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HomeMy WebLinkAbout006-1019-20-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 597463 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: Heather Greene TOWN OF CYLON 006-1019-20-100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: / i?M I G5) 09.31.16.119A-10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER, CAPACITY STATION BS HI FS ELEV. r Septic S Benchmark ~C1 ~G cJ ~ ~ • t /13DZ~ ✓ 2 , r~ ~ ~ti Dosing ~ vw10j~ ~ ~ Alt. BM Aeration ~ btJ~. l u ~ 3 Y~• ~ t~.~ 1 Bldg. Sewer 5-7 19 Holding St/Ht Inlet /l1. 1 TANK SETBACK INFORMATION St/Ht Outlet TANK TO WELL BLDG. Vent to 'r intake ROAD Dt Inlet o I Septic 75- I25 Dt Bottom /3-77 -z Dosing 75 / ( -75 Header/Man. 7 7 09 Aeration Dist. Pipe Holding - Bot. System PUMP/SIPHON INFORMATION Final Grade ! Manufacturer Demand • ~ d • ~ / ~a , St Cover GPM ~r1~4^ Model Number -1A 91T TDH 1-it I ~ Friction Los& System H d~S TDH 61 Forcemain Len th Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of~irenche PIT DIMENSIONS No. Of Pits Inside Dial Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type stem: UNIT Izr Model Number: DISTRIBUTION SYSTEM on Header/Manifold/ TDistnbut' x Hole Siz x Hole Spacing Ve t Air Int pe(s) 7~ Length Dia ngth Dia Spacing ~13Z J SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Cc Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center /-(01 Bed/Trench Edges Topsoil !cz~__ No •+cq~ No COMMENTS: (Include code discrepencies, p rson~sypre ent, etc.) Inspection #1: °f r l - 1 , Inspection #2- W 11 / / Location: 2263 CTY RD H 41J ne W, 1.) Alt BM Description= F t L-" 66 J y 2.) Bldg sewer length = 33 - amount of cover c.(IG JS ~ Plan revision Required? ❑ Yes No Use other side for additional information. _I Z_ L%_11 - - V SBD-6710 (R.3/97) Date Insepctor's Sign ure Cert. No. v / F,,-Il( {.tt Safety and Buildings Division ty ~y~~ 71s coup t i 201 W. Washm ton Ave., P.O. Box 7162 V~ G ~~25 Y f l p11 g Sanitary Permit Number (to be filled in by Co.) ~ r~ d Madison, WI,5370a-716? - CpUNN ~ _ T. cRa ~oPME . g2F ~P G 59 74 (03 anitary Permit. Z8VQA'Y State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submissi, we appropriate governmental unit 7 ' 3 is required prior to obtaining a sanitary permit. Note: Application rotms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary / purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. Zo3 iL.J} 1. Application Information - Please Print All Infor a I G Property Ow er's Name Parcel # V -e -e 0 Property Owner's Mail' g Address Property Location 3 09.31. i~. i►9fl~i City, State Zi Code Govt. Lot P Phone Number ''/a, % G , Section ~C~>v:' ✓ 11 ~iEi~ l ~~GCJ l0/ Z T-31 N; R~~_~(circle E or(~ If. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling- Number of Bedr s 1. Subdivision Name Block # ❑ Public/Cormnercial-Describe Use Q(~. ❑ City of ❑ State Owned -Describe Use CSM Number ❑ Village of k' 75 . Z - 53~~ 49 Town of ~C6",7 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System AReplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing Systein (explain) B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade AE (Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ~ersal/Treatment Area Information: Design Plow (gpd) Design Soil Application (gpdsf I Dispersal Area Required (s Dispersal Area Prop d (so System Elevation V /0 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units H o b Q New Tanks Existing Tanks n U ti a U r w C7 a. Se ti r Holding Tank Dosing Chamber & / G 6v VII. Responsibility Statement- I, 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 >J ~2 Plumber's Address (Street, City, State, Zi Code) SZ %6 S % 21h -Vo0 7 VIII. un /De artment use 0111 pproved sappro Permit Fee Date ~ssueed/ Issuing nt Signature . n Reason for De 1 $ ' IJ J u IX. Conditi easons for Disapproval 1. : tank; etMtAm lifter t+t>,i ..