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018-2007-44-000
Wlsconsm Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM II VVllly St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m)] Iraw, rm 'ST BM Elev. . ID y TANK INFORMATION TOWN OF HAMMOND TYPE rM N�UFACTU ER CAPACITY eptic W tC SE wa L Sri ing ;AeraT H g TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Au Intake ROAD Septic y f So.2 r r Dosing tt �( u 3 3 r }loll' Aer Holdi PUMP/SIPHON INFORMATION Manufacturer _ mar N GPM L ko Model Number �2,V O TDH Lilt Fricti nps Ls System Head TDH�O Ft .� r 3.9 Forcemain Lengt � I Dia t t Dret to Well Z SOIL ABSORPTION SYSTEM }'gfa.Al ELEVATION DATA 3J 018-2007-44-000 05.29.17.983 STATION BS HI FS ELEV. Benchmark 3. 01 !03• o tco.o 0 Alt BM Bldg Sewer �•� 40 svI SVHIInlet ��o -� St/Ht Outlet DI Inlet l' Dt Bottom ' zD 730 i Header/Man. Oz. Dist. Pipe 2-� 2-� ?:O Z` s Bot System O� r F Grade 61�Iw'U bIZ l2-rl d4 t Cover �� f 3.7o se.3 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over c. Depth of u Seeded/Sodded >a Mulched Bedi-Trench Center Bed/Trench Edges Topsoil Yes No Yes No 00COMIENTS-�(Idude cRde discrepancies, persons present, etc) Inspection ft q/7ozz—' Inspection #21 �I2e IZa 2 Z Location: 1690 113TH AVE cam(/ Iij'c'WdTfna�r �i1_nA-� 1.) All BM Description 2.) Bldg sewer length = z - amount of cover = y to -f' �llL,�hu�FtQ 2.Or!'�SBY OA -fig" E Q:1. 1�w+►4Wtad bci a►e Plan revision Required? Yes No /� Use other side for additional information. � _ SBO-6710 (R.3/97) Date Insepctor's Signature Cert Na. l _ � r�nn ll�t� 1f111 is PfN as -a, _ 3s' 7 SY, 1.S a 2.A dp Cunnry�_/ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 ��— / Sanitary Permit umber (to be filled in by Co.) Q 20.�� SEP 2 G Madison, Wl 537C7-7162 33�6 •�Qtoix county Commun( vC ermit Application State Transaction Number q[ -)- In accordance with SPS 3931 V7), Luis. Aden Code, submission of This form unit 1 t O v Project Address (if differem am mailing address) is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are s iacd to the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.040 Hm), .Stvs. 1. Application Information - Please Print All Information Property Owner's Name --- T ►' ENE Parcel M k9/ Y-e;21ro 7- Properly Owner's Mailing Address I i�� Property location O/ Govt_Lot _ Iti Section State Ap a Pbone Number de fyL ( k T N: R W U. Ty of Building (check al that apply) Lot i Subdivision Name r or 2 Family Dwelling - Number of Bea ms ds Block a ❑ Public/Commercial - Describe Use �i ❑ City of ❑ Stale Owned - Describe Use ❑ Village of CSM Number A.TOwn of Uf. T pe of Permit: (Check only one box on line A. Complete line B if applicable) A' ystem ❑ Replacement System ❑ Treannent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous it Number and Date Issued Before Expiration Owner IV, Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Presn¢ved In -hound ❑ Pressurized In-Gnamd ❑ At -Grade ❑ Mound > 24 in, of suitable soil < 24 in. of suitable wil ❑ Holding Tank ❑ Other Dispersal Component plain) ❑ Pretreatment Device (explain) V. DisoersaVFreatment Area Jnforuiati4 S t r Desiiggn Flow (gpd) Desi Soil Application sf) Disposal Atca Requvcd (sf) Dispersal Area Pro Oed (ysf) L15-0 1 .� r'S r '7Elevation /�oSr7 VL Tank Info Capacity in Gallons Total Gallons M of Units Mmufactur s 6 3 u 1aaO .