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Home My WebLink About042-1102-30-100Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safely and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Valerie Schall i TANK INFORMATION TYPE MANUFACTU Rt CAPACITY Septic /C 1 � l 2.5 1�50 Dosing oM�o 760 Aeration ,1 TANK SETBACK INFORMATION TANK TO PILr WELL BLDG. Vent to Air Intake ROAD Septic Dosing ) ✓ C3 % 01 Z u t l -2 Z + Aeration Holding PUMPISIPHON INFORMATION Manufacturer + bfr Model Number �6 + TDH Lil,.s Frictio4s System Head TIY) L Forcemain L north ` Dia\\ Dist. to Well SOIL ABSORPTION SYSTEM La -} GO .} Zo TOWN OF WARREN ELEVATION DATA I" uI" I St. Croix I Permit No: 042-1102-30-100 36.29.18.566A-10 STATION BS HI FS ELEV. Benchmark O I0o (OD Alt. BM Bldg. Sewer 11.65 .R6 SVHt Inlet 8 9-7 • Z SUHt Outlet Dt Inlet Dt Bottom �6.7 8j.3 ii J• J HeadedMan. J712. .9Dist. PipeBotSystem -7.) ' 11 1Z.`1 Final Grade7,St Cover BEDfTRENCH DIMENSIONS Width - % Len th _ VVV Ne-9PTr¢rfcriea- 3 PIT DIMENSIONS No. Of Pits In i Dia. Liquid Depth SETBACK SYSTEM TO P/L N BLDG IWELL LAKE/STREAM LEACHING Manufac INFORMATION Type Of System: ConV`ty-% �/ \ 6, \ CHAMBER OR UNIT G� Model Nu er DISTRIBUTION SYSTEM Header/Manifold y' r t I Length I Die / Distribution Lenglh Dia Spacing Length_ x Hole Size x Hole Spacing Vent to Air Intake DGl — T It ' •� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Svstems Only Depth Over Bed/Trench Center u �L\ _7 J Depth Over Bed/Trench Ed es g \ '7 \\ m Depth of Topsoil p xx SeededlSodded m Mulched Q Yes ■ No Yes Na COMMENTS: (Include code discrrepencies, personspresent, etc.) Inspection #1: Inspection #2: Location: No Address Availa'bbll'e` (l/ nG*S � /`� S r ✓\S �[' 2.) Bldg sewer length = -, 7j ` � � \r(j�� 9Y\ CL9L fNj J `� � - amount of cover = 71 % - Nt.1, I1 I O Uj)-1D 1A Plan revision Required? to Yes icy No Use other side for additional informati n. SBD-6710 (R.3/97) „'L-�P Date Insep is Signature Can. No. 54N- Zo2o - !0-7 ,D �7C Safety and Buildings Division ° 201 NF.'INashington Ave., P.O. Box 7162 —b-(to be tillW in by Co.) Swaney PermitIli A 2020 Madison, WI 53707-71 8 -ce -20 St. Croix County �, permit Application State Transaction Number amm nit Develo us. Ada Code, submission of tltis form to the appropnae governmental unit ��- Project Address (if diffatat dw o mating address) h regoued laic m obtaining a sanday pemm. Note: Application tams for sutebwned POWTS are submttRd to the Depaonea of safety and Professional Servies. Personal information you provide may be used for secondary pamposes to acmadaore with the Privacy Law, s. 15.041 XmStax. L Application Information - Please Print All Information Pmpeny owaa's N Pascal a — Property 0woet's Mailing Address Property Locassoo, 3 .Z1, t$ 5C0(r h Gov[ Lot h��j•,4 Section City, state PbweNtmbc / /" orcl T jN; R/ // E W EL of Building (check all that apply) Lot Subdivision Nam[ 2 Family Dwcl5ng-Numbs of Bcdmoms Block f ❑ PublidCoa inercial-Describe Use ❑ City of Q State Owvcd-Desmbe Use CSMNumber El wage of 20 V-LO G�w.rbberS of / o )II. Permit: (Check only one box on line A. Complete dine B if applicable) `- System ❑ Replacement System ❑ TteennewMolding Tank Replacement Only ❑Other Modificationm Extsmst System (explain) B- Q Permit t Revision ❑ Ctmmge of Plumber ❑ Petmit Transfer m New List Previous Patna Number and Dale Issued Bcfme Expiration Droner of POWTS System/Component/Device: