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Home My WebLink About018-2022-04-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law s 15 04 (1)(ni Oeverin cs I tlM tlev Insp. B Elev BM Description ) %% DD TANK INFORMATION TYPE MANUFACTUR R CAPACITY Septic Dosing if Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing f , L! Aeration Holding PUMP/SIPHON INFORMATION Mi64- 0-/rr.-, L)n Manufacturer Demand GPM Model Number 63 TDH Lift Friction Loss System Head TDH Ft s- Forcemam Length Dia. Dist to Wel' SOIL ABSORPTION SYSTEM OFHAMMOND TION DATA STATION BS HI FS ELEV. Benchmark A` J 2- � _ /D - 160 AIL BM a Zo Bldg Sewer , JT St/Ht Inlet , St/Ht Outlet Ot Inlet Dt Bottom Header/Man Dist. Pipe Bot System Final Grade i St Cover Cbn �� Q y.3 ys.y All All BEDITRENCH DIMENSIONS Width I:� r' Length No Of Trenches " PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L JBLDG 1WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer Type Of System 1, - Model Number UI51 KI13U I IUN SYSTEM Header'Manifold IDistribution x Hole Size x Hale Spacing Vent to Air Intake Length Dia Pipe(s) Length { Dia Spacing'i- : _ -- SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only r P) V r- 2' DsipW,Qver— en r >� r Depth Over edFrrench Edges xx Depth c� `y Topsoil m Seeded/Sodded xx Mulched ' L1 'i _ 1 Z Yes ® No I 'j Yes n r COMMENTS: (Include code discrepancies, persons present, etc.) Inspection#1. `jam J 11130/ZCInspectlon#2 BIZ/I r Loca/o�n: Ns?`- .k.' r>A :...._ _ sd 1 1.) Alt BM Description 2.) Bldg sewer length = < j -amount of cover _' i 3) � � , r 1 �Y r!M �N � J)ti41h� C-t� �,G'l4Y V� t ..r YYf"-✓�-i-t ts4. .4inev`ision9tequiredv. 0lies r`=A No p -Ose other side for additional information D L SBD-6710 (R 3197) Date Signature Cart SAN -avao -36V SYS u di a 7 Cmsnty(fit `T / Safety and Bindings Division . Spry Permit Number (m be filled in by Co) _ a '8$ OCT 02 2020 201 WSWashington Ave., P.O. Box 7162 Madison, WI53707-7162 --- Sanitary Perwit Application , h /{.� go0amraeaiW.tndt Size TransactionNumber P�ti 020p 2. 0 -•C In accmdmrs with SPS 38321(2), W is Adze Code, submission of this form to the appropnae . Project Address (if different than marling address) is regnuedprior to obtaining a sanitary permd. Note Application forms for smm-owned POW TS are submiged to the Department of Safety and Professional Servies. Petsoual information you pmvide may be used for ses in aaordanee with the Law, S. 15.04f1 m). Seats. L cation Information- Please Print All information Proputy Owner's Name oe�erl TeX P eel k O ; 01$� 01g- property Owner's Mailing Address j Property Location lq-223 Ct r A,, i GDn Lot f, j� �h�%%� Zip Code Phone Numsba %% (� W11 IY,XV J l j1ErII.�yW— N: R I"flcity,^State uilding (check all that apply) y�/Ter 2 Family Dwcum,-Numbero Bectooms \ ° Subdmsion Name xl-S pa/ S 1 Block# �P / 11 PubliclCommercial- Describe U / /yt �'�'�� ❑ City of rnb ❑ State Owned - Dese Use Yi14ge of CSM Numbs ?ZCTQ❑ win of in. T of Permit: (Check only one box on line A. Complete line B if applicable) A. en 1 Replacement System 0 TreamrenUHoldmg Tank Replacement Only ❑ Other ModiScanoo toExisting System (=plain) B. ❑ Permit Renewal ❑ Pemut Rension ❑ Change of Plumber ❑ Perini[ Transfato New Lm Nevious Permit Norther and Date Issued Befarc Expiration Owner IV. T ofPOWTS S stem/Com nent/Devi": Check all that apply) — ❑ Non-Preswnix ln-GTm sd ❑ Pressurized In -Ground ❑ fvl-rmde ❑ Mound> 24 m of suitable soil 24 m. of notable soil ❑ Holding Talc ❑ Otha Dapetsai Cmapocer 1 ") ent Device (explam) V. Diu rsal/Treatment Ara Information 1 / DesipFlow (BPd) Design Soil Application dst) Dispersal Atea Required (st) 1 Dispersal Area Proposed ( Syslpn Elevation V 1 & o 0 6?J y VL Tank Info Capacity ininvert Gallons Gallors 8 of Mmufaamer Units v '" O'� y/� r, C ` �,,,1 `t+W1R- U trew Tanks Eceung Tanks \`Lt`^ u o re 2 Septic or FloWmg Tack a' % l�.S VD. Responsibility Statement- 1, the rode nmc responsibility for installation of the PORTS shown on the attached plans Plum s Name (Prim) P ha's