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HomeMy WebLinkAbout026-1168-35-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 582080 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes tPrivacy Law, s.15.04 (1)(m)] z 713& Permit Holder's Name: City Village Township Parcel Tax No: Richard & Joan Derrick /~iAe4 &A'01 I TOWN OF RICHMOND 026-1168-35-000 CST BM Elev: Insp. BM Elev: BM Description: I~ Section/Town/Range/Map No: 22.30.18.1341 6. 5 n6v TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~t uFf&G2T Benchmark lz~o Dosing Alt. BM Z• N /D~. Z. 77 ,tit Q ?SO 51' cam- acme Aeration Bldg. Sewer OA- Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION G, 9Z 9~ q~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom WIt Dosing A H eader/Man. 75 Aeration Dist. Pipe 51 l0 .70O M Holding Bot. System pl~ Final Grade PUMP/SIPHON INFORMATION To gC ` Z.O ?l Dir. $ Manufacturer Demand St Cover o& tj A L~ GPM Model Number t V4 y 10~ TDH Lift Friction Loss ` System Head TDH Ft Z Ids 98. ~O3 ~.g X1.700 .Sy 17.11 I~ 7 Forcemain Length r Dia. w Dist. to Well i yv L Z a- SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS gf SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of Syssttem: % UNIT Model Number: i v4/q) 9' 1 DISTRIBUTION SYSTEM Header/Manifold Distribution / / x Hole Size /2 ix Hole Spacing Vent to Air Intake 1 Pipe(s) Length Dia Length 15 Dia i3 Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over Xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench C nter / Z) 1 Bed/Trench Edges / u Topsoil Yes No Yes V No l Vol (Q n COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 <G Inspection #2: ' C~ c5~• aoLL1JSC-L P4,06J (All AIP~'i~i A`t-ff, Location: 1250 146TH AVE TCA^ *ovi u.r95"f~ "rut, /4 IXT 1.) Alt BM Description = 5.1. / U OU_ V7~ ~D" 2.) Bldg sewer length -1, 1,:' .(il~tlGrifJ~, ~~c ` ~2b~r• Quic~uc/ln/G! N p` - amount of cover = 5 r . `pom I , 36 - Plan revision Required? Yes V1 No Use other side for additional information d C• N Cert. No. ICJ Date Insepctor's Signature SBD-6710 (R.3/97) County • Safety and Buildings Division S77, Cove 201 W_ Washington Ave., P.O. Box 7162 it X JUN 3 Sauntary I'crmd Nnmhcr (to lie hllyd In by 1'rr ) 0 I Madison, VI - -*ftwn7-;11 62 g ~ Sr. CROIX COON GJF4ZPTRC7 4 g0 V14 allltaty Permit Application" State Transaction Number In uccOrdance with SPS 3$3.21(2), W is, Adm. Code, submission of this form to We appropriate govemmental unit 7-71 5G17 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if dilloreut Wml madinr, ,)rJdaes:, ) the Department of Safety and Paofcssiunal Se-les. Ycrsonal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 (m), Stats_ c~ L Application Information -Please Print All Information O Property Owner's Name Parcel # s c?a 3 c~ zC(1-,.,Ci M*pj ~eKgl cr-) 6 Property Owner's Mailing Address '>r Property Location City, State Govt Lot Zip Code Phone Number V / NCt~4" {v J C' ~JyJ Cp r~ lt/l yd / t IVY %a, Section Z ;7 30 _I_V_ 4p (circle one) If. Type of Building (check all that apply) Lot # T N; R B or ❑ I or 2 Family Dwelling - Number of Bedrooms 3-5- Subdivision Name ❑ Public/Commercial -Describe Use Block # JP6 r-' i4'J er- L f16~/ ❑ City of State Owned - Describe Use CSM Number ❑ Village of 4 'town of J C J/~ cn~J D III. Type of Permit (Check only one box on line A. Complete line B if applicable) 7-- Replaccmcnl Syslcm ❑ Treatment/! loldmgfank Replacement Onl Y n Olhcr Modification to P:xisting System (explain) It1'emul [,(.vision Ch llpc of Plumber 1en ud'I I:urai'I kr New List I'r.vlous Permit Numbenmd Date Issued ~SZ wv A/z O,V IICr 7114 IV. •I'ypC of PONV I's Syslcm/('(rnporlenl/Device: (Check all Ihal apply) Non I'rc•.