HomeMy WebLinkAbout030-2145-09-000
County: St. Cr01X
PRIVATE SEWAGE SYSTEM sanitary Perrnrt N 582082
7Safety-ard n Cepartm,n: of Commerce INSPECTION REPORT
Building Divisign
(ATTACH TO PERMIT) State Plan ID No: 2659851
GENERAL INFORMATION ~r eyes (P-ivacy Law, s 15.04 Parcel Tax No:
Persona information you provide may be used fer secondary o P City rlla9e Township 030-2145-09-000
NTJOSEPH
PefmltHolder'sNamr, TOWN OF SAI gecticnTOwnlRange/Map No
Daniel 8r Anna Larson b 30.30.19.3000
BM Descriptio r~ l II n ~I '
I J `v
CST BM Elev.: Insp. BM Elev.
ELEVATION DATA FS ELEV.
tTF~TIOj~ BS U
TANK INFORMATION RN• ; gpACITY ~n U 0 ~~3 S
TYPE MANUFA I,11 ~1 I jl'q UD r
Benchmark ` V L
Septic I I f/
Alt. BM
Dosing M j
Bldy. Sevier QQ
•V
C(O
on 2r S ' t Inlet
Holding
SUHt Outlet
TANK SETBACK INFORMATION Vent to Air Intake ROAD Dt Inlet
-7.
TANK TO PIL WELL BLDG. Dt Bottom 5, 8-7.
~.•2( 007
Septic ' 5b HeaderiMan.
Dosin Z Z DO•-7~
Dist. Pipe
Aeration got. System
Holding
Final Grade p~ ~y R
PUMPISIPHON INFORMATION Demand St cover 1• -I
Manufacturer GPM ~ 3 ! l • 3
Model Number
TD
S tern He /
TDH f~•h Q Friction~oss~ ~ Ys
,
V l Dist to Well
Forcemain Lenqt t Dia. Ztl N4~
nside Dia Liquid Depth
SOIL ABSORPT N SYSTEM PIT DIMENSIO No Of
Length No. Of
BEDITRENCH Width ~J Lr+ LEACHING %lanutacturer.
DIMENSIONS VIELi- LAKEISTREAM
Pit- BLDG CHAMBER OR
SETBACK SYSTEM TO UNIT Model Number.
INFORMATION Ty e i yst~m: Zb'
Vent to Air Int~ "
x Hole Sze x Hole Spacing
DISTRIB ON SYSTEM b(, r ~ ~ ~ ,7JS/
1 1. ~It Distr Dution I f' 11
-,eace anfcl
PioCs)-]l :),a- Spacing s Only
Dia ength_ a _ + t,
I ength_ xx Mound Or At-Grade System xx Muicned
x Pressure systems Only xx SeedediSodded es No
SOIL COVER I ADC Depth of I Yes N° -
epth Over 1 Topsoil 7 1
Cepth Cver Red'T'ench Edges i
9edrTrench center I I 1 Inspection_#2:
on#1: e• VI .{n,S~ (/~1/1~/-f`/L~
rsons present. etc) inspect;
COMMENTS: IInclude code discrepencies, Pe I W
" ~ir ~p1 ~n~l~rr
'
Location: 397 138TH AV~il LOuc s1AW t _ ~)A ~ - WO
Ir C.- S .~o,M ~c;K
=
1.) Alt BM Description o
-C-T.
2.) Bldg sewer length = ~W p on all 1 C
amount of cover = J C17 I
No ~~1 Y I-(((/]]] ►k1 Cert. No.
