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HomeMy WebLinkAbout038-1085-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 569587 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Vlasak, John P. I Star Prairie, Town of 038-1082-50-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: I� YYX ( 20.31.18.342B TANK INFORMATION ELEVATION DATA TYPE �j MANUFACTURER •^' CAPACITY STATION BS HI FS ELEV. Septic 3 /doe) Benchmark /,6 G /O/•D /66 Alt. BM (r.•ll.,., C 57.0/15 Aeration C� Bldg.Sewer 14 , 11 sJ Zy a: ors ko � � •� Holding St/Ht Inlet g •� 9z • 38 St/Ht Outlet 0 9 Z. G` TANK SETBACK INFORMATION 9 TANK TO P/L WELL / BLDG. (y Veto Air Intake ROAD Dt Inlet ■\ \ J S Septic Dt Bottom 2 7;66 Dosing Header/Man. Aeration Dist.Pipe I z•`f8 $� .S Holding Bot.System i 3. 17• ra$ Final Grade '"• L l PUMP/SIPHON INFORMATION 1\ •4 Manufacturer Demand St Cover �-`1 Jam. Cg� mot• GPM Model Numbe TDH Li Friction Loss Isystem Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS `�. 9# �, _14e,--c� SETBACK SYSTEM TO 7 P/L !/BLDG WELL LAKE/STREAM LEACHING Manufa INFORMATION CHAMBER OR A r Type Of System: n '� /I, , /� UNIT Mode Numb -/ t DISTRIBUTION SYSTEM S Zit Z3 ` Header/Manif / Distribution x Hole Size x Hole Spacing Vent to Air)Intake Length Dia__q_ Length Dia \ Spacing � �� ✓w e SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only sr� Depth Over Depth Over xx Depth of xx Seeded/ dded xx Mul e Bed/Trench Center Z' 63 Bed/Trench Edges Topsoil ,� Yes E No es [ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 953 210th Ave..SSOMERSET, 1 54025(NW 1/4 NE 1/4 20 T31N R18W) metes&bounds Lot �, �I�arcel No- 20.31.18.3428 _^ 1.)Alt BM Description= ` ' k, 0 5 �`�' �w ' N . /� 2.)Bldg sewer length= 3 LP / A-&k �� 66J4.oD t,.J b SGIe.�..15 -amount of cover= � n� 7 y ew C Plan revision Required? RN Yes No L ' F� 3 r•f� 7 Use other side for additional information. _— -- Date Insepctor's Signa re Cert.No. SBD-6710(R.3/97) f County f Safety and Buildings Division Sl 201 W.MWashington Ave., P.O.6B2 x 7162 Sanitary Permit Number(to be le in by Co.) -7 pt n0014 S '�Permit Application State Transaction Nlupber In accordance with SFS 019 ubmission of this form to the appropriate governmental unit is required priorJQ,,MWbQX �e Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department off Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privy Law,s. 15.04(l m,Stats. �J JC I. Application Information-Please Print All Information // /V Property Owner's Name Parcel# n o 313% /oTZ- 50 000 Properly Owner's Mailing Addreff Property Location D U Govt.Lot 3 Z City,State Zip Code Phone Number ��/� �, /A, Section ,5 f f` rrcle on w N; R�E W U.Type of Building(c eck all that apply) Lot# or 2 Family Dwelling-Number of Bedroo Subdivision Name Block# ❑Public/Commercial-Describe Use ! AA 0,A ❑ City of ❑State Owned-Describe Use //�� CSM Number ❑ 0!l e of , Z d� t°,�lk� W Z 3 +-7-3 i er j Town of .S�/' _ III.Type of Permit: (Check on one box online A. Complete line B if applicable) x A. ❑New ll System �,-,, y YRe// placement System ❑Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner -� L,A IV.T e of POWTS S stem/Corn onent/Device: Check all that a 1 Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.DispersaVIrreatAent Area Information: Design Flow(gpd) Design Soil Application R gpdsf) Dispe al Area Required(sf) Dispersal Area Proposed(s System Elevation d 6 p �- VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units -CA J 0 New Tanks Existing Tanks c ° p 0 2 a U rn y M w C5 fir Septic or Holding Tank n r Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume respon ihifity for'nstallation of the POWTS shown on the attached plans. Plumber's Name(Print) Pl m ira MP/MPRS Number Business Phone Number u 94I 7 lumber's Address(Street,City,State,Zip ode) 011-9 1;2 r 4 C 4 oun /De artment Use Only Approved rsa Permit Fee Date Issu Issuing ent Signatur ❑ ven Rea or Denial / 1 1 IX.Conditball" easons for Disapproval dd11 , 3 1 5pt�q'tank,effluent filter antl � �- dispersal cell must all be servkes I maintained as per management plan provided by plumber. 