•,unnd hi (;mood I'u•.ssuun,d In (;round AI /ir:ulc Mound )4 ul ul tiudablc •.nll Mnnnd )1 ru o(•,udablr loll luldnq•, l and 1 )Ihrr I )r,pnr.nl ('oloponcul (w l.l,rrn) I'u'Irr,rluu nl I lrvn r (.-vlrl:nnl V, lh%prlAnlfl'rralmenl Array Inlbrrunlioo: I I( %11, o blow (1,10) I 1 Ir-al,ln .`-'od Aplrhralwo Raw(gpd••I) I h•.prrad Aica Rrquord (%I) I h•.pr-r..d Arra I'ui .n•,cd I ~u SA"JD I I 1 `a.lrinllr ^0 v.uruo ~t✓~ y'I, 1'aulk Into ('tyrm l1y m I ~VV lhlal 11 of t i.uorl.u Ilm, ! isdlnn: 1 i:rllun•. I Inrl•. ' Ili .n II,dJr~I. 1 uJ, i .„L. ~ . v 7 r I Il. ItrtltuntihililV ! Ltlrutrul I. Ibr nndrrh(t.nr d, nwnun rr pouubd.lt (or nrrilulLrtlou ul Ibr' 1'I/tV 'Ialto ort Ibr alim I..d plant Plollihcl'-, N,uuc (I'unll I'Inulhrl nnluu JulnL. I ) I MI'/nll'It!: Nund'. I I In•an~ I'huw t6,4j;7 Z Z. /4 7 / 121J_ iW - Plumber's Addicss (Street, ('dy,Statc, /,Ill ('ode) VIII. Coon //Department Use Onl - Permit Fee Approved ❑ Disapproved Dale !soled Issuing Agent Signature - - - ❑ Owner Given Reason for Denial 7- )f'. IX. Conditions of Approval/Reasons for Disapproval Ate- Cva~ 77 610 of S7i~'T~ Affieorii =iZr~ 17- M 6'%r @L_ Attach to rnmpletr• plans for the system and submit to the County only on paper not less than 8 I!2 z 11 inches in size A111611UH01 11/11) n ~xrarF,_ DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov 'ssror Scott Walker, Governor Dave Ross, Secretary May 27, 2016 CUST ID No. 221471 ATTN: POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVA'T'ING, INC. ST CROIX COUNTY SPIA 352 140TH ST 1101 CARMICHAEL RD AMERY WI 54001-2840 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/27/2018 Identification Numbers Transaction ID No. 2713617 SITE: Site ID No. 824448 Laura Behling Please refer to both identification numbers, 1250 146TH Ave above, in all correspondence with the agency. Town of Richmond St Croix County NWl/4, NE1/4, S22, T30N, R18W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1603333 Maintenance required; 600 GPD Flow rate; 80 in Soil minimum depth to limiting factor from original grade; System(s): 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), SSWMP Pub. 9.6; 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. The following conditions shall be met during construction or installation and prior to occupancy or use: The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 6 inches. The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual. Reminders • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. 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. f DENNIS J GILLE Page 2 5/27/2016 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 'This Amount Will Be Invoiced. When You Receive That Invoice, *CarlLrt Please Include a Copy With Your Wastewater Specialist , Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 cart.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm DENNIS J GILLE Page 2 5/27/2016 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your *CarlLippert~r Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 carl.lipp ert@wisconsin. gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday -Friday 8:00 am To 4:30 pm I I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: LAURA BEHLING Owner's Name: LAURA BEHLING Owner's Address: 1250 146 th ave New Richmond Wi Legal Description: NW NE S22 T 30 N R 18 W Township: RICHMOND County: ST. SROIX Subdivision Name: POND VIEW MEADOW 11 Lot Number: 