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HomeMy WebLinkAbout018-1012-50-100AIsconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 631298 State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 I l Vau] Permit Holder's Name City Village Township PamelTo. No Roper & June Lindquist Family Limited I TOWN OF HAMMOND 0 CST BM Elev map BM Elev BM De cr eon W I Lent SechonlTowniRangelMap No O[7 r- 06.29.17.WA TANK INFORMATION `-I ELEVATION DATA II. TYPE MANUFACTURE %r'ems 7" CAPACITY Septic t .� I r 34-} / Dosing b0 r L We f nALe Holding TANK SETBACK INFORMATION LOG �5 -�- ("Ih 5 % TANK TO PlL Al I WELL BLDG vent to Air Intake ROAD Septic > ZS 1 % -3 1 t Dosing 7 ZJ q J/ r � J -�7 / L t Aeration Holding PUMP/SIPHON INFORMATION #1 v5) Pe li II 140 Manufacturer Demand Z- y GPIA Model Number _ 5a Z 80 / TDH Lift, Friction Loss _ System He TDN� �Ft /i ca D l Forcemam Len3t��, Dial n Dist to Well G SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV Benchmark Alt By, to �7 (OG 5 Bldg Sewer / ' D (p /o 5 S UHt Inlet 8•7 /oz.3 St1H1 Outlet Dt Inlet Of Bottom Header/Man C• I Dist Pipe Bot System S.8 2- Final Grade St Drr I ✓ y. 5 /oG , s L OVl �✓r ( ���. / BED/TRENCH DIMENSIONS Width 8 Length ♦ J ! 5—:7 Ne# rims 'Z Imo )- r` 'rc PIT DIMENSIONS No Of Pds Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO PIL BLDIG WELLI LAKE'ST AM LEACHI CHAMBE UNI G OR nufactur Type f System �) l 6 i lD r N� Model Num er UIJ 1 KI13U I III SYSTEM HeaderlMan�ifoid 1 a Distribution t f a f Pipets) � �� x Hole Size 2 is / x Hole Spacmrp V it Au Intake Length Dia Length DSpacing ia 7 h v� e JUIL UUVLK x Pressure Systems Only xx Mound Or At -Grads Systems ONv yam' P/. DaptlrEroer-- it Beal en F CyenterF I3 epth Over Bed,Trench �� xx Depth o zx Seeded,Sodd d xx Mulched } rl L .� I Edges Topsoil h•N Yes L No '� Yes E] No COMMENTS: (Include code discrepencies, persons present etc) Inspection #1 Plow �i/-%j vInspection #2 Location: No Address Available I 9• Qn 1) Alt BM Description = ff e.'C "V4-1 Aip.�� 2.) Bldg sewer length =fps - amount of cover ='> 412 " Plan revision Required? _ Yes iNo -7I Use other side for additional informati _ ��2�_L _ SBD-67111 (R 3/e]) Date Insepctor's Signature Can No _ _ _ t rr j I, , -doh -676 (� Comrtyy< / T Safety and Buildings Division �•(/,7 x• 201 W. Washington Ave.. P.0 Box 7162 rSamtan Penna Numbe (to be rued ui by Co) Madiso WI 53707-7162 !, r ro.. ) B Ar1 llz� S � ran58Ctlw Number // In accordance with $PS $ii�zT- u. Adm Code, subawsimt of this foam Ito appropnate cow taut a required ptior to Xttaming a saoRary permit. Note .Appbcainou forms for state-owrsed A S are submitted m Piolea Address ftf dr6acat rustling address) the Departmem of Safety and Professional Service Pers_mal infonnatioe you provide ay be used for SeCn dory purposes in accords with the Pnvaq Law, S. 15.0411 xml, Stun _ "LL /bQ \ 1 L Application Information - Please Print All Information 1p ..JJ Property owna's Name Parcel a _ O ( —) O I Z �//%7 / 1 I / /, i c/ N l ill° C�/ r � _ _ _ i Property Ow s Mailing Address ` Property Lownon 5 Z us ` Av 4/ d` I fin l City, S - n ( ' Gip ,. Phone Ntmrber / 1/4 Secnon �.fjncic T�N; R1._1_ E W . Type ai fly Dwelling (check all that a i.ot� / 2 Famdy Dwelling-Nwpber of \1 / f Subdinson Name S{. Blnckn � II PublidCommercial-Descnbe L-u /--�- i❑ Cin of El State Owned - Destzibe Use CSM Number Y.3( b Village of -ZITown of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 1 A. T- lvew System ❑ Replacement System 13 Treaunent/Holding Tank Replac nmt Oniv 11 n Other Modification w Existing