HomeMy WebLinkAbout034-1072-40-150
sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
afety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 597480
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:
Adam Oakland TOWN OF SPRINGFIELD 034-1072-40-150
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
~111n \ 32.29.15.485D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 3, gZ S
Alt. BM l
L4 lc,~_ - :3r Lk
Aeration -
fHdg-. Sewer r r,
3
HofdingSt/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom ~y
/ r
Dosing Header/Man.
Aeration Dist. Pipe
lot, Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade ' 0 l -
Manufacturer Demand St Cover F-TT
GPM
Model Number
TDH Lift// Friction Loss System ~jead_ TDH Ft
Forcemain Length Dia. Dist, to Well f
SOIL ABSORPTION SYSTEM 1Q1 • Z.
d~ Sww
BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits nside Dia. iquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR
Type Of System: UNIT
Model Number:
IL
DISTRIBUTION SYSTEM
Header/Manifold Distribution ix Hole Size ix Hole Spacing Vent to Air Intake
t~ Pipe(s) cr- n / ves
Lengthy Dia " Length.~ Dia Spacing
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 i'
Bed/Trench Center 4 Bed/Trench Edges - Topsoil
} Yes Noes L No
A
COMMENTS: (Inc d5e ode discreppencies, persons present, etc.) Inspection #1: 16~/D / 7 Inspection #
2a0 l~
Locati C W /f - -
'
1.) Alt BM Description = 0/6 L-
2.) Bldg sewer length
-amount of cover
Plan revision Required? [1 Yes _ No -
Use other side for additional information. I AI V~
Date Insepctor's Signatur Cert. No.
SBD-6710 (R.3/97)
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County -N -Roo - o?S3
Safety and Buildings Division ST CROIX
b I;€ AUG Q 201 ] 201 W. Wa gton Ave., P.O. Box 7162 Sanitan Permit Number (to be tilled in by Co.)
Mad 3707162
CRQD VEu~ C93g ~q~ Li ~ V
~-'~MUNITY DEVELOPMENT. 1VFN81rState Transaction Number
Sanitary Permit Application OS~j
In accordance with SPS 383.21(2). Wis. Adm. Code, submission of this form to the appropriate gowintri -a} unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-ovamed POWTS are submitted to Project Address (ifdifferent than mailing address)
the Department of Safety and Professional Servies. Personal information you provide mac be used for secondary
purposes in accordance with the Privacy Lasv, s- 15.04(1)(m). Stats.
290 TH STREET
L A lication Information - Please Print :UI Mr
Property Owner's Name Parcel # ADAM AND TIFFANY OAKLAND 034-1072-40-150
Property Owner's Mailing Address Propert} Location
1801 TRILLIUM WAY Govt Lot 3
City- State Zip Code Phone Number SE y,_ NE y, Section 32
HUDSON 54016 651-235-6093 15(circleone)
T 29 N: R E or WX
11. Type of Building (check all that apply) Lot #
Q(I or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name
S~ Block #
❑ Public/Commercial - Describe Use At e
❑ City of
CSM Nr[mbe ❑ Village of
❑ State Owned -Describe Use
I ~y !~p [3Townof SPRINGFIEL lv ON
111. Type o/~ heck only one box on line A. G plete line 6 if applicable)
A.
New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Onl\ ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumher Permit Transfer to New List Precious Permit Number and Date Issued
❑
Before Expiration Owner t i''l f: II
IV. Ty e ofP 0\V-FS System/Com onent/Device: (Check all that apply) to►~
El Non-Pressurized In-Ground [I Pressurized In-Ground ❑ At-Grade El Mound > 24 in of suit e soil Mound < 24 in of suitable sot
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/TreatmentArea Information:
Design Flow d) Design Soil App ate(gpdst) Dispersal Area quired (sf) Dispersal Area roposed =(0)".