Signature MP/MPRS Ntsmber Business Phone Nt bw P 's Address (SreCy: Co y3Z KL , a VD1 Conn !De agent Use OnW �tApproved 0 °rmn�F-7a� Date Issued su g Agent Sipahre MW'e S ❑ - m forD riai �J(J� 11 2- ZOZ ` DL Condition n r 3� l Cy, Q,`itio.a t 1n &-t-C EMOWNER ptictank, effluent filter and ;persal cell be S % maiYt4 fined LJ,1 � y n `� ✓�lll s n Frovi per management plan prnv;ded management 2. a p eo pbm for b rs rm and sabgrt m Cowry paPerroot ka that b v x li aches w as per app'dcablc codclord.n;:nc::�s (� p� elF�3- ,�� SBD-6398 (A 11/11) r PROJECT Oeverina Homes NW 1/4 SW 1/4S 9 System PLOT PLAN ADDRESS 1433 Cemohous Ave Suite A New Richmond WI 54017 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 99•T 1.2' sand lift) DATE 9/15/20 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND X)OC SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 60RO") # of chambers none BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION-100' "Filter Lifetime Filter ❑ BOREHOLE O WELL •H.R.P. same as benchmark 170th St Scale = 1/4° = 10' 2 Acre Lot Pro 4 0' 40' 60' Bedroom House Huffcutt Combo Tank Area 15' below system is to remain undisturbed B-; Property Line U 4% Slope �� JJ 9 7' 9 ' .5�9'B= �010 B-2 Well is to meet all WDNR setbacks Grading is to be done to divert run-off away from system 6 Gov ^aTkp�T� DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay P S hflp lldsps.wi gov/programs/industry-services www wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary October I, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-10-01 Plan Review: PWTS-102002304-C SHAUN R BIRD 1432 120th St New Richmond Wl 54017 SITE: Oevering Homes Lot 4 170th st. Town of HAMMOND St. Croix County Total Amount: S250.00 FOR: 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) Description: 600 GPD Maintenance Required The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter I0L01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06. stars. The following conditions shall be met during construction or installation and prior to occupancy or use: • It is recommended to fence off 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. • R astewater 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 (PONNTS). NR'aste 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. • 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 sod moisture content can be determined by rolling a soil sample between the hands. If it rolls into a I/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. • It is recommended to cut as short as possible and remove ground cover prior to tilling the ground surface for the dispersal area. • Remove and maintain woody vegetation on or near the dispersal component to minimize root infiltration into the dispersal cells • Electrical connections shall comply with SPS 316.300 and NEC 300 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewers beyond 30 feet per SPS 382.30 (11)(c) 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/t nstal I anon/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. Sincerely, U ta.nia Ur/.n�rzav Travis Wagner POWTS Wastewater Specialist, Division of Industry Services (608)598-0715 travis.wagner@Dwi.gov Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8126/20 Owner:Oevering Homes Location: NW1/4 SW1/4 S9 T29 N,R17W Lot 4 170th St. Hammond 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 Attachm - Shaun B Signatu License Page 1 of 9 System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cemohous Ave Suite A New Richmond Wi 54017 NW 1/4 SW 1/4S 9 /T 29 NIB 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 99.7' 1 .2' sand lift( DATE 9/15/20 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 6000 # of chambers none hk BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION too' Filter Lifetime Filter ❑BOREHOLE (� WELL -H.R.P. same as benchmark 170th St Scale = 1/4" = 10' i 2 Acre Lot Pro 4 01 40 Bedroom House Huffcutt Combo Tank Area 15' below system is to remain undisturbed B � 4% Slope 9 7' Property Line li• M5,99'B-1 B-2 Well is to meet all WDNR setbacks Grading is to be done to divert run-off away from system IN Mound System Cross Section and Plan View B 1 L Dimension Feet A g D F G H ,0 J ,6R K q,$ L W aye z -Ta-- Slope = Topsoil F7 = ASTM C-33 = Clean aggregate O = 4 in. sch. 40 pvc _ , Cap Material sand fill /2 to 2 '/2 in. dia. observation pipe Slope Direction -ter 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. 