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/2-/0 -IS` CO /Z`00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 582046 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, 5.15.04 (1)(m)]. 2632289 Permit Holder's Name: City Village Township Parcel Tax No: Croes Udder Dairy LLC TOWN OF STANTON 036-1026-90-000 CST BM Elev: Insp. BM Elev: B Description: Section/Town/Range/Map No: ~Am ~ vF L., evz_ )21 12.31.17.173A TANK INFORMATION ELEVATION DAT 9,s I I TYPE MANUFACTURE fin,, IP)CITY STATION _ BSS OHI FS ' ELEV. • b Septic ~v U l~ Iv Benchmark S 9 Q'~ o0 Dosing h'IV°d Gov Alt. BM Aeration W'1G ~y~~ s~5 Bldg. Sewer cq Holding ! St/Ht Inlet 7~ 9Q lQ SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic } Dt Bottom , t r - ICi,O Dosing I I He er/M 2, / eration Dist. Pipe 2,66 Holding Bot. System 2-,/ Qo~~ final Grade I I v ? b PUMP/SIPHON INFORMATION Manufacturer Utz' Demand St Cover ~j•~y 10Z-53 GPM 715 Ir cF C17 Model Number le D`, l t' l~• J TDH LiftcA Friction Lo~ System Head ' J TDH I h _ t V Forcemain Length Dia. Dist. to Well `b~, t n p /1 ,~L z 2~ , 10 SOIL ABSORPTION SYSTEM p~ BED/TRENCH Width Length ) No. Of_34oR8Hse DI 1~O1 PIT DIMENS NS Nc. Of Pits fei Liquid Depth _ DIMENSIONS Z /J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR INFORMATJ N Type Of S stem: +I~~t / } I h 5 UNIT Model Numb o4o 1j - DISTR ION SYSTEM U Distribution x Hole Size i 1 x Hole pacing, V / t to Air Intakk Head / anifol t t I ' V CC GGii 1' ✓ Pipe(s) qb, I Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over jxx Depth f t xx Seeded/Sodded xx Mulched Depth Over 1 ~/J~ No Bed/Trench Ce Bed/Trench Edges Topsoil ' Yes E] No Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:1Q ' Location: 1950 220TH AVE - F~krenr~}/atJ S?uSB~D uP 7~J'4 ax" D ~~,®YJ ellP Sus' owTS t~E TIkN~R 1.) Alt BM Description = /hDU~ ~NsTRu- /N fP~j v~ 20~~, \ 2.) Bldg sewer length = j s r C hot S Lu ks b~ - amount of cover = } Z Plan revision Required? ❑ Yes No I ILLc Use other side for additional informaribn` Date e ctor's si nature Cert. No. Ins p g SBD-6710 (R.3/97) County GEIV Safety and Buildings Division C"-u 1•k Q 201 W. Washington Ave., Box 7162 Sanitary Permit Number (to be filled in by Co.) S "I P Madison, WI 537 -716 S n ®Q i 2 `i ~xax COMMUNRY QEW3WR", Permit Application " State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental nrt Z (p3Z 2.8 / 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 Scrvics. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Information - Please Print All Information < C~~ Property Owner's Name Z/ 1 Parcel # G~u~s , toCS V~ser d,; eucioz6 ye_)v ov Property Owner's Mailing Address Property Location 1x.31. 17, 1'73 1%561 2~ ~ 4 Govt. Lot Q.31. City, State Zip Code Phone Number /**4F 1j4, S '/4, Section /Z D ~AA L ws SXOz ~ >,s _ 9 97 . DYld (circle one) L AIL /.IIZJ` T 3~ N; R ~oV II. Type of Building (check all that apply) Lot # or 2 Family Dwelling -Number of Bedroom Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of CSM Number ❑ Village of ❑ State ~Iwncd ; Describe Use X 1C/ Town of S h III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 26YLIL 1)(1, A. -ANew System placement System ❑ Treatment, IIolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / IV. Type of POWTS System/Component/Device: (Check all that apply) p ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ,Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat nt Area Information: Design Flow (,-pd) Design Soil Application Rate(gpd Dispersal Area Required (K Dispersal Area Prop d ( System Elevation 300 4 304 ifSU 304 ~b1t VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks ~ / y ~ v L y W ^J 0. i.J v~ n v1 Iz. C7 0. Septic or I lolding Tank i Dosing Chamber 1dW 60V/W 600 ~~f~I2 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plumber's Signat rc MPMPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. Countv/De artment Use Only Approved tsapp dve,a_, Permit Fee Date Issued Issui Agent Signat re ~o - D Owrrer Given Reason for Denial 1-7 IX. CondilSNiFMIPW lE IReasons for Disapproval 3, Goti A t~~~~ ti t o~~f 4 jL t~~ 1. Septic tank, Ofttnt fit f, and d~ disper-al cell mulct all be t;er* se d maintainer' 6&,k- W 4,4 e(.11%A1 as per management plain prpylded by plltmber• P f_1 2. AU setbw* requftmeMs mot pe maintc 60 Go as per applicable code / ardinancos, 1 J Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD-6398 (R. 11/11) M y 0 a Q ~ I ~ O v N j O p N p~ n e o L. U \ ~ C ~ \InV1` :~'1 ry ti Z 1 ~ Y~~~ ~y Ov 'O O y v h O O rN N ti ~ N I ~ N ~ q ~ v 2 a L. m p U C U ~'a ~ ~ ~ a h ~ ac o d is 0. "T-i O ~ Z Z ~ o I C 4 h C J O 3 z I a C C M O sz G ~ zl. N ~ O ~ OU P (%j W R ti rX K O CQ y~~~yy~ 1'~ v h,~J(J j rte` v O h o ~ m tu, O tr"I _ M a II Q 0. m m ti 0. .4 I cC g Ev I r yfl ~ /mss N No O O w ~ ~ ~ n C7 a S ~ ~ II ~ cc ~ W xt~?-j F DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Dave Ross, Secretary November 23, 2015 CUST ID No. 224059 ATTN: PO WTS 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: 11/23/2017 Identification Numbers Transaction ID No. 2632289 SITE: Site ID No. 819104 Jeff Croes Please refer to both identification numbers, 1950 220TH Ave above, in all correspondence with the agency. Town of Stanton St Croix County NE 1/4, SW 1/4, S12, T31N, R17W FOR: Description: Mound, 2 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1574674 Maintenance required; Replacement system; 300 GPD Flow rate; 32 in Soil minimum depth to limiting factor from P Ppv original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure OF Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter k 5S0O1 :irw The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes OF INt and Wisconsin Statutes. "The submittal has been CONDITIONALLY APPROVED. This system is to be cons:.06, ed and located in accordance with the enclosed approved plans and with any component manual(s) referenced abw~ The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. _5r No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.14 stats. 'Th e 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 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 6". 'The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual Reminder • The orientation of the mound 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 mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. KEITH E STONER Pace 2 11/23/2015 • Materials shall conform to the requirements of 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. • 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 PO WTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Reviewer, Division of Industry Services Payment Submittal. (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633 pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm Timothy James Deyoung , Countryside Plumbing & Heating (Plans Mailed To) i~ KEITH E STONER Pase 2 l lr21'2015 • Materials shall conform to the requirements of SPS 384.10. No future, 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. • 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. Patricia L Shandorf Please Include a Copy With Your POWTS Plan Reviewer, Division of Industry Services Payment Submittal. (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633 pat. shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist. (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm Timothy James Devoting. Countryside Plumbing & Heating (Plans Mailed To) Page 1 of 9 Index and Title Sheet Project Name: Jeff Croes Replacement Mound System Property Owner: Jeff Croes Address: 1950220 th Ave. Deer Park W154007 Legal Description: Parcel 1ntheNEl/4-SWl/4 Section 12 