HomeMy WebLinkAbout010-1072-10-020
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 584767
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2695667
Permit Holder's Name: F City V>Page Township Parcel Tax No:
Jerold & Julie Holger TOWN OF EMERALD 010-1072-10-020
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
OD IaYIA 29.30.16.444C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER k/% CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 3 , 163 16~
cSaf
Dosing
C4 " QT Alt. BM~
0 w (tJ~'~ mow.. / !
Ae~eMew
(or Bldg. Sewer C/ 5
Holding St/Ht Inlet pZ
\
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO AP/l WELL BLDP. ent t Air Intake ROAD Dt Inlet
Septic Dt Bottom ~ ~j ~ QC y t~
Dosing 756' (j3 16' Header/Man. b Z4 /61-7
Aeration Dist. Pipe /d
Holding Bot. System Z. o /d/
Final Grade Q . Z /6Z •7
PUMP/SIPHON INFORMATION
1. 41 1CM
Manufacturer GP Demand St Cover
(no J L ~
Model Number
PC, 44 +L~, , 6 s/~ v 3 c i Z_
TDH L~3 .tZ Frictions Loss System H d TDH ~AF 00 43-72 1 ,
Forcemain Lengtly~ Dia.Z/ Dist. to Well G3
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Tren s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /l &
1, a a-
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Ty System: 'Zt a7 UNIT Model Number:
DISTRIBUTION SYSTEM Alt
Header/Manifold Distribution / `Z~ Ix Hole Size / Mole Spacing / Ve Air Inta
Pipe(s)
Length Da Length 4X 0 Dia Spacing 3. 3 Tr
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 . 76 Bed/Trench Edges Topsoil p P- Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: B 1 -q fiv inspection #2:
Location: 2292 130TH AVE '}°.pi4A ~S
T t~-~-- es, y^-
1.) Alt BM Description Cav
= ' t U/ow z5k_
2.) Bldg sewer length = Z,Q I
amount of cover G ~J C~ fe
Plan revision Required? ❑ Yes No
Use other side for additional information. V
Date /In pctor' ignature Cert. No.
SBD-6710 (R.3/97)
6,j~ l ads , w~,k b- ~&ttat fteAj
GOULDS PUMPS Submersible
Effluent Pump
PE
~LUEtJ, PIfMP
SPECIFICATIONS MOTOR FEATURES
Pump - General: General: ■ Corrosion resistant
• Discharge: 1'/z" NPT • Single phase construction.
• Temperature: 104OF (4000 • 60 Hertz ■ Cast iron body.
maximum, continuous when • 115 volts ■ Thermoplastic impeller and
fully submerged. • Built-in thennal overload pro- cover.
• Solids handling: 'h" tection with automatic reset. ■ Upper sleeve and lower
maximum sphere. • Class B insulation. heavy duty hall bearing
• Automatic models include a • Oil-filled design. construction.
APPLICATIONS float switch. • High strength carbon steel m Motor is permanently
Specially designed for the • Manual models available. shaft lubricated for extended
following uses: • Pumping range: see PE31 Motor: ■ service
for continuous
• Mound Systems performance chart or curve. • .33 HP, 3000 RPM operation.
• Effluent/Dosing Systems PE31 Pump: • 12.0 Maximum amps • Low Pressure Pi Systems • Maximum capacity: 50 GPM • Shaded pole design ■ All ratings are within
the
working limits of the motor.
t • Basement Draining • Maximum head: 25' TDH PE41 Motor:
• Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM 0 Qum discmnect lamer
standard length
Dewatering • Maximum capacity: 60 GPM • 7.5 Maximum amps cord,
heavy 20' duty stan16/3 SJTW dad ken with
• Maximum head: 29' TDH ' PSC design NEMA 5-15P, three prong,
PE51 Pump: PE51 Motor: 115 volt grounding plug.
• Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty,
• Maximum head: 37' TDH • 9.5 Maximum amps portable and compact.
• PSC design ■ Mechanical seal is carbon,
METERS FEET ceramic, BUNA and stainless
40
a -
} - - F- ; - ooEts PE3t. mat, PE -51 Steel.
