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HomeMy WebLinkAbout040-1268-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 589765 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2738189 Permit Holder's Name: City Village Township Parcel Tax No: Andrew & Joylynn Auderleth TOWN OF TROY 040-1268-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /45-5 16.28.19.1464 TANK INFORMATION ELEVATION DATA to, (o , PLO , S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing /OCR Alt. BM V 7~. Aeration LJ/PCI lak S Bldg. Sewer Holding /0,7 17 St/Ht Inlet /b s3 9a . TANK SETBACK INFORMATION St/Ht Outlet 11-114 76. TANK TO P/ WELL BLDG. en o Air Intake ROAD Dt Inlet Septic p~~it/.79 7b, 7 ~ AJ4 r Az_ Dt Bottom 15.3 %7. 11, -3 Dosing '54 ` 1~ 33 ~ ~ _ Header/Man. ,y. Aeration ,V ~C ' - :5 16 Z, Dist. Pipe L Holding Bot. System z.cea 5- Af. 4 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand /O~• St Cover 7 - Model 00 5. p Model Number 74 I Go4ft -o., 3.6 /'do. TDH Lift Friction Lo ' Sy em Head TDH - Forcemain Length Dia. Dist. to Well f SOIL ABSORPTION YSTEM BED/TRENCH Width Length No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typ System: CHAMBER OR O J 27 UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution 11 x Hole Size x Hole Spacing Ve Air Intake (0•~7 Z Pipe (S) I 1 / Length Dia Length 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 Mul ed Bed/Trench Center 0 Bed/Trench Edges Topsoil es No Yes i ` No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 17 Ir/ Inspectio Ii Location: 309 EMPIRE BALDER DR w~C a € 1.) Alt BM Description = tt Y 2.) Bldg sewer length = SZ 40 -amount of cover ~i GI Ifs Plan revision Required? j Yes No Use other side for additional information. V T S SBD-6710 (R.3/97) Date Insepctor ignatur Cert. No. ~r. - linty Safety and Buildings Division I 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be tilled in by Co.) Madison, WI 53707-7162 S -57? 5 -/40 , - MULINITY0 X State Transaction Number Sanitary Permit AppllCatlYJ;r 3RcF In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropit.- - Z/V&l 73 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS arc s., ~F Project Address (if different than mailing address) the Department of Safety and Professional Servics. Personal information you provide may be used for secondary ur oses in accordance with the Privacy Law, s. 15.04(I)(m), Stats. S L Application Information - Please Print All Information A if) Lip Property Owner's Name I~ ~ A / Fac i/L-0 1 &0Y'7-_ . /!1 ` h Lt G( !74 4~' 14'-' Y /Z 6 g ` 7 c) L" I Property Owner's Mailing Address Property Location '14 I9 L/ Cs Govt. Lot City, State Zip Code Phone Number I , Yr /a, ~ 4F /a, Section /6/' circle one) T =Z~ N; R E o II. Type of Building (check all that apply) Lot # or 2 Family Dwelling - Number of Bedrooms /61 y Subdivision Name / Block ❑ Public/Commercial - Describe Use g P~~ ❑ City of ❑ State Owned - Describe Use CSM Number [I Village of /no /1, W Town of L11 ~$e J &0 (a " 90 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' Flew System ❑ Replacement System ❑ Treatment Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal El Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 00 IV. Type of POWTS System/Component/Device: (Check all that apply) V ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil n 2 p . of soil X ❑ Holding Tank ❑ ther Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) I