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002-1013-70-000
Flow -~~o,GG` ~:er county: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division Sanitary Permit No: INSPECTION REPORT 579071 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)] vY 0 Permit Holder's Name: City Village Township Parcel Tax No: Scott and Monica Miller TOWN OF BALDWIN 002-1013-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: I/ C00•00 72)P CIL l u U !/f, eO 1&D Y 06.29.16.89B TANK INFORMATION V ELEVATION DATA 7b 54,S . TYPE MAN ` • Z CAPACITY STATION S ' HI II FS Q E EV. Lf. 918 Septic 100 CjA ( Benchmark pn , c Dosing Alt. BM ! X00 a~ . l3~'Sr~~/l~~ ➢ca A Bldg. Sewer q Z +7 p HeldmrJ l ` ~~1 O ^~S St/Ht Inlet W+' S v ` (J St/Ht Outlet TANK SETBACK INFORMAT& St/Ht Outlet TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I I t Dt Bottom IT la •2 0-7,5-43 t a an. -1((J tl'' ~Q Dosin He Zrb J o Aeration Dist. Pipe 3 )O 30 Holding Bot. System v d+!'$ Final Grade 'O 2 PUMP/SIPHON INFORMATION Manufacturer y 5 GPMand St Cover 917- &9 Model Number 7(J V~ Lt ~ Friction~os~D System H&ad• Tt D~I' U~t TDH N~j ~ . 1 Forcemain em" )40 / Dia. r Dist. to Well SOIL ABSOR TION SYSTEM BED/TRENCH Width Len~tl~ No. Of Tmaal *l~ 1~ PIT DIMENS ONS No. Of Pit Inside Dia/ Liquid Depth DIMENSIONS CyJy Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION Tye Of System: I ~t ' O UNIT Model Number: RIBUTION SYSTEM I\ ~i/\.A ~ x Hole Size ~ x Hole Spacing i nta_ke Hea r/Manifold ~ Distribution ~ 1 ~ ~ ~ r i//M.r✓rr ~ Pipe(s) I O _ Length Dia Length Dia l ~ Spacing ~ • SOIL COVER ~ x Pressure Systems Only xx Mound Or At-Grade Systems Only De th Over ` xx D th of xx Seeded/Sodded Mulched Bed/Tr nter r,•r Be /Trench Edges Topsoil ` Yes Noes No ~i PP l / ~ #2: C al ns /~jr//, Il Paction COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Ins Location: 2136 110TH tVE c G C 17 ~JA 1.) Alt BM Description = 0- (d 2.) Bldg sewer length = amount of cover = 10-1 ,t p ho Ve r q S 1 DP?N' cooditims WS I K ~ .1,, ~ Cove lr o>n ~t► . I ? Plan revision Required? ❑ Yes No Cot 118 z Use other side for additi nal information. - Cert. No. Date Vlnsepctor's Signature SBD-2710 (R.3/97) O e Lo Dry L e 4_1' . 01A h p~S a {b 165 (fp . Croix Wisconsin Department of Commerce P~I~E StWAGE SYSTEM County: St Safety and Building Division Sanitary Permit No: INSPECTION REPORT 579071 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 2456822 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No: Scott and Monica Miller TOWN OF BALDWIN 002-1013-70-000 CST BM Elev: Insp. BM Elev: TBM Description: Section/Town/Range/Map No: I -rb 12 id - Alt n ea e-er (r 06.29.16.89B TANK INFORMATION ELEVATION DATA TYPE MANUFACTUREF~X CAPACITY STATION BS HI FS ELEV. Septic Benchmark O Dosing Alt. BM A10 ILME) Aeration Bldg. Sewer l~~ 2 • 7 { J / Holding t Inlet (7t Outlet :J TANK SETBACK INFORMATION A to 6? 1,5~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing W ! Header/Man. A ration Dist. Pipe Holdin Bot. System Final Grade PUMP/SIPHON INFORMATION Manufactur D and St cover PM Mo el Number 0~ lr 0, (~3 TD . Lift Friction Loss ead TDH Ft Force ain Length ia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacturer: INFORMATION Type Of System: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pi e s Leng is Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded T Mulched Bed opsoi E] Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2136 110TH AVE !3 q, 0- Z~ 11~-Ja #,N- y I~~AOn . C ~ (A ; n S La `-S 1.) Alt BM Description = C /n C~ 1 2.) Bldg sewer length = 1 ✓ -amount of cover = 'vM~ ! 