~py~ 6 alsper.-., cell must all be p! o /ia a iu.nbe . as per .ar,ayemen' plan pro ~iaeti b by ptwnber. G.!'~ I Al.~lltid'~". 2. AD-Sf. Yjf K rPCUFemems must to mai tiir;E'j n / as per ppiimbl= c~or',.= / ..rrf,nant; 1 .1 66,tach to complete plans for the system and sub to the County only on er not fss than 8 4b 6, At Q l/a x 11 inches in size SBD-6398 (R. 11/11) M1 it - G _.il 1 ~t tjl (?r f 11 u I f I I t I r~i r t. + ~ 4 h I ~ - n~ aH, p r w ~ t I 1~ J 1 tL t~f P' 'Yl II ~~h JI a S M1~ ,~E»u a• i , S P b t ~I r^ ~r ' I v. - Y{'i' ('r t ~ f-~d I 1. 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E ~ ! u a ~ _ 4 a PL ' I 1 t I li t 1^. ~,mp ,~rp"• § C J t ip li'~ I' 9Jii, F` I 4L I I I r I I , f f, J I t a ~ I I 9 w u I 9 If _ _ -.II II 'L I 5 J I ' J IF x' I I y 4 ~I 1 I I n I r n~ ~f r i !t 1 Y II j S I r Ili I ° i F ~ II J ' S ~ Ck~r 1~lit ' - - Iy~ w .p j r, 9t ~ J I I- - I I I, 7-7 ~1+~a ' y I A 4 F I - I ~ JI - _ ' - +r i ' tlti' n I 1 I I ~ I, 1L - ~i ' f J I _ .f -i~'--• x Il. P I A~' ;L__._...II a,:-. ~ sl.__-IF- 1 k i 1LF ~u ~ j iL,Y, I - f r a 1 44 f Iry 1 I J I I I r'~ J II I Y I I 1 t r _ II r ~ u , I-- - ~fI' w p d } _ J I'. _J i i`;>axr:1E DIVISION OF INDUSTRY SERVICES o - 10541 N RANCH RD HAYWARD WI 54843-6462 Q X11 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov \°Fb si~ti tij Scott Walker, Governor Laura Guti6rrez, Secretary August 22, 2017 CUST ID No. 221471 ATTN. POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SP1A 352 140TH ST 1101 CARMICHAEL RD AMERY WI 54001-2840 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/22/2019 Identification Numbers Transaction ID No. 2973372 SITE: Site ID No. 840367 Heather Greene Please refer to both identification numbers, 2263 CTH H above, in all correspondence with the agency. Town of Cylon St Croix County NW1/4,NEI/4, S9, T3 IN, R16W FOR: i.: Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1716418 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from h~ original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/O1, R. 10/12), Pressure r _ Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; Effluent Filter 14 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: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384. • The existing POWTS must be properly abandoned per s. SPS 3 83.33 Wis. Adm. Code. DENNIS J GILLS Page 2 8/22/1017 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 lation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am 'To 4:30 pm DENNIS J GILLS Paee 2 8/22/2017 A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@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 FCF JUL 0 7 201? Project Name: HEATHER GREENE iN~US~~Y SERVICF~_ Owner's Name: HEATHER GREENE Owner's Address: 24 CTY RD H DEER PARK WI Legal Description: NW NE S9 T 31 NR 16 W Township: CYLON County: ST. CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 006-1019020400 Plan Transaction No.: Page 1 Index and title { Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Pagel Pu p curve pd specifications i'FSi'ONLEN C1 ~LTdr S,p~ r . Designer: DENNIS GILLE License Number: 221471 Date: 07/06/17 Phone Number: 715-268-6637 Signature: z - Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 10/12), 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 7 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 sail treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 450.00 Design Flow (gpd) 5.00 Site Slope 97.70 Contour Line Elevation (ft) 24.0 Depth to Limiting Factor (in) 0 In-situ Soil Application Rate (gpd/ft2) Check maximum soil application n Distri tion Cell Information 75.00, Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1. 