�l-a �� Y Tr u , New Tanks Existing Tanta Sap& w Holding Tank Dosing t.'baalber VII. Responsibility State t- 1, the undcrsigned/zi06L responsibility for installation of the POWTS shown as the attached plans. Plumber's Name (Print) PI s Signature MP/JvVRS *lumber Business Phone Number Plumber's Address (Street, City. State, 2i c� Z /C�o Vlll. County/Department Use Only hf Approved f'{J ❑ Per�mitt F�ecr�r S Date Is s d /O Is i AgentSignatu ❑ ivem for Denial 1(/! ✓� 7- DL Conditions f Appro I n S pk.ttZ t.4^ EM OWNER: )` 1 1/h ✓ ' / pr tank, effluent filter and persalcell must be serviced /maintained per management plan provided by plumber. % - Sl�t.t ►NtQtC selback it m ntsmu tbemaintained Gu�^'J�/ `r' nYdVf� as per applicable codelorc*T1!t ICC£fd'npinePumrorrae SBD-6398 (IL 11111) uoml roc coal p aol Imsman a in xM manes inslxe 1 n on 6,jW r -A-S System PLOT PLAN PROJECT Tim Niohl ADDRESS 1690 1131h ave Hammond Wi 54013 NE 114 SE II4S 5 /T 29 NIR 17 W TOWN Hammond COONTy ST.CROIX SYSTEM ELEVATION 102.2 1.9' and lift X2 cells 9/1121 3 DATE BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK 512E DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 ff of Chambersnone © ENCHMARK V.R.Y. Top of surve n ..� ASSUME ELEVATION 100' Pilfer Ufcun� ❑ BOREHOLE O WFLL •II.R.P- same as benchmark __Z__ Property Line Area 15' below system is to remain 'co undisturbed �r 100.5' 100' 100.3' t ' I B-11 t 1 B-3 'Z Q'z uffcutl Combo I Pro 3 Bedroom House we B-22 r�1 W Grading is to be :done to divert run-off away from system 01 40' 80' l I I� Scale = 1/4" = 10' 343' Property Line ,("Icopy September 27, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-09-27 Plan Review: PWTS-092102401-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Tim Night 1690 113th ave Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: Description: 450 GPD Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 543045211 Contact Through Relay httP://dsps.vA.gov/programarindustry-servicas www.vAsconsin.gov Tony Evers - Govemor Dawn Crim . Seerof�ry Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Y,"— WIJ (/f/gma SEE CORRESPONDENCE 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: 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/instal lation/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 I01.12(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, ./.taara T%a�.rr� Travis Wagner POWTS Wastewater Specialist, Division of Industry Services (608)598-0715 travis.wagner@wi.gov Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/1 /21 Cover Page Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES d4- l m9wa Owner:Tim Night SEE CORRESPONDENCE Location: NE1/4 SE1/4 S5 T29 N,R17W 1690 113th Ave Hammond 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 Y Signature__ License number Page 1 of 9 System PLOT PLAN PROJECT- Tim Nicht ADDRESS 1690113th eve Hammond Wi 54013 NE 114 SE 1149 5 IT 29 NrR 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 102.2 1.9' and lift X2 cells DATE 9/1121 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 OLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 A or Chambersnone BENCHMARK V.R.P. Top of s nro� n ASSUME ELEVATION W' Filter LifOli� ❑BOREHOLE WELL •II. R. P. Same as benchmark /y1 Property Line Area 15' below system is to remain undisturbed 100.5' 100' 100.3' Well is to moo all WDNR setbacks F 113th Ave rN B-2 CeI Grading is to be - done to divert ^run-off away from system 0' 40' 80 1 1 1 / Scale = 1 /4" = 10' 343' Property Line Mound System Cross Section and Plan View z L — Topsoil = ASTM C-33 = Clean aggregate = 4 in. sch. 40 pvc J Cap Material sand fill /, to 2 %: in. dia. observation pipe Geotextile G H Fabric --�— F fit Pt Contour Slope Direction �y GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a''/. inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07Igi Page ov Manifold Pressure Lateral Layout Two Laterals — End Manifold �- Threaded Cleanout Lateral Turn -up —► Plug M t-.3. 