - 10,000 gpd $300 00 GPD greater than 10,000 g $450 00 ❑ Soil Saturation Determination Report (using observation pipes) ❑ Interpretive Determination $24000 _ ❑ Experimental System (One time additional fee) Submit fee for individual system as per appropriate above system type) Experiment Number _ $40000 Priority Review (enter same amount as normal review fee listed above) $ Enter Total (rounded to the nearest dollar) $ SBD 10577 (R 3/19) Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in -situ soil treatment for 1.50iI Peaking Factor (e g 1 5 = 150%) fecal coliform of <- 36 Ziles 600 00 Design Flow (gpd) 10.00: Site Slope (%) 100.00 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 40 In -situ Soil Application Rat pd/ft2) t _ Distributi Cell Information ^y/ 100.60 ersal Cell Length Ale, r (ft) = C 1.00, Dis al Cell Design Loa g Rate (gpd/ft') 1 Influent astewater Quality (1 or 2) Are Pressure Disribution in al E' Center or End M N, 3 00 Lateral Spacing (ft) 2 Number of Laterals 0.156 Orifice Diameter (in) __ 4.00 Orifice Spacing 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) 88.00 Pump Tank Elevation ) 455 System Head (ft) 1 3 1208 Vertical Lift (ft) 0.63 Friction Loss ) — 0.00 In -line Filte oss (ft) 1727 Total Dy mic Head (ft) x Width (ft) 6 laterals the highest point distribution Y rk� If N above, enter the elevation (ftL of the highest point 12 OD ftz/onfce Does the forcemain drain back? Y Forcemain Drainback (gal) 5x Void Volume (gap Minimum Dose Volume (gal) Qystem Demand (gpm) Manifold DiambLer Selection in dia option choice - 125 x x x 1.50 200 _ 300 Gallons_llnch Calculator reatment Tank Information Total Tank Capacity (gal) 1250 00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Huffcuit Concrete Manufacturer gallin (enter result in cell B49) Dose Tank Information Effluent Filter information 758.00 Dose Tank Capacity (gal) Ldetime _ Filter Manufacturer 16 85 Dose Tank Volume (gal/in) LT1/8_ Filter Model Number IHuffcuttConcrete I Manufacturer Project. Brent Wink New Septic system Page 2 of 10 Mound Plan and Cross Section Views —T v'} ' o f © J Observation Pipe K 1 p Qs&I A 40 e B '1 z V� L Mound Component Dimensions A 6 00 ft E 13 20 in H 00 ft K 7 78 ft B 10000 ft F 9 50 in = 10 25 ft L 115 55 ft D 600in 050ft J 413ft W 2038ft 600.00 (ft 2) Dispers I Cell Area 1 1625.00 (ft) Basal Area Available 6.00 (gpolft) Linea oading Ra 1 10.00 (ft) 1110 B Obs. Pipe Placement Mounwross Section View Agil Dispersal Area Finished Grade 10229 (f T H G 1 F Dispersal II 101( ) Lateral (ft) . 100.50 (ft) — Invert Dispersal Cell Elevation € iI s ❑ 4 ❑ 100.00 (ft) Contour Elevation 10.0 % Site Slope Geotextile Fabric Cover S ding Key T Dispersal Cell a lateral details on Topsoil Cap ° 1.5 t �" Page 4 for number, size 2 Subsoil Cap 1 o © O /—�) - and spacing of laterals Laterals are equally ASTM C33 Sand 0 0 v / F Tilled Layer 0 Aggregate c q e a r 0' ft Tvoical Lateral © spaced from the distribution cell's o centerline in the -- - A distribution cell (AxB) Project Brent Wink New Septic system Page 3 of 10 End Connection Lateral Layout Diagram �s,.r,i-...ra.rea _,y_�.:. .. . c.n�-...:. :, •- ruin-u:�.d r•.,ii,,.in..�. :�r+u.� Fr Il ,:n i,�+urr ,r :.t-n :.., ._x_, r .r:._.t:,o �r..>c. •: cr•.. ;�n.-r,�.n. F rvn'n rnrr it :-.r::r r-rt rnC:l7 ril rpr Lf.-r it it-�.n-u --�40 r' l:-r '.F-Tll. i=.ii Number of Laterals teral Diameter La rat Length (P) Late Spacing (S) Lateral ow Rate System F w Rate Total Dvna Head Electrical as per NI SIPS 316 300 Tank component is properly vented Huffcutt Concrete Ca acit 758 00 Volume 16 85 Gal Dose Tank and Dimension Inches Gallons A 2 4 442.14 B 2 00 33 7D C D Total 575 11 00 44 99 9681 885 35 758 00 Orifice Diameter Orifice Spacing (X) Orifices per Lateral Orifice Density Manifold Length Manifold Dial r Forcema n oclty B C 3" Bedding under tan /Iamrm anuafacturer 'SJE Rhombus odel Number Tank Alert anufacturer Zoeller Pump Model Number BN151 _I Disconnect �-A_ Pump Must Deliver 26 93 gpm at 1-7-2-71 ft T D H in ft 2 00 ft/orifice 3 00 ft 1 50 In 2.75 fUsec Locking cover with warning label and locking device