71 " 0~ Cov~v an a ~ ~ /p Plan revision Required? Yes ^ No Le_~~Li~4 Use o ther side for additional information. Date I gepctor'sture Cert. No. SBD-6710 (R.3/97) ~A y~ a~ Z -4 _ Ado N o~~ n n 4k vh Y, . 04 MINE s s o ,y4yrr%Vq N 4 k. ` t 10 O ~ •J w ~ h ~ ~d 44 xm z g - sl G o Z X6- J ' B D County - Safety and Buildings Division n.' 2 t~ 2015 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) S ps 1=I A~~ IWy Madison, W70 716 ~79b~1 s~f: ST. NITt'1D V OPMEN c U State Transaction Number Sanitary Permit Application r~ In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit v^ ~ 3 Z. z- 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. 15.04 I m , Stats. 1. Application Information - Please Print All Information J LJ Property Owner's Name Parcel # " y. .y~. - ~ _ o•-ate L~~. Property Owner's ilmg Address Property Location Q C~' & f l Govt. Lot City, State Zip Code Phone Number /4, Section_ rrcle oX' 'I C) 4 G La Q' lu C l/ 71S'!' T N; R E J 11. Type of Building (check all that apply) Lot # Subdivision Name 0 1 or 2 Family Dwelling -Number of Bedroom V a~ Block # O ❑ Public/Commercial - Describe Use ❑ City of 1 ( CSM Number O ❑ Village of El State Owned -Describe Use Town ofd Ll elt-S -2 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ®'New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner l IV. Type of POWTS S stem/Com onent/Device: Check all that a i ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade 9 Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Ot er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: i Design Flow (gpd) Design Soil Application e(gpdsf) Dispersal Area Require f) Dispersal Area Propos sf) System Elevation / 6 D. Co 6, VI. Tank Info apacity in Total # of Manufacturer Gallons Gallons Units ° New Tanks Existing Tanks i , O ~D L ~f" C U rn ~ rn w C7 a. Septic or Holding Tank % Gi i W / 1~V~ v ~J Dosing Chamber •s~ j e, VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum r' Signat e MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) L1 •E7_ VI11 oun /De artment Use Only Approved ❑ roved Per//milt Fee Date ssued Issuing ent Signatur ❑ tven Reason nial $ W Z5 ~ , IX. Condi*,fg}1Rteasons for Disapproval 1 Septic tank, efguenl filter land (A t t e ►'r~l .dis}5ersal cell,must all be servk~s /'maintained I~J~ GJl wr ag,per management plan provided by plumber. 2. A11`fr64Orequirementsmtist,be tnaiMairibd as per applicable code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 11/11) w~enx7,~1FVr DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA c HOLMEN WI 54636 3 S Contact Through Relay P http://dsps.wi.gov/programs/industry-services yti~~ [ .Si `Gw wvvw.wisconsin.gov ssIO'N'N Scott Walker, Governor Dave Ross, Secretary September 18, 2014 CUST ID No. 648443 ATTN: POWTS Inspector ZONING OFFICE KEITH E KNUDTSON ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMIC14AEL RD ROBERTS WI 54623 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/18/2016 Identification Numbers Transaction ID No. 2456822 SITE: Site ID No. 806051 Scott & Monica Miller Please refer to both identification numbers, 110TH Ave above, in all correspondence with the agency. Town of Baldwin St Croix County SW1/4, SE1/4, S6, T29N, R16W Lot: 5, Subdivision: CSM Vol 13 Pg 3651 FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1502851 Maintenance required; 600 GPD Flow rate; 20 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 component manuals listed above. DES • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. PROF Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. T)IVISION 01 • 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 I • 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 