1X 4t — 1, Long Force Main /jj Sweep 90 j Bend �J r I 0310510 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 • 0 * 0 0 0 6-8 Inch Lawn Sprinkler Valve Box P� Page of Septic -Dose 'Wank Cross Section And; Pump Performance Specifications Tank Manufacturer Tank Model Number Total Tank Capacity Max. Bury Depth Filter Manufacturer / Filter Model Number Minimum Pump retfmmanoe Required L t f D� Outlet Manhole W. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade 8esled Wal ertiydn Switch S s and I2eaerve ca aaty Tank Volume — GPI Dimension; Inchon Volume Gal. () A; 2fit` (slam) B' 2 3 t~ dosc) C . �. s- 7 (dew) D > Total Asa Pumpmartufactuter w C Pump Model Number J Ahmn ManuficunDr (ir % e: . Alarm Modal Number Le Switch Type /rt#�_ Mt l Total Dynamic Heed ([DID -Feet Elevation Head 7 Distal Pressure ; (J Network LAW Force Main Loss 7 Total �_ > Manhole Min. 4" Above Guide WUL r .._L _ ram..:_ BOOM Ek-Anion / �; Ft GENERAL INWALLA71ON: Tho aspt{c/dow tank 4 bedded and back filled 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 mpoead to grade have an effective locking device (padlock) installed. piping at the inlet and outlet is of approved material, connected to the tank with watertight fir gs, and laid On stable soil to prevent settling or sagging. The fora main is sleoved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is styled watertight, Electrimll setvice,,."ptles with NEC 300 and Comm 16.28. 02105 U page—) oE�__ 280=SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series;wovides acost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series Mil provide years of reliable performance. All Models Feature: s Vortex style impeiler permitting passage of solids up toff" (/; O e 416 stainless steel rotor shaft -T-.p, • Permanently lubricated upper and lower ball bearing Epoxy powder coat finish • All fasteners -corrosion -resistant stainless steer 1 yr" Discharge e Stainless steel bottom screen - easily removable • Maximum fluid temperature:140' F. 280-Series Cord Lengths Model 10' 25'(-2) 280 standard Optional Optional Optional 281 Standard Optional Optional Optional 283 Standard Optiotwl_ Optional_ _ WA_, 287 standard Optional WA WA 10' cord length standard wall models. For optional lengths, add "-2, .3 or-5" suffix to model number. Example: ler model 280 with 35' cord, ceder 260.3 Motor Specifications A hp 60 Hz 3450 RPM Oil fined, thermally protected (PSG) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208l230V) Performance Curve: 280-Series 40 7-T7 TT777- FrTTTT77 I-17T7 'TTi7771712 35 30 25 20 11 5 2 0 - 0 D 5 10 15 20 25 30 35 0 5 0 55 6D 65 70 U.S. Gallons I use 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: weight•. 29 lbs. Height 13' Motor Width; 10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10' Factory switch Model 281, 283 Model 287 settings VMF Tum on level 13" 9.5" Turn off level 7" 4.0" Tho Model 2e31eatures a fully adjustable wide-angle Host. Wkrentlal adjuetments can be made easily by t~ng the float to the de- dange pipe or ether mounting point. Venial float model 297 is not adjustable. J M odel 280 Model 281 U Model283 Model 287 anuel, Wldeangle Wide angle VMr--8erlee switch float switch float switch Vertical mag- with quick- with series netic float for disconnect (piggy -back) smaller pits - plug will operate In L a 10" diameter sump cmra ca-cus Certified aVrt�CYl011r e'1 e4tCtpc"e4r'NVu, M,t". � � ^ I / Liberty Pumps a 7000 Apple Tree Avenue s BerOon, New York 14416 • Phone 800-843-2530 Fax (b86)4W-I&M tsvnv.fib&rtypumps.00m rwo$ght 0 Uawb Punpw me 2017 An nots rammea. LUT 2000 ROM F 0 a POWTS OWNER'S MANUAL & MANAGEMENT PLAN paga, ef_ �.,m,r•errnuc hn.C— Owner •--,L/; .r Septic Tank Capacity % al ❑ NA Permit 0 Septic Tank Manufacturer �t �, NA DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Commercial Units t NA Estimated flow (average) rr7gaVday Design flow (peal), (Estimated x 1.5) , aV Sol Application Rate /1 17 gaVdayW Influent/Effluent Quality Fats, Oil A Grease (FOG) Biochemical Oxygen Demand (BODe) Total Suspended Solids (TSS) Monthly average' s30 mg/L 420 mg/L 5150 m 2 Pretreated Effluent Quality Biochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) Fecal Coliform (gcometnc mean) Monthly average" 530 mgfL s30 mgfL 5104 cruAooml Maximum Effluent Particle Size , Inch diameter uawrcue urc SCHE U c • Values typkJl la damnslic Indncamharda9 vnalewalsr snd sapLic tank srfluenl. • Valens typlcsl for prarrealed wattswaler. Service Event Service Frequency Inspect condition of lank(s) At least once every '' O months jd y ar(s) (Maximum 3 yrs.) Pump out contents of lank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cells) At least once every ; ❑ months • ,year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ear(s) Inspect pump, pump controls 6 alarm At least once every — O months ar(s) O NA Flush Literals and pressure test At least once every O months year(s) ❑ NA other: At least once every ❑ months O year(s) NA Other At least once every O months O year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certflcations: Master Plumber; Master Plumber Restricted Sewer. POWTS Inspector. POWTS MaintalW Septage Servicing Operator. Tank inspections must include a visual Inspection of the lank(s) to identity any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface. The dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The pondng of effluent on the ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority. When the Combined accumulation of sludge and scum In any tank equals one-third (V,,) or more of the tank volume, the entire contents of the tank shaft be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code The servicing of effluent filters, mechanical or pressurized POWTS components• prelreat4ment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintalnef. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank($) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a seplage servicing operator prior to use. Page __ of — START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the prosence of painting PfO ti °r °ai°n clnsmleak that may impacts the treatment process and/or damage the dispersal cetl(s). K high Concentrations are detected have the contents of thb tank(s) removed by a Septege servicing operator prior to use. System start up shall not occur when sail from are froat the infiltrat ve surface, is restored the excess vrosleNater will by During power outages pump tanks may fill above normal hlghwater IsVerll. Whenrests in the backup a surface discharge of effttrerd. discharged to the dispersed cea(s) In one large dose, overloading the Ce11(s) and m>eY Servicing Opnator prior to restoring power to tlb To avoid this sllualln have the contents of the pump tank removed by a SOPmanually e etnuam pump or contact a Plumber or pOWTS Maintainer to assist 'r manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal Calls Do not drive or park over. or otr+erwiaa disturb or ramped, the aroa uri 15 feet down slope of arty mound or al -grade ecil absorptkm erthe his of the POVVl u Reduction or elimination of the following from the `.wastewater stream may improve the�i pe s, dissinff fOCUIngts. let: foundation drain anabiouce: baby wipes; cigarette butt' condoms: cotton aWebS:egfe89 �e mar swaps: madfu8on+; oil: 