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HomeMy WebLinkAbout014-1018-60-000Visconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL IN~ORIVJATION (ATTACH TO PERMIT) Personal informati~ you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Nelson, Beck Forest, Town of CST BM Elev: Insp. BM Elev: BM Description: /03 • ~7 /Y1 Z GS TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ e ~ •- /A^~ Dosing ~ ,~ i 1 `~' Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLD Vent to Air Intake ROAD Septic ~ ~~+ 7 ~! ~ ~ / Dosing ~ l~/ 7/~i 74~ ~~ I Aeration Holding PUMP/SIPHON INFORMATION ~~ Manufacturer (1 Demand a e,\,~/~~ GPM Model Number ~~ ~ ~ ~ •7 C', TDH Lift S~ Friction Loss System H~~1 .~ TDH Ft ~b Z t ~- • Forcemain Lengt ~ ~ Dia. ~ '/ Dist. to well ~ ~ SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrOIX Sanitary Permit No: 479422 0 State Plan ID No: Parcel Tax No: 014-1018-60-000 Sedion/Town/Range/Map No: 08.31.15.125A STATION BS HI FS ELEV. Benchmark ~ , ZS X65 , 6 ! D 3 • ~7 7 Alt. BM a.., 3 . /LS / ~ 8 Bldg. Sewer ~ ,~ ~3 • SUHt Inlet ~, Q 1 ~ 7 + ~ Z St/Ht Outlet -~ ~ Dt Inlet ,~~ _ Dt Bottom Il 9 $3• /Z Header/Man. ~ 33 ~~ ~ to~ Dist. Pipe , +, 3 `~ /~ .+ ~$ / Bot. System 5. a~ ~ Final Grade 3.3 0/ ~/O`l St Cover ~•~ X10, 3 • Z • SZ /~ ~ / ~6 v~,t-O ~. r ~p . 0 Z. c c 1 1 /2 ~~ dfC BED/TRENCH Width r Length t No. Of r ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / V~ j - 7lD ~~ '~_ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ,` INFORMATION CHAMBER OR Typ tem: '~/ ,~/ 7 `~ / ~~ UNIT Model Number. DISTRIBUTION SYSTEM 51~a Header/Manifold t ~ / Z h Distribution `Z\ ~ t ( ~ JJ Pipe(s) 7 ~` Di , ~ S i x Hole Size t ~ 3 ~ ~ x Hole Spacing ~ x'~- Ver~to Air Intake w ,,~,~y~ J" - 1 Lengt Dia pac ng Length a SOIL COVER x Pressure Svstems Only zx Mound Or At-Grade Systems Only Depth Gver Bed/Trench Center / / Depth Over Bed/Trench Edges ` ` xx Depth of Topsoil , ~' xx Seeded/Sodded xx Mulched N / 1 ~ Yes ~J No o es [J COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~ / d 5 Inspection #2: / / Location: 2234 County Road O Clear Lake, WI 54005 (NE 1!4 SE 11114 8 T31N R15W) NA Lot C~ ~ ~ P el No: 08.31.15.125A 1.) Alt BM Description = ~-- ~ ~ ~J {l~-+ L~l~•a~ JAS ~ t~~s /_'~ `~-f ~~VrM ~--a 2.) Bldg sewer length = + ~ ~ rr- "'° ` -amount of cover = ~ ~ ,_-- z ~~''~ e ~'S t ~S~,11 ~ 4^• ~~ 5ep~. C Plan revision Required? L ] Yes No i ,,,~ ~ Use other side for additional information. Date SBD-6710 (R.3/97) ~~ i-- - ---- I ~. _ _ -~ 1 - - -' Insepctor's gnature Cert. No. n (,~'n; r P Vin O n Safety and Buildings Division Cow' ~ 201 W. Washington Ave., P.O. Boz 7162 0 ~ /SCO~~~~ Mad ison, Wl 53707 - 7162 Saaitary Pttmit N~ber (to be filled in by Co.) o~ artngent of Commerce IVED 7 9 Z Sanitary Permit App anon .;~ 23 oS ~ ~e Plan LpD. Number Code pei'smal Wis Adm In accord with Comm 83 21 ~t pr~vi~ ®Q~ ~ ` , . . . , may be used !br secondary putposxs Privacy La , s 15.04(1 m Project Addteu (if different than mailing address) 1. AppUcation laformatfon - Plesae Print All In stlQP ~ ZONING OFFICE ` ~, property Owner's Name Parcel # L,ot # Block # tE~~l ~LSa ~ n property Owner's . , Address Prap«ty L.acatim /a1 S' ~~3 ~iT ~v Q ~JE ~ SE, 8 • Sim /~ / City, State Zip Code Phom Number ' ' ~~fiC ld~- 500 S~ ~i'S-Z - X77 ttclet~e) ~E T ~ N; R (check s>il Wet s l ) e of Buildin ll T , p pp y g . yp tai or 2 Family Dwelling -Number of Bedrooms ~ .L~rQ fZ,t+Cw~~~ ~ N ~ ~viaim Name 7 O G~~/ ~ D ib U l l ^ se escr e PublicJCommerc a - ^ State Owned -Describe Use CO k ~ ~ o ~ ^City_^Village Township of 111. T ype o[ Permit: (Check only one bo: on line A. Complete line B if applicable) `~'' ^ New System ~Replaoarnmt system ^ Treatment/Holdiag Task Replaoemerrt Only ^ Other Moditicatim to Existing System B. ^ Petuut Reotwal ^ Permit RevisIm ^ Change of ^ permit Transfer to New list Previous Permit Number sad Date Issued Before Expitatim Plumber Owner / IV. of POWTS a tom: Check all Wert a 1 ^ Nm -Presaaized in-aramd ,1~ Mound >_ 24 is of suitable soul ^ Mound < 24 ia. of sutable soU ^ At-Otade ^ Single Pau Sam Filter ^ Constructed Wetland ^ Prrssurized ln-Orvund ^ l:ioldiag Task ^ Peat Filter ^ Aerobic 'fYeatment Unit ^ Recircula ' Sand Filter ^ ~ Recircula ' S thetic Media Filter ^ Cltamba ^ Dri I~ne ^ Ora PI Other lain J ~r ~ . V. Dia rxa]llYeatment Area Information: Design Flow (gpd) ~ o Design Soil Applicati , 3 / /~ Dispersal Arm (af) apE[Eal ed (af) ~5~~ l~lSY / Z 1 47 System Elevatim loo . a VI. Tank Info Capacity in Total Number Maaufacpuer 1'rdab Site Steel Fiber Plastic Oallana Clallms of Units Q Concrete Conattucted Olass Now 6x6tiaa ( ~Cd ~ a Tuilu Tattle Septic oriiaJdiy.Tadc ~~0 D~D ~ ~ ~ Aerobic rmam,aat Ua@ Dosio~ chamber ~ D'C Vll. Rea mlbW Statement- 1, tht nn sr albitl for installation of.the POWTS shown on the attached Pl (Print) ~ Pl i MP/MPRS Number Business Phont Number G-~Nz- ~ ~ /3 ~{~ Z /S 231~Z1 Ys6' Plumber's Address (street, City, Stott, Ztp ) i VllL Coan me rtment ere Approved ~ppro~ Sariltary Permit Fee (include: (lroundwater D a lu lu ' t Si ' F0e) ~~~ op ~ G 2(O ~J sd-_ t on for I)e~t iX. Conditions of Approval/R staona for Dbapproval SYSTEM OWNER: 1. Septic tank, effluent fitter and dispersal cell must alt be services / m8intalrted as per management plan provided by plumber. 2. Aq setback requirements must be maintained aIS per apppiNccable code / ordirtances. AttaeY eompbte ptaaa (te tM Cowry oaq) !or tea gstew sa papor ra toe tau srn : t r ueaa u arza SBD-6398 (R. 01/03) m, .. _ ___ 4. • . VV c, i .; ~ ~ ,... ~~ ~ ~~ _ ~ ~n ~ ~ _ ~ ~ ~° h ~` + 3 + ~ a ~ - . ~ 0 ~ ~ f J .