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HomeMy WebLinkAbout012-1030-90-050 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592151 j GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's are: City Village Township Parcel Tax No If6d IV 7 TOWN OF ERIN PRAIRIE 012-1030-90-050 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 12.30.17.1788 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER j/ CAPACITY STATION BS HI FS ELEV. Septic y~ p Benchmark I V~ a 6001 Dosing (foM 3 Goa Alt. BM . ~ Lam, La , RF 9'S . 2 Aa ~ ~Z~ Bldg. Sewer r $•4 Q' • .7 Holding St/Ht Inlet p, (02- of/ 6 -4 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/~ WELL BLDG. ent t Air Intake ROAD Dt Inlet Septic 7 50 / '49 / t Dt Bottom IM p 7 i~ 1 ~ Dosing ~'50/ 15 3o I Header/Man. - ~ CM ,3 i7 a [H,ld,tng eraion Dist. Pipe ? - Us 9p. j 3 Bot. System 3. bI 9 7 PUMP/SIPHON INFORMATION Final Grade h Z16 TY• 3 Manufacturer Demand St Cove rer~ C` GPM' I Ir"', I Gp S q / J • 2. p lJ L Model Number v . TDH 16--n Friction Loss System Hea +,5 1 ds T DI~ 2 t 0 Forcemain Lengjh Dia Dist. to Well SOIL ABSORPTION SYSTEM ~i BED/TRENCH Width ~ Length No. Of~Yt~nch PIT DIMENSIONS No. Of Pits Inside Dia. Liquid lk< DIMENSIONS !/V~( SETBACK SYSTEM TO P/L BLDG I WELL ' LAKE/STREAM LEACHING Manufacturer: INFORMATION Type yyst~ : /6 ' 1~ ~k CHAMBER OR Model Number: \ 40 DISTRIBUTION SYSTEM Header/Manifpld Distribution / x Hole Size I rHole Spacing Ve Air Int I ( Pipe(s) 2 4`7 1.61 5 y V Length Dia Length 7•~' Dia Spacing 3Z 2,3 / "0-1 f SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only L-W 1110o% ~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ( ❑ ❑ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:, O ✓I t! Q t , Inspection #2: Location: 2013 170TH AVE 1.) Alt BM Description = 2.) Bldg sewer length amount of cover = ZV e C yinature 3 O Plan revision Required? ❑ Yes o Use other side for additional information. Date InsepCert. No. SBD-6710 (R.3/97) 00 o I ~ tzzU ~o N Rs CA .t jt ~ ~ y U Cp W (3a W I O ti ti o U a U I A ~ C a° a II a, N II W W ~ I 2 A i I ~ O M fi ~ y x H b ti c`y d bry NV- C2, ~ O h ~ ~ s b V 3 W W y°r 00 O O N O bi a V ~ d ~ Q C W ~ v m W ~ d g QO o i p o d W~W h a pmst ~n ,s v o a ~ a W h Do Oa 3 C'n ~ b U II A ,y is Q a o p~y o ~ o ~ W W ~ o a`, o W ~ ro ~ItnJ aO/d --19( _ns rf~o - County ' M~ won- Safety and Buildings Division St. Croix a 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) p S `3 Madison, W 153707-7162 OCR` 1 ~ 2,016 L 1 nOut4TY coM EMS? t Applicatiopq State Transaction Number LJX In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the r'(/ , e al u 2774540 is required prior to obtaining a sanitary- permit. Note: Application forms for state-owned , SV ,b e Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be 'I~ L~6 I I~(> purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. 'I s ~O I. A lication Information - Please Print All Information ~F Property Owner's Name Parcel # Richard and Kari Henry 012-1030-90-050 Property Owner's Mailing Address Property Location I 0, i, 7. t 2013 170th Ave. Govt. Lot City, State Zip Code Phone Number NW NW 12 /a, %a, Section }h~ New Richmond W. 54017 T 30 N: R 1..,P cirolE oreW 11. Type of Building (check all that apply) Lot # iR I or 2 Family Dwelling - Number of Bedrooms 3 1 Subdivision Name Block # ~I/~~1~_ ❑ Public/Commercial -Describe Use I 1 I►~1/~ 1r FT ❑ City of ❑ State Owned-Describe Use CSM Number ❑ Village of U I 1 L El Town of Erin Prairie li -e!!2 Y S V N1~ ELL 1~ n1 - - III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 4-CA (C A. [I New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued q Before Expiration Owner W. Type of PORTS System/Component/Device: (Check all that a 1 ❑ Non-Pressurized ht-Ground ❑ Pressurized In-Ground ❑ At-Gr e M > f suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)- _ t V. Dis rsaVFreatment Area Information: Design Flow (g Design Soil Application Rate(gpdsf) Dispersal A Required f) Dispersal Ar roposed (s System Elevation 45C .40 / 1.0 450 117, 450 /17, 97.60 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks Alylsk i• o C-U v v wC7 Septic or Holding Tank 1000 1000 1 Wieser Combo X Dosing Chamber VII. Responsibility Statement- I, the undersigned, assum responsi for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum s tgngtur MP/MPRS Number Business Phone Number Keith Knudtson 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) (27 150th Street Roberts W. 54023 VIII. Coun /De artment Use On ved El Pe tt Fee O Date Issuedq j~ Issuing Agent Signatur 03 Owne en Reason $ ~ v f Y LX. Conditions pproval/Reasons for Disapproval /~O~ S /n a n v(,{ / / SYSTEM OWNERS e1gt^1e 4 Wl fh ~S J' Peet" I ~ 1. Septic tank, effluent filter and dispersal cell must bg service __/maintained maintained . a (JfM'~~ Q~ 45) S c tfi f leM as per managetmgent plan providedby pl ber as per app~ica ICcQ~lr~c'h system and submit to the Coun p s tha d SBD-6398 (R. I1/11) 01~7-11DIVISION OF INDUSTRY SERVICES 3824 CREEKSIDE LN oHOLMEN WI 54636-9466 (p Contact Through Relay 3 I .S1 p services K http://dsps.wi.gov/programs/industry y w www.wisconsin.gov Z6 `U 16~ossforxtis~~ Scott Walker, Governor Dave Ross, Secretary September 21, 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 W1 54872-8728 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/21/2018 SITE: Identification Numbers Richard and Kari Henry Transaction ID No. 2774540 2013 170TH Ave Site ID No. 828647 Town of Erin Prairie Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NW1/4, NW1/4, S12, T30N, R17W FOR: Description: Three Bedroom Mound System / Sloping site Object Type: POWTS Component Manual Regulated Object ID No.: 1622926 Maintenance required; Replacement system; 450 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative 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. CON" No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, AP DEPT OF stats. The following conditions shall be met during construction or installation and prior to occupancy or use: PRO7 FESSI(. o D"ISION OF INDt Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be mad 1 SE::E the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the improved 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. KEITH E STONER Page 2 9/21/2016 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 C , This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered h and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. KEITH E STONER Page 2 9/21/2016 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 a,44,ZL~l This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jeny.swim@wisconsin.gov WISMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. I 1 SEP 8 ?016 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Richard and Kari Henry Replacement Mound Owner's Name: Richard and Kari Henry Owner's Address: 2013 170th Ave. New Richmond WI 54017 Legal Description: NW1/4-NW1/4 Sec. 12 T30N-R17W Township: Erin Prairie County: St. Croix Subdivision Name: Csm- 2&5997 #01q1-14q ZONALLY -cA)VED Lot Number: 1 Block Number: Na kFETY AND 3 `-"-L SERVICES Parcel I.D. Number: 012-1030-90-050 jSTRY SERVICES Plan Transaction No.: Page 1 Index and title Page 2 Data entry cto, 