Loading...
HomeMy WebLinkAbout006-1045-60-000Wisconsin 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)(m)I Permit Holders Name City Village Township Joseph T. Hoheisel I TOWN OF CYLON I W. 0 1 L3� .o/ T n o� 3w" PuC non e TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic — 1 � Ot1D Dosing CO n Aer n loI `� ,, �; Hol ' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG, Vent to Air Intake ROAD Septic w t * j' Dosing l 'So Aeration Holding PUMP/SIPHON INFORMATION Manufacturer 1 . I r - _ L r r}P� GP � Model Number �0 D , TDH Lift Fncho Loss System ead TDH F} (S.Ii ,q-2. 3.qo Forcemain Length Dia /t• Dist to Well 2 SOIL ABSORPTION SYSTEM _ ' TION DATA STATION BS HI FS ELEV Benchmark �I. l O J04.0 / OC`J.O Alt. BM 51 ant t"1 Bldg Sewer /,/•Q 7 om co St/Ht Inlet �[yr� St/Ht Outlet Dt Inlet Dt Bottom I S•0 (� 6'�a.-6o Header/Man. p`,R i g l • O 6 Dist. Pipe 3 r Ifl 1ae.gD Bot. System 3 S" ICo.za Grade t Cover f •60 Cm y -91ED 1lb0"NS ENSIGNS Widt Len Ih ( No Of Trenches t PIT DIMENSIONS No Of Pits Inside Dia Li ZJ tt. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ufac r INFORMATION CHAMBER OR Type Of System � f � / / J d N IM o 100 !So l/ DISTRIBUTION SYSTEM bcaDD-Vfl-tia..so 1 / e u od — CBIJ t`1S r e Hole pacing Vent to Air Intake 1 HeaderlMamfold it Length Dia Dist Lion LPipe s) 5� •� Lf O Length •7 Dia Spacing x Ho 3�I It � � �— SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed7Trench Edges Topsoil I_ Yes ❑ Na - ❑Yes No 5� I TS: nclude cede discrepenc[e,, p_ eyso $pre nit, etc.) Inspection #1 rp/Z3 {� Z( Inspect n #2 Location: No Address Available fua II m'ppt VlS'ta.l led 'rr l+ fir ��` n�� (2�1 1. ) Alt BM Descnption = lj.r "m6te C� vve! ?, 2 ) Bldg sewer length = 32.0 u or CDvu-. _ -amount of cover =? Z S / I ( 3) 3.0 f Sari nle:� = '. ( I ke—C4* �� . nYe S � �t�t� �TWaW o1L$_yGY�Q.IA?sl f �o e.Q. Plan revision Requiredp ❑YesNo _ I l Use other side for additional informal on. 1" S D-6710 R 3/97) t Date In Signature Cert No S�S Q s1 ,b., t� s 1 � pu a��P%.-1,Q, �37w�� y �e 59N-QQI -07 A Nw�1 � ..-, nd B8ldings Divisionn�Fl I ngtonAve., P.O. Bex 7162 n/Zj�(�o (b�xe l;lld in by Co ) n.VJ53707-7162 �pem�it Z0�7) MAR 221 •Ceti ��... , 'rr�ait ppli ation T a user °n Number It In accordw. with SPS 383 1(2), i77[`s 9Ubtd6pjgy is . to me appropiji�ovemm taI unit �IjI S — is required pr:nr m °I>•a'" ng a sanitary, pe[mtt Note .4pp - far stme-ov PUR'I aMTW-mtd�. j Projee[ Addtess (S diH:rem U� mailing address) the Departcat of Safety and Professional Servies. Personal infumarion you p: ovide may be used for secondary oses m accordance wah the Pnvacv law- s. 15 044I Km, Sou n -j /O WAG /vV� G L A tication Information- Please Print .Adl Information GG PropertyOwner's Name Pare k J b - a0 6 — Aq^ Property Owner's Matting Address LoCa lonA) Gy �i /� ��P�¢•mem Q,lr i.. y4 Section city, .Same ' ' Zips" Pbone N=ba f" IC 11.L1,CX. mil -A �/T N RE V// II. ype o(Building (check all that apply) Lot fe Subdivision Name Family Dwcllmg- Number of Bcorooms — Blocks i ❑ Public/Commercial - Describe Use ❑ City of C1 State Ovned-Desmbe Use CSM Number ❑ V'dlage of I 2No gcr-c p6irttl of 111. Type of Permit: (Check only one box on line A. Complete line B ifapplimble) A Ivew System C Replacement System L TreatmenUHoldmg Tank Replacement Only Omer Modification m Ewstmg System (-plan) B. ❑ Pe[mrl Renewal rl Perrmt Revision L` I Charigr of Plumber 1 � Permit Traolm m New Lin Previous Permit Number and Date Issucd Before Expiration I Owns ' fV. Type of POW'TS Svstem/Com onendDevice: Check all that 1 Q r - I] Noo-Pressiutud In -Ground O Nessunred In -Ground ❑ zu-c de > 24 m of suable soil Mound <24 on of sonaoie sod ] Holding Tank f' Otba Dispersal Component (expl a)_ ❑ Petnetripeta Devir< (explan) Dis rsal(freatment Arm Information: OV $ ur 9051 FV. Dtstgo Flow (gpd) Dail Soil Applicati Rate(gpd5f) Dispersal Atea Req (gt) I Dispersal A.tea o ($f) ystem Elevanon� VL Tank Info Capacity in Total A of Manufacnaer-- Gallon Gallons Units t��---I iA-, ' E S •'_+ u Now Turks x`.'e,^g Tasks • _ a- Sepdc a Holding Talc _ . Detour Camber { _ • VII. Responsibility Staten t- 1, the and time responsibility for installation of the POWTS shown oa the attached pans. Plumber's Nmnc (Print) he's Sipiaturo tviP/MPRS .