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HomeMy WebLinkAbout018-2007-25-000 (3)Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may be used for secondary Homes TANK INFORMA PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) ]Privacy Law, s 15 09 (1)(1)] City Village Township TYPE MANUFACTURER CAPACITY Septic 1 ' It o Dosing Aeration Yvbli Holding TANK SETBACK INFORMATION 1 PIA w:wC TANK TO P/L WELL BLDG n to Air intake• AD Septic b 1 -7 7S0 Dosing Aeration Holding PUMP/SIPHON INFORMATION m._ I. IJA Manufacturer 1 •I,_✓t (-I i{•C �) V / emand GPM, Model Number b � YT� l�-r TDH Lit Friction Loss .'jjj SystemHad TDH Ft 1 Forcemain Len91h 1 ��i� Dia 2N Dist to Well 1 SOIL ABSORPTION SYSTEM OFHAMMOND ELEVATION DATA STATION HI nfs FS ELEV. Benchmark Alt BM Bldg Sewer 1 St/Ht Inlet 9.5 C.14 SUM Outlet Dt Inlet Dt Bottom Header/Man �( Dist Pipe Bot. System 2 • 03.5 Final Grade 49jCoi% 2.5 mt �• . 3 10 $.� 9 7•g d BED/TRENCH DIMENSIONS Width �` Len? ') No Of Trenches /L (( PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKElST EAM EACHING CHAMBER OR . UNIT Manufacturer T p Of Syst I f St O s otlal N bar DiSTRiBiL llliV ATJ I tM Y1n...n —A r.rJ61 1 . Header/Manyold t�t Length \ Dia /�d /' IlDistribution Pipes) I 0 1t 2 1 x Hole ¢e /1 /^ (tD x Hole Spacing 2� Vent to Air Intake Length Dia Spacing { L �/ty OViL VW V CR 1r Pressure Svstems Only rr II rlr et_rr.ae S..e.nme nnh, Depth Over Bed1Tre ch C ter ` /f 1 j epth Over d/Trench es xx Depth Topsoil of - ` ` �t xx Seeded/Sodded [-Yes (-� No xx Mulched -AYes ❑ No COMMENTS: (Include code discrepancies. persons present etc) Inspection# n 1 �y.-t{r fW�' `Insp#2 ection Location: 1168 167TH jST 5/1 B//20 0 Q wC.Y' 1 ) Alt BM Description-�"\-S{i CAJt: !!! r, / ([ )Q (0+ .%6 �,, s-t•' 2 ) Bldg sewer length -V i r lVl q(Al -amount of cover = 70 '1(J Plan revision Required? E] Yes^I No L Use other side for additional information. 1_1 SBD-6710 (R 9/97) Date nsepctor's Signature Cart No s county Safety and Buildings Div= `t: APR 2 9 7021 201 Vtr'Washington Ave., P.O. @®x 7162 sanitary Pe Number (ro b< filled m by Co j J' Madison, V 707 162 �.� 6,333Y5 - Sanitaq Permit Application 3azeT ananonNmbe� In accordance with SPS 38321(2), Wts. Adm Cade, subawstoa of this foss to the appmpnare gov nial nqj o is regoced prior to Obtaining a sanitary petmn. Note Appbcantatn4w on forms for sned POWTS are sobmm¢e to Project Address (if differ= than mailing address) the Department: of Safety and Professional Seretes. Personal information you provide may be used for -secondary ses m accordance wnh the Pnvaq Law, s 15.04(1 yinSets / 7 f/e L Application Information- PleasPrint All Information i C/ s ' PropertyOwner's Name Parcel # ae ;&HEX D �' fan 7�S Property Owaer"s matlmg.4d eroparty Location ` L e. Q GoK Lot Clty. State Zip Code Phone Norther e, Section P.e�J l e�le T N; R r W L II. of Building (check all that apply) Lot # T/T/- Aftv Subdivision 1 \ Name f 2 Family Dwelling -Number of oo(m]S� fg7—J �� Blockf ❑ Pubha/Commerctal - Descnbe I'se 2± 1� ❑City of ' ❑State Owned - Desmbe Use CSM Number ❑villa —of �• of i III. Type of Permit (Check only one box on line A. Complete line Rif applicable) A" eta ❑ R lacement S ep ystem ❑ TreatrnenUHolding lank Replacemrnt Only Other Modi6canon in Ewsting System (explain) B. enewal error[ Revision ❑Change of Plumber Permit Traasfer to New Lis[ Previous Perini[ Number and Date ed BcforeE iianon pwn toll ? 