plan revision Required? LJ Yes - epg~ VSgolure
use other side for additional informaUOn• Date
SBD 6'1C (q 3 +57)
Low
g y S 0~1 ~l a v
6m
s
3 ,as 10 ~.05 100,
~Vy
3
Safety and Buildings Division
t D S 201 VV. Washington Ave., P.O. Box 7162 I Sanitan Permit Number ito be filled iL by Co.l
S. r Madison. WI 53707-7152
58 z 08 ?e
Sanitary Permit Application I atclracuonNu]mber -
n ac:ctidarrr with JYS 3833.21(I i. R'i;. Adm %ode aiixui ier. el his torn to the appropriate cnvcrnmental unit , J
required prior to obminirF, a sanitwr permit. Now Application forms f-ar state-owned AJ'ATS are submitted to "reject Address Iif different than mailing_ addressi
the Department o` Safety and Professional Servies Personal infurmution yot: provide ma} be used for sczondan
purposes in accordance with the Pnva:y Law, s- 15 C4 1 )i m;. Scats. 3(f / 7 13b"' AVe
1. Application Information - Please Print 411 Information
Property Owner's Nan
Parcel k
~lE~ PSar~ j _ 63o~a 5 -6C? -dock
Properr, 0-wrier s Nlaiiirg Address f~ 1 r / Propert% Location
~q • V ic Gorr Lot
~1-y State Zip Code Phone Number J6 I SeCUen C-
gcirele one:
0 v l7"6 ~v _W or
T N; P. _ E
l Z
IL Type of Bui{ding (check all that app)}') ~vt « -
K or 2 Farmh Dwellinp_ - Nijmbei of Bednroms 1 Subdivision Name
- y,~bNi~itd I10uSt~r+ Block i= ~R61~? W0d0 ~'S
- RrblioCoinmercial Describe use
- C Cin of
❑ State iwned -Describe Ilse CSM Numbc, Villaee of
y -7 nn AA SS 11 -
S' 1 W N 1. esa" own of 5-r. t~s Pu
-II. Type of Permit: (Check only one box on line A. Complete line B if applicable)
V
ew S ❑ Replacement System Treat,ncnVHuldir.L I ar.k Replacement Only L Cnher M,difwation to Existing System icxplatni
R. - List Previous Permit Number and Date Issued
❑ Permit Renewal 'Permit Kevsion ,.han~e r.f Plurubrr Permitranster to New
Before Expiration Owner /
r ~
IV. 'I vpe of Pt)V1'TS SvsiemiCo_mponent)Device: (Check all that apply) LZA Q1 a 2
_1 Non-Pressurized ln-C,rnunc _7 r're»unzec Ir-Ground - At-Cirade ~j~ Vioond -,24 in of suitable soy: D Mound < ?4 in. of suitahle soil
l~ Iloldrig Tank 1 Cnher Dispeisal Component icxplaini ❑ Pretreatment Device (explaini _ \ A /1 ~ F- vIt
V. Dis ercaL'Treahnent Area Information: _
Isis Mow is d) DesiRii Soil Application Rate(gpdsil Dispersal Area Required (sfi Dispersal Ame Proposed (sf) Svstem Elevation
E C~ 1 6 a; 405 ,
VI. Tank Info Capacity in Total ii of Manufaztwer
Gallons Gallons Tinitc " -
\ew Tanks tIl~Existit g Tanks k 1 I
` /Lp./~ y s c
V G
Septic or Holding : ank rZCCI zoo,
Dosing Chamber &6( Y t/ G f~ v
II. Responsibility Statement- 1, the undersigned, assume responsibilityor installation of the POWTS shuyyJLpgthe attached plans.
Plumber's Name (Print) Plumber's azure / N - y1L'R- _ mber Ausiness Phone Number
1715--7
Plumber's Address (S=CL City. State. Zip Codei
ECK
VIII. CountyiDcpartment Use Only
roved ❑ Htsa rn ed Pemti?QFe~e Date'Lfsuled r Issuing .4ee , t
Own en e._ Deuial g 1 D •O~ ~ 4 1 ~ CC
EX. Conditions of Approval/Reasons for Disapproval 3 e 0li i -Hilo S 1A 7 *A VQ
SYSTEM OWNER: I
1. Septic tank, effluent filter and t rn P ! t ~S P vM / f
dispersal cell must he serviced ; maintai-red 1
as per management plan provided by plumber.
2. All setback requirements must be maintained
as pertapplwak
iii tow WA_V"~Q• ' u and submit to the county onic on paper not le_c than t i;? : 11 inches in sire
SLID-c ',"(R- 1L1' ;
1
ptp'A Irc;ti;~ DIVISION OF INDUSTRY SERVICES
s , RE~~li~~C~ 10541 N RANCH RD
~1 HAYWARD WI 54843-6462
~0 $ P 1 Contact Thrm gh Relay
Z u I b http !idsps.wi goviprogramslindustry-services
3
S MAY
w` www wisconsin.gov
ST. CROIX COUNTY
30MMUNITY DEVELOPME Scott Walker, Governor
-
Dave Ross, Secretary
titan 2 5, 311 16
CUS'I Ill No. 223242 ATT:V: 1041S Inspector
JEFFERY V FOX ZONING OFFICE
JEFF FOX CONTRACTING; & SL-P i'IC INC ST CROiX COL:-NTY SPIA
PO BOX 56,5 110 1 C.ARMICHAF.I. RD
DIMSSLR Vvl 54009 111IDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/2512018 identification Numbers
Transaction ID No. 2712047
SITE: Site [D No. 820647
Dan Larson Please refer to both idcntification number,
347 138TH .Ave above, in all correspondence with the agency.
