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SAN-2018-340
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 [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: Adam Helgeson City Village Township TOWN OF EAU GALLE CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length IDia. I Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 606937 State Plan ID No: 3076217 Parcel Tax No: 008-2009-1 1 -coo Section/Town/Range/Map No: 01.28-16.578 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht I n let St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type Of System: PIL BLDG WELL LAKE/STREAM LEACHING CHAMBR UNET OR Manufacturer: Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER m Pressure Svstems Onlv YY Mnund Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ® Yes ®No ®Yes ®No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2697 59TH AVE 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover = Plan revision Required? ® Yes ® No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. v - . 46 ety Buildings Division COLintv St. Croix oc� 0 20 W ington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) di dison, WI 53707-7162 C, c ............ 4, r.._..w�._ ant Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to Me ap ro nit 7 (AOZt`7 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are s, mitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary pur I poses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 2697 59th Ave. 1. Application Infor'on - Please Print All Information Property Owner's Name Parcel # Adam Helgeson 008-2009-11-000 Property Owner's Mailing Address Property Location 1 2447 50th Ave. Govt. Lot NE /4, NE 1/4, Section 1 City, State Zip Code Phone Number woodville, W1 1 54028 651-278-5183 ircle T 28 N. R 16 (c' E oonsL ; ff) 11. Tvpe of Building (check all that apply)Lot � # Subdivision Name X I or.3 ) Family Dwelling - Number of Bedrooms is Block F1 Public/Commercial - Describe Use Ndn ^W W City Of El State Owned - Describe Use I ❑ Village of CSM Number Town of _ Eau Gale 111. Ty e of it: (Check only one box on line A. Complete line B if applicable)X-00- A. X New ,!LSystem' EJ Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. 11 Permit Renewal ❑ Permit Revision El Change of Plumber F1 Permit Transfer to New I., ist Previous Pen -nit Number and Date Issued Before Expiration J_ I I Owner 019ft IN'. l'ype of POWTS System/Componcn t/Dev ice: (Check all that v[• F1 k2m 1/Non-Pressurized In -Ground El Pressurized In -Ground ❑ At -Grade, o d 4 S f Z-2h1 soil ound < soil El Holding Tank 0 Other Dispersal Component (explain) explain) V. Dispersal/TpVcat ent Area InformatIA: Design Flow (9 Design Soil IV plicat' n Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro;(sf1 6 7 System Elevation 450 .8 1 ZA W 1) VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units -0 &,--' 0, U Q New Tanks Existing Tanks f.,Cq. 0 Un r� Septic or Holding Tank X 1400 2 q Lewis Bjork LLC X J Dosing Chamber X 17:2ptl 1 � I Lewis kfork LLC X I I I I VII. Responsibility Statement- 1, the un Irsigned, assume responsibility foEjnstadlativ of th4POWTS shown on the attached plans. Plumber's Name (Print) is S_ian MP/MPRS Number Business Phone Number Lewis Bjork 253976 715-231-7375 Plumber's Address (Street, City, State, Zip Code"�.��� E7818 County Road E, Menomonie, W1 54751 A VIII. Coun Milepartment Use Only A/ Pr P pp o�,ed rov I Permit Fee Date sued 1 Issul gent Signature I � $ 06 ;/;; // ;C en en Reason for Denial IX. Condi easons for Disapproval 10.0 1 rl.,=. - r'. k r effln vfim Air end mop ." �fl must W1 be !jrirJq.7s1 61%4w� Is per #-par.3�emeW plan Poo mlde(i tiv plumbe,' VLL 40�w 2. AM PA&w* wq64w.