HomeMy WebLinkAbout002-1069-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 597474
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village Township Parcel Tax No:
ANDREW AND RUTH TOLLEFSON TOWN OF BALDWIN 002-1069-50-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
L t" ,1 r My
28.29.16.420
TANK INFORMATION ELEVATION DATA J o.
TYPE MANUFACTURERS CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /eo
i
Dosing + v r Alt. BM
C.~Owrbb 50a s a.a 3. 1 ` Z
Ag"Itteff-I _j Bldg. Sewer
fr`y' ~ o
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet
Septic N Dt Bottom I .
y+ Z
Dosing Header/Man. `
Aeration Dist. Pipe
Holding Bot. System
5.
PUMP/SIPHON INFORMATION Final Grade
r
Manufacturer De
mand St Cover
GPM 3'~'l 9r
Model Number int
TDH Lift, Friction Loss System Head TDH Ft
Forcemain' Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
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 CHAMBER OR
Type Of System: UNIT
Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution ix Hole Size ix Hole Spacing Ve t t Air intake
Pipe(s) t /
length Dia Length Spacing /
SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil _
Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Inspection #2:
Location: 2329 80TH AVE
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover = oGon
6 aA _ e@ C ;
b
Plan revision Required? ❑ Yes No
Use other side for additional information. y.
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
I.
f~f q t V Safety and Buildings Division / 201 W. W ashington Ave., P.O. Box 7162 ry Permit Number (to be filled in by Co.)
7San y
2p11 Madison, WI 53707-7162
~P o ~9 7y 7~
n
State Transaction Number
J ~TT11 Anp j VAJU
In accordance wiZ, 3.21(2), Wis. Adm. Code, submission to YQTC17W493AMG f
--to J
is required prior to obtaining a sanitary permit. Note: Application t.,,_6 ,or state-owned POWTS are submitt ed to r0 dregs (if different than mailing address;
the Department of Safety and Professional Servies. Personal information you provide may be used for second Y
purposes in accordance with the Privacy Law, s. 15.04(I)(m), Stats.~ 71,
L A lication Tnform n - lease Print Alt rmation
Property Owner's Name
f1 Parcel #
e - yc; c'o
Property Owner's Mailing Address
Property Location
j ~
Govt. Lot P`
City, StateF Zip Code Phone Number
AIj ='/a, Wl,t) Section
,(cucle one
Ill. Type of Building (check all that apply) s~ Lot # T / N; R E or
;1 or 2 Family Dwelling - Number of Bedroom J Subdivision Name
Block #
D Public/Commercial - Describe Use
❑ City of
D State Owned - Describe U CSM Number D Village of
60 A Town of Ord uV t ^ '
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
❑ New System Replacement System ❑ Treatmenl/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. D Permit Renewal D Permit Revision D Change of Plumber D Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
till
IV. T e of POWTS System/Component/Device: Check all that apply)
O v ,
D Non-Pressurized In-Ground D Pressurized In-Ground D At-Grade D Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
D Holding Tank D Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requir (sill Dispersal Area Prop d (sf) System Elevation
0 o D A~ 30 9. i
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units M. .d
New Tanks Existing Tanks U 5 , y
~ d~ ~'Il a U v~ v~ w C7 a
Septic or Holding Tank / G,r,v J J 4,d R~
ibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
e (Print) Plumers Sig ri MP/MPRS Number Business Phone Number
Mmeteet
ress (Street, City, State, Zip Code)
ddf~~~ U s L Y \iri. e, l" T /De artment Use Only
Approved Permit Fee Date I sued Issuing ent Signature
r iven Reason ial $ 6 V '
IX. Condi' soJjjjk`-ns for Disapproval
*fFtiiM tin I~fdhtt by Wtunat+r. 'A- ICI
t -W 3 tot:*ir.41
90 ter Iwppkilillbl„ CO / **JdA Al ~ 5 A
Attach to complete plans for the system and su mit to the County on pn per not less than 81/2 x 11 inches in size
SBD-6398 (R. 11/11)
q Cr
page$OfA
Propeny Owner _ bl l l~u To~FSaitt
.l"=4Qf~
Legal Descriptwn _ALF-A ot- rt4w- ~ i w`A, se- 2-g (except where noted}
tzi~~, r~wa a~ s ou , 57, efttX COu:L~q 13 = Backhoe pit
we s,~l `~p,~~6
-23zGt ~v ,4u~NU~ p~z~iod~-SD-~ North
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K~c.-• ,4$ssV~ PoLIE
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Site Location:
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w
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL STE 150
® GREEN BAY WI 54304-5211
Contact Through Relay
i ' http://dsps.wi.gov/programs/industry-services
y1~` ~w l www.wisconsin.gov
sTON +L% Scott Walker, Governor
Laura Gutierrez, Secretary
August 18, 2017 A -:,PRtj"t
T OF SAFI,
CUST ID No. 224832 ATTN: PO WTS Inspector e ~.Si01L
MARY JO HUPPERT ZONING OFFICE
HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA
28497 KING ARTHURS 1101 CARMICHAEL RD
DANBURY WI 54830 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/18/2019 Identification Numbers
Transaction ID No. 2986377
SITE: Site ID No. 841603
Andrew Tollefson Please refer to both identification numbers,
80TH Ave above, in all correspondence with the agency.
