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HomeMy WebLinkAbout004-1036-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 579028 0 GENERAL INFORMATION 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: Nilssen, Jason & Teresa Cady, Town of 004-1036-60-000 CST BM Elev: Insp. BM Elev: BM Description: ~qq Section/Town/Range/Map No: 28.15.245A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic n~ Benchmark Wig 2 ~ a r~asrx.~ ~ 5gs 26 .5 166 Dosing Alt. BM Co~l~b g5~ oMF . ~ 5; ~r~ l~ /d /da , 5 F71Lw D Bldg. Sewer r✓ 6-36 95.3 ? Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO ^P ` WELL BLDG. Vent t it Intake ROAD Dt Inlet Septic I I / 41 Dt Bottom 7 156 17q 9 6, 37 Dosing 7 50 r 74 / 419 Header/Man. Z .36 94, 3 $ Aeration Dist. Pipe z , 5c, q17, 73T Holding _ Bot. System W, 83 / ; 3o Joo t 3$ PUMP/SIPHON INFORMATION Final Grade Manufacturer r7~Gb~ L/ I GP nand St Cover J, Z y$- D.'7'1 G' Model Number k~ /1 ~ NO a TDH Li Friction Loss System Head TDH Ft .31 3.x`1 .5b 4 o o.z5 ~ai,~g Forcemain Length Dia. Dist. to Well I SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 9 gZ- 5 -e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypefU System: '7 M6 1.7 7 CHA uNER OR Model Number: e.~ / r J DISTRIBUTION SYSTEM /t / Ix Hole Size C I x Hole Spacing Ve to Air/In~take Header/Manifold t #1 Distribution G (c Pipe(s) 3c 7. OZ -1 1 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 BedlTrench Center ~s Bed/Trench Edges ®1 Topsoil 1 `mss No 'Ar No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:2A11 ~~✓1 Inspection #2: Location: 2961 Cty Rd Na(Vilson, WI 54027 (SW 1/4 NE 1/4 15 T28N R15W) 40 acres Lot Pmj Ok- Parce o: 15.28.15.245A 1.) Alt BM Description = v n./J COJL`_ Ir _ 1 , ► I 1 PpG rQ( (/3 2.) Bldg sewer length = '719 - amount of cover = / 1'7 ~J 5.,L, #4a ) A/6 4-Z,, > 5 eti Plan revision Required? Yes 'No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctoes Si ature Cert. No. ~~~Aarar,~v C r f/~® ro RECEIVED Safety and Buildings Division SConty tu. Croix 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) JUL 17 2015 Madison, WI 53707-7162~j ST. IX COUNTY 5 7 / 6 z lizi °"'""Nffiift 4P&%t Application State Transaction Number rdance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is r uired prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to 2567439 Project Address (if different than mailing address) ~hp Department of Safety and Professional Services. Personal information you provide may be used for secondary oses in accordance with the Privacy Law, s. 15.04(1)(m , Slats. I. Application Infor ation - Please Print All Information Same f f Propeerc~'s N I Parcel # Z9 5P Jason E. Nilssen 004-1036-60-000 Property Owner's Mailing Address Property Location 201 Stockman Rd. Govt. Lot City, State Zip Code Phone Number SW NE Section Woodville, WI (circle one) 54028 (612) 210 - 7664 T 28 N; R 15 E or W IL T P'o of Building (check all that apply) Lot # R or 2 Family Dwelling - Number of Bedrooms 5 Na Subdivision Name 6) Block# Na L es ❑ Public/Commercial - Describe Use Na ❑ City of ❑ State Owned - De~cribe Use CSM Number ❑ Village of l k ~Z- S O v Na of Cady III. Type of Permit: (Check only one ox on line A. Complete line B if applicable) 0 /L A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 569505 issued 1/17/14 IV. Type of POWTS System/Component/Device: Check all that apply) ❑ 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) 0 Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Pol