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028-1004-80-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM �County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: 1 G A 0 1 3 O GENERAL INFORMATION (ATTACH TO PERMIT) J "� Personal information you provide may be used for secondary State Plan ID No: O ry purposes[Privacy Law,s.15.04(1 (— Permit Holder's Name: City Village X 7ownshi• �(J Tv �,chard W oven ba r Parcel Tax No CST BM Elev: insp.BM Elev: `BM Descripti �Us 1 v�� ���' O� V r�� t Section/Town/Range/Map No TANK INFORMATION � ' gj� � 2" 21' 1-1 ' 22 el-20 . ELEVATION DATA TYPE MANUFACTUR �" ' \4 3-Y STATION {� Septic ' BIf D 10� 8 fr FS ELEV. Benchmark z .7 4 162.74] ma Dosing n „ // Alt. BM �7 7Jt , Po/v)t),k. G^/�(/•- Sewer ,�}' a Q�Holding G t �// ex ci �S�U� fY11/Yi J(A,�� q,6 q� �j t Inlet At' y TANK SETBACK INFORMA 10 •I INV St/Ht Outlet �' TANK TO WEW ''I• D r4 Vent to Air Intake ROAD Dt Inlet h a s"Se tic \5b )IW o1 ao 1/ 5! DtBottom fit. , . i 13.* 9or Do IMO Heade Ma> 10p loo.Aeration 0 Dist. Pipe 3.04. Holding a 'l too.8. ate. /stem 9' ' 7 PUMP/SIPHON INFORMATION Final Grade Manufacturer ` L�V �� ,EIX) ` Demand 'n St Cover Model Number �PM `� I ,,� 8, j �� ®5 � 3.74i 7, TDH 1Li /Fricti.: Lo ; System Head i TD. 'Wit 1.1 N35 q,�5 ;1,ir' ', � Forcemain Length�q I Dia. 2 II Dist.to Well ) S II 1 SOIL ABSORPTION SYSTEM DIMENSIONS Width / _ C 1Lengt7 No.Of h s PIT DIMENNS No.Of Pit Inside Dia. Liquid DIMENSIONS ' j) i �� SETBACK SYSTEM TO P/L BLDG f INFORMATION 1,�\{I 1 M WELL LAKE`/STREAM LEACHING Manufacturer TypQ , D I 17,01 ,V 1 )Ibb ' N CHAMBER UNIT OR � Model Num DISTR = ION SYSTEM Vi e Heade' anifol. Distribution /= ,, Pipe(s) • r� I x Hole Size `1 x Hole Spacin I Vent to Air Intake Length Dia ,J Length Dia II Spacing i —I 52 . SOIL COVER j.*_.Trepth x Pressure Systems Only xx Mound Or At-Grade Systems Only Bed/Trench Center ' Over xx Depth of 72. Seeded/Sodded xx Mulched , �'( Bed/Trench Edges / Topso 1 1 xx U � Yes Q No 4 Yes D No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 1 / J(e / 1 S Inspection#2: / / Location: 1 123 (btu Ave-Nut 60e1161.11/ w1 5 N602 G�: P/a�.,� '• N`'f ,,// ' '!_ n Parcel No: OZ -IoUy_8'0'200 1.)Alt BM Description= I W` Ntt� Li' i ( it QX1S ' 1:JS 1'7. 101,,,..... z z 2.)Bldg sewer length= ( C ns \�7 �/S I amount of cover= L1(11` d` 1 l.Li► P `'��'.FZ'' D� �pa�n Uf�(�k,✓ ��fkYe YV aU AU S ti '9°IVY Li,5)121 Plan revision Required? ® Yes t No 1 ^ 1 Use other side for additional inforrnati L � , Date insepctor s Signature SBD-6710(R.3197) Cert.No. 1 — x x ,LO IIZf`I x x x x Go Go 0. O Ql bq v U 4 eo tu 4t IZZ W h o' 11110.111111111111mmei t: w K d Z W _ -TZq 0. 2 � © , cy 1 b4D r% c .. N F 0. 0 w ti J C W 3 \ c5 • z o N O \a d h � te t:3 co N O 1:1-1 rTh 00 M L. U ti N b4 00 o ti o o O � `ti o I a o u `^a tto � ZS o° 0 iii U ?1„ ° v2 m v, 11 ir —■•� •.� N •G t.. b ° c w A c. 0 0 °� o II A ci E-4 w 0 mi ,S0'S6L (( `z W A co w w - x ,LO DZF`I x x x x x 0 eo ati, I 0 N O obi 00 t$ ar ~a cc~ A ,y?a U O U 1 03 i`6i y [ti p,~ y ~ w'K y O C o tt W 7 ~LUW ?4 M as N J 0.+ a ~ W rtl o 3 ~ v 1 O CJO 00 o , C2 GY, !r a Z oo tj (z) P U Q L c CA / ~ ry a4 lid 81 o n Y11 F-A1 N ~ A ' 1 t\ O o ~ W ~ O _ 'w+ it O X fl. a p„ O~ w A o o F 11 A Ll H oo W (z ON 0 0~ O O 0; E N 1 y ~x WAcs~ W W , SO'S6L r Safety and Buil ion county St.Croix ® AUG 3 aOll W. Washington Ve., P. . 