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HomeMy WebLinkAbout008-1038-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 582053 GENERAL INFORMATION State Plan ID No: 2643996 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: Gary & Katherine Larson 7 TOWN OF EAU GALLE 008-1038-50-000 CST BM Elev: Insp. BMElev: BM Description: ^ Section/Town/Range/Map No: 1 13 5 13.28.16.194B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE '1,0~,CJ CAPACITY STATION BS HI FS ELEV. Septic 'Z% Benchmark LJ 6 Dosing 500 Alt. BM .3 .76 166-7%. Ca~ I Bldg. Sewer 4.93 9 1, SS ~ l o c, S Holding ® St/Ht Inlet "7•77- 94 .74 TANK SETBACK INFORMATION St/Ht Outlet TANK TO WELL BLDG. Vent Air Intake ROAD Dt Inlet Septic S) Z7 ✓ Dt Bottom 1//.(,'3 Z. %e> Dosing Till, Z.7 Header/Man. 2.74 /b1•7/ Aeration Dist. Pipe .74 -ACO /d/-74' Holding Bot. System 3 •~D ~D1~ PUMP/SIPHON INFORMATION Final Grade l•71 /dZ• 7 Manufacturer Zo ~ Demand St Coverr 3 76 /~A -sp e/i GPM CiOJ W' O Model Number TDH Lift Q~ Friction Losg~ System Head T /t D f r I t, . a Forcemain Length Dia, P Dis . to Well / SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. OfjTrench PIT DIMENSIONS No. Of Pits Inside Dia iquid_De,\ DIMENSIONS 56 /,J( L-4 SETBACK SYSTEM TO P/L BLDG WELL / LAKE/STREAM LEACHING Manufacturer: \ INFORMATION CHAMBER OR Type t stye m: 1.47 160 $`E AA UNIT Model Number: DISTRIBUTION/ SYSTEM p( Header/Manifold pf Distribution Q y -#1 Ix Hole Size + / x Hole Spacing Ve o Air In e 't Pipe(s) J Z _ 1 I If srz V Length / r~7 Dia Length _ Dia / Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a Depth Over Depth Over xx Depth of xx Seeded/ odded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7J I ~P Inspection #2: ti Location: 337 CTY RD B i+ I I J~ 4 1.) Alt BM Description _ Chi 2.) Bldg sewer length = 2q ~ -amount of cover = 7 7-4 a r. a.Q.SZ... Ma 6o trerc 44--- ~-1 a A ; 4 SP -1 ire I Plan revision Required? ❑ Yes ~<No It 1~ -7 fj of Use other side for additional information. `Y ~zj Date Insepctor' ignature Cert. No. SBD-6710 (R.3/97) R Coil IltN' ED "ECEI Safety and Buildings Division St. Croix 201 W. Washington e., P.O. BOX 7162 Sanitar} Permit Number (to be tilled in h\ Co.) ` 3 7015 Madison, W 707 7162 5T. ~R01)(COUP S~ z o5 3 anitary Permit Application State Transaction Nnluber In accordance with SPS 383.21(2), Wis. Adm. Code, submission ofthis form to the appropriate governmental unit 2643996 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Yrojact Address (ifdincrentthan mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy La)v, s. 15.04(l )(nn). Slats. L Application Information -Please Print All Information Same Property~r-n~r's N ex; ti•` / Parcel 1" 0 Gan' Larson 008-1038-50-000 Property OGVner's Mailing Address Property Location 1~~ 37 Co. Rd. B Govt. Lot Citv. State Zip Code Phone Number _NW_ `4. SW_'-4. Section _ 13 (circle one) Woodville, W1 54028 (715) 495-6556 'I' 28 N: R 16 E or W III. Tye of Building (check all that apply) Lot 4 101.: Family Dwelling - Number ol'13edrooms Na Subdivision Name - - - Block 'r Na Public/Commercial -Describe I'so Na ❑ City of ❑ State Owned Describe I's, CS%I Number village of _ - Na 'own of--Eau Galle X 5~ 0 w• Ill. Type of Permit: (Check only one box online A. Complete line B if applicable) p - . ❑ New System 11 Replacement System ❑ Treattnent/Holding 1'atil: Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Pennit Revision Change of Plumber er to New List Previous Permit Number and Date Issued ❑ ❑Pennit "Transf Before Expiration