HomeMy WebLinkAbout020-1106-11-100Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety 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)j
TANK INFORMATION
TYPE
PACITY
Septic[[Dosing
+JHolding
"lkI
TANK SETBACK INFORMATION
MR11#01R
a
PUMP/SIPHON INFORMATION !(! k, Z.
Manufacturer Demand
G1PM
Model Number / �-Z
TDH Lifl)r 35 FrictigP i o Systerr�ea TD(j,`� Ft
Forcemaiiin Le9gth. n Dia? ID11t toAellf L..M
I
SOIL ABSORPTION SYSTEM
ELEVATION DATA
STATION
B
H
�D
FS
ELEV.
Benchmark
1v3.
/oa
AII, BM� y
toI.�
Bldg. Sewer
SUHt Inlet
k
.ZO
9G • os
SUHt Outlet
Dt Inlet
Dt Bottom
9l, 75
Header/Man
Dist Pipe
Bot. System
? 13
J'
?n7- ,73
Final Grade
St Cover
L
LGC- 's'i O.SG
BED/TRENCH
DIMENSIONS
Wtl� r
Length
, ♦]O r
VV
niches
PIT DIMENSIONS
No. Of Pits
Dia.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L 5
JBLDG
WELL
LAKE/STREAM
I LEACHING
CHAMBER OR
UNIT
Manufacturer.
Type Of System
15
f Z_ 5
1150,
Model N mbar
Ul, I KILSU I IVN JYS I tM
Header/Manifold
�
Distributioyryp ri
Pipes) ` %
x Hale Size
i♦
x Hole Spacing
`
Vent to Air Intl
Length D �
/C� a
Length Dia ` Spang�
� Z
Z
� �
1�
SCAL GOVCK /lr. x Pressure Svstems Only xx MnrmA Or er_r;.anc Av«t. . nnly %fir• D 1-_ _ 1
Depth Over
Bedffrench Center
�f
Depth Over
8edlTrench
Edges
�Q
��
xx Depth of
To
7
t `
xx Seeded/Sodded
Yes
�] No
xx Mulched
- Yes No
COMMENTS: yodp TTS: (Include e discrepancies, rssons present, etc )
Location: MAGOO RD `�,
1.) Alt BM Description =✓qqA' 1 CG (j,� �
2.) Bldg sewer length = cxl Z
-amount of cover =,;,, 11,�
L oF�
1(�-nssppetction#1: _ANUIn
Inspection #2e.
3 w J
lD �L� f luvS
Plan revision Required? Yes No
Use other side for additional informatiofi.YJ J S JI
SBD-6710 (R.3/97) Date Insep or's ign tur Cert No.
Fvja lD_3o kPh
5M -dodo — 6ao
Industry Services Division
County
:`;" " .L
202Q
1400 E Washington Ave
-
Sanitary Permit Number (to be filled in by Cc)
pQQ
: JQN D O
P,O. Box 7162
H
Madison, W[ 53707-71
Gro X CDuntV�ent
commallt Itary Permit Application '
State Transaction Number
In acwrden wnth SPS 383.21(2), W is. Adm. Code, submission of this form to the rapri vemorainalin unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned TS are submitted to
Personal information may be used for saondary
O z Oao
Pro'ect Address (if difiermt than mailing addross)
the Department of Safety and professional Services. you provide
purposes in accordance with the Privacy Law, s. 15.04(1 m , Stats.
1. Application Information - Please Print All Informs n
Property Owner's Name (
/6i5/
OOLO 1)01P Y
pr/oep�ert�yjOwrier's Mailiinng Address
Property Location 2/
�7
Govt. La
Nr V�Y., Section�
City, Stare Zip Cade
Phone Number
ircle
x
T 1:q — N; R or W
H. Type of Building (check a6 that apply)
Lot
Subdivision Name
2 Family Dwelling -Number of Bedroom
Ok
Block M
❑city of
❑Public/Commercial - Describe Use�tJ`
❑ State Owned - Describe Use
❑ Village of
CSM Number 0
/`QzuZ P ��?1
Town of
III. Type f t: (Check only one box on line A. Complete line B if applicable) JJ
2,
A
New System
❑ Replacement System
❑ Treatmem/Flolding Tank Replacement Only
❑ Other Modification to Existing System (explain)
B.
