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008-1077-50-050
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT Sanitary Permit No: St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) 589781 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] State Plan ID No: Permit Holder's Name: 2740606 Ken & Alison Werner City Village Township Parcel Tax No: CST BM Elev: Insp. BM Elev: BM Description: ~ TOWN OF EAU GALLE 008-1077-50-050 I too , -0 ~ 4*-- Section/Town/Range/Map No: TANK INFORMATION 27.28.16.404A TYPE ELEVATION DATA MANUFACTURER CAPACITY STATION B HI FS Septic ~ EV~ O i IN• Benchmark Dosin v / 2 ~O O Alt. BM n t( Idg. Sewer S Ht Inlet ~c I 1525 TANK SETBACK INFORMATION) St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1-.-% -~t TL T Dt Bottom q. 2 Dosint0 I J~ Head /Man) Aeration ist. Pipe Holding - Bot. System PUMP/SIPHON INFORMATION Final Grade 1T Manufacturer R Demand St Cover ° Model Number GP 1 ~'J QQ / TDH Lift Friction Lost I System Head I v TD UAL Forcemain Leng h Dia. Dist. to Well . t SOIL ABSORPTION SYSTEM BED/TRENCH Width / I Length DIMENSIONS to 1 No. Of €xerrcttes- J t IT DIMENSIONS No. Of Pits y Inside Dia. ~1t i} SETBACK Liquid Depth ~ SYSTEM TO --f" INFORMATION P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Type Of System: f i t S~~ R ( CHAMBER OR UNIT del Number: DIST N SY T M- _ r~1N ZbJ' - W), Hea er/Manifol 'stribution Pipe(s) I 1 x Hole Size ' , x Hole Spacing Ve Air Intak Length Dia ( Length V Dia /Q SOIL COVER ~ spacing U ~ ~ ~U M ~ X Pressure Systems Only Depth Over Depth Over xx Mound Or At-Gra e d Systems Only 4 ! Bed/Trenc t xx Depth of xx Seeded/Sodded ` , Bed/Trench Edges ~ Topsoil 7 ! ~ xx Mulched 1 ✓I C i i Yes No es No COMMENT : (Include od~j'~ iscrepen ies, persons esent, etc. CV~ `v Q~r^ Inspection #1: ~ • I ~ Inspection # Location: 13 250TH ST ~J T)LON C . ~ j9)X/ 1.) Alt BM Description 1 Tev- coV ~ T 1 2.) Bldg sewer length - amount of cover = \ '1`~ CCU` 0n VIt' I-S~ ~P✓ ~~UMbe\ Plan revision Required? 'I Yes V 'Na 0 Use other side for additional information. ~Q i {J SBD-6710 (R.3/97) Date - Sgnatu L \ Cert. No. i CQ/e. / een /OffO ~~/L ,$6• ,'o!•c Co.rkaa/ I l Add 1G8'2S0St • 0~~u6bse{f tJ;crXrCw,c!'o~e /o~•o' 1030' r- { \ ~ S EY4( ,5 el S' ¢ . 2 7 r-204 y W L/a / ~G SD C'L,.a b n a ~i o+ ~i Tn.o-FEaKEa/k, • St. Croix Co; i.J/• 5.7~i4C. Y /'ol loK~L SCs' v 006 -/077-5v- Osv P /u Nr~ cry e s./_ rru. ,6. ( i • '~1 ee~"n 39.St) acres ~":5C vaU ,frw- /7,95J?✓C. ' E~• S Ern ~ ~ d ti- 'S• rU i r Q ~a 7 wleA%a-~ Y"14 ST,4 3#.1 3 /.T 92 l ti. wQy `*~cS~ o,~ eX~~u/ i'~S,a[a"ree. ~1~'{gym e ~el~Q~cYr~ V~~Gh CGLI~' ~GG~/Q C~ 6L~✓ ~a.7 /CO~' .~.>v'E.r' _ ~[r. b 14 r~.3.rr1. EFF/u~,Elir,1~ ho/rte =/c7 b' ' ScP E' ~ 1 ~ i /e 6 03, f ~,,,~~v Can fiv 6ULt_urrt Comity Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53 7162 ST'WITV COUNTY DEvELOPMENT ~PSP ✓c State "transaction Number Sanitary Permit Application I_181 ,C4 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the tppiopriatc gocoil.. _ 4 C, 27 4 6420 is required prior to obtaining a sanitary permit Note: Application forms for state-owned POW I S u submm I project Address (if different than mailing address) the Department of Safety and Professional Services. personal information you provide may be used for secondary purposes in accordance witl the Privacy Law, s. 15.04(1)(m), Stats. Sallie 1. Application Info r lion Please Print All Information ~ V l7 ~~JCJtI''~t ~ Property Owner's Name Parcel # Ken & Alison Wenner 