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HomeMy WebLinkAbout018-2022-07-000'✓essconsm Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s 15.04 (1)(mp ng BM TANK INFORMATION O TOWN OF TYPE MANUFACTURER )/. CAPACITY Septic r\ V Dosing Aeration Holding TANK SETBACK INFORMATION i1v l/ s ., f.It A • . — ®®®I me PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Fnch InLo sr (� System Head. TDFj,.Ft Forcemain Len x Dia It Dist to Well �I SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI I FS ELEV. � U` gBenchmark C1M ii Bldg Sewer Cj C SUHt Inlet CiG,B SUHt Outlet Dt Inlet Dt Bottom Header/Man a • 9•Z5 Dist Pipe Bot System Final Grade Stiir i Coin-101n � �f. 3 9$. BEDITRENCH DIMENSIONS Width 1 LenTo x No Of Trenches lUIM PI DIMENSIONS N o Inside Die Ligmtl epth SETBACK INFORMATION SYSTEM TO P/L BLDG JVVELL LAK !STREAM LEACHING CHAMBER OR UNIT Manufacturer Ty Qf x stem` 'D' r7) /✓� 7 1 t otlelN ber UIJ 1 RIDU I IVIN JTD I CIVI Headen'M Roltl Distribution t N x Hole Size x Hole Sped Vent to Air Intake Pipes) x ,� I Lengt Di Lengtb Dia Spaang 71 JUIL L Ulii x Pressure Systems Only xx Mound Or At -Grads Bvstems Ouri ll 1 (II...Jd•. Dgptt�Qyer BedlTren Ce to It r 5V epih Ov etl;Tre h Edges xx Depth of Topsoil ! t \ xx SeededrSodtled xx Mulched l • ) Yes L _. No Yes ❑ No COMMENTS: (Include code discrepancies, persons present. etc ) Location: 1715 105TH CT 1) Alt BM Description=.f1&ii/(A�{% w( 2) Bldg sewer length = r4 - amount of cover = -/ ite Plan revision Required? J Yes $ No (� Use other side for additional information SBD-6710 (R 0/97) Date Inspection#1 Ins ction#2 poor s Signature Cart. No SYS 1. St di a: 9 Al 1 _ ., Safety and Buildings Division County .- ` -. $ 'IJ. 9 O21 llPll 201 VWWashington Ave., P O. BBX 7162 Sanitary Permit Number (to be filled m by Co.) Ts Madison, WI 53707-7162 (o 3335 Sarni Permit Applicati Scam Transaction Number �� P 7(/ in accordance with SPS 38321(2), Nis Adm Code, subnissicu of this form to tYG.. c unit I ( L/ Project.Address (if different Tau mailing address) is required prior to obtaining a sanrtary permit. Note .Apphcanon forms for =lo- . ed POV,TS are mites to the Department of Safety and Professional Servies Farsortal information you provide may be used for secondary purposes in eccard2nce with the Pri Izw, s 15.04(1 Xm , Sets. — O — kl L Application Information- Please Print All Information_ Property Owner's Name Parcel A D " O E) ©19—aoaa- oo�f eye i Property Oaver�s Matlmg Add[e5 Property Location Q'q , a` 1 1 . 3 3 " h Lot City, sffit 1 Zip ends I Phore Number�LLAZy e, f y4 Stern ?� 7 11 , Jx+�- � n T N, R Y" /E W 1L ype of Banding (check all that apply) Lot Su rvrsron Name 2 Farmily Dwelbog-Number of ByCm Qi P 6"% P Block 0 rl Publir/fJommernral- Desmbe Use -1 Crt) of ❑ State Owmed-Describe Use CSM Number :i Village of - _ ✓�fntw of I / _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A em ❑ Replacement System Ll Treanvent/Holdrng Tank Replacaurnt Oulu i ❑ Other ModrScauon to Exisvng System (explain) I B. C Permiit,�Renewal ❑ Permt Revwon ❑ Change of Plumber (] Permit TraysfQ m New Lut Prrnous Permit tvumbee artier Dare Issued Before Expvanon ONLQ W. Type of POWTS Svstem/Com onent/Device: Cher that apply) '= Nw-Presnurzed In -Ground ❑ Pressunzbd