❑ Permit Renewal
❑ Permit Revision
❑ Change of Plumber
❑ Permit Transfer to New
List Previous Permit Number and Dace Issued
Before Expiration
Owner
IV. Type of POWTSS stemlCom nent/Device: C I
❑ Non -Pressurized In -Ground ❑ Pressurized In-G d At -Grade Mound?: 24 in. of suitable soil
❑ Mound <24 in. of suitable soil
in
❑ Holding Tank ❑ Other Dispersal Component (explain) reatmem Device (explain)
V. Dis rsaVl'nat ant Area Information•
Design Flow (gpd)
Desi Soil Application ate(gpdst)
Dispe I Area Required (at)
Dispersal Area Wopmed
System Elevation/
s
VI. Tank Info
Capacity in
Total
s of
Manufacturer
3
Gallons
Gallons
Units
c
o
U
New Tanks
Existing
I, ;
I�
E'
2 2
N
g V
a
Septic m Holding Tw&
s
Dosing Chamber
�7 ,�
VIL Responsibility Staten t 1, the onderaiga s me responsibility for iinedladon of the POW TS shown on the attached plans.
Plum is Name(Prim) P b sSignanue MP/MPRS
Number Business PhoneN
tS fk2
PI ber's Ad(Sued, City, S%t,ztp Cole) 5�-,
t �;
VID. C un /De rtmentUse0filv
Permit Fee
Date Psued I
ature
Approved
rven Reason for Denial
M Contriq ek?~easons for Disapproval 3 Js
t
1. Septic tank, effluent filter and W �
e /t
1�AP-a atir"O�
dispersal cell must be serviced./ maintained
as per management plan provided by plumber.
All (AN01
2. setback requirements must be maintained )
as Nm cpyu� �a•y46dId1NtlpWa9Wllae ayenem aW faamnm mee.ounry anry en Parer n.,, ��o.w •.. ...... .. 7- } f tuA
I�
7
SBD-6398 (R. 08114)
System PLOT PLAN
PROJECT Oeverinc Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NW 1/4 NE 1/4s 35 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
SYSTEM ELEVATION 99.0' DATE 1/16/20 BEDROOM 4
CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none
,� BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION loo' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
011ie Court
2 Acre Lot 0' 40' 80,
Scale = 1/4" =10'
Well is to meet all WDNR setbacks
Pro 3
Bedroom
House
Area 15' below system is to
remain undisturbed
374' Property Line
Huff cutt Combo Tank
3% Slope
97.5'
Kinney Road
ftm
B 3 I I IIJIGrading is to be done to
divert run-off away from
system
5' 99b9.5'
c.Mi
7
\ \ 0
MAGOO ROAD
Ir �
1010 - -994-
N N I \ \ \ \
l N _
LOT
e�.r 0 ���~ 2.01ACRES �� \
87,563 SF
— — _ -'90, L.B.O.=993.6
IDETENTION \ 1 /
I POND AREA
SOIL
TEST
NORTH
ELEVATIONS SHOWN ARE
NAVD 1988 DATUM.
•.0 — J / AREA
SCALE:
0 60, 120'
LEGEND
O =VV000 HUB SET AT 10'
OFFSET, IS OFFSET, OR ON
BUILDING EXTENSION
ALL EXTERIOR BUILDING CORNERS
MARKED WITH PIN FLAGS.