162 Sanitary Permit Number (to he filled in by Co.) A S P Madison, WI 162 SS, ST. CRom COUNTY MIMUNITY OE ELOPMENT 73/ V 3 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary / purposes in accordance with the Privacy Law, s. 15. I m , Slats. &o f~ e- L Application Information - Please nt All Information Property Owner's Name Parcel # T Richard Norenber 028-1004-80-200 Property Owner's Mailing Address Property Location 1923 60th Ave. Govt. Lot C City, State Zip Code Phone Number %,N , NW W /a, section 2 Baldwin Wi. TVAO circle one H. Type of Building (check all that apply) Lot # T _ N; R 1 E or 191 or 2 Family Dwelling - Number of Bedroo 3 2 Subdivision Name n2,) Block # El Public/Commercial -Describe Use El City of ❑ State Owned - Describe Use CSM Number ❑ Village of 0/ I5 P q6 Q Town of Rush Riyt X 5 I MDUND CELL V M. Type of Permit: (Check only one box on line A. Complete Hue B if applicable) &F .4 47 &P 4:fU I ~KA A. ❑ New System fR Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) 31 1= B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Numb El Permit Transfer to New e / Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) • /ti s , Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Die ersaVrreatment Area Information: Design Flow (gpd) Design Soil Appfi ation Rate(gpdsf) Dispersal A7112.5 Required (sf) Dispersal A Proposed (sf) System Elevation 450 1.0 0, y 450 450 7nz5 100.08 VI. Tank Info Capacity in To # of Manuf r Gallons Gallons Units / c New Tanks Existing Tanks 525 Polylok, / w U ti wU un wC7 a Septic or Holding Tank 1000 100 Wieser X Dosing Chamber combo VII. Responsibility Statement- I, the undersigned, asV4 respo i fellatio f tbe'POWTS shown on the attached plans. Plumber's Name (Print) Plum ign MP/MPRS Number Business Phone Number Keith Knudtson 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th Roberts Wi. 54023 VIIL Count- evartment Use Only Approved ❑ D Permit 1 $ Fe/e' Date Issued Issuing Age e ~:r Given Reason for Dem ~j✓ IX.CondgPteasonsfor Disapproval 3 Y~ ,n/1C1-rOn// P'r f~ /li~L m~s C s 1. Septic tank, effluent filter and J / dispersal cell must be serviced /maintained / SPICfiG as per management plan provided by plumber, (~1 /I AJ_'~ ~ 6onn~~ ~•Dn~ 4#a&lef~ a ~•P f, 2. All setback requirements must be maintained _ ' f-/ Attach to complete plans for the system and submi to the County on n paper amt less • 80/2: I 1 inches in size 5• &-S-pnj PONTS t b t akodwe~ SBD-6398 (R, 1lJl l) ~~y~B tfpN DIVISION OF INDUSTRY SERVICES ytit' Ton 3824 N CREEKSIDE LA Uo~ HOLMEN WI 54636 Q S a Contact Through Relay hftp://dsps.wi.gov/programs/industry-tervices 92 P S Y www.wisconsin.gov 4 ~O 'sslorScott Walker, Governor Dave Ross, Secretary August 24, 2015 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: 08/24/2017 Identification Numbers Transaction ID No. 2590646 SITE: Site ID No. 816349 Ty Richard Norenberg Please refer to both identification numbers, 1923 60 Ave above, in all correspondence with the agency. Town of Rush River St Croix County NW1/4, NW1/4, S2, T28N, R17W Lot: 2, Subdivision: CSM Vol. 15 Pg 4045 FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1552117 Maintenance required; Replacement system; 450 GPD Flow rate; 23 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the COND component manuals listed above. AP • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. DEPT O Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and PROFESSI dispersal are prohibited. DIVISION OF • The