-oms rn 1M oe ;raiWi?A "" as ;w i r pq r rk Is co*.t /,:rdinamcsi. Attach to complete plans for the system and submi r o the County only on paper not less than 8 1/2 x I I inches in sire ;9 SBD-6398 (R. 11/ 11) CHECK BOX AS APPLICABLE_ SOIL EVALUATION SITE MAP PROJECT NAME: Adam Helgeson CHECK BOX AS APPLICABLE. Scale: 1 40' PAGE 2 OF 0 40 60 80 YSTEM-.� LOT PLAN 101 77 DESIGN FLOW,- 450 GPD Attach design flow calculations for commercial plans, PROJECT ADDRESS: 2697 59th Ave Pipe Material / ASTM Standard (Tables 384,30-3 & 384.30-5) NSanhary Sewer, 4 L 3034 BM Symbol: BM Elevation: 100 FT 2 40 Force Main: sch BM Description: Top of 1112" pvc pipe on South P/L Slope Gradient (%) 5 Well Symbol (It applicable): ID Indicate north by arawing anamm- IMPORTANT: Show ground elevation contours at suitable Intervals, Oaf Tested Area: on the approprite kne. Sot & r v s y A,50, V'�111 Y� 61 March 21, 2018 OUST ID No. 253976 LEWIS C BJORK LEWIS BJORK LLC E7818 COUNTY ROAD E MENOMONIE WI 54751-6637 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/21/2020 SITE: Adam Hel(yesoii 2697 59TH Ave Town of Eau Galle St Croix County NE 1/4 9 NE 1/49 S 1, T2 8N, R I 6W FOR: DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY W1 54304-5211 Contact Through Relay http-//dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Laura Guti6rrez, Secretary A TKV: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016-7708 Identification Numbers Transaction ID No. 3076217 Site ID No. 847379 Please refer to both identification numbers, above, in all correspondence with the agencl. Description: Mound System (3 Bedrooms - New Construction Object Type: POWTS Component Manual Regulated Object ID No.: 1752366 Maintenance required; 450 GPD Flow -rate-, 18 in Soil minimum dei2th to limitina factor from orizinal aradei; System(s): Mound Component Manual - Ver. 2.0, SBD - 1069 1 -P (N.0 1 /0 1, R. 10/ 12), Pressure Distribution Component Manual - Ver. 2.0. SBD-10706-P (N.01/01, R. 10/12), SSWNIP Pub. 9.6; Effluent Filter 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 10 1.0 1 (10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area. • Divert surface water from POWTS Area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire. the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wettoprepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 LEWIS C BJORK Page 2 3/21/2018 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing ad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approvedplan. Any changes may result in pump resizine to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. if no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(I). • 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/instal lation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ��w Va4� co� Tim Vander Leest Private Sewage Plan Reviewer, Division of Industry Services (920)492-2214 , Mon- Fri, 6:00 a.m. - 3:30 p.m. tim.vanderleest@wi.gov Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Payment Submittal. WiSMART code.733 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. LEWIS C BJORK Page 2 3/21/2018 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing ad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing ad is located. • Verify property lines) prior to installation. • Pum Floats to be set and verified Pera roved plan. _Anv changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities 1��.r N� T/��. AN Ark /r�1MA A/y►�A /ti►ti L1Y• -- - MOB 'Mi've ry I��rpy /�T t •f+ 10++pb9- 7"hI77A v-s t ♦Yw f+�rtll�7/1T i7•f? 1+1Y1 lF s l ll�+ Cuil CLIL, G Y` 1341 , cul41 %.f 11 �7LLVJ\+4VL%-' L V YY II`rl, J�141� LUO %OI Y b i.L VVVL 4�LLJ 1L+4i V1 i11V1414i111 1L1J41 LiV41V1LJ 1 V 4L4111� to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, czw i�41e" co� Tim Vander Leest Private Sewage Plan Reviewer, Division of Industry Services (920)492-2214 , Mon- Fri, 6:00 a.m. - 3:30 p.m. tim.vanderleest@wi.gov Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Payment Submittal. WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application