450 5 licatio 450 00 450
11-741 8. poi
V1.'Fank Info Capacit} in f tal # of Manuf cturer
Gallons Gallons Units n
L
Ne~+ Tanks Existing Tanks ` J L 2
r r r i C' Z
Septic or Holding Tank x 1000 1 WIESER X
Dosing Chamber X 600 1 WIESER X
N'l 1. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the PONN TS shoes n on the attached plans.
Plumber's Namc (Print) Plumber's Signature MP/MPRS Number Business Phone Number
PAUL R KOE R 225410 715-246-2660
Plumber's Address (Street. Cite, State, Zip Code)
321 WISCONSIN AVE NEW RICHMOND WI
Vill. County/Dc artment ['se Onhmed ❑ Disapp Penni~ Date Issued Issuing Agent Signatu
$ GG
caner en Reason ,al
IX. Conditions of Approval/Reasons for Disapproval /S/1 ~,`~-Ion C
SYSTEM OWNER: 3~ IIII . J-f s #AVV*I'l
1. Septic tank, effluent filter and p~'tf -4 J `I'N
dispersal cell must be serviced / maintained Pau /J
he regwj A-
as per management plan provided by plumber. '7, QPCG/1flQL "d1'~ ~J"IlrJl
ttach o S ns
ete i a or a s}s en and submit to the Coun only on 1ra1ter t l It es a 8 1/2 z 11 inc si
as per applicat te coc5eyordmahces. 0f)AU- 01 Ot 11~/
)000V sift COMA f Jfi&- I St0e Nom: 6#1 p/s1--Prwn.
sJ 8 (R. PI Ouwl ~'f ( `
5. COrt &~i' !n L11p - 2p1 7- 0'fl " 1~ /
S c d.~vf 1
~~tiP~T-+rF~T DIVISION OF INDUSTRY SERVICES
0 3824 CREEKSIDE LN
HOLMEN WI 54636-9466
3 S a Contact Through Relay
http://dsps.wi.gov/programs/industry-services
P S
'y~ `mow www,wisconsin.gov
sror+NtiSw Scott.Walker, Governor
Laura Gutierrez, Secretary
1
August 03, 2017
CUST ID No. 225410 ATTN: POWTS Inspector
PAUL R KOEHLER ZONING OFFICE
COUNTRYSIDE PLUMBING & HEATING INC ST CROIX COUNTY SPIA
321 WISCONSIN DR 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/03/2019
SITE: Identification Numbers
Adam Oakland Transaction ID No. 2975651
290TH Street Site ID No. 840612
Town of Springfield Please refer to both identification numbers,
St Croix County above, in all correspondence with the agency.
SE1/4, NE1/4, S32, T29N, R15W
FOR:
Description: Three Bedroom Mound System \ Sloping site
Object Type: POWTS Component Manual Regulated Object ID No.: 1717616
Maintenance required; 450 GPD Flow rate; 13 in Soil minimum depth to limiting factor from original grade
System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution
Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R 10/12); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code CONDITI
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 SA
stats. PROFESSIONA
The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF INDLI
Reminders
• A sanitary permit must be obtained from the county where this project is located in accordance with the
0
requirements of Sec. 145.19, Wis. Stats. 17P, co l'i"
• 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.
• All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant.
• 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.
PAUL R KOEHLER Page 2 8/3/2017
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS
occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
rard M Swim When You Receive That Invoice,
POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your
(608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal.
