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022-2003-40-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 592260 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: GREG & STACEY SAYLEN TOWN OF KINNICKINNIC 022-2003-40-100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 6 PLC 36.28.18.563C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( Benchmark ( r ~Ci 'f• ~v;~1 1019 Dosing 3 1 Alt. BM era ion Bldg. Sewer ,Q C ~ SUHt Inlet TANK SETBACK INFORMATION SUHt~optreT TANK TO L WELL BLDG. e t to Air Intake ROAD Dt lptet Septic 3 / _ ( 1 Dt Bottom Dosing 3 6t i 7(Dd Header/Man. ~O XTI-LI Aeration Dist. Pipe 3.I d l of • X1,5 Holding - Bot. System 3 • $ 06. 7 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover o / GPM Model Number 4 - 7 ca o TDH Lift 2 Fri do ss System Head(4- 't TDH Ft T 4 Forcemain , Len t Ot r Dia. t Di. to Well J T SOIL ABSORPTION SYSTEM Width, Length No. Trenches PIT DIMENSIONS No. Of Pits 1 Inside Dia uid Depth BEDITRENCH DIMENSIONS DIMENSIONS ,p (/n Y _ C I Fe r-e'l SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuf ure . INFORMATION Type Cy System: ' f CHAMBER OR UNIT Model Number-. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake + Pipe(s) L&;t Dia f' ~ Length Dia _ Spacing '55 6 ~R SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Py Depth Over Depth Over xx Dept jxx ~ d/Sodded x Bed/Trench Center '7 t ~Lt Bed/Trench Edges~>j~ it Topsoil COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: t 1 Inspection #2: Location:i ' CTY RD M ve- 1.) Alt BM Description =:~L4 77,1, . 2.) Bldg sewer length =3(-.' `L / SQ - amount of cover ` tl [ Plan revision Required? ❑ Yes ❑ No ^ / C q Use other side for additional information. Date SBD-6710 (R.3/97) ' Insepctor's Sign' ure- Cert. No. County =b~vo Safety and Buildings Division a r? ed in by Co.) 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be fill AD~, a+5~,~V , E Madison, WI 53707-7162 OFt~sJOSS State Transaction Number Sanitary Permit App i Z Z 95 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this fosfq t~iq appro ~ ate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms ec) 'PWTS are submitted to Project Address (if different than mailing address) the Departmebt of Safety and Professional Servies, Personal ioform n you pr ide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)( m ) 51 CROV COUNTY 1. Application Information - Please Print.All Inform DE1/ Parcel # Z d Property Owner's Name Z - Zc9e~ ! rdt~~ L Property Location Property Owner's M ing Address 3, S (o j ~ Govt. Lot City, State Zip Code Phone Nu or ~Section f _ _ 1 (circle one) l C C.J ( j 4 2 2 r T -bi- N, R E o II. Type of Building (check all that apply) Lot # Subdivision Name j l or 2 Family Dwelling - Number of Bedrooms Block # ❑ Public/Commercial - Describe Use - ❑ City of F~ ~r SM Number ❑ Village of ❑ State Owned - Describe Use Town of CIPAL bX `t 11 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A El Other Modification to Existing System (explain) New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only List Previous Permit Number and Date Issued B. ❑ Permit Renewal Permit Revision El Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. T e of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground 11 Pressurized In-Ground ❑ At-Grade El Mound > 24 in. of suitable soil W Mound < 24 in. of suitable soil ❑ Holding Tank 11 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (s Dispersal Area Propose s System Elevation 6tpl o VI. Tank Info Capacity in Total # Manufacturer ~ c .o ~ Gallons Gallons Units 6 (5 ° New Tanks Existing Tanks 2 o ° D l~ ~a /Z aU ~ ti V) wr3 Septic or Holding Tank Dosing Chamber {may e'lC" VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber'•§ Signature , MP/IN R Number Business Phone Number Plum er' ess (Street, City, State, Zip Code) VIII. oun epartment Use Only Permit Fee Date Lssue Issuin em Signatur ~ Approved ❑ .Disa roved O' O in Reaso Denial $ IX. Condi easons for Disapproval 3) Cam. j !'i {aPk, Eiflt t.nz tiRe* f+nii ~C OiS Br: <n cell Host all be snt^lc?5 ' ]+c 41tc.re; vwper qWd men! plan pio Tided by Nlumbe:. 