Owner IV. Type of POWTS S stem/Com _ onent/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade hound - 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain)_ ' V. Dispersal/Treat ent Area Information: PolyLok PI-525 effluent filter to be installed at ST outlet Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (s System Elevation 1.0 Gpd/sq. ft. ASTM-C33 sand 104- 101.00' at 12" above 300 Gpd 0.6 Gpd/sq. ft. native soil 6'4 300.00 sq. ft. 300.00 Sq. Ft. 100.00' contour VI. Tank Info Capacity in Total g or ylanufacturcr Gallons Gallons Units ;d v New Tanks Existing Tanks y J r ' r o U n s w C7 Septic or Holding Tank 840 Na 840 1 Wiese Concrele X Dosing chamber 500 , Na 500 1 Combination ST/PC X VII. Responsibility Statement- I, th undersigned; assume responsibility for' tallation of the POWTS shown on the attached plans. Plumber's Name (Print) lumber's Stature MP'MPRS Number Business Phone Number James K, Thompson z - MFRS 30021 (715) 248-7767 Plumber's Address (Street, City, State. Zip C 340 Paulson Lake Lane, Osceola, W1 54020 VIII. County/Department Use Only Approved ❑ pp Permit Pee Date Issued Issuing 'lit Signature Isa i eve ~ r- bb vznReason lorDenial IX. Condi8pg51' Et4fReasons for Disapproval e, 1.` Septic tank, effluent filter and dispemBi cell must all be services / maintainer a Cc~ w f'9^ 9;~ Q rwti~ as per management plan provided by plumber. / 2. AN setback requirements must be maintairied as per applicable code / nrdinanre,: 4, 6 010A" dt arj 606 P4A7 COA Attach to complete plans for the sy:stena and submit to the Count, only on paper not less than 8 1/2 x 1t inches in size SD-63,98 (R 1 1/11 ) RECE{VED ■ So,/ Eau ~~o os~c+'~ou,,-zd~ z/.a=,rGB.co~ ♦ 14/ DEC 14 2 015 Zr% ~zc INDUSTRY SERVICES w'/%8~ Yeu a d i Ste: Ga~'y~,~l-rf ~iilE .Lr..iScri o ~;4• ~~reD.~Pd.B ~.s ~.1 S~r~SWy s rte. /3 Tyr; \ SL. C,, ik (v JI. j / 0 c/ dock-/c. 50-~n f (~ytr1 {'t ld Crn n t*`c/d !~e 1. oLC~ crS - no i~.a-c1a. S ySE~~ alFfi etc P~o~b~cv.cScr ~c.r 5"1_ fA nr og~' j ~ ,o ;1ro<T~ Ex,sE.' S.T/D.u 74 ° 6c d, ~fi • j 94.gS 8~ moo. 1~^~~! ~ u l~uild;n5 5suxr;~t✓c✓'~ elct/`. l p~'~ Crd• ~ f~•s. ~ 99.x/.' ~ ~ 1 ~ ,go F 4 ~ % J 14 fn z Z f Sep-~x-r' b u; 0r Er,s~n~; ~cll ~ Qj 1 1 Mound POWTS Index & Title Sheet Project Name: Larson 2 Bedroom Replacement Mound Owners Name: Gary & Katherine Larson Owner's address: 377 Co. Rd. B., Woodville, Wi 54028 Site address: Same Project Location: Subdivision: Na Legal Description: NW%SW%, Sec. 13, T.28N., R.16W., Town of Eau Galle, St. Croix Co., WI. Parcel ID 008-1038-50-000 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 Plum~er Restricted Service: James K. Thompson, DSPS Credential #30021 Signature: Date: 14C Page I of 6 Design pursuant to ]n-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-1070-P (N.01/01) ~Yp~Rr.11E~ DIVISION OF INDUSTRY SERVICES fo\ 3824 CREEKSIDE LN HOLMEN WI 54636-9466 i~a\ ~ Contact Through Relay ,9t I http://dsps.wi.gov/programs/industry-services www.wisconsin.gov do S'S10 A Scott Walker, Governor Dave Ross, Secretary December 16, 2015 CUST ID No. 30021 ATTN: POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSEN LAKE LN 1101 CARMICHAEL RD OSCEOLA WI 54020-5413 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/16/2017 Identification Numbers Transaction ID No. 26431996 SITE: Site ID No. 819828 Gary & Katherine Larson Please refer to both identification numbers, 377 County Rd B above, in all correspondence with the agency. Town of Cady, 54028 St Croix County NW1/4, SW1/4, S13, T28N, R16W FOR: Description: Mound / Two Bedroom / Level Site Object Type: POWTS Component Manual Regulated Object ID No.: 1578577 Maintenance required; Replacement system; 300 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Ver. 2. 