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018-2022-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1 )(1 Permit Holder's Name: City Village Township Oevering Homes TOWN OF HAMMOND CST BM Elev. In BM Elev: BM Description. TANK INFORMATION FI FVATInAI r)ATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. towels Zl A135URPTION SYSTEM County St. Croix Sanitary Permit No. 642283 State Plan ID No: Parcel Tax No 018-2022-10-000 Section/Town/Range/Map No: 09.29.17.1317 STATION BS HI FS El Benchmark Alt. BM Bldg. Sewer St/Ht Inlet Still Outlet DI Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDlTRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System. Model Number Ill I R I D V I I V 14 J i J 1 C I YI Header/Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing V VIL V V Y Ill V Ill n.k. .... AA.. -A ^1 Af / —A.. 0....4-... ^-1.. Depth Over Depth Over xx Depth of xx Seeded; Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I-] Yes [_] No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 1726 105TH CT 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspection #1: Insepctor's Signature Inspection #2: Cart No. pxxxaTHCyr D , Industry Services Division 4822 Madison Yards Way County �� f �_ 1 '0 % 2ozz Madison, WI 53705 Sanitary Permit Number(to be filled in by Co.) MAR P.O. Box 7162 �/ Zc� Q ? =°�kw Madison, WI 53707-7162qff (i! T (�-lJ J i, �.• tt e " Application State Transaction Number Co . C- is accordance with S I(2), Wis. Adm. Code, submission of [his form to the appropria is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PO u tried to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary % purposes in accordance with the Privacy Law, s. 15.04(I)(m), Slats. L ! rj b 0 S _ L Application Information —:Please Print All Informa ' - Property Owner's Name Parcel # O 1$ Oe e. f; ,tom Property Owner's Mailin dress Property Location %1 Govt. Lot City, State 1 r Zip Code Phone Number r ': , / `�' Q,_ / �� ^ v Section T N R E W ;IL Type of Building (check,all/thnf,]t apply) or2FamilyDwelling-Numbeeddrooms P Lot # < Sub/division Name p/�Q. j A,�— Block # kc []Cityof ublic/Commercial —Describe 1 ❑State Owned — Describe Use Eavillage of CSM Number ® wn of IIL 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 A.7Renewal 1 pceplacement System L❑In-Ground ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B. ❑4t-Grade nd EJ Individual Site Design Other Type (explain) (conventional) C. e ❑Revision ❑Change of Plumber ❑Transfer to New Owner / j__� C / y l � , TV, Dispersal/Treatment Area and Tank Information: ,%L osed (st) System Elevation Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dis ersal Area Required (s7Manufacturer Tank Information Capacity in Gallons Total Gallons # of Units,/ 8 u Z. d y o U y in ya rn w Ci G. New TanksExistingTanks{ Septic or Holding Tank of Dosing Chamber 7 D O V. ResponsibitiStatement-%I, the undersigned, ass sponsibility for Installation 6f the POWTS shown on the attached plans. Plumber's Name (Print) I Plum re MP/MPRS Number Business Phone No her Y 72 r- Plumber's Address (Street, City, S1 e, Zip CgdA ' L County/Department Use Only Approved ❑ DipWA ved/ Permit Fee Datatee.Iss d K Iss g Age, tt Signa ur O Ow)?e&8rve_n_R'_e5`s'drft, Denial Conditions efAppjov Resmrlier•Bieepproval i�` _I /A Concg�psbSfs SYSTEM R: J t ffl 1. Septic tank, effluent filter and '�0"" w dispersal cell must be serviced / maintain PP-C* S r� as per management plan provided by plumbt;r( g t� t ` `f p r0 f/t be maintained ('_,__- ec - 2. All setback requirements must l�n ( ftv lflt ' f as per applicable code/ordinances. DjApL-f Amen in comptele plans sar use sall aua,•,,. •� ....,� ..�....vw /� SBD-6398 (R. 03/21) JJJ+--- — / 1 — System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NW 114S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 103.5' DATE 2/18/22 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 456 # of Chambersnone ENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime BO EHOLE O WELL +H.R.P. same as benchmark 101.51 B.M 102.5' o Slope B 1 B 2 Scale = 114" = 10' � t ❑ 01 40' 80, Huffcutt Combo Tank Grading is to be done to B 3 divert run-off away from system Area 15' below system is to remain undisturbed 3 Bedroom House (VO eA ( 0 GAf _ 71, 105th Ct a q-Q .