7 IV. Type of POWTS S stem/Com onem:/Device: Check all that a I _ ❑ Non -Pressurized ht-Ground ❑ Po ssurtzed In -Ground D At -Dade ound > 24 s. of suitable soil Amount 4 m of suitable soil p r r ❑ ❑ Holding Tank Othcr Dispersal component I ) earrthent Deuce (explain) O V. Dis rsaVTreatment Area Information Design Flow (gpd) Dc gp Soil Applicahcia e(gpdsf) A Dis isal Atea R ed (sfl 7%-v Zs . Dss Pro (st) ' System levaoon 32) U 11 Nam' r2S o VL Tank Info Capacity in Total # of ' Mmufaciner Gallons Gallons Uma .. yl�-.�y,� 1 14-p ( u v ' _ New Tanks Fv, Tanta �a 0;ci `VN'e u Septic or Holding Tank i Dosing C7>mba .� VIT- Responsibility Statement- I, the forinstallation ofthePOw'T3 shown on the attached plans. W,�pousib-ifit�as; Plwhber's Name MPNTRS-Number Business Pliant Nmn/ 7 ZZ//Phmnber's Address (Street, Cny, State, P Co VIII. County apartment Use On ' 1 Approved I ❑ Di Perron Fee Dais issued j Issuing ent S=goature s S Owns en R. Denial / 3,120 DL Conditions of ApprovalfReasons for Disapproval �YSTEMOWNER:LT _L' Septic tank effluent filter and 5 2.V7►'O�I%l Kje- dispersal cell must be serviced I maintained as per manm ageent plan provided by plumber. Ail selhaak reauuenlents must be maintained I as per apphcable CudeA6R9Mto P"- ".1 b otbeCouaty p� n q�nsi iach ;a `aa US out U le) V (I�G, , �s per Sw •+ �.. ..` TSB 9 s 1t�LIdLQY �,•,,�„-r� -% f�w.�:" (jp.wp°"''�� PROJECT Lucas Forseth SW 1/4 NE 114S System PLOT PLAN ADDRESS 1168 167th St. Hammond Wi 54015 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 103.7' 1.5' Sand lift 4/8/21 3 DATE BEDROOM _ CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 BENCHMARK V R P To of surve iron DOSE TANK SIZE 630 # of Chambersnone ASSUME ELEVATION 100' BOREHOLE O WELL rH.R.P. same as benchmark bc`G0 102.2' 102.5� 101.5' Property Line B- Grading is to be done to divert run-off away from systemP 5% Slope Scale = 1/4" = 10'-' B 1 0' 40' 80' Well is to meet all Area 15' below WDNR setbacks system is to remain undisturbed Filter Lifetime Huffcutt Combo Tank Pro 3 Bedroom House 167th St. Property Line (not to r� April 29, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-04-29 Plan Review: PWTS-042100024-M SHAUN R BIRD 1432 120th St New Richmond W154017 SITE: Lucas Forseth 1168 167th st. Town of Hammond St. Croix County Total Amount: $80.00 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http:/Idsps.wi.gov/programs/industry-sewices www.wisconsin gov Tony Evers - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES 41A..v ll 1 -at SEE CORRESPONDENCE FOR: Description: 450 GPD (Revised Location — 3 Bedrooms —New Construction —Mound) 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 pnor to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (1 1)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock 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 owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state starts 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, POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of industry Services email_[mi.t'amteileest�-a.wisconsin.2oN, Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/8/21 Owner:Lucas Foresth Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE Location: SW1/4 NE1/4 S5 T29 N,R17W 1168 167th St. Hammond Revision to permit #3025164 J1/.4 . tit. 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 test 1 ^ Shaun Bird Signatu License number Page 1 of 9 System PLOT PLAN PROJECT Lucas Forseth ADDRESS 1168 167th St. Hammond Wi 54015 SW 1/4 NE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 103.7' 1.5' sand lift — DATE4/8/21 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 N of Chambersnone ' BENCHMARK V.R.Y. Top of !IR iron ..