lit-Gr°uod C Mound > 24 m of suitable soil ❑ Mound 124 m of sortable soil ❑ Holding Tank G Preneannerit Deuce (explain) V.DispeurivaVrre,atmentAxea Information: {p r Flow (gpd) j gt So Rai Du al Area equved (sf) Dis Aria Proposed (sf) System Elevation 'i�Iicmoa 3 1P .s Tank Info Capacryto Total 9of Manufacnucr Gallons Gallons Umts o Sacks Exuvn&7aol ��1otVf�QAerr`-' �77; T Septic or Hnlmag Teak Dosrug VIL Responsibility Statement- L the madersign ume responsibility, for installation of the POWfS sbown oa the attached plans plumber's Name (Pent) 's Signature MPMPRS Number Business Phone Numba 5 11 plumber's Address (SStrce City, S ,Zap 1 � VDI. Countv/De artment Use 0111v APProved ❑ o d Permit Fee Date Issued rs um 4grnt StPaton: l (Us ' �� rven ❑ 0, R on for Denial iC� / ,� 1MConditions ppro 1\ 10 11 f� ,,, n i EM OWNER: l/ 1T�1 1��.0'r`IY,.(',[,Llifa�IyC` tM, bS1 IdIJ�M�/, MU�+c tin\ #pbc tank, effluent litter and r, y�.¢y� w t �l t�+S �bk(�� �_-1 cell muss be serviced I maintained. \ ��, u per m key p (yY I ji $Y�-�^^ per management plan provided by plumber. /J tLi aXY � P VVV se4hack — ; r,manta must be maintained as per applicable code/ordl��"'plarsfor mes,s aaasVpml tbeCaun mp. oless thaa8L..II'rhevmsx t n. Y✓i Cv\- T-b K'Y po d!yy� SBD-6398(R 11/11) Y PROJECT Oeverina Homes SW 1/4 NW 114S 9 /T 29 System PLOT PLAN ADDRESS 1433 Cemohous Ave Suite A New Richmond Wi 54017 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 97.5' 4/10/21 3 DATE BEDROOM CONVENTIONAL AT -GRADE X CONVENTIONAL LD?T 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 ChambersnoneT— 14�)ENCHMARK V.R.P. Top af� survey Iron ASSUME ELEVATIOOI/y 1001L Filter Lifetime'' ❑ BOREHOLE O WELL +H.R.P. same as benchmark, �� R C Pro 3 Bedroom House to 105 B-2 434' Property B - 3 Line L 1 % Slope 97' 200' Area 15' below system is remain undisturbed Huffcutt Combo Tank Scale = 1/4" = 10' � Grading is to be done to divert run-off away from system Property line Property Line 0' 40' 80' L I Well is to meet all WDNR 1 setbacks M Property Line IV -(-q (�'ICp py DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay m1p //dsps wi gov/programs/industry-services www wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary April 29, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-049 Plan Review: PWTS-042 100-10-C ✓ S14AUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Oevering Homes 1715 105th ct. Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: At -Grade Component Manual - Ver 2.0, SBD-10854 (N.03/07, R. 1112) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) Description: 450 GPD (3 Bedrooms — :Veto Construction) Maintenance Required tl/ The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats The following conditions shall be met during construction or installation and prior to occupancy or use. • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (PO WTS). 