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HomeMy WebLinkAbout042-1012-80-398 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597347 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2944953 Permit Holder's Name: City Village Township Parcel Tax No: C&J BUILDERS TOWN OF WARREN 042-1012-80-398 CST BM Elev: Insp. BM Elev: BM Description. Section/Town/Range/Map No: / O U i o b 5 05.29.18.77C-73 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. • S Septic Benchmark p W, l~ia7e 7^ /Z450 rn y ~U3• wC~ Dosing Go wr Ca $a Alt. BM f t~ V • '3 / , • 7 As""fo- Bldg. Sewer I . 3 ♦O Holding SVHt Inlet L g Z ~•7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. vent to it Intake ROAD Dt Inlet `r Septic -7 5- Z Dt Bottom Dosing 7 56I $L/ 9 5 Header/Man. / Q Aeration Dist. Pipe ar 7 Holding Bot. System y, 8 X%. 3 PUMP/SIPHON INFORMATION Final Grade 3• Manufacturer 60,45 GPImNand St Cover rI~ J 3 Model Number PC 4/ Z7,44 6dN~-o J r-- ~j • LIP 5 TDH Lift /U Friction •L System Hea TDH O Fjt Forcemain Lengtt~x Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width/6 Length No. Q~T`rren h s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `Q (/1J -4 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type ystem: CHAMBER OR Model Number: I u w S 33 DISTRIBUTION SYSTEM Header/Manifold Disx Hole S/ Ix Hole Spacing V Air In e Y-`- I'S Pes) d 3 Length to~V~ Dia LengthO Dia Spacing Z 3• v u SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center /.-7 Bed/Trench Edges Topsoil ' Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: g17,4 17 Inspection #2: Location: 1128 109TH ST / e` /D~ ~6 arm 1.) Alt BM Description = kt L, OLAUtA. [r CJr` 2.) Bldg sewer length - amount of cover = 7yz J Plan revision Required? Yes No LIJ ~ 1 ~I ~ ~ Use other side for additional informat n. 7~ Date Insep s Signa Cert. No. SBD-6710 (R.3/97) ~1 County AR 'S~Aft - S C re ('K RECEIVED Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be 51Ied in by Co. a Dpi` Madison, WI 53707-7162 _ ~O si01 S0- MAY n/ 01State Transaction Number si csmiso dr$ ermit Ai, , unit Z9 q95_3 in accordance WWMWr(Y)p, M0Mbmission of this torn. _ 3 to Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for State-owr _ the Departm~tt of Safety and Professional Servies. Personal information you provide may be u~-_ dary purposes in accordance with the Privacy Law, s. 15.04 1 m ,.Stats. ^ I Z C~ t f S' .t 1. Application Information - Please Print.All Infor ation parcel # 3 Property Owner's Name 04 Z /o/-Z o Property Location o5f~el. W.-7 7C-7 3 Property Owner's Mailing Address ,3 ~ L, L ~ Govt. Lot _ City, State t/ ( Vl~ Zip Code1 Phone Number /V j IE Section ) ~j Z L 1 17 l L (circle one) S 1!~" c I--Eor II. Type of Building (check all that apply) Lot # Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms Block # k ❑ Public/Commercial - Describe Use LIE ❑ City of CSM Number ❑ Village of ❑ State owned - Describe Use Town of C 'J L III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A• r New System Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ~ ❑ List Previous Permit Number and Date Issued B. ❑ Permit Renewal Q Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) C, _A 6 i ~ ❑ Non-Pressurized In-Ground' ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Pretreatment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area'Proposed (sWSytemFlevaln tv c" C, VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks Septic or Holding Tank F Dosing Chamber 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/lv 'Number Business Phone Number / J ! z Z Z~, 7 715-27,3' f~t`1~y Plumber's ddress (Street, City, State, Zip Code) VIII. Coun /De artment Use Only Permit Fee Date Issued Issuing Agent Signature 6Q Approved Q Disapproved.. ❑ Owner Given Reason for Denial 1X. Cond', eas s for, Disapproval , . '✓tiitufa arN rtwwf a `Y11ll l..