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HomeMy WebLinkAbout018-2001-14-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600247 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2980781 Permit Holder's Name: City Village Township Parcel Tax No: TROY & LISA LOVESTRAND TOWN OF HAMMOND 018-2001-14-000 CST BM Elev: Insp. BM Elev: BM Description: rU Section/Town/Range/Map No: 166 32. e, ~I OZ e!7_ 14.29.17.878 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 5 CAPACITY STATION BS HI FS ELEV. Septic S Benchmark B.oO L Dosing o~ ftd Alt. BM / Bldg. Sewer Holding SUHt Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO ! ,P/`LL~ WELL BLDG. Q ent Air Intake ROAD Dt Inlet Septic 94 A) A Z Dt Bottom Dosing g1V/ A)k yt Header/Man. s~ Oa Aeration Dist. Pipe 3 . ~ Aso Holding Bot. System Final Grade /f PUMP/SIPHON INFORMATION d~' $ S Manufacturer Demand St Covert ] VOcJ` 5 J•w O ~j.J I GPM Model Number P/ 1 1 Z7 ~ ~64, i 7 G•Z ~g.a TDH Li z Friction Loss System He d TDH 7 4t g a:~ 2 5~ 'y t - Forcemain ILength~a DDist to well SOIL ABSORPTION SYSTEM N , Z BED/TRENCH Width x Length No. Of rich f," PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 0i 0 6e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type ystem: I 5o I l UNIT Model Number: DISTRIBUTION SYSTEM ~e g+ Ve Air In 'L ~ istribution x Hole Size I ( x Hole Spacing Header/Manifold Length 'V Dia /'Z✓ Lepngth +9 Dia Jr Spacing 13.35 !V-J-1 -3 G 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 Bed/Trench Center Bed/Trench Edges Topsoil ( r4-y `7 yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ' Z lel 1`t Inspection 2: Location: 1947 94TH AVE I R. /'I 4A. Cl,,6 V 1i",- 101.) Alt BM Description = If Plo,.j ok- 2.) Bldg sewer length = ZS - amount of cover = if v GQ1~r/w f G(Q,l.~~ Cr a r 7- Plan revision Required? Yes L 11 Use other side for additional nformatyNo V L VA Date Insepct s Signatu Cert. No. SBD-6710 (R.3/97) 1 ' County ~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be 5lled in by Co.) 2 1 1/ Madison, Wt 53707-7162 ~ T~AJ; 01 4 MA-0 Z47 0~3SiON A~-• IND State Transaction Number ; OMMUNI Y r r"Ke-E-Mit Applica 10D ~~?9XE 6 H~ unit In accordance with SPS 383.21(2), Wis. Adm. Code, submission of rh is required prior to obtaining a sanitary perm it. Note: Applicatio r i S are submitted to Project Address (if different than mailing address) j V NJ „vide may the Departmeht of Safety and Professional Servies. Personal in$ ry be used for secondary f~f tat-. purposes in accordance with the Privacy Law, s. 15.04(1 (m , S 1/ I. Application Information - Please Print All Information Parcel # Property Owner's Name Property Location ! ~Cj l 1 „ ` 1 J PropertyOwner's Mailing Address 1 Govt. Lot City, State Zip Code Phone Number Section J y~ (circle one r~ T _N; R L Eo apply) :Block ot # II. Type of Building (check all that a 1 Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms 0j< # e Ityf jQ ESr/~~ ❑ Public/Commercial - Describe Use 1 A ❑ City of 00 CSM Number El Village of ❑ State Owned - Describe Use Town of o- ►~k ~Yl m d /bX(od I0✓ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' System 11 11 Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) New Replacement System g 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 )4jvSound < 24 in. of suitable soil # ❑ Holding Tank ❑ (Itler Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required Dispersal Area Proposed ( System Elevation VI. Tank Info Capacity in Total of Manufacturer CO U 'O 16 Gallons Gallons Units o U ti New Tanks Existing Tanks 2 0 t 2 ~ p ro ~ v) v0 w C7 e Septic or Holding Tank t-1 ~e /V f Z ` i?1 Dosing Chamber lot e ~j f t' 1 C l t 4 6 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/ANumber Business Phone Number l7'~ lam' 0~ 4 . Z zE `j 7 / - 7 Plumber's Ad ess (Street, City, State, Zip Code) VIE. C n epartment Use Only Permit Fee Date ued Issuing nt Signature Approved ❑ ~Disa $ (,dA eason for Detir 'may` /O Z~ J'7 On r al 7X-4 `v r j, r. IX. Condi ort y A efgpisaPProval WIR" 3 r""~ 'disper ai cell must all be sjL icss i rM ink2t as'per management plan pradden by plumber. a.