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Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] TOWN OF HUDSON ,P. j,., ,. �,IP,IIJFL. TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR CAPACITY Septic w i iia I2`O ZGO ( J Dosing Hv `J44- O Ji- 3f+ IF &OO Aeration ------------ TANK SETBACK INFORMATION TANK TO P/L t WELL BLDG. Vent to Air Intake ROAD Septic -.* t 271 Dosing 8 t I' �t Li Z t y Ft Aeration Holding PUMP/SIPHON INFORMATION Manufacturer )1 I L 1 br/ J Demand GPM Model Number 2 56 r C J� TDH Lift/v % Friction SLow 'Diia.. System ygad 5 .tto T�H t Forcemain Le thh r, %1 Dist.5-1 Well/ 3S \ SOIL ABSORPTION SYSTEM I I STATION BS HI FS ELEV. Benchmark `f 1P2.'f D I O m p l Bldg. Sewer :5-. b 9 7• SUHt Inlet 71 q5 ' z> SUHt Outlet ^f' 9q• OJ Dt Inlet ' 6 9411 . S Dt Bottom ll Header/Man. ' Dist. Pipe OC7� S Bot. System Final Grade St Cov�v' 2 OF BED/TRENCH Width /DIMENSIONS Length_ Y s r a� - „^t PR DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type a System P/L S _7V t BLDG t IWELL � 0 t LAKE/STRE M L CHIN CH BER R ITmber. Nnufacller: DISTRIBUTION SYSTEM Header/Manifold I S Z P;stensutioonn ` f ^_ 6 � x Hole Size IN x Hole Spacing Vent toAirIntake Length Dia Leng(th V Dia Spacing 2 `, SOIL COVER �w'Y) x Pressure Systems Only xx Mound Or At -Grade Systems Only Yfr r/V i+fic'R' er O V Bell9fienelrMpt A ' ( �� I • 3 1 Depth Over Bed/Trench Edges r� g xx Depth of Topsoil ) To p J � (� xx Seeded/Sodded XVes ®No xx Mulched Yes 0 No COMMENTS: (Include code discrepenncies, persons present, etc.) Location: 774MAGOOR/D 4LX5 �vk^t^-S 1.) Alt BM Description = r` )-kf 2.) Bldg sewer length = 3G - amount of cover = iy Z ate. r 30�. Inspection #1: `/*`f�1�L0�"` spection #2: eked Plan revision Required? ] Yes VNo Use other side for additional informatio S8D-6710 (R.3/97) ale 1 r Insepctors gnature Cert. No. i, rprrrsTwq�'WE) ' r. SY 1. d Safety and Buildings Division Smhry Permit Number (to be filled o byCe) gcornmijnit� JUN 24 2020 201 Vii�' Washington Ave., P.O. Bex 7162 Madison,yWJll 53707-7162 Croix County � �I?839 "`St. �Develo men Sanitary Permit Applicationt aNn In accordance with SPS 383212). Ws. Adm Cody sub,-aissithis form to the appmpnare gove n nenlal unite Q .T>�r- �p ROTS T S — �2-bmC✓ ` 4- AA Project Address (if ditlam[ than mailing address) is required prior to obtaining a smidry permit Note: Apphcalm forms for stateowrred POWTS art submamd m the Deperamect of Safety and Professional Servies. Personal information you provide may be used for secondary in scorch nce with the law, s. 15.0e(1 m Stars. - -7 L A Ecation Information - Please Print All Information Property Owner's Name J Prod Y i /n� 4Z-c' 02-0 �llo(o—D�—t9B0 Property Owner's Mallmg Ad - property Loclem r GOVILLot Cm'' Phoae Nmbrr 1 T�N-. Rpc W of Building (check aB that apply) Lot a Famffy DwclIm,-NvmberofBcdrocgd �— SubdivisionNme i Blocks ❑ PublidCommercial-Desmbe Use Le va'wy.'e r ❑ City of ❑State Owed-Desmbe Use ❑ of_ 41 CSM Ntmba do of Ill. Type k only one box ON line A. Complete line B if appliabk) Sys-® Replacement System ❑ Treamoem/Holdmg Tank Replacement: Only ❑ Otha Modification to Emoting System (explain) B. ❑PamitR evision ❑CbmtgcofPlmbcr ❑Parma Tratniom New Lice bus Parma Numbs and Daft lmm Befae Expaati Owner ✓ IV. of PO VTS 5 Com onont/Devica Check • I ❑ Noo-Pmoner aed In-Gotmd ❑ Pressmiud In.Oroun Mamd> 24 bin. of suitable soil ❑ Mond <24 in. of nd�le soil ❑ Holding Tank ❑ Orha Disposal Compmont (explain) ❑ premmtnrnt Device (cWlam) V. Dis Vfreatmwt Ara Information: Floowr-(gpd) Deep Soil Application Rata(gpdst) Dispersal Aura Atoned (sl) Disposal Area proposed (sq Syao� Elwation vZ .+ VL Tank Into Cttpacay in Total a of Mmufncoaer Gallons GaOoos Units aq 3 i3 o tr u New Taws Exetmg Talks 'Z ir3 Q£ 9 'm3 h iCD G septicor Holm Taws S - �t � VIL Responsibility Statement- 1, the aadersiga a mponcbility for ittwgatioa of the shown on the a plans. Phmber'tName (Print) PI 's Signature MP/1dPRS Nmba Business Pltom Nm l-- / / y VaICL Co /De artmeut Use On rcityr ❑Denffmved Pamir FeeLssued gAgmt Si ❑ trS 3�ap f'DmiN V Af. Conditiooa of ApprovaVRtxsons for Diwpprov(/ J.,, ' '_ EMOWNER:/, .-p} ptictank, e�luentfilter and persal call must be serviced / maintained by �' per management plan provided plumber. a 2.AI setback requirements cartkenowmmd abmb atbeCemry,00ly-pape,"tlew :n mahe as per applicable code/ordinances. C�20.- Q-rU91s,1 SBD-6398 (IL 11/11) f) JQ V e C l i tvle l S hsNivt 14 I to PROJECT Urchins LLC NW 1/4 NE 1/4S 35 /T 29 SYSTEM ELEVATION 100.31100.2 System PLOT PLAN ADDRESS 1353 Awatukee Trail Hudson Wi 54016 N/R 19 W TOWN I Hudson COUNTY ST. CROIX DATE 6/22/20 BEDROOM 6 CONVENTIONAL AT -GRADE )00( CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1250/750 LIFT TANK SIZE DOSE TANK SIZE 1048 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,� BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 10o' Filter Lifetime Filter ❑ BOREHOLE O WELL sH,R,P, same as benchmark 100.5' 100.3'100.2' 100, 99 5, Scale = 1 /4" = 10' B -1 oc0P 0' 40' 80, B-3 lop( Well Well is to meet all WDNR setbacks Huffcutt Combo Septic Tank Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away from system , = Huffcutt Dose Tank Pro 6 Bedroom Duplex, 1 structure, 1 parcel ID Q 0 � 9 544' Property Line �c B.M. " M June 23, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-06-23 Plan Review: PWTS-062000048-M SHAUN R BIRD 1432 120th St New Richmond Wl 54017 SITE: Urchins LLC 774/776 Magoo Rd Town of Hudson Saint Croix County Total Amount: $80.00 FOR: Descrin8on: 900 GPD (Miscellaneous Review — Chanre of Tanks) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http://dsps. W .goviprogramsAndustry-services www.wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary CONDITIONALLY APPROVED DEPT OF : AFETY AND Pr.OFESSIGNAL SERVICES E 1"JISI t� OF IN:)USTRY SERVICES 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 shat6e properly disposed ofon-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 POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • 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. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. 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. Thanks, POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleest(@,wisconsin.gov Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date:5/22/20 Owner:Urchins LLC CONDITION ALLY APPROVED DEEPT OF SAFETY AND Pt-') ES--!QN.L SERVICES PMSKA4 OF 1NDU,JRY SERVICES Z21-a-,z Y...t Location: NW1/4 NE1/4 S35 T29 N,R19 W 774/776 Magoo Road Hudson Wi Revision to Plan 032000263-C Manuals Used: At -Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications 8.4 Maintance and Contingency Plan Attachments: Soil Test .l r Shaun Bird Signature r. License number 226960 Page 1 of 9 PROJECT Urchins LLC NW 1/4 NE 1/4S 35 /T 29 System PLOT PLAN _ ADDRESS 1353 Awatukee Trail Hudson Wi 54016 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 100.3/100.2 6/22/20 BEDROOM 6 DATE CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK SIZE 1250/750 LIFT TANK SIZE DOSE TANK SIZE 1048 MOUND SEPTIC TANK HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none % BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION too, Filter Lifetime Filter ❑ BOREHOLE (DWELL •H.R.P. same as benchmark Scale = 1 /4" = 10' 0' 40' 80' Well is to meet all WDNR setbacks Huffcutt Combo Septic Tank Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away from system 100.5' 100.3"100.2- 1 100, 99.5. im N Huffcutt Dose Tank Pro 6 Bedroom Duplex, 1 structure, 1 parcel ID A B-3 544' Property Line B.M. Q0TI) At -grade System Sloping Site Cross Section and Plan View E I, 1 W A , I 1 1 t l I �{ { j 7r{? �{{{ { };y� J•r+�11 4{{S�S��}'thiLr {,4�,{ j� {•'{lt r{{ •'{{)7 'J4� .�}J�r} t�} L �{{r}},l}F [ �t}} 4SL}L J.} .4 • S { j�'LrjS 411J :{{ 7_!-7( } •}f JLJ4r4J}JL �yy�. ILFt L L iJ;�4T 4 { {� Ht }. {•L,{F�=4]�SJ_]S J ry} }}}4J }i}}�}.t- Y,'P • {{{ } rt}} }' } 7 tst{{iSt•4 {y { -5•t{-jy { 4i-}t} 1}!Y1 } ,}�J ] 4.4.Lt4,T}{LyYMi } Y}} r 1'yY rL21JY 4a {y{y�l�{Ll{,i.5{ L{ r {�{5{({t{J1i{ty•j j�} R F}7Lrtt}]� Yh r} 7� r r { }r1ry $} {t 4 y}Mr r}r} {'}}r�''1�� t} {,1ttt4 f-]rt�{'Li.t{L r•J •r'fyr}r4tL't{':41{}\F•{t{r'}{tL{4{{r{ h r tL �•y�y}'4y} r .ti}'�.}•L.tf}-'rtf}•4 r r r Yr}r;J}{, }t 4 t4L". J,ri 4 4 }F{ 1{L�,�{t�{�t{{ J� }rS�� l•J`• j}yr )�L'}t }L}�{1r}}r{sC.{� 55SfSf555}}}iiiJy+r.�}��}i&�y;{'}} `i?i rti. ���rti}ti•Fti?17L }} }}� ,•{ {` i I E t 11— 1/6 B ---- - - - - -- --- E r _� 7u,1 � 1 B 1 L I- 'I = Plowed �' = Clean aggregate basal area t{4 %z to 2'/s in. dia. Geotextile Fabric Lateral with 2" aggregate over pipe FBI Topsoil Cap Ft C Q = 4 in. sch. 40 pvc observation pipe !� 7 Observation Pipe With CaD Invert _;_ / Slope Direction --0. Topsoil Cap GENERAL INSTALLATION: The at -grade area is staked out along the desigri contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed: if the soil is wet enough at the plow depth to form a `/4 inch soil wire when a sample is rolled between the palms of the hands.. The A x B area is covered by clean aggregate deposited overhead by a backhoe, ..Special CA.te must be used when placing the aggregate to minimize compaction of the plowed surface: After the topsetil cap is placed, the entire at -grade is seeded and ;mulched to promote. vegetative g;egWih; limit erosion and protect from freezing. The observation pipes are perforated in the lower 6.-in6hes.And secured in place. 03/051gj Page 3 ofl Man I Ul VI 1V16111 Lateral 94 M (Manifol Force Main Force Main 03/05 lgj Pressure Lateral Layout Two Laterals — End Manifold Ft 7 Ft. In. ded out 9 tg Sweep 90 Bend Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral tum-ups terminate with a threaded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. • • • • • Grade • • • • • • 6-8 Inch Lawn Sprinkler Valve Box Page of ......:� • • • • • • • Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer 1PA n Tank Model Number yq Total Tank Capacity . Max. Bury Depth Pump Manufacturer �! Pump Model Number Alarm Manufacturer Alarm Model Number Switch Type C ,- %ft � — Inlet J Minimum Pump Performance R ired - GPM FtTDH Total Dynamic Head (TDH) - Feet Elevation Head Distal Pressure Network Pressure Loss Force Main Pressure Loss Total J Vent G" )1% 6� eather-proof _r AboveeGrade With Cap Junction Box ~L — — — — — - Finished Grade — — — — — — — 1 Depth of Cover 3 Ft Switch Settings and Ftc4erve Capacity Tank Volume =ehqW GPI Dimension I Inches I Volume Gal. (reserve) A , (alarm) B 2 (dose) C , r' (dam) D %SD Total A Off Elev. C q , Ft Bottom of Tank Elev. � Ft D Manhole Min. 4" Above Grade With Locking Device 1 J --- - - - FHole GF14ERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 an Comm 16.28 Wis. Adm. Code. 03105 lgj