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HomeMy WebLinkAbout036-1058-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597462 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2986084 Permit Holder's Name: City Village Township Parcel Tax No: GARY & PENNY BETHKE TOWN OF STANTON 036-1058-10-000 CST BM Elev: 1 Mb Insp. BM Elev: BM Description: Sectionfrown/Range/Map No: EIN` ir , G 25.31.17.373A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 13S HI FS ELEV. 44 6 Septic Benchmark Dosing 1111111640 &60 Alt. B /'SO PQ (a Bldg. Sewer 11-39 ell Z Holding ` St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ly WELL BLDG. ent to it Intake ROAD Dt Inlet ` Septic 50 / ~-3 Zq _ Dt Bottom Lie- c, C3c . 7 ~ U Dosing / I Header/Man. 11 Z4 346 -7 '*7 3 z Aeration Dist. Pipe 3.7 14 ,6, Holding Bot. System Final Grade PUMP/SIPHON INFORMATION .7/e Manufacturer Demand St Cher ~J 3L e~~. Qv GPM Model Number , 3rZ. 3~ y : r TDH Lift Friction Loss System Head TDH -7. -z. 71S 1 Forcemain Length ~ Dia. 0 T ist. to Well f.1 SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length ` No. ren a PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION : CHAMBER OR Type Oem UNIT Model Number:_ 6j L I 17- /w - DISTRIBUTION SYSTEM Header/Manifold *4 1 Distribution x Hole Size Hole Spacing Ve Air Intake Pipe(s) / Length h 4 Length -79 Dia I. Spacing ? jp, SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedffrench Center Bed/Trench Edges Topsoil es No YesI No 'I COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: y` i/ Location: 1995 200TH AVE. 1.) Alt BM Description 2.) Bldg sewer length - amount of cover ~.i a ~ G G ti,(.k, 'S 6j-;z 4- t 6e- --Jo G` C e-j(~ ` Plan revision Required? I`,I Yes )eN0 Use other side for additional information. 1 I _ _ SBD-6710 (R.3/97) Date Insepcr sSig ture Cert. No. IL RFr.Fl ED tai€, tr='i - County AUG 2~ Safety and Buildings Division St. r 201 W. Washington Ave., P. 0. Bax 7162 ary Permit Number (to be filled in by Co.) Madison, WI 537 71 4 ST. CROIX COUNTY ,OMMUNfTY LEVEL PMEPIT fps>E„:~x~ . i l zl( Sanitary Permit Applicat 500,A-vr:a State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to t t e governmental unit ~~V a 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 Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. Same ~fj(~ 1. Application Infortm ~t'PIease Print All Information 6 x+6 Property Owner's Name Parcel # Gary & Penny Bethke 036-1058-10-000 Property Owner's Mailing Address Property Location h Govt. Lot 1995 City. . State 200 Ave. Zip Code Phone Number _NE v4, NE v4, Section 25 . - = (circle one) New Richmond, WI 54017 (715) 222-4341 F-31-N1 R 17 E or W II. Type of Building (check all that apply) Lot # ❑ I or 2 Family Dwelling -Number of Bedroo 3 Na Subdivision Name P I GiCQ~ ~~L ❑ Public/Commercial -Describe Use Block # 6 Na Na ❑ City of ❑ State Owned - Describe Use / CSM Number ❑ Village of fi- Na ❑ Mown of Stanton x 7:5 O ✓d~ V-Q III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ❑ New System ,<eplacement System ❑ TreatmenUHolding Tank Replacement Only ❑ Other Modification to Existing Syst (xplai ) Fo% Permit Transfer to New List Previous Permit Number and Date Issued B. ❑ Permit Renewal 11 Permit Revision ❑ Change of Plumber Before Expiration n er IV. T e of POWTS System/Component/Device: Check all that apply) J , ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. Of suitable soil 11 Mound < 24 in. of suitable soil 11 Holding Tank 11 