HomeMy WebLinkAbout016-1002-10-050Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM
County St. Croix
Safety and Building Division
INSPECTION REPORT
Sanitary Permit No
GENERAL INFORMATION
(ATTACH TO PERMIT)
642231
State Plan ID No
Personal information you provide may be used for secondary
purposes [Pnvacy Law. s 15 0411hm11
Peat Holder's Name
Joe &Wanda Jackelen
City Village Township
1
Parcel Tax No
TOWN OF GLENWOOD
016-1002-10-050
CST BM Elev Ilnsp BM Elev BM Description
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
PIL
WELL
BLDG
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Ft I
JUIL AbbURPTION SYSTEM
HI
BED/TRENCH
DIMENSIONS
Width
Length
No Of Trenches
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL
ILAKEISTREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer
Type Of System
Model Number
DISTRIBUTION SYSTEM
Header/Manifold Distribution xHole Sae xHoie Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
OUIL ii UV i x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
xx Depth of
xx Seeded Sodded
xx Mulched
BediTrench Center
Bed17rench Edges
Topsoil
❑ Yes ❑ No
Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc )
Location: 1799 320TH ST
1.) Alt BM Description =
2 ) Bldg sewer length =
- amount of cover =
Plan revision Reguired9 ❑ Yes E I No
Use other side for additional information
SBD-6710(R 3/97) Date
Inspection #1 Inspection #2
�—
Insepctor's Signature Dart No
W1 CD .� _
Safety and Building. vision
County ada
� (; L. v, Sir
ise
�
Sanitary Permit Number (to be filled in by Co.)
� Q 16 p�21
Department 'afetjd Yld
14 0 E. Washington Ave.. P.O. Box 7162
Madison, WI 537o7-71 2
`
� Z Z 3
Professional ervi s ro,x °'°
ment D
mar N °
State ry Permit Apphca i
State Plan I D. Number
Project Address (if different than mailing address
In accord with SPS 383 21 (2) Wis. Adm Code submission of this form to the appropn a
unit is required prior to obtaining a sanitary permit Note application forms for stale -owned POWTS are
,� zv. f 1 ��
submitted to the Department of Safety and Professional Services Personal information you provide
��
may be used for secondary puiposes in accordance with the Privacy Law, yf5.04H Ron), S
1. Application Information- Please Print All Information
Propert}' Owner's Name
Pare I k
61 00D - 10-oSc�
Property Owners Mailing Address
Property Location
Govt. Lot
'' V.• -' �� ��• Section
City, State
Zip Code
Phone Number
T_ N/R 'W
H. Type of Building (check all that apply)
Lot s
Subdivision Name
t/ I or 2 Family Dwelling - Number of Be ins ----
—
r�a
Public/Commercial - Describe Use ¢i parhau-w- 1�6Vt,5
1
Blockq
City
State Owned -Describe Use
Village of
CSM umber
(V. 29/p."51
0$'�2`6
Town of i
-
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
'4
`- New Svstem
Replacement System
❑ 'I reaimenUHolding Tank Replacement Only
❑ Other Modification to Existing System
B.
Permit Renewal
EJ Permit Revision
Change of
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration
_
Plumber
Owner
IV. Type of POWTS System: Check all that a I
_ Non-Pressunred In -Ground Pressurized In -Ground At -Grade j Mound >_24 in of suitable sojil Mound Q4m of suitable soil
Holding Tank _Other Dispersal Component (explain) Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd)
Design Soil Application Rate( dsf)
Dispersal Area Requir (s
Dispersal Area Proposed (sf)
System Elevation
VI. Tank Info
Capacity in
Total
Number
Manlitacturer
Prefab
Site
Steel
Fiber
Plastic
Gallons
Gallons
of Units
r`{1
Concrete
Constructed
Glass
New
Existing
Tanks
Tanks
Septic or Holding
,
Tank
Doting Chamber
h l
VII. Responsibility Statement- I, the unite igoed, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print] Plu is Si a r, MP/MPRS Number Business Phone Number
Plumber's Address (Street. City, State, ode)
VII(. Count /De artment Use Only_
Approved
❑ DiiSalflxe d
Permit Fee
Date Issued
Issuing Agent Signature
❑ `Owner GivenR for
S �
Denia
1.SSeptic tank, effluent filter and 13� � (.,"r+btS Z)C. c''n -'4%
i
dispersal cell must be serviced./ maintained W ri k AA per rI
as per managback req ent iremplan provided ai tainedf. P, + ik& S ��-e
2. All setback re uirements must be maintained OV I
/I
as per applicable code/ordinances. IjA,(brw, lr -to &tWI
Attach complete plans (to the County only) for the system on paper not less than 812 ill inches in sae
SBD-6398 (R. 01/03)
Gov't lot 2 NW`/a,NW'/,,S1T30N/R15W
Glenwood township �p--
St. Croix county
LEGEND
IBM: 100.0' nail on
west side Elm tree
X - backhoe pit
No DSPS setback
problems
Scale P-60' except
where indicated
System Elev. 112.5'
on contour 112.0'
1
project: JACKELEN
SITE PLAN
®` 7
rwxe.