*Tombs Business Phone Nton Plumber's Adircss (Strx4 Coy: Stain, L CA ) 2 VIIf. onotv/DeDrtment Us Only Approved C Disapproved Pcnu itt FFv, D1.a�re -tied Issuing Agem S��}ayne S O� Z l I { D Owner Givm Reason for Denial W / • L%/�/lr/-- IX Conditions of A roviMeasons for Disapproval — — PP 3)rNo GVf7pP SYSTEM OWNERS 'f,4J tl L� b f . .cyoc, man eniueni n¢er and vt.n.Vt a t{ . dispersal cell must be serviced / maintained ✓ as per management plan provided by plumbe� � 1 (na-I-t'oNS rn !; �,,k d/�� ( 1-e I le r -Z � t 2 NII setback tern a nts must be as per applicable c68t%rc n�a §i i`- °F e 6 sobmrc e M County only w pa not o Wn 8 in r 11 e '6�c4 &Jrf-ApP(^ra;7t-- SBD-6399(A I1/11) S�.1NS 1�a �ltr Wt �'� �✓'ovidf S S �N^ n'lkrn I�ty,�f2c{ p / n� rL/ nf-orNo(41o,, Tv r•��P / Bwl�f- System PLOT PLAN PROJECT Joe Hoheisei ADDRESS 1014 159th Ave New Richmond Wi 54017 NW 114 NE 114s 21 /T 31 N/R 16 W TOWN CYlon COUNTY ST. CROIX SYSTEM ELEVATION 99.7' DATE 3/11/21 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone IL BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION too' Filter Lifetime ❑ BOREHOLE O WELL *H.R.P. same as benchmark 210th Ave 0' 40, 80, i I I {'COPY Grading is to be done to divert run-off away from system ell is to meet all WDNR setbacks Huffcutt Combo Tank M B-1 98.7' 98.5' M Pro 3 Bedroom 350' House i^JJ4- .M.* B-3 _1*_ , 2% $lope Area 15' below system is to remain undisturbed 1320' Property Line DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http I/dsps wi.gov/programs/industry-services www wisconsin gov Tony Evers - Governor Dawn Crim -Secretary March 25, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-03-25 Plan Review: PWTS-032100380-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Joe Hoheisel 210th Ave Town of CYLON St. Croix County Total Amount: $250.00 FOR: Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/Ol, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) Description: 450 GPD (3 Bedrooms — Neiv 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, stats The following conditions shall be met during construction or installation and prior to occupancy or use • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drams discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be property 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 [lie 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 38230 ( I I)(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 fragments, tree roots, stumps and boulders reduce the amount of soil ai ailable for proper treatment If no other site is uvailible, trees in the banal area of the mound must be cut off at gumnd level A larger fill area i, necessary when any of the above conditions are encountered, to provide sufficient infiltrative areal 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 receiv e 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 die 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 municipahty shall be obtained prior to commencement of constru c non/i nstal I ati on/operati on. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions anse 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 budding, 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, J /� POWI'S Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email. tim.canderleestawisconsin.eov Cell. 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/11 /21 Owner:Joe Hoheisel Location: NW1/4 NE1/4 S21 T31 N,R16W 210th Ave Cylon Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications and cross section 8-9. Maintance and contingency plan Attachments: soil nst Shaun Bird vx- Signatu License nufuber 226900 Page 1 of 9 PROJECT Joe Hohelsel NW 1/4 NE 1/4s 21 System PLOT PLAN ADDRESS 1014 159th Ave New Richmond Wi 54017 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX SYSTEM ELEVATION 99.7 3/11/21 BEDROOM 3 DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND XXX SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone IL BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL sH.R.P. Same as benchmark 210th Ave 0' 40' 80' I � I ell is to meet all WDNR setbacks Pro 3 Bedroom House Huffcutt Combo Tank Grading is to be done to divert run-off away from system M B-1 m 98.7' 98.5' M./ B-3 y 2% Slope Area 15' below system is to remain undisturbed MI, M 350' 1320' Property Mound System Cross Section and Plan View t-..