HomeMy WebLinkAbout030-2143-20-000
Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Wisconsin Safety and Building Division INSPECTION REPORT Sanitary Permit No 592244
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village Township Parcel Tax No:
Patrick & Ashley Kurtz TOWN OF SAINT JOSEPH 030-2143-20-000
CST BM Elev: Insp. BM Elev: BM Descriptio Section/Town/Range/Map No:
V-j -I 05.29.19.2089
aq
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic l 1 e Benchmark 7 ~ V 1~ - 1
J ~~X' C'VCJ f l
Dosing Alt. BM v1 GVn iy. a3
~pt~bo x.27 t.i r•• 1~-
Aeration - Bldg. Sewer
t4 5 t v~r
Hol St/Ht Inlet ~•Q1,12 bh , t,t6L/
_l
t/~L1~tlet
TANK SETBACK INFORMATION S
TANK TO P/L_ WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Dt Bottom rl o n Q 7 (1
Septic °~1 I L/~ It li(( s^ T l
Dosing Header/Man.
Aer Dist. Pipe G(~ lu3'Le`
Holding J Bot. System 3L{ d3•t
Final Grade fU lJ
PUMP/SIPHON INFORMATION l ~l
Manufacturer GP Viand St Cove.
Model Number /L52> ~3.0 C ~G(
TDH Lift Q~ Fric o is System Head TDF~4 Ft 2 `J
For emain 1Len~ 11 Di Dist. to well / ll
5 r ^
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ~f Length ( No. Of Tre c~ hes PIT DIME NS N9%bf-Rifs ` Inside Dia. Liq epth
DIMENSIONS ( C /G)r0
SETBACK SYSTEM TO P/L E BLDG WELL LAKE/STREA LEACHING Malra rer:
HAMBER
INFORMATION Type Of S stem:, n w / 7l Model Number:
DISTRIBUTION SYSTEM
HOal ~ a d Distribution y 2 x Hole Size x Hole Spacing Vent to Air Intake
ill Pipe(s) [ r t• r /
Lengt Dia Length Dia L _ Spacing . [
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center r1 / Bed/Trench Edges / To iI \ Yes ❑ No C Yes No
w
t~
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Ptd~G6- VI Inspection #2:
Location: 435 BLUEBIRD DR ~az Cke 0
1.) Alt BM Description
2.) Bldg sewer length = a~~"~' G'ds
- amount of cover = Chu
Plan revision Required? U Yes U No L(R> ~5_ + r l la t
Use other side for additional information. L Cert. No.
SBD-6710 (R.3/97) Date Insepctor'
a l
r. x Cohn
S fI 201 W. vvasnington Ave., P.O. Box 7162 Sanitary Permit Number (to he filled in by Co.)
Madison, WI 53707-7162
Sanitary Permit Application state Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 2 8 - Z 6
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
12u !poses in accordance with the Privac Law, s. 15.04(1 m , Stats. Dr J C,
1. Application Informatio P ease Print All Infor tion
perty Owner's Name A fJ Parcel #
perty
Owner's Mai ' g Address Property Location 0-1
_ _ S I ij L? y
Govt. Lot 1
City, State Zip Code Phone Number
a~ Section 5
(circle one)
II. Type of Building (check all that aPP1Y) Lot # T N; R E oV~
a1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name
El Public/Commercial - Describe Use El Q City of &
❑ State Owned - DescribeYse CSM Number ❑ Village of
V 7 RTown of !a7 Jn C. e0/
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ~y
e~ New System ❑ Replacement System ❑ Treatment/Holding 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 Issuf
Before Expiration Owner
IV. T e of POWTS S stent/Com onendDevice: Check all that "ply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground X At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank 1W Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Trea ent Area Information:
Design Flow (gpd) Design Soil Application Rate( f) Dispersal Area Required (s0 Dis rsal rea Proposed f) System Elevat n
11 Qe,-'
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o ,n u
New Tanks Existing Tanks I v U n
n. U in Cl) ~ V 4
Septic or Holding Tank Z Cori
Dosing Chamber c G
VII. Responsibility Statement- I, 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
Plumber's Address (Street, City, State, Zip Code) ~s
VII Court /Department Use Only
Approved Permit Fee Date sued Issuing nt Signatur
v n Reason for Denial $ G I
) 1-7
3
IX. Con di tuts o v1,
isapproval 3 en r t d G
.