I KEITH E KNUDTSON Page 2 9/18/2014 • 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 This Amount Will Be Invoiced. w' 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 t' rye KEITH L KN )TSON pace 2 9/1&'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(I). • 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`installationi 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 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Scott and Monica Miller Mound System Owner's Name: Scott and Monica Miller Owner's Address.- 1686 99th Ave. - - - - Hammond WI 54015 Legal Description: Sec.6 T29N-R16W Township: Baldwin County: St. Croix Subdivision Name: CSM. Vol. 13 Pg. 3651 Lot Number.- 5 Block Number: Na Parcel I.D. Number: 0021013-70-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan 'JDITIONALLY Designer: Keith Knudtson - License umber: MPRS 648443 APPROVED OF % Date: 08!25/14 Phon umber. 651-470-1737 OE-S FE~ANo SERVICES Signature: INDUSTRy;S,ERVICES Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10681-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and:,Qfl N~ Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) DENCE Version 7.0 (R. 03/2012) Pagel 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 400.00 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. 600.00 Design Flow (gpd) 9.00 Site Slope 99.20 Contour Line Elevation (ft) 20.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ tz) Distribution Cell Information AI86.000 Dispersal Cell Length Along Contour (ft) = 6.98 Cell Width (ft) Dispersal Cell Design Loading Rate (gpd/ft2) Influent Wastewater Quality (1 or 2) Are the laterals the highest pint in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 149 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in)~v~ -1 2.17 Estimated Orifice Spacing (ft) = 7.70 a/orifice 2.00 Forcemain Diameter (in) F 108.00 Forcemain Length (ft) Does the forcemain drain back? Y 90.50 Pump Tank Elevation (ft) EntF 6.50 System Head (ft) x 1.3 17.62 Forcemain Drainback (gal) 9.62 Vertical Lift (ft) 77.40 5x Void Volume (gal) 2.38 Friction Loss (ft) 95.02 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 32.13 System Demand (gpm) 18.49 Total 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 Gallons/inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.00 Se tic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.64 Dose Tank Capacity (gal) Po-Filter Manufacturer 2224 Dose Tank Volume (gal/in) PL-625 Filter Model Number Wieser Concrete ]Manufacturer Project: Scott and Monica Miller Mound System Page 2 of 8 Mound Plan and Cross Section Views _ T 1110 B : . :observation Pipe J . K b - b,sy - , y (r f 5 A W_ L Mound Component Dimensions A A16.00 ft E 23.54 in H 1.00 ft K M26.55 ft B ft F 9.50 in [ 13.37 ft L ft D in G 0.50 ft J 6.20 ft W ft 600.28 (ft) Dispersal Cell Area 1750.04 (ft) Basal Area Available 6,98 (gpd/ft) Linear Loading Rate 8.60 (ft) 1/10 B Obs, Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.33 (ft) .rrrrrrrrrr, rr„rrrrr,.. . rrrriiiirrrirrrrr~ rrrririiiriiirrr.,. 