Town of Saint Joseph
St Croix County
SE 1A. NW l,'4. S30, T30N, R 191•'
FOR:
Object Type: POWTS Component Manual Regulated ( l ject ID No.: 1583497
Revision'. Maintenance required: 600 GPD How rate; 17 in Soil minimum depth to limiting tactor from original grade;
System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01 01, R. I 12). Pressure Distribution Component
Manual - Ver. 2.0. SRD-10706-P (N-01X01, R. 1012), 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 .vitli 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:
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
constructiorv'installationr'operation.
In granting this approval the Division of htdustrti Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101. t2(2), nothing in this review
shall relieve the designer of the responsihility for designing a safe building, structure, or component.
Inquiries concerning this correspondence ma} 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 an
others k%,ho are responsible for the installation. operation or maintenance of the POW "I S,
e f
1H-H-R1 b 1(1V
Sincerely. Fee Required S ?0.00
This Amount NVill Be Invoiced.
When You Receive That Invoice.
Carl J Lippert Please Include a Copy With Your
Wastewater Specialist, Division of Inducrry Services Payment Submittal.
(%15)634- 037 ,'t-f %AM - 12P%I WISNIART code. 76+3
carl.lippert!"i.wisconsin.gov
cc; Edwin A I'avlor, Wa;~tewatcr Specialist. l'-;)634-3434. Mondas - I ridgy 8:00 am Io 1 30 pm
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Daniel & Anna Larson
Owner's Name:
Owner's Address: 347 138th Ave
Moulton WI
54082
Legal Description: SE114 NW1l4 S30 T30N-R1 9W
Township: ST. Joseph
County: St. Croix
Subdivision Name: Brownwood Estates
Lot Number: 9 Block Number.
Parcel I.D. Number: 030-2145-09-000
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry % L g ! D IT I Page 3 Mound drawings 4PPROVED
Page 4 Lateral and dose tank .,T OF SAFETY,
Page 5 System maintenance specifications
Page 6 Management and contingencyFplerv = _SSIDNAL SERA
- V ,
Page 7 Pump curve and specific2ow4sit.: OF IN LI
;pr
r r_
Designer: Jeff Fox License Number MPRS 223242
Date: 05110116 Phone Number: 715-491-3458
Signature.
e 77
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01101, R. 11112), and both
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) and
Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101, R. 10112)
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: Send 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)
6.00 Site Slope
99.30 Contour Line Elevation (ft)
27.00 Depth to Limiting Factor (in)
0.40 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/ft2)
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'% a Center or End Manifold
4.00 Lateral Spacing (ft) If N above, enter the elevation_ft)
2 Number of Laterals of the highest point.
0.156 Orifice Diameter (in)
2.30 -Estimated Orifice Spacing (ft) = 9.38 ft2/orifice
2.00 Forcemain Diameter (in)
120.00 Forcemain Length (ft) Does the forcemain drain back? Y
87.00 Pump Tank Elevation (ft) Enter Y or N
4.55 System Head (ft) x 1.3 19.57 Forcemain Drainback (gal)
12.64 Vertical Lift (ft) 67.41 5x Void Volume (gal)
3.01 Friction Loss (ft) 86.99 Minimum Dose Volume (gal)
0.00 In-line Filter Loss (ft) 34.46 System Demand (gpm)
20.20 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 2.00
1.50 x x 3.00
2.00 x
3.00 x
Gallons/inch Calculator (optional)
Treatment Tank Information Total Tank Capacity (gal)
1260.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in)
Wieser Manufacturer gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
800.00 Dose Tank Capacity (gal) lifetime Filter Manufacturer
22.24 Dose Tank Volume (gallin) 8 Filter Model Number
Weiser Manufacturer
Project: Daniel & Anna Larson Page 2 of 7
Mound Plan and Cross Section Views
T
1 /10 B J
Observation Pipe l
O A
W a: -
.