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 E. Stoner License Number: Designer 1575-007 Date: 09/05/16 \ CO t///gPhone Number: 715-653-2324 Signature: ' l3esig Tpe rsurint to3he Mound Component Manua'Irfor PQWft6krsioj 2.0-DB-10691-P (N. 01101), and both SSWMP Publication 9.6 Desi of ssil ~ Q,. JJIs#ribibn Networks for ST-SAS (01/81) and Pressure Distribution C~ 1alil~~l@r. 2.0 SBD-10706-P IN. 01/01) ~ ~ ~ r l I ! I 1 { { N 1 \ \ Version 7.0 (R. 03/2012) Page 1 of 8 L 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) 2.50 Site Slope 96.85 Contour Line Elevation (ft) 27.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) 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 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 (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 ft2/orifice 2.00 Forcemain Diameter (in) 200.00 Forcemain Length (ft) Does the forcemain drain back? F_ 87.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 32.62 Forcemain Drainback (gal) 10.27 Vertical Lift (ft) 67.41 5x Void Volume (gal) 5.01 Friction Loss (ft) 100.03 Minimum Dose Volume (gal) / to / 0.00 In-line Filter Loss (ft) 34.46 System Demand (gpm) 5 19.83 Total Dynamic Head (ft) O ' Lateral Diameter Selection Manifold Diameter Selection V~ 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 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 603.36 Dose Tank Capacity (gal) PolyLok ] Filter Manufacturer 16.76 Dose Tank Volume (gal/in) PL-525 Filter Model Number Weiser Concrete Manufacturer Project: Richard and Kad Henry Replacement Mound Page 2 of 8 Mound Plan and Cross Section Views 1/10 B . JObservation Pipe F7KK S 4i~ 4 h P J - h 3 4 A W :I : B C L Mound Component Dimensions Down slop a toe extension made. ft A 6.00 ft E 10.80 in H [Aft ft K Aft B 75.00 ft F 9.5Q in z ft L ft D 9.00 in G 0.50 ft J W 450.00 (ft) Dispersal Cell Area 1125.00 (ftz) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Qbs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.39 (ft) dogma G ♦ H I F 98.10 (ft) Lateral Dispersal `Cell'~"'f 97.60 (ft)--► - Invert Dispersal Cell Elevation D A, N :Irk t' { x s .tc? .a ).L) 7 ivy i'~ i 5 > -,i a, ,A k 96.85 (ft) Contour Elevation 2.5 % Site Slope Geotextile Fabric Cover d- Shading Key Dispersal Cell a See lateral details on Q Topsoil Cap c 1.5 ft h•h Page 4 for number, size, Subsoil Cap 0.0 and spacing of laterals. Laterals are T rtm 4 .p} equally ASTM C33 Sand F w 0.5 ft tYp~cal Lateral spaced from the Tilled Layer c ti... distribution cell's Aggregate © Aggregate centerline in the -A distribution cell (AxB). Project: Richard and Kad Henry Replacement Mound Page 3 of 8 End Connection Lateral Layout Diagram laterals centered over the Atic dimension • @ Turn-up vWbell valvo or oloonoutplug laterals are identical IF X -...3I Moles drilled on the bottom Or the lattral S equa4 spaced oicr main co nnection via tip* or doss to manifold at .at* point. rF~Laterals P Morcemein Sch 40 PVC per SPS Table 384.30-5 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 It Orifices per Lateral 32 Lateral Spacing (S) 3.00 ft Orifice Density 7.03 ftz/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 19.83 ft Forcemain Velocity 3.