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) C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 41 Number of Laterals of the highest point. E-~ 0.156 Orifice Diameter (in) 2.00i Estimated Orifice Spacing (ft) = 6.25 ft2/orifice 2.001 Forcemain Diameter (in) 1 125.00 Forcemain Length (ft) Does the forcemain drain back? ~ 88.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 20.39 Forcemain Drainback (gal) 10.70 Vertical Lift (ft) 67.44 5x Void Volume (gal) 3.89 Friction Loss (ft) 87.83 Minimum Dose Volume (gal) 0.001 In-line Filter Loss (ft) 38.77 System Demand (gpm) 19.14 Total Dynamic Head (ft) Z~ 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 x 2.00 1.50 x # x 3.00 2.00 x 3.00 x { Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) huffcutt Manufacturer ff-I gallin (enter result in cell 849) Dose Tank Information Effluent Filter Information 60000 00 Dose Tank Capacity (gal) POLYLOK - Filter Manufacturer 9 Dose Tank Volume (gal/in)PL525 Filter Model Number huffcutt Manufacturer Project: Page 2 of 7 Mound Plan and Cross Section Views 1/10 B': J Observation Pipe - K a A WB I -40 L Mound Component Dimensions A A12.00 ft E 15.60 in H 1.00 ft K 8.83 ft B ft F 9.50 in I 9.15 ft L 92.65 ft D in G 0.50 ft J 5.98ft W 21-13 ft 450.00 (ft2) Dispersal Cell Area 1136.03 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement 01 Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.49 (ft) -----"t t . lfflJJJ..'J/ Lf1lll!!/ f'f!!!i r; F Dispersal Cell 99.20 (ft) Lateral 98.70 (ft)---lb. Invert Dispersal Cell] Elevation F D L 3 r> 97.70 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key Q Dispersal Cell See lateral details on Q Topsoil Cap o 1.5 ft Page 4 for number, Subsoil Cap 0, _a Q size, and spacing of © ASTM C33 Sand t4`- laterals. Laterals are m 0.5 ft Typical Lateral F equally spaced from the Tilled Layer 1 , Aggregate o Q o distribution cell's centerline in the A distribution cell (AxB). Project: Page 3 of 7 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at arty point, Laterals are identical T ~F P S A/L O-Turn-up v0bsllv;3 luror Laterals Morcemain acts 40 PVC clraanauttrlu~ {per SPS Table 384.30-5, Holes drifted on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.10 ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 3.00 ft Orifice Density 6.25 ft2/orifice Lateral Flow Rate 9.69 gpm Manifold Length 3.00 ft System Flow Rate 38.77 gpm Manifold Diameter 1.50 in Total Dynamic Head 19.14 ft Forcemain Velocity 3.96 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter huffcutt Manufacturer 2 in. Capacity 600.00 Gallons Volume 15.96 gal/inch A Weep hole or anti- Dimensia inches Gallons g x siphon device A 24.09 384.49 B 2.00 31.92 C Pump off elevation (ft) C 5.50 87.83 ___j_ 88.50 D 6.001 95.76 D Total 37.59 600.00 Dose tank elevation (ft) 3" Bedding un er tank. 88.00 Alarm ManuafacturerLEVEL ALARM Note: Switches Alarm Model NumberDVL containing mercury may not be used in Pump Manufacturer ZOELLER Pump Model Numbe N140 Pump Must Deliver 38.77 gpm at 19.14 ft TDH Project: Page 4 of 7 r Mound System Maintenance and Operation Specifications Service Provider's Name DENNIS GILLE Phone 715 268-6637 POWTS Regulator's Name ST . CROIX CTY ZONING Phon1_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 Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 3 ears Mound Inspect for pondinq and seepage once every 