100.53 (ft) Dispersal Cell 101.03 (ft) Lateral Invert Dispersal Cell Elevation D .1 ti 99.20 (ft) Contour Elevation 9.0 % Site Slope .0 4) Geotextile Fabric Cover Shading Key d EL Dispersal Cell See lateral details on Q Topsoil Cap V C 1.5 It Page 4 for number, size, o T-~ U) 0 Q rrrrrrrr Subsoil Cap 2 ~y and spacing of laterals. © ASTM C33 Sand D F Laterals are equally ® Tilled Layer 0.5 ft Typical Lateral I spaced from the Q v distribution Aggregate c cell's centerline in the in the - - A * distribution cell (AxB). Project: Scott and Monica Miller Mound System Page 3 of 8 End Connection Lateral Layout Diagram Caterers centered aver the,4& B ditnensiort E P •a Turn-up v6lball valve orolesnoutplug All laterals ate i+lentieal I~ X Noles drilled ~ the bottom or the lateral equerry spaced S Foie* main mnneclion via tee or cross to manifold at am ooint. Laterals Morcerttain Sch 40 PVC per SPS Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.22 ft Lateral Length (P) 84.36 ft Orifices per Lateral 39 Lateral Spacing (S) 3.49 ft Orifice Density 7.70 ft2/orifice Lateral Flow Rate 16.07 gpm Manifold Length 3,49 ft System Flow Rate 32.13 gpm Manifold Diameter 1.50 in Total Dynamic Head 18.49 ft Forcemain Velocity 3.28 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented 6 Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in, Ca aci 800.64 Gallons Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 18.73 416,50 B 2.00 44.48 C _Pump off elevation (ft) C 4.27 95.02 91.42 -t 1 D 11.00 244.64 Total 36.00 800.64 D Dose tank elevation (ft) 3" Bedding under tank. 90.50 Alarm Manuafacturer SJE. Rhombus_ -TM I Note: Switches Alarm Model Number Tank Alert1 _ containing mercury _ may not be used in Pump Manufacturer Goulds T this system. Pump Model Number EP05 Pump Must Deliver 32.13 gpm at 18.49 ft TDH Project: Scott and Monica Miller 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 Coun Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.28 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Ins t 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 month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Ins ect for ponding and seepage once every 3 years fJtl~ er Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • • Grade 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: Scott and Monica Miller Mound System Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 W is. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fiker shall be assessed at least once every 3 years by inspection, The outlet fitter 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. P "The pump (dosing) tank shall be inspected "R _TM 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 Pressu~ nr=tribr~*lon ~,atam No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than fora!l be 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/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contilnuencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project; Page 6 of 8 Page 7 of 8 LqGOULDS PUMPS Submersible sEffluent Pump EP04 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermopias- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance, construction. • Effluent systems heat transfer. ■ Casing and Base; Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation, Auto- superior strength and corrosion • Heavy duty sump matic models include resistance. Canadian standards Auodation • 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 cows Purps is rso 9W1 Rags ed. • Solids handling capability: FEATURES cover with integral handle and Sol maximum, float switch attachment points. ■ EP04 Impeller: Thermoplas- N Pow Cable: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with • Total heads: up to 31 feet, pump out vanes for mechanical rated pi! and water resistant. • Discharge size: 11/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BONA-N eiastomers. • Temperature: 104°F (40'C) continuous 140OF (6090) intermittent. METERS FEET • Fasteners: 300 series 10 _ stainless steel. 9 3° • Capable of running s GPM dry without damage to a 2.s F1 components. Zs~ _ 7 Motor: Single ' •1P55orr230V 60H0.45 PO a 5 RPM, built in overload with o 15 automatic reset. 