10/07lgj Page S ;— Man r Urco ivuuu 3? ofiaa Distribution N Lateral Diameter Force Force 03/05 lgj Pressure Lateral Layout Two Laterals — End Manifold In. In. Ft. 3ed out g ag sweep 90 Bend Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral turn -ups terminate with a threaded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. • • • • • Grade • • • • • • 6-8 Inch Lawn Sprinkler Valve Box Page l- o _ Septic -Dose Tank Cross section And Pump Performance Specifications Minimum Rump �mfonmauco Required In GPMI Q 1 A Ft TDH Outlet Manhole Min. 4" Above Grade With Looking Device. hart Manhole < 6" Below GrWe Sealed watertiaht r — -f — Finished Grade Outlet Filter Lot�- -- -`" Inlet Befits ity Switch S - and ReUVo6h2a Tank Vo Dimension: Inches al. reserve) A(alatm) B: 2. (dam) D / Sx.I Total ; 40'3' r7 it-� :..1 st�rl.:.•. Ld <fLd1�'lri� �►� J switch Total Dynamic Heed (IDH) - Feet Elevation Head Distal Pressure Network Lori Force Main Loss Total Manhole Min. 4" Above Grade Securely Lucking Mounted with Device Weeffia-proof Junction Hex Vent Min. 12" Above Grade With Vent Cap f Disconnect Means A 44y." _ weep B Hole C ? Bottom D GENERAL INSTALLATIOPlt . The cepnrldose tank is bedded and bank filled in accordance with the manafacurres product &*Oval spwifl nations. Maximum depth of bury as specified by the tnauufaCWRf may not be exceeded without prig' 8ppt AL, Manhole covers exposed to grade have an ei.%c Ve k>0k device (padlock) itrstal a Piping at torapes and outlet is nj approved material, mutectod to tlro taok with watertight fittings, and laid on stable soil to prevent Wang or;wg&g. The force main is *.gVvd wifit 4" Sch. 40 PVC to bridge the tank excavation and ffie'deeve is sealed-watmtight .pleotncai;iresvice 1%4&NEC300 and Gomm 16.21%. 02/05Id 290=SERIES 314 hp Submersible Effluent/Sump Pumps The Liberty 290 series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 290-Series will provide years of reliable performance. All Models Feature: • Semi -Open impeller permitting passage of solids up to'a/" • 416 stainless steel rotor shaft • Permanently 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. • 290-Series Cord Lengths Model 10' 25'(-2) 35'(-3) 50'(-5) 290 Standard Optional Optional Optional 291 Standard Optional Optional Optional 293 Standard Optional Optional WA 297 Standard Optional WA WA 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to model number. Example: for model 290 with 35' cord. Order 290-3 Motor Specifications /. hp 60 Hz 3450 RPM Oil filled, thermally protected 115 V. Models 10.4 amps 208/230 V. Models 5.3 amps Performance Curve: 290-Series 50 as Bo 3s € 30 25 20 16 10 ll�l�l� �iVaa Plow t(il M) BB N 114 151 in PP] PBS BOl N1 U. Per Minute Dimensional Data: Weight: 31 lbs. Height:13" Major Width: 10" (model 297) Minimum Sump Diameters: Model 291, 293... 14" Model 297 VMF...10" Factory switch Model 291, 293 Model 297 settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 293 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tethering the float to the discharge pipe or other mounting point. Vertical float model 297 is not adjustable. Model 290 Model 291 Model 293 Manual, Wide angle Wide angle no switch float switch float switch with quick- with series disconnect (piggy -back) plug SP® •••••• ® c us Certified Specifications are Subject to Mango wi0lout nonce. Model 297 VMF-Series Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty Pumps • 7000 Apple Thee Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com Copyright® Liberty Pumps, Inc. 2011 All rights reserved. LLIT 6681 R09/11 i 280-SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site wast water systems, liquid waste transfer and commerci vy-duty sump pump applications that require higher or more flow. Designed around Liberty's unique "U casting, the 280-Series will provide years of reliaMa perfonmana All Models Feature: " Vortex style impeller permitting passage of soli up to %" \ a 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1 K" Discharge a Stainless steel bottom screen - easily removable • Maximum fluid temperature: 140'F. 280-Series Cord Lengths Model 10' Wk2j 3�50'{.