Loading...
HomeMy WebLinkAbout006-1043-30-001 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597344 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2774185 Permit Holder's Name: City Village Township Parcel Tar, No: JON & SUZANNE BARKER- I TOWN OF CYLON 006-1043-30-001 CST BM Elev: Insp. BM Elev: BM Description: Section Town/Range/Map No: " d b II 20.31.16.295A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r ^,t~ CAPACITY STATION BS HI FS ELEV. 2. Z /dZ•Z /ate Septic / Benchmark Alt. B 4;1~ 10 Ga vw b a yc (PM!9 _-XIS doe' ~ Bldg. Sewer i - e6c 41 / b k, Holding St/Ht Inlet J 7• Z -dp $'9• St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. ent t Air Intake ROAD Dt Inlet \ 1. Septic Dt Bottom 4.1, Dosing 7 M- 141' Header/Man. /Z / Ae ration Dist. Pipe 3.15 17104P Holding Bot. System 3, fZ- N, 3 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover 1 Zd5 Nu r Of n 6 1TTL TDH Li Friction Loo' System He d TD711. Forcemain Len tg h Dia i Dist. to Well A_ 1 6 1 _j F SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of nch s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7~ /.{C SETBACK SYSTEM TO P/L rvBLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of tem: 164g T 560 UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifyld Distributioonn rip 19 A x Hole Size~ .41 t x Hole Spacing V o Air Int g - 1 Pip g(s) 7 I~ ✓ I r3Z Len th Dia Len th Dia / • Spacing Z. -3- i I 37 - I L SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a Depth Over Depth over xx Depth of xx Seeded/Sodded . Mulched Bed/Trench Center Bed/Trench Edges Topsoil C No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: ff ' Location: No Address Availabl 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover a v` Plan revision Required? ❑ Yes o !/D ~ ~ ~ Use other side for additional informati n. ` 1 L47 Date Insepctor ignatur Cert. No. SBD-6710 (R.3/97) S~l►~-d1:il~ ors a* CEIVy a County Safety and Buildings Division St- Croix ' 201 W. Washington Ave., P.O. Box 7162 s ~ S ~ 1"1 Sanitary Permit Number (to be filled in by Co.) p~ {3 . S 0'5 W1 Madison, Wi 53707-7162 / 7 2 L/L s-,,,,;~;• LINTY A ~J ,^,OMMUNITY D ermit State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of tn._ a Crnmenta7 unit 2774185 / is required prior to obtaining a sanitary permit. Note: Application forms for ire submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you pro%.- -condary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. D~t I. Application Information - Please Print All Information ~y Property Owner's Name Parcel # L~l Property Owner's Mailing Address Property Location 2130 County Rd. C Govt. Lot City, State Zi Code Phone Number P NW v., NE Section 20 New Richmond Wi. 4 (circle one T -N; N; R 16 E or H. Type of Building (check all that apply) Lot # - 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name 1 _ - Block # ❑ Public/Commercial - Describe Use ✓ Jam" ❑ State Owned - Describe Use SM Number ❑ Village of 1--a City of :f I N4 W o U Town of Cylon k 7,5 y4c~ 5 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Za &A, x, A. New System ❑ Replacement System ❑'Ireatment/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 Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade r] Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)- ❑ Pretreatment Device (explain)_ '7 V. Dispersal/Treat ent Area Information: l -T G Design Flow (gpd) Design Soil ApplicatioA rsal Area R fired 6(s Dispersal Area Pro sed ( System Elevatio450 10 450 450 J 98.35 VI. Tank Info Capacity in T tal # of Manufacturer Gallons Gallons Units Poly-L k 525 °o New Tanks Existing Tanks la I P 0 _ 2 0.U ~ "v, ~ wC7 a. Septic or Holding Tank 1000 1000 Wieser Combo x Dosing Chamber 600 111 600 Wieser X VII. Responsibility Statement- 1, the undersigned, assume esponsibi ' for' ' al bon of the P ;WTS shown on the attached plans. Plumber's Name (Print) Plum s ' gnature MP/MPRS Number Business Phone Number Keith Knudtson - r 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts W. 54023 VIII. County epartment Use Only_ roved isappr Permit Fee Date Issued Issuing Age gnature D" rven Reason for al) ov L $ 7(/, IX. ConditWQllJM1W~easgns for Disapproval 1. S*iri tank, ettlmm filter vhd 6dyjj" W,0 .'A AWf tUiWer su cell must all be sr-ioicivs ' r.