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HomeMy WebLinkAbout018-2022-08-000Wisconsin 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)j Permit Holder's Name I City Village Township Oevering Homes CST BM Elev IaD.a' TANK INFORMATION ofl. I I C—�. TYPE MANUFACTURER CAPACITY Septic 800 Oa Dosing :r? W Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic 3S r Dosing tr It Ir .n.Z2/ iT y� Aeration Holding PUMPISIPHON INFORMATION /.1�I .. e. t Number 2 It Iwet to SOIL A N ,n.-k OFHAMMOND ELEVATION DATA STATION BS HI FS ELEV Benchmark .zp ii I ,Zr. r s0.0 Alt BM Bldg Sewer lXJ- SUHt Inlet j5-- z Wvr St/l Outlet Dt inlet Dt Bottom Zp 12 ki 6 D Header/Mall 1,06 Dist Pipe �ZIZ� / , Bot System � 5 � Final Grade w%l� 6a lZrr Ss: %me.,r - 04 St Cover olxr ` rl6 9f�o NO DIMENSIONS Width I I Length r 1�1 (V No Trerjche �1 Imo,.,. f/ (•BLDG�v —`LL PIT DIMENSIONS No Of Pits Inside Di iqui SETBACK INFORMATION SYSTEM TO P!L LAKEISTREAM LEAC IN CHAMB OR U IT Manufacwrer T e 1 stem P / 6� Model Number UIJIKItSUIIUIV JY` M 61lflr> Heatler' rf Dlseisubo p O 2,.0 x Hole Sae L! 3� x Hale Spacing r Vent to Air Intake -sn9 h Ole Length Dia Spacing I� 2 , SOIL COVER x Pressure Systems only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded n Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes _'. No C Yes � ME TS`^(inctu code tliscre�pencQies persons presentWetc�) Inspection #1 ��L ` InsFpecttiionn{/##2 co 1.) AltBMDescription=C,�a t 1M.R�NJW� Cow r �Y-ay„v,�„ 2.) Bldg sewer length = 15-1 l5✓ u .� -amount of cover = > Plan revision Regmred7 rm on ?_ y ' 1 Use other side for additional information JrfV/��1 ��{}�--^"ttl�"t'�� � 6710 (R 3/97) D to Inseptlor's Sgnature Can No 'bas eve- & 646- k A T . - c a;,-il dl � � x �eLU; 6 -o' r � sow ouv t� k� - t,� r.L[vl e_ / co h14,;r-� 10 5;gw aqa SYST 1. Se d!s as 2 All n `County Safety and Buildings Divisbn � 201 W.'Vilashington Ave., P.O. BHX 7162 SanaarcPermit Number (m be fined in by C $ APR 2 9 2021 Madison, WI 5370 7162 63334� - Sanitary P=itApplication Sai`T�oaNambG in accordsom aids SPS 39321(2), Wis Adm. Code, submissim of this form no the appropriate governmental um �Q�(� lb / 7 is required prior to obmuimg a sanitary perm¢. Note .4pPticalion forms for stateown Project Address (d differem th® mailing ad the Department of Safety and Professional Stavim Personal information you provide may be used for secondary' �,/ purposes in areordance with the Privacy Laws. lym), Sods. i ....a.. ♦....c..ti,.,.r.f_Pl.aca ➢riot All 111 lnfnrmaHnn ( 1] Property' Owner's Nana I Parcel++ nea,, ..�^ nl� 0Ig_aoaa_og-o� Property [Ow7ner`sZffi1mg.4ddre55 Propcm I.ocazton /`I 7 ✓ �7 �- C / / Govt Lot City, State ,/� Zip Code Phone Nimiba (f% ;4.�4 Section (y(/ i / AIL/Type of BnOdi¢g (c eck ell that apply) Lot N 7 N. R- J�{.ol_2 Family Dwelling -Number of Bcc Subdivision Namc IY Q. ock'A �� J -CCr� PublicJCom rercial-Describe Use �. J ciq of 1-1 n. I'faLTown of 4 /lLlELL/� HL Typeof Permit (Check only one box on line A. Complete line B if applicable) A D Replacement Syst® _, TreammenUHolding Tank Replacement Only Otheir Moditira,on to Dastiag System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber E) Permit Transfer t New List Previous Permn Number and Date Lssued Befm Expiration Owaer —, [V. T of POWTS S stem/Com onent/Device;' (Ch$gk all that apply) C) Non-Presaiiii In -Ground F0 Pressurized In -Goon " E: Mound > 24 W. of suitable soil Mound < 24 in. of suitable soil f ❑ Holdmg Tmk ❑ Otba Dispersal Component (cxplam) D Pretrrmmrnt Device (explain) _ V. Dis rsaVTreatment Area Information: Design Flow (gpd) Desip Soil ncatiw Rate(gpdsfj D