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 (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 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 ueces,ary 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 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, r�m � nrlea �eerT POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleest(d)wisconsin.l ov 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 Owner:Oevering Homes Location: SW 114 NW1/4 S9 T29 N,R17W 1715 105th Ct. Hammond 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 P-""/ Signature License number Page 1 of 9 System PLOT PLAN PROJECT Oeverina 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 97.5' 4/10/21 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 ,i)ENCHMARK V.R.P. Top ef� survey iron ASSUME ELEVATION IOUFilter Lifetime'' ❑BOREHOLE O WELL *H.R.P. sameasbenchmark Pro 3 Bedroom House to 105th Ct. B-2 r 434' Property \ I i I III OB` Line t%Slope I ` I" B t 9 7' rM Area 15' below system is remain undisturbed Huffcutt Combo Tank Scale = 1/4" = 10',-� Grading is to be done to divert run-off away from system Property line Property Line 0' 40' 60' Well is to meet all WDNR setbacks M. Property Line At -grade System Sloping Site Crqss Section and Plan View . -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 E i� A = Plowed f�}` = Clean aggregate _ basal area /z to 2 %z in. dia. Geotextile Fabric Lateral with 2" Topsoil Cap aggregate over pipe 0 = 4 in. sch. 40 pvc observation pipe Ft Lateral Invert ti•1 L.1.y.y{ �f•t•f•fY•J•A fi +r:f:J�Ja:r:h '^ ' :{1.1.h.L.t �. 4.bti.4.h.�y.Vt•ti.{.ti....M1 �J1{4Jti 4{ti F 4J f1{•JY. J. J.l:?.{.?.?: J.?.?.?. ._ {.;• ;r Ft Contour �,;y}%, EMPlowed D C Slope Direction _—io. 0� 0� Z % Slope / 0W Observation Pipe With Can � RNWIT /)Topsoil Cap 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'/4 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. Qfterthe topsail cap is placed, the entire at -grade is seeded and mulched to promote vegetative gto' , limit erosion and protect from freezing. The observation pipes are perforated in the lower Ganes and secured in place. 03/051gj Page 3 of ! — Pressure Lateral Layout One Lateral — End Manifold — Threaded Cleanout ForceMain Lateral Turn -up —N Plug \ +1 X L Long Sweep 90 Bend Distribution Network Specifications Lateral Diameter Z In. Orifice Diameter 31 In. X Orifice Spacing) Z In. L Lateral Len Ft. Force Main Diameter In. Force Main Length Ft. Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral turn -ups terminate with a threaded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. • • • • • Grade • • • • :• • 6-8 Inch Lawn Sprinkler Valve Box 03/051gj Page q of I Septic -Dose Wank Cross Section And Pump Performance Specifications I P M,. — Filter Manufacturer Filter Model Number Minimttm Pump Performance Required Z ? 7 GPM i Ft TDH Inlet oudet Manhole Min. 4" Above Grade With Locking Device. Lill Manhole < 6" Below Grade Sealed Watertight . Finished Grade IOutlet Filter ��— !Inlet Baffle Pump Manufacturer AJIZY Pump Model Number di Alarm Manufactuter // Alarm Model Number Switch Type . ie Total Dynamic !Lead (TDH) - Feet Elevation Head 10 4Distal Pressure . 5 Nctwork Lose 1 " rirce Main Loss ow - Manhole Min. 4" Above Grade With Liking Device Water proofMounted Weather-proof Innction Box i—� Vent Min. 12" Discomect "O)"Ve Grade Meads With Vent Cap B40N t Hoe on C Ft .r Bottom Flevadon D r <?7. 