> `d/l *1etlbVplumber. apK -psamlyemant plan pr 2. AN ;Ai i4c mqwwwn must he rMurttr ir.e•i t / n per vWIdoWa cr& I ::Tdinanr!?. f l 1 Attach to complete plans for the system and submit to the County only on paper not less than 8 t/2 z 11 in~ ip size Y r(- SBD-6398 (R 11/11) Plot limn _ Page A fa l'ftv &'Y writer Bur,K DEKEK PALvts)? _ 1 = 4p _ 5. T24Ai * tt~~i t w sr e~cz =oCplt ttru an Y wtis a,Is sM 2. )76 Ad- o4Z- ~r~rz- so-mss Nor& aY'r t / 1Dq'a}h ~ - La at1~ ~ rr tea` 0 rte To Q0~ a ~3~ -mDR Tap DP SPA - ~ _ + a r r A55UAtED ta~ 0qS* Site Loco on: , JCC)p mix y us -r• ~ J~. t - `x sr~ n a- h •n. wv /~r~~2T1rF DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 ~\7 GREEN BAY WI 54304-5211 !r" ;1 Contact Through Relay P S http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Laura Gutierrez, Secretary € r May 10, 2017 PT OF Si,' CUST ID No. 224832 ATTN.• POWTS Inspector wW FE33,3l'01NA'.L r. MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA 28497 KING ARTHURS 1101 CARMICHAEL RD ff// DANBURY WI 54830 HUDSON WI 54016-7708 v.~-, ~1rZ CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/10/2019 Identification Numbers Transaction ID No. 2944953 SITE: Site ID No. 837836 Derek Palmer Please refer to both identification numbers, 109TH St above, in all correspondence with the agency. Town of Warren St Croix Countv NEI/4, SE1/4, S5, T29N, R18W FOR: Description: Mound System (4 Bedrooms - New Construction) Object "Type: POWTS Component Manual Regulated Object ID No.: 1705079 Maintenance required; 600 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 10 1.01(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 by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, MARL' JO HUPPERT Page 2 5/10/2017 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) • 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 pad is located. 1 The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes 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 stars 101.12(2), nothing in this review igb b nine a safe building, structure or component. shall relieve the designer of the responsibility for des 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 S 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 WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest, wisconsin.gov MARY JO HUPPERT Pase 2 5/10/2017 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) • 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 pad is located. 2. The bottom of the tank is located more than 150 feet horizontaliv from where the servicing pad is located. • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizina 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, Fee Required $ 250.00 11~7 This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest@wisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: DEREK PALMER > ~ 9 rJ Owner's Name: Thomas C. Dietert Owner's Address: 1115 Sharptail Run New Richmond, WI 54017 Legal Description: NE 1/4 of the SE 1/4, Sec. 5, T29N, R18W Township: Warren County: St. Croix Subdivision Name: NA Lot Number: 15 Block Number: NA Parcel I.D. Number: 042 -1012 - 80 - 398 Plan Transaction No.: Page 1 Index and title ~;f"~•,, , Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank I1° r a° E 3, Page 5 System maintenance specifications Page 6 Management and contingency plan ( 1`g Page 7 Pump curve and specifications ';Id~,'c Yw Page 8 Plot an in - 40 3 Designer. Mary Jo Huppert License Number: 1859 - 007 Date: 05/01/17 Phone Number: 715 - 426 - 1775 Signature: (,LdL TT- Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), and both SSWMP Publication 9.6 Design of Pressure Pressure Distribution Component MannualnVer. 2.0 SBD-10706- (N. 0 X01) 1) and Version 7.0 (R. 0312012) RECEIVED Page 1 of $ ;Vi AY 0 3 ?U".- i Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or G) T R Residential or Commercial Design Note: sand fig (D) calculations assume a 400.00;, Estimated Wastewater Flow (gpd) Table 3a344-3 in-sin, soil treatment for ~u1.50 Peaking Factor (e.g. 1.5 = 150%) fecal cogform of 36 inches- 600.00 Design Flow (gpd) 10.00; Site Slope 97.504; Contour Line Elevation (ft) 28.00; Depth to Limiting Factor (in) 0.40; In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00; Dispersal Cell Design Loading Rate (gpd/ft2) aw _ 1n Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Pressure- Disribution Information network? Enter Y or N (C or E) _e... a Center or End Manifold 3.33 Lateral Spacing (ft) ff N above, enter the elevation (ft) 3= Number of Laterals of the highest point. 