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HomeMy WebLinkAbout018-2021-16-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal Information you provide maybe used for secondary purposes [Privacy Law, s 15',4 �1)uhl Permd Holder's Name OeveriIn Homes CST BM Elev Insp BM TANK INFIJkMATION Im TOWN OF TYPE MANUFACTURER CAPACITY Septic FC�t. 8Lo Dosing f Aera Holden TANK SETBACK INFORMATION PUMP,SIPHON INFORMATION 30 Irulcm uGul ILCllglrl 1 IUIa N IU'SI fO WEII /- 1/ SOIL ABSORPTION SYSTEM ELEVATION grATA 018-2021-16-000 08.29.17.1297 y•Imp r Ram ITR N DI NS Ildth It Length r O No Oi TrencltES t PIT DIMENSIONS No Of Pits Insl Ia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLCIG IWELL LAKE/STREAM LEACH[ CRAM IT Manufacturer Typ O System Cam— 0 r * oriel Number DISTRIBYTION SYSTEM HeatleriMam tl , r Dlsl1blb n _ t LA —' PiPe(s) x Hole `4ze It x Hole Spacing Vent to Air Intake Length DIa Length DIa Spacing / � '7 Ct, L J SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade gvslnmc Only Depth Over Depth Over xx Depth of xx SeedediSodded xx Mulched Bed,Trench Center Bed7rench Edges Topsoil _ _I Yes ::] No _ OMM/EE TS: (include code discrepencles, perrns present etc) Inspectio#1 n �} r Inspection #2 T a�tioh: {640W02ND it•t4�' /I Nel�( 1 ( /lrDt� /� t h° 1) Alt BM Description = / 'n",',.`^•'Al /I 2 ) Bldg sewer length = - amount of cover = > 2 u 3) $wti..1,.w L, �.•! D "'b , n n / � 6 v/ rhea deu2vQ Z00 r�&}('Cl Nw Plan revision Required? '_? Yes No `� V �"� Use other side forted Ilkon�pl I formation /� �- _ %)�W - O1 —WIC of S Insepctors Signature Carl No �f�DP- 3. r4��kst— ,(.0 �- SYS 1 Be di a s)er o D Cowuy ro $SAP—?0 Z omum r•� = / a AU G 3 0 2021 Safety and Buildings Division 201 W. Washington Ave., P 0. Box 7162 _ , ammry Permit u be ed it by Co ) " _Sp-, r Madison WI 537� 9zb �' St Crow County Cor-munity Deveiopmer: � 11 - /� Sanitary Permit Appli_c It 0 State Transaction Number w_ D Adlc � In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate government is to obtaining a sanitary permit. Note' Application forms for state-owned POWTS are submitted m Prgect Address (if different than mailing address) required print the Department of Safety and Professional Servies Persrm:d infonnanon you provide be used for seco purposes in accordance with the Privacy Law, s. 15.04(1)(m)15uns. / ys) (Cl L Application Information- Please Print All Information Property Owner's Name Parcel #' 0, i 0 ��e Property Owmr's Matting Address Property Location _ , Y ^ Govt I,ot� � // UUU Section _ City, State Zip Code Phone Number , ,Q '0 ,., iy y (Circle n Subdivision Name e H. Type a Building (check all that apply1� XLDT_2 Family Dwolling—Number of rooms Lot q L �7 ock # ❑ City of ❑ PublicvCommercial—Dcscobe Use �� ❑ State Owned --Describe Use ❑ Village of CSM Number _ Town of fI1. Typ f Permit. (Check only one box on line A. Complete line B if applicable) A ystem El System ❑ Tmatment/Holding Tank Replacement Only ❑ Other Modifirahoo to Existing System (explain) R. ❑ Permit Renewal ❑ Permit Revision ❑ Change ofPlwnber ❑ PermitTransfer to New List Previona Permit Number and Date Issued Before Expiration Owner IV. Type of PORTS System/Coin onent/Device: Chet ll that apply) ❑ Non-Pressutned In -Ground ❑ Prmsu=d In-Gmun -Cmade ❑ Mound> 24 in of suitable sod ❑ Mound <24 m. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (e 'n) etrcatrnrnt Deuce (explain) _ V. Dis ersaVTreat tent Area Information: Dest Flaw (gpd) Design Soi� Application Ra dst) DtLS mal Aox. Requ ed (sf) Dispersal Area Proposed (so Syste levauon W ' VI. Tank Capacity m Total # of M ufacturcr o G T 2 Gallons Gallons Units n E rj _ � Ncw Zavks j Exisnvg Tao4s v o a. U b a m m Septic w Holding Tank Dosing Cbember VII. Responsibility Staleme 1, the undersigned, a esponsibihty for installation of the POWTS shown on the attached plans. PI s Name (Print) PI ipnature MPPI RS Number Business Phone bet ✓ Plumber's Atldress (Steel, State, Cade j�1 ' VI . Countv/De artnent Use Ord — Permll Fee Date Issued Iss mg end Signature Approved ❑ Des S / -7 '721 /Zo 2- El ( ` O Rcaso rDenial (O77 jJ' / DL Condition Approv I 7>� O - Q✓DY` S yyt��i n.{�Q M OWNER' 1 -rgnr fie tank effluent filler and n r�S.. s er cell must be iced i maintained S l el _ n ��S � by � /�(,( (:DJtGY.t. - plumbef. t plan plumber. 7l management plan provided / m tained 2 All plm pleas for the system and sub .n the C ry oLXYL pgper not r-ILT tn>�VL4L �I e as per applcable codetordirP�S1E��.eYO L `-;\'-e,_'"-I SBD-6398(R 11/11) EI 4 f Lbo c pP System PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cemohous Ave Suite A New Richmond Wi 54017 NE 1/4 SW 114S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 92.0' DATE 8/15/21 BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFTHOLDING TANK MOUND _ SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 p of ChambersnOne BENCHMARK V.R.P. Top of survey Iron ASSUME ELEVATION 100' Filter Lifetime BOREHOLE O WELL .11.R.P. same as benchmark B M.* Property Line Area 15' below system is to remain undisturbed ■4111II Well is to meet all WDNR setbacks 444' Property Line Scale = 1/4" = 10' 1/ fcut Combo Tank 01 40' 80' 1 1 1 2.5' 9 2' 31.5' 5' Grading is to be done to divert run -of away from system 102nd Ave sc'Copy August 28, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-08-28 Plan Review: PWTS-082102134-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Oevering Homes 1640 102nd Ave St. Croix HAMMOND FOR: Object Type Object Type Description: 450 GPD Maitenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http://dsps wl.gov/programsfindustry-services www wsconsln gov Tony Evers - Governor Dawn Crim -Secretary ro r ftheatly APPROVED DEPT, OF SAFETY AND PROFESSIONAL SERVICES DIVISION Or INDUSTRY SERVICES SEE CORRESPONDENCE At -Grade Component Manual - Ver. 2.0, SBD-10854 (N.03/07, R. 1/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manuals) 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 • This system is to be constructed and located in accordance with the approved plans, and the "At -Grade Component Manual for Private Onsite Wastewater Systems" • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/Ol) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9 6 Design of Pressure Distribution Networks for ST-SAS (O1/8 H.. 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/msiallationroperation. 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 stars 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, Matthew Allen Janze❑ Wastewater Specialist, Division of Industry Services (715)340-0407 matthew.Ianzen(a,wi go, Cover Page Shaun Bird Bird Plumbing Inc. 1432 1201h St. New Richmond Wi 54017 715-246-4516 Date:8/15/21 Foinxro��ry APPROVED MET Of YFFW AND PROEESSNI L S'ZFES DM OR OF INDUSTRY SERWES SEE CORRESPOROERCE Owner:Oevering Homes Location: NE1/4 SW1/4 S8 T29 N,R17W 1640 102nd Ave 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 Coptingency Plan Attachments: Soil Test,'i) Shaun Bird (f l i Signature License number/226900 Page 1 of 9 System PLOT PLAN PROJECT Oevenno Homes ADDRESS 1433 Cemohous Ave Suite A New Richmond Wi 54017 NE 1/4 SW 114S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 92 0' DATE 8/15121 BEDROOM 3 CONVENTIONAL .AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOLND _ SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 k of Chambersnone IL BENCHMARK V.R.P. Top of survey Ron ASSUME ELEVATION too' Filter Lifetime BOREHOLE DWELL .D,R.P. sameasbenchmark Property Line Area 15' below system is to remain undisturbed 200' Well is to meet all WDNR setbacks Pro 3 l Bedroom House Scale = 114" = 10' ­' HuHcut Combo Tank 0' 40' 80' 8-1 B-2 92.5' 92' 91.51 444' Property Line 90.5' B-3 7% Slope Grading is to be done to divert run-off away from system 102nd Ave IJ '- At -grade System Sloping Site Cross Section and Plan View ----------------------------------- E rJ ' I i t i r W A r r i i r t r E 1/6 B �---- - I 1- = Plowed ,;;� = Clean aggregate basal area ':i; %: to 2 %: in. dia. Geotextile Fabric Lateral with 2" aggregate over pipe 0 Topsoil Cap 0 = 4 in. sch. 40 pvc observation pipe �nnaew.� Ft Lateral Invert !�l•Nl•I•!•!•J 4r4 it i > Ft Contour t.m. Slope Direction Dimension Feet A B I /6 B C D 2.0 E 5.0 F 0.5 G 1.0 L W F -' Slo % Observation Pipe With Car) 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 ''A inch soil wire when a sample is rolled between the palms of the hands. The .A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care most be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at -grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/O5 lgj Page of _ Force Main Pressure Lateral Layout One Lateral — End Manifold X L U Distribution Netwbrk Sp ecifcations Lateral Diameter In. Orifice Diameter i In. X Orifice Spacing) _ _ In. L Lateral Length)Ft. Force Main Diameter In. Force Main Length ? Ft. 03/05 Igj •o,aa Grade 00000* 6-8 Inch Lawn Sprinkler Valve Box Lateral Turn -up f— Threaded Cleanout Plug Long Sweep 90 Bend Pressure System Construction erals are constructed of Schedule 40 PVC Orifices are drilled perpendicular to pipe with a sharp drill bit and face down. era] tum-ups terminate with a threaded mout plug and are enclosed in a 6-8 inch peter lawn sprinkler valve box accessible n finished grade. Page of Septic -Dose Tank Cross Section And Pump Performance Specifications Tank ri4nn,ifacnttat Tunk Model Number Total Tank Capacity Max. Bury Depth Filter Manufacturer �-� - i ht8 Filter Model Number / Mmimum Pump performance Required D__i_, GPM //_ FtTDH,3 r Inlet Outlet Manhole "a. 4" Above Grade With Locking Degice. Inlat Manhole < 6' Below Grade Sealed Watertight Finished Grade IOutlet Filter * inlet Baffle Switch Settings and Reserve Ca aciry Tank Volume - i i GPI Dimension. InchesF (reserve) A, B 2 dose) C <. > (�) D Total �. i [Pump Manufacturer t, —`~�-- Pump Model Number Alum Manufact rar Alarm Model Number Switch Type Total Dynamic Head (TDH) - Feet Elevation Heed i Distal Pressure Network Loss Force Mein Loss Total - Seoutely Mounted Weather-proof Junction Box Vero Min. 12" Above Grade With Vent Cap Manhole Min. 4" Above Grade With Locking David , A 44 ` Weep B I Hole Off Elevation C —' Ft :2 Bottom D '` Elevation ( -7 Ft GENERAL INSTALLATION: The wirtioldose tank is bedded and bank Aged 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 exposed to grade have an effootive looking device (padlock) installed. Piping at the inlet and eutiet is of approved materiel, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch, 40 PVC to bridge the tank excavation a�d the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02105U Page--, of_ 28OmSERIES 112 hp Submersible EffluerWSump Pumps The Lberty 280SOHM provides a cost effective `mid- range" Purno for on -site waste water systems, liquid waste Inhaler and commercial heavy-duty sump pump eppllcaNgre that require higher head or more