2. AN' ikW*nft t s must. a rnaintF it e as per eppillw6h c:uc>r: I,: Mina ncr • Attach to complete plans for the system and submit to the County only on paper not less than 8 M z 11 inches in size SBD-6398 (R 11/11) DIVISION OF INDUSTRY SERVICES Sv P RTUE V 0 2331 SAN LUIS PL STE 150 o~ 9 GREEN BAY WI 54304-5211 D Contact Through Relay 3 I S P { http://dsps.wi.gov/programs/industry-services ; www.wisconsin.gov ` v Gw ~OF~ssro'sN Scott Walker, Governor Dave Ross, Secretary .7 7, 6 , R, ',PPROV November 29, 2016 OF SAFE r.g..: CUST ID No. 224832 ATTN: PO WTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA 28497 KING ARTHURS 1101 CARMICHAEL RD DANBURY WI 54830 HUDSON WI 54016-7708 SEE CORF` Y ; aui CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 11/29/2018 Transaction ID No. 2829195 Site ID No. 832743 SITE: Please refer to both identification numbers, Greg Sayler above, in all correspondence with the agency. 1486 County Hwy M Town of Kinnickinnic St Croix County SW1/4, NE1/4, S36, T28N, R18W Lot: 1, Subdivision: V 27, Pg 6198 FOR: Description: Mound System (4 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1656974 Maintenance required; 600 GPD Flow rate; 21 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area. • Divert surface water from POWTS Area. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined b rolliri a soil sample between the hands. If it rolls into a 1/4- inch wire MARY JO HIJPPERT Page 2 11/29/2016 the site is too wet to prepare. If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 3S3.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicin ad is located. 2. The bottom of the tank is located more than 150 feet horizontal) from where the servicing ad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan Any chances may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. 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 SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, FRequiredd $ 250.00 Will Be Invoiced. ceive That Invoice, Tim Vander Leest a Copy With Your Private Sewage Plan Reviewer, Division of Industry Services Payment Submittal. (920)492-2214, Monday - Friday 6 am To 3:30 pm WiSMART code: 7633 tim.vanderleestnwisconsin.goy Page 2 11/29/2016 MARY JO HUPPERT the site is too wet to prepare. If it cru mbles site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing ad is located. 2. The bottom of the tank is located more than 150 feet horizontal) from where the servicing ad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified era roved Ian. Anv changes may result in um resizin to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. 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 SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of constructi on/installation/op eration. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services paPayment S code: 7633 (920)492-2214 , Monday - Friday 6 am To 3:30 pm - - tim vanderleestnwisconsin.gov $Pc N© V 4 2016 srRy~~_ r~ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: GREG SAYLER 9 ~J Owner's Name: (same) Owner's Address: 1486 C.T.H. M _RVIC River Falls, W l 54022 Legal Description: SW 1/4 of the NE 1/4, Sec. 36, T28N, R18W Township: Kinnickinnic County: St. Croix Subdivision Name: NA Lot Number: 1 Block Number: NA Parcel I.D. Number: 022 - 2003 - 40 -100 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings ° Page 4 Lateral and dose tank f0AP . J d • ~ ~ ~ Page 5 System maintenance specifications HUPP~ = Page 6 Management and contingency plan nil, = Page 7 Pump curve and specifications •.~;1,► Page 8 Plot plan v*~~G Designer: Mary Jo Huppert License Number: 1859 - 007 Date: 11/10/16 Phone Number. 715 - 821 -1440 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 of 8 Mound and Pressure Distribution Component Design Site Information W Residential or Commercial Design Note: Sand fill (D) calculations assume a 400 00 Estimated Wastewater Flow (gpd) Table 38344-3 in-situ soil treatment for fecal ooliform 1.50? Peaking Factor (e.g. 1.5 =150%) of 36 inches. 