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HomeMy WebLinkAbout018-1077-30-070 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578958 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: 018-1077-30-070 Mikla, Mark E. & Susan M. Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: ' SectionlTown/Range/Map No: J ot 35.29.17.537A06 I O~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER j CAPACITY STATION BS HI FS ELEV. Septic -1--k Benchmark -2 lam. /b~ Dosing V rv~dD M:P f0 , Alt. BM 5.7g 9 7' 4! (A Ao~ S~ ~ GO r+~+ti Bldg. Sewer 11 - g f J 7 c' Holding St/Ht Inlet SUHt Outlet TANK SETBACK INFORMATION ZIN TANK TO P/L WELL BLDG. I(Vent t Air Intake ROAD Dt Inlet (.~G Dt Bottom ~j$ • tS Septic 7L I S3 r►.--~ - 151. 6 Dosing 2' 53 Z' Header/Man. Z +I Le 1n; Aeration Dist. Pipe 7 •Z- , Bot. System Holding .13 Z Final Grade / • ~ 1 _ / ~ ~ PUMP/SIPHON INFORMATION ~P Manufacturer Demand St Cover GPM C-a Lt ~q a -7 / < < Model Number / b ZS• / CO A, v 3.46 TDH Lift ,54 Friction Loss System Head ~ TDHO' t 17. Forcemain Length DDiia. Dist. to well Z SOIL ABSORPTION SYI?PSP TEM BEDITRENCH Width Length No. Of Tlench PIT DIMENSIONS No. Of Pit- Inside Di= Liquid Depth DIMENSIONS 6.--5 & SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION Type Of S s m: UNIT Model Number: 6 u JZ 915 Irk DISTRIBUTION SYSTEM 5+-- Header/Manifold / 11 Distribution x Hole Size / if x Hole Spacing / Ve t Air I take Z Pipe(s) ZS p Length .3.0 Dia Z Length ' Dia Spacing o 301L COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ,a Mulched )epth Over Depth Over xx Depth of xx Seeded/Sodded [Ij BedlTrench Edges Topsoil ) Yes ed/Trench Center No Yes 0 No OMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: cation: 1925 Cty Rd J rv.,p ldwin, WI 4002 (NW 1/4 NW 1/4 35 T29N R1 7W) NA Lot 3 / Parcel No: 35.29.17.537A06 Ga.CJ~ L,; A, 11 6~ Alt BM Description = / - 3~~ 1, L~ I / a / S a r, Bldg sewer length = 2 t 7 Chia n.S L. c.1~ -amount of cover = 7 Z /f t~ - - I revision Required? Fg-1 Yes No '7 EZ other side for additional information. Insepctor Signature Cert. No. Date )-6710 (R.3/97) County o ID WIo Metv Aail n .,sion St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Department B and 62 Professw.Aerv 571959 ~Yl JLJ IV- State Plan I.D. Number TAfitfhffy Permit Application Trans id as LA4 q C10 jfi dres in ac 1with SPS 383.21 (2) Wis. Adm. Code submission of this form to the appropriate governmental Project Address (if different than mailing ad unit is required prior to obtaining a sanitary permit. Note application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide `C/Z5 ~~I CCC~~~ T may be used for secondary purposes to accordance with the Privacy Law, sI5.04(1 (m), Slats 1. Application Information - Please Print All Information Property Owner's Name Parcel # Mr. Mark Mikla dl,?- I077_ Property Owner's Mailing Address Property Location / ,Q, 413 Cty. Rd. B Govt. Lot 1 ~ ~ 0 City, State Zip Code Phone Number NW NW Section 35 Woodville, WI 54028 715/698-2136 II. Type of Building (check all that apply) T 29 N/ R 17 W Subdivision Name X 1 or 2 Family Dwelling -Number of Bedrooms Four Public/Commercial - Describe Use I- L Block # City CSM Number Village State Owned - Describe ldse / 20-5137 ✓ X Town of f Hammond 5X 25 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) a ra- A, X New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B Permit Renewal ❑ Permit Revision Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) r Non -Pressurized In-Ground Pressurized In-Ground At-Grade X Mound >24 in of