Page --) of 290=SERIES 314 hp Submersible Effluent/Sump Pumps The Liberty 290 series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 290-Series will provide years of reliable performance. All Models Feature: e Semi -Open impeller permitting passage of solids up to Y" 416 stainless steel rotor shaft e Permanently lubricated upper and lower ball bearing Epoxy powder coat finish All fasteners - corrosion -resistant stainless steel 172" Discharge Stainless steel bottom screen - easily removable Maximum fluid temperature: 140' F. e 290-Series Cord Lengths Model 10' 25'(-2) 35'(-3) 50'(-5) 290 Standard Optional Optional Optional 291 Standard Optional Optional Optional 293 Standard Optional Optional WA 297 Standard Optional WA WA 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to model number. Example: for model 290 with 35' cord. Order 290-3 Motor Specifications % hp 60 Hz 3450 RPM Oil filled, thermally protected 115 V. Models 2081230 V. Models 10.4 amps 5.3 amps 6 Model 291 Wide angle float switch with quick - disconnect c Sus Certified 6p� us subject W chops MthaA nd . Performance Curve: 290-Series U 16 114 151 1K 227 me 307 an Mere PerM RO Dimensional Data: Weight: 31 lbs. Height: 13" Major Width: 10" (model 297) Minimum Sump Diameters: Model 291, 293... 14" Model 297 VMF... 10" Factory switch Model 291, 293 Mode1297 settings VMF Tum on level 13" 9.5" Tum off level 7" 4.0" The Model 293 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tethering the float to the discharge pipe or other mounting point. Vertical float model 297 is not adjustable. ML Model 293 - Model 297 Wide angle VMF-Series float switch Vertical mag- with series netic float for (piggy -back) smaller pits - plug will operate in a 10" diameter sump (on Liberty Pumps a 7000 Apple Tree Avenue a Bergen, New York 144�e Phone 800-543-2550 Fax (585) 494-1&W www.libertypumps.com Copyrlght 0 Uberty Pumps, Inc. 2011 All rights reserved. UR 6681 R09n 1 20140048A mt3700 HJOOD lemon M{ fbiN y_vyy A wwn I Gap txlCms antl Sr.rpenMrw ^J A t I� F EVE. SECTION A —A Y O�Y POWTS OWNER'S MANUAL & MANAGEMENT PLAN Psps_o/_ FILE INFORMATION Owner %>! r Cj"_ Permit # DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units j Estimated flow (average) U gaVday I Design flow (peak), (Estimated x 1.5) gal/day Solt Application Rate j al/da le Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) 420 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L 'Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) := mg/L Total Suspended Solids (TSS) 530 mg/L_ Fecal CONforn (geometric mean) 510' cfu/100W �iMadmum Effluent Particle Size )6 in dia. ❑ Other 'Values typical for domestic wastewater and septic tank effluent. IIIIAIAITPWAtdrr- aruFnut F SYSTEM Septic Tank Capacity j1dU 13 NA Septic Tank Manufacturer 13 NA Effluent Finer Manufacturer 0 NA Effluent Filter Model 0 NA Pump Tank Capacitygai l O NA Pump Tank Manufacturer O NA Pump Manufacturer // i 13 NA Pump Model 0 NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration • Disinfection ❑ Peat Filter ❑ Welland ❑ Other. Dispersal Cell(s) Ground (gravity) t-Grade ❑ Drip -Line A ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other. ❑ NA Other: ❑ NA Other. ❑ NA Service Event Service Frequency (Inspect condition of tank(s) At least once every: j 0 o r 8(a) (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (A) of tank volume ❑ NA inspect dispersal oeh(s) At least once every: 0 m e�(s) (Maximum 3 years) ❑ NA (Clean effluent filter At least once every; ❑ mordh(s) -ALyear(s) 0NA Inspect pump, pump controls & alarm At least once every: 0 r sls) ❑ NA Flush laterals and pressure test At least once every: ? 0 onth(s) r(s) ❑ NA At least once every: 0 month(s) ❑ NA �Jther: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master !Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintalner, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shah be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a falling condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (y3) or more of the lank volume, the entire contents of Otte tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin l4dministrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of s12 months, shall be performed by a certified POWTS Maintainer. A service report shah be provided to the local regulatory authority within 10 days of completion of any service event. Page _ of _, START UP AND OPERATION For new constriction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals theft may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal oell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintalner to assist In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POVVT 5: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with smll, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requi0ed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules) in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. -- IThe site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation ; must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be Installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. annlTlnNAI r(INIMPNTS POWTS INSTALLER Name c Phone POWTSMAINTAINER Name Phony ? ' SEPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY AUTHORITY r� Name Name 1 r� Phone r Phone ; - .91, This documentwas dfalted in