HomeMy WebLinkAbout010-1022-10-400VYS n Department of Commerce
Safetittillild Building Division
GENERAL INFORMATION
Personal information you provide may be used for secondary purposes
La
TANK
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Law, s.15 04
TYPE
MANUFACTURER
CAPACITY
Septic
la�lCSE
jaoaA6 OD
Dosing
I
u
Aeration
TOWN OF EMERALD
TANK SETBACK INFORMATION f-t>L =5 YS
TANK TO
P!
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
pi C i
C J
7 r
Q 7
ca
Aeration
Holding
PUMPISIPHON INFORMATION /C{ 1 IL Zt5
Manufacturer
J I
_0C r 1-0-p^
Demand
GPM
Model Number
Li
TDH
Liff1 ' �p
`7 1
FdctyBp L 2.
of
Systemj} aQr 5
(� • J
Tf i Ft
I V r
Forcemain
Lear A t
CC..
Dia.2 •
Dist to Well 1 ,
v4
SOIL ABSORPTION SYSTEM I I t
TION DATA
STATION nL
J�
5�
FS
I
Benchmark
a,.�.�
(02•
l Oc9.0 7
Alt. BM
(7,45
t D
Bldg. Sewer
13•11
V. 8.J
SUHt Inlet
2•�1
J
1
VHt Outlet
Dt Inlet
Of Bottom
/ • /
q / • I
Header/Man.vRto
f - (� I
col •�
1-61
lol.o`t
ax l,&1
I-78160•9z
Final Grade
f e r ytf
(`T
117Z.6
.�.e...!
2.�
Z• T"
Z'�
Do's(
�• P fit'
15.8
BEDITRENCH
DIMENSIONS
Width 1
1
Length C T
—77
c as
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid De
SETBACK
INFORMATION
SYSTEM TO
Ty O SysLemY��
IPILVJ
Z771
BLDG
11 7 (
IWELL
LAKE/ R
LE CH G
CH BE R
UNIT
nin rec
octal NurW
Ill£TGIRIITIr11,J RVATFM 11
HeaderlManifoltl
�It �j•-
IDistnibuton Ji
Plpe(s) A �q
7-
x Hole Size 3
x Hole Spacig
ZZ
V 1 to Air Intakk
Length / v"l Dia
Length Dia Spacing / � `
Ze
QnII (1r)V PQ- - n.. —.— e...•.,..,. n-1,. .. ss. riri nr et_nraAu Au.tams Only irf KI U V. ]--I. (-
Ve-11
BSClReneh-Center if
I
Depth Over
BedfTrench Edges
f t
7
xx Depth
Topsoil
CL
7 1'Z
,yt
xx Seeded/Sodded
xx Mulched
//
Yes
® No
Yes n No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection f##1�'��_ ,L Inspection #2:
Location: 2485 170TH AVE
1.) Alt BM Description = gIrI 17L� ,rA ly(,r �,
2.) Bldg sewer length = 15,/ f` — �V(�� i � 5tV-2)ey- JVt5^l�
- amount of cover = ��(t��( r i w--- W �jjr4•ri l.di.
fads - --e�sLKW-nna..4asifs c rtl 6lofi . NG v(.so-�s//N).c.
Plan revision Requiretl? ` Yes A No
Use other side for additional information.
Data Insepctors SigRature Cart. No.
SBD-6710 (R.3197)
`\
rr.r�nn rc--E0F�l ))I YY1N,aol9 _ 15;? 'L (,r-O ,
Wiscons
ety and Buildings Division
County
St. Croix
N 19 gJ9201
W. Washington Ave., P.O. Box 7162
Sanitary Permit Number (to be filled in by Co.)
