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HomeMy WebLinkAbout026-1133-04-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 597350 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] State Plan ID No 2947790 Permit Holder's Name: City Village Township Parcel Tax No JEFFERY & LADONNA DESJARDIN TOWN OF RICHMOND 026-1133-04-000 CST BM Elev: Insp. BM Elev: BM Description: 6-M Section/Town/Range/Map No: TANK INFORMATION 06.30.18.917 ELEVATION DATA TYPE MANUFACTURER Jr° CAPACITY STATION BS HI FS ELEV. a'i Septic Benchmark Dosing ) ~ ll V . ovi Alt. BM 1 A Z_Wn ' G rof(S'j S / Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION V t outlet 1398 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet o Septic 7& ICY/ S Dt Bottom Dosing I 17 2' 2,Header/Man. won J Dist. Pipe Bot. Syste PUMP/SIPHON INFORMATION Final Grade Manufacturer (L DO Demand St Cover I GPM ®0k, aww4cr 9 ~r 7 Cj 6-U Model Number ~ FForcemain H Lift Friction Loss System tie ad T H 1 Ft y. ~r ( Leng o D Dia. Dist. to well p SOIL ABSORPTION SYSTEM BEDITRENCH Width Length t No. Of Tr nches PIT WMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / ~ A / L SETBACK SYSTEM TO I P/L / LDG WELL INFORMATION LAKE/STREAM LEACHING M4aufactu Ty Of Systgm: CHAMBER OR n / UNIT Mo Number: Ar(t DISTRIBUTION YST M ~J V C~ [H.eader/Manifold istribution ` x Hole Size x Hole /y Spacing Vent to Air Intake Pipe(s) . / r ngth Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over All ~Depth Over xx Depth of 1xx Seeded/Sodded Depth O Center Id, ed/Trench Edges , ] 1+ To soil xx Mulch u es~ jj Yes E] No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: CO i Inspection #2: Location: 928 172ND AVE ILOW 1.) Alt BM Description = 2.) Bldg sewer length =~1 -amount of cover = b~- Plan revision Required? Yes X No V Use other side for additional information. SBD-6710 (R.3/97) Date Insepct Signature Cert. No. n i - SS County Safety and Bindings Division rMix P 201 W. VI -ington., P Box 7162 Sanitary Permit Number (to be filled in by Co.) Cj i 14 App11Ca+l)n State Transaction Number In accordance with SPS is. Adm. Code, submission of this form to the appropriate goven,.. 2947790 is required prior to o g a sanitary permit. Note: Application forms for state-owned POWTS are submits- Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. tU4(1)(m), Stars. 1. Application Information -Please Prin All Information Same 10 -72 Property Owner's Name Parcel # Jeffery & LaDonna DesJardin 026-1133-04-000 , Property Owner's Mailing Address Property Location 928 172nd Avenue Goat. Lot _ City, State Zip Code Phone Number SE y, SW Y,, section 6 New Richmond Wi. 54017 30 18 (circle one) H. Type of Building (check all that aPP1Y) Lot # T N; R E or~ I or 2 Family Dwelling - Number of Bedrooms ('4 , Subdivision Name K y4 ° Bloc h C,r; ❑ Public/Commercial - Describe Use - ❑ City of ❑ State Owned / Describe Use CSM Number ❑ Village of / j, ❑ Tow„ of Richmond tH. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Recision El Chan e of Plumber List Previous Permit Number d D to Issued g ❑ Permit Transfer to New ~b Before Expiration Owner 453080 IV. Type of PORWTS System/Component/Device: (Check all that apply) El Non-Pressurized In-Ground ❑ Pressurized In-Ground D(At-Grade El Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreattment Area Information: Design Flow (gpd) ya Design Soil Application Rate pdsf) Dispersal Area Required (st) j Dispersal Area Proposed (sf) System Elevation 450 .50 900 900 4 107.00 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks U Existing Tanks Zable A 100 w U y C X~ ~41t r=7 0 U V ' / LZ O Septic or Holding Tank 1000 1000 1 Wieser " X Dosing chamber 750 750 1 Wieser X VII. Responsibility Statement- I, the undersigned, assume responsibility f tallation of the POWTS shown on the attached plans. Plumber's Name (Print) Pill r' Signatu MP/MPRS Number Business Phone Number Keith Knudtson 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th Street Roberts W. 54023 VIII. -oun /De artment Use Only 11 F e _ Approved 0 ~~pU; Reason for Denial ie Date ~~ue ~y I~ ing gent Signature ~ IX. Condi Olt ' easo for isapproval - 1. ' k, et t%ni ittfe- ith~ i31~et•.aSi l;Ol must all be s ~ %is **r per We ernent plan prc ae + ✓ N ,no 2 t#1lOp#~~Krec~t ret~At s.mir~t ut: t a»rt. as per offAwbM c4& / ~.rc iitunrm. Attach to complete plans for the system and submit to the County only on paper not less than 8 1✓2 x 11 inches in size SBD-6398 (R. 11/11) L6- - Page 8 of 8 190.00' Sanitary Site Plait For: Jeffrey and LaDonna Desjardin Lot 4 of the Pine Valley Add. Sub. SEl/4-SWl/4 Sec. 6 T30N-R18W Township of Richmond - St. Croix County 0 20 40 Graphic Scale (Feet) i inch = 40 tt_ Grade = 96.14' Ponding of effluent from level S.E. = 91.14' with grounds surface to 8' below. C/L's of Existing 0 Cells o \ Proposed Wieser Grade = 96.79' Concrete 750 Gal. S.E. = 92.21 a Dose Tank Walk-Out Basement 1 Sill Plate of Patio Door n ° Walk-Out = 99.02' Existing Wieser Concrete P/L 1000 Gal. Septic Tank w/a 435.86' Zabel A-100 Filter WELL 4„Bldg. Sewer 290.44 Three Bedroom , BM #1 2.00 Acres Home P/L Garage 42 BM 42 Proposed 2"Sch. 40 O - BM = Bottom of Garage Siding PVC F.M. Elev. = 106.67' ABM = Top of Septic Manhole Cover * IW = S.E. Garage Corner 105.00' ASSUMED ELEV. = 100 ° 7% 106.00' FN4 928172nd Ave. ° 7% 107.00' 108.00' Open Yard Elevation Data Dose Tank grade = 98.00' Proposed 10' x 90' At-Grade Mound dispersal Area w/a System elev. of 107.00' Lot Iron ART~E.y~ DIVISION OF INDUSTRY SERVICES o 1 \ n 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 S Contact Through Relay http://dsps.wi,gov/programs/industry-services www.wisconsin.gov F~SS~` /j Scott Walker, Governor Laura Gutierrez, Secretary May 17, 2017 AP€=`'F OF CUST ID No. 224059 ATTN.° POWTS Inspector KEITH E STONER ZONING OFFICE KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA 23220 WOODCREEK RD 1101 CARMICHAEL RD SIREN WI 54872-8728 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/17/2019 Identification Numbers Transaction ID No. 2947790 SITE: Site ID No. 838165 Jeffrey Desiardin Please refer to both identification numbers, 928 172ND Ave above, in all correspondence with the agency, Town of Richmond St Croix County SEI/4, SWI/4, S06, T38N, R18W Lot: 4, Subdivision: Pine Valley FOR: Description: At-Grade (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1706645 Maintenance required; Replacement system; 450 GPD Flow rate; 54 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 10 1.01(10), Wisconsin Statutes, is respon )1,". requirements. No person may engage in or work at plumbing in the state unless licensed to 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. • 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. • 