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HomeMy WebLinkAbout002-1034-50-000 i'Q~/f~ •_a PL pyJ 30 Wisconsin Deoartment of Comme,ce County: St. Croix Safety and Duildinc Cwisicn PRIVATE SEWAGE SYSTEM , INSPECTION REPORT Sanitary Permit No 582091 ~ GENERAL INFORMATION (ATTACH TO PERMIT] State Plan ID Vo: Nersnnal infnrriatior you pr:vide may he used f:x sec.cndarp purposes [Privacy Law s.15 04 11;(mi] 2675544 Permit Holder's Name City Village Townshio Parcel Tax No Dale & Debra Affolter TOWN OF BALDWIN 002-1034-50-000 CST 131.1 Elev Insp BM Elev BM Description SectionrTo%vnlRanyo Map No: t ' a 16.29.16.233B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , /S CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~ Dosing ~a~ 4 Sab Alt. BM ~l J 3 7 9g AierEdton O L O 1.z ~ Bldg. Sewer c~ 1~ ~Z r ~ z Holding _ . SUHt Inle' _ - la, 9 z3 TANK SETBACK INFORMATION SVHt Outlet TANK TO P!L NiELL BLDG. Vent to In'au ROAD DL Inlet Septic 5.L y qc'I 7 l _ Dt Bottom Dosing HeaderiMan 3 - V\Q 9$ Aeratior( ; - Dist. Pipe 3 g~ Z Holding - Bot. System S Final Grade PUMP/SIPHON INFORMATION Z Q Manufacturer Demand St Cover 3 7r 17 It J G (L, / GPM Z 'n' Model Number ZI .!5q 0 TDH Lift it S7 Friction Loss System H ad I U H Ft ~ ~ ~ Forcemain Leng h Dia. 11 Dist. to VVe q9 Z - E - SOIL ABSORPTION SYSTEM BED/TRENCH 'Aidth Length lir,Io.cj~ircr PIT DIMENSIONS NoOf Pits Inside Dia. Liquid Depth DIMENSIONS G 1.6 e r~ SETBACK SYSTEM TO PiL BLUG WELL LAKESTREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Syste'r: A ) UNIT V idel Number. p~.ti~ '7 I /V DISTRIBUTION SYSTEM Heace0,lanifold Cist-ibutior x Hole Size / 1xi-It-h-Spacing Vent Air intake 3 l.zs P ,P, 2j / z 3. GCS S 32- Z I ength Dia Length 1 ` ID a Spacing `J SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Dep'.h Over JXX Depth of zx Seeded Sodded xx Mulched Bed'Trench Crn[er I Bed,rer--h Edges Topsoil i \_Ye; No YeS No COMMENTS: (Include code discrepercies, persons present, etc.) Inspection ft1: (D le Irspection #2: r y Location: 2341 CTY RD E Ca/bJ ~f'k_ L115- CG' 1.) Alt BM Description = G ~~O il ~y 2.) Bldg sewer length = - amount of cover - w Plan revision Required? Yes No f I V Use other side fo• additional information. Date Insepctor igrat Cert. No. SBD-67'0 (R3T,'t G 16. -~-~X'~^'1Fe+~ee-~•re/f.~E~ i bole," D-bna A{VvIZu 23VI e. 777- ,)I io •cros M. W-e ►1' IcSS 560 it 4 ~ a 1 46 1 o s a T ~ ~1 h ~Ti e y~ 3 Aga 40. 9 r, <rl it M ` \ ys {~s..~ s,-tq _ R W Safety and Buildings Division - n/ 0,5Z p ;T 201 W. Washington Ave.. P.G. Box 7162 Sanrtarp Permit ?;umber (w be Llied if, b} Co.) s I 1'~1a p Madison, WI G7-7162 S MAR L D n cROUC coy" p Eric ~StON~~ g State rarsacuon Number CW Application anitary Permit . )-SYW In aecordance with SPS 353.2]('2), Wis. Adm. Code, submissiuu of this f_+rn: to the appropriate govc tt~µnit is required prior to ubtainiu_• a sanitary permit 'vote: Application forms to,- state-e+wued PORTS arc submittec to Project Address (if different than mailing addrecsl the Department of Safe v and Protessional Servies Prrsonal information you provide ma} be used for secoudar% L ?,q7 G _ purnu_ces in accordance with the Privacy Law. s. I; 04(11(m . Stars. 1. Application Information - Please Print All Information r 1 r~ I L 6ropertyOwner s Name - Parcc: # ~oZ-/D3y- SU - aao Property Owner's Mailing Address Proper[` Location Govt. Lot Cit" Stmc Zip Code Phone Number Nv~l Section /sy irule cruel ~7r5 (o f~' 11. Type of Building (check all that apply) -.1 Lot # I. or ? Famih Dwelline - Number o Bedrooms Subdivisiun Name p //.G✓ o Block # Public/Commercial - Describe Use - ~ ❑ Cit} of CSM Number ❑ Village of - State Owned - Describe Use R LDlrtf!