M
= r - ; - - - T-~F
- - ! - - ' HP. 33, _40, s0 ■ Stainless steel fasteners. -
35 _
- 4---
--r
+ - r - -
T - - - -
110-
cPM AGENCY LISTINGS
30
w 25
c
C us
< Tested i t •
- T
t-
z 20 - - ` i b UL 778 and CSA 22.2108 Standards
3 + - - 1 - - a i' 1 =
' T BY Carsa&ae Standards Asoda6on
15 J ; - File #LR38549
:
- - - - - - - + 1 Goulds Pumps is ISO 9001
1711,
10 i ---1- I j
0 00 101 20 30 40 SO 601 70 GPM 80
0 5 10 1+5 rtt3/h Goulds Pumps
L L-
CAPACITY
0 zooz Geoids Pumps
ITT Industries
AWC JS*f$
CAD - 3, s~' 4 0~ Tim ' f
f~1C~ wAwe
52q. T3ad RLSW~ OF ti~A-ALb s~ Q notao
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~?xRTI RECEIVED County ;
Safety and Buildings Division 1, '
yr ss r 201 W. Washington Ave., P. X 7162 Sanitary Permit Number (to be filled in by Co.)
ps MAY N Madison, WI 53707-
P::~, I C~
51 CFtOIX COUNI'1'
OF~SlON
r Sanitary Permit Application c" ° te Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmen ~t
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Pri c Law, s. 15.04 1 m , Stats. h
(~J IIII 1I L_
1. Application Infor ation - ase Print All Information
Property Owner's Nam Parcel #
Property Owner's Mailing Address Property Location W 3 C. i q qq C
Govt. Lot
City, State Zip Code Phone Number y. y. Section G
(circle one
- Z2? 0 -
i~ T_N; R Ea
11. Type of Building (check all that apply) Lot #
IXJ or 2 Family Dwelling -Number of Bedrooms ell Subdivision Name
Block#
❑ Public/Commercial -Describe Use i ' t ❑ City of
❑ State Owned - Describe Use ' CSM Number /61 Z71 ❑ Village of
~O V V D Jtti 7i n t& Town of (CyV 67t .,Or L P
111. Type of Permit: (Check only one box on line A. Complete line I3 if applicable)
A. New System ❑ Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modication t xis ' g System (ex lain)
l
List Previous P it 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 apply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
❑ Holding Tank ❑ er Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersaVTIreat ent Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (~Vf Dispersal Area Prop;SI s System Elevation /
rl Z) -e%CJ c t94 ~7
/ j
V1. Tank Info Capacity in Total # of Manufacturer
~ Gallons Gallons Units
New Tanks Existing Tanks C U v N
a U cn n J V C
All ICI /off 525 0 N
Septic or Holding Tank
Lr S L~ ~2
Dosing Chamber
4
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plu~pber's Name `(Print) Plumber's Signature
MP/MPRS Number Business Phone Number
fa ~ J
X Z17
7 7
Plumb Address (Street, City, State, Zip Code)
C` t 5ct--~ Z; L
VIII. County/Department Use Only
Approved oved Permit Fee Date Issued Issuing Aggnature
❑ Owner Uiverr Reasonfo'r75enTa7- / y/
IA. Conditions ofApprovaVReasons for Disapproval 'fit/t II _h N~IZ 5e1 ~JQ
'
SYSTEM OWNER J Y Y CkS
Eeptie tank, effluent filter and } i9yj / a ve ~17
dlaparsal cell must t~ 5er`!1 'va lnta v oncl i fiv~S I n s /U ~~''YYi
gs per management plan provided by plumber. ~h 15 a pj)a lOa l
0 Ail ck requirements must be maintained 7
as per appli r the system and submit to the County only on paper of less than 8 in X11 inc
7n siye /I
r he$
t°r Gv 2616,0/(0
SBD-6398 (R. 11/11) ~Cf ~U t~
pnxTAlyr DIVISION OF INDUSTRY SERVICES
0 3824 CREEKSIDE LN
N
HOLMEN WI 54636-9466
I S' Contact Through Relay
P http://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
o~
~o s'sI01N w Scott Walker, Governor
Dave Ross, Secretary
April 26, 2016
CUST ID No. 224832 ATTN.- POWTSInspector
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
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 04/26/2018
SITE:
John H and Susan E Collis Identification Numbers
2292 130TH Ave Transaction ID No. 2695667
Town of Emerald Site ID No. 822969
St Croix County Please refer to both identification numbers,
SE1/4, SETA, S29, T30N, R16W above, in all correspondence with the agency.