al Requved !rri Dspe sal .4mea Proposed (st) S sj�levauon VL Tank Info Capacity in Total 1 a of anufaemaet Gallons Gallons Units z lies Turks Fll $epan «Holding TadsT I ! Domg Climber ! �)+ VII. Responsibility Statement- c undersigned, responsibility for installation of the PORTS shown on the attacbed plans Plumber's Name (Prim) PI itmature 'MP/WRS Number Business Phone Number Sly z 2' ' 7e✓ = Phanber's Address (Street, C , Smw ZiP G y3 /V S 7 z_ VDI Couutv7De artment Use Onl Approved ❑ Permit Fee Date sued ! ksu _ AgrntSignat S/v�S �O 5"1 ❑ ben Reason Drnial !J"L1 IO Conditions fA tro �\ J'�.� CO(�d-lT'l\ l_, �� �^` E OWNER: f v� 1' pLetnuent filter and ,s �d� w�a / ! pell must be se_rv!ced maintained pagement plan prcwdzd by plumber. dfDl Rf �c,rt+►9L -n rements must be ma!nta!ned l T,� �dYt�^"'c as pet applicable code,ordinaAl_"'°cor°pleft Plans, for the symxasand ` b IneC a vni,Paer.otless dii. 9 11 IN ti f, SBD-6398 (R. 11/11) 6 System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 114 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 96.5' 4/9/21 3 DATE BEDROOM CONVENTIONAL AT -GRADE XXK 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 BEN BOREHOLE V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL 'H.R.P. same as benchmark to iQ5th Ct Pro 3 Q Huffcutt Combo Tank Bedroom House Area 15' below ]-- system is to E--:x remain undisturbed ` B-2 3% Slope 393' Property Line 2 Acre Lot I B - 1 95.5' Scale = 1 /4" = 10' 0' 40 Lm Well is to meet all WDNR setbacks B - 3 Grading is to be done to ❑ divert run-off away from system 96.5' 1 5 0' 97.5' M CO 236' Property Line .15 (,�CCpv zA. g April 29, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-04-29 Plan Review: PWTS-042100714-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Oevering Homes 1719 105th ct. Town of HAMMOIND St. Croix County Total Amount: S250.00 FOR: Description: 450 GPD (3 Bedrooms —New Construction) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http //dsps.wi.gov/progmms/indus"-services www.wisconsin.gov Tony Evers - Govemor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE 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) 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 10 1.01(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 front 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 hom POWTS Dispersal Area. • Divert surface water from all POINTS 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. Propel ,oil 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 7 able 384.30-5 • Insulate building sewer beyond 30 feet pet SPS 382.30 (1 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 available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative 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 owners 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 Icuci shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below. or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: um vanderlec,rawrsconsin.eov Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St, New Richmond Wi 54017 715-246-4516 Date:4/9/21 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Owner:Cevering Homes Location: SW 1/4 NW1/4 S9 T29 N,R17W 1719 105th Ct. Hammond SEE CORRESPONDENCE Manuals Used: At -Grade Component Manual version 2.0 SBD 10854 (N. 