B
i
L
Mound Component Dimensions
Ucvrn slope toe extension made
A 8.00 ft E 14.76 in H ft K 8.35 ft
ft L 91.69 ft
B 75.00 ft F 9.50 in t ffilft
D 9.00 in G 0.50 ft J ft W 25.19 600.00 (ft2) Dispersal Cell Area 1500.00 (ft) 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 101.84 (ft)
♦ H
Gj
F Dispersal cell 100.55 (ft) Lateral
100.05 (ft)-♦ - Invert
Dispersal Cell
•'D 1
131. .
Elevation `
a
99.30 (ft) Contour Elevation
6.0 % Site Slope
Geotextile Fabric Cover
Shading Key Q- Dispersal Cell See lateral details on
m
Topsoil Cap c a 1.5 ft a Page 4 for number, size,
and spacing of laterals.
Q2 Subsoil Cap h 2 5 O
'i w Laterals are equally
[3~ ASTM C33 Sand v 2 F spaced from the
m 0.5 ft Typical Lateral
Tilled Layer c a distribution cell's
Aggregate e o 0 centerline in the
_ A distribution cell (Ax8).
Project: Daniel & Anna Larson Page 3 of 7
End Connection Lateral Layout Diagram
Later As centered over the r, dimension Turn-up Y.dball valve or ateanoutplug I
P
rAJ1 laterals are Identical I: X Holes dhdled on the bottom of the laterai 5
oquiatly spaced
otoe main conneCttori Via tee Jt 'rO~S to manlrold at anu ootnt.
Latetal_ Morcemain Sch 40 PVC per SP,--, Table 384 30-6
Number of Laterals 2 Orifice Diameter 0.156 in
Lateral Diameter 1.50 in Orifice Spacing (X) 2.37 ft
Lateral Length (P) 73.47 ft Orifices per Lateral 32
Lateral Spacing (S) 4.00 ft Orifice Density 9.38 ft2/orifice
Lateral Flow Rate 17.23 gpm Manifold Length 4.00 ft
System Flow Rate 34.46 gpm Manifold Diameter 1.50 in
Total Dynamic Head 20.20 ft Forcemain Velocity 3.52 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 E- Alternate outlet
location
Forcemain diameter
Weiser Manufacturer 2 in.
Ca acit 800.00 Gallons
Volume 22.24 gal/inch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 19.16 426.12
B 2.00 4448 C ♦ Pump off elevation (ft)
C 3.91 8699 87.91
D 10.90 242.42 D
Total 35.97 800.001 z
Dose nk elevation (ft)~_
3" Bedding un er tank. 87.00
Alarm Manuafacturer Rhombus Nate Switches.
Alarm Model Number MJ Plugger containing mesuji
may not be used
Pump Manufacturer Zoeller this system.
Pump Model Number BN 152
Pump Must Deliver 3476 gpm at 20.20 ft TDH
Project: Daniel & Anna Larson Page 4 of 7
Mound System Maintenance and Operation Specifications
Service Provider's Name Jeff Fox Phone 715-755-2461
POWTS Regulator's Name St. Croix Cty Zoning Phone 715-386-4680
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 1260 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 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 SPS 384.30-1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in SPS 384. Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn-up Detail
Finished •~~~~~~~~~~~4
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box P!uq or Ball Valve
Distribution
Lateral
`ter Long Sweep 90 or Two
7 45C
egree Bends Same
Diameter as Lateral
Project: Daniel & Anna Larson Page 5 of 7
Mound System Management Plan
Pursuant to SPS 383.54, Ms. Adm. Code
General
This systern shall be operated in accordance with SPS 382-84 Wis Adm. Code, and shall maintained in accordance with its' component
manuals [SBD-10691-P (N.01/01, R. 11112), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manuel Ver. 2.0 SBD-
10706-P (N. 01/01, R. 10112)) 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 shah be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank
shah be disposed of in accordance with NR 113. Wls. Adm. Code. The operating condition of the septic tank and outlet filter shah be assessed
at least once every 3 years by inspection.
The outlet titer shah be cleaned as necessary to ensure proper operation. The fitter 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
fitter shah 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.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. Ail switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent filler 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 shah 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 mglL 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.
Contkwencv 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 dogged absorption and dispersal media, and
related piping, and replacing said components as deemed necessary to bring the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Pretreatment Units
The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection
units are attached as separate documents and are considered part of the overall management plan for this system.