+! 11&:rm ~r IVL / >as prir ,~tarayt3men! plan pro sided by plumber. ~ o T 2. raty'{w~M9tr"fe111"3 h1lJ sinClf) I"lalrit: If6 as per rippAmlb a wde / 'zrdinamw. AA 0~ df"Ht)A 1/1 b f ave /1 eAq Attach to complete plans for the system and bmit to the Countyonly on paper not less Jan S in a 11 inches in size f -Cw3 pz1~31 ! SBD-6398 (R. 11/11) ✓ See CSM ~y`fta20 ~d 311012 R, N00h siv lud I 0 Sanitary Site Plan Page 8 of 8 For: Jon and Suzanne Barker NWl/4-NE1/4 CIL 210 th Ave. See. 20 T31N-R16W Town of Cylon -St. Croix County 0 20 40 Graphic 9oaW (Pwt) 1 inch - 40 tL Proposed 6'x 75 Mound Dispersal Cell located along the 97.35' 939 ft. contour wla system elev. of 98.35' \ 40 Line 40 Acre Parcel 97.50' \ o \ 97.35' BM 97.00' Note: Maintain well and waterline setbacks per en Field Site Cropped SPS 383.43(8)(1) \ 96.00' in soybeans 2015 A BM = Nail w/Pink Ribbon in Base of 10"DBH Chinese ElmTree * HRP =Same ASSUMED ELEV. = 100.00' Proposed Three Bedroom Home Site w/ Storage Bldg. Proposd 2"Sch. 40 PVC F.M. 382 ft. Approx. 1080 ft. to Wert P/L • WEL Proposed Proposed 4"Sch. 40 PVC Bldg. Sewer attached to a Grade = 93.25' Wieser Concrete WLP 10001600 MR Combination Tank w1 a Poly-Lok PL-525 Filter NW-NE Sec. 20 1320' 40 Line NE NE.Sec. 20 Elevation Data 443 ft. Edge of Pond Approx. Bldg. Sewer Elev. = 93.25' DIVISION OF INDUSTRY SERVICES G n 10541 N RANCH RD HAYWARD WI 54843-6462 Contact Through Relay i http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Dave Ross, Secretary September 26, 2016 Ct1ST ID No. 224059 ATTN: POWTS Inspector KEITH E STONER ZONING OFFICE KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY S P I A 23220 WOODCREEK RD ; 101 CARMICHAEL RD S1RLN WI 54872-8728 HUDSON W1 54016-770 CONDITIONAL, APPROVAL PLAN APPROVAL EXPIRES: 09/26/2018 _ Identification Numbers Transaction ID No. 2774185 SITE: Site ID No. 828614 Jon & Suzanne Barker Please refer to both identification numbers, 210TH Ave above, in all correspondence with the agency. Town of Cylon St Croix County NW1/4, NE 114, S20, T3IN, RI 6W FOR: Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1622737 Maintenance required; 450 GPD Flow rate; 24 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. 101/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative CQ4. , and Wisconsin Statutes. "The submittal has been CONDITIONALLY APPROVED. This system is to be constr iAed 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 requ:rernents. No pers=.,n may erigage in or work at plumbing in the state unless licensed to do so by the Department per s. I scats. I':c, 1[611--wir- conditions shall be met during construcr,on or installation and prior to occupancy or use Key Item(s) In the event this soil absorption system or any of its component parts malfunctions so as to create a lit alth hazard, the property owner must follow the contingency plan as describe d in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy ot'this information must be given to the owner upon completion of the project. o Per scale, the slope appears to vary as indicated in the plan submittal. 'The bottom of the distribution cell shall be level per the Mound Component Maraa' The "D" dimension shall be a minimum of 12". The maximum finished dope of the mctind surface shall be equal to or less than 3:1 per the Mound Component Manual. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. 0 1 imit activities in the area 15' beyond the down slope edge of the mound per MOLInd Component Manual. KEITH E STONER Page 2 9/26/2016 ~ • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384. • Maintain well and waterline set backs per SPS 383.