FOUND IRON PIPE PER PLAT OR AS NOTED
T.O.H: TOP OF WOOD HUB ELEVATION
T.O.P.- TOP OF IRON PIPE ELEVATION
— — — UTILITY S DRAINAGE EASEMENT
SETBACKS:
SO FRONT
10' SIDE MIN., 25' TOTAL
25' REAR
PRELIMINARY
FOR REVIEW
-• OEVERING HOMES 19-57 SPEC#2 _°"°^
LOT 1, C.S.M. V30 PG6731
NI
YlN-BMW "IfWI-HTI
W-NF SEC.35.T29N,I9W. TOWN OF HUDSON, ST. CROD( COUNTY. WISCONSIN ^'nFina�s_ n. n>-"1-sa owe
J �'+�+I'W MWWnYLt�
16 YE
HOUSE STAKEOUT PLAN Auth•Consulting/associates S&N Land Surveying
January 28, 2020
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2022-01-28
Plan Review: PWTS-012000109-C
SHAUN R BIRD
1432 120111 St
New Richmond WI 54017
SITE: OeVerillg Homes
Lot 011ie Circle - Hudson
Town of Hudson
Saint Croix County
Total Amount: $250.00
FOR:
6 o
Description: 45 GPD Bedrooms — New Construction)
Main[enan Required
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL
GREEN BAY Wi 54304-5211
Contact Through Relay
http://dsps.wi.gDv/programs/industry-services
www.wisconsin.gov
Tony Evers - Governor
Dawn Crim - Secretary
c L .,
At -Grade Component Manual - Ver. 2.0, SBD-10854
(N.03/07, R. I/12)
Pressure Distribution Component Manual — Ver. 2.0,
SBD-10706-P (N.01/01, R 10/12)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site.
• With new construction; it is recommended not to activate the pump in the dose tank until the tanks are
pumped prior to homeowner occupancy.
• Wastewater generated from contractors cleaning of equipment and tools and/or left over construction
products shall not be discharged into the drains discharging to the private onsite wastewater treatment system
(POWTS). Waste generated shall be properly disposed of on -site or off site.
• Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to
prevent malting 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 Mndciers reduce the amount of soil
available for proper treatment. I f no other site is available. trees in the bawl area of the mound nuul be cut ol'f
at ground lovel. A larger till area is nece.sbaiy N hen tm} ofthe above conditions are encountered to provide
sufficient infiltrative area.
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Thanks,
(%isn Ml "Aemf
POWTS Plan Reviewer— Wastewater Specialist
Department of Safety & Professional Services I Division of Industry Services
email: tiro.vanderleest,iF,%visconsin.eov
Cell: 608-516-6134
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date:1/16/20
Owner:Oevering Homes
Location:NW 1/4 NE1/4 S35 T29 N,R19 W Lot 1 011ie Circle 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.-9. Maintance and Continaencv Plan
Attachments: Soil Test
Shaun Bird
Signature
License number
Page 1 of 9
At -grade System Sloping Site Cross Section and Plan View
--
W A
i
i
i
i
i
i
i
i
i
i
i
E 1/6 B r
`B '
-
— = Plowed r};y = Clean aggregate Q = 4 in. sch. 40 pvc
basal area :;'c %: to 2 '/2 in. dia. observation pipe
Geotextile
Fabric
Lateral with 2"
aggregate over pipe
Topsoil Cap
GGy,_� s �'
Ft Lateral Invert
r ""' r CO Ft Contour
IfM`=;
Slope
Dimension
Feet
A
/Z
B
1/6 B
C
D
2.0
E
5.0
F
0.5
G
1.0
L
W
2Z
Slope I S
Observation Pipe
With Cap
MFL Topsoil Cap
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 % 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 gfoWA4, limit erosion and protect
from freezing. The observation pipes are perforated in the lower 6-inches and secured in place.
03/05 lgj Page -7— of I
Pressure Lateral Layout
One Lateral — End Manifold
Force Main Lateral Turn -up
X —
L
Distribution Netsfork Sp ecifications
Lateral Diameter
Z
In.
Orifice Diameter
113.
Z In.
X Orifice S acin
ez
In.
L(Lateral Len
FtEEI
Force Main Diameter
Force Main Length
Ft.
-- 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 ternunate with a threaded
cleanout plug and are enclosed in a 6-8 inch
diameter lawn sprinkler valve box accessible
from finished grade.