� ASSUME ELEVATION 100' Filter Lifetime BOREHOLE O WELL "Ii.R.P. same as benchmark Property Line Grading is to be done to divert run-off away from system Scale = 1/4" = 10'-, 01 40' Well is to meet all WDNR setbacks In 167th St. B - 1 I' WA 102.2' 102.5� 101.5' 3 5% Slope Huffoutt Combo Tank Area 15' below system is to remain undisturbed Pro 3 Bedroom House Property Line (not to M.' .�_ OT, Mound System Cross Section and Plan View ?------------------------------------ - 1 = Topsoil = ASTM C-33 Cap Material sand fill Geotextile G Fabric F11 ,/Od r, Ft Contour M= Clean aggregate /a r7" to 2 %s in. dia. E Plowed Slope Direction H Dimension Feet A B 5 D E (� F G y" H j, p 1 K L �� W z g Slo % = 4 in. sch. 40 pvc 0 observation pipe 3, 7 Ft GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a''/4 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. 10/071gj page " of V [NMI as L (Lateral Length) M (Manifold Lengl Force Main Diamel Force Main Length �5- s 03/05 Igj Pressure Lateral Layout Two Laterals — End Manifold is In. In. Ft. In. i Ft. ded lout g tg 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 *00•0• 6-8 Inch Lawn Sprinkler Valve Box Page q of __L_- Septic -Dose 'Wank Cross Section And pump performance Specifications Filter Manufacturer � J Filter Model Number / I y C? GPM I ® I % i (o Ft TDH Outlet Manhole Mm. 4" Above Grade With Looking Device, Inlet Manhole < 6" Below Grade Sealed Watertight •� •� Finished Grade I Outlet Filter Inlet f -� inlet Baffle Switch Set4up and Reserve Capacity Tank Vohme = ..5r— GPI Dimension: Inches Volume Gal. (reserve) A A Z r (alarm) B 2 3 (dose) C; 3` -2 (dead) D 93 Total Pump Manuf iowrer 4 t • � [� Model Number Alarm Manufacturer L 5 Alarm Model Number Switch Type Total Dynamic Head (TDH) - Feet Elevation Head 7 Distal Pressure 12 Network Loos AV, c Force Main Loss Total /r, k17 Manhole Min. 4" Above Grade Securely Mounted With Locking DO" Weather' -proof i Junction soot i f Vent Min. 12" Disconnect Above Grade Means With Vent Cap yI" A weep B Hole Off Elevation C 2—Ft Bottom D Y I Elevation Ft GENERAL INSTALLATION: The septiddose tank is bedded and back filled in accordance with the manufacturer's product approval specification. Maximum delth of bury as specified by the mentrfacmrer may not be, exceeded without prior approval. Manhole covers exposed to Bade have an effective krdtmg 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 forgo main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical tzervi O1Q�Ites with NEC 300 and Comm 16.N. 02/05 Li Page 7 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. All Models Feature: • Vortex style impeller permitting passage of solids up to Y" • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1 yze Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature:140' F. 280-Series Cord Lengths Model 10, 25'(-2) 35'(�) _501(-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 9= hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Performance Curve: 280-Series N U ca a) S u�o��rrraraa�ra����r•�������ra���ra i 1 1 . 41 • r./ c. � 1 1 1 U.S. Gallons Per Minute 0 38 78 114 156 192 228 270 Utters Per Minute Dimensional Data: Weight 29lbs. Height: l 3" Major Width:10" (model 287) Minimum Sump Diameters: Model281, 283... 14" Model 287 VMF... 10" Factory switch Mode1281, 283 Model 287 settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 2a3 features a fully adjustable wide-angle float Differential adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point. Vertical float model 287 Is not adjustable. Model 280 Model281 Model283 Manual, Wide angle Wide angle no switch float switch I float switch with quick- with series disconnect (piggy -back) plug 9MV ' �1'a c us Certified SR-ieca —arcs btl to Ihw .n ttwbi , Model 287 VMFSeries 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 800-543-25M Fax (585) 494-1839 ~v.libertypumps-com Coprjel,t 0 weeny ac"ps, trc 2m7 Alln" mmvef. LLr 2000 n0S17 IQ I(D 201 4C!048A SECTION A -A 11f POWTS OWNER'S MANUAL & MANAGEMENT PLAN page___ -of_ FILE INFORMATION Permit # DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Number of Commercial Units B-NA Estimated flow (average) 3,rU gaVday Design flow (peak), (Estimated x 1.5) Njp aild -- Sop Application Rate 40 gallda ff0 Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) s30 mg/L Biochemical Oxygen Demand (BODs) s220 mg/L Total Suspended Solids (TSS) s150 m /L Pretreated Effluent Quality Monthlyaverage" Biochemical Oxygen Demand (BODS) S30 mg/L Total Suspended Solids (TSS) s30 mg/L Fetal Coliform (geometric mean) 5104 cVI()0m1 Maximum Effluent Particle Size Y. Inch diameter MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity t7 al ❑ NA Septic Tank Manufacturer p NA Effluent Filter Manufacturer r p NA Effluent Filter Model p NA Pump Tank Capacity z� al p NA Pump Tank Manufacturer NA Pump Manufacturer ❑ NA Pump Mode( ❑ NA Pretreatment Unit Nq ❑ Sand/Gravel Fitter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Manufacturer Dispersal Cell(s) ❑ In -ground (gravity) round (pressurized) ❑ At -grade ound ❑ Drip -line ❑ 0trier. • Vaues typical for d« stz (nonwrrnerdaf) wastewater and septic 1" eflruenr Values typlml for pretreated wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every j ❑ months p year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume Inspect dispersal cell(s) At least once every ❑ monthsyear(s) (Maximum 3 yrs.) Clean effluent fitter At least once every ❑ month year(s) Inspect pump, pump controls & alarm At least once every p months--5*ar(s) 11 NA Flush laterals and pressure test At least once every v p months earls) ❑ NA odro At least once every p months ❑ year(s) NA ou 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 certifications: Master Plumber, Master Plumber Restricted Sewer, POINTS Inspector, POINTS 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 cells) shall 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 notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (K) 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 POINTS components, pretreatfinent components, and any other maintenance or monitoring at irlervals of 12 months or less shall be performed by a certified POINTS Maintainer. A service 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 celf(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. <ZO4 9 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 chemlcals th> It may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(&) 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 bg discharged to the dispersal cet(s) in one large dose, overloading the oeil(s) and may result in the backup or surface discharge of effluent. To avoid this situation hove the contents of the pump tank removed by a Sep" Servicing Operator prim to restoring power to this effluent pump or contact a Plumber or POWTS Malntalner 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 sbpe of any mound or at -grade soll absorption area. Reduction or elimination of the following from the wastewater stream may improve the perfomnance and prolong the life of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disirrNmtatts; fat foundation drain (sump pump) water; fruit and vegetable peelings: gasoline; grease; herbicides; meet scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fells and/or is permanently taken out of service the following steps shall be taken to Insure that the System Is properly and set* 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 property disposed