0, SBD -10691-P (N.01/O1, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. IT COND • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. APP Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and DEPT OF dispersal are prohibited. PROFESSIO • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorptiDwIS1014 OF IN area. chs. NR 811 & 812c • The existing POWTS must be properly abandoned per SPS 383.33 Wisc.Adm. Code. lE 5E CO • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. JAMES K THOMPSON Page 2 12/16/2015 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(4), Wis. Stat • SPS 383.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors: Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 2 , Division of Industry Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 430 pin. JAMES K THOMPSON Paae 2 12/16'2015 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of 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 Departm°nt 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/installati on/operati on. 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 S 250.00 Fee Received $ 250.00 Balance Due S 0.00 Charles L Bratz POWTS Reviewer 2 , Division of Industry Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsila.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm RECEIVES) DEC 14 2015 EZflow° MOUND AND PRESSURE DISTRIBUTION 9?U68~YMORNICES Re.s; "J r c31 P4,; SIC L,-L10 INDEX AND TITLE PAGE Project Name: Larson 2 bedroom replacement mound Owner's Name: Gary & Katherine Larson Owner's Address. 337 Co. Rd. B Woodville, WI 54028 Property Address: Same Legal Description: NW1/4 SW1/4, Sec. 13, T.28N., R.16W. Township Eau Galle County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number 008-1038-50-000 Plan Transaction No. Page 1 Index and title Page 2 Data entry Page 3 EZflow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Site Plan Page 10 Attached Soil Evaluation Report ONALLY Designer: s K. Thompson License Number: 30021 OVED Date: 12/10 15 Phone Number: (715) 248-7767AFETY AND JAL SERVICES Signature s )USTRY SERVICES Designed Pursuant to the EZflow Mound Component Manual Ver. August 20, 2007, 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) 4ESPONDENCE,.~ EZflow Mound Version 3.0 (R. 3/1/12) Page 1 of 10 ~ ~ ~ Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design 200.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 300.00 Design Flow (gpd) 0.00 Site Slope 100.00 Installation Contour Line Elevation (ft) 100.0OContour Length Available (ft) 24.00 Depth to Limiting Factor (in) _ 0.40 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 6.00 Cell Width (ft) 3 4 - 50.00 =Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? -r c cr e) f El Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 1.50 Est liatml Orifice Spacing (ft) = 4.55 ft2/orifice _ 2.001 Forcemain Diameter (in) 85.001 Forcemain Length (ft) Does the forcemain drain back? L Y 92.00 Inside Pump Tank Elevation (ft) Erin is _ 0.00 Forcemain Filter Loss (ft) 13 6.50 System Head (ft) x 1.3 13.86 Forcemain Drainback (gal) 8.50 Vertical Lift (ft) 30.99 5x Void Volume (gal) 1.37 Friction Loss (ft) 44.86 Minimum Dose Volume (gal) 16.37 Total Dynamic Head (ft) 27.19 System Demand (gpm) VV Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 - 1.50 x j 3.00 . 