FOR:
Description: Four Bedroom Mound System / 8% slope
Object Type: POWTS Component Manual Regulated Object ID No.: 1596027
Maintenance required; 600 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade
System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), 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. CONDITI
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, APPR
stats. DEPT OF S
The following conditions shall be met during construction or installation and prior to occupancy or use: PROFESSION
DIVISION OF INDU
Reminders
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.19, Wis. Stats. Q • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made w SEE
CO S
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per SPS 384 product approval conditions.
• The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or
soil compaction is prohibited in this area.
• 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.
MARY JO HUPPERT Page 2 4/26/2016
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.
• The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS
occurs in accordance with this chapter and the approved management plan under s. 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.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
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
A X4 This Amount Will Be Invoiced.
rard M Swim When You Receive That Invoice,
POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your
(608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal.
jerry.swim@wisconsin.gov WISMART code: 7633
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
Roger D Nelson (Plans Mailed To)
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly
Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with
"SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to
the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered
and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed
by SPS Chapters 360-366.
MARY JO HUPPERT Pan 2 4/26/2016
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.
• The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS
occurs in accordance with this chapter and the approved management plan under s. 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.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
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.
iroard-~M cerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
Swim When You Receive That Invoice,
POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your
(608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal.
jerry.swim@wisconsin.gov WiSMART code: 7633
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
Roger D Nelson (Plans Mailed To)
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly
Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with
"SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to
the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered
and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed
by SPS Chapters 360-366.
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
RECEIVED
Project Name: JOHN H. & SUSAN E. COLLIS i~?R 6 2016
Owners Name: (same) I 1 i-; tip- `;f
Owner's Address: 250 Wilson Heights
Kalispell, MT 59901
Legal Description: SE 1/4 of the SE 1/4, Sec. 29, T30N, R16W
Township: Emerald
County: St. Croix
Subdivision Name: -
Lot Number 3 Block Number. NA
Parcel I.D. Number 010 -1072 -10 - 0$0
)NALLY
Plan Transaction No.: WED
~Etlaliiii: 3sFl!{ter, FETY AND
Page 1 Index and title
.L SERVICES
'S~~~•,,~`~@~F Page 2 Data entry
Page 3 Mound drawings TRY SERVICES
r sa krTY Y a Page 4 Lateral and dose tank
• ~A = Page 5 System maintenance specifications
i rt=, Page 6 Management and contingency plan
Page 7 Pump curve and specifications ONDENCE
Page 8 Plot plan
I <Ffl~~v~Lr'{ dfiA t -A
Designer Mary Jo Huppert License Number. 1859 - 007
Date: 04/02116 Phone Number. 715 -426 -1775
Signature:
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), 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)
Version 7.0 (R. 03/2012) Page 1 of 8
1
Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
(R or C) ~ It Residential or Commercial Design Note: Sand M (D) calculations assume a
f 400 OOI Estimated Wastewater Flow (gpd) Table 383.443 in-situ soil treatrnent for
1.50 Peaking Factor (e.g. 1.5 =150%) fecal c~liforrn of 36 Indies.
600.00 Design Flow (gpd)
8.00 Site Slope
99.50 Contour Line Elevation (ft)
16.00E Depth to Limiting Factor (in)
0.601 In-situ Soil Application Rate (gpd/fe)
Distribution Cell Information
60.001 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft)
1001 Dispersal Cell Design Loading Rate (gpW)
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Disribution Mformmation network? Enter Y or N