film Designed around 1-txM1y's unique "UN -Body" casting, the 260-Serles will provide years of reliable performance. Ail Models Feature. • Vonaa style impeger pennitt nq passage of entice LIP toW • 416 stainless steel rota shaft • Pemorerdly lubricated upper and lower bail bearing • Epoxy powderccat finish • Ail fasteners - cortosion-resistant stainless steel • 1 %• Discharge • Stainless stool bottom screen -easily removable • Maximum flulc tempendum 140' F. 2804erNe Cord Lengths Model 10' 25'- 35*(-31 50' 280 Standard Optional Optional OpUonW 201 Mardard Optional OPUOMI Optional 283 Standard Optional Optlorel _ WA 287 Standard Optional WA WA 1 V cord length standard on all npdels. Foroptbnal lsr g odd 12..1 W L'.Wlh to model nuobK. Fxanple: lermod.l 200 with 35' cnnl,ad.r25" Motor Specifications %hp 60 Hz 34W RPM Oe filed, thermarry protected (ps(y Penrerwnt SPA Capacitor 8.0 ampa (115V1 4.0 amps (208r230V1 Model 281 VAds angle float switch with quick- dalconnect ® SA• c us Certified Performance Curve. 2804odes 25 e 0 0 b 10 1s za 25 90 3s 40 45 So as m 65 70 U.B. Gallons Per Minute +2 0 38 7e 114 16e 102 228 Y70 IAen Per MNxte Dimensional Data. weight: 291bs. HsighC 13" Major Wkkh: 10" (model 287) Minimum Sump Diameters. Model WI, 2 ..14' Model 2S7 VMF... ID' Factoryewhch Mode1281r283 Model287 sett VMR Turn on level 13• 9.5• Turn off level 7• 4.0• no Mode 2931eM.. f&, adaet.ol. Md•rrgu bar. Mlr.neY .gwmrraarar, b reed...rl byl.eerirgde neat to ee al. crr P41. or seer manna, ply Vestal loin mew 3e7 Griot -*et" Model 283 Meld 2a7 Wide angle VMF-BMIs• float switch Vertical Reg - With series row toed lot (pi0111/-badQ smaller phs- plug will operate in a 10" diameter sump L/beery Pumps • 7000 Apple Tree Arran. • Hergenr New Ywk /44/6 • Phone 800-643.25M Fa (586)464.1836 www.!/beslypumpeewrr cw aNGUmrr Nmc.,e¢an7 ,w Maier UXr=17 G! A a. SECTION A -A m T0)1 -F 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN ILIE INFORMATION Owner n.. / Permit a ,�/ SIGN PARAMETERS Number of Bedroom. _ D NA Number of Public Facility Units '4 NA j Estimated tbw (average) Vda Design flow (peak), (Estimated x 1.5) '� alida •. Soil Application Rate 01 aVda Rtl Standen lnauenVEfOueM Quality MoniNy weir gs' Fats, OII & Grasse (FOG) 530 mgrL Biochemical Oxygen Demand (SOD,) &22D rngL DNA Total Suspended Solids (TSS) 51 So mg& (Pretreated Effluent Quality Monthly overage Biochemical Oxygen Demand (Boos) 530 mg& Total Suspended Solids (TSS) 530 mglL ❑ NA Fecal Coliform (geometric mean) S104 cfur100ml Maximum ERluem Panicle Size )k to die. ❑ NA O ner ❑ NA *V&Iles tlrylcel for dam*. is wntewelsr and septic lank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Pays � al_ Septic Tank Capacity el ❑ NA Septic Tank Manufacturer �/ O t D NA Effluent Falter Manufacturer ,(�, ". �, ✓ 10 NA Effluent Filter Model13 NA Pump Tank Capacity ,� at Q NA Pump Tank Manufacturer Nq Pump Manufacturer — _ p NA Pump Model ❑ NA Pretreatment Unit dA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Well D Disinfection OOther Dispsmal Call(s) D NA ❑ In -Ground (gravity) D In -Ground (pressurized) 1-Grade ❑ Mound ❑ Drip -Line ❑ Other. Omer. ❑ NA Other.