0, Z L Ift mltst be;maintakl6d es per tlp0kilite C,WWI t;ir it ��c� ,�' ,�, ✓ Attach to complete plans for the system and sub to the County only on paper not 1 that rn x 11 inches in size G d s SBD-6398(R. 11/11) i KNUDTSON PLUMBING& CONTRACTING, LLC 827160TH ST.648447MPRS ROBERTS,WI 54023-8526 CELL 651-479-1737 Np ,1� / n 6 4 vV:�sa /von q4 t.S,P.�D l�• lee w w�d � �aK s , • X � o< � 2- 8�7�4q CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Vlasak System I Owner's Name: John& Sharon Vlasak I Owner's Address: 953 210th Ave i Somerset Wi. Legal Description: NW 1/4 NE 1/4 S 20 T 31 R 18W Township: Star Prairie County: St. Croix Subdivision Name: Lot Number. Parcel ID Number: 038-1082-50-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing&Cross-Section Page 4 Filter Seecs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber. Keith Knudtson License Number: 648443 Date: 06/04/2014 Phone Number (651)470-1737 Signature J Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 KNUDTSON PLUMBING& CONTRACTING,LLC 927150TH ST.648447MPRS ROBERTS.WI 54023-8526 C 651-4 1737 i e�v�7�rKfe� I� �vod ��.S,Pao�•� dr� rw�w�� Jr. s iota°f ��� $T— 2- t� � t Soil Absq-rpftn System Cross Section 88.96 ft SdNWUie 40 Fine!Grade 4' PVC Vent Pipe 5.00 ft Vifith Vent Cap Chambbeer --► 87.50 ft S.0 ~ m Elevation ft ft Soil AbsoERVgn System Plan View ft 3.00 ft i 5.00 ft � Leaching Trench 1 7Vent b servation Pipe Chambers 4'Dia. Trench 2 Header Leachlna Chamber Soeciflceftne Manufacturer And Model Infiltrator Quick 4 EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.50 gpd/sq ft 450.00 gpd Design Flow+ 0.50 Soli Application Rate + 20 EISA= 45.00 Chambers 00 2 rows of 23. chambers each. i i Page of Filters PL-525 EFFLUENT FILTER The PL-525 Filter is rated for I over 10,000 GPD (gallons per day) 1116" Filtration Slots Ahum making it one of the largest filters Accessibitty in its class. It has 525 linear feet Ilil ' 1 of 1/16" filtration slots. Like the Accepts Polylok PL-122, the Polylok Extension Harde 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. 525Lieear Ft.ofv,G No other filter on the market can FO,ationSIM ! Y make that claim. �• Rated for 10,000 GPO { PL-525 Maintenance: �o C&6- The PL-525 Effluent Filter should operate efficiently for several years9 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 filter contains an optional V/He this alarm, the owner will be notified, ' by an alarm when the filter needs � 5 servicing. Servicing should be applications itis 3' NSF certified for Gas Deffectm done by a certified septic tank residential use only. pumper or installer. E U.S.Patent No#6,015,488 -♦BA When Shut-Off f 1. Locate the outlet of the 5,871,640 septic tank. r — Remove tank cover and pump tank if necessary. PL-525 installation: 3. Glue the filter housing to G 3. Do not use plumbing when the 4" or 6" outlet pipe. If w filter is removed. Ideal for residential and com- the filter is not centered 4. Pull PL-525 out of the housing. mercial waste flows up to under the access opening 10,000 Gallons Per Day (GPD). use a Polylok Extend & S. hose off filter over the septic Lok or piece of pipe to tank. Make sure all solids fall 1. Locate the outlet of the center filter. See page back into septic tank. septic tank. 19-21 for Extend & Lok _ . Insert the filter cartridge back 2. Remove the tank cover and information. into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter the filter is properly aligned into its housing. and completely inserted. 