Design Soil Application Rate(g sf) Dispersal Area Requ d Dispersal Area Prop ed ( System Elevation ""Y C-7 ~16 ~ 4 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n c o v s v Ncw Tanks Existing Tanks c. a in ~ rn i= C7 a w o a, 5'Z ° Septic or Holding Tank Dosing Chamber z _ L VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shoe°n on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. ounty/De artment Use Only Permit Fee Date sued Issuin went Signatur Approved $ 7tveneason for Denial IX. Condi8>r6WQW**ft1E*Reasons for Disapproval '6f xA-e, 1. ' eptio tank, eftant fitter and 4 ~ '0ispemsai cell must all b9_kwvk:Ps / cnz~Ln!rs ux ^ C Perl~d as p6r,Waadment plan provided by plumber. 2 4'~ilbliS`rk1eg4isMust.bertaintzired n per appIlIcabla code / erdinawmts. AA 106 Attach to complete plans for the system and submit to the C my only on paper not less th n S 1/2 x 11 inches in size SBD-6398 (R. 11/11) O _ s' m / / a W z o Q z U O U F- w.........~.. w CL 0 CL Y / qC W ' `n CL m _1 0 / Q ~ f O Z JO O 'n z l2 N N } U Ln __j LLJ J a l`% W w U -1 Z rn LL w W LLI Q< Z O O Z rn O Ln w V) LL 1~1 > O 0 O O d Z o 0 o w W w 6 J 0 z V) U CIO ED to w vi b D w fi W a_ _ o ~,j' co LJ t f a Ln _w EU,I L: w v: o m a k!i r . . . . . . . . otir~xraTg~ DIVISION OF INDUSTRY SERVICES yti~ . Toy 3824 CREEKSIDE LN CIOh HOLMEN WI 54636-9466 3 Contact Through Relay P $ http://dsps.wi.gov/programs/industry-services ?y www.wisconsin.gov 4 ~OssroN~LSw Scott Walker, Governor Dave Ross, Secretary July 14, 2016 CUST ID No. 225410 ATTN: POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING & HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/14/2018 SITE: Andrew and Joylynn Audereith Identification Numbers Empire Builder Dr Transaction ID No. 2738189 Town of Troy Site ID No. 826354 St Croix County Please refer to both identification numbers, SW1/4, SE1/4, S16, T28N, R19W above, in all correspondence with the agency. Lot: 103, Subdivision: Glover Station 5TH Addition FOR: Description: Five Bedroom Mound System / Sloping site Object Type: POWTS Component Manual Regulated Object ID No.: 1612190 Maintenance required; 750 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 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 Cod: . 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. DEFT C No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, PROFESSI stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with 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. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • 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. PAUL R KOEHLER Page 2 7/14/2016 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 This Amount Will Be Invoiced. erard 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 coder 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 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. PAUL R KOEHLER Page 2 7/14/2016 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. SiOerard cerely, Fee Required $ 250.00 This Amount Will Be Invoiced. 