HomeMy WebLinkAbout012-1036-00-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) 584701
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. State Plan ID No: 2680363
o
Permit Holder's Name: City Village Township Parcel Tax No:
Terry Mitchell TOWN OF ERIN PRAIRIE 012-1036-00-000
CST BM Elev: Insp. BM Elev: BM Descriptio qq Section/Town/Range/Map No:
lD u C) I 15.30.17.2258
TANK INFORMATION ELEVATION DATA
TYPE MANUFACT CAPACITY STATION BS HI FS ELEV.
Septic
Cie
I Bench m ark 8(D O; M ,o
Bas,+ig U (J Alt. BM
- VA16 L) too o a i a~ i ►n ash -IYe 02 . /
Asrat+en
Bldg. Sewer
7.1
Hef+ng 5LS__ Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic
.t-~~• O . Dt Bottom
lo / Hea /Man. b
IM4 Y2.
Aera n C~
Dist. Pipe
Holding -:k
Bot. System
PUMP/SIPHON INFORMATION Final Grade
Manufacturer 1,~ ~ C\~ errand St Cover z , ~ Q !
V GPM I
Model Number O
TDH Li€t., Friction Lq _ System He TDH U
J~ 12., 1
IIYn
Forcemain Lengt ' Dia. Dist. to Well k~ 06~
Z~ d piled S it r
SOIL ABSORPTION SYSTEM j ~
BED/TRENCH Width Len th No. Of TseAehes r IT DIMENSIONS No. Of Pits Inside Dia. 1.3 I~ epth L~
DIMENSIONS ' O I 12 ! ~ O / `Y1
J
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION T CH AMBER OR
yster}T „a ) L UNIT
t~'.nl/ Model Number:
DISTRIBUTION SYSTEM - Iv1pw)l,t~l bk/ IV0*C.1 dK&&4f-
Header/Manifold Distribution ~I Ix ole Size X Hole Spacing V t it ~ke
Pi e s
Length D .
ia Length 50y'~ Dia ~ . Spacing , b 4
SOIL COVER x Pressure Systems only xx Mound Or At-Grade Systems Only v
Depth Over Depth Over U xx Depth of ! xx Seeded/Sodded Mulched
Bed/Trench Center ; Bed/Trench Edges Topsoil 1 f
Yes Ljr No es No
COMMENTS: (Include code discre gi ns,pr sgnt, etce`e Inspection #1: ~ 1 ~/t 51 Inspection #2:
Location: 1833 160TH AVE I ~i 1 tbye~ C~ nLDVQ: chisel 1.) Alt BM Description = fi { l r ~L+~~L Q~[~ttM~l~ A q00 j 5*0,(JJ/6 44 lbp. w{~1
an , N,~~t~/1
I v~ W Y
2.) Bldg sewer length=
-amount of cover =
' C~Nwn~cd Iilce SL Si AE V h-ose.
0A all! d~~ S S !
4NV per Sys 6V-3 pevlo~~
Plan revision Required? ❑ Yes (SLAo 1 p
Use other side for additional informatl5. `C 6-1n~ ~ I t_~ ~ N~
SBD-6710 (R.3/97) Date ns p rs ignature Cert.-No.
,*:NV; 1''. ` County
` U L.. IF " Safety (i,au9dlR9&Q1Y
201 W. Was ngton Ave- PA.. Boxk162 Sanitary Permit NSt Cromx
umber (to be filled in by Co.)
