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HomeMy WebLinkAbout018-2022-09-000Wisconsin Cepanment 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 na i U) m,J re�rnn nuw or s Name City '.'Illade Iownsh id Oevering Homes I TOWN OF HAMMOND IEO.01 TANK INFORMATION TYPE MAN A TURER Oct( CAPACITY Septic Fes"-r't" 001D 30a Dosing CIw.. � w Aeration Holduau TANK SETBACK INFORMATION TANK TO P!L WELL BLDG Vent to Air Intake ROAD Septic } 1 5 > rfDp' Dosing u tit Aeration oldtng-1 PUMP/SIPHON INFORMATION / _ i DW&- eC SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV Benchmark 2. o l02•� �ov.o � All BM Bldg Sewer 13 Y471 gg•, r OI St Ht Inlet SUHt Outlet DI Inlet DI Bottom ?+ZO t HeadenMan Z •l0 7 �jY 0. Dist Pipe p jo .o Sol System �� •� nal Grade tl M t Cover 9-w 1140 •'D r JL w�. 1•Sz' r�l• r�o .o DIMENSIONS `Jro1dih S Length 7 5,T N CI �� (a�ts PIT DIMENSIONS No Cf Pns Irs de Die Liquid e th SETBACK INFORMATION SYSTEM TO PIL BLDG WELL LAKEISTREAM LEACHING CHAMBER OR UNIT nuf re Type Of System metLh� a� „) odes er HeaderlM Length Bold t 1 rn� " Dia�_ Drstnbut n ) t 1 t pipe!s Length Dia�_ Spacing Q x Hole Size %/ fl x Hole Spacing 2 Vent to Air Intake SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over epth Over :. Cepth of xx Seeded Sodded Mulched Bed,Trench Center ppecl,T,enchEdges Topson T Yes No yes No e�OrIMEN T�: (In de code discrepencies persons present. etc) Inspection #1 v(/O/2pZZ Inspection #2 F/ Z0OL Z,4on:172311 THCT (tF,,,,� at 1 ) All BM Description = 5 �" ` CFIl ) r 2) Bldg sewer length = s [ - amount of cover = y AlZ 3) Qlc,"Plan revision Required? Yes }[ No � / for adell/ Use other side for additional Information SB -671C tR 3;971 Cate ' Insepctcr's Signature Cert No Lit 5'-0r S`�, t�' �[l6.S�r-tsr'+- / pr!'zlidi OT-Vatpwpl. &q,. s� � c°'"�'` r_.,tcfi-u.�-e� �=�'- P;Pe b r� It►�tl r,w�••�:P+d. SY 1. 2. Industry Services Division County ,{ 4822 Madison Yards Way Sanitary Permit Number t is filled in by Co.) Madison, W1 53705 P.O. Box 7162 / 42 Z�Z f 02 ZOZZ Madison, W153707-7162 Sanitary Pen it Applicatio late Transaction Number In accordance �vith se6 383,PI(2)_-�A'1s. Adii>` mission of this form to the appropr' ernntcntal unit is required pri rig a sanitary permit. Note: Application forms for state -own TS ere submiucd to Project Address (if different than mailing address) the Department of Safely and Professional Services. Personal information you provide mey be used for secondary purposes in accordance with the Privacy Law, s. 15.04(I)(m), Stats. �"'J v V 1. Application Information- Please Print All Information Property Owner's Name Parcel Property Owner's Mailin dress 7 Property Location 7 %n Govt. Lot 7 '/., , , 7-ip Codc p Code Phone Number �C4,,nState ) � 1 Section !v lam/ ��S (, / T2,9 N R i W Ill. Type of Building (check all that apply) Lot ff Subdivision Name y �IVQ.(.i:A�1 r "�U` �� or 2 Family Dwelling - Number of Bed rrgz5—pwe 92- 4 Block tl PabIIC/Uommerelal - Describe Use OCily of ❑Slate Owned - Describe Use F-lylIlagc of CSM Number own of M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicatti A. System ❑Replacement System ❑Other ModlfiCatlmtt to Existing System (explain) Additional Pretreatment Unit (explain) I4. Holding Tank ❑In -Ground OAt-Gradc rid Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before [:]Revision❑(:hongc of Plumber �1'ransfcr to New Owner List Previous Permit Number and Date Issued Expiration ` % !