jerry.swim@wisconsin.gov WiSMART code: 7633
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
l
EZflow® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application;
INDEX AND TITLE PAGE
Y SERVICES
Project Name: ADAM AND TIFFANY OAKLAND
Owner's Name: ADAM AND TIFFANY OAKLAND
Owner's Address:
HUDSON WI
Legal Description: SE1/4NE1/4S32T29R15W
Township: SPRINGFIELD
County: ST CROIX
Subdivision Name: VOL 18 PG. 4832 'NALLY
VLU
Lot Number: 3 Block Number: CSM °ETY AND
SERVICES
Parcel I.D. Number: 034-1072-40-150 TRY SERVICE
Plan Transaction No.:
Page 1 Index and title ~
Page 2 Data entry
Page 3 EZflow mound drawings
Page 4 Lateral and dose tank
Page 5 Distribution media
Page 6 System maintenance specifications
Page 7 Management and contingency plan
Page 8 Pump curve and specifications
Page 9 PLOT PLAN
Page 10 PLOT PLAN OF LOT
Page 11 SEPTIC TANK CROSS SECTION
Page 12 SOIL TEST
Designer: PAUL KOEHLER License Number: MP 225410
Date: 07/11/17 Phone Number: 7152462660
Signature:
Designed Pursuant to the
EZflow Mound Component Manual Ver. August 20, 2007,
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)
EZflow Mound Version 3.0 (R. 3/1/12) Page 1 of
Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
(r or c) r Residential or Commercial Design
300.00 Estimated Wastewater Flow (gpd)
1.50 Peaking Factor (e.g. 1.5 = 150%)
450.00 Design Flow (gpd)
6.00 Site Slope
98.00 Installation Contour Line Elevation (ft) 110.00 Contour Length Available (ft)
13.00 Depth to Limiting Factor (in)
0.50 In-situ Soil Application Rate (gpd/ft2)
Distribution Cell Information
9.00 Cell Width (ft) 3, 4, 5, 6, 7, 8, 9 or 10 Only 50.00 = 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
3 Lateral Spacing (ft) If N above, enter the elevation (ft)
3 Number of Laterals of the highest point.
0.125 Orifice Diameter (in) (e.g. 0.25)
3.00 Estimated Orifice Spacing (ft) = 8.82 ft2/orifice
2.00 Forcemain Diameter (in)
40.00 Forcemain Length (ft) Does the forcemain drain back? y
94.00 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)
5.63 Vertical Lift (ft) 66.72 5x Void Volume (gal)
„a 0.40 Friction Loss (ft) 73.25 Minimum Dose Volume (gal)
12.53 Total Dynamic Head (ft) 21.01 System Demand (gpm)
`.J 9
Lateral Diameter Selection Manifold Diameter Selection
in. dia. ' options choice in. dia. options choice
0.75 1.25 x
1.00 x 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)
Weiser Concrete Manufacturer gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
600.00 Dose Tank Capacity (gal) POLY LOCK Filter Manufacturer
11.82 Dose Tank Volume (gal/in) 525 Filter Model Number
Weiser Concrete Manufacturer
Project: ADAM AND TIFFANY OAKLAND Page 2 of 12
Mound Plan View
T
1/10 B 3 J
Observation Pipe . .
K 5 S
1 A
5
W ; B I -
I
Q........
• L
Mound Component Dimensions
A 9.00 ft E 29.48 in H [Aft ft K 12.56 ft
B 50.00 ft F 12.00 in I ft L 75.12 ft
D 23.00 in G 0.50 ft J W 32.16 ft
450.00 (ftz) Dispersal Cell Area 1173.78 (ftz) Basal Area Available
9.00 (gpd/ft) Linear Loading Rate 5.00 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
EZf/ow Dispersal Area
Finished Grade 101.92 (ft) 10z i15MR!
..riirrriinF.° • H
G 1
7 7
F t Dispersal Cell 100.42 (ft) Lateral
99.92 (ft)--► 6" - • ' Invert Elevation
Dispersal Cell
Elevation. i ED
4 { : `l Y
98.00 (ft) Contour Elevation
6.0 % Site Slope
Typical Dispersal Cell
Shading Key T See Page 5
Topsoil Cap > a) a.
Subsoil Cap a V ';a o o = Approved Geotextile Fabric Cover
1 #
3 0 ASTM C33 Sand 0 ° 2.0 ft
®i : Tilled Layer o
F
050 EZflow Media c U
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: ADAM AND TIFFANY OAKLAND Page 3 of 12
End Connection Lateral Layout Diagram
Place Appropriate Lateral Dia ram From Ri ht Below
4D= Turn -u p vn' b31I valve or cl as n out pl u o
P
> identical, with ortkes equalfy sped.