35 Block Number: Parcel I.D. Number: I~ 1 Plan Transaction No.: of d 5 ° j ACES ,AVIS10"'1 OF INDUSTRY SERVICES Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose to - Page 5 System maintenance specifications' Page 6 Management and contingency plan Page 7 Pump curve and specifications Designer: DENNIS GILLE License Number: 221471 Date: 05/12/16 Phone Number: 715-268-6637 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 10/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 7 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 600.00 Design Flow (gpd) 4.00 Site Slope 99.50 Contour Line Elevation (ft) 80.00 Depth to Limiting Factor (in) 0.50 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 8.33 ft2/orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? 90.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 10.17 Vertical Lift (ft) 67.44 5x Void Volume (gal) 3.12 Friction Loss (ft) 83.75 Minimum Dose Volume (gal) 0.50 In-line Filter Loss (ft) 38.77 System Demand (gpm) 18.33 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 750.00 Total Tank Capacity (gal) 1250.00 Septic Tank Capacity (gal) 44.00 Total Working Liquid Depth (in) HUFFCUTT CONCR Manufacturer 17.05 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) POLY LOCK Filter Manufacturer 15.23 Dose Tank Volume (gal/in) GF10 _ Filter Model Number HUFFCUTT CONCR Manufacturer Project: LAURA BEHLING Page 2 of 7 Mound Plan and Cross Section Views T 1/10 B J Observation Pipe K.. _ p A W l • B I 0 L Mound Component Dimensions Down slope toe extension made. ft A 8.00 ft E 9.84 in H 1.00 ft K EAft B 75.00 ft F 9.50 in z 8.00 ft L ft D 6.00 in G 0.50 ft J 4.80 ft W 600.00 (ft2) Dispersal Cell Area 1200.00 (ft2) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.79 (ft) - ► rfir~rr sir rir^:. H G •rrrrrrrir . r rirrrrrrrr , I .r,•r..}f....f... r F T Dispersal Cell 100.50 (ft) Lateral 100.00 (ft) - Invert Dispersal Cell 1 Elevation 4 E D 14J 99.50 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key a T Dispersal Cell See lateral details on 1❑ Topsoil Cap o c 1.5 ft Page 4 for number, size, 2M r -•fr.<, Subsoil Cap N o O 7 and spacing of laterals. ©0 ASTM C33 Sand I Laterals are equally Tilled Layer a) 0.5 ft Typical Lateral F spaced from the ©0 Aggregate o I 0 distribution cell's centerline in the } A distribution cell (AxB). Project: LAURA BEHLING Page 3 of 7 Center Connection Lateral Layout Diagram Force main connectior. :pia roe or + roa_ to rrrarocdd at arty point P S Turn-u v.y'tall valves or p It- x „12 ) L tara1.~ e:-funcar~i.~iri :Sc r l0 P't ~l as n out pl u g tier SPS Table '184.30-_6 Holes drill?d on th? bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.10 ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 4.00 ft Orifice Density 8.33 ft2/orifice Lateral Flow Rate 9.69 gpm Manifold Length 4.00 ft System Flow Rate 38.77 gpm Manifold Diameter 1.50 in Total Dynamic Head 18.33 ft Forcemain Velocity 3.96 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and 110 LL- SPS 316.300 WAC -T 4 in. min. Disconnect Tank component is properly vented -E- Alternate outlet location Forcemain diameter HUFFCUTT CONCR Manufacturer 2 in. Capacit 750.00 Gallons T Volume 15.23 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 37.75 574.87 B 2.00 30.46 C -d Pump off elevation (ft) C 5.50 83.75 90.33 D 4.00 60.92 D Total 49.24 750.00 Dose tank elevation (ft) 3" Bedding under tank. 90.00 Alarm Manuafacturer LEVEL ALARM _ Note: Switches Alarm Model Number DVL containing mercury may not be used in Pump Manufacturer ZOELLER this system. Pump Model Number N 140 Pump Must Deliver 38.77 gpm at 18.33 ft TDH Project: LAURA BEHLING Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name DENNIS GILLE _ _ Phone 715-268-6637 POWTS Regulator's Name EIPOLKCTYZONING Phone 715-485-9279 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 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 ever 3 ears Mound Inspect for ponding and seepage once every-3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail • Grade Finished ••....