09061lg PrOdUdIS, (supestnitldee sanitary napkins, lampoOnss; and waertsoftener gasoline; d e. grease: ABANDONMENT tam ally Wnen the POINTS faits enmor is permanently taken out of service ore following slope shall be taken to insure that the Sys la Prof and safety abandoned to compliance with chapter Comm 83 33, Wisconsin Administrative Code: • All piping to tanks and pits shall be d'rsconnecled and the abandoned pipe openings seated. • The contents or all tanks and ph shall bs removed antl Property disposed of by a Septage Servicing Operator. • Aker pumping, all tanks and pits shell be excavated and removed or their covers removed and erne veld space fiAed wh sail, gravel or another tried solid matedal. CONTINGENCY PLAN or must he taken, to Provide a clods comPl;rlrM If the POWTS fail& and cannot be repaired the fosowlrg measures have been, replacement system:ern ❑ A suitable replacement area Kea been evaluated and may be utilized for the location of a replacement sou absorption qur The replacement area shou:d be protected from disturbance and comPectlon and eltkxrld rreN areaavdi resuk M the need setbacks from existing and proposed structure, lot lines and Welk$. FMlum to protect if le replace with the In for a new soil and site evaluation to establish a suitable replacementarse. Replacement systems Must co mpt' effect at "t time ❑ A suitable replacement aroa is not available due to setback and/or WO Iimltalxsts. Beming advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. �The sue has not ben evaluated to Identify a suitable replacement arse. Upon tadlure at the POWTS a soil and AM ewluagon / must be performed to locate a suitable replacement areaif no replacement arse is available a holding lerek Mary be installed as a last reson to replace the failed POWTS. Mound and a( -grade sail absorption Systems may be reconstructed in place following removal or the biome) at the klghrolNa woe. Reconstructions of such systems must comply with the rube In etlect at that limn. «WARNING» NO SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN, DO 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---- POWTS INSTALLER POWTS MAINTAINER Name �n tw�• T_ Name ^Phone � . i Phone SEPTAGE SERVICING OPERATOR (PUMPER(PUMPERI LOCAL REGULATORY AUTHORITY --� C..�Name Phone I i��J�Y r ! PhoneThis document was drafted in compusnce wo chapter SPS 383.22(2)(bX1)ldla(r) and 383 ea(I), (2) a (3). Wia:onkr AdmkriWaMw Code. ptDwerwd Of wmrrn SOIL EVALUATION REPORT P."J— pNebnd Bdtry rd &+wnw r tluiu with carom tS.,7 Aam coat �n, s, ��h m„,�y� silt Dlw� On Dtper nr Yst awn t 113 it11 indrt n fr=t. Pttn m.SI '7 i lY li MGb. bN rvt tmbd b .+.sly tn4 nonmrur rvt t Dart MMJ, ryrtt9on t+M Paror 1 D. Ductnr tCW. U" or mmrrs:ons. rwrtr MOw, tM brJtm tnd dctanral r 7 oast mt4. • R P/tatt pllnl dl ln/ornratlon. i♦..�/Yv �,y�.,�•tn re.Me.w Mrs.rW w..tt+ttn u+o�ttl -1y.•r3altrl^II _ / ("��,'�— �� Q /��1 (n' / 6 moeMla+'�'G ^Q MID O+t+er T—, 1, l L� ! .. _ _... t P W f L vt X t w S T O/ ! N R E (u •wr�t MMwq LD t pBrork / Sid or CSAw CPo N"carreucOcn 11i. Rtrdi r" I Nunbw or ntdrooms cDdt derN.d 4wpn tat rau/ D Rtptuawt ❑ PuCic a owNm•wdti - Dw°or Pwwlt RWOW flood Maortvttm A.ppwW nGOWN Call W Wd nmWWWWrlom:.