System (exp:am) B. C Permit Renewal 10 Perrmt R,,mion ❑ Cbnec of Plumber Permit T.arsfer w New Lin Pnntous Permn Number and Dust issued Before Expiration I Owner IV. Type of PORTS Sys tem/Component/Device: (Check all that apply)— J Non -Press rivsd In -Ground 11 Pressurized In -Ground ❑ Ai -Cm& '+fond > 24 in of MIMIC soil D Mound 124 in of suitmie wil Holding Tank El Other' Dispersal Component 45 1 / F.Renrarnrnt Device (explain) V. Dis rsal/Treatment Area Information: - Design Row (gpd) I Desgn d Appbcanon Rase(.Spdst) Dispersal Atra Reqw (sfr TDispersal Aces opus (s1) System Ele anion SY I' S di a 2.A N'L Tank Info Capacity m Crallous S 1 Total a of Mavufa 11 Gallons Units r!'.'LlM ` 1 ••• New Taaks ";a^a Taub - to __ u b' m _ s V i7: = v Sepx or Holding.. TankD`CJC/ vg 6 I VII. Responsibility Statem - I, the undersigned, a responsibility for installation of the PORTS shown on the attached pians Plimpa's Name (Riot) C Pl= s ignaturc MPAV Number Business Phone N bcr e �22� � � .j Phrm 's Address (Street, Ciry, State, Zip Code VID. OUR apartment Use Only Ipf Approved [, d /i I Permn �F-/e7-e-�... S �' tDlate Iss/u/cd sin e_ .4grnt; ignarmy , '•�%'lf -V��•� 7 rveo eon for Denial " / DG Conditionsm"�-- EM OWNER: .�'`�i ��r w ptic tank, effluent Alter and— i ersal cell must be served I maintained per management plan provided by plumber. I ,..-/- �•�'� f!�y� — p rd>Y�eQQ S• WLc+-c✓L4lwvce f ----- as per applicable code/ord e."�°i"Gp�r°"h`�`"`m t� 'Y"_r°t_ u°ry °°w °°tl�stwn ti b. r SBD-6398(R I1111) 5�T V I I& s System PLOT PLAN PROJECT Roaer Lindouist Trust ADDRESS 1652 Us Hiahwav 12 Hammond Wi 54015 NE 1/4 SE 1/4S 6 /T 29 N/R 17 w TOwly Hammond COUNTY ST. CROIX SYSTEM ELEVATION 105.5' 3/11/21 BEDROOM 3 DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TALK SIZE DOSE TANK SIZE 630 LDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone �, ENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑WELL +H.R.P: same as benChmatk BOREHOLE O 300' Property Line OA� Scale = 1/4" = 10' ".' 0, 4I 80, Grading is to be done to divert run-off away from system 66 Io I tto v5c. 160th St. Z D 1 Area 15' below system is to remain 103' undisturbed 104' 60/ Slope 104.5' B-2 I-2 ' rg Well is to meet all WDNR setbacks Cc A- B-3 M_ .rr Property Line March 29, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-03-29 Plan Review: PWTS-032100394-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Roger Lindquist Trust Lot 1 I60th st. Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http Udsps wi govlprograms/industry-services wwwmisconsin gov Tony Evers - Governor Dawn Crim - Secretary 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 10112) Description: 450 GPD (3 Bedroorrrs— Very 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 I01.01(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 poor 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 capacnv of the sod. Proper sod 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 38230 (11)(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 TDII and GPM Specifications. • Areas that are occupied with rock iiagmcuts, tree root,, stumps and boulders reduce the amount of suit available for proper treatment If no other ,ac is available, trees in the basal area of the mound must be cut off at ground level A larger hill area is necessary %hen any of the abut c tondmons are encountered, to provide sal liuent infiltratry e 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 andior 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 c onstmcuon/instal tat inn/operation In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2). nothing in this review shall relieve the designer of the responsibility fur 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 U.i✓n 7/a�9oc�ees� POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: umvanderleestl,4:wtcconsun.