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HomeMy WebLinkAbout024-1027-60-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 597465 Personal information you provide may be used for secondary purposes [Privacy Law, S.15.04 (1)(m)]. Permit Holder's Name: Cit Villa e Townshi Boman Farms y g p Parcel Tax No TOWN OF PLEASANT VALLEY 024-1027-60-100 CST BM Elev: Insp BM Elev: BM Description: Section/Town/Range/Map No: 20.28.17.165C TANK INFORMATION ELEVATION DATA" TYPE MANUFACTURER - fy- = CAPACITY STATION BS HI FS ELEV. Septic 4 Benchmark Dosing O x-• a p Alt. BM Aeration 9c? • Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. 'Writ,to Air Intake ROAD Dt Inlet Septic Dt Bottom ° -;7 5 /3,V-$ i "W" /Jay-, ~ ? 30 Header/Man. P Z -7A ?9, Ziff Aerat n Dist. Pipe Holding 2 ' 7 Z$ - Bot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer r ~d~ • g Model Number S,3 ys. Demand St Cover GPM J,~• Z•Y5 / >I• s r4l a tij TDH Lift A4,.no System Head TDH Forcemain LgDist. to Well We SOIL ABSORPTION S STEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR i6 y,;'p ~ UNIT Model Number: '39 43 Q'7 V DISTRIBUTION SYSTEM of Header/Manifold if Distribution x Hole Size i x Hole Spacing Ven it Inta Leng(h) c3 J 3 / Z. Length-_&D: Dia Length i Dia Spacing c3 5 u SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only e► Depth Over Depth Over xx Depth of Bed/Trench Center Bed/Trench Edges Topsoil /'►A Seeded/Sodded xx Mulched No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ --7 yi~I Inspection. Location: 291 162ND ST 1.) Alt BM Description = l J / ~ u ~ 2.) Bldg sewer length = J a Se r i SA ..~.a...,. - amount of cover = Plan revision Required? Yes XNo 00 Use other side for additional information. 19 1-7 )-71 L4 SBD-6710 (R.3/97) Date Insepc#ture Cert. No. } -%I s; t,*k,tl County Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 G Applic , "XX State Transaction Number In accordance with SPS J4 S.de, submision of this foY404"' overnmental unit 2959567 is required prior to obt~nitary permit. Note: Application fo r- 0 POWTS are submitted to project Address (if different than mailing address) the Department of Safety and Professional Services. Personal inform, IV ,ovide may be used for seconda purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 291 162nd St. 1. Application Infor n - Please Print All Information Property Owner's Name Parcel # Bomaz Farms, Inc. 024-1027-60-100 Property Owner's Mailing Address Property Location C _ i I, I 426 165th Ave. Govt. Lot City, State Zip Code Phone Number _NE '/a, NW_'1A Section (circle one) Hammond, WI 54015 (262) 339-3261 T 28-N, R 16 E or W II. Type of Building (check all that apply) ot# ❑ I or 2 Family Dwelling -Number of Bedrooms 5 Subdivision Name Block # 1 CSM ❑ Public/Commercial - Describe Use Na ❑ City of 11 State Owned - Describe Use CSM Number [I Village of I X QQ~ CSM Vol. 14, Pg. 3859 ❑ Town of Pleasant Valley Ill. Type of Permit: (Check onl one box on line A. Complete line B if applicable) N.. Cam-, A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System Iv B List Previous Permit Number and Date Issued El Permit Renewal 11 Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 d ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of su able soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatm t Area Information: Pol Lok PI-525 effluent filter to be installed at ST