• .... Grade • • * 0 0 0
6-8 Inch Lawn
Sprinkler Valve
Box
03/05 lgj Page —�— of
Septic -Dose Tank Cross Section And Pump Performance Specifications
Tank Maatuhacturar
'rank Model Number
1 Z7�
Total Tank Capacity
s S
Max. Bury Depth
Filter Manufacturer
Filter Model Number
L� inimtun PumP Performance Required
]— GPM I Q IS, e& Ft TDH
Outlet Manhole Iv UL 4" Above Grade With
Looking Dice. Inlet Manhole
< 6" Below Grade Sealed Watertight
' — — — -1 — Finished Grade
IOutlet Filter
Lnlet :`' 1.t iniet Dame
Switch S!!qnp and Reserve Capacity
Tank Volume = GPI
Dimension,
Inches
Volume Gal.
(reserve) Al
-�
(alarm) B
2
dose) C
, T"
(22, �r
(dead) D:
Total
-7 Lr
Pump Manufacturer
_ Pump Model Number
ffd e
Alarm Manufacturer
' e — t
Alamr Model Number
Switch Type
S�n� %ACretCc_�.
Total Dynamic
Head (TDH) -Feet
Elevation Head
0
Distill Pressure
�3
Network Loss
Force Main Loss
Total
!,
_
Manhole Min.4" Above Grade
Securely Mounted ,_-
With Locking Device \
Weather-proof
I
Junction Box
J\\
Vag Min. 12"
7Disconrcct
Above GradeMeans
With Vent Cap
A t
Weep
B Hole
Off E��Oon $�—��► C
40
Bottom
8'j on
T
t$ 6 Ft
GENERAL. INSTAU ATION- The septic/dose tank is bedded and back filled in accordance with the
manufacpuer'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 looking 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, cite force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation aid the sleeve is sealed watertight. Electrical servic mplies with NEC 300 and Comm 16.2$.
r
02105 U 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 flow.
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
upto%"
• 416 stalnless steel rotor shaft
• Permanently lubricated upper and lower ball bearing
• Epoxy powder coat finish
• All fasteners - corrosion -resistant stainless steel
• 1 Y Discharge
• Stainless steel bottom screen -easily removable
• Maximum fluid temperature: 140' F.
2804kwies Cord Lengths
Model 10, 26' - 36' 3 so'
28D 8tanderd Optional 0 8ond optbnel
251 Standard Optional O tpional
283 Standard Optional Optional WA
287 Standard Optional WA WA
10' oord length standard an all models. For options] ie gars,
add "d, -3 or-6" suMbc to model number.
Example: for model 280 with 36' cord, order 280-3
Motor Specifications
Y. hp 60 Rz 3450 RPM
Oil filled, thernalty protected
(PSC) Permanent Split Capacitor
8.0 amps (115V)
4.0 amps (208t230V)
Pet iOnllanC@ Ciume: 280-Self"
d
S
0 5 10 15 2rl 95 !An AS M 45 50 ss an 65 70
U.s. Gallons Per Minute
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... 14'
Model 287 VMF... 10"
S�
G
Factory switch
Model 281, 283
I
Model 287
settin s
VMF
Tum on level
13•
9.5"
Turn off level
7'
4.0"
The Model 283 features a hilly adjustable wide'arloe float Differential
adjusanerm can be made eeally by tdtltaimg the float to the dls
charge pipe or otter mounting point Vertical float m0dal287It not
adjustable.
'YL '�Ir I
Model 280 Model 281 Model 283 Model 287
Manual, Wide angle Wide angle VMF-Series
no switch float switch float switch Vertical mag-
with quick- with series netic float for
disconnect (piggy -back) smaller pits -
plug will operate in
a 10" diameter
sump
SSPN�4 S �'
c us Certified
5prfunw• a• aqc, o dmaa wwn nod-,..
Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-26M Fax (WQ 454.180
www.11bertypumps.cum copyighteLb" Ramps. Imc. ar7
N rlamu r•anrrad. llr 9a00 aosnr
20140048A
J
SECTION A -A
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of_
IFILE INFORMATION
Owner �q„ ,rpr}
Permit #
ESIGN PARAMETERS
Number of Bedrooms
41
p NA
" Number of Public Facility Units
Pail
Estimated flaw (average)
1/0Q
al/da
Design flow (peak), (Estimated x 1.5)
U
galiday
Soil Application Rate
-(0
avda Rtz
Standard Influent/Effluent Quality
Fats, Oil & Grease (FOG)
Biochemical Oxygen Demand (BODs)
Total Suspended Solids (TSS)
Monthly average*
530 mg/L
5220 mglL ❑ NA
5150 mg/L
Pretreated Effluent Quality
Biochemical Oxygen Demand (BODa)
Total Suspended Solids (TSS)
Fecal Coli form (geometric mean)
Monthly average
530 mg&
530 mg/L
510' cfu/1 DDmI
iMaximum Effluent Particle Size
36 in dia.
❑ NA
IOthec
NA
'Values typical for domestic wastewater and septic tank effluenL
IAINTENANCE SCHEDULE
SYSTEM SPECIFICATIONS
Septic Tank Capacity
I ❑ NA
Septic Tank Manufacturer
Effluent Fitter Manufacturer
r
❑ NA
Effluent Filter Model
13 NA
Pump Tank Capacity
i ❑ NA
Pump Tank Manufacturer
O NA
Pump Manufacturer
l r
O NA
Pump Model
13
Pretreatment Unit
❑ Sand/Gravel Filler
0 Peet Filter
❑ Mechanical Aeration
❑ Wetland
O Disinfection
0 Other.
Dispersal Cell(s)
O In -Ground (gravity)
❑ In -Ground (pressurized)
At -Grade
❑ Mound
❑ Drip -Line
❑ Other.
Other.
11 NA
Other.
13 NA
Other.
0 NA
Service Event
Service Frequency
Inspect condition of tank(s)
At least once every:
30
month(a) (Maximum 3 years) ❑ NA
ear s
pump out contents of tank(s)
When combined sludge and scum equals one-third (X) of tank volume ❑ NA
Inspect dispersal oall(s)
At least once every:
3
montg(a) (Maximum 3 years) ❑ NA
Clean effluent filter
At least once every:
�
month(s) NA
ear s
I nspect pump, pump controls & alarm
At least once every:
3
month(s) O NA
Flush laterals end pressure test
At least once every:
-1
J
❑ month(s)
ear 9)
NA
tMr.
At least once every:
0 month(s)
NA
1 We r.
NN,
MAINTENANCE INSTRUCTIONS
iInspections 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
ixmbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal oall(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 ratification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (36) or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
ICI 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 Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
I
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 that
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 hlghwarter 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 effiueni.
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 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 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 Ile of the POWT B:
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 produclle;
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 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 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 Vold 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 sultable 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 requliled
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the "ad
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. Bening 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 she 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.
�1 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomet 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
—
POWTSINSTALLER
Name lkr,_ ---
Phone I 7 1 j
1J12W11A- .UII`.WjtJ xl
Phone
SEPTAGE SERVICING OPERATOR PU t ER LOCAL REGULATORY AUTHORITY
Name eo
Name T
Phone % _ a, Phone
This document was drafted In conpitanos with chapter SPa 383.22(2)(b)(1)(d)ll and 383.56(1), (2) a (3). Whooruln AdminWAN" CO".
ul r*,= 2 9, NIS OIL EVALUATION ORT P"
DivisioncifSafetyansi —of-
11, Comm 85 W3 Ads, Code
Anach complete 11111 inchn ln sue. Plan nvAt
rdtudfte NA 001 ZOMBI MISMIM06 Point (BM). chrectiOn and
pOverd slope. scow or north ,mow, and h,,an and daww to near,",rose.
Please Print all inromiation.
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parcel I o' H- le"
kc
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CST Name (Please Print) Sign CST Number
Bird Plumbing, Inc. Shaun Bird 14w— 2261900
—j;Fd,Z Date E cationcorkwed Telephone Numhe,
1432 120th St, New Richmond, WI 54017 1�/ / F 715-246-4516
Properly Owner parcel 10N
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The Department of Commerce is an equal opportunity service provider and employer. If you need aseisumce to access services or
need material in an alternate format, please contact the department in 608-266.3151 or M 608364-87/7.
po+r Ma
Soil Test Plot Plan
Project Name Dick Stout
Address 1353 Awatukee Trail
Hudson Wi 54016
Lot _1_ Subdivision ---------
NW 114 NE 1/4S 35 T 29 N/R19 W
Boring Q Well PL Property Line
BM or VRp Assume Elevation 100 ft.
