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HomeMy WebLinkAbout008-1038-70-050Wisconsin 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)] Perma Holders Name City Village Township Kurt Swanson CST RM Elev Insp BM Elev, BM Description ILL.0 m TANK INFORMATION TOWN OF EAU GALLE TYPE MANUFACTURER CAPACITY Septic F F��T 2 Sa �jTJ Dosing Aeratl Ho g TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing u 1 Aerano Holding i PLIMISISIPHON INFORMATION --� Manufacturer JJ De /' I g��ly G290 PM Model Number r LD f?F� Friction Loss ISystem Head', TDH �t (j ,0 q �D ain Length /O( Dia, n in I Dist to Well V_ SOIL ABSORPTION SYSTEM —+G TION DATA County St. Croix Sanitary Permit No 633902 State Plan ID No aYTS-O$21o1$10 -C Parcel Tax No. 008-1038-70-050 SectionlTownlRange/Map No 13.28.16.196A STATION BS HI FS ELEV. Benchmark Z • ZO Alt. BM Bldg Sewer iz C) 9� r SUHt Inlet O,I �fz •td/ Sti Outlet Dt Inlet / Of Bottom �yr.� 70, Header/Man. Dist. Pipe 35i3 Q r 94, o Bot. System Fin Grade y ,., , 11 l y _ t. caves 0.i St Cover ' l�r 5• q 1 1 T • �O d 7- _a 9s:2D Tnw. 2-,0 1e11.2,0' t1 4 g. Kayo' IalIM.zo ED ENSIONS Width / ('�J( Length No Of l ( 2 L!/115 PIT DIMENSIONS No Of PM1s Inside Dia. Liquid SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT nufacw Type Of System ' 3ad� _ _ /� Mo tuber oil Header/Manifeld til 1 Distnbution / / x Hale Size N x Hole Spacing Vent to Air Intake .D Pipe(s) L( il 2 �' �3a -7 7/ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil-' Yes — No L- Yes C����JJC//��pp Aka �: ,(Include co discrepencies, persons present, etc.) Inspection # %I' L cation: No Address A 1.) Alt Description = yApy.. -1 r 2.) Bldgg sewer length = � �.�CN1a+� f f����6� � t� rl UUU - amount of cover = �(t,2 !^A-$eC I uc4ni I I kJ D� 3) z•p t� Plan "n Ee k84+ Use othlr•-side fQr a drtio igfornio SBD-6710(R.3197) �' Dale Insepctors Signature Inspection #2t y/ j 12p2, i r� Cart No r) SA" - o Safety and Buildings Division COWty� �� �� r 4 � -- <� ,t 'tQZ-1 i 201 W. Washington Ave., P.O. Box 7962 Sanitary Permit umber (to be filled in by Cc) Madlsor, Wl 53707-7162 oymg t tom Applicatio Permit 3 State Transaction Number r� `/ lv � t� / r� in accordance with 383.21(2), Nis Adrn. Code, submissikii of this form to e mat unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit Note Application forms for suite-owntc! PO WTS are submined'to the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposesin accordance with the Privacy Law, s. 15.04f1�m _Snits. 3 Zf� S'rN ,ST —7 1. Application Information— Please Print All lnformadon Parce110 IWI' Property Owner's Name ���Its �i OUS.1�8'�O'OSO Property Owner's Matting Acidness Pm z- ny Loc t 7Lo. MGA Lu .?. GoA Lot Section Section j 3 )0000f t¢k T N; R E twj City, State L l/ � lf,l � Z�ode Phone Gr� Number f- "� H. Type of Building (check all that apply) Lot q Subdivision Name or 2 Family Dwelling —Number of Becrooms / Block X ❑ City of ❑ Public/Commercial —Describe Use CSMNumbcr ❑ Suite Owned —Describe Use El of '� �L J Z81^Q 31 - -7006 Town of Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) `tfiXew System ❑ Replacement System ❑ TreatmentUoldmg Tank Replacmnmt Only ❑ Other Modificahon to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem/Coin onemlDevice: Check all that appI4 ❑ Nan -Pressurized in -Ground ❑ Pressurized In -Ground ❑ At -Cm uud> 24 m of suitable soil 11 Mound 114 in. ofsmtabJ{e so/il _ Za 1 ❑ Iloidmg Tank El Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreatment Area Information: Desi Flow d) l l Dest Soil Applicati to dso ��- Di is Req ed (so C /C/ 1500 D p6rs Pr used (sf) /U E r67. S em Elevation, 7 VI. Tank Info Capacitym Gallons ToW Gallons pof Units t, ufacmier I LNe xin-" F1 14-c o s E y tj d New 7aoks E�smg Tanks Septe or Holding Tank / P,'J Dosing Chamber J VII. Responsibility Statement- I undersigned me responsibility for installation of the POWTS shown on the attached plans. Plumber's_Name (Print (I PI s Signature _�- MPIMI'RS Number 4 Business Phone Num J l Plumber's Address (Street, City, Statc, Zip ) . Coull a artment Use Or l" Approved ❑ Disapproved Permit Fee $&75.vo Date Issued i Zl Issuing Ag signature El Owner Given Reason for Denial e IX. C qt ,*A*provaVReasons for Disappro 13 � I �oK I �y pt1S IN S 9 rov;r 1. Seotu fYnk, effluent tiller and In /� / 1 ' + 1� dispeeral call mutt be sere rood/tre tuained ,p -Ar a f..c p ; • t C C4 mot/ 4l[, � tl 5 rpti t / l• r 1. as per nunayorrent plan prn4ldod by plumber. 