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HomeMy WebLinkAbout022-1065-40-000 County: St. Croix Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM Sanitary Permit No: 0 Safety and Building Division INSPECTION REPORT 574375 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION Parcel Tax No: Personal information you provide may be used for secondary purposes[Privacy mow'Vi lage (1 X Township 022-1065-40-000 Permit Holders Name: Kinnickinnic,Town of No: Dale M. Section/Town/Ranget ap Grille , - 23.28.18.3556 CST BM Elev: Insp.BM Elev: BM Description: U zf ELEVATION DATA TANK INFORMATION CAPACITY STATI`O I J BSS I C 1 c� _FS 1)e- 01 TYPE MANUFACTURER L`t Benchmark z . 1 6Z � Septic • �� � 1 Alt.BM Cp .l "✓ L�nit �� �'� Dosing / Bldg.Sewer �tl Aeration �L W '�C I y' 10 L _ St/Ht Inlet ' SC� 7 I � �� ,� '�� •!'v Holding St/Ht Outlet � TANK SETBACK INFORMATION� Vent to Air Intake ROAD Dt 1plet /11 TANK TO P/L tp Z Dt Bottom Septic l ° �� a js'� 7� - - p Head Mane 5� LL h Dosing 9 d ,,1 Dist. Pipe S G11 v.,2 / J 7 Z Aeration Bot.system Sli wa Holding - Final Grade PUMPISIPHON INFORMATION Demand St Cover ;-OCY16ali Manufacturer GPM Model Number � -Z F �' TD� t TDH Lift 5 Friction Loss Syste Head Dia. Dist.to Well Forcemain LengthL� � `Z�/ Insid _ ���:.��/�, �,( •� - 't.,, �i Liquid Depth SOIL ABSORPTION SYST / No.Of Trenches PIT. I ENSIONS No.Of its e Dia. BE /TRENCH Width/' Z-U't' Length DIMENSIONS t:�I1\+ Lj'� anufacturer. p/ BLDG WELL LAKE/STREAM E SETBACK SYSTEM TO h UNIT umber: INFORMATION Type System(: d iC C/ /� f ZCIL :~ ��!CL�� J, c �ti� -4 ent toir Intake DISTRIBUTION SYS M x Hole si�e x Hole Spacing Distribution a , ' Lt L'S� 1✓�- Header/Martif Id /� �� Pipe(s) Dia Spacing �n-- Length Dia Length __ �" x Pressure Systems Only xx Mound Or At-Grade Systems Onry"� MulcheJ SOIL COVER xx Depth o seeded/sodded Depth Over ; Topsoil � a a Yes [] No Yes No Depth Over Bed/Trench Edges BedlTrenchCenter t'� 2�' �j / / Inspection#2: Inspection#1: /IO COMMENTS: (Include code discrepencies,persons present,etc.) ` Parcel No: 23.28.18.355B Location: 1358 OAK DR River Falls WI 54022(SE 1/4 NE 114 23 T28N R18W) m et s&bound s Lot 1.)Alt BM Description= I<� -�LU�-�5 �j-k � 2.)Bldg sewer length= (�jl�'y (UGO -amount of cover - Plan revision Required? C Yes No I ( I —� � — Cert.No. Use other side for additional information. L ___111 Date 1 _ Insepctors Signature SBD-6710(R.3/97) w N a O ~ o� O a Z t 01 �i g Q d Q N � N � O 4 0 s a 3 0 0 0 U � w •� o o N ° II kn o -z En 0 ,ti x �° i 1 4 O \ 4 3 O N O, �o N z h 2: 1 A ;, it II II II eve Q ti V •� V N O O O O W W W W GA V� o� M o - `ti o c? �a U L d •� o°p 3 h o a b m cm fi M O N d ;�.. go cc W o ro 2 � ..$ II Cy0.tl GO 'ICI 1 a.� o vas4 County Safety and Buildings Division w'O / D201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) S P S '"J � �i Mad' one 70a lk, - � 571375 S it Application State Transaction Number ! In accordance with S.J. 1�I"'"""'Rode,submission of this form to the appropriate governmental unit ,3;4C To is required prior to f permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Departrnenj,pf and Professional Servies. Personal information you provide may be used for secondary purposes in accdr ance with the Privacy Law,s.15.0 1 m,Stats. /? ©� L A m Application Inforation Please Print All Informat' �J Property Owner's Name / Parcel# Property Owner's Mailing Address Property Location / ^ u� Govt.Lot _ /�•/{ City,State Zip Code Phone Number 3 J s LQJ/.,�!-7,, Section c L e' 4Z5 rY arc one) I1 Type of Building(check all that apply) Lot# Ts�N; R W K-0-1,2 Family Dwelling-Number of Bedr ms Subdivision Name K ❑Public/Commercial-Describe Use q G r%e Block# ❑City of ❑State Owned-Describe Use / Q� / CSM Number ❑,,Village of ? [��' I(d'!"own of Al L III.Type of Permit: (Check only one box on line A. Compete line B if applicable) A- El New System 144eplacement System ❑Treatment/Holding Tank Replacement Only ❑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 IV.Type of POWTS System/Component/Device: Check all that apply) ❑Non-Pressurized In-Ground ❑Pressurized In-Ground CJ At-Grade ❑Mound>_24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ------------ ❑Pretreatment Device(explain) V.Dispersalffircatifient Area Information: Design Flow(gpd) Design Soil Application Rate( sf) Dispersal�r�Required(sf) Dispersal Proposed(s System Elevation /�ZjJl^ 1 ,5- !