Check all that apply) -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound> 24 in. of miwble soil ❑ Mound <24 a. of suitable soil Q Holding Tank ❑ 01berDispersal Campmenr lam) ❑ Remeament Devim (mp1aas) I V. Die rsaUTreatment Area Information: Design Flow (gpd) Design 5ed Apphcwca 6 rJo I , s-- Dispersal Atea Requked (at) Dsspasd AreMoposed(St) 1 124 1 /od/ VL Tank Info Capacity in Gallons Total Gallons a of Units Mmrdaconer a z New Sala Fxialag Dania Sepoo m Holdtgg Tank P Dosing Cbauaw / / ✓ VM ResponsibBity Ste ent- 1, the undersigned, responsibility for installation of the POW'IS shown on the attached plaoa s Name (Frio[) Pl Sigoanmc MP/M�.l,'RS11Number B'usias Phrme NN',�[// .ton G/✓C� !/j �027 1J Plumber's Address CeY Stile, 7 /. Countv/Denartintefft Use 001 APp[wed aapp PermhFat �Issued Dam 1- gAgent Si C enR for Denial ` ao drttonsf Approval/Reasoas for Disapproval 3) � n _ Oft, t Septic tank, a luant Itkaf and y aaA e:t-�a u� pe-� coaPlt- re Ye. dispersal call must ggsrvieed / maintained �[ i t L �—�_ nl.w as per management plan provided by plumber.e/[ �— 'tit.. R. All setback rements must be maintained F'f 16 MA m &&per applicable C ode Ornseel+e PIa. for the system soh m County t9 m ant less the a rrs :11' 3n me dA"tiw SBD-6398 (FL 11111)t4' ('�`S ` [�'JL' y ctj �' System PLOT PLAN PROJECT Valerie Schall ADDRESS 2455 Oakridoe Circle Hudson Wi 54016 NW 1/4 SW 1/4S 36 /T 28 N/R 18 W TOWN Warren COUNTY ST.CROIX SYSTEM ELEVATION 93.5/93.1/92.7 4.5' below grade 5/6/20 BEDROOM 4 DATE CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1219 # of chambers 60 BE 100' CHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATIO filter Lifetime Filter BOREHOLE O WELL *H.R.P. same as benchmark Property Line ALon2 Quick4 Standard Scale = 1 /411 = 10' Leaching Chamber I 20.0 ft2 of Area 98.5 B.M.* 5.6ft^2/pair of end caps 10' 2" � jol Gradeat System Elevation 34" H 3-3' X 82' cells with >3' spacing 97.5'(�E JC\C01?`: Vents B 2O-E x 5 96.5' J c q� piping shall be ASTM SDR 30/34, within of tank, piping shall be ASTM F891 140th St. 35 5% Slope V 1 `05 25' Pro 4 Bedroom Huffcutt House combo tank �— Property Line —P System PLOT PLAN PROJECT Valerie Schall ADDRESS 2455 Oakridae Circle Hudson Wi 54016 NW 1/4 SW 1/45 36 /T 28 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 93.5/93.1/92.7 4.5' below grade 5/6/20 BEDROOM 4 DATE CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1219 # of chambers 60 BE CHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATIO 100' Ilter Lifetime Filter BOREHOLE O WELL IH.R.P. same as benchmark Property Line >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 98.5' 5.6ft^2/pair of end caps 4' Long 12 Grade at System Elevation 34" 01 3-3' X 82' cells with >3' spacing 97.5'-(H Vents Of 96.5' piping shall be ASTM SDR 30/34, within of tank, piping shall be ASTM F891 Scale = 1 /4" = 10' 10, 35 5% Slope Pro 4 Bedroom House B.M.* 25' Huffcutt combo tank 140th St. 91_ 240' `•1 �— Property Line --'p Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard MAY 15 2020 Leaching Chamber with 20.0 ft2 of Area per st, croix county Chamber 5.6f A2 air of end plates munitv Development P Typical Installation Grade 4" -A'30/34 Septic Tank 4' Longll" N 5 Grade at System Elevation Spacing 5' CI 0 To be >1' above grade Finish grade elevation 98.0' 1" at System Elevation 3-3' X 82' Cells Observation tubeNent Same on other end To be located on end of Cells 20 chambers per cell A B System elevations: C A_93.5' B 93.1' C_92.7' 2014C�048A 04S200 193000 IBJM s� i 1921 A r - r r� 9.8166 .1 i� 9.3759 !t, 9.4356 w .01 Gap belen Cose and Serpentine �% +�•d'A- \/Z\ \/A ` C � ?