Loading...
HomeMy WebLinkAbout038-1239-32-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT ATTACH TO PERMIT GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist to Well SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet StlHt Outlet Dt Inlet Dt Bottom Header/Man. Dist Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO JPIL JBLDG IWELL LAKEISTREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: Model Number. DISTRIBUTION SYSTEM Header/Manifold IDIstribution x Hole Size x Hale Spacing Vent to Air Intake Pipets) Length Dia I Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulcted Bed/Trench Center Bedrrrench Edges Topsoil 0 Yes Q No my es Q No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Location: 2173 95TH ST 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Inspection #2: Plan revision Required? 0 Yes ❑O No Use other side for additional information. Date SBD-6710 (R.3/97) Signature Cart. No. e, , Safety and Buildings Division / OCT 2 s 2019 201 W. y�asbington�ve.. P.O. Box 7162 ^ S®rtery Permit N (m be filled m by Go) Bison 53707-7182 1o2�F823 St. Croix CountYnen � °" Permit Ap*lica ' Wis. �t• � TT Ol`� (1 C- (J / v— v In accordance with SPS 393212), Adm Cody submission of this form to the ipproprime ! Troject Address (if dAcrcat time mail g address) is required prior to obtaining a sanitary permit. NM: Application forms for stare -owned POWTS are submit e t to is the Depart of Safety and Profssioual Servics Personal infannaaion you provide may be used fait soon ourposics in ammdaoce with the Privacy Law. s. 15.04(1 Xinj Sut$. a 'cation L Information -PI Print ISnfot•matioo Property Oh 's Name pared Y Property Owner's Mailing Address y P' I ?' 3 !. ! O • 1 d 9 s 6 2 GoVLot y. /i/! a /r/ S Yl-� 4 CaN state t f-!K) Zip Cock ' Phone Number /•�// T _N; R�E W IL Type of Building (check all that apply La 3 Z SubQiviam Name or 2Fam1y Dwdlieg-Numbs ofBcd ❑ PublirlCo®aeial-Desoribe Use ❑ Ci of 0� ElStateOwned-Desmbe Use ❑ of CSM Number of� III. T (Check only one box at We A. Complete line B if applicable) A' System Q Replacement System ❑ TreatmrnUHoldiog Tack Replaoweot Only ❑ Other Modification to Bust og System (explain) B• ❑Permit Renewal ❑ Permit Revision ❑ Changer ofPlruuber ❑ permit Treader to New L P1en Number and Datelsmd Before Expvetion Owner L ay N. Type ofPOWTSS stem/Com nent/Devia: Check all that apply) ❑ Wo-Praw aized In -Ormond ❑ Ptessmved i -Gm and ❑ At -Grade ❑ Mound > 24 m. of suitable omd <24 in. ofsuitabk soil ❑ Hddmg Tack ❑ Dispersal Compmem ( ) ❑ lain V. DisperantI?rea eat Ara Informatio f DsignflGW (gpd) Deep BAppli ds� 6a o oil Am (st) 00Z, soD Dispersal Area (st) GAG /Soo System mevarim VL Tanklnfo Capacity in Gallons TOW Gallon of Unin Mmuficmer � � 3 u tiew Turks F�.Tada i G O Sepuc or Boldlna Talc Doa¢g Chamber �T 60 / VIL Responsibility Studisnent- 1, the undersigned, asw possibility for installation at the POWTS shown a the attached pleas Plumber's Name (Print) PI MP/AM Number Bmisess Phone Nurriper P •a , city. State. Z p ) L✓i S� l Vic Coen /De eat se Only p� I��RO� Q Permit Fee Date Issued , su g Agrnt Siansdure S � 20Zp ❑ Owserenial for D Coed" n for Disapproval 3 (ytpu.v�Q -Sapp': Qa.'C'aQtL ' 1. golf, erll .Sl llte• rM r• _ L u'tipr:••, cell r-st all be:�r_k � amen O•s�w�' � syC As par jnar.3yemen! pia n ,^. c ,ioph Lv plwnbe.- ¢o r 2 Nsays+*kroetk.rionstrar.;ttwi'.e.r.A,he: .(i`snf F'E= M per lffftrb 1 eta -r knC;JbY.Li. FL1 S ni �4 d Amcor to nonplus plain for the aTaem and submit w the councy,"rpm dun8 wx I is& �m saS d' iy ' ll G0. � t �; �1 h K4 - - f ka 11160_ u e SBD-6398 (R 11111) gisFjvrr..,,,,rQQ 30) PROTECT Zach Meskill NE 1/4 NW 1/4S 17 System PLOT PLAN ADDRESS 345 Wisconsin Or. New Richmond Wi 54017 /T 31 N/R 18 W TOWN Star. Prairie COUNTY ST. CROIX SYSTEM ELEVATION 102.0' DATE 10/11/19 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *11.R.P. same as benchmark to 95th st. 353' Property Line G(�P Scale = 1 /41' = 10' 150' Property Line 0' 40' 80' 1 1 1 Grading is to be done to divert run-off away from system Pro 4 Bedroom B-3 House ��—..