0156; Orifice Diameter (in) 3.50: Estimated Orifice Spacing (ft) = 11.76 ft2/orifice LL.. 2003 Forcemain Diameter (in) 30.00' Forcemain Length (ft) Does the forcemain drain back? Y 88 00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) mica! Lift (ft) 55.97 5x Void Volume (gal) 049 7-ction Loss (ft) 60.86 Minimum Dose Volume (gal) 0 In-line Filter Loss (ft) 27.46 System Demand (gpm) 14 80 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options" choice in. dia. a tions choice 0.75 1.25 x x 1.00 . . 1.50 x 1.25 x x ~u 2.00 1.50 x 300 2.00 x - - 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 200 OU f Total Tank Capacity (gal) Septic Tank Capacity (gal) Total Working Liquid Depth (in) ',Wieser Manufacturer gaUn (enter result in cell B49) Dose Tank Information Effluent Filter Information ~ 800 00' Dose Tank Ca paclty (gal) PolyLok Filter Manufacturer 22 24 Dose Tank Volume (galtin) 122 Filter Model Number Weiser F? Manufacturer Project: DEREK PALMER Page 2 of 8 Mound Plan and Cross Section Views 1/10 B t J Observation Pipe K t~l A W t _ : : - z L Mound Component Dimensions Down slope toe extension made. A 10.00 ft E 20.00 in H 1.00 ft K B 60.00 ft F 8.81 ft 9.25 in I 15.00 ft L 77.63 ft D 8.00 in G 0.50 ft J 4.47 ft W 29.47 ft E600.00 (ft) Dispersal Cell Area 1500.00 (ft2) 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 99,94 (ft) 711 POP" N///!!///!!I!!!.~/!!!!!!/II!!!/ - G I 98.17 (ft)--► - Dispersal cell 98.67 (ft) Lateral Dispersal Cell Invert Elevation [E D 97.50 (ft) Contour Elevation 10.0 % Site Slope Shelling Key a Geotextile Fabric Cover Dis Topsoil Cap o 1.5 ft persal CelSee lateral details on 2Q Subsoil Cap o © Page 4 for number, size, and spacing of laterals. © ASTM C33 Sand Z Q T [il Laterals are equally Tilled Layer C 0.5 ft Tvpical L7f~ spaced from the Aggregate ~r c distribu tion cell's centerline in the A distribution cell (AxB). Project: DEREK PALMER Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals otrer the A & B dimension Turn-up %Wball vahr or clsanoutplug AN laterals are identical IF X 401 *s drW" on the bottom of trw lateral E P *gUally spaced 3 Laterals &forceln8i^f $ch 40 PVC per SPS Table 384.90-5 S Force main connet:tion via tee or cross to manifold at any point Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.66 It Lateral Length (P) 58.56 It Orifices per Lateral 17 Lateral Spacing (S) 3.33 ft Orifice Density 11.76 If/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 14.80 It Forcemain Velocity 2.80 Ittsec Dose Tank Information Locking cover with warning label and locking V~ sealed watertight Electrical as per NEC 300 and SPS 316-300 WAC 4 in. rr,a-, Disconnect Tank component is properly vented _ < Alternate outlet location Forcemain diameter Weiser Manufacturer 2 in Ca aci 800.00 Gallons -T Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A` 20.33 452.24 B 2.00 44.48 C 4 Pump off elevation (ft) C 2.74 60.86 88.91 D 1090 ` 242.42 Total 35.97 800.00 D Dose tank elevation 3" Bedding uncler tank. ~ 88.00 Alarm Manuafacturer SJE Rhombus Note: Switches Alarm Model Number Tank Alert AB containing mercury may not be used in Pump Manufacturer Gould } this system. Pump Model Number PE 41 Pump Must Deliver 27.46 gpm at 14.80 ft TDH Project: DEREK PALMER Page 4 of 8 r Mound Svstem Maintenance and Operation Specifications Service Provider's Name Da rrell's Septic Service _ Phone 715-425-1025 POWTS Regulator's Name St Cron Coun~ Zoning j Phone 715-3864680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 118 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 ff 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 every 1.5 years Mound lnspect for pondiin and seepage once eve. _(I 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 erosie 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 Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: VAMEK fAbVER Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01101), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101)) 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, 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 fitter 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 fitter 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 113 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. Ali 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 soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing- Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 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 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. Continency If the septic tank or any of its Plan P y 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 cogged 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: OtRm PALM Qr< Page 6 of 8 Wastewater METERS FEET 404 - MODELS: PE3i P 1 1 E4 ,PE5 35 -1 - Hl-.33,.40,.50 10 - = - 2 GPM - - . 