T31N-R17W Township: Stanton County: St. Croix Subdivision Name: Na Lot : Na Parcel ID: 036102690000 CONTENTS Page: I Index and Title Sheet Page: 2 Plan Narrative Page: 3 Plot Plan Page: 4 Two Cell Mound System Cross Section and Plan View Page: 5 Modified Mound Plan View due to Concave Slope Page: 6 Lateral Layout Diagram Page: 7 Dose Tank Cross Section Page: 8 Pump Curve Data. Page: 9 Management and Contingency Plan (9-1-3) _ J.t,CN0 "C~ Attachment: Soil and Site Evaluation Report Mound Component Manual Used = Version 2.0 SBD-10691-P (N.01/01R. 10/12) Pressure Distribution Component Manual Used = Version 2.0 SBD-10706-P (N O1/01R. 10/12) In-Ground Component Manual Used = Version 2.0 SBD-1075-P (N.01/01R. 10/12) \`~111NUUUlNl~7i Designer: Keith E. e ,S.COLicense # Designer 157-007 Signature: Phone #(715)653-2324 Date: 11-1-15 D-1575 Siren i Wis. //111111111111 Page 2of 9 Plan Narrative The soil and site evaluation for the Jeff Croes property located at 1950 220'' Ave. near Deer Park Wisconsin indicates a very limited site with complex slopes due to the amount of traffic and outbuildings around the farming operation. CST Mark Iverson was working with what appears to be the only available location within reasonable distance to site a new sanitary system. The mound site will be located along a nose slope over which the cells have been located to fit the slope the best we can. To further complicate things the slope becomes increasingly concave as we progress down slope. The area over which I have located the two 4 ft. x 38 ft. mound dispersal cells has a concave deflection ranging from 1.5% to 3.5%. For design purposes and an added safety factor I used the maximum 10% concave deflection as the slope reaches the 10% approximately five feet below the lower cell into the basal area. As recommended by CST Iverson I am also recommending the site be deep plowed to break up the moderate platy structured silt loam he encountered. By incorporating mound sand into the subsoil and re-orienting the platy structure we should be able to improve the permeability of the soil. Due to the nose slope the west K and upslope J slopes may require some additional sand fill to provide the required 3:1 slope ratio. Please contact me should you have additional questions concerning this design. Thank you Keith i I o, -a M p Q ~ 0., a b d s_ 0 o o a p ~ o . ¢si i 40 cz' o US ~ v o tzs m s -o o h ry a v O 3 k - - - - - U 'tj O ' s v o U ~o o s o ti O Q. ~ ~ t v v U o Ln 0~ V Q au j~1v U ~ ~ h ° ❑ C d Itf ~ U q IK O S v a, i s c ~ v w 0 ~ c b ti U o q ~ IE U zt O ~ M ~ ~ Q O i~ W 0 ~ M W a U Q K O co 't O O O h ~ v 0' ~ b O h o p 0. a ~I o p~ 13 o x r I( m o o o C U B Z R a E- w .V O 31. v 'b v EQ C3 fM N D7 s ~ N .g Y O o ~ A O ~i ~ W Q o ^ F'' a:l J 0.i W -cl F Cross Section of a Mound System Using Page 4 of 9 Two Cells for the Absorption Area F T 0 Observation Pipe K O W O T~ B I L A, 4' E 13.20" H K B 3 , C 4' G 5 18 47~ L 53.60' D 6' J 4.70' W 2. T (ft. sq.) Dispersal Cell Area [-7-7-7-.-8--6] (ft.°) Basal Area Available 3.95 (gpd/ft) Linear Loading Rate 3.8 (ft) I/ 10 B Ohs. Pipe Placement Note: C dimension =cell separation. Mound Cross Section View Aggregate Dispersal Area Sv ' Sv Finished Grade 103.04' G ~I H I O O - J >ispersnl Cells 1__' ~J O © E . . D ® Lateral Invert dr-ooo 3-5 % Site Slope 1 0. (ft) Contour Elevation = System Elev. Shading Key Detail of Typical Dispersal Cell GIME!M Topsoil Cap Geotextile Fabric Subsoil Cap Q Cover ASTM C33 Sand ! Tilled Layer 5 F Typical Lateral 0 0 o d ( Aggregate A _-0 Note: Prepare Mound Site per Component Manual Constuction Procedures. c~ O5 o O ti kr~ C O a ct~ 1~ O tr4 r~11 d q, 00 ^1 M M p 00 O Q N(n to h I! II 4 r-: t-- tn II p ob o bo Izu II ; N II II 1 II N o UU~~~~-ate o° m ti Z~ ro ® O ~C ® a ~ om rn ~ e C'A ' M O N ~ zj o o ? ~~a o ~ ~ ~ u