suitable soil Mound <24in of suitable soil _ Holding Tank Other Dispersal Component (explain) -Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: ` Design Flow (gpd) Design Soil Application Rat (gpdsf) Dispersal Area Required (slif Dispersal Area Proposed (s System Elevation 600 0.4 1500sq.ft. 1534.5sq.ft. 100.63' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing ! ~j Tanks Tanks 1,)/o41 f ak rt or Holding 1200 1200 1 Weiser C Crete X Tank MWA Chamber 800 800 1 Combo X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI is Si MP/MPRS Number Business Phone Number Jack A. Bowman MP222839 715/418-1349 Plumber's Address (Street, City State, Z' od N13437 409th' Str , Ridgeland, WI 54763 VIII. un epartment Use Only Approved ❑ Disa roved Permit Fee Date Issued Issuing ent Signature Owne ' n Reason for $ ZS SIZ~ ~5 Dental / IX. Conditjl>ai;TEM !Dw♦~(Reasons for Disapproval 'A- c/ra.i~. ~ ~.8 f L- 58Ptic tank, +e tHu'enf filter and dispersal cell must all be_servtce{,gym ntained a XezC. 1.c)(4A-L Per, v T-^ as per management plan provided by plumber. 2. AS s ck rnqulremerft must IM;ma int. 00 as per appNeilbls codii / ordirmoss. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SITE PLAN NW'/4 ,NWI/4,S35T29N/Rl7W Hammond township St. Croix county 3 acre a,rct( P, 3 ~5" w LEGEND 1 BM: 100.0° on iron pipe a Slt' lot corner pits - grade elevations - contour No DSPS 383 set back problems Scale 1" - 40' except / where indicated D, System Elev. 100.63 on contour 99.8' C ; - L4 Q, !,X f e n UJ r 1 3I{ " /Xk , t ,7 f project: MIKLA ('N 3 5 page 10 of 10 LORETTA LARRABEE Page 2 5/20/2015 • 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 Fee Received $ 250.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 2, Division of Industry Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm t Jack A Bowman, JB Hydro LLC (Plans Mailed To) ~EYVZ1'.upy DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA o~ HOLMEN WI 54636 D S Contact Through Relay P http://dsps.wi.gov/programs/industry-services 9~a ` `GW www.wisconsin.gov ~Ossror~y5w Scott Walker, Governor Dave Ross, Secretary May 20, 2015 CUST ID No. 224580 ATTN.• PO WTS Inspector LORETTA LARRABEE ZONING OFFICE L AN L PERC TESTING ST CROIX COUNTY SPIA N2089 CTY RD Y 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/20/2017 Identification Numbers Transaction ID No. 2544990 SITE: Site ID No. 812709 Mark Mikla Please refer to both identification numbers, ` 1925 County Rd J above, in all correspondence with the agency. Town of Hammond St Croix County NW1/4, NW1/4, S35, T29N, R17W Lot: 3, Subdivision: CSM 20-5153 FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1536135 Maintenance required; 600 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); 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. 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: co Reminders m-PT • This system is to be constructed and located in accordance with the enclosed approved plans and with the pROFE component manuals listed above. ,V151QN o © • 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. G • 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 Private On-Site Wastewater Treatment System (POWTS) Mound and Pressure Distribution Component Design Residential application Index and Title Sheet MAY 112 015 Project Name: MIKLA ',_]"Hy SERVICES Owner: Mark Mikla 1925 Cty Rd. J Location: NW1/4,NW1/4,S35,T29,N/R17W Legal Description: Hammond township, St. Croix county Township/County: Contents: Page 1: index and title Page 2: general information & lateral diagram