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HomeMy WebLinkAbout032-1035-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 589795 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION 2567033 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No: Jody and Mary Ann Anderson TOWN OF KINNICKINNIC 022-1035-40-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 13.28.18.196 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution Ix Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Seeded/Sodded jxx Mulched Bed/Trench Center Bed/Trench Edges Topsoil T Yes No Yes i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1482 CTY RD J 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes I No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) 3 A/v a I G o ?~S County St. Croix s • Safety and Buildings Division 201 W. Washington Ave., Box 162 Sanitary Permit Number (to be filled in by Co.) S AUG Madison, WI 53711 62f ~j 5xt g.~. ST. CROIX COUNTY ET NEVV6ZZ4JQZ1A' / qv NITYD~LOP VVE fransaction Number Sanitary Permit Application 2567033 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ng ad is required prior to obtaining a sanitary permit. Note: Application forms for state-owned YOWTS aze submitted to Project Address (if different than maili dress the Department of Safety and Professional Servies. Personal information you provide may be used for secondary 40 purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. d C;T J2 1. Application Information - Please Prin Information Property Owner's Name parcel # dZZ. /O ' O b - Jody and Maryann Anderson Location y Property Owner's Mailing Address property W7928 180th Ave Govt. Lot City, State Zip Code Phone Number SE _'v, Section 13 54014 715-792-2087 28 (circle ° Hager City W. T_ __N; R 1~-EO II. Type of Building (check all that apply) Lot # tea ~ Subdivision Name ❑ I or 2 Family Dwelling - Number of Bedrooms 6k- ~ Block # ❑ Public/Commercial - Describe Use 40- ❑ City CSM Number '6 ❑ Village of ❑ State Owned -Describe Use 75 011 [3 Town of _ Kinnickinnic L 2l Q x o~ III. Type of Permit: (Check only one box online A. Complete line if applicable) A. [J New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Permi I List Previous Permit Number and Date Issued B. El Permit Renewal ❑ Change of Plumber ❑ Permit Transfer to New / Revision Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that a Round ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)_ ❑ Pretreatment Device (explain) N a ~ V. Dis ersal/Tre ftnent Area Information: fl Dis ~l Area Proposed (sf) System Elevation Design Flow (gpd) Design Soil Applica ate( pdsf) Dispersal Area R e fired (s Pers 450 1.0 Q `t~ 100.0 Tank Info Capacity in Total # of Manufacturer VI. / o 2 Gallons Gallons Units poly-iok 525 ✓ U y New Tanks Existing Tanks A. U septic or xolding Tank 1000 1000 1 Wieser combo x Dosing Chamber 600 600 x VII. Responsibility Statement- 1, the undersigned, assu responsibili install on of the POWT ISviP/MPRS Number ched plans.usiness Phone Number Plumber's Name (Print) Plum ignat a 648443 Keith Knudtson 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts Wi. 54023 VIII. Coun fDe artment Use Only Issuing A Signature Permit Fee Date Issued g Approved $ (oT6 - ~ v Z! _ If er Given Reason for Deni T ~J Y IX. Condit#q*1pft easons for Disapproval 3 rA' I. septic tank, efllue It row attd ` w / p e.~`~w✓4'-' be sela+lcps`! maim 'r, dispersal ceA must all *8;P@r m4fwWwroM Plan provided by plumber. 2. A11'> ' t bt irisd spar too I admilloes. Attach to complete plans for the system and submit to the County only on paper not less than 8 lr2 x 11 inches in sue SBD-6398 (R. 11/11) ti 330 ft. PIL Page 8 of S Sanitary Site Plan For:Orlande E Phillips-Family Trust (Westt Site) { W 1/2 of the E 1/2 of the SE1/4-SE1/4 Sec. 13 T28N-Rl8W Town of Kinnickinnic- St. Croix County 0 25 50 Graphic Scale (Feet) 1 inch = 50 tt 16% ~19% Shared Drive Family Property Proposed 10 Acre Parcel Approx. 