of by a Septage Servicing Operator. • After pumping, at tanks and pits shag be excavated and removed or their covers removed and the void space filled with 6411, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a Dods compliard replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requitled setbacks from existing and proposed structure, lot Ones and wells. Failure to protect the replacement area will result In the need for a new soil and ads evaluation to establish a suitable replacement area. Replaoament systems must comply with the ruled in affect at that time. 0 A suitable replacement area Is not available due to setback and/or sot limitations. Barring advances in POVI/TS 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 auttaMe replacement area. Upon failure of Me POWTS a sot and a" evaluation t be performed to locate a suitable replacement area. If no replacement area is avallable a holding tank may be Installed as a last resort to replace the failed POWTS. Mound and at -grade loll absorption systems may be reconstructed in place following removal of the blomat at the Infiltrative urfaca. 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 ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OP A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name t �r✓�1�/'/� i Phone J / POWTS MAINTAINER Name 5 av A> (� Phone 2 6 . 7S SEPTAGE SERVICING OPERATO (PUMPER) REGULATORY AUTHORI Name q/( q 1 Name S% �✓(� Phone �J ,� C ' .i��� 0 Phone This document was drafted in compliance with chapter SPS 38322(2)(bx1)(d)&(I) and 383.54(1), (2) R (3), Wisconsin Administraave Code. Womnsa; Daparanen;of cornMr^..e SOIL EVALUATION REPORT Divviaix, of Safety ar» 6:md1npc in accordance with iomrr, U. Wis. Mm Cob c o ert S� kbach oxnpiet..ka plan on Parr not or than E 11 padres 4t size. an muse I--�—. trsiude, tr� not 6rdled to: vertical' and havmta! referenn ce part (BMt, dsacbon and Parrz I ^ percera siopa, scale or dimensions, north arrow, and bcatior and distance to nearest road. I L Please print all InNnnatior, Rewew.d by Page _a_ Pw.wri miorm,� ra movide may be �wd hx.er =n y nub+(Pr -c) Law, %. 15.04 (1) (m)1. i perry r^ !{. I C>a�l LIX�(,� S 4 t4 S '` N R E Groprty owner's kw&V Ado�as¢, Lot # Bb S Srbd. No" a Sze CSAai BLi .2S Qli. ,, state Zx Coae Fhcne "umber i O C4 D VAne own /I Nearest Road _ -. Parent matend �Puck- or corTrw:;A - Describe: mid rwoortwiriendebau: • r • ° row 0113�11►IJ' l !fit!/ q�i� JWM99A �,! Parcel 83 a Page _ of MM89 , M MAPM ram © a , IWAM41 F^wt n e BM, > 30 < 220 nVt and TSS >30 < 150 n & - E%wd a2 • B00, < 30 nVL end TSS < 30 myl The Department of Commerce is an equal opportunity service provider and employer. If you neod assistance to access services or need material in an ahemate format, pleasc contact the department at 60S.266.3151 or TTY 608-264-8777- aolrlap.bmt Soil Test Plot Project Name Lucas Forseth Address 1168 167th St. Hammond Wi 54015 M 1TM #226900 Lot 25 Subdivision Farmview Ridge at. 4/8121 S W 1/4 NE 1/4S 5 T 29 N/R17 W .- — Township Hammond EJ Boring Q Well PL Property Line County ST. CROIX lk BM or VRP Assume Elevation 10o ft. Top of survey iron System Elevation 103.7' *HRpSame as Benchmark ino rz, �3 Safety and BulDivisionCountyn9 ";lb-e/ 7 ,naNng* Ave., P.O.9067162 Madison,; 53707-7162 spy Psmh NiaW(to be filed in by Co) OCT31 201 1 A i D s (p) %%-7 % �a>amit Mica ' In acmrdanot nith S ty I o Ihu form to the WPmPtuee staa Trmssctica N®bc d �� Summational unit is required prior to obtaiom8 s Sanitary Pumi( Nac: Apptica^;oo framf for stmc-otwed POWf'S ne Suhmtlmd to Project MNear (it dffqft then mining sM=) the Dcpmmxta Of Safety and Pmfmional Semis, Personal information you provide may be used for eeca,dsy to acadmce wife dse Gw s. 1S.041 " S,,,. / ! G � 6 L Bcation loformuion- Please Print fo d PrOWV Owner's Name Paroel s Property Owores hdneng Address Property Lou°on fPL,. 