3 years .s ti€esMiscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturb-d areas ~'Afil! re seeded and mulched to p; event soil ~rrsion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade \Jo 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution _ Lon Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: HEATHER GREENE Page 5 of 7 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10112)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continqencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: HEATHER GREENE Page 6 of 7 PUMP Pa2FCJR R4CE Ll - --1 .TOTAL HEALYFLOW - ME140C)CL i4W--4140 PER MINUTE EFFl_UQfTAND D5Y7tTERthIG :a ad MODEL 140/4140 1, G F.eI Yo~>, OaC Ltn ~ I 5 13 66 326 \ I 1Q ].p 1 ]xPat - l d] 1ia 7 \ I 9.1 ICs z., Ii._\ !5 13.7 17 I G< K __1 - a,mu S-nA N He v' S3 P 5.2rn1 ~ 70 1s s n tm7 ,a _ 7 s ~ `I I~ ~ _ 1 ~ ! 10 2a uau c.r, _ P] +t 0.v Pf4 w,trTr CONSULT FACTORY FOR SPECIAL APPLICATIONS Electrical altemator,• for duplex systems, are available and supplied with an alarm. Mechanical alternators, for duplex systarns, are available with or without alarms- Con nI alarm syste msareavathlblefor I phase pumps used In simplm-system. I'wN~ See FM0732. Variable level control witches are avallaNa for ci:~rg16ng single phase sys- terns. Double Piggyback variable level float switches are available for variable level brig cycle controls. Sealed Qwik-BOX availilablo to outdoor instala6ori3See FM1420. Refer to FM0806 for applications above 130°F (54°C), --R+cttl~e 140(4140 MODELS SELECTION GUIDE Control Selection L For automatic, use single piggyaack variable level float switch or Model Model Volts-Ph Mode Amps Simplex Duple double 9Yback variable IevEl float switch. Refer to FM0477, N 140 N4140 pig 11.5 1 Non 12.0 1 or z 3 2- Sr,-P FM1228 for correct model of simplex control panel. E140 E4140 230 1 Non 6 0 3. See FM0712 for correct mode( of duplex control panel. 8N140 SN4140 115 1 or 2 3 1 auto 12.0 ` o C k-Jf On1 . BE140 BE4140 230 1 Auto M lnatAR6e or contro6, p!otectlw derl,es and' 1mr 6.0 I'M clecMclm Al decVkaf Mrld shm+ll i e dune by a the m : ified 'Single piggyback swit •"`n1 flatlo^nl Elccirlc Cooc and safer codas should be ralowcQ Inclujt,p the mos: Ch Included. (NEC) and ME Occupldonaf Safely and fkatih Act (OSf IAI. RESERVE POWEPED DESIGN For unusual conditiors a reserve safety factor is engineered into the deslgn of every Zo+;ller pump. Tuft co- Pci mar 16U7 • 1W M Xn CffW1»n FCo.d Ltm (~n.y7 d.. Kvw =asdtr corn I- an. L4tict~t• KY 4fj-1961 / L M r44 774x41 ll PIAGVS a~/YY ~i~c~c~ ® CoWlight W05 Zoettw Co. Aft rsghtc reserved. - 1 r a „ 14 a l l N! I~ I r s~ r I 1~ ~ I a I:I {I d n ~n, I ~L I hN I 1' L d A' ! j /ff a q _ d..... L..,,:I:• III _ . s f 1 ' w . d _ E C f 11 ~ N it ~I i~ Y ~ I II ~I I 1 6 II rI v 1 ~ H ~ ~ ) ~ I ~ h::,..,,'l ! 1 1i ~I I mmy h ~I.~ 1~ a ryl 7 ll.... A f d It I j! :n, ,1 .~ye,m gl.hn~,. I!m n,nl ! ~ II 1 I b tv; , ,1-II'• I l:.l;' ~im ~~.r qr til ~;I -n ,'7tt ne II pl4x 11 Y ° C I ' - Y I WTrn'i` r, liI II ..C p 1 7 .r a, II j M ili : wry it I n :w .r~ . nT .l ° ,r: .wary "y i I I' j I ) 1 f 1 ~r j I ~I ,9 .,;uy r,:W IL.~I-ro lil~.,: .:i,~l~: ,I n~l. nrr .Iran I atil~~:A~.. !I ,.nu.) F! . 111,1'„rl ' Ile, :,i lx r~m,,niCn„~~J~,IVfvne~rt~llYrln~u ~lxn.,: axml~l~.l. .n.am!,rw., ril ,.ua IL •nr !I P ~Ix ?I r r ~ t y Ali 1.11 11" } 1, ! YI If ? nfd. . m r a~ Imnr,nlro!~ ru^~ mm~.~'^xrnnx~}.,len m,~.,urv, a~y U ( i I dr<~I{J b y n! a i r u, I_ r f I f JI u I 1 ! Z .I II 41 l it II a j if a I !I ~ f • } ~1 1~ !y 1 G b' sa ~,I 1. B ! " II II ~ ¢ fl 1 [ I , v II ' ~ ~ 1 a te9 I I ~M1ts r P J! . 1 II 41 I I F P '1 I d l p!t ~hj _.1kfYI fit Ili. ..JL...