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and watertight Electrical as per NEC 300 and sealed SPS 316.300 WAC j 4 in. min. Disconnect Tank component is properly vented F--- Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Capacityl 603.36 Gallons - T Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 18.03 302.21 B 2.00 33.52 C Pump off elevation (ft) C 5.97 100.03 * 87.83 D 10.00 167.60 D Total 36.00 603.361 11 Do♦ se tank elevation n (8 3" Bedding un er tank. 87.00 Alarm Manuafacturer SJE. Rhombus I Note: Switches Alarm Model Number Tank Alert 1 containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number EP05 Pump Must Deliver 34.46 gpm at 19.83 ft TDH Project: Richard and Kari HenryReplacement Mound Page 4 of 8 Mound System Maintenance and operation $e+cificafions Service Provider's Name Powers Sanitation = Phone 715-246-5738 POWTS Regulator's Name St. Croix County Zoning J Phone 715-386-4680 System Flow and L ad 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 month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for nding and seepage once eve 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 T 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: Richard and Kari Henry Replacement Mound Page 5 of 8 Mound System Management Plan Pursuant to SPS 383,54, Wis. Adm. Code Qeatral 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 Tarp 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 filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner 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 mg/L BOOS, 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. csglignaencv elan 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. Pn t %Wnent 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. Project: Page 6 of 8 II Page 7 of 8 [QGOULDS PUMPS Submersible Effluent Pump 7 r r EP04 u 3871 EP05 L. 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, '~B"" • Heavy duty sump matic models include Water transfer Mechanical Float Switch Float Switch N Motor Housing: Cast iron (CSA listed model numbers end + Dewatering assembled and preset at the for efficient heat transfer, in "C" or "F".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Ptmps is ISb 90ot Rested. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. "N' maximum. ■ EP041mpofter: Thermoplas- ■ 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: 1112" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40`C) continuous METERS FEET 14ff (60%) intermittent. 10 - • Fasteners: 300 series stainless steel. s 30- . • Capable of running s cPwt dry without damage to $ zs Fr components. 25 o z Motor: _ • EP04 Sin a phase: 0.4 HP, 115 or NO V, 60 Hz, 1550 RPM, built in overload with automatic reset. a • EP05 Single pphase: 0.5 HP, EP 115 V Or 234V, 60 Hz. 1550 RPM, built in overload with automatic reset. 2 EPOa • Poway cord: 10 foot s standard length, 16/3 t SITOW with three prong Optional 20 grounding Plug. Q oa._ rQ 20 30 ~ ~ _ sti FPM foot length, 16/3 SfrW with three prong grounding plug (standard on EP05). o z 4 6 - 10 12 m3/11 CAPACIT J Goulds Pumps ® 2001 Goulds Pumps ITT I ndustries Efte~tive May, , 2001 B3877 N 00 U et a ON N ~o p LnW ~s wwwv~ o U N U !tI U q 1 ~ o ~a ~ N q R ww Q 2 J J i..J W ! O O 0.~ N ti O GL d ! ~ of O h ~ ~x [y ~ OO h h ~ t5 v O O a o N ri u ~ a 0 0 ~ °o w ! aU U Q 3 W 0 C~ Q O ~ w ~ G ! ° ~6 v ei c d rW~ W O 3a A n A b ba ° o a ~w ~ N ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Richard Henry Mailing Address Same Property Address 2013 170th Ave SDI (Verification required from Planning & Zoning Department for new construction.) City/State New Richmond Wi. Parcel Identification Number 012-1030-90-05Q,,**' LEGAL DESCRIPTION Property Location NW I/4 , NW 1/4 , Sec. 12 , T 30 N R 17 W, Town of Erin Prairie Subdivision Plat: , Lot # Certified Survey Map ' If-%J I I~ ~y , Volume Page # 590,_1 Warranty Deed # lQ UZ-{ R (before 2007)Volume Page # 7 Spec house ElyesEho Lot lines identifiable Byes0no 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 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 SIGNATURE OF APPLIC NT ) DATE I ***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) ICI I Wisconsin Depar f W onal Services (f 51 Division of Indust ~ - #1329 SOIL EVALUAT F P Page 1 of 3 t.