2 Ft GENERAL INSTALLATION: The septiadose tank is bedded and back tilled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers expose.! tc, t.. „ip have an affe�ivo locking dovicc (padlock) installed. Piping at the inlet and outlet is of approved materi.:'. , �i d1 to the tank with watertight fittings, and laid on stable soil to prevent settling or nagging The force ma .v1 I with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is scaled watertight. Electrical service con piles with NEC 300 and Comm 16.28. 02I05 LI Page —�2— of -- _— 280=SERIES 1/2 hp Submersible Effluenusump Pumps The Liberty M-Wes 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 "Unt-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature; • Vortex We impeller pemdtting passage of solids up to V • 416 stainless steel rotor shaft • Pemlanemly lubricated upper and lower bell bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1 yr" Discharge • Stainless stod bottom screen - easily removable • Maximum fluid temperature;140' F. 280-Series cord Lengths _Model 10' 25'(-2) 35'(-3) 501-6) 280 91arxlard Optional OPtional Optional 291 Standard Optional Optional Off. 283 Standard Optional Optional WA 287 Standard OPtiOnal WA WA 10' cord lergan standard on all models. Foroptional lengths, add '-2, 4 or-6" su1Por to modal number. ExamPlw for model 280 with 36' cord, order 280-3 Motor Spec/ficatlons h hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Pemlanent Spilt Capacitor 8.0 amps (115V) 4.0 amps (2087230V) Performance Curve: 280-Selves pR!lrrNNOOROROROOOOOORORO! N!!!!!!!nlRR.\!!!!!!!!!!!!!!' N NalO..RNl:�R/!!!!!!!!!!. r�!!!!!!!\►IOR►\!!!!!!!!!!' . rretrrie��p� �pr♦a:\---MORN! N N RRlOSO owommommIIOOOli\lROO 0 5 10 15 20 25 30 35 40 46 50 55 60 65 TO U.S. Gallons Per Minute 7 114 168 192 228 270 Liters Per Minute L)im ; snal Data: Vde�- ' - 'hs. Heigh- 'd" Major` ',crh:10" (rnode1287) M)c; .;r;*SampDiameters: Modci _c1, 28"�... 14" Model 1"- 1P ......1 0' FFOC�,�l c-i Mode1281, 283 Moda1287Me vrl 13" 9.5'l 7" 4.0" 17a'. x .fraturo-' a fully adjustable wide-angle float. Differential adj., .t t , he m -te easily bytedw tg the float to the die- chary,- c _ . -r nv ,,nting point Vertical float model 2871s not adju$tat Model 280 Model 281 Il s .c A2 '.3 Manual, Wide angle f ,an( le no switch float switchI1 sw'r. ch with quick- µ scri s disconnect �� - _ ry-L..ck) _t g -ter ' �1•� a us Certified aDrsegectbdregc NuaW rceca Liberty Pumps • 7000 APpie Tree Avenue • Bergen, New - wwW.iibertyp. .. T ^FvFi Vertical mag- netic float for smaller pits - will openrte In a 10" diameter sump 30-543-2550 Fax(585)494-18M Copynghl®Liberty AarW an.2017 aargrmeeewd. u7r2De RXM7 -20140048A 9 bi,e SECTION A -A POWTS OWNER'S MANUAL P, ,AGEMENT PLAN Pops_of_ FILE INFORMATION / Owner Permit # V )ESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units NA j Estimated flow (average) I Design flow (peak), (Estimated x 1.5) al d,, Soil Application Rate Standard Influent/Effluent Quality Monthly average i Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) 420 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Preheated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 53o mgA- Total Suspended Solids (TSS) 530 mg/L �t - Fecal Colifonn (geometric mean) 510" cfu/100ml iMaximum Effluent Particle Size Ys in dia. G t Other. NA ', 'Values typical for domestic wastewater and septic tank effluent WNTENANCE SCHEDULE Service Event Inspect condition of tank(s) At least