-----,---------- ---------------------- i — -1 = Topsoil L - J Cap Material Geotextile Fabric =ASTM C-33 LLLJ sand fill 9 / / Ft Contour G = Clean aggregate r, '/2 to 2 '/n in. dia. Slope Direction F A O= 4 in. sch. 40 pvc observation pipe a ( 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 V) 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 '/a inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page -�2— of Pressure Lateral Layout Two Laterals — End Manifold Manifold I Force Main 0 I Force Main Diameter I i 03/05 lgj of Threaded Cleanout Lateral Turn -up —i Plug M X L T Long l Sweep 90 Bend In. In. In. In. Ft. Ft. 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 A- of __ J_ 11 Septic -Dose 'dank Cross Section And Pump Performance Specifications Outlet Manhole Min. 4" Above Grade With Looking Device. Inlet Manhole < 6" Below Grade sealed Watertight Finished Grade Outlet Filter Inlet Imo ---Inlet Baff le Switch s and Reserve capacity Tank Volume o GPI Dimension. Inches Volume Gal. (reserve) A- 2 (alarm) B 2 (dose)mil () D Total Total Dynamic Head (TDH) - Feet Elevation Head ! Distal Pressure p Network Loss Force Main Loss l Total Manhole Min. 4" Above Grade Securely Mounted With Locking Device Weadta1roof )unction sox Vent Min. de )ff� DiMeans Above Grade Means with vow cap GENERAL INSTALLATION: The septic/dose tank is bedded and beck filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by rho manufaetarer may not be exceeded without prior approval. Manhole covers exposed to Bade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sjwved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Eketrical servi ties with NEC 300 and Comm 16.23. Page 02/051 J �_ of • NEW! Cast Iron Submersible a v Effluent/Sump ± :` Pumps "..."=° 3/4 hp 1- i/2" Discharge 3/4"Solids Handling t A Liberty's unique, one-piece >- "Uni-Body" casting Quick -disconnect 10' standard power cord allows replacement of cord in seconds without breaking _. seals to motor (other lengths available) Permanently lubricated upper and lower bearings Oil -filled, hermetically sealed motors with thermal overload protection Stainless steel, removable bottom screen Stainless steel rotor shaft Stainless steel fasteners ' " - 115 V. Models: 290 Manual 291 Wide -Angle Float with Quick Disconnect ti> 293 Wide -Angle Float, Series Plug 297 VMF, vertical magnetic float for heavy-duty sump pump applications I YearWarranty 48-230 V Models: 290HV Manual 291 HV Wide -Angle Float with Quick Disconnect 293HV Wide -Angle Float, Series Plug 297HV Vertical Magnetic Float (VMF) Switch 1.1Wide-Angle Floats are mercury -free, no � mechanically activated UU IIIIIS U 0 290=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 perfonnanci All Models Feature: • Semi -Open impeller permitting passage of solids up to''/." 157.1 • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • I%" Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature: 140` F. • 290-Series Cord Lengths Model 10' 251(-2) 35'(-3) 501(-5) 290 Standard Optional Optional Optional 291 Standard Optional Optional Optional 293 Standard Optional Optional N/A 297 Standard Optional WA N/A 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 Dimensional Data: I LQ Weight: 31 lbs. Height:13'. Major Width: 10" (model 297) 1e 12 C-PM 62-6 S � 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. ML Model 290 Model 291 Model 293 Ino anual, Wide angle Wide angle switch float switch float switch with quick- with series disconnect (piggy -back) plug PVA i! lCoa fpus Certified Specifications are subject to charge without notice. Model 297 VMF-Series Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty pumps • 7000 Apple 7iee Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com Copyright 0 Liberty Pumps, Inc. 2011 All rights