J61 n
WO
Ijd,� f 15'%4.1 s c&4o riscn z«5
� tl ` , 55' U" "3.3,4
Y — :—
v 1e��1
{a w.1+.Tv�Tgnl°
/�►ao 30' 2°s°A4a
Rsrr- Uk s
J� J u0-0 t tank
Idsd
u1 f
LR° cO �C. / 2-co 1`
u ` �
5 a/ page 10 of 10
' L G`
November 10, 2021
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2023-11-10
Plan Review: PWTS- 112102908-C
Loretta Larrabee
N2089 County Rd Y
Menomonie, WI
SITE:
Joe Jackelen
1799 320`h Street
Glenwood Township
St Croix County
NW'/e NW X 51 T30N R15W
FOR:
Description: 3 Bedroom — 450 GPD — 30" to
limiting factor- Effluent Filter- Maintenance
required.
DIVISION OF INDUSTRY SERVICES
10541 N RANCH RO
MAYWARDWI 54a 3W2
Cor ao Th"h Relay
hap 14" - 90VtPWa"MWU try�
Tony Evan. Gov "
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 above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This
system is to be constructed and located in accordance with the enclosed approved plans and with any
component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin
Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per
s.145.06, stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• The 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 inspection shall be
made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis,
Stats.
A state approved effluent filter is required. Maintenance information must be given to the owner of
the tank explaining that periodic cleaning of the filter is required.
• 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 Deoartment which may include local
inspectors.
Owner Responsibilities
The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also
receive a copy of the appropriate operation and maintenance manual(s) and be responsible for
ensuring that POWTS is operated and maintained in accordance with this chapter and the approved
management plan under s. SPS 383.54(1).
In the event this soil absorption system or any of its component parts malfunctions so as to create a
health hazard, the property owner must follow the contingency plan as described in the approved
plans.
The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or
additions should conditions arise making them necessary for code compliance. As per state stats
101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe
building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or
at the address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the
owner and any others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely,
Joshua Rowley
POVYfS Plan Reviewer, Division of Industry Services
(715)813-9111
Project Name: JACKELEN
Owner: Joe Jackelen
1799 32e SL Glenwood City, Wl
Site Address
N W l /4.NW 1/4.S 1 ON/R15w
Legal Description
CQlanwood lownchin Cr Croix count
Township/County
Contents:
CcntliGmmlF/
APPROVED
DEPT. OF SAFETY ANO PROFESSIO.L
SERVICES
DIVISION OF INDUSTRY SERVICES
S-_E CO3RESFv1:GERC_
Page 1:
index and title
Page 2:
general infomtation & lateral diagram
Page 3:
mound drawings
Page 4:
dose tank
Page 5:
pump information
Page 6:
tank detail
Page 7:
filter information
Page 8:
management plan
Page 9:
contingency plan
Page 10:
site plan
Attachment: soil test to state plan
Designer's name and license no: Loretta Larrabee
Address:
N2089 Cry Rd. Y
Menomonie, WI
Phone:
7151664-8184
Cell:
715/505-1628
e-mail:
Designers Signatuetz /,_
81872-007 LppET<A a:
LARRAa"
54751 ' * i 1872
Bate: Oct. 21 a , 2021
I the undersigned submitted these plans under my authority
Mound component manual for POWTS Version 2.0 SBD-10691-P (N.01/01;R. 10/12)
and Pressure Distribution component manuei — Version 2.0 SBD-10706-P (N.01/01;R. 10112)
page I of 10
Three bedroo
10% slo m h°me, 450ga1 D
WF
0.6 soil appli�h
30 li syst,n mate
1000/60p 9 soil factor
effluent quality//jal LP combo tank
C;3;j �, �l��, ll�,f�; i3l�P✓lA x ��Pd
dispersal Ysll d w/2 late�s
wear rate 6.0� ' loading rate 1.0
orifice sq/]t. 7.50
LA7 ' L LAYOLIT
Numberoflaterals 2 tttl DJAG,;�
Lateral dia 1'ed ystettt (not to
Lateral length 1 /„
Laterals (p) 72.52 orifice dia.