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 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. REC? INED i EZflow® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: DERRICK / AUDEREITH Owner's Name: ANDREW AND JOYLYNN AUDEREITH Owner's Address: N/A Legal Description: SW1/4SE1/4S16T28R19W Township: TROY County: ST CROIX Subdivision Name: GLOVER STATION 5TH ADDITION Lot Number: 103 Block Number: ONq~LY Parcel I.D. Number: 040-1268-20-000 ,4 7'YA^IQ Plan Transaction No.: ,QTR FSE yes RVjCFs Page 1 Index and title Page 2 Data entry r Page 3 EZflow mound drawings N Page 4 Lateral and dose tank DFNCE Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 PLOT PLAN Page 10 PLOT PLAN OF LOT Page 11 SOIL TEST 4 PAGES Page 12 POLY LOCK FILTER Designer: PAUL KOEHLER License Number: MP 225410 Date: 06/30/16 Phone Number: 7152462660 Signature: 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, R. 10/12) EZflow Mound Version 3.0 (R. 3/1/12) Page 1 of 12 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design 500.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 750.00 Design Flow (gpd) 2.00 Site Slope 99.75 Installation Contour Line Elevation (ft) 125.00 Contour Length Available (ft) 24.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 9.00 Cell Width (ft) 3, 4, 5, 6, 7. 8, 9 or 10 Only 90.00 = Dispersal Cell Length (ft) 0.95 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation (ft) 6 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 1.50 Estimated Orifice Spacing (ft) = 4.50 ft2/orifice 2.00 Forcemain Diameter (in) 20.00 Forcemain Length (ft)- Does the forcemain drain back? F _.-Y 90.00 Inside Pump Tank Elevation (ft) Enter Y or N 0. cemain Filter Loss (ft) 6.50 em Head (ft) x 1.3 3.26 Forcemain Drainback (gal) /r a~ 1 rtical Lift (ft) tV oid Volume (gal) ion Loss (ft) um Dose Vol ume (gal) Total Dynamic Head (ft) em Demand (gpm) Lateral Diameter Selection eter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.50 1.2 x 2.00 x x 0 mac- x 3.00 x 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1645.00' Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser Concrete Manufacturer gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 1000.00 Dose Tank Capacity (gal) POLY LOCK Filter Manufacturer 22.24 Dose Tank Volume (gal/in) 525 Filter Model Number Weiser Concrete Manufacturer Project: DERRICK / AUDEREITH Page 2 of 8 Mound Plan View T 1/10 B : 3 J Observation Pipe K I♦ 5 A W _ B ::.0.. I L Mound Component Dimensions Down slope toe extension made. A 9.00 ft E 14.16 in H 1.00 ft K 9.27 ft B 90.00 ft F 12.00 in z 11.83 ft L 108.54 ft 12.00 in 0.50 ft J 7.08 ft W 27.91 ft i 810.00 ispersal Cell Area 1875.00 (ft2) Basal Area Available 8.33 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 102.75 (ft) - 1 /{/f//fff//ff//f~!///ff/{fflf/// G 1 F Dispersal Cell 101.25 (ft) Lateral 100.75 (ft)-~ Invert Elevation Dispersal Cell • f . Elevation E ••••...Q: 1 99.75 (ft) Contour Elevation 2.0 % Site Slope Typical Dispersal Cell Shading Key ~ See Page 5 Elm Topsoil Cap > 2.2- o- Subsoil Cap o Approved Geotextile Fabric Cover e 1 3 0 ASTM C33 Sand d" 2.0 ft ®0 Tilled Layer d 'v d F 5Q EZflow Media w U)`r o 0.5 ft 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: DERRICK / AUDEREITH Page 3 of 8 Center Connection Lateral Layout Diagram Force main c nnerAion via tee or cross ro manifold at ana point- Lateral, are identical t~ E P EE - S • = Turn-up v4ball valy^ or q.