/V r n~ ~ ~ Towm or Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, New S}stem C Rrplacrment System U TreatntenU'Floiding'Iank Keplacemeu:Only ❑ Other \4ctdtficazrun lu Existmc Sx-,tcm (explain) B. I ❑ I'c:mit Renew'ti List Previous Permit Number and D Issued E Permit Revision 11 Change of Plumber . Prmtit Transfer to New Before Expiration Corner -?Z 0 3 - ~ IV. Tv pc of POVI'TS SystemiComponent/Device: (Check all that apply) Non-Pressurized In-Crround ❑ Pressurized In-Ground ❑ At-Tirade ❑ Mottnd >24 in of suitable soil X Mound < 4 in of suitable soil ❑ Holdmg'l ank ❑ Other Disper sa; Comprnent ;,explain) Pretreatment Deviec (explain; V. Dis ersaffreatment Area Information: Design.:low (gpdj I D sift Soil ? ppli=ion Rate(=pdsfl Dispersal Area Required (sf) Dispersal.Area Proposed ,sf) Systent Elevation _ ~E•~ ;;fib .N VI. Tank Info Capacity in Total # of Manufacturer s ~0 t Gallons C:ailons Unis v Ne%% Tam`s Fxusung Tanks s a - ~Sepnc DT Holdmr "::m4 - Dosm,v Chamber CAS/. , 1 VII. Responsibility Statement- I, the undersigned, sume respousibilih for' ctallation of the POWTS shown on the attached plans. urnb .r s Name (Pr int ) PI bens 5ignaturd ; b1I r14t'RS Number Business Phone Number 11 - Piurnbers Address (Street. Cin. State. 'Lip C:odel _ VIII. .ounty)Department Use Only Approved Disapproved Pemtit Fee Date issued Issuing Arent Sift I I~ ' ❑ Owner Given Reason for Denial ~a 10 I , `~5-, ` & L\. Conditions of ApprovalfReasons for Disapproval SYSTEM OWNER: of 5( L(_ CCV j-x off ~~U~L' 1. Septic tank, effluent filter and dispersal cell must be serviced i maintained as per management plan provided by plumber. 2 All setback requirements must be maintained as rer applicable codeiordinnnnpc Artach to complete plans fur the system and submit to the County only on paper not less that s F2 z 11 niches in size SHI)41398 fill'. I I'I I DIVISION OF INDUSTRY SERVICES 3824 CREEKSIDE LN HOLMEN WI 54636-9466 Contact Throug'ri Relay ~D S p r http i!dsps wi-govlprogramstinc:ustry-services 1 S www.•,visconsm.y::v n Scott Walker, Governor Dave Ross, Secretary March 02, 2016 CUSI ID No 2245,2 .4TTt: P01VT.Sfnsuector MARY JO IIUPPERT Z()NIN(_i Of 1 ICE. HOLLISTERS SOIL TESTING R DESIGN ST CROI \ COUNTY SPIA W9875 690TH AVE 1101 CARMICHAFL RD R1VF,R FAILS WI X40?? HUDSON W1 54016-7708 CONDITIONAL APPROVAL - PLAN API'ROVAI. L\PIRICS: 03,102!2018 Identification Numbers Transaction ID No. 267S~;44 SITE: Site ID No. 8217-53 Dale and Debra Affolter Please refer to both identification numbers, X above, in all correspondence xvith the a~ „ CTH E ency. 41 1 M n of Raldwin St Croix Countv N1 1 4, NL1 4. S16. 1?9N. R16W FOR: Description: Taw Bedroom Mound System 7°0 slo ne Object Type: POb1`1 S Component Manual Rr11ulaled Object ID No.: 1589379 Maintenance required: 300 GfD L low rate: [Sin Soil minimum depth W limiting factor from ori_;inal grade Sy-tom(s): Mound Component Manual - Ver. SIM -10691-11 (N.01,01. R. 10!12). Pressure Distribution Component i49amtal - Ver. 2.0, SBD-10706-P (N.o I X01, R. 10.' 12): Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVL:D. This svstern is to be constructed ar:d located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as del fined in chapter 101.01(10). Wisconsin Statutes, is responsible for compliance xvith all code requirements. CONDIT No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06. APPA DEPT OF Si stats. The I:)llow in-, conditions shall be met during construction or installation and prior to occupancy or use, PROFESSION DIVISION OF INDt Reminders • A sanitary perntit must be obtaincd Irony the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private se\~ awe system installation is required. Arrangements for inspection shall be made w S RCS