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HomeMy WebLinkAbout038-1139-90-100 sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix afety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 592108 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2743723 Permit Holder's Name: City Village Township Parcel Tax No: George Ktsanes TOWN OF STAR PRAIRIE 038-1139-90-100 CST BM Elev: Insp. BM Elev: IBM Description: , ` I Section/Town/Range/Map No: N _N +T4•#r 34.31.18.574C TANK INFORMATION ELEVATION DATA TYPE ANUFACTURER CAPACITY STATION BS HI FS ELEV. fit, t$sz.r 1 Z.o(a 1(v~ 2. orb tae ,a b Ic 2 ~ 106: Benchmark 2• J IV2. I~ J Dosing j 5 Alt. BM c'a'ps 5 A"au" r 1 A n ' Bldg. Sewer 9 "~`t J D ~l IS• f IiGlcl~rrf ~a INb~•3' `J f / k Ht Inlet d TANK SETBACK INFORMATION Ht Outlet 5ZJ 1 •S /'7• V TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / _ qr N uY4,h 10 G7 Se106 Dt Bottom (IO Dosing lAh1 nab r 0 I ~ Header/Man. p I/W~J Dist. Pipe Ak .C QOQ •C H~~ ~/W , ~i , y lY / • J~ Final Gra C~ PUMP/SIPHON INFORMATION N It)' US I'~ Manufacturer t Demand OF- St Cover r,,l V~ 3•q2 ~8• ~a GPM -~j Model Number C) /Li •n e ' ` •2_5 9 . TDH Friction Loss System Head TDI H Ft, 4 t_ I nr • h • • 6 7 Forcemain I Leng .y Dia. Z , r I I Dist. to well 1 J ul bS• S~ S. (0 SOIL ABSORPTIIO;N) SYSTEM BED/TRENCH Width I t Length I No. Of Trenches PIT DIMENSIONS No. Of Pity Inside Dial Liquid Depth DIMENSIONS SETBACK SYSTEM TO ~-lJ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR e Of Sys m: UNIT Model Numbe W Il DISTRIBUTION SYSTEM Nhr+n Header/Manifold ID istribution I, x Hole Size „ x Hole Spacing Vent to Air Intake Pie s ^7 11 I ' n ~j Length Dia Length I . , Dia Spacing g ~ . C1 ' t , • ' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of I` xx Seeded/Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 Yes Lj No Yes [j No COMMENTS: (Include code disc-rreepencies, persons present, etc.) Inspection #1:'O • l v / W Inspection #2: Location: 1156 18Qm%r P ~ IW U 1 ^ hLL C(bS *PLO' 1. r/J f( 7 ecr OK• c h all 1.) Alt BM Des tfcfi = J~ l./ ^2) 1 I7vr L6A ' ~1' J 1 2.) Bldg sewer ITngth = . } CI fo shed 3 $S 41 q O 'm V) -amount of cover= 47 t U b t ) 01W (M n/ ewe r o t AN,, ~E2 c CDVV a A a ~ ~v 1~ ~~w Plan revision Required? ❑ Yes No Use Use other side for additional information. 14__ Date *Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ` : sa rta County Safety and Buildings Division St Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) SPS ob Madison, W1 53707-7162 S~. ~RO1X COUN- z 1 ~S ELOPMEN CQ Sanitary Permit Applicat. 2FZKEOVGW6GIG State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 2743723 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Infor to Please Print All Information 1156 180th Ave Property Owner's Name Parcel # George Ktsanes 038-1139-90-100 u Property Owner's Mailing Address Property Location I , 1 . 5 7 l G 1194 Hwy 64 Govt. Lot City, state F54C01 ode Phone Number SW /4, SE %4, Section 34 New Richmond W. 7 T 31N, R 18(cirelEoonet) H. Type of Building (check all that apply) Lot # LT 1 or 2 Family Dwelling - Number of Bedrooms 4 Subdivision Name Block # ❑ Public/Commercial -Describe Use - ❑ City of ❑ State Owned - Describe Uy L CSM Number ❑ Village of /x X l Zo~ -~.A ❑ Town of Star Prairie III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System [X Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision Change oFPlumb List Previous Permit Number and Date Issued ❑ er ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) r El Non-Pressurized In-Ground ❑ Pressurized In-Ground XI At-Grade 11 Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil ❑ Holding Tank ther Dispersal Component (explain) ~~~"'a ❑ Pretreatment Device (explain) V. Dis ersaVfre ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpd Dispersal Area Required (s Dispersal Area Propo d (sf) System Elevation 600 .50 1200 1200 