Department Serf ty Br4
adison,WI 53707-7162
RA
Professional Se icesst. Croix co
my
State Plan I.W. Number
Co muni i
State S 5U►
arm Ap
SIT - 63963 651146 4ftl 4
In accord with SPS 383.21 (2) Wis. Adm. Code submission of this form to the appropriate govemmental
Project Address (if different that mailing address
unit is inquired prior to obtaining a sanitary permit. Note application forms for state-owned POWTS are
submitted to the Department of Safety and Professional Services. Personal information you provide
may be used for second purposes in accordance with the Privacy[aw, s15. I m , State
7�Ij• �`j, / ...r� PI —
kit
I. Application Information - Please Print All Inf a ' a
Property, rio
Dance N�rry
Parcel p Ole - lea a -► o _ yo v
Amundson
Property /Tuners Mailing Address
Property I.acation
GovL Lot
NE '/., NE v.., Section 10
City, state
Zip Code Phone
Number
T 30 N/ R 16 W
IL Type of Building (check all that apply)
Lot #
Subdivision Name
X 1 or 2 Family Dwelling- Number of Bedrooms Three
PubGdCommercial- Describe Use
Block p
City
State Owned -Describe Use f
Village of
X Town of Emerald
CSSM Number
O 5 l ckof
/O
III. Type eck only one boa on line A. Complete line B if applicable)
A.
X New System
eplacement System
❑ TreatmentlHolding Tank Replacement Only
❑ Other Modification to Existing System
B.
Permit Renewal
❑ Permit Revision
Change of
❑ permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration
plumber
Owner
IV.
Type of POWTS System- Check all that apply)
Non -Pressurized In -Ground Pressurized In -Ground X At -Grade M >24 in of suitable soil _Mound Q4in of suitable soil
Holding Tank _Other Dispersal Component (explain) _Ftebeatmeat Device (explain)
V. Dia rsal/Treat eat Area Information: /
Design Flow (gpd)
Design Soil Application dst)
Dispersal Area Required (
Dispersal Area Proposed ( System Elevation
450
0.6
750.Osq.ft.
I
750.Osq.ft. 100.0'contour
VL Tank Info
Capacity in
Total
Number
Manufacturer
Prefab
Site
Steel
Fiber
Plastic
Gallons
Gallons
of Units
Concrete
Constructed
Glass
Nmbi
yIak 5!/S
TEa
Septic w Hotdmg
1000
1000
I
Weiser Concrete
X
Tack
Dallas Chamber
600
600
Combo
X
VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached pleas
Plumber's Name (Prim) Plum s Si
MP/MPRS Number
Business Phone Number
Jack A. Bowman
MP222839
715/418-1349
Plumber's Address (Street, City Stale, Code)
N 1343 7 400 S eet, Rid eland, WI 54763
VIIJiltounty/Department Use Only
Approved
❑ D'
Permit Fee
Date Isedr�JQ
Issuin t Sign
Owner Reasonfor
S 5a
G 01
son for Disapproval
IX Condi i easons
)
lirpwu>yetibea,attA�a�lyt�ltx. &me- (/� �ryCGJ�- r✓I �/�'g^^�--,
m per �G1+�e p� Budded Iry yltunbo;.
2. M eelaau * tee tter^encs to althe r. wrJrYsd
up par pppdwbh a1d! / :rKnAmAx.
ya
I
Atteeh eomplete plans (to the Couaty only) for the system on paper not lesatame 8112 ill inches In she
SBD-6398 (R. 01/03)
Larry Amundson 5
NE'/.,NE'/.,S 10,T30,N/R16W
Emerald township
St Croix County
LEGEND
!BM: 100.0' base of
Orange fence post
^_BM: 100.0' base of
Orange fence pest
7X— backhoe pits
® -Bade elevations
- contour
No DSPS 383 set back
problems
Scale I" — 40' except
where indicated
System Elev. 100.0' contour
Lateral invert elev. 1005'
Part of 6A.0
il-
project AMUNDSON
SITE PLAN
R5'
iA
9
ws
� b0' a` 44 ScA 3 C 4
3
ip044 km, LP
264's�
100.0, Ir
� o
I
page 10 of 10
I
x D K SP
S
aanvs�
May 1, 2019
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2021-05-01
Plan Review: PWTS-051900496-C
LORETTA LARRABEE
N2089 County Road Y
Menomonie WI54751
SITE:
Larry Amundson
170th Avenue
Town of Emerald
Saint Croix County
NEl/4, NEI/4, S19, T30N, R16W
Total Amount: $250.00
3824 CREEKSIDE LN
HOLMEN WI 54636-9466
Contact ThMugh Relay
httpl/dsps.v,i.govlprogramslDefaLdt.aspx
www.vAscoron.gov
Tony Evers - Co emor
Darn Crim - Secretary
Conditionally
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
SEE CORRESPONDENCE
FOR:
Description: Three Bedroom At -grade System 1 Sloping site
At -Grade Component Manual - Ver. 2.0, SBD-10854 (N.03/07, R. 1/12), Pressure Distribution Component
Manual — Ver. 2.0, SBD-10706-P (N.01 /01, R 10/12), 450 GPD, 37" depth to limiting factor from original
grade, New construction, Maintenance required, 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:
Reminders
• A sanitary permit must be obtained from the county where this project is located in accordance with
the requirements of See. 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be
made with the designated county official in accordance with the provisions of See.145.20(2)(d), Wis.
