HomeMy WebLinkAbout024-1015-10-001
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 597460
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2980483
Permit Holder's Name: City Village Township Parcel Tax No:
JERI GROTHBEIG TOWN OF PLEASANT VALLEY 024-1015-10-001
CST BM Elev: Insp. BM Elev: BM Descriptio Section/Town/Range/Map No:
:'C HOOS., S dJ 09.28.17.81A-10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
1. ~O i& J C)
Septic Benchmark q /l/
T, IL 0 /0 ~ 10
7. /VV
Besm9 a, Alt. BM
Ag~ ` Bldg. Sewer
Holding SUHt Inlet fi
14-
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L, WELL BLDG. "Vent tb Air Intake ROAD Dt Inlet
t2, 27 - -Z
Septic Dt Bottom
32 .r ° '7'57. Z
Dosing Header/Man. st
J
Aeration Dist. Pipe
Holding Bot. System
a.9~ •3 ' 1,
PUMP/SIPHON INFORMATION Final Grade
7-Z 't7.1 3
Manufacturer Demand St Cover ;
GPM a1 7~7" 9L ~9
Model Number r A
C5 X11.73 3,5
TDH Lift Friction Loss Y System He d l . JTdt. y L
Forcemain Length Dia. Dist. to Well
.yy,nY ~ t
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 t CHAMBER OR
Type Qf System: UNIT
yr Model Number
DISTRIBUTION SYSTEM _7a Y'
Header/Manifold y Distribution x Hole Size . x Hole Spacing I a Vent to Air Intake
Pipe(s) x >
Length / Dia Length ".1 Dia 1 r' Spacing
SOIL COVER
x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded k.. xx Mulched
Bed/Trench Center ? Bed/Trench Edges Topsoil T1_.
r r r [LYes F No i t Yes No
COMMENTS: (Include code discrepencies, personls present, etc.) Inspection #1: Inspection #2:
h ~'se~ ~lor~ o K S C(~ uVGI I S ►c{ nc
Location: 490 CTY RD T
w
1.) Alt BM Description = ° l" b' E 'iu Z l~W ~ 4. aveG, Mowed raid
2.) Bldg sewer length 4-, C.,
-amount of cover= ° Il c~at^~ JQ®{~/,V a k~Y6flpJ~i';~~
17 5
Plan revision Required? ❑ Yes ' No
Use other side for additional information
SBD-6710 (R.3197) Date Insepctor's Signature i Cert. No
)
rv -a.~- 69
County
~ir~■ w Safety and Buildings Division St. Croix
' ' 0 S 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
x
PS AUG 1 ZOO Mar '`n. WI 07-7162
~r
~oIN sMo,~o Q. 59 7#4 o
~OMMUNI 3ft A I'y jrm it Application VG$C State Transaction Number
2980483
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate g ~A
S R
0
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWT are suoi.._ toject Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information nu provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. t.
1. Application Information - Please Print All Information k490 Co. Rd. T
Property Owner's Name Parcel #
WTI aMAU Ua;y ~ UjtZ ~I✓1 024-1015-10-001
Property Owner's Mailing Address Property Location
490 Co Rd. T Govt. Lot
City, State Zip Code Phone Number NE v. NE Section 9
Hammond W. 54015 28 N; R 17 (circle one)
H. Type of Building (check all that apply) Lot # T E or W
® I or 2 Family Dwelling - Number of Bedroo 3 Subdivision Name
Block #
❑ Public/Commercial - Describe Use
❑ City of
ate weed- DescribSUse CSM Number /Alt ~V i 3 ❑ Village of
X S o 0, P GDIr$ ®Town of Pieasant_Valley
ype Permit: (Check only one box on line A. Complete line B if applicable)
,70
A. El ~~yy
New System In Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued /
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ 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 ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) _ ❑ Pretreatment Device (explain)
V. Dis ersal/Tre ment Area Information: 1
Design Flow (g Design Soil Applicatio at gpdsf) Dispersal Area Requ (s Dispersal Area sed (sf) System Elevation
450 1.0 -1 1 450 ' 1 `VP 450 ~y ~t $ Z 95.33
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o v
Sim Tek of 100 filter
New Tanks Existing Tanks w c
n. U in ~ rn [s. C7 Q.