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) ra- V. Dispersal/Treat nt Area Information: PolyLok PL-525 effluent filter Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Required (sf) Dispersal Area Proposed (st) levation 1.0 gpd/sq.ft. ASTMC-33sand 99.67' 11" above 450.00 Gpd 0.6 gpd/sq.ft. native soil 750.00 sq. ft. 1,0235 Sq. Ft. contour VL Tank Info Capacity in fetal # of Manufacturer Gallons Gallons Units c o U New Tanks Existing Tanks U _ Septic or Holding Tank 1,000 0 1,000 1 Wiese oncrete X Dosing Chamber 650 0 650 1 Combination ST/PC 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 Wam Sillichumaker k( MP 227990 (715) 386-2 13 1 Plumber's Address (Street, City. State, Zip Code) 1070 Scott Road, Hudson, WI 54016 VIII. Count /De artment Use Only Approved ❑ DJ Permit Fee Date Issued Issuing nt Signature ❑ t eason for Denial $ 30 17 IX. ConditYhli$'"$gVV Reasons for Disapproval 1. Aar*r w tin lifter 0d 3~ au 8S pOr. ON ~ n,pWli o by PiUM13ea. v 2. AG tul6~ricirxll;:ir.~d as ;filf vri11Ct1bIR t4drl / krd11IUlOtf. Attach to complete plans for the system and su it to the Con ty only paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) 6) M61 -7;:,Jl 4, 6A, 6 4V;A 33't 2-,z-.fA Alt . U.(.J• ® Ei~'/J tCin y YcYC~d-c' /l~' 12Sl :5 Cale-., as Car enli ~ -d\ \ S`~( ~ ~ />cJ., Tq. of'Jtu• ~ cry \ , ` Oda ~t. croir C.., c,,J/. ~ J u.T~o{s!y„Stec/ r' 6v Q\ 41fUmGC/G/Ct o \ t7SPS 1, 3o(!JYL<). EStl.rtai r W h r Clla!d.~in~i~~9d.~g,~e , iF z ".5cL. 1/O'A h o ~.d.G. blrJea 6C.uiveuYly Proposed c,J; tse 3 t/ L!f'1 GmcrvE.c w~P/~~ ~ ~ JQcS/dwJCt s...1 e . Y AVy ~L- SZS l FF/u ~ ~ -tY. 'seL . 44U145rnr- vrt eo•.c/<bc Nkd GQra~F ~ Popa~~„1«~.-,dad /9. S~:r 9~90cl - \ / u.yL'x75'd,s/ousa/Ce/% 7'wo(z~ x 73.37''/ ce rs,-o,-cec4 \ LAX/54/ U'rYin~~~,G~ L:. ,'/~•.KJ°,. ~a./duly -SGc.~li'''~<•L~ ~ :J~; otiyTSrs.~. DIVISION OF INDUSTRY SERVICES tic Tp~ 3824 CREEKSIDE LN o~ f y HOLMEN WI 54636-9466 ® a Contact Through Relay S http://dsps.wi.gov/programs/industry-services v~ P S www.wisconsin.gov O~ lG/ ;~pkssroNN Scott Walker, Governor Laura Gutierrez, Secretary August 21, 2017 CUST ID No. 227990 ATTN• POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016-7302 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/21/2019 SITE: Identification Numbers Gary and Penny Bethke Transaction ID No. 2986084 1995 200TH Ave Site ID No. 837505 Town of Stanton Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NE 1/4, NE 1/4, S25, T31N, R17W FOR: Description: Three Bedroom Mound System \ Sloping site \ REVISION Object Type: POWTS Component Manual Regulated Object ID No.: 1703506 Maintenance required; Replacement system; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, 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. The approved changes will become an addendum to the plans that were previously approved on 5/8/17 under Transaction ID No. 2937839. 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 CONDITI compliance with all code requirements. APPR No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT OF S PROFESSION stats. The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION' OF IN® 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. SEA Ct~hES • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with 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. WILLIAM C SCHUMAKER Page 2 8/21/2017 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 $ 85.00 Fee Received $ 85.00 Balance Due $ 0.00 