TCTAL DYNAMIC HEAD/CAPACITY
HEAD CAPACITY CURVE PER MINUTE
Er-l-W N I. AND JEWATERING
MODEL 152/153
M00i 15: 153
50
j Feet Meters Gal. Liters G-Y. ! Liters j
,153 1.5 '-69 l 261 ;7 29
12- 40 10 3.1 61 231 70 265
52
cJ 15 4.6 Y 201 61 231
W
-
ZC E.1 44 67 52 197
c 30 - 1
25 i 7.6 34 129 r 42 5.9
8 -
o
{ 3C 9 1 25 87 33 I25
q (p 1 35 '0.7 22 85
4-t ( Lock Volvo. }39 (l t. (11.6-n) 44.0 Ft. (13.4n,
I r,
0
2C 40 60 80 100
3ALLONS
0 80 160 24C 32D
3 _ t 4 =;I8-►~
LOW PER MINUTE - T
~v.,, .e.. 1~. u 1 _.i la~. u.., SL. n.ls. .5:~ 1'.. ~ ~ 1~%~c
- 1l
• Timed dosing panels available.
• Electrical alternators, for duplex systems, are available and supplied with
an alarm. I - -
• Variable level control switches are available for controlling single phase I
systems.
• Double piggyback variable level float switches are available for variable
level long and short cycle controls.
• Sealed Qwik-Box available for outdoor installations. See FM1420.
• Over 130°F. (54°C.) special quotation required. r i
i I
1 l l
152'153 Series 12 118
- - r
1521153 MODELS Control Selection
A-WL VORs-Ph Mode Mn ~s ! Sim der ! Ii
N152 115 1 Non. 8.5 1 2or3__
BNt52 115 1 ALdD 85 1 hrLkded 2or3 i z
t i 11~w~P I 1 z w
Ei52 230 t Non 4.3 1 <or
BE152 230 1 ` _A& ; 43 Inck d `2 or 3
2 or 3 -
N153 1115 -1 -Non 10.5 1
W531 115 1 Auto 10.5 hCki(Ied 2 or 3
E153 230 1 Non 53 1 2 or 3 1. Single piggyback variable Irivel that switch or double piggyback variable laves float
8E153 230 1 Hula 53- Inckrded 2 a 3 I
switch. Refer Lc 1`1010477.
CAUTION 2. See FM0712 for correct rnodei of EleWikal Altemalor E-Pak.
All Installation of a itrols, protection devices and wiring should be done by a qualified 3- Variable level control switch 10-0225 used as a corltrDl activator, specify duplex (3)
licemcd e4=.rtdciar. ial electrical ar.d safeti codes should b2 Vlov ed ir.cludine lbe most
rrcent Nation l Electric Code I NEC), and i%re ]rsulsdonal Safety and lS22f? Au (0S Fl. A1. Of (4 float system.
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
- MAIL 76: P.O. BOX 1&347 -
I TO:fl 3, avre 37 Adenu/edu+ers d .
~ O SHIP 71t): J849 49 Care Run Road
Lacsvdls, KY 40211.1961 :*&.17y pLA,#W S#eE /939
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'✓aisconsin Department of Safety and Professional Services
Division of Industry Services
' ' SOIL EVALUA
RECS. Page of
in accordance with Comm 85, VVis. Adm. Code
County
Attach complete sig n ?~apet not less than 8 112 x 11 rc'ies in size. Plan must V
include, but rot limited'o v ~l rizontal reference point (BM), direction and "Ercel I.D.
percent slope, $31~r r and location and distance to nearest road. '_i
-oMMVNIrY pEV~E~° - :
Please print all information. Rev by Date
Pe*<_oral i, for nation ye-j provide tray be used for st--,wiary purposes (Pr'vacy Law, s. 15.04 (1; (in:) ZJ
Property Owner Prccerty Location ~~~~YYYY /CM
f GoA. Lot 7% . 1!4 114 S 7 T N R E❑(cr) W
Property Owrer's Mail ng Address i of # Block # Subd. Name or CSfv1#
City ; State Zip Code Phone Number ity ® Village Town Newest Road
® New Construction Usee Residential ! Number of bedrooms Code derived design flow rate GPD
Replacement r] Public or commercial - Describe:
Parent material T 1 Flood P!ain elevation if applicable _ ft.
Gereral comments
and reccmmerdations
F/I Boring # Boring _
0 Pit Gr and surace elev. r_ft
. Cepth to limiting factor. . in.