2.00 x 3.00 Gallons/Inch Calculator (ul)iivficii Treatment Tank Information 508.261 Total Tank Capacity (gal) 840.00 Septic Tank Capacity (gal) _40-0-0-1 Total Working Liquid Depth (in) Weiser Concrete Manufacturer 11.82 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 508.26 Dose Tank Capacity (gal) PolyLok iFilter Manufacturer 11.82 Dose Tank Volume (gal/in) PL 525 Filter Model Number Weiser Concrete ]Manufacturer Project: Larson 2 bedroom replacement mound Page 2 of 10 Mound Plan View J F... Observation Pipe ~ - 14 5 A B / Y :C] I~ 7,h Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 12.00 in H 1.00 ft K A21.00 ft B 50.00 ft F 12.00 in z 7.50 ft L ft D 12.00 in G 0.50 t J 7.50 ft W ft 300.00 (ftz) Dispersal Cell Area 1050.00 (ftz) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 103.00 (ft) G 1 1 F Dispersal cen 101.50 (ft) Lateral Dispersal Cell i 101.00 (ft)--►• Invert Elevation : . Elevation D 3 100.00 (ft) Contour Elevation 0.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 1❑ Topsoil Cap > (D c. n. o a. Approved Geotextile Fabric Cover 2 Subsoil Cap o .2 r- 0 2.0 ft ASTM C33 Sand d ®0 Tilled Layer O F 515 EZflow Media °'c n U) 0 0.5 ft A See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Larson 2 bedroom replacement mound Page 3 of 10 End Connection Lateral Layout Diagram ♦=Turn-ur-ta't,311v3iv9r ,.La~n,.u+. ,lug P r 1 e, or11:.~2 lo_.yte:, at I X- I tIR l" r1l 1., _ _Y~d _ , r1 _dl' S i F~rCFT31n?.Jnr:eC[lor'JI3IF?ol toss 'ofT!~'tlf0!C it pG L ;c.•ri Ir- rr n_ P': C S i 40 r11 laleral` rder'ical .1h wrilc?3 e•Ua i•_rfi c oc.M Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 1.52 ft Lateral Length (P) 49.32 ft Orifices per Lateral 33 Lateral End (Z) 0.68 ft Orifice Density 4.55 ft2/orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 13.59 gpm Manifold Diameter 1.25 in System Flow Rate 27.19 gpm Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Capacity 508.26 Gallons T Volume 11.82 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 25.20 297.92 B 2.00 23.64 C Pump off elevation (ft) C 3.80 44.86 93.00 D 12.00' 141.84 D Total 43.00 508.26 i 1--E Dom se tank elevation (ft) Bedding And Backfill As Per Manufacturer 92.00 Alarm Manufacturer SJ Rhombus Alarm Model Number SJE 1011421 Pump Manufacturer Zoeller Pump Model Number BN151 Pump Must Deliver 27.19 gpm at 16.37 ft TDH Project: Larson 2 bedroom replacement mound Page 4 of 10 EZf ow0 Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 6 ft Wide i Component Legend SR1-7A Bundle - 5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or @108 SR3-12H in 5 ft or 10 ft lengths 0 4" Perforated Distribution Pipe With Pressure Lateral Inside • Turnup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 50.00 Cell Length - B (ft) Force Main --_y 6 ftWide End Manifold Project: Larson 2 bedroom replacement mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Jmaes K. Thompson Phone 715 248-7767 POWTS Regulator's Name [St. Croix County Zoning Dep't 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 Inspect and clean as necessary at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested eve 3 ears Mound Inspect for onding_and seepae once everyq_y~ars 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 EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 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 Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same EZflow Synthetic Media Diameter as Lateral 1.86 Feet Distribution Lateral Lateral Cleanout - 1 Project: Larson 2 bedroom replacement mound Page 6 of 10 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 (EZflow Mound Component Manual 8/20/07, Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. 