Town of Baldwin
St Croix County
NE1/4, NW1/4, S28, T29N, R16W
FOR:
Description: Mound System Q Bedrooms - Replacement)
Object Type: POWTS Component Manual Regulated Object ID No.: 1721930
Maintenance required; Replacement system; 450 GPD Flow rate; 22 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.
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 POWTS dispersal area.
• Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches
Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil Proper soil
moisture content can be determined by rolling a soil sample between the hands If it rolls into a 1/4- inch wire
the site is too wet to prepare. If it crumbles site preparation can proceed If the site is too wet to prepare do not
proceed until it dries.
• Abandon Existing System per SPS 383.33
• 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)
• Tank Installation to follow all manufacture's recommendations.
• Verify property line(s) prior to installation.
l
r
MARY JO HUPPERT Page 2 8/18/2017
• Final elevations of pump off and invert of distribution pipe; need to be verified for proper pump sizing.
• This system is to be constructed and located in accordance with the approved plans and with the "Pressure
Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P
(N.01/01).
• This system is to be constructed and located in accordance with the approved plans, and the "EZflow
Mound Component Manual " (R.7/12).
• 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.
• The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall have
one out of every five orifices installed at the 6 o'clock position. The remaining four orifices shall be installed at
the 12 o'clock position. The laterals shall drain fully after every dose.
• The lateral turn-up ends shall extend out past the exterior end of the cells at both ends. The observation pipes
shall be located in between where bundles come together. These requirements must be followed so that the
aggregate bundles will not be damaged during the installation process
• SPS 383.54(l)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an
aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist:
1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located.
2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located.
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.
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/instal Iation/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.
MARY JO HUPPERT Page 2 8/18/2017
• Final elevations of pump off and invert of distribution pipe; need to be verified for proper pump sizing.
• This system is to be constructed and located in accordance with the approved plans and with the "Pressure
Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P
(N.01/01).
• This system is to be constructed and located in accordance with the approved plans, and the "EZflow
Mound Component Manual " (R.7/12).
• 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.
• The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall have
one out of every five orifices installed at the 6 o'clock position. The remaining four orifices shall be installed at
the 12 o'clock position. The laterals shall drain fully after every dose.
• The lateral turn-up ends shall extend out past the exterior end of the cells at both ends. The observation pipes
shall be located in between where bundles come together. These requirements must be followed so that the
aggregate bundles will not be damaged during the installation process
• SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an
aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist:
1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located.
2. The bottom of the tank is located more than 150 feet horizontallv from where the servicing pad is located.
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.
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.