C'EN INDEX AND TITLE PAGE R� Project Name: Adam Helgeson - New Mound Design Owner's Name- Adam Helgeson Owner's Address- 2447 50th Ave Woodville W1 54028 651-278-5183 Legal Description: NE NE 1 28 16W Township: Eau Gallie County: -St. Croix Subdivision Name- White Pine Meadows Lot Number: 11 Block Number: Parcel I.D. Number: 008-2009-11-000 Plan Transaction No.: 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 Plot plan Page 11 ATT. Filter , Manhole , level alarm soil report Page 12 Tanks used Designer: _LgwLs_E4Qrk License Number: 253976 Date: Phone Number: 715-231-7375 Signature-,, rz 1-2== I I\J Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (R. 03/2012) Pagel of 10 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) r Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in -situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of <= 36 inches. 450.00 Design Flow (gpd) 6.00 Site Slope (%) 98.70 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.80 In -situ Soil Application Rate (gpd/ft2) Distribution Cell Information 70.00 Dispersal Cell Length Along Contour (ft) 6.43_lCell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Pressure Disribution Information network? Enter Y or N (C or E) e, Center or End Manifold 3.22: Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. r 0.188 Orifice Diameter (in) 3.75 Estimated Orifice Spacing (ft) 11.84 1 ft2 /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) 90.00 Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 Vertical Lift (ft) Friction Loss (ft) 9.70 0.55 0.00 In -line Filter Loss (ft) 13 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. options choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information (2)700 1 Septic Tank Capacity (gal) Lewis Bork LLC Manufacturer Does the forcemain drain back? I Y Enter Y or N 6.52 Forcemain Drainback (gal) 5x Void Volume (gal) Minimum Dose Volume (gal) System Demand (gpm) 62.92 69.45 24.90 Manifold Diameter Selection in. dia. options-_ choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) irgotal Tank Capacity (gal) 0 otal Working Liquid Depth (in) gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 700.00 Dose Tank Capacity (gal) orenco Filter Manufacturer 18.85 Dose Tank Volume (gal/in) Filter Model Number Lewis Bork LLC j Manufacturer Project- Adam Helgeson - New Mound Design Page 2 of 10 W A Mound Plan and Cross Section Views ................................. * ... * ........... .... ...................... .................. 1 /10 B ................ . . . . . . . Observation Pipe ' * ' ' ' ' * ' :[:•:•: .... ...... ........ ........ ............... ............ ........ 0 C .... .... .............................. B........... ............................. I ....................... —, ............. --* .............................. ................................... * ................. ..................................................... ........................................... 11 ........ .......... ................................... ...... ............................................. ...... ............................................. .......................................... ............................................ ........... I ......................................... ............................. * ....................... ..................................................... .................................................... .......... * .......................................... .................................................... ................................................... ................................................. Mound Component Dimensions A 6.43 ft E 22.63 in B 70.001ft F 1 9.50 in D 18.00 in G 0.50 ft 450.10 (ft2 ) Dispersal Cell Area 6.43 (gpd/ft) Linear Loading Rate -1 H 1.00 ft K 10.45 ft 1 1 11.62 ft L 90.91 ft J Tlo ft W 25-15 ft 1263.84 (ft2 ) Basal Area Available 7.