008-1077-50-050 Property Owner's Mailing Address Property Location 7„ , 168 250" St. Govt. Lot City, State Zip Code Phone Number SE NE Section 27 (circle one) Woodville, WI 54028 (715) 220-5980 T 28 Ni R 16 E or W It. Type of Building (check all that apply) Lot tt ❑ I or 2 Family Dwelling Number of Bedrooms Subdivision Name Na Block ~ Na '34T. J G>~ ❑ Public/Commercial - Describe Use Na ❑ City of ❑ State Owned - Describe Us' CSM Number ❑ Village of Na ❑ Town of Eau Galle IIL Type of Permit: (Check only one ox on line A. Complete line B if applicable) A. ❑ New System AR-Placement System ❑ TreatmenUHoldiug Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Pernit Revision ❑ Change of Plumber I] Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 1 IV. Type of POWTS System/Component/Device: Check all that apply) d ❑ Non-Pressurized In-Ground Pressurized In-Ground ❑ At-Grade ❑ Mound - 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: PolyLok P;-525 effluent filter to be installed at ST outlet. Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Require/OP Dispersal Area Proposed (st) System Flevatio 1.0 Gpd/sq. ft. ASTM-C33 sand 104.33' atKabove 450 Gpd 0.5 Gpd/sq. ft. native soil 450.00 sq. ft. 480.00 Sq. Ft. 103.00 contour VI. Tattle Info Capacity in Total 4 of Manufacturer U Gallons Gallons Units o New Tanks- Existing Tanks 'd D P, U in " ~ Ci i~ P ~ Septic or Holding Tank Na 1,000 1,000 1 Wiese Concrete X Dosing Chamber Na 650 650 1 Combination ST/PC X VII. Responsibility Statement- 11 the undersi ned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pit be s Signatur MP/MPRS Number Business Phone Number James K. Thompson _ MPRS 30021 (715) 248-7767 Plumber's Address (Street, City, State Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIII,Countv[Department Use Only % oel ~ Dat Issued to Issuing nt Signature Approved [I Permit Fee 1'E~hm o. m Reason for Denial 1 40-66 1 Y~ IX. CondilMT4V*fWVNEi*`Reasons for Disapproval /6 vrs .t ~ JA. p~J 3, L0 ~5 V 1. &eptio tank, effluent filter and disperrsli cell must all be seiNk:ps ! nu nt°,_nes' as per malragement plan prodded by plumber. 2. AN iper a requirements must be rtatntr tried a per #ppli \ n r r~~d/ n ctlblis code / ~~rdinance3. J\\ 4` IX 1/Je. v off` Attach to complete plans for the system and submit to the Countyap~ not less S 111, es in siye SHD-0 398 (R. /11) 4> ~ old sbee,,, 4 V be, a~lo "AP "'u :5) ' I S c4/e /fin f/.¢/~SQh ~errtel /DAD vn.ga/e SE•• lol.oC~.rbd~/ o~ulin cJ/, S,/0 °Z :S:fc/ldcl : /Gb,Z~~St • / 0~-. 0' S EVv s e. a 7, 7-2a,(. i G~1 k,iGcv, Tn.OeEaKQ/ky D 56. croj" co. (J/, t 1 %oc/'~ova-1077-sQ-osv 2-l'A 39.5 7 acres 1 p E~-, S Erh ~ ~ ``C~ `V propost d cc~; esc~ Conc, j ~ cf Pas%dee7ce w-1-5'O tQ/~w•+c~G{.a,K6..- 41 ♦~w~~ J ~Pa~o( acax` o1L~ c '1 E IA of ~SE;nta Ltd ele✓ a-6 h n bu%/d S;t e = 1is, vt~ Ij h W~ ~~AI~IC_ ASTM/3 303Ci h e FFIu c„ t l~ a e ~ ~ O C Z ,~u14 57'Hq L) ;~a3 {we,. J Q`0 h 33w r 3 bcdreta, f rcc ~t4;n 92 oa Rcs~'de.