reserved. LLIT 6681 R09/11 280-SERIES 112 hp Submersible Effluent(Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require high head or more flow. Designed around Liberty s uniq "Uni•Body" casting, the 280-Series will provide years liable performance. All Models Feature; " Vortex style impeller permitting passage solids up to %" • 416 stainless steel rotor shaft " Permanently lubricated upper and lower ball g • Epoxy powder coat finish • All fasteners -corrosion-resistant stainless steel " 1 y:" Discharge " Stainless steel bottom screen -easily removable • Maximum fluid temperature:140• F. 280-Series Cord Lengths Model 10, 25'(-2) 35'( 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 lengths, add "-2, 3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications V2 hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor &0 amps (115V) 4.0 amps (208/230V) //n//�\////Fin///////■//// , ■■///r,//r/////n /////////►�/ ,/// 38 78 rs Min 192 21 Liters Per Minute 'tensional Data: I 291bs. ht: " v W :10" (model 287) limu ump Diameters; Model 281, 283.j1 Model 287 VMF... Factory switch Atel 281, 283 Model 287 settings VMF Tum on level 3" 9.5" Tum off level 4.0" The Model 283 features a fully adj igle float. Differential adlustnerltscan bemade easily by thefbattothedis- chargepipeorofhernwxarUngpoint.v model 287 is not adjustable. Model 280 Model 281 Model 283 7 Manual, Wide angle Wide angleetr no switch float switch float switch Vertical mag- with quick- with series netic float for disconnect (piggy -back) sinallerpits- plug will operate in a 10" diameter sump C us Certified Liberty pumps . 7000 Apple Tree Avenue " Bergen, New York 14416 " Phone 800-543-2550 Fax (683) 494-1839 www:llbertypumps.com Copyxiaht6Ub"Punp",IW-2e17 0� MVft re""rved. 111T 2000 tW5/17 I i1 InJ".((tl POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —of FILEINFORMATION owner U v Permit � I, DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Number of Commercial Units 7b NA Estimated now (average) gaVday Design flow (pgak), (Estimated x 1.5) aV Sot Application Rate • l] gal/da Influent(Effluent Quality Monthly average' Fats, Off & Grease (FOG) S30 mg/L Biochemical Oxygen Demand (BOD6) 5=o mg/L Total Suspended Solids (TSS) 5150 mcfL Pretreated Effluent Quality Z�,4A Monthly average" Biochemical Oxygen Demand (BODS) S30 mg/L Total Suspended Solids (fSS) <0 mg/L Fecal Coliform (geometric mean) s10' cfuftroml Maximum Effluent Particle Size a inch diameter MAINTENANCE SCHEDULE • Vakms typical rdr domestic (�rdaq reasto mar end sepec tank effluent Values typical forpretrested w sterater. Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (g) of tank volume Inspect dispersal cell(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Clean effluent fitter At least once every / ❑ months ar(s) Inspect pump, pump controls & alarm At least once every _2❑ months earls) O NA Flush lat9rals and pressure test At least once every ❑ months ear(s) O NA w. ' At least once every O months O year(s) NA aver. IAt least once every ❑ months ❑ year(s) 5NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certlficatlons: Master Plumber, Master Plumber RestriOW Sewer, POWTS inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or pending 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 pending of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires the Immediate mbfication of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (,) 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 pressurized POWTS components, pretreatfinent components, and any other maintenance or monitoring at irtervals of 12 months or less shalt be performed by a oertifk0d POWTS Mafntalner. A servkill 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). It high concegtrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page __ of — START UP AND OPERATION For new construction, prior to use of the POWTS Check freatoterd tank($) for the presence of palming products a other ctlefnlcels thr{t may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use, System start up shall not occur when soil conditlons arc frozen at the Infiltrative surface, During