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 len add "-2, -3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications A hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) 35 30 25 LL 20 15 = 10 e 6 6 m -al 38 78 114 156 192 228 270 NIL Uters Per Minute Date: Weight: 29 lbs. Height: 1 W Major Width,10" Minimum Sump Model 281, 283... 14" Model287 VMF...10" Factory switch Model 281, 2 Model 287 settings VMF Turn on level 13. 9.5' Turn off level 7" 4.0" The Model 283 features a fully adjustable wido-angle float Differential adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point, vertical float model 287 Is not adjustable. Model 280 Model 281 Model 283 anual, Wide angle Wide angle switch float switch float switch with quick- 11 with series disconnect i (piggy -back) plug c us Certified • w augan m ti�a..mewr tau. 0 Model 287 VMF-Series Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty Pumps • 7000Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-25W Fax (585) 494-1839 www.ldwrlypumps.com copylgM O Ub"ny pumps, 1 .2017 M npMs revved. Ulf 2000 ROSn 7 2p14004aA .wv SECTION A -A "I -t � Al IF POWTS OWNER'S MANUAL & MANAGEMENT PLAN pag.,.f_ FILE INFORMATION Permit 0 MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity ai 0 NA Septic Tank Manufacturer NA Effluent Filter Manufacturer ❑ NA Effluent Fitter Model ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer Pump Manufacturer ❑ NA Pump Model ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Peat Fllter ❑ Mechanical Aeration ❑ Welland ❑ Disinfection ❑ Other. Manufacturer Dispersal Cell(s) ❑ In -ground (gravity) ❑ n-ground (pressurized) ❑ At -grade nd ❑ Drip -line ❑ Other. Valdes typical W domestic wastaw�t, end "plk tank of ~L •• Values typical for protroated �Stewater. Service Event Service Frequency Inspect condition of tank(s) At least once every —3 ❑ months ar(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (y) of tank volume Inspect dispersal cell(s) At least once every ❑ months ar(s) (Maximum S yrs.) Clean effluent fitter At least once every ❑months aqs) Inspect pump, pump controls & alarm At least once every 3 ❑ month earls) ❑ NA Flush Wtbrals and pressure lest At least once every ❑ months ar(s) ❑ NA °c At least once every ❑ months ❑ year(s) ❑ NA over. 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, POWfS Maintainer Septage Servldng Operator. Tank inspections must Include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the gmund 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 (K) 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 filters, m"nical or pressurtzed POWTS components, pretreatfinent components, and any other maintenance or monitoring at irltervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servicg report shall be provided to the local regulatory authority within 10 days of completion of any service event - 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 concegtrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. -86� / Page of _, START UP AND OPERATION or other Gnernicde itutt For new construction, prior to use of the POWTS oback treatment tank(B) for the pr rice of PelnUrg prodiuts may impede the treatment process and/or damage the dispersal cell(s). If high concentration• We detected have the contents of tha lank($) removed by a septage servicing operator prior to use. System start up shall not occur when loll conditions are frozen Of the Infiltrative surface. During power outages pump tanks may fill above normal hlghwater level. When power Is restored the excess weatekvatar will be discharged to the dispersal call(s) In one large does, overicading the cell(a) and may result In the backup or surface discharge of effluerd. To avoid this situation have the contents of the pump tank removed by a Seplage Servicing Operator prior to restoring power to to effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore rwrmal level$ Within the pump tank. Do not drive or park vehicles over tanks and dspsraei oaks. 