(C or E) e+ Center or End Manifold
3.33 Lateral Spacing (ft) If N above, enter the elevation (ft)
3 Number of Laterals of the highest point A._.
01561 Orifice Diameter (in)
y 3.50' Estimated Orifice Spacing (ft) = 11.76 fe/orifice
2.00; Forcemain Diameter (in)
20.00; Forcemain Length (ft) Does the forcemain drain back? Y
89.00 1 Pump Tank Elevation (ft) Enter Y or N
4.55 System Head (ft) x 1.3 3.26 Forcemain Drainback (gal)
11.76 Vertical Lift (ft) 55.97 5x Void Volume (gal)
0.33 Friction Loss (ft) 59.23 Minimum Dose Volume (gal)
jo 0.00; In4ine Filter Loss (ft) 27.46 System Demand (gpm)
16.64 Total Dynamic Head (ft)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. o ions choice in. dia. options choice
0.75 1.25 x x
1.00 _ 1.50 x A
1.25 x x 2.00
1.50 x 173.00 _
2.00 x
3.00 x
Gallons/Inch Calculator (optional)
Treatment Tank Information Total Tank Capacity (gal)
1200 00 Septic Tank Capacity (gal) Total Working Liquid Depth (in)
Wieser Manufacturer gal/in (enter result in cell B49)
Doss Tank Information Effluent Filter Information
800.00; Dose Tank Capacity (gal)
PolYLok rFilter Manufacturer
22.24 Dose Tank Volume (gal/in) 525 Filter Model Number
Weiser Manufacturer
Project: JOHN H. & SUSAN E. COLLIS Page 2 of 8
Mound Plan and Cross Section Views
- - . J1
1/10 B Observation Pipe ' T
K 'S ~S'4~4•°.•S.5.5.4+4.4+Y 4.4•S•4.4.5•S•S 5•YL•5.4.4•S. 4`4•S•S5-7---•4•S•5.4 4.5+4•
.4,,.5. 1•.•J•f•f•.•:•r•:•:•J•J r•:•d;f•r•r•r•r•r•r•r•r•r•1Jrr•r•:•: ••i-r•r•r
4.4•S•`.•4 X4.4.4•°.•4• 5.4.4 4••.•i••..4••.•S•4.4.4•S•4.5.5.4• S•4•S• A
d•d• d•d•d . f•: •:•1 d•f r..°.f.d•f •J,d.:.f.f.J.f,f•r.f.•`. f•f.1
~.'~..•.•4~..'i:::~,av.%..,. y...•S•4•\J ~i.S.S 4.4.4.•.•g•4.4.4. S+S.S•4.4. S.S•4 S:'.•i.g•
• t•l•J•f d•f•r•r•2•: •f•J ~ l•J•P•d.J•: •f.f.f.r.J•f.f.1•f•f..`..•.. •l•f.r..'.r
.S.S••e••,•g..•.4•`..S•g•4•g •4•g•5,•,.5.5.4•.,.v g.4.4..,.4.1..,.5.g..•.4..,.5.4.5..,.y..•..°..,.4.,•.
.1.1•r.J•J•1.1.1.:•.'•2.:•f•1•a'*f•1•:•1'f:l.•,d..°•J.l.f.r.f.l.1.r•1a1..•.f.1•: •f.••.d.1~J
. .
W _ 1..
B
L
Mound Component Dimensions
in H 1.00 ft K 11.51 It
A 10.00 ft E Ift
B 60.00 It F in I 14.75 ft L 83.03 ft
D 20.00 ' G ft J 7.11 ft W 31.86 600.00 (fe) Dispersal Cell Area 1485.20 (ftz) Basal Area Available
10.00 (gpd/ft) Linear Loading Rabe 6.00 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 102.94 (ft)
G ♦ H
j
I F : Dspersal Cell ♦ - 101.67 (ft) Lateral
101.17 (ft)-* Invert
Dispersal Cell =
Elevation D .
c ,alt: _ Kkc
9.50 (ft) Contour Elevation
8.0 % Site Slope
Geotextile Fabric Cover
Shading Key m - Dispersal Cell See lateral details on
Topsoil Cap c ° 1.5 ft 5.4. Page 4 for number, size,
2l Subsoil Cap 0 o n spacing of laterals.
-t-
ASTM C33 Sand Laterals are equally
spaced from the
Tilled Layer c e H0 ft 4:T.1laterarti'' distribution cell's
Aggregate .00
`tip:°~=~ sr'• ~rs':a f: centerline in the
A * distribution cell (AxB).
Project: JOHN H. & SUSAN E. COLLIS Page 3 of 8
s
End Connection Lateral Layout Diagram
Center the laterals over the A & 8 ainerrsGOn Turn-up vdball valve or clean out plu 9
E P -r
All laterals are identl" k - y~,I Moles drilled on the bottom of the lateral s
ew•aw! spaced
Laterals Morcernairl Sch 40 PVC per SPS Table 384.30-5 g
Force main connection via tee or cross to manifold at any point.