power outages pump tanks may fill above normal hlghwater levels. When power Is restored the excess wastewater will be discharged to the dispersal ceh(s) In one large dose, overload rig the cell(a) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septege Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Maintalner to assist In manually operating the pump controls to restore Twrmal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade Boll absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the Me of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs: degreasere; dental floss; diapers; diatnfactar fa; fat; foundation dr n (sump pump) water, fruit and vegetable peefings; gasoline; grease; herbicides; meat aaapa; medications; al; P"ng Prod• pesdddes; santary napkins; tampons. and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safety abandoned In compliance Win chapter Comm 83.33, Wisconsin Administrative Code: • Ail piping to tanks and pica shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servk:ing Operator. a Aker pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or mast be taken, to provide a code oomplikfnt replacement system; El A suitable replacement area has been evaluated and may be trtiltred for the location of a replacement soli absorption systlm. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by re9uiried setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area vAl result In the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comofy with the ruler. in effect at that time. ❑ A suitable replacement area Is not available due to setback and/or soli limitations. Barring advances In POWTS technology a holding tank may be Installed as a last resod to replace the failed PORTS. _The has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a sou and site evaluation be performed to locate a suitable replacement area. if na replacement area 'a available a holding tank may be Installed as --//a last resort to replace the failed POWTS. ound end at -grade loll absorption systems may be reconstructed in place following removal of the blomet at the )nf4Rrative rface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name k Name /tQ� /�fw Phone �,� Phone �%/v ^a•' r��, fj 8EP Neme SERVICIN G OPERATOR PER LOCALName 6ULATORY LS%`/ AUTHORITY Phone /j/—A S�(,.i Phone This document was naffed In kwrnpllance win chapter SPS 3e3.22(2)(b)(1)(d),(1i and 383,e4(1), (2) 8 (3), Wleobnsxn AdminiMroawM Cod•. 20140048A Ell SECTION A -A ®'HUFFCUTT' 1,000 6g11`100 i TANK L 2' HII FORME OUTLET SIDE EL (TANK BASE, TOP, ENTILATION. 1s. oPnoNa s R anw w TUM 10 own MMN1 ➢If DDT a ITS MY s ST CRo TY. SANITARY SYSTEM File#`__ Office Use Only OWNERSHIP/ADDRESS FORM Canted 212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. Owner/Buyer Mailing Addn City/State/ZiF Phone Number (required) Email Address (required) n at f° ) Parcel Identification NumbeO d b (found on the property tax bill) Property Location/< ,1 u -^, Sect-1 J TN �W, Town of —Y Subdivision Plat —.Lot tr;'. Certified Survey Map # /� Volume Page # Warranty Deed # />' �c p dl (before 2006)Volume Page # Number of bedrooms Spec house ❑ yes o Lot lines identiflabI94yes O no New Property Address G 4--1 / G- I (./ / j-7 rl VC/ (Verification of new address required from Community Development Department for new [onstm tion-) -Z `r 1 G 1 2— / (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is mode in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cddQsccwi.aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwiaov mimmAmi- I EYT Ll VATION 10-I'a REPR ELEVATION I/& FRONT ELEVATION Il4' <+b 4'O POVRCD CONE FOVNDATION /B'CEIDNG®MAIN IPVEL FOR BIDDING ONLY NOT FOR CONSTRUCTION I #1�249 FOR BIDDING ONLY NOT FOR CONSTRUCTION m s �m FOR BIDDING ONLY E CONSTRUCTION �3 - a o • :i na ,�6 u oi — —Ror ^a I oI ti- �___ _ i of �• o. s a � 41 .a o V�__ ---------- , I i i � I I MAIN tfVEL — 0-I HB'CE1lING MUN INEL a C1 vy§ ,v a 0 �^ p RD f PLAN 1/4-- F-0 FOR BIDDING ONLY NOT FOK CONSTRUCTION civ q ,, 14 19, Wisconsin Department of Canmerce Division of Safety and Build)xfs 1 o 5 2021. Csfi -,)Oa / — 031 'LAI" SOIL