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 ifs following from the wastewater stream may improve the perfomhenoe and prolong the We Of the POWTS: antiblotcs; baby wipes; cigarette butts; condoms: coton awsbs; degraesere; derhtal floss; diapers; diskNadanta; fat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; [neat smeps; medications; oil; patrlting product*; pesticides; sanitary napkins; tampons; and ureter softener ttrtne. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the fcUowing steps shall be taken to Insure that the system Is prcpeply and safety abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • Ali piping to tanks and pts shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits ahall be removed and property disposed of by a Septage SeivkUrhp Operator. • After pumping, all tanks and ptta shall be excavated and removed or their covers removed and the void space filled with sell, gravel or another Inert solid material. CONTINGENCY PLAN If the POWT8 fatia end cannot be repaired the foliowIng measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of s replacement soli absorption systelm. The reploomnent area should be protected from dishubantce and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wit resuk In the need! for a new soil and alto 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 Ikmitstkhns. Barring advances In POWTS tehnclogy a holding tank may be ktatalled as a leaf resort to replace the failed POWTS. 4—r a sae has not been evaluated to Identify a suitable replacement area. Upon failure of Ole POWTS a sold and sib evaluaton must be performed to locate a sultathle replacement area. If no replacement area 'a available a holding talk may be Installed as e last resort to replace the failed POWTS. Mound and shade soli absorption systems may be reconstructed In place following removal of the blornat at the InAttraitve surface. Reconstructions of such systems must comply with the rules In effect at that time. <<WARNING>a SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO 40T ENTER A SFPTIC, 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 INSTALLER /1 ��WAI'fn� �JN!� POYYTR MAINTAINER Name Phone SEPTAGE SERVICING OPERATQ# jPUMPER)LOCAL REGU�L-A.TTOORYYAAUTTHHORITY /1J�/ �e / / /�2(S✓c /c.� LPhone 9/.f�a'i� -'J�qg Phone Thle dockarara was draaed In oonpaence with chapter 8PS 3e3.22(2)(bX1)(d)&(m and 3e3.54(1), (2) a (3), Wirwn.in Admk4sb-W- CeW. W� Wisconsin Department of Safe t Professional Services DMsbn of Industry CD�SOIL EVALUA 19 - any Pape / of In accordance with SPS 385, We, Adm. Code County Attach U "pets a q$yaYnot lase hen 8 W x 11 Inches in size. Plan must Include, Parcel J.D. Nut nol Mled hand horizontal ref once point (BM), direction and percent elope, scale imenelons, north artC�gd locg0 and distance to nearest road. Revle by Date 5 Gto� a Oen t v nt a8 In/ormatlon. Personal In mt tt e may be used for secondspurposes Pdaa Lew. a, 15.04 1 m G Property Property Location ❑ GavL Lot Aj %. Y. R E (a) W Property 0vq1a to Melling Address Lot # Black N Bubo. Name CSMN ss /. City SI to Zip C e Phone Number ❑ City ❑ V ilage Nearest Rued, New Consbucllon Use: Residential/ Numbwofbsdrocme Code derived design flaw rate GPD Gfb ❑Replacement Putdcorcerdal—Describe: _ Parent material � mmeFlood Plan elevation If spplfcade� a A P-PNnoce Cd M mid. VQ,-' C General corrunenls and recommendations: Ca +K A&FCi(p Q VA 7 1 Boring 0 Boring ® PII Ground surface eiev. W ft. Depth to IlmlBn�p