Page 3: mound drawings Page 4: dose tank Page 5: pump information Page 6: tank detail g~N•••••• 6,~i~ Page 7: filter information O? • e • ~2 : Page 8: management plan Q'Qry OF Page 9: contingency plan y :a= Page 10: site plan •••••••••sy Attachment: soil test to state plan i~~~l"PROfr~ Designer's name and license no: Loretta Larrabee #1872-007 Address: N2089 Cty Rd. Y Menomonie, WI 54751 Phone: 715/664-8184 DITIONALLY Fax: 715/664-8164 PPROVED Cell: 715/505-1628 )F SAFETY AND e-mail: lanlperctesting@wwt.net SIONAL SERVICES INDUSTRY SERVICES Designer's Signatur a a~ SCy-~.t Date: May 1St, 2015 I the undersigned submitted these plans under my authority CORRESPOND E Mound component manual for POWTS Version 2.0 SBD-10691-P (N.01/01), and Pressure Distribution component manual - Version 2.0 SBD-10706-P (N.01/01) page 1 of 10 PLAN VIEW OF MOUND (not to scale) 3= 6.0' D= 0.83' ( 10") K= 8.5' required bed 600sq.ft A= 6.5' E= 1.06' ( 12 3/4") B= 93.0' proposed bed 604.5sq.ft. I = 10.0' F= 0.83' (10") L.= 110.0' required basel area 1500.Osq.ft. W= 22.5' G= 0.50' ( 6") proposed basel area 1534.5sq.ft. H= 1.00' (12") observation pipe @ 18.5' Observation pipe 6.fl' $ A W O 6S' 22.5' L4 10, Mound Cross Section View (not to scale) Finished grade elev. 102.51' t Lateral invert elev. 101.13' II 2 Dispersal cell elev. 100.63' G 11111111 lIllllllllllllllllllllll 4 dispersal cell $ 2" Of-lateral O - - ' - Aggre ate bed 6" - F - - - - - - 3 - E D - - Chisel layer Chisel layer contour 3.5% site slope elev. 99.8' Numeral I topsoil cap 2 subsoil cap 1.5ft. 3 ASTM C33 sand 4in. dia. observation pipe 4 synthetic cover over cell with 1/4in slot 5 aggregate 0.5ft. Closest Flange to secure observation* project: MIKLA page 3 of 10 GENERAL INFORMATION Four bedroom home, 600gal DWF end fed system w/2 laterals 3.5% slope system area dispersal cell design loading rate 1.0 0.4 soil application rate linear rate 6.45 26" limiting soil factor orifice sq/ft. 9.75 1200/800 Wieser tank with 525 polylok septic filter effluent quality #1 LATERAL LAYOUT DIAGRAM (not to scale) End Fed.System Number of laterals 2 orifice dia. 1/8in. (0.125) Lateral dia. 1 %2" orifice spacing (X) 36in. (3.0') Lateral length (P) 90.Oft. orifice per lateral 31 Lateral spacing (S) 3.25ft. lateral discharge rate 12.71gpm Manifold dia. 1 I/2 in total system rate 25.42gpm Force main dia. 2.Oin O seepage 9 of 10 for construction details of turn-up turn-up end on lateral at manifold for access of lateral at both ends for servicin Valve box \ Pressure lug. finish grade P first orifice next to fitting X manif 1 1 f~" S 3.25' (39" Orifices located on bottom of lateral Last orifice next to fitting 1.62' 0 9.5' Force main 2" dia. project: MIKLA page 2 of 10 PUMP PERFORMANCE CURVE v PER MINUTE v`• MODEL 14014140/14514145 t LL15 EFFLUENT AND DEWATERING 37/6 65!,6 22 7 0- 140/4140 145/4145 45M 2° 65 ~ F2O Meters Gal. Liters Gal. Liters O ~ 1.5 86 326 61 232 O 0 329/32 to 3.0 80 303 60 228 _ < 4.6 73 276 56 213 0 6 p 6.1 66 250 53 201 7.6 59 223 49 186 11rz-ntnNPT a5 9.1 49 185 45 171 40-T-1-2.2 28 106 35 133 12 50 15.2 - - 26 99 a o u 60 18.3 - - 16 61 10 Shut-off Head, 50 fQ15.2m) 74 ft.(22.6m) 0 3° 6 25 I 12,3!2 6 ~ t5 150090 J 4 5(32 10- 2- SK1524A 5 tJV um ' JtJS ° 10 m m JO 50 66 70 00 90 GALLONS ~62t5 0 81 160 24 320 FLOW PER Ntf fE I 4 53 CONSULT FACTORY FOR SPECIAL APPLICATIONS 3718 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Mechanical alternators, for duplex systems, are available with or without alarms. 