Pal .RpF9, 41Rb#4+Ft~4
cell r-+ust do §LNUM .R." " •
As per management plan pfoAdo by pkwdw. 41L i fill 8"f4-,
2 AN mUrA( re. Ureraertlts must be r *6ined' /
ail par awkeble code / dna4mm- D
d r MIL- i ~
Attach to complete plans for the system sad submit the County oaly a paper no than 8 t/2 1 inches in size
f✓
SBD-6398 (R. 11/11)
Brushy Mound Partners
r. • NE1/4, NW1/4, S5, T29N, R19W
- / Town of Saint Jgseph-----------_
LOT #20 St. Croix QoGnty
BLIJrFS - 1ST ADD.
BLUFRPDSCALE 1 40'
Lot-20 -,3-06 Acres -
OR'i1r i 1
Prposed drive way i Drai age easement
Hig water line = 930.1 _
Proposed well 4
.0001,
~ t
Pr osed ho enc mark 1 0
c
-'wed room x 60
At Grade System
septictank 1 0/8 0 O / 11% Slope
e
Combo p Borin 1100.25 Loring.2101
Obe =e'Fp do ipes
Poly lock 525 filter
p - l
I .
' Boreing 3
Contour Line 109 Bench Mark 110.9
O~
` of conduit
'COP
oti4PRTkFV DIVISION OF INDUSTRY SERVICES
3824 CREEKSIDE LN
y HOLMEN WI 54636-9466
3 $ K Contact Through Relay
P .S http://dsps.wi.gov/programs/industry-services
920 `Gw www.wisconsin.gov
~~OssroNNScott Walker; Governor
Laura Gutierrez, Secretary
February 23, 2017
CUST ID No. 225410 ATTN.- POWTSInspector
PAUL R KOEHLER ZONING OFFICE
COUNTRYSIDE PLUMBING & HEATING INC ST CROIX COUNTY SPIA
321 WISCONSIN DR 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 02/23/2019
SITE: Identification Numbers
Derrick, Patrick and Ashley Kurtz Transaction ID No. 2897693
Bluebird Drive Site ID No. 835054
Town of Saint Joseph Please refer to both identification numbers,
St Croix County above, in all correspondence with the agency.
NE1/4, NW1/4, S5, T29N, R19W
Subdivision: Bluebird Bluff- I't Add. - lot: 20
FOR:
Description: Four Bedroom At-grade System \ Sloping site
Object Type: POWTS Component Manual Regulated Object ID No.: 1689322
Maintenance required; 600 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original
Grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure
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 CONDITIO
requirements. APPR
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT OF S
stars.
PROFESSION
The following conditions shall be met during construction or installation and prior to occupancy or use: D1,VIS10N OF INS
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 made
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.
• All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant.
• 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 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
NOTE: Deep chisel plowing as part of the site preparation is recommended due to presence of platy soil
structure in boring #2.
PAUL R KOEHLER Page 2 2/23/2017
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
This Amount Will Be Invoiced.
rard 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
PAUL R KOEHLER Page 2 2/23/2017
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.
arar~d rely, Fee Required $ 250.00
This Amount Will Be Invoiced.
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
RESIDENTIAL AT-GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
Project DERRICK/ PATRICKAND ASHLEY KURTZ
Owner BRUSHY MOUND PARTNERS
Address 1505 HWY 65
i
NEW RICHMOND WI 54017
a_LY
VIED
Legal Description NE1/4,NW1/4,S5T29,R19W =ETY Ah
Township ST JOESPH County ST CROIX SER\
Subdivision Name BLUEBIRD BLUFFS Lot No. 20
Parcel ID Number 030-2143-28-000
Plan Transaction Number
Index sheet Page 1
Calculations Page 2
At-grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump curve & specifications Page 7
TANK DRAWINGS Page 8
PLOT PLAN Page 9
SOIL TEST Page 10
Designer PAUL KOEHLER License Number MP 225410
Signature -ZoPhone Number 715-246-2660
Date 01/31/17
Designed pursuant to:
At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07), and both
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and
Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)
Version 7.0 (03/12) Pagel of 10
i
PRESSURIZED AT-GRADE DESIGN
At-grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
400.0 Estimated wastewater flow (gpd)
600.0 Design wastewater flow (gpd)
11.00 % Site slope
109.00 Contour elev. below lateral (ft)
36+ Depth to limiting factor (in)
0.50 In-situ soil application rate (gpd/ft^2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality-
5.00 Linear loading rate gpd/ft
10.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
120.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) a Center or end lateral connection
1 Number of laterals
0.125 Orifice diameter (in) e.g. 0.25
Not a final 1.50 Estimated orificespacing
calculation (ft)