once (Pump out contents of tank(s) When combii. vj� Inspect dispersal oell(s) At least once Clean effluent flfter i At least once �•: Inspect pump, pump controls & alarm At least once ev=ry- Flush laterals and pressure test At least once ev Jther At least once MAINTENANCE INSTRUCTIONS lnspectlons of tanks and dispersal cells shall be made by an . Plumber; Master Plumber Restricted Sewer; POWrS Inspector, include a visual inspection of the tank(s) to identify any miss;ny combined sludge and scum and to check for any back up or po, , Visually inspected to check the effluent levels in the observation 'The ponding of effluent on the ground surface may indicate a Igulatory authority. When the combined accumulation of sludge and scum in any t,i, the tank shall be removed by a Septage Servicing Opera, Administrative Code. All other services, including but not limited to the servicing of e and any servicing at Intervals of 512 months, shall be performed A service report shall be provided to the local regulatory authc ri S"STF" SPFCIFICATICINA S_ aC-_ ank Capacity /_007-) Gal 0 NA '.leptic 1 ank Manufacturer 0 NA Effluent Filter Manufacturer 0 NA Efgtj rat Filter Model ❑ NA . Pum,� -I nk Capacity al ❑ NA acturerYOU i-'u:,;n,ifacturer �/' 0 NA rent Unit ravel Filter ❑ Peat Filter - nioal Aeration ❑ Welland O Other. 0 NA -i r, vity) ❑ In -Ground (pressurized) 11 Mound - " O Other: 0 NA 0 NA O NA Frequency (Maximum 3 years) 0 NA r ea s(s) Ials one-third (36) of tank volume 0 NA o month(s) (Maximum 3 years) 26-year($ 0 NA y❑ onth(s) ear($0 NA ❑ month(s) " year(s) Cl NA ❑ month($) [3 NA months) earls) 0 NA ❑ NA following licenses or certifications: Master o Servicing Operator. Tank ktepectlons must c any cracks or leaks, measure the volume of _and surface. The dispersal cells) shad be ponding of effluent on the ground surface. 0 r ,',.fires the Immediate notification of the local �re of the tank volume, the entire contents of ordance with chapter NR 113, Wisconsin aressurized components, pretreatment units, lamer. n of any service event. Page _ of _ START UP AND OPERATION For new construction, prior to use of the POWTS Check trearm of painting products or other Chemicals that may Impede the treatment process and/or damage the dispe:. s 1 _^,gahons are detected have the owdsints of the tank(s) reproved by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen a' i ve During power outages pump tanks may fill above normal hig' sill. er is restored the excess wasfewater will bit in the badarp or surface discharge of effluert. discharged to the dispersal cell(s) in one large dose, overloadln t £ :er ing Operator prior to restoring power to the To avoid this situation have the contents of the pump tank rel a rating the pump controls to resiare normal lervsls effluent pump or contact a Plumber or POWTS Maintainer to : ao'. within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. D ^rig nr c : c ,r, or otherwise disturb or compect, the area withln 15 feet down slope of any mound or at -grade soil absorption ar Reduction or elimination of the following from the wastewat. fnrmance and prolong the life of the POWT$: disinfectants; fat foundation drain antibiotics; baby wipes; cigarette butts; condoms; cotton sw, (sump pump) water, fruit