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 8.4 Maintance and Contingency Plan Attachments: Soil Test / Shaun Bird Signatu License number Page 1 of 9 System PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 96.5' 4/9/21 3 DATE BEDROOM CONVENTIONAL AT -GRADE XXX 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 •II.R.P. same as benchmark RR to 1051h C11\ Pro 3 \ Bedroom Huffcutt Combo Tank \ House Area 15' below L— system is to remain undisturbed t B-2 3% Slope 393' Property Line 2 Acre Lot O B - 1 95.5' Scale = 1 /4" = 10' 0' 40' M. 1 5 0' Well is to meet all WDNR setbacks B _ 3 Grading is to be done to p divert run-off away from system 96.5' 97.5' 236' Property Line At -grade System Sloping Site Cross Section and Plan View E 1�----------------------------------- T- I t 1 W A 1 i 1 I I I 1 I I 1 I I I 1 1 1 1 E %1% �— 1/6 B 4 i %—--------------------------------'1 — = Plowed r:i; = Clean aggregate I 1 basal area ;t{ %: to 2 % in. dia. — 4 in. sch. 40 pvc L — a observation pipe Geotextile Fabric Lateral with 2" aggregate over pipe rip Topsoil Cap G r r�SR1T�IR�� 7. L) Ft Lateral Invert f.r:r:r.r f•r.f:f. ti 1.1.1.1•y1•ti.1•ti.1 L i.i.r.r.r•r.J•fa•J•J J f1fL.1•.ti.t.1.ti. V.ti.1.ti ti ti .: 1�•f�r_•J.r. f: f.f�f_f f f f �:JirLr�Jihr•?� L•L•1•ti• J.J•J•J•. —_ Plod Slope Direction _ __* I 11 1 1 I ©�LL �I� I©� © .A7 �I Slope Observation Pipe With Cap \ tiTopsoil Cap il J.l. 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 surface. After 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. 03/051gj page -� o Pressure Lateral Layout One Lateral — End Manifold Force Main y5' �nA� Intl.- /'.Lyon.. X, Distribution Ne ork Specifications Lateral Diameter Z In. Orifice Diameter 3 In. X Orifice Spacing) In. L Lateral Len 22 Ft. Force Main Diameter Z In. Force Main Length 5—D Ft. Lateral Tum-up ♦— 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 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 03/05 lgj Page 9 of- Septic -Dose Wank. Cross Section And Pump Performance Specifications Tank Manufacturer Tank Model Number --1 "total Tank Capacity Max. Bttty Depth Filter Manufacturerp1 Filter Model Number r-- Minimum Pump Performance Required GPM' Ft TDH Outlet Manhole Min. 4" Above Grade With Iocking Device. Inlet Manhole < 6" Below Grade Sealed Watertight — — — 1 - Finished Grade Outlet Filter Inlet i *_—•---- Inlet Baffle Switch Settpt and Reaerve Capacity Tank Volume = S' GPI Dimension. Inches Volume Gal. (reserve) A, ^ . y 3 67 — (alarm) B 2 (dow) C : 7 s (dead) D Total Z D Pump Manufecttuer r - --- Pump Model Number Alarm Manufacturer iC�cs Alarm Model Number —1 Switch Type ii10 i4.»rC Total Dynamic Head (TDH) - Feet Elevation Head /L Dlstal Pressure -1, j -- Network Loss Force Main Loss Total Manhole Min. 4" Above Grade securely Mounted With Locking Device \ Weather-proof Junction Box tff7 Vent Min.12" Disconnect Above GradeMeans With Vent Cap H44 \,, �.. oe B Off Elevation C i� Ft Bottom D Elevation ._ Ft GENERAL INSTALLATION: The septwidose tank is bedded and back filled in accordance with the manufacturers product approval specifications. Maximum depth of bury as specified by the msnufacturer may not be exceeded without prior approval. Manhole covers exposed to grade 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 kid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Bloc service plies with NEC 300 and Comm 16.28. 02/05 LJ Page of 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. I All Models Feature: �v�- • Vortex style impeller permitting passage of soli s up to'4" • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners -corrosion -resistant stainless steel • 1'%• Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature:140• F. OWSenes Cord Lengths Model 10, 25'(-2) 35'(-3) 50'(-5L 280 Standard Optional Optional Optional 281 standard Optional Optional Optional 283 Standard Optional optional WA 287 Standard Optional WA WA 10' cord length standard oo all models. For optlooal lengths, add '-2, -3 or-5" suffix to ,model number. Example: fa model 280 with 35' cord, order 280-3 Motor Specifications % hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Pernanem Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Performance Curve: 280-Series m ILL m 2 WIN NONE MEE/O��000EEEElEEEOEEOEOEEEE EOEEOE.