compliance with chapter S 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) a (3), Wisconsin AdminJetr0 • Cod•. wlsoorstnDevaroneuofCanme" SOIL EVALUATION REPORT Pege_of_ Division of Safety W4 BtAdings In s000rdanee va Carom 85, Wlc Adm. Code CaaeY A7nm mmplete she pan on paper notIesa than 812 x 11 hqh" In site. Plan moot J� Illdtds, but M Wed to: v"csl and horizontal referara pokA (BM), dkedbn and Parcel LD. parcera atopa, acue or d1men0ona, north arrow, and location and dlalsous to neareat road. Please print all Informatfon. Reviewed by Data Pereantl kdanrwtion you Provide may be used for see ,v P.PaN (PrN W/ L", e. 1a.e4 (1) im)). P111party Ownw Property sedation uovt. Lol AA-41 1141N B3ST ZZ N R Owners �) Late 8bdc • Nana a CBAM S 3o �-- . , City 1 lahas Neered Road PW�L`°" t> iaManWlf NrxtwrdM6omw(Q_Code dented design a0W n0a Y(j!J GPO ❑ Replamm ra ❑ P "Ill or _ Pantmw w '.GCXS�(A—xl/-1Li.L[J l'� Flood Plain 11WvdM a applicable irzf/A_—_ 8. General oomnwry and recom aniaUay: t—Systtem Type System Elevation / '✓� �'L�7 •Blend e1•SOD, > 305220 mall and TM s301 laVW Effluent 02. 80D.:5 30 mall. and T88530 mall. CST Name (Please Print) - CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address D 7/vajuailp Conducted TMsoi Maribor 1432 120th St, New Richmond, WI 6401 715-246-4616 Ptopxty Ovmer_ 37 BotkV t 2-Z parcel 10 0 o B tPiip Drantl araLoa.lw. t 'J f<. Depth to *rA*V lacbr 3 b a Pape _of — Bnllapp�den�t. QQoo ELF?.5i►]Rrtll�,rilEJ���;�I�lll�® ,, �llrJ�'!®!�� OBM 000 MW •Mhentpl s SOD,> 30<= mWL end r3S>30: 150 mp7L ' Eftent 02 s BOD._ 30 nVtL" TSS<30"WL The Department of Commeree is an equal opportunity service provider and employer. If you need assistance to accen wrvicce or need material in an alternate forrnat..plwn contact the department at.608-266.3151 or M 608-2644777. Project Name Dick Stout Soil Test Plot Address 1353 Awatukee Trail Hudson WI 54016 #226900 Lot 2 Subdivision Summer Prairie Dote 9111119 N W 1/4 NE 1/4S 35 T 29 N/R19 W —^ Township Hudson [] Boring Q Welt PL Property Line. County ST. CROIX BM or VRP Assume Mavation 100 ft. Top of survey Iron System Elevation TBD 'HRPSameasBenchmark 4.• erty Line SAN- 2020-cw3 M D Safety and Buildings Division .f CD I (ID behaw inbyCo.) V 201W.Washington Ave.,H.O.box /lU;�_.&aonatyPamitNomber .,. 2ozo ! Madison, 37 71 � 1 County S Permit Applicati � Star T St. Croix rs. Adm Code, submission of this form to the apptopnete gwanmestal unit Project Add rf t than nailing address) o obtaining a sanitary permit Note: Application forms for state-owned POWTS are fo nr red m the Depertmrat of Safety and Pmfmicud Sevier. Pmmei wfonnatioo you Provide may be used far seconday purposes m acconanee with the PrNwY Law, S. 15.04(I XxaStahc �� L lication Information — Please Print AB Information Property Owner's Name tt' Pared Y o2P —1106— G*f—wo Property Owner's Mailing Address '?JP Locsdon 7 GOVL Lot Z _ � r/, Y Section J= City; 14 Code Pbone Ntmbcr � w v T L R E W EL Type of Building (cheek aU that apply) p6 Lot R _ Sutbdirisi� Name —^ Su or 2 FanHy Dwelling —Numer bof Bedrooms V _ g S Block ❑ PablidCommercial—Describe Use .� ❑ City of ❑Stare Owned —Describe Use CSM ❑ Village of Ntnnbo III. of Permit: (Check only one b on line A. Complete line B if applita A' ysrm AI ❑ Replacemnt S ❑ TrtatmnNHolding Talc mt Other m ysr®( ) B. ❑Panit Renewd ❑Permit Revision Chnge of Plumber Permit Ttaasferm' L'''t N d Befine Expiration / W. ofPOWTSs stem/Com nentA3evice: C6 aB thata ' _ ❑ Non-Pressnamd lo-Ground ❑ Prasmiud In-i d Moumd> 2 ofsuibble ❑ oumd < n. a roil ❑ Holding Took ❑ Other Dispersal Compncut ( �) ❑ Patresanmt (aryl V. Dis DmexmmusVlreatmeat Area Information: Flaw (ad) Desigy Soil Applieanan Dispersal RNWred (a) '— Disposal Am Pro (s Systan Elevation by 19 1 3 Z VL Tanklefo Capacity, in low Gallons nos 16#0f ' c It L40e Vo ;�rt sg y a New Tanks F.'cm Tanks Septic six Hol&ag Talc I r Dosing CLantw b VM Responsibility Statemen the nadcw*ucd, pQupqjmpo.sdydity for installation oN POWTS shown on the attxh d plans. S��: —?,)I PI s inure MPIWRS Number Business Phone Narober Phimber's Address (Street, City. S Code) _ lqf 2- �o S VIlL Con /De eat Use Ool �Approved ❑ Disapproved Fee Date Issued =jAg4swature ❑ Owner Given Reason for Deald lK Coadidoos of ApprovaVReasous for Disalfrawal 3 \ J ; SYSTEM OWNER: l 'G6y� 1. Septic tank, effluent filter and dispersal cell must be tr. �) serviced maintain p as per management plan provided by plumber. AL p,a S tt�i _._.__-__.. _ m_ n npens''si-�>ud mbiaku Ubecaaoiyann9 as Wpwaotlesstaan a vt:irucsamsca as per applica z D : C\1 r p �S /1 L wi U A� ��y `n SBD-6398(R. 11111) 7 CPFc'��- ` �•Y� 0+2 MAC `-Lo cwanPat e� I I DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 543045211 Contact Through Relay http://dsps.wi.gov/progmmsriindmtry-services www.wiscunsin.gov Tony Evers - Governor Dawn Crim - Secretary March 2, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-03-02 Plan Review: PWTS-032000263-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Urchins LLC Lot 2 Magoo Rd Town of hudson Saint Croix County Total Amount: $250.00 FOR: At -Grade Component Manual - Ver. 2.0, SBD-I0854 (N.03/07, R. 1/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) DescriDdon: 900 GPD (6 Bedrooms — New Construction Maintenance Required 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 I01.01(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, stars. 