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 10 1. 99 (ft) H G F .................. Dispersal Cell 100.70 (ft) Lateral 100.20 (ft) Invert ........... ............ ............ . . ....... .. Dispersal Cell . .................. ...... ........... ........... ... ...... .......... .. ...... ......... .............. . ............. o ....................... .............. .............. ....... ...... Elevation ..... ........ D ..... ...... ....... .......................... .................. ................. .............. ................................. ......................... .......... . ................... . ............... ............. :* 98.70 (ft) Contour Elevation 6.0 % Site Slope Geotextile Fabric Cover Shading Key Am, a T Dispersal Cell See lateral details on P-1 Topsoil Cap 0 CL 1.5 ft 0) 0 0 Page 4 for number, size, and spacing of laterals. 2 Subsoil Cap (i T 0 le-� Laterals are equall y F21 ASTIVI C33 Sand 00 F spaced from the Tilled Layer El Aggregate 0.5 ft 0 H I Typical Lateral distribution cell's centerline in the 16 AL Ir 71 A distribution cell (AxB). Project: Adam Helgeson - New Mound Design Page 3 of 10 End Connection Lateral Layout Diagram L yrwr � I rt r ►- .1 F r 1, t oi- A ... P G d r, -7 1 r, Turn -up vat bail valve or aleancout plug A x Holes drilled on the bottom of the lateral T FFoice �..IkAally spaced main connection via tee or cross to maroold at -anq point. Laterals Morcemain Sch 40 PVC per SP`_'. Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.81 ft Lateral Length (P) 68.58 ft Orifices per Lateral 19 Lateral Spacing (S) 3.22 ft Orifice Density 11.84 � ft2 /orifice Lateral Flow Rate 12.45 gpm Manifold Length 3.22 ft System Flow Rate 24.90 gpm Manifold Diameter 1.50 in Total Dynamic Head 13.50 ft Forcemain Velocity 2.54 ft/sec [In-qp- Tank 1nfnrmnfinn P_ Electrical as per NEC 300 and oo SPS 316.300 WAC Tank component is properly vented Lewis Bork LLC Capacity 700.00 Volume 18.85 Dimension Inches Gallons A 19.45 366.65 B 2.00 37.70 C 3.68 69.45 D 12.00 226.20 Total -1 37.141 700.001 Locking cover with warning label and locking device and sealed watertight Ct 4 in. min. Alarm Manuafacturer SJE-RomBus Alarm Model Number 1011421 Pump Manufacturer Zohler Pump Model Number 152 Pump Must Deliver 1 24.90 1 gpm at 1 13.501ft TDH Alternate outlet location Forcemain diameter a 2 in. Weep hole or anti - siphon device Pump off elevation (ft) r 91.00 0:0] Dose tank elevation (ft) IR 1 90.001 Note: Switches containing mercury may not be used in this system. Project- Adam Helgeson - New Mound Design Page 4 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Lewis� Bjork LLC Phone715-231-7375 POWTS Regulator's Name st. Croix County Phone 715-386-4680 1 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD51 220 mg/L Septic Tank Capacity (2)700 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450.1 ft2 Maximum FOG 30 mg/L Type of Wastewater[ Domestic Maximum Fecal Coliform >10E4 Jcfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Frequency Inspect and/or service once ever 3 yea .. r q% y Should inspect and clean at least once every 3 years Test once eve [y 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years 3 years Inspect every �pect for ponding and. seepage once eve _Lewis Bork, for Pumping 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)(i), 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 ............... ................. ........ ....... Threaded Cleanout r . ....... ... 6-8" Diameter Lawn 0 1"**.*'1'.*'**1'1* ..... * ....... ........ ......... Plug or Ball Valve Sprinkler Valve Box ........ .......... ......... .......... .......... .......... ......... .......... ........... .......... .......... ........... .......... ........... ........... .......... ........... .......... .......... ........... ........... Distribution . -...................... . Long Sweep 90 or Two 45 Deqree Bends Same Diameler as Lateral Project: Adam Helgeson - New Mound Design Page 5 of 10 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SIPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N-01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] 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 septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. 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 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 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 infiltrative 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 BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 CfU/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. Contingency 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 1© CHECK BOX AS APPUCABLe. CHECK BOX AS APPLICABLE. PAGE I OF SOIL EVALUATION Scale: 111 - 40' YSTEM SITE MAP 0 40 60LOT 80 PLAN PROJECT NAME: 102_ DESIGN FLOW-.450 GPD --- Adam HesonAttach elg t // design flow calculations for commercial plans. PROJECT ADDRESS: 2697 59th Ave Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) BM Symbol: BM Elevation: 100 _FT NSanitary Sewer: 401 3034 Maln: 2" sch 40 BM DescrIption: To of - 11/2" Lvcpipe on South P/L Force Slope Gradient (%) of Tested Area: 5 Well Symbol (if appilcable): Indicate north by drawing an arrow IMPORTANT: Shaw ground elevation contours at suitable Intervals. on the approprhe Ore. Sol AeSB Ar/wnYJ 11 VV1 + �1 -traM I , Slro 4� a7Dli, Sficc�' �Jo �1�i'� ClG ow So E �7Y�' .7 /ldOsnS sFr l�,V4 TssvFs 150 Series Effluent Pumps I Zoeller Pump Cot-npany littps:)',/www.zoellerpunips.coni!en-na/products,,'suiiip-effluent-pumps/ef.. LU 2 z L-1 I L-1 1%j 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE I? of 5 2 2/21/2018, 10:05 AM FT -Series Base In[e+- L'f fluent Filter-c� Product 5heet > TechnicaL Das •at > A. M.AMI& TufowTl'te Ri'ser Sys-tef A Ti d Concrete L Safety Lid - te" I Safety Pan W" Tall Riset low,, Availatt,.,ok7 in 12 14 12 Tall Riser . ..... Tank Adapter Ring (7 F I Tank Al ErtO AB Indoor Alarm System Auto Reset, Battery Backup) The Tank Alert' AB indoor alarm system monitors liquid level conditions in lift pump chambers, sump pump basins, holding tanks, sewage, agricultural, filters and other waste applications. The sleek design of the alarm features a user friendly touch pad with colored LED indicators for easy visual detec- tion. The alarm horn and red LED indicator activate for a high water alarm condition. Once the condition is cleared, the alarm automatically resets. The green LED indicates 120V primary power to the alarm. If primary power fails, the alarm continues to work due to 9V battery backup. 0 NEMA 1 rated enclosure for indoor use 0 Automatic alarm reset 0 9 VDC battery backup with low battery chirp 0 Colored LED indicators: 0 Red alarm 0 Green power on 0 Alarm test switch 0 Horn silence switch 0 External terminal block for easy Aoat Installation 0 Includes 15'SJE SignalMaster" control switch • Alternative float models for high and low level alarm • Optional auxiliary contacts for remote devices 0 1011421 TA AB, High, 15'SJE SignallVlaster SIGNALING tR5424', LISTED 288X battery t door 'T J N "test" button silence" button alarm" light "power on" light j! 1 attach float switch here mounting flange power cord www.sjerhombus-com Toll Free 1-888-342-5753 Phone 218-847-1317 �3 SE-F0XrtLS Rev C2113 DIVISION OF INUU61 KY )tt1V1Ut--0 PO BOX 7302 MADISON WI 53707-7302 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor 6 Laura Guti6rrez, Secretary May 19, 2017 OUST ID No. 253976 LEWIS C BJORK LEWIS WORK LLC E7818 COUNTY ROAD E MENOMONIE WI 54751-6637 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/31/2022 Identification Numbers Transaction ID No. 2944957 L Site