Starts.
• 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.
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also
receive a copy of the appropriate operation and maintenance manual(s) and be responsible for
ensuring that POWTS is operated and maintained in accordance with this chapter and the approved
management plan under s. SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a
health hazard the property owner must follow the contingency plan as described in the approved
plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shalt 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,
GeAld M. 5wZ40.
Gerard M Swim
POWTS Plan Reviewer, Division of Industry Services
(608)789-7892 — voice \ (608)785-9330 — fax
ierrv.swim(awi.00v
AT -GRADE AND PRESSURE DISTRIBUTION COMPONENT DESIGN
New Residential application
INDEX AND TITLE, PAGE
Project name: AMUNDSON
Owner's name:
Larry Amundson
Owner's address:
Conditionally
Location:
17&Ave. Lot
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
Legal description:
NE'/.,NE'/o,S10,T30N/R
16W SERVICES
DIVISION OF INDUSTRY SERVICES
Township:
Emerald
County:
St Croix
I/
Subdivision name:
Lot number
Lot 4
SEE CORRESPONDENCE
Designer's name and license no:
Address:
Phone:
Cell:
E-mail
Page 1 title page
Page 2 general information & lateral diagram
Page 3 at -grade view
Page 4 tank cross section
Page 5 pump information
Page 6 tank detail
Page 7 filter information
Page 8 maintenance
Page 9 management plan
Page 10 site plan
Attachments: soil test to state plan
Loretta Larrabee #1872-007
N2089 Cty. Rd. Y
Menomonie. Wl 54751
7151664-8184
715/505-1628
laniperetesting@wwt.net
Designer's Signatlue: ('/Itop— JCh U C42 Date: April 23, `cu 17
Designed pursuant to the At -Grade Component Manual for POWTS SBD-10854-P (R_03/07)
Pressure Distribution component manual SBD-10706-P (R.01/01)
page I of 10
GENERAL INFORALATION
Residential site , three
Soil application raten'Om home450
Site area oWF
c0 at 37inches 8a1 D
1000/ti00 Wieser end fed system I laterals
etlluent Concrete tank w/ orifice dia.
quaiity is # 1 Polylok orifice 5/32 (0.15t7
contour line 200.0' S25 filter
(system elev. linear Spacing .fL
100.5' required � ft
revert of late
ProP°Sed bed 750s�q.ff
END FED _ LATERALone LAYO
lateral
@° 74ft. (p) (not to scale UT DIAGR A_M
ral dia. 2 in )
force main dia tin.
0.52 Per late
20.52gpm Per later a 38 orifices
'see construction details 3.5 Pressure 0.54 0.52gpm total system
m ft,
OD Page g of 10 for turn up 8Pm Per office
Finisl��=
Valve box at fi
O Wish grade
Pressure
P
�r
0.5, orifices located 2" lateral dia. W) on bottom of lateral
last Force Main �„ orifice next to dia.
fitting **tirstorifice
at O inches
Project AMUNDSO
N
Page 2 of I0
W
22 JA-101.
E = 2.Oft.
A = 1 O.Oft.
C = 12.Oft.
W= 22.Oft.
PLAN VIEW OF SINGLE ABSORPTION AREA
L-85'
B-75'
"-5 �D-5'
F = 0.83ft.