$)+S•ki- if✓ it, nr• X-1 / n • ••t ,,�, �{-¢. jms7ii Dark �at� PH Gnxtrd ettfios eW.a DtOtr b I n*V r+� SN Rr Min DW*Wd color ZZ Dt VbW Ttn^ $° � caroeterce "RooftGr. Sz Sl. Mu+w Du s,: col+ crar . xr- r-- © • pa Grounduahcet1W ✓9''S DKMb1m�m9 nruL n. • EArM t2.90D : ;w lryt ao ,.., _ �,..,,,. • EtYrN t1 • BOD > 30 <_ 720 mD'L wd T�'� � 1 GST MariWr CST 401 IPuut'Inc ' 226900 Bird Plumbing Inc Shaun Bird cat r E won L'0 a od Teiepnor+NumDa /bd411) 11 715.246-4516 i006 192nd Ave, New Richmond, W1 54017 �j - �-'LJ Pmp" oww . nB"Ve lb4 POMO ID 0 ql Iq5�bV vn O1amd wf a Wv. 9ri. t1 OMb b GNiV bdu h SdAaabbelM"RY�i ©rw®wr•�''�®©© ® MEMMEM 08� oO m WIN •El Il s8O0.s 50:230myLea TSS 401150 nV& •mw..a-WD,_ W Rot tmd TSSI 3Dfl L The Dep mM, of Canmerco ism cqusl oppm"ity s iu pmida sad employer- If you need saistua l* "cM savias a pad msurisl m N sltertub ro t, Pea" c L&a the dcparmml st 60&266.5151 or TTY 6092644777. tl PL l Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Shaun Bir Address P.O. Box 489 Somerset Wi 54025 CSTM 2 Lot 44 Subdivision Farm View Ridge Date 5/8/ NE 1/4 SE 1/4S 5 T 29 N/R17 W Township Hammonc ❑ Boring Q Well PL Property Line County ST. CROIX BM or V" Assume Elevation 100 ft. Top of Survey Iron System Elevation 102.2' •HRPSameasBenchmark Alternate Benchmark Top of 1/2" Pipe (9 100.2' SO 170' Property Line 17c.71) Scale is 1" = 40' unless otherwise noted 383' Property line Pro Town Road B-3 Slope Alt. 8.h 100.5' 60' 1B' 30' _ 345' Propeny line State Depart entofnsin Grant Project Resolution Department of Natural Resources dnr.wi.aov Form 8700-388 (08/21) Instructions: Each applicant must submit to the Wisconsin Department of Natural Resources (DNR) an Authorizing Resolution that is approved by the governing body of the organization and indicates which officers or employees of the organization are authorized to do the following: 1. Sign and submit the grant application 2. Sign the Agreement/Contract between applicant and the DNR 3. Submit required reports to the DNR to satisfy the Agreement/Contract (See Agreement/Contract for Requirement, if any) 4. Submit reimbursement request(s) to the DNR 5. Sign and submit other required documentation that maybe required for your specific project. We strongly recommend that the applicant indicates the authorized person(s) by the title of position in the Authorizing Resolution, rather than by the name of the employee or officer. Employees have been known to retire or change jobs in the middle of a project, and, were this to happen, your resolution would be ineffective if it only lists the employee by name. If your organization requires that a person be named in an Authorizing Resolution, then the resolution should also include the title of position and contact information for the named individual. Note: If applicant is required to submit a drab "intergovernmental agreement (IGA)" along with your agreement, an Authorizing Resolution is not a substitute for an 1GA. STANDARD AUTHORIZING RESOLUTION WHEREAS, (applicant) St. Croix County is interested in obtaining a cost - share grant from the Wisconsin Department of Natural Resources (DNR) for the purpose of Lake St. Croix Civic Engagement Initiative - Phase lI (as described in the application); WHEREAS, the respondent attests to the validity and veracity of the statements and representations contained in the application; WHEREAS, an Agreement/Contract is required to carry out the project; and NOW, THEREFORE, BE IT RESOLVED, that (applicant) St. Croix County will meet the financial obligations necessary to fully and satisfactorily complete the project and hereby authorizes and empowers the following officials or employees to submit the following documents to the DNR for financial assistance that may be available: Task Title of Authorized Email address and phone number if Representative alternative is used Sign and submit application Comm. Devel. Director ellen.denzer@sccwi.gov / (715) 386-4673 Enter into an Agreement/Contract with the DNR Comm. Devel. Director ellen.denzer@sccwi.gov / (715) 386-4673 Submit required reports to the DNR to