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 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 alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner as to 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 Wisconsin Department of Commerce. Pump Tank The dosing (pump) 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. If the force main has a weep hole, it should be noted if it is functional during pump operation, and if not, it should be cleaned. No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death. 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 BOD5, 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 3 years. 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Larson 2 bedroom replacement mound Page 7 of 10 PUMP PERFORMANCE CURVE MODEL 151/152/153 TOTAL DYNAMIC HEAD/FLOW 5o PER MINUTE 11 45 153 EFFLUENT AND DEWATERING 12 40 MODEL 151 152 153 3s i to 152 Feat Maters Gal. Liters Gal. LJterc Gal. Liters v 5 1.5 50 189 69 261 77 291 30- 10 3.0 45 170 61 231 70 265 s 25 151 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 37'-T~,/ 6 20 25 7.6 18 61 34 129 42 159 30 9.1 - 23 87 33 125 i5 1 35 10.7 - 22 85 10 40 12.2 - - - 11 42 2 Shut-oH Head' 30 ft. (9.1m) 38 ft. (11.8m) 44 A. If 3.4m) 5 0745088 0 10 20 40 60 0 BO DO 1 GALLONS LnERS 0 40 e0 1 0 1 240 0 3 3 FLOW PER MINUTE 0145MA Model 151 Models 1521153 Z- 7. /9' yo.n(. Ay,%l i n'r u M d,-sc~~ mac. rc~ d. CONSULT FACTORY FOR SPECIAL APPLICATIONS 67/52 611, -1 7 718 1578 7 27/32 N 5,g ,y I Tuned dosing panels available. - Electrical afternators, for duplex systems, are available and 2731 supplied with an alarm. 1 776 1 Variable level control switches are available for controlling ® 6 7 single phase systems. 1 Double piggyback variable level float switches are available for variable level long and short cycle controls. Sealed Qwik-Box available for outdoor installations. See FM 1420. Over 130'F. (54'C.) special quotation required. i 1511152!153 Series it 1+716 121/9 151152/153 YODELS control Selection Yodel Volts Ph Mode Amps SIm ox Duplex - /&C s vs N151 115 1 Non 6.0 1 2 of 3 BN151 115 1 Auto 6.0 Included 2 of 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Ali to 3.2 Included 2o( 3 SK2A44 SK2064 H152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 of 3 E152 230 1 Non 43 1 2 of 3 BE152 230 1 Auto 4.3 Included 2 or 3 1,1153 115 1 Non 10,5 1 2 of 3 BN153 f30 1 Auto 10.5 Induced 2 or 3 E153 1 Non 5.3 1 2of3 SELECTION GUIDE BE153 1 Auto 5.3 Induced 2«3 1. Single piggyback variable level float switch or double piggyback variable level floa( o cAUr1oN switch. Refer to FM0477. All nstallation of controls, protection devices and wiring should be done by a qualified 2. See FM0712 for correct model of Electrical Mernata E-Pak. ucensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA) 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 L Louisville, KY 4 02 56-034 7 Manutecfurers of . SHIP TO: 3649 Cane Run Road Louis isville, KY 40211-1961 p~7p 9 v v QL/.!L?Y PU.4/PB SNCE ~il~/~l (502) 778-2731 - 1 (800) &PUAfP httpJ/www.zoallercom FAX (502) 7743621 © Copyright 2004 Zoeller Co. All rights reserved. RECEIVED pl-110s4c~//~ou,1da~ z/.a~r~8.~ ♦ 6X%s4.,t7 you DEC 14 2015 ' s ~c e e/edtnbela CZ INDUSTRY SERVICES u %IF ~ W/%B' o~:4'Yccs a t i sz.: Gary X~~~i 337~.,ed.13 5 cC. /3 7. A ~ U~1 lCouJ. T.o au O SE . 