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HomeMy WebLinkAbout191-1011-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 112,17 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.1 04 (1)(m)). Z 'TV Permit Holder's Name: „ City ciage, Tnwnshin Parcel Tax No: CST BM Elev: Insp. BM Elev: BM D scription: Section/Town/Range/MapNo- b 5 2. TANK INFORMATION ELEVATION DATA O'g 101.05 /O TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. . 17:9 5 6b Septic d Benchmark r Dosing Alt BM C~D✓U- y7 9z' z Aeration Bidg. Sewer ~ O Holding St/Ht Inlet , . ; .n • ~3 St/Ht Outlet TANK SETBACK INFORMATION TANK TO 1`1 WELL BLDG. Vent tck Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. 39 174 Aeration Dist Pipe Holding Bot. System' e! ~J. PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover., P °r 75 z , Model Number p 1 C3 3a,~~ , TDH Lift Friction Loss System He d TDH - gj a~.C , O Vk P. ,dam SS Forcemain 1 Length Dia. 'j Dist. to Well O® 'Z: i SOIL ABSORPTION SYSTEM th BED/TRENCH Width Length No. Of Trenches PIT DIM NSIONS No. Of its _ Inside Dia. Liquid D DIMENSIONS SETBACK SYSTEM TO V P BLDG WELL I LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: f ~ DISTRIBUTION SYSTEM t ' Header/Manifojd / Distributi`on~ 1 - x Hole Size Ix Hole Spacing Vent to Air Intake Length Dias' . Length (0' , w Dia 0 5 Spacing -3.(o Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over jxx Depth of ~ xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Y, 'fS Yes E No es E] No L COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 17 . t Inspection #2: Location: 1163230TH STP 1.) Alt BM Description (Ok, 2.) Bldg sewer length OUL ~ O'G - amount of cover Plan revision Required? E] Yes "No ~ t „3 Use other side for additional information. 7 Date Insepctor's S' nature Cert. No. SBD-6710 (R.3/97) SIM wok L;IVCLJ County } Safety and Buildings Division Ar D 3-1 NOV 201 W. Washington Ave., P.O. Box 7162 y ) e S P Sanitary Permit Number (to be filled in b Co. Madison, WI -71 ST. CROIX COUNTY ~ 7 47 Sanitary Permit Application t Transaction Number r c 1 6 3 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ' - _J is required prior to obtaining; a sanitary permit. Note: Application forms for state-owned POWTS are submitte-d-to P6 ect 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(l m Slats. I 76 X r, 1. Application Information - Please Print All Information (J u Property Owner's Name Parcel # cKc+ kz 01 Property Owner's Mailing Address Property Location -7 L ~Govt. Lot City, State Zip Code Phone Number Section Cy j r circle on II. T ofBuildin T . -f N, REo ype g (check all that apply) Lot # Z Family Dwelling -Number of Bedrooms Subdivision Name Z ` Block # Elublic/Commercial - Describe Use ity of ~~77 ~~,U - - - L9tate Owned -Describe Use CSM Number K01 lage of y , ( Z ✓ own of III. Type of Permit: (Check my one box on line A. Complete line B if applicable) O A. Dew System placement System reatment/Holding Tank Replacement Only ther Modification to Existing System (explain) B. ermit Renewal ermit Revision hange of Plumber rmit Transfer to New List ~e ous ermit N 47 z, paai70 Before Expiration Owner q! / IV. T ' of POWTS S stem/Com nent/Device: Check all that a I Qti J , on-Pressurized In-Ground ressurized In-Ground t-Grade Lnd 24 24 in. ofsuitable soil ound 1<2 E 4 in. of suitable soil lolding Tank Other Dispersal Component (explain) etreatment Device (explain) V. Dis rsaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (so Dispersal Area Pro sed (st) System Elevation c>7c~ ~ ~ (e 106 ~ 3 VI. Tank Info Capacity in Total # of Manutacturer Gallons Gallons Units 4 0 New Tanks Existing Tanks J 4q y Septic or Holding Tank 7Q Dosing Chamber ! r~ r VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number c i ~h k-1u~; - S IZz463 7 715- -16 3 -3,-? 