Pacing (g 08. ce Manifold dia. ) 3' spat ng (� 3032in (0.156)
Force main dia 1 % in Per lateTo 2.5'
2.0 in lateral dischar ral ( )
total system rage rate 16.162nm
See page 9 ot, a 32.31gpm
turn-tt 10 for turn -up detail
> Pend on or
at manifold for access oflateral at both
.4 Valve boe
ends for setvicittg
finish grade
P 72.5t
.S ,
orifice next to ll(ting
1 50' 1 Last orifice Orifices located on bottom of
(18••) i
next to lifting latetnl
Project: JACOL 1.
porCe main 2"
dia.
Page 2 of 10
PLAN VIEW OF MOUND (nor to scale)
J=
4.5'
D= 0.5'
(6")
K= 8.0' required bed 450sq.ft
A=
6.0'
E= 1.10'
(13 1/4")
B= 75.0' proposed bed 450sq.ft.
I =
10.5'
F= 0.83'
(10")
L= 91.0' required basel area 750.Osq.ft.
W=
21.0'
G-- 0.50'
(6")
proposed basel area 1237.5sq.fG
H=1.00'
(12")
observation pipe @ 7.5'
Mound Crass Section View tc, scar:-)
Finished grade elev.114.29'
Lateral invert elev 113.0'
3
Dispersal cell elev. 112.5'
Or-lateral -- -- --
Aggregate btedJ6" -- -- -- --
---- - - - --- - - - --
-- - -- -- -- -- - I E -- --
----
- I tilled layer
Numeral Key
I topsoil cap
subsoil cap
ASTM C33 sand
4 synthetic cover over cell
5 aggregate
Secure observation
- - D -- -- — -- -- -- --
tilled layer tir
contour
site slope elev. 112.0'
1.5ft.
4in. dia. observation pipe
with 1/4in slot
project: JACKELEN page 3 of 10
i
Warning Label
(No Scale)
,Approved Locking Manhole Cover
With Warning Label Attached\
Weatherproof
Junction Box
\ . 1eKL+
,y„
Approved
VQnt Cap
12" Minimum
Final Grade-\ ,y 4" Minimum .
n I II Quick
18 Minimum Disconnect
I
1/4" Weep
Hole
Baffle
Approved Joint t6 , A 4
v/4,1_sA40 Pip. i 1
�xt=_nding 3' LVAlarm 61
Onto Solid Soil On 61 B Approved Joint
W/4" S" flpe
C Extending 3'
Elev O Off 6' Onto Solid Sed
Conc. Block
3" of Bedding Under Tank
20% DWV' = 90 O bo�
ynt Pump and Alarm Are On Separate Circuits -V )QN no, _
, M :l 5•�
1 J
Tank Manufacturer: �J se. Cr4pt -•-i
Tank Size-Septic/Pump: 00 $-1]? Gallons
Alarm Manufacturer: ho o. ti^����c+' qVdLkc-{
Model Number: 9sp I2-t., Capacities: A CL _inches or:31t4q Gallons
Switch Type: ry C<,Ja .r. C_ + B- 2 . inches or 33,51 Gallons
Pump Manufacturer: + C_ r inches or g3.ga Gallons
Model Number: * + D to inches orlt,7.Lo Gallons
Minimum Discharge ate ar 3 a GPM total ..... = , inches or o .3t.Gallons
Vertical Difference -Between Pump Off and Distribution Pipe:7,,6Feet g-al/in 16•'l�0
Minimum Required Supply Pressure: ...... 1f3 ?I:. s ..........f ,53 Feet
,30 Feet of Force Main x 2.0 Friction Factor/l00 Feet: +A1,1 Feet
a Inch Diameter Force Main
Total Dynamic Head:...=LI.3aFeet
project: JACKELEN page 4 of 10
25
q 6 20
x
_U
5
i 4
0
10
0
2-
5-
0
GALLONS
LITERS p
PUMP PERFORMANCE CURVE
MODEL 98
10 20 30
TOTAL DYNAMIC HEAD/FLOW
PER MINUTE
EFFLUENT AND DEWATERING
MODEL
98
Feat
Meters
Gal.