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 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. • Abandon Existing System per SPS 383.33 • Pump Floats to be set and verified per approved plan Anv changes may result in pump resizing to meet TDH and GPM Specifications • Divert surface water from POWTS Area. 0 Well setbacks to meet chs. NR 811 & 812. KEITH E STONER 1Paee 2 5/17/2017 • 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) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • 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 at-grade 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 din ~~~z~ir o~ 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.vanderleestoa,wisconsin.gov KEITH E STONER Page 2 5/17/2017 • 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) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • 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 at-Prade 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 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 RESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET kArlD t`" ICES Project Jeffrey and La Donna Desjardin At-Grade Mound. Owner Jeffrey and La Donna Desjardin Address 928 172nd. Ave. New Richmond WI 54017 Legal Description SE1/4-SW1/4 Sec. 6 T38N-R18W Township Richmond County St. Croix Subdivision Name Pine Valley Addition Lot No. 4 Parcel ID Number 026-1133-04-000 Plan Transaction Number Index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 Pump curve & specifications Page 7 Plot Plan Page 8 Attache g%1m0 pal Float Settings 71 Designer Keith E. Stoner KEITH * %icense Number Designer 1575-007 STONER Signature D-Siran 1575 Phone Number 715-653-2324 WrS. Date 051074 7 /'/~~i~~~F`S'1•C•i N~\\\`\\\\~~ ~h►rrnn►►~~~ Designed pursuant to: At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 031107), 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) (r j Oil ` J A Version TO (03112) Page 1 of 8 INwSTRY SFPh/l ` PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 300.0 Estimated wastewater flow (gpd) 450.0 Design wastewater flow (gpd) 7.00 % Site slope 107.00 Contour elev. below lateral (ft) 54.00 Depth to limiting factor (in) 0.50 In-situ soil application rate (gpd/ft"2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 10.00 Linear loading rate gpd/ft 10.00 Effective absorption width (ft) TT 10.00 Max. effective width permitted (ft) 90.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) end Center or end lateral connection 1 Number of laterals 0.125 Orifice diameter (in) e.g. 0.25 Nota final calculation 1.75 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 2.19 Forcemain flow velocity (f /sec) 136.00 Forcemain length (ft) y or n Does forcemain drain back? 91.45 Pump tank elevation (ft) y or n Are laterals at highest point? 6.5 System head (ft) x 1.3 NA 15.22 Vertical lift (ft) 22.2 Forcemain drainback (gal) 1.41 Friction loss (ft) b 45 40.5 5x Lateral void volume (gal) 0.00 In-line Filter Loss (ft) 62.7 Minimum dose volume (gal) 23.13 Total dynamic head (ft) 21.4 System demand (gpm) Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Design options Design choice Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select: 1.25 in Gal/in (enter result in cell G46) one lateral 1.5 in X X diameter 2 in x Treatment Tank Information 3 in x Wi 000 Septic tank capacity (gal) s er Concrete Manufacturer Effluent Filter Information