Soil Acc'ica:ion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bourdary Roots GPDlff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh 'Eff#1 -Eff#2
X, LL i Z - %
Boring # ® Boring
Pit Ground surface elev. % 7
ft Depth to limiting factor - f 'n.
Soil A licatlon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisterce Boundary Poots GPDift'
in- Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
l_, + l
' Effl nt 41 = BOD, > 30 < 220 mgI and TSS >30 < 150 mgiL fluent #2 = BOD, < 30 mcy'L and TSS < 30 mg I
CST Na (Pfease Pint) Signature CST Number
_ / i
Address Date Evaluafcn Conducted Telephore Number
SRD-9330 i ROTi 1? )
Page' of
Property Owner Parcel ~D #
Boring
a Boring #
Pit Groundsurfaceelev j'1 - ft. Deprh to limiting factor x~`± in Sail Application Rate
Horzon Depth Don-inart Cclor Redox Descriptcn Texture Structure Consistence Boundary Roots GPDqf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh `Eff#1 -Eff#2
'V "I
F-I Bcring
Boring #
P t Ground surface elev. ft- Uepth to Imiting `actor n. Soil Applicatzn Kate
Horizon Depth Dominant Color P,edox Descr ption Texture Structure Consistence Boundary Roots GP /t
r Munse I Qu. Sz. Cont. Color Gr. Sz. Sh 'Eff#1 "Eff#2
Q G~cring
Boring # Ground surface e'ev ft. Depth to Imiting fac:vr n.
r P t Soil A lication Rate
Horizon Dept`i Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfl?
in tutunsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Fffluent #1 = BOD. = 3", < 220 mg,t and TSS >30 < 150 mc!L " Effluent #2 = BODS < 30 mg )L and TSS < 30 mg,L
Parcel IC Fag-- -::7-' of
3or ng~o`ing
p ; Ground surface elev. Death to bmitin5 factor in
Soil Acollcatior Rate
I to-izon Depth Dc'mnant Color Redox Descdpt.cn -ems ure Structure Corsistence Boundary Roots G°D ft
in, Munsell Qu. Sz. Cont. Cc c Gr. Sz Sn. _
L /
JI I
Boring # ❑ Boring
Nit Ground surface eleVd ft D_~tn .o : mitinc fa ;tc- in.
Soil i,Jpl catior Ra-,e i
Horizon Depth Dominant Color Redox Descnpuon Texlxe Structure Consistence 3oundary/ : Roots GPD ft
ir. ML rIsell OL Sz. Con;. Color
Gr. Sz. Sri
=f-~ I _ff##2 I
I
I
i
1 '
❑ R.--ba Boring
Pit Ground surface : Icv. _ ft Depth to li-nitirg f3dor in.
So Appiication R=te
H_rlmn Depfh Domina:i; Cc c'' Redox Description Texture Structure 7,onslstcnc_ bounca-y Roots G°C,'f'
in. Munsell Qu. Sz. '.Ont. C G'. Sz Sh Eff#i «Fffn2
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" Effluent 1 = EDC, > 30 < 22.. mg.! a 1c .i S5 >3G
- mg._ ``Fl.~en' -BCC < 30 rrglL a.nc T?= 3G rrra;L
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CIS ',,D
17
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ST. CROIX COUNTY
SEPTIC TANK MAINTE-IANC'E. AGREEMENT
AND
OWNERSIIIP CERTIFICATION DORM
D_an and Anna Larson
N I~tilittgAtdtlres5 14830 38th PI N. Plymouth MN 55446
'347 138th Ave
Property Address - - - ';(g
erificatio_n re7nire-d om Planning hr. Z Department for new construction.) '
(V
City/State nuoulton/WI Parcel ldentilication Number
LEGAL DESCRIPTION
Property Location '/4 , '/4 , Sec. , T _ _N R-_-W, Town of
Subdivision Plat: , Lot #
Certified Survey Map # - , Volutrtc . Page 4
Warranty Deed # (before 2007)Volun e Paget"'
house ❑yesC1to Lot lines identifiable ❑ yes0no
SYSTEM MAINTENANCE AND O«'NER ('1?lt'1'iHCATION
Improper use and maintenance of your septic system could result in its premature failm•c to handle wastes. Proper
r-aintenanee consists of pumping out the septic tank every three years or sooner, is needed, by a licensed pumper. What you put into
tLe system can affect the function of the septic tank as a treatment stage in the waste disposal systcrn. 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 I )epartment a certification form, signed by die
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veritying that (1) ffic on-site
wastewater disposal- system is in proper operating condition andior (2) after inspection and pumping (if necessary), the septic tank is
less then 11,3 fillf of sludge.