Liters
5
1.5
72
273
10
3.0
61
231
15
4.6
45.
170
20
7.1
25
95
Shut-off Head:
23 iL(Urn)
aW971
40 50 60 70 80
8o 160 240
FLOW PER MINUTE
r0iX'SUd1 F.;'.'CT0;V7F0 SPF-Citl: li _.1.7,,.'S
W
SK11ar
Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
Mechanical alternators, for duplex systems, are available • Double piggyback variable level float switches are available for
with or without alarm switches. variable level long cycle controls.
• Refer to FM1922 and FM0806 for temperatures above 130'F.
98 series
Control Selection
Model
volts -Ph
Mode
Amps
simplex
Duplex
W98
115 1
Aldo
9.4
1
4
N98
115 1
Non
9.4
2 or 3
4
698
230 1
Auto
4.7
1
4
E98
230 1
Non
4.7
2 or 3
4
1. Integral float operated mechanical switch, no external control required.
2. For automatic use single piggyback variable level float switch or double
piggyback variable level float switch. Refer to FM0477.
3. See FM1228 for correct model of simplex control panel.
4. See FMO712 for correct model of duplex control panel or FM1663 for a
residential alternator system.
For information on additional Zoeller products refer to catalog on Piggyback Vadable Level
Switches, FMG477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/
Sewage Basins, FM0487; Single Phase Simplex Pump Control, FM1596; Alarm Systems,
FM0732.
4 CAUTION
..I! i �staC� !or. of J�r:rcls, ;-ctaaaar. �eldces tad ::!.figs ;cold be does by E
cucii9a.i Buscsaci =Lc_ ;clr: Al! elecfr!csl::cd a'cfaty co Ess S:1CL'id �afJ110Red
icclst:mg tho r_ ; racsnt !iEtlzr.E!=Ssa!;Ei :ode (1 EC) End the oc:77Et:Onal
'Easy assembly"
(pump S dimbarge pipe
rN frduded.)
Di n
• Reduces potential clogging by debris.
• Replaces rocks or bricks under the pump.
• Made of durable, noncorrosive ABS.
• Raises pump 2' off bottom of basin.
• Provides the ability to raise intake by adding sections of 1W
or 2' PVC piping.
• Attaches securely to pump.
• Accommodates sump, dewatering and effluent applications.
NOTE: Make sure float is free from obstruction.
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
NAILTD: P.O. BOX 16347
Loa$Wle, xy' 40256-0347 Merndacrurers ol..
Z �� sHm ro: 3649 cane rsun Road
® • Lcuati0lk, K7' 40211-1961
°�,�„r, — �!6�MP CO_ f�/ �z(5ozj n�a3e 4aPuuP 4 TYP7F1/P9 ✓iNCE I�V Y
Datgt �o� L(i
0 Copyright 2008 Zoeller Co. All rights reserved.
4" CAST -A -SEAL
Ipl Ir
/ -*
24 / '.
VP
FILTER OR !I111
BAFFLE
WLP1000/600-MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL;- 3"
BOTTOM: 3"
COVER: Ei
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 56" O.D.
LENGTH: 150" O.D.
WIDTH: E4" O.D.
BELOW INLET: 42" O.D.
LIQUID LEVEL: 36"
4" CAST -A -SEAL WEIGHT: 14,970 LBS.