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy ofthe 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 PO WTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerel Fee Required S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, L S orf Please Include a Copy With Your POWTS Plan Reviewer, D' ision of Industry Services Payment Submittal. (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633 pat. shandorf a wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson (Plans Mailed To) Note: Effective January 1, 2012, all codes under the jurisdiction ofthe Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. it KEITH E STONER Page 2 9/26/2016 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384. • Maintain well and waterline set backs per SPS 383.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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/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. Smcerel Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L S~ orf Please Include a Copy With Your POWTS Plan Reviewer, vision of Industry Services Payment Submittal. (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. WISMART code: 7633 pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson (Plans Mailed To) Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. - ECEIVED ~T P 0 8 2016 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN ~FRVICGc~ Residential Application !NDUSTRY INDEX AND TITLE PAGE Project Name: Jon and Suzanne Barker Mound System Owner's Name: John and Suzanne Barker Owner's Address: 973 Longwood Rd. Amery WI 54001 Site Location 210th Ave. Legal Description: NW1/4-NE1/4 Sec. 20 T31N-R16W Township: Cyio n County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: 006-1043-30-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications ~f Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Keith E. License Number: Designer 1575-007 Date: 09/06/162°!~V Phone Number: 715-653-2324 1 Signature: 1575 O- c C% nect-Pur~ewnt to the 1,)/l Mound Component N*ual f6br.p S*p*n 2.0 SDB-10691-P (N. 01101); and both SSWMP Publication 9.6 tar ~y9 ~OFk4 bistribution Networks for ST-SAS (01/81) and Pressure Distribution ft1pg11 ~Utanual Ver. 2.0 SBD-10706-P (N. 01101)(0' lc'//. ) Version 7.0 (R_ 03/2012) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 450.00 Design Flow (gpd) 2.50 Site Slope 97.35 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.33 Estimated Orifice Spacing (ft) = 7.03 ftz/orifice 2.00 Forcemain Diameter (in) 225.00 Forcemain Length (ft) Does the forcemain drain back? I! 87.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 36.70 Forcemain Drainback (gal) 11.18 Vertical Lift (ft) 67.41 5x Void Volume (gal) Z~~ 5.64 Friction Loss (ft) 104.11 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 34.46 System Demand (gpm) 21.37 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia options choice 0.75 p 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 603.36 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 16.76 Dose Tank Volume (gal/in) PL-525 Filter Model Number Weiser Concrete Manufacturer Project: Jon and Suzanne Barker Mound System Page 2 of 8 Mound Plan and Cross Section Views T 1/10 B J Observation Pipe •K. «.I ~n~oa^~m^!,M1:e„^b:'5,:.«:4..4;, e.:1.=M1.:.a.'5.,.•.« .~•L:m ^y,,...0...4:'•.:. .:'1.. ^.ory,~..:5:. "e. L A B L Mound Component Dimensions Down slop a toe extension made. ft A 6.00 ft E 13.80 in H [Aft ft K [Aft B 75.00 ft F 9.50 in I ft L ft D 12.00 in G 0.50 ft J W 450.00 (ft2) Dispersal Cell Area 1125.00 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.14 (ft) ,rrr,; G H . ,rrr„rr,,,,r rrr„rrrrr, F Dispersal Cell 98.85 (ft) Lateral 9835 (ft)--0-- Invert Dispersal Cell Elevation E 7K1. 97.35 (ft) Contour Elevation 2.5 % Site Slope Geotextile Fabric Cover Shading Key c Dispersal Cell See lateral details on 1 Topsoil Ca c. 1-5 ft .ti,ti,• .t."