~:, j~ 2. 'Ak nftwA( race ,i". -om trust ue r-, ntr ir..d im per Pipplicnblq ccdro / crdinarrm. Attach to complete plans for the system and submit to the County only on paper not less than 8 U2 x 11 inches in size SBD-6398 (R 11/11) Plot .Flan Pages oft" Property owner `1~---------- Legal Description Jj4 L% Pz,WIL- ZFSWITW_~_S (except where notegQ 7.p~ say T ~7 t M = Bac ioe pit ~~t_ t~ r~c~~ S~ ~.~ix CCLZ,~~y 1,cJts~=ts?LS>!t,' ~ ~3~~J 7 } 1/41'7 q` t 4V,, G If zotl -114 -COO North l7 Q;, O X :F J LIN ` `te r C+ t ~1t~'tZaX, y30fT0 WaL To 8e: q&m 5V' 7P CAI JDC7$5' - I Site Location: 'Cg 14 _ a ~?t3~ t ,4Uc. f • ~~tiY~x7.1rE.~T DIVISION OF INDUSTRY SERVICES 0 2331 SAN LUIS PL STE 150 7 GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov SSior+aScott Walker, Governor Laura Gutierrez, Secretary August 17, 2017 ra r CUST ID No. 224832 ATTN: POWTS Inspector i MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA 28497 KING ARTHURS 1101 CARMICHAEL RD DANBURY WI 54830 HUDSON WI 54016-7708 f~ CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/17/2019 Identification Numbers Transaction ID No. 2980781 SITE: Site ID No. 841495 Troy Lovestrand Please refer to both identification numbers, 94TH Ave above, in all correspondence with the agency. Town of Hammond St Croix County NE1/4, SW1/4, S14, T29N, R17W FOR: Description: Mound System (4 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1721564 Maintenance required; 600 GPD Flow rate; 15 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 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. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off 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. • Divert surface water from POWTS Area. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, MARY JO HUPPERT Page 2 8/17/2017 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. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fi-aaments, 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 ~tirrr eeaf This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services Wyment S code: 1. 7633 (920)492-2214 , Monday - Friday 6 am To 3:30 pm tim.vanderleest a wisconsin.gov MARY JO HUPPERT Page 2 8/17/2017 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. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Anv changes may result in pump resizing to meet TDH and GPM Specifications. • 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. Private Sewage Plan Reviewer Division of Industry Services b WiSMART code: 7633 (920)492-2214 , Monday - Friday 6 am To 3:30 pm tiin.vanderleest@wisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: ` iz-0 LaG-s-r i - Owner's Name: (same) Owner's Address: Legal Description: NE1/4 of the SW1/4, Sec. 14, T29N, R17W Township: Hammond County St. Croix Subdivision Name: Forest Ridge Estates Lot Number: 14 Block Number: NA Parcel 1_D. Number_ 018 - 2001 - 14 - 000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings LiARY •1 Page 4 Lateral and dose tank Page 5 System maintenance specifications 3 D 180 Page 6 Management and contingency plan Page 7 Pump curve and specifications RIVER PKUZ~. ! 