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HomeMy WebLinkAbout018-1006-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600310 GENERAL INFORMATION State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 30381 1 6 Permit Holder's Name: City Village Township Parcel Tax No: David Dalton TOWN OF HAMMOND 018-1006-30-000 CST BM Elev: nsp. BM Elev: BM Description: Section/Town/Range/Map No: g~ 03.29.17.43A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER S CAPACITY STATION BS HI FS ELEV. Septic nwbv t` U Benchmark 0° .~a 6g ~a t V d I. vo.n 0 Desnig 3 J{ t Alt. BM 7' - P 1 7 ~r (-~x 47 /o M Aeration Bldg. Sewer -ILI d!Holding St/Ht Inlet lQdF TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to A Intake ROAD Dt lnl - Septic t 34 t 1 Dt Bottom ~I Dosing Header/Man. U 1 Aeration Dist. Pipe Holding t. System Final Grade ~t PUMP/SIPHON INFORMATION . 45.6 Manufacturer ©,L ~ Demand St Cover 'l GPM Model Number TDH Li Friction o~ System Head T DH 33 Ft Forcemain Len h2, Dia tt Dist. to Well ( SOIL ABSORPTION SYSTEM BED/TRENCH Width / [ 111h No. Of Tr nches PIT IME IONS No. Of P' s Inside Dia. Liquid Depth DIMENSIONS p~ TREAM LEACHING Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL LAK INFORMATION CHAMBER OR Type Of yster t j UNIT Model Number: DISTRIBUTION SYSTEM Header/ nifold i Distribution x Hole Size x Hole Spacing Ven o Air Intake Pipe(s) Length a~ Length Dia 1 ' V Spacing lJ 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 J L1 rj No L] Y~L No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: plmoCj(- Inspection #2: ~ Location: No Address Available iF 1.) Alt BM Description = jRkV CZVAf C"-,s + 's 2.) Bldg sewer length = 3L4 - amount of cover = 7►4 Plan revision Required? n Yes [ j No ~ } ~ J ~ ~ ~J ~ l~l Use other side for additional information. -11 L J 1 J C Date Insepctor's Si Cert. No. SBD-6710 (R.3/97) jlti cj - N. -va. eti,-, County ' ';t St, Croix r: 7 Safety and Buildings Division 9 ; 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) `-,Sp J' ~DU~ Madison, WI 5 7-741 S = ST. ~RO~X t (0 6631 C) Sanitary Permit Apt) t State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submiss' G~~~~ _ appropriate governmental unit 30381 16 is required prior to obtaining a sanitary permit. Note: Applica 9 „ state-owned POWYS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal n _..ation you provide may be used for secondary ' t ~j u lses in accordance with the Privac Law, s. 15.04(1)(m), Stats. l i rl yV~~ 1) I. A lication Infor on - Please Print All Information Property Owner's Nam , Parcel # David Dalton 018-1006-30-000 Property Owner's Mailing Address Property Location Q'~ 1 t~ t h y3 1794 110th Ave. Govt. Lot City, State Zip Code Phone Number SW /q SW 1/q Section 3 Hammond Wi. 54015 elrcle on T 29 N; R 1 ~ E or~ II. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name 6k Block # ❑ Public/Commercial - Describe Use - 1 ❑ City of _ _ ❑ State Owned - Describe Use ` CSM Number ❑ Village of _ _ ® Town of Hammond III. Type of Permit: (Check only one box on ine A. omplete line B if applicable) y ❑ Replacement System ❑ Treatment/Holding'rank Replacement Only ❑ Other Modification to Existing System (explain) A. IN New S stem B. ❑ Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. T e of POWTS S stem/Com onent/Device: (Check all that a 1) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground [x 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/Treatment Area Information: Design Flow (gpd Design Soil Application R e(gpdsf) Dispersal Area Req red (sf) Dispersal Area Pro d (sf) System Elevation 450 -50 900 900 103.50 V1. "Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units Poly-Lok 525 .o 2 o 2 New Tanks Existing Tanks o 0 a` U c7 ~ v~ w C7 t% Septic or Holding Tank 1000 1000 Wieser X Dosing Chamber 600 600 Combo VII. Responsibility Statement- 1, the undersigned, assume responsibility for,installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Keith Knudtson ) ,:1 648443 651-470-1737 C _ •ti Pf - Z_.