__. u e! r I I Y I I (b* 1' n I I ~ +II !a } ! 'L. 1 It f I xy~ t }I Y i q y~ ^ns A ~dd r i_._,.• h In p,'{I I ~ I IF.. t i tI ~ f,_. d~ ss ' : a_,__ ( L._. ,._,1 II_._. ! 11 I. I 1 ! ,,rya! m ~ _ a~ If ' >V r I ,i~v~, A! I 1 I I ~ Y ~ r lit IWP)i ! } I 1 Y d f i 5 a r ~ ~y gyp{'' ! '11 a[P I I ...._,I I~ 1 1 ,,..fy w d M1I s~ 1! ¢ , T~ ' II r _ - J r I IL I~y'i~ 1 rl , p! I f~'rGl r d'- d to I" ~i 19, II F l IYi 1 f q II I 4~ P F ` _1I ~ + r I w I? L r ~ Ir .f I I G • I J ~ I~ 'I r•, 7 _ ItIc I!. _ y! It q 1! } I rI ` la ' ~t M m ^ I ~1 II l 0 I, I Z ' I J I rry 1 yy11 11 . " IC I };u, >a;~; I ~ r '"~S Il ~ m, ~ 1 X19 , d t^~~!f~ _ y a' _ _ . A , h L } 1 MI ~ J4 1 I , ~ ! I 1 I 15, ,I It J.. _ 4 y( h I Iy +4 1 f II II 1,.. IL... _ II i ~y_!.. II N~juT ! diYp4;d"I, M1^ „CI1 ~r~ rj ,999 1~ 1Aq II I, d, N.7. I { I I } 5., l ; II r wV y _ II j I ; i " II , I_.. I m a w , F S .I;.._. I' ! )I II I r~ INSTALLATION INSTRUCTIONS 8 Wusfcw~fer hwffdei~ u,"f""", Zf301, a PL-5251PL-625 FILTER INSTALLATION INSTRUCTIONS Center filter with opening ~r S A t4.~ I'!v.ft rr ~ ~ - l az w z ~S I' I ~r ® t d' Addf6onal pipe or ~4' r Polyiok Extend & Lok° for center Glue- Step 1: Step 2: Step 3: (A) Locate the oullet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge le properly alignod and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS F r- - y ~h•f~ ~ 7S i r t tep 1: Step 2: Step 3: )sate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back _ if necessary. into the the housing making sure (B) Pull the filter out of the housing. the filter is properly alighed (C) Hose off the filter over the septic tank and completely inserted. USE RUBBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover WHEN CLEANING FILTER septic tank. ST. CROIX COUNT' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buver Heather Greene . Mailing Address 2263 County Road H, Deer Park WI 54007 Property Address 2263 County Road H, Deer Park WI 54007 (Verification required front Planning & Zoning Department tier ne%v consiruction. ) City,'State Deer Park, WI Parcel Identification Number LEGAL DESCRIPTION Property Location Nal `4 ',/4, Sec. T N R ` Town of . Subdivision Plat- Lot Certified Surr=ey Map Volume Page ii Warrant) Deed (before 2007)Volume Page ii Spec houseOyeW60 Lot iinr idcnti SYSTEM MAINTENANCE AND OWNER CERTIFICATIW, Improper use and maintenance of your septic system could result in it,, maintenance consists of pumping out the septic tank every three years or sooner, iI ncccicd, by a licensed pumper. What the system can affect the function of the septic tank as a treatment stage in the waste disposal system. (honer maintenance respon,ibilities 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 mvner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the ou-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. L'w=c, 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 Count- 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. Ihve am/are the owner(s) of the pi opci tc described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 Digitally signed by Heather Greene Date: 2017.08.28 14:48:22 -05'00' SIGN ATU'RE OF APPLICANT(S) DATE ,Am- inl')Tiniatiun that is misrcpresernted may result in the Sill] tiff, permit heiu~- revoked by the Planning; ~L /on ii- 1epartment_ Include with this application a recorded warranty deed from the Repister of Deeds Office and a copy of the certified survey map if reference is oracle in the wirrauty eked (RED'. 04/12) LLI 1 L f 3 Ail- CSfi a~~7- 173 Wis. Dept. of Safety and Pro`es0iorip' ' vices p~ MfION REPORT Page ~ of Division of Safety and B,lildir,-- ' r"( _ w n~ v n accordance with SPS 385, Wi. Adm. Code a Q ~,11''(~, c. 201 1 County - {4 r VA Att 9vAw r,dper not less than 8 1/2 x 1 t~dD~e~iYsize. Plan must V!