Uwc, the undersigned have read the above. recuircmcnts and agree to maintain the private sewage disposal system wi.h the
standards set forth, herein, as set by the Department of Safety And Professional Service; and the Department of Nahu•at 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 Dcpartmenl within 30 days of the tluee year expiration date.
llwe certify that all statements on t)is torm are true to the hest of my!our knowledge. Ilwe am/arc the owner(s) of the
property described above, virtu of a warranty deed recorded in Register of Deeds Office.
Number of bedroom
SIGNATURE OF ICANT(S) - DATE
* *Any information that is misrepresented may result in the sanitary pertni: being revoked by the Planning & Zoning Iepartment. i
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. 04112)
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347 138th AVF/1UE, HOULTO/Y, W154082
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RECEIVED v coon y
Safety and Tidings Division
< 0 Sanrtan Pennn Number (to be filled in by Co.
201 W. Wasnington Ave., P.O. Box 7162
`~s P s FES 0 5 2016 Madison, vvl . 7-7162
\rn+"ice QT r.Rnlx COUNTY-_ ?
COMMUNRjfJTWllt 4, State _rarsactionNumber
Application '96S C/8 S/
In accordance with SPS 3S-? 1('), ifiis Adm. Code, submission of this iortn to the anPronriate g. 'crnnwriL t um: ,
is required prior to obtaining a sannan. permit Nute Application forms for state-owned POTS arc ~uhrnittcc to Project Address : if different than mailing address)
the Department of Safety and Professional Scrvics Personal inkninitior you provide may be used f.' s ; r.nd:rn i,
purposes to accordance with the Priva:.v Law s ('4-1 i(ml. Stats.
1. Application Informatio Please Prit I Information
Properly Owner's Name A CA I Parxl r
~A t,:;,4 & 030- a ►`15'-o~_oov
Pfopem Owner's Mailing Address i Propein Loeation ~ ~ 3 ~ . 3(00
~r~ ijOyt I .ot
J Y7 3 -T IT
c., Sectior.
City, State - Lip Code Phone Number N VV
f-bunt \ /I Icir le one)
N Vl/` T 30 N; R 1= aro
II. Type of Building (check all that apply-) I of
C~ Subdivision Name
0 _ ramih Daelhng-Number of Bedrooms, `
ok C.4 PA, 00st Bl« ~ w'ti~ tnlro0 ~S`r~tTGS
PuoliclCormnercial - Describe Use I F Cin of -
CSN ~ ~ E~ illa~e of
_ State turned - Describe Use
75 X{. ,An of IST $E7
-K x
lll. 'hype of Purmit: (Check only nne box on line A. Complete I e B if app able) Z x
D1A4
A. ❑ istingSN'Slem (explain)
i ~Icw System I F Replacement System El 7 recto ut' Tang cp grit Otih' Other ModrBcatior: to Ex
List Previous Permit Number and Date Issued
B. ` Peludt Renewal I ❑ Permit Revision Chang of P bcr - ermit Transfer to New
Before Fxpiratior ner
R'. TvDe of PUV4"fS S}'stem!Contponen evice.: (,('heck all at • Ivi
I ?ion?ressurizcd In-Ground ❑ 1're s•u ed Groun t C- Mnuad > 24 in. of suitable soil F Mound 24 in. of suitable soil
❑ Nold'uic Tank Other DispCSal C' nponen explai i ❑ Pretreatment Device texplainl_ n
n
V.DispersaLTre mentArea In f ation:
Design Flo.c'; Pd) Design Soil A unon R ,)dsfi Dispersal Area Re ed (sf Dispersal Area Pr Al i System Ficvattor.