97.70 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units Ploylok 525 o New Tanks Existing Tanks o a U v: un u C7 a septic or Holding Tank 1250 & 320 1570 Wieser X Dosing Chamber 800 800 Wieser X VII. Responsibility Statement- 1, the undersigned, assume responsi ity for insto)fation of the WWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Keith Knudtson ,r 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts W. 54023 V oun /De artment Use Only ssue Issui g gent Signa re f _)t) pproved lsapproved Permit Fee Date O en Keason for Denial $ ~~O ' 4 14 IX. Condi ~easons for Disapproval ~4 3) 6M.:1-; ;V_ s ItIL ,A rai MVACIod by pwr. L 'At Attach to complete plans for the system and submit to the County only o paper not legs than 8 112 x 11 inches in size P4A, 4-o tQz_ SBD-6393 (R. I 1/I1) ..v 4, o C' W ~ o ~ v C-n v1 p o°O ° N +LID c II 2 3 O Ln 5 p on C. cl O ..U. c4J o II h Q' U + 1 ¢ C cG 3 p C) U U i F ° ~ ~ c q u a II ry f=1 %b. ate. o W C7 C7 ~ C ~ ~ C C d it O J y V R \ N Ory ~ p Q C h ~ ^C O N Q J h ~ n N V per„ a U h a ~ O C C^ N x '••2L• ~ rIyye~ O VJ ~ ~ , C3 q y N '3 U Q O ~ p V ~ dJ U y0 I•L O a ~ J ? ~ O C, C, L J 0 ~ \ J C o • J Ln Ul © U U C V fy U n LO v, Z~ Z Lo m O l En y IND t0 Al @ O _ h M ~ C7 ~ I N V S o h o ` Luo 900 q co U J b 5 a d a mII ~ N II ci 'C ~ I v .q tt\ > W ~ a q L1 o C _ v h o ~ ~ a y C h o DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 i I Contact Through Relay I`S v http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~~F?ssrov~~%~~r~ Scott Walker, Governor Dave Ross, Secretary August 15, 2016 CUST ID No. 224059 ATTN: POWTS Inspector KEITH E STONER ZONING OFFICE KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA 23220 WOODCREEK RD 1101 CARMICHAEL RD SIREN WI 54872-8728 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2018 Identification Numbers nsaction ID No. 2743723 SITE: e ID No. 826911 George Ktsanes ease refer to both identification numbers, 1 156 180TH Ave ve, in all rab correspondence with the agency. Town of Star Prairie St Croix County SW 1/4, SE 1/4, S34, T31N, R18W FOR: Description: At grade, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object 1D No.: 1614699 Maintenance required; Replacement system; 600 GPD Flow rate; 48 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure 5''•'~~ Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/O1, R. 10/12), SSWMP Pub. 9.6; Effluent FiltoolvisioN 'The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. "The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the 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: Key Item(s) • In the event this soil absorption system malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described the At Grade Component Manual are complied with. A copy of this information must be given to the owner upon completion of the project. Reminder • The orientation of the at grade system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual. • Surface water drainage shall be diverted away from the system area. • Materials shall conform to the requirements of SPS 384. SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. KEITH E STONER Pa2c 2 8/15/2016 • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/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. r When You Receive That Invoice, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson (Plans Mailed To) KEITH E STONER Page 2 8/15/2016 • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat. shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson (Plans Mailed To) RESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Replacement At-Grade Mound for 1156180th Ave. Owner George Ktsanes Address 1194 Hwy 64 New Richmond WI 54017 Legal Description Sec. 34 T31N-R18W Township Star Prairie County St. Croix Subdivision Name Na Lot No. Na FParcel ID Number 038-1139-90-100 w R J es Plan Transaction Number ~N S~ V 1t s r