fac—ta,�—�—in. � Shcl Annllaellon Role I ®®MM ® Boring %ng Pit Ground surface elev. ft. Depth to ikniting factor 3a In. 4MI Arnll lcatlon Rate I MW M1 ti�.1 CST N (P ® Boring %ng Pit Ground surface elev. ft. Depth to ikniting factor 3a In. 4MI Arnll lcatlon Rate I MW M1 ti�.1 CST N (P M1 ti�.1 CST N (P CST Number Adoresa �Q t Date Evalualbn Conducted Telephone Number NBoring p ❑ Boring ,,�/ J@ Pit Ground surface elev. 2-z ft. Depth to limiting factor _11Z In. C"l AaaArmit.n Gel. ®®® e:.. e:• ®®®®®® ❑ Boring p ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to Ilmlting factor In. Sall Aoolicelbn Rate Horizon Depth In. Dominant Color Munsell Redox Descripton Cu. Az. Coro. Color Texture Structure GI. Sz. Sh. Consistence Boundary Roots GPDIFe 'Eff#i 'Eff#2 ❑ so" 0 ❑ Borkv ❑ Pit Ground surface el". _ ft. Depth to limiting factor _ In. RM Aml atle Rate Horizon Depth In. Dominant Color Munsell Redox Description Cu. Az. ConL Color Texture Structure Gr Sz. Sh. Consistence Boundary Roots GPD/FP 'EHA7 'EffN2 EffluentIll - BOO, > 30 5 220 mg/L and TSS > 30 5 150 mgrL ' Effluent 42 - BCD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L BE I-J. J ST. CROIX COUNTY —\ SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address required from Planning & Zoning Department for new construction.) City/State —Parcel Identification Number 0 / 3 — 2ozz- 0-y—OGD LEGAL DESCRIPTION Property Location/ '14 , J K l V4 , See. ,rT % N R_7 W, Town of d. Subdivision Pkaasa-. t (�� W e$ ✓ . Lot # y . Certified Survey Map # Volume Page # Warranty Deed # I I l Z.S',"T Volume Page # Spec house no Ixt [fries identifiabl ye no SYSTEM MAINTENANCE AND OWNER CERTMCATION 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 §Conn 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The prop" owner agrees to submit to St. Croix County Planning & Zoning Department a certification form 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 full of sludge. llwe, 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-Naun-al 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. i/we certify that all statements on this form are tare to the best of my/our knowledge. I/we amlare the owner(s) of the property described above, by virtue of a watratdy deed recorded in Register of Deeds Office. Number of bedrooms IGNA OF APPLICANT(S) LA Tj DATE *`*Any information that is misrepresented may result in the sanitary permit being revoked by the Planning &'Loring Department *** Inchtde 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. 09/05) 011 Eat mg I��li. I4 IINIIIII RIIINII n. I NM I NN IIIIIItlI�J II I ®®® ®m IIIIIIII 11 ® I I ewe FRONT ELEVATION 4; RJGHT ELEVATION JOB INFQR TION r, rr flAN INIVRMATION' r.1 _ 11 i _mow _ _ _ � •r _ ' Y� I I II 17 rrmp I rm�o 1 - - 1 9ry[r R{MiICN' INfO SHEET 2 OF 5 FOUNDATION PFIJJfR I. I&17 yuac. As srrovm - fW! INIORMATION: - e r s I d lI a - 9� rr� m u u _ ri :� _ — rs - -- sNttt INf OPMATION: -_-__— 5HEET txoxa� iai� �-- scn� �sn- 3 OF 5 VEL MAIN LEVEL PLAN MAIN LE O RAN INMR TIONI SECOND LEVEL PLAN SECOND LEVEL PLAN 3 3, l oo 2 ti o r z z z 3 1046.3 2 p J w 3 B B, 33.170 I Sf/9L38 n O I SW CORNER SEC lON 9 (MAG NAIL) 57'37"F2d6.38' b \ Rq� FF� s e . roo FMFNT r?Srs\ \rs 0 6 � 128.01' N89°49'38"E 442.00' ssa:re� 1os1.6a �FrQs'3s \ b N `LOTS 4 103,?0 w CBES N L.B.O =1047.50 a ti 0 0 N 442.00' S89°49'38"W 475.00' ILCT a 1a68.D Each Parcel shown on this map is subject to State, County and Township laws, rules and regulations (I e., wetlands, minimum lot sae, access to parcel, etc) Before Purchasing or developing any parcel contact the St Croix County Zoning Office and the Town of Hammond for advice This map contains areas that are subject to the Floodplain Overlay Zoning Oistnd, additional restrictions apply Contact Me Communiry Oevelnnnn—f n—,r..,e„, r,,. S89°49' PREPARED FOR: ITIRY ILABEMENT DEPTH. COUNTY PLAT OF: w.w PHEASANT RIDGE WEST PREPARm BY: LOCATEDIN PART OF THE SWI/a Of THE NWI/C AND PART OF THE NW I/E UE THE SW IN 01 SECTION 9, TIEN, RIM, TOWN Of AMMONO, ST"DIX COUNTY, WSCONSIN, BEING omF.11T i95 rFS LCWe8T8mLOMC OPWINO (NLA.0) OUTLOT I OF CERTIFIED SURVEY MAP VOLUME 30 PAGE 6723, DOCUMENT NO. 1091874 < T"f6'F3•F Ni ggy' 89't9'l)'f ]f901' 3" V= NE9 <91i F993 US, Wt xy, 1 EI 1� a �•y LOT ID LOT II )re.uo 'g ).....R u.o.