Lok P1-535 effluent filter to be installed at ST outlet Design Flow (gpd1 Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation 1.0 Gpd/sq. ft. ASTM-C33 sand 98.83' at 22" above 750 G d 0.6 G d/s . ft. native soil 750.40 s q. ft. 750.40 S q. Ft 97.00' contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units D t~ O New Tanks Existing Tanks ( J ` Y d I d Z JZ a U v~ v0 w C7 i, Septic or Holding Tank Na 1585 1,585 1 Wi er Concrete X Dosing Chamber Na 950 950 1 Combination ST/PC X VII. Responsibility Statement- , the unde gned, assume responsibi installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe s Signature MP/MPRS Number Business Phone Number James K. Thom son - MPRS 30021 715 248-7767 Plumber's Address (Street, City, State Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIII. un epartment Use Only Approved I Permit Fee Date Is ed c Issuing nt Signature venReason o enial /7 ~j `rD IX. Cond118iwf6Yleasons for Disapproval , 0 4i-G Septic~ank, effluent 6Rer bnd 3 o 6~~ /It. disorsal cell must all be services maintairag # ~ t as per management plan provided by plumber. / A. 2. yAN setpeck reclWom rats must be rpoWs 11W (_Jti ^ -u per applicable code / ordinances. ' D LAJ / Attach to complete plans for the system an )ubmit to the C ty only on paper not less than 9 rn x 11 inches in size / SBD-6398 (R. 11/11) Pa,-. ( ~dr~ /1 ~jj`~~ All ~i ~sse~,or.,arr~ 5wf'fAr ~f! Sec, /G ~ZY~ef; o~CaG(Y D 5e; fee. O a c re s Ass'('ne- d Q(LC/ = /0, a., 575'4- Pro PC s e'.1 5 k~cd~cbr,-• f~e~;dertee y prePoatc1 U_9;c s~ Cn,,c r~ be L.. Zp , ~dS/9so ~tc, Id n Stwtr Clllit o as5,'.u,$.,, ss /Pe. tj lylat' P<- s as' . -6b Ccm y 3 .3 eF{1~ccnE fi/64- t s.T, o,; BPS 387. 30(!(~~~-,~, ~ A~7- Q303yP✓e. .51ap.c ro4j~ +,e n4 c4. e F{/u ~a E /,'vc c . '~/:4sr~!'7 17 r7Bs 5 .SAO,4c%C, inBUu t of 7ZA' ! s nn .o~ lei-✓sof ol~D or d ~ t / ~.go{~o a~. Mound POWTS Index & Title Sheet Project Name: Nilssen 5 Bedroom Mound Owners Name: Jason E. Nissen Owner's address: 201 Stoclanan Rd., Woodville, Wi 54028 Site address: XXX Co. Hwy. N Project Location: Subdivision: Na Legal Description: SW%NEY, Sec. 15, T.28N., R.18W., Town of Cady, St. Croix Co., WI Parcel ID 004-1036-60-000 Page 1 Index and Title Sheet Page 2 State Approved Mound Design Page 3 Treatment Tank Cross Section Page 4 Filter Specifications Page 5 Septic Tank Maintenance Agreement Page 6 Warranty Deed Attachments: Soil Evaluation Report Mater P1 er Res 'cted Service: James K. Thompson, DSPS Credential #3 Signature: s---- Date. 3 201j Page 1 of 6 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ~,,rAxT.+rF',r DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 Q GREEN BAY WI 54304 Contact Through Relay l9` t P S http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Dave Ross, Secretary July 08, 2015 CUST ID No. 30021 ATTN.• POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LN 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/08/2017 Identification Numbers Transaction ID No. 2567439 SITE: Site ID No. 814430 Jason Nilssen Please refer to both identification numbers, Co Hwy N above, in all correspondence with the agency. Town of Cady `M St Croix County SW1/4, NE1/4, SNS, T28N, R15W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1544079 Maintenance required; 750 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Version 2.0 SBD-10706-P (N.01/01).; 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. 