outlet Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s0 evation 1.0 Gpd/sq. ft. ASTM-C33 sand 98.67' t 8" above 750 Gpd 0.5 G d/s . ft. native soil /11 1,500.00 s q. ft. 1,648.94 S q. Ft. 0' contour V1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks Septic or lfolding Tank 1,500 Na 1,500 1 ieser oncrete FDL X Triple Dosing Chamber 1,000 Na 1,000 1 Combination ST/PC X VI L Responsibility Statement- 1, a 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 James K. Thompson '?1lDfrsG ~f MPRS 30021 (715) 248-7767 Plumber's Address (Street, City, State, " ode) (j 340 P ulson Lake Lane, Osceola, WI 54020 7Apr Count / e artment Use Only 4 Permit Fee Date ssue 7 Issuin gent Signature roved $ G 3~ i en Reason for Denial IX. Condi IDisaPProl yal 3 6,1A q'lD ,',L S Y'v 11 `ulsperf>;~ crtt Mast ~ '~1, ~ s' ar a ayerr n+ Pl4n p!, rlded by pluinlkir. erg' 22. Attach to complete plans for the system and so it e unty only on aper not les than 8 t x 11 inches in s .6 7 C"AA SE3D-6398 (R. ]1/11) tot 30 EX~3 G~~ ~~ia. cr~~ G-l2 v< ~I .9` Sca/e,•/= ~9700 1 1 PC'c ~t 14 .W 6nQ ~i s ors l l t , ; r1cLt!>JcvjySec..'.'o, ~,,~~t> t ' I t ' 1 t 4 t t t t t t I 1 Proprscdu~;rs~ Concre& Lo15-OC .P, ~rl~/1 5.%•/~~. /~o/y%~KP1-S25<rF/u-rt- ~I ! 61 L C=D /~r r S~'~G7`i ~ ~ ~uy~ ~ ~ "sv!. Ord ~r''3T.r1- l~ /7~'~. C, ~ F c.cn= ~ ~ w ::...f~ j ~~I~v Pr.Pes~ o , ~ro(JaSea eJ:e~C.- ~e~-z'E c.s;la~o-rs.. i I nsp4rvdr~ Lei iS p ~Y Wt~~. ~O • F' o~c~vt.'_a 4 : r:x.l~ ~ C. . 75 I !i'n d ~a ✓c / drrvr w-aY f ~u~~ lL~ , ffsS~-MeQ' ~ r. = ~ cb , I, ~ ~n~Ki n~ h i ~s- U ~a pouSc, i' L , r~u-trl~,~•;is: /si.yl ~L/ Uo',~'-:~7n ~ i i.0y I i c~~Y~R7sg,~. DIVISION OF INDUSTRY SERVICES T°n 3824 CREEKSIDE LN HOLMEN WI 54636-9466 3 I S K Contact Through Relay ~2~~ P 5, v http://dsps.wi.gov/programs/industry-services C~w www.wisconsin.gov e ~O sSIONN s~ Scott Walker, Governor Laura Gutierrez, Secretary June 27, 2017 CUST ID No. 30021 ATTN: POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSEN LAKE LN 1101 CARMICHAEL RD OSCEOLA WI 54020-5413 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/27/2019 SITE: Identification Numbers Bomaz Farms Transaction ID No. 2959567 291 162ND St Site ID No. 839019 Town of Pleasant Valley, 54015 Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NE1/4, NW1/4, S24, T28N, R16W FOR: Description: Five Bedroom EZFlow Mound System \ Sloping site Object Type: POWTS Component Manual Regulated Object ID No.: 1711108 Maintenance required; Replacement system; 750 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System(s): EZflow Mound Component Manual, (R. 7/12), 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. CONDI APP No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, r°° R?r OF stats. PROFESS101 The following conditions shall be met during construction or installation and prior to occupancy or use: ='piM OF 1t~C Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. 14 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with CQ; the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • The existing POWTS shall be abandoned per SPS 383.33, Wis. Adm. Code. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. JAMES K THOMPSON Page 2 6/27/2017 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. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 A Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm JAMES K THOMPSON Page 2 6/27/2017 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. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 S 250.00 Fee Received S 250.00 e~ Balance Due S 0.00 Gerard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swirn@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Residential Mound POWTS Index & Title Sheet Project Name: Bomaz Farms 5 Bedroom Mound Owners Name: Bomaz Farms, Inc. Owner's address: 426 165th Ave., Hammond, WI 54015 Site address: 291 162nd St., Hammond, WI 54015 Project Location: Subdivision: Lot 1, CSM Vol. 14, Pg. 3859 Legal Description: NE% NW%, Sec. 20, T.28N., R. 16W., Town of Pleasant Valley, St. Croix Co., W1. ' Parcel ID 024-1027-60-100 Page 1 Index and Title Sheet Page 2 State Approved Mound Design Page 3 Grease Tank Cross Section Page 4 Septic/Pump Tank Cross Section Page 5 Filter Specifications Page 6 Septic Tank Maintenance Agreement Page 7 Certified Survey Map Page 8 Warranty Deed Mater Plurnber Restricted Service: James K. Thompson, DSPS Credential 430021 Signature Date: 61 Pagel of 8 Design pursuant to In-Ground Soil Absorption Component Manual for POW] S, version 2.0 SBD-10705-P (N.01/01) RECEIVEEFn Ezflow "J MOUND AND PRESSURE DISTRIBUTIO COMPONENT DE GN Residential Application JUN 8 2017 INDEX AND TITLE PAGE INDUSTRY SERVICES Project Name Bomaz Farms 5 bedroom replacement mound Owners Name Bomaz Inc. OwrFrs Address: 426 165th Ave. Hammond, WI 54015 Property Address: 291 162nd St , Hammond, WI 54015 Legal Descrip ion NE1/4 NW1/4, Sec. 24, T ,28N , R ,16W. Townsnip Pleasant Valley County St. Croix Subdivision Name. CSM Vol. 14, Pg. 3859 Lot Number. 1 - Block Number. Na Tt®NRLLY Parcel I.D. Number: 024-1027-60-100 ~'4FE]y► AN Plan Transaction No . ~ L ERV/ES RYS Page 1 Index and title ~RVlO Page 2 Data entry Page 3 EZf/ow mound drawings Page 4 Lateral and dose tank ~NC~ E'"-~•. Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Site Plan Page 10 Attached Soil Evaluation Report Designer: K. Thompson License Number: 30021 Date: 05/11/1 Phone Number (115) 248-7767 Signatt.re - Designed Pursuant to the EZflow Mound Cornponent Manual Ver. August 20, 2007, SSWMP -Iublication 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 10x'12) E'fIoty Mound Version 3.0 (R. 3/1/12) Page 1 of 10 Mound and Pressure Distribution Component Design Design Worksheet Site In_tormation r cr c) _ R Residential or Commercial Design 500.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 750 00 Design Flow (gpd) 2.00 Site Slope 98.00 Installation Contour Line Elevation (ft) 125.OOlContour Length Available (ft00 Depth to Limiting Factor (in) ~v 0.50 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 9.00 Cell Width (ft) 14, 5, 67. 8 9 or 10.Only 100.00 = Dispersal Cell Length (ft) 0.85 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 ~r e) r e Center or End Manifold - 3 Lateral Spacing (ft) If N above, enter the elevation (ft) _ 3 Number of Laterals of the highest point. 