Septic or Holding Tank 1000 1000 X
Dosing Chamber
750 750 1 Wieser x
VII. Responsibility Statement- I, the undersigned, assu a respon ' dityr i allation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum r' ignatu MP/MPRS Number [=ess Phone Number
Keith Knudtson 648443 -470-1737
Plumber's Address (Street, City, State, Zip Code)
927 150th St. Roberts Wi 54023
VIII. Countyy
/De artment Use Only
pproved I' p $er/m-it Fee Dgate sr~lued Issuing ent Signa e
dlSh en Reason for llenial V ' v J~ '
IX. Condi caso9's fo~;Pisapproval
8P r: 8i GEr1: 11 e, k, e 3 C ; d"-4 a^
OISper: ti cell rust all be E%Ai S ! r"E ]n r4'.i; /,'`t.~
.
es per ,7tarsgement plan plo rioed by plumber / G
2. AY,,nft t'reqWl%t*m TwtW ma ntvi4cl
ar W►aPF Cade 1 ~ 6~ aQ
Attach to complete plans for the system and submit to the County only on f7r-+ t les~ than 8 1/2 x 11 inches in size
SBD-6398 (R. 11/11) I
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ox? DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL STE 150
GREEN BAY WI 54304-5211
3 Contact Through Relay
P http://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
~?ssio*~~ti Scott Walker, Governor
Laura Gutierrez, Secretary
August 16, 20171
'T CT SP
CUST ID No. 224059 ATTN: PO WTS Inspector 41,7E 8 13]OW
KEITH E STONER ZONING OFFICE
KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA
23220 WOODCREEK RD 1101 CARMICHAEL RD p
SIREN WI 54872-8728 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/16/2019 Identification Numbers s
Transaction ID No. 2980483
SITE: Site ID No. 841491
William Schultz Please refer to both identification numbers,
Cty Rd T above, in all correspondence with the agency.
Town of Pleasant Valley
St Croix County
N1/2, NE1/4, S9, T28N, R17W
FOR:
Description: Mound System (3 Bedrooms - Replacement)
Object Type: POWTS Component Manual Regulated Object ID No.: 1721557
Maintenance required; Replacement system; 450 GPD Flow rate; 14 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); 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 mound area.
or to construction of the dis ersal area check the moisture content of the soil to a de th of 8 inches.
earing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil
isture 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
• Pump Floats to be set and verified per approved plan Any changes may result in pump resizing to meet
TDH and GPM Specifications.
• Divert surface water from POWTS Area.
• All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5
KEITH E STONER Page 2 8/16/2017
• 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.
• 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.
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 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.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Please Include a Copy With Your
Tim Vander Leest Payment ayment Submittal.
Private Sewage Plan Reviewer, Division of Industry Services T coder". 7633
P
(920)492-2214, Monday - Friday 6 am To 3:30 pm
tim.vanderleest@wisconsin.gov
KEITH E STONER Page 2 8/16/2017
• 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.
• 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.
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 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.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice.
Please Include a Copy With Your
Tim Vander Leest Payment Submittal. j
Private Sewage Plan Reviewer ,Division of Industry Services WiSMART code: 7633
(920)492-2214, Monday - Friday 6 am To 3:30 pm
tim.vanderleest@wisconsin.gov
Page 1 of 7
Index and Title Sheet
Proiect Name: William and Mary Schultz Replacement Mound
Property Owner: William and Mary Schultz
Address: 490 County Rd. T
Hammond WI 54015
Legal Description: NE '/4 -NE '/4
Section 9 T28N-RI 7W
Township: Pleasant Valley County: St. Croix
Subdivision Name: Csm 26-6048 Lot 1
Comp.#/Parcel ID: 024-1015-10-001
CONTENTS
Page: 1 Index and Title Sheet
Page: 2 Plot Plan and Sizing Calculation
Page: 3 Two Cell Mound Cross Section and Plan View
Page: 4 Lateral Layout Diagram
Page: 5 Dose Tank Cross Section
Page: 6 Pump Curve Data
Page: 7 Management and Contingency Plan
Soil and Site Evaluation Report Attached
Mound Component Manual Used = Version 2.0 SBD-10691-P (N.01/01 R. 10/12)
Pressure Distribution Component Manual Used = Version 2.0 SBD-] 0706-P (N 01/01 R. 10/12)
Designer: Keith E. Sto yJ\s•...•^!SLicense # Designer 157-007
KEITH E.