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:Roger Lindquist Trust Location: NE1/4 SE1/4 S6 T29 N,R17W Lot 1 160th st. Hammond Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications and cross section 8-9. Maintance and Attachments: soil test Shaun Bird Signature_ License number Page 1 of 9 System PLOT PLAN PROJECT Roaer Lindauist Trust ADDRESS 1652 Us Hiahwav 12 Hammond Wi 54015 NE 1/4 SE 1/4S 6 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 105.5' 3/11/21 3 DATE BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK XXX 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE LDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 k of Chambersnone ,�`� ENCHMARK 5 V.R.P. Top of survey iron ASSUME ELEVATION too' Filter Lifetime ❑BOREHOLE O WELL •H.R.P, same as benchmark — 300' Property Line Area 15' below Scale = 1/4" = 10' system is to remain 103' undisturbed 01 L 4I g I 104 6% Slope 105' 104.5' B-2 Grading is to be done to divert run-off away from BB^3 system 7 Pro 3 Bedroom House Huffcutt Combo Tank 160th St. /?' D 4-I Well is to meet all WDNR setbacks 0 B-1 MHO Property Line Mound System Cross Secjion and Plan View _7 Dimension Feet A B D E F G x O 1 r8 J r..0_ K s3 L , (o W S z - Slo e ' - -I = Topsoil Ca Material = ASTM C-33 ® - Clean aggregate : = 4 in. sch. 40 pvc P sand /� to 2 /: in. dia. observation pipe lQ L�� Ft Contour Slope Direction �� 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 keepiag 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 seuted in place with rebar or a closet flange. 10/071gj page 3 of PressureLateral Layout Two Laterals — End Manifold Lateraf Tt)m-up Manifold I Force Main 9& 0(< Ft. In. Ft. M 4— Threaded t 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 tum-ups terminate with a threaded cleanout plug land are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. ••••• Grade •••••• 6-8 Inch Lawn Sprinkler Valve Box 03/65 lgi Septic -Dose Wank Cross Section And Pump performance Specifications Tank Filter Manufactaw ; / Filter Model Number i 7 Outlet Manhole Min. 4" Above Grade With Locking Dkee. Inlet Manhole < 6" Below Grade Sealed Watertight — — Finished Coach outlet Filter Inlet a met Baffle Switch and Reserve Capacity Tank Vohnne a Y_' GPI Dimension: Inches Volume Gal. (alarm) B; 2 3 D (dose) C (dead) D, Y Total . CYO {_711 UT 1 11=M1 1-I WARM I Wig _Fry q \• [q_ tr7i. ,Z � � � ; w7x" V, a Total Dynamic Head (TDH) - Feet Elevation Head v Distal Pna W= p Network ions Force Main Loss 7 Total Manhole Min. 4" Above Grade Mounted ' Locking �"� SecurelyWeather-proof Weatitenpmof Junction Box i Vent Min. 12" Disconnect Above Grade means With Vent Cap A. Weep B Hole Off Fjevation C Ft il Bottom D Elevation �^ Ft GENERAL INSTALLATION, The septic/dose tank is bedded and back filled in accordance with the manufacturer's product.a0proval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior 8pprovai. i Manhole coven exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outla is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sah. 40 PVC to bridge the tank excavation and the sleeve is sealed ight. Electrical//.servi lies wi@t NEC300 and Comm 16.24. 