•ZM 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 e ree Bends Same Diameter as Lateral Project: LAURA BEHLING Page 5 of 7 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 W is Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet 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 of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. The pump (dosing) tank shall be inspected at least once every Pump 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 Svstem 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 BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. If the septic tank or any of its components become defective the tank Contingency or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. The information and schedule of mananagement and maintenance nfor~pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: LAURA BEHLING Page 6 of 7 PLWPPERFORUVTOTAL P~ IC HE !FLOW ` EFR )tifODElf4llrtf~~~E 6 UE rAt") M- VATERING _ MODEL 140/4140 t. c F.,t Llohfi 0.{ LAW, 1 5 is ae _ an ~ , =nor ` ss 7s- i2, > - I ( 29 ~ 1~6 (5 13.7 S` S 17 4G - atraU `T+t7/ttcsC - e ~o S~4~t5.?n) < h f0 7 5 __,I L T~ aorta, ,0 m =a r. fsa 2w owrf E i:ojp -i. CONSULT FACTORY FOR SFE~'1$p~lp y ~~•-~F I{K SPECIAL A1~1°.~{}LICr \T10tqS 1)A ElocWcai altemator; fc duF~lex, sysfsms, u alarm. ern avariable and su Mechanical s~ f 1fed w ih an ernato, alarms. Ir duplex systo ns, are a~a,iabia with o i' 1 c:nntrofalarmsr wthouf ,stern s See are avgY{able for 1 ease F&V732, pumps usodin sirnplcrs Variable level control s ~ ystem. v" terns. are r+vailaN3 for c ntotFnasa gie phase sys Dokibie pig9Yback variable level fioai switdres ero av - I009 Cfa cnntrols. allabf13 for vanaNo level Svulc t Qwr";-(sox available kx outdoor in I ~ { Refer toFM0806 fora stade6o See FM1420. PPlicaiions above 130°F (54°C). 1 ~--L s~ 140(4140 •Vppi_LS s Model Model Contort S®fec!;n 1 Fora SELECTION GUIDE Volts-Fh Mode A n utomn6r, (rge te piygyaacl variable L vel !,oat svji ch (-,r N 140 N4141) Amps Simplnr Dunlo.c double pi 7 ?yback v,2' b ,15 1 fJun 1~ ` nor Ic Icvel flog--,, stiyitch, E 140 E4140 .U 1 or 2 3 b S? Tfv11228 for correct model of. lax etrr 1n F1.A0477. 230 1 Non 3. See FM0712 for p con of pane,. BN140 BN4140 115 6.D 1 or 2 3 marred model of du 1 auto 12-0 plea control panel. BE140 Br4140 230 - - - _ _ • _ 1 Rriio Nl,t~ty ° ~~'Jrior 6'0 Ge Galen v( canDo[= y oMctlw 'Singfe 1 i piggyback $v✓)iGJ1 1nciUCred. • - recer„ N locos El~r-U ''1c~"'~ wcn. ~ e shcnr,6 br 6vne fly A'l-rfied c (NEC) and the Dcc~pitl on al SL'. htl owc It'd He0th Ac (051 A) For unusual cond RESERVE POWERED DESIGN rtvrs a reserve salaty fauor is cngineerod into fho des! 9n of eve curt ' F Y Zo,aler pomp. y 4 BCaX 16N7 L-"' KY 40256,030 ,~y r ~ ~ fit=/ ldlf ~A L _ rtivwcrosq came a .fJ~ ~ 47 • ~lL KY {ajlf-1A1i Wkt_k •T c!