~ce ~ ~ 1 (~/eP~sed ~,.7;ese~ Po„er.e~t e.J-t,uvo y~►,p O {l~`r ~;9srn+ ~zCLS/?J.C.i'l d O .e y F~~~~ ~rfde/ Q, I • ~le `c'4y Residential Mound POWTS Index & Title Sheet Project Name: Werner 3 Bedroom Mound Owners Name: Ken & Alison Werner Owner's address: 168 250th St., Woodville, Wi 54028 Site address: Same Project Location: Subdivision: Na Legal Description: SEYNE%, Sec. 27, T.28N., R. 16W., Town of Eau Galle, St. Croix Co., Wl. Parcel ID 008-1077-50-050 Page 1 Index and Title Sheet Page 2 State Approved Mound Design Page 3 Treatment Tank Cross Section Page 4 Filter Specifications Page 5 Septic Tank Maintenance Agreement Page 6 Warranty Deed Mate Plumber Res icted Service: James K. Thompson, DSPS Credential #30021 Signature: _ Date: Page I of 6 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS. version 2.0 SBD-1070 -P (N.01/01) ~tiPARTd~.VT DIVISION OF INDUSTRY SERVICES a$ 3824 CREEKSIDE LN U ~ 3 j s a HOLMEN WI 54636-9466 Contact Through Relay 0 http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Sf ONT Scott Walker, Governor Dave Ross, Secretary July 28, 2016 CUST ID No. 30021 ATTN: PO WTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSEN LAKE LN 1101 CARMICHAEL RD OSCEOLA WI 54020-5413 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/28/2018 SITE: Ken & Allison Werner Identification Numbers Ken Transaction ID No. 2740606 168 250TH St Town of Eau Galle, 54028 Site ID No. 668688 T T Croix County Please refer to both identification numbers, SE1/4, NE1/4, S27, T28N, R16W above, in all correspondence with the agency. FOR: Description: Three Bedroom EZFlow Mound System / Sloping site Object Type: POWTS Component Manual Regulated Object ID No.: 1613393 Maintenance required; 450 GPD Flow rate; 20 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. OONDITIO No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, APPRO stats. DEPT OF FA The following conditions shall be met during construction or installation and prior to occupancy or use: PROFE$$IC Reminders DIVISION OF IN z • 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. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made ith SEE -C+; . ' 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. Page 2 7/28/2016 JAMES K THOMPSON Owner Responsibilities subsequent owner, shall receive a copy of this letter including instructions relating The current owner, and each 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. Fee Required $ 250.00 Sincerely, Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim WiSMART code: 7633 POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm jerry.swim@wisconsin.gov 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. JAMES K THOMPSON Page 2 7/28/2016 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 ~Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633 (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm jerry.swi-in@wisconsin.gov 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. RECEIVED i ~ r ® ~ n erg., EZflow MOUND AND PRESSURE DISTRIBUTION COWidktNT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Werner 3 bedroom replacement mound Owner's Name: Ken & Allison Werner Owner's Address: 168 250th St. Woodville, WI 54028 Property Address: 168 250th St., Woodville, WI 54028 Legal Description: SE1/4 NE1/4, Sec. 27, T.28N., R.16W. Township: Eau Galle County: St. Croix Subdivision Name: Na ULLY ✓ED Lot Number: Na Block Number: Na ED AND Parcel I.D. Number: 008-1077-50-050 SERVICES TRY SERVI'" Plan Transaction No.: Page 1 Index and title Page 2 Data entry - Page 3 EZflow mound drawings (77 Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Site Plan Page 10 Attached Soil Evaluation Report Designer: James,K. Thompson License Number: 30021 Date: 06/14/ 6 Phone Number: (715) 248-7767 Signature: rJ 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) Pagel of 10 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%) 450.00 Design Flow (gpd) 9.00 Site Slope 103.00 Installation Contour Line Elevation (ft) 105.00 