~ to: vertical and horizontal reference and r_ scale or dimensions, north arrow. and I Parcel I.D. ,``poin E~~~# road. Uh - Q / ~ ~,..5 -000, print all lnf$ t~p- - Revie ed by Date Personal information you provide may be used for secondary purposes (privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 11 Ar-~kVr t F)arr- oice- ~f V-f Govt. Lot t~W1/4_ 114 S I T3 N R E(orVV Property Owner's Mailing Address Lot # Block # Subd. Name rCSM# City Ark State Zip Code Phone Number ❑ City ❑ Village gTown Nearest Road V tC WY Oh Y71( ) C ❑ New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate ~f S © GPD ® Replacement b ❑ Public or commercial - Describe: ^ Parent material Flood Plain elevation if applicable ft. General comments ' and recommendations-, 3 4 N, I r f Boring # n Boring 111 III FI pit Ground surface elev. U,73 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 W-1 F5 1? W- ri F 61 v2 4 _ Y f y ® Boring # ❑ Boring Pit Ground surface elev. 2 3 ft. Depth to limiting factor - „ in.. Soil Application Rate Horizon Depth Dominant Color ::Redox Description ?exhtre Structure onsistence oundary Roots GPD/ft in. Munsell . Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 1 E r wt 4- < t it l l~ O 5 -In k t 1"1 r ILI ci i, } fFp y rj ' L~ S`P P- YA I 7.S Y ~ ' t ~ = 1 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) _ Signature CST Number Add41, a b p t k } ate Evaluation Conducted Telephone Number 3 t~ r SI D-8330(RII/I I) Property Owner ' 1"% Y" Parcel ID # Page of Boring # ❑ Boring i 1_- 1 Pit Ground surface elev. z Inc Depth to limiting factor C~S in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence boundary Roots GPD/ft in. Munsell tQu- Sz. Cont. Color Gr. Sz. Sh. ff#1 f(#2 6-L? ID P -1Q Ja A5A) . t 3 g a5. !v'~ Q Y~ r 5 ! e. i T J' 4 ~v' C._ 7.5 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ® Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 " Effluent #1 = BOD 30 < 220 mg/L and T SS =30 < 150 mg/1- " Effluent #2 = BOD 30 mg/L and TSS < 30 mg/L The Dept. of Safety- and Professional Services is an equal opportuni!-4service provider and employer. If YOU need assistance to access services or need material in an alternate formai:, comae[ the dep~x[ment at 608-266-3151 or TTY through Relay. sxu-g;?o rri ua i ~ I Property Owner M~ Boring El Boring Yp I ° Fit Ground Sill-race elev. -6 Dnpth to limiting factor ~ in. fSnil A Ircation Rate Horizon Depth Dominant Color I?edox Description I i=rtnre -t~trnctuie ,nnsrstence ounda Roots C C'D/fk in. Munsell -C)u_Sz. Cont. G'oloi - - - +.;r S;•• Sh. 1 =ff#2 - D v An~ E Boring # tD Boring pit Ground surface elev- f. Depth to limiting factor_ in. - - - _ Soil Application Rate I-101izon Depth Dominant Color Redox Description i , ;!rife Structure ~'.ons!stence nundary Ronts GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. - _PE#1 ff#2 E - Boring J# F-I Boring El Pit Ground surface elev. to limiting factor in, - ` - Sell Al?l2lication Rate Horizon Depth Dominant Color Rednx Description T ~r.ue ~~nrc.lure onslstenre oundary hoots GPD/ft ' in. Munsell flu S z, Cont Color I r S:_ Sh. =ff#1 ff#2 - - - - FfFluent I = BUD > 30 < 220 mg/L and TSS >30 < 1 -)o mcI/L_ FfFluen(#2 = BOD < 30 mg/Land TS, < 30 my/L -i-he DeN. of Snrc0y and Protc,siolml Sereiccs is an equ,il oppmturlity ,crvice provider and emplover. lfyorr need assistance. 10 r:rct,rss Scn ices nr uecd lmif'c.rial in an ,Ilicrnsdc fnrnl:.ii- conl;tcl the dcirrrlrnrul. ;ft 605-260-3151 or TTY' I:hrough Rcla}'. rnu-assn (rtr v; •~1