329/32 • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. + -1 • Variable level control switches are available for controlling single phase systems. a • Double piggyback variable level float switches are available for variable level long cycle controls. t,a-,,,rzRPr • Sealed Qwik-Box available for outdoor installations. See FM1420. • Refer to FMO806 for applications above 130°F (54°C). 14014140 8614514145 MODELS Control Selection Model Model Volts - Ph Mode Amps Simplex Duplex N140 N4140 115 1 Non 12.0 1 or 2 3 76116 E140 E4140 230 1 Non 6.0 1 or 2 3 BN140 BN4140 115 1 Auto 12.0 BE140 BE4140 230 1 Auto 6.0 * - 45132 N145 N4145 115 1 Non 13.0 1 or 2 3 -i_ SK1524B BN145 BN4145 115 1 Auto 13.0 * - *Single piggyback switch included. SELECTION GUIDE 1. For automatic use single piggyback variable level float switch or double OPTIONAL PUMP STAND PIN 10-2213 piggyback variable level float switch. Refer • Reduces potential clogging by debris. to FM0477. • Replaces rocks or bricks under the pump. 2. See FM1228 for correct model of simplex • Made of durable, noncorrosive ABS. Easy assembly" control panel. (pump & discharge pipe • Raises pump 2" off bottom of basin. not included.) 3. See FM0712 for correct model of duplex Provides the ability to raise intake by adding control panel. sections of 1 or 2" PVC piping. a cnurloN Attaches securely to pump. A8 installation of controls, protection devices and wiring should • Accommodates sump, dewatering and be done by a qualified licensed electrician. All electrical and effluent applications. safety codes should be followed including the most recent NOTE: Make sure float is free from obstruction. National Electric Code (NEC) and the occupational safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ~ (cl f'nnvrinht 9MR 7nPIIPr r:n All TI67I1tS fPCPI1/PfI Dose tank cross section (No Scale) .Approved Locking Manhole Cover With Warning Label Attached 4„ Weatherproof Approved Warning Label Junction Box Vgnt Ca I wn-., ' tp 1 Z Minimum q~ ~r Final Grade-~ .y 4 Minimum .n Quick -R-- Disconnect 18" Minimum 1/4" Weep Hole Baffle R~ er Approved Joint A e Alarm B Approved Joint V/ SJ~46 Extending 3' x Onto Solid Soi 1 On 6; w/44 Sc410~ ?Ce 1 C Extending 3' S Onto Solid Sod Elev. ©p Off d~ D Conc. Block 3" of Bedding Under Tank a0~o DWP t~010 Note Pu *s and Alar~t Are -on SapararP Circ i s S 1on~~ S~o1 F~ aa~)1 Nom n h ~T L ~a~~ ~t DXl l 0 3 i^" 1 ~~Q te_ Tank Manufacturer: o J Q Tank Size-Septic/Pump: k1_00 2iu Gallons Alarm Manufacturer: S .3 ~Cinv.b~1 " Capacities: A 19 inches or422,5~Gal l ons Model Number:s~ + B Z, .inches orGallons Switch Type: Me- ^~1 + C inches or 111.20 Gallons Pump Manufacturer: 2 t D o inches orte a.o~Gallons Model Number: Total = 3to inches or Gallons Minimum Discharge Rate: ~h gal/in gaga 1 Feet Vertical Difference. Between Pump Off o and Distribution Pipe:(4 _..-r.'~............+(Q,5 Feet Minimum Required Supply Pressure:.. * Z,EFeet of Force Main x k,4 Friction Factor/100 Feet: _.q3 Feet 2 Inch Diameter Force Main Total Dynamic Head:...= 2lo3 Feet project: MIKLA page 4 of 10 . 