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' j i 8M-W9/ODOU4 :3 13 95-v8-5z~-008 0 \ OSLVS IM 'NOON N301VW 01 .IMH Sn 9LL£M :anOd-iSOd :31V0 00/00/00 31V0 lb`nNb'W OI1d3S w O ~anOd-38d :3lVOS OS dOM :AR NMV31380 \ „0-,t=„4 l aO !!00 V3531M w 21W-OOS/OtBM L w W ~ J w w H Q\ U) Of L / Q z m O LL > D O W (7 J n W w V) CL } L) <W L) J W w m O 0 0 F- O m w_ m Q Q °w U W F- J W F- D- J § O O CO o 0 In om 1io~ ~Z D v w w H O ° o z < ;Tit ° Q z o W~ ¢ 5 5 3: LL > ~ N I= v o ~J z -m Q "I _v Z W W Q > v LLI Q it 0 p Ow a`~O Q Q N F- w~ 0 a a o a~ mfn JWW a 0F- V a z O U O .'o = z m --r Q O U) N N ZO ~v o -N\ot'4-J W I mLL. WW O Q V d 00 Q \ M O U) F- 0 F- p (n 4h \W Mt N~ x J LLJ r J J ZN } z U) W U U, UZ z u7 M F- F- - F- :3 F= (n - O N LOJ..=OZJ ~U)W OZ~ U W V W WpW I'N 00 Y 0~O>ZCD ZOo5c=~ z~Q °zo L'i ¢ ° m a N x~x QQQQW W -WOW Qd<D Q3~ U G7 Q (Wn O ~m NOf Z N3mc)M=J3m:3 z_ c) 50 z F- F- Q U- Q w J 5 ° Y WY F' Q V) p Z Z Q U J Q W I I F- N Q ~ U w p J Q z „9t a ~ O W z W ~ W 0 D! y (I I SVo „t I N / N „St do 7 w w V) 41-IF I _ 0 ° w U- x L~ "f Li I 1 0J I Ln CO-) J m / svo ,t o e r/ I I „9t dn~ W O F- W D w F- J Z „gt U - D Ob32i _ ~ S6 SV 6S ww a Y z Q F- Technical Specifications PL-525 EFFLUENT FILTER ( o Allp 612' BA-L CHECK ~ I EXCEPTS 6'SHD 4L Ip/1 FOR IN ET EXTENTION 1435 9 JI,Y-ET BUSKING EXCEPTS ."SO, 4085'SCH 40 d^0 I T If i I % ~4\ 5 23 , ~Z 33.02 r. PL-525 FILTER HOUSING PART NO -30142-525 s MATERIAL: ' HOUSING-POLYPROPYLENE 4 OUTLET BUSHING - PVC 65 BALL -HDPE L__r_ S04ET EXCEPTS UAT SV4TCM _ ,--O ➢ 10.23 - EXCEPTS 1'SCH -0 FOR HANDLE EX NTION _ I zi Irn< 614 OF 1 ".6' SLDTS MIN ss6 - SOCKET EXCEPTS 601 BALL PUSH ROD 77 T 1.09 OPE4NG sun.r~:ea 20~7t 1 L, \r:, j ~ I of i o s' I 1802 2244 ~j II POLYLOK PL-525 FILTER CARTRIDGE PART NO - 30141.525 - - - MATERIAL -POLYPROPYLENE ~I I I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Gary Larson Mailing Address ' CO. Rd. B, Woodville, W1 54028 Property Address Same :033 -7 (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 008-1038-50-000 LEGAL DESCRIPTION Property Location NW '/4 SW '/4 ,Sec. 12 T 28 N R 16 W Town of Eau Galle Subdivision Plat: N a , Lot # N a Certified Survey Map # Na Volume Na Page # Na Warranty Deed # Na (before 2007)Volume 685 Page # 581 Spec house ❑yes0-io Lot lines identifiable Elyes❑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 svstem 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 fiill 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 th form are true to the best of my/our knowledge. I/we am/are the oN~ ner(s) of the property described above, by virtue of a \\a ante deed recorded in Register of Deeds Office. Number of be oms 2 /2 /is/l/s SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) P5 sa~`~ RECEIVED P ]A) ~j 17 ZU c5g 6q 1 2417 Wisconsin Department of5Ps SOIL EVALUATION RE Page I of 3 5F5 - Ge+ft=@F8C- ST. CROIX COUNTY Q w 36c, OPMEt~P(accordance with 5, Wis. Adm. Code Count A.C.E. Soil & Site Evaluations Nt`I Y DVEt- County Attach ~compplete site plan on paper not less than 8% x 11 inches in size. Pla St. Croix include, but not limited to: vertical and horizontal reference point (BM), directio percent slope, scale or dimensions, north arrow, and location and distance to Parcel I 00811038j50-000 Please print all information. Rev' ed By Date .