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HomeMy WebLinkAbout018-2021-12-000Wisconsin 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)] Permit Holders Name City Village Township Oevering Homes I TOWN OF HAMMOND CST BM Elev Insp BM Elev. BM Description. l0o I T Sv, U s ,'r v TANK INFORMATION ELEVATION DATA TYPE MANUFACT RER �,( CAPACITY Septic N Dosing Cowlbv /� y.s occ> Ai 14r Holding TANK SETBACK INFORMATION LG{ t S 4- (�taf,'k 5.1 TANK TO P14 WELL ROAD Septic Dosing MVent Aeration Holding PUMP/SIPHON INFORMATION / L61 rlitW 3,�) Jq Manufacturer Demand GPM Model Number TDH Lift D G O / Fnctlon o Systteem Vd T 1 ` �Ft Forcemain Leng ., Dia Z ,r Dist to Well ✓D SOIL ABSORPTION SYSTEM County St. Croix Sanitary Permit No 631207 State Plan ID No Parcel Tax No 018-2021-12-000 Section/Town/RangelMap No 08.29.17.1293 STATION BS HI FS EL V. Benchmark Ann g (De'. Bldg. Sewer � . S Vr IO`'I. 1 SLIM Inlet Q .5 /OZ • �1 St/Ht Outlet Dt Inlet Dt Bottom -Z 9�5 Header/Man. Dist. Pipe z /e, Bet. System Final Grade St CovAlZ. t3 Cv o4vuy- 3. 5 IbL 3 BEDITRENCH DIMENSIONS Width 1 Z n Length Cj0 r II No OfSrseehes / / ly '4,� / PIT DIMENSIONS No its Inside Or Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STR A LEA ING Manufac urer INFORMATION CHAM ER O U IT Typ Of b System ?O r D� 1 �, I Model N mb DISTRIBUTION SYSTEM HeaderlMandold IDistribution x Hole Size ?) ,. x Hole Spacing Ventto Air Intake t ipe(s) p 11 —� O t 1 z 7`� U S C' P Length Dia Length Dia Spacing (� Y SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Vpr %7uW arr Debi 13.Ouer---� ft / Depth Over Bedfrrench Edgac— -- �a Depth `y Topsail '1 xx SeededlSodded xx Mulched Be�enter 1"0� 1 �, ` L i Yes J No Yes No ZI COMMENTS: (Include code discrepancies, persons present, etc) Inspection #1. I p p tY o Inspection #2: _ Z z1 Location: No Address Available r 1_� I 1)AIt BM Description=f:-,I k'r t�wCr 2) Bldg sewer length = 2 -amount of cover=7LIZ,� p I" Plan revision Required? `_� Yes INo 5 11 IL1 Use other side for additional informations... Date Insepclors ;,n?br�e' Ced. No SBD-6710 (R. 3197) < AN -aual7 — V'3 9 Safety and Buildings Division Coon $ l Saoaary nermrz Number no be 54ed m by Co ) 8$ =� C 1 i ZDZ� 201 V� . Washington Ave., p 0. �X 7162 Madison, WI 53707-7162 . RA (931 Zo7 . C0m1n22 am Permit Appl. _ swe Transaction N®ber In accordance with SPS 38321(1), Wm Adm Code, submission of this form to the apy ental unit Ice C is required prior to obtawng a sanitary permit Note Application forms for staroowned POWTS are to Project Address ilt diffacm than mailing address) the Department of Safety and Pmfessiorral Servies Personal infortnanon you provide may be used fw secondary i in accordance with the Pnvacy law, s. 15.W1 m),S=. L Applimtion Information - Please Print All information Ptopcn} Owncr's Name r "'k ! Piece[ # a-o2oal-Ia� Property Owver's Mmtmg Address ��J/ Property, Locanon - .2�•J7./�/i//z43 C / c% CiOK i.Ol Phone Nr>mba � city, State r � ,. � Zip Cade ip ( k on 7N, RE W Lot # �� Subdrvr Name II. ype of Building (check all that apply) r 2 Family Dwelling-Numm ber of Beaoms am on ,I{" PublidCommeraal - Describe Use Block# i �- ❑ City of ❑ Stare Owned - Describe Use CSM Nurnbcr Village of >Tawv of �/ Z 0JU /� III. Type otPem . (Check only one box on line A. Complete line B if applicable) A - System Replacement System ❑ Ttearment/Holdmg Tank Replacement Only ❑ OthQ ModiScazroo to Esdsting System (explain) B. ❑ Permit Renewal ❑ Pemut Revision E]CbmgcofPlumba etmit Traasfa m New Lot PfeVWm Permit Numbea and Daze Issued Before Exp ration Owoer- IV. Type of POINTS S stem/Com nent/Device: (Cb=Vall t a 1 Non-Preswmusd