EVALUATIOEPORT Page _ of in accoroani a win wmm co, vvrs ham woe Attach complete site plan on paper not less than B 11 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal ref nce point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road Please print all information. / Pa l mfortnW an You Wadused for may be ufor aawndary Purposes (Privacy low, a 15 06 (11 S /i Cow+b J t r� Parcel 1.0 v // R viewed by Date 441t +1`fl-�_ y zl Property Owner J r'1 S Property Location 11� , f - Govl. Lot 1/4 /�114 S Z l T I N R E( w Property owner's Mailing Address I c 1/ / SQL Lot # Block # Subd. Name or CSM# o City ?'L fate Zip Code Phone Number ❑ city ❑ Village Town Nearest Road Construction Use esrdential / Number of bedrooms �_ Code derived design flow rate YSV GPO Replacement , ❑ Pubfic ocanGrtIerdaf- Desorbe: p� grial ,�Str;tS Flood Plan elevation if applicable A-�' General comments and recommerdationys::� System Type //! O c!'r - System Elevation T )S kD I 9orvg # ❑7 - Pik Ground surface elev. �r r E. Depth to Wilting factor .1k in. Sod ApplicationRate Horizon Depth in. Domlrlant Color Munsel Redox Desorption Ou. Sz. Cont. Color Texture Stnxxlae Gr. Sz. Sh. Constance Boundary Roots GPDM 'Ef#it 'ES#2 12 Baring # ❑ Boring @, pit Ground surface elev. R. Depth to limiting fa rT th. Sod itatial RffiB Horizon Depth in. Dominant Color Munsed Redox Description ou. Sz. Cont. Color Texture Strlx kxe Gr. Sz. Sh. Consistence Boundary Roots GPDRF 'Eff#1 'Eff#2 Z . � �— � ' . � it /' ,>-�J • rye 3 - '- , F_ E11uent #1 a BOD. > 30 < 220 frSrL and TSS >30 < 150 ' Effluent #2 - BOD. < :w MWL and I a�i < M MWL CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017715-246-4516 1 Parcel ID At Page —of 3 Boring # ❑ Boring ( i �— Pit Ground surface elev. ' l ft Depth to amitirg factor Sol Application Rate Horizon Depth in. Dominant Coicr Munsell Redox Description Qu. Sz Cont. Color Texture Structure Gr. Sz Sh Consistence Boundary Roots GPDMF 'Eff#1 'Eff#2 -� 3l z I i ®f ®�®©© Effluent #1 = BOO, > 30 � 220 mg4 and TSS >30! 150 mg& ' Event #2 - BOD, < 30 mg& and TSS 130 mg1L 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. Moon" O�j Prop" Owner Parcel ID l' Papa _o( ENM ' MAN #1 aSODr> 3o_220 rrg1 and TSS>3011W";t *Mani 02- BOD._30 n9t" TS5130 mpiL The Department of Commerce is an equal opportunity service provider sad employer. If you need auiusnce to access services or need material In as alternate format please contset the department at 608-266-315I or TTY 608-264-8777. ' MAN #1 aSODr> 3o_220 rrg1 and TSS>3011W";t *Mani 02- BOD._30 n9t" TS5130 mpiL The Department of Commerce is an equal opportunity service provider sad employer. If you need auiusnce to access services or need material In as alternate format please contset the department at 608-266-315I or TTY 608-264-8777. Soil Test Plot Project Name Joe Hoheisel Address 1014 159th Ave New Richmond Wi 54017 Lot --- Subdivision ------ NW 1/4 NE 1/4S 21 T 31 N/R16 W ❑ Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft. Bird CSTM #226900 2/4/21 Township Cylon County ST. CROIX Top of 3/4" pipe System Elevation TBD *HRpSame as Benchmark 210th Ave 3 - & duo r.-S SA. CPo: x COUNTY NO. 631292 STATE SANITARY PERMIT 2zY9 z�a+F � PSdiG✓� OWNERSO S Cp A;I CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. �) PLUMBERS in $� LIC. # Z O (b) The approval of the sanitary permit is based on regulations ce on date ofapproval. in forThe sanitary is val. (c) The sanitary permit is valid and maybe renewed for a specified period. TOWN OF O Changed regulations will not impair the validity of a sRpermit sanitary �1 SECE� N' R G 7l (e) Renewal of the sanitary permit will be based on regulations re force at the time renewal is sought, and that changed regulations may impede renewal. ' AND/OR LO BLOCQKTT (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 1/D T— TCT SUBDIVISION BDIVISION wish to c renew the permit, or transfer ownership of Note: If permit, the permit, please contact the county authority. AUTHORIZED ISSUING OFFICER - DATE / N THIS PERMIT EXPIRES 4 UNLESS RENEWED BEFORE THAT DATE it POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R. 10/11)