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. CottdQ' The following conditions shall be met during construction or installation and prior to occupancy or se: APP • Reminders DEPT. OF SAFE AND P IDNISwN OF • The orientation of the mound system must be such that the mound's longest dimension is perpen icular to th direction of the slope. • Bedding must be capable of bearing the weight of the tank. Bedding material must have the abili for o to pass through'/4 inch screen. Bedding thickness must be 4 inches minimum compacted (thickness ay vary du ~E to soil conditions). • Sidewalls of tanks must have dry backfill materials that have the ability to pass 100% through a 2-inch screen. Provide a min. 12 inches on all sides from bottom to top, placed with a backhoe or concrete bucket to avoid impact loads on sidewall of tank. No compaction of backfill material is permitted on sidewalls; if more than 85% modified Proctor compaction is required, then use 3/8- or 3/4-inch washed gravel for backfill material. • This POWTS dispersal component and septic system shall meet all setback requirements per s. SPS 383.43(8)(1), Wis. Adm. Code. • As per the Mound Component Manual, activities shall be limited in the mound area. Vehicular traffic, excavation, and soil compaction are prohibited in the basal area and 15 feet downslope of the basal area. + JAMES K THOMPSON Page 2 7/8/2015 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Rachael E Huempfner POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633 (920)492-7727, M-f 7:45 am To 4:30 pm rachael.huempfner@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Nilsssen 5 bedroom residential mound Owner's Name: Jason Nilssen Owner's Address: 201 Stockman Rd. Woodville, WI 564028 Site Address: XXXX Co. Hwy. N Legal Description: SW1/4 NE1/4, Sec.15, T.28N., R.15W. Township: Cady County: St. Croix Subdivision Name: Na ,i~-- r~ally Lot Number: Na Block Number: Na ,v~D Ssv4AL SERV~I/CES r, Parcel I.D. Number: 020-1448-31-000 STRYSERVI6ES lots Plan Transaction No.: Page 1 Index and title EsppNOE 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 Site Plan Page 9 Distribution Cell Concave Deflection Calculations Page 10 Attached Soil Evaluation Report Designer: James . Thomson License Number: 30021 Date: 06/18/1 Phone Number: (715) 248-7767 Signature: s Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), 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) Version 5.1 (R. 06/06) Page 1 of 10 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill (D) calculations assume a 500.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 750.00 Design Flow (gpd) 10.00 Site Slope 97.00 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 92.50 Dispersal Cell Length Along Contour (ft) = 9.00 Cell Width (ft) 0.90 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? c Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 6 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.00 Orifice Spacing (ft) = 6.03 ft2/orifice . rcemain Diameter (in) 2 60.00 rcemain Length (ft) Does the forcemain drain back? Y 0 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 8.46 Vertical Lift (ft) 125.11 5x Void Volume (gal) 3.79 A Friction Loss (ft) 134.89 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 56.85 System Demand (gpm) 18.75 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. o tions choice 0.75 1.25 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator Treatment Tank Information 950.00 Total Tank Capacity (gal) 1585.