the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Scats. • A state approved effluent filter is required. Maintenance information must he `*iren to the owner of the tank e\plaininu that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 383 product approval conditions. • I he area ]thin 15' downslopc of the dispersal cell shall remain undisturbed. Vehicular traffic. excavation or soil compaction is prohibited in this area. • A copN of the approved plans, specifications and this letier shall be on-sitc durin1_ construction and open to inspection b` authnri ~t{_rcpr~ cn:ati~e of the Den.irtment. \ti`iich ma\ incluce loc.rl n,pectors. \11~•;,' I~)tll~r'I'I RI I'acc? _r?(ili, Ox~ ner Responsibilities • The current oviner. and each subsequent owner, shall rcceiv;: a copy Orthis letter includim instructions relatin- to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance rnanual andior o%rncr's manual for the PO1V1 S described in this approval. • The owner of a PO\N' TS shall be responsible for ensuring, that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved mana-ernent plan under s. SPS 383.51(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health haiard. the proper-tNI o,,%ner must follow the comingricy plan a, described in the approved plans. • 1 he m,~ ner is responsible for submittir., a maintenance verification repott acceptable to the count-,, for maintenance trackim- purposes. Reports shall be submitted at intervals appropriate for the component(S) utilized in the POWTS. In <-rantim,, this approval the Division of Industry Services reserves the ri«ht to require changes or additions should conditions arise makinu, them necessary for code compliance. As per state stats 101. I?(2), nothing in this review shall relieve the desi-ner of the responsibility for desi-nim, a sale buildinstructure, or component. Inquiries concernin', this correspondence may he made to me at the tckphone number listed hC10"'. or at the addre,s on this letterhead. The above left addressee shall prm ide a copy of this letter and the. PO\V I S manallement plan to the owner and any others who are responible for the installation, operation or maintenance of the POWTS. Sincerer, fee RequiredS 250.00 This Amount Will Be Invoiced. icrard 1.1 Swim Vdhen You RCLVi%e That In. oice. N AV I-S Plan Reviewer, Division of Industry Services Pler:se Include a Copy GVith Your (608)789-7892, '%-ion - Fri, 7:15 am - 4:00 pill Payment Submittal. jcrry.,~\ inr cr\\ isconsin. ov Vl'iSMART code: 763 cc: F(k%In A Taylor. Wastewater Specialist, (7 15) 6334-3484 , Monday - Friday 8:00 am To 4:30 pm David M Triemert ( Plan Mailed To) Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerh Satety & Buildings) will be modified. Code references %%ith prefixes startim. with "Comm" have been replaced with "SPS" to rcco,Inizc the relocation of the Division of Industry Service, from the former Department of Commerce to the Department of Salcty & Professional Services Additionally, all 4S (formerly S,-.B) codes have been renumbered and addressed in a ";00" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN- INDEX AND TITLE PAGE `H 2 9 2016 Project Name: DALE W. 8. DEBRA M. AFFOL.TER 3 Y S FRVICES Owner's Name: (same) Owner's Address: 2341 C.T.H. E Baldwin, WI 54002 Legal Description: NW 114 of the NE 114, Sec. 16, T29N, R16W Township: Baldwin County: St. Croix Subdivision Name: NA 0 ' ^ LLY Lot Number: NA Block Number: NA OVED 'AL `TY AND Parcel I.D. Number: 002 - 1034 - 50 - 000 AL SERVICES STRY SERVICES Plan Transaction No.: Page 1 Index and title Page 2 Data entry ' ° • Page 3 Mound drawings D C c ° "F;r~y.