+~.SPS i..1 11.1 3~~~aS Madison, WI 53707-7162
Sanitary Permit ApplicV. OIX COUNTY State Transaction Number
^^''~-ytFg %N-T
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of tl~/I,,,,''tt t~}t p rtf np'fid'te`governmen'tal' unit 2680363
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
ses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 18J3 1 60th Ave
1. Application Informati - Please Print All Information
Property Owner's Name t Parcel #
Ter Mitchell 1 012-1036-00-00
Property Owner's Mailing Address Property Location
1852 Co. Rd G Govt. Lot
City, State Zip Code Phone Number NE /a! , W %y Section _1 r
New Richmond Wi. 54017 circle one)
T O N; R 1f Eore
H. Type of Building (check all that apply) P Lo
t #
or 2 Family Dwelling - Number of Bedrooms Subdivision Name
Jm L12
Block #
❑ Public/Commercial - Describe Use
- ❑ City of
r
❑ State Owned - Describe Use CSM Number ❑ Village of
EkTown of F ri n Prai rm
io x 13 ra -
III. Type of Permit: (Chec my one box on line A. Complete line B if applicable)
A. ew System Replacement System
❑ Treatment/Holding "lank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS System/Component/Device: (Check all that a 1) p
El Non-Pressurized In-Ground El Pressurized In-Ground EXAt-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain)_ ❑ Pretreatment Device (explain)
V. Dis ersal/Trea ent Area Informati
Design Flow (gpd) Design Soil Applica n Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose sf) System Elevation
450 .40 113 1130 98.0
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units °o
525 Polylok
New Tanks Existing Tanks
0
n`. U in ~ ~ is. C7 G.
Septic or Holding Tank 1000 1000 Wieser X
Dosing Chamber
VII. Responsibility Statemen - I, the undersigned, assume response ' ity for est afion o the TS shown on the attached plans.
Plumber's Name (Print) Pluml)e" s ignature . r MP/MPRS Number Business Phone Number
Keith Knudtson 648443 651-470-1737
Plumber's Address (Street, City, State, Zip Code)
927 150th St. Roberts Wi. 54023
VIII. un epartment Use Only
_JPgty
Approved ❑ Permit Fee Date Issued Issuing ent Signature
c,ya 31Z.41((4
Ow n Reason for Denial
IX. CondilUfi WAJi0 tfReasons for Disapproval
1. Septic tark, e `lt:-nt filte, and
disper::.; cell must all e s~~r:ic^s ! rnainta'rec
as per management plan provided by plumper.
2. AU seUick requilaelxlwnts tnuat,;oe rleini€iryEd
n pw sp*." dodo / iudinAlltfai, t
Attach to complete plans for the system and submit to the County only on paper not less'ban 81/2 x 12 inches in size
SBD-6398 (R. I1/11)
Sanitary Site Plan Page 8 of 8
For: Terry Mitchell
Parcel in the NEl/4-NWl/4
Sec. 15 T30N-R17W
Town of Erin Prairie -St. Croix County
0 20 40
--i
Graphic Scale (Feet)
1 inch 40 ft.
CIL of 160th Ave. FN# 1833
A BM = Top of 3/4" Gray PVC Pipe
2.73 acre Parcel * HRP = Same
i ASSUMED ELEV. = 100.00'
BM#2 = Top of Gray PVC Pipe Elev. = 100.10'
• WELL
IL
PIL 150' est
fisting Garage
3 0 330'
Existing Mobile Home
Proposed Three
C, Bedroom Home Existing Septic Tank PIL
Surface Grade 0 Failing
4
c~\C 0 ~~Q4L -104.30' Suer
♦\QV
Proposed 4"Sch. 40 PVC Building Sewer
Insulate Building Sewer Per SPS 382.30(11)(c) and
r sed Ff''e e on rete provide frost protection per SPS 383.43(8) (4)c
0 /6 R C bination Tank
/ P ly-Lo P -525 Iter
#O
M #1 f 98.20'
~r
Proposed 2" Sch. 40 PVC F.M. / 9710'
Open Slope w/a Few Trees
Pro osed IO' x 113' At-Grade Mound Dispersal Area___
w/a System Elevation of 98.00'
96.501
3% '
360' PIL
s /
DIVISION OF INDUSTRY SERVICES
10541 N RANCH RD
y HAYWARD WI 54843-6462
Contact Through Relay
http://dsps.wi.gov/programs/industry-services
w;
www.wisconsin.gov
~FSS iav~j
Scott Walker, Governor
Dave Ross, Secretary
March 18, 2016
CUST ID No. 224059 ATTN: POWTS Inspector
KEITH E STONER ZONING OFFICE
KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA
23220 WOODCREEK RD 1101 CARMICHAEL RD
SIREN WI 54872-8728 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 03/18/2018 Identification Numbers
Transaction ID No. 2680363
SITE: Site ID No. 821971
Terry Mitchell Please refer to both identification numbers,
1883 160TH Ave above, in all correspondence with the agency.