rard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jen-y.swim@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm WILLIAM C SCHUMAKER Pace 2 8/21/2017 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 continency 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 $ 85.00 Fee Received $ 85.00 v Balance Due $ 0.00 rard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WISMART code: 7633 jen-v.swiin@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Bethke 3 bedroom replacement mound Owner's Name: Gary & Penny Bethke Owner's Address: 1995 200th Ave., New Richmond, WI 54017 Property Address: Same Legal Description: NE1/4 NE1/4, Sec. 25, T.31N., R.17W. Township: Stanton County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: 036-1058-10-000 aVE Plan Transaction No.: AND SERVEC S ' Page 1 Index and title 7'yr SC a IR tiP 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 Site Plan Page 9 Soil evaluation report Designer: Bill Schumaker License Number: 227990 Date: 07/14/17 Phone Number: (715) 386-3121 101, Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), 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. 10/12) Version 7.0 (R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for . 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches 450.00 Design Flow (gpd) 2.50 Site Slope 98.75 Contour Line Elevation (ft) 25.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 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 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. j 0.156 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 7.50 ft2/orifice 2.00 Forcemain Diameter (in) 120.00 Forcemain Length (ft) Does the forcemain drain back? =Y 87.00; Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 19.57 Forcemain Drainback (gal) 12.17 Vertical Lift (ft) 67.32 5x Void Volume (gal) y' 2.67 Friction Loss (ft) 86.89 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 32.31 System Demand (gpm) 19.38 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 646.00 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 17.00 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 646.00 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 17.00 Dose Tank Volume (gal/in) PL-525 _ Filter Model Number Wieser Concrete Manufacturer Project: Bethke 3 bedroom replacement mound Page 2 of 9 Mound Plan and Cross Section Views 1/10 B J * Observation Pipe K a r r r r r r r r r r r r r ~r rrr rrrr r I~~~7 r rr r rrr rr r t d > r r J r {!~~+r'r r-r ra'r'rrr r A rrr rr 'r r rrr rr trr rrrrtir s- r , W _ B I F31'. . I i ii o L Mound Component Dimensions A All ft E 12.80 in H 1.00 ft K 8.35 ft B ft F 9.50 in 1 7.65 ft L 91.70 ft D in G 0.50 ft J 6.16 ft W 19.81 ft 450.00 (ftz) Dispersal Cell Area 1023.65 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.46 (ft) r rr gi °i G F 100.17 ft Lateral 99.67 ft Dispersal Cell ( ) O Invert Dispersal Cell Elevaton D 98.75 (ft) Contour Elevation 2.5 % Site Slope Geotextile Fabric Cover Shading Key a I Dispersal Cell See lateral details on 1 Topsoil Cap o ° 1.5 ft r Page 4 for number, size, C , , Subsoil Cap N o r. r and spacing of lateral;: r? r Laterals are equally ASTM C33 Sand F ,r Typical Lateral spaced from the m H0.5 ft Tilled Layer c ,n distribution cell's © Aggregate v o ,r r a, r r r r 5 v centerline in tine - A distribution cell (AxB). Project: Bethke 3 bedroom replacement mound Page 3 of 9 Erid Connection Laterai Layout Diagrain 1..7 rat: ~b~rt~a4~i v%.t€h,At,U&rr ioo 0-Turn-up mba ilvaIwtcwol+aun~,utpluo s .E . 