1 V L Filters r - - s- 61" PL 525 EMUEAff RLTER ft -041MER G14L) IIIIIIIIIIEWW Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of ~ Pts PVC accessibility Acce the largest commercial filters in its f'r extension handle class. it has 525 linear feet of 1/16" filtration slots. Like the Polylok PL 122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1116' removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't t. leave the tank. No other fitter on the mar&et can make that daimt Accepts 4° & 6` SCHD_ 40 Pipe PL -E2E A-Mri enance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years- If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. -t ball when fitter 1. Locate the outlet of the U.S. Patent Nog 6,015,488 is removed septic tank. 5.871,640 2. Remove tank cover and pump tank if necessary. PL 525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. !lake sure all solids fall 4" or 6" outlet pipe. If the bade into septic tank. filter is not centered under the access opening use a Polylok 6. Insert. the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic k cover. S. Replace easeptic tank cover. 53 ~ 96„ 41" - z r m n 4i n 1 1 ~ 11 i II ~ 1 Y e 6 co 44" > m~~ ~O i W I ° p \ C I I I m / I 0 I Ll =PF Z 11 u c(n 39„ u A D C m rn O n r Z ~mi C m p D --1 D N c Zm > z r C z m ~o Z Z ° p m m m D p nD O --4 -4 r_OD_gr2~nW*N r p Z7ZC O to D D ~Z 0 t1 O~Z DZ mD-rnO Zrrn>O O~~ m~ m'DD Z O r(n v DO =00 7,n0 XOOCT -Ac) z O=iO~ ~rN m m m n co m n M MOO m>p -I r W -D N D N C C m z m O~ O c -0~,c r,< z ,--c (z~ n I oor~rr - Z_! w fTl O O to n x cn = y - ~ D D < --1 r -O `p n -4 p rn O I A q O (A ~ 6 0 Op ~l m p 0 < Z !N3 w m m ao r" : C0 n N = z N m o N~ tnm-n aD Jrn = v' v O m o O G7 m ~+rn mmr I r v N O C7 0 n z o z Z na mDm mO po o D j to D rn N Z r. m O =rZ r- --1 r mo D D p m C zZ Di v aD0 co r~ O n cn m m vOm Om (A z O cm i N m rr- U) M D 0i N N = O m fn v r m Z m 1 O D R rn n c D Z p r m < (n M M m m rn m Z m r- rn \ WLP1200 800-MR SCALE:1/4' REV NO. DATE: rn WIENER coNCIETE DRAWN BY:SWT O'n SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK. WI 54750 DATE: JANUARY 2008 REV. JAN. 2008 800-325-8456 FILE- V&P1200 800-MR Mound Svstem Maintenance and Operation Specifications Service Provider's Name: J.B. Hydro, LLC Phone: 715/418-1349 POWTS Regulator's Name: St. Croix Zoning Phone: 715/386-4680 System Flow and Load Parameters Design Flow - Peak 600gpd Maximum Influent Particles Size I /Sin Estimated Flow - Average 400gpd Maximum BOD5 220mg/L Septic tank Capacity 1200gals Maximum TSS 150mg/L Soil absorption component Size 604bed Maximum FOG 30mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100mL Service Fre uenc_v Septic and Pump Tank --------Inspect and/or service once every 3 years Effluent Filter-------------------Should inspect and clean at least once every 3 years Pump and Controls ------------Test once every 3 years Alarm----------------------------Should test monthly Pressure System ---------------Laterals should be flushed and pressure tested every 1.5 years Mound --------------------------Inspect for ponding and seepage once every 3 years Other----------------------------Initially filter should be checked yearly to determine service schedule Miscellaneous Construction and Materials Standards I. Observation pipes are slotted and materials conform to Table DSPS 384.30-1, have a watertight cap and are secured as shown in the mound component manual. 2. Dispersal cell aggregate conforms to DSPS 384.30 (6)(I), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in DSPS 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 6. Lateral Turn-up to finish at grade or above, enclosed in a 6-8" diameter lawn sprinkler valve box or similar product. (lateral turn-up consists of a long sweep 90 or two 45degree bends same diameter as lateral) 7. Lateral Turn-up on end of distribution laterals after the last orifice. project: MIKLA page 9 of 10 Mound System Management Plan Pursuant to DSPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with DSPS 382-384 Wis. Adm. Code. and shall maintain in accordance with the component manuals and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with DSPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8" in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slip off the filer when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personal shall advise the owner of when the next service needs to be done to maintain less than maximum scum and sludge accumulation in the tank. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings maybe made around the mound's perimeter and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since compaction may hinder aeration of the surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations dictate that the mound be heavily mulched as protection from freezing. Influent flow may not exceed maximum design flow 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 at least once every 18 months. When a pressure test is performed is should be compared to the initial test when the system was installed to determine if orifice clogging has occurred, if clogging has occurred orifice cleaning is required to maintain equal distribution within the cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner and any levels above 6" considered impending failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or components shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank or its components become defective the defective components(s) shall be immediately repaired or replaced with a component of same or equal performance. If the mound fails to accept wastewater or discharges wastewater to the ground surface, it will be repaired or replaced. Increasing basal area if toe leakage or by removing biologically clogged absorption and dispersal media and related piping and replacing components as deemed necessary to bring the system into proper operating condition. See page 9 of this plan for the name and telephone number of your local POWTS regulator and service provider. project: MIKLA page 8 of 10 SITE PLAN NW'/4 ,NW'/4,S35T29N/Rl7W Hammond township St. Croix county 3 acre F ar c_e ( LEGEND 113M: 3 00.0 on iron pipe a: SW lot corner ``pits '0 - grade elevations -contour No DSPS 383 set back problems Scale 1" - 40' except / where indicated l System Elev. 100.63 on contour 99.8' t,..,, \ao r ~1' ! E I El? Sa LAO C /SST. , 2665 17 project: MIKLA page 10 of 10 !LO ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner uyer Me. M aRNk W kl a Mailing Address 41 Co: Rom L a~> v.1~ e_ , ~S- 5 4o z PropertyAddress kQ Z5 0 , ~ „ (Z~. J (Verification require from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 0 1$- 10"1'1 --:Z'J -O`l O LEGAL DESCRIPTION Property Location ~'/4 , W 4J '/4 , Sec. '_9 5 , T _2:t_q_N RAW, Town of ~ c,, ryx m o hL Subdivision Plat: Lot Certified Survey Map # . , Volume , Page # Warranty Deed # t,,\. - (before 2007)Volume , Page # Spec house ❑yes((l o Lot lines identifiabl/`yes❑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 thi orm 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 ty deed recorded in Register of Deeds Office. Number of bedrooms r SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Parcel 018-1077-30-070 02/22/2008 09:30 AM PAGE IOF1 Alt. Parcel 35.29.17.537A-06 018 - TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/20/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - MIKLA, MARK E & SUSAN M MARK E & SUSAN M MIKLA 413 CTY RD B WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1925 CTY RD J SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 3.001 Plat: 5137-CSM 20-5137 SEC 35 T29N