3 Plumber's Address (Street, City, State, Zip Code) -7 7C VIII oun /De artment Use Onl rove tsapp Permit tFFeee~ Date ;L/ I - Issuing ent Signatur P K ven Reason for Den $ ~i7 1 IX. Conditgffi'K I A"Measons for Disapproval 1. Septic tank, ed`[L: n: lilte- ;,n d ulsper cell muit all be ic_s ! r inta~rec' / t as per management plan pro tided by plumber. 2. AA'serbprit"ragtllrerlanls mint be r np intrired 666 as per *F*Abis cal /:r6nance3, Attach to complete plans for the system and sub ' o the County only on paper not less Mans t/ 2x 11 inches in size Y SBD-6398 (R. 11/I1) Plot Plan Page *f Property Owner U S rmy K TR Ursa _ Legal Description 6W 'A (except where note _rZIRIJ , FI5 0, yi U-A&* al:7, WILsO,u, sr c ,~X ~ou+u ry - Bachhoe pit 870 ~o±c~~sos~ ss T NoKh IQ 1011-Z0-ODO 141-1ot1- 10-U)b Li g~at~ a o~ r L~ W~ U..T iR LNG E 6t P vG PROp°SEr :10 j ID {►t rii~y® GrL rtcT 2a 5~ L'&. -plTMOT • A EXIS-rI FG too -5z~' 1. ~6Z rt IYZ rq& A LL -fl- ell s_ r1 0 ~ Site Location: V r DIVISION OF INDUSTRY SERVICES R-j 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 }i\ Contact Through Relay http:I/dsps.wi.gov/programs/industry-services vwnAi.wisconsin.gov Scott Walker, Governor oFE.y j Dave Ross, Secretary CONDIT1°0" 4 APPROV November 01, 2016 D'.-PT OF SAFI A7,TN: POYV7SInspector P-ROFESSIONAL cuST ID No. 224832 DIVISION OF INDUS' ZONING OFFICE MARY JO NUPPERT ST CROIX. COLiNTY SPIA HOLLISTERS SOIL TESTING & 'DESIGN 28497 110 1 CAP~1vIICHA.EL RD KING ARTHURS I101 CA WI 54016-7708 DAI~BL RY WI 54830 SEE GORRESPI ____en CONDITIONAL APPROVAL Identification Numbers APPROVAL. EXPIRES: 11/01/2018 Frae nsaction II} Na. 2794633 ID No. 830473 SITE: Please refer to both identification numbers, Nickolas and Amv Thaver above, in all correspondence with the agency. Johnson St Village of Star Prairie St Croix County SW1/4, NEl/4, S26, T29N, RI 5W FOR: Description: IVIound Svsteni (3 Bedrooms - Replacement) Object Type: POWTS Component Manual Regulated Object ID No.: 1632470 g fact Maintenance required; Replacement system: 600 GPD Flow rat" 30 Soil mini P m depth ,to lim ln) Pressure from original grade; System(s): Mound Component Manual -Ver. 10, SBD -10691 Distribution Component Manual - Ver. 2,0, SBD-10706-P (N,01/01, R. 10/12); Effluent Filter ist The submittal described above has been hareviewed for s been CONDITIONaALLYitAPPROVED. hi~ system dis to be ctiveonstr Codes and Wisconsin Statutes. The submittal 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: Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. Any tall grasses, leases and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area. Prior to construction of the dis ersal area. check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil Proper soil moisture content can be determined by rolling a soil sam le between the hands. If it rolls into a 1/4- inch wires the site is too wet to prepare If it crumbles site preparation can proceed. If the site is too wet to re are. do not proceed until it dries. • Abandon Existing System per SPS 383.33 il_. nnc $ 1-a,, rj Csu;`. 1 1 1 7 S1Zln t0 f 88t i s t Purr-) i lo2;ts t0 be ~e"- al)tl 'rerii -d TJe. -norm,ed [ ;-i 17'r _ i ivtl ant] GP--Ni Spe ifJcnt1ons. Divert surface water from POWTS Area. All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 PaQe3 11/i120i6 VILkRY JO HUI'PERT m Insulate building sewer beyond 30 feet: per SPS 352.30 (11)(c) E Tank Installation to follow all manufactures recommendations. F Verify property line(s) prior to installation. Well setbacks to meet chs. NR 811 & 812, with rock fragments. tree roots. stumps and boulders reduce the amount of soil ® Areas that are occupied basal available for proper treatment. If ino other sire is available. trees in the area of d~1e mound must be cut off at around level. A larger fill area is necessary w1Ien any of the above conditions are encountered, to provide sufficient infiltrative area. SPS 383.54(1)(e) 'Fhe management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. QtiYner° 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 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. 