3 r' Page 8 Plot plan f0gttttlt4!! t!! Designer: Mary Jo Huppert License Number: 1859 - 007 Date: 07/16/17 Phone Number: 715 - 426 -1775 Signature: - Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), 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) Version 7.0 (R. 03/2012) 1:1ECENED Page 1 of 8 jUL 19 2017 RY SERVICES INOUS 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 40.000 Estimated Wastewater Flow (gpd) Tame 38344-3 in-situ soil treatment for fecal Cditortrt of 36 inches. 1.50: Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) 3.00: Site Slope 97.80:. Contour Line Elevation (ft) 15.00; Depth to Limiting Factor (in) 040 In-situ Soil Application Rate (gpd/fe) Distribution Cell Information 60.00; Dispersal Celt Length Along Contour (ft) Cell Width (ft) TJ 1.00; Dispersal Cell Design Loading Rate (gpd/fe) 1' Influent Wastewater Quality (1 or 2) Are the laterals the highest point v.. a. in in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) a Center or End Manifold 3.33 lateral Spacing (ft) If N above, enter the elevation (ft) 3: Number of Laterals of the highest point. 0.156 , Orifice Diameter (in) 3.50 Estimated Office Spacing (ft) = 11.76 felorifice 2.00" Forcemain Diameter (in) 50._00' Forcemain Length (ft) Does the forcemain drain back? Y x89.00; Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 8.16 Forcemain Drainback (gal) 10.14 Vertical Lift (ft) 55.97 5x Void Volume (gal) 0.82 Friction Loss (ft) 64.13 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 27.46 System Demand (gpm) 15 51 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection choice in. dia. options choice in. dia. options 0.75 1.25 x a x 1.00 1.50 x 1.25 x ! x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gat) 1200.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) A Wieser Manufacturer ~J WI/in (enter result in cell 1349) Dose Tank Information Effluent Filter information 800.00; Dose Tank Capacity (gal) PolyLok 'Fitter Manufacturer 22.24= Dose Tank Volume (gal/in) 122 Filter Model Number Weiser. Manufacturer Project: Page 2 of 8 i Mound Plan and Cross Section Views 1110 g _ ~77 J Observation Pipe K A B ` - . _ L Mound Component Dimensions mown slope toe extension made. ft A 10.00 ft E 24.60 in H 1.00 ft K Aft B 60.00 ft F 9.25 in 1 15.00 ft L ft D 21.00 in G 0.50 ft J 8.31 ft W 1 600.00 (ft) Dispersal Cell Area 1500.00 (ft2) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.32 (ft) ,...ter..... j t H Z F 4 100.05 (ft) Lateral Dispersal Cell 99.55 (ft)-► Invert Dispersal Cell Elevation = = D ~A A' 97.80 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key m Q T Dispersal Cell See lateral details on 10 Topsoil Cap o 1.5 ft Page 4 for number, size, r...f- 0 Subsoil Cap 0 c 0 and spacing of laterals. 0 ASTM C33 Sand 16 ° f - Laterals are equally 'a Typical Lateral F spaced from the Tilled Layer 0.5 ft distribution cell's © Aggregate o H ~ ~ ~ ~ : W.: centerline in the - A distribution cell (AxB). Project: Page 3 of 8 End Connection Lateral Layout Diagram Csnter the lxeraLs over the A&B dimension dam Turn-up wlball valve or cleanoutplug P J AU lata als are identical (E X -3 i Holes drilled on the bottom of the lateral S owaft spaced laterals &Iiorcemaan Sch 40 PVC per SPS Table 364.30-6 s Force main camp tion via tee or cross to manifold at ang point. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.66 ft Lateral Length (P) 58.56 ft Orifices per Lateral 17 Lateral Spacing (S) 3.33 It Orifice Density 11.76 0orifice Lateral Flow Rate 9.15 gpm Manifold Length 6.67 ft System Flow Rate 27.46 gpm Manifold Diameter 1.25 in Total Dynamic Head 15.51 ft Forcemain Velocity 2.80 ft/sec Dose Tank Information Locking cover Wit, warning label and rocking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC Disconnect 4 in. min_ Tank component is propedy vented Attemate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 800.00 Gallons Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.19 448.98 B 2.00 44.48 C Pu of elevation (it) C 2.88 64.13 89.91 D 10 90 242.42 D Total 35.97 800.00 Dose tank elevation (ft) Bedding under tank. 89.00 Alarm Manuafacturer SJE Rhombus_ _ Nate: Switches Alarm Model Number Tank Alert AB containing mercury may not be used in Pump Manufacturer Gould _ this system. Pump Model Number PE 41 Pump Must Deliver 27.46 gpm at 15.51 ft TDH Project: Page 4 of 8 Mound Svstem Maintenance and Operation Specifications Service Provider's Name Darrell's Septic Service Phone. 715-425-1025 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 f? Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Fitter Should inspect and dean at least once eve 3 Years Pump and Controls Test once ev 3 years Alarm Should test month Pressure System Laterals should be flushed and pressure tested eve 1.5 years Mound Inspect for ponding and seepage once every 3lrears Miscellaneous Construiction 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. AN 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 •....rrr.r.rr• •rrrrrrrrrrrrr♦ Grade _ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution . / Lon Sweep 90 or Two 45 de ree Bends Same Diame~er as Lateral Project: Page 5 of 8 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 strati maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2-0 SBD-10706-P (N. 01/01)) 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 tarns 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, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shad be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter 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 fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shag 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 shag 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 shag be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shag be inspected at least once every 3 years- All switches, alarms, and pumps shall be tested to verity proper operation. If an effluent fitter 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 shag 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 60135,150 mg/L TSS, and 30 mg/L FOG for septic tarn effllent or 30 mg/L BODS, 30 rng/L TSS, 10 mg/L FOG, and 104 cfiu/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 it orifice dogging has occurred and if orifice clearing is required to maintain equal distribution within the dispersal cell- Observation pipes within the dispersal cell shag 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. 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 detective the defective component(s) shag be immediately repaired or replaced with a component of the same or equal perfomance- 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 leafage 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. Prebeatrnen t Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment writs or disinfection units are attached as separate documents and are considered part of the overall management plan for this system- Project. ` 'Sty U 1 5TN7%D Page 6 of 8 f Wastewater METERS FEET 40 PE51 _ 1 - `MODELS: PE31, PE41, PE HP..33, -40, -50 35: - - - 10 i - L - 2 GPM _ f 4 30 PE41 - - - 1 Fr w PE3t~- - - 25 e - Z 20 15 - - p 10 - 5 - - - - 0 0 10 20 30 40 5-0 60 70 GPM 80 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 PE41 PE51 Total Head Total Head (feet of water) GPM (feet of water) GPM