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002-1049-95-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 579057 0 Personal information you provide may be used for secondary purposes [Privacy Law, S.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Hailing, Karl Baldwin, Town of 002-1049-95-000 CST BM Elev: Insp. BM Elev: BM Descriptionsa .,n Section/Town/Range/Map No: out weQQ~ 21.29.16.309B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ti~S CAPACITY STATION BS HI FS ELEV. Septic ar Benchmark W, c cl° F, I I.w 41' /Z60 • a1- /Jo , 51 / 6 91 e4 Dosing Alt. BM c to 2 J, Z. /d 7 46 Bldg. Sewer r;1 d- t=ea r3~Z 97.3 Holding St/Ht Inlet l5. So qS, a~ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent to it Intake ROAD Dt Inlet Septic > Sb > /Za f Dt Bottom lg , s y/' s~ Dosing g 50 rLb 340 / yZ' Header/Man. 0 Aeration ~d ( /d Z • y Dist. Pipe Ex~ b c` Holding Bot. System PUMP/SIPHON INFORMATION Final Grade l6 1b3 , yt~ Manufacturer Demand St Cover oJ~ S GPM /QO C> I Model Number ZS Og TDH Lia G 2,1 Friction Loss System Head TD 3 `pt ~D Z5 JJ77 Forcemain Lengt Dia. 21 Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS " trc7 L' SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of Syst ~ CHAMBER OR M. ~ x~ 41 /A.. UNIT Model Number: DISTRIBUTION SYSTEM /V Header/Manifold Distribution Ix Hole Size Ix Hole Spacing VeOt Io Air Intake Pipe(s) lJJ /g length Dia Length Dia Sp cing SOIL COVER x Pressure Sys my 15 xx ound Or At-Grade Systems Only Depth Over Depth Over xx th of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 t 0 Yes Rfl No ~ Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 891 230th Street Baldwin, WI 54002 (NW 1/4 NW 1/4 21 T28N R16W) metes & bounds Lot Parcel No: 21.29.16.309B 1.) Alt BM Description 2.) Bldg sewer length = 3 - amount of cover = tl dlw~b r ~wv.. d/e 7 ~ Z 6~ Plan revision Required? ❑ Yes "No Use other side for additional information. SBD-6710 (R.3/97) Date Insep Tr s Sign re Cert. No. '0A r County nd Buildings Division """~VW,ngton Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co ) P Madison, WI 53707-7162 A 0 202015 '577657 Sanr<t State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this o' f rm id the appropriate governmental unit 71 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than in ling address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary Cif 1 .7-30 Y"- S - purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. V 1. Application Information - Please Prin I Information property Owner's Name Parcel # _ 0 0 - /O qOo 0 k2 L 11 ---S_ Propertv Owners Mailing Address Property Location S / g 3 Qss ' k $ Govt Lot Citv. State Zrp Codc Phone Number AXJ_y, AA Section r ,nn o circle one ~ ya z- T _~2J_- N; R E o(, IT Type of Building (check all that apply) JCL eke¢/► 1 Lot K, K or 2 Family Dwelling - Number of Bedrooms LIMA Subdivision Name 3 Block # ?.D &crests 4Z - ❑ Public/Commercial -Describe Use ❑ City of nber ❑ Village of State Owned Describe Use own of 8'__X57__ _ (Che k onlyone box on line A. Complete line B if applicable) I 11. TN pe of Permit. . A - j Neti System ❑ Replacement System Treatment/Holding Tank Replacement Onl r L1 Other Modification to Existing System (explain) t W L_ R. Permit Renewal ❑ Permit Revision List Previous Permit Number and Date slued ❑ Change of Plumber Permit Transter to ew Before Expiration Owner a l 0 5 1.. l~) _ II\N "Type of In-Ground ent/Dev ue El (Check At-Grade all that ppNlound 2 of suitabl- urrred In PONVTS Ground SvstemL] pressurized /C om von G e soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain)__ _ ❑ Pretreatment Device (explain) N' Dispersal/I'i-eatt ntArea Information: Y~ft_~ Dcsii,n 1 mN (gpd) DcsreJ ~SoIl Appl ttron Rate(gpdst L rspersal Area Re aired (sf) Drsp rsal Area Pro osed (sf) System Elevation f7/ T V1. 