Town of Erin Prairie
St Croix County
NE 1/4, NW 1/4, S15, T3 ON, R17W CONDITI
FOR: APPR
Description: At grade, 3 bedroom residence
Object 'Type: POWTS Component Manual Regulated Object ID No.: 1590839 DEPT OF S
Maintenance required; Replacement system; 450 GPD Flow rate; 42 in Soil minimum depth to limiting factot"FE,SSION
original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pres}sfine~j 014 OF «jC
Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; EfflueQlMkW
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 abo SEE CORD
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:
Key Item(s)
• In the event this soil absorption system malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans. In addition, the owner must insure that the
operation, maintenance and monitoring duties as described the At Grade Component Manual are complied
with. A copy of this information must be given to the owner upon completion of the project.
Reminder
• The orientation of the at grade system must be such that the longest dimension is oriented along the surface
contour per SPS 383.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual.
• Surface water drainage shall be diverted away from the system area.
• Materials shall conform to the requirements of SPS 384. SPS 384.10. No fixture, appliance, appurtenance,
material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,
unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and
ch. 145, Stats.
KEITH E STONER Page 2 3/18/2016
• The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Please Include a Copy With Your
Patricia L Shandorf Payment Submittal.
POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633
(715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m.
pat.shandorf@.wisconsin.gov
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm
Keith E Knudtson, Knudtson Plumbing (Plans Mailed To)
il~
KEITH E STONER Pate 2 3/18/2016
• The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required S 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Please Include a Copy With Your
Patricia L Shandorf Payment Submittal.
POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633
(715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m.
pat.shandorf@wisconsin.gov
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
Keith E Knudtson , Knudtson Plumbing (Plans Mailed To)
RESIDENTIAL AT-GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
Project Terry Mitchell Replacement At-Grade Sanitary System
Owner Terry Mitchell _
I
Address 1852 County Rd. G
New Richmond WI 54017 Phone 715-246-5502
Real Property Site Address: 1883 160th Ave.
Legal Description Part of the NE1/4 - NW1/4 Sec. 15 T30N R17W
Township Erin Prairie County St. Croix LY
S'4•T 4 C.
Subdivision Name Lot No. )VED
TY AND
Parcel ID Number 012-1036-00-000 (2256) '~L SERVIC
;T RV ES
Plan Transaction Number
Index sheet Page 1
Calculations Page 2
At-grade drawings Page 3 _SPONDENCE
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump curve & specifications Page 7
Plot Plan Page 8
Soil Report c e
Designer Keith E. Stone ~\SCON,S+/License Number Designer 1575-007
Signature r KEITH E.
_ ~xQNFA Phone Number 7J E
D-1575
Siren,
Date L/01/16 Wis.
I Oed
GSigIT, pursuant to: I,~ i ~L)
At-grade Component MalW~. 2.0 for POWT5 SBD-10854-P (N. 03/07 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)(0 i0K)
Version 7.0 (03/12) Page 1 of 8
PRESSURIZED AT-GRADE DESIGN
At-grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or t;) r Residential or commercial?
300.0 Estimated wastewater flow (gpd)
450.0 Design wastewater flow (gpd)
3.00 % Site slope
98.00 Contour elev. below lateral (ft)
x42.00 Depth to limiting factor (in) /
0.40 In-situ soil application rate (gpd/ft^2)
Distribution Cell Information
(1 or?) T_1 Influent wastewater quality
10.06 Linear loading rate gpd/ft
10.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
113.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) c Center or end lateral connection
2 Number of laterals
0.156 Orifice diameter (in) e.g. 0.25
Estimated orificespacing (ft)
calculation a r"a`
2.00 Forcemain diameter (in)
3.51 Forcemain flow velocity (fttsec)
28.00 Forcemain length (ft) y or n Does forcemain drain back?
-90.50 Pump tank elevation (ft) y or in Are laterals at highest point?