\OOEOEE000EEEOOEOEEEE, E/EEEOEMIM9?EEnMI§MM EOEOOEN. OOOEEEEOOEE/C9IEOOEEEOEEEson' MONSOON OOOElIEIIE1 E101EE OOOOOOEEOOONOEIIEOENEmmEgmmE/ Eomm/NEEENNN�E limmonEEEEr40/E /!N!/EEEOEENIEIinOEEEENEEN►RO ' r • r ., .r r :r r U.S. Gallons Per Minute 38 78 114 156 192 2M 270 Liters Per Minute Dimensional Data: Weight: 29lbs. Height 13' Major Width: 10' (model 287) Minimum Sump Diameters: Mode1281, 283...14- Model 287 VMF... 10" m g Factory switch Model 281, 283 Mode1287 settings VMF Tum on level 13" 9.5' Turn off level 7' 4.04 The Model 283 features a fully adAistable wide-angle float Differential a[Nustments can be made easily by tetherirg the }bat to the dis- charge pipe or other mounting point. vertical Moat model 287 Is rat adj. Model 250 Model 281 Model 283 I MU T n 1ie •1 • if c us Certified Wide angle Ma" 287 VMF-Series Vertical mag- netic float for smaller Fits - will operate in a 10' diameter sump Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 18416 • Phone 800_ 43-2560 Fax (585) 494-18M minvw.liberlypumps.curn coyq,e o Ub" A,"o•. kx, 2017 N rights ru",v,& u.fr2 P46M7 im 2n14:048A SECTION A -A 1921 7. i POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page__, of_ FILE INFORMATION ROwner oe '/'J,1 mit til DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units _'NA Estimated flow (average) _5tY79 naVday I Design flow (peak), (Estimated z 1.5) f lJ aVda Soil Application Rate al/da /RZ Standard Influent/EtHuertt Quality Monthly average' Fats, Oil & Grease (FOG) 5330 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L 0 NA Total Suspended Solids (TSS) 515o mg/L 'Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (SOD,) 530 mg/L. Total Suspended Solids (TSS) 530 mg/L >I�NA Fecal Colifotm (geometric mean) 1 5104 cfu/1 tbml 'Maximum Effluent Particle Size J¢ in die. ❑ NA Other. 'Values typical for domestic wastewater and septic tank effluent MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al 0 NA Septic Tank Manufacturer 0 NA Effluent Filter Manufacturer % 0 NA Effluent Filter Model ❑ NA Pump Tank Capacity 3 v I 0 NA Pump Tank Manufacturer ❑ NA Pump Manufacturer ❑ NA Pump Model a U ❑ NA Pretreatment Unit ❑ Sand/Gravel Fitter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland 0 Disinfection 0 Other. Dispersal Cell(s) ❑ NA ❑ In -Ground (gravity) ❑ In -Ground (pressurized) 11�AI-Grade ❑ Mound O Ddp-line ❑ Other: Other. 13 NA Other. NA Other. ❑ NA Service Event Service Frequency (Inspect condition of tank(s) At least once every: ? [J (Maximum 3 yeas) 13 NA canths(s) :Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal cells) At least once every: 3 0 moearls) 8) (Maximum 3 years) ❑ NA Clean effluent fitter At least once every: � ! 0 mordh(s) ./jil year(s) ❑ NA Insped pump, pump controls & alarm At least once every: At least once every: 0 t of his) ❑ moMh(s) ear s) ❑ NA ❑ NA - - Flush laterals and pressure test. __ IJttax At least once every: 0 month(s) ❑ ❑ NA --- year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; 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 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 failing condition and requires the immediate notification of the local i-agulatory 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 chapter NR 113, Wisconsin