2. All setback, Cyuirenserita must bit maintained I /- P1 wK lice 5L /% rov1 de S iekh i3tai h YtgH ag obt aoolleable (ddb1brdldahcea. Attach to complete plans for the system and sub t to the fain only on pap/er not less that 8 m x 111itchees in site f��rN—c4 /Dn 4 Prr�a�✓'IC� orN�¢J�. SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Kurt Swanson ADDRESS 302265th St. Woodville Wi 54028 SE t/4 SW 1/4S 13 IT 28 SIR 16 W TOWN Eau Galle COUNTY ST. CROIX SYSTEM ELEVATION 960' DA'IE7/14/2/ BEDROOM 4 CON%ENTIONAi. AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 0 ARSORPTON AREA 600 # of Chambersnone BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION IUe' Filter Lifetime BOREHOLE O WELL - II. R. P. same as benchmark Cry Rd N Well is to meet all WDNR setbacks Grading is to be done to divert run-off 95.5'95'94.5' 93.5' away from system B-1 8% Slope Scale = 1/4" = 10' p 40' 80' � B 3 I � I Area 15' below system is to remain undisturbed B 2 Pro 4 I Bedroom Huffcott O cop A Combo Tank 1 Property Line 4 ^yn l� M oySMTx4.{j-. .kr'- t.. August 3, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-8-3 Plan Review: PWTS- 082101920-C Shaun Bird 1432120`h St New Richmond WI SITE: Kurt Swanson Lot 1 Cty Rd N Town of Eau Galle St Croix County SE Y4 SW Y4 S13 T28N R16W FOR: Description: 4 Bedroom — 600 GPD — 24" to limiting factor- Effluent Filter - Maintenance required. DIVISION OF INDUSTRY SERVICES 10641 N RANCH RD HAYWARD WI 84e43-M2 Coned Through Relay hftp:itdaps.wl.goWprogramoAndusUy.*elV = WWW.WWWnSWOM Tony -Oawrnor Ortm Dawn Orlm • Saorotary Mound Component Manual — Ver. 2.0, SBD- 10691-P (N.01/01, R 10/12) 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 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: Reminders The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. 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. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SIPS 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. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. Sincerely, ,Job Ro-lv4ey Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)813-9111 Joshua.rowleyPwisconsin.gov Cover Page Shaun Bud Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/14121 Owner -.Kurt Swanson Location: SE-1/4 SW1/4 S13 T28 N,R16W Lot 1 Cty Rd N Eau Galle 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 Shaun Bird i Signature— License number 900 Page 1 of 9 PRO F,CT' Kurt Swanson SE 114 SW INS 13 System PLOT PLAN n DIIREss 302 265th st Woodville Wi 54028 1f 28 wR 16 11 IOWN Eau Galle tuLNTV ST CROIX SYSTEM RLEVA'l'IO.N 96.0' 7/14/21 4 U A'1 P: DEDROO�1 CONVEN110NAI, AT -GRADE Co SiVE9TIONAL Llr l ❑OLDINO TANK XXX 1255 gallons 'TANK I,IF`I"f.ANK SME DOSE 1AN'K SIZE 765 MOUND SEI'"I'IC SIZE TIOLDISG LANK SIZE LOAD li 1.0 ARSORH ION AREA 600 k of Chamhersnone All ARK V.R.P. Top of steel fence post ACNLIII: k'LFN t'rION too' Filler Lifetime BOREHOLE Ot1'ELL III. R.I'. same as benchmark Cty, Rd N BM' Well Is to meet all WDNR setbacks 95. 5'95'94, 5'93 5' B -1 I I I I B-2 Property Line Grading is to be done to divert run-off away from system 8 Slope Scale = 1/4'' = 10' B-3 Area 15' below system is to remain undisturbed Huflcutt Combo Tank 0 Pro 4 Bedroom House 40' 80 Mound System Cross Section and Plan View --------------------------------- J I I � I i I jA 1 I I � �I i I I 1 t — -1 - Topsoil = ASTM C-33 Cap Material sand LII Fabric Z5,-O I t Contour I = Clean aeglcgatc !