--.- Plumber's Address (Street, City, State, Zip Code) 927 150th Street Roberts Wi, 54023 VIII oun /De artment Use Onl Approved Permit Fee Date Is 'fed Issuing A ignature O riven Reason Denial $ IX. Condi easp~1s for Isapproval 1. r ark, v tint ItIt9, nt j i~i a,h4 i t~ t (Asper.-an ce8 must all be s _fc:~s ! ro+ ink g5 - pGf/M.~Q"' as per;pal3~PtTlerl'. plan p5criae'i by Niumbe;. / 2. A kN~i rec irptnemn tn~.PA tx: mo;,rt, ir`E 1 all pK #XJkmWs cndtf I ~ rdi xtsy. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 z 11 inches in size SBD-6398 (R. 11/11) 1 x c W ~ q o ~ II M ~ o 0 ~ p ~ p a c ~ o II ~ p ~ N `'y+ ~~~U a o1130 ~h U x x tV W ..p~ Ad o00 ~Ca c~dx Q U ~ ~ FG ~ ~ a II II II 40 .v ~o ^o ~ M ~ ~ ~ ~ WWa1WHC7E-C7 ~ ,N ti N N _ O O O p ~ M O O O W q o 0 0 0 ~ ~ o 0 U °o 0 0 N 03~ O 0.0 qz. Cr o ~x ~ ~o C N N O ~ !V W ~ ~U ~ o o z d N C/~ ti 00 W It ~ Ivy I' L DIVISION OF INDUSTRY SERVICES ' on 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ti Ro ssio*~t7~~ Scott Walker, Governor Laura Gutierrez, Secretary December 18, 2017 CUST ID No. 224059 ATTN: POWTS Inspector ZONING OFFICE KEITH E STONER ST CROIX COUNTY SPIA 23220 WOODCREEK RD 1101 CARMICHAEL RD SIREN WI 54872-8728 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/18/2019 Identification Numbers Transaction ID No. 3038116 SITE: Site 1D No. 845284 David A. Dalton Please refer to both identification numbers, 110TH Ave above, in all correspondence with the agency. Town of Hammond St Croix County SW1/4, SW1/4, S3, T29N, R17W FOR: Description: At-Grade (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1739770 Maintenance required; 450 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; 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 the POWTS Dispersal area. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Divert surface water from POWTS Area. I KEITH E STONER Page 2 12/18/2017 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • 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 at-grade 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. • 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. 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, Tim Vander Leest Please Include a Copy With Your Payment Submittal. 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 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson , Knudtson Plumbing (Plans Mailed To) KEITH E STONER Page 2 12/18/2017 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizin2 to meet TDH and GPM Specifications. • 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 at-grade 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. • 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 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, Tim Vander Leest Please Include a Copy With Your Private Sewage Plan Reviewer, Division of Industry Services Payment ment Submittal. 1. 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tiin.vanderleest@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson, Knudtson Plumbing (Plans Mailed To) RESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project David A. Dalton At-Grade Mound System Owner David A. Dalton Address 1794 110th Ave. Hammond WI 54015 Phone 715-796-2715 Property Address East of 1812 110th Ave. Legal Description SW 1/4 - SW1/4 Sec. 3 T29N-R17W Township Hammond County St. Croix Subdivision Name Na Lot No. Na Parcel ID Number 018-1006-30-000 Plan Transaction Number Index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 Pump curve & specifications Page 7 Plot Plan Page 8 rrrr tic r^%. Designer Keith E. Stoned. License Number Designer 1575-007 Signature Phone Number 715-653-2324 AV Date 11/29/17 %,o.'