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HomeMy WebLinkAbout022-1022-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 589780 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2739749 Permit Holder's Name: City Village Township Parcel Tax No: Noble Nygaard TOWN OF KINNICKINNIC 022-1022-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 4 / • (3- 1 G ST 08.28.18.127D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. S. Z, lob 1 1% / a d.9 Septic .9 t Benchmark Z. 30 163.4 161.1 Dosing 11 ob0 Alt. BM GO 97' V Bldg. Sew r Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet Septic *Il 5b 3 (p J ~ Dt Bottom $9, &B 7 -r O O Dosing / Header/Man. ~ ~o ~0 ys 5! 4.1~6 /n z. o$ Aeration Dist. Pipe 4, it b la z . ~8 Holding Bot. System At t /d,` 3 G s PUMP/SIPHON INFORMATION Final Grade D 3.1 o /63. wa Manufacturer ~ ~ GPM and St Cover / J~+ ~ • 3 1 ~7 7g Model Number 63 O C• 7 6:4 zs•g5 Cows-d~~ z.s AD& TDH Li; Z Friction Loss System Head TDHE F - -7 2. 1 J ~'s Forcemain Length IDia. Dist. to Well / 4 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. O~.Trench PIT DIMENSIONS No. Of Pits Insid Dia. Liquid Depth DIMENSIONS (/O_ ~JL e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: a INFORMATION CHAMBER OR Type stem: 6 2 UNIT Model Number: DISTRIBUTION SYSTEM S~G EZ /0~..1 BvY. Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air I tp ake Length Dia Length 51- ~j 7 I Dia Spacing z • i5y 1 01a v~o~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded V Mulched Bed/Trench Center 1 - Bed/Trench Edges Topsoil ► No es No COMMENTS: (Include code discrepencies, persons present, etc. In ection #1: / / ) LQI Inspection #2: Location: 1067 COULE RL 1.) Alt BM Description = 4`;^,A! F11bL j o 2.) Bldg sewer length = t - amount of cover = ~ G G8 saw I /7 J1 G `h,S IDS S bf, ~Gt Plan revision Required? Yes No Use other side for additional informat' n. I Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) yF4, County 4~.. Safety and Buildings Division 0, end r 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Sp 1=3 Madison, WI 53707-7162 anitary Permit Application State Transaction Number In accord ~tg P ~1(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 1 Al 7 is requir% r t g,a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) they rofessional Servics. Personal information you provide may be used for secondary ur~cs § Y tl e Privac Law, s. 15.04(1)(m), Stats. ~n~~ tt~~~ i t ease Prin Information V ~~.••00 Property Owner's Name ~ Pali 11I~r ~ O Z Z..7a -6Q d.~ le- IV A- 7 Property Owner's Mailing Address Property Location 1&401 6a a Ile e- 7W,44'1 Govt. Lot City, State Zip Code Phone Number y, Section _EL_ 2a~e, W.17 23 circlcone d (O T Z.8 N; R18 Eo& II. Type of Building (check all that apply) Lot # Subdivision Name >(I or 2 Family Dwelling-Number of Bedrooms Block # 3~ - - ❑ Public/Commercial - Describe Use ❑ City of CSM Number [I Village of ❑ StatcOwncd - Describl Use V XTownof ~CIAAiG&JA!l/C. ,0 &10'j &0~ I X J 1Y III. Type of Permit: (Check only one box online A. Complete line B if applicable) ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) A. ❑ New System Replacement System :5,t 4c_ .+L loo . Ike B. ❑ Permit Renewal ❑ Permit Revision El List Previous Permit Number and Date Issued Change of Plumber El Permit Transfer to New Q Before Expiration Owner 78 ✓ IV. T e of POWTS S stem/Com onent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade X Mound > 24 in. of suitable soil ❑ Mound < 24 in. suit; le soil j~ ❑ Holding Tank Other Dispersal Component (explain) .511n Jai r2 ❑ Pretreatment Device (explain) A. V. Dispersal/Treat ent Area Information: oposed (s System Elevation Design Flow (gpd) esign Soil Application Rate(gp f) Dispersal Area Required (s f) Dirarer `g C~. G 7SV /01.30 VI. Tank Info Capacity in Total # of Gallons Gallons Units New Tanks Existing Tanks Pte- U v~ ~ v~ u. C7 P.. Septic or Holding Tank Q Dosing Chamber 776VI 75P_ )l VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb ' Si nat e MP/MPRS Number Business Phone Number oef/,t t Rd Jew ~~o i -9(zs--G24o Plumber's Address (Street, City, State, Zip Code) VIII. n /De artment Use Only pproved isapproved Perrm~i/t Fee Dilate iss d Alssument ature a snf,,Denial •IX. CondiOWST Reasons for Disapproval 1. iptia tank, effluent lifter aM dispere si cell must all a sets 4ps I rnainrk G~-~ K/ as per Wagement plan provided by plumber. / 7. ` AN a ci1111p01," teclka Inust lbe maiMa ined as per appiialbM code 1 erdinanees. Attach to complete plans for the system and submit to the County only on paper not less than S 1/2 x 11 inches in size SBD-6398 (R. I1/11) Ell- 73' Nil gAARD I bi °7 C-©jkLE TR}t I L_ pa Alt - dRsa ,,,k)y24 DF T4fr= o OF j, ~Ihe• 5 ~`s`~ KW/VCKIA/A:ie 'Due ~ G ~ ! ~1' ~ pew -rolp .e , 5p7AG /A! Tt2 &F $M al. DO SprKE JAI , L0 C i i T Q% Sanitary Permit Checklist for Replacement Mound Owner's Name Noble Nygaard 1067 Coulee Trail Roberts, WI 54023 Located in the SW'/4 of the SE'/4 of Section 8, T28N, R18W. TOWN OF KINNICKINNIC ST CROIX COUNTY WI Parcel # 022-1022-70-000 CSM V4 P1158 Previous Permit #7339 8/9/1978 C for 5640 Sanitary Permit Application State Approval & Plan Soil Test (un-reviewed copy, orig. to be submitted by CST) Septic Tank Maintenance Agreement Certification for Utilization of existing tanks CSM Property report - Record of Warranty deed not found at Reg. of Deeds 1978 As-Built Aerial photo w/contours Prepared By Michael Rodewald 285 County Road SS River Falls WI, 54022 71 -821-6229 RS 931384 Signature DIVISION OF INDUSTRY SERVICES \fo~ 2331 SAN LUIS PL STE 150 ~;n \ GREEN BAY WI 54304-5211 Q ^I Contact Through Relay 'Sj11 `5 Fi I` http://dsps.wi.gov/programs/industry-services www.wisconsin.gov 'oFE.SSION-k ° Scott Walker, Governor Dave Ross, Secretary July 14, 2016 i OF CUST ID No. 224832 ATTN: P 0 WTS Inspector '.'IFESSIO~ : F .a MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA 28497 KING ARTHURS 1101 CARMICHAEL RD - DANBURY WI 54830 HUDSON WI 54016-7708 v SEE CO i-%ESP0 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/14/2018 Identification Numbers Transaction ID No. 2739749 SITE: Site ID No. 826530 Nygaard Please refer to both identification numbers, 1067 Coulee Trail above, in all correspondence with the agency. Town of Kinnickinnic St Croix County SW1/4, SE1/4, S8, T28N, R18W FOR: Description: EZ-FLow Moune (3 Bedrooms - Replacement0 Object Type: POWTS Component Manual Regulated Object ID No.: 1613020 Maintenance required; Replacement system; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s): EZflow Mound Component Manual, (R. 7/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the s at'-' ul le~ iicem'c,d r.J0 SO h: t! IC D partm::nr pe!~ ~ I'~ 0,;) stats. The following conditions shall be met during construction 01 MSta11at1Un Utd E',rior t(; uccu; .nc} cn us~~. • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches. Smearin- and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire the site is too wet to prepare If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. • Abandon Existing System per SPS 383.33 • Pump Floats to be set and verified per approved plan Anv changes may result in pump resizina to meet TDH and GPM Specifications. • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 MARY JO HUPPERT Page 2 7/14/2016 • Insulate building sewer beyond 30 feet per SPS 382.30 (1 1)(c) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Areas that are occupied with rock fi-agments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans, A cop, 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. Sincerer Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a. Copy With Your Private Sewage Plan Reviewer, Division of Industry Services Payment Submittal. (920)492-2214, Monday - Friday 6 am To 3:30 pm WISMART code: 7633 tim.vanderleest@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday -Friday 8:00 am To 4:30 pm Mike Rodewald, Bettendorf Excavating (Plans Mailed To) MARY JO HUPPERT Page 2 7/14/2016 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at round level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. 