and vegetable peelings; gasoline . ; diapers; -: scraps; medications; OR; painting PrOdudls; Pesticides; sanitary napkins; tampons; and water softener br;m ABANDONMENT When the POWTS fails and/or is permanently taken out of st = "� he taken to Insure fret the system is Props* and safely abandoned in compliance with chapter Comm 83 3 11 - he: • All piping to tanks and pits shall be disconnected and entr is sealed. • The contents of all tanks and pits shall be removed a.n ')y a Septage Servicing Operator. • After pumping, all tanks and pits shall be excava�� �i _, removed and the vokd space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the followir, must be taken, to provide a code COMpll*FTt replacement system: ❑ A suitable replacement area has been evaluated P- ''ion of a replacement soli absorption system. The replacement area should be protected from : e :: should not be Infringed Upon by requited setbacks from exlstirg and proposed structure, lot -A the replacement area will result In the nele l for a new soil and site evaluation to establish a sult ,u, _ement systems must comply with the rul" in effect at that time, ❑ A suitable replacement area is not available due t. - ..r. is. Bailing advances in POWTS technology a holding tank may be Installed as a last resort to re e she has not been evaluated to Identify a su:t I sure of the POWTS a soil and ate eveivar" m t be performed to locate a suitable replacemer, is available a holding tank may be instelledl as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may ' Mow ng removal of the bfomat at the Infiltrative ace. Reconstructions of such systems must c� � t ' �f t;me. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY ,rro/OR INSUFFICIENT OXYGEN. DO NOT MAY RESULT. RESCUE O� A ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN, -LS. DEATH PERSON FROM THE INTERIOR OF A TANK MAYBE DIFF ADDITIONAL COMMENTS POWTS INSTALLER "`Rdq Nam e� Phony - — i l r " -IL J SEPTAGE SERVICING OPERATOR (PUMPER14 (PUMPER i ORY AUTHORITY Name Phone This document was drafted In compliance with chapter SPS 383.2::' ). Wisconsin Administrable Coda. NOV 21 2019 WSCW,W Dpebrwnt of Fab, Croix County DMticoutaafetyaniSul mmunit Develo rtlent IL EV,' In aocwdance wnh Comm 85, `. Attach Ootopleta site plan on paper not lass than a 112 a 1 i Inches In ,' Include, but not Wiled to: vertical and hadzontat reference point (BM), " puoentelope, owlew dimensions, north arrow, and loeallon and dlst Please print all Information. PM ertonaeaon Yewerq my be used rat weendary pugmse(P&Oe Propentrowner . PmpsrtyOmWaMWWVAd&sq_ ( tab P • umber i Gauttudlcn Us . esldendallNumberofbedr�•n,s_ ` [3Replacement ❑ Public or wmmerdal-Des Woe, _ Parw4mwAdal_.'L'i. General co ..we Sa(IS Siliall A il•+�«- and nmrtamxgaeons: System type a eoWrbv fR—ph Ground aurlen elev. ✓ h. horizon Depth h. MffAnantCdw Munson Redoz Desolpaon Ou• Sz. Cont. Ca« 2 2 Pit Ground surfaco Slay.