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HomeMy WebLinkAbout034-1061-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600370 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 3076249 Permit Holder's Name: City Village Township Parcel Tax No: Rick & Margo Holden TOWN OF SPRINGFIELD 034-1061-60-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 28.29.15.425 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head T DH Ft Forcemain Length Dia. Dist. to Well 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 CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution ix Hole Size ix Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length- Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No -1 El COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2929 80TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Ll County Safety and Buildings Division St. Croix 0S P ~tl APR 19 2018 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ~ Madison, :t. Croix County F3Z07~ LIB 1b v Io m nt loM3~~ Sanitary Permit Application - State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 3076249 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary u ores in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 2929 80th Ave. 1. Application Information - Please Print All Information Propert y Own s Name Parcel # r 10.0 Rick Holden 1 034-1061-60-000 Property Owner's Mailing Address Property Location 3015 US Hwy 12 Govt. Lot City, State Zip Code Phone Number NE NW %4, Section 28 Wilson, WI 5 715-505-5574 T 29 N R 15 (circle on W - II. Type of Building (check all that apply) Lot # XI or 2 Family Dwelling - Number of Bedro s C~? Subdivision Name ❑ Public/Commercial -Describe Use Block # - ❑ city of - ❑ State Owned - Describe Use CSM Number ❑ Village of 5 ('00 0✓ A.~ X Town of _Springfield III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade X Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suit le oil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 1l V. Dis ersaI/Treat ent Area Information: Design Flow (gpd) Design Soil Applicatio te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation / SR /I It 912- 161-50 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o New Tanks Existing Tanks QI eMd G"a 0. U n v u C7 G Septic or Holding Tank X 700 1 Lewis Bjork LLC X Dosing Chamber x 700 1 Lewis Bjork LLC X VII. Responsibility Statement- 1, the undersi d assume resp ibility for installation of the POWTS shown on the attached plans. Plumber's Name Print) Plumber's e MP/MPRS Number Business Phone Number y/ 7'$ Plumber's Address Street, City, State, Zip, Code) K r~ 'W ~ VIII. County /De artment Us Onl Approved ~sapproved Per//miitdFeee Date ssued Issuin gent Signature er Given Reason for Denial $ IOYtJ Iiy I IX. Condi' ~I2M easons l*r fir Disapproval 3, ~ ~U~0 + ` C 4 1r rk.rtf(k Ctti t~Ia* i.61 G~ (iisper w cell must all be SIX-- ct?s-!-rjtk tL t r~l as per giaLrsyernent plan p!o tided by pluinbe7. ~ taJ~~A QeC~~• 2• Ail rlt f bs w& I zrdi.,wV i:'eBtTt.11:E j as per 1>Ip~ikxSbla txtE~F ~.Mi:t1111r,S?. J\ Attach to complete plans for the system and submit to the Copnty ly pn paper not less than 8 U2 x I1 inches in size It SBD-6398 (R. 11/11) CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. ,E] SOIL EVALUATION Scale: 40 40, so a0 SYSTEM PAGE 2 OF SITE MAP LOT PLAN PROJECT NAME: 10z DESIGN FLOW: 300 GPD Rick Holden Attach design flow calculations for commercial plans. PROJECT ADDRESS: 2929 80th Ave Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) BM Symbol: BM Elevation: 103 N FT Sanitary Sewer: 4" 1 3034 BM Description: Spike in power pole Force Main: 2° / SCh 40 Slope Gradient Indicate north by IMPORTANT: of Tested Area: 4 well Symbol (it applicable): C) drawing an arrow Show ground elevation contours at suitable intervals. { on the approprite line. 2 v r^_ sJr ~ V (~`jfi4Y Si 1M iQFn~ t~zS t L ; y X I i oc: t(E3rv4~ K~U3 1 E t Y - TAtik5 f t cox 42~ f i f t ty`,b t , f L 1 7 5M P1, L t t t i r a r"J F-7- &,.i } r4Et rtr,4i ~'~,,r DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 'I Contact Through Relay ' In http://dsps.wi.gov/programs/industry-services us Scott Walker, Governor Laura Guti6rrez, Secretary March 21, 2018 ET`i' CUST ID No. 253976 ATTN: POWTS Inspector LEWIS C BJORK ZONING OFFICE> LEWIS BJORK LLC ST CROIX COUNTY SPIA E7818 COUNTY ROAD E 1101 CARMICHAEL RD MENOMONIE WI 54751-6637 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/21/2020 Identification Numbers Transaction ID No. 3076249 SITE: Site ID No. 847385 Rick Holden Please refer to both identification numbers, 2929 80TH Ave above, in all correspondence with the agency, Town of Springfield St Croix County NEI/4, NW1/4, S28, T09N, R15W FOR: Description: Mound System (2 Bedrooms - Replacement) Object Type: POWTS Component Manual Regulated Object ID No.: 1752419 Maintenance required; Replacement system, 300 GPD Flow rate; 18 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.01/0I, 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. • 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. • 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. • Abandon Existing System per SPS 383.33 • Pump Floats to beset and verified per approved plan. Anv 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 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) LEWIS C BJOP-K Page 2 3/21/2018 • 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 /err '61ew" 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 WiSMART code: 7633 (920)492-2214, Mon- Fri, 6:00 a.m. - 3:30 p.m. tim.vanderleest@wi.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. LEWIS C BJORK Page 2 3/21/2018 • 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 emmponent mart..- malfiinctinnc gp as to rrPate 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 1 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 Submittal. WiSMART code: 7633 (920)492-2214, Mon- Fri, 6:00 a.m. - 3:30 p.m. tim.vanderleest@wi.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN v , - INDEX AND TITLE PAGE - Project Name: Rick Holden - Replacement Mound Design r.,, 4A~ Owner's Name: Rick & Peg Holden Owner's Address: 2929 80th ave I1ter5'iry1NI W :1,5,- 715-505-5574 Legal Description: NE NW 28 29 15W Township: Spring Field County: St. Croix Subdivision Name: Fourty Acre parcel) Lot Number: na Block Number: na Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot plan Page 11 ATT. Filter, Manhole, level alarm , soil report Page 12 Tanks used Designer: Lewis Bork License Number: 253976 Date: 0 Phone Number: 715-231-7375 Signature: J~7 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), 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) Page 1 of 10 Mound and Pressure Distribution Component Design Site Information r Residential or Commercial Design Note: Sand fill (D) calculations assume a 200.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 300.00 Design Flow (gpd) 4.00` Site Slope 100.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.80 In-situ Soil Application Rate (gpd/ft2)~~ Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution _ Y Pressure Disribution Information network? Fn ter Y or N e'. Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 2' Number of Laterals of the highest point. 0.250 Orifice Diameter (in) 4.75 i. rr « Orifice Spacing (ft) = 11.54 ft2/orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 95.00 Pump Tank Elevation (ft) rer 3.25 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 6.00 Vertical Lift (ft) 53.73 5x Void Volume (gal) 0.79 Friction Loss (ft) 60.26 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 30.29 System Demand (gpm) 10.04 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 i 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator Treatment Tank Information Total Tank Capacity (gal) 700.00 Septic Tank Capacity (gal) { Total Working Liquid Depth (in) Lewis Bjork LLC Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 700.00 Dose Tank Capacity (gal) orenco ;Filter Manufacturer 18.85; Dose Tank Volume (gal/in) Bio-tube Filter Model Number Lewis Bjork LLC Manufacturer Project: Rick Holden - Replacement Mound Design Page 2 of 10 r I Mound Plan and Cross Section Views t 91108 J Observation Pipe © - ♦ 1 FKK'Al O F5] A W B 2 L Mound Component Dimensions A 5.00 ft E Mft in H 1.00 ft K A22.68 ft B 60.00 ft F in 1 10.20 ft L ft D 18.00 in G J 7.48 ft W ft 300.00 (ft2) Dispersal Cell Area 911.93 (ft) Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.29 (ft) H r~rrr: vrr. rrrrrrr.ri.:. G 1 ~ ,rrfr.