�C'CO PY March 1, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-03-01 Plan Review: PWTS-032200293-C SHAUN R BIRD 1432 I20th St New Richmond WI 54017 SITE: Oevering Homes 1726 105th ct. Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary 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) Description: 450 GPD (3 Bedrooms - New Construction) Maintenance Required The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (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 matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to beset 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 (ill 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 and/or owner's manual for the POWTS described in this approval SPS 383.54(t). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, Zw 7/.a."�.eeaif POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleest(i)wisconsin. eov Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 2/18/22 Owner:Oevering Homes Location: SW1/4 NW1/4 S9 T29 N,R17W 1726 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 Attachmer' _ Shaun Birc Signature License rn Page 1 of 9 System PLOT PLAN PROJECT Oeverinc Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 103.5' DATE 2/18/22 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 FOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone ENCHMARK V.R.P. Top of survey Iron ASSUME ELEVATION 100' Filter Lifetime BO EIIOLE O WELL .H.R,P, same as benchmark 101.5' B.M 102.5' o Slope B 1 B 2 Scale = 1 /4" = 10' � s 01 40' 80' Grading is to be done to B 3 divert run-off away from system Area 15' below system is to remain undisturbed 105th Ct Huffcutt Combo Tank 3 Bedroom House (W eA 1 0 C, A" -:-- � � ) t—f Mound System Cross Section and Plan View = Topsoil =ASTM C-33 .Cap Material LU sand fill = Clean aggregate '/2 to 2 % in. dia. Dimension Feet A B D I,_O E s' — F G H K Z, L c W Z Sloe % = 4 in. sch. 40 pvc O observation pipe H111�1111151».... - ►�1�11�1�1111111��11��1�V. ��1�111`i11�1�1111�111Y1�111111111 i►��1��411�t111�1.....- ' ' ���11ti11111�`i1„ ��;"i1111�11111111111�11111�.. ,• - - _"'1 111111 1111�1 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'/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 s ured in place with rebar or a closet flange. 10/07ld Page 3 of� Man rulUv iv14111 023 o (-, Distribution N Lateral Diameter Force. Force 03)05 4 Pressure Lateral Layout Two Laterals — End Manifold Ft. Ft. ded Lout 9 ag oweep 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. ••••• Grade °°•••' 6-8 Inch Lawn Sprinkler Valve Box qPage _Of9_ z Septic -Dose 'Wank Cross Section 2 Tank Manufacturer' Tank Model Number 1 InN I I Ql 6 _ Total Tank Capacity i Max. Bury Depth ,Filter Manufrau er Ait qt:.ti-� Filter [Number Minimum Pump Performance,Rt quired GPM; I @ T 1 : -, (, Ft TDH Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight ft-- .. — -- -y' -- Finished Grade Outlet Filter Inlet Inlet Baffle Switch Settings and Reserve, Capacity Tank Volume = GPI Dimension: Inches Volume Gal. (reserve) A; .r (alarm) B' 2 (dose) (dead) D: Total Pump Performance Specifications Pump Manufacturer i f Pump Model Number p Alarm Manufacturer Llec.S t d Alarm Model Number Switch Type a Total Dynamic Head (TDH) - Feet Elevation Head Distal Pressure n Network Loss Force Main boas Total / Securely Mounted Weather-proof Junction Box W r aY w tiw r .r Vent Min, 12" Above Grade With Vent Cap GENERAL INSTAILL.ATION: The septic/dose tank i manufacturer's product approval specifications. Maximum del be exceeded without ppor approval, Manhole covers exposed installed. Piping at the inlet and'outlet is of approved materia laid on stable soil to prevent settling or sagging. The force ma excavation mud the sleeve is sealed watertight. Electrical