( IV. Dls ersalfTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rale(gpd/sf) oQispersal Area Required (so Dispersal Area Pr6posed (so System Elevation I Capacity in Total q of Manufactu t✓1 y o Tank Infomsalion Gallons Gallons Units I�✓ A V New Tanks Existing Tanks a U in H vt ii. V i1 Septic or Holding Tank Dosing Chamber Q 0 a V. ResponsibilityStatement- 1, the undersigned, assu r ponsiblllty for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb gnature MP/MPRS Number Business Phone NO ber r -71 - / / {'lumber' Address (Street, Cloy, i ' t C� l �--� — 1. County/Department Use Only Approved ❑ Dis ed Permit FCC Dat Is ed Is in gent Signs or t ❑ "ell Rc for Denial 5 6 i / 2 �y zz_ Conditions Approv /Ittesonsfarijisapprmro}- �\ , , I B� p S o ilk TEM OWN `-�! I ptic tank effluent flier and 1 sper cell must 1 s� ✓1i�C2_ It I iAi m t anserviceddmaintainedI�rbv, I per management plan provided by plumber: �J prove l. I setback requirements must be maintained I applicable per code/ofdinances. SHD-6398 (R. 03/21) Attach to complete plans for the system and subndl to the County only on paper not less Ihan a 112 x II Inches In size .I PROJECT Oeverina Home SW 1/4 NW 114S 9 SYSTEM ELEVATION 98.0' /T 29 CONVENTIONAL AT -GRADE System PLOT PLAN _ ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 N/R 17 W TOWN Hammond COUNTY ST. CROIX 2118/22 DATE CONVENTIONAL LIFT MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 11LBENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL IH.R.P. same as benchmark cOlpY to 105th Ct z BEDROOM 3 HOLDING TANK DOSE TANK SIZE 630 # of Chambersnone Scale = 1/4" = 10'239' Property Line � 0. 40' 80'� J o` Well is to meet all WDNR setbacks Pro 3 Bedroom House Area 15' below system Is to remain undisturbed B-3 387' Property Line 97'r 0 B-1 Grading is to be done to divert run-off away from system 3% Slope tC5 March 2, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-03-02 Plan Review: PWTS-032200303-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Oevering Homes 1723 105th ct. Town of HAMMOND St. Croix County Total Amount: S250.00 FOR: Description: 450 GPD (3 Bedrooms —New Construction) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.vA.gov/programsfindustry-serviGes www.vAsconsin.gov Tony Evers - Governor Dawn Crim -Secretary Condidonlly APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES 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: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or Icft over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent malting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384,30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (1 1)(c) • Well setbacks to meet chs. NR 81 1 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual andlor owner's manual for the POWTS described in this approval SPS 383.54(1). • lit the event this soil absorption system or any of its component pars malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, J ,/ ro" %/.lt./LQl4.�C-PPwtf POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tintl %:MdCl'1 CC �t (1 wi,Co its I n. QON Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Date: 2/18/22 Owner:Oevering Homes Location: SW1/4 NW1/4 S9 T29 N,R17W 1723 105th Ct. 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 B Signatu License Page 1 of 9 PROJECT Oeverino Home SW 1/4 NW 1/4S S SYSTEM ELEVATION 98.0' /T 29 CONVENTIONAL AT -GRADE System PLOT PLAN _ ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 N/R 17 W TOWN Hammond COUNTY ST. CROIX BEDROOM 3 HOLDING TANK 630 MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE. LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION too' Filter Lifetime ❑ BOREHOLE (DWELL •H,R.P. same as benchmark to 105th Ct pro 3 House Area 15' below system is to remain undisturbed B-3 M 387' Property Line 2/18/22 DATE CONVENTIONAL LIFT Scale = 1 /4" = 10' � 0. 40' 80'�, I 1 1 239' Property Line Well Is to meet all WDNR setbacks Huffcutt Combo Tank 97'� !