In-Cxound ❑ Pressurved in -Ground ❑ Mond > 24 m of wrtable soil ❑ Mound < 24 m. of writable sod �] Holdmg Tank ❑ Orba Dispersal Component(explsm ❑ Prarcatrnent Dense (explain) V.Dispensilflreatmeut Area luforma on: Design Flow (gpd) I Design Soil AropbrAm Rate(.gpdsf) DmrsalAreaRcgimed (s DRcrsal Area Propose sf) ! S. ' [ O VL Tanklnfo Capwrry m Gallon Total Ga llnn # of UmE aufacnua 4%k o r) fil e o , � t .8 m o 9= u n New 7avlcs ew4ng 7av13 iU y in =C _ Sepec or Holdmg Tank DM.g Cbambcr 69 / VIL RLwpomsibiiity Statement- [, W e underetgned, assa Ponsibllity for installation of the POINTS shown on the attacbed platy Plrmsber's/?lame (Print) Plum MP/NeRS Number Rwmess Phone Nino , '-t.' O` m Pluber's Address (Street, Cry. Stare, bp zffi 5Z County/Department Use Only Approved �Di58ppIWCd Permit Fee $�50.0o Dale sued Iz zs�zo ksnmg AgrntS atme G vnn Rca on fw Den a IXIConditiasgai AppFp rnsyoslfor Disapproval3 q (nn.6� l7-liCIL5 dh �1.f T s 1A son, ca ; in maintaed �h ) 1 n kerytio pl-n F� Vr� by pl�r~I ,be _ �" - ilerrs r r be mam,a... e lh) �+��(r'/liCul�tiPer VSTP roUr� S�)7CNn I Aiv,l(Q� r Ili r f�l rbn �n �i�1/rG fr <V OW�C/ 1 ..••ny�+e pumtur eae aria saomrro me t,omryarls oa paps am legs tl»oa V. x'I esm� -7TktforJ a^ -+kt No e2f ssk,i( 61� �lecu4l�c C e0.StWUY1�-' 1 ho sub��c} d o Sl�lftr,ol �� Orarht,y� Ecisef�Yi4 �tb% 1k 5f-a��11499 /I Duerll.ii s ) 0 sX 5kr;i ins A � AK tans{ PROJECT Oeverina Homes SE 1/4 SW 1/4s 8 /T 20 System PLOT PLAN _ ADDRESS 1433 Cemohous Ave Suite A Now Richmond Wi 54017 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 106.9' DATE 12/10/20 BEDROOM 3 CONVENTIONAL AT -GRADE - X%Ot CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of Chambersnone IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE (DWELL sH.R.P. same as benchmark 220' Grading is to be done to Pro 3 Bedroom divert run-off away from House system Itt Combo B-2 El -1 0 7' 1 6.9 3/0 Slope / Well Is to meet all WDNR setbacks B-3 Area 15' below system is to remain undisturbed Scale r�'1/4" = 10' 0 40' 80' B. /propertyLin DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http //dsps wi gov/programs/industry-services www wsconsin gov Tony Evers - Governor Dawn Crim - Secretary December 16, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-12-16 Plan Review: PWTS-122002844-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Oevering Homes 1637 102nd aye Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: At -Grade Component Manual - Ver. 2.0, SBD-10854 (N.03/07, R. 1/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) Description: 450 GPD /3 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, scats. 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 (1 1)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fiagments, tree roots, stumps and boulders reduce the amount of sod .rvailable for proper treatment. If no other site is as,ulable, tees in the basal area of the mound must be out (,if at ground level. A larger till area is necessary when any of the above conditions are encountered, to provide sufficient inliltratire 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 sod 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/in stallati on/operate on 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 PONVFS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, rl un "U.asr�en ocze.7,� POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services � Division of Industry Services email: tim.vmiderleest(aavisconsin.eov Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date:12/10/20 Owner:Oevering Homes Location: SE1/4 SW1/4 S8 T29 N,R17W 1637 102nd Ave Hammond Manuals Used: At -Grade Component Manual version 2.0 SBD 10854 IN. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications 8.-9. Maintance and Contingency Plan Attachments: Soil Test ( Signatu License Page 1 of 9 PROJECT Oeverin0 Homes SE 1/4 SW I/4S 8 System PLOT PLAN ADDRESS 1433 Cemohous Ave Suite A New Richmond Wi 54017 /T 20 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 106.9' DATE 12/10/20 BEDROOM 3 CONVENTIONAL AT -GRADE X00( CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of Chambersnone BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL .H.R.P. same as benchmark Grading is to be done to Pro 3 Bedroom divert run-off away from House system At ComCb B-2 -1 03 07' 1 6 93% Slope / 106' 22 / Well Is to meet all WDNR setbacks B-3 Area 15' below system is to remain undisturbed Scale y 114" = 10' 0. / 40' 80' Property Lin 9 At -grade System Sloping Site Cross Section and Plan View ���----------------------------------- — = Plowed :��, = Clean aggregate 0 = 4 in. sch. 40 pvc _ basal area observation pipe qq %2 to 2 '/2 in. dia. Lateral with 2" Topsoil Cap aggregate over pipe Geotextile Fabric Ft Lateral Invert Fsr�{4 • ►i1�tii%1111��":6� 111111111111V-V-4 ' �1111�cSlope Direction Obi 0� ©R ©m Observation Pipe With Cap Topsoil Cap Surface GENERAL INSTALLATION: The at -grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/. inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed suti'ace. Aftgr the topsail cap is placed, the entire at -grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6-inches and secured in place. 03/05 lgj Page 2. Force Main Pressure Lateral Layout One Lateral — End Manifold OW, L l n P Y i, 05-�o AQ- — i K Distribution Network S ecifications Lateral Diameter Z. In. Orifice Diameter 3 / In. X Orifice Spacing) obX In. L Lateral Len 9 Ft. Force Main Diameter In. Force Main Length rT Ft. 03/05 lgj • • • • • Grade • • • 6-8 Inch Lawn Sprinkler Valve Box Lateral Turn -up f— Threaded Cleanout Plug Long Sweep 90 Bend Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral turn -ups terminate with a threaded ceanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. Page t ofL Septic -Dose Wank Cross Section And Pump Performance Specifications Filter Manufacturer Filter Model Number Q �/ Mitvmum Pump Parformattce Required t GPIvL• Ft TDH Outlet Manhole lv(tn. 4" Above Grade With Looking Deeice. hilat Manhole < 6" Below Grade Sealed Watertight � , . . -' . Finished Grade ` Outlet Filter Inlet I.0 Net Baffle Switch S!!!�p and Reserve Ca acity Tank Volume = / GPI Inches Volume Gal. 2S gDimension, 2 3 J PUMP Manufacturer Pump Model Number a- _ Alarm Manufacturer S $ Alamo Model Number D t— c/ Switch Type 1R±t Total Dynamic Head (TDH) - Feet Elevation Head /(} Distal Pressure o2 S— Network Loss 1 Force Main Loss Total c , Manhole Min. 4" Above Grade Securely MountedWith °g Device Weather-pmof I Junction Box i Imo— -4 Vent Min. 12" Disconnect Above Grade Means With Vent Cap A 44 A" Weep B Hoe GENERAL INSTALLATION: The septicAdoso tank is bedded and back filled in accordance with die: manufacturer's Product approval apacifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior Approval. Manhole covens mcposad to grade have an effective looking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight flutings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation sud the sleeve is sealed watertight. Electrical serv1 plies with NEC 300 and Comm 16.2R. 02l05 LI Page S of 280=SERIES 112 hp Submersible Effluent/Sump Pumps The Uberty 280-Series provides a cost effective -mid- range' pump for on-slts waste water systems, liquid waste tranlifer and commercial heavy -dirty sump pump applications that regLire higher head or more flow. Designed around UbWY3 unique-Uni-Bodyr casting, the 280-,Series will provide years of rellabis performance. All Models Feature: • Vortex style impeller permitting passage of solids up to V a 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing a Epoxy powder coat finish a All fasteners-oorosion-resistant stainless steel e 1'%m Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature: 140' F. 280-Series Cord Lengths Model 10' 25'(-2) 35'(-3) 50y-5) 280 Standard optional Optional Options! 281 Standard Optional Optional Optional 283 Standard Optional Optional WA 287 standard Optionsi WA WA 10' cord larger sfendard on all rnodels. For optional iengftas, add'-2, -3 or 5' sWru to model nunber. FxamPla: for model 280 with 36' cord, order 280-3 Motor Specifications X hp 60 Hz 3450 RPM Oil filled, themlalty, protected (PSC) Permanent Spin Capacitor 8.0 amps (115V) 4.0 amps (208/23OV) Performance Curve: 280-Serfes I u. m N 2 12 0 5 10 15 2n 2-5 :in IN an 15 Sn 5.5 An 71 U.S. Gallons Per Minute 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29 Ibs. Height: 13' MaJor Width:10' (model 287) Minimum Sump Diameters: Model 281, 283... 14' Model287 VMF...10' Factory switch Model 281, 283 Modal 187 I settings I VMF Turn on level 13- 9.5' Turn off level 7- 4.0' The MOdel 283 features a tuft adtuatable wid►argle float. DiHwontlW ad)uslnmlts can be rude easily by tadW t0 the nost to fM di - orwge pipe or Other nou tang polar. versoal noel naiad 267 in not adtuetabfe. 0' Model 280 Model 281 Model 283 Model 287 Manual, Wide angle Wide angle VMF-Sertes Ii no switch float switch float switch Vertical mag- withqulck- with series nedcfb®tfor disconnect (piggy -back) smaller pits - wpl In plug ;k a 104 diameter SUMP C Sous Certified eprYc� w �qct b wta,p wanvt meow uberty Pumps • 7000 Apple Tr" Avenue • Bergen, New York 14416 • Pawn 8004W3-25M Fu (38S) 4" 1839 w Jlbertypumpa.00rr coA.ays a Lkwty Rama � W!7 Mrbhrararved LLr] RONi7 0 ()4 1 20140048A SECTION A -A POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of FILE INFORMATION Owner �e.t7P ✓ I In c � Permit # )ESIGN PARAMETERS Number of Bedrooms -J ❑ NA Number of Public Feel Units - NA Estimated flow (average) j V� Design flow (peak), (Estimated x 1.5) %y auda Soil Application Rate aVda /fir Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) :M mg/L Biochemical Oxygen Demand (BOD!) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L !Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510' cfu/100m1 iMaximum Effluent Particle Slze 36 in die. ❑ NA Other A "Values typical for domestic wastewater and septic tank effluent. NIAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer ❑ NA Effluent Fitter Manufacturer ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity .3 al 0 NA Pump Tank Manufacturer ❑ NA Pump Manufacturer , / ❑ NA Pump Model �% ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration ❑ Weiland ❑ Disinfection ❑ Other Dispersal Cell(s) ❑ NA ❑ in -Ground (gravity) ❑ In -Ground (preseunr:ed) -Grade 0 Mound ❑ Drip -Line ❑ Other. Other. ❑ NA Other: ❑ NA Other. ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge end scum equals ona-third of tank volume ❑ NA �Inspect dispersal oell(s) At least once every: 3 ❑ ear s(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ((� s(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ months) 44-yeans) ❑ NA Plush laterals and pressure test At least once every: O month(s) ❑ NA tfar At least once every: ❑ month(s) ❑ year(s) IJther MAINTENANCEINSTRUCTIONS 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 Inspectors must tnclude 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) shag be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a falling condition and requires the Immediate notification of the local regulatory authority. Men the combined accumuleLon of sludge and scum in any tank equals one-third (k) or more of the tank volume, the entire contents of he tank shag be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, W econein Adm1nistrative Code. IVI other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. e) Pegs _ of _, Name Phone 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 tW may impede the treatment process and/or damage the dispersal ceil(s). If high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. System start up shall riot 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 by discharged to the dispersal oell(s) in one large dose, overloading the oell(s) and may result in the backup or surface discharge Of eftlusnt. To avoid this actuation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to 1Ne effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWM antibiotics; baby wipes; curette butts; condoms; cotton swabs; degreasers; dental floss; diapers; d13infadaft; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; Oil; painting producfA; Pesticides; sanitary napkins; tampons; and water softener brine.' ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shell be taken to Insure that the system is prope(ly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits snail be disconnected and the abandoned pipe openings sealed, • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the Vold space titled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS faits and cannot be repaired the following measures have been, or must be taken, to provide a coda oompilant replacement system: .A A suitable replacement area has been evaluated and may be utilized for the location of a replacement $oil absorption systeyn. The replacement area should be protected from disturbance and compaction and should no be Infringed upon by requitied setbacks from existing and proposed structure, tot Imes and wells. Failure to protect the replacement area wtll result In the rated for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule$ In effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. BeffIng advances in POWTS technology a h ....../// ��olding tank may be Installed as a last resort to replace the failed POWTS. �qt-�tke site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation moat be performed to locate a suitable replacement area. If no replacement area is available a holding lank may be Installed as 1) a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the hmfittrelive �' u'datce. 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 ASEPTIC, 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 _ POINTS INSTALLER POWTS MAINTAINER Name .�ADti 5 i 0 I Name S Phorx lf—O- 6 .- , % Phone !��-_a SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHO ITV Name Phone �%J % 3> tom' This document was drafted In oonpllanoe with chapter SPS 383.22(2)(b)(1)(d)&M and 383.54(1), (2) & (3), Wisconsin Administrative Code. P A-" wraa■m Dep.rtmem of ca,vrw e SOIL EVALUATION REPORT------cy,in owr,n otSabbaM au tl4ns C—ty Mterh corrplstn sW Pon on paper not Ins titan a 112 x t t Wiches in size. Plan must �• �• Ydude, but not LTAod to: terdol and hortzmtal refrsras Potm (SM), CYSGion ,nd PaoY LD. (r PWCW dope. cc" ordkrwvk ts. MM arrow, and bcadon" distance to nearest rwd. 0� p — 0 7i/ Pleaaa print all 6dor don. Ra �• Ore Mews tllbnnx„eYw prwwemywwe, braeewaery Nede< (t)(m)i. 7/�za7 