~ OC,Utv1 ( in accordance with SPS 385, J 755 MS285 KCDR Keith E. Stoner Attach ciai t~ i 4t lss than 8%2 x 11 inches in size. Plan must include vertical and horizontal reference point (BM), direction and St. Croix perczi scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. 012-1030-90-050 Personal information you provide may be used for secondary purposes (Privacy Revie Date Law, s. 15.04 (1) (m)). Property Owner Property Location Richard And Kari Henry _ - _ _ _ Govt. Lot NW1/4, NW1/4, S12, T30N, R17W • 1 ~ D(J~ Property Owner's Mailing Address -Lot Block # Subd. Name or CSM# 2013 170th Ave_ _ 1 ~ Csm-26-5997 r yL City State Zip Code Phone Number _ City ~ Village ] Town Nearest Road New Richmond WI 54017 Erin Prairie Same Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD eplacem-- -1 Public or commercial - Describe: _ F ew Con7inH2 t materin loamy deposits over sandy loam till Flood plain elevation, if applicable Na ft. al commft. x 75 ft. mound cell located along the 96 .85' contour w/a system elev. of 97.60'. Upslope contour staked onsite. and recommendations: ❑ Boring # Boring Pit Ground surface elev. 96.20 _ ft. Depth to limiting factor 27 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc undary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR3/2 sil 2msbk mvfr cs 3f-co 0.6 0.8 2 9-16 _10YR4/4 _ sicl 2msbk mfr gs 2f-co 0.4 0.6 3 16-24 5YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0 4 24-27 2.5YR4/4 - sl m mvfr gs 2f 0.4 0.7 5 27-52 2.5YR4/4 c2d 5YR5/8 sl m mvfr if 0.4 0.7 Edge of old field, worm casts present inhorizons #1-3 Boring # - Boring T,I Pit Ground surface elev. 96.35 ft. Depth to limiting factor 40 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 0-10 10YR3/2_ sil 2msbk mvfr cs 3f-co 0.6 0.8 2 10-22 10YR4/4 sicl 2msbk mfr gs 2f-co 0.4 0.6 3 22-30 5YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0 4 30-40 5YR4/4 sl lmsbk mvfr gs if 0.4 0.7 5 40-53 2.5YR4/4 c2d 5YR5/8 sl m mvfr if 0.4 0.7 Edge of old field, worm casts present inhorizons #1-3 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD5 < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: Keith E. Stoner CST Number Address Keith E. Stoner 224059 Date Evaluation Conducted Telephone Number 23220 Wood Creek rd. Siren, WI 54872 5/20/2016 715-653-2324 SBD-8330 (R.07/13) Property Owner Richard And Kari Henry Parcel ID # 012-1030-90-050 Page 2 of 3 Boring F3]Boring # Pit Ground surface elev. 97.05 ft. Depth to limiting factor 37 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 0-9 10YR3/2 sil 2msbk mvfr cs 3f-c0 0.6 0.8 2 9-18 10YR4/4 Sid 2msbk mfr gs 3f-m 0.4 0.6 3 18-24 5YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0 4 24-37 5YR4/4 sl lmsbk mvfr gs 2f 0.4 0.7 5 37-48 2.5YR4/4 f2d 5YR5/8 sl m mvfr 0.4 0.7 #5 w/ inclusions of 5MR 3 loamy sand FIBoring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Descri lion Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. or Gr. Sz. Sh. 'Etf#1 'Eff#2 Boring FIBoring # I Pit Ground surface elev. _ ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and v' SS < 30 mg/L 2661 a ~ C7tl ~N ° \ a d 11 ~ .Z7 ~ Q I P p~(N7~ Z O N y h o s O ry C+ .p OQ p cp l M N A p f (0 O _ .7 O ~ a + O b O V b <Zl N O O o k c ,y b ~ zs a s Q D ~ k ~ ry c„ O' co O v a Zz W o `0 ► ~ ° a bd a o ° o h m a r m e II N A b II 00 Q O ~ n S b S s k ~ Ct7 C17 GJ tU b7 CIJ ~ < 0 N O co1 14 N k b ~ ~ ~ p O ~ I w `L