Signature: Phone # (715) 653-2324
D-1575
Date: 7/15/2 17 Siren,
IS. JUL 19 2017
~~;,,TRY SERVICES
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Page 3 of 7
Cross Section of a Mound System Using
Two Cells for the Absorption Area
1/10 Observation Pipe
A B O Force Main
w
A O O
K
B - j
1
L
A 4 ft. E 28.24" H K 11.66'
B F 9.5 1 12.47' L 80.32'
C 5 ft. G J 8.34' W 33.81'
D 22"
(ft. sq.) Dispersal Cell Area 1451.7 (ft') Basal Area Available
4.00 (gpd/ft) Linear Loading Rate 5. ]0' (ft) I/10 B Obs. Pipe Placement
456 Total Dispersal Area ( sq. ft.)
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 97.12'
H
G
G
95.33' b F O Dispersal (ells'
Lateral
Dispersal Invert
Cell
Elevation for
each cell.
4% to Slope 93.50'
Detail of
Typical Dispersal Cell ~Geotextile Fabric
Shading Key Cover
Topsoil Cap 000000000000000
000000000000000 4" Sch. 40 PVC
MEM Subsoil Cap 000000000 00 Observation pipe w/6"
m ASTM C33 Sand 0000 Typical Lateral 000 F minimum slot
Tilled Layer 00000000000000 anchored with water
0 0 o0i4~ b°o°°
Aggregate closet collar or 3/8"
0 0 0 ° 0°O ° O ° O°O ° o O
010-0 0-0-0 0-0. re-rod.
o-- A
Note: Prepare Mound Site per Component Manual
Constuction Procedures.
Page 4 of 7
Lateral Layout for the Typical Cell
End Connection Lateral Layout Diagram
Laterals and Force Main of PVC Sch. 40
per SPS Table 384.30-5 X X
50` P I 50'
Turn-up w/ball valve or clean
out plug
Laterals centered over the A&B dimension
Number of Laterals I Orfice Diameter .156/5/32" in
Lateral Diameter 1.5 in. Orifice Spacing (X) 2.00 ft.
Lateral Length (P) 56.00' ft. Orifices per Lateral 29
7.96 ft2/
Lateral Spacing (S) Na ft. Orifice Density orifice
Lateral Flow Rate 15.66 gptn Manifold Length Na ft
Cell Flow Rate 15.66 gpm Manifold Diameter Na in
System Flow Rate 31.32 gpm Total Dynamic Head 14.82 ft.
Lateral Turn-up Detail
Finished Grade Threaded Cleanout Plug or Ball
6" to 8" diameter Lawn Sprinkler Box Valve
[il
000000
Long Sweep 90 or Two 45° Bends Same
Diameter as Lateral
000000
O O O
0 0 0 0 0 0 Distribution Lateral
Note : Lateral ends at last orifice where variable
length to ceanout begins.
i
Pg. 5 of 7
Dose Tank Component Cross Section
Approved Manhole Covers With Warning Labels
and Locking Device / 4" Min. Above Final Grade
Weather Proof Junction Box
Electric per NEC 300 & SPS.
4" Sch. 40 Vent 316.012 WAC
> or = to 12"
Above Final Grade Disconnect
7010 mtech STF Alternate Outlet Location
W/Approved 4" Sleeve
Filter
Inlet Force Main Diam. = 2 "
Weep Hole or Anti Siphon Device
Note: Pump switch and alann to be A
wired to separate circuits. 87.50'
B Pump Off Elev.
C
Tank Mfr. Wieser Concrete 750 gal. D
Dose Tank Elev. 86.50'
Vertical Difference Between Pump Off and Distribution Pipe = 83T_
Minimum Required Supply Pressure 4.55
75 FT. of Force Main x 2.58 Friction Factor/100FT.... IT ~
Min. Dose 51.52 gal. Total Dynamic Head = 14.82' -7
Max Dose 90 gal. Number of Doses _ -5 Per Day Gal. Per Day/ #of Doses =89.17 Gal.
Volume of Backflow = 12.23 Gal.
Total Dose Volume = 101.40 Gal.
Pump Tank Capacity 750.36 Gallons Dimensions Inches Gallons
Pump Tank Volune 20.28 Gal/ln h A 18 365.04
B 2 _ 40.56
Pump Mfr. Goulds C 5.00 101.40
Pump Model EP04 _ D 12 243.36
Minimum Discharge Rate= 31.32GPM
Alarm Mfr. S.J.E. Rhombus Total= 37 750.36
Alarm Model Tank Alert 1
Bed Tank per SPS 383.45(5)
Anchor Tank as necessary to negate buoyant forces per SPS. 383.43(8)(g).
Page 6of7
RGOULDS PUMPS Submersible
Effluent Pump
EP04
3871 EP05
0
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses: heat transfer. ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• farms manual operation. Auto- CanadianS r~oaawn
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".)