�.0 102' H uffcutt 101 ' Combo Tank I �s 1 T ' 8% Slope Well is to meet all WDNR setbacks Area 15' below the system is to remain undisturbed Squaw Lake o� i October 22, 2019 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2021-10-22 Plan Review: PWTS-101902318-C SHAUN R BIRD 1432120th St New Richmond WI 54017 SITE: T.Bch Meskill Lot 32 95th st. Town of Star Prairie Saint Croix County Total Amount: $250.00 FOR: Description: 600 GPD (4 Bedrooms — New Construction) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS Pl. GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/progrems/iridustry-services www.wisconsingov Tony Evers - Governor Dawn Crim - Secretary CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SCE CGR.RLSPONDENCE Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, 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 a.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 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 (11Xc) • 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 cutoff at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/'installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state starts 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, // rT,ein &I "o1� POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleest(erwisconsin.gov Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/11 /19 CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Z� 21- L,4 SEE CORRESPONDENCE Owner:Zach Meskill Location:NE1/4 NW1/4 S17 T31 N,R18W Lot 32 Squaw Lake Estates Star Prairie Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications and cross section 8-9. Maintance and contingency plan Attachments: soil test %/ // Shaun Bird License Page 1 of 9 System PLOT PLAN PROJECT Zach Meskill ADDRESS 345 Wisconsin Dr. New Richmond Wi 54017 NE 114 NW 114S 17 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 102.0' DATE 10/11/19 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE. 1.0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION too' Filter Lifetime Filter ❑ BOREHOLE 'O WELL •H.R.P. same as benchmark to 95th at. 353' Property Line Scale = 1 /4" = 10' 1 50' 0' 40' 80' 1 1 1 Property Line Grading is to be done to divert run-off away from system Pro 4 Bedroom House 1\ Huffcutt 101, Combo Tank C B 1 100, B.M.' 98, 8% Slope Well is to meet all WDNR setbacks Area 15' below the system is to remain undisturbed Squaw Lake 20_4� Mound System Cross Section and Plan View _ 1 = Topsoil = ASTM C-33 t Cap Material sand fill ld� Ft Contour Dimension F et H L W = Clean aggregate = 4 in. sch. 40 pvc /2 to 2 '/s in. dia. 0 observation pipe Slope Direction �y GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is 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. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page E of 7 Ck. %- J Signed: License Number: Date: Perforated Pion DanU �.��."vuvo .ape LaYani 50 Feet of 2" PVC Force Main 1 L04,416d On $011", s [own! $"Gee rIRAT MALL M&UT TO Cwfl AC4"`d 1 P,S,L Ft. R-.2L Ff. X 3 J InChef Y . Inches Hole Diameter -513L Inch Lateral 2-Inch(es) Manifold Z Inches Force Main 2— Inches ► of holes/pip Invert EtevAtion of Lateralsj�a"SFt •• Septic -Dose Tank Cross Section And Pump Performance Specifications arm. TXRMFTM�., :1 11 pl• 1 11 11 1 111 • � N I 11 1 �• i1 Ib • 1/ : 1 IF MI l- �/ F !.11 \I :11 . " M I� KI 111r.7 ri Total amic Heed (rDH) - Feet Elevation Head ZZ12— DisW pressure Network Loss Force Main Loss Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. Above Grade < 6 Below Conde Sealed WatertiOt Secirely Mounted with Locking g) Dev Weather-proof i Junction Box Finished Grade — — " — — — — Vent Min. 12" Disconnect Above Grade Means With Vent cap Outlet Filter lnlot . Inlet same Switch Sctt{n and Re07,—� Tank Volume = Dimamsioa: Inches reserve A' S elatnt B: 2 (dose) C r(dead) D r Total E! GENERAL INSTALLATION: The sept"Ose tank is bedded and beck fillet[ 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 tank excavation and the sleeve is sealed watertight. Elettricalpervice Iles withNBC3o0 and Cara 16.28. 