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HomeMy WebLinkAbout002-1034-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 582038 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 Township Parcel Tax No: Dale & Debra Affolter TOWN OF BALDWIN 002-1034-50-000 CST SM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 16.29.16.233B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding -tmt inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL 7K-E/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Length Dia 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 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes Q No 0 Yes Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2347 CTY RD E 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ra-1 Yes Ed No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) 04 RECEIVED County t Safety and Buildings Division St. Croix ` gP 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) r~ g NOV 0 6 NI S Madison, WI 5370 6162 Z/ 0 30MMUNl78ffi wit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 00 1 -7 3 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 Services. Personal information you provide maybe used for secondary u oses in accordance with the privacy Law, s. 15.04 1) m , Stats. rh 1. Application Informat' - Please Print All Information fit- 7 Property Owner's Name / Pazcel # Dale & Debra Affolte 9. 1 Property Owner's Mailing Address 002-1034-50-000 Property Location 3241 Co. Rd. E Govt. Lot City, State Zip Code Phone Number , NW /4, NE Section 16 Baldwin, WI 54002 (715 684-3154 (circle one) II. Type of Building (check all that apply) Lot # T 29 N; R 16 E or W ❑ 1 or 2 Family Dwelling - Number of Bedrooms 2 Subdivision Name Na Na Block # ❑ Public/Commercial -Describe Use Na City of ❑ State Owned - Describe Use CSM Number ❑ Village of Na ❑ Town of Cady III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System Q Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. 11 Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T of POWTS System/Component/Device: Check all that apply) 00, ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) If V. Dispersal/Treat ent Area Information: Pol Lo L-525 effluent filter at outlet of two chambered se tic tank Design Flow (gpd) Design Soil Application Rate( gpds Dispersal Area Required (sf) Dispersal Area Proposed s j ( Elevation 300 Gpd 1.00 Gpd/Sq. Ft _ 0.4 300.00 sq. ft. 300.00 S . Ft 97`5 at 18" above VI. Tank Info C aci q 6.00 contour ap ty ir► Total # of Manufacturer Gallons Gallons Units o° New Tanks Existing Tanks nn U Ya ld ~ ~ZS aU in v V.Q P, septic or Holding Tank 1,000/500 0 1500 1 ieser Concrete X Dosing Chamber 750 0 750 1 Wieser Concrete X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ature MP/MPRS Number Business Phone Number Dale Hudson X Plumber's Address (Street, City, State, Zip Code) MP 220853 (715) 684-3378 820 Main Street, Baldwin, WI 54002 VIII oun epartment Use Only Approved ieapp Permit Fee WIssue Issuing ent Signature rven Reason for vial 61 • co 5 IX. Condl ~pWWReasons for Disapproval 1. 'epU~tank,'Qtflea~►t INt1Fs~~d 3~ ('o.,ie.,Q G, ,cti>giRYSaI ceq must ~ Jtees / n ntaine~~' ~OI~,cS tt~ i?Mf,,ll'linapa pAP provided by plumber. •tn t~ _ L ~ /~~~~I ttigW t# must 0e maintc coed ~~~'CCS ( ~G -ail Eur sppNo~bb oodtt / ordinances. Attach to complete plans for the system and submit to the County only on paper aot less than 81la a 11 inches in size SBD-6398 (R. 11/11) C A ~,rrst;~~ wade .e It L 5d•%,Coc...,d to bt u.nStt:{~b~e vp /e v 6-4 A44,I,~ar 23Yi Cam. ~Pd. E" t~r✓~~v.77~ SyQDZ /0, 6-o- coo J /Da cn"5 More OP /e,ss r+ ~ ~Ci nC r~ 0 ~ C 0 1 rd~ 5 ct.x~l /ova-~ 4 Z g¢ /~roPas.c~ (.v,-eSer C.a+,or'e~2 ` ~oPoeed `J ncc. 96 S-k k) e. jj 00,16 0 76g--<. ~r'o6Jdsed C.c.~~Y.SQ.l"Cr►'iCJ'{~2 7S0 n-r,~--~ ~ To d / ~Y ~ 3 voc~r~-,~o c~~-rn6cs: ~ j~'✓0~rc~%pF. ~ss4,~cd p P /~Joa.ndat.2/. 