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Punps is ISO 9WI iiec~wnd.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
3(4" maximum. ■ EP04 Impeller: Thermoplas- ~ power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: I V NPT. seal protection.
• Mechanical seal: Carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
104°F (40%) continuous
140°F (60°C) intermittent METERS FEET
to I
• Fasteners: 300 series
stainless steel. -
y 30... - , S Gf~F
• Capable of running
dry without damage to $ 2.5 rr
components. 25
n 7
Motor: x
20
'
• EP04 Sin le phase: 0.4 HP, Q 6-
g
115 or 234 V, 60 Hz, 1550 z 5 -
RPM, built in overload with
c 15
automatic reset.
• EP05 Single phase: 0.5 HP, o a . EPOS ,
115 V or 230V, 60 Hz, 1550 3 10 - - -
RPM, built in overload with EPOa
automatic reset. 2
• Power cord: 10 foot 5
standard length, 16/3 t
S1TOW with three prong
roundi u 0 onal 20 o ao
foot length, 1613 SflW with to Zo 30' 5 40 9 n9 Pl 9- Ptio GPM
three prong grounding plug
o z a e s 10 12 nlh
(standard on EP0).
CAPACITY
Goulds Pumps
ITT industries
® 2001 Goulds Pumps <&
93871ve May, 2001
83871
Page 7 of 7- 1 of 3
Private Onsite Wastewater Treatment System Mound
Management Plan
Pursuant to SPS 383.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) Shall Include information and procedures for maintaining the system
within the parameters of SPS 383 and 384, and the conditions of approval by the
department, agent, or governmental unit. The approved plans and permits for the system
will be filed with the county zoning or health department.
This management plan complies with SPS 383.54, Wis Adm. Code, the Mound
Component Manual for Private Onsite Wastewater Treatment Systems (Version 2.0)
SBD-10691-P (N.01/01R. 10/12) and the Pressure Distribution Component Manual
(Version 2.0) SBD-10706-P (N 01-01R. 10/12) EZ Flow Mound Component Manual (N.
06/03)
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms 3
Design Flow (GPD) 450
Soil Absorption Component Size (sq. ft.) 450
Septic Tank Capacity Gal. 1000
Pump Chamber Capacity Gal. 750
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow-Peak (GPD) 450 450
Max. Influent Particle size NA 1/8 Inch
Maximum BOD 5 (mg/1) NA 220
Maximum TSS (mg/1) NA 150
Maximum FOG NA 30
Table 3: Maintenance Schedule
Inspect and/or service once every 3 years
Septic Tank
Outlet Filter Should inspect once a year and clean every 3 years
Pump Chamber Inspect once every 3 years
Soil absorption Component Flush laterals every 18 months.
Page 7 of 7- 2 of 3
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under sec.
281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,
Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors,
Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms).
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 scum and sludge 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 an 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.
Pump Chamber
The pump chamber also requires monitoring once every three years or the time of problem,
complaint or failure. Inspection should include checking the dose rate, volume and frequency.
Note: This dose tank will be equipped with an in-line pressure filter as the existing septic
tank has no manhole over the tanks outlet. Filter servicing to coincide with Table 3.
Warning: The dose chamber may fill due to flow continuing during pump malfunction or power
outages. One large dose when the power comes on or when the pump is repaired may cause the
dispersal system to have problems. In this situation, the pump chamber should be pumped by a
licensed pumper before pump cycling begins or other measures shall be used to dose the
component with only the proper amount of influent. This may include manual operation of the
pump controls until such time the pump chamber has reached its normal level.
Septic tank and Pump chamber 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 to the tank
Warning: No one should enter a septic or other treatment or holding tank for any reason without
being in full compliance with OSHA standards for entering a confined space. The atmosphere
within the septic or other treatment or holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be accordance with SPS 383.33, Wis Adm. Code when the tank is no
longer used as a POWTS component.
Page 7 of 7- 2 of 3
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under sec.
281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,
Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors,
Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least once every 3
Years by y 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 scum and sludge 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 an 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.
Pump Chamber
The pump chamber also requires monitoring once every three years or the time of problem,
complaint or failure. Inspection should include checking the dose rate, volume and frequency.
Note: This dose tank will be equipped with an in-line pressure filter as the existing septic
tank has no manhole over the tanks outlet. Filter servicing to coincide with Table 3.