4 } • EP05 Single phase: 0.5 HP, o EPOS 115 V or 230V, 60 Hz, 1550 3 10. RPM, built in overload with automatic reset. 2 EP44 • Power cord: 10 foot s standard length, 1613 1 SJTOW with three prong grounding plug. Optional 20 ° °0 10 20 foot length, 16/3 SJTW with 30 40 so GPM three prong grounding plug (standard on EP05). ° 2 4 6 a 10 12 m34i cAPACrrY Goulds Pumps ®2°°i Goulds Pumps ITT Industries Effective May, , 2001 03871 cp Ilk ts cm rQ o 't si At 0. wa ~ ~ 4 F an 0 4 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Scott & Monica Miller Mailing Address 1686 99th Ave Hammond Wi. 54015 Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 002-1013-70-000 LEGAL DESCRIPTION SW~ SE 6 29 16 Baldwin Property Location '/4 , '/4 , Sec. , T N R W, Town of Subdivision Plat: , Lot # 5 Certified Survey Map # , Volume 13 , Page # 3651 Warranty Deed # (before 2007)Volume Page # Spec house Oyes[Dno Lot lines identifiable [Dyes[:] 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. [/we 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 virt u of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 1 , " 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) N sl c It J,Tge rcN y~9~~`tl3 mii LL j HIM s"11fr'l. 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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. S 1 J3 002-1013-70-000 Please print all information. Reviewe y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~z Property Owner Property Location Thomas M. & Melody A. Kanten Govt. Lot SW 1/4 SE 1/4 6 T 29 NR i W ubd. Name or CSM# e(t CfSfi / ! 13 Property Owner's Mailing Address Lot # Block # j S --1 1187 220th Street 5 CSM Vol. 13, Pg. 3651 City State Zip Code Phone Number City Village ✓ Town Nearest Road Baldwin WI 54002 (715) 684-2613 Baldwin i Z 13 G 110Th Ave. ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial drift Flood plain elevation, if applicable Na _ General comments and recommendations: Soil eval. completed to verify findings of previous report by A. Wegerer dated 6/6/98. Site found to be consistant with original report - see memo page. ❑ Boring # Boring ✓ Pit Ground Surface elev. 98.20 ft. Depth to limiting factor -Gym. 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 0-10 10yr3/3 none sil 2fgr mvfr as 2fm,1c 0.6 0.8 2 10-15 10yr4/4 none sil 2fsbk mfr cs 1fm 0.6 0.8 3 15-20 7.5yr4/6 none gr Ifs 0 sg ml cw 1vf,f 0.5 1.0 4 20-24 7.5yr4/6 f2d 7.5yr5/8 gr Ifs 0 sg ml aw 1 of 0.5 1.0 5 24-36 10yr5/1 m 1 p 7.5yr4/6 sc 2fsbk mfi - - 0.2 0.3 * Effluent #1 = BOD5> 30 < 220 mg/L an TSS >30 < 150 mg/L Effluent #2 = BOD5 <.30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: 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 11/7/2009 715-248-7767 PROPERTY OWNER: Thomas M. & Melody A. Kanten SOIL AND SITE EVALUATION 2194 Page 2 of 3 PARCEL I.D.# t 1013-70-000 A.C.E. Soil & Site Evaluations REPORT MEMO Soil evaluation completed to verify findings of previous report by A. Wegerer dated 6/6/98. Site found to be consistent with original report. Soil profile reported as B4 of this report indicates limiting factor of 20", slightly more restrictive than the Wegerer findings of 27". Damaged Benchmarks have been reset and 90' long system contour staked with wood lath. Recommended system elevation to be 103.34' at 16" above 100.00' contour. g7 /off G~h e. O Swy~5E1'<! Sec !o, T. 29iL, ~ , :5,1-_ 0 8l ~ ~ ~9 oF1~`s~• tw,av.'