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Home My WebLink About018-2022-06-000Wisconsin 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)] Edward Forlitti TOWN OF HAMMOND TANK INFORMATION Lod- tl, -Vc.r ELEVATION DATA TYPE MANUFACT RER ;^55 CAPACITY Septic if � hlk,- � I ZS o Dosing ('0Mio P� l,5 75a Ah Ir[r �" G; tG jl Holding TANK SETBACK INFORMATION L t3r• )- < TANK TO P/L W WELL BLDG Vent to Air Intake ROAD Septic 3 ? 2-5 Dosing 32 7Z5, 3 r Aeration Holding PUMP/SIPHON INFORMATION VS Manufacturer L Model Number Z -1- yz �p TDH Li Z-5 Frictio Los3 System Head TDH Ft 3.5 /9.38 Forcemam Length ,� • Dia Z Dist to Well %50 r SOIL ABSORPTION SYSTEM STATION 3BS I JI' I FS ELEV Benchmark 3.3v ]oi.i Ivy. v Alt BM It, / �7 Bldg. Sewer 8-7 SVHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man I. �51v2. Zs Dist Pipe Bot System Final Grade StCowerZ.1 102.7 r ff ,v, BEDITRENCH DIMENSIONS Width O t b Length th , Na -Al... es I / C Z Iy 7Z� 5 PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/ R LEACHI C AMB OR IT anufact r Type Of Sys[e r >50 ` Mn el Number urJ r INIQU r 1VIN Jill Elm Header/Manifold r1 Distribution , r 1 x Hole Srze r • x Hole Spacing Vent to Air Intake Z Pipes) % ^D -ength �I Dia L� LengM / Dia L Spacing Z 7— OSC• � Yt SOIL COVER . Pr>«..re a era A..i•, _ .._- -i r De @nt f 0 - Depth Over Bed/Trench Edges -----------------...__..., xx Depth o 7 Topsoil % Z ` ram. xx Seeded/SoddedOw Yes ,-., n• xx Mulched $w ®No ed Yes No GUMMENTS: (Include code dlscrepencies, pe s rent, a /1/2I Inspection #1/ I Zo 1 Inspe4on 02, /qI;j y L Location: 1711 105TH CT 1,) Alt BM Descriptlon"�l.�y`r 2.) Bldg sewer length = (lt+�' 2S`^` t-ra;'; ��ra-�r S Q; / - amount of cover Plan revision Required? Yes IIEI No C Z "� Pf Use other side for additional Information l 1 3 I f SBD-6710 (R 3/97) Date Insepc is ignature Ced Ne J err\)-aDao - Ll/' Buildings Division2 moSafety and Z�Z� 91� 201 W. Washington Ave., P.O. Sax 7162 San LaryPermnNtmrba(mbefilleditby Co ) Madison, VA 53707-7162 3 IG iiZc� 1.,. ,- ermit AppliLatio State Trausamon Number -7 3 In accordance aTd1 SPS i83_' 1(2), Ais Adm. Code, subutrssicu m of this forau gw wit 1/ZUV✓ 3 Project Address (if different than maibes ng addrs) is required pnor to obtaining a sanitary permit Note' .Application forms for stated submitted to in the Depamnent of Safety and Professional Servies. Persemal infotrnahon you provide be used purposes in accordance with the Privacy Law, s. 15.040)(ml, Sats. L AppliCZfiDn Information- Please Print All Information PropertyOwne's Name _ PazW a Roper 8? mg Ad ProprtLoranonrt. fp/ City, Stare Zip Cod Phone Ni®b. SLL/ ' Sauw ' 1 S ' �1-pie T N; R / / W IL pe of Building (check all that apply) apply) clot I Subdi in we 2 Family Dwe(ling— Number o}'Bceroom5 ((\\as el BlockN LI Public/esen Coinkr=ia,—Dbe Use { ❑ City of ❑ State Owned — Describe- Use CSM Number ❑ Village of f III. Type of Permit. (Check only one box on line A. Complete line B if applicable) A stem R lacentat S eP yst® ❑ TrearmenuHoldmg Tank Replacement Only ❑ Other Modk.Scanon to Existing System (explain) B. Permit Renewal ❑ Permit Revision ❑Change ofPlumba ❑Permit Transfer to New Litt Previous Pemm Nwnber and Date Issued Before Expiration iV. Type of PO S stem/Com onent/Device: Check all that apply) s ❑ Non-Pressuri>ed In -Ground ❑ Pressurrzed li -Ground ❑ At -Grade > 24 in of suitable soil L Mound < 24 m. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (expl atrnent Devi cxplam) V. Dis Vrreatment Area Information: c go Flow (gpd) �Go i Desk. Soil Appbca�w Rate(gpdsf) Dk.sperxa Ana Requred (at) /� G o Du Arcs Pro sed (ed 6 0U Syrian Elevanw 1-1 VL Tank Info Capacity in ToW Nof Manufacouer Gallons Gallons Unk.rs m u o 3 u New rinks Fir a� Tml¢ �viilC. Yt ('C� -' g v m I ts s a _ Al W septic « Hold* Tauk '1 j Ibswg Cbamba -) —2 � / VIE. Responsibility Statement- I, the undersigned, IQ responsibility for installation of the PORTS shown on the attached plans PI 's Name (Print) Plum ignaae MP/mm Numb. Business Phone1*=bcp �`—�— 2 Z j Plumber's Address (Street, Cuy, Stan%Zap 2 3 VUL County/Department Use Only proved ❑ Di Permit rFee Date Issued Issuing Agrnt Signature ❑ Own m Reaso Denial DL Conditions A rov 3) 1 11 I� _ �t .I� - p...2_ Lv' STEM OWNER: Septic tank, effluent filter and dispersal cell must Le serv;ced 1 maintained r1\ p� / �-1-- rovi d .4- a - ❑y plumber. -f J ( G��t1YD as per mane-,ement plan prov,ded <t h' nl,a nta n'd ( 0\ U�rWla'Ci 2 ,ill seEhael igu; ements A lire plans for We system and sabmn m 1be Couary amy a papa ao less a 8 N es m s¢e as per applicable codelor tna`��p SBD-6398 (R 11/11) System PLOT PLAN PROJECT Edward Forlitti ADDRESS 1894 11'0th ave Baldwin WI 54002 SW 1/4 NW 114S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST, CROIX SYSTEM ELEVATION 101.5' 11/12/20 4 DATE BEDROOM CONVENTIONAL— AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00( SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 LDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of ChambersnOne NCHMARK V.R.P. TOP of rye i on ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL «H,R.P. same as benchmark 394' Property Line 105th Grading is to be done to divert run-off away from system B-1 A 2% Slope MD1163 Well is to meet all WDNR setbacks 26 Area 1 below i system s to remain undisturbed �B-3 \ 100.5' 99.5' 0' 40' 80' / I I B. M. Scale = 1 /4" = 10' z�g 189' Property Line OD naTAr DIVISION OF INDUSTRY SERVICE _: _ jror 2331 SAN LUIS PL kc? I r GREEN BAY WI 54304-5211 3 0 1=i Contact Through Relay S P f K http://dsps wi govlprograms/industry-services wwwmisconsin gov Tony Evers - Governor -- Dawn Crim - Secretary November 11. 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES 2022-11-11 Plan Review: PWTS-I 12002733-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Edward Forlitti I05th court Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual — Vec 2.0, SBD-10706-P (N.01/01, R 10/12) Description: 600 GPD (4 Bedrooms — New Construction) Maintenance Required The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 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, slats. 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 onsue 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 mound area. • Divert surface water from POWTS 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 sod 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 a 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 38430-5 • 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 • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist. 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPNI Specifications. • Areas that are occupied with rock Ihaaments tree roots, stumps and boulders reduce the anwunt of Soil mailable for proper treatment, If no other site rs as ailable, trees in the basal area of the niouml must be cut tiff at ground level A larger I ill area is necessary when any of the above conchnons are encouotci ed, to prm ide sufficient infiltratne 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 slats 101.1212), 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, q POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: rim vmiderleest(a;wisconsin. Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11 /12/20 Owner:Edward Forlitti Location: SW1/4 NW1/4 S9 T29 N,R17W 105th Court 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 conti cy plan Attachments: soil test Shaun Bird Signature License nu Page 1 of 9 System PLOT PLAN PROJECT Edward Forlitti ADDRESS 1894 110th ave Baldwin Wi 54002 SW 1/4 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 101.5' 11/12/20 4 DATE BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 OLDING TANK SIZE LOAD RATE 1-0 ABSORPTION AREA 600 # of ChambersnOne NCHMARK V.R.P. ToP of QWy2y-ron ASSUME ELEVATION 100' Filter lifetime ❑ BOREHOLE WELL 'H.R.P. same as benchmark J 394' Property Line 105th Court Grading is to be done to divert run-off away from system B-1 A 2% Slope N B-2 Huffcutt Combo Tank Well is to meet all WDNR setbacks \ Area 1 below jr iystem s to emain ndisturbed B-3 \ 100.5' 99.5' B.M.' 4 Bedroom House 0' 40' 80' / Scale = 1 /4" = 10' "� 189' Property Line )_04 Mound System Cross Section and Plan View = Topsoil t' Cap Material Geotextile Fabric 16V , 4C Ft Contour = ASTM C-33 sand fill 0 `` = Clean aggregate '/a to 2'h in. di a. H Surface Slope Direction A 6 B 7,� D • r7 E ;_Z F G •� H El. I 1 K i5� 0 = 4 in. sch. 40 pvc observation pipe S Ft 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 sRcured in place with rebar or a closet flange. 10/07 lgj Page —5.— of/ Pressure Lateral Layout Two Laterals - End Manifold Man 1' Vl41 IvMIL1 ). 37o„/ Distribution N Lateral Diameter Manifold Diamel Orifice Diameter L I Force Main Length I 03/051gj Ft. ded [out 9 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 tum-ups terminate with a threaded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. •• • •• Grade •••••• 6-8 Inch Lawn Sprinkler Valve Box Page � of- Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Tank Model Number Total Tank Czp=wc IjS Max. Bury Depth Filter Manufacturer Filter Model Number Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Glade Sealed Watertight Finisbed Grade Outlet Filter IIT met 13affie Switch Settings and Reserve Capacity Tank Volume= GPI Dimension: Inches Volume Gal. (reserve) A. (alarm) B 2 (dose) c ; 7, .r 7, (dead) D S3 Total i Total Dynamic Head (rDH) - Feet Elevation Head C Distal Pressure 3- Network Loss Force Main Loss Total Manhole Min. 4" Above Grade SecurelyMounted With I' ocking Device eaththr�proof WF Junction Box — Z Vent Min. 12" Disconnect Above Grade Means With vend cap A 1W, Weep B Hole Off Elevation C ► Bottom D Elevation �..j '?l�Ft GENERAL INSTALLATION: The septic/dose tank is bedded and back fined 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 Wade have an effective locking de fittings' and installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight 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 Electrical service complies with NEC 300 and Comm 16.2s. 02105 U Page --a of 280-SERIES 112 hp Submersible EffluentfSump Pumps The Liberty 280Seties 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 uptoV • 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. 280-Series Cord Lengths Model 10' 25'(-2) 35�(.3) 280 Standard Optional Optional 501(-5) Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional WA 287 Standard Optional WA WA 10' cord length standard on all models. For optional lengths, add "-2, 3 or-5" suffix to model number. Examples for model 280 with 35' cord, order 280-3 Motor spermcations Y2 hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/23OV) Performance Curve: 280-Series 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 U.S. Gallons Per Minute 38 78 114 156 192 228 270 Lfters Per Minute Dimensional Data: Weight: 29 Ibs. Height 13" Major Width. 