- %?241 Lateran & force main of PVC Sch 40 c!.?snouip(u~ per SPS Table :34.30 Orifices point up, except every ,60, rrne points down f.)r drainage, Number of Laterals 6 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 1.50 ft Lateral Length (P) 44.25 ft Orifices per Lateral 30 Lateral End (Z) NA ft Orifice Density 4.50 ft2/orifice Lateral Spacing (S) 3.00 ft Manifold Length 6.00 ft Lateral Flow Rate 12.36 gpm Manifold Diameter 2.00 in System Flow Rate 74.15 gpm Forcemain Velocity 7.57 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented f - Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Capacity 1000.00 Gallons T Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 27.84 619.18 B 2.00 44.48 C Pump off elevation (ft) C 5.62 125.06 -t 90.79 D 9.50 211.28 D Total 44.96 1000.00 11 Dom se tank elevation (ft) Bedding And Backfill As Per Manufacturer 90.00 Alarm Manufacturer SJ RHOMBUS Alarm Model Number PS PATROL Pump Manufacturer zoller Pump Model Number 161 Pump Must Deliver 74.15 gpm at 19.03 ft TDH Note: Switches containing mercury may not be used in this system. Project: DERRICK / AUDEREITH Page 4 of 8 EZf/ow® Distribution Cell Media Layout 9.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 9 ft Wide Component Legend ® SR1-7A Bundle - 5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or @0~8 SR3-12H in 5 ft or 10 ft lengths O 4" Perforated Distribution Pipe With Pressure Lateral Inside • Turnup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 9.00 Cell Width - A (ft) 90.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram •z" Force Main - 9 ftWide - - - - - Project.- DERRICK / AUDEREITH it f7~~C Page 5 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name DARRELS SEPTIC Phone 7154251025 POWTS Regulator's Name PAUL KOEHLER Phone 7152462660 System Flow and Load Parameters Design Flow - Peak 750 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 500 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1645 gal Maximum TSS 150 mg/L Soil Absorption Component Size 810 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 ears 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 ears Mound Inspect for pondin and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SIPS 384.30-1, have a watertight cap and are secured in as shown in the EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow 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 De ree Bends Same Diameter as Lateral EZflow Synthetic Media 1.25 Feet Distribution Lateral Lateral Cleanout Project: DERRICK/ AUDEREITH Page 6 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 [EZflowMound 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 manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, 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 filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner 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. "***"No 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 mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly.treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 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. 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 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: DERRICK / AUDEREITH Page 7 of 8 C F o d o r ro . o. c~ m / w ' w I a z o O O Z Q v ~ u / > u a O aw w U- Q 0 O / V) a Ln cn Y " O LNn w U / w lD O Y > a. m r-I ° cL u O a = U O o Lai) Z N N L u Ji w w J 0.::.. w w F- - co a0 Ln C7 U Z LL w Q Z O C) H Z m O w 't } w0 O °o °o a to u .