� FE` n JS'': ' „iL;:(viib SECTION A -A - - Septic -Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer Tank Model Number Total Tank Capacity Max. Bury Depth Filter Manufacturer , Filter Model Number Z �� Minimum Pump Performance Required GPMI 5-- Ft TDH Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight �- — — — -f r Finished Grade Outlet Filter Inlet Inlet Baffle Switch Setlptgs and Reserve Capacity _Tank Vohune = 7 GPI Dimension, Inches Volume Gal. (reserve) A: (alarm) B 2 (dose) C, g (dead) D 5Pi Total y� 6� Pump Manufacturer Pump Model Number Alarm Manufacturer �p Alarm Model Number / / Switch Type �e Total Dynamic Head (TDH) - Feet Elevation Heed Distal Pressure ---- -- Network Loss �- Force Main Loss Total Manhole Min. 4" Above Grade Securely Mounted With Locking Device \\\ Weather-proof �� Junction Box Vent Min.12" Disconnect Above Grade Means With Vent Cap A 44 Weep B Hole Off Elevation C �9. S Ft e, Bottom D Elevatiion l e. 7 Ft GENERAL INSTALLATION: The septio/dosc 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, conrras6ad 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 tank excavation sud the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 W Page of 280-SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-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 flaw. Designed around Liberty's unique "Uni-Body' casting, the 280-Series will provide years of reliable performance. All Models Feature: • Vortex style impeller permitting passage of solids Up to Y" • 416 stainless steel rotor shaft • Pemlanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners- corrosion -resistant stainless steel • 1 %" Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature; 140' F. 280-Series Cord Lengths Model 101 25' -2) 35'(-3) 501(-5) 280 Standard Optional Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional WA 287 Standard Optional WA WA 10' cord length standard on all models. For optional lengths, add "-2, -3or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications hp 60 Fiz 3450 RPM Oil filled, thennalty protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Performance Curve; 280-Series US. Gallons Per Minute I I I I I I I I 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data. Weight: 29 lbs. Height:13" Major Width:10' (model 287) Minimum Sump Diameters: Model 281, 283...140 Model 287 VMF... 10" Factory switch Model 281, 283 Modet 287 settings VMF Tum on level 13" 9.5" Turn off level 7- 4.0" The Model 283 features a fully adjustable wide-angle float Differential adjustments can be made easily by teiherirg the float to the dis- charge pipe or other mounting point Vertical float model 287 is root adjustable. J Model :1 _ .. :< f�<=J - de angle no switchI float switch with quick- with series disconnect .. -- plug - Acks Certified Model 287 VMF Series Vertical mag- neticfloat for smaller pits - will operate in a 10" diameter sump Uberty Pumps • 7000 APP1e Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.fibertypurnps.com coglgx® ut�ry pulp lac.2D17 Alin rIC+I wnped. tLn2000nain7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner Permit # DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units RLdq I Estimated flow (average) 4 dgal/day Design flow (peak), (Estimated x 1.5) 6 60 allda Soil Application Rate ' 7 gaudayW Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mglL Biochemical Oxygen Demand (BODa) 220 mglL ❑ NA Total Suspended Solids (fSS) <150 mglL Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) s30 mglL Total Suspended Solids (TSS) <30 mglL ❑ NA Fecal Coliform (geometric mean) 510° cfW100ml Maximum Effluent Particle Size Ya in dia. ❑ NA Other. ❑ NA 'Values typical for domestic wastewater and septic tank effiue t. NIAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page __ of _ Septic Tank Capacity a al ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity al NA Pump Tank Manufacturer NA Pump Manufacturer NA Pump Model NA Pretreatment Unit NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection O Other. Dispersal Cell(s) ❑ NA Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other. D NA Other. ❑ NA Other. ❑ NA Service Event Service Frequency (Inspect condition of tank(s) At least once every: ❑ eamhs(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA inspect dispersal cell(s) At least once every: 3 ea�(s) (Maximum 3 years) 1&4Clean ❑ NA effluent filter At least once every: Qmonth(s) ear(s)rspect pump, pump controls S alarm At least once every: �Y�s)s)-lush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) tNA Other. At least once every: ❑ month(s) ❑ year(s) 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 Maintainer, 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 !zombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cells) shall be wisuady 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 notification of the local Iegulatory authority. When the combined accumulation of sludge and scum in any tank squalls one-third (Ye) or more of the tank volume, the entire contents of l:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, Ihnd any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. la service report shag be provided to the local regulatory authority •Mthin. 10 days of completion of any service event. Page _ of _, START UP AND OPERATION s or other chemipls thn t For new construction, prior to use of the POWTS check treatment tank(s) for the presence of Painting de rodudduohave the contents of the may impede the treatment process and/or damage the dispersal cell(s). If high concentrations ti tanks) 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 cel(s) in one Lange dose, overlong the oell(s) and may result in the backup or surface discharge of eftluel To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator Prior to restoring Power to ft effluent pump or contact a Plumber or POWTS Maintainer 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 ceds. 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 POW $: anbbiotks, baby wipes cigarette butts; condoms; cotton webs; degreasers; dame l foss; diapers; dis'vrfechints; fat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline. grease; herbicides; meat wraps; 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 propefly and safely abandoned in conpkance with chapter Comm a3.33, 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 soil, gravel or another inert solid material. CONTINGENCY PLAN ff the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requitled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wadi result in the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruleo in effect at that time. O A suitable replacement area is not avallable due to setback and/or soil limitations. Bening advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation nwst be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installedi 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 ADDITIONAL COMMENTS — POWTS INSTALLER POWTS MAINTAINER Name 'o Name J . c Phone SEPTAOE SERVICING OPERATOR P IMPER LOCAL REGULATORY AUTHORITY Narrme Name ," . y Phone ^ J C ( Phone This doaanent was draped in compliance with chapter SPS 383.22(2xb)(1)(d)&(f) and 393.54(t), (2) 8 (3). vvisco m Adminiatrativve . ST. CROIX COUNT"y (� S$PTIC TANK MAINTI NANCEt.1GRMMif L AND OWNERSIIIP CERTIFICA'rTcgq v ARM , y f........... -- --- Mailing Address- 2Y5—S— Plvp(•.ftyAddness_ 6 3 /467-(y Sj - (Verilication required fnnn planning & Zoning Dopw1r,mun,fits wev constmotion.j--._—.._ City/State.^ _ _ Ptuoel Identification Nutabesr Q / d llod` ,3 0 , 0 I�GA1 DT�SCItCPTION q �. �.._ Property LocltUon �/, , �'/. , Sa:.� 6,'t'_�( N R,��W, Town of ��//('i`✓ Subdivision Certified Survey Map # --,� 0 — Warranty Deed #___,.7 , _< —2-2- O Speotwuse yos Pale II I- Pago tut linty identifiable (9 no SYSTEM MAINTENANCE AND OWNER CEI MICATION hnproper use and rminrenance of your septic system conld rmat in its pr mmtury failure to handle wastes. Proper maintenance consists of pumping out Ole stpde tank every three years or sooner, it needed, by a licensed pinapar. what you put into the systen call affect the function of tie septic tack as a tmamtent stage in the walla disposal systual ownor cesiaterallee res7w1151bililies are specfited in }Comm, 83.52(t) alai in (arapter• 12 -St. Croix County Sanitaryontinance. 11m property owner agrom to submit to St. Cloix County Mullins & Zen mg Deparimcnt a Certification form, signed by the owtter and by a'motor phunber, journeyman plundrer, tvstticted plunder or a atroused pumper verifying that (1) flit on -situ wastewater disposal sysanu is inpropor• operating condition amllor (2) Rase itapcution and pumping (ii•recessary), the septic fmdr is loss than 1/3 full of sludge. Uwa, tie tmdaraignad lutvv road Into above mguirements and ugroc re maintain the luivew aysysga disposal system with Iha aaudards sot forth, ltoroin, as eat by the Doparanent OfContnetcv and fie Dtgxtrbneat ofKalwel ltnsourvcs, Stara ofwiscorrslo. Cortification sating that }rota septic system las beeer rmrimabrrd tmrst be conrylehe+l nett xehuned to arc Sf. (Unix (malty 1'iunnutg & ZoaingDepartmoal With"'" days nfthe date year expiration data. a Uwe certify that sit stalammats on this form are true to tho hest of uty/nor h nowlc(Igo. 1/wc uaJm'o rho mvm;t(s) of tle properly described above, by virtue of a wamnty deed nxonled in Rt gister of Dctnls office. IYo or of edrooms y- - SIU"NA'1'U - F APPTdCANT(S}..--- FDA i"Any iuforrmtiva that is atiump mented nay reach in tilt Military flumrit being orvoked by tle Planing & Tuoiug 1)epart'Gax. •ss hicludo with this application a nx:orded warranty deed 14om thu Ragishn of Deuds Gffice and a copy oftie certified survey rip if reference is mnk: in the warranty deed. (REV. ems) ST. CROIX COUNI, Y SEPTIC TANK MAINTENANCE AGREEMLNT AND OWNERSHIP CERTIFICATION FORM OWUW/Buyer Property Address (03 C1ty/Stat6 Property Location h/ '/, , f t.t/ '/, , Subdivision CertUnd Survey Warranty Deed # Spec house yes ao uL_.�51L7 tm P"-- ag & •zoning Parcel Identification J� f 2-9 �.