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, FThisAmountlude red $250.00 Will Be Invoiced. Receive That Invoice, a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services WiSMAKT code: 7633 (920)492-22 t4 , Monday - Friday 6 am To 3:30 pm tim.vanderleestic'~i wisconsin.gov t MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: NICKOLAS R. & AMY THAYER "Y 1A ND Owner's Name: US BANK TRUST ItY S'rERVICES Owner's Address: 3701 Regent Boulevard Irving, TX 75063 _Zea~_ dDENCE Legal Description: SW 1/4 of the NE 1/4, Sec. 26, T29N, R15W Township: Village of Wilson County: St. Croix Subdivision Name: NA Lot Number: NA Block Number: NA Parcel I.D. Number: 191 - 1011 - 20 - 000 Plan Transaction No.: 'olS1W111;i IBl!!/fI Page 1 Index and title Page 2 Data entry esc•®Page 3 Mound drawings Page 4 Lateral and dose tank ;RY d® r Page 5 System maintenance specifications EIPIET Page 6 Management and contingency plan D 1959 Page 7 Pump curve and specifications r-EF1 I~ LL S.- = Page 8 Plot plan 3 Designer: Mary Jo Huppert License Number: 1859 - 007 Date: 10/16/16 Phone Number: 715 - 821 - 1440 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (R. 03/2012) t. Page 1 of 8 Mound and Pressure Distribution Component Design F)esign Worksheet Site Information (R or C;) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 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. 600.00 Design Flow (gpd) 14.00 Site Slope 95.80 Contour Line Elevation (ft) 30.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 66.67 Dispersal Cell Length Along Contour (ft) = 9.00 Cell Width (ft) 1.00 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 N a Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 3 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 3.50 Estimated Orifice Spacing (ft) = 10.53 ft2/orifice 2.00 Forcemain Diameter (in) 60.00 Forcemain Length (ft) Does the forcemain drain back? Y 86.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 9.89 Vertical Lift (ft) 89.68 5x Void Volume (gal) 1.21 Friction Loss (ft) 99.47 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 30.69 System Demand (gpm) (PD 15.65 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 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 21 50.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Huffcutt Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) Lifetime Filter Manufacturer 16.50 Dose Tank Volume (gal/in) na Filter Model Number Huffcutt Manufacturer Project: NICKOLAS R. & AMY THAYER Page 2 of 8 Mound Plan and Cross Section Views t . 1/10 B . n J t Observation Pipe 1 0 A W _ B • L Mound Component Dimensions ft E 21.12 in H 1.00 ft K 8.77 ft B ft F 9.50 in z 15.78 ft L 84.20 ft A [Aft D in G 0.50 ft J 3.79 ft W 28.57 1 600.03 (ft2) Dispersal Cell Area 1652.38 (ft2) Basal Area Available 9.00 (gpd/ft) Linear Loading Rate 6.67 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.09 (ft) .,,//r,,,... • H I F Dispersal Cell 96.80 (ft) Lateral 96.30 (ft) Invert - - Dispersal Cell] Elevation E.. i 95.80 (ft) Contour Elevation 14.0 % Site Slope Geotextile Fabric Cover Shading Key Q T Dispersal Cell See lateral details on 10 Topsoil Cap c c 1.5 ft t-T Page 4 for number, size, r„rrr Subsoil Cap W.0 LS.t 0 ~ and spacing of laterals. 