_ B - 1 B-2 Grading is to be done to divert run-off away from system 3% Slope Mound System Cross Section and Plan View t-t---1e-------- --------------------------- . —1 =Topsoil = ASTM C-33 Cap Material Lj sand fill i 0 Ft Contour = Clean aggregate 1/2to 2 1/3in. dia. Slope Direction �'- ► Dimension Feet B $ D , E ,3 F G H 1$ ( J K � �, [� L 7S W z Slope % = 4 in. sch. 40 pvc O observation pipe 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. n 10/07 lgj Page --,)_ of Man llulto� WHIM C23C) ri Lateral Diameter Orifice Diameter L (Lateral Length) M (Manifold Length) Force Main Diameter Force Main Length Pressure Lateral Layout Two Laterals — End Manifold C/J_ k S ecitications Z In. In. 3 In. y In. Ft. Ft. Z In. 1` e) Ft. ••••• Grade 6-8 Inch Lawn Sprinkler Valve Box ded gout 9 ig Sweep 90 Bend Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral turn -ups terminate with a threaded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade, Page J _ of 03/05 lgj Septic -nose Wank Crosse Section Tank Manufacturer Tank Model Number Total Tank Capacity ji..' Max. Bury Depth Filter Manufacturer �. Filter Model Number r Minimum Pump erformanoe Required GPM 15.6' TDH Outlet Manhole Iv;in. 4" Above With Looking Degioe. Inlet < 6" Below Grade Sealed Watertight '*- - - - -y - Finished Grade -0 Y - Outlet Filter Inlet .0 ---- Wet Bate Switch SoNs and Reserve Capacity Tank Volume = GPI Dimension, Inches Volume Gal. (reserve) A, (alarm) B • 2 dose) C • , (dli:4 D'. Total � 2- ^ GENERAL INSTALLATION: The septic/doee tank i manufacturer's product approval speoi6ations. Maximum del be exceeded without prior tlpproval. Manhole covers expoaW installed. Piping at the Inlet and'oolet ie of approved materia laid on stable soil to prevent settling of sagging. The force ma excavation and the aleeve is sealed water fight. Electrical aehvic 02/05 U Page —� of Pump Performance Specifications Pump Manufacturer �A//- Purrip Model Number C.2 g 0 Alarm Manufacturer _ S - Alarm Model Number _LCAI Switch Typo ', C, Total Dynamic Heed (TDH) - Feet Elevation Head �) Distal Pressure S O Network Lose , \ Fora Main Loas Total Manhole Min. 4" Above Grade securely Mounted With Locking Device Weather-proof I ]unction Box Vent Men. 12" Disconnect Above Grade Means With Vent Cap A ' Y. 04 Weep B :ti Hole Elevation I C Bottom D ;{ Elevation ems- Ft bedded and back filled in acoordance with the h of bury as speolrod by the manufacturer may not 1 grade have an effective looking device (padlock) connected to the tank with watertight ffftgk and is sleeved with 4" Sch. 40 PVC to bridge the tank omplies with NEC 300 and Comm 16.28. 290=SERIES 314 hp Submersible Effluent/Sump Pumps The Liberty 290 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 290-Series will provide years of reliable performance. All Models Feature: 2--`9�.59 • Semi -Open impeller permitting passage of solid54 up to %N • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • Ail fasteners - corrosion -resistant stainless steel • 1 You Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature:140' F. • 290-Series Cord Lengths Model 10' 25'(-2) 3510) 501(A 290 Standard Optional Optional Optional 291 Standard Optional Optional Optional 293 Standard Optional Optional WA 297 Standard Optional WA WA 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to rlodef number. FEcample: for model 290 with 35' cord. Order 290-3 MOW Specifications % hp 60 Hz 3450 RPM Oil filled, thermally protected 115 V. Models 10.4 amps 20a(230 V. Models 5.3 amps Perfonmrme Cum: 29&4%. fes U re 114 1.1 1ee,� 27T tee 303 7e1 Lftm Dimensional P« '.•�'a{+ 5"1 (P "• Ulsigl>f: 311�0 W. Height 13' Mgjor Widtfc 10" ( 297) Minimum Sump Diameters.• Model 291, 293... 