~. Y-2 'V:5 416 oO E/c v = cY7 Ica, aD' ~dS~{ (13187' I I II I i I ~ M h -Sl III l I h Parcel 002-1013-70-000 03/26/2007 09:09 AM PAGE 1 OF 1 Alt. Parcel 06.29.16.89B 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KANTEN, THOMAS M & MELODY A THOMAS M & MELODY A KANTEN 1187 220TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 2136 110TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 13.410 Plat: 3651-CSM 13/3651 SEC 6 T29N R16W PT SW FRL 1/4 LOT 1 CSM Block/Condo Bldg: LOT 5 3/1113 NKA LOT 5 CSM 13/3651 13.410AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 13.410 1,600 0 1,600 NO Totals for 2007: General Property 13.410 1,600 0 1,600 Woodland 0.000 0 0 Totals for 2006: General Property 13.410 1,600 0 1,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Labor and d Human ment Relations Industry, SOIL AND SITE EVALUATION REPORT Page of A Labor Division of Safety & Buildings in accord wi ILHR 83.05, Wis. Adm. Code FOUNTY A a p e st e p an o pa er not les an 81/2 x 11 i ches in size. Plan must include, but ST - C(2 FJ not limited to vertical and horizontal refer ce point (BM), direction and % of slope, scale or PARCEL I.D. # -7 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RE kVE BY DATE ~ ~r PROPERTY OWNER: PROPERTY LOCATION T~t"l AIVD ft 1 ~L OD`f f ~JTEf~ 66V~ COI S W 1/4 SE 1/4,S T N,R 1 E (or) W~ PROPERTY OWNER'ZMAI`LIINGADDRESS LOT BLOCK # SUBD.NAME OR CSM # - CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE QfOWN NEAREST ROAD 'ji SyoZ1 (713) 3r~'` vvt~7 Ito nt f~v~, New Construction Use (JC) Residential / Number of bedrooms AdditiQn to existing building Replacement Public or commercial describe 14 6 -A- Code derived daily flow ''o 3O gpd Recommended design loading rate bed, pd/ft2 trench, gpd/ft2 ' Absorption area required Soo bed, ft2 trench, ft2 Maximum design loading rate S bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) \ . O ft (as referred to site plan benchmark) Additional design / site considerations Y 1uvr. , 1 S`/ C., a -~)~ur Parent material sI -:7-r Flood plain elevation, if applicable w . - ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem EIS QU ®S ❑U ❑S ®U EIS ©U EIS ®U ❑S DU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Botrxiary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tren& -13 )ui Ground 3 Zo 33 -I _S1 P_ 31 y S) Z-M 3 b4r rn F~ cs • S , 6 elev. On-1 ft 33 -S 8 S `t R 3 /y •S `1 R S/$ S~ 1 Orr, y~, h • Z Depth to limiting factor Remarks: Boring # 0-9 lo`t~Z31 Z sl l 3~ab%~ vn ~i ~S Z~ S L Z Z 9_Z~ 1o~ttz 3!~ s>1 Z~ sbk cw Ems 3 -X. -V6 S~tcZ~1 sc 1 1~5b Ground ~'t 1~ F1- ~S - Z • 3 ~ ev.. L16-60 LO`1 R Y/2 S `1 2 S f 8 C O~~, Yn i ' dvh NP ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Mress: Arthur L. [de erer 715-425-0165 egerer Soil,Testing & Design Service-P.O. Box 74 River Falls-,WI .5402.2 Signature: ' - / - - ' Date: CST Number: `:fEilyi r., M00576 PROPERTY OWNER \c P\KJTE:N SOIL DESCRIPTION REPORT Page L of PARCEL I.D. # F'FJ`JO 1 %v C Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o l0 t tZ 1 Z - s1 I Z'f sbFz Y,, Fr 0-S Z Ground 3 1~-171 -S`1R elev. Yn 0ft. 1- - t~\~ i1vP Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # k' Ground elev. ft. Depth to limiting factor Remarks: - SBD-8330(8.05/92) PROPERTY OWNER _ \-c(\lJTlE:t~7 SOIL DESCRIPTION REPORT Page a of PARCEL I.D. # PFJ~~p 1 iv c Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots Bed Trerxh r'` 3 x o- g i opt 2 I Z O-S -L ; lo-, a 3/` si I Zn Ground 3 1-Z`1 S `7R 3/ - s 1 elev. 1 e_~ bk c s • S ft. Z -~/0 1 uy I~ y/Z S/f; e CJ~ ~v~, Yri FI- - NP iv\~ Depth to limiting factor Remarks: Boring # ~S: Ground ' elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. ! Depth to limiting factor Remarks: Boring # 4 Ground f elev. -ft. Depth to limiting factor Remarks: SBD-8330(8.05/92)