-Z - 1 st orificEEE
Forre main connexi
Laterai> & force main of PVC Sch 4u
per SPS Table 384.30-5
Orifices point up except every stt~ one points do~Arn for drainage.
Number of Laterals 3 Orifice Diameter 0.125 in
Lateral Diameter 1.50 in Orifice Spacing (X) 3.03 ft
Lateral Length (P) 49.24 ft Orifices per Lateral 17
Lateral End (Z) 0,76 ft Orifice Density 8.82 ftz/orifice
Lateral Spacing (S) 3.00 ft Manifold Length 6.00 ft
Lateral Flow Rate 7.00 gpm Manifold Diameter 1.50 in
System Flow Rate 21.01 gpm Forcemain Velocity 2.15 ft/sec
Dose Tank Information docking cover with Warr ng
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 E Alternate outlet
location
Forcemain diameter
Weiser Concrete Manufacturer 2 in.
Capacity 600.00 Gallons T
Volume 11.82 gal/inch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 33.06 390.82
B 2.00 23.64 C Pump off elevation (ft)
C 6.20 73.25 94.79
D 9.50 112.29 D
Total 50.76 600.00
Dose ank elevation (ft)
Bedding And Backfll As Per Manufacturer 94.00
Alarm Manufacturer SJ RHOMBUS
Alarm Model Number PS PATROL
Pump Manufacturer GOULDSIV
Pump Model Number weo5 I
Pump Must Deliver 21.01 gpm at 12.53 ft TDH
Note: Switches containing mercury may not be used in this system.
Project: ADAM AND TIFFANY OAKLAND Page 4 of 12
EZf/owe Distribution Cell Media Layout
9.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft)
Distribution Cell Cross-section Arrangements
9 ft Wide
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 1201 P or @IXD SR3-12H in 5 ft or 10 ft lengths
o 4" Perforated Distribution Pipe With Pressure Lateral Inside
• Turnup Enclosure - - - - - Pressure Lateral
Bundles are covered with approved geotextile fabric as per the their product approval.
Distribution Cell Plan View Layout - Typical
9.00 Cell Width - A (ft) 50.00 Cell Length - B (ft)
Center Connection Later' ' -'ram
Force Main ~i
End
04 - ftWide
Manifold
Project: ADAM AND TIFFANY OAKLAND Page 5 of 12
Wastewater I
METERS FEET
10 ' ; 1 I
9 s
30 I -►~-4- 5 GPM I
i !
t
25 ` I 2.5 FT
°a 7
I
= E i
U 6 20 i I
a - - !
Z 5 i T - - - - -
J {
---1- r
EPO
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3 10 i
i
2 - - - EP04 - - - - - - -
5 i
k
1 1 ~ f E G I
i
0 10 20 30 40 50 GPM
I I I I I
0 2 4 f V, 6 8 10 12 m3/h
CAPACITY
MODEL INFORMATION
Minimum Minimum Minimum Minimum Maximum Shipping
Order No. HP Volts Amps Circuit Phase Float Switch Cord Discharge On Off Basin Solids Weight
Breaker Style Length Connection Level Level Diameter Size Ibs/k
EP0411 Plug /
No Switch 10' l Yz" Manual Manual k1155 20 / 9.1
EP041 1A Piggyback / 10' 1 Yz" 12" b" 21 / 9.5
115 12 20 Wide-Angle
EP0411 F Plug /
No Switch 20' 1'/z" Manual Manual 20 / 9.1
.4
EP0411 AC Piggyback
Wide-Angle / 20' 1'/z" 12" 6" 21 / 9.5
EP0412 Plug /
1 No Switch 10' 1'/z" Manual Manual 15" 3/a" 20 / 9.1
230 6 10
EP0412F Plug /
No Switch 20' 1'/z" Manual Manual 15" 20 / 9.1
EP0511 F Plug /
115 13 20 No Switch 20' 1 Yz" Manual Manual 15" 22 / 10
EP0511AC .5 Piggyback/
Wide-Angle 20 1'/z" 12" b" 15" 23 / 10.4
EP0512F 230 6.5 10 Plug /
No Switch 20' 1 %z" Manual Manual 15" 22 / 10
Por.~ ei
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- 41.