14' Model 297 VMF... 10' Factory switch Model 291, 293 Model 297 settings I VMF Tum on lava! 130 9.50 Turn off Well 7' 4.00 The Model 293 features a fully adjustable wide-angle flwt Diffewbal adjustments can be made easily by tetlerfrg the float to the discharge pipe or other mounting point vertical float model 297 Is not adjustable. Ino odel 290 Model 291 Model 293 anual, Wide angle Wide angle switch float switch float switch with quick- with series disconnect (piggy -back) plug C-•-••• • Qeis Certified sp.eel�elwn..,..ubl.lx b a1.np. , ,h ax notice. Model297 VMF4Serfea Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump UbwV Pumps • 700D Apple Dee Arrerwe • Bergen, New Vbrk 14416 • Plane 800-543-2550 Fax (510) 494-1839 wwwNbertypumps.com copyright O Lb•rty Pumps, Inc. 2011 AM rights renewed. LLr 6681 fi09/11 2804EMES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature: e Vortex style impeller permitting passage of solids upto%" • 416 stainless steel rotor shaft Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1 Y? Discharge e Stainless steel bottom screen - easily removable Maximum fluid temperature: 140' F. 280-Series Cord Lengthe Model 10' 25'(-2► 35'(-3) 601(-5) 280 Standard Optional Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional WA 287 Standard Optional N/A N/A 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specffhcations Yt hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) / Model 280 Model281 Manual, Wide angle no switch float switch with quick - disconnect • S UT IN S c us Certified ap/cNb.Noru ys IWlsa ro dwp wehwl nab.. •■■■■■ ■■■■■■■■ NUM %NMEN501 t t 12 11 9 8 s 0 78 11 158 192 228 270 Ltters P Minute Dim sionai Data: Wei b 29 tbs. Hei t:13" M or Width: 10" ( at 287) inimu Sump Diameters: odel 281, .14" a Model2M a..30" Turn Turn 0 281, 283 Model 287 VMF 13" 9.5' 7" 4.0" PW'Model 283 features a fully adjustable wide-angle That Differential %djustments can be made easily by tsttarfng the float to the dis- charge pipe or other mounting point. Vertical float mods) 287 Is not adjustable. I Model 283 E4Z Model 287 Wide angle VMF-Series float switch Vertical mag- with series netic float for (piggy -back) smaller pits - plug will operate in a 10" diameter sump Liberty Pumps a 7000 Apple Tree Avenue " Bergen, New York 14416 " Phone 800-543-2550 Fax (665) 494- IB39 www.iiberwpumps.com copyright UbWAY wrro., r,c. 2017 AN rights resewrved. LUT 2000 AOSM 7 FN 91 SECTION A -A 921 1. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Paue.of FILE WFORMATION Owner ? ✓ �,,� Permit III, DESInN PARAMETERS Number of Bedrooms ❑ NA Number of Commercial Units Estimated flow (average) = avda Design flow (peat). (Estimated x 1.5) C 2 7 add - Sol Application Rate 0 gaiidaylv Influent/Effluent Quality Monthly average, Fats, Oil & Grease (FOG) 00 mg/L Biochemical Oxygen Demand (BODa) &220 rng/L Total Suspended Solids (TSS) s150 /L Pretreated Effluent Quality Monthly average — Biochemical Oxygen Demand (BODa) s30 mg/L Total Suspended Solids (TSS) 53D mg/L Fecal Colifonn (geometric mean) s10' du/100 it Maximum Effluent Particle Size Y. Inch diameter NAINTFNANCF SCHFnt It F SYSTEM SPECIFICATIONS Septic Tank Capacity at ❑ NA Septic Tank Manufacturer C O NA Effluent Filter Manufacturer %H� NA Effluent Fitter Model ❑ NA Pump Tank Capacity 1 oal Cl NA Pump Tank Manufacturer NA .Pump Manufacturer ❑ NA Pump Model rji O ❑ NA Pretreatment Unit NA ❑ Sand/Grgvel Filter ❑ Peat Fitter ❑ Mechanical Aeration ❑ Welland ❑ Disinfection ❑ Other. Manufacturor Dispersal Call(s) ❑ In -ground (gravity) OJn-ground (pressurized) ❑ At -grade ound ❑ Dri 'ne O Other. • Vskies typical for domestic (non-aomrnardN) wastewater end ae, lank of ant •� Vakm typical for pratrested wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months years) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (K) of tank volume Inspect dispersal cell(s) At least once every ' ❑ month years) (Maximum yrs.) Clean effluent filter At least once every ❑ months ear(s) Inspect pump, pump controls & alarm At least once every ❑ mom earls) ❑ NA Flush laterals and pressure test At least once every 213 