and sealed watertight 4 in min <— Alternate outlet location Forcemain diameter 2 In Weep hole or anti - siphon device Pump off elevation (ft) 88.92 f Dose tank elevation (ft) 88 00 Project Brent Wink New Septic system Page 4 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name T L Sinz Plumbing Inc Phone 715-235-2644 POWTS Regulator's Name St Croix County Zoning Phone 715-366-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft' M imum FOG 30 mg/L Type of Wastewater Domestic Maximum F I Coliform >10E4 cfu/100 mL S eFre c / Septic an Pump Tank E uent Filter Pump auretem rols arm I ct ice once eve 3 ears Shoul s d clean at least once ve 3 ears Test once every3 e Should test most Laterals should be Flushed and res re tested every 3 years Inspect for ponding and seep e once every 3 years Call T L Smz Plumbing fpf your service needs 1 Observation pipes are slotted and aten and are secured in as shown in the Nour 2 Dispersal cell aggregate conforms to 3 All gravity and pressure piping material 4. Tillage of the basal area is accomplished 5 The mound structure and other disturbed and help reduce frost penetration Is conform t able SPS 384 30-1 have a watertight cap I compon manual 384 30 0). Wis. Adm Code onfor o the requirements in SPS 384, Wis. Adm Code. dh old board or chisel plow- 3 will be seeded and mulched to prevent soil erosion Lateral Tur up Detail Finished ...... .............. Grade yr 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distn Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project. Brent Wink New Septic system Page 5 of 10 00 '00 Will Hei Soil -testing NN3503 He ock Road M()ndo\ti, 54755 (715) 579-- '84 -.7 , - bt W econaln Dspartrnam of Ssfaty gntl Profaulonai Sernoea Pepe % of Z DR:flon of Industry Services SOIL EVALUATION REPORT In accordena N4ih 8P83M V& Adm. Code County Attach complete acre plan on paper not lose than 8 112 x 11 Inches In size. Plan must Include, out not urni ed to: vaRtat and hortzontel roteroncs point (Ill dlrootton end paroant slaps, Partial I.D. tale or dlnnnNone, north arrow, and location and distance to nsaraat road. Please Print all information. Raft"d by Deb Property OemM Property Loatlon ❑ _ �! OovL Lot ! u,� Y. Nu-Iti Y. 8 071;-- T 30 N le E (or; w Prop" 0wruWafeeling Addreas ?L' Loth Blohka 8ubd.Name sir �) '/�i 'ru.le rrL •J Ctty , • 8tals C•'�a,uu^,C�„ l;,r Zip Code I�;vv/31 Phone Numbsr ❑ City , ❑ Milsgs 15 Town �...,�_,.I,;� I Nom* Road /yr)A,:,L.?�LS+ NewCo on Liss: e Rasidemlall Numberofhedroome,j Code dedveddn'gneow rote Lr2D ❑Replan Publlo or oopensrolsi—Resarlpr. Parent Mahn al - � - 1l Flood Pion slavetion If eppil la /uf tt. General comments and mmandAthol": ). f /U�%•i b'(�I�t S,j 44.T•:,/f�. Q Cr•, JGN Tif 3 ✓ - 1 Borng 8 ❑ Boring t 1 L Pit c su a alsv. DWM to knbv teotor In. Horizon Depth In. Dominant Color man ascription QLL Az L Color structure Or. 8z 6h Conablenos Boundary Roots OPD/Fir , - ,oil i 4, s`C D t I C o Boeing #. ❑ Boring �Pft Groundeurlaa vr,�-_fL DapM to l4nitlna laotot N. s� F -- Hodzon Depth Damina olor Radox Description Towum i Btruaturs Consistence Boundary Roots OP ' In. M e11 Qu. Ace. Cont. Color or. 8z Sh.*ew , - is ' 3 v P ,• -, t. r��r 4. - �. C� 5 �LJn Ins i I WK Hop. r9 >9 ISO malL. s • s a GOT Neme IeOsPAnt) P,tpnap�LI / /; • COT Number Addme ate sysivadon Conducted, Ill HeidtSoilTesting Tsisohan.Nantcn�j 1� . ^ —. VV Y HBD A30e (ae4lla) MondovI WI 5475E __.- __. (715) 579-9531 aBO" 0 PR G=nd WrM= WK 4�011L DOW to Il "fsftr3 L III. � ua Dd Colorr ANrreNl RB&X Dosottpllon Qu. Az Cont. Color Tad.I W. 8a. !h. CarYhu,e. Boundary tmots vow Z ' :nqfY 6Yl 14 c L ;a.. P- Oy 167 I 3F 1 906np r i Boring oralnd wrha slevJ ` .rt Depth to Dmidnp racmr 5 ;r In. Hart= DOM In, DcmirornCater nnura w tied DssWp9on Cu, A&V4F& Coto Texture StUAM ss sh. Consmonce Boundary I pools - < lent t /c— govingoi PROt Pit around eurha _ R Depth to ww" %ftr _ In. • EMU" 01 a SM, 2- 30 9 220 nV& and TW>30s 150 myL `EMuent02. 300,> 30 6 M rr4?L wd T&f> 30 e 1 o0 rVL 2� ?yy� i>LIhoco l Will Heidt Soil Testing W3503 Hemlock Road Mondov5 91g584 5 (715) i al. ou- r �i ' "