~Personal information you provide may be used for secondary purposes (Privacy Law, s. /7-/21//15 Property Ownei Property Location I / r Gary & Katherine Larson Govt. Lot NW 1/4 SW 1 S 13 T 28 N R 16 W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 337 Co. Rd. B na na Na City State Zip Code Phone Numbei City Village ✓ Town Nearest Road Woodville WI 54028 715-698-2316 Eau Galle Co. Rd, N New Constructior Use: ✓ Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD ✓ Replacement Public or commercial - Describe: Parent material Glacial Drift Flood plain elevation, if applicable na General comments and recommendations: Soil conditions require mound POWTS with dispersal cell placed on 100.00' contour. Recommended Infiltraive surface elev. to be 101.00' at 12" above contour. FT] Boring # Boring ✓ Pit Ground Surface elev 99.84 ft. Depth to limiting factor 24 in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft2 in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-12 1Oyr2/2 none I 2fgr mvfr as 2fmc 0.6 0.8 2 12-18 1Oyr4/4 none sil 2fsbk mvfr cw 1fmc 0.6 0.8 3 18-24 7.5yr4/4 none sl 2msbk mfr cw lfmc 0.6 1.0 4 24-40 7.5yr4/6 f2d 7.5yr5/8 sl 1 csbk mvfr cw 1 fm 0.4 0.7 5 40-58 7.5yr4/6 f2d 7.5yr5/8 sicl 1csbk mfr gi 0.2 0.3 6 58-66 7.5yr4/4 none scl Om mfi - 0.0 0.0 H#6 grading to limestone bedrock at >66". ❑ Boring # Boring ✓ Pit Ground Surface elev 99.88 ft, Depth to limiting factor 32" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture StructurE Consistence Boundar Roots GPD/ft2 in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-12 1Oyr2/2 none sil 2fgr mvfr as 2fmc 0.6 0.8 2 12-16 1Oyr4/4 none sil 2fsbk mvfr cw 1fmc 0.6 0.8 3 16-32 1Oyr4/4 none sl 2fsbk mvfr gw 1vf,fm 0.6 1.0 4 32-48 7.5yr4/4 f2d 7.5yr5/8 sicl 2msbk mfr cw 1vf,f 0.4 0.6 5 48-74 7.5yr4/4 f2d7.5yr5/8 scl 1msbk mfr aw 1vf,f 0.2 0.3 6 74-84 7.5yr4/4 none SSBR Om mfi - - 0.0 0.0 H#6 constitutes weakly cemented SSBR bedrock at 74". Effluent #1 = BOD 5 30 <220 mg/L nd TSS >30 < 150 m * Effluent #2 = BOD5< 30 mg/L and TSS < 30 mg, CST Name (Please Print) Signatjlre: CST Number James K. Thompson 5.--- 3&@2 3cc7Z1 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Numbei 340 Paulson Lake Lane, Osceola, WI 54020 10/12/2015 715-248-7767 Property Owner Gary & Katherine Larson Parcel ID # 008-1038-50-000 / Page 2 of 3 31 Boring # Boring ✓ Pit Ground Surface elev 99.91 ft. Depth to limiting factor 26" in. Soil Application Rat F 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 0-12 1Oyr2/1 none I 2fgr mvfr as 2fmc 0.6 0.8 2 12-18 1Oyr414 none sl 2fsbk mvfr cw 1fmc 0.6 1.0 3 18-26 7.5yr4/4 none sl 2msbk mvfr gw 1vf,fm 0.6 1.0 4 26-50 1 Oyr6/4 c2p 7.5yr5/8 fs Osg ml gi - 0.5 1.0 5 50-63 1Oyr8/4 f2d 7.5yr5/8 SSBR Om mfi - 0.0 0.0 H#5 constitutes weakly comented SSBR at 50". ❑ 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/ft" in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 ❑ 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/ft; in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 * Effluent #1 = BOD 5 30 <220 mg/L and TSS >30 < 150 mg Effluent #2 = BOD 5< 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 608-266-3 15 1 or TTY 608-264-8777. SIM-8330 (P 0- 00) A.C.E. Soil & Site Evaluations fzc ~ary~ 1Ca Lit ~illf 337&•,ed 8 U Qom] R. !(o uJ., T . o{ E'er u. C=x~ ue, SE.. Cl0 ~O c./. #006 - io.~ - SG - cm (~yrn {'c ld corn ~ti/d Ex,~~„S 64~c.a/ ~o5/tee f~ra~bL rw l d4f: s ys be,+1 cv erg EwSEi' S.T /D•u2 I C ' tc~di C i~OC 1 J w M 'wr da 1 44.gS eJ C'o• fly, Q ~ Bu:~d;. J s~-;nrc.,r~ ` ~ .8z a.6~'ow.da~•'on= 9T.l9.~ 99. Y/ I ,r, Gad- ak i5.•s, i ~6o or Ass 4 arc d ~ lt+~ =~ce~.~o • , ° Ex, SE~irj 9972 f'Y, 8i' y~ 1 Q~s,cko A Q( i /oc~ l a ~X~S~•~~jj c-cull, eo. ,ed. ",I " 3 o-F 3