` ~ + ~ ~ O ~ ~ ~ v. d. i i/ O ~ Q . Q ~ O ~ Q ~ ~ r O` ~` J _ ~ ~ r v~ t = oo ~ t ~ ~ ~ c Z ~" M .~ - ~, g 4 o J fir, ~~ ~ V ~ ~ ~ ~ V ~~ S ~~ j v 4 J ~" ~ r ~ ~ ~ `° 'ALL o 3 ~ ~~,~--.~ ~ 3p ~ W ~~ ~J ~ T ~ -. a cr2 Z ~ _ ~~ ~ ~.~ ~ ~ 1 O ~~ a # £ ~ a 3 ~o fi~3N o J ~ ~ 3~~ ,~ g15o, cQ c'' -~ ~ ~ -~ ..ar q'1 ~~ Lc ~ 1 .~ ~ 1 •r .v ~~~ ' ~~ r ~~ ~ J ~ ~ ~ °• ~ s ~o Z ~- ~ a- I" ]~ ~ ~ ~0 h ~' + ~ ($ o ~a ~ ~ ~ ~~ 2 4 ~ ~v ~~~~~~°~ wqA r~h4~~. '~~ ~ ~~ '. ~ ~~ ~. ~~ .` j J ~ h s = o 1 ,~ Z M ~ ~ ~b a ~ ~ ~ ~ ~ i, J ~~' •• J 11- d was ~ ~ c~~ ~ T , f.~~ c~ 2 9 ,may ~~ ~ ~ a~ f i r/ J O ,~ V V V' Y „~---~ o r/' 3 V d ~ .;;;; ~s.1 .. ~. ~ f s _°~` q ~- + ~ ~, o tw ~ ~ ~ ~ ~ ~~ ~ o a r o ~ ~o o ~ ~ r ~ ~ 2 ~ £ "' ~ d - ~ ~2 d C~ ry ~ 4.~.~ o' ._.. X -' 3 H ~ ~. ~ -~ ~ ~ ~sO~ ~ q1 ~50, . 99_ ,0y ~'° ~~~~_ J 1 ~ or r--- ~ ~ ^...--- L~ V J Z ~-- ~ ci ~. / ' H ' ~ ~ S °~ a r j ~ * h ~ ~ s d . J -t- ~ ~- 4 3 GL. 3~'~ 0 T v `~ ~ * ~ ~ j .~ -~ ~ T ~ ~ ~ ~ ~ d 3 s `o CQ ~ -~ J ~ © Q ~ ® _ ~~~ ~'D 0 J s 0 y1 T • ` ` ; ~ RECEIVED DEC 4 8 2003 Wisconspn Deparltnent of erce S L EVALUATION REPORT Division of Safety and Building ST. CRO~X C911N1y.,~ „ _ __ „~ Page ~ of t LUIVING'Q~~ ."... ... a .+a, •.w. inn. ann~c COUnty Attach complete site plan on paper not less than 81/2 x in es in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and p~ I_p_ 0 / y _ ~ ~ ~ g _ by _ popO percent sbpe, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi ed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (mp. ~ ` ~ 2~ Property Own er Property location ® e t: Imo- L (N 1 Govt. Lot F 1/45 E 1/4 S~ T 3 1 N R (S E (o Property Owner Mailing Addre Lot # Bbdc # Subd. Name or CSM# ~~3 C'~r State Zip Code Phone Number ^ City ^ Village ~ Town Nearest ^ New Construction Use: ~ Residential / Number of bedrooms a - 3 Code derived design flow rate ~~ - SO GPD '~ Replacement t ^ Public or commercial -Describe: Parent material CZ i ~..G a!. ~ ~` ~ ~ ~ Flood Plain elevation if applicable ft. anted recomcem~ert~da~G son ~ S v 5 ~'j e.- S ~' Gt„ (n , X75 r ~H- D V•~ ~- 5 e. ~- c~- /Ob, oD ~ C3 _ b~~ roa •-• 3 t Boring # ~ Boring ® pit Ground surface elev. `~ D O ft. Depth to limiting factor a ~ in. Sal Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Etf#2 3 a 7.S `f ----~--- N~ ti Gw ~ ~~ . S h - v ?.S y/ FS ~~ boring # ~ Boring - ~ ~ I .Cil .... ,.__.._~ _..y__ _._.. 97 4~ a ~ h - - ~ .., _.__..---....- ......... .... ,.. ..~,,~........,.~..y .o~ .~ .~ ~~~. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Eff#1 'Eff#2 o. ~ ~0 3/ ~ a ~? ~ as a , s 0 7. `h2 YI - N ~ ~ G-v l a1 ~ -roo s ~-y F7•s ~ g 5 ~. ~s~ ~ ~ ~. - c - - w _ acv ..yr~ a~ w ~ a~ ~~v ~ iau ~~K,~/~ - tiilUeni i'FL = kiVU c JU nK„~rL aria I JJ ~ .itl frlglL CST Name (Please Print) ~ Signature CST Number ~^ 1 10 ~ r~ 1 ~ a-rt- ~ 5~ ~ Date Evaluation Conducted Telephone Numb Cj. to (~ -a~. _ ~3 ~ ~s.