0_.125 Orifice Diameter (in) (e.g. 0.25) 2.30 Estimated Orifice Spacing (ft) = 6.98 ft2/orifice 2.00 Forcemain Diameter (in) 40.00 orcemain Length (ft) Does the forcemain drain back? L Y 8 .00 Inside Pump Tank Elevation (ft) Enter Y or N _0.00 Forcemain Filter Loss (ft) 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 12.17 Vertical Lift (ft) 135.84 5x Void Volume (gal) 2 23 Friction Loss (ft) 142.37 Minimum Dose Volurne i,gal; 20.90 Total Dynamic Head (ft) 53 14 System Demand ;gpm ateral Diameter Selection Manifold Diameter Selection in. dia. options choice in dia. options choice 0 75 1.25 1 0 0 - 1.50 x - { 1.25 2.00 x x_ 1.50 x x3.00 J 2.00 x 3.00 x _ Gallons/Inch Calculator (optionah Treatment Tank Information 1035.62 Total Tank Capacity (gal) 1585 OO~Septic Tank Capacity (gal) 5 Total Working Liquid Depth Wieser Concrete Manufacturer 19.54 /in (enter result in cell B49) _ J Dose Tank Information Effluent Filter Information 1035 62 Dose Tank Capacity (gal) PolLok Filter Manufacturer L19 541 Dose Tank Volume (gal/in) IPL625 Filter Model Number Wieser Concrete Manufacturer Protect Boman Farms 5 bedroom replacement mound Page 2 of 1 0 ,si-oh ~d i0U0001-009ut :ally 958-5Z~-008 0 \ NfnOd-lsod 31V0 00 00 00 --31VO 094-V9 PA 'HOOH N301VW Ot ,AH sn 9tL~M TVMVW OIldIS Z n3a ~ ° ~af10d-3ad „0-,l=„tl -3lVOS dOM :,lB NMVaO 313UUU0D I ~ lla1 l ml-oool/OOSlt. z •ll HQ -j J w m C n_ ~ CY Q O j m a o w In - Z Z F F l1 } f" w F-- U Ow w 'a w F- In Q o - m LL ¢ ~m ¢ w L~ U O o zzz m a mw z Z t1' \ Z a w ~2 L, w zz \J J Q U O H C o aQa 07 F oQ c) 3 LL Q -V) N Q i p O m J UUU j Luz fl. m U Cl c lb J Lul h ~t e (N (n O co z tY 2 a c) W = o o u,n Q rn Ln o Q v a zv~ rn~ Q L - O ° p V, m O oo Oi 00 _j C) 0 N6piot W1~ WQ Jw } V)wU Uz z0 z if') Lo Z W 0.7 fl 1- =J F- z Z) N F W V1 Q N Z) V) D w Ow LO Cl. Q zJF->O?ZC)L ~U Z0 Q Zw~ ~m Nm LC) 2 QOO G, w w U <U)o O r- NsmU~=J~m= a`r aw Z O 0 ci~ w 0 {I LJ V J N 5 Q > z o C1 U :D Q z z O z J J < U F- U Q w I Q I Q U w III ~t z _j „9s > o . It ~ fir- ~ ~ ~ III 1 II I I I :Da_ ~ r Li I I. I II II E N II iI. ~ I . I I i U ~ cn n II 1 I~ I I - ~ > o o w tl I W cw „9 „8l o _11 x Lj -j N - - o - -BAIT ninon 0 c o Q .I i O l o I' m w x = w I III- I- „s IE f I I `n d ~ ~ I I. I I ` r~ I f I I o [if w Z w ~ Q J ~ Z w 0b3a ~ „L8 sv z z F- i Mound Plan View Y 1/10 B J D . . Observation Pipe FK T :7- 5 A B i I a I L Mound Component Dimensions ft A 9.00 ft E 10.16 in H 1.00 ft K [Aft B 100.00 ft F 12.00 in ! 7.49 ft L ft D IA in G 0.50 ft J 6.13 ft W F---9-00-0-0] (ft`) Dispersal Cell Area 1648.94 (ft2) Basal Area Available 7 50 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 100.67 (ft) H F t Dispersal Cell 9917 (ft) Lateral 98.67 (ft)-► - 6 Invert Elevation Dispersal Cell 33 levation D 98.00 (ft) Contour Elevation 2.0 % Site Slope Typical Dispersal Cell Shading Key U See Page 5 1 = Topsoil Cap > .a ? i Subsoil Cap ° 1 2.0 ft Approved Geotextile Fabric Cover 37 ASTM C33 Sand 0 Tilled Layer 6 5 F s ~ 5 ] EZflow Media V) 0 0.5 ft H -iF- - A See details on page 4 for number, size, and spacing of laterals. Late; als are located in the 4" gravity distribution pipes as shown on page Project: Bomaz Farms 5 bedroom replacement mound Page 3 of 10 End Connection Lateral Layout Diagram r 7vrr7 uF>r'Lvi sr-,. t n. tpi r:i) X X Hti 11Ir 23t- l , ra,rr -inh Igj.0~ sp,% el - Yr I ~,t r t'n.:~ir (z'np"TjCar ha trrt rrx ,r'trzs to raarrfralO w awry p wil i wsai. E`t i r r M-4x x t' fr. rA. 4') y~r i s T.tla :vi r~ r x r p cxa: SIR ,tt, :arse {_c~rrty r~;.zy;7 tot or 'w ;~_le i Nu!m)r l of Laterals 3 Orifice Diameter 125 in Latera. Diameter _ 1.50 in Orifice Spacing (X) _ 2 35 ft Lateral Length (P) 99.35 ft Orifices per Lateral _ 43 Latera !End (Z1 0.65 ft Orifice Density -6 93 ft-/orifice Latera spacing (S) 3100 ft Manifold Length 6 00 ft Later3 >=low R,3te 17.71 gpr71 Manifold Diameter _2 00 In Sys'r I I glow Rate 53.14 gpm Forcemain Velocity 5 43 ft/sec Dose Tank Information Lock no, cove! with label a! 0 locking device and sealed N,31eitight le-t ca as pt r NEC '-,00 and SP ; 316 300 WAC Disconnect _ ianK cc i xit i propany venaed Alternate o.,tlet -Lt o'.auon I n i FD (.emain J:time!er ~VVies -morn: rete Manufacturer 2 in f Capac Ity1 1035,62 Gallons - V ~olt.une 19 54 gal/inch A V~'Eel hole or arti- Imenslon Inches Gallons B sipnc'i device A_ 31.71 619.69- i 2.00 39.08 Pan g o'l elevatiof, t I L 729 7 142.37 _9 D 12.00! 