02105 Li 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 unlque "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature: • Vortex style Impeller permitting passage of solids up to %" • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish e All fasteners - corrosion -resistant stainless steel • 1 %" Discharge e Stainless steel bottom screen -easily removable • Maximum fluid temperature: 140'F. 280-Series Cord Lengths Model 10' 25'(-2) 35'(-3) 601-5) 280 Standard Optional Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional WA 287 Standard Optional WA WA to' cad length standard on all models. Fm optional lengths, add "-2. -3 or-5" suffix to model number. Example: for model 280 with 35' cord. order 2803 Motor Specitfcations hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Performance Curve: 280-Series v S ■���:\rrrrrrrrrrrrrrrrrorr■ .............................i r 1r c.� c .I - . ..� :. t U.S. Gallons Per Minute 38 78 114 156 192 226 270 titers Per Minute Dimensional Data: Weight: 29 lbs. Height:13" Major Width. 101' (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10" Factory switch Modef 281, 2831 Model 287 settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 283 features a fully adjustable wide-angle float Differential adjustmertz; can be made easily by tethering the flan to the dis- charge pipe a other mounting point. vertical float model 287 Is not adjustable. J J J J . Model 281 �def 283 Manual, -==. e ide angle switch tno .•, plug c us Certified Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14476 www libertypumps.com Model 287 VMF-Series Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump • Phone 800-543-2550 Fex (583) 494-1839 copyright 0 Libah Pumps, Inc. 2017 All lights reserved. Ufr 2000 FMM7 POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page— of_ FILEINFORMATION Permit # • Vakws typical for dorncstic (non-meanernao wastewater and septic tank of mnL Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 7 ❑ months ear(s) (Ma)imum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (.) of tank volume Inspect dispersal cell(s) At least once every ❑ months r(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ear(s) Inspect pump, pump controls & alarm At least once every ❑ months ar(s) O NA Flush L*rals and pressure test At least once every H2O months r(s) ❑ NA co1er. At least once every ❑ months ❑ year(s) NA Outer. At least once every ❑ months ❑ year(s) 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 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 combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cefl(s) shal(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 notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent fitters, mechinlcal or pressurized POWTS components, pretreatFment components, and any other maintenance or monitoring at irltervads of 12 months or less shall be performed by a certified POWTS Maintainer. A serAcg report shall be provided to the local regulatory authority within 10 days of completion of any service event STARTUP 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. ;1 t)4? 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 cternlcels thelt may Impede the treatment process andlor 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 condition are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored fhs OxcM wastewater will be discharged to the dispersal collie) 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 perk over, or otherwise disturb or Compact, the area withm 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 Iffe Of the POWTo: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floes; diapers; disinfectants; fat: foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbiddes; meat scraps; medications; oil; painting productls; 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 prope)ty 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 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 falls and cannot be repaired the following measures have been, or must be taken, to provide a code complipnt 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 distudbance and compaction and should not be infringed upon by requbled 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 ails evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled 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 lest resort to replace the failed POWTS. The site has not been evaluated to Identify a suitable replacement area. Upon tallure of the POWTS a soil and site evaluation t be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a Iasi resort to replace the failed POWTS. \_�Iound and et -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Inflltrallve ce. 