18t R: ek: bto Woovio,1 X r ~ Hoil is driUot a Co d* bout in rtf 01* jeri.1 et~;l~ sriai=cTd ~cr,:~ rraa~trr rWatiorr ~a try c~ ete~s~ ta;« m~rrtf+~c1 ~ arar r,crt. ~ l...J L,,AA Als &Iercemain Sch 40 PVC per SFS Tile 3844.30-6 Number of Laterals 2 Orifice Diameter 0 156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral 30 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft'/orifice Laterai Flow Rate 16.16 gpm Manifold Length 3.00 ft System low Rate 32.31 gpm Manifold Diameter 1.50 in Total Dyiialr,ic Heac 19.38 ft Forcemain Velocity 3.30 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Flectncal as per NEC 300 and 1► SPS 31 3 300 WAC 4 in ruin. Disconnect Tank co+r,,onent is properly vented Alternate outiet location LFurcernain ciamater Wieser Concrete Manufacturer 2 in. Capaci y, 646.00 Gallons Volume 17.00 gal/inch A Weep hope or anti Dimension Inches ; Gallons B siphon device A 18.89 321.11 B 2.001 34.00 C Pump off elevation ;ftC 5.11 86.89 -88.00 D ; 12.001 204.00 D Total ~i 38.007 646.00 Dose tank elevation Bedding un er tank. 87.00 Alarm ivlanuafacturerFSJE hombus Note: Switches Alarm Model Number 1011 421 containing mercur,, may not be used ir: Pump manufacturer Goulds this system Pump Model Number; EP05 Pump MLAst Deliver j 32.31 g p m at 19.38 ft TDH Project Bethke bedroom replacement mound Page 4 of 9 lViound System Maintenance and Operation Specifications Service Provider's Name Bill Schumaker Phone (715) 386-2131!1 POVVTS Regulator's Name St. Croix County Zoning Dept. 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 ft2 Maximum FOG 30 mg/L Type of `JVastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly PresE L: re System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1 Observation pig es 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 a jgregate 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 bzsal 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 Grate i. 6-3" Diameter Lawn Threaded Cleanout Sprinkler Valy 3 Box Plug or Ball Valve DistnbL 1 Jn Long Sweep 90 of Iwo 45 Degree Bends Same Diameter as Lateral ire ect Bethke 3 :croon replacement mound Page 5 of 9 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 :omponent manuals [SBD-10691-P (11, R. 11/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual /er 2.0 SBD-10706-P (N 01/01, R 10/12)] 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 aoandonment shall be in accordance with SPS 38133, Wis. Adm. Code when the tanKS are no longer used as i'OWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness ana 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 oe replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an affective ccking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The peptic tank shall ue maintained by an individual certified to service septic tanks unaer s. 281 48, Stats. The contents cf the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fhter lr:all 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 a arm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may inaicate surge flows or an impencing 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 tna next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biolo( ical or chemical additives to enhance septic tank performance is generally not required- However, if such )roduc.s are used they slra:i be approved for septic tank use by the Department of Commerce. Pump