��,,_,.7� H0FtM) t Depth In. Dominant Color Munn Radon Deaalption Du. Sz. Cont. CD;x 'I L. ' Effluent e1 • SOD. > 30 a 220 myL and TSS > w < 150 CST Name (Please Print) Bird Plumbing, Inc. Shaun Bird Addreee -- 1432 120th St, New Richmond, WI 5401— C5T-a0►I -3a 1 Pape—Lof 3— rk • n-^ �� Dot 4' T Z/ N R/ / E(11w 14 1 t n NeatestliAe ,tom/_rI ri GPD .t and TSS = 30 mp1L CST Number 226900 Telephone Number 715-246-4516 R Propany o+ wr 3 Boring 0 0r� Boning &pit Gourd swface eavl�V_fl, y' ������l�aTla•Jy©�/ ©'t?lIJ OM of . _© ❑ Bonrlp ❑ pit Gound wface slay, ft. HM= Do* h Dotnlnant Color Mtnse9 Redox Owaip:ion Taxi",. Cu. Sz ConL Cola ❑Bwfng N Boring - ❑ pit Gmunduxfamalay. f;. Honmrt 'kpot in. Dominant Color Munsall Redox DesmipL..n. 1 7.>' Du, St Cont Color i Emuerrt Yf-BOD,>30<220mgL"TSS>3O�1 y The Depa=cnt of Commerce Is an equal opporrun4y s.'l,cc prr necd material In an alternate format, pleasc c Fact thr seoauoasuoi Pape ` of .._in. Sop Maeonl Roots Gp" �... 'E1fp1 'Fdi y, L < - :iSS<30ngll. o to access seryices w ..-264-8777. Soil Tesl f Project Name Edward Folitti Address 1894 110th Ave Baldwin Wi 54002 Lot _.LSubdivision r S W 114 NW 1/4S 9 T 29 N/R17 Boring 0 Well PL Property Line ,BMorVRP Assume Elevation IOC ft. System Elevation T13D �H, , 434' Propert 97.0' 9T5 20ri F R t.' 343 inl 226JX 3 Ile is 1" = 40' mess otherwise c 1;d Property Lines � . 5hEET ,z, __r or HO.\fF5 gang qes€ ppe§ 'sg�99 a E� a 5HEET 2 Of b.- ra0!EC! 203 'FOUNDATION :...b. scai ns snaxm m wo � � .aww�.m z - ewin aew r _ a - i --2 7 t ............ ......... . _ ........... I....i _ i )l0IM 5'a MAIN LEVEL PLAN €; rwu iueoa+a7ou ioc wrowenriou 5HC iurow.Anou EE LG s•corvwenr vorice — 4 OF 5 — — ... Paaear zo ai 2ND LEVEL S r CRo' ' ury rY SANITARY SYSTEM File #: I OWNERSHIP/ADDRESS FORM OCreated )>212027 y 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 Mailing Addre City/State/Zip Phone Number (required) �/� �O G / c Email Address (required h Parcel Identification Number�— (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Locatici- I , Sec. TZ Subdivision Plat: ,Town Lot #-7. Certified Survey Map # Volume Page # Warranty Deed # /l 7 ( (before 2006)Volume . Page # Number of bedrooms —S Spec house�y 0 no Lot lines identifiabl*es O no New Property ddress (St ff Initials) OFFICE USE ONLY /OS Y<� (Verification of new ddress required from Community (� Z( (Date) Department for new construction.) 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 cdd0sccwwri.(iov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.00v C3 zz S40° 24' 14"W 34 70' r / N ... / G5 / ss •' 0>, SW_1/4 OF THE NW_1/4 NWl/4 OF THE SW 1/4-- LOT 7 a,lzs sQ. Fr ACR LOT 6 85,557 SQ, FT 1.96 ACRES sl, �f 21 128.41' I09.I2 S89"49'38"W 189.27' LOT 9 82,749 SQ. FT. 190 ACRES S86°46'47"E 367.46' LOT 8 1061.34 73,996 SQ, FT 170 ACRES I 1061.83 (Q nn�I r �'VVl DRAINAGE EASEI AN UNOBSTRUCTED EASEMEI (3� HAMMOND FOR THE CONSTRL NECESSARY UNDERGROUND INCLUDING RIGHTS TO CONDL EASEMENT SHALL HAVE NO PI TREES, SHRUBS OR OTHER OI INSTALLATION, FUNCTION, OR TOWN OF HAMMOND SHALL W TO PROHIBITED OBSTRUCTIOI MAINTENANCE SHALL BE IMPL STORMWATER MAINTENANCE WEST AND ALL COSTS FOR RE FOR IN EQUAL SHARES BY RE: THE PI ET I nTe r nu — a rn-. (^ST-doI�-3a1 wisconsinDepartment ofCommeme SOIL EVALUATION REPORT Division of Safety and Buildings Page J— of _L in turn uouw mm.nnwn ov, •va. rv,u,. �.wc County � I - - Attach compete site plan on paper not less than 8 112 x 11 inches in size. Plan must Parcel L. PAC k si: 0161 8—L40- I DO include, but not limited to: vertical and horizontal reference point (BM), direction and Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. a by Date PondW nn infoabon YOU PnN10 mry be used IW isco^d.ry pure . .c (Pmy law, S. 15.04 (1) (m)) 2 / 2 2 Propertyowner Property Location r Govt. LotA,) 1 /4/g Jl l4 S 9' T24 N R E( ) W Propertyownefs Mailing Address Lot# Block# subd. Name i� c Masan-1 del t City ( State Zip Code Phone Number ❑ City ❑ Village own Neafest Ro h / ( ) u ti Construction Use. Residential / Number of bedrooms - Code derived design flow rate q-JX7� GPD ❑ Replacement ❑ Public or commerdal - Describe: Parent material flood Plain elevation if applicable %�✓ //f- �l�.GR Generalwmmenis fp;ls Stich AGE SyNtwr LO p a and reco mhandations: System Type _ _ System Elevation 230 M ME © 1 jff/A M��WMMM �j .� .:MYAA 1�&- Effluent 01 - BGD. > 30 < 220 frg7L and TSS >30 < 150 • Efllueru #2 = BOD. < 30 mglL and TSS < 30 nKA CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 //_ o o2 / 715-246-4516 16 sti, Courf Property Owner Parcel ID # Paine Z �, � Ong # t❑r� Boring /yy/�� --� 1C4, Pit Ground surface elevlft. Depth to limiting factorn. Sal iration Rate Horizon Depth Dominant Color Redox Desorption Texture Structure Consistence Boundary Roots GPDIff in. Munsell Ou. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z /z ^ A C n -' 46 0 1, "— - s s ' --r Ac ❑ Ong # ❑ Boring ❑ Pit Ground surface elev. it Depth to limiting factor in. Sod oration Rate Horzon Depth in. Dominant Color Munsed Redox Desai ption Cu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 Boring # ❑ Boning ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L . Effluent #2 = BCO, < 30 m94. and TSS < 30 mg/L 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. SSIMUM(s- 0 ) Soil Test Plot Plan Project Name Edward Folitti Address 1894 110th Ave Baldwin Wi 54002 Lot Subdivision S W 1/4 NW 1/4S 9 T 29 N/R17 W ❑ Boring Q Well PL Property Line `. BM or VRP Assume Elevation 100 ft. VrM #226900 Date 11/22/19 Township Hammond County ST. CROIX Top of survey iron System Elevation TBI) *HRpSame as Benchmark 434' Propert; 30� 3 C'� _ _1 _ _ 115 A/ 5 PREPARED FOR: IM(C�i=mil\\ �,_ulx� I FEB 03 2020 PREPARED HY: I 54 CmxCce tiv COTrtlll ll'i 1, C¢V2 �E` PLT aol9-o06 l:ECTON B. R9N. RlT PHEASANT RIDGE WEST}��t��c' PRELIMINARY PLAT a WONTED IN PART OF THE SWC4 OF THE NW3/4 AND PART OF THE NW 1/4 OF SW 1/4 '^^"+ 6 ?4 OF SERION 9, TEEN, P11 W, TOWN OF HAMMOND, ST CROIX CONNW,, WISCONSIN, BEING OUTLO-1 OF CERTIFIED SURVEY MAP DOW ME 30 PAGE 5723, DOCUMENT NO 1091874, e _ ____ sv'a m aj i 1 LEGEND ® FEE, ND! ono ouEclu oEu�u,ra x.rxcu=xwx IlAX owxu�� eoi.aamo.meno. m -,,I NEEEE caxlm,ws E—LEuc. ox TxE s-�` 0— ReDII ED. E>3 s RED, IURWTNcx—_MD, I,a PHEASANT RIDGE WEST EDWARD FORUTI SEC 09 T29N.i7W IpWN pFHPMIfpNIJ $i Cf\:M CCUNIY W'SCOiJSIV PRFI IMINARY PI AT I datE•CORottiRE/aaon4s SRN Lod Rundhr 3 - bear wA ) �5c COUNTY NO. 633351 STAT IVANITp�RY PERMITr7 Mr /of PREVIO OWNERDV/904 PI G �1JS, LJX, PLUMBE Jk'A J 1 TOWN OF SEC_ C1 j N, AND/OR LOT 14� EXPIRES IN LICK 2Z6104 BLOCK :�SSUBDIVISION 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 maybe renewed for a specified period. to) 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 UNLESS RENEWED POST IN PLAIN VIEW THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (Rl1/20)