3.Z Se \ w/3Xiov'drJ~a~Sc/cel/ Ewa2~ /7' ~ S 4e,5 -~aa CCd 0,2 ~,s 40ca 6 . e4 (~C1 !C®p,IY DIVISION OF INDUSTRY SERVICES 5~: - on 3824 CREEKSIDE LN HOLMEN WI 54636-9466 I/ ( a? Contact Through Relay r K P http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ss1014 ~ Scott Walker, Governor Dave Ross, Secretary October 08, 2015 CUST ID No. 220853 ATTN. POWTS Inspector DALE E HUDSON ZONING OFFICE BOLDTS PLUMBING & HEATING INC ST CROIX COUNTY SPIA 820 MAIN STREET 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/08/2017 Identification Numbers Transaction ID No. 2613540 SITE: Site ID No. 817838 Dale and Debra Affolter Please refer to both identification numbers, 23XX County Rd E, above, in all correspondence with the agency. Town of Baldwin St Croix County NW1/4, NEIA, S16, T29N, R16W FOR: Description: Two Bedroom Mound System / 7% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1558628 Maintenance required; 300 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, 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: This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. C O N Q E No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, APF . Q E PT OF stats. PROFESSIO The following conditions shall be met during construction or installation and prior to occupancy or use: D [ Ili S i O N OF IN[ Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made wi C`~r" `i • the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A cony 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 DALE E HUDSON Page 2 10/8/2015 a Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of 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. 4rard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jeny.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-31484, Monday - Friday 8:00 am To 4:30 pm DIVISION OF INDUSTRY SERVICES ~o~YT~1vTG~ 3824 CREEKSIDE LN ~N HOLMEN WI 54636-9466 _ Contact Through Relay 3 K httP://dsps.wi.9ov/Pro9rams/industry-services P S www.wisconsin.gov ~~O~sstoNAtiSw Scott Walker, Governor Dave Ross, Secretary October 08, 2015 CUST ID No. 220853 ATTN: POWTS Inspector DALE E HUDSON ZONING OFFICE BOLDTS PLUMBING & HEATING INC ST CROIX COUNTY SPIA 820 MAIN STREET 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 10/08/2017 Transaction ID No. 2613540 Site ID No. 817838 SITE: Please refer to both identification numbers, Dale and Debra Affolter above, in all correspondence with the agency. 23XX County Rd E Town of Baldwin St Croix County NW 1/4, NE 1/4, S16, T29N, RI 6W FOR: Description: Two Bedroom Mound System / 7% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1558628 Maintenance required; 300 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, 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: This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code CONDI requirements. APP No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, . DEPT OF stats. PROFESSIO The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF IN Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the 09 PC A 9 R, (CA - requirements of Sec. 145.19, Wis. Stats. EE CORR • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made wi the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. F ` $ -C EI V EEC SEP 21 2015 MOUND AND PRESSURE DISTRIBUTION COMPONFFIffc $I9 VICES Residential Application INDEX AND TITLE PAGE Project Name: Dale & Debra Affolter 2 bedroom mound Owner's Name: Dale & Debra Affolter Owner's Address: 2341 Co. Rd. E Baldwin, WI 54002 Site Address: 23xx Co. Rd. E Legal Description: NW1/4 NE1/4, Sec. 16, T.29N., R.16W. Township: Baldwin County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: 002-1034-50-000 ROVED Plan Transaction No.: I L -r Y A VD SERVICES Page 1 Index and title USTRY" SERVICES Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications NDENCE Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached Soil Evaluation Report Designer: Dale Hudson License Number: 220853 Date: 09/15/15 Phone Number: (715) 684-3378 Sig ure: ~ 2)az Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P N. 01/01 R. 10/12 Version 7.0 (R. 11/12) Pagel of 9 Vile ■..v......w.... (R or C) R Residential or Commercial Design Note: Sand MI (D) calculations assume a 200.00 Estimated Wastewater Flow (gpd) Table 3t A4-3 in-situ sou treatment for 1.50 Peaking Factor (e.g. 1.5 =150°x) fecal ooifforrn of - 36 Inches. 