existing POWTS must be properly abandoned per SPS 383.33 Wisc.Adm. Code. • 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 SEE CO • 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. KEITH E KNUDTSON Page 2 8/24/2015 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat • 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 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2, Division of Industry 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 M~ Y . KEITH E KNUDTSON Page 2 8/24/2015 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat • SPS 383 22(7) A copy of the improved plans specifications and this letter shall be on-site during construction and open to inspection by authorized rgpresentatives 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, Division of Industry 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 I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Ty Richard Norenberg Replacement Mound System Owner's Name: Ty Richard Norenberg i.- Owner's Address: 1923 60th Ave. YC°` `V. Baldwin WI 54002 Na Legal Description: Parcel in the NW114-NW1/4 Sec. 2 T28N-R17W Township: Rush River County: St. Croix Subdivision Name: Csm Vol. 15 Pg. 4045 Lot Number. 2 Block Number: Na Parcel I.D. Number: 028-1004-80-200 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Keith Knudtson License Number: MPRS648443 TIONALLY Date: 08/Q5 Phone Number: 651-470-1737 VED SAFETY AND Signature: )NAL SERVICES JDUSTRY SERVICES Designed Pursuant to the f D.[01177) Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 0110 band 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. 01/01ta, ~RESPONOEN Version 7.0 (R. 03/2012) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information _ (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 =150%) fecal coliform of 36 inches. 450.00 Design Flow (gpd) 4.00 Site Slope 99.00 Contour Line Elevation (ft) 23.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution I YJ Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.33 Estimated Orifice Spacing (ft) = 7.03 ft2/orifice 2.00 Forcemain Diameter (in) 210.00 Forcemain Length (ft) Does the forcemain drain back? 89.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 34.25 Forcemain Drainback (gal) 10.83 Vertical Lift (ft) 67.41 5x Void Volume (gal) 5.26 Friction Loss (ft) 101.67 Minimum Dose Volume (gal) 0.00 ln4ine Filter Loss (ft) 34.46 System Demand (gpm) 20. -T66 Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 603.36 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 16.76 Dose Tank Volume (gal/in) PL-525 Filter Model Number Weiser Concrete Manufacturer Project: Ty Richard Norenberg Replacement Mound System Page 2 of 8 Mound Plan and Cross Section Views t - 1/10 B J Observation Pipe • K •.4.4•L°4^'M•L'='L.S.:L=L.L.4.b.L~L.L.L•4.L•°.=°.Wa ~~°~.!x".•L:4.L;p ~a ~b•°e•4.5•'4: L.L.LvL. 1•L°L•L • r r d.r. ~ r t ° ° • r a .P. 1'.r d' d'.d'.r.l' lpd.rnr. nL b 4 L 4ew S.°L 1 es°. a'b ti ~ •°°•'L"x'tei ~9. ti b.L,e ~b ~b ~^nR..biL:L°Lv'L. L.•..L A ••~•r•• r.r.r.r:. ...r.r..r.r~r.r•m•. ~•w •r°. . r.r.r.r.r.r. r.r.r. r. `1r °.wS L°L 1~'4 L'4 •°L ~4 ;L 5 b L;•. Lq".;°.•L.°.•L.°a.L•; •S.:.L 1-• L•'L.L r^%$ a r;r"rr s~ i;x r { : r•a°e x°.;br• t•r~s.r°.r• ti . ti L~4 aL La~L L L 4 ti Leb 4 LeL pL ti 4; Sra r;b ati '1 L L.h: w ,b .b 'L° 'S.:°o 9'°ti`e °r.r°r.r, .r.. .r.r.^.}xr.r.. er. aPw o .r.r. •r•r. ..•r. °°r. r°. W t,.