months earls) ❑ NA odw. At least once every ❑ months ❑ years) NA Other. At least once every ❑ months ❑ years) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shall be made by an IndlMual carrying one of the following licenses or Certifications: Master Plumber, Master Plumber Reableted Sewer; POWTS Inspector: POWTS Maintainer; Septage SeMdng Operator. Tank inspections must Include a visual Inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface. The dispersal cell(s) 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 ponding 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 (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113. Wisconsin Administrative Code. The servicing of effluent filters, mach ncal or pressurized POWTS components, pretreatFment components, and any other maintenance or monitoring at Mervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process and/or damage the dispersal celks). It high concentrations are detected have the contents of the tank(s) removed by a septage 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 presence of painting Products or other chemicals ttalt may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of (hq tank(&) removed by a septage servicing operator prior to use. System start up shall not occur when soil Conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess westeWstef will by discharged to the dispersal celf(s) In one large dose, overloading the cattle) and may result in the backup or surface discharge of Nfiuert. To avoid this situation have the contents of the pump tank removed by a Seplage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Malntalner to assist in manually operating the pump controls to real/" normal levels within the pump tank. Do not drive or perk vehicles over tanks and dispersal cola. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or al -grade soil absorption area. Reduction or almination of the following from the wastewater stream they Improve the perfomuM9 and Prolong the Ifs 01 'ha POWI $: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floes; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; harbloldes; most scraps; medications; oil; painting P(Odul* pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or Is permanently taken out of service the foilowing steps stall be taken to Insure that the system Is Property and safety abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: • AN piping to tanks and pits shall be disconnected and the abandoned pips openings sealed. • The contents of all tanks and pits shall be removed arxi property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or theft covers removed and the void space filled with e011. gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code cof 4ftnt replacement system: ❑ A suitable replacement area has been evaluated and may be udllzed for the location of a replacement sol absorption sysiOn. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requi4eed setbacks from existing and proposed structure, lot lines and welts. Failure to protect the replacement area will result In the nged for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruleil In effect at that time. ❑ A suitable replacement area Is not available due to setback and/or sot limftatlims. Barring advances In POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. e site has not been evaluated to Identify, a suitable replacement area. Upon tafiure of the POWTSsoil an a d OVA evalua$on must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be installed as a last resod to replace the failed POWTS. mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules In affect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SOR OTHER PUMP OOTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE O A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMP033181-C. ADDITIONAL COMMENTS POINTS INSTALLER Phone 7 /s- c4S G POWTS MAINTAINER Name S «. �, `-- Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name17 — Name rV Phone _< le Phone This document was drafted In complance with chapter SPS 383.22(2)(bX%d)3(f) and 383.54(1), (2) s (3), Wisconsin Administrative Code. yrlwawa+ Dwarlrlwa of cmwr*" PAW of Safety and Buldirrps n. SOIL EVA UATION ION R PORTa3 1o.0'"GI- Per -La—�- rn awwoerim wen wrrm w, ms rom. %,use Aaadt aomplw alto plan on paper not Ma than a 112:11 Incas In size. Plan must ndt,de.but na omii.a a: rertica( arrd horizonAW relarena pant (BM). direction dins PWoW%slope, scale or diRMwldM, rwrlh arrow, end loation end dwtanoe to IMenet road Plssas print NI information. wtinorrr 6 0 moft yew vo.,de nwy be wed for seaeMwy pwew« (►N.wy Law. r. +sea t+J (rap_ Percat LD of t3- Dew 1'%Zo�Zd Property owwr Properly Location Gont CL,) 1N/4/AJp S T Z N R E( W y. li 9Mwty0MW4Mb4pAddrea lggqoJel Loll Block# Md. N@naer6en I►09 BheM z; M'WC44 1 LU 1 ock a� f cawat,awn / NUMbar or bvdroo w cow derMd deso slow raw yjv .4K Qa GPD n Rw>mrwnt o Pubic or oomrwd.( . oeealbe: Pwwt nwAw is e Flood Plah eWsW N eppkable ,Crrdk w iemrnrwdetlorw!°''I S Shwl I nth SMw @ p(0,41 Systsm Type---y4/2irl ee system Ewievw � 13,� Bodry � a� I �°'"'°' B-ft Ground arfaw Nev. r 7-,L Dspn a irrrasrq bare own 1ldrmort Dsolh h Donn" C<dor hlumd Red=Deea( m Ou. SL corn. coon T90AM Savcaae Gr. SL Sh Carwiatenoe aoemduy Roost GPM •E1Y//1 OEM Jig i L J— L, l� Il6 Z- % — i PP �LGrow4w1wee(ev.l L—R• OepthaMIMVisclor yD h Sol Ri Hwtmn Depth k Dw*wti WrIsed Redua tpi Deeam OU. SL Cons. Cdw Tesbee 8tnakre Gr. SL Sh. Com"arla BoumWy Roan ( 'MI -0102 91y.2 14�i L , • Eftient $1- Boo. 90 s M moL and TSS Sao < iSo • Mused 02 • BGo. <>o maL and Tss s oo myL CST Name (Plesse Print) S re CST Number Bird Plumbing, Inc. Shaun Bird 2269M Address Date EVAMM Ccxwx'4 M Tdwv" Mxrbw 1432 120th St, New Richmond, WI 54017 /r- as —/P 715-246-4516 45 st l kf> Pmpaay Owner Parcel ID Y Pw• Za—L mom ©I i�y�� 1�■ �i .�i '�c�y� WE�'AW�I MMMM ■ ■ ■■■■ ■■■■■■■■■■ - Ealu.r[ 01 . BW& a 30 c 22D myL.r.d TSS 40 1150 m9L - EMMC 02 - SOD,: 3D wet and TSS 130 nQ L TLe Departnteat of Commerce is an equal opportunity service provider and employer. If you need assistance to acew aerviaa or need material in an alternate format, please contact dw department at 609-266-3151 or T1Y 605-264-SM. Soil Test Plot Plan Project Name Edward Folitti Shaun Address 1894 110th Ave �\ Baldwin Wi 54002 #226900 CS Lot 9 Subdivision Date 11/22/19 S W 1/4 N W 1/4S 9 T 29 N/R1 7 W Township Hammond [:]Boring Q Well PL Property Line County ST. CROIX `,� BM or VRP Assume Elevation 100 R. Top of survey iron System Elevation TBD •HRpSame as Benchmark Scale is 1" = 40' unless otherwise ST. C Ro TY SANITARY SYSTEM File #: Office Use Only ` OWNERSHIP/ADDRESS FORM cratted212021 I i 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 Addr( City/State/ZiF Phone Number (required) ' //J - / ) n - Email Address (required) Parcel Identification Number (found on the property tax bill) Property Location-LLi&ZA,44 , Sec, _, T &N R/2W-, Town of G Subdivision Plat: j,//tb- Lot # �. T _ Certified Survey Map # Volume '— Page # Warranty Deed # Z (before 2006)Volume . Page # Number of bedrooms Spec house yes 13 no Lot lines identifiabl�es O no New Properly ddress / %-"L --.7> 129S - (Venfica ' n of rlev6address required from Community Development Department for new construction.) 0 OZ oZ,'7— (DtZa r no /urrn musr ae suomirrea with all Private Onsite Water Treatmfnt 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 Lii r sccwi aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwioov I I elf J t ��i O O 2' t rye: q .O� 0..9n NOUN ry.. (7i 5)248-3010 - ------------- ----- ----- ---------------- - ............ - =L 11 L i ne --A - --- --- - ------ ------ -------- ----- ---- -- -------- FOUNDATION PLAN 5MEET 5Cti �5 5-0" 2 OF 5 I FOUNDATION ft� a iJ\�l ��rd s`r (:")) `1. [�A�i'1'IL9�j D6/22/20 wnMrt" N89049'37"E 553.09' o 7 f9.r�Z �8 , 1 M LOT 10 yF��f� . / lo? m 78,766 SQ. FT. / ^� 3 1.81 ACRES L. B. 0.=1048.85 1053.91 v o, n 0 / 'L 1 /C�51' in N N / LOT 9 — — / 82 74 / C3 1 90 ACRES p tt 1 I 2062.91 Z.y 1 S86°46'47"E 367-46' I 1062.58 .. ....... �\ I: •S�y� LOT 8 ' 73,996 SQ, FT. 7062"i4 11 / 1.70ACRES LEGEND FOUND SECTION CORNER ® / MONUMENT AS NOTED 1 Vft= in Department of Commerce SOIL EVALUATION RPORT V Page of Division of Safety and Buildings 11,)3 Q J d- in accordanciPwith Comm 85, Ws Adm. Code County � t Attach compWis site plan on paper not less than 812 x 11 inches in size. Plan must irldude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D of $- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Re Date Pwsonel errormeeon you provide mey be used for wcon0o7 Wxpos" (Pmeq law. a 15 04 (1) (m)), Property Owner Property Location Govt. Lot (� 1/4JIl4 S 9' T Z N R E( } W Property Owners Mailing Address Lot 0 Blodu >< Subd. Name ar9BhMr � -A� CAW( State . Zip Code Phone Number ❑ Cdy OD Village own N ! 1VILJ 1 f 1 cal l Calstruclion UsegRmdential I Number of bedrooms Code derived design Bow rate ` j x-7�li 0 GPD ❑ Replacement ❑ Public or commercial - Describe: --- Parent marial teFlood Plain elevation 0 applicable /�✓ //� �� /1 R �So1'lS 5hit(I AOk 5txw@ plolll System Type/J[/'J System Elevation Bori v, ��l Boring'977 ' tu-Pit Ground surface elev. r 2—ft. Depth b linitinig I rcw in Soil, Ra6s Hmtmn Depth I Dominant RedoxDew"on Texture Structure Boumdary Roofs PON In. Mussel ou. Sz- Corn. Color Gr. Sz- Sh. 'Ef #1 ',E7� �}} I z kn-3z1/�'_ </V I te,7/ Imo,. tl)I` I 1 I /-(-, I- y I., 4 1 El ®sorkv * U Pit Ground surface ekv. l L- n. Depth to limiting factor / cna nr,r r:�nnn 12�, �r ' IrLTi�i<•� ®.'�MMMW.A�MM EIlluerR 81 - BOO. > 30 < 220 mWL and T55 >301: 150 MWLZI EnMM Wd 2 5W. ! -Aj mgti W10 1 -�Z � au r"WL CST Name (Please Print) CST Number Si re Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 — A —/� 715 246 4516 Property Owner - Borirg # Parcel ID 9 ❑ Boring Os, Pit Ground surface elev. �h. Depth tD WMbW factor U o in. Page -7-- of mom■o 1 ... �1JMM # ❑ Boring No Effluent #1 = SODA > 30 < 220 nVL and TSS >30 < 150 mg& ' Effluent 02 = BODE 130 mg1L and TSS < 30 nv& The Department of Commcrce 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. .B64730 (R100) Soil Test Plot Plan Project Name Edward Folitti Shaun Address 1894 110th Ave Baldwin Wi 54002 Lot 9 Subdivision SW1/4NW1/4S9 T29 C&fM #226900 Date 11/22/19 Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRPSame as Benchmark N/R17 W Scale is 1" = 40' unless otherwise Ww\wNn] FC'.3 83 2u20 PREPARED BY: c..rA�r�a uFsrre• ' �' �• � artrE uat' I A M1a I �R� ,F- F I'li Ap 11 PHEASANT RIDGE WEST, 1" KCTIO" i. TlYN, Rt m PRELIMINARY PLAT ED[areD N Dper nr na swImol THE Nw,/n AND DAFr o=niE ew L/a or THE sw 1/4 OF SECTION 9, r29N,917W TOWN Of HAMM'�4D IT (.Oir. COUNtt WISCONSiV, BEINf, OU'10r :OE C! Ptli lE."i SU9VFY MAC V�J'.I. MC 30 VASE (723, f><CUMENI NO 1M:tliC � � •nvn ' T- oIq-oo6 1 " vunA*�u LA" i wT 3 . I YQL ;a II ra �PHEASANT RIDGE WEST EDWARD FORU'n e LEGEND .Y..-MFI i-.. . " .. u' kM)Ovl �II^Y I R�wilDw M1•Itt f W .I V>IY'h • D5K iGr�• al•OtJtia SH rain u. Y-• STAT OWNER PLUMBE EXPIRES > —�cQrADM'l NO. 642282 i ?*213 A M PE pywow CT PREVIOUS NO -: SUBDIVISION ISSUING OFFICER IT CHAPTER 145.135(2)—WISCONAN STATUTES (a) The purpose of the sanitary permit Is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not Impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contactihe county authority. - DATE UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)