17. 9' r Govs. fci_ t-(/ Sew Sty Ap Code Pbom Nw,ber Type Building( bat T�N' Rgw of of apply) TC' subdivision Name Family Dwelhog- Number ofeedrocros aS ❑ PublidCommccyl- Desmbe Uu� s ' ❑ City of t—� ❑ state Owned- Dwmbe UK 1 - / ❑ nf� CSM Nmebc )f OWt ^ of f ar. TyP of (Chtxk only Got box on line A. Complete Una B ifapplimb � Synem ❑Repl.eemmt synem ❑TtumoraUHoldiog Took Rep ❑onta Modi6euwn to Sdnins syat®(cepbtn) ' Reoc»al ❑ P " Rwistoo ❑ Change ofNuenbet P mNew sous Permit Number and Deb kmW Before uau G 0�228-5__ IV. iype orpovm S stewLom nant(Dw,,: Check all that a ❑ Non-R.amiaee in-Dwmuad ❑ and ❑ At > 211fe, of.W <24 in. of suitable ❑Holdms Teak ❑Omer D4er"W (expl ❑ �( V.DispenalIrreaugatent Arta Informati n r HOW (gpd) Deap Soil Appli Q Dig Required (20 Synw Fla Lido Jv Z o p. 11 147 OS •Taulthdo Capacity in Gallon aof Uoib ` •gam tvew lake Fsipivg SWrk or Reldit Teak Dodegtbembc VM IRtspowilbUlty Statement- G the e M'PROW&Wulhation of the POWfS shown on the attached plans. Phmbs's Name(Aiot) PI sisaaaae %MP/WRSNomber Boli,less Nualbor L e ti - 4 _ 's Addten a (Strt, Cny. Sure. iZ apartment Use auy ❑ Permit Fee Deb rued lamas Signuma 'vm Rewoo far Denial S 90 • DO a �/ % Ix cos. m fur Disapproval • ep5t nk• Oflluent 0 ter and D) 1•,O }- �„w`guL� �,`, 1/ y Q_ dispersal cell must k4 serves / main in d t as per management plan provided by plumber. 1AtO-&LLJ , 0, 2. All setback requirements musl be maintained as CelV1dl.; r (.a_, r0.k.� E r a lies. I gf.( wu.cu...P.pears rorma.pars. wed sub." mw aewee• all rwW..t 1w tale a w a ll beta V she 1 q. )n u` le P„fs1.s� SBD•6398 (R 11/11) t r ST. CRo jJ NTv. SANITARY SYSTEM File ce �L9setur,+ue Office Use Only OWNERSHIP/ADDRESS FORM Created 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 INFORMATION Owner/Buyer fir Mailing Address L� City/State/Zip AAl Phone Number (required)_ Email Address (required)_ Parcel Identification Num (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Locatioq,�4t/a ,Sec. T �N R ,Town of A'""^ ` ` _ p Subdivision Plat: _ r-kA V1 OA.1 Lot* 0(-� Certified Survey Map # q Volume —` Page # Warranty Deed # l (before 2006)Volume Page # Number of bedroom Spec houses 17 no Lot lines identifiabl-e�es O no OFFICE USE ONLY New Property Address //� V rX� /[�1Z7�� (Verificat n of ne address required from Community Development Department for new construction.) (Sta Initials) (Date) CPU This form must be submitted with all Private Onsite Water Treatment System (POINTS) 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 cdd(o)sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.aov Kevin Grabau From: sbird@frontiernet.net Sent: Wednesday, May 12, 2021 2.55 PM To: Kevin Grabau Subject: Re: Oevering - Lot 25 - Farm View Ridge Attachments: CC F 12052021.pdf On Wednesday, May 12, 2021, 01 05:00 PM CDT, Kevin Grabau <kevin.grabau@sccwi gov> wrote: Hey Shaun, I need a set of house plans for Lot 25 — Farm View Ridge. This is a change of owner, a renewal and a revision to the system location. Thanks. Kevin Grabau I Community Development - Land Use & Conservation Specialist 1101 Carmichael Rd Hudson WI 54016 T: 715-381-4382 Kevi n. G ra ba u @sc cwi. g ov ST. CRO IUNTY C T _ I. l �r ELEVAT K ELEVA ELEVA RECEIVED MAY i Z ZOZI 5T CROIX CCUNTY CDD RECENED ST. CROIX COUNTY CDD FOUNDATION PLAN c MAIN I �mt W _ W N 7 C W J LGV �. MAY 12 2021 } o'g ST. CROIX COUNTY CUD r I�.v N W RECEIVED w w w wI�0o MAY 12 2021 z �avxw N ST. CROIX COUNTY CUD'..'; -' ------------ ,......