�(n Csc� VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units �js�' D ycls U O y New Tanks Existing Tanks Septic or Holding Tank Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for'nstallation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb gtta MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip Code) V o u n /De artment Use Only pproved Permit Fee Date �su�jed l� Issuin gent Signature ven Reason for Denial / ``� / IX.Condi' easons for Disapproval 3) 1Septictefflupnffifteranii" dispersal cell must all be services I maintained 1,r, L✓I ��`c" t as per management plan provided by plumber. /� r- /J 2. Aq s*agk feguiremel►ta must De maintained 4l C� (� a ✓�✓ Attach to complete plans for the system and submit to the County my on paper not less than S in x 11 inches in size GoaQm '. SBD-6398(R. 11/11) KErFH E KNUDTSON Page 2 9/2/2014 SPS 383.22(7)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 Owner Responsibilities: • SPS 383.52 Responsibilities. 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. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 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. 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, Fee Required$ 250.00 1&4e�4 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (608)789-7893 ,7:45 am-4:30 pm Monday-Friday WiSMART code:7633 charles.bratz @wisconsin.gov cc: ldwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm y �9,,yPR DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA t m HOLMEN WI 54636 Contact Through Relay p c www.dsps.wi.gov/sb/ 9� w www.wisconsin.gov o e Abe SSJOIN w Scott Walker,Governor Dave Ross,Secretary September 02,2014 CUST ID No. 648443 ATTN.•POWTS Inspector ZONING OFFICE KEITH E KNUDTSON ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMICHAEL RD ROBERTS WI 54023 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/02/2016 Identification Numbers Transaction ID No.2452640 SITE: Site ID No. 805537 Dale Griffey Please refer to both identification numbers, 1358 Oak Dr above,in all correspondence with the agency. Town of Kinnickinnic St Croix County SW1/4,NE1/4, S23,T28N,RI 8W FOR: Description:At-Grade/Three Bedroom/Sloping Site Object Type:POWTS Component Manual Regulated Object ID No.: 1500475 Maintenance required; Replacement system; 450 GPD Flow rate; 44 in Soil minimum depth to limiting factor from original grade; System:At-grade Component Manual,Version 2.0, SBD-10854-P(N.03/07,R. 1/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01 101,R. 10/12); 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. The owner, as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. CD ppR No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, OF CJ stats. zoves to The following conditions shall be met during construction or installation and prior to occupancy or use: QR Of�N Reminders 104 10" • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. SeE co • Per manual cited above,limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,excavation,vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area.chs.NR 811 & 812c • 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 POWTS 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. Stat KEITH E KNUDTSON Page 2 92/2014 SPS 383.22(7)A1cgM 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. Owner Responsibilities: • SPS 383.52 Responsibilities. 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. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 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. 