-i a w z O O O w w Y r i J D ~ Z a--1 N Z OC. LL Ou co o m m r• ti a vJ l: N y o w iJV S~ a o cr co _ a. Ln ^ w Yi a_ •.i i'O J 1',! ww .i) w o Ln o . CD U w oo z z co n m ow ° o O Q o 0 ~ a Q J m co w Z w 0~ a ~a Q D J~0 (r -w Z r W UZ Z W 0O ~ p ? ~z g OZ U°oLL U) C) o W w O Q !Y OOO LL ~O a~Inin y a v Z C) WiF Z w 15 LL, FJ5 W ow ~wz az p¢ o E= Ca LLJ cr o J D Q w U- X F- 0 O-1 Y a ° Q U U- co O w co U F- w ~ M a~ Z A s ® X = o o a Z F- O F- 0 I 3 a co Q- o n. 2 7 sip 3 m w ti Y b a~ NZ-66Z M AZ ZSLON Colo b C:) d $~a nnC N x<~ cd 9 G7 h~ `tee I I ca I I d L I co _Ow ' a N Q z SOS f- a I m Z I 3 _O _ i w O N z w O (n J W rnn `-'a C- co W ~ I I Z o- w < L 0- 00 f_ I > Z W "I a IJ LLJ I Z 0 O IY I CD Y cc: o O_ ' Q m ~ Iw I O U j Y of W Iz J O I I m Z J x= U W o ~W c ~C) z W _ C) Q L'86Z 3„bZ,617,TON sit ao. 1 OF 1 PUMP PERFORMANCE CURVE wIw PUMP PERFORMANCE CURVE PUMP PERFORMANCE CURVE SUMP 1 EFFLUENT MODELS LL EFFLUENT MODELS 318", 112" & 314" SOLIDS PASSING CAPACITY , 160 318" 1/2" & 3/4" SOLID PASSING CAPACITY I 53155 a2 MODEL 48 g7/Sg 72 76 98 1371139 140/4140 151 152 153 3 191 Feet Meters Gal. I Liters Oal. Liters Gal. Liters Gal. Liters Gal. Liters GaL ter6 Gal. Liters Gal- Liters Oal, 'Liters Gal. Litem i 6 13 5 1.5 29 ?10 43 163 38 144 50 189 72 273 1 93 352 86 326 50 ' 189 69 261 '7 291 10 3.1 22 93 34 129 30 114 40 151 61 231 79 299 80 1 303 45 170 61 231 70 265 3 12 15 4.6 10 38 19 72 14 53 30 114 a5 170 64 242 73 276 1 38 144 53 201 61 231 20 _ 5.1 17 64 25 95 36 136 66 250 29 110 44 187 52 197 ' 8 30 59 223 I 16 61 34 129 ' 42 159 3 120 38 25 7.6 j - - - - - - - _ _ 49 185 - - 23 87 33 125 4186 30 9.1 11 40 12.2 3 1101- 50 15.2 I 50 18.3 - - - - - - - - - - - - - - - - 32 1070 21.3 80 24.4 - - - - - - - - Too 90 27.4 - - - - - - - - - - - - 3 100 30.5 - - - - - - - - - - - - - - - - - - 95 110 33.5 - - - - - - - - - - - z 120 1 36.8 - - - -9 - - - - - - - - - - - - - - - s6 130 39.6 - - - - - - - - - - - Ti - - 2 95 Shut-off Hsad 18 ft.(5-5m) 19.25 IT 5.9m) 18 ft.(5-5m 25 It 7.6m) 23 ft. 7.Oml 26 ft.7,9m) 50'u15.2m1 ft.(9.1m1 1 38 ft. 11_bml 44 ft. 13.4m1 ¢ 80 24 4165 i 75 0 22 1, 16114161 16314163 1 16514165 5/4185 1 186/4186 18814188 18914189 191 9 o 4683 Gal. Liters Gal. Lifers Gal. Liters Lit Gal. Liters Gai. Llers Gal. Lters Gal. Lifers 2 65 F:1379 fit 231 61 231 - - 58 220 145 549 145 549 I 45 170 _ 93 1 352 61 231 61 I 231 - - 58 220 140 530 140 530 45 170 80 85 322 60 227 61 231 - - 58 220 134 507 135 511 45 170 1 16 4689 79 299 59 223 60 227 - - - 220 128 l 484 1 131 496 1 45 1 170 55 70 265 57 216 59 223 - - 58 220 122 462 I 125 473 45 170 1 140 62 236 56 206 58 220 85 1 322 58 220 111 116 1 439 120 454 46 t70 50 6140 188 45 170 46 172 55 206 70 285 58 220 104 394 109 ,13 45 1 170 4188 20 76 33 125 50 189 51 193 58 220 90 1 341 ' 97 367 - 45 1 170 14 45 _ 15 57 39 148 32 121 58 220 71 269 85 322 45 170 j 23 87 1 9 34 52 197 51 193 69 261 45 170 12 6 - - - - 10 38 - - 45 170 26 108 51 193 45 170 152 153 - - - - - - - - 31 117 2 8 34 154 40 151 35 15 - - - 30 714 3 6185 _ 10 38 25 569.(17.tm1 661L120.1m) 899.(28.4m) I 73 ft-(22.3m) 1149.(34.7m) ! 919.(277m) 110 ft(33.5m) 1379.(41-dml 98 15- 009922 4 i CAUTION Model 185/4185 should not be subjected to less than 30 feet TDH. 48 72 53,55 7s 137 NOTE: For PUMP Performance on Model 112, Industrial column 57.59 9 o 10 20 30 150 explosion proof pump, see FM0219. d0 50 60 70 90 90 100 119 120 130 140 GALLONS LITERS 0 80 160 240 320 400 480 560 =LOW PER MINUTE SEWAGE AND M°°EL 211 264 266 267 268 27014270 28214282 20414284 29214292 29314293 29414294 295/4295 i-F 51, 1 '12 DEWATERING A 11 1 317 31, 1 "1 r, 34 3 21 3c 211 11 7al 21 l A 211 11 21 z I E5 1 1 - zoj, se - - 1 Ks~, ,wsEm ~5~~ s.m 60 7- 009904 m a a I w i i i 6- z 4 D dG X93 40 PUMP PERFORMANCE CURVE 0~1 SEWAGE MODELS 30 1 II 1 1 C APA P 2>> CAPACITY 1 SOLIDS PASSING C 260,E X82 O'I 3J 20 257-. 