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 25.00 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 950.00 Dose Tank Capacity (gal) PolyLok Filter Manufacturer 25.00 Dose Tank Volume (gal/in) PL-525 Filter Model Number Wieser Concrete Manufacturer Project: Nilsssen 5 bedroom residential mound Page 2 of 10 Mound Plan and Cross Section Views T 1/10 6 Observation Pipe Tr-"T K O A B z L Mound Component Dimensions ft A 9.00 ft E 32.80 in H 1.00 ft K Aft B 92.50 ft F 9.50 in z 17.25 ft L ft D 22.00 in G 0.50 ft J 7.21 ft W 832.50 (ft2) Dispersal Cell Area 2428.13 (ftz) Basal Area Available 8.11 (gpd/ft) Linear Loading Rate 9.25 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.63 (ft) ♦ H 98.83 (ft) - Dispersal Cell 99 33 (ft) Lateral IF Invert Dispersal Cell Elevation D 97.00 (ft) Contour Elevation 10.0 % Site Slope Geotextile Fabric Cover Shading Key T Dispersal Cell See lateral details on Topsoil Cap o r 1.5 ft Page 4 for number, size, Subsoil Cap U ).O © /~Q and spacing of laterals. ASTM C33 Sand / Laterals are equally ® Tilled Layer 0.5 ft Typical Lateral F spaced from the - N © I distribution cell's © C~ Aggregate It o -il - centerline in the 0 A distribution cell (AxB). Project: Nilsssen 5 bedroom residential mound Page 3 of 10 Center Connection Lateral Layout Diagram l T Number of Laterals 6 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.02 ft Lateral Length (P) 45.45 ft Orifices per Lateral 23 Lateral Spacing (S) 3.00 ft Orifice Density 6.03 ft2/orifice Lateral Flow Rate 9.47 gpm Manifold Length 6.00 ft . System Flow Rate 56.85 gpm Manifold Diameter 1.50 in Total Dynamic Head 18.75 ft Forcemain Velocity 5.81 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Ca acit 950.00 Gallons Volume 25.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.10 502.61 B 2.00 50.00 C ~ Pump off elevation (ft) C 5.40 134.89 90,8 D 10.50 262.50 D Total 38.00 950.00 Dose tank elevation (ft) 3" Bedding under tank. 90.00 Alarm Manuafacturer SJ Rhombus Alarm Model Number SJE 1011421 Pump Manufacturer Zoeller Pump Model Number BN 140 Pump Must Deliver 56.85 gpm at 18.75 ft TDH Project: Nilsssen 5 bedroom residential mound Page 4 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name James K. Thompson Phone (715) 248-7767 POWTS Regulator's Name St. Croix Co. Zoning Dep't. Phone (715)386-4680 System Flow and Load Parameters Design Flow - Peak 750 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 500 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1585 gal Maximum TSS 150 mg/L Soii Absorption Component Size 832.5 ft2 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 month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1 Observation pipes are slotted and materials conform to Table C j54.30-1, have a watertight cap, and are secured in as shown in the mo component manual. 2 Dispersal cell aggregate conforms to,9464.30 (6)(i), Wis. Adm. Code. 3 All gravity and pressure piping materials conform to the requirements in 4, Wis. Adm. Code. 4 illage 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 Proieci Nilsssen 5 bedroom residential mound Page 5 of 10 Mound System Management Plan Pursuant to 03.54, Wis. Adm. Code General This system shall be operated in accordance with OvriiTT 12-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N 01/01)] 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 CQ=wf%3.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. sf~ 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, Stalls. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The 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 aiarn 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 ,vnen 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 riot required. However, if such products are used they shall be approved for septic tank use by the n(~Y' Pump Tank Tne pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary . Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings 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 ire 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 rng/L FOG for septic tank effluent or 30 rng/L BOD, 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 ce rlusned 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 ar:y levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring if the septic tank or any of its components become defective the tank 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 rnedia, aria 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 anits are attached as separate documents and are considered part of the overall management plan for this system. Project Page 6 of 10 w TOTAL DYNAMIC HEAD/FLOW ' PUMP PERFORMANCE CURVE PER MINUTE MODEL 140/4140 EFFLUENTAND DEWATERING 3118 85n6 /SB 16 MODEL 140/4140 50--~ Feet Meters Gal. -Liters Y 7 u 45 5 1.5 - 86 326 10 3.0 80 303 + 15 4.6 73 276 z 20 6.1 66 250 g,114410 4140 25 7.6 59 223 rla rzsvt 35 - 1 30 9.1 49 185 1p 35 10.7 38 144 40 12.2 28 106 45 13.1 17 64 8 0 25 o~a.KO Shut -oHHead : 50fl.15.2rnT, ,113/37 15 10 4 5x37 2 i K`52AA 5 10 20 30 40 5o 60 70 80 e0 t , 0(10145 LfT$2$ 0 fm 160 2a0 320 FLOW PER MINlf1E 1 rre B vm s~.85 per, Min~MUN~ a~S~a/qQ lc~a/, , 6 CONSULT FACTORY FOR SPECIAL APPLICATION'S -F 3 N9 Electrical alternators, for duplex systems, are available and supplied with an + i alarm. Mechanical alternators, for duplex systems, are available with or without V< -:W, alarms. Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. Variable level control switches are available for controlling single phase sys- tems. Double piggyback variable level float switches are available for variable level long cycle controls. I6 V6 Sealed Qwik$ox available for outdoor installations. See FM1420. Refer to FM0806 for applications above 130°F (54°C). I . v7< SELECTION GUIDE 140/4140 MODELS Control Selection 1. For automatic use single piggyback variable level float switch or Model Model Volts-Ph Mode Am s Sim lex Du le double piggyback variable level float switch. Refer to FM0477. p p p 2. See FM1228 for correct model of simplex control panel. N140 N4140 115 1 Non 12.0 1 or 2 3 3. See FM0712 for correct model of duplex control panel. E140 E4140 230 1 on 6.0 1 or 2 3 BN140 BN4140 115 1 Au to 12.0 _ s cnunoNA All installation of controls, protection devices and 'N lrin9 should be OGn@ Dj ] tJ u3'I,:FO BE140 BE4140 230 1 Auto 6.0 licensed electrician. All electrical and safety codes should be foilowed mcluunl.; n. ^3os, recent National Electric Code !NEC) and the Occupational Safety and rIe wn :.c. CS-: `Single piggyback switch included. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAX T P0. BOX 16347 Louisville, KY 40256-0347 Manufacturers of.. SHIP T0: 3649 Cane Run Road ouwi,ille, KY 402-1961 ® 502)L77 8-2731 - 1 (800)1928-PUMP QVaUTY PUMP6 SNCF ~9~9 www.zoeller.com !~~/Y//~ L ( FAX (502) 774-3624 pyright 2005 Zoeller Co. All rights reserved ca./e: t10~ rj; /sic n P~~~~y SwY~hE~s! Sec, iG f, Z~~, ~Sc,J.