'Tank Into Capacity in Total # of Manufacturer v Gallons Gallons Units v o a r. v I\ew Tanks Existing Tanks Septic or Holding Tank Zoe Dosw,, Chnmbei VI 1. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' inature MP/MPRS Number Business Phone Number Plumber's Address (Street City. State Zip C)de) aunty/Department Us— Only_ Pennrt Fee Date Is red Issuing A t Signature ~ \ppioved d O~ n Reast ,`tar Denial X. Con di 1. a, Septic an tea its for Disapproval I 11iltergrid 3~ C.o~d~o((1~~-11+e+~ t ~4.. eJ.~, ~ez e.l e. ( uen drspF.. 'co't ^il,-r ,r ;t Pz r maintained Lj F 2r P . as per rnandyt:rner,i pi An r ~ ~ w: r t%er. n ~k l , oattttalned O U L YD Attach to complete plans for the system and submit to the County onl on paper not less than 8 I/2 x I I inches in size j SL3D-6;98 (R. I I/i I) KM(, Hq l L 111 f-14G~- 'I'M AJ "b BV ~30A -s _7? -/d q,7 6 Qro~ l~ tia+~ E~ y$2 Sps 393.3s All '7 if rot f ft "Ye"D 906"A , qq ~/eT force u)e 895 ` 7-a eq' e,}Asf lttt~ ICA) Sep. , fj? llr vet U eS%y^~ o- ` ~ /~~F D[Cct~Aae` (r, pPoPle. r~ DIVISION OF INDUSTRY SERVICES 0, 3824 N CREEKSIDE LA HOLMEN WI 54636 Q a Contact Through Relay D ` http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Iol'! Scott Walker, Governor Dave Ross, Secretary August 07, 2015 CUST ID No. 9313 84 ATTN: POWTS Inspector ZONING OFFICE MIKE RODEWALD ST CROIX COUNTY SPIA 285 COUNTY RD SS 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/07/2017 Identification Numbers Transaction ID No. 2583686 SITE: Site ID No. 815745 Karl Halling Please refer to both identification numbers, 891 230TH St above, in all correspondence with the agency. Town of Baldwin St Croix County NW1/4, NWIA, S21, T29N, R16W FOR: Description: Mound / 450 gl / Per Capita Sizing / Combo Tank Replacement Object Type: POWTS Component Manual Regulated Object ID No.: 1549786 Maintenance required; Replacement system; 450 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, Combo Tank Review 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. • NOTE: This approval is only for the replacement of the combo tank and force main. The assessment of the Np Aft absorption field for the compliance of Department of Safety and Professional Services SPS 383.25(2)(b)2. Wis. Adm. Code rules as they pertain to treatment capabilities is the responsibility of St. Croix County. p► DEp~ OF • The sizing for this mound system is based on per capita of not more than 6 person residence. Evidence of a 105P ~ deed recording that indicates that the system is designed and operated at occupancy is required prior to p iROVES QF issuance of the sanitary permit. ~I5l0~ • The existing POWTS tanks must be properly abandoned per SPS 383.33 Wisc.Adm. Code. • All of the conditions of approval for this system as noted in the transaction I.D. number 1431692 shall remain in SEE G force including the management plan. MU(E RODEWALD Page 2 8/7/2015 • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • 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 $ 80.00 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` 4f,farles.bratz@wisconsin.gov . cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm. REUSE / RECONNECT OF A MOUND SYSTEM (tank replacement) 3 2015 FOR ;Y SERVICES A RESIDENCE WITH A DESIGN FLOW OF 450 gpd (Maximum occupancy of 6 persons) LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION 21, T29N, RI 6W. TOWNSHIP OF BALDWIN, SAINT CROIX COUNTY WI. INDEX PAGE 1 TITLE SHEET PAGE 2 PROJECT SUMMERY PAGE 3 DATA PAGE 4 DOSE CHAMBER CROSS SECTION PAGE 5 PUMP PERFORMANCE CURVE PAGE 6 PLOT PLAN PAGE 7 MANAGEMENT PLAN PAGE 8 INSPECTION REPORT 11/16/2007 PAGE 9-$ ORIGINAL 2007 MOUND DESIGN/approval PREPARED FOR KARL HALLING 891 230t" ST Baldwin WI, 54002 PREPARED BY MICHAEL RODEWALD