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, Fee Required$ 250.00 / This Amount Will Be Invoiced. �{ When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (608)789-7893 ,7:45 am-4:30 pm Monday-Friday WiSMART code:7633 charles.bratz @wisconsin.gov cc`-Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm 406 2 0 2014 RESIDENTIAL AT-GRADE DESIGN _)UST I' Pressurized-Sloping Site INDEX AND TITLE SHEET Project Dale Griffey Replacement At-Grade Mound Owner Dale Griffey Address 1358 Oak Drive Legal Description Part of the SW1/4-NE1/4 Sec. 23 T28N-R18W Township Kinnickinnic County St. Croix Subdivision Name Lot No. Parcel ID Number 022-1065-40-000 Plan Transaction Number Index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 NALLY Laterals and dose tank Page 4 WED Specifications Page 5 ,.FETY AND Management&contingency plan Page 6 .AL SERVICES Pump curve&specifications Page 7 )USTRY SERVICES Plot Plan Page 8 Designer Keith Kn dtson License Number ND Signature Phone Number C',$X— 73 Date 08/09/14 Designed pursuant to: At-grade Component Manual Ver.2.0 for POWTS SBD-10854-P(N.03107),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(03/12) Page 1 of 8 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet-Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 300.0 Estimated wastewater flow(g pd) 450.0 Design wastewater flow(gpd) 10.50 %Site slope 98.00 Contour elev. below lateral(ft) 44.00 Depth to limiting factor(in) 0.50 In-situ soil application rate(gpd/ft n 2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 9.00 Linear loading rate gpd/ft 9.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 100.001 Aggregate length(ft) Pressure Distribution Data Entry (c or e) a Center or end lateral connection 1 Number of laterals 0.125 Orifice diameter(in)e.g. 0.25 Not a final 2.00 Estimated orifice spacing ft calculation P 9( ) 2.00 Forcemain diameter(in) 2.14 Forcemain flow velocity(ft/sec) 70.00 Forcemain length (ft) y or n y Does forcemain drain back? 90.75 Pump tank elevation (ft) y or n y Are laterals at highest point? 6.5 System head(ft)x 1.3 NA 6.75 Vertical lift(ft) 11.4 Forcemain drainback(gal) 0.70 Friction loss(ft) 45.0 5x Lateral void volume(gal) 0.00 In-line Filter Loss (ft) 1 56.41 Minimum dose volume(gal) 13.95 Total dynamic head (ft) 21.0 System demand(gpm) Lateral Diameter Selection Gallonslinch Calculator(optional) Pipe diameter Design options Design choice Total Tank Capacity(gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in Gatlin(enter result in cell G46) one lateral 1.5 in X X diameter 2 in x Treatment Tank Information 3 in x 1000 Septic tank capacity(gal) Wieser Concrete I Manufacturer Effluent Filter Information Dose Tank Information Pol -Lok _ Filter manufacturer 603.4 Dose tank capacity(gal) PL-525 Filter model number 77J-6A Dose tank volume(gal/in) Wieser Concrete Manufacturer Project: Dale Griffey Replacement At-Grade Mound Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW D —t T1/6 B Observation pipes(2 typical) A 9.00 ft D 1 B 100.00 ft �T 1/6 B 16.67 ft C 11.00 ft W c D 5.00 ft E 2.00 ft D L 11 0.00 ft D B W 21.00 ft —J AXBl 900.00 ft"2 —L — Fes"'Cap =Total aggregate cell Ax B Slotted n th Typical in th pipe. e lower 6",and = Plowed area L x W anchored securely. 6° I AT-GRADE CROSS SECTION Svnthetic fabric cover 99.79 ft Finished grade Lateral elevation invert elev. 98.50 ft -.— Observation pipe at aggregate toe E 10.5 %Slope Surface contour gg,00 ft C A and system elevation D ® = 12 in. topsoil and subsoil plowed layer over aggregate and tapered to toes. Y below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: Dale Griffey Replacement At-Grade Mound Transaction Number: Page 3 of 8 f PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram-End Connection E P Last hole dkiNed newt to end Laterals 6 faro*main of PVC 80h 40 Holes drilled on the bottom of tlw lateral per SPS Tsbl4 384.30.6 equally spaced Turn-up w?ballvalvo orol®snout plug Lateral Specifications I 0.125 Orifice diameter(in) End Lateral connection point X 1.96 Orifice spacing (ft) 1 Number laterals 51 Orifices/lateral P 98.00 Lateral length (ft) 21.0 Lat. discharge rate(gpm) 1.50 Lateral diameter(in) 2.00 Forcemain diameter(in) 21.01 Sys. discharge rate(gpm) 70.00 Forcemain Length(ft) 13.95 TDH(ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device junction box --i Final grade 4" disconnect Tank component is Alternate properly vented - 'w , outlet location 18" min. Electrical as per NEC 300 and 1t Approved SPS 316.300 WAC outlet Tank full joint c Inches Gallons JA Provide 1/4" .