ID No. Please refer to both identification numbers, aboven all correspoiidelice with the a�nqy. Re: Description- SEWAGE TANKS, CONCRETE Manufacturer: LEWIS WORK, LLC HOLDING (TANK AND ADAPTOR ) Product Name: CtYrans id 2944957) SEPTIC, PUMP OR Model Number(s): L13700, LB1 150 (700 AND 1150 gals.) [LB700 BASE TANK; LB1 150 CONSISTING INU OF 3 SECTIONS WITH THE 450- GAL. ADAPTOR AS THE MID -SECTION] [38 IN. L.L., 18.85 GAL/IN,; 96 IN. MAX. DEPTH OF BURY, 335 OR 551 GPD WHEN USED AS A SEPTIC; TANK BASED ON A 3 YR, SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; TANK DIMENSIONS = 66 IN. L X 36 IN. W X 54 IN. H; ADAPTOR DIMENSIONS = 66 IN. L X 36 IN. VV X 24 IN. H1 Product File No: 20170151 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 May 2022. �l suersedes the approval issued on 6/2 8/2012 under product file number 20120193. This approva p This approval is contingent upon compliance with the following stipulation (s), 0 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 arid specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. 0 All manhole covers terminating at or above grade must have effective locking devices. WhE.%n 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 rng/L, TSS of less than or equal to 30 mg/L TSS and F.O.G. of less than 30 mg/L, ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/BuyerAdam Helgeson Mailing Address2447 50#h Ave. Property Address 2697 59th Ave. (Verification required from Planning & Zoning Department for new construction.) City/State Woodviile,Wl Parcel Identification Number 008-2009-11-000 LEGAL DESCRIPTION Property Location NE 'A NE IY4. Sec. 1 T 28 N R 16 W, Town of Eau Galie Subdivision Plat: White Pine Meadows Lot Certified Survey Map # Warranty Deed # Spec house OyesElno Volume Page 4 (before 2007)Volume , Page 9 Lot lines identifiable El yes]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic systein could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank ever), 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 oil -site wastev�,ater 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. Fwe, 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 Sen1ces 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.,,Nve certit�y that all statements o his form are true to the best of nlyiour knowledge. 1/we ainiare the owner(s) of the property described above. by virtue of arrant), deed recorded in Register of Deeds Office. Numb r of bedrooms 3 SIGNATURE CIF 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 neap if reference is made in the warranty deed. (REV. 04/12) Documaq*&&r\0p�Ne State Bar of Wisconsin Fon-n 1-2003 WARRANTY DEED Document Name Tf&illED, made between Wisconsin Tile & Stone., Inc., a Wisconsin corporation and Adam K. Helgeson, a single 2erson ("Grantor," whether one or more), ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See attached Exhibit A 1046867 BETH PABST REGISTER OF DEEDS ST. CROIX CO,, WI RECEIVED FOR RECORD 04/28/2017 8:45 AM EXEMPT#: REC FEE: 30.00 TRANS FEE: 75.00 PAGES: 2 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address Land Title, Inc. 2200 West County Road C, Suite 2205 Roseville, MN 55113 LT File No. 553585 008-2009-11-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, Restrictions and Covenants of record, if any. Dated April 27'h, 2017 Wisconsin Tile & Stone, Inc., a Wisconsin corporation (SEAL) cp (SEAL) * Brian A. Hanson, President (SEAL} (SEAL) AUTHENTICATION ACKN0WLF'.D(-,NI ENT 0 Signature(s) STATE OF Wisconsin authenticated on `'-,`��' •' �'�°��� St. Croix COUNTY cc OF 05, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Larry S. Mountain, Attorney at Law Personally came before me on April 27",--2017 the above -named Wisconsin Tile & Stone, Inc.., a Wisconsin corporation,corporation, by Brian A. Hans -on its President t me known to be the perso s) who xecuted the foregoing