�- W, Town of .1 —e,. — -- --- -- .Lot # Volume __._,Page#.— — l.ot Iinr ideanfinbf ye no Improper use and maintenance of your sap, system could res n its pmm�attm failwe to handle wastes. Proper tnaintcnatuc consists ofpumping out the septic very three yews or or" it aeodeei by a licenser! pumper, what the system coat affect the function of the a you put into septic to as a tteatmeol atago in waste disposal system Owner maintenance responsibilities tm specified in §C:otmn. 83.52(1) a1 in (.9wpter ] 2 - St. Croi 'ootrty Sanitary Urrtnaua;. The property owner agrocs to submit t St. Croix County Pletutin & Zo Uo owner and by a master plumber•, jomhe g parimnm a certification [omy sigoehd by dhe Yman p r, restricted plumber nr a liven d pumper verifying that (1) the on -site wastewater disposal system is in proper oper g condition and/or (2) after inspcoei and u m irnecessa less than 1/3 full of sludgo. P mP K ( ry), the septic tank is I/we, the undaraigoed ]wvo road t above tequiremeuts and agree to maintain thjrivatc sewage disposal system with tho sraneiatda sm forty hereto, na act by thv D rt,=t ofComntetce and tie Dopatirnonr of tool Rnxowsos, Shin of Wtswrtsia Certification sitting that your septic systa4 has been maintainod must be completes and renamed to the St. Ohoix Cotmty, planning & Zoning Dopwmwnt within 30 days of the year expnation date. I/we certify that all stalemvnts o 's form are true to the best of my/atu k nowlodga. I/we un✓s m dw awner(s) of Ux Property described above, by virtue of a warranty deed recorded in Register of Deals Office. Number of bedropms �Z_` TiATURE O ' LTC W I'() 0 ' b � *"',"oh J` (fit<ttyocy` Any information that i§ lMAPPresented tray result in the sanitary ptamit being n rooked by the Plumung &Zoning Department. «aa Inchtde with this application a recorded warranty deed fiom the Register of Deeds GtTrce and a copy of the certified survey map If reference is made in the warranty deed. (REV. 0W @11V - a 0 a 0 — 0'sk `�,arua7 o' Industry Services Division 1400 E Washington Ave County/ MAR j 6 2020 P,O. Box 7162 Madison, Wt 53707— 2 Sanitary Permit Number (to be filled in by Co.) b� �� UIX 011 State Transaction Number Commu% r�ew it App icati In accordance w1 IS. Adin tCode. submission of this form tmAh. appropriate e it is required prim to obtaining a sanitary permit. Note. Application forms for srate-o S are so to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may secondary ournosm in accordance with the Privacy Law, S. 15.04(1 Xni Stars. L Application Information - Please Print All Information Property Owner's Name F//-- Parcel # 2krk S e 1, 1 1v�yZ /OL-3o'/tea Property Owner's cling Address ' / 1 pfwty J„gati ins' -lO 7 ��f0a, IFV G.v; Lot / i . / y�� y4 section(p City, Sta Zip Code Phone Number j ✓� Felm N; RE \��JJ//// ype o Building (check all that apply) t # or 2 Family Dwelling- Number of Bedrooms Subdi sion Name ❑ Public/CommeDescribeial - Describe Use lock # ❑ City of %-� ❑ State Owned- Describe Use ❑ Village of CSM Number 6 own of 4-24 llI. Ty of Permit: (Cbe&k only one box on line A. Complete line B if applicable) A. w S stem y eplacement System ❑ Treatment/Holding Tank Replac-204y ❑Other Modification to Existl System (explain) B• ❑Permit Renewal ❑ Pe evision El Change of Plumber ❑ Pe mnsfer to New List Previous Permit Number to Issued Before Expiration T ofPOWTSS stem/Com ne evice: Check all that