Contour Length Available (ft) F 20.00 Depth to Limiting Factor (in) 0.50 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 6.00 Cell Width (ft) 3 4, 5 6, 7 8 9 or 10 Only 80.00 = 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 Y Pressure Disribution Information network? Enter Y or (c or e) C Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) =E=U0 ft 2/orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 95.00 Inside Pump Tank Elevation (ft) Enter Y or N 0.00 Forcemain Filter Loss (ft) 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 8.83 Vertical Lift (ft) 49.95 5x Void Volume (gal) 0.92 Friction Loss (ft) 56.47 Minimum Dose Volume (gal) 16.26 Total Dynamic Head (ft) 32.95 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 646.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 17.00 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information Filter Manufacturer 646.00 Dose Tank capacity (gal) ;xEEE] 17.00 Dose Tank Volume (gal/in) Filter Model Number Wieser Concrete Manufacturer Project: Werner 3 bedroom replacement mound Page 2 of 10 Mound Plan View T J 1/10 B Observation Pipe K ~-T TA 5 W I.. B z L Mound Component Dimensions A 6.00 ft E 22.48 in H A6.69 ft r< U ~ f i rt B 80.00 ft F 12.00 in 1 ft L 101.62 ft D 16.00 in G 0.50 ft J ft W 26.56 ft 480.00 (ft2) Dispersal Cell Area 1589.04 (ft2) Basal Area Available 5.63 (gpd/ft) Linear Loading Rate 8.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 106.33 (ft) > G l F Dispersal Cell 104.83 (ft) Lateral I. ; 104.33 (ft) 6, ►I - Invert Elevation Dispersal Cell . Elevation D " ~l A 103,00 (ft) Contour Elevation 9.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 Elm Topsoil Cap a o .a 7 App 2 0 Subsoil Cap o N o 2.0 ft roved Geotextile Fabric Cover ASTM C33 Sand ® Tilled Layer ( s 5 F 05 EZflow Media s N ) 0 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: Werner 3 bedroom replacement mound Page 3 of 10 Center Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below Fort,- main cow)oouoh via t*o of troS. to m5n4oid w any pent. Lafdr alY and idomic of ~~rifices point u, e;<Ct {~i e, er 5ih onp point cto vn for Ural~~zs. •_Turn-up•rtbaIIvalveor X =,~~x72 ~ rf2il LaCera4sSforQ~rnalnorPl~CSch4f.~ cl aa n oul pl u a per SP$ Table 384,30-5 Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 39.20 ft Orifices per Lateral 20 Lateral End (Z) NA ft Orifice Density 6.00 ft-/orifice Lateral Spacing (S) Agpm ft Manifold Length 300 ft Lateral Flow Rate gpm Manifold Diameter in System Flow Rate Forcemain Velocity 3.37 ft/sec Dose Tank Information Locking cover with warning label and c sealed watertig r_: r: Electrical as per NEC 300 and SPS 316.300 WAC 4 in. m n Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacity 646.00 Gallons -T Volume 17.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B Siphon device A 20.68 351.53 B 2.00 34.00 C Pump off elevation (ft) C 3.32 56.47 96.00 D 12.00 ! 204.00 D Total _ 38.00 646.00 Dose tank elevation (ft) Bedding And Backfill As Per Manufacturer 95.00 Alarm Manufacturer SJ Rhombus Alarm Model Numbe ,SJE 1011421 __~J_ Pump Manufacturer Zoeller Pump Model Number~BN151~ Pump Must Deliver 32.95 gpm at 16.26 ft T D H Note: Switches containing mercury may not be used in this system. Project: Werner 3 bedroom replacement mound Page 4 of 10 EZflowo Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 6 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 J f - SR3-12H in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or 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 6.00 Cell Width - A (ft) 80.