-. a ~Oarrs~ht-. W 1504 ns, lrfk"n v° Sir /9~9 " 2oeCa co, An rk?htc nmervv4 - J. i Y ~ 63 G s~ C~ ~lar ~ SCac j6c P-1 / Is, all ti EIVED Wisconsin Department of CommeL EVALUATION REPORT Division of Safety and Buildings NOV Page I of 3 nce with Comm 8 Wis. Adm. Code ' Lh Attach complete site plan on paCOUNTY County St. Croix include, but not limited to: vertica~I es in e. Plan must percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ©Zt!O~/~~~ 6 , } Please print all information. Re ' wed by Die / Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). Property Owner Property Location O ard/Robe orenDe trick Rich E (or) W P Govt. Lot NW 1/4 NE 114 S 22 T 30 N R 18 roperty Owner's Mailing Address Lot # Block # Lubd. Name or CSM# 1310 Hwy 65 35 Pond View Meadows IIL City State Zip Code Phone Number New Richmond WI 54017 ( 7115-246-5425 VIlage Town Nearest Road CTH G New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate zsystem, :the Re lacement GPD P Public or commercial - Describe: Parent material Loess over outwash sand and till Flood Plain elevation if applicable General comments ft. and recommendations: These are massive soils with the need for extremely careful installation techni qg used the metalling contractor. My recommendation would also be to consider a pressurie effluent t can be closed over the entire distribution area. Not ir3redbut reoomtnended_This site is suitable for a below grade rC ~r- Q~L -I conventional system ..s ith 1" continuous lenses of sl Om, 7.5yr4/ ❑ Bonng Boring Pit Ground surface elev. 95.85 / pT ft. Depth to limiting factor >80 in, Horizon De Soil lication Rate Pth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDj in. Munseff Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 Efl'#2 1 0-8 10yr3/3 sil 2mgr dsh cw 2f .8 V 2 8-22 1 4/4 sil 2msbk dsh cw if .g 3 22-47 7.5yr5/6 Is Om ds y cw ,5 .7 4 47-80 5yr4/6 sl 0m dsh - - .3 .5 a Boring # Boring 98.63 >80 Pit Ground surface elev. ft. Depth to limiting factor _ in. Horizon Depth Dominant Color Redox Description Texture S Soli icaf? Rafe Structure Consistence Boundary Reacts GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `EfffF2 1 0-12 1Oyr3/3 sil 2mgr dsh cw 2f 2 12-18 8 1 4/4 sit 2msbk dsh Cw 2f 8 d✓ 3 18-60 7.5yr4/6 ` sl Om dsh cw .3 .5 4 60-80 7.5yr4/6 , s om dsh - - .3 .5 ~1 S 1 ~ b ISO Effluerrt #1 - BOD > 30 < 220 mg/L and TSS > < 150 g1L • Effluent #2 = SOD < 30 mg/L and TSS < 30 mg/L CST Name (Please PnM) Signature CST Number Thomas C Nelson Address 227387 Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 10/31/03 715-246-2454 - I 2 3 Property Owner Derrick Parcel ID # Page of Boring Boring # © Q Pit Ground surface elev. 99.91 ft. Depth to limiting factor T f in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 1 3/3 - sil 2mgr dsh cw 2f .8 2 12-19 1 4/4 - sil 2msbk dsh cw if .8 3 19 62 7.5 4/ Om dsh cw _ 3 5 - 4 62-81 7.5yr4/6 s* om dsh .3 .5 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in Soil lication Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 H Baring F-1 Boring # Ground surface etev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 I, I Effluent #1 = BOD, > 30:S 220 mg/L and TSS >30 < 150 mgfL * Effluent #2 = BOO, < 30 mg/L and TSS < 30 mg/L ICI The Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Department of need material in an alternate formut, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Tw (8.07/00) POND VIEW MEADOWS LOT 35 /r - T (.,SCALE V=30'~ bM TOP-Or6ONDUIT 100.00' BM2~ N BM2 TOP OF CONDUIT PIPE98.95' B1 95.85' B2 98.63' B2 B3 99.91' 0 A 1.84 ACRES 1 , 13' 103' 4% SLOPE BM1 1 B 28' 1 uO S LOT CORNER i t THOMAS NELSON 227387 OF;rp, VF County _ Safety and Buildings Division 1 2W01 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 1 Madison, WI 53707-7162 ST. CROIX OUNTY h ~O COMMUNITY D LOPME~IT State Transaction Number Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governor r~t is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POW TS are submitte Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 1/(~^ 1. Application Information - Please Print Informati Property Owner's Name Parcel # I- I.