°°°°: Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan -M: ` • Page 7 Pump curve and specifications ' Page 8 Plot plan Designer: Mary Jo Huppert License Number: 1859 - 007 Date: 02/24/16 Phone Number: 715 - 426 -1775 i Signature: J V Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), 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. 01101) Version 7.0 (R. 0312012) Page 1 of 8 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note. Sand Fill (D) calculations assume a 200.00 Estimated Wastewater Flow (gpd) Table 383.443 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) feral dorm of - 36 inches. 300.00 Design Flow (gpd) 7.00 Site Slope 96.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 50.00 Dispersal Cell Length Along Contour (ft) = fi.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? e Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.50 Orifice Spacing (ft) = 7.50 ft2/orfice 2.00 Forcemain Diameter (in) 16.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation (ft) System Head (ft) x 1.3 2.61 Forcemain Drainback (gal) l I 9.09 Vertical Lift (ft) 30.87 5x Void Volume (gal) ✓ 0.17 Friction Loss (ft) 33.48 Minimum Dose Volume (gal) 0.00 In4ine Filter Loss (ft) 21.54 System Demand (gpm) 13.81 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallonslinch Calculator Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 500.00 Dose Tank Capacity (gal) Polyl-ok Filter Manufacturer 9.84 Dose Tank Volume (gal/in) 525 Filter Model Number Weiser Manufacturer Project: DALE W. $ DEBRA M_ AFFOLTER Page 2 of 8 Mound Plan and Cross Section Views 1/10 B Observation Pipe K - O ❑s oil A g . • L Mound Component Dimensions ft K 10.44 ft A 6.00 ft E 23.04 in H [Aft B 50.00 ft F 9.25 in I ft L 70.89 ft D 18.00 in G 0.50 ft J ft W 24.99 300.00 (ftz) Dispersal Cell Area 905.85 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99-27 (ft) ,T~ ♦ H F Dispersal Cell 98.00 (ft) Lateral 97.50 (ft)-,O. - Invert Dispersal Cell . . Elevation E D 96.00 (ft) Contour Elevation 7.0 % Site Slope Geotextile Fabric Cover Shading Key ID a Dispersal Cell See lateral details on Q Topsoil Cap o c 1.5 ft Page 4 for number, size, 05 ands cin of laterals. 02 Subsoil Cap m c 0 Pa 9 0 ASTM C33 Sand Z / F Laterals are equally Tilled Layer » 0.5 ft TvPpcaI Lateral spaced from the ~ v © I distribution ©Aggregate c cell's Tj centerline in the in the A distribution cell (AxB). Project.- DALE W. & DEBRA M. AFFOLTER Page 3 of 8 End Connection Lateral Layout Diagram Lit?r As r?nreredcv o the Au Gdrmensw~n Turn-up -MballValve rcl?3nautpluq 1 P AN later:Is are i.]eril ,al Hole= drilled on rht- butt rr, of the laroral Pgri.I1V sr, iGBd Fortes mare, connection !A.4 ree or cross to m anirukl at -4na Dort UOReralt. R forcern,in _:ch 40 P%la pc-r :T`= T=jbl~ ' 4 3Q Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.55 ft Lateral Length (P) 48A5 ft- Orifices per Lateral 20 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 10.77 gpm Manifold Length 3.00 ft System Flow Rate 21.54 gpm Manifold Diameter 1.25 in Total Dynamic Head 13.81 ft Forcemain Velocity 2.20 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and j SPS 316.300 WAC ftForremain in. min. -~Tank component is properly vented ARemate outlet location diameter Weiser Manufacturer 2 in. Capacityl 500.00 Gallons Volume 9.84 gal/inch A Weep hole or anti- Dimension Inches Gallons g siphon device A 34.51 339.58 C B 2.00 19.68 Pump off elevation (ft) C 3.40 33.48 88.91 D 10.90 107.26 Total D 50.81 500.00 Dose tank elevation (ft) 3" Bedding un er tank- 88.00 Alarm Manuafacturer SJE Rhombus Alarm Model Number Tank Alert AB Pump Manufacturer Zoeller Pump Model Number 98 Pump Must Deliver 21.54 gpm at 13.81 ftTDH Project: DALE W. $ DEBRA M. AFFOLTER Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Darrell's Septic Service Phone 715-425-1025 