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HomeMy WebLinkAbout018-1011-60-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597452 GENERAL INFORMATION State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2980495 Permit Holder's Name: City Village Township Parcel Tax No: LEILA ALBERT TOWN OF HAMMOND 018-1011-60-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 06.29.17.86C-2 "rv TANK INFORMATION ELEVATION DATA J TYPE MANLtACTURER CAPACITY STATION B.& ~ I FS ELEV. D IV (s S A r6 Septic Overg- r,L,f' 000 l 67A f Benchmark ~P 7,13/6/,45 /66 Dosing / Alt. BM bD A Arefetterr- L/ Bldg. Sewer q. is- 0? .7t ~c Hem Y Ht Inlet 8~• 7 49 TANK SETBACK INFORMATION 11S 10i J TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Septic Dt Bottom D ng + ea er/M J7 %J i J ~ Aeration Dist. Pipe Holding} Bot. System / Final Grade PUMPISIPHON INFORMATION Manufacturer Demand St Cover S GPIM h l~ll~ S. Model Number 009 a ~,.~S 5 TDH tib G ~ Frictio Lo s4 System Head T H ' Ft Forcemain Lenc IlDia..2 ) + Dist. to Well (0 SOIL ABSORPTION SYSTEM BED/TRENCH Width Len No. A Trenches PIT DIMENSI NS No. Of Pit Inside D> Liquid D DIMENSIONS , &v 6cJ J SETBACK SYSTEM TO ~~~~IIII//// P/L BLDGWELL LA STREAM LEACHING Manufacturer: INFORMATION Type M f stem CHAMBER OR K 0 N O I' T f M /LIZ UNIT Model Nu er IBUTION SYSTEM `JJ Head Manifooll`d Distributio I x Hole Size 5 • Ix Hole Sp cing IV .{e/~❑)rt/ to Air Intake J' J) Pipe(s) O ! + 7 Y~t Length Dia Length Dia Spacing 1 l~ ~W SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over ~Y xx Depth t xx Seeded/Sodded TMJ55e8 a Bed/Trench ent~ \ O Bed/Trench Edges I Topsoil 1~ - ) 1 ~ V ~ ` es No es No COMMEN S: nclude cod( crepencies, persons present, etc.) Inspection #1: c z4 7 Inspection #2: 1Y Location: 1517 CTY RD E old l A T 0 ~V1~ 1 ~ _ t 1.) Alt BM Description Cpa- V V r 0 ? ab m 2.) Bldg sewer length = t r SoS~ t' ~-41~. •'~.]L Cry v7 `c0< amount of cover = `'14 P~o~ it r ~,J r " Low on All! Plan revision Required? Yes No n. A I'l l Use other side for additional informati 629 SBD-6710 (R.3/97) Date Insepct ' Signature Cert No SAN -Rgyt - aka County RECE VE Safety and Buildings Division St. Croix p `=~`j 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) IPS AUG 21 201 Madison WI 53707-7162 ,OMMUN r1Zit i SMDXDVGSCHARO State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submissio ~...Y,.u, guverntnentai unit 2980495 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondarypurposes in accordance with the Privacy Law, s. 15.04(1)(m), Stars. 1517 County Rd. E 1. Application Infor n - Please Print All Information Property Owner's Nam Parcel # Leila Albert 018-1011-60-000 0 00 Property Owner's Mailing Address Property Location 0 • - q• • 2035 Co. Rd. J Govt. Lot City, State Zip Code Phone Number NW NW 6 Section Baldwin W. 54002 (circle one T 29 N; R 17 E or H. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 00 Vol.3 Page 690 ® Town of Hammond • 6 or III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber L t r v}ou~Pertt Number and Dat` Issued / ❑ Permit Transfer to New (`~`7 1.7634 Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 V ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade J3 Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsal/Trea ent Area Information: 4 Design Flow (gpd) Design Soil Applicati ate( dst) Dispersal Area Re d sf) Dispersal Area o At (sf) System Elevation / 450 1.0 b t 450 ~ 450 96.50 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units poly-Lok 525 v° New Tanks Existing Tanks / 4,d 0 o p a, U v~ v~ w C7 0 Septic or Holding Tank 1000 1000 Wieser x Dosing Chamber 600 600 combo x VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Keith Knudtson 6484, 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 159th St. Roberts Wi. 54023 VIII. Coun epartment Use Only Approved pprove Permit Fee QDat il s ued Issuing ent Signatur co -7 riven Reason for Denial $ ~ IX. Conditp)d$' easolns for PisaPProval 1~ 31 ~ it o~,n~ 1 ~"tarok; tsaflusrtzt t~ti f ' ~ t3"en b, celt Must all be seL_ !nun ^es 11 ^ t..J`t t f +M.~ . ~s per 10r919ement. plan p,ulided by plumbee. 2. 