Administrative Code. Pall other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, I nd 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. gDf9 Page _ of _, START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals theft may Impede the treatment process and/or damage the dispersal ceil(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 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 be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) 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 Septage Servicing Operator prior to restoring power to the 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 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 soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (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 fails and/or is permanentty taken out of service the following steps shall be taken to insure that the system is propely and safely abandoned in compliance with chapter Comm 83.33, Wisconsin 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 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 void spece filled with soil, gravel or another inert solid materiel. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement sot absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requhled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. mue site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation st be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as A t resort to replace the failed POWTS. dand at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative ce. 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 OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. annlTlnNA1 COMMFNTS POWTS INSTALLER I Name 15A Phone ?J- �- / - J ! SEPTAGE SERVICING OPERATOR iPUMPSR1 Name Phone 7/fe S%i� POWTS MAINTAINER Name la� Plane 1�%/J =eZ -3 ncer oPlMr1 eTnI2V errTHORITY ---Name !944 C!/%[% Phone This document was drafted in compliance with chapter SPS 383.22(2)(1b)(1)(d)8,(f) and 383.54(t), (2) 8. (3). Wlsconsm Administrative Coda I wV272019 _ a WisoonslnDepartmdntofCommerce SOIL EVAL ATION REPORT Page d� Division of Safety Buildings lruix County Community Devine whh Comm85, Ws. Adm. Code City Attach complete site plan on paper not less than 8 1I2 x 11 Inches In size. Plan must ' include, btu not limited to: vaNcel and horizontal reference point (BM), direction and Parcel I.D. V" e� 1 al W- 1619- Y b- too Percent elope, scale or dimensions, north a"", and location and distance to nearest mad. Please print all Information. ReNew Data Penmv[1Miwmwnywp & my be usedlaaesdnderypurpwas(Pr " low, s. 15.04 Mimi) 2 �'� Property Owner Property Location Govi. Lot C,) 114 I4 S T Z N R E( W Property owner'Sqqs MOO Address„ Lot Blom dName weew !n �♦ Sth. (State P Phone I N i ( ❑ Cay ❑ Village own -Nearest Roe r+. l Construction U esidential I Number of bedrooms Cade derived design sax rate y�%V -/6 r(2 GPD 0Replacement ❑ Public or commercial - Desaibw Parent material Flood Plain elevation ff applicable Gerwalconvneas SP;Is shall srvwsl- Q p1.�+1, and racertxrrnxfations: nn �- System Type ^/p ' 1e2✓ System Elevailon % !� El &AV Boring fig-pli Ground surface elev. 2 77 a. Depth to WNtlrp factor 4 Din. �g Ra4 Hodzm Depth trn. Dpdnva Dolor Mures Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consieterae Bdurrdary Roots •EOa1 *Elm L Q . — / fo I ® B«inn s ❑ Boring Q SDepth tersor�n.�Plt Groundsurfaceelev. 5olf IceeceR�de Horizon Depth kt Dominant Cdor Munsell Redox Description Ou. Sz Cont. Odor Texture Structure Gr. Sz. Sh. Consistence Boundary Rose GPDlR 'Effe1 I •Eaa2 S i i •Effluent a1•BOD. >'30<22D myL and TSS>30<15o;;rL -Effluent a2• BOD.