2.00 Forcemain diameter (in)
3.37 Forcemain flow velocity (ft/sec)
60.00 Forcemain length (ft) y or in y Does forcemain drain back?
90.00 Pump tank elevation (ft) y or n y Are laterals at highest point?
6.5 System head (ft) x 1.3 NA
x 18.58 Vertical lift (ft) 9.8 Forcemain drainback (gal)
O 1.39 Friction loss (ft) 96.0 5x Lateral void volume (gal)
0 0.00 In-line Filter Loss (ft) 105.8 Minimum dose volume (gal)
1. Qg 26.47 Total dynamic head (ft) 33.0 System demand (gpm)
Lateral Diameter Selection Gallons/Inch Calculator (optional)
Pipe diameter Design options Design choice Total Tank Capacity (gal)
Designer 1 in Total Working Liquid Depth (in)
must select 1.25 in Gal/in (enter result in cell G46)
one lateral 1.5 in
diameter 2 in x x Treatment Tank Information
3 in x 1200 Septic tank capacity (gal)
WIESER Manufacturer
Effluent Filter Information Dose Tank Information
POLYLOCK Filter manufacturer 800.0 Dose tank capacity (gal)
525 Filter model number 22.2 Dose tank volume (gal/in)
WIESER Manufacturer
Project: DERRICK/ PATRICKAND ASHLEY KURTZ
Transaction Number: Page 2 of 10
AT-GRADE PLAN VIEW
116 B Observation pipes (2 typical) A 10.00 ft
D B 120.00 ft
1 /6 B 20.00 ft
W C 12.00 ft
C D 5.00 ft
E 2.00 ft
p L 130.00 ft
B W 22.00 ft
A x B 1200.00 ft^2
1 L
T
Cap
= Total aggregate cell A x B Typical obs. pipe.
Slotted in the lower 6", and
~-J = Plowed area L x W anchored securely.
6"
AT-GRADE CROSS SECTION
Svnthe is fabric cover
1001_ U 110.83 ft Finished grade
Lateral elevation
invert elev. 109.50 ft `!ai: i
• Observation pipe
at aggregate toe
E
Surface contour 109.00 ft C A 11 % Slope
and system
elevation D
= 12 in. topsoil and subsoil Plowed layer
over aggregate and tapered to toes. = 6 in. aggregate below below L x W
pipe(s), and 2 in. above pipe.
Project: DERRICK/ PATRICKAND ASHLEY KURTZ
Transaction Number: Page 3 of 10
s
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - End Connection
P
rH- rilled ne-n to end cap 1F x Laterals & force mains of PVC Sch 40
d on the bottom of the la tera9 per SPS Table 384.30-6
ced i - Turn-upiWballvalveorclesnoutplug
Lateral Specifications
0.125 Orifice diameter (in) End Lateral connection point
X 1.49 Orifice spacing (ft) 1 Number laterals
80 Orifices/lateral P 117.71 Lateral length (ft)
33.0 Lat. discharge rate (gpm) 2.00 Lateral diameter (in)
2.00 Forcemain diameter (in)
33.0 Sys. discharge rate (gpm) f 60.00 Forcemain Length (ft)
26.47 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover Wth
Weather-proof warning label and locking device
junction box
Final grade 4"
disconnect
Tank component is Alternate
properly vented outlet
location 18" min.
Electrical as per NEC 300 and Approved
SPS 316.300 WAC outlet
Tank full joint
Inches Gallons
=o A Provide 1/4"
.N A 18.3 405.6 Alarm on weep hole or
c B 2.0 44.4 antisiphon
_E C 4.8 105.8 Pump on B device.
G D 11.0 244.2 90.92 ft C
Totals 36.1 800.0 -10 --A 111
Pump off
D
3" Beddi under tank ~ 90.00 ft
zoller Pump manufacturer SJE RHOMBUS Alarm manufacturer
153 Pump model number ps patrol Alarm model number
Project: DERRICK/ PATRICKAND ASHLEY KURTZ
Transaction Number: Page 4 of 10
At-grade System Maintenance and Operation Specifications
Provider's Service SERVICE Phone 7154251025
lator's Name COUNTRYS DE I P
POWTS Re9 LUMBING Phone 715-246-2660
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 1200.0 ft2 Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 years
Effluent Filter Inspect and clean at least once every 3 years
Pump and Controls Test once ever 3 ears
Alarm Should test monthly
Pressure System Laterals should be flushed and pressure tested ever 1.5 ears
Mound Inspect for pondin and seepage once every 3 years
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap,
and are secured in as shown in the at-grade component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07).