«" Page 4 for number, size, and spacing of laterals. * w rrrrrrrr Subsoil Cap 00 ASTM C33 Sand Laterals are equally Tilled Layer m 0- ft Typical«Lateral F spaced from the distribution cell's © Aggregate d o centerline in the * A } distribution cell (AxB). Project: Jon and Suzanne Barker Mound System Page 3 of 8 End Connection Lateral Layout Diagram Lateraftcentered over the Atc dimension Turn-upvd bell valvoorclssnoutplug t p All laterals ate identical I<- x - -9I Holes; drilled on the bottorn of the lateral equaft spaced `3 Force main connection via too or doss to manifold at arA point. Latetrals Morcemain Sch 40 PVC per SPS Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.37 ft Lateral Length (P) 73.47 ft Orifices per Lateral 32 Lateral Spacing (S) 3.00 ft Orifice Density 7.03 ft2/orifice Lateral Flow Rate 17.23 gpm Manifold Length 3.00 ft System Flow Rate 34.46 gpm Manifold Diameter 1.50 in Total Dynamic Head 21.37 ft Forcemain Velocity 3.52 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC I 4 in. min. Disconnect Tank component is property vented Aftemate outlet location _ Forcemain diameter Weiser Concrete Manufacturer_ 2 in. Capacityl 603.36 Gallons Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.79 331.65 B 2.00 33.52 C Pump off elevation (ft) C 6.21 104.11 87.67 D 8.00 134.08 D Total 36.00 603.36 Do4 se tank elevation (ft) 3" Bedding under tank. 87.00 Alarm Manuafacturer SJE. Rhombus Note: Switches Alarm Model Number Tank Alert 1 containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number EP05 Pump Must Deliver 34.46 gpm at 21.37 ft TDH Project: Jon and Suzanne Barker Mound System Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow ang Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10L4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound ins ct for 22nding and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • • • • . • • . Grade v1 _ 6-8" Diameter Lawn Threaded Cleanout 00. Sprinkler Valve Box Plug or Ball Valve Distribution` y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jon and Suzanne Barker Mound System 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 ISBD-10691-P (N.01101), SSWMP Publication 9.6 (01/81), 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 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 fitter 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. Pumw 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. Mound and Pressure Distnibuftri System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10" cfu/100 ml. for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Coaftencv 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. Pra rmnerrt Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page 7 of 8 NGOULDS PUMPS Submersible Effluent Pump ` EP04 EP05 3871 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: • heat transfer. ■ Casing and Base: Rugged Effluent systems • thermoplastic design provides AGENCY LISTING • Farms Homes Available for automatic and superior strength and corrosion manual operation. Auto- resistance carmdan S Association • Heavy duty sump matic models include " • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or "f".) factory, strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Go ftftttpsisisom 1 RWrod FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. la" maximum. ■ EP04 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities; up to 60 GPM. tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. Pump out vanes for mechanical • Discharge size: I1/ ' NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40%) continuous 140OF (6090) intermittent. METERS FEET • Fasteners: 300 series 10- stainless steel • Capable of running g 3 , dry without damage to a 2.5 Fr components. 