~`/~ -.3sg ~ . ~;, .. Page ~ of 3 Boring # ~ Bo ng , [~ pit Ground surface elev. . so ft. Depth to limiting factor ~J in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o-g b1R3 ---- Z aF55-~ aw dF ~ s ~ $ g- s 5 ~ Fsb~. 5~ c w ~- ~ s . q 7.sy y ~ - `~~ b Gw Iv .S .9 ~5-6D 5 `I ~F1,5`( ~'/ sL ~K. ~h -- ~ ~ to Property Owner ~ ~ Parcel ID # ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sal 'cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tf? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # ~ ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fE= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 * Effluent #1 = BODS > 30 _< 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 =GODS _< 30 mglL and TSS <_ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sao-ssso ~rt.ovoo~ t Property Owner ^ ~~)C Parcel ID # ® Boring # ~ Bo n9 ~ ~' p;t Ground surface elev. _lg, sfl tt. Depth to limitinn farlnr ~J ~.. •~~ms Page ~ of Horizon :.Depth . Dominant Cobr Redox Description Texture Structure ~ Consistence Boundary Roots Soil Rate GPD/ftt in. Munsell Qu. Sz. Cont. Color Gr. Sz.'Sh. 'Eff#1 •Ef~ o-g b1R3 ----- ~- aF55~ act aF ~ 5 E i3 9- y 5 5 ~ FSbk. ti, Cw ~- ~ S - 7rs y y ,, --- - ~~ ~ Gw Ir ~ , S . 9 a~s-~o s Y i F 1.5 `I 4l s L b K- ~ R -- -~ ,~ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil cation Rate Horizon Depth Dominant Color Redox Description Texture Stnxxure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ~ ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Spit Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fi? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Et~~ •~~ 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODE _< 30 mglt. and TSS _< 30 rrglL The Department of Conunerce 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 (R0~/00) (~•,,w~,a ..~~.. r +s a ~.....~,_._~-~--..___~.~eax~._ ' 7 ~1 n 1 ~ 4 ~ ~ ; ~ fi ~ ~r + 3 a s ~ o ~ O.r + ~ d` p ~ ~ ~ ~ t .i ~ ` ~ d~ ~ ~:.~ ~ I rw~ 9C~ d 4 ~- ~ ~ v ' a ~ ~ Q ~ .a ~ ~ i" J . ~ ~ ~ t N S t c e d ~~ d r ~ ~ ~ ~ M J _ ~ ~. f \ c~- a w t S ~ ~ , ~ a ~ 7 J ~ ~ „ ?~. _ ` .r ~ ~ * _ f N d ~ a 'n _ o ,f ~ 4 J 4.. LL 3 r N o ~ ~ a-t ~' s o _ '~ ~ ~ . ~ J d ~ ~ ~ 3 a ~ 1 ~ ~ ~Q ~ ~? ~ ~ ~ M 1 _..-` ~ f~.\ ® ~- r ~ ~ ~ .~ -~ '"'ter q1,o ~ J r'S ° .~.~ ~ ~ • ,..•r- `mow .~..