'A~'11 fef* plki ~nvs mutAlitle rnaintzirf'1 p aal per *licaNi c4di / c:Mina,'l m 4 Odd! •6 Attach to complete plans for the system and su nit to the County only in paper not less than 8 112 a 11 inches in size (/-per pj//IV~L► ' SBD-6398 (R. 11/11) 0 y U Q 0 0 °J a \ ao c a CA- I ti o s 'n nl U ~ o o~;~'; a P N~ o d ~ .K o ~ II h O ty ~ N CS ~ U ~ b ~ ~ II • r E~ k ~ ~ O oD w q M y c bA o0 vim, ~ p rn ~ o~ o ~ s ~ II "`r a C t x V o V e ~ 0.0 V RThTS0 y~o DIVISION OF INDUSTRY SERVICES n 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 i `p AM's S Contact Through Relay http://dsps.wi.gov/programs/industry-services V P www.wisconsin.gov rRO~2'ssio ~ Scott Walker, Governor Laura Gutierrez, Secretary August 16, 2017 OF SAKI CUST ID No. 224059 ATTN: POWTS Inspector -"k L 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 Identification Numbers PLAN APPROVAL EXPIRES: 08/16/2019 Transaction ID No. 2980495 SITE: Site ID No. 841493 Leila Albert Please refer to both identification numbers, Cty Rd E above, in all correspondence with the agency. Town of Hammond St Croix County NW1/4, NW1/4, S6, T29N, R17W FOR: Description: Mound System (3 Bedrooms - Replacement) Object Type: POWTS Component Manual Regulated Object ID No.: 1721560 Maintenance required; Replacement system; 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. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • 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. • 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. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Divert surface water from POWTS Area. • 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) KEITH E STONER Page 2 8/16/2017 , • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • 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 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 KEITH E STONER Page 2 8/16/2017 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • 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 &eal 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 tini.vanderleest@wisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Leila Albert Replacement Mound System Owner's Name: Leila Albert `e)i,, Owner's Address: 2035 County Rd. J Baldwin WI 54002 Property Address: 1517 County Rd E Legal Description: Parcel in the NW1/4 - NW1/4 Sec.6 T29N-R17W Township: Hammond County: St. Croix Subdivision Name: CsM Vol. 3 Pg. 690 Lot Number: 2 Block Number: Na Parcel I.D. Number: 018-1011-60-000 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 Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan sE'~'~ QG(P "~JCar~ r°5 ``~\;\\111111 I N!/l~~~~ Designer: Keith E. Stoner Z~ \SCONq/ ense Number: Designer 1575-007 Date: 07/15/17 .~Ph4ne Number: 715-653-2324 * t • KEITH E. % aF Signature: STONER Siren, tesig'wd IbliBsuaFiF to t* Mound Component Manual for F(Q ~t9i q+,gAB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pi' fj ICfit~K"~l1~ion Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)(i 1,111'L) Version 7.0 (R. 0312012) RECEIVED Page 1 of 8 JUL 19 2011 INDUSTRY SERVICES 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) 8.00 Site Slope 95.50 Contour Line Elevation (ft) 24.00 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) = 7.50 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 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 3.75 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.17 Estimated Orifice Spacing (ft) = 8.33 ft2/orifice 2.00 Forcemain Diameter (in) 93.00 Forcemain Length (ft) Does the forcemain drain back? Y 85.20 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 15.17 Forcemain Drainback (gal) 10.97 Vertical Lift (ft) 53.68 5x Void Volume (gal) 1.70 Friction Loss (ft) 68.85 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 29.08 System Demand (gpm) 17.22 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 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 L I 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 _ lFilter Model Number Weiser Concrete Manufacturer Project: Leila Albert Replacement Mound System Page 2 of 8 Mound Plan and Cross Section Views -:1/10 B : ' J Observation Pipe : K. d l }•t J .rn d .P J• M1 1 4 1 S S 1 1 d ,t . L 1r .