G = 0.50ft.
H = 1.00ft.
D = S.00ft.
501
0
' 1/6 obserbatio
B = 75.Oft. observations @ 12.5ft.
L = 85.Oft.
CROSS SECTION — SLOPING SITE
�� Finish grade elev.101.83'
Lateral invert100.5'
fabric H=12" G = 6"of subsoil of H
observation —i 2 F=1 plowed laver
1 6'
6% slope
contour elev. 100.0'
D=5' A=10' E=2' D=5'
1.) '/." — 2 %:" washed sewer rock
2.) soil cover 'T 1.Sft.
4in. dia. observation +
pipe with'/4" slots
flange secure observation 0.5ft.
project: AMUNDSON page 3 of 10
Compo tan
He �ross section
o Sca
.Approved Locking Manhole Cover
With Warning Label Attached
Weatherproof
Warning 1 Label Junction Box
l,-Ai ,
Final Grades ,'�_
y„
Approved
Vint Ca
� 12" Minimum
4" Minimum
Quick
18" Minimum Disconnect
1/4" Weep
Hole
Baffle
r
Approved Joint} A
Y/4S,%401'ipe
Extending 3' Alarm 6V
Onto Solid Soil On � B Approved Joint
w/41 SJAO ppe.
C Extending 3'
�' �'� ' Off Onto Sol id Soil
6'
Conc. Block
3" of Beddinq Under Tank--,`
4nrec Pwpp and Alarm Are On Separate Circuits `�'`�� ��' F �e•� and_
S 1E- Oc3zgo.�i =�.
� inn „+,', a — q.'l $ n •0"
Tank Manufacturer: 0 e tAn
Tank Size-Septic/Pump: pop 0o LP —Gallons
Alarm Manufacturer: S s. e , ' ',.l is ,:. ? u &-J-
Model Number: vh 7 s1 Capacities: AL�_inches or 318.44 Gallons
Switch Type: m + B a inches or 33.51Gallons
Pump Manufacturer: -7— �Qvsti Vj + Cinches or gs.xO Gallons
Model Number: 9 + D l C inches or t 67 be Gallons
Minimum Discharge ate: Z1 Total ..... = winches or Ne 3�66a11ons
Vertical Difference. Between Pump Off rp,, Distribution Pipe: 9.C)C Feet gal/inlb,t�
Minimum Required Supply Pressure:..... ?. '` 3.S.. .......+ ,ss Feet
Feet of Force Main x b'19 Friction Factor/100 Feet: + 6,1i3 Feet
;Z Inch Diameter Force Main
Total Dynamic Head: ... =14,38Feet
project AMUNDSON
page 4 of 10
■■■■■■■no
U ms
eo 160 240
FLOW PER utanE
MODEL 98 60 CYCLE
Feen
Comorsi
Meters
Ulars
s
n
u
xn
10
is
a
s.e
1ro
x,a, v,wc xs
rta ni
CONSULT FACTORY FOR SPECIAL APPLICATIONS
18
16
1 1/2-11 1/2 NPT —\
axllex
'16
• Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available • Double piggyback variable level float switches are available
with or without alarm switches. for variable level long cycle controls.
Standard all models - Weight 39 lbs. - Yx H.P.
are Seri" contra
aenecuon
Yodat
VoaMh
Yod•
sim hr
Duplex
am
115 1
Auto
9.4
1w1&7
N96
115 1
Non
9.4
2w2&6
3or4&5
D96
230 1
Auto
4.7
1 or 1 & 7
—
E98
230 1
Non
4.7
2p2&8
3ora85
SELECTION GUIDE
1. Integral float operated 2 pole n1acherucal switch, m external control xequyed.
2. Single piggyback variable btel float switch or doui piggyback variable level.
Goer ewactt. Neha to FMO477.
3. Mechanical albrttebr 10-0072 or 1040075.
4. SWFM07IZ for urrect., of Electical Aaarnalcr.
5. Contra swath 10-VM used as a coned activator, ,parry duplex (3) or (4)
float system.