~ _, r---~ ,--W J -- ~ J' v ~ ~ ~D Z~ ~ ~ ~ commellce.wi.gov i~consin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD lA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com me rce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 28, 2005 CUST ID No.139462 TODD L SINZ T L SINZ PLUMBING INC E5609 708TH AVE MENOMONIE WI 54751-5520 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/28/2007 SITE: Becky Nelson 2234 Cty Q Town of Forest Identification Numbers Transaction ID No. 1159954 Site ID No. 702138 Please refer to both identification numbers, above, in all corres ondence with the a enc . St Croix County NE1/4, SE1/4, S8, T31N, R15W FOR: Description: Three Bedroom Replacement Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1030735 Maintenance required; Replacement system; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • 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. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. P.® ~*~~.'~,$. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Coder,a'~ .1p~i~yj,ally p~.®VE® pARTMENT OF COMMERCE ~~.... „c ceFf_7Y AND BUILDINGS TODD L SINZ Page 2 7/28/2005 • Comm 83 22(7) - A copy of the approved plans svecifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. 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. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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 Safety & Buildings 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 Y Becky Nelson -Mound Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. struction methods must comply with the following Component Manuals: ~~`~ ~~ 1 ~p05 ,vL `~ Mound, SBD-10691 P (01 /01) &QU~`QO~G'~ressure Distribution, SBD-10706-P (Ol/O1) sPF~~ Location: NE '/4, SE '/4, Sec. 8, T 31 N, R 15 W Town: Forest County: St. Croix Date: July 27, 2005 Owner: Becky Nelson Address: Plumber Signature: License: Attachments: 2234 CTHW Q Clear Lake,~~VI 54005 Todd Sinz MP 139462 SBD-10577 -Plan Approval Application SBD-8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management ~,,., SEE ~~kKES NDENCE page 1 of 8 Design Criteria ~~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L Bedrooms x 100 gal/bedroom/day x 1.5 ~~ gallons/day hydraulic load In situ designed loading rate- ~ ~ Depth to estimated high ground water ~- Zs Depth to bedrock ~ ~~ Cross slope at system ~ < 3 Force main length \ 'o ~~ Manifold/header length 3 Drain-back ~ ~-~ b~- Lateral length ~. @ ~ 2 ~ d Lateral elevation t ~'°~5 3 Lateral hole size ~~b in. @ ~o ~ ~ holes/lateral ~ ~ Lateral volume \~-Z4'`~ Total lateral discharge rate 2 S ~ © g Network pressure compensation losses n ~~5~ Elevation difference ~ ~ s Friction loss ~ ~4' b Total dynamic head ~ ~ ~ 2..1 Pump/siphon S ~ gpm @ ~ ~ Manufacturer ~ o e..~,` ~- Dose volume ~q ~~ ~ Lift/sip~ton tank' w~~ c ~ t ~ - l,a-o - - - CA ~~ Septic tank ~ ` `` '' `` Effluent filter ~`~~~ ~ ~ ~~Z2- \4'~~ Measurement pump on anti off ~ ~ c~ Height alarm from tank bottom ~ ~•~ Reserve capacity ~'~"Z~ specs.calcs.res ga ons sq. .per ay in. in. ft. of ~ in. \~-,t Z ft. of ~ `I z in. o ,s S' gallons ft. of 1 ~~ z- in. ft. @ bottom of lateral in. ( 4'~ ~ ft.) Spacing holes total gallons i gallons/minute @ ~ ' ~ ft. head ft. ft. i ft. @ 2'S gallons/minute ft. ft. of head Model # ~ ~ Z gallons ~ ~ gallons ~ `~"`~ gallons in. in. gallons Page ~ of ~ Design Calculations ~ ~ 11 / ft d .