5. Replace and secure the septic tank cover. Replace septic cover. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION SYSTEM SPECIFICATIONS Owner - _ Septic Tank Capacity G 9� ❑ NA Permit _ _ _ Septic Tank Manufacturer 1 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer/ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model - ❑ NA Number of Public Fac7ity Units '- = NA Pump Tank Capacity al 'MA Estimated flow (average) allday Pump Tank Manufacturer V sAA Design flow (peak), (Estimated x 1.5) _ gal/day Pump Manufacturer uA Soil Application Rate 01 57—al/day/ft' Pump Model ilA Standard lnfluentlEffluent Quality Monthly average* Pretreatment Unit "mot NA Fats, Oil &Grease (FOG) G30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter r' Biochemical Oxygen Demand (BODS) X220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Disrersal Cell(s) _ _ = `; ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L "round (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other. Maximum Effluent Particle Size i'ys m dia. ❑ NA ❑ NA Other: - - ❑ NA ❑ NA 'values typical for domestic wastewater and septic tank effluent. Other ❑ NA MAINTENANCE SCHEDULE Service Event Service icy fn tic ondition of tank(s) At least once every: ❑month(s) s) (Maximum 3 ears) ❑ NA yearis) Y Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑ axmth(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 0 nth(s) ❑ NA k-1 Ayear(s) Inspect pump, pump controls & alarm At least once every: ❑ month❑ysar(s) ) r-NA Rush laterals and pressure test At least once every: 0 Y mear(s) ANA Other. At least once every: 0 Ymonth(s) ❑ NA Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any mussing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. page of — sXm P AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellist. if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellist in one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or art-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs, degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides;sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not_be infringed upon by required setbacks from existing and proposed structure, lot limes and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ing jank ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that tune. <<WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone i05 4-76_ Phone SEPTAeE SERVICINe OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. t V 2DAtlti1 Phone '^ Phone This document was drafted in compliance with chapter Comm 83.22(2►(b)(7)(d)&(fl and 83.Wl), (2) &(3),Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer John Vlasak Mailin g Address 953 210th Ave Property Address Same (Verification required from Planning&Zoning Department for new construction.) City/State Somerset Wi. Parcel Identification Number 038-1 082-50-000 LEGAL DESCRIPTION Property Location NW '/4, NE '/4, Sec. 20 ,T 31 N R 18 W,Town of Star Prairie Subdivision Plat: , Lot# Certified Survey Map# , Volume , Page# Warranty Deed# (before 2007)Volume ,Page# Spec houseQyesOno Lot lines identifiable 0 yeso no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on t s form are true to the best of my/our knowledge. i/we am/are the owner(s)of the property described above,by virtue of a w my deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) IM-1060 �.. ' Features & Benefits • Strong injection molded polypropylene construction • Lightweight plastic construction t and inboard lifting lugs allow for easy