❑ EEEEE N Other. ❑ Service Event Service Frequency Inspect caMNion of tank(s) At least once every mo a) 0 s (Maximum 3 yore) ❑ NA Pump out contents of tank(s) When combined Nudge and scum *quota one-third QS) of tank volume ❑ NA Inspect dispersal pill At lout once every: ❑ monlh (a) (hNxfmum 3 3 s s years) ❑ NA Clean emtxnt Slier At least once every: u dh(s) DNA Inspect pump, pump controls & alarm At lent once every. O month(s) a DNA Flush laterals and pressure test At less) Once every: _ D moneh(s) a s) D NA At but once every: U montr la) ❑ NA ner: ❑ NA MAINTENANCE INSTRUCTIONS ilnspectons of tanks and dispersal coils shall be made by an Individual carrying one of the following lcemes or certifications: Muter Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maimainer, Septage Servicing Operator. Tank Inspections must Include a visual inspection of the tank(s) to identify any missing ar broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cells) share be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surfam, The ponding of effluent on the ground surface may Indicate a failing cond'Rion and requires the annMGNte notification ct she loch regulatory authority. When the combined aaunulatlon of sledge and scum in any tank equals one-third ($) or mom of the tank volume, the .mire contents of the lank shal be removed by a Septage Servicing Operator and disposed of in accidence with chapter NR 113, Wisconsin Administrative Code. All odter services, including but not limited to the servicing of *muern filters, mechanical or pressurized components, pretreatment units, nod any servicing at intervals of 512 months, $hell be performed by a certified POVVTS Maintainer. A service report shall be provided to the local regulatory authority vvitMn 10 days of completion of any service event. Pape START UP AND OPERATION For new, construction, prlor to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals tW may Impede the trealment process and/or damage the dispersal cell(s). If high concentrations era detected have the contents of the tank(s) removed by a seplage servidng operator prior to use. System start up shall rat ocou when sod conditions ere frozen at the Infiltrative surface. Dunng power outages pump Lanka may III above normal highweler levels. When power Is restored the excess wastewater coil be discharged to the dispersal ced(s) in one large does, overloading the cells) and may result In the backup or surface discharge of effluent. To avold this aduatlon have the contents of the pump tank removed by a SepLAge Servicing Operator prior to restoring power to the effluent pump w contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehides over tanks and dispersal cells. Do not drive or park over, or othervdse disturb ar compact, the area wkhln 15 feet dawn slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotion swrebs; degreasers; dental floss; diapers; disinfectants; fat; foundation dryn (sump pump) water; fiuk and vegetable peeargs; gasoline; grease; herblckf a, meet soaps; medico s; oil; paindng products; pesticides; sanitary napklns; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or Is Pertnenentby taken out of service the foiknNng steps shed be taken to Insure trot the system is Propelly and safely abandoned In compliance with chapter Cornet 83,33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The conlenls of ail tanks and pits shall be removed and properly disposed of by a Sepbge Servicing Oparela. • After pumping, all tanks and pits shell be excavated and removed or their covers removed and the void space filed with sail, gravel or anothe Inert solid m ttedal. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utitzed for the location of a replacement soil absMtlon System. The replacement area should be protected from disturbance and compaction and should rat be infringed upon by required setbacks tom existing and proposed structure, lot lines and waft. Failure to protect the replacement area will result in the naiad for a new soil end she evaluation to establish a suitable roacement area. Replacement systems must Comply with the Men in effect at that time. ❑ A suitable replacement area Is not available due to setback and/or soll Iimitators. Bamng advances In POWTS technology a .holding tank may be instelled as a lest resort to replace the failed POWTS. -The aka has rat been evaluated to Identify a suitable replacement uea. Upon failure of the POWTS a soil end she ev lluaFon must be performed to "to a suitable replacement area. If no replacement Arse A evadable a holding ran* prey be kutailed As a )set retail to replace are failed POWfS. Mound and at -grade soil absorption systems may be reconatruied in place following removal of the blomet at the inNtrankve tudace, Reconsinatiorl6 of such systems must comply with the rubs In~ 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 OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTSINSTALLER POWTS MAINTAINER �^ Name < theme ; j4l; ,- • �., � Phone y/ �� / +- / Phone SrPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORY AUTHORITY Name /r_ ��,(� Phone / : 7 �: ;'v"f' PhOfe This documentwm droned in mmpliancewith chapter SPS 393.22(1)(b)(11(e19(1) and 30.94(t). (_) a (3), WW"WM AdnlnktrsOWCGW. NYo> Dwlnr. a[amsa SOIL EVALUATION REPORT awnl as.ny.m eWm,q .m�m.wrma�o, waa.n ru m.,e+rz.�1 FCNNfW.RW im.� xaa,eaba,n.ea:..rywroaaw nl.m,a oo.t tRay. ae.ma, .,a Pl.... Pry1 W /Momatlon. tirW lb•6e.�prba m.M eawb a(!. 1�1(M1. •C •�` Revd 1D. D?lam w D.Y �� IL �� Pmwt // oeo? A O 4 o lAJ6 114�l igT Z9 N R r EI w Oa . / 7 ld. Stoa t — as YWp. Tangy NWW Nr oauntem u..�IR.+e««ieNlwna«ao.momu.y_waaeeMaaWp+wlr,.. GPO ❑wa.amr+ b Rt•.rO lr ftWFWnWMlw Kawka . G.r�o.mba .N �m.�rtlMs' 9 Sri1aa TY➢a - sysd Elm /. aMry ❑ ,pt Ga.tla.lam .lw.f) R UeMbftfty aorJ1<--h /kltCn D.4A h 'ORCOW Y.W ROO.. Dmo". DLL Le. Cat Caa lr m S.vo.. G.USR CaW>!uv BaMny Rana 2 ' — 5 — m� ZY PIt faaMwhoWvia-, t UM�biNS'O bash 4N RW Wmm D.p.l h LbatirV W.W R.OD<D.V1..m Cu liz Cant Calor TKO.. emm. G. Si Sh Comna+w Swib�y Raub ORCLI 'EMl £Rh 'Ebr. n • SOD a OD a Z20"Q& m-Za1M 'EIl..M1R•BOD .yp rtpt �d TS9!JD npt 5T CST Mn Bird Plumbing, Inc. Shaun Bird 226900 Ahbma Dau EvWUOw Cafdca0 LYavr NumO.r 1008 192nd Ave, New Rlohmood, WI W17 0 7t 5-24 516 Ree+bO fte IDM '�'Q nit or B""° �9n'� a o.d6mlmYYe eerc�h Pap —a— u����s�wr��ac�� u�uu■�—���u■uuu�u uu�uiu��■�uu�u�� Okftt ❑� ❑ PO arms leo. . 6. owbw k v b7 h SN Itf1111aY rMs�n—rO�MI � Cclad �0—"- I T-1 SYudn JC-r Bovdvf' f-7 . a mp , eert11- OW. >501ZMffWLndUS>d0_150MOL Eftr Q-BOO,130 QLowI=s30 We& ru Depu t ofCommetm is N equd oppommlty rtvke pmvider and employe. Wyou oeod a=L o brear servicer - peed mareiel io a ehumte frmet• pi m mm the depertrcot Y W84661151 a TTY 604164 rn. Soil Test Plot PI Project Name Oevering Homes LLC S rd Address P.O. Box 179 New Richmond Wi 54017 SZ #226900 Lot 18 Subdivision Hammond Hills Estates Do e 6/2/07 NE 1/4 S W 1/4S 8 T 29 N/R17 W Township Hammond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 tL Top of Survey Iron System Elevation 92.0-HRPSameasBenchmark Line 15' B-1 rL•.t1 Property Line Scale is 1" = 40' unless otherwise noted Please note: survey was not complete at the time of testing, installer must check all setbacks prior to installation. B-2 T92.5' 30' •T6 o o u - O (715)246-3010 NOTE OTICE P- Oevenng HOMESMSG FT 13-23 ELEVATIONS O s:m �SCFT alLO�R LEVEL O .. E A C1 NoncE: w irr y 6 BRACED WALL LINE PANEL DETAILS ssz MAIN LEVEL LEE a ENTRY i—N� e ia! I : ��i I in:l `I I I I I I I I ST. CROIX "?LINTY. SANITARY SYSTEM File#: caasrse Office Use Only OWNERSHIP/ADDRESS FORM Created2/2021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addl City/State/Zi Phone Number (required) Email Address (required) r cx-� Oha Parcel Identification Number /l ')ie ';Ixt 61—��— (found on the property tax bill) Subdivision Plat: Certified Survey Map # Volume — Page # Warranty Deed # (before 2006)Volume Page # Number of bedrooms 3 Spec hous>ies O no Lot lines identifiable)9gtes 0 no j NEW �SYSTEM: LEGAL DESCRIPTION ?Z0'1111 '`� Property Locatiortl/C t/ W /a , Sec.O L�N I/Z Town of I y ` ,Lot#�. OFFICE USE ON // 1 New Provs s / f/ /L/�1� l � / AS W / (Verificatio of ne address required from Comm unity�Development, Department for new construction.) 