A #226900
9/ 19
Township Hudson
County ST. CROIX
Top of survey iron
System Elevation TBD •HRpSame as Benchmark
c
l
r
Owner/Buyer
Mailing Address
Property Address
City/State
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHW CERTIFICATION FORM
(Verification required from Planning &
construction-)
Parcel Identification Number pzo -110 6 - l I — l00
LEGAL DESCRIPTION
,t z i � g
Prope ity Location�l/'/a / �� %a , Ste. J , T G ( N R,LLW, Town of _
Subdivision L(ot#_/
Cer ified Survey Map # ( n (Z C'(� Z Volume 3 , Page # __ p 31
Warrantv Deed # 6 c _ Vnlume, �f pa up. 9 e-�
Spec house/'yes / no Lot lines ideatifiab ye [to
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Conmi. 83.52(t) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St Croix County Planning & Zoning Department a certification forth, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 113 hill of sludge.
Itwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and retained to the St Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are hue to the best of my/our knowledge. I/we amlare the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds t>$ee.
Number of bedrooms�z�/
IG— OF APPLICANTS)
L&/F0
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning &'Zoning Department ""`
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
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Divisionof Safetyand Idings
n errnManrn r^-- eL LW,e AA... 1-,1-
St. Croix t
Attachcomplete site inches insize. Plan must
include, but not limh0d,40-er6carane narizon�i reference point (BM), direction and
Percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please Print all information.
Peraenal bdorrrubOn you Provide may be wad for secoridery Pie es (Privacy taw, s. 15.04 (1) Imll-
County C �`1
J 7--
Parcel I.D. n I '
au - - 90-b 00
Re y Date
O le
Property Owner
c
Property Location
Govt. Lot 114Wr 114 S j �T Z2 N R E (orjQ
Pnperty3 = M*9 Address ,
AlI
Lot p
Block #
Srbd. Name
—
State Zip Code Phone Number
❑ 5 y ❑ V Wown l a Road
Construction Use: &,Residential 1 Number of bedrooms Code derived design flow rate el 1-0 GPD
❑ Replao=ment ❑ Pu c or meia Describe:
Parent �."{- a/�/j� Flood Plain elevation d applicable
General conrrrerys ,{�,�jr steel i H-
and
Type 7 �Ci 1- System Elevation r f RJ
jSystem
1 Baring # Boring
�I- Pit Ground surface elev. [ �. S fL Depth to kmitirp factor f sld n. Sol Application Rats
Horizon
D=plh
In.
Dominant Cola
Munset
Redoz Description
Ou. Sz. Com. Color
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Roots
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Pit Ground surface elev. ` r R. Depth to limiting factor n.
Sod Application Rate
Horizon
Depth
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Dominant Color
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Redox Description
Qu. Sz. Cont Color
Tezhae
Structure
Gr. Sz. Sh.
Consistence
Boundary
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- t:ffKMm 91 - BOLT, > 30 < 220 mg1L and TSS >30 < 150 mckvi I' Effluent #2 = BOD. 130 ng/L and TSS < 30 n4l.
CST Name (Please Print) Sign CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date EvAuation Conducted Telephone Number
1432 120th St, New Richmond, WI 54017 C—/— 715-246-4516
Property Owner
n ��# ❑ it
ng
Kplt
Parcel ID #
Ground surface elev12A— ft. Depth to limiting fadof in.
Page —of
Sale
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MUSLIM
f�tti�/��r�/���MMM�
❑ Boring# ❑ Boring --
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Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Ou. Sz Cont. Color
Texture
Structure
Gr. Sz Sh.
Consistence
Boundary
Roots
GPDIff
'EfF#1
'Ef#t2
Bonrg # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limitag factorin.