delivery and handling • Integral heavy-duty green lids that interconnect with TWTm risers and pipe riser solutions • Structurally reinforced access ports eliminate distortion during installation and pump-outs • Reinforced structural ribbing and fiberglass bulkheads offer additional strength • Can be installed with 6"to 48" of cover The Infiltrator IM-1060 is a lightweight strong and durable septic tank. • Can be pumped dry during This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic tank, revolutionary improvement in plastic septic tank design, offering long-term pump tank, or rainwater exceptional strength and watertightness. (non-potable)tank Inlet Side • No special installation, backfill or TANK CUTAWAY Infiltrator water filling procedures are required TW Riser System HEAVY DUTY LID y CUTAWAY Reinforced 24"structural Partition access port baffle wall` i Structural bulkheads MID-SEAM CUTAWAY Reinforced water tight mid-seam gasketed connection IM-1060 General Specifications and Illustrations LIFTING STRAP UFfING LUG RISER CONNECTION (TYPICAL) (4TOTAQ (TYPICAL) The IM-1060 is an injection molded two piece mid-seam plastic tank.The IM-1060 injection molded plastic design A A allows for a mid-seam joint that has precise dimensions o°" 0°for accepting an engineered EPDM gasket. Infiltrator's o b gasket design utilizes technology from the water industry °Q °o nss EXTERIOR to deliver proven means of maintaining a watertight seal. MOTH The two-piece design is permanently fastened using a series of non-corrosive plastic alignment dowels and locking seam clips.The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. 127.0(32261 EXTERIOR LENGTH TOP VIEW I I OUTLET Working Capacity 1094 gal(4141 L) Total Capacity 1287 gal(4872 L) 543 Airspace 16.5% IT3897 EICTERIOR Length 127"(3226 mm) SEAM CLIP HEIGHT (TYPICAL) Width 62.2"(1580 mm) - LIFTING STRAP Length-to-Width Ratio 2.3 to 1 (TYPICAL) Height 54.7"(1389 mm) END VIEW t.iquid Level 44"(1118 mm) Invert Drop 3"(76 mm) 040027 0 24[6101 ACCESS OPENINGS WITH LOCIONG LIDS(2) -- PVC OR ABS �FIREEBOAWRD _.�'_' C OR Fiberglass Supports 2 INLETTEE 10212604[1021 Compartments 1 or 2 INLET 16.5% AIR SPA Maximum Burial Depth 48"(1219 mm) PER n.0 T PER c CODE Minimum Burial Depth 6"(152 mm) 44.0 L Maximum Pipe Diameter 6"(152 mm) 5L)ASS ['QUID FIBERGLASS LIQUID 1181 SUPPORT (TYPICAL) DEPTH (TYPICAL) WITH BAFFLE Weight 320 Ibs(145 kg) WALL WHERE REOU1RED SIDE VIEW TANKTOP CONTINUOUS HALF GASKET TANK INTERIOR SEAM CLIP ALIGNMENT DOWEL TANK BOTTOM 4 Business Park Road HALF P.O.Box 768 Old Saybrook,CT 06475 860-577-7000•Fax 860-577-7001 MID-HEIGHT SEAM SECTION IN s t LTR AT 0 4-1 1-600.221-4436 www.infiftratorsystems.com U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,163;5,588,778;5,839,844 Canadian Patents:1,329,959;2,004,564 Other patents pending.Infiltrator, Equalizer,Quick4,and Sidewinder are registered trademarks of Infiltrator Systems Inc.Infiltrator Is a registered trademark in France.Infiltrator Systems Inc.is a registered trademark In Mexico. Contour,MicroLeaching,PolyTuff,ChamberSpacar,MultiPort,PoslLock,QuickCut,QuickPlay,SnapLock and StraightLock are trademarks of Infiltrator Systems Inc. PolyLok is a trademark of PolyLok,Inc.TUF-TITE is a registered trademark of TUF-TITE,INC.Ultra-Rib is a trademark of IPEX Inc. ©2013 Infiltrator Systems Inc.All rights reserved.printed in U.S.A. IM02 1213 Contact Infiltrator - •, •r assistance at 1-800-221-44 P ARTM SAFETY AND BUILDINGS DIVISION � ; Plumbing Product Review 323_ 0 9 P.O.Box 2658 Madison,Wisconsin 53701-2658 3 TTY:Contact Through Relay S� Scott Walker,Governor A�ossro�AtiS Dave Ross,Secretary April 10, 2012 INFILTRATOR SYSTEMS INC. GOVERNMENT AFFAIRS