1500 f t. by new drive to County Rd. J Proposed Grarage Proposed Proposed Top of ' WELL Basement Wall =106.00' 1320 ft. 16% Open Grass Sidehill Site Proposed Threee Bedroom Home Proposed Look-out o 104.55' partial walk-out basement Open Grass Sidehill Site Proposed Proposed 4" Sch. 40 PVC Bldg. 102-00' 19% Sewer P/L SEE CORRESP E 99.00' Proposed Proposed Wieser Concrete WLP I~~~ONCE o 0 p/L Combination Tank w/a Poly-Lok PL-525 Filter 96.00' BM 19% Proposed 2"Sch. 40 F.M. 93.00' 19/0 Proposed 6'x 75'Mound Dispersal Cell w/a System Elev. of 100.00' Field Edge Planted Corn Approx. 1035 ft. to County Rd. J Note: Mainain well and waterline setbacks per SPS 383.43 (8)(1) from field edge' Note: Insulate building sewer per SPS 382.30(11)(c) and provide frost protection per SPS 383.43(8)(4)c Elevation Data Pipe at basement wall = 96.00' BM = Top of 11/4" Iron Pipe Set near proposed lot line. IMP =Same C co - ASSUMED ELEV. = 100.00' /au7.~ri DIVISION OF INDUSTRY SERVICES f\ 3824 N CREEKSIDE LA HOLMEN WI 54636 } D Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov t ~ ssio Scott Walker, Governor Dave Ross, Secretary July 06, 2015 CUST ID No. 648443 ATTN: POWTS Inspector ZONING OFFICE KEITH E KNUDTSON ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMICHAEL RD ROBERTS WI 54023 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/06/2017 Identification Numbers Transaction ID No. 2567033 SITE: Site ID No. 814398 Orlande E Phillips Trust Please refer to both identification numbers, County Road J above in all correspondence with the agency. Town of Kinnickinnic St Croiunty W1/2, SE1/4, S13, 1-28N, R18W FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1543792 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Ver. 2.0, SBD 40691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-I0706-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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • The pipe materials for the sewer pipe between the house and the septic tank shall conform to SPS 384.30 Wis. C® Adm. Code. Required under plan submittal - SPS 383.22 (2)(a)4.b. Specification, including a description of the materials for the project (This includes size, material and ASTM number.) DEPT PROFS • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and D1VIS10N 0 dispersal are prohibited. • The well must be a minimum of 25 feet from an POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c 2J-44stLE-0 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. KEITI I E KNUDTSON Page 2 7/6/2015 • Inspection of the POWTS 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. Stat • SPS 383.22(7) 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 Owner Responsibilities: • SPS 383.52 Responsibilities. 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). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2 , Division of Industry Services Payment Submittal. (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday WSMART code: 7633 char]es.bratz@wisconsin.gov ~'i cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm KEITH E KNUDTSON Page 2 7/6/2015 • Inspection of the POWTS 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. Stat • SPS 383 22(7) 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. Owner Responsibilities: • SPS 383.52 Responsibilities. 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). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the count-_v° for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2, Division of Industry Services Payment Submittal. (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday WiSMART code: 7633 charles,bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm j 2015 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Phillips Trust (West Site) Owner's Name: Orlande E. Phillips Family Trust Owner's Address: 109 S. Dallas River Falls WI 54022 Na Legal Description: W1/2-E112-SE1/42nI/4 Sec. 13 T28N-R18W Township: Kinnickinnic County: St. Croix Subdivision Name: CSM in the process Lot Number: Na Block Number: Na Parcel I.D. Number: 022-1035-40-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Keith Knudtson