• - ~~ =- Q. _- - . 3 ,~ o~~ `. ~ ~. Mt ZS~ L~t (~~~ ~\Ow Zu / 1, 'J1 1 ` Cn~tz~ iLa.O~) ~+y QA.v ~Vr i~~n.t'V.' JV` \ \ 1 ~ ~[ a..v , 1 X9"!7 ~ ~ ~ M O ~ ~ n Q I ~1 b p t~ t 1 ~ o a w. 1 e-o ~ o I c~«,y , ~a~ ~o i~bto~` / f~~~ e.r ~.._ ,. ~ a , p g 2,~t .~~ ~b~~ ~~ ~ 4. ~c~, o 3 _........_.._.. ....... .. __ Zb,l ~.. N o~.~~, ~ e~~ ~..~1 ..y •~.~~ ~o" o. ~ 3' C G 1 ~~ 2 , tw~,c.w~ a ~e.~ t C9 ~~~ ~ ) 1~ ` a r. y ; v. ~.. _ ~ o ~.s ~ ~ ~- ~•~ b'° ~~~~ 1 S ' I~-\ 2 ` ~I \33' ~`/ 1 O '. 4, r^ \t ` c ~ a~c~ O~ t L~r v .'l's ~ ~. ~.. a l l j ~ 9 b a ~ e +. i ~ . ~~ ,~,~~~P~~ S~ ~ r ~~ /~z, o `r{ ~4v1hy~~(l ""/ ~`~'~'~J[.`40L G+'1.1~1+~ ~e CS .b.1,~ ~f~'b0~.(d' 1 r~i-O.~'rad( ''~'-/ V R1vt ~• 1teC O`• wovrl.~Ow? ~~_ ~~ ` ( ~ JJ -~ ` c ` (1 11 k `' l /l b ~ 0\ c~ O ... 1 . { ~• ~,•,~ ~-+• ~~ c 1 `1' c ... `; .. ~,,,1~ (\~ `T b , c~ A~ d,,,~ T , O a\ K 9... \ a.~ sue- ~ ~ ~ 1s 4. c\ t 1 ~-O`-F ~ ~ ~ ~ ~ a ~.~ S ~~ g i~i~ ~ ~ il: ~ `~(.~ ~ , „. ~. G L~ • ~ ~~oz --> 4m PIP6 3' no >r~IsTuae~o Sol t_ ~cWuwr,.r~. CTRSb4 T' s`o. ~~~ ~~L ~~p~ c.o ~v~~~~T~ar~ c~e~. ~ I' ~ iCl.Fv. ~~ ~,~. -LOCKIUG COVfiR --~ WAn'N iN~ ,c ABF~ . avlcK ol~co~~~cT--1 24" 2.'D. t~axua~ > '4~ A _~_ ~FLE a D ~ ~ ~` o R "C r h'1n~N WEATNERPRC>JF ~,J1.~NLT~ON &~c II jl ____1J rc~ ~.5~ o" .L A~4RM z„ ON - ~, o~l o>:~ , 9'~ I~' P ~c k:, ~ ~" 4 0 Ytti~ J --~ g I ~ s~~ 3' ono I so~~~ JRpu-.O 4z° PwyP Go^rcaeF-r~ I bcoCK O,p 14•g ~~;.~.,- SEPTIC t SPECIFI~CATIOIJ C 00 5 C ~ ~ ~ S ~ M, i- ~ w T~u..S MA-JUFACTURCR. IJUM9ER OF pOSCS: `~'~ PEK C~~ TA-JK SIZE : `~~ ~ ~~ GAC.L01J5 S x ~ • .DOSC VOLUME ~~ ~ ALARY~ /"lMIUiACTURCR; J ~ ~~'~- v~ IAJCLUDIIJC, OACK/LOW: ` C,~~„ Cry. N~OD[L, -JUIhl~CR: • 1 ° I 1'4 ``' CAPACITIES A -~'S' O IuCNCS OH 3~Z'~/ SWITCH TyP[; ~~~` '"`~ ~>,.LOks Z 2a'g PUMP /7A-JUFACTURCR: ~~2 ~ 8= IucHESOa C•quou5 ~~O ~Q 4 Moocu uuMecR; `S Z- C + IUC nE 5 OR G.Allpl/~ g•J 13 4 1 SWITCH T>jPC: ~~`"''~ w . D+ 11J~HE5 cR ~aLLOUS _ MI-JI11U1"~ OISCMARfsr< RAMC ~~'` GPN IJOTE: PUMP A1JD ALARM ARC TJ BC INSTALlEO 0-J SEPARATC ~1/~Lu~'~'$ VCRTICAt. DIFFCRCIJCE DfTWCC-J PUMP pif AUO OISTRIDUT OIJ =~ I PIPE.. FEET + MIuIMUM -~ETWORK SUPPI.y PRftLURE ~'S ~ Z S .. ~ +\°~ F L E T O F FO R C C MAI N X 1,_~ f~ FRICTIOry loo FCC7 , - ~~---.,--. 2 S~ iACT ~ ~. r[ OR. FEET _ TOTAI. Dy-JAMIC HEAP t¢_2'~_ FEET ~' ~ IIJTERI,IAC. DIMEIJ610A1>A Of TA-JK~ L.E-.1bTH ~' ~ ~~'~ ~ 2 " 4 2 .. ~. ;W'DTH ~ t_IgUID DEPT H _ • Pa~.