23448 D - Tctt -l-l 53 00F 10 ---35.62 Bedding And Backfill As Per Manutacture~ PEJM~ Val LfL,cturei SJ Rhombus _ FJarni vo"e~ NumberSJE 1011421 Pulnll ~;ar r ~Gct~_trel Zoeller Pump IV1ocel Number;BN140 Pump Must Deliver 53.14 gpm at 20.90 ft TDH Note riJlt' fees Con mrlg I71C;rCUry may t-,ot be jse(i in this ;y ;[eiil r,iBomm,l _amis 5 bedroom replacement mound PE g,- 4 Y I(, EZhow Distribution Cell Media Layout =JJ :]Celi Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Lft Wide] `r Component Legeria SR1-7A Burdle - 5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or SR3-12H in 5 ft or 10 ft length= 4'' Perforated Distribution Pipe With Pressure Lateral Inside TurnuF, Enclosure - - - - Pressure Lateral Bund es are covered with approved geotextile fabric as per the their procuct appro"ai Distribution Cell Plan View Layout - Typical 9 T lCell Width - A (ft) 100.00 Cell Length - B (ft) Center Connection Lateral Layo, ` Force Main - 9 ft Wide _J End Manifold - J IIrcjf-ct BomGz I-arms bedroom replacement mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Jmaes K. Thompson = Phone (715) 248-7767 POWTS Regulator's Name (St. Croix County Zoning Dep't Phone! (715) 386-4680 System Flow and Load Parameters Design Flow - Peak 750 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 500 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1500 gal Maximum TSS 150 mg/L Soil Absorption Component Size 900 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 rr L Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean as necessary at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested every 3 years Mound Inspect for ponding and seepage once every 3 years 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 EZflow Mound Component Manual Ver. August 20, 2007. 2 Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 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. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade . . . 6-8" Diameter Lawn/ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve _ateral Ends at Last Orifice Where Variable Length Cleanout Begins rxa Long Sweep 90 or Two 77 45 Degree Bends Same ;EZflow Synthetic Media Diameter as Lateral <r 1.80 Feet Distribution Lateral Lateral Cleanout No Project: Bomaz Farms 5 bedroom replacement mound Page 6 of 10 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' ce nporent manuals [EZfiow Mound Component Manual 8/20/07, Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 0101) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting 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 deerned unsound defective or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an of ectve ocking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank Tne septic tank shali 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 cutlet filter shal 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 eguwppec wirn an a arm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge Bows or an imoerding 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 task. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the cwne as to 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, it such pro-eucts are used they shall be approved for septic tank use by the Wisconsin Department of Commerce. Pump Tank The dosing (pump) 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 . If the force main has a weep hole it should be rioted if it is functional during pump operation, and if not, it should be cleaned. one should ever enter a septic or dose tank since dangerous gases may be present that could cause death. 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 BOD5 150 mg/L TSS, and 30 mg,L FOG for septic tank effluent _)r 3C 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 3 years. When a pressure test is pertormed it should be compared to the init,,ai test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equa. distribution within the dispersal cell. Observation pipes wiViin the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner and an; levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan It the s eptic tank or 3 it of its components become defective the tank or component shall be repaired o~ replaced to keap the system in ;,rope, operating conc ton. If the dosing tank, pump, pump controls. alarm or related wiring becomes defective the defective component(s) shall be imrnedately rer airee 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 n 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 co rdition See Page 6 of this plan for the came and telephone number of your local POWTS regulator and service provider Pro]ec-.: Bomaz Farms 5 bedroom replacement mound Page 7 of 13 ,:h ~xw vKi"P 't 8 N~rs-l {l6 irw'4~^ .6S'Ql'lyt c 3 d w s Z F r a 'f e,k 1H +u Ev l~`~t! (4%!h 7•.~~`{`~.~e f~i t;4 a V[a ki d m.5 rb .O. k1 t f'. \ •S fit` s ELM VIM am paci D" MIC eai a rr • r r on-Site G CAUTION 3,4 ' i )c b~ s :12t: t- I. 3- 88 '5 82. 16 t\ F WNUIE a 3 3 8 9 '70_-aT 242 71 278 r- 6L :27 ! 6~ 2}, 22 Y. 95 .6 6c ?57 299 59 223 6C _2J a8< 3 e_ 21 4 L2 ~ t 2 16 - _ °j >}5 5~ 206 58 220 35 S:. 2'D E a3_ "L 4 4 7C ac 2 _5S 2J6 '0 697 7 Zc 26 3125 50 1 89 _ S7 S9 ~2 23 _8 -y--9~ }a Sd - n - Copyright 1998 Zoeller Co All rights reserved_ y 30~~~ • ® So~i~uG<;G<aEr'o,, ~i6. u(~ I SCa /e = s co, a- t p,~9,{'(,[-'~l%~ X78 Sol' , t 5'7, so' m\I P~PI L~2 Jarna Fu- .nS 1 ~ ~t ~ ffa~nrrOna; GJ/, Ss' 0/S~ i t ~ ~ ,1 C~Z tt „:43.! 5y5 t .~Ur 1 ~ 1 i1 t t I l 1 \ ' 1 1 \ 1 f~ivpos of .a;~scf COgCrZ C q/stxirc D -F U 61 szs</..-, be ios 6,14-W- E-,.tle or'1^'cr 4, ~~r i~ Sc~. std ./STS! v /795- rl. c'., i r/ i O. W- o r , y: 4t~ld' fir.po S~ wo(~aSeduJ,'FSr.- wnc.-t~k c,"1OO~'rt , ".s,k. 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O CcV c0 J Q Q Q Q co J~ =O N W Y - t - U - L) O D} r7 W I ^ 0_ U Q 0 to 0 Z § L LJ ~-D - F x 0 L/) N N Q CO 0 Q U J } O Q V) Z r)1-- -JH OQ W O U ZF-J (n W (n °W r Vl 11! 7i U Cr ~ =rip Y Q QWQ W MQ ° D z_ _j ~ W 'S_ C^. 0 °`')(In ° Q W X_x ~U ow~ N Y t U >O'Z'i w s Q d< Z U p~ U U Q C~ } ;71 ¢ 021 ~sMj Q ° ZOQ Z U OO r t~ "y J J J D _j Q Y WLi~W Y N Z Z O_ O p Z > Z J S J r O0F p i _J I J < Li L) J - U ~ L A j V) W ? O I < ,5 .9~ LLI it v) O C ~ i GoAd I F, u~ 1. 