30 -PE4i . ~ - - - - 1 FT o z 25 = PE31- t _ - - - a z 20 _ 5 5 i e o rm 10 5 4 x i -r p p 0_. 10rt 20 30 , 40 50 60 70 GPM 80 'V 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 PE4i PE51 Total Head Total Head (feet of water) GPM (feet of water) GPM (feeTotal t of wat ) GPM 5 52 8 61 10 67 10 42 10 57 15 59 15 29 15 46 20 50 20 0 16 20 J:~ 33 25 39 25 0 25 16 30 26 35 g Plot Plea .Page 150fa -cws e. oiEr~~r IC D F'ALMCIQ l ss = Wtw I'txJwi Or Wl4RR".ST CRatX -1.7~i~~e W% 5 . CS k-A U - ~.I76 At S --PAZ- t4DIZ-$O-3qs Nor& (A l lDg41L YT Y e 4- 83,24 io-A x;s > 5e -M DRAWRELb lei Top OF See +q n+ kv l ice& LaD ` a Vol oft55uA~Ea toO.Oe Q~y ,Site Location: J, Sec. 5 -4 t x slrE . ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND 01AWERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address-?;;, t t0 ~~M ~-bm PS PL.gL Property Address ` (a8 t " ~ 0~1 ,S"~S'ecT (Verification required from Planning & Zoning Dep tment for new construction.) City/State NeW P46\MloNA W-' Parcel Identification Number®`{zklo1 Z80312 LEGAL DESCRIPTION Property Location All L` I Sec. T Z'1 N R 9 W, Town of Subdivision Lot # 5 . Certified Survey Map # Volume , PageWarranty Deed # X1.1 , Volume Pale _ Spec house yes no Lot lines identifiable yes 110 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 §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 and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. UNve, 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 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 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. Uwe am/are the owner(s) of the property described above, by virtue of # warranty deed recorded in Register of Deeds Office. Number of bedrooms _ S /P-C>/ 2,017 ;4'S41GAA OF APPLICANT(S) DATE ***Any informtion 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. 08/QS) Parcel 042-1012-80-398 04/25/2013 11:48 AM PAGE 1 OF 1 Alt. Parcel 05.29.18.77C-73 042 - TOWN OF WARREN Current X ST. CROIX COUNTY. WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 09/19/2008 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WHITE PINE INC WHITE PINE INC PO BOX 504 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ` 1128 109TH ST SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.170 Plat: 5566-CSM 23-5566 042-2008 SEC 5 T29N R18W PT NE SE AND BEING PT Block/Condo Bldg: LOT 15 LOT 12 CSM 22-5375---BEING LOT 15 CSM 23-5566 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-29N-18W NE SE Notes: Parcel History: Date Doc # Vol/Page Typk 11/04/2009 906454 W L 09/19/2008 881655 23/5566 CSI` 03/22/2007 846986 22/5375 CSM 01/07/2003 704934 16/4438 CSM m o rc... 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/06/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.170 37,200 0 37,200 NO Totals for 2013: General Property 2.170 37,200 0 37,200 Woodland 0.000 0 0 Totals for 2012: General Property 2.170 37,200 0 37,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 noxva'vmm-tutw.s'r~S~f.souz ~ SNO1LVt13II4IQRIII3Q AZ2ISIOZOAAN9'JPHE E 4 osa m amw ,vgc ~vuna~u - _ a YAJ toHaNvx :IDIWi g 4 S2Ial'IIflfl 1Vz) _ a s t Q' fi zl o, Q' Ed it e i 000 iid 4 1000 (r;~ II ! i _ i I ~ I ~7, r I ICI II II t ❑ ' z it iF 1, { o; e s ~i B 8 it r i III II ICI i II i;, 11 O 0 ~IIc ❑ a' E I{ff~ I I{ . . _ ssib-iass~c~,a mi e38SIOZOMIMOJ£sc E morsu~-x.