License Number: MPRS648443 JDITIONALLY Date: 06113/15 , Phone Number: 651-470-1737 PROVED OF SAFETY AND Signature: -SIONAL SERVICES Designed Pursuant to the F INDUSTRYSERVICE 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_ 01101) CORRESPOND CE Version 7.0 (R. 03/2012) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 450.00 Design Flow (gpd) _ 19.00 Site Slope 99.00 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 50 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.33 Estimated Orifice Spacing (ft) = 7.03 ftz/orifice 2.00 Forcemain Diameter (in) u 24.00 Forcemain Length (ft) Does the forcemain drain back? Y 91.50 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 3.91 Forcemain Drainback (gal) 8.25 Vertical Lift (ft) 67.41 5x Void Volume (gal) 0.60 Friction Loss (ft) 71.33 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 34.46 System Demand (gpm) _ 13.40 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x -x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information T Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete ^ Manufacturer gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information __603.36 Dose Tank Capacity (gal) PolyLok v Filter Manufacturer 16.76 Dose Tank Volume (gal/in) PL-525 Y Filter Model Number Weiser Concrete Project: Phillips Trust (West Site) Page 2 of 8 Mound Plan and Cross Section Views 1/10 B J , . . Observation Pipe . K T 4 A W B I L Mound Component Dimensions A A12.00 ft E 25.68 in H [A4.38 ft K 10.09 ft B ft F 9.50 in T ft L 95.17 ft D in G 0.50 ft J ft W 34.32 ft 450.00 (ftz) Dispersal Cell Area 2245.64 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.79 (ft) rrirn (~rrrr;~r... H ~ rrriirriirriirSfsS•riirrrrrrii... G F Dispersal Cell 100.50 (ft) Lateral 100A0 (ft)-♦ Invert . Dispersal Cell Elevation E D 99.00 (ft) Contour Elevation 19.0 % Site Slope Geotextile Fabric Cover Shading Key d a- Dispersal Cell See lateral details on Topsoil Cap o f 1 5 ft a Page 4 for number, size, 0 rr.rrrrr Subsoil Cap 0.0 and spacing of laterals. ASTM C33 Sand i° Laterals are equally `5 a F spaced from the ® Tilled Layer d 5 ft Typical Lateral w distribution cell's © Aggregate o centerline in the A distribution cell (AxB). Project: Phillips Trust (West Site) Page 3 of 8 End Connection Lateral Layout Diagram Laterals centered over the A?- B dimension • - Turn-up w0ball valvo or eloonoutplug =main enticat Ih X Hot es drilled or, the bottom of the lateral S equally spaced rFote;. P aonneelion via tee of doss to manifold at am point LateralS &forcenrain Sch 40 PVC per SPS Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.37 ft Lateral Length (P) 73.47 ft Orifices per Lateral 32 Lateral Spacing (S) 3.00 ft Orifice Density 7.03 ff/orifice Lateral Flow Rate 17.23 gpm Manifold Length 3.00 ft System Flow Rate 34.46 gpm Manifold Diameter 1.50 in Total Dynamic Head 13.40 ft Forcemain Velocity 3.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and 0 SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Ca aci 603.36 Gallons Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.74 347.67 B 2.00 33.52 C -Pump off elevation (ft) C 4.26 71.33 92.25 D 9.00 150.84 D Total 36.00 60136 Do♦ se tank elevation (ft) 3" Bedding Aer tank. 91.50 Alarm Manuafacturer SJE. Rhombus Note: Switches Alarm Model Number Tank Alert 1 --r - containing mercury may not be used in Pump Manufacturer Goulds _ this system. Pump Model Number 3871 EP04~ Pump Must Deliver 34.46 gpm at 13.40 ft TDH Project: Phillips Trust (West Site) Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix County Landuse Dept. Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 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 monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once ever rears other 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 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: Phillips Trust (West Site) Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01 /01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter 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, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 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 of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the 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 mglL BOD_ 30 mg/L TSS, 10 mg/L FOG, and 10" 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 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 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continnency 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. II Project: Page 6 of 8 Page 7 of 8 HGOULDS PUMPS Submersible Effluent Pump EP04 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. Cmvvhart Standards ASSDMa" • Heavy duty sump matic models include • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic r,wids ftw is Iso 900' Rgered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '!a" maximum, ■ EP04 Impeller: Therrnoplas- ~ Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 11/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104`F (40'C) continuous METERS FEET 14 • FasOt ne6s0 300 serjesttent. 10 stainless steel. 9 30 _ s GPM • Capable of running dry without damage to a 211 components. zs z Motor: x • EP04 Single phase: 0.4 HP, u e 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with 77 o s t automatic reset. Q a s < _ EPOS • EP05 Single phase: 0.5 HP, o 115 V or 230V, 60 Hz, 1550 3 lo RPM, built in overload with EpOd automatic reset. 2- • Power cord: 10 foot s 1 standard length, 1613 SJTOW with three prong Optional 20 ° °0 10 zo 3 o t a grounding plug. 0 so GPM foot Iength,16/3 SJTW with three prong grounding plug o z a s a 1 a Z z rrr3~h (standard on EP05), CAPACITY Goulds Pumps ® 2D01 Goulds Pumps ITT industries Effective May, 2001 B3871 330 ft. PIL Page 8 of 8 Sanitary Site Plan For:Orlande E Phillips-Family Trust (Westt Site) W 1/2 of the E 1/2 of the SEI./4-SEl/4 Sec. 13 T28N-R18W Town of Kinnickinnic- St. Croix County 0 25 50 Graphic Scale (Fast) 1 1 inch = 60 tt. II 16% 19% Shared Drive Family Property Proposed 10 Acre Parcel Approx. 1500 f t. by new drive to County Rd. J - Proposed Grarage Proposed f Proposed Top of • WELL 1320 ft. Basement Wall =106.00' Ih% F Open Grass Sidehill Site Proposed Threee Bedroom Home Proposed Look-out 104.55 0 partial walk-out basement Open Grass Sidehill Site Proposed 4" Sch. 40 PVC Bldg. 102.00' Proposed Z19% Sewer P/L SEE CCR E ?qIs 700~~gNCE 99.00' Proposed Proposed Wieser Concrete T 0 p/L Combination Tank w/a Poly-Lok PL-525 Filter 96.00' - BM ~19% Proposed 2"Sch. 40 F.M. 93.00' t^ 19• Proposed 6'z 75'Mound Dispersal Cell w/a System Elev. of 100.00' Field Edge Planted Corn Approx. 1035}1. to County Rd. J Note: Mainain well and waterline setbacks per SPS 383.43 (8)(1) from field edge. Note: Insulate building sewer per SPS 382.30(11)(c) and provide frost protection per SPS 383.43(8)(4)c i Elevation Data Pipe at basement wall = 96.00' BM = Top of t 1/4" iron Pipe Set near proposed lot line. * HRP = Same ASSUMED ELEV. = 100.00' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Jody or Maryann Anderson Mailing Address W7928 180th Ave. .Property Address (Verification required from Pl ing & Zoning Department for new construction.) City/State Hager City Wi. Parcel Identification Number 022-1035-40-000 LEGAL DESCRIPTION I/r Property Location SE '/4, Sec. 13 , T 23 N R 1$ W, Town of KinnlCklnniC Subdivision Plat: , Lot # Certified Survey Map # Volume Page # Warranty Deed # (before 2007)Volume , Page # Spec house Dyes[no Lot lines identifiable ElyesE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (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. Lowe, the undersigned have read the above requirements and agree to .maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 1/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 warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 qJGNATURE 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 if reference is made in the warranty deed. 