02/05 Ll Page J o 280-SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature: Vortex style impeller permitting passage of solids up to %" e 416 stainless steel rotor shaft e Permanently lubricated upper and lower ball bearing Epoxy powder coat finish e All fasteners - corrosion -resistant stainless steel e 1 %_" Discharge e Stainless steel bottom screen - easily removable • Maximum fluid temperature: 140'F. 280Series 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 %hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) %J Model 280 Manual, no switch 'JiL Model 281 Wide angle float switch with quick - disconnect S�3 c us Certified Performance Curve: 280-Series 40 :-r rrr 35 30 25 LL 20 D 15 = 10 1 . A •.� .1 ..I .. r U.S. Gallons Per Minute 0 36 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29 lbs. Height:13" Major Width: 1 0"(model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10" Factory switch Model 281, 283 Model 287 I settings VMF Tum on level 13" 9.5" Tum off level 7" 4.0" The Model 283 features a tuiy adjustable wide-angle Boat Differential adjustments can be made esslN try tethering the float to the dls- charge pipe or other mounting point. vertical float model 287 is not adjustable. ti Model 283 Wide angle float switch with series (piggy -back) plug V Model 287 VMFSertes Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty Pumps " 7000 Apple Tree Avenue " Bergen, New York 14416 " Phone 800-543-2550 Fax (885)494-1839 www.libertypumpsoom copyrgm o ubsny Purni k Ire 2017 Ali h"reserved. LUT 2OW R0617 OR 2014004aA i L :t7 SECTION A -A POWTS OWNER'S MANUAL & MANAGEMENT PLAN page�of_ FILEINFORMATION 'SYSTEM SPECIFICATIONS Owner (L� k n r IA -1 — Septic Tank CapacityVV gat NA Permit 0 l �` Septic Tank Manufacturer 1 NA • Vakros lyplcal far dameslic (non-odmrerdaq wastewater aM septic: lank erBuant !' Values typical fix preaeated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 1410months ar(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (g) of tank volume Inspect dispersal oell(s) At least once every D month ear(s) (Maximum # yrs.) Clean effluent fitter At least once every ❑ months earls) Inspect pump, pump controls & alarm At least once every �? ❑ months ear(s) ❑ NA Flush Iarals and pressure test At least once every ❑ months ear(s) ❑ NA °n At least once every 0 months ❑ year(s) bNA a W. At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or oertificetions: Master Plumber, Master Plumber Restrict@d Sewer, POWTS Inspector, POWTS Maintalner, Septage Servicing Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cake) 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 (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechinical or pressurized POWTS components, pretreatFment components, and any other maintenance or monitoring at iritervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servkp 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 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. t:3 or Pegs _ of ____, START UP AND OPERATION For now construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thElt may Impede the treatment process and/or damage the dispersal calls). If high concentrations are detected have the ooments of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frocen at the Infiltrative surface. During power outages pump tanks may 1111 above normal hlghwater levels. When power Is restored the excess wastewater will big discharged to the dispersal oell(s) in one large dose, overloading the oell(s) and may result in the backup or surfim discharge of affluent. To avoid this situation have the contents of 'the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntalner to assist In manually operating the pump cwhtrds to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, of otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption wee. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the We of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; dagressere; dental floes; diapers; disinfectants; fat foundation dreM (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting product's; pesticides; sanitary napkins; tampons; and water softener brine, ABANDONMENT When the POWTS falls and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is propetly and safety abandoned in compliance with chapter Comm 83.33, Wlsconsin Administrative Code: • All piping to tanks and pits 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 Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with stall, gravel or another inert solid materiel. CONTINOENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must he taken, to provide a code compllk►nt replacement system; ❑ A suitable replacement area has been evaluated and may be utllized for the location of a replacement $oil absorption system. The replacement area should be protected from disturbance IIand oompactbn and should not be infringed Upon by requited setbacks from wdating and proposer) structure, lot lines and wells. Failure to protect the replacement area will result In the naiad for a new soil and site 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 soli limitations. Baring advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. The site has not been evaluated to Identify a suitable replacement area. Upon tailure of the POWTS a adt and sib evaluation be performed to locate a suitable replacement area. If no replacement area ;s available a holding tank may be Installed as �` 1111 a last resort to replace the failed POWI-S. Mound and at -grade loll absorption systems may be reconstructed in place following removal of the biomot at the Infiftrelive urface. Reconstructions of such systems must comply with the rules In effect at that time. <MIARNING» SEPTIC, PUMP AND OTHER TREATMENTT TANKS MAY CONTAIN LETHAL BASSES 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 SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORITY Name TkN.-114i� 'f /p�� Name `. Phone [�.% dam: L—.-ll`/1 0 Phone This doasrorN was drafted In compliance wtth chapter SPe 383.22(2)(bx1)(d)a(niand 383.54(1), (2) a (3), Wlacasin Administrative Code. 17�X N'boorWl DeprtnleM of C w"= SOIL EVALUATION REPORT paged_ Dlvlalon dSsfety ww &idlnpa In so=denos wtth Caren 85 No Adm Code Mach complete Us plan on Paper not less dmn 812 x 11 trofrs in eta. Plan must Inckids, W not intiad to: ver6cal and hadaorar rstrenoe potrrt (SM), Aredlon end Percent *"- sale Or dlnbnNaN, north arrow. and location and distance to nearest road. Please Print NI Informewn. PererW aernWbnyou revidelneY tw uwd on eemndenr Pxixrr (Pussy Lew, e. 16.04 (1) W). County 1.14, Parcel I.D. Reviewed by Date Property Properly Locadon / GOA lot 114 114 S T� N R l � E( W s M�sWg 7 Lotfl Gbdc0 &led. or CSMa Cllyd Wage 2SZ6vA Nearest lda) �^ /Number dbedrooms Cods dwvad design flow rate v GPD o Radaoomenl ❑ PL"c or cormwdal • Describe: Parent material �J I^ Q� ^ Flood Plain elevation N appicable .Al )k R °"er'd°m ern sea 6 and nmrnrtd.6a,,: System Type 17%9 LLcfY System Elevation_ swing Pry Groundrrtece Nev. � IL Depth to l(mttlng factor 3Z_ In. Sap Awkellon Raft Nalmt Depth In. DaNnrtt Call Mvroel Redoc Description Qu. SL Cont. CObr Teudtae Struatra Gr. Sz Sh Corudstanoo Wunder, Root 'MI -E1802 u Borrva Boft O�Pft Grwnd arfau elw.