4.55 System head (ft) x 1.3 NA
7.17 Vertical lift (ft) 4.6 Forcemain drainback (gal)
0.70 Friction loss (ft) 51.0 5x Lateral void volume (gal)
0.00 In-line Filter Loss (ft) 55.6 Minimum dose volume (gal)
12.42 Total dynamic head (ft) 34.4 System demand (gpm)
Lateral Diameter Selection Ga_llonslinch Calculator (optional)
Pipe diameter Design options Design choice Total Tank Capacity (gal)
Designer 1 in eTM Total Working Liquid Depth (in)
must select 1.25 in Gal/in (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
3 in x m _M _106-0 Se tic tank capacity (gal)
;Wieser Concrete Manufacturer
Effluent Filter Information Dose Tank Information
Poly-Lok Filter manufacturer ~ 603.4 Dose tank capacity (gal)
PL 525 Filter model number 16.8 Dose tank volume (gal/in)
Wieser Concrete Manufacturer
Project: Terry Mitchell Replacement At-Grade Sanitary System
Transaction Number: Page 2 of 8
AT-GRADE PLAN VIEW
D
1/6 B Observation pipes 2 typical) A 10.00 ft
D B 113.00 ft
1/6 B 18.83 ft
W C 12.00 ft
D 5.00 ft
E 2.00 ft
D L 123.00 ft
B W 22.00 ft
_ A x B 1125.00 ft^2
L
Cap
obs.
pipe.
= Total aggregate cell A x B Typical
Slotted in n the lower 6", and
E_ = Plowed area L x W anchored securely.
s°
AT-GRADE CROSS SECTION
Svnthetic fabric cover
/ 99.79 ft Finished grade
elevation
Lateral g8 50 ft
invert elev.
Observation pipe
at aggregate toe
E
3 % Slope
Surface contour 98.00 ft C A
and system
elevation D
= 12 in. topsoil and subsoil
over aggregate and tapered to toes. Plowed layer
= 6 in, aggregate below below L x W
pipe(s), and 2 in. above pipe.
Project: Terry Mitchell Replacement At-Grade Sanitary System
Transaction Number: Page 3 of 8
PRESSURE, DISTRIBUTION AND DOSE TANK
Lateral Diagram - Center Connection
I<- X °---I~ xi2 I x12 a~ Laterals 6c fotce mavw of PVC Soh 40
fast hole drilled next to end cap per SPS Tatrfe 384.30.6
Holes drilled on t he bottom of the labsral.
equally spaced • = Turn-upwsbalivalveorei4anoutplug
Lateral Specifications
0.156 Orifice diameter (in) Center Lateral connection point
X 1.76 Orifice spacing (ft) 2 Number laterals
32 Orifices/lateral P 55.44 Lateral length (ft)
17.2 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
34.4 Sys. discharge rate (gpm) 28.00 Forcemain Length (ft)
12.42 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather-proof warning label and locking device
junction box
Final grade q"
disconnect
Tank component is Alternate
properly vented ? v-~, outlet
location 18" min.
Electrical as per NEC 300 and t(" Approved
SPS 316.300 WAC outlet
Tank full joint
Motet Double Float
® Inches Gallons JA Provide 1/4" Pump switch required
.N A 20.6 346.2 Alarm on weep hole or due to narrow pumping
d B 2.0 33.6 antisiphon
_E C 3.3 55.6 Pump on B device. range.
a D 10.0 168.0 91.33 ft C
Totals 35.9 603.4 - f
Pump off
D
3" Bedding der tank 90.50 ft
iGoulds Pump manufacturer JE Rhombus Alarm manufacturer
4 Pump model number Tank Alert 1 Alarm model number
Project: Terry Mitchell Replacement At-Grade Sanitary System
Transaction Number: Page 4 of 8
At-grade System Maintenance and Operation Specifications
Service Provider's Name Powers Sanitation Phone 715-246 5738
POWTS Regulator's Name St. Croix Coun Zornn Phone 715- _._386-4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 1125.0 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 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 every_ 1.5 ears
Mound Insect forponding_and seepae once eve 3 ears
Ctl7er
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 at-grade 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 at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at-grade component manual SBD-10854-P (N, 03/07).
Lateral Turn-up Detail
Finished
Grade
6-8" Diameter Lawn Threaded Cieanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Long Sweep 90 or Two
98.50 ft 45 Degree Bends Same
Diameter as Lateral
Project: Terry Mitchell Replacement At-Grade Sanitary System
Transaction Number: Page 5 of 8
At-grade System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SBD-10854-P (N. 03107), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N. 01101)]
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, Slats. 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 113 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. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent filter is installed within the tank A shall be inspected and serviced as necessary.