•_....... r. t. . .i.. • . . B L Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 15.88 in H Aft ft K 8.99 ft B 75.00 ft F 9.50 in z L 92.97 ft D 13.00 in G 0.50 ft J W 21.36 ft 450.00 (ftz) Dispersal Cell Area 1125.00 (ftz)Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.88 (ft) -t .rriiii rnrii . ♦ H I F Dispersal Cell 100.58 (ft) Lateral 100.08 (ft)-► Invert Dispersal Cell Elevation D 99.00 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on Q ® Topsoil Cap o ° 1.5 ft 1•b b~L~tij•.jLgb fb~L L LlSlrb~L Page 4 for number, size, S.ti.b•S•S•1.1•Svti•L.•se o a. 4.e° a.•..4.4 and spacing of laterals. ❑ rrrrr Subsoil Cap a o; ff1p.: r r ® ASTM C33 Sand Laterals are equally spaced from the Tilled Layer 0 5 ft Typical Lateral ' distribution cell's 4 4 4 4 1 .L e'.,M1 S ~S: L Aggregate et © o _.j___ •ti a ~.ti~;:ti~";•ti,-ast centerline in the A distribution cell (AxB). Project: Ty Richard Norenberg Replacement Mound System Page 3 of 8 End Connection Lateral Layout Diagram Latetak oenter over th & ion • m Turn-up W bell volvo or oleanoutplug h tmerals are Wntical 1<-X---+l Hops: dri"d os the bottom or the lateral equally spaced S oroo main oOrlnoction via toe or cross to manifol ! at am ooint. rzaterals Worcemain Sch 40 PVC per SPS Table 384.3D-6 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.37 ft Lateral Length (P) 73.47 ft Orifices per Lateral 32 Lateral Spacing (S) 3.00 ft Orifice Density 7.03 ft2/orifice Lateral Flow Rate 17.23 gpm Manifold Length 3.00 ft System Flow Rate 34.46 gpm Manifold Diameter 1.50 in Total Dynamic Head 20.64 ft Forcemain Velocity 3.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --10 SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented F-- Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Capaci!yl 603.36 Gallons Volume 16.76 gal/inch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 18.93 317.33 B 2.00 33.52 C Pump off elevation ft) C 6.07 101.67 89.75 D 9.00 150.84 D Total 36.00 603.36 Dose tank elevation (ft Bedding un er tank. 89,00 Alarm Manuafacturer SJE_. Rhombus Note: Switches Alarm Model Number Tank Alert 1 containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number 3871 EP05 Pump Must Deliver 34.46 gpm at 20.64 ft TDH Project: Ty Richard Norenberg Replacement Mound System Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name _ Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix County Landuse Dept. 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 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freguencv Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SIPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • • • • • Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Ty Richard Norenberg Replacement Mound System Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code Goneral This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)j 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, State. 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 fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter 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 floras 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. Mound and Prm- uLre Distrbbuticm Svatmn No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg& FOG for septic tank effluent or 30 mg/L RODS, 30 mg/L TSS,10 mgfL FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clM mg 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 pending. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failare requiring additional, more frequent monitoring. Corrtirmerwv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed rmecessary 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. Pretreatrnent Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page of 8 MGOULDS PUMPS Submersible Effluent Pump 3871 EPOS 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 • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- Canadian Standards Assot~ation • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic Gmkls Pimps is ISO 9001 Aqjswed FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 'l4" maximum, ■ EP04 Impeller; Thermoplas- X Pourer 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: 1'12" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104"F (40"C) continuous METERS FEET 140"F (60cC) intermittent. 10- • Fasteners: 300 series stainless steel. s 30 s GPM • Capable of running dry without damage to $ 2 s FT components. 25 0 7 Motor: • EP04 Single phase: 0.4 HP, u s 1q 115 or 230 V, 60 Hz, 1550 D . b RPM, built in overload with s 15 automatic reset. j • EP05 Single phase: 0,5 HP, 0 4 Eros 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with automatic reset. 2 EP04 • Power cord: 10 foot s standard length, 1613 1 SJTOW with three prong grounding plug. Optional 20 o 00 io Zo 30 ao _ so_ Grnn foot length, 16/3 SJTW with three prong grounding plug ' (standard on EP05). 0 2 4 6 8 10 12 malh CAPACITY Goulds Pumps t 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 - X ,Z0,017f 1 X X x 0 h O h J N Q r~, \ v v ~ c ~ fr ~~..II a0= 12 4UW ~ v w J oi, oo LL1 v a 3 U ~ C7 • o v v ~ 0 79~ '~v o 00 N ~ o a ~ <r aO q Q4 o ~ 4O U ~M 44 N 110 v1 U A ~ e ~ ri u h II W U 'It ° a RI cFct N II y a~ ex. CN / ~ ~ WAW W W ,SOTG 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Ty Richard Norenberg Mailing Address Property Address 1923 60th Ave. , (Verification required from Planning & Zoning Department for new construction.) City/State Hammond Wi. Parcel Identification Number 028-1004-80-200 LEGAL DESCRIPTION Property Location NW NW '/4 , Sec. 2 , T 28 N R 17 W, Town of Rush River Subdivision Plat: , Lot # Certified Survey Map # Volume Page # 5 . Warranty Deed # (before 2007)Volume , Page # Spec house DyesEho Lot lines identifiable Byes❑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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE 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) WisconsinU onal Services 4 Divts'i'~11101` Indus ices SOIL EVALUAT #3030 AEG e (4S4 Page 1 of 3 in accordance with SPS 385, Wis. Adm. Code Keith Stoner CST S CRW 7r~1(COUNTY County Attach Mall §apMENT er not less than 8%x 11 inches in size. Plan must St. Croix incit*k invited 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. o s-1 o04-so-2oo Please print all information. Reviewed B Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Ty Richard Norenberg Govt. Lot NW1/4, NW1/4, S2, T28N, R1 7W Property Owner's Mailing Address Lot # Block # Subd. Name or C 1923 60th Ave 2 CSM Vol. 15 P gSM# 4045 J\ City State Zip Code Phone Number C' Village ❑ ~Y ❑ ®Town Nearest Road Baldwin WI 54002 Rush River Same ❑ New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable NA ft. General comments Propose a 6 x 75' mound cell located along the 99.00' contour with a system elevation =100.08'. Upslope contour staked onsite. and recommendations: f if P Jo ` Boring # ❑ Boring Pit Ground surface elev. 99.24 ft. Depth to limiting factor 24 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 0-7 10YR3/3 - sil 2msbk mvfr is 3f-m 0.6 0.8 2 7-14 10YR5/4 - sicl 2msbk mvfr gs 3f-m 0.4 0.6 3 14-24 10YR4/4 - sil 2msbk mvfr gs 2f .6 0.8 4 24-42 10YR4/4 c2d5YR5/8 sil 2msbk mvfr - 2f 0.6 0.8 *H20 bleeding out of pit wall at 32" - standing water in bottom of pit ❑ Boring ❑ Boring # ® Pit Ground surface elev. 98.00 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0-10 10YR3/3 - sil 2msbk mvfr cs 3f-m 0.6 0.8 2 10-20 10YR5/4 - sicl 2msbk mvfr gs 3f-m 0.4 0.6 3 20-26 7.5YR4/4 - sl imsbk mvfr gs 2f 0.4 0.7 4 26-46 7.5YR4/4 c2d5YR5/8 sl imsbk mvfr - 2f 0.4 0.7 *H20 bleeding out of pit wall at 30" - standing water in bottom of pit Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ffluent #2 = BODS <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: - CST Number Keith Stoner 224059 Address Keith Stoner CST Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 7/20/2015 715-566-2128 SBD-8330 (8.07/13) Property Owner Ty Richard Norenberg Parcel ID # 028-1004-80-200 Page 2 of 3 ❑ Boring F3 Boring # Pit Ground surface elev. 98.19 ft. Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou dary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10YR3/3 - sil 2msbk mvfr a 3f-m 0.6 0.8 2 6-15 10YR5/4 - Sid 2msbk mvfr gs 3f-m 0.4 0.6 3 15- 10YR4/4 - sd 2msbk mvfr gs 2f 0.4 0.6 4 23-36 10YR4/4 c2d5YR5/8 scl 2msbk mvfr - if 0.4 0.6 *Standing water in bottom of pit F-I ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#t *Eff#2 ❑ Boring F-I Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L 795.05' Boo- It N c~ II II II mat. Q ► * II y 0~o oho "o d II y Cs ° O Jr' ~ $ y w ~v II n A O / A, A A b / ~ Oq ~ ~ G1 ~ ti o A' o otiyo~b~ b -ly C w ti o ~ b ~ti • ^n IM n r m m r o k ~ a a A o b oos3 p~ ci. ~ N O co N 4 N ~ tJ A ti ~ O w ~ b x x x x x 1,32.07' w x 2372 RECEIVED . Wisconsin Department of SOIL EVALUATION REPORT Page 1 of 4 4'0i'ifE3E11 c; in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations ST. plan on paper not less than 8% x 11 inches in size. Pla County M,. vertical and horizontal reference point (BM), directio St. Croix .OMR1lSE r `s 9emsions, north arrow, and location and distance tc Parcel I. . Please print all Information. 028-)P04-89f200 Revi By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 5//5 Property Owner Property Location George & Diane Ktsanes Govt. Loi NW 114 NW 1 S 2 T 28 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 1923 60th Ave. 2 na Vol. 15, Pg. 4045 City State Zip Code Phone Number City Village V Town Nearest Road Baldwin WI 54002 (651) 270-9320 Rush River 190Th St. New Constructior Ilse: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General commentv and recommendations: Soil conditions require mound POWTS. Dispersal cell to be placed on 97.75' contour. Infiltraive surface elev. to be 99.00' at 15" above contour. ZoAe- FBoring # Boring Pit Ground Surface elev 96.86 ft. Depth to limiting factor 21 in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/f - in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh `Eff#1 1 0-7 10yr3/3 none sil 2fgr mvfr cs lvf,f 0.6 0.8 2 7-21 10yr414 none sicl 2fsbk mfr cw lvf,fm 0.4 0.6 3 21-30 7.5yr4/6 f2d 7.5yr5/8 sicl 2fsbk mfr gw 1vf,fm 0.4 0.6 4 30-46 7.5yr4/6 f2d 7.5yr5/8 scl 2fsbl mfr - 1 vf,fm 0.4 0.6 2 ] Boring # Boring v' Pit Ground Surface elev 97.63 ft. Depth to limiting factor 31 ° in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft; in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh "Eff#1 'Eff#2 1 0-6 10yr313 none sil 2fgr ds cs 3f,c2c 0.6 0.8 2 6-12 10yr4/4 none sil 2msbk ds cw 2fmc 0.6 0.8 3 12-22 7.5yr4/4 none sicl 2fmbk dsh 9w 1fmc 0.4 0.6 4 22-31 7.5yr416 none scl 2fsbk ds cw lvf,fm 0.4 0.6 5 31-46 7.5yr4/6 f 1 d 7.5yr5/8 scl 1msbk ds - 1vf 0.2 0.3 I ' Effluent #1 = BOD ? 