Index sheet Page 1 Calculations Page 2 l At-grade drawings Page 3 Laterals and dose tank Page 4 ~SPONpE G Specifications Page 5 :UST' Management & contingency plan Page 6 Pump curve & specifications Page 7 Plot Plan Page 8 Designer Keith E. St r ,,``x%SCON 'License Number Designer# 1575-007 Net Signature _ _TNE,••': Phone Number 5,3 - 3~ i Date 07/22/16 Siren 5 W. (,s •"E#e*-ed pursuant to: At-grade Component'N►4;HR~t~~.o for POWTS SBD-10854-P (N" X13/07), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) C p-1 C// -Z RECEIVED Version 7.0 (03/12) Page 1 of 8 JUL 2 3 2016 INDUSTRY SERVIC PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow (gpd) 600.0 Design wastewater flow (gpd) 2.50 % Site slope 97.70 Contour elev. below lateral (ft) 48.00 Depth to limiting factor (in) 0.50 In-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) Influent wastewater quality 10.00 Linear loading rate gpd/ft 10.60 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 120.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) e Center or end lateral connection 1 Number of laterals 0.125 Orifice diameter (in) e.g. 0.25 Not a final calculation 2.00 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 2.56 Forcemain flow velocity (ft/sec) 25.00 Forcemain length (ft) y or n Does forcemain drain back? 86.80 Pump tank elevation (ft) y or n y Are laterals at highest point? 6.5 System head (ft) x 1.3 NA 11.07 Vertical lift (ft) 4.1 Forcemain drainback (gal) 0.35 Friction loss (ft) 96.0 5x Lateral void volume (gal) 0.00 In-line Filter Loss (ft) 100.1 Minimum dose volume (gal) 17.92 Total dynamic head (ft) 25.1 System demand (gpm) Lateral Diameter Selection G_allo_n_stinch Calculator (optional) Pipe diameter Design options Design choice A Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in ___Gal/in (enter result in cell G46) one lateral 1.5 in diameter 2 in x ~x Treatment Tank Information T 1250 Se tic tank capacity (gal) 3 in x Wieser Concrete Manufacturer Effluent Filter Information Dose Tank Information Polk-Lok Filter manufacturer ! 7_50.4 Dose tank capacity (gal) PL-525 Filter model number 20.3 Dose tank volume (gal/in) Wieser Concrete_ .Manufacturer Project: Replacement At-Grade Mound for 1156 180th Ave. Transaction Number: page 2 of 8 AT-GRADE PLAN VIEW 1/6 B Observation pipes (2 typical) A 10.00 ft T D B 120.00 ft 1/6 B 20.00 ft W C 12.00 ft D 5.00 ft E 2.00 ft p L 130.00 ft ~:B W 22.00 ft A x B 1200.00 ft^2 T L Cap I =Total aggregate cell A x B Typical obs_ pipe. Slotted in the lower 6", and Plowed area L x W anchored securely. 6° AT-GRADE GROSS SECTION Synthetic fabric cover 99.53 ft Finished grade Lateral f elevation invert elev. 98.20 ft Observ ation pipe at aggregate toe E , Surface contour 97 70 ft A f ~2 5 % Slope and system elevation D 12 in. topsoil and subsoil over aggregate and tapered to toes. Plowed layer 6 in. aggregate below below L x W Pipe(s), and 2 in. above pipe. Project: Replacement At-Grade Mound for 1156 160th Ave. Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - End connection P Last hole dr W next to 4nd cap ( X -i, t.atetals & force, main of PVC Sch 40 Holes drilled on the bottom of the lateral per SPS Tabin 384,30-6 equallgsp.aced • Turn-upMball valveorcleanoutplug i it Lateral Specifications 0.125 Orifice diameter (in) End Lateral connection point X 1.96 Orifice spacing (ft) 1 Number laterals 61 Orifices/lateral P 117.60 Lateral length (ft) 25.1 Lat. discharge rate (gpm) 2.00 Lateral diameter (in) 2.00 Forcemain diameter (in) 25.1 Sys. discharge rate (gpm) 25.00 Forcemain Length (ft) 17.92 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device junction box Final grade 4 disconnect Tank component is Altemati properly vented E V-, outlet location 18° min. Electrical as per NEC 300 and Approved SPS 316.300 WAC outlet Tank full joint inches Gallons JA Provide 114" A 26.0 528.5 weep hole or Alarm on B 2.0 40.6 