<. [0 7 !•i indin. tt tipti JSii:: >iP`i+ I: t S SPIOw'ed SlSrfaCC �— Slope Direction Feet 1 1 1 I ( I 1 I I I 'I i_51=1� _- 4 in sch. 40 po,c C observation pipe hl , L7 r't 5.71 GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the situ The mound basal area (L x %V) is plowed with a moldboard or chisel plow. Plowing may not proceed if the sod is wet enough at the plow depth to form a '/. inch soil wire when a sample is rolled between the palms of the hands. ASTNI C-33 quality sand is placed innnechately ahei plowing. Sand Is placed with a tracked machine keeping i 3 or more inches of sand under the tracks or is placed overhead by a backhoe. Special cane must be used when placing ,and of less than one foot thickness to minimize compaction of the plowed saiface After the topsoil cap is placed, the entire mound is seeded and nmlchcd to promote vegetative giowth, 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. Ct 10/07 lg1 Page -J of Pressure Lateral Layout Two Laterals -- End Manifold t o— 'Threaded Clennout lateral Turn -up —10 Plug Manifold .y t— x —1 Long Force Main / Sweep 90 Bend �7 03/05 Ig) ion Nehvdr_k S eciticn_ Lions meter oameler_ --- in. —h� Mete �cing)_____td Z Id Len ! FL I Pl- `Z i Diameter in. 1 Length _ -55 � Ft. Pressure System Consti uction I.uterals are constructed of bche(iute 40 PVC pipe. C)rm"eec are dulled perpendicular to the pipe with a sharp drill bit and taco down. Lateral turn -ups terminate with a (Ineaded cicanout plug and are enclosed in a 6-8 inch dtamcv,r lawn sprinkler valve box accessible lium finished grade. _ ••••• Grade • • . " * . 6-8 Inch Lawn Sprinkler Valve Box Septic-Dose'{ank Cross Section And: Pump Performance Specifications Conk ivlanutactluer _�l 1'xnk Model Number Total Tank Ca�erity - j Bury Dept Filter Manufacturer Filter Model Number r _ Minimum P rtmp Performance Required _GPM Q 3 Ft TDH Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole <6" Below Grade Sealed Watertight — — Finished Grade Outlet Filter tract I.,r Inlet Baffle switch Selt#tt sg and Reserve Capacity _ Tank voturno GYI Dimension Inches Volume Gai, (r_serve) A -�- (alarm) B 2 -:1 (dose) C : J IO°%. •. (dead) D Total _ • ;_ " — Pump Manufacturer _] Pump Model Number _ _ _ �J____ ----- ---- Alarm Manufacturer ✓/y 7�_5 � rAlazm Model Number Switch Type Total Dynamic Head (TDH) -Be-et Elevation Head Distal pressure Network Loss —37. —>7--_ i. Force Main Loss %• j _ Total _ __ Manhole Min. 4" Above Grade Secumly Mounted With Locking Devi Weather-proof 1 Junction Box i Vent Min. 12" Disconnect Above Grade Means With Vent Cap A„ Weep B Hole Off Elevation C P� FfX. Bottom D Elevation GENERAL INSTA'LLATTON: The septiddosa fink is bedded and back Rlled in accordance with the manufacnuar'e product approval apeed ications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and Mier is or approved natordal, connected to the tank with watertight fittings, and laid on stable will to prevent settling or sagging 7Le force main is sleeved with 4" Sch. 40 PVC to bridge the tank axcavauou and the sleeve is seated watertight. Electrical service compties with NEC 300 and Comm 1628. 0210S IJ page 5 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-Sons will provide years of reliable performance, All Models Feature: • Vortex style Impeller permitting passage of soilds up to %" • 416 stainless stool rotor shaft • Permanondy lubricated upper and lower brill bearing • Epoxy powder coat finish •All fasteners -corrosion resistant stainless steel • i t? Discharge • Stainless steel bottom screen -easily removable • Maximum fluid temperature: 140' F. 280-Series Cord Lengths Model 10' 25'EK 35'(_3f 50'(-5) 280 Standard Optional Optional _ Ophona{ 281 Standard Optwnel O 1p tonal Optional 2a3 Standard tonal 2p0onai N/A 287 StandaM�O honal N/A _ N/A _ 10' cord length slandant on 0 models. For optional lengths, add "-2, -3 or-5" suft in model nuniber Example: for model 280 Wh 35' cord, ,or 