MPRS 931384 715-425-6200 FAX 715-425-8466 Bettendorf@dishup.us IONALI.Y This plan has been prepared in accordance with the ROVED Pressure Distribution Manual V2.0 SBD-10706-P (N 01/01 R10/12) SAFETY AND PAGE 1 MAL SERVICES .40USTRY SERVICES f4:1 . yx;4e~ ORRESPONDENCE PROJECT SUMMERY I A mound was constructed in 2007 for a 3 bedroom home -Design Flow of 450gpd. The existing 3 bedroom home and all out-buildings have been razed. Construction is planned on a new home on the site in a different location than the original, existing septic/pump tanks are to be abandoned as per SPS 383.33 and a new septic/pump tank installed in a new location & elevation. Homeowner is filling a occupancy statement with St Croix County showing a maximum occupancy of 6 people -(Design Flow 450gpd) as the new home will be in excess of 3 bedrooms. KARL HALLING PAGE 2 of Reuse/Reconnect of mound Original Conditional approval letter 8/15/2007 Transaction Id # 1431692 Site ID # 729151 Customer 226524 --Roger Timm As-built data from St Croix County inspection report 11/16/2007 Alt BM -top of filter cover 101.75 ft Manifold 102.33 ft Design data from Mound design 8/15/2007 Lateral volume 9.936 gallons Manifold dia 1.5 inch Manifold length 4 ft System demand 25.08 gallons/min Distal Pressure 2.5 ft Network pressure com loss 0.75 ft New force main dia 2 inch Force main length 240 ft Force main volume 39.12 gallons Mainifold volume 0.37 gallons Drain Back 39.49 gallons Manifold elevation 102.33 ft Pump pad elevation 93.45 ft Vertical lift 8.88 ft Distal Pressure 2.5 ft Network pressure com loss 0.75 ft Vertical lift 8.88 ft Friction loss 3.34 ft @25gmp --1.39ft/100ft x 240ft Total head 15.47 ft Minimum pump preformance 25.08 gallons/min at 15.47 ft 5X void volume 49.68 gallons Drain back 39.49 gallons min dose volume 89.17 gallons 20% of DWF 90 gallons Design Dose volume 90 gallons Septic / pump tank Wieser WLP 1200/800-MR Combo 800 gal pump chamber 22.24 gallons per inch Effluent Filter Best GF-10 Project Karl Hailing Page Septic-Dose Tank Cross Section And Pump Performance Specifications Yank Manufacturer Wieser Pump Manufacturer Gould 'l'ank Model Number WLP 1200/800 -MR Pump Model Number o Total Tank Capacity Alarm Manufacturer SJE Rhombus Ma_x, Bury Depth 8.00 Alarm Model Number Tank Alert AB Switch Type Float - non mercury Filter _Manufacturer _ est Total Dynamic Head (TDH) - Feet E Filter Model Number~BGF-10 Elevation Head 8,88 Distal Pressure 2.50 _ Network Loss 0.75 Minimum Pump Performance Required Force Main Loss 34 25.08 GPM (a) 15.47 Ft TDH Total 15.47 Outlet Manhole Min, 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grad < 6" Below Grade Sealed Watertight LJunction rely Mounted With Locking Device her-proof 3. 3 Box Finished Grade Depth of Cover Vent Min. 12" Above Grade Disconnect 3 Ft With Vent Cap Means S < < S < S S t < < < < iYt S t < t < S < i S < < t < f t < QS Outlet Outlet Filter ---__y ` Inlet ><s - Inlet Baffle _ _ > t A > > .Switch Settings and Reserve Capacity < Tank _Volume= a GPI>< pop- 't Weep ; }t> Dimension Inches Volume Gal. B Hole (reserve) A 17, q `L. 398.64 (alarm) B 2.00 44,48 4>4 Off Elevation C (dose) C t1t05 9000 Ile Ft y< <~< ♦ Bottom (dead) D 12; 08 266.88 D Elevation Total ,15. 