10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF...10' Factory switch Model 281, 283 Model 287 _settings VMF Turn on level 13" 9.5" Tum off level 7" 4.0" The Model 283 features a fury adjustable wide-angle float Differential adl strT is can be made easily by tethering the float to the dis- charge pipe orolher mounft point. Vertical float model 287 [a not edlustable. ■ r J ■ : ■a 280 _ Model ." - switch float switch floatno with quick- I `i plug ''+A Q00eus Certified Me" 287 VMF-Series Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump UberlY Pumps • 7000 Apple Tree Avenue • Bergen, Now York 14416 • P/rwre 800-543-25W Fax (585) 494-1839 www.libertypumpe.com capyrVA0 ibany PwVa, en 2017 All tWft Mm red U-n 2000 RO&I7 20140048A O4 SECTION A -A POWTS OWNER'S MANUAL & MANAGEMENT PLAN FiLEINFORMATION Owner Permit iot • Vakws typkaf for domestic (non-ammaraeq waatowatw mW septic tank efMmnt. .•• Vakm typical for pretreated v tawater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑months years) (Maximum 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 ❑ month s,-,-'6�ear(s) (Ma)imum 3 yrs.) Clean effluent filter At least once every ❑months ear(s) Inspect pump, pump controls & alarm At least once every ❑ month years) ❑ NA Flush lat.6rals and pressure test At least once every ❑ months _19.Kear(s) ❑ NA Oerer. t At least once every O months ❑ year(s) NA ar1°r At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS I Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certlficattons: Master Plumber, Master Plumber Resbi t@d Sewer, POWTS Inspector, POWTS Maintainer, Septage SefVidng 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 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 (X) or more of the tank volume, the entire contents of the tank shelf be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mectynical or pressurized POWTS components, pretreatIment components, and any other maintenance or monitoring at 4Rervals of 12 months or less shall be performed by a certified POWTS Maintainer. A serAW report shall be provided to the local regulatory authority within 10 days of completion of any service event START UP AND OPERATION For new constnKlion, prior to use of the POINTS 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 conoegtrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use_ par — 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 ehemlrale thep may Impede the treatment process andlor damage the dispersal ceil(s). If high roncantrat(one are detected have the contents of thO tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will b discharged to the dispersal cell(s) In one large dose, overloading the cetl(s) and may result In the backup or surface discharge f To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restOdng power to the effluent pump or Contact a Plumber or POWTS Maintainer to assial in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or pads vehicles over tanks and disperse( cells. Do not drive or park over, or otharwlse 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 IWO Of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floes; diapers; disinfectants; fat foundation drain (sump pump) water, fruit and vegetable peallngs; gasoline; grease; herbicides; meat scraps; medications; oil; painting producye; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails andlor Is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned In compllancewith chapter Comm 53.