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram A-- Force Main 6 ftWide Center Manifold - Project: Werner 3 bedroom replacement mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name FsJ a_e_s_K. Thompson POWTS Regulator's Name Croix County Zoning Dept Phone F71 ) 3 6- 468 6 ) 386 0 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 Septic Tank Capacity 1000 gal mg/L Soil Absorption Component Size 480 ft2 Maximum TSS 150 mg/L Type of Wastewater Domestic Maximum FOG 30 mg/L Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean as necessary at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested every 3 years Mou nd inspect for ponding and seepage once every 3 years Hher 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 EZf/ow 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 Degree Bends Same EZ11owSynthetic Media 1.31 Diameter as Lateral a. 1 Feet - Distribution Lateral = Lateral Cleanout Project: Werner 3 bedroom replacement mound Page 6 of 10 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 [EZ#ow 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 manhole risers, access risers and covers should be inspected for water tightness and sounaness. 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, Stars. 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 S stem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound snail 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 of 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 latera be flushed of accumulated solids at least once every 3 years. When a pressure test is performed it should be compared to ;nt inin~j es. when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equa distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the r any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. 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. PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 1511152/153 PER MINUTE 5o EFFLUENT AND DEWATERING 4 45 153 12 40 MODEL 151 152 153 35 152 Feet Meters Gal. Liters Gal. Liters Ga. Liters 10 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 0 9 2 151 15 4.6 38 144 53 201 61 231 M 20 6.1 29 110 44 167 52 197 6 20 y 25 7.6 16 61 34 129 42 159 ~G•~G 30 A - 23 87 33 125 D, 5 35 10.7 - 22 85 4 12.2 - 11 42 10 ui-off Head: 30 tl. (9.1mj 38 tt- (11.fim) 44 ft. (13,4m) dl- el 10 2,0 30 4o so 60 7o ao eo 1 C cxLOr+s LRF32S 0 40 6p 1 0 200 240 260 3 3 ^ FLOW OW PER MINUTE d,t Model 151 1\ Models 152 1153 32.96'~PM s~,yr1'y 1 CONSULT FACTORY FOR SPECIAL APPLICATIONS 67132 3 718 4 5re 3 27732 4 5A Tuned dosing panels available.__ i Electrical alternators, for duplex systems, are available and J 718 3 2132 supplied with an alarm. Variable level control switches are available for controlling ® S 7re 3 27'32 single phase systems. t Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed QWIk-Box available for outdoor installations. See FM 1420. Over 130'F. (54'C.) special quotation required. i 1 ~ 121re 151/152/153 Series 151H521153 YODELS Control Sdsctlon s ,a Yodel Volts-Ph Mods Amps Sim ex Duplex 43A N151 115 1 Non 6.0 1 2o(3 BN151 115 1 Auto 6.0 Included 2 of 3 t E151 230 1 Non 3.2 1 2 a 3 BE151 230 1 Alto 3.2 Ind, 2 a 3 SK2444 SK2064 N152 115 1 to 8.5 1 2 a 3 BN152 115 1 Auto 8.5 Included 2 o r3 E152 230 1 Non 4.3 1 2 of 3 3 BE152 230 1 Auto 4.3 Irxiuded 2 or N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 ncluded 2a3 SELECTION GUIDE E153 1 230 1 Non 5.3 1 2 of 3 BE153 30 1 Aulo 5.3 Included 2 or 3 1 Single piggyback variable level float switch or double piggyback variable level float o CAUTION switch. Refer to FM04T7. All instaration of controls, protection devices and wiring should be done by a qualified 2. See FM0712 for correct model of Electrical Alternator E-Pak. rcensed eie,mcian. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 LouMv lb, KY 40256 0341 Manufacturers of P T0: J649 CanRun Road HI L2 111 86 1 1f5S 02) T7"2731.1 (800) 828 PUUP hrrpl/www.me1Iercom PUMP LO. FAX (502) 774.3624 © Copyright 2004 Zoeller Co. All rights reserved. 9'0 00 Cod .00 i i I~ /DAD ~iC SE. &10o din, cJr. 6-9(0 oZ f S%te Add : /Gb SE{'vSC,'V, Spa . 27, r-284,, • SC. Croix Coy L.)4 > B1 P' 008-/07'7-SO-060 bea'„ 39.Sv acres 2 EX "SErh9 A-dpo3td uo escl Core I o v t,~•~5arr1 Q~ou-~cro G{.a,K~..- i s o ~ Pas.'d~ce r i/y~,4sTn~-Dz~GSO✓,c. 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PUSH ROD OPENING I oe - I i E,;rl ~ c I 1 - 12c.r I - b of e> I I i f 1904 'I 22 b'. I I I I E i I I i I , 'v POLYLOK PL-525 FILTER CARTRIDGE PART NO - 30141-525 MATERIAL - POLYPROPYLENE ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Ken & Alison Werner Mailing Address 168 250th St., Woodville, WI 54028 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 008-1 077-50-050 LEGAL DESCRIPTION Property Location SE 1/4 , NE 'r4 , Sec. 27 . T 28 N R 16 W, Town of Eau Galle Subdivision Plat'. N a . Lot # IV a Certified Survey Map # N a -,Volume N a Page # N a Warranty Deed # (before 2007)Volume . Page # Spec house ❑yes lno Lot lines identifiable [I yesOno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its preutaturc failure to handle mistes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What cou put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owncr 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 ovvraer and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site ;,aste~~atcr disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessarn the septic tank is less than ll_, Dull ol'sludge. 1/\yc, the undersigned have read the above requircrnents and agree to maintain the private sewage disposal system vNith the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural [Zcsourccs, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retUuned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this orm are true to the best of my/our knoiylcdge. l/~~c au>/arc the o~~ner(s) of the property described above, by virtue of a Warr my deed recorded in Register of Decds Ol tice. Number of bedrooms 3 A / 6.1f...".~_ SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map it reference is made in the warranty deed, (REV. 04/12) ~i o -L oQ Cu rc~ X: m Lu x b O ~ Vz Z a 0 o U W a a W z W 5 O a :y I I I W sD ~.n H I Aix OGO O/ Lo C oo~ i ~z I Cl V V7l WED ~ I p n I a~ ~L V I AF ❑0 Z I ¢W ~~I--1 I Q H o? W Q k3) I u W J I QW F-~ / So: I J I 1 3W i`H . WJ I W r3u F- w 9~ ~J M- Lil I , o l W A 03 ~ y I I I o I r~ Z o ;W W Z_ > L'i I H I ► I W ZL _ W \ UO J t J JH t) W w LO Zz c0 r y y y ~A 0 d Y~ CD y Y e a cv m ~ cu cu Yon Aa M yy 0J o Mill ° ~ o W Q Q r o .0-,LZ Uv ~ ~ O Z D X O o F _ O X AM NIl ~ ~W ~ ~ ~ ~ W PD o W C: o W 0 p V] < m o ~ A o o nF ; ~ o D" 0ON 2 ~ ~ p 1 C) 0, Q' [u C3 F' ly N Vj w z: LO X CG U0W n'.I H O x rol < ~J In W tom E:.-AWWOOpW~AUm o~OFOzwwz a~6a~oz 1 Fzi=Oy W~ "O i U X ~~tAx6a W X 33 Y W 0, U CC m 2: 0 C7 i7 iu ooz ~ aAL)w U o Q~r W f~d0.