Lateral Turn-up Detail
Finished
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
~ Long Sweep 90 or Two
106.50 ft 10 L 45 Degree Bends Same
Diameter as Lateral
Project: DERRICK /PATRICK AND ASHLEY KURTZ
Transaction Number: Page 5 of f0
At-grade System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SBD-10854-P (N. 03/07, R. 01/12), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706
(N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or
subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking
device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet 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 filter is installed within the tank it shall be inspected and serviced as necessary.
At-grade and Pressure Distribution System
No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at-grade system may not exceed 220 mg/L BOD5 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow
specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: DERRICK /PATRICK AND ASHLI Transaction Number: Page 6 of to
v~
Ems-:
LLI
L PUMP PERFORMANCE CURVE
MODEL.1:51.11.52/1,53
50
X53
4 °
a0 &
162
10-
r~
30.
151
NIS
~ 25,
63. if
Fea
=z and
6 2Q
is
15 yY.
MODE 4
Product M
1
PERFO
Models 15
Performs 10 20. 30 40 50 60 70; 80 90' 100
GALLONS:
LITERS
D I M E N 0 40 120 160 200 244 280 320 360
Model 151 FLOW PER MINUT'E, 01:4508
Models 15 Models 151/15 Hz
Optional
CAUTION
All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All
electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the
Occupational Safety and Health Act (OSHA).
ACCESSORIES
Piggyback Variable Level Float Switch (/en-na/product/34-piggyback-variable-level float switch)
Simplex Electrical Control Panels (/en-na/product/29-simplex-electrical-control-panels)
Variable Level Control Switch (/en-na/product/33-variable-level-control switch
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Brushy Mound Partners
• NE1/4, NW1/4, S5, T29N, R19W
/
LOT #20 Town of Saint Jgseph------------
St. Croix Gothy----------
SCALE 1" - 40' i BLUF_RfRD 13LIO S - 1ST ADD.
LoJ 0 -,3-.66 Acres..--------------
1, i
ORTM
Prposed drive way i Drai age easement
i Hig water line = 930.1 ~ - ,
Proposed well C '
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\ At Grade System
Wieser septic tank 1 0/8 0 O / 11% Slope
Combo p Borin/ '100.25 oring. 2 101
bb e ' do apes -
Poly lock 525 filter
I .
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Boreing 3 [,0
t
Contour Line 109 Bench Mark 110.9 Q~ I
0 f conduit
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2,
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
~iol~;: j'r ~✓JC ~ Tank Manufacturer. e'L// cs t,,- ❑ NA
Permit #
E?T Septic l~ Dose ❑ Holding Volume: (gal)
DESIGN PARAMETERS Tank Manufacturer: Z'Z' . c J cY ❑ NA
Number of Bedrooms: ❑ NA ❑ Septic RLDose ❑ Holding Volume: (gal)
Number of Public Facility Units: $ NA Vertical Distance Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft)
Specific servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: v (gal/day/ft) Effluent Filter Manufacturer: ❑ NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model:
Fats, Oil & Grease (FOG) 530 mg/L `"1 Pump Manufacturer: ?.,,,~e //i
Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ NA
Total Suspended Solids (TSS) :5150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:
(BOD5) >220 mg/L $rNA ANA
(TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter
❑ Disinfection ❑ Wetland
Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other:
(BODO 530 mg/L Soil Absorption System
(TSS) :_30 mg/L 'VNA
Fecal Coliform (geometric mean) 5104 ❑ In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA
At-Grade ❑ Mound
Maximum Effluent Particle Size %a in diaUt' ❑ NA Drip-Line ❑ Other:
Other: q~NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) 'When combined sludge and scum equals one-third of tank volume
❑ When the high water alarm is activated
Inspect condition of tanks At least once eve El month(s)
every: (Maximum 3 years) ❑ NA
0 year(s)
Inspect dispersal cell(s) At least once every' B ❑ month(s) (Maximum 3 years)
❑ NA
year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
4 year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
®,year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
4] year(s)
Other: At least once every: ❑ month(s) NA
❑ year(s)
Other:
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
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 a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third (3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
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 30 days of completion of any service event.