t'1. Tank Info ::In : o al ? of Manufacturer
y
(k n Callors l nits ? L
Sepnc m Huld:ng -auk /ZOO
IZCx~ E J _
)waag Chambcr d~ - 6l
Y11. Responsibility Statement- I, the undersigned, assume responsibility for installation of the PONN'TS show the attached plans. -
Nu riber's Name (Print) Phlmbcr's Signature N +1RS N ber Business Phone Number
- Z FF X l ' - x ~73zY 2 715- - `f 5~
plumber's Address (.StrecL Cin, State. Zip Codcj L) If
VI .ounrWDe artmenl Use Only
Fermi: Fee Date suc lssuin-. ent Signature
-ApPrnved
riven Keasau for benial J•~U 1
LX. ConditSUTEK ,eIRReasons for Disapproval 5 G ' iti
1. Sepla taarkeftluent flRer and 3 t~'O~~ t • ,
diSperss calf moat all ygsPr. leas ! ri,t'r "4•
as per management plan pro tided by plumber,
2. AM setbdck.regWmmants must W maint; Triad
as per appicable code l ordinances, croms ar-t,, ~ A476 ` ✓ i o (~1
Attach to complete plans for the system and submit to the CounIN alt on pa root less than 8 1!2 i 11 che+ in site
S L3 D-h ;~lS i :R. l i' 1 I 1
DIVISION OF INDUSTRY SERVICES
~o~.. 10541 N RANCH RD
r`•• HAYWARD WI 54343-6462
S i Cortact Through Relay
P http'lldsps.wi.govlprograms'industry-services
?2`. l S www.wisconsin gov
=~?•ssmv~~.'-~ Scott Walker, Governor
Dave Ross, Secretary
January 28. X016
CUST ID No. 22242 A 17' P0111S Inspector
JEFFERY V FOX ZONING OFFICE
JEFF FOX CONTRACTING & SEP FIC INC ST CROiX COUNTY SPiA
PO BOX 565 1 101 CARMICHAEL RD
DRESSER WI 54009 HUDSON Wl 34016-7703
CONDITIONAL. APPROVAL -
PLAN APPROVAL EXPIRES: 01;2812018 identification Numbers
Transaction ID No. 2659851
SITE: Site ID No. 820647
Dan Larson Please refer to both identification numbers,
347 13RTH Ave above. in all corres ondence with the agency.
own of Saint Joseph
St Croix Countv
SE 1,4. \-W L4. S30. T3 ON. RI9'W
FOR:
Object Type: POWTS Component Manual Re.-ulated Object ID No.: 1581-197
Maintenance required: 600 GPD Flow rate; 26 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. 1012), Pressure Distribution Component Manual -
Ver. 2.0, SBD-10 706-P (N.01 '01, R. 10' 12), SSWMP Pub. 9.6; Effluent Filter
The submittal described above has been revicvvcd for contormance 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) reterence,i rh
The owner. as defined in chapter ]01.01(10). Wisconsin Statutes, is responsible for compliance with all ci .I.:
requirements.
No person may engage in or work at plumbing. in the state unless licensed to do so by the Department pc- i 1
stats.
t he followin! conditions Thal'. be met during conctru: tion or installation and prior to occupancy or Ll-c
Reminders
• Pursuant to outlet filter product approval stipulations. maintenance information must be gig on to the o.1ner ol-
the POWTTS explainin~f, 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 <_rrade with a N,\-atcrti'it cover.
• . The pump chosen fur the dcsi,,n is at the limits of its capacity. If the total dynamic head is calculated to be
higher at the time of construction, a pump that meets or exceeds the system demand will need to be installed. It
is recommended that the actual pump-off elevation be determined vdien the dose tank is installed to establish
vertical lift and FD[ I pump demand early in the installation process. The County POWTS inspector will veriR
adequate pump capacity upon inspection. Performance specifications (pump curve) for the employed pump
shall be made available at the job site upon inspection.? he pump chosen for the design is at the limits of its
capacity. If the total dynamic head is calculated to be hi,her.. at the time of constniction, a pump that meets or
cxcccds the s\ stern flora w ill need to be installed.
IrrrTRY VFOX Pa,c2 1129,2015
A copy of the approved plans, s' pecitications 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 b% the state or the local municipality shall be obtained prior to commencement of
construction;'installationloperation.
In granting this approval the Division of lndustry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 10 L 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 PO~VTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POVVTS.
Sincerely. Fee Required S 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Car'. J Lippert Please Include a Copy With Your
Wastewater Specialist . Division of Industry Services Payment Submittal.
(715)634-503~ , %-1-f 7AM - 12P1vl WiSNIART code: 7633
carl.lippe~t i(wisconsin.taov
cc Edwin ,1 Ta\ hir, W<t~;tc~\atcr Specialist. (7715) 634-3454 , %londa\ Fidav 5:00 ar7 To 4: 30 pm