Tank _he pig rip (dosing) t~irk. shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify .)riper o; Eration . If an et Lent f'Itei is Instalied within the tank it shall be inspected and serviced as necessary Mound and Pressure Distribution System No trees or shrubs snouid 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 frorn 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 mouna and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that ne mound be heavily mulched as protection from freezing. nflueut quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent cr 0 r -ig/L BODs, 30 mg/L -1 SS, 10 mg/L FOG and 101 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum ties gn flew 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 hushed of accumulated solids at ;east 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 uistributiur within the dispersal cell. Cbseraation pipes w;ihln the dispersal cell shall be checked for effluent Dancing, Poncing levels snail be reported to the ow,rer, ai,u sir ,y levels above 6 inches considered as an impending hydraulic failure requiring additional, more fregcert moi storing Contingency Plan if the _,eptic tank or am/ of its components become defective the tank or component shall be repaired or replaced to keep the system i proper operating conail-on. 1, the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately ia~aired of replaced wigs a cornponent of the same or equal performance. It the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or iapiaced r its' present location by increasing basal area if toe leakage occurs or by removing biologicaily clogged absorption and ui,Fersa! media, and related piping, and replacing said components as deemed necessary to bring the system mto proper operating con iition 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 scn,_dule of rnananagement and maintenance for pretreatment devices such as aeruLic treatment units or ~lswfectija units are att3k r ec as se?arate cocuments and are considered part of the overail management plan for this s}stern Project Page 3 of 9 ' OULLS PUMPS Submersible Effluent Pump ► f HIM, JIM, MIA 4.w.r„JWYWZ y.. 3871 EP04 EP05 f.PPLICATIONS _ Lily )ubmerged in high u EP05 Impeller: h(_nri,>D a 1W Bearings ~_[J;'ef J~ t a . grade turbine oil for tic enclosed design for heavy d-t. ball oeari i; pedt ca ly designed in the lubrication and efficient improved perrormance. ceps:ruction Acv.ing uses: heat transfer. Etflgent systems a Casing and Base: Rugced Hof_1,s Available for automatic and thermoplastic design provides AGENCY LISTING rur 7s manual operation. Auto- superior strength and corrosion Sf1 Can,idunS[anaard~F-ssxi::u_n Hecq duty sump matic models include resistance. A a:er transfer Mechanical Float Switch H Motor Housing: Cas! iron Guutis Puy„ ~s IS ISO 900] 6eo>tE t >s catering assembled and preset at the for efficient heat transfer, - factory. strength, and durability. SPECIFICATIONS n Motor Cover: Thennop ast,c FEATURES cover with integral handle and Sch 1, handling cao,il-Iiity: float switch attachment peints. naxinlum. L EP04 Impeller: Thermoplas Cap,icities: up to 60 C Pf"I. tic Semi-open design with ra Power Cable: Severe ciu~.y rated oil and water resin::,ri'. ict'd meads: up to 31 feet. pump out vanes for mechanical Discla-ge size: 1'/_' ` 01. sual protection. M,(Fnanical seal: caro)n- ro_a ~;ceramic-staticn.i _,UP:A-N elastome s en aerature: C4 1 40 `C) conti ]',c Js u0 ; X60 Q interin ':t int. METERS l FEET o r Fasts Hers: 300 series r stai Tess steel. 