antisiphon c 4.9 100.1 Pump on $ device. o 4.0 81.2 87.13 ft C Totals 36-9 750.4 - ♦ Pump off D 3" Bedding under tank 86.80 ft Goulds Pump manufacturer _SJE Rhombus Alarm manufacturer EP05 Pump model number Tank Alert 1 Alarm model number Project: Replacement At-Grade Mound for 1156 180th Ave. Transaction Number: Page 4 of 8 AL -grade stem Maintenance and Operation Specifications Service Provider's Name Powers Sanitation _ Phone 715-246-5738 POWTS Regulator's Name St. Croax Counter Zonin ~ _ _ Phone 715-386-468-0- System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1200.0 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 Inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Insect for ondin and seepage once every 3Vears _ 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 at-grade 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 at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished Grade ` 11 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution . ' - Long Sweep 90 or Two 98.20 ft 45 Degree Bends Same Diameter as Lateral Project: Replacement At-Grade Mound for 1156 180th Ave. Transaction Number: Page 5 of 8 At-grade System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code n ral This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10854-P (N. 03/07), SSWMP Pub. 9.6 (01181), and Pressure Distribution Component Manual Val 2.0 SBD-10706 (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 he 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 filter 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 filter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume oft 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 filter is installed within the tank it shall be inspected and serviced as necessary. At-grade and Pressure C:itttribu on Sustain No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade 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 at-grade 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 at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade 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 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 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 at-grade 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 renovating the biologically clogged absorption and dispersal media, Installing new piping, and replacing other 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. Project: Replacement At-Grade Mound fo Transaction Number: Page 6 of 8 Pa.~e of 8 NGOULDS PUMPS Submersible Effluent Pump V M11 11 EP04 3871 EP05 v, • full submer in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower APPLICATIONS y q "Pd tic enclosed design for heavy duty ball hearing grade turbine oil for 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 Avmdffbm • farms manual operation. Auto- resistance. - • Heavy duty sump matic models include m Moto, Housing: Cast iron (CSA listed model numbers end • Water transfer Mechanical float Switch for efficient heat transfer, in "C" or 'T".) • Dewatering assembled and preset at the strength, and durability. factory, rr ds pumps is GO MM Wit. A Motor Cover: Thermoplastic SPECIFICATIONS cover with integral handle and FEATURES • Solids handling capability: float switch attachment paints. 114" maximum. a1 EP04 impeller: Thermoplas- N 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: 9112' NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomem • Temperature: 10411f (40`C) continuous METERS FEET 140" F (601f;) intermittent, • fasteners: 300 series stainless steel. 3 GPM Capable of running e - 3o zs rr dry without damage to a 1 components. 