~ Tit. o{t°_ao(Y J 56, C6'o i,r L'c~,~ cJ(, oo~- 1036 - (oo-tXC Q 5e;.t~ Sao. o ~ c~cs Assk at c d Q l tcl = /ov. ctn. 575-4' Prd(-o s c.al 5' bcdre+t~n-• ~Qes;dt~ce A-aPoacc1 ~;liarCo,,,cra6C- wL/~!, ~"dS~45o (3u~ ldin 5cwv C/ oa as~u ~a+tJ~: sr./Re. ~cy~ y ' P'~- ~ -65 ce-y"ev,..,it1. 5~3g1.3S efj/Kc.1EFt/ atS.T.Uw~/- . BPS 38~.306o&). yP✓.e. /offnta~,S/c~JC-E ~o~b(~ ':W,5 7-,q 303 SySft•►1 w'e4. e(,t//ae~l E /inc. -i/ i¢sTjr10r7Bs 4,f. C7 g ~ r ~ r i r Oropo s-c d Me ccod 4L,6 33.14 QS ' o, - / ~ 9 X t2• s'~nxdc/d~.yovsA,/e~✓/. S;x (y1 ~ ~ ~ ~ d; sEr; 6a•~'on /e ~L/./J aie t< x.02; / / y~~/~ w/ y8 of~i Ce~c 3,Oae~o(0. < Di aS Distribution Cell - Concave Deflection Worksheet Nilssen 5 bedroom residential mound Sec. 15, Tn. of Cady, St. Croix Co., W1. Site Information: 1. Design wastewater flow: 750 gpd (5 bedroom)(100 gal/bedroom)(1.5 peaking factor) 2. Depth to limiting factor: 14" 3. Land slope: 10% 4. Infiltrative capacity of soil at system elevation: 0.40 gpd 5. System elevation: 97.85' at 22" above 97.00' contour Dispersal cell sizine: 750 sq.ft. required (750 gpd / 1.0 gpd/sq.ft. ASTM C33 med. sand) Cell length (B) 90.00' Cell width (A) 9.00' Dispersal cell deflection: Cell Length = defleetion)(00265) + I] [ Effective length] ? .00265 conversion factor Dispersal cell deflection: I . Percent deflection: (9'deflection/100' down slope effective cell length)(100) = 9.00% 2. Adjusted cell length: [(9.00% x 0.00265) + 1] x 90.0' contour effective cell length = 92.15 3. Actual cell length along contour = 92.5'. Pg. 9 of 10 096-sa dM :TIJ 95 8-5Z~-008 0 -a1JOd-1SOd E-:31,VO v0 00 00 00 31V0 091*9 IM 'NOOa N301bW Ol AMH Sfl 9lLfM z \ r- 3a ~df1NdW OIld3S w \ aO {I w anod-3ad wo-,~=,~ s d0M:l8 NMV 3130UUO313131m 056/9851d1M N w 0 x w U.j N O ~J H Q (n > Z w J w 00 O J i-.-0 O U lNi1 fY Z m ww~ F ° Ind } O F OF F- d O ~il d F- (2 m Ln Q LLJ Na Q U In Q o U N F- G: pW d' p -m F- > w o w o cn~ ° Z= z, k m w~ o Z Z co ~ w 0 o Z _ J \J Q H w 00 U a°°°Q o o Q~W JQ U 4 J U O> C5 w w oM Y Q LL . dp 8 m m" CL cL C) Ln W o= m= = on J ° (7) n 00 C;i = vwi O -tn z a o C/) LL, m < CL e N Z> F- I Q W 0_ \ Z J na0 I J wQOwQ wZF- (n w U UZ Y Lr) ~ _ ~ w o -j F- U H ~ ~cn z o cn F v'5 2 z (n ccn °o LLJ ~U Q Gi ..O~p~•~ 0Q opw Q in m F U Li F- OQpOQwz°OC7V Z(np Q ° z W ~O Z3mU~=J~ CO J 33 Q •t Q~... U Z V N w F- F - Y W~ O LLI J Or Q Z > Z (n O Z Z p OUP U wZ Ln 1I Q ` , II III I' 1I ~ ~ II w II QN II l I Q I I II II' II k. - - _ ~jl N w - -'J M ~ i ` 1 I I a- O Q 11 of II, ~ - ° al Q ~Q II I w ~I w m I o C 1 I~: II < uj I f: „s „~ti LLJ I h III Lw° - Q z Q J w Z x ~j Q 00311 (n „lOl sv ZQ F- Technical Specifications PL-525 gFL~'IV'T FILTER (COMMERCIAL) 81718ALL CHECK l~ EWTSB'010 FLETWENTION ~ 1435 11.57 OUTLETBUSHNGE%CEPTS -7 , 4'SCH 408 S SCH 40 1 / 1110 ~I ,068 - u Ilk" 3102 PL-525 FILTER HOUSING I \ 1834 PART NO. - 30142525 11 I e 111,7 MATERIAL: HOUSING -POLYPROPYLENE - 6BALL -HOPE BUSHING OUTLET -PVC &6 BALL -HOPE ~ SOCKETEXCEPTSFLOAT SWTCH 10.23 EKCEPTSPSCH40 i _ 98 J FORNNUZE70BiRON 1084 330' OF 1118' SLOTS 624 + \\l - SOCKETEXCEPTS 647 6.01 Ss' BALL PUSH ROD OPRlING - , 7.09 OPEhM10 ~ .71 1 C~ o v 19.02 2244 III POLYLOK PL-525 FILTER CARTRIDGE o I PART NO, - 30141.525 MATERIAL -POLYPROPYLENE ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Jason E. Nissen Mailing Addres 201 Stockman Rd. 291 Co. Rd. Property Address (Verification required from Planning & Zonin+ment f or new construction.) City/State Parcel Identification Number 004-1036-60-000 LEGAL DESCRIPTION Property Location SW '/4 , NE '/4 , Sec. 15 , T 28 N R 15 W, Town of Cady Subdivision Plat: Na , Lot # Na Certified Survey Map # Na Volume Na -,Page # Na Warranty Deed # 998462 (before 2007)Volume , Page # Spec house 0yesOno Lot lines identifiable El 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 ASPS. 