�� l R Depth lo rNBrp frda In. Sap Awflowlim Ross Hcrlaort DWar in. Domhorm Color, Wool! Redac Deeaip w Qu. Sa. Cont. Color Toxkn Struck"Canatatencs Gr. SL Sh. 9oundery hods GPpNP 'Edtit 'EIfa2 7- 7-Ir M7, m ' Ellawd al a Wo.x 30< 220 ffQ& and TSS> _ mpt ' EBhmrt a2• 8615 30 mat and TSS a 3D mat CST Name (Please Print) atuto CST Number Bird Plumbing, Inc. Shaun Bird 225900 Add1B0e Date &v luatlon Conducted Telephone Number 1432 120th St, Now Richmond, WI 17 /Q~ P Zl� 715-246-4516 © Bor,ty 0 Parcel IOI �q pit Ground suface dev. u7l/ft. Depot to WT&p tacimy h page __ot- CrrY�a.v�'I ©®�� ■l•/mII/�7[m©_E]r, Olaf ' t1®l•� ©MI WA/7 rlim� MrLrA�m�m low !mm■■ ■■■■■r■�■�■■■■■. ' Mont #1-WD.>30<22Dmot G,dTSS>W1160WQ&•Emuent►2-BOD,_30nV&W4TSS<_30mdt. The Department of Commoroe is an equal opportunity service provider aced employer. If you need aairtaoce to tocess services or need material in an alternate format, please wntact the dcparUnent at 608-266-3151 or TN 608-264-8777. Soil Test PloYh Project Name Anthony Czerminger Bird Address 716 Sarah Ann AveRoberts Wi 54023 #26900 Lot 1 Subdivision 9/20 NE 1/4 SE 1/4S 6 T 29 N/R17 W Township Hammond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBI) *HRpSame as Benchmark File #: ST. CR llvr�a Y L SANITARY SYSTEM ire use only *OWNERSHIP/ADDRESS FORM Created2jla71 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. Mailing Address Parcel Identification Number (found on the property tax bilo Property Location NF t/a Subdivision Plat: Lott#�. Certified Survey Map # Volume ( Page* 4 d ? 6 Warranty Deed # _ tf (before 2006)Volume / ? > . Page #7. Number of bedrooms , ^? Spec house 04es O no Lot lines identifiable,4-yes O no New Property Address f f—T(o_ If &V U / %-1 --> (Verification of new address required from Community Development Department for new construction) �f g / 2 (Staff Im4als) (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 made in the warranty deed. Community Development Department— Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd0sccwiyov 1101 Carmichael Road, Hudson, W( 54016 www.sccwigo Tt SOUTH ELEVATION EAST ELEVATION WEST ELEVATION NORTH ELEVATION T ------------- f____________ i-1-nin,min my PFI DORM sTg mDAM pp „4ABIBR BED m n r v. l•-i"1"i •• ; iT..:� _ , ,............... mR 8 .. GAIA i Nruwer d � j i i .B xTM A - ___ --.e.A.. BORIf " me a iLS WC i r------ .- � mwrwBw - i I MAIN FLOOR PLAN �..,. FT erminger A-2 C s7 3 JCT 3 Q 2020 Wisconsin Department of CCCC0000��lli merce SO EVALUATION REP13RT Page _ of Division of Safety and Buich 5 _,: --- --Jrrr �m.r r'� f, m 85, wls. Adm Code _ County - Attach complete site plan on paper not less than 8 12 x 1' inches in size. Plan must �' include, bul not limited to vertical and honzontai reference point (SM), direction and Parcel I D. Y �, percent slope, scale or dimensions, north arrow, and location, and distance to nearest road Please print all information. Reviewed by Date Pw ! mfomubon you orovw may b used for secondary purposes (P,acy new : 1 s a (1) Im)I "operry ar _. ' S -� Property Location Govt Lot Nj� 114 1f4 S �/ T L N R � � E ( r) W 'mperty Owners Mailing ress Lot % Block # — Stibd. t1r CSM# 6 7 ,t c� Sly // State Zip/Code Phone Num�beerr O %/1.'. — Ira>; lsYo�3l6r�.)