300.00 Design Flow (gpd) 7.00 Site Slope 98.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpolfe) Distribution Celt information 100.00 Dispersal Cell Length Along Contour (ft) = 3.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 &2) Are the laterals the highest point in the distribution ~ Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifolds 0.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point 0.125 Orifice Diameter (in) 1.00 Estimated Orifice Spacing (ft) = 3.06 fig/orfice 2.00 Forremain Diameter (in) 30.00 Forcemaiin Length (ft) Does the forcemain drain back? l -ice 90.00 Pump,Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) 7.00 Vertical Lift (ft) 45.39 5x Void Volume (gal) 1.01 Friction Loss (ft) 50.28 Minimum Dose Volume (gal) 0.00 In4ine Filter Loss (ft) 40.37 System Demand (gpm) 14.51 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. lions choice 0.75 1.25 1.00 1.50 1.25 2.00 f.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information 501.84 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 51.00 Total Working Liquid Depth (in) Weiser Concrete Manufacturer 9.84 gaVin (enter result in cell B49) Dose Tank Information Effluent Filter Information 501.84 Dose Tank Capacity (gal) Po Lok Filter Manufacturer 9.84 Dose Tank Volume (gaVin) PL-525 Filter Model Number Weiser Concrete Manufacturer Project: Dale & Debra Affolter 2 bedroom mound Page 2 of 9 Mound Plan and Cross Section Views 1/10 B : . J K~ + Observation Pipe 7 7 Q A W - F B I ~~ry I L Mound Component Dimensions A 3.00 ft E 20.52 in H A6.92 ft K 10.19 ft B 100.00 ft F 9.50 in z ft L 120.38 ft D 18.00 in G 0.50 ft J ft W 21.32 ft 300.00 (ft) Dispersal Cell Area 1439.87 (ft) Basal Area Available 3.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.29 (ft) ` / !/fllf//fffNN.. G 1 _ F 8.00 97.50 (ft)-lo-1 dispersal Cell 9 (ft) Lateral Dispersal Cell - - Invert Elevation : E D 96.00 (ft) Contour Elevation 7.0 % Site Slope Geotextile Fabric Cover Shading Key n a. T Dispersal Cell See lateral details on Q Topsoil Cap C 1.5 ft Page 4 for number, size, 7 Subsoil Cap Y :BSI. and spacing of laterals. ASTM C33 Sand f Laterals are equally Tilled Layer = 4) 0. ft Typical Lateral F spaced from the © r Aggregate c distribution cell's a © centerline in the 0 A distribution cell (AxB). Project: Dale & Debra Affolter 2 bedroom mound Page 3 of 9 t P I (f X~~( +I Laterals Worcemaln Sch 40 PVC per SPS Table 384.3D-6 HoMsOrHlMontHeOottomdtfielateal O Turn-up WOMIwa/wordrancutplug tQuatlq spso~d Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 1.02 ft Lateral Length (P) 49.47 ft Orifices per Lateral _ 49 Lateral Spacing (S) 0.00 ft Orifice Density 3.06 ftz/orifice Lateral Flow Rate 20.18 gpm Manifold Length 0.00 ft System Flow Rate 40.37 gpm Manifold Diameter 0.00 in Total Dynamic Head 14.51 ft Forcemain Velocity 4.12 ft/sec Dose Tankinformabon Looking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 In. min. Diswnned Tank component is property vented c Attemate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Capacityl 501.84 Gallons Volume 9.84 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 31.89 313.80 B 2.00 19.68 C Pump off elevation (ft) C 5.11 50.28 91.00 D 12.00 118.08 D Total 51.00 501.84 IF- Dose tank elevation (ft) Bedding un er tank. 90.00 Alarm Manuafacturer SJE Rhombus Note: Switches Alarm Model Number SJE 1011421 containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number 3871 EP04 Pump Must Deliver 40.37 gpm at 14.51 ft TDH Project: Dale & Debra Affolter 2 bedroom mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Dale Hudson Phone 715 684-3378 POWTS Regulator's Name St. Croix County Zonin Dept. Phone 715 386-4680 System Flow and Load Parameters Design Flow - Peak 300 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 200 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 300 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once 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 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: Dale & Debra Affolter 2 bedroom mound Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General 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, R. 11/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] 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 filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent finer alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System 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 BOD,, 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. Continency 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 9 [qGOULDS PUMPS Submersible Effluent Pump EP04 A, _i6, 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ 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. Q. Canadian Standards Association - • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is ISO 9001 Registered. factory, strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic • Solids handling capability: FEATURES cover with integral handle and float switch attachment points. 3/4" maximum. ■ EP04 Impeller: Thermoplas • Capacities: up to 60 GPM. tic Semi-open design with ■ Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: V/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (400C) continuous 140°F (60°C) Intermittent. METERS FEET - • Fasteners: 300 series l o stainless steel. • Capable of running 9 30 .-5 GPM dry without damage to $ components. 2.S FF 25 a 7 Motor: _ • EP04 Single phase: 0.4 HP, 6 115 or 230 V, 60 Hz, 1550 RPM, built in overload with 5 automatic reset. • EP05 Single phase: 0.5 HP, ' o 4 -i EPOS 115 V or 230V, 60 Hz, 1550 3 1 or _ RPM, built in overload with I - - _ EP04 _ i- automatic reset. z • Power cord: 10 foot 5l- 1 standard length, 16/3 1 SJTOW with three prong i grounding plug. Optional 20 0 0010 Z 30 40 50 _ GPM foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). 0 2 4 6 s 10 12 m3/h CAPACITY .2U,~8g~Jn(wl~n~.nceM / /y,& Goulds Pumps G c'2002 Goulds Pumps ITT Industries Effective September, 2002 63871 Pig . 7 a Q6 h Ex~SL~iiIA Grade ~ l1 ~ Gait: 1/U Qe~ ~.t yp~ AA/e d 6rG A~v/+Ser 23y/ C4,. jea( E 0 &✓~w,~i, cj/, 5-fcv1 i2cvyf~~lcJy~ 5ge . T. 29/l., C/' gt.C,-o %X Co., cr.~ I. d P~% ~an~ - io3s~ so- u~o 3 SCE r~ io access store o/' /C.SS 5C~ " a ~ .C 1 /'lO~oO,f{~ (.~re5e~ ~4++G/~ipQ ` loPo3.t-0/ `7 oZ/szv L cl1R m be~.d ` lid eoc< c 6~ sue. ✓o i0 cC p.?0. P,~cpased /y(aandat~/.3z~ elegy =/ao.cD, x/20.38 / w13Xiov'd,S~a~.J~/ce!/ Two ~2~ ,/yy; Slo,4e,64L-pr,$4. /a ei£ L a E /~Z' r Y9. s/T ~.3/y o l~ Sys 6e vk sreq 4ell~ -5/ad ccdoa, 6- 0,2 "tom. ~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C1 ~ ~ / Mailing Address Property Address (Veri 1cation required from Planning & Zoning Department for new construction.) City/State Zga j/ /131[.t7s Parcel Identification Number c>o / 5-0-.000 LEGAL DESCRIPTION Property Location/ 1/4 , %LZ Sec. Lam, T 2-9 N R,/4~ W, Town of CeZ Subdivision Plat: , Lot # Certified Survey Map # Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yesAno Lot lines identifiabloryes ❑ 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 of the St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form 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 warr my deed recorded in Register of Deeds Office. Numbe of bedrooms l 3~llS NATURE 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) . iw~ !`~^n~-,[.L'v:.TiY.T1+~SeS -~iS3: ~...~.•.'v^ftti~.. - _ _ - _ "°C4PYr2ksNT ***PRELIMINARY D I Thew c~ awlrwja a-* the prcparty of Pro6uf ld SCALE I 1 /2 They mbj not be reproduced, redrae:n, u used for conatructlon purpose* w1thotet utltten pormiselon from ProlBuild per Federal Gop!rlght Latza. unauthorized we may result in copyrtght tnfringemaret damaw- 45!-T e STORM SHF CONC Or VMU 0 a't 3 CAR GARAGE 9 1? 9 N f. i i e Q e , ~ = t i ~ i ~ Vd 0.-0. Cd ~`.Ssd:. r r-pox- BIT rte" lra° z v- e~• , . 1l 46'-0" MAIN FLOOR PLrl% SfJA E:1/4" 1e`9N ,LMNQ S.F. 1683 SHELTER S.F. 64 GARAGE S.K 1181 x~3..av ;.:...s.~....: ..,~.:,.t•~... - ..~.voas~-.