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected end the abandoned pipe opeNngs sealed. • The contents of all tanks and pits ahall 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 fined with stall, 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 compllrpd replacement system: ❑ A suitable replacement area has bean evaluated and may be utilized for the location of a replacement soh absorption systeyn. The replacement area should be protected from dNturbence and compaction and should not be infringed upon by requited setbacks from existing and proposed structure, lot litres and wells. Failure to protect the replacement area will result in the rw4ed 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. Baiting advances In POWTS technology a holding tank may be installed as a last rssort to replace the failed POWTS. f _The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a son and sae evaluation must be perfomred to locate a suitable replacement area. if no replacement arm is available a hddirg tank may be installed as a last resort to replace the failed POWTS. Mound and all -grade roil absorption systems may be reconstructed in place following removal of the biornat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in affect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS _ POWTS INSTALLER Name 7C"-:Z'>' ( Phone.. % J -- A'� —Y_ POWTS MAINTAINER IName ? Phone 71J^— 7� ID SEPTA43E SERVICING OPERATOR (PUMPER) ITY �r LOCAL REGULATORY AUTHOR 1 Phone r%/J�� 7�� This docunbrn was drafted In compliance whh chapter SPS 383.22(2)(b)(t)(d)f(f) and 383.a4(1), (2) & (3), Wlso In AdmkdsintnVe Code. NUV 27 2Uty ou wisccrWn Dope5[.CrtozDCevelnotyment OL EVAy T sale Division of tyntS C�-dolq -3a� Page of in awxoenco ww,,wxrxn oa, ruts. rom. wuey Attach complete alle plan on paper not less than 81/2 x 11 Inches In aize. Plan mat Include, but rot 11mited to: vertical and horizontal reference point IBM), direction and percent slope, soale wdlmenslons, north snow, and location and distance to nearest road. . Please print all Information. Pa lNipmea you ldamaybov"dfwwo. .J., / ' ParoW I.D. V7 r4 0 r bib- I b l p -y0- f00 Retie by �Date 1 I Propeny0vrtur PropertyLocation Got. Lot� 114AW14 S P T N R E( W Pmpertypwsufa Muting AddIrneu''o//- Aecy=kw Lot Bbcks Subd. Name orf0.9Ala'Paw-u Na t rate 4113 Nurntw I 1 I] Cary ❑ Vll, own at Roe 1. Construction U eatdendal, Numbs of bedrooms Code derived design flow rateyi t, ��i ra GPD ❑ Replacement V 1 Public or commercial - Describe: Parent material Flood Plain elevation if applicable //1- Z �R Generral oamlents �pi(S S f+t A SMta✓ plc and reoonvnardatlrw: System Type System Elevation 7 )� 1-11 OWN a Cl B-N ®—Pit Ground surface elev, q9. 8. Depth to krdWV teas ;7- 7 In• SOy Appkadon Rate Hodim Depth In. Dominant Color I Munson Redoz Description Gu. Sz. Cont. Color Tezbue Structure Gr. Sz. Sh. Ccoalsteoce acundary Roots GPDtlf -Eaa1 TM C r 1 8—; Boring pit Ground surface elsv. /42t r% it. Depth to 1Im ft factor 30 N. Shc Application Rota Hatron Depth In. Dominant Color Munsel Redox Description Du. Sz. Cord. Color Twftm Structure Or. Sz. SR Consistence Boundary Roots GPDAP 'Effat 'EfIQ A 2 5 iAyrrry 'EMuent etaBOD,> 30<22D mp% and TSS>30<_160 rrwlL 'EfflaM12a5OD.530lrWLanal�<uurrQL CST Name (Please Print) u CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 //_ ��2—/9 715-246.4516 %t LEfT ELEVATION Non noon inui- ni-- Nnm i mi �� mmm i ��' ill�l Ig m inn mnn i i — il� n � i i � n m i i m ®—■ FPONT ELEVATION BACK ELEVATION RRGH-T EaLEVATION rw+ lurou�nnou doe wrow.unou. SHEET I[Lt I' IB99 r ws snaum I OF 4 ELEVATION5 