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 orm are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w 7 my deed recorded in Register of Deeds Office. 7 Numbe f bedrooms 5 SIGNA 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) RECEIVED Wis. Dept. of Safety an fp Division of Safety and n s j0vices ION REPORT Page I of 6 ST. CROIX COUNTY" accordance with SPS 385, Wis. Adm. Code Attach co County I~IIdhI tbTl6eper•rferl~ 8 1/2 x 11 inches in size. Plan must St. Croix include, bu 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. 004-103 60-0000 Please print all information. Review by Date Personal information you Provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner - 11 Jason E Nilsen Property Location Govt. Lot SW 1/4 Ei/4 S 16T 28N R 1 Property Owner's Mailing Address SE (or) W® 201 Stockman Lot # Block # Subd. Name or City State Zip Code Phone Number Woodville Wisc 54028 ( 71x5/698/4299ItyVllage own Nearest Road Cty Rd N Cady I New Construction Useo Residential / Number of bedrooms 5 750 GPD Replacement ~ Public or commercial -Describe: Code derived design flow rate Parent material Glacial Drift Flood Plain elevation if applicable General comments l`1/A ft• and recommendations: Mound System Contour El. 97ft Boring # 1 Boring El Pit Ground surface elev. 97 ft. Depth to limiting factor 21 in. Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots Soil GPD/ft a lication Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 fi#2 1 0-6 IOYR3/4 sl lmbk mfr as 2 6-21 IOYR4/4 sl 3 0.4 0.7 I pI mfr cw 1 0.4 0.6 3 21-48 7.5YR4/4 f1d7.5YR5/6 scl 2mp1 mfr cw 0.0 0.2 F -2 Boring # D Boring 97 0 Pit Ground surface elev. ft. Depth to limiting factor IS in. Horizon Depth Dominant Color Redox Description Texture Structure Soil Application Rate onsistence Boundary Roots GPD/ft : in. I 0-5 Munsell 10YR3/4 Qu. Sz. Cont. Color sl x ff#1 ff#2 Gr. Sz. Sh. lmbk mfr as 3 0.4 0.7 2 5-15 10YR4/4 sil I pl mfr cw 1 0.4 0.6 3 15-48 7.5YR4/4 fId7.5YR5/5 scl 2mpl mfr cw 0.0 0.2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluerrt #2 = BOD s < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig lure CST Number Thomas W Gedatus Address 962178 Date Evaluation Conducted Telephone Number 670 10th Ave. #17 Baldwin, Wisc. 54002 5/15/2015 715/694/5166 SBD-8330 (111 1 /11) Property Owner Jason E Nilssen Parcel ID # 004-1036-60-0000 Page 2 of 6 ❑ Boring # Boring D pit Ground surface elev. 93 ft. Depth to limiting factor 14 in. Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots Soil GP ID/ft 2 Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. fr#1 11f#2 1 0-5 10YR3/4 ~j sl lmbk mfr as 3 0.4 0.7 k-Y - 10YR4/4 sil 1 m 1 mfr cw 1 0.4 0.6 3 14-48 7.5YR4/4 scl 2mp1 mfr cw 0.0 0.2 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots Soil GPD/ft Application Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. " fF#1 ff#2 ❑ Boring # Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPDfft x in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. " ff#1 ff#2 Effluent #1 = BOD 5 > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 5 _ 30 mg/L and TSS < 30 mg/- The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330TW (R 11/11) N~ Z/7 J o t- fo Sc L w IN O_b41.0 3.6y_ oova --OOVi 0 366 000 Pro Poste / Tv e e. eC-Arov E 1. i o u L H--v % AS E~ j7C- AN qs~L ~ ~-iss~~ qtr ~ a,n ! 