25 A 7 Motor: x • EP04 Single phase: 0.4 HP, n • zo' 115 or 230 V, 60 Hz, 1550 Y RPM, built in overload with r c 4 1 s'. automatic reset. • EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 EPOS 3 10 ; RPM, built in overload with automatic reset, zEP04 • Power cord: 10 foot 5 standard length, 16/3 1 S.lTOW with three ronal 20 grounding plug. Optional 0 00 ' foot length, 16/3 SlTW with 10 20 30 s o GPM 1 three prong grounding plug (standard on EP05). a 2 4 6 s 10 12 m3lh CAPACITY Goulds Pumps Ef 2001 Goulds , Pumps ITT Industries Effective May, 2007 63871 Sanitary Site Plan Page 8 of 8 For: Jon and Suzanne Barker NWI./4-NE1/4 CIL 210 th Ave. Sec. 20 T31N-R16W Town of Cylon -St. Croix County 0 20 40 G-phfo Sams (r..t) i inch - 40 ft. Proposed 61x 7SIMound Dispersal ° Cell located along the 97.35' 939 ft. contour w/a system elev. of 98.35' \ 40 Line .5 40 Acre Parcel 97.50' a \ \ 97.35' - BM \ 97.00' Note: Maintain well and waterline setbacks per \ Open Field Site Cropped SPS 383.43(8)(1) 96.00' in soybeans 2015 A BM = Nail w/Pink Ribbon in Base of 10"DBH Chinese ElmTree * HRP =Same ASSUMED ELEV. = 100.00' Proposed Three Bedroom Home Site w/ Storage Bldg. Proposd 2"Sch. 40 PVC F.M. 382 ft Approx. 1080 ft. to West P/L • WEL Proposed Proposed 4" Sch. 40 PVC Bldg. Sewer attached to a Grade = 93.25' Wieser Concrete WLP 10001600 MR Combination Tank w/ a Poly-Lok PL-525 Filter NW-NE Sec. 20 1320, 40 Line NE-NE Sec. 20 Elevation Data 443 ft. 1 Edge of Pond Approx. Bldg. Sewer Elev. = 93.25' 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Jack Barker Mailing Address 2130 Co Rd C New Richmond Wi. ( . -y l : ' Property Addr (Verification required from Planning & Zoning Departmen o ew construction.) City/State Parcel Identification Number 006-1043-3$=6W LEGAL DESCRIPTION Property Location NW '/4 , NE '/4 , Sec. 20 , T 31 N R 16 W, Town of Cylon Subdivision Plat: , Lot # Certified Survey Map # 1044620 , Volume 28 , Page # 6322 Warranty Deed # (before 2007)Volume , Page # Spec house ElyesElno Lot lines identifiable (]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 and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on t is form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virt ue of a w ranty deed recorded in Register of Deeds Office. NumbO of bedr oms _ S PZ12 SIGNATU , OF APPLICANT(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) sE I I I I I god I u, r-------- p4F FaF 6 sosu w,.u ar.HS Ell t_`~.-st - 1 3 . ~ I x i I I _ I 1 S E I 1 S p I 1 I 1 P Bee ~ o I I I ' - - a~o oIa p - - K % z - _ - cia ~ 1a rrA E-- K - ° I o e;K - 1 i r I I I I I I I I I I I I I i I I I I E - I I I Z Z 2 rn r 0 r-Ta <m< m a m y rt10~ ~ Dr ~r Z m VKH D ? y ~ g~w gz Ig' o s~ 7 M z o, gym= re=mH m X80 e s . ~ rs ~ - ggP~ ' l 4Visconsir f rofessional Services 2-1 Division s #3071 FEB 18 SOIL EVALUA L~ [ t, in accordance with SPS 385, Wis. Adm. Code a'fL c`''? Keith Sto er CST A er not less than 8'% x 11 inches in size. Plan must County St. Croix c~C~ 1• :CIS vG QUOLMal and horizontal reference point (BM), direction and - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. PLcel 3-3 -000 e print all information. 006-1 RDate o / Pleas Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~Z Z p' Property Owner Property Location Jon & Suzanne Barker Govt. Lot NW1/4, E1/ , S20, T31 N, R16W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 973 Longwood Rd M/ 4erk-5 City State Zip Code Phone Number City Village Town Nearest Road Amery WI 54001 715-268-4572 Cylon 210Th Ave New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial Till NA_ ft. _ Flood plain elevation, if applicable General comments Propose a 6 x 75' mound cell located al the 97.35' contour with a system elevation = 98.35'. Upslope mound contour staked and recommendations: onsite, D fie, t Boring / ❑ Boring # Pit Ground surface elev. 96.95 ft. Depth to limiting factor 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistency Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 Eff#2 1 0-6 10YR3/2 - sil 2msbk mvfr cs 3f-m 0.6 0.8 2 6-12 10YR4/3 - sil 2msbk mvfr gs 3f-m 0.6 0.8 3 12-20 10YR4/4 - cl 2msbk mvfr gs 2f-m 0.4 0.6 4 20-26 5YR4/4 - sl lmsbk mvfr gs 1f-m 0.4 0.7 5 26-30 1 5YR4/4 - sl m mfr gs 1f-m 0.2 0.6 6 30-60 5YR4/4 