servic 02/05 U Page Elevation q1. )Ft Manhole Min. 4" Above Grade With Locking Device r `7� I ` r Disconnect Means A 'A _ Weep B I t Hole C Bottom D Elevation rr:., ,_ Ft ,: bedded and back filled in accordance with the i of bury as specified by the manufacturer may not grade have an effective locking device (padlock) connected to the tank with watertight fittings, and is sleeved with 4" Sch. 40 PVC to bridge the tank complies with NEC 300 and Comm 16.28, 280-SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow, Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature: • Vortex style Impeller permitting passage of solids Up to''/." • 416 stainless steel rotor shaft $ Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel $1%" Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature:140° F. 280-Series Cord Lengths Model 10' 251(-2) 35'(-3) 50'(-5) 280 Standard Optional Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional N/A 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 Specifications hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Performance Curve: 280-Series 12 11 s f 6 tv 5 3 n F to �n �, sn tR a as sn F;R Rn RA 7r U.S. Gallons Per Minute 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29 lbs. Height:13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 1 On Factory switch Model 281, 283 Model 287 I settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 283 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point. Vertical float model 287 Is not adjustable. n 2Mode1280 Model 281 Mode1283 Mode1287 Manual, Wide angle Wide angle VMF-Series no switch float switch float switch Vertical mag- with quick- with series netic float for disconnect (piggy -back) smaller pits - plug will operate in a 10" diameter sump CERTIFIED c us Certified Speclllcallone are eublect to change without notice. Liberty Pumps $ 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (586) 494-1839 www.Ilbertypumps.com Copyright m Liberty Pump$, Inc. 2017 All fights reserved. LUT 2000 R05117 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION Owner Permit #. nPAIrN PARAMETERS Number of Bedrooms ❑ NA Number of Commercial Units %tiA Estimated flow (average) aVda Design flow (peak), (Estimated x 1.5) gaVday Soli Application Rate qal(da /fe Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) 420 mgfL Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality -NA Monthly average" Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510' cfu/100ml Maximum Effluent Particle Size Y. Inch diameter nu o SYCTr-M SPECIFICATIONS Septic Tank Capacity al ❑ NA' Septic Tank Manufacturer ti NA Effluent Filter Manufacturer � NA Effluent Filter Model ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer NA Pump Manufacturer 1/ i ❑ NA Pump Model oZ a ❑ NA Pretreatment Unit NA ❑ Sand/Gmvel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other Manufacturer Dispersal Cell(s) ❑ In -ground (gravity) ❑)ri-ground (pressurized) ❑ At -grade /❑ ound ❑ Dri ine Other. • Values typical for domestic (noncommercial) wastewater and septic tank effluent. " Values typical for pretreated 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 (,) of tank volume Inspect dispersal cell(s) At least once every �� ❑ months year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ears) Inspect pump, pump controls & alarm At least once every ? ❑ month ear(s) ❑ NA Flush lati3rals and pressure test At least once every months earls) ❑ NA Other: At least once every ❑ months ❑ year(s) P NA Ot1ef At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Rartricted S©war. POWTS Inspector, POWTS Maintainer, Septage Servicing 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.ponding 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, mechanical or pressurized POWTS components, preireatement components. and any other maintenance or monitoring at trftervals of 12 months or Jess shall be performed by a certified POWTS Maintalner. A servit% 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 cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator priorto use. S n fq Page .