30 <220 mg/L nd TSS >30 < 1 mg ffluent #2 = BOD5< 30 mg/L and TSS < 30 mg, CST Name (Please Print) Signat e: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/25/2014 715-248-7767 Prroope`rtj Owner George & Diane Ktsanes Parcel ID # 028-1004-80-200 Page 2 of 4 3 I Boring # Boring L__J J Pit Ground Surface elev 97.96 ft. Depth to limiting factor 32" in. Soil Application Rat Horizon Depth minant edox scription exture Structure ConsistenceBoundar Roots in. Color Qu. Sz. Cont. Colo GPD/ft' Gr. Sz. Sh *Eff#1 *Eff#2 1 0-5 10yr3/3 none sil 2fgr ds cs 2vf,f1 0.6 0.8 2 5-12 10yr5/4 none sil 2msbk ds cw 2fm1c 0.6 0.8 3 12-18 10yr4/4 none sil 2fmbk dsh gw 1fmC 0.4 0.6 4 18-32 7.5yr4/6 none Sid Imsbk ds Cw lfmc 0.4 0.6 5 32-42 7.5yr4/6 f2f 7.5yr5/8 scl 1 csck ds - - 0.2 0.3 Mg conccretions observed at 24". 4] Boring # Boring tl Pit Ground Surface elev 96.86 ft. Depth to limiting factor na 7 in. Horizon Depth Dominant Soil Application Rat Redox Description Texture Structure Consis GP /ft: in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-7 10yr3/3 none sil 2fgr mvfr cs 1vf,f 0.6 0.8 2 7-21 10yr4/4 none sl 2fsbk mvfr gw 1vf,fm 0.6 1.0 3 21-30 7.5yr4/6 none sl 1msbk mfr gw 1vf,fm 0.4 0.7 4 30-36 7.5yr4/6 none sl 2fsbk mvfr - 1vf,fm 0.6 1.0 5 36-54 gravel dispersal cell Soil backfill over existing dispersal cell has developed sufficient structure to allow adequate wastewater infiltration and treaatment, making construction o mound component over existing dispersal cell acceptable. ❑ Boring # Boring Pit Ground Surface elev ft. Depth to limiting factor in Soil Application Rat Horizon Depth Dominant Redox Description Texture structure Consistence Boundar Roots GPDlfN in. Color Qu. Sz. Cont. Cob Gr. Sz. Sh *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg - * Effluent #2 = BOD <-30 mg/L and TSS < 30 mg, 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-8334 (R.07/00) A.C.E. Soil & Site Evaluations SOIL AND SITE EVALUATION PROPERTY OWPIE&r¢e & Diane Ktsanes 2372 Page 3_ of 4 PARCEL I.D.tb28-1004-80-200 AC.E. Soil & Site Evaluation REPORT MEMO The existing dispersal cell was constructed in 1979. Soil backfill over the dispersal cell has developed sufficient structure to allow adequate wastewater infiltration and treatment, making the construction of a mound component over the existing dispersal cell acceptable. As a safety measure, it is recommend that additional square footage be designed into the mound dispersal component equal to the area of disturbance created by the original dispersal cell installation. SSD,%ed~/!AG Eian~, ♦ ~raall e Lod- 4.tt : /'A l0~ 1Qs~~`Z 3T~ G e7:0, d .'unesa„ es,~yo f~ 192m •4re. p st~ooz r i 1-ve- C eK t/&/ 4W*/" k eadrly wavd.~d it 64C. ,~T. t, i i pe%~ozg-iebs~ 8o-za f ~ kt4W(y waded 1,5acres it a ~r rr v i is 97 8s~ r ~ c r , ^ " ~ 4 Feu o'~ ~Y( d 1 Ca ~ F,Yi:S~n ~ ~ ~ ConC~i ~c~< ~ Concf~l ~ f h 5(sb r Sve„,c- t-'k 2cs; d~nc` M ~di 3~►n% ~ . 7~ro o~• ~ ~XiSE~ - Q (Q, 1J; ! Ulf. C~~ wed It ~4 di /r uJ ae d cd