f2d5YR5/8 sl m mfr - - 0.2 0.6 H2O running out of till at 40" H2O in pit bottom 50" Boring# Boring 2 Pit Ground surface elev. 96.99 ft. Depth to limiting factor 33 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 -Eff#2 1 0-9 10YR3/2 - sil 2msbk mvfr cs 3f-m 0.6 0.8 2 9-12 10YR4/3 - sil 2msbk mvfr gs 3f-m 0.6 0.8 3 12-15 10YR4/4 - Sid 2msbk mvfr gs 2f-m 0.4 0.6 4 15-22 5YR4/4 - cl 2msbk mfr gs if-m 0.4 0.6 5 22-33 5YR4/4 - sl lmsbk mfr gs if-m 0.4 0.7 6 33-55 5YR4/4 c2d5YR5/8 sl m mfr - - 0.2 0.6 #5 - c2d10YR2/1 mangons H2O in pit bottom 51" * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L *.Effluent #2 = BOD5 s30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Keith Stoner) LjL z" 224059 -Af Address Keith Stoner CST / Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 11/13/2015 715-566-0900 SBD-8330 (8.07/13) * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and SS <30 mg/L III • Soil Test Site Plan Page 3 of3 For: Jon and Suzanne Barker NW1/4-NE1/4 CIL 210 th Ave. Sec. 20 T31N-R16W Town of Cylon -St. Croix County 0 20 40 Graphic Scale (Feet) 1 inch s 40 tt B #2 939 ft. \ B #3 40 Line 40 Acre Parcel 1B #4 \ ~ KI 2.5% 97.50' \ \ 97.35' BM #1 97.00' Open Field Site Cropped Note: Maintain well and waterline setbacks per 96.00' in soybeans 2015 SPS 383.43(8)(1) Proposed Three Bedroom Home Site w/ Storage Bldg. 382 ft. Approx. 1080 ft. to West P/L A BM = Nail w/Pink Ribbon in Base of 10"DBH Chinese ElmTree * HRP =Same Elevation Data ASSUMED ELEV. = 100.00' B# I = 96.95' B#2 = 96.99' Backhoe Pit B#3 = 97.53' B#4 = 96.65 O Grade = 93.25' Approx. Bldg. Sewer Elev. = 93.25' NW-NE Sec. 20 1320, 40 Line NE-NE Sec. 20 November 13th, 2015 443 ft. 1 Edge of Pond Keith E. Stoner CST# 224059 1 J ArcGIS Web Map w • M a° 9 t P 9 f ~5 -'"k sett ~S ~ ~ w Y f ♦ ~ $ S $ . 4f y ;S @1 4 ~g~f Y } i i^Yp ~ • . AA, - S, I n n h, s s Tt' r a , t .e 'SIG t ~ Y 3 'ct F 3 S t t `t"t s ^`r e e a s e. ~,~q•~` s a _ x= b.. r` i A C, May 16, 2017 1:4,514 0 0.035 0.07 0.14 mi House Numbers INTERMEDIATE DEPRESSION 0 0.0425 0.085 0.17 km Site Address Points IndexContours IntermediateContours - <all other values> - <all other values> - INDEX INIIFx INnFx nFPRF.q.ginN SCCCDD Land Use ST. C R O I,X CCa U,NTY Planning & Land Information Resource Management Community Development Department 5/25/2017 Jon & Suzanne Barker 2130 County Road C New Richmond, WI 54017 RE: Conditional Approval: Land Use Permit, File# LUP-2017-018 Project Location: 20.31.16.295B, Town of Cylon PID 006-1043-30-025 Project Address: 2165 2101h Ave Dear Jon & Suzanne Barker, Community Development staff have reviewed the Land Use Permit application for the construction of a new Single Family Dwelling and to fill and grade greater than 10,000 square feet for the construction of a driveway and Private Onsite Wastewater Treatment System (POWYS) within the Shoreland Overlay District, Chapter 17.30. The request has been conditionally approved based on the application submission and the following findings. • The proposed project meets all applicable setbacks and the proposed house will not exceed the 35-foot height maximum. • The project is greater than 300-feet away from a navigable water body; therefore, the Impervious Surface calculation is not required. • Vegetation will not be disturbed within 35-feet inland from the navigable water body. • Erosion and Sediment Control plans have been submitted that meet Wisconsin Department of Natural Resources Technical standards. • The property received the Sanitary Permit #597344 and coverage is valid for two years. • The applicant understands land disturbance over one acre may require additional permit coverage. Based on these findings, approval of the Land Use Permit is subject to the following conditions: 1. The new property lines described in CSM#1044620 shall be staked prior to any land disturbance so that the contractor is aware of the new property boundaries. 