+r-~cz~.z::-- _ - aaz- ~ INGS ONLY - NOT FOR CON _ i a .:s !O USE*** NOTE: - - - ~ UNLESS OTHERWISE NOTED S SHOWN IF PRINTED O 11X 4112, S/IZ.,& 6/12 = 24" OH A. EAVES 7112 & 8/12 PITCH =18' OH AT EAVES 9112, 10/12, 11112,12112 =18° OH AT EAVES ; IT OH TYPICAL AT GABLES TRUSS MANUF. TO ADJUST HEEL HEIGHTS j " ACCORMISIGLY TO ALIGN FASCIAS { W-0" 11'4• f X-3Y.'k Y-5;.• 7-t /X'x7-Y7Y,• ~ P-11X`xtx6;.' P-1115'sS-011S• t_ 12 3'R uo a~ a BEDROOM V KITCHEN 4t1i1Lti Et44M c PANTRY Xw - N ~ ra' rv uw.N Y4r ti MASTERBEDROOM MASMR u ? ` rmi•xrav r r xiixk tttt• cttcvmw ' YANYf6,GVRpThllpgll/ f I f r RECEIVED 16 2G i ga4so6 2401 Wisconsin Dep ent of SOIL EVALUATION REPORT Commerce Page 1 of 3 ST. CROIX COUNTY in accordance with Ceswrr85 Wis. Adm. Code A.C.E. Soil & Site Evaluations ITYVMLOPMENT 05ps 3W ac complete site plan on paper not less than 8% x 11 inches in size. Pla County include, but not limited to: vertical and horizontal reference point (BM), directio St. Croix percent slope, scale or dimemsions, north arrow, and location and distance tc Parcel 1. D. Please print all information. 00 2,11 034-50-000 Personal information you provide may be used for secondary purposes (Privacy Law, s. Revi d By Date Property Owner 9 ~S Property Location Dale & Debbie Affolter Govt. Lot NW 1 4 NE 14 S 16 T 29 N R 16 W Property Owners Mailing Addre ss Lot # Block # Subd. Na a or CSM# 2341 Co. Rd. E na na Na City State Zip Code Phone Number City Village ✓ Town Nearest Road Baldwin WI 54002 (715) 684-3154 Baldwin 240Th St. New Constructior Use: V Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comment: and recommendations: Soil conditions require mound POWTS with dispersal cell placed on 96.00' contour. Recommended Infiltraive surface elev. to be 97.50' at 18" above contour. ❑ Boring # Boring Pit Ground Surface elev 94.53 ft. Depth to limiting factor 18" 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 0-10 10yr3/3 none sil 2fgr mvfr as 2vf,fm 0.6 0.8 2 10-18 10yr4/4 none sl 2fsbk mvfr cw 2vf,fm 0.6 1.0 3 18-22 10yr4/4 f2d 7.5yr5/8 sl 1 msbk mvfr cw 2vf,f 0.4 0.7 4 22-35 7.5yr4/6 f2f 7.5yr5/8 scl 1csbk mfr 1vf,f 0.2 0.3 ❑ Boring # Boring ✓ Pit Ground Surface elev 98.10 ft. Depth to limiting factor 26 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 0-11 10yr3/3 none sil 2fgr mvfr as 2vf,fm 0.6 0.8 2 11-16 10yr4/4 none sl 2fsbk mvfr cw 2vf,fm 0.6 1.0 3 16-26 10yr4/4 none sl 2msbk mvfr cw 2vf,f 0.6 1.0 4 26-38 7.5yr4/6 f2f 7.5yr5/8 sl 1 msbk mfr - 1vf,f 0.4 0.7 * Effluent #1 = BOD 5 30 < 220 mg/L an TSS >30 150 mg * Effluent #2 = BODS< 30 mglL and TSS < 30 mg, CST Name (Please Print) Signa re: CST Number James K. Thompson X7- 3681 Address A.C.E. Soil & Site Evaluations `~~'v Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 6130/2015 715-248-7767 t Property Owner Dale & Debbie Affolter Parcel ID # 002-1034-50-000 Page 2 of 3 1:E Boring # Boring Pit Ground Surface elev 97.45 ft. Depth to limiting factor 28" in. Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots Soil Application Rat in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-10 10yr3/3 none sil 2fgr mvfr *as2vf,fm 0.6 0.8 2 10-18 7.5yr4/6 none scl 2fsbk mfr 0.4 0.6 3 18-28 7.5yr4/6 none sl 2msbk mvfr 0.6 1.0 4 28-40 7.5yr4/4 f2f 7.5yr5/8 scl 1csbk mfr 0.2 0.3 a Boring # Boring V Pit Ground Surface elev 94.52 ft. Depth to limiting factor 24" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *EfGPDlftEff#2 1 0-10 10yr3/3 none sil 2fgr mvfr as 2vf,fm 0.6 0.8 2 10-18 10yr4/4 none sl 2fsbk mvfr cw 2vf,fm 0.6 1.0 3 18-24 10yr4/4 none sl 1 msbk mvfr cw 2vf,f 0.4 0.7 4 24-30 7.5yr4/6 f2f 7.5yr5/8 scl 1 csbk mfr - 1vf,f 0.2 0.3 ❑ 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 GPD in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 . . . . . . f L1111 I * Effluent #1 = BOD 5 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-5330 (R.07100) A.C.E. Soil & Site Evaluations i ~ 5o;/ads/uu~E:r„-3~•,•E i ♦ eXi'S6,7a pia We It I Ga/e va/ed v~brr, A~4- 1&r 2 3 y! . ~Pd. E itwl'~/fcJY~ S¢c. ?"2911•, A6~ 0G7,-y - /0,-w 1-0- CCJo /a 4C-rej more of /ess 51d~ ~f 0 s f ♦ ML'- X90 ~ ~ sue. ✓o ~°rc,~:pP. s~ssk /do.cD. ~ ~ ~ > 9'. S/off \ Sys f~Lm 4r eq ` ~ I3Z 3 F