600.00 Design Flow (gpd) 5.00, Site Slope 99.50 Contour Line Elevation (ft) 21.00; Depth to Limiting Factor (in) 1-21 0.40, In-situ Soil Application Rate (gpdJu -Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00! Dispersal Cell Design Loading Rate (gpd/W) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? E' Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) _ 3- Number of Laterals of the highest point. T 0156; Orifice Diameter (in) 350; Orifice Spacing (ft) = 11.76 fe/orifice b 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.00; Pump Tank Elevation (ft) d 4.55 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 11.34 Vertical Lift (ft) 55.97 5x Void Volume (gal) 0.66 Friction Loss (ft) 62.49 Minimum Dose Volume (gal) 0.00; In-line Filter Loss (ft) 27.46 System Demand (gpm) 16.55 Total Dynamic Head (ft) Lateral Diameter Selectionm _ Manifold Diameter Selection in_ dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x m 2.00 1.50 x 3.00 2.00 x 3.00 x Gallonslinch Calculator Treatment Tank Information ` Total Tank Capacity (gal) 1200 00= Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer L~ gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00: Dose Tank Capacity (gal) ?gyLok Filter Manufacturer 22.24; Dose Tank Volume (gal/in) 122 Filter Model Number Weiser Manufacturer M~ Project: GREG SAYLER Page 2 of 8 Mound Plan and Cross Section Views 1/10 B . J 1 Observation Pipe Q . - K. O A W I - 4 B z L Mound Component Dimensions ft A A15.00 ft E 21.00 in H Aft ft K Aft B ft F 9.25 in ft L ft D in G 0.50 ft J W 600.00 (ft) Dispersal Cell Area 1500.00 (ft) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.52 (ft) IH G F 101.25 (ft) Lateral 100.75 (ft)---b-1 Dispersal Call Invert Dispersal Cell] Elevation E. D 99.50 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key .3.Z Dispersal Cell See lateral details on 10 Topsoil Cap o 1.5 ft Page 4 for number, size, 0 Subsoil Cap m c © and spacing of laterals. ASTM C33 Sand ~ / Laterals are equally 0 Tilled Layer 0 0.5 ft Typical Lateral F spaced from the v ® distribution Q Aggregate c cell's centerline in the in the A * distribution cell (AxB). Project: GREG SAYLER Page 3 of 8 End Connection Lateral Layout Diagram Center ttre laterals over the A & B dimension Turn-up vdball vah. or cl.rsanoutplug pForcem~n P Holesdrilled on the bottom of the lateral equa"g spaced Laterals &forcemain Sch 40 PVC per SPS Table 354.30-5 S tion via tee or cross to manifold at anq point. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.66 ft Lateral Length (P) 58.56 ft Orifices per Lateral 17 Lateral Spacing (S) 3.33 ft Orifice Density 11.76 ft2/orifice Lateral Flow Rate 9.15 gpm Manifold Length 6.67 ft System Flow Rate 27.46 gpm Manifold Diameter 1.25 in Total Dynamic Head 16.55 ft Forcemain Velocity 2.80 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in_ min. Disconnect Tank component is properly vented F- Attemate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 800.00 Gallons Volume 22.24 gaLtinch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.26 450.61 B 2.00 44.48 C Pump oft elevation (ft) C 2.81 62.49 89.91 D 10.W 242.42 D Total 35.97 800.00 Dose tank elevation (ft) 3 Bedding un er tank. 89.00 Alarm Manuafacturer SJE Rhombus w _ Alarm Model Number Tank Alert ABv~ Pump Manufacturer Gould- Pump Model Number PE 41 Pump Must Deliver 27.46 gpm at 16.55 ft T D H Project: GREG SAYLER Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Darrelrs Septic Service Phone 715-425-1025 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 fe 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 Should inspect and clean at least once eve 3 years Pump and Controls Test once eve 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 years Mound Inspect foruponding and seepage once every 3 years 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 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lon Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: GREG SAYLER Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Ws. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), 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 84nches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s_ 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet 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. Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. Alt 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. 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 sal 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 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 pant 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 dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately 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. Pretreatment 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: ~R S`I L Page 6 of 8 Wastewater &mama METERS FEET 40 - =MODELS: PE31, PE41, PE51' -PE5'~ a" T _ i HP 33, .40, .50 35 10- _ - t 2 GPM - 1 Fr w 25 =-PEST V # _ . ` - z 20-, _ _ ! # t j - - e 1 _J i- # a 7-1 5 _ - O 0 - - - - 0 10 20 30 40 50 60 70 GPM 80 N 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 PE41 PE51 Total Head (fe Total Head _ Meet of water) G (feet of water) GPM (feeTotal Head t of water) GPM 5 52 8 61 10 67 10 42 10 57 15 59 15 29 15 46 20 50 20 16 20 33 25 39 25 0 25 16 30 26 35 8 .1AGE-3 Plot Plan Page Faff8 Property Urvner gp, s yL I I"=44fl. Legal Description cs.~A %l z r 614s, sw'/y (except w11t n~ote~ Dr ~ntr nt~`/4, sw. ate rzsa, ~sw,, -roves of KtaW)er,) v.c, _ pit sT. C-MI C cokM-m WN-so-O tSItj. HALAL -SoR nG ~z z- 0-00 3 -AID - X00 g ~S North ~~~~D q~ 45 s ca. M D4T S~S79, `3. FO~.Yti/yaN `41` ~ ~7 loo z~ ~eQ 4.a~ o oa y8' y ~ ' d ~ ?5 s cnT vv '{'RoPtZSF~~ ~flLP~~Fh RIU ) c~ . IZOO/ goo `=-4L4,Dpj ooM o P/PE t~CROw,iv tvr~ -ASSZd M%f~, /00.071 ~~-f D C r p N h ~ W 2 o_ r N ~ o Site Location: StcC • ~ ' ~ t i v ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Greg & Stacey Sayler Mailing Address 1486 County Road M, River Falls, WI 54022 ;&x County Road M PropertyAddress (Verification required from Planning & Zoning Department for new construction.) City/State River Falls, WI Parcel Identification Number L} ~ Z - Zoe ~ ~co v LEGAL DESCRIPTION Property Location SW /4 NE ,/4 ~ Sec. 36 , T 28 N R 18 W, Town of Kinnickinnic Subdivision Plat: na , Lot # Certified Survey Map # Volume 7, Page # Warranty Deed # 7y (before 2007)Volume , Page # Spec house 0yes[Dno Lot lines identifiable El yes[-] no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition andior (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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. Uwe certify that all statements n 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 warranty deed recorde R ter of Deeds Office. Number of bedrooms 5 V'L4 x \rim' 1~l r/ l~ SIGNATURE OF PLICA T(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) 9T/T£/OT awOH M@N aajA2S :)-l-1 ubisaa -8 buippq e44ad jo Al-jado.ad l 111, Hi i H~~ L H 12 (c~ CC C C r tHr E f4i !Ln ~O a.+ 41 N I yrN i rut+~n(1n, :3 m V 0 u 0 U Q RH N;H lion - a ano n ~E ! Z I I i Hill 17 n I I) D-11 u61s p g 6u p/01 awoN maA iaa e5 Efflffl LEN 9T/T£/OT @WOH MaN aalAeS W ~-l-I ubisaa V buip~ q eglad Jo ~(~adoad Q 84 D .9E .0£ ,8 O 6-,41 , x. wN,A l-9 II 07 ° I I ° ~W CL 0 CL cV M a I I oQ W°O I I Co m r A P i Q U x' ® T /F ° r x O N O N W N o ' msaMF Neiowr(ar J I X C i, Co = 00 U ( Z Tai $ Z w Z-,9 W .j w ~ m m ~ r ° O Z o a Y CcxQ I a < _ 0 =7 O - - - - - O W - b x I ..4n s,£i „e,9 ~ I I 3 i J iv 18" FLOOR TRUSS DIRECTION al `O I N wa ICI 3 LL ICI N W . 