2❑ ~ _ © ASTM C33 Sand `6 co Laterals are equally spaced from the ® Tilled Layer = H H0.5 ft Typical Lateral IF distribution cell's © Aggregate M Q I centerline in the A distribution cell (AxB). Project: NICKOLAS R. & AMY THAYER Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension Turn-up wf ball valvA or cl annout plug P All laterals are identical (E X-~I Holes drilled on the bottom of the lateral s equally spaced laterals &forcemain Sch 40 PVC per SPS Table 364.30-6 s Force main connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.62 ft Lateral Length (P) 65.16 ft Orifices per Lateral 19 Lateral Spacing (S) 3.00 ft Orifice Density 10.53 ft2/orifice Lateral Flow Rate 10.23 gpm Manifold Length 6.00 ft System Flow Rate 30.69 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.65 ft Forcemain Velocity 3.13 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented E- Alternate outlet location Forcemain diameter Huffcutt Manufacturer 2 in. Capacit ~750.00 Gallons Volume 16.50 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 26.53 437.68 B 2.00 33.00 C Pump off elevation (ft) C 6.03 99.47 86.91 D 10.90 179.85 D Total 45.45 750.00 Dose tank elevation (ft) 3" Bedding un er tank. 86.00 Alarm Manuafacturer SJE Rhombus Note: Switches Alarm Model Number Tank Alert AB containing mercury may not be used in Pump Manufacturer Zoeller this system. Pump Model Number 98 Pump Must Deliver 30.69 gpm at 15.65 ft T D H Project: NICKOLAS R_ & AMY THAYER Page 4 of 8 Mound Svstem Maintenance and Operation Specifications Service Provider's Name Advanced Septic Systems Phone 715-235-0935 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.03 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 pondin and seepage once every 3 ears 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 \ ~1 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution M45 g Sweep 90 or Two egree Bends Same Diameter as Lateral Project: NICK & AMY THAYER 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.01101), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. filiii111ann +ncai nr sfiata rliiag ngrtamm~ to cycrl?m mainiananre anti mains_anance rannrFmg_ 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, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter 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 fitter alarms may indicate surge flows or an impending continuous storm 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 #11 ~...v /_I__:.-_~ a_~1~_-11 L_:__._-_a_J _a l___a 1..____ r e pumip (dosnry) tank sharr uc nspe,tcu at reast unce every 3 years. nn swnunca, amm~ia, anu NwnNa anon uc twtcu w venly Nwircl operation. If an effluent filter 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 muiched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 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. 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 rcuaired or rerlaied with a component of ure 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 smite arp attarhpii ac cpnaratp rinrnimpnm anri arp rnnciriprpri part of the nvpraii mananpmpnt niAn forthic cvctpm W HEAD CAPACITY CURVE 7/0 0 1/9 W V ~ MODEL "98" 30 4 5/8 s - 25- t _ 3 5/8 g 20 0) _ 'TaFF is + r Q ~ 4 a o tD 4 3/16 z 5 ~ J o Mt) 1 1/2-11 1/2 NPT U.S. GALLONS lO 20 40 50 so 70 80 UTFRS 0 80 160 240 FLOW R MINUTE MODEL 98 60 CYCLE Feet Gallon Meters Liters 5 72 1.5 273 10 61 3.1 231 15 45 4.6 120 12 zo zs 6.1 es X71 4 3/16 SK1102 CONSULT F-.4miC 1 ORY FOR SPECIAL APPLICATION-S Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available - Double piggyback variable level float switches are available with or without alarm switches. for variable level long cycle controls. SELECTION GUIDE Standard all models - Weight 39 lbs. - '/z H.P. 1. integral float operated 2pole mechar~Iswitch. noextemalr~olregwred- Single piggyback variable level float switch or doubt- piggyback variable level. 