INLET AND OUTLET:
4" CAS", -A -SEAL BOOT OR EQUAL
GASKET, CAST -A -SEAL B0OT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
UOUID CAPACITY: 7. 8 GA �N �PU- TIC)
LOADING DESIGN: 8' 0" UNSATURATED SOIL
TANK CAN BE USED AS:
SEPTIC/SEPTIC, SEPTiC/PUMP
4" VENT OR SEPTIC/SIPHON
COVER: MIX DESIGN #8 (NO FIBER)
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
in
CUSTOMIZED TANKS:
- - - - FOR CUS10M TANKS CONTACT WESER CONCRETE
INLET -- - - - - _ OUTLET
3"
r7
PUMP PAD
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
APPROVAL DATE: 11
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS IIPRODUCTS NEEDED BY:
0
PL-525 EFFLUENT FILTER ( 1
Polylok, Inc is pleased to add its
new commercial filter to its existing
fine of quality effluent filters. The
PL-525 is rated for over 10,000 GPD
(gallons per day) making it one of
the largest commercial filters in its
class. It has 525 linear feet of 1/16"
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed
with every filter When the filter is
removed for cleaning, the ball will
float up and temporarily shut off
the system so the effluent won't
leave the tank. No other Filter on
fhe market can make that daim!
6PL-525 MW�1i Tfe'L''aiinc'i.
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at least every three years. If the
installed fitter contains an optional
alarm, the owner will be notified
by an alarm when the filter needs
servicing. Servicing should be
done by a certified septic tank
pumper or installer.
I. Locate the outlet of the
septic tank.
2. Remove tank cover and pump
tank if necessary.
3. Do not use plumbing when
filter is removed.
4. Pull PL-525 out of the housing.
5. Hose off filter over the septic
tank. Make sure all solids fall
back into septic tank.
&. Insert the filter cartridge back
into the housing making sure
the filter is property aligned and
completely inserted.
7. Replace septic tank cover.
Alarm
accessibility ----
525 linear feet
of 1116-
filtration slots
Accepts V & 6"
SCHD. 40 Pipe''
U.S. Patent Noe G,075,4
5,871,640
PL-525 ips aflation
Ideal for residential and com-
mercial waste flows up to
10,000 Gallons Per Day (GPD).
Accepts PVC
n handle
over
nD
for
shutoff
filter
I
1. Locate the outlet of the
septic tank.
2. Remove the tank cover and
Pump tank if necessary.
3. Glue the filter housing to the
4" or 6" outlet pipe. If the
filter is not centered under the
access opening use a Polylok
Extend & Lok or piece of pipe
to center filter.
4. Insert the PL-525 filter into
its housing.
S. Replace the septic tank cover,
e q,ft0
Mound System Management Plan
Pursuant to DSPS 383.54, Wis. Adm. Code
General
This system shall be operated in accordance with DSPS 382-384 Wis. Adm. Code. and shall maintain in accordance
with the component manuals 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 DSPS 383.33, Wis. Adm. Code when the tanks are no
longer used as POWTS components.
Septic or pump tank manholes 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" in diameter
shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48, Stars. The
contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Code. The operating condition of the
septic tank and outlet filter 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 slip off the filer when removed from its enclosure. If the
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
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
personal shall advise the owner of when the next service needs to be done to maintain less than maximum scum and
sludge accumulation in the tank.
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 maybe 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 compaction may
hinder aeration of the surface within the mound and snow compaction in the winter will promote frost penetration.
Cold weather installations dictate that the mound be heavily mulched as protection from freezing.
Influent flow may not exceed maximum design flow specked 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 at least once every 18 months. When a pressure test is performed is should be compared to
the initial test when the system was installed to determine if orifice clogging has occurred, if clogging has occurred
orifice cleaning is required to maintain equal distribution within the 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" considered impending failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or components shall be repaired or replaced to
keep the system in proper operating condition.
If the dosing tank or its components become defective the defective components(s) shall be immediately repaired or
replaced with a component of same or equal performance.
If the mound fails to accept wastewater or discharges wastewater to the ground surface, it will be repaired or replaced.
Increasing basal area if toe leakage or by removing biologically clogged absorption and dispersal media and related
piping and replacing components as deemed necessary to bring the system into proper operating condition.