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CROIX COUNTY in accordance with SPS 385, Wis. Adm. Code Keith Stoner CST Attach comp142BdWbNhTd'nP hallRATi 8Y: x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parce D. r-A Please print all information. 2-1 5-40-000 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Rev ed B D e Property Owner Property Location ~,f Orlande E-Family Trust Phillipps _ Govt. Lot SE1 SE1/4, S13, T28N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 109 S Dallas ity State Zip Code Phone-Number I I City ~ Village F,'j Town Nearest Road River Falls WI 54022 Kinnickinnic County Rd J New Construction Use: x~ Residential / Number of bedrooms 3 Code derived design flow rate _ 450 GPD Replacement Public or commercial - Describe: Parent material Sandy Residium from Weathered Sandstone Flood plain elevation, if applicable _ NA ft. General comments Proposed 10 acre parcel. Propose a 6 x 75' mound cell located along the 99.00' contour ith a system elevation =100.00'_ and recommendations: Upslope mound contour staked onsite. (i OV ❑ Boring # L Boring - Pit Ground surface elev. 94.15 ft. Depth to limiting factor 24 _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-11 10YR3/2 - Ifs ifgr mvfr cs 3f-m 0.5 1.0 2 11-21 10YR4/3 - gr Ifs Osg mvfr gs 3f-m 0.5 1.0 3 21-24 10YR6/3 - fs Osg ml gs 2f 0.5 1.0 4 24-42 10YR6/3 c2d5YR6/4 fs Osg ml gs 2f 0.5 1.0 5 42-54 10YR8/1 c2d5YR6/4 fs m mfr - - 0.5 1.0 6 54-65 10YR8/1 - wb _ #4 + 5 - 2 - 6" bands of 7.5YR4/6 Is *#5 - Sandstone bedrock residium Boring # Boring Pit Ground surface elev. 99.80 ft. Depth to limiting factor 36 in. _ Soil Application Rate Horizon Depth Dominant Color I Redox Description Texture Structure Consistencg Boundary Roots GPD/ t2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-10 10YR3/2 Ifs ifgr mvfr cs 3f-m 0.5 1.0 2 10-22 10YR4/3 - Ifs Osg mvfr gs 3f-nn 0.5 1.0 3 22-27 10YR6/3 - Ifs Osg ml gs 2f-m 0.5 1.0 4 27-36 10YR6/3 - Is Osg ml gs If 0.7 1.6 5 36-56 10YR8/1 _ wb _ *#5 - Sandstone bedrock residium *Soil saturated above bedrock " Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L LITInt #2 = BOD5 <_30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Keith Stoner 224059 Address Keith Stoner CST Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 5/15/2015 715-566-2128 SBD-8330 (R.07/13) Property Owner Orlande E-Family Trust Phillipps Parcel ID # 022-1035-40-000 Page 2 of 3 Boring (n • 3 Boring # Pit Ground surface elev. 94.75 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure J7onsistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-10 10YR3/2 - Ifs lfgr mvfr cs 2f-m 0.5 1.0 2 10-15 10YR4/3 - Ifs Osg mvfr gs 2f-m 0.5 1.0 3 15-26 10YR5/4 - Is Osg ml gs 2f 0.7 1.6 4 26-31 10YR6/3_ weakly cemented Is Osg ml gs if 0.7 1.6 5 31-56 10YR8/1 - wb _ #4 - bands of Is 7.5YR4/6 *#5 - Sandstone bedrock residium j Boring F-1 Boring # I Pit L Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring F-1 Boring # I Pit Ground surface elev. ft. Depth to limiting factor r g ° 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 = BOD? 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L - - F 330 ft. P/L Page 3 of 3 Soil Test Site Plan For:Orlande E-Family Trust Phillips I W 1/2 of the E 1/2 of the SE1/4-SE1/4 Sec. 13 T28N-R18W Town of Kinnickinnic- St. Croix County 0 25 50 I Graphic Scale (Feet) 1 inch 50 R 16% 19% Shared Drive Family I Proposed 10 Acre Parcel Property Approx. 1500 ft. by new drive to County Rd. J ~ Proposed Grarage Proposed Top of I Basement Wall = 106.00' 16% I 1320 ft. Open Grass Sidehill Site Proposed Threee Bedroom Home I 0 104.55' I Walk-out to South Open Grass Sidehill Site 102.00' Proposed 19% P/L Q 99.00' Proposed Proposed Dose Tank P/L 96.00' ABM 19% 93.00' I 19% I Field Edge Planted Corn Approx. 1035 ft. to County Rd. J I Note: Mainain well and waterline setbacks per SPS 383.43 (8)(1) from field edge. I Elevation Data I B#1 = 94.15' B#2 = 99.80' I B#3 = 94.75' A BM = Top of 1 1/4" Iron Pipe Set near proposed lot line. * HRP =Same I ASSUMED ELEV. = 100.00' = Backhoe Pit I I May 20th, 2015 Keith E. Stoner CST# 224059 p I,a' 1