GMW-005 (02/05)
Page 2 of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when' soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the
area within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems 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 (pumper).
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with 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 compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone -~j - 2 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name ^ Name /
vrr~ t' I'C 1~~ c c_.~;✓,1 JL. 6CO i,tr D y
Phone Phone 5 - .31 (0 _ 4 L gb
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer . ~ !
Mailing Address t.. 1 -co
Property Addres`>>
(Verification required from Planning & Zoning Department for new co ction.)
City/State ~ r r Parcel Identification Number
LEGAL DESCRIPTION
Property Location W '/4 61 1 , Sec. T N R P/ W, Town of y~ t}
Subdivision_ ~L -vac 't~ 6L_. ; ~ ,Lot # 1=
Certified Survey Map # , Volume , Page #
Warranty Deed # r, Volume Page #
Spec house ves :(no Lot lines identifiable yes ~ no
SYSTEM MMNTENA.NCE 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 cau affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(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 andlor (2) after inspection and pumping (if necessary), the septic tank is
less than 113 full of sludge.
]/we, the undersigned have read the above requirements and agree to maintain the private sewage disP0801 system with the standards set forthherei as set by the D
" , n, y th epartment of Commerce 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 Depailment within 30 days of the three year expiration date.
Uwe certify that all statements on form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a wa my deed recorded in Register of Deeds Office.
I
Number of be¢' aoms
IGNATURE OF APPLICANT(S) DATE
Any information that is misrepresented rnaY 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. 08105)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I. l
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. D &--21 3 U
Please print all information. Revi ed by Date
Personal information you provide may be used for secondary ouruo (P.dvacy Laly, s. 15.04 (7) (m)).~ 3
Property Owner - 1 Property Location n )W
Brushy Mound Partners Govt. Lot NE 1/4 NW 1/4 S 5 T 29 N R 19 EE (
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
1505 Hwy 5 ? 20 - Bluebird Bluffs 1st Addition
City State Zip Phone Number E]City [:]Village Town Nearest Road
New Richmond WI 5401 I 42nd Street
New Construction User Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement 1:1 Public or commercial - Describe:
Parent material Loess over outwash and glacial till Flood Plain elevation if applicable NA ft.
General comments This site is suitable for a conventional below grade system, recommending that a pressurized system with equal
and recommendations: distribution be used so as to distribute the effluent over the entire available area due to the massive(Om) A. This is
not a code requirement, but rather a suggestion. 1
FTIBoring # ❑ Boring
a pit Ground surface elev. t oy .25 ft. Depth to limiting factor >88 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
1 0-8 10yr3/3 sil 2msbk mfr as 2f .6 .8
2 8-15 1 is Os ml cw if 1.6
15-24 7.5yr4/4 sl Om mfi cw - .2 •6
4 24-88 7.5yr4/4 fsl Om fi - - .2 .5
2 Boring # ❑ Boring
❑ pit Ground surface elev. 10 1. y 5 ft. Depth to limiting factor >92 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
1 0-5 10yr3/3 sil 2msbk mfr as 2f .6 .8
2 5-15 10 4/4 sil lmpl mfr cw if .4 .6
3 15-24 10yr4/4 Is Osg ml cw _ .7 1.6
4 24-58 10yr4/4 sil lmsbk mfr cw - .4 .6
5 58-92 7.5yr4/4 is Osg ml - - .7 1.6
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = B <.30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 6/5/04 715-246-2454
x
Property Owner Brushy Mound Partners Parcel ID # Pending Page 2 of 3
a Boring # ❑ Boring >90
Pit Ground surface elev. 41 ft. Depth to liming 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
1 0-8 10yr3/3 - sil 2msbk mfr as 2f .6 .8
2 8"26 10 4/4 - sil 2msbk mfr cw If 6 .8
26-90
3 ; 7.5yr4/4 - fsl Om mfi - - .2 .5
F-1 Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rats
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # Boring
Spit 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
T
Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD6 < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330Test (R.07/00)
BM1
~ x -
,Thomas Nelson 100'
227387
88'
,or
A 81
82
102'
104'
1
170' slope
106'
' 137'
108'
BM2 58'
54' y5
Nod
Scale 1" = 30'
Bm1 Top of conduit 100.00'
BM2 Top of conduit 110.90'
B1 100.25'
B2 101.45'
B3 110.65'
Bluebird Bluffs 1st Addition
Lot 20