800.00 3/S1 t t < < t < < < { < > <i< < { ; i t t t t 1 < < i < < t < < < < < < < t < i < { t < < { < t < { < t < < / i 1 t < <'< Y > > > ) > > Y Y_f > > Y > Y > } ) Y > Y > > Y Y f Y Y Y Y Y Y > Y > Y > > > Y Y > r Y > > Y > > Y > > Y > ' GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC, 02/05 L,J Page of Wastewater x'. k4ETERS FEET 10 SGPM 2.5 FT 25 n Y E r 6 20 5 . T-D , f EP05 10~ I 0 50 GPM _ Q M I ( nl~n( I I Y I 70 ~z• \ /©g b ~ M 102,...,,_. ~ •~~0 ~ rA) fl~r tb 7QCj /ygriNOn1~° Gr,x No Sys t , `-F/,end cwntz- /ol,7S ro nn~rq ~i'e aaan q ArAje S(-PTr i pgA lJ~ 717G. S~* hie ~nSf''i 7 ~'ra L.LG P ! °J',2fJ' ~f~sT .J trl ae5c+ e~. k r ~@ p 4 / ~ci sue!. Ell ye- 3n ,5 ei o Drive u~y IDLSry,J e0d~ `,4 l l j arc; Ott 1 y System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, A?j, "e,"" I > the St. Croix County Zoning Department, 715-386-4680, should be contacted for assistance. -7 =Ga_00 General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into.the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some t\ pe of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health, I . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease of oil down any drain or stool. 5 Garbage disposals are not recommended; if you must have one, use it sparingly 6 No paper products other than tissue should go into the system. 7. No chemicals should go into the system, 8 Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11, If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance I fhe septic tank must be inspected every three years by a properly licensed person. 2 If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3 When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the Filter should be made every 6 months until a minimum time sequence is determined. 4 Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5 If this system contains specific treatment components other than those mentioned here,.maintenance requirements will accompany their specifications. G The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system alloy" reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8 Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9 Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the s\ stem arc'i. I I Warning; Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring. may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2) Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional resting, designing. and/or installation of additional treatment components or conversion to a holding tank may be necessary. #14 l stn ~I PA A e__ - 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: A St. Croix Safety and Building Divisiw Sanitary Permit No. INSPECTION REPORT 506397 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No. Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name. City Village X Township Parcel Tax No: Simmelink, Earl Baldwin, Town of 002-1049-95-000 CST BM Elev: Insp. BM Elev SM DescripI Section/Town/Range/Map No: A0 ' O f V a' c) '-^J l 21.29.16.309B TANK INFORMATION ELEVATION DATA TYPF. MANUFACTURER CAPACITY STATION BS HI FS ELEV. 7• o rS /dy. /od Septic ~..n. / Benchmark , 4 /boo 3 /Tld d Dosing 7 Alt. -11 L, 6oe, 75 f B dg. Sewer F;.l__. e C~ /mar r~1~. 4 •o yti. a$ Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet a • ~2 ~(p 44 TANK TO /1 ~P/1-- WELL BLDG. Vent to Air Intake ROAD Dt Inlet /O , 5 I ~g Septic I b-/ t•-/ //y i / ~ Dt Bottom Dosing //q 6g /g Header/Man. 76 162.3-3 / ee-i-to Dist. Pipe S•b~ ~Q~,. a5 Holding Bat. System Final Grade PUMP/SIP ON INFORMATION ~~v3 /63.0 O~ Manufacturer C 5 (AK GPM Demand St Cov 5,33 16 I.7 cJ,~ Cp Model Number G• Pd ~3 <d~r d TDH I i Friction Loss System H ad TDH Ft Forcemain Length If Dia. / / Dist to Well SOIL ABSORPTION SYSTEM BED/1 RENCH Width Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS .47 (3c SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O ystem CHAMBER OR CI J~ Z3 / 32 UNIT Model Number DISTRIBUTION SYSTEM C&IIL t. Acf L j rte' Heaver/Manifold Distribution x Hole Size x Hole Spacing Ve to Air iake - 1 /'S Pipe(s) T Length -4 Dia Length_~~ Dia Spacinga 3 SOIL COVER _ x Pressure Systems Only xx Mound Or At-Grade Systems Only u~ Depth Over Depth Over xx Depth of xx Seeded/Sodded T Mulched Bedirl ench Center Bedr'Trench Edges Topsoil N5„Xes N. Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: L/ / Inspection #2: Location: 891 230th Street Baldwin, WI 54002 (NW 1/4 NW 1/4 21 T28N R16v metes & bounds Lot Par I No: 21.29.16.3098 1.) Alt 8M Description = ~ ~ U ~ ~//~11 ~ d""a. ' • 2 ) Bldg sewer length = 2q ~ L%Iili -e,. PL;4 rA~ ned5 oarL /4 4--b a~ i ✓t amount of cover = i , t 3 UG~i"IGG4~~~"'~~~ f~ot.a i`~ lb D7 Co3`f7s PROJECT KARL HALLIN(i I - Date Insepcto Signat Cert. No. / PAGE OF Safety and Buildings 4003 N KINNEY COULEE RD commerce,wi.gpv LA GROSSE WI 54601-1831 TDD (608) 264-8777 i sco nsin www.commerr-e.wi.gov/sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary August 15, 2007 CUST ID No. 226524 A7TN: POWTS Inspector ROGER L TIMM ZONING OFFICE TIMM EXCAVATING ST CROIX COUNTY SPIA 3128 20TH AVE 1101 CARMICHAEL RD WILSON WI 54027 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2009 Identification Numbers Transaction ID No. 1431692 SITE: Site ID No. 729151 Earl Simmelink Please refer to 'both identification numbers, 892 230TH St above, in all correspondence with the a genc Village of Baldwin St Croix County NW1/4, NW 1/4, S21, T29N, RI6W FOR: Description: Three Bedroom Mound System / Replacement construction Object Type: POWTS Component Manual Regulated Object ID No.: 1147470 Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2,0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01) 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 private sewage system 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. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on-site during PROJECT KARL HALLIN(i authorized representatives of the Department, which may include local R P.O.W.T.S. PAGE OF A Conditionally Ali PROVED DEPARTMENT no: rne•mACnnc l ROGER L TIMM Page 2 8/t5/2007 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. Comm 83.54(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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stals 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm W]SMART code: 7633 jerry.switn@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Henry F Grote , Certified Soil Testing PROJECT KARL HALLING PAGE OF Earl Simmelink - Mound v`~' y g 100> Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Pressure Distribution, SBD-10706-P (01 /O1) Mound, SBD-10691-P (01/O1) Location: NW '/4, NW '/4, Sec. 21, T 29 N, R 16W Town: Baldwin County: St. Croix Date: August 15, 2007 Owner: Earl Simmelink Address: 886 230`h St. Baldwin, WI 54002 Plumber: Roger Timm Signature: ✓ License: 2265 4 Attachments: SBD-10577 - Plan Approval Application SBD-8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management DIVIS►U SAFETY AND BUILDINGS p of 8 ES ONDENC~ PROJECT KARL HALLING PAGE OF { Design Criteria Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 efu/100 mL Fats, oils, grease < 30 mg/L _ Bedrooms x 100 gal/bedroom day x 1.5 di'm gallons/day hydraulic load Design Calculations In situ designed loading rate gallons/sq. ft. per day Depth to estimated high ground water Z ° in. Depth to bedrock in. Cross slope at system S' % w v Force main length S S ft. of Z in. '2-9 6 Manifold/header length 4-0 ft. of z in. 0,-S Drain-back 9-i gallons Lateral length @ 4-.0 ft. of 11/z in. Lateral elevation ft. @ bottom of lateral Lateral hole size in. @ 3~ co in, ( 3- O ft.) Spacing ~ 1~ holes/lateral 3 holes total Lateral volume gallons Total lateral discharge rate 2 S' ° Q gallons/minute @ z S ft. head Network pressure compensation losses ft. , Elevation difference ft. i F4/5 riction loss ft. @ ~S gallons/minute Total dynamic head .4 ft Pump/si'p~ion gPm @ 1 ~ ft. of head Manufacturer C91- ° cQs 3 ! Model # ' 'P 0 Dose volume 56 6,8 6 gallons Lift/sip)ibn tank 2 e~<< c'~ gallons Septic tank \ gallons Lffluent filter o ~Q¢„ s Z 0„-Q Measurement pump on and off in. Height alarm from tank bottom ' O in. Reserve capacity ~g+ gallons specs. calcs.res PROJECT KARL HALLIN(i Page Z- of g 1,03 PAGE OF 1 . - CL OpZ- 1 p~.a5•c~oo l Off'' ~ v < ( I` (l . cw- ~ c.0. ~ 1 - so l l ~,o~ w C~. S 5 z , I~Uc Lu 70 `-o }►~cQ w H r _ i i C 4 " ` 1 U-U-t7 V I N~ ~S sa~bo~~ JU Sq l~j ~~~.o> ~bC¢ Q bwe C7 L( Q OSQS~ e-~Q-v ~I ICI~R M b•c~'4toe_ PROJECT KARL HALLING D PAGE OF 1r 04~ '7 ~-OS 0. C.J~Yf 4~ ~ VOs.