II U o o .r ~ a~ b Q Q ~ v 0 0 'S .6 _ •N N rZ' ~ qq Z ° 0. C Lateral Layout for the Typical Cells 1 + 2 Page 6 of 9 End Connection Lateral Layout Diagram .62.5' Laterals and Force Main of PVC Sch. 40 per SPS Table 384.30-5 x Turn-up WWI valve or clean out pin X 625 Laterals centered over the A&B dimension Number of Laterals Orfice Diameter .156/5/32 in. Lateral Diameter 1.5 1.75 in. Orifice Spacing (X) ft Lateral Length (P) 36-75 ft. Orifices per Lateral 22 Lateral Spacing (S) 1.75 ft. Orifice Density 6.91 orifice Lateral Flow Rate 11.88 gpm Manifold Length Na' ft Cell Flow Rate 11.88 gpm Manifold Diameter Na in. System Flow Rate 23.76 gpm Total Dynamic Head 15.26 ft. Lateral Turn-up Detail i Fib" to 8 diGrade ameter Lawn Sprinkler Box Valveded Cleanout Plug or Ball I I i 000000 Long Sweep 90 or Two 45° Bends Same O 0 O O Diameter as Lateral 000000 0 0 - 0 Distribution Lateral Note : Lateral ends at last orifice where variable length to cleanout begins. Page 7 of 9 Combination Tank Component Cross Section Approved Manhole Covers With Warning Labels and Locking Device / 4" Min. Above Final Grade Weather Proof Junction Box 4" Sch. 40 Vent Electric per NEC 300 & SPS. > or = to 12" 316.012WAC Above Final Grade Discon ct Alternate Outlet Location W/Approved 4" Sleeve Inlet Approved Force Main Diam. = 2 Effluent Filter Baffl < or = to 1/8" Weep Hole or Anti Siphon Device Particle Size A W 1000/600B B Pump Off Elev. 91.60' Wieser C Tank Mfr. Concrete D Dose Tank .Elev. 90.60' Vertical Difference Between Pump Off and Distribution Pipe = 10.15' Minimum Required Supply Pressure = 4.55 40 _ FT. of Force Main x 1.39 Friction Factor/1 OOFT.... _ .56 Total Dynamic Head = 15.26' Number of Doses...= 5.7_ Per Day Gal. Per Day/ #of Doses= _52.58 Gal. Volume of Backflow = 6.52 Gal. Total Dose Volume..................................................................... = 59.10 Gal. Pump Tank Capacity 602.82_ Gallons Dimensions Inches Gallons Pump Tank Volune 11.82 Gal/Inch A 32 378.24 Pump Mfr. Goulds j B _ 23.64 Pump Model EP_04 _ J C _ 5 59.10 D 12 141.84 Minimum Discharge Rate = 24 GPM Alarm Mfr. S.J.E. Rhombus Total= 51 602.82 Alarm Model Tank Alert I - Bed Tank per SPS. 383.45(5) Anchor Tank as necessary to negate buoyant forces per SPS. 383.43(8)(g). Note: Pump Controls and Alarm Switch require separate circuits. Page 8 of 9 GOULDS PUMPS Submersible Effluent Pump t EP04 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: • heat transfer. ■ Casing and Base: Rugged Effluent systems ° thermoplastic design provides AGENCY LISTING Horner Available for automatic and Farms superior strength and corrosion manual operation, Auto- ' • Heavy duty sump matic models include resistance. Canadian standards Assmiabon • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic G(x c Pimps is ISO 9001 Wqftnd, FEATURES cover with integral handle and Solids handling capability: float switch attachment points. 1/4" maximum. ■ 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: 1'12" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104"F (40`x:) continuous 140"F (60'C) intermittent. METERS FEET • Fasteners: 300 series 1° stainless steel Capable of running 9 30 s GPM dry without damage to a 2 5 Fr components. 25 Motor: _ • EP04 Single phase: 0.4 HP, v 6 20 115 or 2,10 V, 60 Hz, 1550 RPM, built in overload with ? s a 1s automatic reset. • EP05 Single phase: 0.5 HP, 0 4 EPOS 115 V or 230V, 60 Hz, 1550 1 10 RPM, built in overload with EP04 automatic reset. 2 • Power cord: 10 foot 5 standard length, 1613 1 STOW with three prong grounding plug. Optional 20 0 to 20 ( 30 40 so GPM foot length, 1613 S1TW with three prong grounding plug (standard on [P05). ° 2 4 h a 10 12 m'Ih CAPACITY Goulds Pumps 700' `May, 2001,PS ~ ITT Industries Effective May, 2061 03871 Page 9- 1 of 3 Private Onsite Wastewater Treatment System Mound Management Plan Pursuant to SPS 383.