DEPARTMENT 4 BUSINESS PARK RD PO BOX 768 OLD SAYBROOK CT 06475 Re: Description: SEWAGE TANKS, THERMOPLASTIC Manufacturer: INFILTRATOR SYSTEMS INC. Product Name: SEPTIC, SEPTIC/SEPTIC, SEPTIC/PUMP, PUMP OR HOLDING Model Number(s): IM-1060 (1060 GAL. ONE-OR 2-COMPARTMENT THERMOPLASTIC SEWAGE TANK; 1247 GAL. ACTUAL CAPACITY WHEN USED AS A HOLDING TANK;713.3/356.7 GALS.; INJECTION MOLDED POLYETHYLENE OR POLYPROPYLENE RESIN, 2-SECTION TANK WITH MID-LEVEL SEAM) [44.0 IN. L.L., 6 IN. MIN. AND 48 IN. MAX. DEPTH OF BURY; 507.6 G.P.D. WHEN USED AS A SEPTIC TANK;341.6 G.P.D WHEN USED AS SEPTIC/PUMP TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; SEE TABLE 1 FOR TANK CAPACITY IN ONE-INCH INCREMENTS;TANK DIMENSIONS (OD) = 127 IN. L X 62.2 IN. W X 54.7 IN. H] Product File No: 20120143 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384,Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of JANUARY 2016. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of the manufacturer's installation and servicing instructions must be given to the owner of the system. • When this product receives wastewater from dwellings, it will produce an effluent quality with a maximum monthly average value for BOD5 of less than or equal to 30 mg/L,TSS of less than or equal to 30 mg/L TSS and F.O.G. of less than 30 mg/L and fecal coliform of less than or equal to 10,000 cfu/100ml. • Before this product is installed a warning label meeting the requirement of SPS s. 384.25(8)(b), Wis. Admin. Code must be securely attached to the manhole cover. SBD-10564-E(N.10/97) File Ref:12014301.DOC INFILTRATOR SYSTEMS INC. Page 2 April 10, 2012 Product File No: 20120143 • BEDDING: Tank bedding consisting of native soil (without rocks or protrusions) or 4-inch depth of granular material—pea stone, sand or gravel. Anti-buoyancy control measures may be required if the IM-1060 tank is to be installed with less than 16 inches of soil backfill cover and the seasonal high groundwater table has the potential to rise above the elevation of the tank bottom. Otherwise, no control measures are required. If the seasonal high groundwater is higher than the elevation of the tank bottom at the time of installation, coverage with at least 16 inches of soil backfill cover will eliminate the need for anti-buoyancy control measures. For backfill depths of less than 16 inches, the need for anti-buoyancy control measures must be determined based on backfill cover depth and height of groundwater above the tank bottom. If the groundwater table has the potential to rise above the elevation of the tank bottom, see the attached document(s) for information on the types of controls and applicable backfill and groundwater conditions. • This tank is approved to use the following: . The tank is provided with 3 ports on each end (one from each side, one for the tank end) used for inlet and outlet piping, depending on site configuration(s); Four-inch diameter inlet and outlet piping, Schedule 40 or SDR 35. Department-approved effluent filter installed in accordance with the product approval for the filter including a properly sized and located access opening for service and maintenance. . Inlet/outlet pipe water tightness is provided though the use of a rubber gasket, Serco Septic-Tite gasket. See tank wall penetration detail in attached document(s). . Mechanisms for pump electrical connections from riser lid or other locations in riser must be completed in conformance with the riser manufacturer's instillation instructions. . Compatible risers include 24-inch-diameter riser products—Infiltrator TW Riser, EZset by Infiltrator, PolylokO, Inc., and Tuf-Tite®Corporation;other state-approved risers recommended by Infiltrator. Maximum