Dose Tank Information Zabel Filter manufacturer F750.4 Dose tank capacity (gal) A-100 Filter model number 20.3 Dose tank volume (gal/in) Wieser Concrete Manufacturer Project: Jeffrey and La Donna Desjardin At-Grade Mound Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW 1/6 B Observation pipes (2 typical) A 10.00 ft T ~D o B 90.00 ft 1 /6 B 15.00 ft C 12.00 ft VV C D 5.00 ft -i- E 2.00 ft p L 100.00 ft B W 22.00 ft A x B 900.00 ft^2 L Cap = Total aggregate cell A x B Typical obs. pipe. Slotted in the lower 6", and = Plowed area L x W anchored securely. 6" AT-GRADE CROSS SECTION Svnthetic fabric cover - 108.79 ft Finished grade Lateral elevation / f ff invert elev. 107.50 Observation pipe at aggregate toe E Surface contour 107.00 ft C A 7 % Slope and system elevation D = 12 in. topsoil and subsoil over aggregate and tapered to toes. Plowed layer = 6 in. aggregate below below L x W pipe(s), and 2 in- above pipe. Project: Jeffrey and La Donna Desjardin At-Grade Mound Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection P t. t how dW to 4,I,- X Uterals & (oroo main of PVC Snh 40 Flok_ dM d on the bottom of tat"A W SPS Table 384,30.6 #q"19 S0*C*+d M Turn-up vWball,ralvw at *tea noutplug Lateral Specifications 0.125 Orifice diameter (in) Center Lateral connection point X 1.72 Orifice spacing (ft) 1 Number laterals 52 Orifices/lateral P 88.58 Lateral length (ft) 21.4 Lat. discharge rate (gpm) 1.50 Lateral diameter (in) 2.00 Forcemain diameter (in) 21.4 Sys. discharge rate (gpm) 136.00 Forcemain Length (ft) 23.13 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device junction box Final grade 4" disconnect Tank component is Alternate properly vented' outlet location 18" min. Electrical as per NEC 300 and I~ Approved SPS 316.300 WAC outlet Tank full joint Inches Gallons JA Provide 1/4" N A 21.9 444.1 Alarm on weep hole or B 2.0 40.6 B antisiphon _E C 3,1 62.7 Pump on device. o D 10.0 203.0 92.28 ft C 11 Totals 37.0 750.4 Pump off D 3" Bedding under tank 91.45 ft Goulds Pump manufacturer SJE Rhombus Alarm manufacturer EP05Pump model number Tank Alert 1 Alarm model number Project: Jeffrey and La Donna Desjardin At-Grade Mound Transaction Number: Page 4 of 8 At-grade System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name ISt. Croix County Zoning Phone 715-386-469-0- System Flow and 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 900.0 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter 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 Inspect for ondin and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SIPS 384.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn Threaded Cleanaut Sprinkler Valve Box Plug or Ball Valve Distribution - Long Sweep 90 or Two 107.50 ft 45 Degree Bends Same Diameter as Lateral Project: Jeffrey and La Donna Desjardin At-Grade Mound Transaction Number: Page 5 of 8 At-grade System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10854-P (N. 03/07), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (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 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. At-grade and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade system may not exceed 220 mg/L 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 clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Jeffrey and La Donna Desjardin / Transaction Number: Page 6 