~~.;!t.•rr.:•.rr::. rrri»rrrrrrrriiE,. F Dispersal Cell 102.00 (ft) Lateral 101.50 (ft)--► - Invert Dispersal Cell. t Elevation E D F41 51 100.00 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key a Dispersal Cell See lateral details on 1❑ 0 Topsoil Cap c a 1.5 ft Page 4 for number, size, 2❑ Subsoil Cap W.0 © 0 ~Q and spacing of laterals. ©0 ASTM C33 Sand R ° / Laterals are equally L F spaced from the ®0 Tilled Layer d m 0.5 ft Typical Lateral w distribution cell's ©0 Aggregate a o © centerline in the 0- A ♦ distribution cell (AxB). Project: Rick Holden - Replacement Mound Design Page 3 of 10 1 End Connection Lateral Layout Diagram aIerals centered over the A ~r 97 dimension ♦ = Turn-up vii tball valve or cleanoutplug I P All IateraFv ale i.~entical I« X -I Hole_ drilled on the bottom of the lateral S eq jallir ;paced ForcN main connection Ilia tp9 Of cross to rnanilold at anq Point. Lateral & for r emair 40 P ""C per S P S Table 334.30-5 Number of Laterals 2 Orifice Diameter 0.25 in Lateral Diameter 1.50 in Orifice Spacing (X) 4.88 ft Lateral Length (P) 58756 ft Orifices per Lateral 13 Lateral Spacing (S) 2.50 ft Orifice Density 11.54 ft2/orifice Lateral Flow Rate 15.15 gpm Manifold Length 2.50 ft System Flow Rate 30.29 gpm Manifold Diameter 1.50 in Total Dynamic Head 10.04 ft Forcemain Velocity 3.09 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC j 4 in. min. Disconnect Tank component is properly vented - Alternate outlet location diameter Lewis Bork LLC Manufacturer 2 in. Ca acit 700.00 Gallons Volume 18.85 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.94 375.84 B 2.00 37.70 C Pump off elevation (ft) C 3.20 60.26 96.00 D 12.00; 226.20 T D otal 37.14 700.00 Dom se tank elevation (ft) 3" Bedding un er tank. 95.00 Alarm Manuafacturer LSJE RomBus i ! r .;le, Alarm Model Number', 1011421 containing mere may not be use Pump Manufacturer LZohler Pump Model Number 1152 Pump Must Deliver 30.29 gpm at 10.04 ft TDH Project: Rick Holden - Replacement Mound Design Page 4 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Lewis Bjork LLC j Phone, 715-231-7375 POWTS Regulator's Name st. Croix County Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 300 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 200 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 700 gal Maximum TSS 150 mg/L Soil Absorption Component Size 300 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Lewis Bjork for Pumping 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 mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Rick Holden - Replacement Mound Design Page 5 of 10 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), 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 tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L 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 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 defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 10 150 Series Effluent Pumps I Zoeller Pump Company littps://www.zoellerpumps.com/en-na/products/sump-effluent-pumps/ef... U) W w PUMP PERFORMANCE CURVE U MODEL 151/152/153 50 14 45 153 12 40- 35-7 7 < 15 r 10 cv 30 _ !5 a ~z 8 151^ gym'"' 0 25 4.. 6 20 - ~T 154 10 - a . 5 0-- 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 2 of 5 2/21/2018. 