-- of Name Phone 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 thrlt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thls tank(s) removed by a septage servicing operator prior to use, system start up shall not occur when soil condltlons are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will bia discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge of efftuerilt, To avoid effluent punis mp orucontact(on ave the a Plumber fents of the or POWTS pump to assist tank inma manually operas operating the pump focontrols to rior to restoring nower to the ormal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or Compact, the area within 15 feet down 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 POWI':$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralln (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting prodUCIIS; pesticides; sanitary napkins; tampons; and water softener brine, ABANDONMENT When the POWTS falls and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is propejly and safely abandoned In compliance with chapter Comm e3,33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with still, 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 complirpnt replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soli absorption systelm. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the ncled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled in effect at that time. ❑ A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances In POWTS technologi/ a holding tank may be Installed as a last resort to replace the felled POWTS. '�he site has not bean evalusted.to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluaillon must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be instailedl as a last resort to replace the failed POWTS. ,.Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Inflitrallve surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL (SASSES AND/OR INSUFFICIENT OXYGEN. DO NIOT ENTHR A aFFTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE o' A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOS3I61-E. ADDITIONAL COMMENTS -,— POWTS INSTALLER Phone % /Y-- POWTS MAINTAINER ~— Name Phone /f:ar�f��, SEPTAGF SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY I - Name r'f�ls���2`0 rl /- Phone This document was drafted In compliance with chspter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wlsoonsln Administrative Code. 9� g � NOV 27 2019 W)scorai DepenbientdtCgisagr�px7OUrCy SOIL EVALUATION REPORT P"aJ—of 3 Division of @dkVnP3nity ozvelc men I?a4 to — with Comm B5, Wia. Adm. Code anon trlokde, b Apnd Bmlted M: tiaer not lwlItn size, P lan must courtly r -al f Y- verclland horizontal rreference poln(BM)dretllon and Percerislops, scale adtmanslons, north snow, and location and distancato nearest road. Please print all Information. R by Dan I>erWW Yeameeen you wovfde mey be used for seowdwy pipe (nrlvwy Law. s-15.er(1)(m))• Z U ZD Property owner r Property Location Gout Lot (,; 1141gd 14 S T Z N R E( ) W Property0M*e3MaAingAddresa jggqt� !� 70 � Bbcit0 --- � Slbd.Name orN— endin' e4aw. R; c Qet 4-I I Oq City 1 t tate Ph" ! J ❑ raty ❑ Musge om N t PzW u l Gansbtldfon U esidenaal I Numberof bedm roos Code dertvW design (low rate `>E>t7��5ii'i� GPD DReaacarrwrtt ❑ Public or commercial - Describe: Parent material Flood Plain elevation If applicable ZOIII —n. General$hall�/n�j+ smtK C��//�?to-41 System Type 4� m 0 r,, System Elevation Bo"# ❑ Boring %—pit Ground surfaceelay. 'r is Depth toemlarpfactor ,3 in. SoA Application Ran Ho I= Deph In. Dominant Color Mures Redo: Description Ou, Sz. Cont. Color Texture Structure Gr. SL Sh. Constalence Boundary Roots 'EfAs1 'Ema2 ' e—S9 . y C Lt/ G / 5 Bork® V * ;LPIt Ground surface elevl 7 -7 R Depth to Or t V factor b in. Sod Application Rds Hwtmn Depth h Dominant Odor Munsea Radon Description Ou. Sz Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDRF 'Ef of 'Eff#2 36^ 0 3 5 I ` I I - truant n � nw, > .w � �v mGti tiro r ti5 >� � lour - cmuera xa � ovv, _ w w� . ti "�•• •,., •,�� CST Name (Please Print) a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 Z/r- as / 715-246-4516 )0 PmpenyOwner Paroel IDA _ Page � of 3. © • �. s.. �1 W.