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 out 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 POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • 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. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to beset and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger rill 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(t). • 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 POINTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POINTS. Thanks, r/. U,a rd v �ere.� POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleest(a`wisconsin.gov Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date:2/25/20 Owner:Urchins LLC Location:NW 1/4 NE1/4 S35 T29 N,R19 W Lot 2 Summer Prairie Hudson Manuals Used: At -Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications 8.4 Maintance and Conting�cy Plan Attachments: Soil Test Shaun Bird License number Page 1 of 9 PROJECT Urchins LLC NW 114 NE 1/4s 35 /T 29 System PLOT PLAN _ ADDRESS 1353 Awatukee Trail Hudson Wi 54016 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 100.3/100.2 DATE 2/26/20 BEDROOM 6 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons X2 LIFT TANK SIZE DOSE TANK SIZE 630 X 2 1+0�DING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none NCHMARK V.R.P. Top of of survey iron ASSUME, ELEVATION 100' Filter Lifetime Filter BOREHOLE O WELL sH.R.P. sameasbenchmark Scale = 1 /4" = 10' Me Well is to meet all WDNR setbacks Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away from system � �.:,...:"I 100.5' 100.3'100.2- 1 1 00' 99 5' m Pro 6 edroom Duplex, 1 str cture, 1 parcel ID 2ol � o `o Slop 544' Property Line At -grade System Sloping Site Cross Section and Plan View 5< Z -- - t t i t W A i i i i i i t i i i i i t t i t 1 E �x 1/6 B i E--------------- B---------------- i �I — = Plowed basal area L ,yy = Clean aggregate ry;{ %, to 2 '/z in. dia. Q = 4 in. sch. 40 pvc observation pipe Dimension Feet A /L B 1 /6 B C ID D 2.0 E 5.0 F 0.5 G 1.0 L / W 7— Slo e 14 Lateral with 2" Topsoil Cap aggregate over pipe Geotextile G /� 7 Observation With Cap Pipe Fabric r.r. r•Sr{{{{{},� '!T Ft Lateral Invert ��/ .r.r.}.r.r.}.}. r.r.r:r.r. r.r:r., Topsoil Cap ►7 i ►tiiii1ti111L �. � . ���»111111111111111'11� ���»ti11111�� Slope Direction ---*. GENERAL INSTALLATION: The at -grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a `'A inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After'the topsoil cap is placed, the entire at -grade is seeded and mulched to promote vegetative groaeth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/051gj Page 3 3 Pressure Lateral Layout One Lateral — End Manifold Force Main L Y- 0 /" ZOr%(i ne/� G-a.A Distribution Net*ork Sp ecifications Lateral Diameter Z In. Orifice Diameter 3 In. X Orifice Spacing) o2 In. L Lateral Len d'$ Ft. Force Main Diameter Z In. Force Main Length Ft. 03105 lgj Lateral Tum-up 4 Threaded Cleanout Plug Long Sweep 90 Bend Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral turn -ups terminate with a threaded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. •• • •• Grade •••••• 6-8 Inch Lawn Sprinkler Valve Box Page Jf Z Septic -Dose f ank Cross Section And Pump Performance Specifications n�►!�r IrM 0 Filter Manufacturer ,, Filter Model Number I q Minimum Pump Performance Required Z! �Ava GPM: Ft TDH , Outlet Manhole Non. 4- Above Grade with Looking De-iice. Iolet Manhole < 6" Below Grade Sealed Watertight -% Finished Grade Outlet Filter Inlet ¢- Wet Bade Switch Setts and Reserve Capacity Tank Volume m -,$ GPI Dimension, Inches Volume Gal. (reserve) A: () B' 2 3 J (dose) C' Sjiik�] (dead) D Total Dynamic Heed (TDH) - Feet Elevation Head Distal Pressure Network lass Force Main Loss Total 3 Manhole Min. 4" Above Grade Wea Securely Mounted �Looking� Weather-proof Junction Box Imo— � Vent Min. 12" Disconnect Above Grade Means With vent Cap WeepB Hole Off Elgyation C Ft Bottom %D.. % D Fevation 9t O. O Ft 49 GENERAL INSTALLATION: The septiddose tank is budded and back tilled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded withcut prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the teak with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation avd the sleeve is sealed watertight. Electrical servi mplios with NEC 300 and Comm 16.2$. 02l05 U Page of 280=SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Serles provides a cost effective "mid- range" punk for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Unt-Body" casting, the 280-Series will provide years of reliable perlom ante. All Models Feature: " Vortex style impeller permitting passage of solids LIP to %" e 416 stainless steel rotor shaft " Permanently lubricated upper and lower ball bearing Epoxy powder coat finish All fasteners - corrosion-resistartt stainless steel e 1 Y Discharge " Stainless at" bottom screen - easiy removable • Maximum fluid temperature:140' F. 280-Series Cord Lengths Model 104 25' -2 35' -350' 280 Standard Optional Optional optional 2S1 &ardard Optional Optional Optional l 283 Standard Optionall Optlonsil WA 297 Standard Optional WA WA 10' cord ian slancland on all models. For optional lengths. add "-2, -3 or 5'suit to model nurnber. Example: for model 280 with 35' cord, omrer 280.3 Motor Specifications Yc hp 60 Hz 3450 RPM Oil filed, themtaly protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (20&MV) Performance Curve: 280-Series 2 U.S. Gallons Per Minute 38 78 114 166 192 229 270 Liters Per Minute Dimensional Data: Weight 29 lbs. Height 13' Major WkML 10' (model 287) Minimum Sump Diameters: Model 281, 283... 