satisfy Resource Management tim.stieber@sccwi.gov / (715) 531-1905 the AgreemenUContract, as appropriate Administrator Submit reimbursement request(s) to the DNR Resource Management tim.stieber@sccwi.gov / (715) 531-1905 per the Agreement/Contract Administrator Sign and submit other documentation as Resource Management tim.stieber@sccwi.gov / (715) 531-1905 necessary to complete the project per the Administrator AgreemenUContract BE IT FURTHER RESOLVED that respondent will comply with all local, state, and federal rules, regulations, and ordinances relating to this project and the cost -share Agreement/Contract. I hereby certify that the foregoing resolution was duly adopted by St. Croix County Supervisors at a legal meeting held on this 5th day of October , 2021 Authorized Signature Date Title Community Development Director NOTE: The Authorized Signature and the Representative should not be the same person, unless minutes of the meeting where the resolution was adopted are attached. RETURN DETAIL FRONT ELEVATION r M.N COLUMN DETAIL .W.,. 4 rr n.r.r�rr.. ROOF PLAN r W.. Mr-.-FLNL PAGE INFORMATION A1.10 I EXTERIOR, ROOF A2.10FOUNDAtION PLAN .1 UMN iLDOR PLAN A4.lU SECTIONS DETML WINDOW DETAIL (FRONT ONLY) r M-,+ Hill, ;191I����� RIGHT ELEVATION r w.14 REAR ELEVATION rW-lam LEFT ELEVATION . M..4 R Al 10 Y ; r____ i ---------------------- ___________________________________________ i 1 I � i � 4 1 I I w i 1, 1 i I 1 1 ' _�V\\ 1 '�JtiVARi'' 1 r „ , ■ Z NOTE: 12" GARAGE DROP 1 I r I I _J I t ` • 1 inuiy6 �TM R� 1 1 h � , I 1 I L ' IY I ; WIIYf•f/�•� 1 1 N•I� 1 I i I , I 1 1 J I NAY I i l 1 t 1 1 t , @5WCnw I FOUNDATION PLAN r W.ram k a GNM • I ®1,17 + 4 NAM an OATH r, HALL ± , I 10AE,+ • ar __ L1{•LRr OI �____-_w.M_� ____1 F-_M.MN_ -] • �,' , � , + Z I I '� r i r ; qg + + MT M FMS,OID W sr as II i + + Y I l_ __________ ���_____________J + o o 0 o MAIN FLOOR PLAN m N-ra mr wn r A3.10 GS JA TZ aIVa— _ FBA02. ss�a �-:asss SN r<w-,. +o r �A4.0 ST CRO, LY.'NTYFile #: veleill"VII SANITARY SYSTEM Office Use Only OWNERSHIP/ADDRESS FORM Created212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. Owner/Buyer Mailing Address / O� City/State/Zip Phone Numbei Email Address Parcel Identific (found on the property tax bill) OWNER/BUYER INFORMATION NEW SYSTEM: LEGAL DESCRIPTION Property Location/f�Et/a,�- 1/4 , Sec.J T N Subdivision Plat: Certified Survey Map # �— Town of 4xti0j'o L Lot # , Volume . Page # I Warranty Deed # (before 2006)Volume . Page # Number of bedrooms Spec house O yes 9'4 Lot lines identifiabl yes 0 no New Property Address (St ff Initials) . Qf FICE USE ONLY (Verificati n of ne address required from Community Development Department for new construction.) (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 mop if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.00v UNPLATTED LANDS N 89'26'33" E 1258.42' — I 1 _ 227.68' _ 176_16'_ 170.99' 214.85' S.M. TOP of 3/4" -1 rZ f � I- — I I 1 `IRON PIN ELEVATM Z 1109.71' I Io 1 Iz I I 1 w LOTy3 A I I� I ILA N a PG. 795 18 11 42 10 L4 a 45 1 N N 1.331133I 65358 S.F. 11' 43 I 1w 04F. I I. I u c 65400 S.F.P, 1.50 Ac. m w II 65341 S.F. I I I I*1.50 Ac. I N 00'23 36 W a u 1.50 Ac. Iu m 7.00' I 1 1 \ 1 w -_ 1b 1 IN i u _ I S 89'S7 53 E S 89*57' 3" I� 1 w _ I co m J 84.70 W C7 J I C1 135. 3' w U 0' NsI I J _J5✓2�C2 `-�1-00-.-00Qo' 51I53 45i670 0�0 ,9•1Cs� o; Z N C55- 3 £ 6 6 L4 C3 71 a�.36 46 E' 59 l C60 589 ",E LLJ ?