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 O� A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INS;*ER POWTS MAINTAINER NSme �,�,�, Name qy1-3 Phone .Jf r Phone 17/ as SERVICING OPERATOR P tPE� LOCAL REGULATORY AUTHORITY Name Rhorial ame Phone - /r—�, �j r-�e- I%JS= This document was reall in oompllence with ehspwr ePS 383.22(2)(bX1)(d)a(f) and 3e3.54(f ), (2) d (s), Wlm+kn AdMWN&Wre Cads. D1­7 20140048A 04mw 19900� 18A000 1 i 1921 t 7. 99464 93759 ham, 9A 06 OlGcp belw en C[ ae $Crpen" 'E18 SECTION A -A _- w9econstn Department of Carvreroe SOIL EVALUATION REPORT pne_cf_ Division or Safety and Sul", In acmMence weh Gomm 85. Wis. Adn, Code Attach comptW site pen on paper not loss than S 1R z i i kxdree M size. Plan mwl include, but not limited to: vertical end horizontsl roferance point (SM), diredion and Percent at". scals or dimendom. north snow, and location and distance to neatest road. please print all Information. Pendul Momvaon You Prwlee meY a was far Mm^ee7 geeWw (PrMrry W, e. 13.01 (11 im11 Go rdY Parosl I.D. Reviewed by Date property ry Owner G.L— / � Lacetion 114 14 S T ?j I N R�� E( W Pmpwty Q~s Malang Addresp r4rls f Dr. Lol 4 g ft* a -- StM. Name or C!PW S UY fate n� S ❑ City OVIRagr Wown Nearest Rolld r New ConstnKtim UseyEIIJ@ilWeMW I Nunber of bedrooms Code d.rivad dswv now rate ri GPO ❑ Replacwnent /J ❑ Public or commercial - Describe: Parent material 6 PAZ Floodd Plats tlon If applicable y/�------ n. General wmneraa`7/ / and remmnendatlans: System Type r4y o System Elevation,/ / B a 0 lwrg 9L Pit Ground surf= slev. 91a=11. Depth to 6Ntlrp factor �—Q- N. Raw Horlmn Doplh in. DpNrwn Color Muses Redo: Description Gu. Sz Cont. Color Texb rs Struo" Gr. Sz Sh. Com4tenoe Soundsry Root GPOM 'ERa1 'ERa2 I o- 16 Song a�� axing Ground surface elev/�a. Deph to IIMI&V fS=-542 in. Sob Application Rate Hodzm Depth In. DomInantWor Munsel Redox Description Cu. Sz. Cont. Color Tezlure StnwMa Gr. Sz Sh. Garulsence Boundary Root GPDMP Will 'ERa2 If ZO A S art- i� 'Effluwd#1-SM. > 30522D nv& end TSS>30< 150 W Effluent 02- BDD. 130 myL SM T � < W nWL CST Name (Please Print) r CST Number Bird Plumbing, Inc. Shaun Bird 226900 Addrwe Date Ev/e/luatlon Gorduded Teebe phone Numr 1432 120th St, New Richmond, WI 5401 �7_�9 715-246-4516 Properly Owner Parcel ID # Pape _ of MM�9I.1fIJL•� M i/llfdla ".11 O%MMAM�WArim " M. 0 ■. _ , E#krrs 01 > BODE > 30 1220 mgrL mro TSS 130 1 160 nV& ' Enluera #2 • BODO 130 mg.L and TSS 130 mg•L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to acc#ss services or need material in an alternate format, please contact the department at 608-266.3151 or TTY 608.264.8777. sw&#MO A j Soil Test Plot Project Name Zach Meskill Address 345 Wisconsin Drive New Richmond WI 54017 Lot NE 32 Subdivision Squaw Lake Estates Date 3TM #226900 8/14/19 1/4 NW 1/4S 17T 31 N/R18 W Township Star Prairie Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft. System Elevation TBD To 95th st. — County ST. CROIX Top of 314" pipe •HRPSame as Benchmark Owner/Buyer Mailing Address. Property Address City/State ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Parcel Identification Number 3 3'S 6a-s f LEGAL DESCRIPTION Property Location h)y,- r/4 , N\)) r/4 , Sec. STA , T N RW. Town of Subdivision Plat: �o�7 q C Lot # Certified Survey Map # / Volume , Page # J Warranty Deed # D 'S tly / 6v (before 2007)Volume f , Page # ^� Spec house 0 yes Q no Lot lines identifiable (] yes © no Uail • IU \ I)XIMav_DI C _LOF4111JUJA Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(I) and in Chapter 12 of the 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 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this orm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the described above, by virtue of a w 7 ty deed recorded in Register of Deeds Office. w of bedr(Ls . OF APPLICANTS) DATE that is misrepresent 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. MAIN FLOOR PLAN KJ Design Co eminl RaldmNal 451-H35iM 11 A4 KJ .o Design [nmmercMl ltesdental ._ 551-249.5119 oPW q. $x r ^Q L r 1 o __ Z o LL 1"74 rao .� FOUNDATION PLAN -� \ ' .erm i ' sww FAMILY ROOM i s it mv.a � BEDROOM iR � em ----------------- _ __ .Wwco.C. nn.e - i LOWFfi 0ARA6E I