2i 2�( aff 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 cddCc)sccwi. ov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov Wisconsin Department of Commerce SOIL EVALUATION REPORT -- __ __ _/ of 3— Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code (� Attach complete she plan on paper not Jess than 8 1/2x 11 inches in size. Plan must `' JCQ include, but not limited to: vertcal and honzontal reference point (SM), direction and Parcel LID, \ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. t4/ � 2() / � —at Please print all information. Re ' by �tZs. & (1)(m)). Z 67 Property Owner / / P Location Oe 1..� /`I R D i7'r ep (,... \__, Gout. 1/4 (.(/1/4 Z9 T G 9 N R ( E (olnW Owttefa Address JUN 3. Lot # Block # Name or CSM# o , ok 7 &fA� r s Ptate zip L,Cctle ❑C' // El Village Town Nearest Roof i/ �2iC/1 j S�fOI 71_(7 iYd .n iu,..vyO I �On( n2(/ �Ywe� Now0onstrituction uw�denfial/Numberofbedrccnris Code derived design flow rate GPD ■ Replacement Cl Parent material General comments • Effluent #1 - BCD > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 - SOD 130 mg/L and TSS 130 mg/L. CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird / 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 46L c2_ 0 715-246-4516 • Effluent #1 - BCD > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 - SOD 130 mg/L and TSS 130 mg/L. CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird / 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 46L c2_ 0 715-246-4516 1( Property Owner, Parcel ID # Boring# ❑ Boring n on Ground surface elev. ft. Depth to limiting factor in.T A ❑ Boring # ❑ boring ❑ Pit Ground surface elev. ft. Depth to uniting factor In. Sole Effluent #1 = B005> 30 1220 mglL and TSS >30 1150 mgA- ' Ef kwd #2 - BOO, 130 rrgL and TSS < 30 mg& 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. 56DIUMM61L) 4 • Soil Test Plot Project Name Oevering Homes LLC Address P.O. Box 179 New Richmond Wi 54017 Lot 16 Subdivision Hammond Hills Estates rd STM #226900 e 6/2/07 NE 114 S W 1/4S 8 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 92.0 *HRPSameasBenchmark 144' Property Line 15' B-1 90' 7% Slope 45' B-3 0O !�- 444' Property Line 102nd Ave Scale is 1" = 40' unless otherwise noted Please note: survey was not complete at the time of testing, installer must check all setbacks prior to installation. B-2 �— 92.5' 1« 90.5' COUNTY PLAT OF: HAMMO ND HILLS RECEIVED STATES -SOILS MAP NOV 0 5 2007 ST, CROIX COUNTY IN PART OF TIE NW U4 OF THESE 114, THE SW U4 OF THE E NE 1NOF IHESw U4 NtO THE SE tN OF THEBW TN OF A T2MI, R1iW, ALL m THE TOM10F rvPMMOND, 8T. Max NOONNEIt OR RE910ENT&LLLLOO PNYTWNO WHB]f WVULO WRERFERE WRFC HANGS TIE OPERATION OF THE APPROVED COMPREHENSIVE STORMWATER MANAGEMENT PLAN, SEDIMENT AND EROSION CONTROL PLAN FORTHIS PIAT. THIS INCLUDES, BUT IS NOTLLMTEDTO, BVRDINO UPON, OBSTRUCTING, ALTERING, FlLLINO, EXCAVATING, OR RANTING IN ANY ORNNAGE EASEMENTS, STORMWATER PON08, WATER DRAINAGE DITCHES, WATER RUNWAYS. WATER CULVERTS OR BERMS. GENERAL NOTICE STATEMENT. EACH PARCEL SHOWN ON THIS MAP JP T) W SUBJECT TO STATE, COUNTY, AND