25 0 7' Motor: u s 20 • EP04 Single phase: 0.4 HP, - 115 or 230 V, 60 Hz, 1550 i I RPM, built in overload with automatic reset. a s • EP05 Single hase: 0.5 HP, 115 V or 239,V, 60 Hz, 1550 3 10:1 RPM, built in overload with EP04 automatic reset. ? • Power cord: 10 foot st S)TOW andard length, 1613 , o with tifegptional20 o to 20 3o ao so GPM grounding pl9, P foot length, 1613 SJTW with prong grounding p o z 4 r; s _ in 12 m11111 three lug 2 (standard on EP05). CAPACITY Goulds Pumps iTTIndustries «2001 Goulds Pumps f_ffertive. May, 2005 113871 Y y y N c II 00 y0 6n y IQ II ~ CJ ~ p y c u 5 _v n ea a~ 3 c Ca D ° a C C. Vi z/' o ~ W ° :a ~ u p A o o a c y ~ C ~ y C Q C~ C z c, y ~ ~ c_ y w ~ U J J - VI~ J ~ O L a y 0°. ZZ- ° N a ~ ~ O C C-N U .b n n A j C ~ C cu a yl LQ +7 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer George Ktsanes Mailing Addre 1194 Hwy 64 New Richmnd 1156 180th Ave Property Address (Verification required from Planning & Zoning Department for new construction.) New Richmond wi 54017 038-1139-90-100 City/State Parcel Identification Number LEGAL DESCRIPTION Property Location SW 1/4 , SE %4 , Sec. 34 , T 31 N R 18 W, Town of Star Prairie Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house OyesEino Lot lines identifiable Elyes[:]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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on t s form are true to the best of my/our knowledge. 1/we am/are the owner(s) of the property described above, by virtue of a w ranty deed recorded in Register of Deeds Office. Number of bedrooms 4 114w A4I~~ 1,7s"i,16 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 if reference is made in the warranty deed. (REV. 04/12) 1 Wisconsin Department of Safety and Professional ServicesT'~d f Divisiomof lndu IV/ E D I SOIL EVALUATION RPEDH pD u L #3107 Page 1 of 3 AUG 16 '10 ~ b in accordance with SPS 385, Wis. Adm. Code RQ V6A Keith Stoner CST Attach complete sit I eery not less than 8%2 x 11 inches in size. Plan must St. include ~{tft~Ag`hiohorizontal reference point (BM), direction and . Croix pt(WIM~IQI-MID rth arrow, and location and distance to nearest road. Parcel I.D. Please print all information. 038-1139 0-100 Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (JR4Y Property Owne r Property Location George Ktsanes Govt. Lot 4, S34, T31N, R18W Property Owner's Mailing Address Lot # Block # Subd. Nanfe or CSM# 1194 Hwy 64 City State Zip Code Phone Number F City ' Village ~ Town Nearest Road L_ "J New Richmond WI 54017 Star Prairie 1156 180Th Ave New Construction Use: F~'] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial -Describe: Parent material Sandy loam till - Flood plain elevation, if applicable NA ft. General comments Propose a 10 x 120' at-grade mound cell with a system elevation= 97.70'. Pipe contour staked onsite. and recommendations: Zo'r.a„X F1_1 Boring # L-1 Boring [x] Pit Ground surface elev. 96.70 ft. Depth to limiting factor 48 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR3/2 - sit 2msbk mvfr cs 3f-m 0.6 0.8 2 9-16 10YR4/3 - I 2msbk mvfr gs 2f-co 0.6 0.8 3 16-30 10YR4/4 - cl 2msbk mfr gs 2f-m 0.4 0.6 4 30-36 7.5YR4/4 - I 1-2fsbk mvfr gs 217-m 0.4 0.6 5 36-48 7.5YR4/4 - I m mfr gs if-m 0.2 0.5 6 48-77 5YR4/4 f2d5YR5/8 Is/sl lmsbk/m mvfr - - 0.2 0.6 #2 - silt coatings on ped surfaces #6 - alternating Is inclusions and massive sl bands Fil Boring # 'r ! Boring ;1 Pit Ground surface elev. 97.70 ft. Depth to limiting factor >81 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR3/2 - sit 2msbk mvfr cs 3f-co 0.6 0.8 2 9-19 10YR4/3 - sicl 2msbk mfr gs 2f-co 0.4 0.6 3 19-32 10YR4/4 - cl 2msbk mfr gs 2f 0.4 0.6 4 32-39 7.5YR4/4 - gr Is Osg ml gs if 0.7 1.6 5 39-56 7.5YR5/4 - sr s Osg ml gs - 0.7 1.6 6 56-66 5YR4/4 - sl m mvfr gs - 0.2 0.6 7 66-81 7.5YR5/4 Alternate bands sr 5 Os - - of massive sl g mI 0.7 1.6 * Effluent #1 = BODs> 30 < 220 mg/L and TSS >30 < 150 mg/L 7ffAuent #2 = BOC> 5.30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Keith Stoner 224059 Address Keith Stoner CST a Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 7/5/2016 715-566-0900 SBD-8330 (8.07/13) Property