14- Model 287 VMF... 10' Factory switch Moda1281, 283 Model 287 settingsVMF Tum on level 13' 9.5' Turnoff level 7' 4.0' The Model 293 Natures a fully adjustable widwergle float DdbmntW adjucbnarh an be made easty by le8adnp the fbst to the din charge pipe or oars mounting point Vertical float mnodel 287 IS not adjustable. J J Manual, �- no switch�with quick- with series .disconnect (piggy -back) I I I plug Model 287 VMF-Series Vertical mag- netic float for smaller pits - wlll operate in a 10" diameter sump Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phorw 800443-26M Fax i15SM 494-1830 www.11bertypumps.com ccprrvt o tn-g Pu- a 2M7 addrreree-ved tLr2OWFMn7 (0®C of 20140048A 04S2U0 19AM 18AOOD � 1.1921 balween Case ontl Serpentine 9.456 �•81' '}- .OIGop /`v l� C SECTION A -A POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of FILE INFORMATION Owner (% (� Permit # q ESIGN PARAMETERS 1 Number of Bedrooms O NA Number of Public Fadlity Units ❑ NA j Estimated flow (average) 'K00 gaVday I Design fkrw (peak). (Estimated x 1.5) al/da Soil Application Rate S— gaVdayMe Standard InfluenUEffluent Quality Monthly average Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD@) 420 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) 530 mg/LNA Fecal CoYforn (geometric mean) 5104 cfu/100m1 iMaximum Effluent Partlde Size )6 in dia. ❑ NA Other. 'Values typical for domestic: wastewater and septic tank effluent AINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacityh Z_ rCi't� gal G NA Septic Tank Manufacturer ❑ NA Effluent Filler ManufscturerY7— / ❑ NA Effluent Filter Model i/ ❑ NA Pump Tank Capacity 3gal ❑ NA Pump Tank Manufacturer ❑ NA Pump Manufacturer O NA Pump Model (3 NA Pretreatment Unit @ NA ❑ Sand/Gravel Filter O Peat Filter O Mechanical Aeration ❑ Wetland O Disinfection O Other: Dispersal Cell(s) ❑ NA ❑ In -Ground (gravity) 0 In -Ground (pressurized) -Grade ❑ Mound CI Drip e ❑ Other: ❑ NA Other: 13 NA Other. ❑ NA Service Event Service Frequency iInspect condition of tank(s) At least once every: 3 T0m e) (Maximum 3 years) ear a ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA (inspect dispersal °eti(s) At least once every: 3 e(s) (Maximum 3 years) ElNA Olean effluent filter At bast once every: °�(s) yeaI ❑ NA nspect pump, pump controls & alarm At least once every: 3 ❑ on e(s) ❑ NA Flush laterals and pressure test At bast once every: 3 month(s) j4war(s) NA 7thec At least once every: O mom hi s) ❑ NA tither. ' l7 NA MAINTENANCE INSTRUCTIONS (inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber ResWcted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank Inspections must 6nciude a visual inspection of the tank(s) to Identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of ,00mbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate notlfloation of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (%) or more of the tank volume, the entire contents of the tank shad be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. NI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintalner. A service report shall be provided to the local regulatory authority within 10 days ofcompletionof any service event. 1 T Z Page _ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thelt may impede the treatment process and/or damage the dispersal cell(s). if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During pourer outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal oell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effiuentt, To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntalner to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade &oil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat snaps; medications; oil; painting producgs; Pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails andror is permanently taken out of service the following steps shall be taken to insure that the system is prope(ly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shell be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shelf be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system; ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by requl�ed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the need for a now soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulerl In effect at that time. ❑ A suitable replacement area is not available due to setback and/or soll Ilmitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The she has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluai)on rr�ust be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. Mound a a -tiro soil absorption systems may be reconstructed in place following removal of the biomet at the infiltrative surface. Rons of such systems must comply with the rules in effect at that time. «WARNING> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone %? j— — Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name M/ 1n J —1 Name V',!