Warning: The dose chamber may fill due to flow continuing during pump malfunction or power
outages. One large dose when the power comes on or when the pump is repaired may cause the
dispersal system to have problems. In this situation, the pump chamber should be pumped by a
licensed pumper before pump cycling begins or other measures shall be used to dose the
component with only the proper amount of influent. This may include manual operation of the
pump controls until such time the pump chamber has reached its normal level.
Septic tank and Pump chamber 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 to the tank
Warning: No one should enter a septic or other treatment or holding tank for any reason without
being in full compliance with OSHA standards for entering a confined space. The atmosphere
within the septic or other treatment or holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be accordance with SPS 383.33, Wis Adm. Code when the tank is no
longer used as a POWTS component.
Page 7 of 7- 3 of 3
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic wastewater
from a residential facility. The limits of operation of this component are shown in Table 2.
The longevity of a soil absorption component depends greatly on proper and timely maintenance,
and system use within or below the limits of reliable operation. Good water conservation
practices by all occupants and the installation of water conserving plumbing fixtures are key
factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least once every 3
years. Lateral turn ups are provided at the ends of the laterals for the purpose of flushing the lines
of any solids. Flushing these lines should be done every 18 months. The inspection shall include
recording levels of ponding, if any, in the observation pipes, and visual inspection for any
evidence of surface discharge from the component. On steeply sloping sites, areas of erosion
should be identified and reported to the owner for repair. The surface discharge of domestic
wastewater or sewage from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly during
winter months. The compaction or removal of snow cover over the component may lead to
hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, clogging of the soil.
The property owner should be aware that any change or modification to the existing private
road might affect the mound systems ability to disperse effluent.
Planting of deep rooted trees and shrubs directly over or within 10 feet of the component should
be avoided since root intrusion into the component may obstruct wastewater flow.
.
Contingency Plan
In the case of septic or dose tank component damage, measures shall be taken to repair or replace
the tanks to there original operating condition. Upon failure of the distribution cell component,
the system shall be inspected to determine the cause of failure. Steps taken to repair or replace
the mound may involve the removal of a bio-mat, which would require cleaning or replacement
of the distribution network as well as replacing the rock and clogged portions of the sand fill. It is
important to monitor the observation pipes as noted above to prevent complete failure of
the system so alternative corrective measures can be discussed.
Component Owners Contact List
KeithKnudtson / Plumber (651) 470-1737
St. Croix County Zoning (715) 386-4680
Wieser Concrete Products Maiden Rock WI - (800) 325-8456
Septic Pumper Powers Sanitation (715) 246-5738
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 4so co Rd. T located
at: NE 1/4, NE 1/4, Section 9 , Town 28 N, Range 17 W,
Town of Pleasant Valley , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service 6/16/17
Did flow back occur from absorption system? Yes No x
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: `Pr
Construction: prefab Concrete x Steel Other
Manufacturer (if known): weeks??
Age of Tank (if known):
Permit number (if kipwn)
Keith Knudtson
(Licensed Plum er Signature) (Print Name)
648443
(Title) (License Number) MP/MPRS
8/18/17
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
jtECE'%j'"; ST. CROIX COUNTY
ANDANCE AGREEMENT
t~U0 ~ 0 20,11 SEPTIC TANK MAINTEN
^^vX000N'1Y OWNERSHIP CERTIFICATION FORM
'a~IELOpMENT
Owner/Buyer ,(?X l C-~~o 1 b-2 ►'G
Mailing Address 490 Co. Rd. T
Property Address Same
(Verification required from Planning & Zoning Department for new construction.)
City/State Hammond W i . Parcel Identification Number 024-1015-10-001
LEGAL DESCRIPTION
Property Location NE NE ,4 Sec. 9 , T 28 N R 1 7 W, Town of Hammond
Subdivision Plat: , Lot # 1
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house 0yes0no 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 pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 day of the three year expiration date.
I/we certify that all statements on this form c true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty d d recorded in Register of Deeds Office.
Num er of bedrooms 3
S16-NATURE OF A NT(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)
Wisconsin Department Xa~l 12 ` ssional Services Y +y` f 1 r
Divisicn ;~f Ind V G
RT CST-o°►7 rqI #3226
1$ Jp1I MQQM6FS6Y9NMP .I Page 1 of 3
in ac aoo, Wis. Adm. Collis Keith Stoner CST
Attach less than 8'% x 11 inches in size. Plan must County
include, 0 &'W horizontal reference point (BM), direction and St. Croix
I.
pM a or dimensions, north arrow, and location and distance to nearest road. Parcel
024-1 15-10 01
Please print al information.
ed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Revi $ A3 /
Property Owner Property Location
William & Mary Schultz Govt. Lot NE1/4 E1/ , 59, T28N, R17W ~__T Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM#
490 County R T 1 CSM 26- 048
City State Zip Code Phone Number City Village L/1, Town Nearest Road
Hammond WI 54015 Pleasant Valley Same
Ej New Construction Use: [x] Residential / Number of bedrooms 3 _ Code derived design flow rate 450 GPD
, f Replacement F Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable NA ft.