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Mound System Maintenance and Operation Specifications
Service Provider's Name DARRELS SEPTIC Phone 7154251025
POWTS Regulator's Name PAUL KOEHLER Phone 7152462660
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 Inspect and clean as necessary at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test periodical)
Pressure System Laterals should be flushed and pressure tested eve 3 ears
Mound Inspect for pondin and seepage once eve 3 ears
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap
and are secured in as shown in the EZflow Mound Component Manual Ver. August 20, 2007.
2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component
Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric.
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn-up Detail
Finished Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Lateral Ends at Last Orifice Where
Variable Length Cleanout Begins
Long Sweep 90 or Two
45 De ree Bends Same
Diame er as Lateral
EZflow Synthetic Media
2.02 Feet
- Distribution Lateral --*14 Lateral Cleanout
Project: ADAM AND TIFFANY OAKLAND Page 6 of 12
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 [EZf/ow Mound Component Manual 8/20/07, Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) and
SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting.
Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer
used as POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening 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 as to
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if 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 shall be tested to verify proper
operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. If the force main has a weep hole, it
should be 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) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the
mound be heavily mulched as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent 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 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 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 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 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: ADAM AND TIFFANY OAKLAND Page 7 of 12
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of '2-
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ADAM AND TIFFANY OAKLAND Septic Tank Capacity 1000 gal ❑ NA
Permit #
11 Septic Tank Manufacturer WIESER ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer POLY LOCK ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model 525 ❑ NA
Number of Public Facility Units E)(NAA Pump Tank Capacity 600 gal ❑ NA
Estimated flow (average) 300 gal/day Pump Tank Manufacturer WIESER ❑ NA
Design flow (peak), (Estimated x 1 .5) ! 450 gal/day Pump Manufacturer GOULDS ❑ NA
Soil Application Rate .5 gal/day/ft2 Pump Model WE05 ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand +(BOD:~:~~~ mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solidmg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality ly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand g/L ❑ In Ground (gravity) El In -Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade E ( Mound
Fecal Coliform (geometric mean) <10' cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size %e in dia. ❑ NA Other: ❑ NA
Other:
❑ NA Other:
❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event I Service Frequency
Inspect condition of tank(s) At least once every: 3 El month(s) (Maximum 3 years) El NA
ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: 3 X ❑ month(s) (Maximum 3 years) [I NA
year(s)
Clean effluent filter At least once every: ❑ month(s)
1 • E3 year(s) ❑ NA
Inspect pump, pump controls & alarm I At least once every: 3 Rjnonth(s)
❑ NA
L-Yyear(s)
onth(s
Flush laterals and pressure test ( At least once every: AS NEE64a
r(s) ) ❑ NA
Other: ❑ month(s)
At least once every: ❑ ❑ NA
year(s)
Other:
~ ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION Page 7i of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in PO"7S
technology a holding tank may be installed as a last resort to replace the failed POWTS.
T
aluati a o dmg~ank
be i e aie ~DffI~TT~ I-D2lJ6, J Carv57')ZC1~tt~
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name L Name
r~ d r Lo
Phone Phone '75'°-
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name .~✓.~~i .;fit. f Name SS'. U ( C~U(J 20A~11
Phone yZ Phone -715- 3E~0- 41(a ID
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(11, (2) & (3), Wisconsin Administrative Code.
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RECEIVED
ST. CROIX COUNTY
AUG 0 8 2011 SEPTIC TANK MAINTENANCE AGREEMENT
ST. CROIX COUNTY AND
,OMMUNITY DEVELOPMENT OWNERSHIP CERTIFICATION FORM
Owner/Buyer ADAM AND TIFFANY OAKLAND
Mailing Address rl /~/Vim Y V lam/ l~ elseyl I ✓ / ~l
Pro#r~Oys~aress 290TH STREET TOWN OF SPRING FIELD t;u
(Verification required from Planning & Zoning Department for new construction.)