TONN LAWS, RUES AND REGLRATIONS (LE WETLAND, MINIMUM LOT SIZE. ACCESS TO PARCEL ETC.) BEFORE FURCHABING OR DEVELOPING ANY LOT OF LAND, CONTACT THE ST. OF OCOIMTYPLANNDq BO XCE. OEPARTMFMAND 1NETONN F HA MMOND BOARD FOR ADVICE. UTILITY EASEMENT NOTE: NO POLE OR DUR SO CABLES ME TO RE PLACED SUCH THAT THE INSTALLATION WIOIA.D Dlsru2e ANYsuTAIEYSTAR. aR OBS1nUCT OFASULONGANYILITUNE OR911EETLA7 NH SETIX2BANCE OFA SURVEYSTAIO: BY ANYONE USA VIOLATION OF SECTION 2G.92 WECONSM STATUTES. UTERY fASEMENT8A5 HERQI SET FOR1H ARETlESkU UGARJGHTTOS9RVETH0RINAtEPDB1C UTIUTEB HAVING A IUGHT TO SERVE TIEAREA NOTES: FRONT SETBACK .6P (UNIEBS OTHERWISE NOTED) smE sETBArx=12spsaDLLBIN9n) REBACK�ss' WETLANDLAFD SETBACK=IP ALL BUILDINGS TO BE COVBTRUCTED IN PROXIMITY WITH DRAINAGE ELEVATION NOT UESS III10 FEET MOVETCOR WPAOW WETSR ELEVATION NOT THAN TWO FEETABOVE THE TIIOH WATER ELEVATION SHOWN. N S9KL1 r E 444.W LOT LOT 14 o 15 8 LOT 16 8 ' 9-0� 0 B_2� �t 0 •-2 � e-1 _ a A $ e TO f£NTER Of E.LSEYENT / r« V ® 29.92' ® _ LOCATION MAP: (NOT TO SCALE) SECTION 8, T2914, RI7W, N� IIOtN woF1:A HE NW SULf: 1' - 100• i gpi ':fir' a s9" ALL BEARINGS ARE REFERENCED TO TLE SOUTH L W E OF THE S.E. IN OFSECTION B. T2914, RITY; ASSUMED TO BEAR N WN4r E. (ST. CROIX COUNTY COORDINATE SYSTEM) PLAT LOCATION LEGEND: ----- 60'ROAD SEIBACN LINE • FOUND IRA IRON PIN IY UTILITY EASEMENT ------ (UNLESB OTHERWISE NOTED1 • SET I VC BY IV Y ION PIN AFT. A 172 LBS IFT. ---- DRAINAGEEASEMENTUNE SET&4' BY IV B9)N PN WT. 1s0 --�A9 FENCELRIE II 1 uxB T. ATALLOTHERLm CORNERS TREEUNE PROPOSED DTd VF WAY lf%wTIDH HIGH WATER ELEVATION PROPOSED JOINT pRIVE1VAY LOCATION LOWEST BUILDING OPENING Cg1NTYMONUED) —WET-- IA'eTV:NO Y (FOUND AS NOIEU) 693l _ W 196/.02 08.1 SOIL BORING _ N 59 0'53' E 392.90' ---/75.00'- f ---175.00'---- 1,0T,2 LOT 11 B0 LOT- -2 Qg e' 12 e Q h 0 2 0 e-] B_2 B --N 892ti 539E 425.5Y--- •,^e`— I- ) r -Tor 9T I _ u LLOT 6 IL-tT �' m � A59' � . £ N 9_2 e u 1 L_• "LOT 5 0 9) B t NV,�IP LOCATION S.W. CORNFR-- -- SEC. B, T29N, RI]W R OFSOUTH lHE OF THE F (FOUND COUNTY SECTION S.W. X B SURVEY MARKER) B-1 LOT 4 e �0 B-2 0 )W �q� £ LOT 3 N V0 J B-] a 0 B-1 N 695426- W 65J,B1" 195C28' S6E w _W — — UNPLATIEUL�WoS _ SOLDdIhTlFiEflY.Qil1Qt5 SEC. (FL ,AG. _ng.lf JlJ& SJF 5701OZOWOUNTY ( 1vo. 633926 STA�# E SANI'�RPERMIT 1640 10760 PREVI01 JS NO. OWNER��'�`� � CHAPTER 145.135 (2)1pISWNSIN STATUTES (a) The purpose of the sanitary permit is to allow installation IF of the private sewage system described in the permit �a'.{I (b) The approval of the sanitary permit is based on regLIC 7T 0 O (c) The sin force permit the date d approval. PLUMBS specified The sanitary permit is valid and maybe renewed for a • specified period. TOWN OF (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on SEC � T /` N' R regulators u force at the time renewal is sought, and that Lchanged regulations may impede renewal. u (t) The sanitary permit is transferable. ND/OR LOT BLOCK History: 1977 c. 168t 1979 c.34,221; 1981 c.314 TGVote: If you wish to renew the permit, or transfer ownership of ` SUBDIVISION the permit, please ca tac[the county authority. RI D ISSUING OFFICER -DATE HIS PERMIT EXPIRES NLESS RENEWED BEFORE TH DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20) S 89'20'53" W 444.00' e ".j z�4 „ N �, 3 1 z � 07 u,d=LA-T� : ;,,NDS LOT LOT l `J55G� S 89'20'10' 14 15 jI � LOT 16 LOT 17 c ©M tlnS�e `_ i nz n, �FLtvni A n LOT 18 \ � � % OD -rC -- 89i20'53' PI i9'? 9u _- _ CD) j% — _ D 0 LOT 19 o O _ OD 0 O N � 0 LOT LOT of LOT 11 "60 S 13 8& L �I Ti / LOT 10 c 0 �,,o. '„ '30 �" nl:yI ?r 0 _ LOT 9 � ;rr•PD Sf/""'LO n1T, 0;;' c_ - r7'S 00 7�5'' T 8