~ 6 ~, R ~ -~ ;~. e 0 a w x U a z r 0 0 0 3 11/3 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Owik-Box available for'outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series _ __ 1521153 MODELS Con rot S tattoo Model Volu•Ph -_ ^ Mode Am Sim lex Du lax N152 u5 1 Non 8.5 1 2or3 _8ri t 52_ t t 5 1 Auto 8.5 Induded 2 or 3 E 152 230 t -_ -- Non 4.3 1 2 Or 3 BEt52 230 1 Auto 4.3 Included 2 a 3 N 153 t i 5 1 Non 10.5 1 2 or 3 BN t 53 t 15 _ 1 Auto 10.5 Included 2 or 3 E 153 230 1 Nan 5.3 1 2 or 3 BE t 53 230 1 Auto 5.3 Included 2 or 3 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL t52 153 Feet Meters Gol Liters Gol. Ulers i 5 t.5 69 261 77 291 i 10 3.1 61 I, 231 I 70 265 ' 15 4.6 53 201 6 t 231 20 6.1 44 167 52 '97 '. 25 7.6 34 r t 29 I 42 ' S9 30 35 9.t 10.7 23 -- 87 33 '~~ ' -- 22 65 40 12.2 -- -- ' t c2 Lock Volve: 38.0 Fl. (1'.6m;i,dc0 ~; ('3.~.~^;' o+.soa t- ~- I I it ,. ~_,,-__n._-. i2 '~/F ~. i I ~, ~ = - I 1 -L sKZOa+ SELECTION GUIDE t. Single piggyback variable level float switch or double piggyback variable level fbat switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E•Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) Aoat system. p ~ a RESERVE POWERED DESIGN ~~ For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. 90X 18347 ~ Louisville, KY 40256-0347 Manufacturers ol. . SHIP T0: 3619 Cane Run Road ~ Louisville, KY 40211.1961 http://www.zoel/er.com PUMP !O_ (`2)118.2131^^1(800) 928•PUMP QUaL/TY /SUMPS S,vCE /9,.~9 O CAUTION All installation of controls, protection devices and wiring should ba dons by a qualMled licensed electrician. All electrical and safety codas should ba followed includlny the moat recent National Electric Code (NEC) and the Occupational Sa}ety and Haalth Act (OSHA). © Copyright 2000 Zoeller Co. All rights reserved - - - 0 80 160 240 320 ' ~ ~ ~ System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, TL Sinz, 715-235-2644, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Instal] water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. If possible, the upslope toe of the mound system should be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ' sx cROgc covrrryt SEPTIC 'SANK MAFI+~~'BNANGB A4R$E~N'r AND OWNSR'SHfP CE~tT}FICATIOrN FORM C}w~nerBuyar _ ~~~.P.1~_.. - Mai}irt~ Addroso , 22 ,.~,C,~~~~~~ T ~ a~~~ Proporty Addrass ,r~~~ ,,...~.... -~-- -----•- (Vetifcatioo:ega3s+ed nom trFtaAlaa Departrnent for new aenstrrrotioel} - _ , f,~ty/St~ce Pa~roel tdentifieeua~c Namber _, 3l •/S~• l.?SA,M~ PropoctY Loc~tian ~.,,~Y~, , il, Sec. ~ , T..N-R l S"_~1, Tvwa of ...• Y ,y ll.,~i # Cel't#lied Sarvey Mzrp # , votttme ~_.+ P~tga # ~~. ~atr~tnty Deed # ~ Volumo _ -_-• Pscge # ^-,---.---^• . Speo boost q yea nv Lvt lines 4ddntifis6le ~' yes O as ~pKapet r~ae and atalgtet3anr~of Your scPtie srelom eovtd:etuitt m its pt~etasat[+e talltuo iA baudic vraaoaa. E'tvpcr mtuueasa''.