6. Four (4) hold J-Pak)uhdionbm for watertiehtconnection orwta6h
s nlpmx xr duplex operation, 10-0002.
7. Two (2) holeJ-Pak forwalsW connection or space.
MW n Fs:tomaum 0o adttama Zcarw pmductrCAUTION
txarMg m Pipgjosd+ VaMob lWen 9esraws, Julur inatalbdon of wntek, llroletllon devlm as and wiring cAWd be cede by a qualHisd
11100477;EIehidAaaha/or, R10WIlecarataiAlanator,ROKS1nprSeelpate tRew licensadebetrician. All elactriml and safety Codes should be followed laduding the am
5algia Puss Satchel PhahgCanhd, F'MISW Nam SyLNrea, FAIDM recent National Electric Cade (NEC) and the Occupational Sdety and He" Ad (11SNA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered Into the design of every Zoeller pump.
he-r%= MllF1 DSO y1 �Ssf. S E lfl
WE LDU irk P.O. 90x 1647
` TO.- 3 KY are l 0347 Nas4dearaof..
0 31liD: 3B19CeneRnRoed
• toast, KY 402114M afaarii /-!1/T (5N.wSr A.�"
PUMP !O. 02J77a-2731.1(8MgM-U1 a
ltNnJhrw.zoe�a/earn FAK(W477+3M
WLP1000/600-MR
TANK SPECIFICATIONS
gg
DIMENSIONS:
S
��
WALL: 3'
w
G
v-
150"
BOTTOM: 3"
y
COVER: !I*
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
u
HEIGHT: 56" O.D.
o
LENGTH: 150" O.D.
h
WIDTH: E4" O.D.
-
BELOW INLET: 42" O.D.
' k�
LIQUID LEVEL: 36"
4" CAST
-A -SEAL
�r 4" CAST -A-SEAL
WEIGHT: 14,970 LEIS.
o
IGII INLET AND OU TLET:
lI 4" CAS--A-SEAL BOOT OR EQUAL
24" \
/ I cl)GASKET,
CAST -A -SEAL B00T OR EQUAL\
INLET AND OUTLET BAFFLE AND FILTER:
m $
IIII III
WISCON';IN, SEE DETAIL p10
STATES SEE CHART)!
FILTER OR
(OTHER
0
.II
- --_
BAFFLE 11.11 I�
_ -- _ _ _-J�= _ -SI
LIQUID CAPACITY: 27.88 GAL/IN (SEPTIC)
16.7EI GAL/IN (PUMP)
c
a!
W 8
,
Lu
LOADING DESII;N: 8' 0" UNSATURATED SOIL
TOP VIEW
j5
�
TANK CAN BE JSED AS:
N
SEPTICI'SEPTIC, SEPTIC/PUMP
W
4" VENT
OR SEP RC/SIPHON
OI
a $
COVER: MIX DESIGN / p8 NO FlBER)oo
TANK: MIX DE:;IGN 0STRUCTURAL FIBER)
=
in
CUSTOMIZED T,\NKS:
- -
FOR CUS10M TANKS CONTACT WIESER CONCRETE
OUTLET
.I
—m
I.I
I.I I
Q cl
d < a
SUBMITTED
i
PUMP PAD
DRAWINGS
"
FOR AP
SIDE VIEW -::'...
mono 1r:
ski%. _
-
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227
• o Filters
PL-525 EFFLUENT FILTER (COMMERCIAL)
Polylok, Inc is pleased to add its
new commercial filter to its existing
line of quality effluent filters. The
PL-525 is rated for over 10,000 GPD
(gallons per day) making it one of
the largest commercial filters in its
class. It has 525 linear feet of 1116'
filtration slots. Like the Polylok
PL-122, the new Polylok PL-625 has
an automatic shut off ball installed
with every filter. When the filter is
removed for cleaning, the ball will
float up and temporarily shut off
the system so the effluent won't
leave the tank. No other filter on
the market can make that cfaim!
PL-525 Maintenance:
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at least every three years. If the
installed filter contains an optional
alarm, the owner will be notified
by an alarm when the filter needs
servicing. Servicing should be
done by a certified septic tank
pumper or installer.