98 Series control Selection goal switch- Rerer to FMO477_ Model Volts-Ph Mode Mips Simplex Duplex 3. Mechanical afternator 10-0072 or 10.0075. M98 115 1 Aldo 9.4 1 or 1 & 7 - 4. See FMO712, For erxrec model of Electrical Alternator. N98 115 1 Non 9.4 2 or 2 & 6 - 3 4 & 5 5. Control svmtch 104 225 used as a control activator, specify duplex (3) or (4) float 098 230 1 Auto 4.7 1 or 1 & 7 - systern. 6. Four (4) note J-Pak. junction box, for watertight connection orwired-in E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, l0-0002. 7. Two (2) hole J-Pak, for watertight connection or splice. CAU T IoM For iMarmatim an addil=l Zoeller pmducs refer to raWog an Piggyback Variable Level Swilcaes, All installation of controls, protection devices and :hiring should be done by a qualified FMO477 EledicalAltemal r,fWNKMecha agAllemalor,FMO495;SunpRSewageBadns,FM04U licensed electrician. All electrical and safety codes should be followed including the most Single phaseSimplmkpumpCaid, Rd1WAlmm SyMems. FM0732 recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DF-S For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump- /~J MAILT& P.O BOX 16347 J. Z ° f./lJ mrSr 3M 4tRwP7 i A darersc.. - . SYf6r7nt 3649CawreldnRoad Louisville. KY 40211-1961 ~j~T7 f7~ps ,j/NCE /&N~ P°I hNyr://wwar xoeNer_eorn PUMP !O_ _ (504 FAX((SM 774-3624 A C", < Plot Plan Page do Property Owner ~(S r~hV K Tp I I 40ft. Legal Descrtwn 1 ip sw dl- -s-~.'F- / sic. Ztv (except where note - 1-J, v►u,4&* o:F w►LsOno, 'S-T- e,D,x e-OUATY to $ackhoepit I8 O -T"K)SON ST R:~-£T .North IqI- Inll-zb-oOb ~ 191-)dlt- to-ObD ~ 4 gCDR00~ LV ~gM 1- 1 I L' y 1 b0' $~h13ti2~'TOP OF W lRIAr, ~N nvc 1'' Fe ?bYa~t~€ , - t lzoM PRb~OgC LIU l q7.-7q .5-L pt r~~R~ 1 0.00 MOUNo a py> IT %JOT -P7aD ReWx@ o a0 ( -rRNK-'Tb Be 0 0 ° a~ ~.t3k' tip . =u 2` AsT PSG? ,4t3An3t~onr~v K~L L~~ a 10~ 2j,~3 5_4 j-R 3 ~y / y 047c~N5 Site Location: V a z ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l C_ la, (L- ,V-Mailing Address j Property Address iel C' h nsc.,,yi (Verification required from Planning & Zoning Department for new construction.) City/State "~un Parcel Identification Number 2L LC) LEGAL DESCRIPTION W, 1 of ; >'-~C 7~ JL_ Property Location lL '/4 , '/4 ,Sec. TN R Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yes❑no Lot lines identifiable ❑yesOno 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 /ont 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 nty deed recorded in Register of Deeds Office. Number of bedrooms 4 *~A 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) Wisconsin Department of Safe Md Professional Services Division of Indust~jc,sj v R lr V L~ SOIL EVALUATION REPO 1PT100 Page 1 of 3 ~a in accordance with SPS 383, Wis. Adm. Code 71HSFM7 ~QV ~ ~ "r ST. CROIX Attach complete site Wh!, not less than 81/2x 11 inches in size. Plan must include, ontal reference point (BM), direction and parcel I.D. 19 - 11 - 20 - 000 percent sl north arrow, and location and distance to nearest road. vOM~VN► r e by Date Please print all information. Revi Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location US BANK TRUST NA(Buyers: Nick & Amy Thayer) Govt. Lot SW 1/4 1/4 S 6 29 N R 15 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name oifcsm# 3701 Regent Boulevard city State Zip Code Phone Number []City Village own Nearest Road Irving, TX 75063 ( ) NK Johnson Street son ® New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD El Replacement ® Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable NA ft. General comments Mound System 0.50 ft. sand fill 0.6 loading rate and recommendations: a Boring # ® Boring Pit Ground surface elev. 94.25 ft. Depth to limiting factor 35 