260-3 Motor Specifications yz hp 60 Hz 3450 HPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (2081 7 tno odel 260 anual, switch He C� -- Motlel281 -f Wide angle float svntch With gilick- discorl Ls SS § $ R" c us Certified Performance Curve: 280-Series 40 _ - 12 35 11 30 g i25a'-'� 8 d 6 � i1j 15 = 10 5 � 3 2 0- — .0 0 5 10 15 20 25 30 35 40 45 50 65 60 65 70 U.S. Gallons Per Minute 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight- 291bs. Height: 13" Major W)dtht 10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF...t 0" Factory switch Model 281,283 Motlel 287 settings yMF Turn on level 13" 9.5" Turn oft level 7" 4,0^ The Modol 28311 a fully adjustable w oeanglefloat DiBerenOW adrystments can be made eadlyby gAl,orrigthe III to the dis- chargepip,.. M.r mounting point. Vertical fioatmpdel 287,snot aWustabk Liberty Pumps • 7000Apple Tree Avenue • 9er9an, New York 144 P6 www.kbortypumps.com Model 283 Model287 Wide angle VMF-Series float switch Vertical mag- with senes neticfloatfor (piggy -back) smaller pits - plug will operate in a10'dlameter sump • Phone 800-543.2650 Fax (585) 494.1839 r.4 mOIOLtWIPumpv1nc W17 A:Inptsma a LUT1000R0 7 cic.: oew�:�oco><,,.,n:ememloa eQ �.:s l� SECTION A_A. .__._ =ai« s FILEINFORMATION POWTS OWNER'S MANUAL & MANAGEMENT PLAN SYSTEM SPECIFICATIONS rasped_ owner '� �n,n✓ - ' I.W—' Septic Tank Capacity al O NA Permit S Septic Tank Manufacturer NA DESIGN PARAMETERS Effluent Fitter Manufacturer _M1 r /,,,Z� DNA Numberof Bedrooms `{ O NA Effluent Miter Model O NA Numbarof Commercial Units g.NA Pump Tank Capacity al O N Estimated Bow (average) '111130 gai Pump Tank Manufacturer IA Design flow (posti (Estimated x 1.5) payday Pump Manufacturer '/y.. NA Sol Application Rate _ r v da yfl' Pump Model ❑ NA InfluentrEtluenl Quality Monthly average' Pretreatment unit A Fats, Oil & Grease (FOG) S10 mg;& O SandlGraval Fitter ❑ Peat RAW Biochemical Oxygen Demand (BODJ Q20 fngyL O Mechanical Aeration ❑ Welland Total Suspended Solids (TSS) SIS0 O Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell($) Biochemical Oxygen Demand (8ODJ 00 mg/L O In -ground (gravity) fil inVound (pressurized) Total Suspended Solids ('TSS) s30 mg1L ❑ At -grade Mound Fecal Colifarm (geometric mean) s10' clu/100ml ❑ Drip -line D Other. Maximum Effluent Particle Size YInchdiameter vawm Mimic `!"- -4 (non�unmerWq.-asloWater en0 . Vaues tWMJl for wekeanee wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ' ❑ months Fyyaar(s) (Maximum 3 yrs.) Pump out contents of fank(s) When combined sludge and scum equals one-third (Y.) of tank volume Inspect dispersal cells) At least once every J'xO months Jtlfear(s) (Maximum 3 yrsJ Clean effluent filter At least once every / (D months 25-yasr(s) Inspect pump, pump controls & alarm - Al least once every „7�❑ monlfu,fTear(s) ❑ NA Flush latvals and pressure test At least once every ..a D morl hg�ar(s) ❑ NA °s10f At least once every ❑ months O year(s) O NA outer. At least once every ❑ months O year(s) DNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cans shall be made by an Individual carrying one of the following acenses or certifications. Master Plumber, Master Plumber Ri stdeted Sower, POWTS Inspector, POWTS Maintainer; Septege Servicing Operator. Tank inspections must Induds a Visual inspection of the tanks) an 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 W 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 ponding of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires the Immediate notdicatlon of the foal regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third (YY) W 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 Friers, mechanical or pressurized POVVTS components, pretreatfinew components, and any other maintenance W monitoring at irAervals of 12 months or less shall be performed by a certified POWTS Maintainer. A set," 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 or the POWTS cluck treatment tanks) for the presence of paining products or other chemicals that may impede the treatment process and/or damage ure dispersal cell(e). if high concentrations are detected have The contents of the lank(s) removed by a septage servicing operator prior to use Pepe.