4 not be - ®CAUTI - - -21 4 i 162 284 2941 ~ 295 ~ Mode( 293/4293 should I 1 I 15 feet TDH. less than ed to sub(ect 10 20 30 40 W 60 70 30 90 CO ' 10 20 130 '.40 150 16C 170 180 190 200 210 220 23 GALLONS -r-- LITERS 0 30 '60 240 320 400 480 560 640 720 800 FLOW PER MINUTE © Copyright 2003 Zoeller Co. All rights reserved. 6 r Inc. FOIDLYAN1460,X Innovations in Precast, Drainage Zabel" PL-525 Effluent Filter & Wastewater Products A Division of Polylok Inc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent wont leave the tank. Features: 1/16" Filtration Slots • Rated for 10,000 GPD (gallons per day). Alarm Switch (Optional) • 525 linear feet of 1/16" filtration. t . • Accepts 4" and 6" SCHD 40 = Accepts 1" PVC pipe. Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for 10,000 GPD • Accepts PVC extension handle. f PL-525 Installation: Ideal for residential and commercial waste flows up to 525 linear Ft. 10,000 gallons per day (GPD). of 1/16 1 Filtration Slots 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. Accepts 4" & F 3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 0 Ce=f"i 5. Replace and secure the septic tank cover. NSF/ANSI PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for fseveral years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned°aevery time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified bar an alarm when the filter needs servicing. Servicing should be done by a certified „ Gas Deflector septic tank pumper or installer. Automatic Shut-Off Ball 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Outdoor smaitPilter> alarm Extend l,crk~ Polvlok, Zabel & Best filters accept Easily installs 7. Replace and secure septic tank cover. ` the SmartFilterJ switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com RECEIVED ST. CROIX COUNTY 0 U L 2120'16 SEPTIC TANK MAINTENANCE AGREEMENT AND ST. CROIX COUNTY OWNERSHIP CERTIFICATION FORM 'OMMUNITY DEVEI-PMENT Owner/Buyer Mailing Address > C Y~ r fl ~ ( 1j +Q~ 1(Ca Property Addresses `ti Ss~ (Verification required from Planning & Zoning Department for new constructio City/State tl t-( Parcel Identification Number l 2-''CSC 1.~ LEGAL DESCRIPTION Property Location' ' W /a , '/a Sec. , T N R W, Town of f'? Subdivision 1 7~ Cam - cK4 1 i~ I"T I J ,4 ,Lot # 10 J Certified Survey Map # , Volume , Page # Warranty Deed # C w rj , Volume , Page # Spec house y no Lot lines identifial5iry~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 WComm. 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 the 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 & Zoning Department within 30 days of the three ye expiration date. Uwe certify that all statements on this orm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a wa ty deed recorded in Register of Deeds Office. NumbeSIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey trap if reference is made in the warranty deed. (REV. 08/a5) I ` N 88.10' 36" w 390.00' W, ANDS ..om g 33 33' L _ L49.49' _ ;L20,58- 1 " W y 50 2 N i ° 10' 38" W 2.9 r r+) Lea 82 l - . CHATTANOOGA DR 2.734 ACRES S 88.1038" E 7574 lot h ~ 119.071 S.F. EASEMENT i ~ = ~ / ~ i ~ 10.00' VD 77 N TEMPORARY CU.OESAC it 58.68, 86.00' EASEMENT. SEE NOTE 4. 