a I AW -Pressurized In -Ground ❑ Pressurized Ground ❑ At -Grade ❑ ou 4 in. itable wil �Jdound <24 i it Holding Tank ❑ Other Dispersal Component lain ) mart Device (explain V. Dig raaVfrealment Area Information ow. 1077 Desi Flow (gpd) Design Soil Application te(g Dispe Requi Di rsal Area Prop Syste evati �9 S VI. Tank Info Capacity in Tool # of Manuf u Gallons Gallons U u 2u New Tanks Existing Tanks i V ffi iL c7 a Septic or Holding Tank i r s- Dosing Clamber VII. Responsibility Statement- I, the mode ' ed, pony or taataaation of the POWTS shanjan the attached plain Plum 's Name (Prim) ) Plu statute MP RS Number RS Business Phone N ben(/�� Plumber' ddress (Street, ity, State, Zip z �co 3,N ,�14u-11' s VIUL County/De artment Use OAfly *KApproved ❑ Disapproved Permit Fee Issued 1 ui Age-t Signature �— ❑ Owner Giv Reason for Denial O IX. 0Qf6UQRE4 easons for Disapproval ~ - sea 1. Septic tank, efiRAnt filter and foe(j bit Sir r LQAf�I S9i� dispersal CallOust 4ea�elviced !maintained as per management plan provided by plumber. 94 Pt"'t, v_ �{ 2. All setback requirements must be maintained tR NAQ k— A for the gatin an�au mi to the CouW only J1 pa -per aof_Ira than 8112 x mime a / ce �P(t. ,mbar s(tiro�r�e sc�tw. w�a�-a= i SBD-6398 (K 08/14) 1Lftr" W AO A 4 10 i M Q Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/12/20 Owner: My Location: NW1/4 SW1/4 S36 T28 N,R18W Lot 4 140th St. Warren Manuals Used: , In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance a ntigency Plan 7. Filter Cross S i Signature License n"er #226900 System PLOT PLAN PROJECT Mvron Kemoen. 'f ADDRESS 430 E. Chevenne St. Roberts Wi 54023 NW 1/4 SW 1/4S 36 /T 28 N/R 18 W TOWN Warren COUNTY ST.CROIX SYSTEM ELEVATION 96.5/96.0 4.5' below grade DATE 3/14/20 BEDROOM 4 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 ✓ BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL -H.R.P. Same as benchmark ProDertv Line _ Vent Scale = 1 /4" = 10' >6.. Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12 Grade at System Elevation 692' RRI] Pro 41 House 10213-1 yv-- 2-3' X 90' cells with >3' spacing B-2 `100.5' 0 140th St. All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6f A2 pair of end plates To be >1 above grade Finish grade elevation Typical Installation 101, Vent Grade QVent A/30/34 Septic Tank 5, 1 „ 5' Long t 5' Long Grade at System Elevation 10 Grade at System Elevation Spacing 5' 2-3' 90' qFells Same on of r enj Observation tubeNent At end of cell 22 chambets peNell System elevations: A 96.5' B 96.0' 0 u� /z21oy Ylnwsnwin Departrrrert of Co Men" 4--tom-Ad '�j � COT SOIL EVALUATION REPORT Page / al 3 - - - in accordance with Amen mmpble &na Ptah on Paper not lean than 8 1 f2 x 11 Inin siip e��Mile/+�� dtV E D Include, but NO limited bw : rbwl and horizontal referannW 1 , direchm ana pernnt sbpe. &Cale er dknenslen&, rwWth Grow, end e d J `o I ePleeee print all Inform tlon.A. ry Ul;,�, PMoglal lnr-mruon p, 0•a m W-nee Ion Mr-rdwry 1 �1'5. 3', i� 1•_�. . P I. . by 3 � �•O PlapatyOw>•r C /�7q�2�T , z 1( � Q e C c- tbl k11 q 6 T N R/ E la)NfJ / l CJUIPC zipD KOD r� aL 1?