Property O.wfer Location //�� )) Q & '/I GovL 1I47Jw1N Q T 2 9 N R f E( w ow ses Ames, J U N 01 % Lot a IL Black d — Nuns or dY CVIY.0, ..r�5x0/ZV OixG _ veep. Tow, Nerest -ev �/ r{5� NOW Corobt�oon,.yU.6-,V R.....s��,,kcelwftI Number d bedroom, Code daMM design Sox rate —0 OPT PrramWrW 0 6= nertxneTiel- o Olzp'S n Fbotl Pies, ekveom X app&ads �✓/.Q R Gateai oo mrrd and rectmmerblod": n System lype_System Elevation Boeova �tL-7�f{ 6afnp Ka- P[t �rld sunKs elev. �R Deign b IYNtlnp I*= �. = IM Sall Appksfon Ray Hcxbnn Depth In. Damirurd Color Muuea Red=Desaipom Qu Sz Cad color Tex6as Ssuotae Gr. Sz SR Co*stanoe Sotrdary RcoU 'VW1 EM2 2 -yj /IV q AXY 14,/ aka Ory� Pit GNud WAacs Nev. v ' �L DsWA toWtdWv hdu In• Sol Amhoadon Rate Hortmon Denm In Domb aN Colcr or MuaN Redox Deeotdo, Du. Sz Cut color TeAue I Seuc4ae Gr. Sz Sh. Ctlrxtleterae Bourdary ROoH GPDOR EtY1 Etro3 75may/ Z4F5i - 6 •Meol ai-SM >30<220mtrd TSS >30<150 n-Q& • EMLWU a2 a BOD<30 m6'L and TS3130 - - - myL a ma (Please Pr l* CST Nmnbr Nom Bird Plumbing, Inc. Shaun Bird 226900 Address Date E.eluetiw Cor,duaed Telephone Num 1008 192nd Ave, New Richmond, WI S4017 , 0 715-246-4516 I-L� Pmprty Oa Pamel ID / Pop —of — •^zirm ■ ■■■■■■■■■■■■■ a:: 'EMu..,t61a80 ,r 30_2Mff9tand TWS 301150myL -Ef mta2a80D,_30ffvLs dT88_30ff9t he Depu cnt of Commetoe ism equal oppomWty aervim provider and employar. If you aced aairtmce to aeeaa aeroioet a nccd. tmtedd is m altermte fomut, please contact the depubnent at60&266.3151 or TTY 60$-2644777. Soil Test Plot PI Project Name Oevering Homes LLC S B' Address P.O. Box 179 New Richmond WI 54017 TM #226900 Lot 12 Subdivision Hammond Hills Estates Dat 6007 SE 1/4 SW 1/4S 6 T 29 N/R17 W Township Hammond Boring 0 Well PL Property Line County ST. CROIX BM or VRl' Assume Elevation 100 ft. Top of Survey Iron System Elevation 106.9' *HRpSameasBenchmark 102:id Ave Please note: survey was not complete at the time of testing, installer must check all setbacks prior to installation. 140' "+' B-2 107' 5% SLope 106' 100' Scale is 1" = 40' B-s unless otherwise noted Owner/Buyer Mailing Addn Property Addr City/State LEGAL DESCRIPTION ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM _ Parcel Identification Number t!:�/ Property Location— � '/� ��144 , Sea �L, T ZO Subdivision-o Certified Survey Map # Warranty Deed # o Q l b R 1W, Town of — cA'-A0YLR Lot#J Volume , Page # Volume , Page ## _ r' Spec house/yes / no Lot lines identifiab ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Inproper use and maintenance of your septic system could result in its premature fa we to handle wastes, proper maintenance consists of pumping out the septic tank every three years or sooner, if ne eded, by a licensed pumper. What you pat o, the system can affect the function ofthe septic tank d a C treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Conan. 8352(I) and in Chapter 12 - St. Croix Coup Sani tary tary Ordinance. The property owner agrees to submit to St Croix County planning & Zoning DepatVnent a certification form, signed by the owner and by a resister 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 shidge. Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resouromav 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 tree to the best ofmy/our knowledge. Uwe amlare, the owner(s) of the property described above, by virtue of a warranty deed retorted m Register of Deeds Office. Dumber of bedrooms IGNA F APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanit sty permit being revoked by the Planning &Zoning Department *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. OM5) s z h i 0 � I I H Big i -: I4 Fnrn ` y C ®®'� 0 li I .III r�— ,f x IT 0 ti 1I' O `VERIFG HOMFS .