General comments 'Ed Taylor approved dispersal cell location - Propose 2 - 4 x 57' mound dispersal cells with a 5' separation using a.4 basal loading
and recommendations: rate:-Locate ups Tope cell along e 93. c ntour w/both cells system elevations = 95.33'. Upslope cell edge staked.
1 Boring # I Boring
Pit Ground surface elev. 93.82 ft. Depth to limiting factor 16 ✓ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2
1 0-9 10YR3/3 - sil 2msbk mvfr cs 3f 0.6 0.8
2 9-16 10YR4/3 sil 2msbk mvfr gs 3f 0.6 0.8
3 16-23 10YR4/4 c2d5YR5/8 Sid 2msbk mfr gs 2f 0.4 0.6
4 23-31 5YR4/4 m2d5YR5/8 sl m mfr - - 0.2 0.6
7.5YR6/2
*Boring completed on 6/28/17 during Ed Taylor onsite
Boring # Boring
VJ Pit Ground surface elev. 92.32 ft. Depth to limiting factor 14 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Y 1 0-9 10YR3/3 - sil 2msbk mvfr cs 3f 0.6 0.8
2 9-14 10YR4/3 - sil 2msbk mvfr gs 3f 0.6 0.8
3 14-29 5YR4/4 c2d5YR5/8 Cl 2msbk mfr - 2f 0.4 0.6
7.5YR6/2
*Boring completed on 6/28/17 during Ed Taylor onsite
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/_ /19uent#2 = BODS <_30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
Keith Stoner 224059
Address Keith Stoner CST ate Evaluation C nducted Telephone Number
23220 Wood Creek Rd Siren, WI 54872 6/20/2017 t(~~ 715-566-0900
SBD-5330 (8.07/13)
Property Owner William & Mary Schultz Parcel ID # 024-1015-10-001 Page 2 of 3
Boring
Boring # Pit Ground surface elev. 92.02 ft. Depth to limiting factor
14 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. °Eff#1 'Eff#2
1 0-9 10YR3/3 - sil 2msbk mvfr cs 3f 0.6 0.8
2 9-14 10YR4/3 - sil 2msbk Invfr gs 3f 0.6 0.8
3 14-18 10YR4/3 c2d5YR5/8 sil 2msbk mvfr gs 2f 0.6 0.8
4 18-30 5YR6/1 m2d5YR5/8 cl 2msbk mfr - - 0.4 0.6
7.5YR6/2
I
*Boring completed on 6/28/17 during Ed Taylor onsite
Boring
4 Boring # ` Pit Ground surface elev. 95.60 ft. Depth to limiting factor 0 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure ConsistenceBoundary Roots GPD/ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2
1 0-7 10YR3/3 cld5YR4/6 sil 2msbk rnvfr cs 3f 0.6 0.8
2 7-16 10YR4/3 c2d5YR5/8 Sid 2msbk mfr gs 3f 0.4 0.6
3 16-27 5YR4/4 c2d5YR5/8 sl lmsbk mvfr gs 2f 0.4 0.7
4 27-39 5YR6/1 c2d5YR5/8 cl 2msbk mfr gs - 0.4 0.6
5 39-56 2.5YR4/4 c2d5YR5/8 scl m mfr - - 0.0 0.0
7.5YR6/2
Worm tunnels, water running into sidewall of pit at 35"
Boring
F-s]Boring #
Pit Ground surface elev. 90.40 ft. Depth to limiting factor 0 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
1 0-7 10YR3/3 cld5YR4/6 sicl 2msbk mvfr cs 3f 0.4 0.6
2 7-11 10YR4/3 c2d5YR5/8 cl 2msbk mfr gs 2f 0.4 0.6
3 11-17 5YR6/2 m2d5YR5/8 cl 2msbk rnfr gs if 0.4 0.6
4 17-22 2.5YR4/4 m3p5YR5/8 cl m mfr - - 0.0 0.0
7.5YR6/2
*Redox in horizon #4 also has 10YR4/6 color
f4
" Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS <_30 mg/-
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