At-grade and Pressure Distribution System
No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade 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 at-grade 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 at-
grade be heavily mulched as protection from freezing.
Influent quality into the at-grade 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 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 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 at-grade 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 renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other 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.
I
Project: Terry Mitchell Replacement At-Gr Transaction Number: Page 6 of 8
Page 7 of 8
GOULDS PUMPS Submersible
Effluent Pump
EP04
3871 EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade =oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance, construction,
following uses: heat transfer.
• Effluent systems ■ Casing and Base: Rugged
• Homes Available for automatic and thermoplastic design provides AGENCY LISTING
• Farms manual operation. Auto- superior strength and corrosion
Heavy duty sump matic models include C&Wian
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".)
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Punps is ISO Sari Pe~
• Solids handling capability: FEATURES cover with integral handle and
float switch attachment points.
'14° maximum. ■ EP04 Impeller: Thermoplas
• Capacities: up to 60 GPM. tic Semi-open design with ■ Power Cable: Severe duty
• Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant.
• Discharge size: 11/2" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BONA-N elastomers.
• Temperature:
104"F (40GC) continuous
140°F (60`x) intermittent. METERS FEET
• Fasteners: 300 series °
stainless steel.
9 30 - 5GPM
® Capable of running
dry without damage to
a 25 rr
components. 25
o z
w
Motor. _
• EP04 Single phase: 0.4 HP, 6 zo
115 or 230 V, 60 Hz, 1550
RPM, built in overload with } s
automatic reset. 1 s
• FP05 Single phase: 0.5 HP, a 4
i _ EPOS
115 V or 230V, 60 Hz, 155Q
RPM, built in overload with
automatic reset. EPOa
z
• Power cord: 10 foot s
standard length, 16/3 t
SJTOW with three prong
grounding plug. Optional 20 ° °o to zo 30 4o so GPM
foot length, 16/3 SJTW with
three prong grounding plug - ,
(standard on EPOS). ° z 4 6 a 10 12 rWlh
CAPACITY
Goulds Pumps
Ef 2007 Goulds Pumps ITT Industries
Effective May, 2001
83871
Sanitary Site Plan Page 8 of 8
For: Terry Mitchell
Parcel in the NE1/4-NW1/4
Sec. 15 T30N-RI.7W
Town of Erin Prairie -St. Croix County
0 20 40
Graphic Scale (Feet)
i inch 40 ft
C/L of 160th Ave. FN# 1833
BM = Top of 3/4" Gray PVC Pipe
2.73 acre Parcel HRP = Same
ASSUMED ELEV. = 100.00'
•O BM#2 = Top of Gray PVC Pipe Elev. = 100.10'
WELL
/L
P/L 150' West
Existing Garage
330'
330'
Existing Mobile Home
Proposed Three
Bedroom Home Existing Septic Tank P/L
O Failing
Surface Grade 3
104.30' Sewer
Proposed 4" Sch. 40 PVC Building Sewer
Insulate Building Sewer Per SPS 382.30(11)(c) and
Proposed Wieser Concrete provide frost protection per SPS 383.43(8)(4)c
REP] 000-1600 MR Combination Tank
w/a Poly-Lok PL-525 filter # O
• M #1 98.20'
Proposed 2"Sch. 40 PVC F.M. 97.10'
Open Slope w/a Few Trees
_,Proposed 10' x 113' At-Grade Mound Dispersal Area
System Elevation of 98.00' 96.50'
s
3%
360' P2
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Terry Mitchell
Mailing Address 1852 City.Rd. `7
Property Addref 8 3 160th Ave
(Verification required from Planning & Zoning Department for new construction.)
City/State New Richmond Wi. Parcel Identification Number 12-1036-00-000
LEGAL DESCRIPTION
Property Location N E ,/4 , NW 14 , Sec. 15 T 30 N R 1 7 W, Town of Erin P ra i rre
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house 11yesEbo Lot lines identifiable Byes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, J journeyman P(umber, restricted plumber or a licensed pumper verifying that 1 the on-site
b
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe, 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.