/,�iJ —�O-�� City �//(y�+ Village /`Y7i .ft ,nf ,.r4 Nearest Ro�add {. I 66v T•l�tS Construction Use esidenhal / Number of bedrooms Code denied design flow rate Z/>y GPD I❑Replacement ❑ Public or commerdai- Describe ____� _/___ Parent material -t Flood Plain elevation if applicable /�/ LF�d %� it Gerner��! comments and recomirrandatiottis; System Type zMo NIX Systern Elevation L�Z� 1 ❑ Boring �^n8 # VJ' Pit Ground surface alai. ft. Depth to writing factor 7 in. Soil Application Rate Horizon Depth in. Dominant Co4of Munseill Redox Descriptiion Qu. Sz. Cont. Color Taft" Structure Gr. Sz Sh. Consistence Boundary Roots GPQI •Eff#1 •Efr#2 0—I L Z 1L -19 '</4/ 3 p- 75 - •o .5c_/ P ® Baring # Pit Ground surface alai. 17 ( I ft. Depth to Itrnxting factor in. Sod Application Rate Flacon Depth in. Dominant Cola Munsell Redox Description Qu. Sz. Cont Color Texture Stnicture Gr. Sz Sh. Consistence Boundary Roots GPD/fF •Eff#1 -Eft#2 I O- i) - J rP +— • Eftient #1 = SOD. > 30 < 220 mg& and TSS >ZfVmg& • Effluent #2 = SOD, < 30 mg& and TSS < 30 mcWL CST Name (Please Print) - ature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54 17 /Q a11- 2-o 715-246-4516 ��P,,,;o—.p.,e€ rrN Owner Parcel ID # Pace _ of EO^' # Bonng f 1___ _,__ 1 12, d _. _._ __ - ra .,..,,......,... .......... - ....,,,..... _.... z ......... - Sol[ ApPlication Rate Horizon Depth in. Dommant Munse6 Redox Description Qu. Sz Cont- Color TezMe S6uchae Gr. Sz Sh. Consistence Boundary Roots GPD,1f -Eft#1 'Etf#2 i 0 0 �z ' s' ��� � IZ --7 /✓11� i � I I F-1 Boring U pit Ground surface elev, ft. Depth to hmrbN factor to Soi�Rate � Effluent #1 = SOD, > 30 1220 mg& and TSS >30 < 150 mgyl ' Effluent #2 = BOD, < 30 nV& and TSS < 30 mg4 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. saa-csssaumt Property Owner Parcel ID # Page —of _ Boring # F-I ring Ground surface elev. I. D3 , 3 R Depth to limiting factor v in. IJ� Sell Appitcatim Rate Horizon Depth in. Dominant Color Munseti Redox Description Ou. Sz. Cont Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots I GPDRF 'Eff#S I 'Eff#2 0 l& eS A 3 �to r ; . � 05 +c, O - 6 1., I ❑ Boring # Q Boring 0 Pit Ground surface elev. ft. Depth to fimiting factor in. ' Effluent #1 = BODs> 30 <220 mgfL and TSS >30 < 150 mg& . Effluent #2 = BODs < 30 mg& and TSS < 30 mgfL 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. ss 3m(- j Soil Test Plot Project Name Anthony Czerminger Address 716 Sarah Ann Ave Roberts Wi 54023 Lot 1 Subdivision NE 1/4 SE 1/4S 6 T 29 N/R17 W Boring (D Well PL Property Line BM or VRP Assume Elevation 100 ft. C o '5TM #226900 10/29/20 Township Hammond County ST. CROIX Top of survey iron System Elevation TBIJ *HRpSameasBenchmark Mom 3 - I5ed�) �• Mom COUNTY NO. 631298 STATE�SANIT�ARY PERMIT wo sr.nr LLJiRA1iSFPWBPNEM'AL PRE\'IOGVV),. OWNER It 414Y jJ04QA1%Trjt�f• f PLUMBERS Ill TOWN OF SEC_(g:,, T Z' AND/OR LOT V. 3I�P. �g96 LOT_, PA 1 Q6 LIC. # 22A DO AI 1 N, R__Ll_ BLOCK �- THIS PERMIT EXPIRES SUBDIVISION CHAPTER 145.I35 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. AUTHORIZED ISSUING OFFICER - DATE UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R. 10/11 ) (Sm-as-6go Certified Survey Map Roger and June Lindquist Family Limited Partnership Part of the Northeast of the Southeast Y of Section 6, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. C.S.M", VoL 2, Page 320, Doc" No_336298 S 00'0423'W2636.43'R(Southt , m Ir n n S0°0423300.00' R(south)0W ELIneSE 114 4(;n , N 00°0423"E 300.00' LLLL N 00"0423"E MOM' Unplffited Lands � o y a P M 3 N 0 h o C o c m � J �3a o w� a y �I Owner's Address: 1652 U.S Highway "12" Hammond, WI 54015 C OmSmNr ovv02 020 Ir[ y m m m a d o a o m m 4 C j i O o O a 2LL '\va Qy N Z b wb. QE Inc �r U N y O `O M beatings referenced to the East line of the Southeast Y of Sec. 6, T 29 N, R 17 W. assumed S 00'04'23"W Dated: October24, 2020 Sheet 1 of 2 Sheets