� A 18.6 311.8 Alarm on cr weep hole or antisiphon = B 2.0 33.6 EC 3.4 56.4 Pump on B device. o D 12.0 201.6 91.75 ft C Alternate Float Setting. Totals 36.01 603.4 —`i Pump off A = 18.6 inches 311.74 gals. D B = 2.0 inches 33.52 gals- G = 6 inches 100.56 gals. D = 9.4 inches 157.54 gals. 3"Bedding under tank ~- 90.75 ft 36" 603.36 gala. Goulds Pump manufacturer SJE Rhombus Alarm manufacturer EP04 Pump model number Tank Alert 1 Alarm model number Project: Dale Griffey Replacement At-Grade Mound Transaction Number: Page 4 of 8 At-salrade System Maintenance and Operation Specifications Service Provider's Name I Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow- Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 900.0 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound 1 Inspect for ponding and seepage once every 3 years Other 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 at-grade 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 at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished �..•••�......•• --r,•�-. 000060000600600 Grade v1 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 98.50 ft 45 Degree Bends Same Diameter as Lateral Project: Dale Griffey Replacement At-Grade Mound Transaction Number: Page 5 of 8 II At-grade System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-384 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[SBD-10854-P(N.03/07),SSWMP Pub.9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706(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,Slats. 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 fitter is installed within the tank it shall be inspected and serviced as necessary. At-arade and Pressure Dfstrlbution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter,and the at-grade 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 at-grade 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 at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade 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 specked in the permit for this installation. The pressure distribution system is provided with a flushing point at the and 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 4 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Condrinencv 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 at-grade 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 renovating the biologically clogged absorption and dispersal media,installing new piping,and replacing other 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. Project: Dale Griffey Replacement At-Gra,Transaction Number: Page 6 of 8 Page '7 of 8 [QGOULDS PUMPS Submersible Effluent Pump a 387EP04 1 EP05 -Al- Iiii,111.1, APPLICATIONS •Fully submerged in high ■EP05 Impeller:Thermoplas- ■Bearings:Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■Casing and Base:Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Hanes Available for automatic and superior strength and corrosion • Farms manual operation.Auto- resistance. 41 Canso en StarW,&Ammom • Heavy duty sump matic models include • Water transfer Mechanical Float Switch N Motor wing:Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in"C"or"F".) factory. strength,and durability. SPECIFICATIONS ■Motor Cover:Thermoplastic GaJdsa.npsis19090M Regs>ered. FEATURES cover with integral handle and •Solids handling capability: float switch attachment points. 3/1"maximum. ■EP04 Impeller:Thermoplas- N Power Cable:Severe duty •Capacities:up to 60 GPM. tic Semi-open design with rated oil and water resistant. •Total heads:up to 31 feet. pump out vanes for mechanical •Discharge size:l t/s"NPT. seat protection. •Mechanical seal:carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 104 (40cQ continuous METERS FEET 140OF 6090)intermittent i •Fasteners:300 series 10 stainless steel f 3 9- 30 i 5 GPM •Capable of running dry without damage to $ 2.5 Fr components. 