& e/!/i'ht ~ Property Owner's Mailing Address Property Location j C X Govt. Lot City, State Zip Code Phone Number y, /4, Section 2 Z S d (.circle one), T,3cN; R Eor&' 1. Type Building (check all that apply) Lot # Subdivision Name ❑ 1 or2 Family Dwelling-Number ofBedroo s Bloc i;7J~ / /c w' %)rc:tU(cv s ❑ Public/Commercial - Describe Use 61~ ❑ City of CSM N er ❑ Village of [I State Owned - Describe Use Town of /C- .c ~ 330 5 Z III. Type of Permit: (Check only one ox on line A. o p to li i plicable) A. New System ❑ Replacement System L1 ea e 1 mg Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ C Plumber El Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that a I i- Non-Pressurized In-Ground El Pressurized In-Ground ❑ At-Grade 11 Mound > 24 in. of suitable soil Mound < 24 in. of suifabl soil~JOS M rL7 ❑ HolqTank ther Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dint Area Information: Designesign Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation ~79W) M,/itV1. TanCapacity in Total # of Manufacturer y Gallons Gallons Units I~ o A New Tanks s o - epti' or Holding Tank Dosing Chamber i VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbers Signature MP/MPRS Number Business Phone Number 7 7 -2 Plumbers Address (Street, City, State. Zip Code) 57 Z / yu ~j S i art i r i li✓ ~j 41C I X1111. ount /De artment Use Onlv Permit Fee Date sued Issuing . t Signature ~ Approved Disapproved ~ Z9 /(4 yen Reason for Denial ~ ~ V5 IX. Condit8Ni9THPA~IwW "Reasons for Disapproval 1. Septic tark, c ltllUtt fine, and disper- cell rr*det all be sei-Jc?s ! rnaintaiee„~, as per managr>hti(orit plan provided by plumber. 2. AN setback rents must qe: mainttirAd as per app& d)b bode / cirdimmm. Attach to complete plans for the system and submit to the County only on paper not less than 8 11/2 X I l inches in size SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential application INDEX AND TITLE PAGE Page 1 Index and Title Project Page 2 Plot Plan Name:t Page 3 System Sizing & Gross-Section Owner's Page ,4 Filter Specs Name: Z~~.tl[, Page 5 Manntenancc Information Owner's Page b Management Plan Address: Page 7 Septic Tank Maintenance Form Page 8 CSM or Platte ~UX Attachment: -Soil Test Legal Description: A Y-_~I-L Subdivision- Lot# Town: ~C lk" County: ,ST, C-t-le-t/ Parcel ID# l & r3- c' e c Designer/Plumber: Ili1i',S License #2_ / Signature: Date: Comments Designed pursuant to the In-rruund Soil Absorption Component Manual for POWTS Version 2.0 IndPx+TitleConv 2/3/2012 r1or 141 /V/v /Vk~J-ZZ/,30 lC c2 / f i C. rh d c /2 41 .1 ln~, c 901 1 _ l ~J Soil Absorption System Cross Section ft 7 ft 4" Schedule 40 Final Grade PVC Vent Pipe C~ 7 With Vent Cap T ft c Leaching Chamber 1 t - /ft System Elevation r I Z ft _ ft ft l3~, z` Soil Absorption System Plan View ft Z ft { ft Leaching Trench 1 Chambers /0n I 4" Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model ' ' C(t EISA Rating,~2& sq ft per chamber Soil Application Rate gpd/sq ft ( gpd Design Flow _ Soil Application Rate EISA = 7S Chambers 3 r 3 rows of 2--" chambers each. Page of i aL ~q-hc INSTALLATION INSTRUCTIONS 4 Zabel, PL-5251PL-625 FILTER INSTALLATION INSTRUCTIONS Center filter with opening _ k T: JIM Q, ~Z Additional i e or { Polylok Extpipe- nd & LokTM Glue i for centering. Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service, completely inserted in the housing. MAINTENANCE INSTRUCTIONS r 1 { 1,= I r r I f` Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back o _ ! if necessary. into the the housing making sure • y r (B) Pull the filter out of the housing. the filter is properly alighed (C) Hose off the filter over the septic tank. and completely inserted. USE RUBBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover WHEN CLEANING FILTER septic tank. 04/04/2001 10:07 MAX 7155376847 BARRON CO ZONING U01 SYSTEM SPECIFICATIONS l u-ground Soil Absorption! Component SBI7 :._/0 s'G %7- /`:~7 Project Name: cQ.e,e" r t Distribution Cell Type Septic Tank Aggregate ❑ Lee ching chambers~ 14Sin. cc r ~ptic Tank ~ uli.u ic; 0 gal.. Wastewater Quality Septic Tank Volume wai- Treated n Unrre-tired K] Manufacturer 4#;4& Number of Bedrooms -3 Effluent Filter Design Loading Rate PLR) / Manufacturer C~ (Maxunum Soil Application Rate) / N'Iodel L ' S Z S I Combined wastewater: - Number of bedrooms 3 pip Tank gal/day/bedroom x 50 Manufacturer _ Daily Was cewater - ~J Flow 17W1~ I Volume Cleat and gtaywater only: Number of bedrooms Diverter valve []yes [7no gal/day/bedroom tf Manufacture Daily Wastewater Flow (DWI Model Blackw'ater Note : The use of a dive ter valve shall be indicated on the management plan ith d 4;;.ting how and whin the valve Number of bedrooms shall be used- gal/day/bedroom x 60 Daily Wastewater Flow (DWF) Distribution Cell Sizing (Aggregate) D WF / DLR / ftz Distribution Cell. Sizing (leaching chambers) Leaching Chamber Manufacture `-c Model Adjusted Design Loading Rate 41 gpd/ft' Chamber size, bottom area L7 ft, Syseem sizing = DWF / ADLR / [ u Cize I IV (l7WI) (ADI,R) (sq.ft.) # of hams Number of chambers to be used = f? ` ✓ Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 6 0 0 gal El NA ermit Septic Tank Manufacturer W&A ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer /Y/,,p El NA Number of Bedrooms -;N A Effluent Filter Model ❑ NA Number of Public Facility Units A Pump Tank Capacity gal `J'-] NA Estimated flow (average) YD U gal/day Pump Tank Manufacturer A] NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ~ NA Soil Application Rata gal/day/ft, Pump Model ~NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) _<30 mg/L LJ Sand/Gravel Hlter ❑ Peat filter Biochemical Oxygen Demand (BO DS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) _<150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality _ Monthly average _ -Dispersal Cell(s) El NA Biochemical Oxygen Demand (BOD,) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_10' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size %a in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. '!~[NTENANCE SCHEDULE Service Event I Service Frequency Inspect condition of tank(s) I At least once every: __7 El month )(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) I When combined sludge and scum equals one-third (%3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: l month )(s) (Maximum 3 years) ❑ NA 7 Clean effluent filter At least once every: El month(s) ❑ NA J 40 year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) El NA ❑ year(s) Flush laterals and pressure test At least once every: El month )(s) El NA year(s Other: ❑ month(s) At least once every: El year(s) El NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (%3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01)