•• e~sa ~ •,~l~~°, ~jl , .t. , ,tip Designed pursuant to: At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07; and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) (r,1C11,L) Version 7.0 (03/12) Page 1 of 8 :71 17 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 300.0 Estimated wastewater flow (gpd) 450.0 Design wastewater flow (gpd) 7.00 % Site slope 103.50 Contour elev. below lateral (ft) 38.00 Depth to limiting factor (in) 0.50 In-situ soil application rate (gpdift^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 10.00 Linear loading rate gpd/ft 10.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 90.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) end Center or end lateral connection 1 Number of laterals 0.125 Orifice diameter (in) e.g. 0.25 Not a final calculation 1.75 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 2.19 Forcemain flow velocity (ft/sec) 25.00 Forcemain length (ft) y or n y Does forcemain drain back? 94.70 Pump tank elevation (ft) y or n Are laterals at highest point? 6.5 System head (ft) x 1.3 NA 8.47 Vertical lift (ft) 4.1 Forcemain drainback (gal) 0.26 Friction loss (ft) 40.5 5x Lateral void volume (gal) 0.00 In-line Filter Loss (ft) 44.6 Minimum dose volume (gal) 15.23 Total dynamic head (ft) 21.4 System demand (gpm) Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Design options Design choice Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in Gal/in (enter result in cell G46) one lateral 1.5 in x x diameter 2 in x Treatment Tank Information 3 in x 1000 Septic tank capacity (gal) Wieser Concrete Manufacturer Effluent Filter Information Dose Tank Information Poly-Lok Filter manufacturer 603.4 Dose tank capacity (gal) PL-525_ _ Filter model number 16.8 Dose tank volume (gal/in) Wieser Concrete Manufacturer Project: David A. Dalton At-Grade Mound System Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW D 1/6 B Observation pipes (2 typical) B A 10.00 ft 90.00 ft ~7 1 /6 B 15.00 ft C 12.00 ft W C D 5.00 ft E 2.00 ft L 100.00 ft D B W 22.00 ft A x B 900.00 ft^2 L T Cap obs. = Total aggregate cell A x B Typical pipe. Slotted in n the lower 6", and = Plowed area L x W anchored securely. 6" AT-GRADE CROSS SECTION Svnthetic fabric cover s 105.29 ft Finished grade elevation Lateral invert elev. 104.00 ft Observation pipe at aggregate toe E . 0 Slope 7 /o Surface contour 103.50 ft C A and system elevation D ' p = 12 in. topsoil and subsoil over aggregate and tapered to toes. Plowed layer below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: David A. Dalton At-Grade Mound System Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection a rPkAe-, Laterals LN force main 4 PVC Soh 4€~ on We bang n cd 04e talefal per SPS Table 384.:30-6 pac*d ! = Turn-up Mball+xatve car --Eeanoutplug Lateral Specifications 0.125 Orifice diameter (in) Center Lateral connection point X 1.72 Orifice spacing (ft) 1 Number laterals 52 Orifices/lateral P 88.58 Lateral length (ft) 21.4 Lat. discharge rate (gpm) 1.50 Lateral diameter (in) 2.00 Forcemain diameter (in) 21.4 Sys. discharge rate (gpm) 25.00 Forcemain Length (ft) 15.23 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device junction box ~ Final grade 4" disconnect Tank component is Alternate properly vented outlet location 18" min. Electrical as per NEC 300 and Approved SPS 316.300 WAC outlet Tank full joint Inches Gallons JA Provide 1/4" A 21.3 357.2 weep hole or Alarm on antisiphon B 2.0 33.6 g Pump on device. E C 2.7 44.6 o D 10.0 168.0 95.53 ft C 10 All 6 Totals 36.0 603.4 Pump off D 3" Bedding under tank ~ 94.70 ft Goulds Pump manufacturer SJE Rhombus Alarm manufacturer EP04Pump model number Tank Alert 1 Alarm model number Project: David A. Dalton At-Grade Mound System Transaction