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 300 gpd Maximum Influent Particle Size 118 in Estimated Flow - Average 200 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 300 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 years Effluent Filter Should inspect and clean at least once eve 3 years Pump and Controls Test once eve 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 years 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 (6xi), 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 1-finished ~ oases Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Proiect: DALF W. & DEBRA M. AFFOLTER Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01101), SSWMP Publication 9.6 (01161), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01!01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with 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 shag 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 fitter 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 it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the rnaund. Plantings may be made around the mound's perimeter, and the mound shag 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. Colo weather installations (October-February) dictate that the mound be heavily mulched as protection Iran freeing. Influent quality into the mound system may not exceed 220 m91L BODS, 150 mg1L TSS, and 30 mglL FOG for septic tank effluent or 30 mg1L B005, 30 mg/L TSS, 10 mgrL FOG, and 104 cfu1100 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 and 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 cbgging 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. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related pining, 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. Project: Page 6 of 8 ~ rho o i~4 HEAD CAPACf1Y CURVE MODEL `98' 4 5/8 -1 3D- 25- 6 3 ' S 5/8 = 6 20 v + + z _ r , 15 O a D 1 4 3/16 a to 9 z Y 5 _ - 1 1/2-11 1/2 NPT 0 tLS. G1 LMI ra 20 ' 30 40 50 6o m so Lam 0 - - 160 240 FLOW PER M118M MODEi M60 CYCLE Feet Comore Meters Liters s n r-s zrs so cr v zv is 45 .-s r2o 12 20 a Er n Garay 4 3/16 =low `j CONSULT FACTORY FOR SPECIAL APPLICATIONS El x%kal aAtenuft s, for duplex systems. are available and - variable w%mm hoot swlatres are available for contmfty sure suppk d wiitt an alarm_ and flues please systerns- • mechamcal alternators, for duplex syslafm am available • Double p99Yback variable k%el ilaat swflrltes are ava~ will or v#hort alarm svitches- for variable leMm tong Cycle controls- _ SELEC i10N GUIDE 1 ~ boat epesgldd 2 pole maCho1MC l swidr, no external carMrol regaled. Standard all models - Weight 39 lbs_ -'/z H.P_ 2- Sitgfe pig v®tiattle teed mat wide ar domle piggybadt trariabia level. w ~ Comw $ Yom 6ni21 ReW Io FU N77- Yodd HaMspb Irodk 3. Machoticdl attt mmr 100M or 10-0(XIM AM 115 1 Ado 9.4 1 or 1 8 7 - 4. So a lMT12„ bra ed modlel or Bactiirel Amaeior- 3 or 4 b 5 5- Comad 104M used as a admaler spwW dopiest (3) ~ (4) N9D 9.4 2or 2d 8 115 1 mm 098 290 1 Aub C7 1 or 1 d 7 - 6- Four (4)) bob J-Pa jail b uK torraMmVt aorared- arriar}it EBB 290 1 Non 4.7 2 or 2 &6 3 Q 4 & 5 singlet r: drpte=apar11dm110-0002- 7- Two (2)hair 3-Pak for worm gM oorata fm or spke. CAUTION Forb iuaaioa oa adMotd Zaeier Aodaefste w iocaftg as p%gybg*Mailable Levd 9ukhm All installation of controls, protection devices and airing should be dom by a qualified FU04TUEhdicdAkmOiKFUMMMachmiclUM- 1, FMDM3w tpGe mWBa1kK FID167; treated electrician. An electrical and safety codes should be folle med vaMaling the wCfst 9M&Phtea8w0w PbepDw" FMI! ftAlntS0~ fiNM recent National EkcWc Code (NEC) and the Occupational Safety and Health Act (OwH RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered wob the design of every Zoeller pump. MILM Ra am 16W . Lm tdk iff 43M4317 - - • tla,aftdwod.. - - ~ lad 4112114 (bmi k ~ KY Rr N2/}-19i1 boa PU/lL1P ~O_ I1 FFeL7~k"f ~'o. lQal. ~F pl, 4, tit -T".t 23y/ Co. aW / kW.f4f.I Sae. ~G, Y29/!y Sz4r04 e,. /o acrss ,Kwre O ` cr» p 1 o w ~ a • i9o - , -N _ DTI ~ ~ = a a I , ~0°f ~ e ltv, = iavc~. Sys 6emok area i~o ;A z oF8 e- o_ `,T. C'ROIX COUNTY NLUN'I'ENMNI CE• AGREEMENT .kN D 1vERSHIP CER1IPICATION7 FORM 71~ - -riiica:iu: r' juircc from planning Zoning Department for new construction.) P eel Identification Num1-)er -X',~C aPTION r)pert%' Locator. /C_L~ . J Sec. . T R NV. 7'awn of~G<Ji/) r Lot Map # 'Volume age n ',"F arrnnth• Deed - (before 2007)Volunte Paoe 4 St?eC house C yes . no Lou lines identifiable N cs no S4 "'I"' MAINTENANCE AND ONIVNER CERTIFIC'A'I'ION improper use and maintenance of votrr septic system could result in its premature failure to handle wastes. Proper :r:a.nter.ance con:ist> of pwrrpuu out the septic tank every three years or sooner. ifneeded. bN a licensed pumper. What you put into me s+>tem can attect the function of the ceptic rank as a treatment stage in he N+aste disposal system. Owne- maintenance responsibilities arc specified in cSPS. ?8?.53(: and in Chapter 12 - St. Croix Counn Sanitary Ordmance. The property owner afrrees to suhmh to St. Crwx Counn• Planr.in_< & Zoning Department a certification form, signed by the owner and b+ a master -)lumber. Journey rnar; plunr'ocr. restricted plumber or a licensed pumper yeriij mg that (1) the on-site ++astewater disposal system is in r.roper operating, condition arc-"or (''1 after irspcction and pumping (if nccesiw%), the septic tank is less than 1 , full of slud'Ec. I, we, t:he under signee have read lire above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as se' by the Depa-rmerrt of Saiety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certi ication stating that \ .,our septic system has been maintained must be complete;: and returned to the St. Croix Count+ Planrin_-, K- Zonin_• Department +'+'tthtn ',tl days of the three year expiration date. I!we certify that all sta:emens on this form are true to the best of my/our know edge. Uwe wu-are the owner(s) of the propert+ describec by v0ue of a warran.~ deed recorded in Register of Deeds Office. Number of bedrooms S1(r~ t k.l ()F~- .WANT(S) DATE *Any ir ion t i<.t is - is esen_c may result in the sanitary Hermit being revoked by the Plan tin<_ Zoning Department. *x* Include with this application a recorded warranty aced from the Register of Deeds Office and it cope of the certified survey map if -eterence is made in the u•amanr% deed. (REN'. (14!12) a = U Z I J T 4,.y Nb W i ou~N M~Zrye- ED Ln e X s lam i ii j j i Co F- j N N w ~ 0 0 0 _ W P HIT: ® Ffl 000 ~ 000 w v c Mrim F-7 Elli- Z Z/L 9-.t U sm-M xa-ua O s _ ~r O 0: LO io v U~ I .n M 5 N 1' C I ~1 IJ ' S 1 Z v= F !p! -751 -4 C) b I p Ooo tl ry LL. 3 N 1 _ To 3wm J Flak it i I ,,K ~ £ ~ a~ x raL ~4 g I wOC 5CY e-py CF ~ S 2 ~ryQ~r--fn a J M 1 99 cdzpg TMr --1 ZSZ - vi- Q-'a i L b ~Jg R i (A In O W - CD • I QW - 111 I ♦ iy in I 2z N 2 '1 ZJ 1P ~ O ~ l~ Q x D- L -J I ~-b 1 ~ a I - d1 _o t2 Q q I ~N~ 00 I I 3w b L saw 01.1 n I L X y i I n ' Q e<y ! 11901' OlR r ' I r L I L J o X14 I m U W W bn I 0 I I _ - I~I oi I I 1 0-. J-.4! ,8-11 II !I I I I - to ova ~ i II ~ I I z g~ ~ III I I eE i t I I Z a I I I I I Ib ~ I I I I ~o ~ III I n = J Z ~ h 1 Q < J Q' ~ - U Z q Se 0 O U- vcr x r a J ~ Q dam' ~l° N W L .6~ I J - 0) W a I ® © ` w CO LL ® goal l N~JJL J - <_I F ry~ so. WR 0 Z W Jy~~ai U W Zg. L RECEIVED P A JLJR r ~ 6 2 U 1 q P y SO 2401 ^lisuonsin Dep~ai1t41en: of SOIL EVALUATION REPORT Page I of 3 CcmmercE§T CROIX COUNTY in accordance wit,i 4'Vis Adm. Cod( A.C E Soil & Site Evaluations -'nIT1(VEt4PMENT c)3Ps 38s' county r 73c complete site plan on paper not less than 8'/z x 1' inct'es in size. Ra St. Croix irclude. hu* iot I mited to vertical and horizontal reference point IBM), directio ecrt :I ,F, sca _ or dimensions, north arrow, and location and distance t( Parcel L.D 00 034-50-000 Please print all information. Rev By Date .r'.. :.J OrO iiv"e may to cse., h.'sr~.urr.