in. $al Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz_ Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10YR3/3 1 3fa&sbk mvfr ai 2vf-co 0.6 0.8 2 10-29 10YR4/4 s1 2fsbk mvfr cs lvf-m 0.6 1.0 3 29-35 10YR4/6 - Is I msbk dl es 1 vf=m 0.7 1.6 4 35-40 7.5YR4/6 f2f 7.5YR5/6 sc Om dh cs 0.0 0.0 40-till 2 ] Boring # Boring 99.10 30 ■ pit Ground surface elev. ft. Depth to limiting factor in_ F Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10YR2/2 - I 2fa&sbk mvfr cs 2vf-co 0.6 0.8 2 10-30 7.5YR4/6 _ sl 2fsbk mvfr cw lvf-m 0.6 1.0 3 30-40 7.5YR4/6 f2f7.5YR5/6 sl Ifsbk dh cw lvf-f 0.4 0.7 40-till ' Effluent #1 = BOD > 30 < 220 mg/- and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/- CST Name (Please Print) psrre CST Number MARY JO HUPPERT Hollister's Soil Testing&Design) G/~224832 Address Date va uatron Conducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 10-11-2016 715-426-1775 SBD-8330 (R07/13) 5 Property Owner US Bank(Buyers: Thayer) Par I ID # 191 - 1011 - 20 - 000 Page 2 of 3 Boring ❑ Boring # pit Ground surface elev. 93A0 ft. Depth to limiting factor 32 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10YR2/2 I 2fa&sbk mvfr cs 2vf-co 0.6 0.8 2 12-24 10YR4/4 sl 2fsbk mvfr cs lvf--m 0.6 1.0 3 24-32 10YR3/6 sl Ifsbk ds cs lvf-f 0.4 0.7 32-till ❑ Boring # HBoring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/- and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/- SAD-8330 (807/13) 1 Plot Plan Page 4of --2!; Property Owner U S E&V K TY, ws1 •P t ~l 1~ n a v~1 40 Le Legal D l f~ g escripturn sw tiy b -vfte N~/, 3 (except where noted) _ -~~r~ , _ > VI OF w►t-sow ST CF~01x dauKrTY Backhoe pit x-70 ~aO-H )SON sT~~£T /North IQ I- IU11-Zb-oao F 191-1oti- Ia-Obo ~ 4 geDRODM v ~ 1. Bh't~t2~TuP oIF loo L~+1R~NG ea nve taF'o~ ! WRoM PR6 r~RL't'i- p Gc~ E3U M t- At 13'Rd sswAnsr-EQQ. 0,AAJ 2 _PET A1oT Exi 5~ ~x @ 'CRN K - 'To Be _ ,gr~n~t~onrE;v Jul. q, Z5 A. 4~ 2 ~6 y~J~\ j J 1 l a LA A) i~ Site Location: r ~bo zv 14 f v - . . n , 40, x 4 M 4 s n $ -di t' k AWN IRM 3 Sa, Syr ~9K< w, m . r ~ a * 4 + " 2 S 4pf v Y N z "'7 a g n mow, A7 ~M1 A yf m 3' '~ssnw 7b - x ~ w a ~ r gg I ° s cc lob f-i Mod, e nF 4 4 'a~t'3~' 6 ij N 4k , t o o M O fn a Or y Q ~ CO C C~ O t T~ N vJ N O C_ Y O X ~ N o m C z c ~ m LL o w -c, d to M r- Z N W E Z O Z rn co N a m N f C O C V" U O 2 d' c !n F C z c ~ °a O ~ N N a N N O a o T G J o a d o Z (n z N C r ~ y o c E a C? m o c. m w c c L O V N d - O _ o ❑ a E (D z, 0 0 0 0 o (n 0 0 o t!7 J V ~ 07 ~ z ,~hJ O N O O O cc O O o m n o p .6 .2 r- z 03 00 G) C O c Q N C O -o E 4 .R O m~ o N O O y y O M> O~ Ci O p ~n O ~ ~ 07 ~ O N N ° c ~ JI U. i N !6 C co ' pV r rn N> rn o E~ 2 z U?I E Cl td N a xt _a a T CL z .2 -1 E L c = en O O m 3 v a 2 O v~ v i Wisconsin Department of Health and Social Services ?lb. #67 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK 2,6 r _13 A. OWNER OF PROPERTY / U~j f7s(Jn Nerve Address (Street, City, Zip Code) B. LOCATION OF PROPERTY Wt' SYSTYM WILL BE CONSTRUCTED A TERED OR EXTENDED COUNTY Check One: 27,f 16 CITY V VILLAGE LEGAL DESCRIPTION ~ / -7 TOWNSHIP rr✓D Y"ZF/ C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? _ YES NO PERMIT NLMFR D. SEPTIC TANK CAPACITY ; Gallons NEW INSTALLATION REPLACKKENT ADDITION MATERIALS- -Prefab Concrete Poured in Place SteAl Other NUMBER OF TANKS TO BE INSTALLU: i E. TYPE OF OCCUPANCY Check One: One or Two Family Residence l Comercial Industrial other (specify) Number of Persons to be Accommodated ? Number of Bedrooms F. APPLIANC'E'S, ETC: Food Waste Grinder i YES Y NO Automatic Clothes Washer P' YES NO Dishwasher YES 1 NO Autoratio Potato Peeler YES t•. NO Other (Specify) - G. Nu"+ST£R PLLr3ER MAKING INSTALLATION Name: ;n4? S _ . ,•r. Address: ~a,~,_,. License Numberi HP Signature of Applicant: _ MP RF'j Address- g, ( o be ompleted by Issuing Agent) Date of Application 7!' Fee Paid Permit Issued (date), Permit Number Agent (Name) `V/ Town, Vil age, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents wi-'l fornard application, the fee of 41.00 for each septio tanx and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY ruw RETURNED i (Initials) / (Date) -~r.res.) FEE RECEIVED VALID. No. ~ 7,f PERMIT N0. es or No REVIEWED BY APPROVED _ DATE (Initials) Yes or No COMPLETE OTHER SIDE SEPTIC TANK PTFu1I7 NO. R Z P 0 R T O N S O I L P T R C 0 L A T I 0 N T Y S T A N D S O I L B O R I N G S TO DIVISICV OF HEALTH - PLA`MIW, S=TIbt P.O.Box 309, F dison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P E R C O L A T I O N T Z S T Test Depth Character of Soil Hours Water Test Time Drop in Vater Level Inches utes Number Inches Thickness in In,3he3 Since Hole in Hole Interval Second to Next to Last To Fall 1st Wetted Overnight, in V nutes Last Period L&s` Period Period Ong Inch Example P - O 3611 Top Soil 10" Clay 26" 25 1-Yes or No 30 1 2 1 2 l_/2 30 RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code- S O I L B O R I N G S- Fini3um 3611 Below Praposed Absorption Svstom Boring Total Depth Depth to Ground SFater Depth to Badroc% a Number Inches Obs©rvod Estimated Observed Estimated Character of Soil with Thiolzne3s in Inches Example B - 0 721# 72" Black. Too Soil 1211• Clay 1811Sand 18"• Gravel 2411 REv':+DTD DATA FROM MINI-;L:4 0? 3 BOPS HOLES TYPE OF OCCUPANCYA RESIDENCE: Numbar of Bedrooms )TH R: (Specify) Number of Persons ROOD WASTE GR LNDERt Yes No DisYr;ashers Yes No Auto=atic Clothes hashers Yes No EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLAMIrENT Tile Size =t No.Lin,Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Diameter Liquid Depth Ie the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter h 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME TITLE Type or Print REGISTRATION NO. or MASTER PLUMBER.LICENSE NO. ADDRESS 7r t fir. / - h - j DATE 7' / / r• SIGNATURE ' I Parcel 191-1011-20-000 06/27/2007 05:04 PM PAGE 1 OF 1 Alt. Parcel 26.29.15.88B 191 - VILLAGE OF WILSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current CO-Owner O - CURRY, JAY A & MARY K JAY A & MARY K CURRY 1870 JOHNSON ST WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1870 JOHNSON ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 26 T29N R15W PT SW NE COM 200 FT N Block/Condo Bldg: OF SW COR SW 1/4, TH E 270 FT, TH N 160 FT, W 270 FT, TH S 160 FT TO POB VIL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) WILSON 26-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1025/03 WD 07/23/1997 462/287 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 10,000 160,700 170,700 NO Totals for 2007: General Property 1.000 10,000 160,700 170,700 Woodland 0.000 0 0 Totals for 2006: General Property 1.000 10,000 160,700 170,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 108 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 191 -1011 -10-000 06/27/2007 05:04 PM PAGE 1 OF 1 Alt. Parcel 26.29.15.88A 191 - VILLAGE OF WILSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CURRY, JAY A & MARY K JAY A & MARY K CURRY 1870 JOHNSON ST WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 39.000 Plat: N/A-NOT AVAILABLE SEC 26 T29N R15W SW NE EXC P88B VIL Block/Condo Bldg: WILSON Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1025/03 WD 07/23/1997 461/469 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2005 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 39.000 46,800 0 46,800 NO Totals for 2007: General Property 39.000 46,800 0 46,800 Woodland 0.000 0 0 Totals for 2006: General Property 39.000 46,800 0 46,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00