30 rI --~t--S G r, - L pa ale of running iry si:houtdamayet_) cnp:nents. 25 0 v'r a 1:1otor. r ~ 19.3--r. a EFO-I Single pnase: J. -I HP 5 cr 230 V, 60 H~, 55C Q RFf.', built in overloac witi1 5 o act(_matic reset. El-C3 Single phase: U.5 HP 41 EPOS 5 b' or 230V, 60 Hz 1550 0 3~ 10 J!', , built in ovenoao v iVi EPO latic reset, z r ~cv.er cord: 10 foot s star ward length, 16.3 1 C F( \y, with three p c1g Iii i cling plug. Op ti( nul c0 c °o to zo oo: I"ngth, 16/3 SJ~GI with they prong ground.n j plug - - - ~ o z a 6 ~ r,u s:a ~ard on EP05). CAPACITY ~I gfJM d Goulds Pul11ps zro-_~~lust~~nns ~ ITT Industr,(_s r'rat. < 'ent,mber, 200 - w l~~'9 5' -co4 Alt- 33 - ~ Soy%~✓a/k4~'an p~"~ . U.r~•~. ~ ~c ~.~'i.J Eivrq gYQO~~ lam" /2 eS-r ~ c3S \ /~r_:.✓,~i'c~ mane!. ~J/. 550: r P' vv ao ~ e~CKar£~~ Tod~{3/y'j ee/S CJ \ ~a r~ JOE - B ,k; 54-)- . y0/ o \ DS PS r 2.3D h ® C!L✓d~in(r9tr.577'gr°It 2'~c4. voC. t \ x a Ade. ben ec d ui JeuX1y i /sf~ q ~ Proposed v~rese.,~, ~ j pEd = 957'~' C[mcrvE.C W L/~/~'~°'U ~ ~sSrcl+wrcL "Sc,L . rya ~¢sTw7• Jrt po..Grct rn ou-E 6! t:e- Jt~ \ ~ar~'~~15 GQrQ~Q I Pad J (f ProPa~-d /Ytc~.adC~~ /9. S/rx q/.704yL X7s'~,S/0lls.E~eC/~ 77iJO(4) x 73.37'w/% "vrrceSS,oae _,d r h to £ sE ,e, c der e-: Xis ~'n~ jQ v~7 5 b.c ci 5e~vi!'f1s ~.e !'/r,A/cr 7m 303 Y/~ V ~/'O ol[ G JV GC1: id,•„ 9.5ccu~~ = S5, , J~ ~'aa9 5 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ANT) OWNFIZSIIIP CERTIFICATION FORM Owner,/BuNer Gary & Penny Bethke Mailing Address 1995 200th Ave., New Richmond, WI 54017 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 036-1058-10-000 LEGAL DESCRIPTION Property [.,ovation N E ,4, N E ra Sec. 25 -,.1' 31 N R 17 W, -Down of.Stanton _ Subdivision Plat: Na Lot P' Na N a Page 4 N a Certified Survey MaP # N a Warranty Deed # 7 9 Z c I (before 2007)Volume . Page # Spec house Elyesolo Lot lines identifiable Elyes❑no SYS"r1 m MAINTENANCI 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 tidI of sludge. 1/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 ot'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 with' 30 days of the three year expiration date. liwe certify that all statements o this form are true to the best of my/our knowledge. li"we amore the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numb r of bedrooms _ 3 SIGNATURE OF APPLICANT(S) DATh: ***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) p5 s~~~ Wis Dept of Safety and PIT P A it, E'VALUATI Page _/Of 3 Division of Safety and Buddi 37AXZB412XRCJ - ----war-o s85, wiis. 1 CrD / Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reFerence point k3M), direction and percent slope, scale or dimensions, north arrow, and location and distance to near 36 - I 'sv /d -000 Please print all information. R by Date Personal information you provide may be used for secondary Purposes (Privacy Law. s. 16-040) (m)). Property Owner Property Location Cj a d- ?e"'.4 Bet Ife Govt Lot NE 19 AIJF 114 4T T N R/ 7 to (or)9 Property C6mes Mailing Address Lot # Bbdc # Sutxi Name ordsw l 99s-' ~6a e city State Zip Code Phone Number 0 City ❑ Viflage [3Town Nearest Road er,~/f c~i o~~ GuT SYp/? (~/s , 2 y6- Sl~~ s~a~ tom 2 ❑ New Construction . Ilse. Residential / Number of bedrooms 3 Code derived design flow rate yS0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ct-i- a J A Flood Plain elevation if applicable S e e- /71 a fL General comments ~Q SG °f ?Dun D ICP 9b'. 