MARY JO HUPPERT Page 3 8/18/2017
Sincerely, Fee Required $ 250.00
ee'tl 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 Wyment S code: 1. 7633
(920)492-2214 , Monday - Friday 6 am To 3:30 pm
tim.vanderleest@wisconsin.gov
EZnowo MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: ANDREW M. & RUTH TOLLE>=SON
Owner's Name: (SAME)
:f-3
Owner's Address: 2329 80TH AVENUE
BALDWIN, WI 54002
Legal Description: NE1/4 OF THE NW1/4, SEC. 28, T29N, R16W
Township: BALDWIN
County: ST. CROIX
Subdivision Name: NA
Lot Number: NA Block Number: NA
Parcel I_D. Number: 002 - 1069 - 50 - 000
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry
S ,
s4/ y wly Page 3 EZflow mound drawings
~ Page 4 Lateral and dose tank
• MARY JO ~ Page 5 Distribution media
HUPPRT Page 6 System maintenance specifications
3 D 1859 Page 7 Management and contingency plan
~i R I V ER FA 1..Lo.' Page 8 Pump curve and specifications
dyl ° Page 9 Plot plan
f fin
Designer MARY JO HUPPERT License Number: 1859-007
Date: 07/21/17 Phone Number: 715-426-1775
Signature:
Designed Pursuant to the
EZflow Mound Component Manual Ver. August 20, 2007,
SSW MP 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)
RECEIVED
EZflow Mound Version 3.0 (R. 3/1/12) JUL 2 4 2017 Page 1 of 9
INDUSTRY SERVICES
Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
(r or c) u Residential or Commercial Design
300.00 Estimated Wastewater Flow (gpd)
1.50; Peaking Factor (e.g. 1.5 = 150%)
450.00 Design Flow (gpd)
5.00: Site Slope
94.94 Installation Contour Line Elevation (ft) 120.00 Contour Length Available (ft)
22.00' Depth to Limiting Factor (in)
0.60 In-situ Soil Application Rate (gpd/fe)
Distribution Cell Information
8 .00, Cell Width (ft) 3, 4, 5, 6, 7, 8, 9 or 10 Oniy 60.00 = Dispersal Cell Length (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
~41 Lateral Spacing (ft) If N above, enter the elevation (ft)
2 Number of Laterals of the highest point.
0125, Orifice Diameter (in) (e.g. 0.25)
1.50 Estimated Oriflow Spacing (ft) = 6.00 fe/orifice
2.00 ` Forcemain Diameter (in)
40.00 Forcemain Length (ft) Does the forcemain drain back? _ Y
89.00 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)
6.61 Vertical Lift (ft) 53.68 5x Void Volume (gal)
0.92 Friction Loss (ft) 60.20 Minimum Dose Volume (gal)
14.03 Total Dynamic Head (ft) 32.95 System Demand (gpm)
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 _.~m_..
1.50 x x 300 - ryw w s
2.00 x
3.00 x
Gallonslinch Calculator (optional)
Treatment Tank Information Total Tank Capacity (gal)
1000 00 Septic Tank Capacity (gal) Total Working Liquid Depth (in)
Weiser Concrete Manufacturer C 1 gain (enter result in cell B49)
Dose Tank Information Effluent Filter Information
650 00; Dose Tank Capacity (gal) POLYLOK-.~~_. . Fitter Manufacturer
17.00 Dose Tank Volume (gal/in) 122 Filter Model Number
Weiser Concrete Manufacturer
Project: ANDREW M. & RUTH TOLLEFSON Page 2 of 9
Mound Plan View
T
1/10 B J
Observation Pipe
K
5 A
.
W _
I :
• L
Mound Component Dimensions
A 8.00 ft E 18.80 in H 1.00 ft K 10.10 ft
B 60.00 ft F 12.00 in z 10.82 ft L ft
D 14.00 in G 0.50 ft J 6.96 ft W ft
480.00 (ft2) Dispersal Cell Area 1129.41 (W) Basal Area Available
7.50 (gpdfft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
EZflow Dispersal Area
Finished Grade 98.11 (ft)
,
H
G
rrrrrrfr..,r2 rr.,.rrr.~rr
F - Dispersal Cell 96.61 (ft) Lateral
96.11 (ft) - ► - - - 6" Invert Elevation
Dispersal Cell
Elevation E D 3 :
1{q-,~
t ~.L.! as .a ata.a a ..i~a.1.~aaa _L.a a1a a tt is a.a ,a.-.
94.94 (ft) Contour Elevation
5.0 % Site Slope
Typical Dispersal Cell
Shading Key See Page 5
0 Topsoil Cap > 22L
AL ~
Subsoil Cap C2,2 = 2-0 ft Approved Geotextile Fabric Cover
2 ®
3 ASTM C33 Sand o ° r
4 Tilled Layer r r:r.; r;.•
Q EZflow Media t ~ w ' r• • r•: •r• r•.-_•: •r•: •r•r•:
V a ...j rtir . ~ ~ ~ ~ ~
.s.
m 0 0-5 ft
See details on page 4 for number, size, and spacing of laterals.
Laterals are located in the 4" gravity distribution pipes as shown on page 5.