F-ISotl Application Rate
Horzon
'lepth
in.
Dominant Color
Munsell
Redox Description.
Ou. Sz. ConL Color
Texture I
Shucture
Gr. Sz Sh.
Consistence
Boundary
Roots
GPDM
'Eff#t I
'Etf#2
Effluent #1 = BOD, > 30 < 220 mgcL and TSS >30 < 150 mgnL ' Effluent #2 = BOD, < 30 axA and TSS < 30 mg4
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.
SaDUIOIx-b90�
Soil Test Plot Plan
Project Name Dick Stout
Address 1353 Awatukee Trail
Hudson Wi 54016
Lot I Subdivision ---------
N W 114 NE 1/4S 35 T 29 N/R19 W
Boring 0 Well PL Property Line
BM or VRP Assume Elevation 100 ft.
A #226900
9/19
Township Hudson
County ST. CROIX
Top of survey iron
System Elevation TBD *HRpSame as Benchmark
o NE CORNER SECTION 35� y
OWNER NIA CORNER 85 SB9.41'14� VffiGjl
SECTION / 7g{.Bg
1353AURCHINS, LLC Bern'1tw 1B77DS_
1369AWATUKEE TRAIL � NORTH LINEOOFE NE1It THY
HUDSON. VA 54018
SURVEYOR INTER_S7A7E'QP - - - . p%
EDWIN C FLANUM N T AAA
NORTHLAND SURVEYING, INC.
P.O. BOX 152 —
AMERY, WI 54001 — — —
SEE SHEET2FORDETAB.OF
MWEWTY LOCATION AND DANNAGE EASEMENT DATA
LOT 2 - CSM VOL 29_PG_8814_ DOC. 01077M
BORINGS
I � 3w•Ie'27'E 323.ee' Dz
DEDICATED TO THE PUBLIC / r�q
�i---EEPIYPTE 217.70' --- I---------� /BBB/�.
(Bi SBWIB'27'E 274.24' 1 A� �.1@27w- -Qi,
i I E.O.F.-9845'5Wp�3 % L02.01 CR
H.W.E.-984.8 �I T�I�j ��.\ 7,663S SO. FT
C /
_ . ES
B7B O SD..0 '� f� lE0EN0
-------- �- � 1 �.BI . / I 0 ST. CROU(COUNTV SECTION CORNER POSITIONEC
91 r It 82.81, I- i / FROM COUNTY COORDINATES. POSITION VERIFIEC
444 ACRES i so \ �I� 8 N75 IBA � I % WITH MONUMENT AS NOTED OR TIES OF RECORD
202,070 SO. ET. I _ _ _ _ J , 34154'
L B.O.-DB8 B 1 i , O • 1' O.D. IRON PIPE FOUND
dUlLLE MI FFEET/• . P00' _ t1sAd, 1 i I
-rr"'------� g 108. w�pUB'�--'� �S 2.OLOOCRES i I ' 1.5x� IRON PER INEARFOOT INo
0 20D 400 ST5LOT 3 87,285 SO. Fr. • i
INSTRUMENT DRAFTED BY EDWIN FLANUM 2.00 ACRES �.77,, L.B.O.=993S IN W4' IRON REBAR FOUND
JOB NO: 19-06 DWG: CSM3 87,182 SO. T.T. `D
DRAFTED: 3/07/19 FIELD: 3/07/19 L.B.0 -BBB B L.B.O993.6 I I -- -- - UTILITY AND E EASEMENT
FOR IN
.-
REVISED: VIPJID 'eft (SEE SHEET2OR NFORMATION)
471.93' 195.83, _ _
BEARINGS ARE REFERENCED TO THE NORTH 198.12 000°IT'11•W 308.21' � I LB.O. LOW BUILDING OPENING ELEVATION
LINE OF THE NE1/4 BEARING SSV4114-W. SOUTH LINE OF
ST. CROD(COUNTY COORDINATE SYSTEM THE NWI/4-NEI/4 IBiB' HW.E. HIGH WATER ELEVATION