~WA0 O~ za C1ru Q~~adWZU~ X a F? g amwl,.M 0 ~m z ID N~ J oz 30 Z i J d (nW0.+ "7~EEwA NW q x m 03 Q O `OUGtAZOF'Wgz vj Z WAp mu `F~0.fn'J OFsjG fs. n ^ 3 _J lJwzWf>~ CC'N 771777 0 1d0 LuOz ~O U~ E- f- Cl) zazvaio ale got 1 1 c - ~ S e i i Vd"S a~ v 81 i f a ♦'~1 92 • ss N ..s, 1 ~ Y w i I 1 ' • 1 4jo j RECEIVE _ Wisconsin Department of Commerce D SOIL EVALUATION REPORT K ivision of Safety and Buildings Page of NOV it34o@@ with!Comm 85, Wis. Adm. Code Attach complete site plan o pap no less than 8 1/2 x 11 inches in size. Plan must County -7 include, but not limited to: v rticar #@ ekence point (BM), direction and percent slope, scale or dim F Parcel I.D. t~' , t#nd locati'wand distance to nearest road. j <11 n " I Please print all information. Revi ed by Date Personal information you provide may be used for secondary pumoses (Privacy Law, s. 15.04 (1) (m)). Property Owner I~ Property Location JJ 64 1/4 ('•~`1/4 S - T u N R E (cr)' Property Owner's Mailing Address Lot # T11 lock # Subd. Name or CSM# City State Zip- Code Phone Number „ J, J~J~~ ~ ❑ City ❑ Village Z] Town Nearest Road Q New Construction Use: B Residential /Number of bedrooms Code derived design flow rate ~J GoD ❑ Replacement ❑ Publi or commercial - Describe: Parent material Flood Plain elevation if applicable _ N ft General comments _ and recommendations. L i U I_• S 1:,--, 3 Boring# ❑ Boring (AS4.&MbS tD E:r-3• MY Q Pit Ground surface elev. 1 0 L ft. Deo limiting f for • Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots Soil Application Rate , Z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ 'Eff#1 'Ef f#2 ? c, L 0`1 FL J i Boring # ❑ Boring Pit Ground surface elev. I~fl ft- Depth to limiting factor 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 "D Z~ - U $-3' ,SY-~~ly Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa re CST Number Arthur L. Wegerer k~~ C~ )-S :'s 220254 Address N e g e r e r S o i l T e s t i n g & Design S e r v i c e Date Evaluation Conducted Telephone Number 421 i3. !lain St . River Falls , [dI 54022 _ 715-425-0165 Property Owner vy z Parcel ID # Q' 0 S o Page Z of [7~] Boring # ❑ Boring ❑ Pit Ground surface elev. lea- 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 0 10~! IZ_ 3 ) Z. 5` l 1 -.-'.-,f --s Ott S CS 8 Z 10y2 3/6 -`1 1 s~k S~ ~V-~ -S - 3 Zu-zS -1•S`1(<23! y ~1 ~.S~R mac, ~esbk m~l^ L°f.V zs~7 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizori,; 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 ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L Tlie 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. SBD-8330(R.6100) Property Owner vyY2:7~t Parcel ID # u~ ~ S a 0 j Page 2 of Boring # ❑ Boring ® Pit Ground surface elev. 1 Cam- o ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. %*Efl#l -C S cs Z ZSJ 102 3/b - S t s1-ir 3 Z.U-ZS~•S~G231y~1 ~.-5~~~~~ ~ ~esbk F-1 Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Horizon;; Soil Application Rate n;; _ Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. - Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ' 2 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 r r Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 rng/L ' Effluent #2 = BODY < 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. L. ~BA8330 (R.6100) PLOT PLa"i Paoe of Scale 1'=', r ' v L "'l 1 J ( loo YJ UT ~o Pr~' 7 i t aa ~--Ue J /v i r 4Z,' 0 F7z.z Jam; 1 U i If I 'r~ I 1 i=- 0 I 715-425-0165 220254 CD 7~_ ~S3 CST Signature Date Telephone ITo. CST No. Job NO.