of 8 Page 7 of 8 GOULDS PUMPS Submersible Effluent Pump EPO4 j 3871 EPOS APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto. superior strength and corrosion • Heavy duty sump matic models include resistance. Is- Cmadien standaft AsMd8eon • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Cents Pi nps is ISO soot W gifted • Solids handling capability: FEATURES cover with integral handle and 3l4" maximum. float switch attachment points. EP04 Impeller: Thermoplas- ■ Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with • Total heads: up to 31 feet, pump out vanes for mechanical rated oil and water resistant. • Discharge size: 11/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BONA-N elastomers. • Temperature: 104°F (4090) continuous 140OF (609C) intermittent METERS FEET • Fasteners: 300 series o stainless steel. • Capable of running a s GPM dry without damage to $ 2s rr components. zs Motor: • EP04 Sin le phase: 0.4 HP, 2 6 zo 115 or 230 V, 60 Hz, 1550 RPM, built in overload with n s 15 automatic reset. ~ ~ _ _ I • EP05 Single phase: 0.5 HP, EPOS 115 V or 23oV, 60 Hz, 1550 a 10 ; RPM, built in overload with automatic reset. z EP04 • Power cord: 10 foot 5 standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 ° °0 10 20 _ 30 40 s° . ~P foot length, 16/3 SJTW with three prong grounding plug _ (standard on EP05), ° z a 6 e t o i z man, CAPACITY Goulds Pumps E 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 Page 8 of 8 190.00' Sanitary Site Plan For: .leffrey and LaDonna Desjardin Lot 4 of the Pine Valley Add. Sub. SE1/4-SWl/4 Sec. 6 rl'30N-R18W Township of Richmond - St. Croix County 0 20 40 Graphic Scale (Feet) 1 inch = 40 & Grade 96.14' Ponding q f effluent, from level S.E. = 91.14' with grounds surface to 8' below. CIL's of Existing ° Cells ° Proposed Wieser Grade - 96.79' \ Concrete 750 Gal. S.E. = 92.21' ° Dose Tank Walk-Out Basement Sill Plate of Patio Door (n) ° Walk-Out = 99.02' Existing Wieser Concrete PIL 1000 Gal. Septic Tank w/a 435.86' Zabel A-100 Filter • WELL 4„ Bldg. Sewer 290.44 Three Bedroom - BM #1 2.00 Acres Home P/L Garage ABM2 42 Proposed 2"Sch. 40 O - BM = Bottom of Garage Siding PVC F.M. Elev. = 106.67' A BM= Top of Septic Manhole Cover * EIRP = S.E. Garage Corner 105.00' ASSUMED ELEV. = 100 ° 7% 106.00' FN# 928 172nd Ave. ° 7% 107.00' 108.00' Open Yard Elevation Data Dose Tank grade = 98.00' Proposed 10'x 90' At-Grade Mound dispersal Area w/a System elev. of 107.00' Lot Iron 1 1 r KEITH E. STONER LAND USE CONSULTANT CERTIFIED SOIL TESTER AND DESIGNER OF SANITARY SYSTEMS 23220 Wood Creek Rd. Siren Wisconsin 54872 Phone ('715) 65'-2 324 Adventurers(a~Centutel.neT Optional Float Settings Dimension Inches Gallons A 19.50 395.85 B 2.00 ------40.60 C 5.50 111.65 D 10.00 _ 203.00 Total 37.00 751.10 37 inch liquid level 20.30 gals./inch Optional Pump Na ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Jeffrey & LaDonna DesJardin Mailing Address Same Property Address 928 172nd Avenue (Verification required from Planning & Zoning Department for new construction.) City/State NeW Richmond, WI Parcel Identification Number 026-1 1 33-04-000 LEGAL DESCRIPTION Property Location SE '/4 , SW '/4 , Sec. 6 T 30 N R 18 W, Town of Richmond Subdivision Plat: Pine Valley Lot # 4 Certified Survey Map # Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yesElno 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 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. 