Number: Page 4 of 8 At-grade System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 900.0 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 at least once every 3 ears Pump and Controls Test once eve 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for pondin and seepage once every 3 years 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 at-grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SIPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished ••....X75 Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distributiong Sweep 90 or Two 104.00 ft 45 Degree Bends Same Diameter as Lateral Project: David A. Dalton At-Grade Mound System Transaction Number: Page 5 of 8 At-grade System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SIPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10854-P (N. 03/07), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (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 tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. At-grade and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade 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 at-grade 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 at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade 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 BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 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 at-grade 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 renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other 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. Project: David A. Dalton At-Grade Mound Transaction Number: Page 6 of 8 Page 7 of 8 NGOULDS PUMPS Submersible Effluent Pump EP04 EP05 3871 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: ThermoPlas- ■ Bearings: UPPS 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- a earmlim Standards Association • 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 GoL" Punpsr. ISO 90M Re i FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 14" maximum. ■ EP04 Impeller: Thermoplas- E 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: 11/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40`C) continuous 140-F (60-C) intermittent METERS FEET to • Fasteners: 300 series stainless steel. • Capable of running 9 30 s GPM dry without damage to s 2s Fr components. 25 0 7 Motor: _ • EP04 Single phase: 0.4 HP, v 6 20 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with Q 5 15.. automatic reset. a 4- • EP05 Single phase: 0.5 HP, EPOS o 115 V or 230V, 60 Hz, 1550 3 10, RPM, built in overload with automatic reset. 2- • Power cord: 10 foot s standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 ° 00 10 20 1 30 40 so GPM foot length, 1613 S.1TW with three prong grounding plug (standard on EP05). ° 2 4 6 a 10 12 m3/h CAPACITY Goulds Pumps ® 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 k O u ~ O d O oM m IOM O 06 N ti c O ~ ~ O O a' p ~ o ~O II ,`,r) oo N Q U d X 30 121 N = A s~. o n o q -Z e. w lcl; M II 0. c O ti V ~ U a1 ~ ~ > o 'C o b ~ ~O M 1 wHv~v ~ M O N I ~ I C C s U N z, O ~ U O M W O QL) o • o 00 s o o ~ c a U 0 ° N y II o ~ ~ ~~llll ~ , M ~ a, ~ N O O U ~.C r t/1 p~, U U O rr U ~ O ~ obi ~ M O U ~ ~ ~ o W C, ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer David Dalton Mailing Address 1794 110th Ave Property Address* 1 '71 lL 4 t a /1 'Q__ (Verification required from Planning & Zoning Department for new construction.) City/State Hammond Wi. Parcel Identification Number 01 8-1006-30-000 LEGAL DESCRIPTION Property Location SW SW I/4 , Sec. 3 , T 29 N R 1 7 W, Town of Hammond Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house Oyes[Dio Lot lines identifiable DyesOno 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. Uwe, 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 a warranty deed recorded in Register of Deeds Office. Number of bedrooms a4,1 /7 --r SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) ~1 yf V? I ~ _ _ r- - . ' ~ ~ ~ ' ~ 3'`~~ _ , , <,.3 ~ ~ ~ , _ _ ~ _ ~ ~ _ ~ - ~s ~ 4 _ ~ ~ - ~ ~ ~ _ ~ ~ C ~ - ~ .t~~ t Wisconsin Department of qbe(.