� _ ;.coP.wcnr PIAN iNFORNA➢ON JOB INFORMATION StlffT INFORMAPCN ,w - —Ji SnEET OF 5 FRaem1 m-31 ELEVATIONS scar ns snowN i Nml¢ �• - ,,. N/NJ4$ Sb 3i0Y-J N011VaNnOd IE-02 I1�3f0`dd S �Q Z - � - 3JI10N luORudO.`FN 1331-IS _ wvs a. r .�r, 53%OH'J.V' L3A� 1\ NOI1bYlYUfNI l33M5 NOI1ttYMUJN100'x4 HOIlYWYOdNI NIId d =s 1I6 C dg qqg v} i r� . z a 'I 9r • a ��� o a � III � r��',• s ' r �_ .a r_f _ I. ��= I i it ril� • � f OL LL 1 %AN INFORMATION Zb IMrOWAT ON INFO Tl( VEAII.G HOMES rec .... SHEET ,cormwn� Nonce « - _ 3 OF S «. ^Roxcre 203, MAIN LEVEL - scA�c- As srpvN PIAN INFOPNw*IPV JOB INfORIMiION SnE[i INFOPJIgTION a ' PFOJER I 2031 aoFs ' 2ND LEVEL • scnu• ns snoxN I VITH N EASR!I `n m �\ N 89:20 53" E 392 9O' o 892 '0'C' 1h E9' yG' y 175 n, :/J 'I 1/S IIO 42 QO' - C7 _ OD �605 qc , q' z LOT LOT LOT 11 / O 0. 60_ o _ J q8 B 4'1 12 n3SF 4 / � &13 00 w LOT 10 (/1-i ry v _ µ J C hYr is 7 O. I Bo 0Vy JJ 4, O LOT 9 n o 9yzj s a t I fn c'C•�� 45 It. 175 DO' LOT 8 o 03 \\ �- \ qg t *BM r_ I z m - =• LOT 6 F°n 0' 'OT SF — m 0' 4g ry 17W, 13R C 2 q9' /8 \ rl LOT 7 (/ / / i)• 10 29 µ p n r•I r"� \ O _ rn _ 8 85'S4'i8 E 706-8' ra `. 1O1ST AVENUE m f 9 / N 8w 911'15" 200.48' a. s" 6 �WEz = •. 'LOT 126.67' 79 81' �( LOCATION j 5 / Op ! O O y\lo z- �( Wisconsin Department of Commerce SOIL EVALUATION REPORT.age i'of-3— Division of Safety and Buildings in accordance with Comm e5 Vr.s. Adm 17' f . Attach complete site pan 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 intionnation. Para mal inf m aon you pnwi0a may ne uses for 6e0on0ary pwposaa Priv (1) (mU Parcel to. v /0 6 Zl Re " by Date /! /Z b % Property Owner D G P Location ���� ) Gout rj 1/4�Z 1/4 8 T Z9 N R I E (q W Owner's Maft Address J U N 13 W # Blod # Name or CSMR Lary Zip Cotle^Q,°ROIX CO OctrG ; S�0/ ( .n - Cl C' ❑ Village Tovm Nearest ;C) ";" New Construction Code tion Useg Residential / Number of bedrooms �_ derived design flow rate GPO ❑ Replacement ❑ Pu�b or commercial • Parent material o.,.IYOLt Flood Plain elevation it applicable --tt General Comments and recommendations: System Type `<� cKX-//� » System Elevation Boring # Banng Pit Ground surface elev. 01 AL Depth to GrNting factor in. Sod Application Rate Harmon Depth in. Doma rant Color Mtnsell Redox Description Ou. Sm Cont. Color Texture Structure Gr. Sz. Sh.ffzz�' Consistence Boundary Roots GPD/fP •Eff#1 •Eff#2 311L- Z S-yam I ' C n "s ` -' - 7. - ,re #O�2 xy Pit Gnwnd surface elev. r R. Depth to limiting factor�. Shc ication Rate Horizon Depth In. Dominant Color Mursell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM •Eff#1 •Eff#2 I 6)-1 3i �- ( r 6 D r/q L I -r f ' Mastiff #1 a BOD > 30 < 220 tug& and TSS >30 < 150 mg& • ERWem #2 a BOD < 30 rtrgrt and TSS _ _ < 30 mg& CST Nrme Lease Pri4 CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 0 - o , 715-246-4516 Parcel ID # Page _ of Efti #1 = BODY > 30 < 220 niWL and TW >301150 mg1L ' Effluent #2 = Bi 130 mglL and Ti 130 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. s Soil Test Plot Pla Project Name Oevering Homes LLC S R;ttQ Address P.O. Box 179 Z. New Richmond Wi 54017 TM #226900 Lot 12 Subdivision Hammond Hills Estates Dat 6/2/07 SE 1/4 S W 1/4S 8 T 29 N/R17 W Township Hammond Fj Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 1 oo ft. Top of Survey Iron System Elevation 106.9' *HRpSame as Benchmark 102nd Ave Please note: survey was not complete at the time of testing, ,)erty installer must check all setbacks prior to installation. 140' B-2 107' 40' B 57a SLope 106' 100' i Scale is 1" = 40' B-3 unless otherwise noted .M. 175' Property Line