�9,ases oLa uo=:oHp �/ fj t •� seocc 3 R / LOTS, 12 pLOT X is iwisi _i LOT 13 1S11II O,T. u.=.''PP I / LOT 6 / i / win nnxe swm LOT / LOT6 1.11 F,•i .. 4 / LOTS n9pacn % . .9o•zw: s. �4 . _ 4 I a I E a ooTa'4 I LOWfTgN BREECH 8E4 . B, T29N. N)TW �lir- 7 O - u y LEGEND ER ® NUMJEirtK MOi,n BE P�aPN • _ o _ 4w.Tna 3 - wnPExrEO n �T xbq Rox aEaan.iwnroai - $" mPf wfu�w�� uTy=ppu PMx Tea a,w,. wnnf°:n.� I — — w..xW[vsBE.YT RfR - CYI9VB PiTA T•Ylt 9_any Wisconsin Departmentof Saf2VaPj Professional Services / Page of Division of Industry S "•tom... �j SOIL EVALUA RT- ` ^' �q�p �- In accordance with SPS 385. Wis. Adm. Code County 1 Attach omplete site p11 R40not less than 8 112 x 11 inches in size Plan must include, ' but not united tdC��e ica and horizontal ref ence point (BM), direction and percent slope, Parcel I.D. scale o imensions, north arrow,-�qd loc b and distance to nearest road L -C" en� cp, .V e' mt all information. Revie by Data Personal in nn i e may be used for seconds purposes Pnva Law, s. 15.04 1 m . !/ Property Ow Property Location ❑ Govt. Lot / 1 % '/. O R E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# City State Zip Cpde Phone Number ❑ City ❑ Village ®yawn Nearest Ro I ❑ New Construction Use ❑ Residential / Numberof bedrooms Code derived design flow rate GPD "'r 'I"LLvf ill it ❑ Replacement Parent malenal Public or commercial - Describe Flood Plan if ft. ,N,tfvfff1r �r'O�IOSPC GV [-"z r rUL elevation apphcai (/V/ Vela General comments and recommendations: Q 1 4- cz IIk._. �'$ L7 I � �C f 7 Ntt c-F4;a ��1YYYJY�iIII7 Boring # ❑ Boring ® PR ��p Ground surface elev in' / ft Depth to limiting factor�in. Soil Aooll ication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 'ER#2 ' s - e Boring # ❑ Boring 0 PR Ground surface elev.�,' ft Depth to limiting factor��2 in. Soil Aooll ication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/i -Eff#1 'Eff#2 s ✓ G- / n .5b ' Effluent #1 = BOD. > 30 s 220 ma/L and TSS > 30S 150 mafl, - ' Effluent #2 = BOD. > 30 s 220 ma/L and TSS > 30 <- 150 rri CST N 9ne"(Ple e ini); Signatur CST Number Address / / J Date Evaluation Conducted Telephone Number C<> ��G 6BU-8330 IH04/1 b) 7 Boring # ❑ Boring Pit Ground surface elev Lx ft. Depth to limiting factor_7_L in. Soil Aoolication Rate Horizon Depth In Dominant Color Redox Description Munsell Qu. Az Cent Color Texture Structure Gr Sz Sh. i Consistence Boundary Roots GPD/Ft' 'Eff#1 'Eff#2 n ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in Soil Aoolication Rate Horizon Depth In Dominant Color Munsell Redox Description Qu. Az Cont. Color Texture Structure Consistence Gr Sz Sh Boundary Roots GPD/Ft2 �Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev ft Depth to limiting factor in. Soil Application Rate Honzon Depth In. Dominant Color Munseil Redox Description Qu. Az Cont. Color Texture Structure Gr. Sz Sh Consistence Boundary Roots GPD1Ft' 'Eff#1 'Eff#2 ` Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 <_ 150 mg/L ' Effluent #2 = BOD, > 30 < 220 mg/L and TSS > 30 <— 150 mg/L "-10f-// aBonng # ❑ Baring PR Ground surface elev.2/.-�ft Depth to limiting factor, in. Soil Annliration Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cent Color Texture Structure Gr Sz. Sh. Consistence Boundary Roots GPD/Ft' `Eff#1 -Eff#2 m e / S7 — 2 � n n 62- 7 r — ❑ Bonng # ❑ Bonng ❑ Pit Ground surface elev. _ ft Depth to limiting factor in. Soil ADDIcatlon Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cent Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 "Eff#1 I -Eff#2 ❑ Boring # ❑ Bonng ❑ Pit Ground surface elev. ft. Depth to limiting factor_ in. Soil Annliration Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 'Eff#1 `Eff#2 ` Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ,�owrrxa � C.u>t -j7,