See page 9 of this plan for the name and telephone number of your local POWTS regulator and service provider.
project: JACKELEN page 8 of 10
Mound System Mainteimace and Operation Spcelfications
Service Provider's Name: JB Hydro LLC Phone: 715/949-0099
POWTS Regulator's Name: St. Croix Zoning Dept. Phone: 715/386-4680
System Flow and Load Parameters
Design Flow — Peak 450gpd
Estimated Flow — Average 300gpd
Septic tank Capacity 1000gals
Soil absorption component Size 450 sq.ft.bed
Type of Wastewater residential
Maximum Influent Particles Size 1/8in
Maximum BOD5 220mg/L
Maximum TSS 150mg/L
Maximum FOG 30mg/L
Maximum Fecal Coliform >10E4 cfu/100mL
Service Frequency
Septic and Pump Tank --------Inspect and/or service once every 3 years
Effluent Filter----------Sbould inspect and clean at least once every 1- 3 years
Pump and Controls ------Test once every 3 years
Alarm ------ ------------Should test monthly
Pressure System -----------Laterals should be flushed and pressure tested every 1.5 years
Mound ------------------Inspect for pending and seepage once every 3 years
Other --------------------------- Initially filter should be checked yearly to determine service schedule
Avoid surge flows of water: try to spread laundry throughout the week
Avoid winter traffic such as sliding or snowmobiling which might lead to mound freeze-up
Miscellaneous Construction and Materials Standards
I . Observation pipes are slotted and materials conform to Table DSPS 384.30-1, have a watertight cap and are secured
as shown in the mound component manual.
?. Dispersal cell aggregate conforms to DSPS 384.30 (6)(1), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in DSPS 384, Wis. Adm. Code.
-I. 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
6. Lateral Turn -pp to finish at grade or above, enclosed in a 6-8" diameter lawn sprinkler valve box or similar product.
(lateral turn -up consists of a long sweep 90 or two 45degree bends same diameter as lateral)
7. Lateral Turn -up on end of distribution laterals after the last orifice.
project: JACKELEN page 9 of 10
Gov't lot 2 NW1�4,NW��4,S1Tnn�.m. ...
Glenwood township
St. Croix county
LEGEND
IBM: 100.0' nail on
west side Elm tree
X - backhoe pit
No DSPS setback
problems
Scale 1"-60' except
where indicated
P3�
System Elev. 112.5'
on contour 112.0'
I
project: JACKELEN S
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page 10 of 10
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ST. CRo NTY SANITARY SYSTEM File #:
r. „ Office Use Only
OWNERSHIP/ADDRESS FORM Created 212021
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. If you would like to view your issued sanitary permit online, you can
do so by using the Property Files Scanned weblink.
OWNER/BUYER INFORMATION
Owner/Buyer 3ce
Mailing Address *2-CI9 kaA-Y1 {)rUQ_
City/State/Zip
Phone Number
Email Address
Parcel Identification NumberOkLp- 1�a- Il>-OS��
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location NW 1/4 ,Nt W 1/4 , Sec. T N R W, Town of 11lP.nU)r(l Tl/
Subdivision Plat: , Lot #.
Certified Survey Map #-Lff�y -1), � I Volume_, Page #
Warranty Deed # Y T �393 (before 2006)Volume 9 !/ Page # S00
Number of bedrooms E Spec house 0 yes 13 no Lot lines identifiable dyes E3 no
OFFICE USE ONLY
New Property Address
(Verification of new address required from Community Development Department for new construction )
i4 I I l 30 i Z(
(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 mode in the warranty deed.
Community Development Department — Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
cddC@sccwi.ciov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.00v
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer josepn & wanaa oaCKeien
Mailing Address 3179 180th Ave Glenwood City, WI
Property Address 1799 320th St Glenwood City, WI
(Verification required from Planning & Zoning Department for new construction.)
City/Stat,Gienwood City, W1 Parcel Identification Number 016- 0
LEGAL DESCRIPTION
Property Location I/ , '/. ,Sec. 02 -1, 30 , R 15 W l-own of Glenwood
Subdivision Plat:-_ _ . Lot # 02
Certified Survey Map # _ Volume 29 Page # 6659
Warranty Deed # 23]3 (before 2007)Volume_91. Page #�
Spec house Oves Ej�ho Lot Imes identifiable yes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use grid maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. N'hat you put into
the system can affect the Junction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in ✓;SPS 38352(t) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The properly owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources.