5}~~►.,A t~ f-7 L WOOaJmit,n/ 3stl~S. syp~3 PT0 o0 Ail 0.3b 0000 -f-~wr o -F OgAy .ets ~ ~ alb AC Zr 7 d' Pa~C ~a-P 6 S , F8 1© Town 0~-avy 17 s r ~tzs N o soo iooo ' ISON DISCLAIMER This of guar~leed accurate. correct. dxreet or - t- -Idusioes drawn a4 the ras -Pl e lur of the ! ! and s 2015 Property Record I St Croix County, WI Assessed values not finalized until after Board of Review. Property information is valid as of MAY 14 2013 10.22PM . OWNER CO-OWNER(S) JASON E NILSSEN 201 STOCKMAN TERESA A NILSSEN WOODVILLE, WI 54028 FORMER OWNERS PROPERTY INFORMATION 2013 MERRY STOCKMAN 2004 REX D STOCKMAN Parcel ID: 004-1036-40-000 ARernate ID: School Districts• SCH D BALDWIN-WDVILLE PROPERTY DESCRIPTION Other Districts- SEC 16 T28N R1 5W 13.84A NW NE EXC PT LYING N`OF HWY N WITC Pr00erty Address' c i n Town Range Qtr Qtr Section Munttalb ec ' n TOWN OF CADY i-ot Black; DEED INFORMATION Pi t-?>z Names NOT AVAILABLE Volume Page Document Plat History: 998462 2015 NOT AVAILABLE 260 321 812358 1188 387 1168 552 TAX INFORMATION Net Tax B_ eforg .00 LAND VALUATION Lottery Credit Valuation Date .00 20091027 First Dollar Credit: .00 Code Acres Land Value Improvements Tot Net Tax After: .00 G6 13.840 45,700 0 45,700 Tax Amt. Due Amt. Paid Balance 13.840 45,700 0 45,700 .00 .00 .00 Total Acres Special Assmnt .00 AO .00 13.840 Special Chrg .00 Assessment Ratio: AO 00 .0000 Delinquent Chrg 00 00 Mill Rate: .00 0.000000000 Private Forest .00 .00 Fair Market Value: Woodland Tax '0Q 000 .00 .00 .00 Managed Forest .00 00 Prop. Tax Interest .00 .oo .oQ, INSTALLMENTS Spec. Tax Interest .DO .00> Prop. Tax Penalty 00 Period End Date Spec. Tax Penalty .00 Amount AO .00 Other Charges .00 .00 .00 TOTAL .00 .00 Over-Payment QO .00 PAYMENT HISTORY (POSTED PAYMENTS) General Date Receipt # Source T e Special Amount Tax Status Assess. Status Interest Penalty Total S~ n N o~~ ~m0 O O dN~ U c+Oi as C ~ E N >N Q N m m W > N O '602 m S > CJU O ~ N O C ~ .O N W t 0) V N L G m m m N m a U rc° ' O E x C g d c N rn o o U m w _a 2 y. K o. K d ami x 3 m '6 U r x > K o tm3 •O C1 m u. u°. I- F U > tq O J K 5 W U J K K R K ~i t J IJ ❑ I I _ O waic 1F+ (0) g oN3 ~ - 10, mot. 2 Nir •1 QQ~: y J'r i t r yi. , E * it a ,z ~ NTH 3 d~ ~ . z Parcel 004-1036-60-000 07/17/2015 04:02 PM PAGE 1 OF 1 Alt. Parcel 16.28.15.245A 004 - TOWN OF CADY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JASON E NILSSEN O - NILSSEN, JASON E TERESA A NILSSEN C -NILSSEN, TERESA A 201 STOCKMAN WOODVILLE WI 54028 Property Address(es): Primary t ' Districts: SC = School SP = Special 1 Ip ( C1"~ N Type Dist # Description SC 0231 SCH D BALDWIN-WDVILLE SP 1700 WITC Notes: Legal Description: Acres: 40.000 SEC 16 T28N R15W 40A SW NE Parcel History: Date Doc # Vol/Page Type 07/11/2014 998462 WD 11/18/2005 812358 2930/321 WD 07/23/1997 1188/387 WD 07/23/1997 1168/552 WD Plat: * = Primary Tract: (S-T-R 4ov.16o~r, GL) Block/Condo Bldg: * N/A-NOT AVAILABLE 16-28N-15W 2015 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/27/2009 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 40.000 132,000 0 132,000 NO Totals for 2015: General Property 40.000 132,000 0 132,000 Woodland 0.000 0 0 Totals for 2014: General Property 40.000 132,000 0 132,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00