��,4 I -- Phone - - '� )- /54/9 —1 Phone j ^38 Title doemient was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(g and 383.114(1), (2) 8 (3), VyNconslr AdmMiatretNe Code. Wisconsin Department ofcommerce SOIL EVALUATION REPORT Division of So* and Bulldrps Page _ of m aCCONance y n Conan a, Y . nont. l v Aaach corrtplale site plan on Doper not lees tMn B 1f2 s 11 Inches In size. Plan mot hduda, but not limited to: vertical and horizontal reference poira (BM), diractlon and percent slope, seals or dimensions, north arrow, and location and distance to nearest road. Please pNnt all information. pommnW wwmeoon you prwlos they be ewe for s«w+ien p,ayna (Mary Lw., r. 1 o pt v 11m)) - 1 — Parcel I.D. Re wed by Data Property owrw PropaM Lora 7 Govt. Lot 114Art: 14 S>,S T N R Owner's Mafty >s �) 5 ! Lot 0 Z Block a . Name a CShW I it ute ❑ Csy a Nearest Weal Nave CarestruGon Use,;rcy�ialen tlbal l Number be of drooms ❑ Replacement ��n❑ P—odic or cpmrertial-//�rsm�b�a Parent Material 'Aft aj�/ �L .vY�^'_Jj�. GarwW oomneras and ramrrvrwrgetlons: System Type —9 Code domed design nowrate ____ _ __ Flood Plain elevation If app4ade System Elevabon 7—So GPD R 17 BaMg 0 ❑ aonnp ig PIl Ground surface slev. R. Depth to Wrshrp factor Yd In Sod Application Rao 110101101 I Depth I k, Dortiront color Muael Rooms Description ou. Sz Com. Color Texture Structure Gr. Sz. Sh. Cornistenca Boundary Roots 'ERp1 'EfW2 I o- !: Cr , . �- %o v y —J ZZIEN • Z-- y a3 Pit Ground surface Wev..� R. Depth to lim" factor in Sod Applicebon Rote I/ortran Depth in. I Dominant Color Munsea Redos Description ou. SL Cori color Tamura Structure Gr. Sz Sh, consistence Boundary Roots Gp0M 'E"l I 'Effe2 1 A, n T / 3 3- ' Ellkwa 01 . BOD. > 30 < 220 mWL and TSS >30 < 1 ' Effuend 02 ' BOO, <_ 30 myt and TSS <_ 30 MA CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address nl Del1 velwW Conducted TWsphone Number 1432 120th St, New Richmond, WI 5401 I —/1 � 715-246-4516 Z Property Ovmer Parcel ID e Bodng p❑�7777� �/� 'sa+. pit GrWnd surface elay.` ' ft. Pape _ of Depth to WNery tecbr in. SaM Ppparatlon Rate ©� it.ir►/� 1 F�MM /, r�71Alt�y�y�slllllll�®l1��.1ErJL'�®w/.l MEN Q� Radox .. .:nt. Color mm- MOM MM MM Effkwo e1 . BOD, > 30 c 22o nVL and TSS ,30 < 150 mgpL 'End a'2 • BOO, 5 3o myt and TSS < 30 myL The Department of Commerce is an equal opportunity service proyider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266.3151 or TTY 608-264-8777. sewrwla. ' Soil Test Plot Project Name Dick Stout Address 1353 Awatukee Trail Hudson Wi 54016 Lot 2 Subdivision _ N W 1/4 NE 1/4S 35 T 29 Summer Prairie N/R19 W �fi�I M #226900 Date. U9/11119 Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD "H R pSame as Benchmark Vl.* petty Line ST. CROIX COUNT•,' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTWAT1ONFORM Owner/Buyer MailingAddress..1_ -- -- --------.__.- Property Address -7- Z`+._- (Verification inquired Cram Planui & 7O���.._ nB ningDepaitmentfornewconsWrtion.) __.'—.------.. City/State_ _ Parcel IdentificationNutaber LEGAL DESCRIPTION property Location t S �'�'�''�^`-i� < , Sec.3S , 'r .��N R. � W, Town of Subdivision - 4-•Lot Certified Survey Map # '� Vohrtne (, .-----__-' Page # _ Warranty Deed # --- ------ _..----..� Volume—.----, Page l/ � Spec; house yea u Lot film, identifiable yes o Fw IYSTEMMAYNTetvnL ...,.,.._._._..._ Improper use and usin-" enan is of your septic system could result in its premature failmc to lwndle wastes. proper maintenance consists of pumping out the septic tank every three years or sooner, it the system can affect the function of the septic tank as a huatment stage in he wawa " by a licensed pumper. What you put into responsibilities are specified in §(;ormn. 83.52(1) aril in Chupter 12 -- St. [:reix County Sanitary Ordinance. sposal system. Owner maintenance sp The Property owns agrees to submit to St. Qnix (:ouury Planting & Zen mg Department a certification form signed by Nrc 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 inspeciion and pumping (ifnecessary), are septic tank is less than 1/3 full of sludge. I/we, are Undersigned hnvc read the above requirements and agrw to maintain the private sewage disposal system with the standards sot £orris, mereiu, as net by the Department of ('ommwcc and are Dupatmenl of Natural Resoa a di State s Wisconsin. Certification sorting that your septic system has been maintained must he compleun I and returned to Ilu St. Croix County planting & Zoning Department within 30 days of the dome Year expiration date. 1/we certify that all statements on this form are true to the best of'mylour k nowledge. I/we anJate thu uwneo(s)of the Property described above, by virtu'' of t warranty deed recorded in Register of Dea.is Off,,,. Number of bedrooms �J SIGNATURE OF PLICANT(S} v2 /�'„� DATF, ***Any information that is misrepresented may leault in the sanitary permit being nwoked by the pLvnting & Zoning Departm c L +++ Include with this application a recorded warranty deed from the ltegista of Deeds Office and a copy of the certified survey map it reference is made in the warranty deed. (REV. 08M5) — Yl------ weir ------- - rim wi� vir T�14f ,rc p 578 SD. FT. 1800 SO. Fr. EACH GARAGE EACH UNIT 0.G PU6Ee FlNI AVOARE SJBINTmeN xEE.Ix�IX ` FONMICE V�A D NNNNN YOU DN Mn YOUR. (715)248-3010 .....a.loa.,.