1. Locate the outlet of the
septic tank.
2. Remove tank cover and pump
tank if necessary.
3. Do not use plumbing when
filter is removed.
4. Pull PL-525 out of the housing.
5. Hose off filter over the septic
tank. Make sure all solids fall
back into septic tank.
6. Insert the fitter cartridge back
into the housing making sure
the filter is properly aligned and
completely inserted.
7. Replace septic tank cover.
Pb�«R - PwW-,305en
Alan"
accessibility t`y extension handle
525 linear feet
of 111G,
filtration slots ' �_� Rated for over
10,000 GPD
Accepts V & V
St2113. 40 Pipe e, -
a
0
Gas deflector
_ Automatic shot -off
bag when filter
is removed
U.S. Patent Noa 605,488
5,871,640
PL-525 Installation:
Ideal for residential and com-
mercial waste flows up to
10,000 Gallons Per Day (GPD).
Locate the outlet of the
septic tank.
2. Remove the tank cover and
pump tank if necessary.
3. Glue the filter housing to the
4' or 6' outlet pipe. If the
filter is not centered under the
access opening use a Polylok
Extend & Lok or piece of pipe
to center filter.
4. Insert the PL-526 filter into
its housing.
5. Replace the septic tank cover.
"a rio4PLb
AT -GRADE SYSTEM MAINTENANCE AND OPERATION SPECIFICATIONS
Service provider's name: J.B. Hydro Plumbing, LLC Phone: 715/418-1349
POWTS regulator's name: St. Croix County Zoning Department Phone: 715/386-4680
System Flow and Load Parameters
Design flow — peak
450gpd Maximum influent particles size 1/8in
Estimated flow — average
300gpd Maximum BOD5 220mg/L
Septic tank capacity
1000ga1 Maximum TSS 150mg/L
Soil absorption component size
750sq.ft. Maximum FOG 30mg/L
Type of wastewater
Domestic
Service Frequency
Septic and Pump Tank.........................inspect and/or service once every 3 years
Effluent filter...'..............................inspect and clean at least once every 3 years
Pump and Controls...................................................test once every 3 years
Alarm .................... . .................................................should test monthly
Pressure system .........laterals should be flushed and pressure tested every 1.5 years
At -Grade ...............................inspect for ponding and seepage once every 3 years
Other ...........initially filter should be checked yearly to determine cleaning schedule
Miscellaneous Construction and Materials Standards
1. observation pipes are slotted and materials conform to Table DSPS 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 DSPS 384.30(6)(I), Wis. Adm. Code
3. all gravity and pressure piping materials conform to the requirements in DSPS 384, Wis. Adm. Code
4. tillage of the basal area is accomplished with a chisel plow
5. At -Grade structure and other disturbed area will be seeded and mulched to prevent soil erosion and help
reduce frost penetration
6. Areas within L5fr. of the down slope toe will be protected from compaction
7. all other construction details are as per the at -grade component manual SBD-10854 (N.03/07)
Lateral Turn -up Detail
Finish grade
threaded clean -out olue or
distribution lateral
6-8" dia. valve box
lons 90 or two 45 degree bends
same diameter as lateral
project: AMUNDSON page 8 of 10
AT -GRADE SYSTEM MANAGEMENT PLAN
Pursuant to DSPS 383.54,Wis. Adm. Code
General
This system shall be operated in accordance with DSPS 382-384 Wis. Adm. Code, and shall maintain in accordance with
its component manuals and local or state rules pertaining to system maintenance and maintenance reporting.
No one should enter a septic or pump tank, dangerous gases are present that could cause death.
Septic and pump tank abandonment shall be in accordance with DSPS 383.33, Wis. Adm. Code when the tanks are no
longer in use.
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 openings deemed
unsound, defective, or subject to failure must be replaced. Exposed access openings > 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 certified septic tank pumper. The contents of the septic tank shall be disposed in
accordance with NR113, 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 drop off the filter when removed from its canister.