-Miry E.ur:ui-C i~nv Ldvo Propc'ty Ownei Property Location -'ale & Debbie Affolter Govt. Lol NW 1 4 NE i4 S It T 29 N R 16 W Property Owner's Mailing Address Lot # Block # Subd Na e or CSM# -341 Co. Rd E na na Na t" State Zip Code Phone Numbei City Village ✓ Town Nearest Road P?;ldwin ! WI ; 54002 (715) 684-3154 Baldwin 240Th St. ✓ New Constructior Use ✓ Residential! Number of bedrooms ? Code derived design flow rate 100 GPD Replacement Public of commercial - Describe. ~ arent material Glacial Till Flood plain elevation, if applicable na -eneral comment and recommendations: Soil conditions require mound POWTS with dispersal cell placed on 96 00' contour Recommended Infiltraive surface elev to be 97 50' at 18" above contour Boring # Boring ✓ Pit Ground Surface elev 94.53 9 Depth to limiting factor 18" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD;ft; n Co'or Qu Sz. Cont. Cato Gr Sz. Sh •Eff#1 'Eff#2 1 0-10 10yr313 none Si' 2fgr mvfr as 2vf fm 06 0.8 2 10-18 10yr414 none i sl i 2fsbk mvfr Cw 2vf,fm 0.6 1.0 3 18-22 10yr414 f2d 7 5yr5/8 sl 1 msbk mvfr cw 2vf,f 04 0.7 i - 4 22-35 7.5yr4/6 f2f 7.5yr5/6 scl lcsbk mfr 1vf,f 02 0.3 2 Boring # Boring it ✓ Pit Ground Surface elev 98.10 ft 26" in Depth to limiting factor .'[.:fl R.ah I lorizon Depth Dominant Redo)( Description Texture Structure Consistence Boundar Roots GPDift' n. Color Qu. Sz. Cont. Colo Gr. Sz. Sh 'Eff#1 1 -Eff#2 1 0-1 1 10yr313 none sil 2fgr mvfr as 2vf,fm 0 6 { 0 6 2 11-16 10yr414 none sl 2fsbk mvfr cw 2vf,fm 0.6 1.0 3 16-26 10yr4l4 none sl 2msbk mvfr cw 2vf,f 0.6 1.0 4 26-38 7.5yr4/6 f2f 7.5yr518 sl 1 msbk mfr - lvf,f 0.4 0.7 i Effluent #1 = BOD s 30 < 220 mglt an TSS >30 -<i 150 mg • Effluent #2 = BCD 30 mg~L and TSS < 30 mg. a- CST Name (Please Print) Signat ee CST Number James K. Thompson 2 i address A.C.E. Soil & Site Evaluations Date Evaluation Conducted , Telephcre NL:mbei 340 Paulson I ake Lane Osceola '.NI 54-~ZD 6130/2015 715-24S-'16% nrcaerty Owner Odle & Deobic Attolter Parcel ID # D02-1034-7D-00D ~-Ugc of 3 3] F Boring # Boring ✓ Pit Ground Surface elev 97.45 ft Depth to limiting factor 28" in Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPDrft~ in. Color Qu Sz Cont. Colo Gr Sz Sh 'Eff#1 Eff#2 1 0-10 10yr3/3 none sil 2fgr mvfr as 2vf,fm 06 0.8 2 10-18 7.5yr416 none scl 2fsbk mfr cw lvf,fm 04 06 3 18-28 7.5yr4/6 none sl 2msbk mvfr cw 1vf1f 06 1.0 4 28-40 7 5yr4M f2f 7 5yr518 scl icsbk mfr - 02 03 i i ❑ Boring # Baring ✓ Pit Ground Surface elev 94.52 it Depth to limiting factor 24" in, Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD ft- in Color Qu. Sz. Cont. Colo Gr. Sz. Sh 'Eff#1 'Eff#2 1 0-10 10yr3!3 none sil 2fgr mvfr as 2~,1,fm 06 0.6 2 10-18 10yr4/4 none sl 2fsbk mvfr cw 2vf,fm 06 1 0 3 18-24 10yr4/4 none sl 1 msbk mvfr cw 2vf,f 04 0.7 4 24-30 7.5yr4/6 f2f 7.5yr5J8 scl icsbk mfr - 1 vf,f 02 0.3 ❑ Boring # Boring Pit Ground Surface elev ft Depth to limiting factor in Sod Apolica6on Rat Horizor Depth Dominant Redox Description Texture Structure Consistence Boundar Roots _ GPQ?ff n. Color Qu Sz Cont. Colo Gr Sz Sh 'Eff#1 Eff#2 i i i i I i I Efflu nt #1 30 221-- rng and =30 :51 rig Ef°:eert 4' - LGC I:a f ~1 I tip. 3U roc, I he I)elxwrlincat of t`ommercc is an equal oprwai nt}' set--,iec pro-, idcr and eiriplo%ci. ll jtiu need a sislaiice to access xr.11, . nerd wateri.il ill,-vi nlt(-Iv v format, plo;im- cnnt.ict the Jcpu,twuv t it mils 2~~r~ ? I ` I „ 1'-1'Y !