6 L I 1 J I : 5 Technical Specifications PL-525 EFFLUENT FILTER (G'a 6 1Z BALE GaECR - EXCEPTS SHD40 FOR INLET EX*ENTICN 1.57 141135 y q DLT-ET BUSHING EXCEPTS 4"SCH 9&6'SCH 10 11 ~ p ~ I I 1 I li 14 LPL SiJ _1_1_1 JI ~r II - 70.68 A 3~ 5.43 1~ II I ~ TI 1 L ff+' 33,02 PL-525 FILTER HOUSINGl 9 j - - ; 1830. i 11 PAF2TNO--3.3142525 MATERIAL HOUSING - POLYPROPYLENE [ OUTLETBUSHING - PVC ~~II 6.5 BA-L - HDPE 1- --1 SOCKET EXCEPTS E-OAT SWTCki pc=t ~'3 10.23 - E XCEPTS 1'sCH40 sl 0 - 98 FOR H AtiDLE EXTENPCI, IC.6d ~T. I( ~l ii 624 -_-6.17 SOCKETEXCEPTS _ 604 9~ " 'ALL PUSH ROD OPENING ✓ e 4 I ~ 1 I-, u 7.09 =c I I I ~ I OPEING ,'r0 y,: x--;FI1 12^.171 -AI E 119102122dJ~ 1 1 ~ L. POLYLOK PL 525FI L1ER 1 CARTRIDGE I I PART NO, • 30141.525 i MATERIAL - POLYPROPYLENE O o -a, o t~ s° ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Bomaz Inc. Mailing Address 426 165th St., Hammond, WI, 54015 Property Address 291 162nd St., Hammond, WI, 54015 (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 024-1 027-60-1 00 LEGAL DESCRIPTION Property Location NE '4 , NE '/4 , Sec. 20 , T 28 N R 17 W, Town of Pleasant Valley Subdivision Plat. Na Lot # 1 Certified Survey Map # , Volume 14 Page # 3859 Warranty Deed # (before 2007)Volume Page # Spec house ❑yes[Zlno 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 (I ) 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. l/we am/are the owner(s) of the property described above, by virtue of a warranty deed record d in Register of Deeds Office. Number of bedrooms 5 SIGNATUR 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) ~J 0.( J w Ryan Yarrington From: Swim, Jerry M - DSPS <Jerry.Swim@Wisconsin.gov> Sent: Thursday, August 31, 2017 1:26 PM To: Ryan Yarrington Subject: RE: 3 pumping cycle i Hi Ryan - I believe the tank can still stay on a 3-yr. maintenance cycle since there are (2) tanks in series. There is a 1250 gallon grease interceptor (rated at 603 gpd), in front of the 1500/1000 gallon combination tank rated for 735 gpd. Why is a GI proposed? I don't know. In any case, this tank can be applied toward the necessary septic tank capacity which results in a 1330 gpd capacity and is well above what a 5-bedroom house requires for a 3-yr management cycle; there is an approved Weiser 1500/1000 tank w/19.54 gi shown on the Register so that is ok. Please give me a call if you still have questions. Thanks- Jerry Swim POWTS Plan Reviewer Department of Safety & Professional Services I Division of Industry Services 3824 Creekside Ln.1 Holmen, WI. 54636 Tel: 608-789-7892 Fax: 608-785-9330 1 email: aerry.swim(~%wi.w ~ ;,)a our curve} https: //www. surveymonkey. com/s/d`spsiscustomersatis factionpowt,5 ith the DSR' The Department offers an email subscription service that provides electronic notification of news and/or notices that may be of interest to you. To sign up for this service, click here. From: Ryan Yarrington [ma i Ito: Rya n.Ya rri ngton @co.sa i nt-croix.wi. us] Sent: Thursday, August 31, 2017 10:08 AM To: Swim, Jerry M - DSPS Subject: 3 pumping cycle Hey Jerry, I was getting ready to issue this but I just have a quick question. Since this is a 5 bedroom can I still keep this on a 3 year pumping cycle. It looks like Jim put the wrong gallons per inch into the crew file showing the septic tank volume is 1585 gals when I get 1534.35 which is below the 1566 1 think it needs? Take a look and let me know. Thanks! i Wisconsin Professional Services Page 1 of 3 Division of, ~1 rt~1 C~ N