2. Sediment and erosion control shall be installed prior to any land disturbance or construction activities as proposed in the plan. Temporary stock piled soils shall be placed upslope of sediment and control measures. 3. St. Croix County reserves the right to require additional sediment and erosion control measures to be installed if found necessary due to site-specific concerns. 4. Phosphorus fertilizer shall not be used to establish and/or maintain vegetation unless a soil test confirms phosphorus is needed. Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 www.sccwi.us/cdd www.focebook.com/stcroixcountywi cddCcDco.saint-croix.wi.us II Land Use S T. C R O Ij.X Al U.N TY Planning & Land Information Resource Management Community Development Department 5. Permanent vegetation shall be established once final grade is reached spring of 2018, after the ground thaws - June 1. A temporary cover crop such as oats, winter wheat or rye shall be applied on all disturbed areas if seeding cannot occur prior to June 1. 6. Sediment and erosion control shall not be removed before the project site reaches a point of at least 70% perennial vegetative cover. 7. It is the applicant's responsibility to secure any other required local, state or federal permit(s) and approval(s) prior to land disturbance activity. 8. Failure to comply with the terms or conditions above may result in the revocation of this permit by the Zoning Administrator according to Chapter 17.30(13). This approval is subject to the conditions listed above; it does not allow for any additional construction, structures, grading, paving, filling or clearing of vegetation beyond the limits of this request. Your information will remain on file at the St. Croix County Community Development Department suite. It is your responsibility to ensure compliance with any other local, state, or federal permitting or regulations, including contacting the Town of Cylon and the Wisconsin Department of Natural Resources to inquire if additional permissions are required. This permit is valid for one year, with the possibility of up to two (2) six-month extensions if the applicant submits the appropriate permit extension fee and documentation to the Zoning Administrator. A copy of the Land Use Permit placard should be submitted to the local Building Inspector for the town upon application for the building permit. The orange placard must be posted on the job-site and visible from public view. Please feel free to contact me with any questions or concerns. I am typically available Monday- Friday from 8:00 a.m. - 5:00 p.m. If you would like to schedule an inspection, please call the main office so your call can be directed to the next available staff= member to accommodate your request as soon as possible at 715-386-4680. Respectfully, ?~k6K Sarah Droher Land Use Technician II cc: File ec: cvlonderk@amaii.com, barkerjack973Ca)gmail.com LL enclosure: Site plan Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 www.sccwi.us/cdd www.focebook.com/stcroixcountywi cddPco.saint-croix.wi.us Standard Erosion Control Plan for 1- & 2-Family Dwelling Construction sites According to Chapters Comm 20 & 21 of the Wisconsin Uniform Dwelling Code, soil erosion control information needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1- & 2-family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. PROJECT LOCATION Z-1 ,tt ~'J Jc I Please indicate north ( - n completing the arrow. BUILDER OWNER C,n 1 ;.l v ~ h r WORKSHEET COMPLETED BY J4'--t DATE -0 N SITE D IAG M Scale: I inch = feet K4 Ir 1 1 1 I I '11 ! ( EROSION CONTROL PLAN III LEGEND PROPERTY f !i i > i rn. i.A - - LINE EXISTING II 1! 1 1 ( - DRAINAGE taw i1,; J~ TD TEMPORARY i I 1 DIVERSION I FINISHED DRAINAGE it ' i' I I I I I 1 1 1 1 1 1 I I LIMITS OF klI GRADING iI > gel`~~ SILT l ~I I4-' FENCE 'I STRAW ,x t I BALES l ( ( GRAVEL rl O SPECIFICATION I IA 0 I I r 1 1 SPECIFICATION I I ~I~;d 1 TREE I 1 l ~ PRESERVATION ~ I I I I eve 1 1 I I I I 1 1 STOCKPILED I U/ SOIL II II II