8 C e and recommendations: F q] ROnrrg # ® PBoring it Ground surface elev. q6' g ft. Depth to feniti g factor MGG n Rate Horiz on Depth Dominant Color Redox Description Texture Stnicture istence Boundary Roots i . Munsefl Qu. Sz Cunt Color Gr. Sz. Sh. 2 0 0-/0 IOYO/2 ~ SL 9fn M vP1 a s 2 c G. 6 1#0 2 /o- ~s sYn S/ - a n1S6k m~f w r~, 0.6 or 8 3 18-29 7.57)-k S~ ~mSbk M-P.- c 4i / m 0.6 0 `q 28-80 7,S-YR 616" l~'SYR s/g SGr OS MiO/- 0, 7 1,6 Son SL Q Boring # ❑ SQg g n ® Pit Ground surface elev. / ft Depth to limiting factor oC ' in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cant Color Gr. Sz Sh. 1 tf#2 1 0-8 /DYR V12- 9-17 SY l L. 2ms61c m P., C cv 0, 6 Or 8 3 17-a5 7,Sre SL :ZmS4k n7p,, C t-- 14 0,6 K ZS-`/I 7rSY l^If' SYRS/ S~ /f,7ft~A IrlA C 6V /1/16 0,y 0, 7 s ~r 79 -5- -3/./ C2P R Of 4~ sL om rn) P; - Ord a, 6 Effluent #1= BOO > 30 < 220 mglt. and TSS >30 < 150 mg/L ' Effluent 92 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print} B r rr G C l Signature e/V Dam/ .2 3 )3 / V Ad3 98- /92 a e- .SoMt~r-cam GvT S4%2.s C*ft Evalu-0?7 7i5-zv~7-3 3{ -10 SBD-83. (RI 1/11) e -J4, A41 Property Owner Ga /Yd- ~C~n • t°~ h ke Parcel ID # 636- /05"8- /D-000 Page 2 of 3 Boring # Boring 161 pit Gro und surface elev. • fL Depth to NrMVV factor ~S irr Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ammistence Boundary Roots GPDift Y in. Munsel OLL Sz. Cont Color Gr. Sz. Sh. ' ff►fi ff#2 3 /6-.25- ZS-rh' yj S 6 amsbt- inF✓ cW 016 /.O 2s Y8 7,5'rR i Flf S'yRs~a 5Z~ IM rkl - MA' c w ~ a-F 0,1/ 0,7 S y~ 7~ 5YR 3XY 4 4z SL Om rnvp,/ - 0-2 4.6 F-I Boring # ❑ Boring ❑ pit Ground surface elev. fL Depth to Wniting farms in. SOB Application Rate Horizon Depth Dorr*=A Color Redox Description Texture Structure :;o~e Boundary Roots GPD/ft 2 in. Munsel Qu. Sz. Cont Color Gr. Sz. Sh. ff# 1 - { D Boring F] Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ~ons~stenca Boundary Roots GPQM ' in. Munsel Qu. Sz. Cont Color Gr. Sz Sh. ffaXi 11#2 • Effluent #1 = SOD s > 30 < 220 mgA. and TSS >30 < 150 mg/L ' EMuent #2 = BOD 5 < 30 mg& and TSS a 30 mg/L The Dept of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD4330 (811/11) Property O%n r Gt c~ % ~,n j r /t Pant CD # fib" !USA- ~U ° rJC~ r GCE y o 3atir,y 161 ® Pit Graunct suuface efev. q.Y'0 ft Depth to lintitirxj facto 2S 91 ScW iicaticf, rllz;ic Horizon CEpth Dornina,rt Color Redox Description Te>dure Strudwe nsisienex x;ary Floois Gl'Oht - _ n. Mw rrefi Qu. Sr- Conk Color Gr. Sz Sh. _ tf#l ff# 2 1 _ o- 7 /OYli' z 5 [ ,ern ~ m vii 4 s l 016 2 7-16 3 %6-~S 7,SY; 5L ams6~ /nF/ Cw /V-k ~c 2s= Yy 7.-P/-P sYrQ~iB s`~ rm.~~k [AA cw 0,,/ 0,7 e- r8 5YR C 2.9 Si I? SL O m fn vp,, # ❑ Bonn - - - ❑ Pit Ground surface elev- ft. Depth to limiting fittcx -41 1 - Horizov L*-Vth Dorninait Cc3cr RadoxDE:Saiption Texture Structure L;e ntia,y Runs GF'Drn n- Murl e Qu Sz- Cont. Color Gr. S7- 5h ftfl'Itf2 i i 3oi ing Cwaur;d surface elev. ft. Depth to laniting ffac tur ❑ Pit 5oi1 I:c:ai;.r, Rate : j Honaxi Depth Domir a, Color Rec ox Desaiption Texture Stru.. undary Rook G?Uft _ Mun::eil Qu- Sz- Cunt Color Gr. Sz_ Sh. ft ° =tf#~2 - 7- i t, . t = - iti' 2201A)L. z nj TSS >30 < 150 rr4L ' EfBuent #2 = B J" < 3L r: 4 L ¢i ,I S S gel : u! S-ICry rto.:i ioclai Services is 311 goal apportuuity scrvic pravidtr:u.a ace= set v.c--s of ne-d materW is an aftezram format, contact the &-parhnent at 608-266-3151 or I Y through :Zeiay V-1m. Dept of Sahyi and Prokss-o Services SOIL EVALUATION