owner G_eoTe KtSanes Parcel ID # 038-1139-90-100 Page __Z _of 3 a Boring # Boring U Pit Ground surface elev. --W40 _ ft. Depth to limiting factor >90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 1 0-8 10YR3/2 - Tsil 2msbk mvfr cs 3f-co 0.6 0.8 2 8-21 10YR4/3 - 2msbk mvfr gs 2f-co 0.6 0.8 3 21-32 10YR4/4 - 2msbk mfr gs 2f-co 0.4 0.6 4 32-43 7.5YR4/4 - Is Osg ml gs 2f 0.7 1.6 5 43-47 SYR4/4 - sl m mvfr gs if 0.2 0.6 6 47-90 7.5YR5/4+4/4 - sr s Osg ml - - 0.7 1.6 #6 - frequent 1/2 - 1-1/2" bands of sl 5YR4/4 Boring ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in. J Soil Application Rate Horizon Depth L Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W 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 GPDKF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <_150 mg/L • Effluent #2 = BOD5 < 30 mg/- and TSS <_30 mg/L h 0 Q ~ b O r w o ~ b b0 b ~ ~ Z/1 ~l bJ h ~ z 00 r s A o ~ G~ ro ~N ti a O ~ V ~ N Q .a ~ i R1 (p ,C A S PON. W 4t O 3 N' S n co w w m O t~ E. A ~ ~ ~ II II II ~ ~ ~ z g x x d n CD O y o C> A ~ A N a c k o b w h 8 3 9 2 3 4 3 Document Number Document Title TX:4328287 1034660 St. Croix County BETH PABST REGISTER OF DEEDS Affidavit for a single POWTS ST. CROIX CO., WI servicing Two Structures via Private ]Interceptor Main RECEIVED FOR RECORD 08/26/2016 9:51 AM t-- ---5►\ EXEMPT 4t: Name - ( ner) yped or printed REC FEE: 30.00 being duly sworn , states, under oath, that: PAGES: 2 He/she is the owner/co-owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume - " Page " Document Number /oL (o 9/S St. Croix County Register of Deeds Office: 2ecording,4rea A parcel of land located in the '/a of the of Section, T31N Name and Returnl Address R J$W, Town of ; W Q4f//c/E , St. Croix County, Wisconsin, being duly described as follows (include lot number and subdivision/CSM or detailed l (q legal description: U WT_ J-;540/•7 - S EF ~ ~yG ~l~ v Parcel Identification Number (PIN) As owner of the above described property, I acknowledge that a Private On-site Wastewater Treatment System (POWTS) serving the primary residence is sized for bedroom(s) with a design wastewater flow of boo gallons/day (DWF is based on /50 gpd /bedroom @ 2 persons per bedroom). A maximum of _S'occupants are permitted; if the number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate increased wastewater flows and/or contaminant loads and may be subject to premature failure. An accessory structure NOT to be used as a 2nd dwelling has been connected to the POWTS via Private Interceptor Main Sewer (PIMS) in compliance with SPS 382.30(12). I understand that disclosure ofthis information will be made to any parties interested in purchasing this property in the future. Dated this day of AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. St. Croix County. ) authenticated this day of Personally came before me this <9Ce4"~" day of (year) rl (p (year) the above named * - ``~s~ t u u„,,t~~ Q(}~Ot,F ~ 1. ~ ~ ( i ww~ IL nSLS ROETTG~.~a ---to me known TITLE: MEMBER STATE BAR OF WISGIN (If not, CT- 0I P qy t&be the person(s) who executed the foregoing _ instrument and acknowledge the same. Authorized by § 706.06, Wis. Sta& c) - Z j°U g~N ? THIS INSTRUMENT WAS DRAFTWgY. " G2 ~c OF, W St. Croix County Community Development Department Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. My Commission is permanent. If not, state expiration Both are not necessary.) date: Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE" This information must be completed by submitter: document title name & return address and PIN (it' required). Other information such as the granting clauses, legal description, etc. may be placed on thisfirst page of the document or may be placed on additional pages of the document Note_ Use of this cover page adds one page to your document and 2 00 to the. recordinglee.. Wisconsin Statutes, 59.43. St. Croix County 1034660 Page 1 of 2