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 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.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms and pumps should 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. Planting may be made around the at -grade's perimeter. At -grade
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other
than mowing) on the at -grade is not recommended since soil compaction may hinder performance of the system. Snow
compaction in the winter will promote frost penetration. Cold weather installations (Oct -Feb) dictate that the at -grade be heavily
mulched as protection from freezing.
Influent quality into the at -grade system may not exceed system flow and load parameters permitted for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral. 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 cells
shall be checked for effluent pending. Ponding levels shall be reported to the owner and any levels above 4inches 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 become defective the defective component(s) shall be
immediately repaired or replaced with a component of the dame 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. By increasing basal area if toe leakage occurs or by renovation 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 8 of this plan for the name and telephone number of your local POWTS and service provider.
project: AMUNDSON page 9 of 10
SITE PLAN, 7O +" 096---
Larry Amundson 1�
NE'/4,NE'/4,S 10,T30,N/R16W
Emerald township
St. Croix County
LEGEND
IBM: 100.0' base of
Orange fence post
2BM: 100.0' base of
Orange fence post
X— backhoe pits
0 - grade elevations
-contour
No DSPS 383 set back
problems
Scale 1" — 40' except
where indicated
System Elev. 100.0' contour
Lateral invert elev. 100.5'
Part of 6A.0
project: AMUNDSON
I /
9
x,RF'
W
Q4 /
�Y
cv
".
�3 w-i-s4w,•t,
{
U i
M' i p0•y
i ba
i
-•'eo'.%yn �3, 34 ,
60_w Vs�AVn `Ik'T.n266S)
i
r
a
All A) ^ YL iILYJ•J�Lw rti
a�-
page 10 of 10
Owner/Buyer
Mailing Addre / C
Property Addr€�'s (
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
for new construction.)
City/State L�M?J�d 1kh(OSIAPareelIdentificationNumber
LEGAL DESCRIPTION
Property Location '/+, JJf '/. , Sec. //) ,
Pcw� of ,� NE Yy of +he. NE Yq
Subdivision Plat: LLam�1 /
Certified Survey Map # R5 1 i
p� p� Lot #j 2
Volume p%r31C Page # 7QA
Warranty Deed # a_' ,S Qy a (before 2007)Volume , Page
Spec house ❑yesAo Lot lines identifiableXes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification forth, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than I/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 within30,ys of the three year expiration date.
11we certify that all statements on thisare true to the best of my/our knowledge. i/we am/are the owner(s) of the
property described above, by virtue of a w ed recorded in Register of Deeds Office.
Number o edrooms —3 /Q
SIGNATURE OF APPLICANTS) 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_ 04112)
Visconsfn
Department of Commerce
Division of Safety and Buildings
SOIL EVALUATION REPORT
in accordance with Comm 85, Wis. Adm. Code
#2273 lot 6
Page 1 of 3
Gustum Septic Service
Attach complete site plan on paper not less than 81A x 11 inches in size. Plan must
County St Croix
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.
Please print all information.
Revie By Date
Personal information you provide ass ( rivacy Lew=Mbfd, s 15.04 (1) (m)).
Z y Z. p 7
Property Owner
Property Location
Arvold, Don
Govt. Lot his NE1/4, E7/4, S10, T30N, R16W
Property Owner's Mailing Add s
Lot #
Block i
Subd. Name or CSM#
1673 250th St.
n/a
Pending
city fate $Tp 0 W X C=OMPM NI umb r
Ciy ,Village r�J' Town Nearest Road
Emerald 49
Emerald 1 170Th Ave.
✓; New Construction Use: f1 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
J Replacement ..-� Public or commercial - Describe:
Parent material sandstone Flood plain elevation, if applicable n/a ft
General comments Part of new 10 acre parcel. House area not yet determined. Recommend at -grade system along 100.0'
and recommendations: contour
1
9 d J Boring
Bonn Pit Ground surface elev. 100.0 ft. Depth to limiting !odor 44 J in. Soil Application Rate
R
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Cu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consists
Boundary
Rohs
GPD/W
'EW
'Et
1
0-10
10yr2/2
none
sit
2mgr
mvfr
as
if
0.6
0.8
2
10-15
10yr4/4
none
sil
2msbk
mfr
cw
if
0.6
0.8
3
15-23
7.5yr4/4
none
sit
2msbk
mfr
cw
-
0.6
0.8
4
23-44
7.5yr4/6
none
gr. sl
2msbk
mfr
cw
-
0.6
1.0
5
44-65
7.5yr4/4
c2-3d 10yr7/2
7.5yr5/8
yr. sl
2msbk
mfi
-
0.6
1.0
ti Boring
Z Boring # jim Ph Ground surface elev. 98.8 ft. Depth to limiting factor 43 J in. Soil Application
Depth
in.