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Code County OLX Attach complete YttLoh sRtptt 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I. 2 - 2003 - 40 - 100 percent slope, scale or dimensions, north arrow, and location and distance to nearest road- Please print all information. Revi by Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location GREG SAYLER Govt. Lot SW 1/4 E 1/4 36 T 28 N R 18 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1486 C.T.H. M 1 V 27, PG 6198 M City State Zip Code Phone Number [jCity Village Town Nearest Road River Falls, WI 54022 ( 715 ) 222 - 9391 C.T.H. M New Construction Use>n Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ElPublic or commercial - Describe: Parent material LOESS OVER TILL Flood Plain elevation if applicable NSA ✓ft. General comments MOUND SYSTEM 1.25 FT. SAND FILL 0.4 LOADING RATE !t and recommendations: Pk6VW1t-'5 -501L Tt5T q-2'4-r5 1❑ Boring # Boring o pit Ground surface elev. 100.70 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 `Eff#2 1 0-10 10YR3112 A 2fgr&abk mvfr ai lvf-m 0.6 0.8 2 10-21 10YR4/4 sil 2fabk mfr cs lvf-f 0.6 0.8 3 21_23 10YR4/4 ftf 10YR4/6 cl lfabk mfi 0.2 0.3 horizon 3 has some gr. ❑ Boring # Boring 99.97 21 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-11 10YR3/2 sil 2fgr&abk mvfr - 0.6 0.8 2 11-21 10YR4/4 sil 2fabk mfr 0.6 0.8 3 21-24 10YR4/4 ftf IOYR4/6 cl lfabk mfi 0.2 0.3 Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number MARY JO ITUPPERT Hollister's Soil Testin &Design ~ Olt d-' 224832 71-t ~ L~~ Address Date Evaluatin onducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 11-09-2016 715-426-1775 SBD-8330 (R07/ 13) Property Owner ~ SAYLER, Greg Parcel ID # 022 - 2003 - 40 - 100 Page 2 of 3 Boring ❑ Borin # g D pit Ground surface elev. 98.87 ft. Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10Y3/2 sil 2f-ma&sbk mfr 0.6 0.8 2 12-23 10YR4/4 Sid 2fabk mfr 0.4 0.6 3 23-26 10YR4/4 flf 10YR4/6 cl Ifabk mti 0.2 0.3 ❑ Boring # H Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sod 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 I H Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil lication 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 * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-8310 (R07 13) Plot Plan Page 3of.3 Property Owner 5OLF-K 1"=44f~ Legal Description dot , csh z~, s, sw ~/y (except where noted) OF The Ns`f'4 ~ 5~ 31p, TZ SiJ, i~lB~J, -ro WAJ OF KI VAII C NN iC, pit sT. CRUIX CoKI~-ty v~\ScO~iS~IJ• ~ _ ~-fRND f3atZ!PJG 02 z-Zoo 3 -Ho - goo North F ltg8 p 525 2 (ALFAL bM #1~ 70POrpvc 1°/PE tRICROt~N2~ Zit200/A o ~SSLtM~I~ ioO.Da ~ C szfl~fl ~ ~ ~ 1' ® k3 r N w o N ~ 0 Site Location: s v -v7- x l g's Wilwat'- N1,- w . 4 TOP. rp, t u ry 0 w^ v - „ -Ar 1~~' 1% Al . 1PC /~i\1\1 ) 4 lob. ' !V } k a d ~ rrr s ~,s ' eFeP 1 , ^ ~ ~x,. i ~ 4 :;?215 Wisconsin Departmen~ OUNr SOIL EVALUATION REPORT Page of Division of Safety and ur lh Ings Etl i .Cr~'64TE N";' in accordance with Comm 85, Wis. Adm. Code County s 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.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. d ZZ. 3 1j16 - Please print all information. Re ' ed by al" Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot /41 /4 T N E ( r) W Property Owner's Mailing -re Lot # Block # Subd. Name CSM# GtY State Zip ode Phone Number ❑ City ❑ Villa a Town Near st Road ew Construction Use:6-Residential /Number of bedrooms Z Code derived design flow rate s' GPD ❑ Replacement Public or commercial - Describe: Parent material Flood P in elevation if applicab General comments V sC and recommendations: ~~~JJJ System Type System Elevation ' 0 Boring # Boring -7 ` lit Pit Ground surface elev. 't ° 7- 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 l#2 .71 Boring # ❑ Boring Pit Ground surface elev./-C- > > 4 R. 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 ' r z'IL Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD, < 30 mg/1- and TSS < 30 mg/L CST Name (Please Print) S' e CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 715-246-4516 Property Owner Parcel ID # Page of ❑ Boring Boring # I t ft. Depth to limiting factor v in. Pit Ground surface elev 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. 'Effff#1 'Eff#2 Z- Z F-- i F-1 ❑ Boring Boring # ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff E in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, < 30 mg/- 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-8330 (8.6/00)