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) Shall. Include information and procedures for maintaining the system within the parameters of SPS 383 and 384, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for the system will be filed with the county zoning or health department. This management plan complies with SPS 383.54, Wis Adm. Code, the Mound Component Manual for Private Onsite Wastewater Treatment Systems (Version 2.0) SBD-10691-P (N.O1/OI.R. 10/12) and the Pressure Distribution Component Manual (Version 2.0) SBD-10706-P (N 01-01R. 10/12) Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms 2 Design Flow (GPD) 300 Soil Absorption Component Size (s q. ft.) 304 Se tic Tank Capacity Gal. 1000 -Pump Chamber Capacity Gal. 600 ..Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Comp onent _Design Flow-Peak (GPD} 300 300 Max. Influent Particle size NA 1/8 Inch Maximum BOD 5 (m91) NA 220 Maximum TSS (mg/1 NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every three years Outlet Filter Should inspect at the time of tank servicing. Pump Chamber Inspect at every septic tank servicing. Soil absorption Component Flush laterals every 18 months. Page 9- 2 of 3' r Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under sec. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed by inspection per Table 3 of the maintenance schedule. 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 pffthe 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 scum and sludge 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 an 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. Pump Chamber The pump chamber also requires monitoring and should be inspected when the septic tank receives inspection or the time of problem, complaint or failure. Inspection should include checking the dose rate, volume and frequency. Warning: The dose chamber may fill due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have problems. In this situation, the pump chamber should be pumped by a licensed pumper before pump cycling begins or other measures shall be used to dose the component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. Septic tank and Pump chamber 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 to the tank Warning: No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be accordance with SPS 383.33, Wis Adm. Code when the tank is no longer used as a POWTS component. Page 9- 2 of 3 t Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under sec. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed by inspection per Table 3 of the maintenance schedule. 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 scum and sludge 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 an 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. Pump Chamber The pump chamber also requires monitoring and should be inspected when the septic tank receives inspection or the time of problem, complaint or failure. Inspection should include checking the dose rate, volume and frequency. Warning: The dose chamber may fill due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have problems. In this situation, the pump chamber should be pumped by a licensed pumper before pump cycling begins or other measures shall be used to dose the component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. Septic tank and Pump chamber 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 to the tank Warning: No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be accordance with SPS 383.33, Wis Adm. Code when the tank is no longer used as a POWTS component. Page 9- 3 of 3 Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every 3 years. Lateral turn ups are provided at the ends of the laterals for the purpose of flushing the