<30 mg L and TSS530 mWIL f CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 i Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 715-246.4516 1 f" outj Property Owner Parcel ID 0 i Page - o1 L nnr�©n .��nnn�n�n n�n►�a�©nnnn ; ��►� nnrn�nr.�nnnnn nn�n�n�nnnnn ❑ Boring p ° Boring El pit Ground surface elev. R Depth to Ilmiting factor In. Shc Application Rate Hodzon Depth in. Dorrsnent Color Munsell Redox Description Ou. Sz. Cont. Cola Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDRf 'EMl1 -Efdt2 ❑ BoTing ❑ pit Ground surface elev. R. Depth to limiting factor In. A APdkaOom gale ❑ Pit So ®®� � s.. • ®®®©®LJIJaL1YZ7 nn��n�nnnnn nn��n�nnnnn nn��n�nnnnn nn��n��nnnnl nn��n�nnnnn nn��n�nnnnn Effluent #1 - BODr > 30 < 220 myl and TSS >30 < 150 mg& ' Effluent 02 - BOD. 130 mg& end TSS < 30 rnWL 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. a9ea)le(P6 l Soil Test Plot P1 Project Name Edward Folitti un Bird 3�7 Address 1894 110th Ave Baldwin Wi 54002 CSTM #226900 Lot 8 Subdivision Date 11/22/19 SW 1/4NW 1/4S 9 T 29 N/R17 W Township Hammond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRPSame as Benchmark 393' 0' >e Line SANITARY SYSTEM Filece ST. C R O NTY Office Use Only OWNERSHIP/ADDRESS FORM Created 2/2021 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 AddrE City/State/Zip Phone Numbi Email Addres< Parcel Identifi (found on the property tax bill) Property Location Subdivision Plat: OWNER/BUYER INFORMATION NEW SYSTEM: LEGAL DESCRIPTION Town of �49e�- p Lot # 8. Certified Survey Map # f Volume "— Page # Warranty Deed # I_ �_ (before 2006)Volume Page # Number of bedrooms --25 Spec hous yet O no Lot lines identifiable yes O no Q OFFICE USE ONLY %OONLY d New Property Address / / . -5- ✓ `n (Verification of new address required from Community Development Department for new construction J ,5�'12-102-1 (S ff 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 made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cddCd)sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.gov NOI1VAT9 luJlb NOUVA3191'OV9 NOIly/ all 1Ng1 ¢$ dyg e1 S 4 4 S 31'3 I � s NOIIVAI3 g 1N0?Jd 4 a b k g � �I, � 1. '] ftlflft➢ ®®Wll IIllL��.� k n. m i TI I rn - y tl z N SLON 14, it ID -1 JIL 2 Of 5 FOUNDATION ® ® yW� W J $ = O z 3 L e Iwo — _ _ a 1 y v pYp" p a `� 9{ MAIN LEVEL PLAN �VE�RLVG HONES .. ___ _ _ _ ^J.N IYfJWJTiION ___ ABiNfCfWA¶ON ....u. �. ..• •..,� ;T SHEET INfORMPiION __—_ SHEET 40F5 i2ND LEVEL ccrrwcnr NoncE __ "�" "g� -7 — I .... 11 6 / I I / 33, SW_1/4 OF THE NW 1/4 NWI/4OFTHESW 1/4 LOT 7 84,128 SQ FT. 1.93 ACRES r 6 1F SQ. FT. T ACRES LOT 9 82,749 SQ. FT. Ln .n 1.90 ACRES C h 1061.9I �'�l 586'46'47"E 367.46' 'Y s' b 7 106'1.58 � ��/ i7 a� LOT 3,996 5q18 :U61.34 5 LEGEND FOUND SECTION C, ® MONUMENT AS NO © FOUND 3/4" IRON RI FOUND 1" OUTSIDE IRON PIPE 93 N N ,y SET 1-1/4" DIAMETE O BAR .y M WEIGHING 4 17 PER LINEAR FOOT 3 ALL OTHER LOT CORNERS MONUME WITH 1" OUTSIDE DIAMETER BY 18" 1 a� PIPE WEIGHING 1.13 LBS, PER LINEA r LOWEST BUILDING L.B.O. (THE LOWEST WIND DOOR ELEVATION.) 1063.61 PROPOSED DRIVEW — DRAINAGE EASEME a — — 12' WIDE UTILITY EA — — — — — — FLOOD PLAIN ELEVi FLOODPLAIN LIMITS J Wisconsin Department of commerce SOIL EVAL ATION REPORT Division of Safety and Buildings ... C.St-aQl"7-3a6 Page J— of 3 Attach complete sne plan on paper not less than 8 112 x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and Percent slope, sale or dimensions, north arrow, and location and distance to nearest road. Please print all information. intorn%*U you provide may be uMd for teary Purpom (Pmaty law, a 15.04 (1) (m)). - COY 1 Parcel I.D. QNk a.F : alb- 1019- NO- I by Revie Date lPa Z Property owner „u r Property Location Gout. Lot 6� 1/4//Jd/4 S� T Z N. R E( ) W Property owner's Mailing Address /l- Lot Block # I SLbd. Name ore".