25' c0 7 1Y ` .. .... .G. ....,... ..�. .. .�. _ ...... ... ... ..,...... Motor: _ •EP04 Single phase:0.4 HP, u 8 Zo 115 or 230 V,60 Hz,1550 s ;. RPM,built in overload with c ESL. ...... ....._. automatic reset. 4 •EP05 Single phase:0.5 HP, c eP05 .. ... . 115 V or 230V,60 Hz,1550 ~ 3 10, 1 RPM,built in overload with EP04 I automatic reset. z •Power cord:10 foot s _.. . ;.._.. standard length,1613 1 :... ...... SJTOW with three prong �__._.._... grounding plug.Optional 20 ° °0 10 2 50 GP 3o ao _.i M foot length,10 SIf W with three prong grounding plug ' (standard on EP05). 0 2 4 s a 10 12 tn'/h CAPACITY Goulds Pumps 82001 Goulds Pumps ITT Industries Effective May,2001 83871 m a 00 N a 00 0 a d o Q d O A e m o c O H IF K o 0 W 3 ti °o 0 o o� ® a o ►► as 0 tn C> Lei W) ItT Itt V1 '� C., 00 2 o q o to ON 110 eq 2 N O \ o as ON e CA) � H c o o WAUC� PUf.� r/� O 0o ti LZ ^1 i O �o a o 0 s QQ� 8 h W b m v O ..4 h 3 \ e p .., n 11)�L: n 1D II��Hrryy � r 0 Or SOIL EVALUATION REPORT . , #1244 � �r �' Department �aid r)nal ices ������ �u 1 of 3 Division of S�y aatl1 E "" Keith E.Stoner CR accordan( tti Comm 85,Wis.Adm.Code Attach complete site �l�� aaper not less than 8%x 11 inches in size. Plan must County St.Croix include,but not li"'ti5:vertical and horizontal reference point(BM),direction and percent slope sca or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. 022-1065-40-000 Please print all imbrmat ion. R sewed By — DaW Personal information you provide may be used for secondary purposes(Privacy law,s.15.04(1)(m)). �� Property Owner Property Location Dale Griffey Govt.Lot SW1/4,NE1/4,S23,T28N, R18W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 1358 Oak Drive City State Zip Code Phone Number City ❑Village ® Town Nearest Road River Falls I WI 1 540221 Kinnickinnic I Same _Conslrean Use: ® Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial-Describe: Parent material Sandy Residuum weathered from Sandstone Flood plain elevation,if applicable NA ft. General comments Propose a 9 x 100'At-Grade mound with a system elevation=98.00'. Mound contour staked onsite. and recommendations: � y�/s�`�► �; �2�d Av7s lam. sns 3P3. 3 3 Boring# Boring 1-1 ®Pit Ground surface elev. 95.50 ft. Depth to limiting factor 51 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1112 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'EfW 'Eff#2 1 0-5 10YR3/3 - Ifs lfgr mvfr a 3f-co 0.5 1.0 2 5-32 10YR4/4 - Ifs Osg ml gs 3f-co 0.5 1.0 3 32-51 10YR5/4 - Ifs Osg ml gs 2f-m 0.5 1.0 4 51-88 10YR5/4 7d5M/$7.57.5M6/2/2 Ifs Osg ml - if-m 0.5 1.0 t I I I I I *Horizon#4-second dominant color 2.5YR8/3 a Boring# ❑Boring ®Pit Ground surface elev. 99.40 ft. Depth to limiting factor 47 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 10YR3/3 - IN ifgr mvfr a 3f-co 0.5 1.0 2 4-43 10YR4/4 - Ifs Osg ml gs 2f-co 0.5 1.0 3 43-47 10YR5/4 - Ifs Osg ml gs 2f-co 0.5 1.0 4 47-60 10YR5/4 �d56;28 Ifs Osg ml - if-m 0.5 1.0 *Horizon#4-second dominant color 2.5YR8/3 #4-with dense bands of fsl 'Effluent#1=BOD 5>30<220 mg/L and TSS>30<150 mg/L nt#2=BODS<30 mg/L and TSS 1.30 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,W154872 7/302014 715-653-2324 OD-8330 kR r vi 1) Property Owner Dale Griffey Parcel ID# 022-1065-40-000 Page__Z_of 3 ❑Boring 3 Boring# ®Pit Ground surface elev. 96.45 ft. Depth to limiting factor 44 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `Efl#t -Eff#2 1 0-5 10YR3/3 - Ifs lfgr mvfr CS 3f-co 0.5 1.0 2 5-33 10YR4/4 - Ifs OSg ml gs 2f-co 0.5 1.0 3 33-44 10YR5/4 - Ifs Osg m) gs 2f-co 0.5 1.0 4 44-69 10YR5/4 c2d5YR5/8 Ifs Osg ml - if-co 0.5 1.0 7.5YR6/2 *Horizon#4-second dominant color 2.5YR8/3 F ❑Boring 4 Boring# ®Pit Ground surface elev. 92.70 ft. Depth to limiting factor 51 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `Eff#1 'Eff#2 1 0-6 10YR3/3 - Ifs lfgr mvfr Cs 3f-co 0.5 1.0 2 6-29 10YR3/4 - Ifs Osg ml gs 3f-M_ 0.5 1.0 3 29-51 10YR5/4 - Ifs Osg ml gs 2f-m 0.5 1.0 4 51-72 10YR5/4 c2d5YR5/8 Ifs Osg MI - if-m 0.5 1.0 7.5YR6/2 *Horizon#4-second dominant color 2.5YR8/3 *With large fragments of limestone F-I ❑Boring Boring# Pit Ground surface elev. R 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. •Eft#1 •Eff#2 Effluent#1=BODS>30<220 mgA-and TSS>30<_150 mg `Effluent#2=BODS<-30 mg/l.and TSS<_30 mgA. 