REPORT Paae 1 of Division of Safety and Buildings in accordance with SPS 385, VViis. Adam Code Attach complete site plan on paper not less than 81J2 x 11 irwl s in sizes Plan must Cotarty ~T C O /J- o - cad a perccent slope. not knited or da m r Marro w, relarence and location point dddstan to wrest road Para I.D. O 36 _ /OS ~r-/ road- Please print aft h7forma#ion. Reviewed by Date Per-on,A nformation you provide may W used for secondary praposes (PmrCy LWK s. 15-04 (1) (m))- Property Owner Property Location 6,,X ;,L ?e,,, .X t /1re Govt Lot N-,e 114IV~F 1/4 S 2`-T 31 N R 17 la (or)g Property net's Mailing Address Lot # Block # Subd. Name or CSW C ty State Zip Code Phone Nurnber ❑ City ❑ Village MTown Nearest Road eu~/~ic,~ o~~ Gar SYa/7 (7is , 2 y6- S/I j ,~~"an tort 2 ❑ tie+nr Construction rise [a Residential J Number of bedroorrss 3 Code derived design Sour rate G P D ~ ❑ Replacement ❑ Public or 00mrnercial - Describe: _ i Parent mataiet Q--f (1 a-S1i Flood Plain elevation if applicable _ .5'C C M a General comments Base °Mo,-n D ~ 9f`. 8 Ct L,~ e and recormneMations: ❑ ~ # ❑ Boring Cj ® Pit Ground surface efev_ ` 8 ft. Depth to 6miliV factor `°28 in. Sod tion Rate Horizon Depth Dominant Cobr Redox Description Texture Stricture nsistence Boundary Roots GFDJft ' in. Mu lsell t lu. Sz. Coat. Color Gr_ Sz Stu 1 ff#2 0--10 /oYff "41 SL V.mg~ m vR. 6L5 2 C C5.6 d Z /0-18 SYl~ a M S6k rn c w 2 M 0", 6 O, 8 3 ] 8- 28 7SY~C 51- 2MS4k /;I-P.- c 4. / m 0.6 /,0 2340 7,SrR 616-' 17'SYR 5/8 Scr US mPI- o,-1 1,6 w ga„ s c. Boring g r-1 Boring S ® Pit t (mound satiate elev. • ft Depth to (aniting factor irr Sod licaticn Rate Horizon Depth Dorinant Cobs Redox Description Texture Structure nsistence Boundary Roots GPDJiI in_ - Uunseii Qu. Sr- Cont Color Gr_ SL SK 11 1 - ft#2 1 0-,9 10 R V12- 2m a s /M 0,6 1/-0 9-17 SY l L, 2mS6k mP., c cv 14 0, 6 U. -3 17-~s , M 5 ~k' .SL :Zm56k mj~i c w 0,6 1,0 q 25- 7,Sr l SYRSzs SG /n?sgA In ell C tw /✓-P 0, y 0. 7 S q1-71 -5- X9 31y CZP R 0 M) P 6,2 , 6 t-t--- F#F l = BCD > 30:S 220 mg& and TSS >30 < 150 mg& ` EfSuent 92 = BOD 30 n-qL and TSS < 30 my/ l CST Name (Please Print) - Signature CST Number i Br1Gn P/-nC// ~23I31V Address Date Evaluation Conducted Telephone Numt e, 3 %c /92 a Som err GuT S4~o2 G_o~9_~7 7/S-ZY7-3z - SBD-93 0 (IU 1/1-1) OWNER Page 3 of 3 Name Gc~CA n ~J & mre Brian Parnell Address_ 19 9S = a2~~ a ~e CST 23 314 So n, er rer wl S~O.Z S Date -,2 9- 7 A Benchmark 1 1`4 A Benchmark 2 Safe e4 .r Z%,o.- ~~'/e ❑ Soil Boring Suitable Area 1" = 40' Scale U IQ t I re r E ! i I } c i 0 tc k ~ I I, ! ! ! fi , } I T1 T 1 V4 J, t , are V, I 76 i I n. ' ! 1 tl I i ~ t S f 13~ 'nub ~ I o ys a u i e r L. ~t 4r 'f a K I F I ~y rit f 4 t In + F P:l J ~r d? } 17 4 -4 1 P w f 4 ~ P. f t e Y, .t rte. r r • LLJ sY s T Qv r, P , It , a~ , f CV .~#°k`N» d 5 a? m LLJ ~E0 ` o N - (D rn p o 0 N ~ z m "mt n L O F W 'N N G ~ O U ~ c R a ~ U O ~ ~ o m o m c y E >m o a _N Q 3 N d l0 N C O 10 O w 9 N 11 N N (n T L ~0~,~~C C W V O O E N d V U N U O C C d L 0 O Z L y aN ~ N ry x LL = Z c E E m m m p o O m w w O1 = a a °m U N m 'O m o m v Q a `m s 2 m co E ° O O u c o _ o 0 -T E $ m o m o aoi U z m 'o o m o m Lo -E w L CA (n LL c0 ❑ ❑ w LL J u) F F- U > V) N O J 7 fn U J K K LL' cr > p U ul w mc V/ O U o o _ O U - 'ww- mw r I b ~ 4 r vw¢1`d dM wry 1 } max, ys. iP % p i. 3l it T „ "ffi. ~ 4~r .d~. ^`9. t ) t s ♦ i x ~ , +pY,h,0.rtYsu~ b"" ."'°.i . 1 1, k '=k LLJ 47, a Y r i4s POW&, 4 V Ilk i gam,' LLJ r m