REPORT JUIv 4J t; i I ! In actor County Attach complEWs0QFIb K0 St. Croix ~NTi~6t less than 8 1/2 x 11 inches in size. Plan must include, but not liDW%VJ i a PWNTrence point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 024-1027- -100 Ref #2475 Please print all information. Review y Ddat Personal information you provide may be used for seconds purposes Privac Law, s. 15.04 1 m . V 3~ ~7 Property Owner Property Location ❑ Bomaz, Inc. Govt. Lot NE % NW % S 20 T 28 N R/7 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 426165 1h St (property 291 162nd St.. 01 Na CSM Vol. 14, P g. 3859 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hammond WI 54015 (262) 339-3261 Pleasant Valle 301h Ave. ❑ New Construction Use: ❑ Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD 7,6 ® Replacement ❑ Public or commercial - Describe: ~J►IQ~ ~y Parent material Glacial Till Flood Plan elevation if applicable na ft. -O~ dl1 General comments and recommendations: Site suitable for mound POWTS. Recommended infiltrative surface elev. to be 98.67' at 8" above 98.00' contour. F Boring # ❑ Boring ® Pit Ground surface elev. 97.25 ft. Depth to limiting factor 33" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structu;re Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. *Eff#1 *Eff#2 1 0-14 10yr3/2 none sil 2fgr mvfr cw 2fmc 0.6 0.8 2 14-25 7.5y4/4 none sicl 2fsbk mvfr cw 2fmc 0.4 0.6 3 25-33 7.5y4/6 none fsl 1 msbk mfr cw 1 fm 0.2 0.6 4 33-61 7.5y4/6 c2d 5yr 5/8 fsl 1msbk mfr 1f 0.2 0.6 2] Boring # ❑ Boring Pit Ground surface elev. 97.98 ft. Depth to limiting factor 28" in. JJJ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/2 none sil 2fgr mvfr cw 2fmc 0.6 0.8 1 2 12-21 7.5yr4/4 none sicl 2fsbk mvfr cw 2fmc 0.4 0.6 -i 3 21-28 7.5y4/6 none fsI 1 msbk mfr cw 2f1 m 0.2 0.6 1 4 28-45 7.5y4/6 c2d 7.5yr5/8 fsl 1 m&csbk mfr 1 f 0.2 0.6 * Effluent #1 = BOD, > 30< 220 m /L nd TSS > 30< 150 m /L * Effluent #2 = BOD, > 30:5 220 m /L and TSS > 30:5 150 m /L CST Name (Please Print) Signatu CST Number James K. Thompson 30021 Address ate Evaluation Conduc d Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 April 6, 2017 (715) 248-7767 SBD-8330 (R04/15) 3 Boring # ❑ Boring J ® Pit Ground surface elev. 97.19 ft. Depth to limiting factor 31" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10yr3/2 none sil 2fgr mvfr cw 2fmc 0.6 0.8 2 13-19 7.5y44 none sicl 1 msbk mvfr cw 2fm1 c 0.2 0.3 3 19-31 7.5y4/6 none fsl 1 msbk mfr gw f21 m 0.2 0.6 4 31-48 7.5y4/6 f3d 7.5yr5/8 sicl 1csbk mfr cw 02 0.6 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ❑ Boring u ❑ Pit Ground surface elev. ft. Depth to limiting factor in. _ _ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. r *Eff#1 *Eff#2 I * Effluent #1 = BOD, > 30:5 220 mg/L and TSS > 30 150 mg/L * Effluent #2 = BOD, > 30 s 220 mg/L and TSS > 30<_ 150 mg/L r♦ EXiS~i3,S ~i~~✓c cl~v~ P= F-77:E7 cR pv~ ~e~. 97.00 ~ c9"U~8 So' 97sa m 63 .PC~c 1 4//G1 ^~.st 1 ~ ~ i ~o t ESN( do~ 385: l 1 U ~J ~IrG~rlw Se c.1 o/ r!~x 4~ 1711). Tn. o/ /xaSa.~ t S~.Cw"A Co. cJ/ a D.ZS~ /0-Z ~0 -/60 1 ,~>>~Iv a 11 ■ lb 2- 1 ` r , 56ree~ Or V r- I ~~;5{~~ S~E,•~6a.X e-It;sti4y dey will. ~ ~ Ret, ~/anq~ ~ I IJ¢+~c~ {1UKl~ '.aim CT/* 5. . a n.E. cam, na. ~i,lve- drrvt U.My 54 e rLcwc3t. /fsS~•r~cd ~Itv. =/c~.cY' IDaiK~ it~ h I 5'5t;rrrai-e 6,< ~cwt.- Y/ erccf = 9/.7~' Ss 6 7Z, lJe-/~ x'115, je u5a, 1 A"/0 G~i wrrt bu t r: r be = Blo.~.'Gid. °917 J