Number of Laterals 3 Orifice Diameter 0.156 in
Lateral Diameter 1.25 in Orifice Spacing (X) 3.66 ft
Lateral Length (P) 58.56 ft Orifices per Lateral 17
Lateral Spacing (S) 3.33 ft Orifice Density 11.76 if/orifice
Lateral Flow Rate 9.15 gpm Manifold Length 6.67 ft
System Flow Rate 27.46 gpm Manifold Diameter 1.25 in
Total Dynamic Head 16.64 ft Forcemain Velocity 2.80 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and -i
SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented E-- Alternate outlet
location
Forcemain diameter
Weiser Manufacturer 2 in.
Capacityl 800.00 Gallons
Volume 2224 gal/inch A
Weep hole or anti-
Dimension Inches Gallons B sown device
A 20.41 453.87 C
B 2.00 44.48 _ Pump off elevation (ft)
C 2.66 59.23 89.91
D 10.90 242.42 D
Total 35.97 800.00
Dose tank elevation (ft)
3" Bedding under tank. 89.00
Alarm Manuafacturer SJE Rhombus Note: Switches
Alarm Model Number !Tank Alert AB
containing mercury
may not be used in
Pump Manufacturer Zoeller this system.
Pump Model Number
Pump Must Deliver 27.46 gpm at 16.64 ft TDH
Project: JOHN H. & SUSAN E. COLLIS Page 4 of 8
Mound System Maintenance and Operation Specifications
Service Provider's Name Miller Portabale Sanitation Phone 715-265-4839
POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680
System Flow and Load Parameters
Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Should inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested eve 1.5 ears
Mound Inspect for ponding and seepage once every 3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn-up Detail
Finished
Grade vl
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
Project: JOHN H. & SUSAN E. COLLIS Page 5 of 8
Mound System Management Plan
Pursuant to SPS 383.54, Vft. Adm. Code
GarkWal
This system shall be operated in accordance with SPS 382-84 W is. Adm. Code, and snail maintained in accordance with its' component
manuals (SBD-10691-P (N.01101), SSWMP Publication 9.6 (0181), and Pressure Distribution Componert Manual Ver. 2.0 SBD-10706-P (N.
01/01)] and local or state rules pertaining t0 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.
Se
~Septic y pump ~ abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as
Septic or pump tarok manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be steed watertight upon the completiort 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.
Seofic 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
tarns 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 yeas 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 fiber 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 impernda>g continuous
atom.
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 shad advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the lark
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.
Puana Tank
The pump (dosing) tank stall be inspected at least once every 3 years. AN switches, alarms, and pumps shall be tested to verify proper
operation. If an affluent fitter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure DistrIndion System
No trees or shrubs should be plaited on the mound. Plantings may be made around the mound's perimeter, and the mood shell be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative mainter ance) on the mound is not recommerded since soil corrVaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-Fetn,ary) dictate that the
mound be heavily mulched at protection from freezing.
Influent quality into the mound system may not exceed 220 mg& BOD,150 mglL TSS. and 30 m9IL FOG for septic tank effluent or 30
mglL BOD& 30 mg/L TSS.10 mglL FOG. and 10' Cfu1100 ML for highly treated eff uerrL Influent flow may not exceed maximum design flow
specified in the permit for this imitation.
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 acc rnulated solids at wast 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 dogging has occurred and if orifice cleaning is required to maintain equal distributonh
within the dispersal cell.
Observation pipes within the dispersal call shad be checked for effluent ponding. Ponding levels shad be reported to the owner, and any
levels above 6 inches considered as an impending hydraulic failure requiring adddfonal, more frequent monitoring.
Continency Plan
If the septic tank or any of its components become defective the tank or component shad 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) shad be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component felt to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' Present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and disposal
media, and related piping. and replacing said components as deemed necessary to bring the "stern into proper operating condition.
See Page 5 of this plan for the none and telephone number of your local POWTS regulator and service provider.
Pretreatment Units
The information and schedtAe of mananagement and maintenance for pretrw6nent 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: ~t~`'~ lp%"-5 Page 6 of 8
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CONSULT FACTORY FOR SPECIAL APPLICATIONS
- Electrical abarnatm for duplex syswms, are available and - Variable level float wallches are avalabie for controlkv shig e
suppled illiffl an alarm. and three phase syslesm
wdh or m* for d*kx wjsWM are able - Double piggyback variable level float swdles we avelabis
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for variable level long cycle controls.