R1 7W PT NW NW CSM 20-5137 Block/Condo Bldg: LOT 03 LOT 3 (3.001) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-29N-17W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 02/14/2006 818577 WD 12/29/2005 815271 20/5137 CSM 07/24/2002 684932 16/4339 CSM 07/23/1997 706/252 2008 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 3.001 300 0 300 NO Totals for 2008: General Property 3.001 300 0 300 Woodland 0.000 0 0 Totals for 2007: General Property 3.001 300 0 300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Property Owner Miklat Mark Parcel ID # 018-1077-30-070 Page 2 of ~ 3 % J Boring 73Boring # Z Pit Ground surface elev. 99.2 ft. Depth to limiting factor 26 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell, Qu. Sz. Cont. Colcr Gr. Sz. Sh. 'Eff#1 -Eff#2 1 0-12 10YR 3/2 - sil 1 m sbk mvfr cs lm .4 .6 2 12-26 lOYR 4/4 - sil 1 m sbk mvfr y - cs m 4 6 f2d 10YR 6/3 LL 3 26-30 10YR 4/4 f1f 7.5YR 4/6 sl 1 m sbk dsh .7 4 30-46 7.5YR 4/4 c2d 7.5YR 4/6 sl 1 m sbk dh - 1m `.4 .7 ro common massive gy si coats on peds and large inclusions 5YR 4/4 cl in H4 Y ' Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L 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. SBD-8330 (R.07/00) Certified Soil Testing, LLC ORIGINAL' #2465 $ " n IL EVALUATION REPORT Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Certified Soil Testing, LLC Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. 018 1077-30-070 Please print all i Revi d By Date Personal informati ~u pr e m be rREGEIV01rivacy aw, s. 15.04 (1) (m)). 5 Q~ Property Owner Property Location Mikla, Mark 2 2006 Govt. Lot NW1/, NW1/4, S35, T29N, R17W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM4 413 CTHW B ST. CROIX COUNTY 3 CSM 20-5137 City State ip Code Phone Number City Village ®Town Nearest R Woodville WI 54028 715-698-2136 Hammond 1925 CTHW\ New Construction Use: Z Residential / Number of bedrooms 3 Code derived design flow rate GPD Replacement LE Jl Public or commercial - Describe: Parent material loess over pitted till Flood plain elevation, if applicable NA ft. General comments install 5'x 91.2' rock cell mound on 99.5 contour as upslope edge of rock w/ 1.0' sand fill @ 0.4 gpd/sq ft and recommendations: basal loading Boring # Boring / X Pit Ground surface elev. 99.1 ft. Depth to limiting factor 28 ✓ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10YR 3/3 - sil 2 f sbk mvfr cs 1M .6 .8 2 8-16 10YR 3/4 - sil 1 m sbk dh gs lm .4 .6 3 16-28 7.5YR 4/4 - sl 1 m sbk dh cs lm .4 .7 4 28-30 7.5YR 4/4 f2d 7.5YR 5/8 sl 1 m sbk dh cw lm .4 .7 5 30-60 7.5YR 4/4 f d 7.5YR 5/8 sl 0 m dh - - .2 .6 occasional gr, cob, st w/ pockets of s (0, sg, dl) below 16" Boring # J Boring Pit Ground surface elev. 99.8 ft. Depth to limiting factor 29 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. *Eff#1 *Eff#2 1 0-11 10YR 3/3 - sil 1 m sbk dsh cs lm .4 .6 2 11-18 10YR 4/4 - sil 1 m sbk dh gw 1m .4 .6 3 18-29 7.5YR 4/4 - sl 1 m sbk dh cs lm .4 .7 4 29-35 7.5YR 4/4 f2d 7.5YR 5/8 sl 1 m sbk dh as lm .4 .7 5 35-60 7.5YR 4/4 f2p 10YR 6/2 sl 0 m dh - - 2 6 7.5YR 4/6,5/8 H5 has a few small pockets of s and occasional 5YR 4/4 cl inclusions * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >3 < 150 mg/ * Effluent #2 = O 5 < nd mg/L CST Name (Please Print) Signatu CST Number Henry F. Grote c e~~ 22774 Address Certified Soil Testing, LLC Dnation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 6/20/2006 715-233-0398 SBD-8330 (R.07/00) C-lHU-,) b o J S \ ~9 'Y CA+v1k QIr UaA-jt 0 ~.S raj / ~~S~b T7 V W pJ 150 ~ 0 ne I , 2 Property Owner FoCrSier