=an NOTICE NR➢ER ro YEPoiY Au gEERSI'. AND ffl�RT XYEM1PtliB VMOR TO>ROLEEDIXO. rt�n TXTif Rxu KNkAIIORne>u Dick Stout Duplex ELEVATIONS e¢a�c r Al I I I , ' i I i I � ' I ' I , , i I I � i � I i i , i i e I � � I , , , i i i I i i i i I I i 3-D Design 3' i a» »�pn rou mpe YOWw.. as (715)248-3010 s t. 71� -- NOT CEI ». K.mvemnnu �orsrv�m »mover Didc SlDut 4-4 O SMCED WALL LINE PANEL DETAILS MAIN LEVEL ..r-.• nnwaa r A3 13M so. FT. EACH UNIT w•ry i i i i T I i i i i i I I . N _ r i 1 i I I I I I I I I I I I I I I » I I I I I i I I I i I I I I I I I I I I u0 M un�ae O wn: D lbigry YW Oulpn YOVR Ibm° (715)248-3010 NOTICE 1Nn0ixf `°` SECTIONS u.R udu R+ae vnan m° o-,a r-e r-v enr wws s-ow� a-ox R e.m uTvs a-ox a-ox eas°�mm c e.w woex urxs .ox nrtwn 1093113 mum "SUMMER PRAIRIE L HCINTNE MVII/Mn"EM114MMMMNEVSMETNEMl/NUMMMNM.RMN,MM,IMWNWRUDSO. R.GMMELMUMEY.ErMLWMN:MMMMP MELMESMELEMUEIEMSURVEYMRPRELp DIN MUMFMM PME MIN. MMLUMWMUWFR 1MTRY1. 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Nw.. w r.Nn rn.u.. a w.nmamr .n yNaF=au=F nF Fe, ®wa°9E.w�me� ._nd,adana.aa..nmw+Yn.wr•ubw a / '®'b nnxn.e. ro �'.��N.pn I E4T11Sw m.x...n.ox..nNrrn.i.naNNNprrxm NNxNam 1 IAR4MF/OMWSN_ I I-� '�'� WTN \ 9-�n I IK1RIiFOVAfS Y — -- nEw bvrrxnwM�mmN � x0— nvNrrawrt Y IEBBM NE ex a .M. VS N/96TNrE9I mna ev.�rtu Uri y)N 3 f 9 / NMIF \ I\\ / suMrEloEE MMIEM S87°40541 480.18' NO ACCESS S880561350E 440.32' 183.2(Y 144.09' 296.23 Y SETBACK 50' HIGHWAY SETBACK v LOT 3 OT 2 z w o^ .00 ACRES w 3. ES Z hp LOT 1 ),860 SO. FT. a 130,938 SO. FT. 3.01 ACRES / $ 131,254 SO. FT. / z BENCHMARK TOP REBAR ELEV. = 995.06 BENCHMARK TOP REBAR ELEV. = 997.3,V / g^aQp/ / zz B°i 6'27"W 323.66' — MAG00 ROAD — - cr ----- LOT1 / CST dplti - al5 wmoonsii,Department Of rce SOIL VALU Division of Safety and BuildingsSFP 12 2019 Page _ of m aaaroarxx vrrm wmm pD, twos. mom. was Attach complete site plan an pa not leas than 8 112 M'lit 'wtches in size. Plan must include. but not limited to: vertical ",, "pntel reterarro4 BAD). direction and percentslope. scale or dlmensiMrfw&'drrow, a ocatan and distance to nearest road. Please print all information. PWSWW bfonnaeon you Povgs M&Y be ueea for "OwWry purMft (Pm" c 15.04 (1) (rn)) countycounty` S 4 Parcel I.D. Tw+0-f: QZO (Q (ate Z(y�7 Re Date IA / Property Owner Property Location Govt. Lot / � 114� 1l4 S3 -T 7 N R Property Owners Mailing Add i- 5 Lot # Block # $ubd. Name or Ls rw rQ� / Slate Zip Code PFgr1e Number ❑City ❑ ge Nearest jtoad New Construction UsgrLesidential i Number of beAoorns ❑Replacement n�•/n�/�❑ P—Publicacammerdal- scribe: Parent material �C.IUY/ (jj Sii ..� General comments and reccim"w Wools: .41 System Type // ! �9T[lA V Y —tea Code derived design lbw rate �� GPD __ Flood Plain elevation if applicable R. System Elevation / '✓ I ❑ Boring Bong # J9 Pit Ground surface elev. 49L:� R. Depth to Ii ding factor YP in. Soil Application Rate Flaimn Depth in. Dominant Color Mussel Redox Description Du. Sz. cont. Color Text" ShxWm Gr. Sz Sh. Consistence Boundary Rods GPDM° 'Eff#1 -ER#2 C s' "' lU,• v s"� N ,2 , B°'i'8 # 9 Boring Ground surface elei R. Depth to smiting factor in. Pit Shc iwtian Rate Harmon Depth in. Dominant Color Muael Redox Description Ou. Sz. Cont. Color Texture I Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'ER#1 •ER#2 ` zjoh? I J I 2 IZ-3 L �� C rt 1 ' 3 Z ' Effluent 91 = SOD. > 30 < 220 mWL and TSS >30 < 157W L4Effkjerd J112 = BOO.1 M ngfL 8M i aQ _ .1u mga. CST Name (Please Print) a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Dat val� 9 Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 9 715-246-4516 2-1 Property Owner Parcel ID # Page — d _ © • ' Or Bo,i,g# Boring pit Ground surface elew. ft. Depth to linAkV factor _ in. —limbon M PRIME Effluent #1 = BOD, > 30 < 220 ng1L and TSS >30 < 150 mg& ' Effluent #2 = BOD5 < 30 mglL and TSS 130 nglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seouw(nsuo) Soil Test Plot Project Name Dick Stout Address 1353 Awatukee Trail Hudson Wi 54016 Lot 2 Subdivision Summer Prairie N W 1/4 NE 1/4S 35 T 29 N/R19 W F-IBoring Q Well PL Property Line L� W or VRP Assume Elevation 100 ft. M #226900 Date 9111119 Township Hudson County ST. CROIX Top of survey iron System Elevation TBD *HRpbame as Benchmark M.* perty Line -R LM , ro�mw®tisax.rosww�.a nwrnexmxuraM,xounwn,exwamrr —L ena�rucr�oanae.,rEv�.wnanaEm � � — w„ve.wwuro, rf aeaaruamo wanua� marvia u.nr mmnm wt xea, ffrwm,,rEwnrE�ar �aiteo®wn x.MrexaucunnasrMr.,o TEnanroQBfe � rrexu varrxmsa.ixwnerwoun.asex g ro srwre many no ro.,a� vna aura xo aeaunar®1+-'x�nvM r.aruna� xv. m.w �c®roxwae,c�.e.aenm.sow ss — — smlw ,w �smwvt� oAemn,wrrvmswoaorticn,.n. — . — . — — . — — - — - — _ ���.no+axxaMwaanartrowM—_— U8 �l ,.m. xore rowraxa,�rt..umwm,w _—_ �. WmwWE--'_ ___ ____ __ __ wMawaanx�wnvo,owaa=„E - - —� - -}--a veMro,vr�xam.®maaaas.Exrne, �` pw.a¢ x�o Bol.,0.or1 ww rw nq wAr l,n xan®.rtexmun®roa.nrouvi � � a89MaC1aA Nl..a,, H1Hq O. oG'wgnaxa ax n,vnw xxrcw.wacxaao,�Q LEGEND +Wren ae Mo«� e ecammanraxnu1ma�n wa,rr� _ wxIrFM M,dImWfYWLYQlYn64 xrnuxw.anwm, �i _tim� / rlw�rtnsxrnma„®avr�ao ❑ ,vax,.wr�raswaer,xaaao�nue xn �I MN / i>rowwor � �� MBN a17.x9pN3,dlmm l / • —._— ,ewa�unnrrweas,r L;� U1. Lor cs i.enFr. ,m�nw LOCATION SKETCH WI • / uaMwwrtsr — g' c.w- LEGEND a»aaxfw N / / // NOTE �� � / �/ / ,ms,,xxa auEow.iwamwvrea rwr�rvw,aq we SURVEYOR OWNER 4 L0T4 �- mvw�cww.. im«a uc LaT7 orawMian.marw.rc ,�nxu �ma gill xercaxw I Mww I Maw MNE x sE I I I I remx¢ rms ®a ixr I I G9H40L �.-- / uw,Ea.aM,a reurn,na avnr3arx,va¢cm rona:Mwnr �_ IJ SGIESIFM 1'-IW ,W m