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RESERVE POWERED DESIGN
For untaud concNons a n mmve safely facbr is engir*wW bib the design of every Zne1w puny.
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lace corresponding lateral diagram in the space provided on the sheet to the sett.
this by clicking in one of the drawings at the right with the arrow too/
,rid holding the mouse button down while draggin(
e picture until it's in the correct position.
r .ng! ne ; :Et pi`essy d lctr° vihf?fi lateral .
1 P
X-) 'E-xt2 I xl2->I Laterals &forcemain Sch 40 PVC
per SPS Table 384.30-6
Holes drilled on the bottom of the later al, • = Turn-up W ba l lva lve or clean out pl u g
equally spaced
Force main connection via tee or cross to manifold at any point. Laterals are identical
P
•=Turn-up valball valve or (fX~IEx12 x1231 Laterals &forcemainSct-,4i,
cleanoutplug per SPS Table 384.30-r
Hales drilled on the bottom of the lateral.
Force main connection via tee or cross to manifold at any point. Laterals are identic al
1-
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y
• = Turn-up with cleanout plug or ball valve S
P
IE X--31Fx12 x1241 Laterals Morcemain Sch 40 PVC
Holes drilled on the bottom of the lateral. per SPS Table 384.30-6
Laterals centered over the A & B dimension • = Turn-up va'ball valve or cleanout plug
P ,l
Last hole dlrilled next to end cap Laterals & forcemaln Sch 40 PVC
Holes drilled d on the bottom of the lateral per S P S Table 384.30-6
equally spaced
atera s centere over t e rmension ♦ = Turn-up vdball valve or cleanoutplug f
P
All laterals are identical IF X-~~ Holes drilled or. the bottom of the lateral S
equally spaced
Force main connection via tee or cross to manifold at anv point.
Laterals Morcemain Sch 40 PVC per SPS Table 384.30-6
Force main connection via tee or cross to manifold at any point. Laterals are identical
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Wisconsin Department of Safety and Professional Services
Division of Industry Services
SOIL EVALUATION REPORT Page I of 2
in accordance with SPS 383, Wis. Adm. Code
County ST. CROIX
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 010 - 1072 - 10 - 0L0
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location ❑ M
JOHN & SUSAN COLLIS Govt. Lot SE 1/4 SE 1/4 S 29 T 30 N R 16 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
250 Wilson Heights 3 V. 27, P. 6115
City State Zip Code Phone Number Licity Village ■ Town Nearest Road
Kalispell, MT 59901 ( 406) 257 - 7451 130th Avenue
0 New Construction UseE] Residential ( Number of bedrooms 4 Code derived design flow rate 600 GPD
n Replacement Public or commercial - Describe:
Parent material loess over till Flood Plain elevation if applicable N;A ft.
General comments Mound system 20" sand fill - 0,6 loading rate
and recommendations:
4p Boring conducted to move system out of 16 % slopes.
Property Address: 2292 130th Avenue
4 Boring # F1 Boring
n Pit Ground surface elev. 98.75 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
1 0-8 10YR3/3 sil 2fabk mfr 0.6 0.8
2 8-12 10YR4/4 sil 2fabk mfr 0.6 0.8
3 12-18 7SYR4/4 - sl Ifabk tnfr 0.4 0.7
4 18-20 7.5YR4/4 ftf7 YR4'6 sl Ifabk mfr 0.4 0.7
2 ] Boring # ❑ 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
' Effluent #1.= BOD > 30 < 220 mg/L and TSS >30 < 150 mg/- ` Effluent #2 = SOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) _ _ Si gnat r f CST Number
MARY JO HUPPERT Hollister's Soil Testing&Des224832
k
Address Date Evalua o' Conducted Telephone Number
28497 King Arthur's Court. Danbury, WI 54830 04 - 01 - 2016 715-426-1775
SBD-8330 (807113 )
DECEIVED
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of " apduf~ In accordance with Comm 85, Wis. Adm. Code
County
per not less than 8 'h x 11 inches in size. Plan must St. Croix
I~~I~yrI'~~hTr~ical and horizontal reference point (BM), direction and Parcel I.D.