lines of any solids. Flushing these lines should be done every 18 months. The inspection shall include recording levels of ponding, if any, in the observation pipes, and visual inspection for any evidence of surface discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, clogging of the soil. Planting of deep rooted trees and shrubs directly over or within 10 feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the case of septic or dose tank component damage, measures shall be taken to repair or replace the tanks to there original operating condition. Upon failure of the distribution cell component, the system shall be inspected to determine the cause of failure. Steps taken to repair or replace the mound may involve the removal of a bio-mat, which would require cleaning or replacement of the distribution network as well as replacing the rock and clogged portions of the sand fill. Component Owners Contact List - I Countryside Plumbing & Plumber MPRS# 664713 715-246-2660 Heating St. Croix County (715) 386-4680 Community Development Wieser Concrete Products Maiden Rock WI (800) 325-8456 Se tic Pumper Powers Sanitation (715) 246-5738 I I i )o POWTS OWNERS MANUAL & MANAGEMENT PLAN Page 1 or -2 FILE INFORMATION Owner SYSTEM SPECIFICATIONS :5FC_ ''q CidCS Septic Tank Capacity 1000 qal El N' Permit # Septic Tank Manufacturer WIES R ON, DESIGN PARAMETERS Effluent Filter Manufacturer 0 No Number of Bedrooms Q NA Effluent Filter Model 525 ❑ No Number of Public Facility Units fa~NA Pump Tank Capacity 600 gal ❑ Nr Estimated flow (average) 300 gal/day Pump Tank Manufacturer WIESER ❑ N.C Design flow (peak), (Estimated x 1.5) ys"v - qal/day Pump Manufacturer GOULDS ❑ N.s Soil Application Rate - al/day/ft2 Pump Model EP04 ❑ N.a Standard Influent/Effluent Quality Monthly average• Pretreatment Unit 12 N,a Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS} 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (SODS) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L ❑ NA ❑ At-Grade Q Mound Fecal COliform (geometric mean) 510" ofu/100ml 4 Drip-Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: _ ❑ NA Other ❑ NA *Values typical for domestic wastewater and septic tank effluent, Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ N/k year(s) Pump out contents of tank(s) 3 YEARS When combined sludge and scum equals one-third (Y,) of tank volume ❑ N Inspect dispersal cell(s) At least once every: 3 ® ❑ year(s) month(s) (Maximum 3 years) ❑ jN Clean effluent filter At (east once every: 0 month(s) 1 ( year(s) E, Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑1 yea (s) Flush laterals and pressure test At least once every. '0 month(s) XJ Other: (3 year(s) At least once every: ❑ month(s) ❑ Nf Other: O year(s) ❑ N<, MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surfaca. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a falling condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11:3, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page Z of e For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conte of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating eratin the restore normal levels within the pump tank. y P 9 Pump controls Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the or within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.elimination of the foflowing from the wastewater stream may improve the performance and prolong the life of t POWTS, antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; f,; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; to painting products; pesticides; sanitary napkins; tampons; and water softener brine. A13AND ONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled witl soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliarr replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkir system. The replacement area should be protected from disturbance and compaction and should not be infringed upon lid required setbacks from existing and proposed structure, lot limes and wells. Failure to protect the replacement area vt it result in the need for a new soil and site evalt;iation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. t alua ' k be ' a o tng ati e ai fZDI-(f 8 ri I~ N k1 CaNS'T72Uc-ql [ ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS t POWYS tI1iSTAf.I.ER ' POWTS MAINTAINER Name ecc~~ Name PAUL KOEHLER Phone S- -ZS~6 - Z 1 6 o E Phone 715-246-2660 epm SEPTAGE SERVICING OPE=RATOR (PUMPER) LOCAL REGULATORY AUT14OFM Name DARRELL' S SEPTIC SERVICE Name s-t' C~ ( 2D/JIIJ Phone 715-425-1025 Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)ld)&(0 and 83.54(71. (21 & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address Glicul CO Property Addres~ (Verification required from Planning & Zoning Department for new construction 03a-10a(, -o Cit /State p{t.k La-. Parcel Identification Number n3, ioRg--19() LEGAL DESCRIPTION Y4, ~ Property Location ~ SO L /a Sec. 10 T 3) N R 1-7 W Town of 5THN 70tJ Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 0yesDao Lot lines identifiable 0yesono 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 dog form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the Office. .property described above, by virtue of a tY an deed recorded in Register of Deeds Number of,. dr oms w` 4,f16&ATC-RE O ICANT(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 Commerce SOIL, EVA fYT Page I of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code n ~n County Attach complete site plan on paper not less than 8 x 11 inches in s )31 cinlSt~ St. Croix M Include but not limited to: vertical and horizontal reference putt d Parcel I. . Percent slope, scale or dimensions, north arrow, and B M"a tan ~ 03610;690000 t T NLOPMENT Revie by Date Pleas e print all information rsonal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) opOwner Property Location ri oCroes Govt. Lot i4 SW 'i, s 1 T 3 R 17 w opOwner's Mailing Address Lot # Block # Subd. Name or CSM# 1950 220th Ave City State Zip Code Phone ❑ City ❑ Village ElTown Nearest Road Deer Park WI 54007 715-269-5156 Stanton 220th Ave El New Construction Use: B Residential / Number of Bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or Commercial - Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments and recommendations: For Boring #1, horizon #2 the moderate platy structure breaks to moderate blocky structure when disturbed. I recommend deep chisel plowing to 21" plus, then utilizing application rates of 0.4 GPD/ft2 for EFF#1 and 0.6 GPD/ft2 for EFF#2. Because space is limited along the contour a double celled mound is recommended or pretreatment. Boring 1 Boring # p Pit Ground Surface Elevation 99.7 ft. Depth to Limiting factor 49 in. Soil A lication 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 0-10 10YR2/2 - SIL 3-f-gr mfr as 3f 0.6 0.8 2 10-21 10YR4/4 - SIL 2-m-pl mfr cs 2f 0.0* 0.2* 3 21-32 10YR4/4 - SICL 2-m-bk mfr cs if 0.4 0.6 4 32-49 7.5YR4/4 - LS 1-co-bk mfr cw - 0.7 1.6 5 49-70 5YR4/4 7.5YR4/6&10YR6/1 c-3-p SL 1-m-pl mfi gw - 0.4 0.6 j 6 70-110+ 7.5YR4/4 - SCL 1-co-bk mfr - - 0.2 0.3 - - Boring # ❑ Boring OPit Ground Surface Elevation 101.4 ft. Depth to Limiting factor 56 in. _ Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10YR3/2 - SIL 2-m-gr mfr cs 2f 0.6 0.8 2 10-21 10YR4/4 - SICL 2-m-bk mfr gs 1f 0.4 0.6 3 21-33 7.5YR4/4 - SL 1-co-bk mfr gs 1f 0.4 0.7 4 33-56 5YR4/4 - SL 1-co-bk mfr gw - 0.4 0.7 r- - j 5 56-62+ 5YR4/4 7.5YR4/6 c-2-d LS 0-m mfr - - 0.7 1.6 * Effluent #I = BOD5> 30:S 220 mg/L and TSS > 30 < 150 mg/L * Effluent #2 = BOD5 Ti-0-mg-/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 July 28, 2015 715-796-5664