77� MAIN LEVEL PLAN $H[ff IN�ONMAiI(MI __— 5HEET 3 OF A MAIN LEVEL PROJ[Q Ir ID33 scau• ns snwm Owner/Buyer Mailing Addn Property Address City/State ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND r & Zoning Department for new Parcel Identification Number O(o — OC31 LEGAL DESCRIMO�N� 9 Property Location �Y�/u,(�' '/a , Sec. / Subdivision Certified Survey Map # T 2? N RZZW, Town of b5� Lot it 6 . Volume , Page # Warranty Deed # 10 2 10 Volume Page # Spec yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its prcmamre failure to handle wastes. Proper maintenance consists of Pumping out the septic tank every three years or sooner, ii needed, by a licensed pumper. What you pm into the system can affect the function of the septic tank as a troatrneat stage in the waste disposal system Owner maitenance responsibilities are specified in §Corms 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification foam, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licerued 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. Uwe, the underaigmd have reed the above requirements and agree to maintain the private sewage disposal system with the °*-lore= sot forth, herein, as act by the Department of Commerce and the Department of Natural Resources, State of Wisconai^ Certification slating that your septic system has beer maintained mast 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 form Us true to the best of my/our knowledge. llwe amain the owner(s) of the property descnbed above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of,�b�ed�roomms / UL" �rGf� l I SIGNATURE OF APPLICANT(S) DATE *.*Any infoxmatiom that is misrepresented may result in the sanitary permit being invoked by the Planning & Zoning Department. '*a 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 wan2rity deed. (REV. 08/05) Parcel #: 018-2022-06-000 12/02/2020 01 25 PM PAGE 1 OF 1 Alt. Parcel #: 09.29.17.1313 018 - TOWN OF HAMMOND Current 'X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 08/11/2020 00 0 Tax Address: EDWARD J FORLITI 1894 110TH AVE BALDWIN WI54002 Districts: SC = School SP = Special Type Dist# Description SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.960 SEC 09 T29N R17W PT NW SW & PT SW NW COUNTY PLAT OF PHEASANT RIDGE WEST LOT 6 Owner(s): O = Current Owner, C = Current Co -Owner 0 - FORLITI, EDWARD J Property Address(es): '= Primary * 1711 105TH CT Notes: NEW FOR 2021 AFTER PLAT TAKES ALL OF 018-1018-40-101 FOR 10 LOTS AND RD Parcel History: Date Doc # Vol/Page Type 08/11/2020 1109045 11/100 PLAT 11/05/2019 1091874 30/6723 CSM 11/06/2015 1021060 WD 12/28/2012 970424 LC ire... Plat: * = Primary Tract: (ST-R 40% 160'G GL) Block/Condo Bldg: 11-100-PHEASANT RIDGE WEST COUNTY PLAT 09-29N-17W NW SW LOT 6 6723-CSM 30-6723 018-2019 09-29N-17W SW NW OUTLOT 1 5794-CSM 25-5794 018/2011 09-29N-17W SW NW OUTLOT 01 5794-CSM 25-5794 018/2011 09-29N-17W NW SW OUTLOT 01 2021 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Land Totals for 2021: General Property 0.000 0 Woodland 0.000 0 Last Changed: 10/20/2020 Improve Total State Reason 0 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0,00 0.00 0.00 589'4938"W 257 99' f 105TH COURT DEDICATEDTO THEPUBLIC i N89'49'38''E 25].99' SW'1/40F T_HE NW 1/4 v6,5o' NW1/40FTHESWI/4 a LOT MFT 5E� g 193 ACRES J S / 41. LOT 6 T11�SJ S(. F a e,' 19 5 02 LOT 5 sue. 122,0605Q FT, Nam, 2 80 ACRES Wp L B4O =1047 SO w�. 