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. SincerelylJ ~ Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a. Copy With Your Private Sewage Plan Reviewer, Division of Industry Services Payment Submittal. (920)492-2214, Monday - Friday 6 am To 3:30 pm WiSMART code: 7633 tim.vanderleest@wisconsin. gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Mike Rodewald, Bettendorf Excavating (Plans Mailed To) I, EZHow" MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: NOBLE A. & SUSAN M. NYGAARD Owner's Name: (same) E>RVItR Owner's Address: 1067 Coulee Trail Roberts, WI 54023 1DENCE Legal Description: SW 1/4 of the SE 1/4, Sec. 8, T28N, R18W Township: Kinnickinnic County: St. Croix Subdivision Name: NA Lot Number: 2 Block Number: NA Parcel I.D. Number: 022 -1022 - 70 - 000 Plan Transaction No.: Page 1 Index and title ``~`~~~ttttutuurgrprir'i!j Page 2 Data entry oo,~s(%®NS/:r~V Page 3 EZflow mound drawings % Page 4 Lateral and dose tank MARY JO Page 5 Distribution media HUPPERT t Page 6 System maintenance specifications ° D 1859 Page 7 Management and contingency plan RIVER FALLS = Page 8 Pump curve and specifications Page 9 Plot plan WI Designer: Mary Jo Huppert License Number: 1859-007 Date: 07/11/16 Phone Number: 715-821-1440 Signature: C Designed Pursuant to the EZflow Mound Component Manual Ver. August 20, 2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) iECEI `ED EZflow Mound Version 3.0 (R. 3/1/12) Page 1 of 9 JUL 1. 3 Z~71[, Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e-g. 1.5 = 150%) 45050 Design Flow (gpd) 3.00 Site Slope 100.80 Installation Contour Line Elevation (ft) 78.00 Contour Length Available (ft) 30.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 8.00 Cell Width (ft) 3, 4, 5, 6, 7, 8 9 or 10 Only 60.00 = Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 4 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 10.00 ft2/orifice 2.00 Forcemain Diameter (in) 140.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.00 Inside Pump Tank Elevation (ft) Enter Y or N 5'8.69' Forcemain Filter Loss (ft) 4.55 System Head (ft) x 1.3 22.84 Forcemain Drainback (gal) 11.80 Vertical Lift (ft) 53.60 5x Void Volume (gal) Z a~ 2.06 Friction Loss (ft) 76.44 Minimum Dose Volume (gal) 18A1 Total Dynamic Head (ft) 25.85 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 11 0.75 1.25 x 1.00 1.50 x x 1.25 dr_... 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) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) Simtech Filter Manufacturer 20.28 Dose Tank Volume (gal/in) A2 100 Filter Model Number Wieser Concrete Manufacturer Project: NOBLE A. & SUSAN M. NYGAARD Page 2 of 9 Mound Plan View T - _ 1/10 B J _ _ _ Observation Pipe j . _ - 1 .:4•'.•S'°..L. 1.1.1.1.4.+..•.:•..L.L. S:•.•b.L.S.•e>S.`.•4•S=1••.• 1 • W 5 1 4 S• S r e1 4•Lr 1 1 i B I L Mound Component Dimensions A 8.00 ft E 8.88 in H 1.00 It K A20.89 ft B 60.00 ft F 12.00 in z 7.38 ft L ft D 6.00 in G 0.50 ft J 5.50 ft W ft 480.00 (fe) Dispersal Cell Area 923.08 (ft2) Basal Area Available 7.50 (gpd/ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 103.30 (ft) H ar~rir_rrrrifrrf ~~r~r~r .cri~iririrri»rii F Dispersal Cell 101.80 (ft) Lateral 101.30 (ft)-► - 6R = Invert Elevation Dispersal Cell 7 Elevation E D 3 ZQ' h~Gil♦ {..a~ tit:♦to~t~ti:~«i ~..ti.i 100.80 (ft) Contour Elevation 3.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 Q Topsoil Cap > m Q• 2Subsoil Cap C y c 2.0 ft Approved Geotextile Fabric Cover 0 ASTM C33 Sand m 4 Tilled Layer •p : : r;.; :,r 1r•r:rti 1 r.: ti;. L 1 L• L• 5 ~r;'r 1 EZflow M d F 5 ft '1.1• .tir1• .tirlrLrl•L. 1.1.1r, 1.1 e la v! v ~ •.:S . • L i.