Dominant Color
Munsell
Red01r Description
Cu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consisten
Boundary
Roots
GPD/R2
•Ema1
'Ee1
D-9
10yr2/2
none
sit
2mgr
fri
as
if
0.6
lRateHorizon
0.2
9-16
10yr4/4
none
sit
2msbk
mfr
cwif
0.6
0.3
16-26
7.5yr4/4
none
sit
2msbk
mfr
cw
-
0.6
0.
4
26-43
7.5yr4/6
none
gr. sl
2msbk
mfr
cw
-
0.6
1.0
5
43-65
7.5yr4/4
c2-3d 10yr7/2
7.5yr5/8
g r. A
2msbk
mill-
0.6
1.0
' Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mgA.
CST Name (Please Print) Signature: CST Number
'Tom Gustumzav�zv 227618
Address Gustum Septic Service Date Evaluation Conducted Telephone Number
N13450 937th St. New Auburn, WI 54757 12/29/2006 715-658-1344
Property Owner Arvojd,-Don, - �� ., 3 Parcel ID #
Page 3 of 3
3
� J Boring J
Boring # y� Pit Ground surface elev. 100.9 ft. Depth to limiting factor 37 in, Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Ou. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDM-
'Etf#1
'EM
1
0-10
10yr2/2
none
sil
2mgr
mvfr
as
If
0.6
0.8
2
10-21
10yr4/6
none
sil
2msbk
mfr
Cw
if
0.6
0.8
3
21-28
10yr4/6
none ?
gr. sil
2msbk
mfr
Cw
-
0.6
0.8
4
28-37
7.5yr4/6
stoney
gr. A
2msbk
mfr
Cw
-
0.6
1.0
5
37-55
7.5yr4/4
7.55 8 10y8
gr. sl
2msbk
MR
0.6
1.0
{
Boring
Bormg # J Pit Ground surface elev. R Depth to limiting factor in. Soil Application Rate
Horizon
Depth
in.
Dominant Color
j Munsell
Redox Description
Ou. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDAC=
'Eff#1
'ER#2
Boring
Boring # _ Pit Ground surface elev. R Depth to limiting factor in. Soil Application Rate
Horizon
Depth
in.
Dominant Color Redox Description
Munsell Ou. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDAI'
-EB#1
'E02
I
ii
i
Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 -,150 mgA. ' Effluent #2 - BODs c 30 mg/L and TSS -S30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services r
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877 1
SBD-8330 MOM) Gu m se SerIR
8 1 7 1 6 1 5
3
I
I
i
I
i
�I
I
I
I
I
I
I
I
.
I
I
I
I
I
I
..
I
i
I
m
1
Plot Map
Lot'O l Part of 8 Acres
■
■
0
■
a
170th Ave.
---------------------------------------------------------------------------
I
I
II
�c I
� I
� I
CPc`OJ
■ CO
B3
100.9, BM2 o.
I
I
B2 i
98.8'
II
i
I
I
I
LEGEND L___
IN = Soil Borings With Badchoe
BM1= ELEV.100.9 -Orange Fence Post- also HRP
BM2= ELEV.100.9-OAange Fence Post- also HRP
SCALE: 1" = 40'
6 1 5 T 4
C
■WE
UUMM p15>2e5a7as A
.5. 9 C 1673 25M 81.
Emaal0. VA, W2
Tom of Firm
NE14 ci NEY. er sec 10 735NR761V
e 3 f
—1�
3 2 1M1
VS
LIUM \..
�l 16 \1 'ti
I
Ax I-x be wrer,
oil
J
!Sn(Ak
ob C7
c I ,
I