10:05 AM, CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. [-1 SOIL EVALUATION Scale: 1" = 40' SYSTEM PAGE 2 OF SITE MAP ° 40 so ao LOT PLAN PROJECT NAME: DESIGN FLOW: 300 GPD Rick Holden Attach design flow calculations for commercial plans. PROJECT ADDRESS: 2929 80th Ave Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) N Sanitary Sewer: 4" / 3034 BM Symbol: + 8M Elevation; 103 FT Force Main: 2 ~ / SCh 40 BM Description: Spike in power pole Slope Gradient (°6) Indicate north by IMPORTANT: of Tested Area: 4 well Symbol (It applicable): drawing on the appro an arrow pthe lte line. Show ground elevation contours at suitable intervals. -Sat I 5tt j%w/ v6~ i s E- 00 PL f r ! % -760 103, talc 0 ) arz i a i WI), l.J " R8MtD1N3 .1t I Ij- 1. i ill cl, "rl t r, -71 i 1 AJ it Y t._' pn. i l Tufts . vc~ ~ Ae y - - v Pan i Rts A ~w ~ r to 10. M r ' Tank Al er t ® PB Indoor Alarm System (Auto Reset, Battery Backup) Function The Tank Alert" AB indoor alarm system monitors liquid level conditions in lift pump chambers, sump pump basins, holding tanks, sewage, agricultural, jters and other waste applications. The sleek design of the alarm features a user friendly touch SEeRous pad with colored LED indicators for easy visual detec- tion. The alarm horn and red LED indicator activate for a M 3 high water alarm condition. Once the condition is cleared, the alarm automatically resets. The green LED indicates ~sr 120V primary power to the alarm. If primary power fails, the alarm continues to work due to 9V battery backup. Sf1MCI Features P P~ NEMA 1 rated enclosure for indoor use Automatic alarm reset 9 VDC battery backup with low battery chirp Colored LED indicators: SIGNALING fl'% CIP U, • Red alarm R~<« LISTED zaex • Green power on Alarm test switch Horn silence switch battery r door i External terminal block for easy float installation 1 I. test' button y silence" button R alarm" light Includes 15' SJE SignalMaster" control switch ? - 1 ~ ---primary power on" light Alternative boat models for high and low level alarm r K 1 Optional auxiliary contacts for remote devices attach float switch here mounting • • . • • flange power cord 1011421 TA` AE3, High, 15' SJE SignalMaster'' www.sjerhombus.com Toll Free 1-888-342-5753 Phone 218-847-1317;,:; r ~ r ~vEeARTkC~r DIVISION OF INDUSTRY SERVICES 5~ 0 s 1 C 1 PO BOX 7302 MADISON WI 53707-7302 3 I S Contact Through Relay y P S http://dsps.wi.gov/programs/industry-services `cw www.wisconsin.gov 1. ~dssiONScott Walker, Governor Laura Gutierrez, Secretary May 19, 2017 Identification Numbers Transaction ID No. 2944957 Site ID No. Please refer to both identification numbers, above, in all correspondence with the agency. CUST ID No. 253976 LEWIS C WORK LEWIS WORK LLC E7818 COUNTY ROAD E MENOMONIE WI 54751-6637 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/31/2022 Re: Description: SEWAGE TANKS, CONCRETE Manufacturer: LEWIS BJORK, LLC Product Name: (tyrans id 2944957) SEPTIC, PUMP OR HOLDING (TANK AND ADAPTOR) Model Number(s): LB700, LB 1150 (700 AND 1150 gals.) [LB700 BASE TANK; LB1150 CONSISTING OF 3 SECTIONS WITH THE 450- GAL. ADAPTOR AS THE MID-SECTION] [38 IN. L.L., 18.85 GAL/IN.; 96 IN. MAX. DEPTH OF BURY, 335 OR 551 GPD WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; TANK DIMENSIONS = 66 IN. L X 36 IN. W X 54 IN. H; ADAPTOR DIMENSIONS = 66 IN. L X 36 IN. W X 24 IN. H] Product File No: 20170151 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of May 2022. This approval supersedes the approval issued on 6/28/2012 under product file number 20120193. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • All manhole covers terminating at or above grade must have effective locking devices. • When this product receives wastewater from dwellings, it will produce an effluent quality with a maximum monthly average value for BOD5 of less than or equal to 30 mg/L, TSS of less than or equal to 30 mg/L TSS and F.O.G. of less than 30 mg/L. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Rick Holden Mailing Address 3015 US Hwy 12 Property Address 2929 80th Ave. (Verification required from Planning & Zoning Department for new construction.) City/State Wilson, wl Parcel Identification Number 034-1061-60-000 LEGAL DESCRIPTION Property Location NE '4 , NW ~4 ,sec. 28 , T 29 N R 15 w, Town of Springfield Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume . Page # Spec house Elyes0no Lot Iir;.,~ I 1,o 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 days of the three year expiration date. I/we certify that all statements n this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue a warranty deed recorded in Register of Deeds Office. Num,be,,of bedroom 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) i 1~ APR 19 2018 Wisconsin Department ofC"merce S IL EVALUATION REPORT Page l of 3 Division of Safety and Buildings St. Q. i~x,,,, -~y~n th _ Community WV10ens mm85,Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6 Please print all Information. Revi® by Date Personal information you provide may be used for seoondery purposes (Privacy Law, s. 15.04 (1) (m)). 9 / Property Owner Property Location . Rick Holden Govt. Lot NE 1/4 1/4 28 T 29 N R 15 E (or) 11 Property Owner's Mailing Address Lot # Block # Subd. Namil or CSM# 2929 80th ave - - Part of>100 acres city State Zip Code Phone Number ity ®Village • Town Nearest Road Wilson W1 547027 ( 7)15-505-5574 Spring Field 80th ave / 292nd street n New Construction Use[D Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Replacement El Public or commercial - Describe: NA Parent material _ Loess cap over till Flood Plain elevation if applicable NA ft. General comments Install replacement mound cell , use the 100' contour , use , .8 basil loading rate after 12" of mound sand , and recommendations: cell 5'x 60' with up-slope 1.5' sand lift , abandon existing system , < 36" separation X, E Boring # E )Boring 11 Pit Ground surface elev. 99 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 A 0-6 IOyr4/3 sil 2fgr mvfr as 2f .6 .8 E 6-18 1 r6/4 sil 2fsbk nrvfr as if .6 .8 Bt 18-24 10yr6/8 C2PSyr5/3/ 10yr6/2 scl - B2 Boring # El pit 99 18 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 1 0-6 IOyr4/3 A 2fgr mvfr as 2f .6 .8 2 6-18 1O r6/4 A 2fsbk mvfr as 2f/lm .6 - 8 3 18-24 10yr6/8 C2P5yr5/3/ I0yr6/2 scl - - - - - - " Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 5 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Lewis Bork 253976 Address Date Evaluation Conducted Telephone Number E7818 County E Menomonie WI 54751 10-15-2017 715-231-7375 1-- .1- 1111111-1 Property Owner Holden Parcel ID # 2 3 Page of B3 Boring # ~Boring E:J pit Ground surface elev. 10© ft. Depth to limiting factor l 8 in. Soil Nation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe In. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. -Eff#1 -Eff#2 1 0-7 1Oy4/3 - sit 2fgr mvfr as 2f .6 g 2 7-18 10 r6/4 - sit 2fsbk mvfr as 2f .6 .8 3 18-24 1 0yr6/8 C2P5 r5/3/ 10 r6/2 sit Boring # Boring • Pit Ground surface elev. ft. Depth to limiting factor in. oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh, 'Eff#1 -Eft#2 U 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 p In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eft#1 -Eff#2 " Effluent #1 = BODB > 30.a 220 mg/L and TSS >30:< 150 mg/L • Effluent #2 a BOD, < 30 mg& and TSS < 30 mg/L 1"he Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in a» alternate format, please contact the department at 608-266-3 15 1 or TTY 608-264-8777. s»r>-8330 r~l (R.Wioo) CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE, OIL EVALUATION scale: 1" = 40' [J SYSTEM PAGE 2 OF 3 SITE MAP ° 40 ~o so PLOT PLAN PROJECT NAME: 10' DESIGN FLOW: 300 GPD Rick Holden Attach design flow calculations for commercial plans. PROJECT ADDRESS: 2929 80th Ave Pipe Material / ASTM Standard (Tables 384.30-3 & 384,30.5) BM Symbol BM Elevation: 103 N Sanitary Sewer: 4" 3034 Fr 2" sch 40 SM Description: Spike in power pole Force Mein: Slope Gradient Indicate north by IMPORTANT: of Tested Area: 4 Well Symbol (IfaPPIicable): Q drawing an arrow Show ground elevation contours at suitable Intervals. on the appropr@e Ike. 5 _ 92 SE of VQ, Jam- 5 p r- t~~~,. - /100 r: AV 5o'k I ~o P h6 Nos lck~ ' TANk s c"t• h611' (2) ert 1 09429 leo Ajp- wt1~tl,~cpo„J i o u S °7 S=' p~l t