~ ~istf of ~ptai out the sepdo tsn]c erery three Yaali or tooger, tf ntedodby • tioeaaed 1~P~*• W9~sc Y~ but tuto the rysteus caa ate mG ltmotfen o4 eke eepda task u a troattuont ~C to rho rvaata diepettit yytteea. The peopaly owutt aaree~t to s-ibml[ to St Crobc 2eaiug Depa~nen! s eerdt~ioa fbtas, aiSaed by tltie owacc sad by a m~tptmaber, jeurgeymapl~~, ~#aesedp3ttmberarttlicansedp~et ~~ (~ the et}-el~+~std~Oasi sy:s~ is m ncv9er trporadag oeaditioa uWar (3) attar }nspeeiton ata pumpiaB (if necoctaly), tlce ~P'de eea8 f. less thaw t~ fuII of tlndSe. t/vc, the uaderalgoed tufts road rife shove ~qutremet-a sad agree m miinhslt the p~-te servaga Qisppstt aysteoi ~rlth tke: standetds est tAetby hecst4 a sot by ~ of Uomonotoe aIId tho ~ of'Nattwl R:a~s. StA-te of W'ats. t;7erdtintttm ctat~y that Yam soplie s7.uat ba+'bsaa sasiettaiard mtibct bo ooarpktadsadretwtab8 so Iha tat. Qotx C~mq ZoafuII OP6ee s~ithiu 30 days of [be thtte as CJegtiXtioil data. I Q ~-~ DATB ~ Olt J+~pIdt:AN't' ~~$' -- ao am era the ovaer(a) of i (K^a) ccieity tbit sIl ftatpCDMta Pn llus f0[ft1 arc [rue to ~e heft OLIN (,O~ir} tQSOWIaQge. I ( ) rbe property decarlbed abort. by rfttua of a ~vicsariry dRCd seeordsd fn iteglaur of needs QCliw. Sl ~'~ ~~ ••.~.. • • ••• s pay ittlbralatiaP,tAit i, mi.-xvpvawted may rrsnctt fn tlta tuunry palmit ifCinl revolrod by t}u 7oaJ~ De¢sltII-ent •+ Yncivde with t3~ls ngpIIeRtian: a ataasped rn~aocy.dad ~oaa the Re$seter of Docda o~Etm• e copy oC ttu oerlitied~egrYey sup if irht~ is rasds i[s tb~e wammtyr deed Parcel #: 014-1018-60-000 Alt. Parcel #: 8.31.15.125A 014 -TOWN OF FOREST Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Category Use Value Assessment Valuations: Last Changed: 04/17/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.080 5,500 69,800 75,300 NO AGRICULTURAL G4 5.000 500 0 500 NO Tax Address: Owner(s): O =Current Owner, C =Current Co-owner O -NELSON, BECKY M BECKY M NELSON 2234 CTY RD Q CLEAR LAKE WI 54005 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 2234 CTY RD Q SC 1127 CLEAR LAKE '~ ~ ~ I/y~ ~~G~~ ~ ~ SP 1700 WITC ' ~JQ Legal Description: Acres: 7.080 Piat: N/A-NOT AVAILABLE SEC 8 T31N R15W 7.08A IN NE SE COM 1320' Block/Condo Bldg: ' N OF SE COR SEC 8, TH W 33 TO POB; TH W 552', TH N 558.5', THE 552' TO CL HWY Q Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH S 558.5' TO POB CSM VOL 1/63 08-31N-15W Notes: Parcel History: Date Doc # Vol/Page Type 09/30/1998 588038 1361/220 WD 07!23/1997 2001 /471 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Totals for 2005: General Property 7.080 6,000 69,800 75,800 Woodland 0.000 0 0 Totals for 2004: General Property 7.080 6,000 69,800 75,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 213 Specials: User Special Code 08/25/2005 01:48 PM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00