~A" -?(,-I-8777 for/av'a./4G~~rtr►') f,.E ~ ZUNI \ / 1 c 3,1 C ftwy~rlr~, Sec. T~9/l., W. ccx) h e /0a C-/'r.5 Marc of less r/ I X i ~ V 'Nr 3 -alp- + ~~ta~ `Tia cf ! -rW. Sloes f.w oai. Azz ~ r ~v 3 &#.r 06 rl4 St. Croix DALE W & DEBRA M AFFOLTER Municipality: TOWN OF BALDWIN 2341 CTY RD E Permit Number: 582091 BALDWIN WI 54002 Parcel Number: 002103450000 Alt Parcel Number: 16.29.16.2336 Site Address: 2347 CTY RD E Components Component Manufacturer Description Last Next Status Schedule Service Service Mound Current 36 Effluent Filter Polylok 525 Current 36 Effluent Pump Zoeller 98 Current 36 Pump Chamber/Tank Wieser 500 gal Current 36 Septic Tank Wieser 1000 gal Current 36 `No data found for Maintenance History, Notices, Violations, Notes Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 582038 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Dale & Debra Affolter 7 TOWN OF BALDWIN 002-1034-50-000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town/Range/Map No: 16.29.16.233B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution IX Hole Size IX Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil El Yes ❑ No L] Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2347 CTY RD E 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. LLLJ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~(rrat~iF~~ County R E~ ~ mss. CIS Safety and Buildings Division St. Croix D 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be tilled in by Co.) ` Madison, WI 5370 "16 0 V 'OMMUN?ftfffmit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 3 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 Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. Z3q 7 1. Application Informat' - Please Print All Information Property Owner's Name / Parcel # Dale & Debra Affolte 002-1034-50-000 Property Owner's Mailing Address Property Location 3241 Co. Rd. E Govt. Lot City, State Zip Code Phone Number NW _''v, NE _'/4, Section 16 (circle one) Baldwin, WI 54002 (715) 684-3154 T 29 N; R 16 E or W II. Type of Building (check all that apply) Lot # ❑ I or 2 Family Dwelling - Number of Bedrooms 2 Subdivision Name Na Na 61 Block# ❑ Public/Commercial - Describe Use ~C, A~ Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of / ❑ Town of _J°, AL7~~~.Y•cJ ✓ A Na III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System El g Y Treatment/I-loldin Tank Replacement Only D Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: Pol Lo L-525 effluent filter at outlet of two chambered se tic tank Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (s Elevation 97:5 at 18" above 300 Gpd 1.00 Gpd/Sq. Ft. 0-4 300.00 sq. ft. 300.00 Sq. Ft 6.00 contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n o o t~ New Tanks Existing Tanks d FL-~ w U inn ~ r~ ii C7 P. Septic or Holding Tank 1,000/500 0 1500 1 V ieser Concrete X Dosing Chamber 750 0 750 1 Wieser Concrete X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number 1-1 Dale Hudson t~- z_ MP 220853 (715) 684-3378 Plumber's Address (Street, City, State, Zip Code) 820 Main Street, Baldwin, WI 54002 VIII, oun /De artment Use Only Approved ❑ teime Permit Fee Date Issss :Issuing ent Signature ad 1 / I S wcn Reason for nial $ &Z5 ue IX. Condit$"Reasons for Disapproval 1 1: Septic tank, eitluont 'gt1F) 3, LOII~O~ f101~~ ttn 1 G Oispersal cell mush #N ps / a nM ~G 1~• awper management plan provided by plumber. 2.' s k regUjt'e1llents must be rnaintz ined ae per WpAoeble W& / cirdinance;s. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD-6398(R. 11/11) 5aeL IIIEST /vow 14-frR tiC-,w farh/~r* 5yoo f/