7.13 234.00,' j DANCER 22.22~0i -jot I : 's,0, N 88.10' 6" W 300.0 ' RCLE s 86.10' 36" 300.00' I -t'i 1 0 1 0 , 2.535 ACRES 9 ti i 3 '10$-73' .$6~5r - 110,405 S.F. h w " 100 :7.12' a 2.503 ACRE S, - r~ + 109.038 S.F. ' z 103 102 a 77 I x.511 ACRES , 1 t 2.68 ACRES I 109.398 S.F. 1'SK1 50 117,053 S.F. ~,1 . ' ..481.85 220.04' W17'30" W 1318.93' S 1J4 CORNER TT228 R 199 UNPLATTED LANDS (BERNTSEN CAP) 'g -Ekn" mow RECEIVED JUL 2 7 2G to sT CROIX COUNTY COMMUNITY DEVELOPMENT - - - - ~u++armmurnanMe Lions avr~. AIVU SITE EVALUATION REPORT ision of salary s BcdlcSngs Page J of o 3 In accord with ILHR 83.05, Wis. Adm. Code UNry Attach complete site plan on ~ Paper not less than B 12 x 1 t inches in size. Plan must include, but, S" r' C,CZ f} 1x not limited to vertical and horizontal reference point (W &&ctfon and % of slope, scale or c4 mensioned, north arrow, and location and distance to nearest road. ' AARCEL I.O.Ir i APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION d BYZ $ O PROPERTY owNEFL 6 Zg/I C PROPERTY LOCATION C CUB L -7-Z r.'9~¢..6G9 ,,i,,•S 1t4 F ;OPERiY OWhtER' MAILING ALlOFIESS. Z 114 T NR I El Z S CLI U 1ULOT 9 ~ BLOCKS SU80. EDP -D2LUe tN LME ORCS1r1 Cl7Y=STATE ' 11 ! I VE FIIONE NUMBER [jCfIY QvILIAGE G u S D ~ti k3 ~ 5 o'L ri 155) 4 is - al 61 ~ tnNN ' tqlp ST ROAD $fl New Canstrttc[an use R ~"?PiR-C' ~Uttp~, p2, 6d i~ 113,;m6er of bedrooms . 4 f } ReplaMffd f j Pu* or =Mrdai desmbe (}Add, to existing ll---- - code derived dally flow bsp spd . Recommended design loading rate- • bedgpdfltz gpW AbsoMlIon area regdred Su4 bed, ft2 Soo trends, 42 - &Umcml design foaang race Recommended infiltration swfam etevatcWO) 1b0,1 S (as 001 2--' tr .9PrNt2 AdUmaidesign Isb 0011siderdons; MOUN-b W 8 ►~Q A referred- site pin bendtmark} Parentmateriai L.Crc59 4V ih~ . t~ a~ $L_ t:..I . S ~ Suri~e for system colave~r~, Fkod ' elevation, I applicable 4~.1 ~ 6 Cf . Unsalable for Q S Rl u mmom 9V GROfJNp PAE55ilRg AT•GAAt1E SY5T8rt Fti Q M III _Q ~U 11 S Mu I ❑S 8fU Q~ ®U SOIL DESCRIPTION REPORT ®G Boring 1f Horizon Depth I Dominant Color Moines Structure Munseil Qtl. Sz (;ont Ill Texture GP!}ift ~ •ti-1 } tiD 2.31' Gr. Sz. Sh. Y Roots ~ Z lt-z~ tib~2 ~!6 _ lr Lf TI 1 iA un g4-Z ft: 4.Z-f-z S L2 23 IV 7-31t Do* to Remaft: Boring # J c5 -t 0 1LjLj R ~l 2 Z 10-zt? L4 Lc~ 3Ib - L 1 cs}~ y Is V 3b4s ~~l- ~S r 1pp.S a Litz av svp-S o,, pxs -Ph . I b Remarks- --Please Prtnt Arthur L. We erer Pae715-425-0x65 re r Soil Testing & Desdgn Service-?.0, Box 74 River .Falls=WI. 54022 . t~ 103- t u 3 t3ate S,~ e} -0 CSTNuaber 0 220254 - - - - - - - - - - - - - - PfOPF-STY OWNER g ,,UFy y,•2 PARCEE.tO-ir SOIL DESCRIPTION REPORT TJf Page ? al 3 Boring Horizon Depth DOMMant in Cvior Munseit Qu. S CortCAla . Texture Structure 0-1-2 1 oy i7 3 t z Gr. Sz. Sh. Consistence e« ~y floats GP D/ft t~- ~~sbh wL rn...... 12=7 2 i D'-l 1Z 311 Bed - ~-.3 SI I L t~ S~al2 .G Ground SYtL31 ~S - 6 elev. ft' Lf IZ -31 -S Depth to C1h-, limlltng 2 i •3 .S[ factor Remarks: Boring # Ground elev. ft "epth 10 bmiling factor Remarks: Boring # Ground elev. f t, • ]epth to . Imiting actor Remarks: 3r ing # - )und V. ft. iUJ 10 Ing x' Remarks; . PLOT PLAN Page Z of SCALE I,,= Sp P12 L-~VtLt~~`12 bt~1U 'h0 tJ11T L'b1 lp OR 1 i • h t5'tvct,p 'efts ~rec~q 4a ^tS. 1 ' i Pi 00 -103- Ida C575Pgna"vret 3,-~}-Q(~ Z2ozSY - Qate 51 gned{7~ • TeteRhone No.