~,•tir. ir.r.r.l. U See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4° gravity distribution pipes as shown on page 5. Project: NOBLE A. $ SUSAN M. NYGAARD Page 3 of 9 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below ' E P •=Turn-upwfballvahreorcleanoutplug PF~orc*emaaiinnecconnpetion orifice located at Z IF X-+l Orifices paint up except every Sth one points down for drainage. S via tee or cross to manifold at ang point. Laterals & force main of PVC Sch 40 All laterals identical with orifices equally spaced. per Sf'S Table 384.30.6 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.54 ft Lateral Length (P) 59.21 ft Orifices per Lateral 24 Lateral End (Z) 0.79 ft Orifice Densi Lateral Spacing (S) 4.00 ft gt 10.00 ft2/orifice Manifold Length 4.00 ft Lateral Flow Rate 12.92 gpm Manifold Diameter 1.50 in System Flow Rate 25.85 gpm Forcemain Velocity 2.64 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- Tank Disconnect Tank component is properly vented E--- Alternate outlet location Weiser Concrete Manufacturer Forcemain diameter Capaci 750.00 Gallons 21n. Volume 20.28 gal/inch A Dimension Inches Gallons Weep hole or anti- A 19.21 389.64 B siphon device B 2.00 40.56 C -t - E- 3 77 76 44 - Pump off elevation (ft) C 90.00 D 12.W 243.36 Total 36.98 750.00 D Dose tank elevation (ft) Bedding And Backfill As Per Manufacturer 89.00 Alarm Manufacturer SJE Rhombus- _ ~ Alarm Model Number tank alert EZT Pump Manufacturer Gould Pump Model Number Pump Must Deliver 25.85 gpm at 18. 1 ft TDH Note: Switches containing mercury may not be used in this system. Project: NOBLE A. & SUSAN M. NYGAARD Page 4 of 9 E&Iowo Distribution Cell Media Layout 8.00 Cell Width (ft) 2.00 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 8 ft Wide doew"One Component Legend ® SR1-7A Bundle - 5 ft or 10 ft length;-; SR1-12A or EZ 1201A in 5 ft or 10 tt lengths SR3-12H or EZ 1201 P or exm SR3-12H in 5 ft or 10 ft lengths O 4" Perforated Distribution Pipe With Pressure Lateral Inside • Tumup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 8.00 Cefl Width - A (ft) 60.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram Force Main 8 ft Wide End Manifold - - - - - - - - - - - - - - - - - - - - - - - - - Project: NOBLE A. & SUSAN M. NYGAARD Page 5 of 9 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 Community Develop 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 480 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 years Effluent Filter Inspect and clean as necessary at least once eve 3 ears Pump and Controls Test once eve 3 years Alarm Should test periodical) Pressure System Laterals should be flushed and pressure tested eve 3 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 walcIriight cap and are secured in as shown in the Mow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZBow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn/ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral EZflow Synthetic Media 2.08 Feet Distribution Lateral a Lateral Cleanout Project: NOBLE A. & SUSAN M. NYGAARD Page 6 of 9 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SIPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' canponent manuals [EZNow Mound Component Manual 8/20/07, Pressure Distribution Component Manual Ver_ 2.0 SBD-10706-P (N. 01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manacle 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 84nches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s_ 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 year; by inspection. The outlet filter shall 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 fitter is equipped with an alarm, the fitter 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 as to when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Wisconsin Department of Commerce. Pump Tank The dosing (pump) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. If the force main has a weep hole, it should be noted if it is functional during pump operation, and if not, it should be cleaned. " Ado one should ever enter a septic or dose tank since dangerous gases may be present that could cause death.- Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulcted 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 freeanq. Influent quality into the mound system may not exceed 220 mg/L BOD5,150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components became deflective the tank or corn nt shall be proper operating condition. pale repaired or replaced to keep the system in If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: NOBLE A. & SUSAN M. NYGAARD Page 7 of 9 Wastewater METERS FEET 40 _.PE31._ MODELS: PE31, PE41, PE51 35 HP:.33, -40, .50 10 \ _ - - - - 2 GPM , - - - - - 30 PE4 - - - - f 1 FT i a -J7 - 25 PE31-- z _ - - s a . } .T 5 rQ- 15 _ T - - { i O S 5 10 5 . Y v ~ 5 0 00 10 20 i 30 40 -=50 60t 70 GPM 80 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 PE41 PE51 Total Head GPM Total Head (feet of water) Total Head GPM (feet of water) (feet of water) GPM 5 52 8 61 10 67 10 42 10 57 15 59 15 29 15 46 20 50 20 16 20 33 25 39 25 0 25 16 30 26 35 g 13 L S ~n~ ~y P i c o q NV (~,A,4RD M 01 7 CoIkC.E TRA i I ° PR i ZO$r1Z75, Ws ~5. Zb AaRIES VF -r*rz t der- p ~ 5 I l' y f foe Cj~l y ~ e a i 3kZ s 5PiKE lti 7W 8nt{ t /0/.00 SptKE JA f i ,5 A e 1 ~ - uie" aojo j uie aojoj f- _ UIE'N gaio_~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /Jd 6 /P N Yet 4A t_4) Mailing Address /6f 7 (?6m~ee Qi Property Address (Verification required from Planning & Zoning Department for new construction.) City/State 2diUJ CJf Parcel Identification Number D ZZ- - /d 22 -'7d- QVd LEGAL DESCRIPTION Property Location S~ '/4 SGT '/4 ,Sec. y , T Z46N R/t9W, Town of Afc'lc-lel'otw Subdivision Plat: / Lot # Certified Survey Map V # q Volume Page # Warranty Deed # fl df f-.4 J (before 2007)Volume Page # Spec house ❑yesE41-0 Lot lines identifiable R*yesE]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, journeyman plumber, restricted plumber or a licensed pumper verifying that (I ) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are tr to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed r orded in Register of Deeds Office. Number of bedrooms SIGNATURE O ICAN DATF. ***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. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) I This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) /047 eou.lee TP%l t located at: .54) 1/4, 5 e '/4, Section j own T„° N, Range/_W, Town of */.,,i fakihA1`e- , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service ~/BhZa/d f Did flow back occur from absorption system? Yes No-A-1' (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: Construction: Prefab Concrete X Steel Other Manufacturer (if known): yes erg Age of Tank (if known): /?78 Permit number (if own) 7339 /C~ae L ~d~2..JAZ~ icensed Plumber Signature) (Print Name) (Title) (License Number) MP/MPRS g///7 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Parcel 022-1022-70-000 03/27/2006 11:25 AM PAGE 1 OF 1 Alt. Parcel 8.28.18.127D 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - NYGAARD, NOBLE A & SUSAN M NOBLE A & SUSAN M NYGAARD 1067 COULEE TR ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1067 COULEE TR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH i Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 8 T28N R1 8W 5A IN SW SE LOT 2 CSM Block/Condo Bldg: VOL 3/653 N/K/A LOT 2 CSM 4/1158 (THIS CSM CORRECTS AND REPLACES CSM 3/653) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 08-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 143195 374,900 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 299,100 379,100 NO Totals for 2005: General Property 5.000 80,000 299,100 379,100 Woodland 0.000 0 0 Totals for 2004: General Property 5.000 40,000 213,100 253,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 205 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT 71 ..p , TOWNSHIP SEC. T act N, R •t3~ ADDRrSs_ 17 ST, CROIX COUNTY WISCONSIN. BDIL'ISION LOT LOT SIZE PLAN VIEW -Distances dimensions to meet requirements of H62.20 S dW EVERYTHING WITHIN 100 FEET OF SYSTEM L'.3 5 71, '1 1 :'TIC TANK( S,2'G`It. _CONCRETE L--SfiEL O. of rings on cover Depth it DRY WELL ~ENC S NO of width length area I3 ao. of 11ne width 3ength area:7Eg4 4r1 depth to top of pig sG40 MATE , lag 1tK RATE .:1.