>Atll Ve a U Moran+ Q; w e es{ City ( State Lp Code Phone Number ❑ ❑ \A" ovvn earest RoW Construction U Residenbal / Number of bedrooms Code derived design Row rate 'i�17 Ag QJ0 GPD ❑ Replacement ❑ Pudic or commer ial - Descnbe: Parent material Flood Plam elevation n apploable i^✓ i/� 2 IWI R Gener-dmrre comments Sp;IS 5kki( SrAuw- Q P(av1, and recommendations: System Type_ System Elevabon D 1-11 gorin9 # ���71t Boring C''c tu-Pit Ground surface elev. / ✓' 2 R. Depth Oo limiting fa � in. S icaiw Rate Mortzan Depth in. Dominant Color Mlmses Redox Description Ou. Sz Corn. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDM -ER#1 •Ef012 all qZ4 °-66 s D 17 let Scring # ❑ Bonry Pit Ground surface elev. � ' 7 R. Depth to Itrllitirg factor in. Soo icatibn Rate hloraw Depth in. Dominant Color MMunsell Redox Description ou. Sz. Cont. Color Texture I Structure Gr, Sz. Sh. Consistence Boundary Roots GPDRr 'ER#1 'ER#2 .- f- r% �' S— �' T Emuent #1 - Boo. > 30 < 220 mg& and TSS >30 < 150 rrglL ' ERtuerd 02 = BOD. < 30 mg/L and TSS < 30 ma 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 5401 _ �^a i/0 715-246-4516 1 O �oat� i Property owner Parcel ID # Page ` of 3 Boring# o Boring ❑ pit Ground surface elev. ft. Depth to limting factor m. §N Application Rate Fiot¢on Depth in. Dominant Color Munsell Redox Descnp6m Ou. Sz Cont Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDTF •Ef#i1 'Ett#2 ®®ice Effluent #1 = BOD, > 30 < 220 mgrl and TSS >30 < 150 mg1 ' Effluent ill = BOO, 130 mg& and TSS < 30 mgti 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 TrY 608-264-8777. seoarw 0.smi Soil Test Plot PI Project Name Edward Folitti un Bud Address 1894 110th Ave / Baldwin Wi 54002 CSTM #226900 Lot 8 Subdivision Date 11/22/19 S W 1/4 N W 1/4S 9 T 29 N/R1 7 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRpSame as Benchmark 393' 0' ;e Line T— 019-006 PREP�:�=0P9: p /%� � � ory eNnexn nNnx ��. PHEASANT RIDGE WEST ,�,�tc! s=� - ' FEB is ?u— PRELIMINARY PLAT PFEPMiO9Y 5I LOGY-) IN PAR- OF 'i _ - -E 11 VI 0E11E SW 1/4 COn:Fu d. C] e Crt OF SERON 9, TILL, R1 [ T -B _] JNI,WSCONSIN, RPNG OVTWT ] OF CFRiIFIED $.. n.cY N.J� .J.JNiC 3J Fr.Gc o]25, DO.JM_M NO 1091R19 i O�evu mfw WN � F yn�uriEn LANOE "` q J LOT11 TLOT10 AlglVx�n� y yav Km�a 4tIl I / II ✓ B LOT S -" JOn / �• d= , r II I _ I I T� S', II Id ,LOr 19 �l;A,. el I' I^ I J , p Oi9 nw4 ' - i Ll - �ggtl i cr+¢y�,E V p' x n.Mss, LOUR)j-- 7 "1I I 11 II • i _� �__ __ _ __ w4. —e _ Y'r= � T it rtoT6 R� y gl� �. $$ $j LEGEND .l,, r2 � ' t J�y�F _ �rn� arsrrou •,wn !4 4 1 - - - - L Illy mwme♦ _ ta FGFL UN_ELFlITI Le -LT arsI -' aI .� xI s: a _ ti' 1 e Iwl If CTI I,I �I' LOP]` It-Ji ash. v_gL wvk srv_ IF I, TTL .€ I PHEASANT RIDGE NEST EDWARD FGRLITI v' IF w To,Tn OF 1111 LY c s ceorx _ TsII PRELIMINARY PLAT 6ath•ConealWmcirtm N _SAN laud StimeJm9 a ,,, (3 41� 9ftafft9m) �CRoPeoUm STATE SANITARY qk 1 il9 /05 C'r PRE4'10 OWNER t-)EU921N PLUMBEIaHAKW I TOWN OF SEC,T N, AND/OR LOT SC IR cow LICX 22-6160 BLOCK SUBDIVISION NO. 633347 PERMIT NO. :RONE 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. (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. in) Changed regulations will not impair the validity of a sanitary permit. (c) 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. Iirw�� �IfI�AU RI ED ISSUING OFFICER -DATE � / F W GVAC/ PERMIT EXPIRES y UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)