\ o... o 1o~,4r \ M vMa ~o iv~Co~1 w.: q1 ti.y . i i I I PROJECT KARL HALUNG PAGE l ( OF -N k~ .``gyp- (1 Cl ~ 10.h ~ yaw.. -4, C b ob 1 Ire L 40 r ~ ~ Z- p j c 4' ov- nrS4~o' 1 ( n~ V1 ( rat Q.~ i~ V ti`vt U c C. I- 4t 4L. -Ir • / `b p\ t~ O 1 1 A.J+ QQh~ Q.~. 0 ` 1 O \ i QR O-'- V C / CA IL PROJECT KARL HALLING PAGE OF It k~ O o VEIJT CAP `I C.Z. VEMT PIPf_ ~I WEATHER PROOF APPROVED LOCKINK, JUAICTIOM BOX MAIJHOLE COVER. 25' FRQM DOOR, wA2N~w v WWDOW OR FRESH ,Z I -AQ V1-- AIR IIJTAKE GRADE a\ev,w~oz I COUDUiT 11~ PROVIDE AIRTIGHT SEAL 'LZ• o`I `I . _ ( I I I APPROVED Jai TS `NRR `c~ I I III W/ PIPE I I ALARM EXTE1J0IUG 3' OIJTO SOLID SOIL 0ti . T4 !-.o . I I 10 ev, PUMP-~ OFF CA r BLOCK i E ,I PROJECT KARL HALLING c B I I • ~ O T U j i PAGE OF 19 11 ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Gallons Per Item Total Head Minute No. Description (ft. of water) EP04 EPOS 1 Impeller 6 5 53 - 2 Base 130 4 7 46 62 3 Pump Casing: 36 55 4 Mechanical Seal - 21 46 5 Ball Bearings t 0 33 6 0-Rings 9 - i t Power Cord 8 4 8 Oil Filled Motor 4 3 9 Motor Housing/ Stator Assembly. 10 Motor Cover METERS FEET ..y...._ r r I , 10 i_ 9 30 L.. 5 GPM 8 2.51 i ~1, 25 Q W _ i.... 6 20 i._ z _ t 151 0 4 f EPOS Q EP04 i_ ._~_---1--.-. ......,....J . 0 OQ 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m'/h CAPACITY PROJECT KARL HALLING 3 4 o PAGE OF-4 System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. I f problems develop with the adsorption system or any other system components, the installing plumber, Roger Timm, 715-772-3214. or the St. Croix County Zoning Department, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance I I"he septic tank must be inspected every three years by a properly licensed person. 2, If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the titter should be made every 6 months until a minimum time sequence is determined. 4 Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allov~ s reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. i. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9 Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the s\ stem ,area. 1 1. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 43.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing. dmuniriu. and/or installation of additional treatment components or conversion to a holding tank may be necessary. PROJECT KARL HALLING Page 8 of 8 PAGE OF ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer K'- l ua I I m, Mailing Address q15' 1!1, H -o"Cl , W1, 5'xt y i S- Property Address 8 Q t p3o ~i_ S~ Ba icy W%~_' L)t- 5,11ooa (Verification required from Planning & Zoning Department for new construction.) City/State Ida l~ f..~,l~ Parcel Identification Number DOa 10 yqq Sooc) LEGAL DESCRIPTION Property Location VQ '/4 , NlJ '/4 , Sec. _9, T a 9 NR. I W, Town of l3a ldw,t~ Subdivision Plat: , Lot # Certified Survey Map # p , Volume , Page # Warranty Deed # ~~l 1 0 (before 2007)Volume , Page # Spec house ❑yesOno Lot lines identifiable ®yes[:]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on 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 warranty deed recorded in Register of Deeds Office. Number of bedrooms 4~~ =7/W/ / s" SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. P 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)