_' _= _ I. V' W > SECOND LEVEL PLAN sS �ZL gzzCO 199*112 y I ,99"ll� _\ \ 27Z,lZ.99 co Lam, �j `\ Ln js 00 p 01 ss �d 45 � N �-' Imo! � � �''�� '\ ,�•,p CO N lol �I� N �� �_. I tt, M ..9Scn 14 — 0,�S.L9 N O/ 9 9 �d O9 1 Z I I Z j0 NC f �I // cli js lv 9Z9 � I� N Z 1 W O1 / ' y L C I S qZ9�` ' � d,\OA N ---- /:a � �p6`L v� Jet N4soonWr Dapartrtnt o' Conxlt� o� OIL EVA1 AIION REPORT B.A�din ,, • r WY* ]mT BE � Jlb 4'0^ cooe C rv�'�a�� u tta& complete site Flan a P>3 , les than E 5. x in es r s e Pian must indude, but not limitec iF v€.tB arran hc. ontareference do ectior ano percent slope, scale or djmensions north arrow and location anc distance tc nearest road. Please print all information. Ra. rt�wev. by 4� rxomutror wiz aovroe met be use: fa mwnaan p,ryosee law 2 ''.01 CST -soar— 6-73 cage -L of Date / TZ� N R / E (o' i Property Owner's Mailing Address - 1 ' Lot # Block # 1 Su d Name or CSN # , //b � /�/�Clt �-2s- I Sri �. ���Cc<� ice, Gly v State :D; Cane pnane Numox ` Cr) r; iilage -own Nearest Rcad New Construdi r. jss '�`euoentia : N. ber o` bebr-a . s - 5 Cooe denved design fia rate A/-� U GPD i CD Rep laoement Paret, rraterar cicoc Pialn elevatxr a applicable !C'anera oomments sp� sexte-5 0Mk .TRaJi ! and recommendations: Srster, Type/�lf%i -> >" / 7 Systerr Eievation /� i i i Boring # ❑ Boring n IF 17, pit Ground sufaos elev L (--) 2 ` Gepfi to hmrtn3 facts m. Soil ication Rate Horizon Depth in Dominant Color Munso Redox Desmptim Qu. Sz Cont Color I Te#.re I Structure f Gr. Sz Sh. Consistence ! Boundary Roots GPDIW 'Eft#? 'Eff#2 I I ! #❑�tt / tCF Pit Ground surface slev40 �, f0 ft. Depth to Ixrnhrg factor in. � iced Rate Horizon Depth in. Dominant Color Munsel Redox Description Qu. Sz Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDtW 'Eff#i 'Efr#2 0 -1/ 1 ` 2 1ilKnCti . 1 7-1 1hlz4 • Eflkuert #S = BOD. > 30 < 220 rtxyL and TSS >30 11 • Effluent #2 = BOO. < 30 mgrL and TSS < 30 mKA 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 4 715-246-4516 Property Owner Parcel ID # 1 �\ Page M 3 Red,, DescriptI, ©�Il11�/ W �, WMMWAMWIA M'IN_1� ���—'�MM ■. Mat #1 a BOD, > 30 < 220 mgrL and TSS >30 < 15o ng& ' Effluent #2 a BOD, 130 mg& and TSS < 30 91 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. Mat #1 a BOD, > 30 < 220 mgrL and TSS >30 < 15o ng& ' Effluent #2 a BOD, 130 mg& and TSS < 30 91 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. Property Owner Parcel ID If � Page `' of 3 © ■ ,& ©IlI17ri1�Li MWI PWIMM�LLi�A,`L WAMW,�� M% W. �%� /Y � 1FMA0MMA, IWII//IlRT7GIf4Ya' ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. R Depth to Smiling factor in. Sod ApplEation Rate Fwtzon I Depth I Dofrlirfard Redox Description Tex6xe Struck" Consistence Boundary Roots GPORf in. Mussed Ou. Sz Cont. Color Gr. S. Sh. 'Eft#1 'Etf#2 Boring # ❑ Borg ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soi� Rafe Effluent #1 = BOD, > 30 < 220 mg4 and TSS >30 1150 nV& ' Effluent #2 = BOD, 5 30 rngA- and TSS < 30 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. seauwra.svof Soil Test Plot PI Project Name Lucas Forseth n Bird Address 1168 167th St. Hammond Wi 54015 CSTM #226900 Lot 25 Subdivision Farmview Ridge to 4/8/21 S W 1/4 NE 1/4S 5 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX CM or VRP Assume Elevation 10o ft. Top of survey iron System Elevation 103.7' *HRPSameasBenchmark 5r- 00 1W COUNTY C STA E SANIT4RY �rRaia�aixe.v�wt. vaevio OWNER TOWN PERMIT EXPIRES BLOCK SUBDIVISION NO. 633348 PERMIT NO. 6 CHAPTER 145.135 (2) y1SCONSIN 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. ISSUING OFFICER - DATE r3 UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)