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. , � . � � \ � a � , q $ � \ k / � § 4 7 Al 2 � \ � ~ q % / , g / 0 R ■ f � � � k m� ® - . m � 110 � 2 w k 2 f \ 3 ON ON ON ON H ] � 2 @ e l l l § a - 2 3C'4 � ƒ \ � \ 2 I 4t � � A � Q 2 � 2 ■ ® W � A � � � O Lon § � \AS cu a � Q # � s � . _ # k - 8 / _ � a � 2 06 VPW m 2 . 2 ■ �2 0 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Dale Griffey Mailing Address 1358 Oak Dr. Property Address S� (Verification required from Planning&Zoning Department for new construction.) City/State River Falls V� parcel Identification Number 022-1065-40-000 LEGAL DESCRIPTION Property Location SW '/4 , NE '/4, Sec. 23 , T 28 N R 18 W, Town of Ki n n icki n n is Subdivision Plat: �V , Lot# Certified Survey Map# G , Volume , Page# Warranty Deed# -3 j 0 6 w (before 2007)Volume 5x'6 ,Page# 2 Spec house 13yes0no Lot lines identifiable 0yes[]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 this f 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 warran deed recorded in Register of Deeds Office. Number of bedrooms 3 9101NJT 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) f3¢C[lldEMT 1Y0. Y STATE BAR OF cifSL'CsW'-Fb1WrA i _1F�)'L/}�j)'��/�d hf��'''1i r• i[yARAI..'sFY (7EE12 ry 1 V© .LNLT fit a••,CS �CtS S?:t.-E�RESEl7" v,ir 413 R¢i:+.•'?-.G;.irP �s-r� 133860 B .�_ - _ GoiYtas� -a £ey and yi r�=7,ia ,-� a —-- -- REGM v E�.S OFFICE TICS DEED. v;de between_ -f_ a— cROIX C-,C _— .Ous3xand and r ire - - _——-- -- fitee 4 for R44=TCf*dT l th Granioa. .day Of U .?<-oh A.D.- �9 i and Dale M_ Gri;zfey an+i vita M. Gri�f�= busband aitit �trrsarst e ?P.itnesaeth. Than 1.he said fcra ne or.faz a valuable considera3io.-t_ --- -- --• ------_-- - a. c-loveys to Grantee the following described real a;tate in-��•�'�O3--r +- Cam r. gSY UAN Ttt State of 9asconsilw - - ? The East Assts of the Southwest Quarter of the Nor-theast Quarter (Fa SWt N-A.L) ,of Section 23., T28N, RIM. � Tax Key,-' eg,- — 'Preis it-mo-t_h—stead groale:h,. I The East 3 rods of the West Half of the Soutbwe-st quarter of the Northeast Quarter (W-j SW ) of Section 23, T29N, RIEW. " '*T_ S'!M j Tagc--ehr-r with all and singular the :.arerlil:a.senta atnd appuz*enane,es ihere.urxo Klonging or in any a ise ay erminin'm - And_ Gordon Girl . ° nri l.-?•Fo warrants that the title is good, indefeasible In fee simple amd free and clear of encumbrances except easements includ3tlg t°yi st* public roads.. _ — —---— __--- and will warrant and defend the same. n i ? _ 11 Executed at Rz9 ihis 22nd day ^��E ./< � (SEAT) �r i. SIGN:aD AND SEALED W PRetiE�•L.E Oi? y--�-�-�-� �.. - I - (SEAL) :y T7:Lra3_nJa Grif'fje3gam -- - 8• -'c.Lfr-•��/... '✓.c c l�^ - - —LSEALr j;- 1, I Gordan. GrifS ara F,vtta artrin�i ari P� �i Signatures oC— -s7 ,__ _7,.'C$ Si�u ,.�.+.�.y -�. - aulhenUcated this day of—Eebr,xp,1:3r _ 79�- _ �E Title. Member State Bar of Wiseorsin OF Ot'ner Party i Authorized under Soc. ?06.06 vix. Ij li STATE OF WISCONSIN l Pier.ce ss. _County. � !- 1 22nd Februa-r 1977 Personally came before me, this day -,nf Wi Fig ' i; the above named---. !!(! to me known to be the person___ who executed the foregoing instcument.an¢ acknowledged the• same. This instrument was drafted by f_ Doris ZaxsOn —• Ralph U. .Senn, Attorries_ _ - t- -M Nbary'Publie Pierce_ _County, Wis. W River Falls, I 54022 C� O r , Mv"C�mmission(Expires)(Is) 4,/30/72 The use of wi;.nesses is optional. r - t' Names of persons signing in any capacity should be typed or printed below their-signatures.~ �1 .. 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