233 J:' SB3'g•3..FJaJ 33 � E83-5'3"F22631' c '76fFgSfM a.ry� � I2901' N8949'E8"E 44200' Po'F as es , 3q LOT 4 103,2605Q FT 2 37 ACRES 589'49'38"W 3 ALL 0 -- a WITH -- =�- - PIPE1 R ti v� L E io63.6z m za6z.eT -A i/ 7l/ i l�A ti DRAINAGE EI AN UNO�MOBSTRUCTED HE Et j`�' NECESSOFORTHEOC S, NELUDINGYUr'T"TO INDERGP NCLUDING PIGYTSTO EASEMENT UBSSHOOR IA TREES SHROT INSTALLATION FUNDID TOM OF HTED ONDCBS 51 TO PROHIBITED HAS 8 MAINTENANCE SHALL B STOR WEST AND ALL STI WEST EQUAL ALL HARES FCR IN El LOTS SHARES B THE PEAT LOTS CAN BE MY REQUIRED M41NTE HEREON NO OWNER OR RESIDE! INTERFEREORCE DOMPPEWATE THIS PLAT.T. THIS INTERS PONDOBSTRUCTING , PLTEFIA PONDES WATER DITCHES WATER RUNJ/ SEEDINGS C�r -do i01'-3a,;z J Wisconsin Department of Commerce SOIL EVAL A al RE T Division of Safety8 " ' and Wda+9s"'-._. Page —L of 5 c Attach complete site plan on paper not less than 8 1/2 x 11 inches in size' Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal inlamer,on you pronide may be used for secondary purposes (Pmary Law. s. 15 Os (1) (m)) County t Parma I.D. Pu.L e : OI b- 1 b I a -4D- IOO of Re ' by Date 2 I2.�' 20 Ply Owner Property Location Gmt. Lots 114`gd /4 S T ZtV N R E( ) W Property Owner's Mailing Addressll /04 Lot Block # Su W. Name of-e&1AV' Pna.0 wr) ?V'Lwsp„y- Q- t v3e34- Cny State _ Zip Code Phone Number I ❑ city ❑ Village own Near t Roe Construction U Residential I Number of bedrooms Code derived design flow rate �6 rj/i GPD ❑Replacertrent �///I ❑ Public or commercial - Desonbe: Parent material .) Flood Plain elevation if appLnble �✓ //a- ft. General comments lo;IS Shall Ao4 Sntitor ple.J, No remrrrnendauons: System Type__ _ System Elevation j Boring • DPfig-pit Boring Ground surface elev. r % ft Depth to Gritting factor 7i in SortApplication Rate Hodmn Depth in. Dominant Color Mtmsel Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'E##1 'E142 D r ,pl l.. - , 3 7- Z - ®Boring % pig Ground surface elev.42ZF-' ft. Depth to IirrwGlg factor �� n. Sod Applicalkin Rate Flaroon Depth in. Dominant color Munsel Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDMI 'Eft#1 'EfRi2 �7 n ��- n fIC 3 0 . 3, '- Etnuolt #1 a BOD. > 30 < 220 moll. and TSS >30 < 150 molt. ' F_fMnent #2 = SOD- < 30 mg& and TSS < 30 myL CST Name (Please Print) Sur CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 �l_ �afI 715-246-4516 M COut� I Property Owner Parcel ID# Page 2 of l • �� I / '. �# ElBoring ❑ Pit Ground surface elev R Depth to limiting factor in. Sofl lc ti Rate Horizon Depth rn. Dominant Cola Munsefl Redox Description OU. Sz Copt Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 I •EW Effluent #1 = SOD, > 30 c 220 rrg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seoarw"L6Mj Soil Test Plot Project Name Edward Folitti Address 1894 110th Ave Baldwin Wi 54002 Lot 6 Subdivision S W 1/4 N W 1/4S 9 T 29 N/R17 P Bird �/CSTM #226900 Date 11/22/19 Township Hammond Boring Q Well PL Property Line County ST. CROIX `. BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD "HRPSame as Benchmark 394'1 3af-3 T� olq-oo6 PREPARED FOR. I I^TGLocAFTON —D PHEASANT RIDGE WEST EXII BRa. �RR.B, W FEB 83 2020 PRELIMINARY PLAT PREPARED BY: yL _ T[Y " LOCATFNPAPTDFTH-11Y11<.ITNENWIIAI.IARTOFTNENWI/1OFTHESW.P, �a OFSE"0N9,T29N, g1TV, TOWN 0; FAMMORD, 7CPOIX CC-NT, WRCONS N, RE" OIFID'IOF C°RT19E O SURVEY MAP VOLUME 3C PAGE 6l23, DCCLME`PT NO ICE182< - - _ _ $a RRO �.' I i1051H COURT - LOT 5 :II i g I 'JI �� II •_ — _— � sezvs,°�w las zr z=1. ``IX 1 au.. Lma 141 III elf11 a A(' FIX.` � �I I obi I 'g 3 I N]9Y9A]"E. sW L073 '� S's I b �M1q] §I� LEGEND a �F3 llp LOAPF— °.��.,� *,f a °use XF-1111A C.Ss YOU. Y' rB_rm II fNO !I _ Ouv- ARIL F� f� ESG I, a. �E PHEASANT RIDGE WEST EDWARD F7, TJ, TP_ vPLO I PRELIMINARY PLAT AuWConsultin6/e®ocutra SkN Imd SSHvepio[ a,�,,,,a.,.