__ of _, START UP AND OPERATION For new construction, prior to use Of the POWTS check treatment tank(a) for the presence of PSINing Products or laltm ch'a MET may impede the treatment Process andlor damage the dispersal eNi(S). If high conrenireliona are detected have the contents of tha tank(e) removed by a septege aervicing operator prior to usa. System scan up shall cal occur when soil conditions are frozen at the infiltrative Nufflice, During power outages pump tanks may fill above normal highwater knee. When power to restored the exceas waalewater will DP discharged to the dieparsai cell(e) in one large do", overloading the cell(a) and trey result In the backup or surface discharge of effluent To avoid this satiation have the contents of the Pump lame removed by a Septage Servicing Operator prior to majoring Dower to the affluent pump or confect a Plumber or pOWTS Maintainer in assist in manually operating the pump controls to makes formal levels wiWn the pump tank Do not drive or park vehicles Over tanks end dispersal taus. Do not drive or Perk over, er otherwise dlsturb or compact, the area wahln 15 feet down slope of any mound cr at-gmda aril absorpilon area, Reduction a Annimi5orl of the Missing hall the wastmadw slraem rally improve the performance and prolong dN life of the POVJf$: sagoodes; baby vApes; cigarette butts; condoms; cotton uvabs; degressere; demsl floss; diapws; disinfectants; fill: foundet on drain (amp pump) water, (ma end vegetable peaik➢a gasoline; grease; herbkddee meat scrape; medications; oft; peiming products; pesticides; sanaary napkins; tampons; end water softener brine. ABANDONMENT When tie POINTS fails antllor is permsaenay taken out of service the following slaps shag be taken to insure that the system is propolly and safety abandoned In compliance wlin chapter Comm 83,33, Wisconsin Administrative Code: • AN piping to tanks end pits shell be disconnected and the abandoned pipe Openings sealed. The contents of all mks and pits shall be removed and propedy disposed of by a Sepage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed o then covers removed and Me veld space eNad with eoll, grave; orarrother inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the fosowing measures have been, or must be taken, to provide a cede Compiupht replacement system: ❑ A suitable replacement area ties been evaluated and may be utilized for the location of a replacement sop absorption system. The replacement was should be protected from disturbance, sad compaction and ahould not be Infringed upon by Required ambaeka from existing and proposed structure, lol tines and wells, Fellure to protect the replacement ems will maul in the need for a new sell mid site avalumlon to establish a suitable replacement area. Replacement systems must Comply with Me atoll In effect at that time. ❑ A sultabie replacement area Is not available due to setback anNor soil limitations. Barring advances In POWFS technology a holding tank may be Installed as a Isat arson k replace the failed POINTS. X3- a site has not been evalusled to Identify a suitable replacement area. Upon 1m;Ore of the POINTS a aril and site evaluation moat be performed to locate a suitable replacement area. If no replacement area is available a t oldhig tank may be Installed as a leaf resort to mplace the failed POINTS. Mound and al -grade aoll absorption systems may be reconstructed in piece following removal of the bloand at the Infiltrative ace, Reconstructions of such systems must comply with the rules In affect at Mat Unto. <<WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT MNTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE &A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POINTS INSTALLER POINTS MAINTAINER Hama S�irL •'T/i j�''``� Name r��o-w�7fv7'��j'�'�' Phpne Phone '�/—I J 9FPTAaa SERVICW ER TOq MP R LOCAL REGULATORY AUTHORFTY Name T%t.r� .