~s'~SmNSO~Z tSVId'~A3IPIIVW Iii a,m.uem 'anv~' 7vua~sx ! mA3nd LaFL7xVH - - -am a y Mama l~D H(.6 - APe ~,o-F O.M I I i - - .T,a I II • i 4 I I I I I I I I 41 + °f - I I ; * 4111 I I" ~ 0 I Alk Off I I Y = of ? ~ ~ I I I i i I I~ I I ( i i I i ZW 7 1D 1 1 ~ - mob.. i } 1 1 ~ I 1----- - ~ - cl; 1 1 I L~ '","U~ 71ua~ mnn ara as HONVId ~ s al lip I ~ oll dll: °le .aw i ~ i I.I - I III I s R > F = II - I I I I , i I I i 'f-- - I f t v ; III •.i~-t 9 i I l j I I I I it ~ x ~ RI I I I I I I I I I I~ ~ ' I I I ~ 9 ~ I si ~ I i I I - 0 - I I i . t I I - I; I I I li I A I ` ~ Igg Wisconsin Department of Safety and Professional Services Division of Industry Services Y GU RT Page 1 of 3 R"VG~ 0 2 20 accordance with SPS 383, Wis. Adm. Code County ST. CROIX Attach complete site p paper not less than 8 1/2 x 11 inches in size. Plan must include, but not lim 0 9 I ~6ntal reference point direction and rcent slo e, seal (BM), Parcel I.D. 042 - 1012 - 80 - 398 Pe P Qnd location and distance to nearest road. '0 MMUt Please print all information. Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 4 THOMAS C. DIETERT (Buyer:Derek Palmer) Govt. Lot NE 1/4 S 1/4 S 5 T 29 N R 18 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name,,or CSM# 1115 Sharptail Run 15 23-5566 City State Zip Code Phone Number ity Village Town Nearest Road New Richmond, WI 54017 ( 605 ) 728 - 3187 109th Street El New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 11 Replacement Public or commercial - Describe: Parent material loess over till Flood Plain,elevation if appl:__-t-- NA ft. General comments Mound System 0.67 ft. sand fill 0.4c loading rate and recommendations: Boring # 11 FTI El Boring Pit Ground surface elev. 95.57 ft. Depth to limiting factor 30 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 0-10 1OYR3/3 sil 2fgr&sbk mfr as 2vf-co 0.6 0.8 2 10-16 10YR4/4 sil lfsbk mfr cs 2vf-m 0.4c 0.6 3 16-30 7.5YR3/4 - sl 2fabk mvfr as lvf-m 0.6 1.0 4 30-40 7.5YR3/4 m2f 7.5YR4/6& I OYR6/2 sl Om mfr 0.2 0.6 2 Borin9# ® Boring ® F 96.57 30 If • 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 0-5 7.5YR2.5/2 sil 2fsbk mfr as 2vf-co 0.6 0.8 2 5-21 10YR3/3 sl 2fsbk mvfr as 2vf-m 0.6 1.0 3 21-30 10YR4/4 sl 1 fsbk mvfr as 1of-m 0.4 0.7 4 30-40 10YR4/4 m2f IOYR4/6&IOYR6/2 fs Om mfr 0.5 1.0 * 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) Sign CST Number MARY JO HUPPERT Hollister's Soil Testing&Design) 224832 Address Date Evalua Conducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 04- 19 - 2017 715-426-1775 S13D-8330 (RO7113 ) , : . . F { it . , ~ .gyp t ~ ark 1 1 3 4 $ C , a w o y N ~ a p.' S xR ~ _ x r r. k4 ~ ~•n ~ ~t$, ~3 fir: # ~ ~o~ . e 2111 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'%x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. from 042-1012-80- Please print all information. WeC gY 1 Date Personal information you provide may be used for second es 26ya Law, s. 15.04 (1) (m)). Revie j Property Owner Property Location White Pine, Inc. - H. Fogelberg Govt. Lot NE 1/4 SE 1/4 S 5 T 29 N R 18 W Property Owner's Mailing Address t IV Block # Subd_.Narr~e-or C Z 3 ' 5-7~ 400 South Second Street 6uUNTr 15 % ; Proposed C -CSM 2/5375-- City State Zip C#¢pt(b SW& RU41fi181ET City Village ✓ To est Road Hudson Wl 54016 715-386-8236 Warren ; I 109Th St. ✓ New Construction Use: W, Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial till _ Flood plain elevation, if applicable Na General comments and recommendations: Evaluation completed to facilitate creation of 3 lot CSM from existing lot 12, CSM vol. 22, Pg. 5375. See memo page or system design and-,i-nstallatio.n.-.colnsiderat'ions. ❑ Boring # Boring Depth to limiting factor >81 in. Soil Application Rate ✓I Pit Ground Surface elev. 98.82 fl. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/3 none sl 2msbk mvfr cs 2fm,1c 0.6 1.0 2 4-24 10yr4/6 none Ifs 0 mvfr cw 2fmc 0.5 1.0 3 24-52 7.5yr4/4 none scl 2fsbk mfr cw 1fm 0.4 0.6 4 52-81 7.5yr4/4 none sl 1csbk dsh - lfm 0.4 0.7 g Boring F2 Boring # ✓l Pit Ground Surface elev. 98.70 ft. Depth to limiting factor >84" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr313 none sl 2fsbk mvfr cs 2fm,1 c 0.6 1.0 2 4-28 10yr5/6 none fsl 2fsbk mvfr cw 2fmc 0.4 0.8 3 28-60 7.5yr4/6 none sl 2fsbk mfr cw 1fm 0.6 1.0 4 60-84 7.5yr4/6 none sl 1csbk dsh - 1fm 0.4 0.7 * Effluent #1 = BOD5> 30 < 220 mg/L nd TSS >30 < 0 mg/L * Effluent #2 = BOD <_30 mg/L and TSS s.30 mg/L CST Name (Please Print) Signat CST Number James K. Thompson S~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola. WI 54020 2/1212008 715-248-7767