City/State WOODVILLE WI Parcel Identification Number 034-1 072-40-1 50
LEGAL DESCRIPTION
Property Location SE ,4 NE 4 sec. 32 T 29 N R 15 W, Town of SPRINGFIELD
Subdivision Plat: Lot #
Certified Survey Map # :?t 77S7 7 Volume C/ Page #
Warranty Deed # T~ lj~qqLO&b (before 2007)Volume Page #
Spec house ❑yes(Dlo Lot lines identifiable ❑yes❑ no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of ptnnping 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 ASPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I ) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources.
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of arranty deed recorded in Register of Deeds Office.
Numbe of b ie~oms
8/8/ 17
SIGNATURE OF APPLIC T(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
Wisoonsin Dep"a erce SOIL EVALUATION REPORT
~J Page of
Division of Safety an moldings
in accordance with Comm 85, Wis. Adm. Code (C~ 7 v
. O .
Attach complete site pldn on paper not less than 8 1/2 x 11 inches in size. Plan must County 4Z;
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. C D O 7~- Y~
percjnt slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Rev b Date
PersAaLiwfiikion you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 y
Property Owner Property Location
t 41r, i Yl2 r Govt. Lot 1/4,' - 1/4 S T ! N R E (o W
r
Property Owner's Mailing Address Lot # Block # Subd. Name or CSNW
~''u ~~t~ / 5,.302
City State Zip Code Phone Number ❑ City ❑ Village Town *"Nearest Road
New Construction Use:I Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material ! \ \ Flood Plain elevation if applicable ft.
General comments
and recommendations: - ;
f bU , t~ D r
Boring # Boring Q L
Pit Ground surface elev. U 19 ;~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
rl _ a FS %K o , a a
a
6- I3 3o yR 7i~
3 LaS
FI F 7,5
°y t I r1
{ Q
Boring # ❑ Boring lit
1-771, Pit Ground surface elev. I Z) ft. Depth to limiting factor in.
Soil Application Rate
A 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
E }cyR.i
14 SIR 1 _ SL F M m h ~'r,~ ; , S
I _
L4
t1
' a~, SO fi `'I`I L
' 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) SignaturA CST Number
I j r. ,
Address ` ate Evaluation Conducted Telephone Number
L
~i
Property Owner :S t e ' , ~ Parcel ID # Page of
Boring # ❑ Boring
P' pit Ground surface elev. 9 1, --7 S 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
M
6-!?~ UyR a L- t!'Sr rnF C NA
Rff S(;Aks YV)FR W F
3 11.)1 `lsgp'51 l FIFSv/P, 0Z " IS
r 1, H~, A~ 6A S 121, tFn ► _ ► c.
EJ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
17 Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ pit
Soil ligtion 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
• Effluent #1 = BODS > 30:< 220 mg/L and TSS >30:S 150 mg/L ` Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00)
Property Owner S i1 r Parcel ID # Page of
Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor ! in.
Soil lication 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
-13 G ` jram" f ar F• E~ !ti^ F 1 1 t^. r~
-lap 5 t-`4 54/
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
it
I
i
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00)
3 7S
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Site Plan Form
I-Croix n
Name:
Property
l4-
1810 Crest View Drive, Suite #1C Address: aPc99 GS J z
Hudson, WI 54016 SGn~i ~,e~~~ I • w~ S^~jo~
715-377-2152
N
w
(v~rj v n c~
l
7
.550
I certify that the above Site Plan is a true representation of this lot and accurately shows all dimensions, easements, and
proposed and existing structures on said lot. Any eviction from this approved Site Plan may void the Permit.
Signature of Owner/Builder or Contractor: AV, Date: l 3 0 o ( 7
I 4 i i s I I
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