i and ac ow ged e M ff eri*reJJ. Bune Notary Public, State of WisLlonsin My Commission (is permanent) (expires: 10/17/2017 (Signatures may be authenticated or acknowledged. both are not necessary.) NOTE: Tills IS A STAND,MID FORM. ANY ,MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENT11:11"11). NVARRANTY DEED C' 2003 STAI-E BAR OF NVISCONSIN FORNI NO. 1-2003 Tvpe name below SiUllatffes. St. Croix County 1046867 Page 1 of 2 LT File No. 553585 EXHIBIT A Lot 11, County Plat of White Pine Meadows, Town of Eau Galle, St. Croix County, Wisconsin. St. Croix County 1046867 Page 2 of 2 2 BEAR ELEVATION 1-9 ! nE ELEVAIM al NZERTM XQ HgWA mD I� U a M (7 Z 5) 24 8-3010 3-tlorslymrdw* corn r C or4utAm d•r Ae. a.. AA..0 Ph+ FM t-r s•r -s,rJ- ,' r Wisconsin d"t:partment of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less `tha 8 111 inches in size. Plan must include, but not limited to: vertical and horizontaiil qeoe point (BM), direction and Parcel I.D. ad. 004 percent slope, scale or dimensions, north arrow, andjopation and distance to nearest road. R iew Date Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7- ,�j � .� � �� Property Owner Property Location Govt. Lot A; 1 1/4 E (or W P60--i A�, 1/4 S T N R rk� Lot # Block # Subd. Nam or CSM# Property Owners Mailing Uj S C� city State Zip Code Phone Number ❑ city 0 Village own Nearest Road J _ �� GPD 05--Kew Construction Use: Ekkesidential Number of bedrooms Code derived design flow rate• 7 Replacement Public or commercial - Describe: Parent material c5o(fkT� Flood Plain elevation if applicable VA 24 % - General comments 8 /I , I d' e- _ 0 1( ��� r _{��� and recommendations: �, % J 0 V1 -Fou�� Fle L) Boring 9 Boring Ground surface elev. Kli Depth to limiting factor in. Horizon Depth Dominant ColorRedox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. % �- c 0'-1 I I jai 44 7.5y i C" [] " Bo ing goring Pit Ground surface elev. Yc�, Y ft. Depth to limiting factor ,,2_in. Horizon Depth Dominant Color Munsell CAL Redox Qu. Sz. Description Texture Structure Consistence Boundary K0015 Cont. Color Gr. Sz. Sh. !I- -D0- SoiLAtMlication Rate GPD/ff *Eff#1 *Eff#2 61 c Soil Application Rate _GPD/f`F *Eff#1 *Eff#2 C Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BODI 530 mg/L and TSS _< 30 nVL Sign CST Number CST Name (Please PdnU e- Address e (1, - Date Evaluation Conducted Telephone Number 76 1�) LIcc-)II 1_7 Property Owner PC-U, e - 0 tl**-- Parcel ID # Page o� of 3Boring # ❑ Boring m / Ground surface elev. q7, � ft. Depth to limiting - factor in.Lam' P � tSoil I icaUon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 61, q 10 ff !U � d ID Y((- u i ❑ I Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Soil Application Rate GPD/ff *Eff#1 I *Eff#2 i ❑ Boring Boring # ❑ Ground surface elev. ft. Depth to limiting factor in. Pit Soil 6Wicafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/M in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 5 150 mg/L * Effluent #2 = BODE 5 30 mg/L and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R 07/00) i r P"ty owner Paax--t... I PaioW ID M a owing it 0 BorkV COOM0001 &wxM wMos Nev. 0? Z s R. oeM bnMwoc,C wftb IM ❑Pit Depth b 1hW* Q (actor In. �naund surface ele~+. ft. Sol Aab Horizon I Depth DOndW1 Color �tedooc #i c "k)n Twdure 8truaure Coi-iena BOWWWy #toots C3P In, MunaelI Qu. OL Oon#. Cvtor - - Car. Rz. Sh. ❑ OWN . . 0 PitAodaft GrovN auriaos ela% (t. Depth to ttmltinQ (aoW tn. Menton Depth Dominant COior Texture OWL" Con tents Boundary h Mur" Chu, SL Cont. COW Sz. Sh, *a I i • EMuent 81 a BODE :0 301220 MgAL and TSS W c 160 n & ' Mod 02 w SODS 130 nV& and T88130 rrqL The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to aces cervices or need material In an altemate fomut please contact the deparbneant at 608,266-3 l S l or 'l"'t'Y 608464.8777. �►na.usot+�oo� i ad,d end „Y1 3,o dol. � o0 00 l