State of W isconsin. Certification stating that your septic system has been maintained must he completed and retumed to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certily that all statements on this form are true to the best of mylour knowledge I/we am/are the owner(%) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number gybed rooms
SIGNATURE'PP CANTS) DATE
"'.Aiv information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Depuruncnt.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
JACKELEN RESIDENCE
FULL JOBSITE ADDRESS
SHEET INDEX _
Al - COVER SHEET
A2 - FLL%,F'ONS
A3 - F-Crul'O[.S
A4 FOtlNDAT100 FV.N
AS HRST FLOOR PLAN
A6 - ROOF LAYOUT
A] DPPILS
AS
AS -
A10-
Al1
Al2-
A13
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VIZION
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Ws. pept. of Safety and P�rnof�e�pnal Se 'ces
Division of Safety and �1Oa SY£r`ment
4fST-d017- CI If
Page 1 of 3
{ n1 auarmanu wm1 ara a , vns. „urn. wue
AttatFfEomplete site plan on paper not less than 8 112 x 11 inches insize. Plan must
include, but not limited to vertical and horizontal reference pant (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information-
Personal intomaLon you pmvide may tie used for aemndary pury ws (Pnvacy Law, s. 15 M (1) (m)).
County ST CROIX
Parcel I.D. S ,�. 016100030000
R y Date
5
Property Owner
JOE JACKELEN
Property Location ❑
GovL Lot 2 114 S 1 30N R tg (or) W
Property Owner's Mailing Address
3179 Both Ave
Lot #
2
Block #
I Stbd. Nacre or CSW Y&W jol
proposed CSM
Cdy State Zip Code Phone Number
Glenwood City I WI 1 54013 (
ity []Village j&own Nearest Road
d I 320th St
® New Construction Usefa Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
ayParent material Cl.-I� Flood Plan elevaton if applicable ft.
General comments LO
recommend a mound, having a centerline located on or near the 111.0' contour «-"w'
groundwater seepage at 65" in B3 (9 1ADVAID ,+0 cq"jcj
09&
7
Bonng 'Am II
Bodrg #
® Pit Ground surface elev 1081 fL Depth to limiting factor 30)in.SoA Application Rate
Horizon
Depth
m.
Dominant Color
Munsel
Redox Description
Ou. Sz Cont. Color
Texture
Structure
Gr. Sz. Sh.
ns
undary
Roots
GPD/fl I
ff#1 •
1#2
1
0-8
7.5YR 4/4
-----
1
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0.6
0.8
2
8-12
7.5YR 4/6
----
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1f
0.6
1.0
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12-24
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-----
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1.0
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24-30
10YR 5/8
-----
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---
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1.0
5
30-59
10YR 5/6
rscl
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02
0.3
❑ Boning❑ Bonny # ® Pit Ground surface elev. 108.7 36 ft. Depth to limiting factor in. Soil Applimtion Rate
Horizon
Depth
in.
Dominant Color
MunseA
Redox Description
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
onsistence
Boundary
Roots
GPD/fl
11#1
ff#2
1
0-9
7.5YR 414
-- --
I
2fgr
mfr
as
2vf
0.6
0.8
2
9-18
10YR 5/4
-----
sil
2fabk
mfr
9w
lvf
0.6
0.8
3
18-29
10YR 5/8
-----
Its
2fabk
mfr
dw
ivf
0.5
1.0
4
29-36
1 OYR 518
-----
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lfabk
mfr
di
---
0.4
0.7
5
36-57
1 10YR 5/6
fld 7.5YR 5/8 &
qrscl
lfabk
mh
---
---
0.2
0.3
f2d 10YR 614
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ng/L ' Effluent V24D < 30 mglL and TSS < 30 mglL
CST Name (Please Print) Sgna CST Number
Chris Fredericks 71618
Address / fe Evaluation Conducted elephone Number
499 - 4 1/2 Ave. Clayton, WI 54004 4129119 715-419-0127
SBD4330 (RI I/11)
11
Property Owf1ef Jackelen . parcel ID#
Page 2 of 3
3�
V Boring
# ® Pit Ground surface elev. 113.2 ft. Depth to limiting factor 31 in. Sod Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz Cont. Color
Texture
Structure
Gr. Sz. Sh.