Total Head GPM 5 SZ (feet of water) 10 42 0 8 61 S7 t0 67 15 29 15 59 15 46 20 50 20 16 20 33 25 0 25 25 39 16 30 26 35 8 Ty Plotplan P eaof8 LegidDescripfion cmept where noted) f @t< 7 ~e Sbtr l`i~S C I~ 7 t7tt~j ri.. G5 1 Backkoe pit T tom! ~1~ C i1_,~~. Gi CCG4.7}/ ~,'t St'G ti5>q,' s 4a,-306 19147 qe",4V~. North 1 ~ y 0 ~rSS 3 ~ 2,5, Irp To TO 3)Rrtlh~'~t~lD 'ev . Two ,41V ('vr ,~~>1as ~~r. yv Site c ' n: 19 14 0 q, ;*k ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Troy & Lisa Lovestrand Mailing Addres 545 Lokhorst Street, Baldwin WI Property Addr 1947 94th Ave. (Verification required from Planning oning Department for new construction.) City/State Hammond, Wl P Ircc! 018-2001-14-000 LEGAL DESCRIPTION Property Location N E r/4 , 6 v v %4 , Sec. ' i T L N R i W, Town of ri a rn m o n a Subdivision Plat: Forest Ridge Estates Lot # 14 Certified Survey Map # , Volume Page # Warrain Deed # 1049138 ty (before 2007)Volume Page # Spec house 11yes0no Lot lines identifiable Elyesnno 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 ySPS. 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 t.ounty Planning & Zoning Department wit 'n 30 days of the three year expiration date. 14we certify that all statements n 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 warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 SIGNATURE F APPLICANT 1 DA1 E ***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) i - aO' RADIUS TEMINPARY co 1 .J6 14C. 1 CUL-DE-SAC EASEMENT (TO BE REI OVW UPON EASTERLY I EXTENS ON OF ROAD 119~86'5-r w 15&22"'Ol $ ~ S 96.54 • I z C ~ D r~ ~ O I I o~ I z II I ~I z I I la N I . Ic w LOT 13 LCD T 14 I I~ 291253 S. F. 274596 S. F. I 6.69 Ac. I 6.30 Ac. VE - 1159.00' ~ I 14 I II ~I II I II I W e ~ Al QJ ' N6ZI `i i N011035 "S N803 tr l MS A Hi 4+ V/ L HODS 105 ,94 1C£ ,9109C ~ .~tc 116. Lag RECEIVED LT/S/OT puea4sanoI OCT 24 201 D~~ u6!saa )3 6u!pl!n9 p449d jo A:padoad ST. CROIX COUNTY 7 ~i~1 gal I I V) Ln Lr) CA L- i L. 0 E In In L i u 0 u D u h F i. I ~I 4 _j i' i LL-j - i 1~7 LT/S/OT puea4sano-l :)~j u6isaa )8 6uipling e44ad 40 A3,jadoad Tc~ ql~' I j. 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CROIX Attach completes than 8 IL size. Plan must include, butsitt rid horizontal refen _ pmint (BM), direction and Parcel 011- 20 1 - 14 - 000 percent ~qpv imensions, north arrow, and location and distance to nearest road. J Please print aft information. Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) :i~zy . /v ?+7 Property Owner Property Location REED & KRISTA SHIPLEY(Buyer: Uby L0VEST9W Govt. Lot NE 1/4 SW 1/4 S 14 T 29 N R 17 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 14 Forest Ridge Estates City State Zip Code Phone Number riY []Village Town Nearest Road ( ) 94th Avenue 0 New Construction LlseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement © Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable NA Tt. General comments Mound system 1.75 ft. sand fill 0.4c loading rate and recommendations: PROPERTY ADDRESS: 1947 94TH AVENUE a Boring # 11 Boring Q Pit Ground surface elev. 97.00 ft. Depth to limiting factor 20 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fti in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10YR2/1 sil 2fgr mfr cs 3vf-co 0.6 0.8 2 12-20 10YR2/2 sic[ 2fabk mfr cs 2vf-co 0.4 0.6 3 20-24 IOYR3/2 cl 2fabk mfi cs lvf-m 0.4 0.6 4 24-30 l 0YR4/4 m2d 10YR5/6& 10YR6/2 cl 1 fabk mf 0.2 0.3 a Boring # ® Boring 98.10 21 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10YR.2/1 sil 2fgr&sbk mfr cs 3vf-co 0.6 0.8 2 12-21 10YR2/2 - sicl 2fabk mfr cs 2vf-co 0.6 0. 