� �� --mow-=---- 38 '� SIn 0023'36' E �3 I Z I w LLJ �i ��_ uC56 '�32 / I 7.00' 4 0 � �2 --- C58 I Io l80 =11031' j W icn �►� `W I �l �' -- I IZ I I A I G'�I ( cn oo, I O I ry I I I Io I V I 10 N I 4 n 2 I `' 126383 S.F. !oi a �° B326 S.F. I I 3 I I A 86316 S.F. I 1 2.90 Ac. I 'po m1-3 I 2.03 Ac. w I I MI 80642 S.F. I I 1.98 Ac. I I� _ DRAINAGE I 100' j t v 1 I m 1.85 Ac. 90 EASEMENT I ryI I I IL, I Il I i N1 IH I z I I-1286.64'--� II _ I 3300.1 6 6' L 237.14' J 2 1✓%5 — J — 'f�8.45' -J L 37)930' J S 89'25'01" W 2639.28' 31 SOUTH LINE OF THE N 1/2 OF THE SE1/4 N OD Lo vi cc rnol At tr Wisconsin Department of Commerce SOIL EVALUATION REPORT Page J—of_ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code county) �, Attach complete site plan on paper not less than 9 112 x 11 inches in size. Plan must include• but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. /�, L percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6 7 Please print all information. vie Dat Personal infermWn you Prov4e maybe used for secondary wrpaas f . s. 15.01(1) (m)i. � / >mpeqOwner^ �, C�� � nn r ropertyLrxalion y/. /j t ovt. Lot 114 —<4e 114 S T p� % N R E (or W property 0 Mailing Address Lot 0 Block 9 Stbd:7F'e,.J NW rI k1 2004 ,;fly State Zip Phone Number C ty ❑ VillageToNearest Rojd New Construction UResidential / Number of bedrooms Code derived design flow rate % )W _ GPD ❑ Replacement /❑ Public orcommercial - Describe: ------—/----------- FL material /�'.. Ct �,nP. c Flood Plain //-elevation if applicable General comments wW feooriv lendations: J �/�.kt Q, ��,/ ,-..•yv (J t� v� / /r l'/��'�i l ! � EDBorg N Boring Pit Ground surface elev.IY— �11. Depth to limiting factor in Sal Application Rate Nortaon Depth Dominant Color Redox Descnpbm Texture Structure Consistence Boundary Roots GPofff in. Munsel Ou. Sz. Cont. color Gr. Sz. Sh. I *Eff#1 /*EfW2 1 a Boring 1 �-1g o:. (;round surface eleV ✓O -5-m. Depth to limiting factor ZL in. MWOA ARM WA "IMWM=M=M ' Eflkuerrt p1 = BOD 5-3u 17.11l mgfL arc 1 JJ �JV = iau �, „R„• - _ -- - -- - - CST Name (please Print) nature CST Ntniber Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 Property Owner ❑ Borng n �# :C, o:• Parcel ID # Ground surface elev. LPL ' k Page 13 of Depth to limiting factor _I in. c.a e�u,� M.I. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDMF 'Eff#1 'Eff#2 z of — U,., --- 1 0 r rr, s cri r l ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in.Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Cdor Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDAf 'Etf#1 I 'Eff#2 ❑ BoringBoring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sod Appication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cons Color Texture Stnicture Gr. Sz. Sh. Consistence Boundary Roots GPOM 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 nwYL and TSS >30 < 150 mgrL ' Effluent #2 = BODE 130 mglL and TSS < 30 nVL The Department of Commerce is an equal opportunity service provider and employer. If you necd assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or M 608-264-8777. SBD4330(l_-6M) 1 Soil Test Plot Plan P� 3 Project Name P.C. Collova Bldrs. Inc. Shaun Bir Address P.O. Box 489 Somerset Wi 54025 CSTM 26900 Lot 44 Subdivision Farm View Ridge Date 5/8/a NE 1/4 SE 1/4S 5 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation too ft. Top of Survey Iron System Elevation 102.2' *HRpSame as Benchmark Alternate Benchmark Top of 1/2" Pipe @ 100.2' 38: Prc Lin rro 1 own Koad -.64* lwaorw) CO TY NO. 633964 STAT14ANIT,4R2) PERMIT loo /13 me OWNER VZ9 PLUMBE TOWN F SEC 5 ,T PREVIOUS NO. BLOCK SUBDIVISION OFFICER CHAPTER 145.135 (2)WISCONSIN STATUTES (a) The purpose of the sanitary permit Is to allow installation or the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit wW 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 Mthority. - DATE RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)