~1~y1: M1~LJ d P~ s tS . 'S,r :~1 t d' .t- P W r.r%s.t;z r r .r• s r . B I L Mound Component Dimensions A A12.00 ft E 19.20 in H [Aft ft K 9.28 ft B ft F 9.50 in ft L 78.55 ft D in G 0.50 ft J W 24.46 ft 450.00 (ft2) Dispersal Cell Area 1134.87 (ft2) Basal Area Available 7.50 (gpd/ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.29 (ft) 96.50 (f#~-► - Dispersal Cell 97.00 (ft) Lateral Invert DispeCell Elevation E D : . 95.50 (ft) Contour Elevation 8.0 % Site Slope `Geotextile Fabric Cover Shading Key 2- Dispersal Cell See lateral details on Q Topsoil Cap o 0. 1.5 ft Page 4 for number, size, C r' r Subsoil Cap y a and spacing of laterals. © ASTM C33 Sand Laterals are equally Tilled Layer 4a) 0,5 ft ~ Typical Lateral F spaced from the distribution cell's Aggregate $ ...s.s.r. ' ° . centerline in the 0---- A distribution cell (AxB). Project: Leila Albert Replacement Mound System Page 3 of 8 ii End Connection Lateral Layout Diagram taercavtsrs asrea the n • ■ Xurn-arlp r~9ri1,~1uv~ efr ot;rwrrauk l~lar P an taesralx ors i>Iat ~~-.X _ H~rtc~c drles4l an tt~r botk.+rr1 +YF th+r lstrral eq~aali3 aP IWO" main co, tin t4a kov 't or"; to mid at 0014t, LaUerals Morc in Sch 40 PVC per SPS Take 384:" Number of Laterals [A,"2 Orifice Diameter 0.156 in Lateral Diameter in Orifice Spacing (X) 2.25 ft Lateral Length (P) ft Orifices per Lateral 27 Lateral Spacing (S) ft Orifice Density 8.33 ft2/orifice Lateral Flow Rate gpm Manifold Length 3.75 ft System Flow Rate gpm Manifold Diameter 1.50 in Total Dynamic Head .ft Forcemain Velocity 2.97 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect y Tank component is properly vented F - Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Ca acit 603.36 Gallons - T Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.89 333.39 B 2.00 33.52 C __P ump off elevation (ft) C 4.11 68.85 86.03 D 10.00 167.60 Total 36.00 603.36 D ♦ Dose tank elevation 3" Bedding un er tank. 85 20 Alarm Manuafacturer SJE. Rho_mbus_ 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 29.08 gpm at 17.22 ft TDH Project: Leila Albert Replacement 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 Zonin Phone 715-386-4680 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 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank =shhouldd or service once eve 3 ears Effluent Filter d clean at least once eve 3 ears Pump and Controls t once eve 3 ears Alarm hould test month) Pressure System ed and ressure tested e1.5 ears Mound andseepage 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 6-8" Diameter Lawn Threaded Cleanou Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Leila Albert Replacement 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 [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 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 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. 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 BOD$, 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page 7 of 8 RGOULDS PUMPS Submersible Effluent Pump EP04 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP~05 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 Inatic models include resistance. CmuKli n 5rendards A%Ddation • 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 solyds wraps is ISO 9001 Nx;im red. • Solids handling capability: FEATURES cover; with integral handle and 9 float switch attachment points. 'A" maximum. ■ EP04 Impeller: Thermoplas • Capacities: up to 60 GPM, tic Semi-open design with ■ P~ Cable: Severe duty • Total heads: up to 31 feet, pump out vanes for mechanical rated oil and water resistant. • Discharge size: 1112" NPT, seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (4090) continuous 140°F (6090) intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel. 9 • Capable of running 30 I _ SGPM dry without damage to a 2 components. s 25 0 7 Motor: • EP04 Single phase: 0.4 HP, Li 6 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with c-~ automatic reset. • EP05 Single phase: 0.5 HP, o EPOS 115 V or 230V, 60 Hz, 1550 a 10 RPM, built in overload with automatic reset. ! EP04 • Power cord: 10 foot 2 5 standard length, 16/3 S1TOW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with o° 10 20 0 40 50 GPM three prong grounding plug (standard on EP05). 