:®Nl nt slope, scale or dimensions, north arrow, and BM referenced to nearest road. 07L ' !C~ - Q7.0
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))
Property Owner Property Location
Susan Collis Govt. Lot SE v< SE '/4 s 29 T 30 N R 16 w
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
250 Wilson Heights 3 G S~'Ll U. 2-7 O #10/7-7
City State Zip Code Phone ❑ City ❑ Village 0 Town Nearest Road
Kalispell MT 59901 406-257-7451 Emerald 4Z2,?,? 130th Ave
0 New Construction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or Commercial - Describe:
Parent Material Loess over Till Flood Plain elevation if applicable N/A ft.
General comments and recommendations:
_kWp IFy WEIL&AYD toc-f17oe) XFO/Ljr:~7 ~FSIb41
1 Boring # Boring
0 Pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor 16 in.
Soil A lication Rate_
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-7 10YR3/3 - SIL 2-m-bk mfr cs 2f 0.6 0.8
2 7-16 10YR4/4 - SIL 2-m-bk mfr cs 2f 0.6 0.8
3 16-23 7.5YR4/4 5YR4/6 f-1 A SL 2-m-bk mfr gs if 0.6 1.0
4 23-40+ 7.5YR4/4 7.5YR4/6 f-2-f LS 1-co-bk mfr - - 0.7 1.6
Boring # ❑ Boring
Wit Ground Surface Elevation 100.0 ft. Depth to Limiting factor 16 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 10YR3/2 - SIL 2-m-bk mfr cs 3f-m 0.6 0.8
2 10-16 10YR4/4 - SIL 2-m-bk mfr gs 2f 0.6 0.8
3 16-21 10YR4/4 7.5YR f-1 A SL 2-m-bk mfr gs 1 f 0.6 1.0
r 4 21-30+ 7.5YR3/4 5YR4/6 f-2-d LS 1-co-bk mfr - - 0.7 1.6
i
Effluent 41 = BOD5> 30< 220 mg/L and TSS > 30 < 150 mg/L * Effluent 42 = BODs < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Mark Iverson 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, WI 54015 Aril 10, 2015 715-796-5664
-3
Property Owner Susan Collis Parcel ID# Page 2 of 3
Boring # O Boring
EIPit Ground Surface Elevation 99.4 ft. Depth to Limiting factor +36 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/frz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-15 10YR3/2 - SIL 2-m-gr mfr cs 3 f-co 0.6 0.8
j 2 15-23 10YR4/4 - SL 2-m-bk mfr gs 2f 0.6 1.0
3 23-36+ 5YR4/4 - SL 1-co-bk mfr - 1f 0.4 0.7
❑ Boring
4 Boring # Elpit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
- -
i
Boring # 11 Boring
opit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
{
* Effluent #I = BOD5> 30 < 220 mg/L and TSS > 30:s 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
Need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
Page 3 of 3 0 ft. 24 ft. 40 ft. 80 ft.
L v ~ 3 , N
CD
BM#1 - Top of 12"PVC Pipe 0
100.4' G
B-1
100.0
B-3
99.4
5\~QrO~
B-2
100.0
BM#2 - Top of 112"P V(~ Pipe'` I9&
100.7' `9'q 0,
.0,
~O
1 ?0
The property lines are
approximately 150' east of B-2
and 280' north of B-1.
BM# & Description =Bench Mark
Elevation 100, = Boring Location & Elevation
Owner: Susan Collis Site Information: Completed By: Mark Iverson, PSS #197
250 Wilson Heights SE1/4, SE1/4, S29, T30N, R16W 680 Larcom Street
Kalispell, MT 59901 Town of Emerald Hammond, WI 54015
St. Croix County 715-796-5664
Phone: 406-257-7451 CST# 46672
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
_ AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State Parcel Identification Number 0/6 - /G 7-Z - / G
LEGAL DESCRIPTION
Property Location %4 , 1/4 , Sec. T C N R_,_ W, Town of 4 h
Subdivision Lot
Certified Survey Map # ( 61 z-7 Volume , Page #
Warranty Deed , Volume , Page #
Spec house yes Lot lines identifiable s 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 §Comm. 83.52(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 (1) 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 th
standards set forth, herein, as set by the Department of Commerce 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 az
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this 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 warn ty dee&recorded in Register of Deeds Office.
Number o. bedrooms
SIG 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. 08/05)