3onsisteence
Boundary
Roots
GPDM '
fr#1 •
1#f2
1
0-9
7.5YR 4/4
---
1
2fgr
mfr
mfr
2f
0.6
0.8
9-17
10YR5/4
-11
2fabk
mfr
mfr
lvf
0.6
0.8
17-31
1 YR
----
Its
2fabk
mfr
mfr
0.5
1.0
4
31-45
10YR 5/8
fld 7.5YR 518 &
sl
1fabk
mfr
mfr
-
0.4
0.7
f2d 1OYR 614
5
45-68
10YR 516
flit 7 5YR 5/8 &
qrscl
lfabk
mfi
---
---
0.2
0.3
f2d 10YR 614
Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in. 75&d tlon Rate ,
Horizon
Depth
in,
Dominant Color
Munsell
Redox Description
Qu. Sz Cont. Color
Texture
Structure
Gr. Sz. Sh.
nsistence
Boundary
Roots
GPDlft '
if#1
fi#2
❑
Boring Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit Soil Aoo� Iiration Rate
Effluent #1 = BOO , > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 =13OD , < 30 mg/L and TSS < 30 nxA
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or 7TY through Relay.
Seo4133urm 0 1 rn n
Properly flamer Jadtelen, f Parcel ID#
Page 2 of 3
3
Boring # V Boring .
® pit Ground surface elev. 113'2 ft. Depth to limiting factor 31 in.
Sol Application Race
Horizon
Depth
in.
4immand Color
Munsell
Redox Desorption
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz- Sh.
onsistence
Boundary
Rods
GPDIIt '
tf#'I
tf#2
1
0-9
7.5YR 4/4
-----
I
2fgr
mfr
mfr
2f
0.6
0.8
9-17
10YR 5/4
2fabk
mfr
mfr
1vf
0.6
0.8
17-31
10YR 518
----
Ifs
2fabk
mfr
mfr
0.5
1.0
4
31-45
10YR 5/8
fld 7.5YR 518 &
sit
lfabk
mfr
mfr
0.4
0.7
fld 10YR 6/4
5
45-68
10YR 516
f1d 7.5YR 518 &
qrscl
lfabk
MIN
---
0.2
1 0.3
fld 10YR 6/4
Borng # Boring . .
Pit Ground surface elev. ft. Depth to limiting factor in.Sod lion Rate
-Horizon
,Depth
in.
Dominant Color
Munsell
Redox Desorption
Ou. Sz. ConL Color
Texture
Structure
Gr. Sz. Sh.
nsistence
Boundary
Roots
I GPD/R '
T91
vw
Boring # Boring
Pit Ground surface elev. R Depth to limiting factor m.
Soil Application Rate
Redox Description
Qu. Sz. Cont Color
NO M
. Effluent #1 = BOD ,> 30 <220 mg/L and TSS >30 < 150 mg(L • Effluent #2 = BOD , <30 mg(L and TSS <30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
SBD 133Rrm(RI tln)
leb +`
fide
-vE - -i-l.
L dt 2
Pao-T AoV,
'rowel of Lg4Eh1U30�'�
sr, cRo/x �aWa�7
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EX cEPt MHE1'-E t��'��
ST
NO. 642231
AY PERMIT
Me
rvious Na
OWNER
��
�'w�GI�LEIII
CHAPTER 145.135 ( 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
re
regulafions force the date of approval.
PLUMBE
{�
IC.#
ni
The sanitary permit is valid and may be renewed for a
permit
specified period.
TOWN OF
Changed regulations will not impair the validity of a
sanitary
sanitary permit.
SEC T
N, R
(e) Renewal of the sanitary permit will be based on
regulations in force atthe time renewal is sough[, and that
changed regulations may impede renewal.
(t) The sanitary permit is transferable.
ANDOT
BLOCK
History: 1977 c. 168; 1979 c.34,221; 1981 c.314
• L�
A
SUBDIVISION
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
PITEXPIRES
D ISSUING OFFICER -
1(ftoVIRIZ
DATE
IS PE&
TLESS RENEWED BEFORE TRA DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)