Parcel ID # Page of 3 Boring # ❑ Boring 131 ® Pit Ground surface elev. 9~ 52 ft- Depth to limiting factor 3 rJ in. Soil Application 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 0-110 loYrt ?i - :Q 2&742/ M f''' C S 3m Z l b-35 tom `F/4 - 1 c of bK m f g S 3 of 3 35.60 10-( 2 44 2 j 6 Ye- M ID K m of l a w 60-66 1oYrts/4 - S/ I c bK. M f r a w - 5 66- I0,ei, 7/4 - ~ 5 Q I - - -~f c f<5 t-ESS T/•i so°% P~# $ A4 N E jov5 AS vMD I/`J R/ / UrQ/ n1 • ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Mumseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -01#2 Boring F-1 # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil Applicat Horizon Depot Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -Etf#2 I Effluent #1 = BOD$ > 30 < 220 mg& and TSS >30 < 150 mgA- ' Effluent #2 = BODS 130 mg/L 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. SBD-030(RAM) • 1 r Wisconsin Department of Cory SOIL EVALUATION REPORT Page I of 3 Division of Safety and Building in ce with Comm 85, Wis. Adm. Code County S i c 201 ~c Attach complete site plan on papa less than 81/2 x 11 inches in size. Plan must indude. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ? percent slope, scale or dimensions, north a r-m dJocafti distance to nearest road. O / 8 - /0 77 -J0 -'O&M` Please print all fo m I e Revie by Date Persoriei information you Provide may be used for purposes (Privacy I aw, s. 15. (1) (m)). ~Z a Property Owner „ ii Location Denni s and -rcri Floe S+C't^ Govt. N h/ 1/4N104 1/4 S 35T 2-j N R I7 E(or)@ Property s r. 'ngAddress COL T" LdA Block # Subd. Name or CSM# 19 0 '5 C-t Y (L t0 ..gradip"aer- r~ G ) City State Zip Code Phone Number 0 City ❑ village 12 Town Noiast Road Baldwin W1 ,"0o2- ( 715) gAt-3&7/~ I4A MM0 rJD c%,r 2a j O New Construction Use: egResilntial / Number of bedrooms 3 + Code derived design now rate 45 O do GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable NIA ft. General comments and -THIS AcftErl / 5 Stir/?AC3i.~ Fog A . ~.s iv1'7-1>! /.3 In/~rfEs Mnun)4 0.o•vv i v1= 5 A.,ar ?C/ MBorkV # © Pit Ground surface elev. 3q-'42-.ft. DWth to limiting factor 2's in. Sod Applicedon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. *011#1 -011#2 1 0-12- Ib Y0/l - k 2 vc bK M Fr C- S M 2 12-2 10 YP- -1/1. - 5 ► c i 3 f 10K M i C vv 3 r- 13 - 3 1 10YR-4+14 . 1 -f ,•5YaS/g 5ic1 3m bK my-f i 0..S 3vF Irp "7/ 1 H id /bYR ¢/4 Sc.1_ M/t3SlV M EF1 C0f&-k1F--Th9A)S a Boring # ° Boring ❑ Pit Ground surtace elev. 9 9. '512- ft. Depth to limiting factor 2-4 n. Sod Application Hoemon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots GPD/1F In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef #l *Eff#2 0-1 ID YR 2/2 _ .Q '.Z t» pl m -Fr 0-S m 2 13 -Z. 10 YR '*4 - 5; c I 2 m bK m f i s 3 v-r- 3 21-3 10'0L -F 3d ~:s~ies/8 siC- 1 2vcbK rn V-Fi gS 2vf - 1 34-17 t o `f i 2 "1 t . YY1 -7.5-Yx s- I z m b K rn -ri as 5 '`1-7- 5 YA4/ - 51 2er bK, M -f r - - * &%M t #1= BM,:- 30:S =0 ng1L and TSS >30:S 150 mglL • Effluent #2 = BOD < 30 mg& and TSS 130 mg& CST Name ( Print) 8 {21r✓! IT Signature k~ 9N Address - Evaluation Condixbd Telephone Mxrtber -ia 12 1 CTM ,~ilG Si~Ri/Jh 1 'ALk_EY~ WI 624-7b7 OGT- 7 2oc6 1 S~ 772 -34FV2- FO,4=~5?A;z: rz P # Perc=E 3 ate-3 SC A L- i -4~0' c-o t,) -To L) FZ f3 A C <F. Oe Prrs F3ENc.HM,42KS C T Y Oe- 23 7' V2 ~ = P SET ~ P r~c~pas~o UN i FOlQM M0 L) ^j $ 6 N cti4 ~►JTbuFZ MARK1 _ 'oo.oo 2 M V2- Z C~ S E T 61 8E ^J t..t..I MARK 2. ~ = 1932 ,9,0% i38' • N ~ B2 70 ~ • 5 0' moo, V) a 9 • 03 -7o' o Q~ 50 97.52 A I- ~l 3 So UTH PPOOZ-/ -T Y ~ P ~2v Pos k., ~ L