1/we certify that all statements on I's form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a w ranty deed recorded in Register of Deeds Office.
Nu of bedrooms 3
NATURE 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)
~ ST Z a I l~ - °b 3
Wisconsin Department of Safety and Professional Services
Division of Industry Services
RECEIVES SOIL EVALUATION PORT jib Page 1 of 3
~ 2 in accordance with Comm 85, Wis. Adm. Code
Attach complete §iL~lalf o Pa l r C not less than 8 1 /2 x 11 inches in size. Plan must County -
include, but not i horizontal reference point (BM), direction and parcel I.D. 012-1036-00-000 ZZ_ \ g 1~ percent slop ~60rrow, and location and distance
to nearest road. J
dOMMUN
Please print all information. Zd b Date j
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7-1
~
Property Owner Property Location ❑
Terry Mitchell NE NW 15 30 17
Govt. Lot 1/4 1 S T N R E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1852 Cty Rd G na na 2.73 Acres pit-
city State Zip Code Phone Number EJCity ❑ Village Town Nearest Road
New Richmond Wi 54017 715-246-5502 160th Ave
( ) Erin Prarire 33
New Construction UseC] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
n Replacement Public or commercial - Describe: na
Parent material Pitted Outwash Flood Plain elevation if applicable na ft.
General comments At Grade Design, System Elevation 98.20ft based on contour line 98.20ft or to be adjusted by designer.
and recommendations:
K.+•~ 'mil
1 11 Boring 98.20 49
Boring #
❑
Q Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 10yr 3/1 none sil 2msbk mfr cs lvf .6 .8
2 10-21 7.5yr4/4 none sicl 2msbk mfr gw lvf .4 .6
3 21-49 5yr 4/4 none sl om mfr gw na .2 .6
4 49-55 5yr 4/4 c2d7.5yr 5/6 A om mfr na na .2 .6
a Boring # ❑ Boring 98.20 42
0 Pit Ground surface elev. ft. Depth to limiting factor in.
Soil 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 0-16 10yr 3/1 none sil 2msbk mfr cs lvf .6 .8
2 16-30 7.5yr 4/4 none sicl 2msbk mfr gw 1 of .4 .6
3 30-42 5yr 4/4 none sl om mfr gw na .2 .6
4 42-55 5yr 4/4 c2d7.5yr 5/6 sl om mfr na NA .2 .6
1
* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BCD 5:5 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) ignatur CST Number
David J Steel - 248956
Address n Date Evaluation Conducted Telephone Number
1609 151"1th qt /L/40/r.'~✓~Y►U 715-76f1-MA7
~L/c%7
Property Owner Terry Mitchell Parcel ID # 012-1036-00-0000 Page 2 of 3
FT] Boring Boring 97.10 42
Q Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 1Oyr 3/1 none sil 2msbk mfr cs lvf .6 .8
2 10-24 5yr 4/4 none scl 2msbk mfr gw lvf .4 .6
3 2442 5yr 4/4 none sl om mfr cs na .2 6
4 42-55 5yr 4/4 c2d7.5yr 5/6 sl om mfr na na .2 .6
❑ Boring # ElBoring
Pit Ground surface elev. ft. Depth to limiting factor in. Soil 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
Boring
❑ Boring #
D Pit Ground surface elev. ft. Depth to limiting factor in.
Soil 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
* Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
SBD-8330 (R07/13)
STEEL'S SOIL SERVICE 3 of 3
David J. Steel Terry Mitchell 1699 150th St.
CST-POWTSM NEl/4,NW1/4,S4,T30N,R17W New Richmond, Wl 54017
Lic. 4248956 Township of Erin Prairie, St Croix Co. Direct 715-760-0347
Fax 715-246-0318
Legend N
1"=40' I
♦ = Benchmark Ele. 100.00 ft
Top of 3/4" gray pvc pipe
• = Alt Benchmark El 100.10 ft
Top of 3/4" gray pvc pipe
J 0 = Borings
Boring Elevations
? i t%, 1 BI = 98.20 ft
B2 = 98.20 ft
B3 = 97.10 ft
B4 tit,
n l -
if
/rG t lJ i~
r Y ~ i
t
n
217e, -1/1 3-71
~ . t•~s'I'e : 3~6