riser height is as per the state-approval and riser manufacturer's installation instructions. • BACKFILL: Backfill with suitable native soil. If native soil is unsuitable, replace unsuitable fraction with suitable soil. Suitable soil includes soil textural classes defined in the United States Department of Agriculture soil triangle. Suitable soil textural classes are based on the tank installation depth, as measured from finished grade to the top of tank. See detailed information on backfill suitability in the attached document(s). • attachment A B and C. Additional information is included as attachments to this letter;see attac e t , This approval supersedes the approval issued on 1/12/2012 under product file number 20100475 This approval letter shall be incorporated with your previously approved plans and/or specifications approved under product file number 20100475. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Jean M. MacCubbin, CST Engineering Consultant--Plumbing Products Review DSPS WEST, Safety& Buildings Div. PO Box 2658 201 W Washington Ave. Madison WI 53703-2658 Phone: 608-266-0955; Fax:608-283-7456 E-mail: Jean.MacCubbin@WI.GOV gj� SOIL EVALUATION REPORT #1209 - � ` s �' �i Department of Safety and Professional Service:SPAID Page 1 of 3 C Division of Safety and Buildings cco Keith E.Stoner in a rdah Comm 85 Wis.Adm.Code ��: County Attach comp n paper not less than 8%x 11 inches in size. Plan must St.Croix include to:vertical and horizontal reference point(BM),direction and cale or dimensions,north arrow,and location and distance to nearest road. Parcel I pV 14 038- 2- O���Please print all infwnation. Rev By Date Personal intion you for secondary purposes(Privacy Law,s.15.04(1)(m)). Property O CEJ I Property Location John \'� Govt.Lot NW1/4, E1/ ,S20,T31N,R18W Pro er's Mailing Address Lot# Block# I Subd.Nam or CSM# 953 a21 0th Ave City State Zip Code Phone Number ❑ City ❑Village ® Town Nearest Road Somerset WI 1 54025 1 Star Prairie 1 953 210Th Ave ❑New Construction Use: ® Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD ®Replacement ❑ Public or commercial-Describe: Parent material Sandy loam till Flood plain elevation,if applicable NA ft. General comments Propose 2 cells of leaching chambers using a.5 SAR Tx 94'. Center the upslope cell over the 89.79 contour w/SE=88.25'. Center and recommendations: downslope cell over the 89.1)0'contour w/SE=87.50'. Centertlines of cells staked onsite. F1-1 Boring# E]Boring ®Pit Ground surface elev. 88.96 ft. Depth to limiting factor 76 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-4 10YR2/3 - sl 2mgr mvfr cs 3f-co 0.6 1.0 2 4-23 10YR3/3 - 1 sl 2msbk mvfr gs 3f-co 0.6 1.0 3 23-36 5YR4/4 i I sl 2msbk mvfr gs 2f-oo 0.6 1.0 4 36-50 5YR4/4 - sl 2fsbk mvfr gs 1f-co 0.6 1.0 5 50-76 5YR4/4 - sl imsbk mvfr gs if 0.4 0.7 6 76-81 5YR4/4 f2d5YR5/8 sl m mfr - - 0.2 0.6 2]Boring# Boring ®Pit Ground surface elev. 88.66 ft. Depth to limiting factor 56 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-12 10YR2/3 - sl 2mgr mvfr a 3f-oo 0.6 1.0 2 12-28 10YR4/3 7 sl 2msbk mvfr gs 3f-co 0.6 1.0 3 28-40 5YR3/4 rt sl 2fsbk mvfr gs 2f-oo 0.6 1.0 AAA 4 40-56 5YR4/4 - sl imsbk mvfr gs lf-CD 0.4 0.7 5 56-84 5YR4/4 c2d5YR5/8 sl m mfr - if 0.2 0.6 "Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L `Effluent#2=B005<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature: CST Number Keith E.Stoner 224059 Address Keith E.Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd.Siren,WI 54872 5/29/2014 715-653-2324 SM-6330(IL 11/11) Property Owner John Mask Parcel ID# 038-1082-50-000 Page 2 of 3 3] Boring# ®Boring Pit Ground surface elev. 89.86 ft. Deem to limiting factor >$0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. "Efr#1 *Eff#2 1 0-4 10YR2/3 - sl 2mgr mvfr fs 3f-oo 0.6 1.0 2 4-17 10YR4/3 - sl/Is 2fsbk/imsbk mvfr gs 3f-M 0.6 1.0 3 17-27 10YR4/4 - sl 2fsbk mvfr gs 2f-m 0.6 1.0 4 27-56 5YR4/4 2msbk mvfr gs if-m 0.6 1.0 5 56-80 5YR4/4 �� sl m mfr - if-m 0.4 0.7 1 411 No redox visibel although soils very moist at 68" F-I ❑Boring Boring# Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Ef#2 F-I ❑Boring Boring# El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. "Eff#1 *Eff#2 /C� 7 *Effluent#1=SOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5-s 30 mg/L and TSS<_30 mg/L The Department of Safety and Professional Servicese 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. Page 3 of 3 Lot width 305' CIL of 210 th Ave. FN#953 210 th Ave. Soil Test Site Plan 0 2s 50 For: John Vlasak Parcel in the NWl/4-NEl/4 omphk soak (F"O Sec.20 T31N-R18W 1 inch- do & Town of Star Prairie-St.Croix County County BMDetail BM#2=Top S.E Corner of Last Smallest Step. Elev.=99.30' 10 Acre Parcel ABM �o Garage A BM#2 Elevation Data #1 Three Bedroom Horne B#1 =88.96' Exis �BM Patio ting Sepdc B#2 = 88.66' Tankand o B#3 = 89.86 Inspection 94.86 A BM#2 Effluent Level=93 37' •WELL Lot Depth 1075' 92.26' Existing Drain Field Vent 0 89.96' / Appraz.P/L 89.00' 89.71' Open Yard / 88.00' 89.56' 89.00' % V +t3 89.00' � � P/L 1 2 89.96' 91.00' A BM=Top Center of 2nd Concrete Step from Patio * HRP=Same ASSUMED ELEV.= 100.00' May 29th,2014 ' =Backhoe Pit Keith E.Stoner CST#224059 1 KEITH E. STONER LAND USE CONSULTANT, CERTIFIED SOIL TESTER AND DESIGNER OF SANITARY SYSTEMS 23220 Wood Creek Rd. Siren Wisconsin 54872 Phone(715)653-2324 Adventurers p_Centuryte Lnet June 2nd,2014 To whom it may concern: Regarding the soil application rates applied to the sanitary system design I reviewed the In-Ground Absorption Component Manual (Version 2.0) particularly Table 2 Size and Orientation and page 12-33 B. Component Design.. States that the design of the component is based upon the DWF and the soil characteristics. It must be sized such that it can accept the daily wastewater flow without causing surface seepage or groundwater pollution. Consequently,the surface area of the treatment and dispersal zone,which is the in situ soil area beneath the component, must be sufficiently large enough to absorb the applied effluent into the underlying soil. The component must also be designed to avoid encroachment of the water table into the treatment and dispersal zone. For this design I have placed the dispersal cells on the contours and propose a system elevation that puts the system elevation 18 inches below the grounds surface. This depth at B#1 allows for the lower cell to have at least 32" of the sandy loam with a moderate structure below the system with an additional 4" of sandy loam with a weak structure with a SAR of.4 making up the 3 ft. separation. B#2 provides only 22" of the .6 SAR with the additional separation made up of the .4 SAR. And lastly B#3 provides for 38"or the total separation requirement with a.6 SAR. Based on the mowed yard site and a landscape position with a 5% slope the proposed dispersal cells will be able to take advantage of the evapo-transpiration that an open grass site provides as well as lateral water movement down slope drawing effluent away from the dispersal cells. With almost two thirds of the required three foot separation provided in our most restrictive boring and basically the entire separation provide in the other two borings I believe a soil application rate of.5 gal./day/sq. ft. will meet the intent of SPS 383.44(4)(a)and(c). Please review and call with any questions you might have. I Thank you very much for your time. Oe�� Keith E. Stoner CST#224059