0 2 a 6 s 10 12 rr>31h CAPACITY Goulds Pumps ®2001 Goulds Pumps ITT Industries Effective May, 2001 83871 00 a co y Q y b ~ t\ U O N p ~ O O O o, ~ O WqW M Z4 M O N W a U ~ W _m o ~ o ~ oW ~ r, OO ~W 5j o~ U a o M W N U +v ~ fI ~ ~ ~ E~ u • t ° a Zj o0 rv v~~ o ~ v ~ 0 o r WW z% o~ ~ ~ sy c ~ 00 O v .n" y II Ql M GC N O oc H a O U x C Vl ail ~ g o 6 ~ f ~ ~ N II p A ,tl ~ ~ G ,n 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Leila Albert Mailing Address 2035 County Rd. J Property Address 1517 County Rd.E New Richmond Wi. (Verification required from Planning & Zoning Department for new construction.) City/State Baldwin Wi. Parcel Identification Number 18-1011-60-000 LEGAL DESCRIPTION Property Location NW NW '/4 ,Sec. 6 , T 29 _NR 17 W, Town of Hammond Subdivision Plat: , Lot # Certified Survey Map # , Volume 3 , Page # 690 Warranty Deed # (before 2007)Volume , Page # Spec house Ilyesfao Lot lines identifiable 0yes0no 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 (ifnecessary), 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 this form are true to the best of my/our knowledge. 1 we anvarc the oNNiierw of the property described above, by virtue of warranty deed recorded in Register of Deeds Office. NVS1 of 00 3 ~/7/ A7 )RIO PPLICANT(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 ofthe certified survey map if reference is made in the warranty deed. (REV. 04/12) Wisconsin Department QLS, 1 Services " 0 `I~d r, r r Division of Industry SG i9NFtjVVq-(VVE #3225 a s 2a~; $C0 . ":0 Page 1 of 3 in accordance with SPS 385, Wis. Adm. Code Keith Stoner CST Attach com TM than 8%x 11 inches in size. Plan must County St. Croix include, but [Donzontal reference point (BM), direction and percen a or dimensions, north arrow, and location and distance to nearest road. ParcLed l I018 0 1-60-000 Please print all information. RevDate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I 7U/ &is 1 Property Owner Property Location ~cUrY~'k i Leila Albert Govt. Lot W1/4, W /4, S6, T29N, R17W Property Owner's Mailing Address Lot # Block # Subd. Name r CSM# 2035 County Rd J 2 Vol. 3 Pg. 690 City State Zip Code Phone Number City Village ~ Town Nearest Road Baldwin WI 54002 Hammond 1517 County Rd E ] New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Sandy Loam Till Flood plain elevation, if applicable NA ft. General comments Propose a 6.5 x 70' mound cell located along the 95,50' contour with a system elevation= 96.50'. Upslope edge of mound cell and recommendations: staked onsite. 1 Boring # _1 Z Boring Pit Ground surface elev. 94.35 ft. Depth to limiting factor 27 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10YR2/2 - sil 2msbk mvfr cs 3f-m 0.6 0.8 2 12-18 10YR3/3 - sil 2msbk mvfr gs 3f-m 0.6 0.8 3 18-27 10YR4/4 - sil 2msbk mvfr gs 2f-m 0.6 0.8 4 27-34 10YR4/4 c2d5YR5/8 sit 2msbk mvfr gs If 0.6 0.8 5 34-45 5YR4/4 c2d5YR5/8 sl 2msbk mvfr gs - 0.6 1.0 6 45-60 5YR4/4 m2d5YR5/8 sl m mfr - - 0.2 0.6 7.5YR6/2 Boring # Boring III Pit Ground surface elev. 94.15 ft. Depth to limiting factor 24 in. Soil Application Rate Fil - - Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10YR2/2 - sil 2msbk mvfr cs 3f 0.6 0.8 2 12-24 10YR4/4 - cl 2msbk mfr gs 2f 0.4 0.6 3 24-28 10YR4/4 c2d5YR5/8 cl 2msbk mfr gs if 0.4 0.6 4 28-42 5YR4/4 c2d5YR5/8 sl lmsbk mvfr gs - 0.4 0,7 5 42-62 5YR4/4 c2d5YR5/8 sl m mfr - - 0.2 0.6 ' Effluent #1 = SODS> 30 < 220 mg/L and TSS >30 < 150 rn Effluent #2 = BODE <_30 mg/L and TSS s.30 mg/L CST Name (Please Print) Signature: CST Number Keith Stoner 224059 Address Keith Stoner CST ` Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 6/20/2017 715-566-0900 SHU-8330 (8.07/13) E03 o co tai 3 ~ " C 3 o m b o ~ o O ~ O 'U O Uj _d 7 OQ G' 7 rn N p II II 11 'D "D "D ~ D N " w ~ k y CD o v v, C7 p y 11 ( b e o S ti ti. ul~ O p \o o o f ti N \ o vO o o' W - b w ~ w 0 ! A. ~ `0 0 0 o W o x n o ~ b W N `0 N w O w U ~O