~ AREA REQUIRED AREA AS BUILT. stWiaer: The inspection of this system by St. Croix County does not imply complete -apliance with State Administrative Codes. There are other areas that it is not possible , inspect at this point of construction. St. Croix County assumes no liability for .stem operation. However, if failure is noted the County will make every effort to termine cause of failure. ,OASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. '-INSPECTOR i DATED, "1 PLUMBER ON JOB / LICENSE NUMBER 151 8/4/2016 Topographic Mapping Sr. CRC uv, v w Find address or play 1R ~ V 14 t Act µs P a; a w "Aff `a- a , A 1, -vn s>,~ + ` 60 ft } ~ R "k -wraiwlM11.'awx~Wr''M~M+ r`~..rWIM."w r A „ , _ ~ ,.ems http://scccdd.maps.arcgis.com/apps/webappvi ewer/index.htm I?i d=b721791727754dO2935l b625d85e279f 1 /1 CST - -2010 - Iq-L Wisconsin Department of Safety and Professional Services Division of Industry Services SRttV I N REPORT e l of 3 in accordance with SPS 383, Wis. Adm. e 4.1 ~n1 County Attach complete site plan on paper not less than 8 1/2 x 11 incag U p1ah-must include, but not limited to: vertical and horizontal reference RRoint (BM), direction and Parcel I 0I 1022 - 70 - 000 percent slope, scale or dimensions, north arrow, and locatiR;Jaii AQWnC'i 0*13;est road. Please print all informatiionUNITY DEVELOPMENT Revi d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). $ I Property Owner Property Location NOBLE A. & SUSAN M. NYGAARD Govt. Lot SW 1/4 E 1/4 S 8 28 N R 18 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1067 Coulee Trail 2 V4/1158 City State Zip Code Phone Number ity ®Village Town Nearest Road Roberts, Wl 54023 ( ) Coulee Trail New Construction Used Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD R Replacement Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable NA ft. General comments Mound System 0.50 ft. sand fill 0.6 loading rate and recommendations: IT] Boring # 0 Boring pit Ground surface elev. 101.10 ft. Depth to limiting factor 35 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 0-7 7.5YR2.5/2 1 3fgr ds cs 2vf-co 0.6 0.8 2 7-14 10YR4/4 sil 2fabk mft cs lvf-co 0.6 0.8 3 14-24 10YR3/6 Cl l fabk dh cs lvf--m 0.2 0.3 4 24_35 7.5YR4/6 cos Os dl cs lvf-f 0.7 1.6 5 35-40 7.5YR4/6 m2d 7.5YR5/6&t0YR6/2 c Om deh 0.0 0.0 [--2 Boring # F rol ]Boring 99,20 30 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 0-7 7.5YR2.5/2 1 3fgr ds cs 3vf-co 0.6 0.8 2 7-14 10YR4/4 sil 2f-mabk mfr cs 2vf-co 0.6 0.8 3 14-24 10YR3/6 Cl 1 fabk dh cs 1of-co 0.2 0.3 4 24-30 7.5YR4/6 sl 1 fsbk mvfr cs l of--f 0.4 0.7 30-till E * Effluent #1 = BODS > 30:S 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig It CST Number MARY JO HUPPERT Hollister's Soil Testin &Desi ''C l 224832 Address Date Evaluati Conducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 06 - 30 - 2016 715-426-1775 SBD-8330 (807/13) Property Owner NYGAARD, Noble & Susan Parcel ID # 022 - 1022 - 70 - 000 page 2 of 3 F3 Boring # Boring pit Ground surface elev. 99.50 ft. Depth to limiting factor 30 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 0-7 7.5YR2.5/2 1 3fgr ds cs 2vf-co 0.6 0.8 2 7-14 10YR4/4 sil 2fabk mfr cs 2vf-m 0.6 0.8 3 14-24 7.5YR4/4 CI 1 fabk dh cs 1 of-m 0.2 0.3 4 24-30 7.5YR4/4 scl 1 fabk dh cw 1 vf-f 0.2 0.3 30-Isbr/ till ❑ Boring # Boring n 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/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring ❑ Boring # 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-H; 30 (RO? 13) 3 A1~Kt J~ 286.73' N)05LF- A. 4,Sc-si4 M. . A34 CA A R D 10~ 7 Cokc. T-RA AR i ~,28ls, W3 -A $F Tfi9 Sa, 77 T 41 qi{ s5r. cRotn eouiq f t Oa' W i5~alVSi1~ V. F 5PIKE IA; 79 ~ ~-ssu 4 ~t -a ~ f IJ, 1 1