Project: ANDREW M. & RUTH TOLLEFSON Page 3 of 9
End Connection Lateral Layout Diagram
Place Appropriate Lateral Diagram From Right Below
f P •=Turn-up v ballval eorcleanoutplug
Z 1 st orifice k)caled at 2 k- X--3I Orifices point up except every 5th
one points down for drainage. S
Force main eormeetion sria tee or cross to marafold at aN point Laterals & force maIn of PVC Sch 40
All laterals identical with orifices equally spaced. per SPS Table 384.30-6
Number of Laterals 2 Orifice Diameter 0.125 in
Lateral Diameter 1.50 in Orifice Spacing (X) 1.50 ft
Lateral Length (P) 59.25 ft Orifices per Lateral 40
Lateral End (Z) 0.75 ft Orifice Density 6.00 ft2/orifice
Lateral Spacing (S) 4.00 ft Manifold Length 4.00 ft
Lateral Flow Rate 16.48 gpm Manifold Diameter 1.50 in
System Flow Rate 32.95 gpm Forcemain Velocity 3.37 f;,, - t
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and --1►
SPS 316.300 WAC Disconnect 4 in. min.
Tank component is properly vented E- Alternate outlet
location
Forcemain diameter
Weiser Concrete Manufacturer 2 in.
Capaci 650.00 Gallons
Volume 17.00 gal/inch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 20.69 351.80 C
B 2.00 34.00 Pump off elevation (ft)
C 3.54 60.20 ~ 90.00
D 12.00'. 204.00 D
Total 38.24 650.00
L Dose tank elevation (ft)
Bedding And Backfill As Per Manufacturer 89.00
Alarm Manufacturer SJE RHOMBUS
Alarm Model Number AB TANK ALERT
Pump Manufacturer ZOELLER
Pump Model Number 98
Pump Must Deliver 32.95 gpm at 14.03 ft TDH
Note: Switches containing mercury may not be used in this system.
Project: ANDREW M. & RUTH TOLLEFSON Page 4 of 9
EZflowo Distribution Cell Media Layout
8.00 Cell Width (ft) 2.00 Sidewall to Lateral (ft)
Distribution Cell Cross-section Arrangements
8 ft Wide
(3)"00@4we
Component Legend
® SR1-7A Bundle - 5 ft or 10 ft lengths
SR1-12A or EZ 1201A in 5 ft or 10 ft lengths
SR3-12H or EZ 1201P or GxM SR3-12H in 5 ft or 10 ft lengths
4" Perforated Distribution Pipe With Pressure Lateral Inside
Tumup Enclosure - - - - - Pressure Lateral
Bundles are covered with approved geotextile fabric as per the their product approval.
Distribution Cell Plan View Layout - Typical
8.00 Cell Width - A (ft) F-6-0-0-07-1 Cell Length - B (ft)
'enter Connection Lateral Lavout ni--, -am
Force Main -
8 ft Wide
End
Manifold
Project: ANDREW M. & RUTH TOLLEFSON Page 5 of 9
Mound Svstem Maintenance and Operation Specifications
Service Provider's Name DARRELL'S SEPTIC SERVICE Phone.715-425-1025
POWTS Regulator's Name ST. CROIX COUNTY 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 480 f? Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 years
Effluent Filter Inspect and dean as necessary at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test periodical
Pressure System Laterals should be flushed and pressure tested every 3 years
Mound Inspect for ponding and seepage once every .3 years_
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 Mow 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.
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 Tum-up Detail
Finished Grade
6-8" Diameter Lawn/ Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Lateral Ends at Last Orifice Where
Variable Length Cleanout Begins
!1 1, dhli'di
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
EZflow Synthetic Media
2.00 Feet
Distribution Lateral --*'1 4 Lateral Cleanout
Project: ANDREW M. & RUTH TOLLEFSON Page 6 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' component
manuals {EZf7ow Mound Component Manual 8/20/07, Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) and
SSWMP Publication 9-6 (0181)) 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 deemed unsound, defective, or
subject to failure must be replaced. Exposed access openings greater than 84nches in diameter shall be secured by an effective locking
device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis- Adm- Code. The operating condition of the septic tank and outlet fitter 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 reproved unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filler is equipped with an alarm, the
fitter 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 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 riot required- However, it such products
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 shalt 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 noted if it is functional during pump operation, and if not, it should be cleaned-
No 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) our the mound is not recommended since sal 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 BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BOD5, 30 mg/L TSS, 10 mgt- FOG, and 104 cfu/100 mL for highly trued effluent Influent flow may riot exceed maximur► design flow
specified in the permit for this installation.
The pressure distnbutim system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral to
flushed of accumulated solids at least once every 3 years- When a pressure test is performed it should be compared to the initial test when
the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within
the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in
proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fads 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 We leakage occurs or by removing biologically dogged absorption and dispersal
media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition.