- VnEMlces Division of Industry Servic SOIL EVALUATION REPORT #1347 r DEc 0 1 / , ; Page - 1--of 3 L in accordance wit SPS 5, A odP Keith E. Stoner twarfical 01X COON 1°Y County Attach complete s ,9A* 8'/2 x 11 v~ C~1~ C ix include, but rand horizontal reference poi-' " f~ - - - - - percent slope, I- ~ $ ~ Esc road. Parcel I.D. ercent slo e, scale or dimensions, north arrow, and R Z - 18-10 -3 00.0 Please print all into Q - - . _ - X ..W I Personal information you provide may be used for sect _poses (Privacy Law, s. 15.04 (1) (m)). Review By Date /2 ~Zg h Property Owner Property Location David A. Dalton Govt. Lot W1/4, 1/4, S3, T29N, R17W Property Owner's Mailing Address Lot # Block # Subd. Name iM# 1794 110th Ave. City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hammond WI 54015 1 715-796-2715 Hammond 110TH AVE. ® New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Sandy loam Till Flood plain elevation, if applicable Na ft. General comments Propose a 10' x 90' At-Grade Mound Dispersal located along the 103.50' contour w/a System Elev. of 103.50' Pipe Contour is and recommendations: staked on site. - ,X11 ❑ Boring # ❑ Boring Pit Ground surface elev. - 104.45 - ft. Depth to limiting factor 40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistency Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 ry 1 0-9 10YR3/2 I 2msbk mvfr cs 3f-m 0.6 0.8 2 9-20 10YR4/4 Cl 2msbk mfr gs 2f-m 0.4 0.6 3 20-35 7.5YR4/4 Is Osg ml gs 1f-m 0.7 1.6 4 35-40 5YR4 4 sl lmsbk mvfr gs if 0.4 0.7 5 40-63 5YR4/4 c2d 5YR5/8 sl lmsbk mvfr 0.4 0.7 Site is an open corn field. #5 w/ bands of massive sandy laom 2.5YR4/4 2-3 inches Boring # ❑ Boring Z Pit Ground surface elev. 102.00 ft. Depth to limiting factor 42 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz 5h. *Eff#1 `Eff#2 1 0-8 10YR3/2 I 2msbk mvfr CS 3f-m 0.6 0.8 i- 2 8-15 10YR4/3 Cl 2msbk mfr gs 2f-m 0.4 0.6 27 10YR4/3 , sl 2msbk ml gs 1f-m 0.6 ~ 1.0 4 27-42 5YR4/6 Ifs Osg ml gs if 0.5 1.0 5 42-70 5YR4/6 c2d 5YR5/8 Ifs Osg ml 0.5 1.0 Site is an open corn field * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Keith E. Stoner 224059 - - Address Keith E. Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd. Siren, WI 54872 11/28/2017 715-653-2324 SB D-8330 (R.07/13) Property Owner David A. Dalton Parcel ID # 018-1006-30-000 / Page 2 of 3 S~ Boring# Boring J 3 Pit Ground surface elev. 102.85---- ft. Depth to limiting factor 38 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 0-90-7 10YR3/2 I 2msbk mvfr cs 3f-m 1 0.6 0.8 - r - - t- - 2 7-16 10YR4/3 sl 2msbk mvfr gs 2f-m 0.6 1.0 3 16-38 7.5YR4/4 sr Is Osg ml gs if-m 0.7 1.6 4 38-52 7.5YR4/4 c2d 5YR5/8 Is Osg ml gs if 0.7 1.6 5 j 52-70 5YR4/4 c2d 5YR5/8 sl lmsbk mvfr 0.4 0.7 Site is an open corn field. #5 w/ massive bands of 2.5YR3/4 sandy loam 2-4 inches Boring F-1 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/ftZ in. j Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ~ j j fi Boring F-1 Boring # Pit Ground surface elev. ft. Depth to limiting factor in. ❑ - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistencei Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. j "Eff#1 -Eff#2 i Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-8330Test (R.07/13) Keith E. Stoner I x ca M O O U O ~ r•. O r„ ~ ~ o c ~ ~ II ~ O 00 N q~ ti U ~ °o ~ ~I 3 0 v vE ~ a s W y e~c ~n o ~n o v°'i ? N E W o Q 0 O0 a o o Q ~v N O P4 p~ ~~k It ~ o o scC, ~ N I U O M O O U O O O f~ ti O O O O W W o o w 0 0 ~ CL~ 2zmm o o U ~ y y all N CLI ? r~ c a ~ ~ ti