3 21-24 1OYR4/4 c2d IOYRS/6 sl Ifsbk mvfr cs 1of-m 0.4 0.7 * Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L * Effl ent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa " CST Number MARY JO HUPPERT Hollistees Soil Testin &Desi Z 224832 Address Date Eva n Conducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 O6 - 21 - 2017 715-426-1775 SBD-8330 (R07/ 13 ) i Property Owner SHIPLEY, Reed (Buyer: Parcel ID # 018 - 2001 - 14 - 000 / page 2 of 3 ❑ 3 Boring # Boring V El Pit Ground surface elev. 98.10 ft. Depth to limiting factor 15 in. -§;d -Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10YR2/1 sil 3fgr&abk mfr cs 3vf-co 0.6 0.8 2 9-15 10YR2/2 sici 2fabk mfr cs 2vf-co 0.4 0.6 3 15-20 10YR3/2 fld 10YR4/6&10YR6/2 cl Ifabk mfi lvf-f 0.2 0.3 i I ~I ❑ Boring # H 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 GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz_ Sh. -Eff#1 `Eff#2 H 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 = BOD < 30 mg/L and TSS < 30 mg/L SBI"310 (R07'13) Plot Plan Page 3 of- --25 Property Owner I~ kRvs , s i`-'--~ EUYW` I 1» = 40, f~ Legal Descricptron 144 a asr Pa~r- s (except where noted) a = Backhoe Pit MA.mkyc,;D_5-r C-ROI)c aU,cTY w+6ec.MsW , X300 Jgq7 -26U/-,e4 -oac North T ~ 0 Onn ~ ^J Gv w r C ~WRox, ~O L a oa f7 ~ ~ Q D t t Site Location: 14 AWE r 9l r+ve. 7XI VI) 3 I eY ~r p -I ti„ 4 a, ~rt io, t ~ f f I~ M~ ~ G K 1, _414.. ~t Jf ~12 _ ~ tom,, •L~i - 'S ~ d ~~C3 m ' W t-u ~ a b JJ R• a e ry •F ,~....ds.Y't 1,•!' W ~ H° ~lpaka..,.. -.»4>.«, ...~+wy~.t ;M+= 4MS.l.F~P. IY+kY *sn+ ~>6 y.•y„aw.s+:,'. .y ::.M+V.~e~ ~3. k 3 c i Wisconsin Deparo-nent of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page of in accordance with Comm 85, Wle. Adm Code Atl2W complete site plan on paper not less than 8 112 x 1 1 Inchos in elze. Pian must COUnty 5T" l) I Include, but not limited to: vertical and horizontal reference polnl (BM), direction and percent slope, scale or Clmenslons, north arrow, and location and dlslanee to nearast road 1 Parcel I D P~NPI►~?o Please print al! lnfarmaflon. eview Dare Penonu,nlo-Hon yon provlde may be used for ieeonduy purposes (Privacy Law, a 15 at tit (m)). P paro~rtyOwner - - - property Locati c V Nrc 1/4 SW 114 S 1! T N R 7- r W Property Owner's Malling Address Lot Y Block # Subd. Name or CSW - flit{ >J, n~Qt51oN sr , - OKC51" RIPC-E e5-FA-7ts City Slate Z1p Code Phone Number city Rw>CiQ FA h' Q Villega X Town Nearest Road LI S i wr syoz2 `tzb_ySo M,h A~ 02.1--/6 E New Constructlon Usa:~ RealdentlaJ / Number of bedrooms Code de ived design now rate R Q eplacement Public or commercial • Describe. Parent material Flood 'tam elevation if applicable e - General comments _ _ Ile and recommendations. 5 STE 9Z SfWD K fu- z (,,.0 A1Q t 13& R-A-Ve /3 3 rl Born I ~ Boring q t--j g h L.6 7 l3 t~0 I'~' PI; Ground surface ele _ DI S_ Depth to limiting factor Horizon - Soil A lication Rate eDth Cornlnant Color Redox Ooscrippon Texture Structure Consistence Boundary Roots __GPp/(F in. Munsen CU. Sz. Conl. Color Gr. Sz. Sh 'EfTpt 'Erra2 0- lm Z L d Or 5- M 5) Z ds ' S , 4 y ms -d~ s 0 L, n Boring 9 ❑ Boring ~J Pit Ground aurfece etev. _ qq. 50 h, Depth to Ymlting factor in 1cadon Rate Horizon Depth Cominanl Color Radox Description Texture StrUClure Consistence Boundary Roots in. Munsell ~ [t!GPD/tf Qu. Sz. Cont. Color Gr Sz. Sh. •Effg1 'EftN2 015- 0.v L l _ a .5 0, g 4 13 L-- r5 Ord i I - as _ r z o Effluent #1 _ p, 30 < 220 MQ1L and TSS >30 < 150 mgr Effluent 92 • BOD < 30 mg& ano TSS < 30 mg/L CST Name (Please Print) - Signature CST Number /YlA oL 2Z 3Z Address Data Evaluation Conducted Telephone Number 5 q-= W9g75 69o"AdE vEl~ FAuS~ WT SyOZZ 0$-0 -0Z 4- --rls) y zb7S REU~.s~ : o9-►Q-oz 1