%r A/F Name ' phone �/� '- O(. �] _Phone %/_i%- YGl — ( i �% ✓ This daaenentvreedraaad hcompllM whhdlWw SPa 3al.aa(aXeX+)(a)6(q aaa 38omil+L(2) a(3),wlmmWn AdnNisbeak, cede. MAIN FLOOR TOP VIEW UPSTAIRS TOP VIEW UUNN51AIK5 IUP Vltw ST CRO ^Y�UNTy SANITARY SYSTEM File #: Use OWNERSHIP/ADDRESS FORM Office Created /2021 212027Only 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. Kt t 4+- _':f,W0'/j (J\r— Mailing Addre City/State/Zip Phone Numbe Email Address Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location Sk 1/4 ,1�(�/4 , Sect 3 11 T Z N f W, Town of 6e� G / Subdivision Plat: Lot # Certified Survey Map # //13%`I15 Volume 31 Page # 7&V8 Warranty Deed # _5�96 7, (a (before 2006)Volume Page # Number of bedrooms `7 Spec house*es ❑ no Lot lines identifiabl�Jd4es ❑ no OFFICE USE ONLY New Property Address 3 Z-Z 2 6,S-7T/-{ _5' `Gy / (Verification of new address required from Community Development Department for new construction) S� 1S 7 30 i Z f (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cddgsccwi gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.aov CSTaw- ly 1 wisconsm Departrrrer D^rsior a'sate , aro tlotCan p3 ���� �CiL EVALUATION REPORT Page _ of ct. xl at g, C mrr BE MISor^ Cob rtt, Ocae Comty �� Attacr complete site an 00 than x .. inches it sue Piar. Host ndiude, put na. 6mhec - vet a and honzonza ra-erance ao'n• BN', drew'on anc Parma I Gi; percent slope, scale or dimensions nonh arrow, and location anc distance tc nearest road. (Xj 8 - 10 36 -70 - 060 Please print all information, I Reviewed by Date Parsorar, mfonmaaon yw oroviae ma, be usae (a a unary purposes (Privacy Law, t t E 04 l? Prooe-' Curter Fropert, Locatior —5 r{ fV1(^Z � Govi. Lot �C 1 �4 �'t✓ t1a S � 3 T L- � N R � � E ( ' WW' Property Ow-ws NaiiiN Aco ess I L t # Black # ; Sub, Name o' C" n -L b-'�5-I— crd' i CAy State Zip Caoe Pna'* Number I7 C4 1iliage Town Nea/r��s'.Roared �//� ems./P., " New Construction ;1se�Revdenhal; Number o, bedrooms ! Cade denved design flow rate f-(A GPC Reaiaoament Pmhc or xnr-�e-aa�-D_esmbe Parent n•.atena f%K�IX—Cs�r?-t .t/ �t.� t� 1/l� Floot Piam. eievatian �`applicabie � Genera' comments W k't kA 5 1 Loa 4" reicommOndaeans' System. Eeoation 7 5L/ •Baring Boring #Pit Ground sunace ele sSAF Depth to Emiting factor L ERWISM • . M. Q I.��p��� .sljaTSTi�7I///.������ ©C���MM y�A X WYTMMWMMM �uMo MMM ' Effluent #1 - BOD. > 30 < 220 not and TSS >30 < 150 ' EfRuerd #2 = BOD. � 30 mg1L and TSS < 30 nvk i CST Name (Please Print) l ore CST Number I Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond. wl 715-246-4516 Parcel ID # Page _ of WIM Effluent #1 = BOD• > 30 <220 nv& and TSS >30 < 15o mg& . Effluent #2 = SOD. c 30 nYA and TSS < 30 rnA 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. sso "( ) Effluent #1 = BOD• > 30 <220 nv& and TSS >30 < 15o mg& . Effluent #2 = SOD. c 30 nYA and TSS < 30 rnA 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. sso "( ) Soil Test Plot PI Project Name Kurt Swanson Address 302 265th st. Woodville Wi 54028 Lot Subdivision SE 1/4 S W 1/4S 13 T 28 N/R16 W ❑ Boring O Well PL Property Line ',� BM or VRP Assume Elevation 100 ft. _1 / CSTM #226900 ate 5/26/21 Township Eau Galle County ST. CROIX Top of steel fence post System Elevation TBD * H R pSame as Benchmark 4/ &d 00 w� . Ltb� COUNTY NO. 633902 STATE SANITARY PERMIT ._ _ 32'L Z65'lft 54-0 OWNER PLUMBER TOWN OF I• LIC.# ZZ(c qoo SEC 13 ,T Z$ N, R 16 E/& AND/OR LOT I BLOCK EXPIRES SUBDIVISION ) ISSUING OFFICER Zone. k 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. (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. 1W 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. - DATE Z3 UNLESS RENEWED AIN VIEW Z/ THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)