/S 3v/v, -Lca� Lot 0 BID* 0 8ubd. Name CS1�tl! � �� j tj � vgLw ill Nearest Road 0 New Ounehudlan Uae: ® Residential f Number at bw ors 3 — Y Coda &~ design Ibw rate )� SO �� O C/ GPD O Repiaberent ❑ Public or mnrnetdal - Describe: — Parent esais z r I i — Flood Plain 40 v bon K appYmbie . // ,-+ R General a, warn Cana: s ys .n v ' p , Z r Ps- Sa It l /S�4yA�t�•�' S �'1�'�i Tom" D Cr'crl/ l►� v� y.III - r �s4p u7 re C t wr a sarling 0 Boring 4 awl- o.v-r Lo Pit Ground w efto akv. /00, YG It. Depth to ng factor In. RAO Hahn DWM In. Dcatnem CdWr Murrell Redo: peaaip8on pW SL Cori Cob Texture Strudhas Or- 82. Sh. Cmclslenca Boo darY Rom 'Et@1 E= r c5 vj o ❑ Boft 0 Pit Crowd •clam eiev 0 / /ti R Depdn to Wnw% factor `� In. Sol Rao Hart= Dept ei Donntlnam COW Wave& RedsDeaoipion Gu Sm Cont Color Texhm Stan" Car. SL ML Canddelra boundary Rmis Gpw 1 'ErtA4 C - 3f z Effluent 01 - BOO > 30 < ZW at* **-" 5 >30 c t5D rrg4 • Efted 02 - BDO 130 IngIL and TSS e 30 mg& C5f Nana Pam CST N Santo a fddrm ... _ -.... - (, .. Dos& EveSa0an Caduaed Telephone hkrfbw • Z Property Owner St'1 � : 4 Panai to x Bev 8 ❑ Bowing' Ground aurlow Bev. Pepe Z d - ' MAM Marra ei - BOO, > 30 1220 MYL and TSS >30 < 150 rrgti, ' Eldlertt 02 • BOo, < 30 moll. and TSS < 30 mWL Ire Department of Commome 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. Hob)a(a.aao) Z ?4z yS<. el u, day Y Zo 41�r?S--oo ,a,/IN Gay i - r SIDE ELEVATION m_a FFM- m ❑o❑ m m m m 00 m REAR ELEVATION 6 FRONT ELEVATION GENERAL NOTES A -I ---------------------------------------------.------ n cPo-- -.. L ,R .T51 2 _ m— .wm..PP. bw w ma�uueonww�xoie. KM40�'P KI ND WURb WH�Ma P��lY W.A LCIbYY�P��wnl. A-2 0mamm n A x I� Y i .q f fix' �Qa -- C� PIE IN ES INS, Y x — F h GENERAL NOT iW �ilF6N RED MIMl�'O UCIJWet�O�� W�MNMM MAIN FLOOR PLAN A-3 0 v �� 11�11 i = m•®m6 ,II 00 R property Owner _ Parcel ID # Page —of IDBonng # ❑ Boring pit Ground surface elev. - �7 n. Depth to limiting factor [ Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary I Roots GPD1fF 'Eft#1 I 'Eff#2 Lc ; , G 2AAZ 93. v' iL 3.4 ❑ Boring ❑ Bering # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. FEW 'Rate • Effluent #1 z BODE > 30 1220 mg/L and TSS a30 1150 mgrL ' Effluent #2 - BOD, < 30 ng1L and TSS < 30 mglL 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. seo-9330(Rb ) Property Owner Parcel ID # Page _ of _ ® Boring # ❑Boring (ar, _ Pit Ground surface elev. �7 G1CL_ ft. Depth to limiting [actor, io. Soil iption Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots GPDIff 'Eff#1 'Eft#2 3L ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Cola Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDlfF 'Eff#1 •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. " Soil Application Rate Qu. Sz. cont. color Effluent #1 = BODE > 30 < 220 mgrl- and TSS >30 < 160 mglL ' Effluent #2 = BOD, < 30 mgrl. and TSS < 30 mg1L 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. SB"330 pr.svot System PLOT PLAN PROJECT Valerie Schell ADDRESS 2455 Oakridae Circle Hudson Wi 54016 NW 114 SW IMS 36 /T 28 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 93.5/93.1/92.7 4.5' below grade DATE5/6/20 BEDROOM 4 CONVENTIONAL _CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1219 # of chambers 60 BE CHMARK V.R.P. Top of 3/4" pipe 100° ASSUME ELEVATIO filter Lifetime Filter BOREHOLE 0 WELL :H,R.P_ same as benchmark PrOnerty Line _ >6tj uick4 Standard aching Chamber of Coh 20.0 ft2 of Area 98.5' ftA2/pair of end caps 4' L Grade at System Elevation O{ 3-3' X 82' cells with >3' spacing 97 5,-Qf Vents Of piping shall be ASTM SDR 30/34, within of tank, piping shall be ASTM F891 fit?) Scale = 1 /4" = 10' B.M.* 10, B 35' 96.5' S0' 20' 5% Slope � 90, Pro 4 Bedroom House 25' Huffcutt combo tank j 4 - Property Line