See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: ANDREW M. $ RUTH TOLLEFSON Page 7 of 9
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Legal Descriptions (except where noted)
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Oct-19-2010 01 59 PM St Crcix County Plan/Zon ng 715-386-4686
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGRIsiEWNT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer --4inp.. 2 J- Aou
Mailing Address _
Property Address Z 3 Z~1 4
~(Vertfication required from Planning &Zoning
Department for new consuuction,)
City/State Parcel Identification Nurnber DOZ 4L9
LEGAL DESCRIPTION
Property Location '.Ain t/, . Sec. T °l r (p r Ll-, NRW, Town of ~A_
Subdivision Plat:
Lot #
Certified Survey Map # , Volume , Page # _
Warranty Deed # _ 2_5r/ (before 2007)Volume. pAge # /147(p
Spec house yes no Lot lines identifinblo - yes : no
SYSTEM MAINTENANCE AND OWNER CERT FICATIQ
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 lank every three years or sooner, if needed b a licon e
the system can affect the function of the septic to y s d pumper. What you put into
nk as a treatment stage in the waste responsibilities arc specified in §Co►ltnt. 83.52(1) and In Chapter 12 - St, Croix County Sanitary system. maintenance
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certiricmion form, signed by the
owner and by a master plumber, jounieyntan plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposvi system is in pfoper operatin!; condition and/or (3) tifler inspection and pumping (i(necesstuy), the septic Innk is
less than A hill of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards sot forth, herein, us set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin,
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we sm/are the owner(s) of the
property described above, by virtue or a warranty deed recorded in Register of Deeds Office.
Numb • bedroo
SIGNATU OF APPLICANT(S) /
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department,
Include with this application a recorded warranty deed from the Register of Deeds Office and it copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
P A
Wisc00V1§ y and Professional Service
Divis ervices et
es 9 GJV23M9569CNO
RT Page 1 of 3
in accordance with SPS 383, Wis. Adm. Code County
Attach 0 i'l ppaper not less than 81/2 x 11 inches in size. Plan must ST. CROIX
includ i ed to: vertical and horizontal reference point (BM), direction and Parcel 1. 0 2 - 10 9 - 50 - 000
pe ope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Review by Date
I 1 / _
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 9
Property Owner Property Location •
ANDREW M. & RUTH TOLLEFSON(Buyers:Kevin&Crystal) Govt. Lot NE 1/4 N W/114 S T/29 N R 16 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or M#
2329 80th Avenue
City State Zip Code Phone Number ity village ■ Town Nearest Road
Baldwin, WI 54002 ( 715 ) 760 - 1712 80th Avenue
New Construction UseG Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
0 Replacement 0 Public or commercial - Describe:
Parent material loess over till Flood Plain elevation if applicable NA ft.
General comments Mound System 1.17 ft. sand fill 0.6 loading rate
and recommendations:
F] Boring # ® Boring
ID Pit Ground surface elev. 97.59 ft. Depth to limiting factor 23 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 7.5YR2,5/2 sil 2fgr&abk mfr cs 2vf-m 0.6 0.8
2 10-19 7.5YR3/4 - sl 2fsbk mvfr cs Ivf-f 0.6 1.0
3 19-23 7.5YR3/4 - A 1 fsbk mvfr cs 1 of--f 0.4 0.7
4 23-30 7.5YR3/4 QfIOYR4/6&IOYR6n scl Om mf 0.0 0.0
2 ] Boring # ® Boring 92.59 22
F
• 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/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 7.5YR2.5/2 sil 2fgr&abk mfr cs 2vf-m 0.6 0.8
2 9-14 7.5YR3/4 - sl 2fsbk mvfr cs lvf--m 0.6 1.0
3 14-19 7.5YR3/4 A 1 fsbk mvfr cs 1of-f 0.4 0.7
4 19-22 7.5YR3/4 scl 1 fsbk mfr cs I vf-f 0.2 0.3
5 22-26 7.5YR3/4 f2fl0YR4/6&10YR6/2 scl Om mfi 0.0 0.0
* Effluent #1 = BOD > 30.< 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) CST Number
MARY JO HUPPERT Hollister's Soil Testin &Desi n 77&16/1 e 224832
Address Date Eval n Conducted Telephone Number
28497 King Arthur's Court, Danbury, WI 54830 06 - 30 - 2017 715-426-1775
SBD-8330 (R07/13)
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