1/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the Number of Register of Deeds Office. property described above, by k06F/APPLICA arrant reco in Regis be ms 3 _ 05/05/17 SIGVATiXE NT(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) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 928 172nd Ave New Richmond located at: SE V4, Sw V4, Section 6 , Town 30 N, Range 18 W, Town of Richmond , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 4/16/17 Did flow back occur from absorption system? Yes x No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser Age of Tank (if known): 15 yr Permit umber ('f known) 453080 Keith Knudtson `(Licensed Plumber Signature) (Print Name) 648443 (Title) (License Number) MP/MPRS 5/15/17 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ~I 100 1314/001 UNPLATTED LAND - NORTH LINE OF THE S 1 /2 OF THE SW 1 /4 "W 2596.63' oo*39,05'f < 620.00 190.00 132.00 20( 2A ASEMENT .W . DRAINAGE 986.1 5~2.,Z~42 - g --r'S©0yR N Zg ` ` ` 217.72' 50 00L-1~41 S89'20'55'W 267.72' BUi 96,648 SgFtf M 2.22 Acrest rr ; ~M 0) i~ 88,184 SgFtt 6 2.02 Acrest 0 E 16500' z 3 N Go `loft 16 ~1g \ 87,857 500' \ ? 2.02 A 00, SS--------- '~.r 11" 17 ~C~ \ \ ` ` .a C?? 12' U TI E/4, C23 7,431 SgFtf c``., AD - - 70 Acrest I c2J C24 17, 765.22' N89.21'40"E f693.12' Wisconsin Department of Safet essional Services 2 Division of Intig:&q:' #1341 RR vv` SOIL EVALUATION REPORTJ.' A T ^ Page 1 of 3 - MAY ( `~Q~ ; in accordance with SPS 385, Wis. Adm. Code Keith E. Stoner oun y 1 County- Attach cornpje},~,itXWernsions, aper not less than x 11 inches in size. Plan must St. Croix incl~ TWI Wd horizontal reference point (BM), direction and - - - peao, north arrow, and location and distance to nearest road. Parcel I.D. _026-113 -04-000 Please print all information. Reviewed y 7 Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). If Property Owner Property Location /l' C/' Jeffrey+ LaDonna Desjardin Govt. Lot SE1/4, SV1i1~1/4, S6, T30N, R18W PropertyOwner's Mailing Address Lot # Block # Subd. Name or SM# 928 172nd Ave. 4 Pine Valley Add. City State Zip Code Phone Number Y P ❑ City ❑ Village X Town Nearest Road New Richmond WI 54017 Richmond Same ❑ New Construction Use: Z Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD E Replacement ❑ Public or commercial - Describe: Parent material Loess or Lucusterine deposits over Sandy Loam Till - Flood plain elevation, if applicable NA ft. General comments Propose a 9 x 84' At-grade mound system locating the pipe along the 107.00' contour with a system elevation =107.00'. Mound and recommendations: contour staked onsite. ❑ Boring 1 Boring # ® Pit Ground surface elev. 105.98 ft. Depth to limiting factor >80 in. Soil Application Rate Sh. ~ Struuct cture ~ Consisten Boundary Roots GPD/ftZ_- Gr. Sz. Horizon Depth Dom `a t Color <Re ox ❑nt ipti Color Texture Structure in. M 'Eff#1 *Eff#2 1 0-7 10YR3/3 - sit 2msbk mvfr cs 3f-m 0.6 0.8 2 7-12 10YR4/2 - sil lmpl/2msbk mvfr gs 2f-m 0.4 0.6 3 12-19 10YR4/4 - cl 2abk mfr gs 2f-m 0.4 0.6 4 19-51 5YR4/4 - Is Osg ml gs 1f 0.7 1.6 5 51-80 5YR4/4 - sl lmsbk/m mvfr - - 0.2 0.6 #4 - inclusions of sl #5 - bands of gr Is Z Boring # F-I X ❑ Boring Pit Ground surface elev. 106.43 ft. Depth to limiting factor - >54 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistences Boundary Roots GPD/f 2 j in. Munsell Qu. Sz Cont. Color i ( Gf. Sz. Sh. -Eff#1 -Eff#2 1 0-8 10YR3/3 - sil 2msbk mvfr cs 3f-m 0.6 0.8 2 8-12 10YR3/4 - sil lmpl/2msbk mvfr gs 21' 0.4 0.6 3 12-17 10YR4/4 - cl 2msbk mfr gs 2f-m 0.4 0.6 4 17-26 5YR4/4 - gr Is Osg ml gs 2f-m 0.7 1.6 5 26-54 5YR4/4 - sl m mvfr - 2f 0.4 0.7 " Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD5 <-30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Keith E. Stoner 224059 Address Keith E. Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd. Siren, WI 54872 5/312017 715-653-2324 SBD-8330 (R.07/13) Property Owner Jeffrey+ La Donna Desjardin Parcel ID # 026-1133-04-000 - Page - 2 of 3 ❑ Boring F3 ]Boring # Pit Ground surface elev. - -_107.38 ft . Depth to limiting factor >70 in. ® Soil Application Rate Horizon Depth Dominant Color ! Redox Description Texture Structure Consistence! Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz_ Sh. 'Eff#f 'Eff#2 1 0-12 10YR3/3 - sil 2msbk ' mvfr cs 3f-m 0.6 0.8 2 12-29 10YR4/4 - cl 2msbk mfr gs 2f 0.4 0.6 3 29-36 5YR4/4 - sl lmsbk mvfr gs 2f 0.4 0.7 --4 i 4 36-70 5YR4/4 - sl lmsbk mvfr - if ' 0.4 0.7 I j I #4 - with bands of gr Is interpersed ❑ Boring F4 ]Boring # Pit Ground surface elev. - 94.89 ft. Depth to limiting factor 54 in. ® - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence! Boundary Roots GPD/ftZ in. Munsell 1 Qu. Sz. Cont. Color Gr. Sz. Sh. 'Erf#a 'Eff#2 1 0-6 1OYR3/3 Fill sl 2msbk mvfr cs 3f-m 0.6 1.0 2 1 6-13 10YR2/2 sil impl ! mvfr gs 3f-m 0.4 0.6 3 j 13-27 10YR4/4 sil 2f-msbk mvfr gs 2f 0.6 0.8 4 27-44 IOYR4/4 sicl 2msbk mfr gs if 0.4 0.6 5 44-54 5YR4/4 w/bands of sil slmsbk mvr gs 0.4 0.7 6 54-80 10YR5/4 c2d - 5YR5 8 lmsbk mvfr gs 0.4 0.6 - L ~-Si*l .Existing verificatin boring completed 4/24/17 ❑ Boring F5 ]Boring # Pit Ground surface elev. 97.63 ft. Depth to limiting factor 72 in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistences Boundary 1 Roots GPD/ftZ i 'Ef~f#1 `Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-10 1OYR3/3 Fill sil 2msbk mvfr cs 3f-m 0.6 0.8 2 10-15 IOYR5/4 sil lmpl mvfr } gs 3f-m 0.4 0.6 3 15-24 10YR4/4 sicl 2f-msbk mvfr gs 2f 0.4 0.6 4 24-42 5YR4/4 sl lmsbk mvfr gs if 1 0.4 0.7 5 42-56 5YR4/4 gr Is Osg ml gs 0.7 1.6 6 56-72 I, 5YR4/4 Veins of sand sl m mfr gs 0.2 0.6 - : - - - 7 72-90 ! 5YR4/4 f2d 5YR5/8 sl m mfr 0.2 0.6 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Efflu nt #2 = BODS < 30 mg/L and TSS < 36 /L SBD-8330Test (R.07/13) Keith E. Stoner 190.00' Soil Test Site Plan For: Jeffrey and LaDonna Desjardin Lot 4 of the Pine Valley Add. Sub. SEl/4-SWl/4 Sec. 6 T30N-Rl8W Township of Richmond - St. Croix County 0 20 40 Graphic Scale (Feet) 1 inch = 40 [t. ' Grade = 96.14' #4 S. E. = 91.14' Ponding of effluentfrom level C/L's of Existing o with grounds surface to 8' below. Cells o Grade = 96.79' S.E. = 92.21' 0 Walk-Out Basement o Sill Plate of Patio Door (a~ PIL Walk-Out = 99.02' , # 5 Septic Manhole Cover = 100.00' • WELL O - BM #1 290.44' Three Bedroom 2.00 Acres Home P/L 435.86' Garage #2 BM #2 O A BM Bottom of Garage Siding Elev. = 106.67' A BM = Top of Septic Manhole Cover * EIRP = S.E. Garage Corner 105.00'_ _ ASSUMED ELEV. = 100 Backhoe Pit 7% ~ FN# 928172nd Ave. 106. 00' # # 2 7% ' Elevation Data 107.00' B4 1 = 105.98' 108.00' Open Yard B#2 = 106.43' B#3 = 107.38' B#4 = 94.89' B#5 = 97.63' Dose Tank grade = 98.00' May 3rd, 2017 Lot Iron Keith E. Stoner CST# 224059