�� 4 0AN MMW.M WE �/��IA WA VA= EMO _ 'Effluent Al = BOO* > 30 1220 myl and TSS >30 < 150 mgt ' Et&ora p2 a BODr < 30 rnq%. and TSS 130 n L The Department of Commerce is an equal opportunity service provider and employer, If you need assistance to access services or need material in an alternate format, please contact the department at 608-266.3151 or TTY 608-264.8777. saoa3wtaewi Soil Test Plot Project Name Edward Folitti Address 1894 110th Ave Ba►dwin Wi 54002 Lot 10 Subdivision S W 114 N W 1/4S 9 T 29 N/R17 W Boring Q Well PL Property Line ' BM or vRP Assume Elevation 100 ft. Bird /' >TM #226900 11 /22/19 Township Hammond County ST. CROIX Top of survey iron System Elevation TBD *H RpSame as Benchmark v' File #: ST. CRo �; t�av SANITARY SYSTEM Office use only OWNERSHIP/ADDRESS FORM C►oftedW021 Community Development Departmentwill utilize this information to provide the property owner with information regarding operation and maintenance of your newior 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. Phone Number (reauired) ' / /J — ) /, 0 — K77Tt7 / Email Address Parcel Identification Number (found on the property tax bill) Property Location_ t/a Subdivision Plat: v iAPt:MrrM -j&L11/1 LY2 zi Lot Certified Survey Map #_ Volume Page # Warranty Deed # J - (before 2006)Volume Page # Number of bedrooms 3 Spec houseyes 13 no Lot lines identifiablees 0 no New Prope A dress n� =94 Cis (Verifica on qew address required from Community Development Depa ent for hew construction.) Z ZZ ( aff nitials) ( te) This form must be submitted with all Prryote Onsite Water Treatment System (POWTS) applications. New System: Include with this form a record pd warranty deed from the �egister of Deeds Once 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 Govemmen Center 715-245-4250 Fax cddPsccwi,;ov 1101.Carmichael Road, Hudson, WI 54016 www.sccwioov 1 T�I 14 E IM°' y M 1pl O YOU pngn YOUR Xpml ;t: (715)248-3010 ggyygQ I I ggtpg _ El NOTICEI win ro wwrr u� oueraia,+s. srEs.um Lauraeunr[rom un [ nrmns rxwn ro vxocEmw. �duvw u awnmoron¢a�xw � I I BRACED E PANEL DETAILS 982 SO. Ff. MAIN LEVEL a 8 &ENTRY &AINLEVEL myNM�Mggl TYR { DODOS o P UU_[�11p�G�1 C D L&MUS a6rL2no dq M N89049'37"E 553.09' 1048.D8 287.71 55l RIDGE WEST H IF- '9,y LOT 11 (LSQ, 10��`F / �0�43 FT.7,383 SQ, FT. CRE 1.78 ACRES 3 .85 1 3.0.=1046.80 , ro � r c 50 CD�g9 �1 y LOT 9 / 82,749 SQ. FT. C3 1.90 ACRES � � � 24' 14 "W L 34.70' S86046'47"E 367.46' N / 1062.58 �- .• Sy P LOT 8 / 73,996 SQ. FT. loc2.3a 33, / 1.70 ACRES LI Gti / 39?93 m N N .-i 0 ACC E WEDD ' � NOV 27 2019 Wisoons., Department of Commerce aunty Division of Sa*y qtd nQS __ AL . SOIL EVALUATION REPORT Csr-ao►q —3►$ Page — of County I Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Parcel I.D. include, but riot limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi by Date Personal infomnabon You pro, de may be used for secondary purposes (Privacy Law. s. 1 S.es (1) (m)) Property Owner Property Location Govt. Lots 1/4`j/4,� 14 S T Z N R E( w ) Property Owners Mailing Address LotJ Bbck # Subd. Name or-6.3fagC a ndi n City State Zip Code Phone Number City ❑ Village ialown Ne rest Roa Construction Use4RResidentlal / Number of bedrooms Code derived design flow rate zip i��cz/aj GPD ❑ Replacement �/) ❑Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments !p;Is Shai1 n(>+ S►twvv- 6) Plo") and recommendations. System Type O u System Elevation % 13 Boring # ��LJt Boring '�► `� ' [a —Pit Ground surface elev. v. % R. Depth to limiting factor JiF) in. Soil nation Rate Horizon= Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 'Etf#2 —�75 t 7— ( S 1, , C , 3 3s- FflS.rtng # p Boring Pit Ground surface elev 4l 1 R. Depth to limiting factor in. ® a r RedoRedox Description �Color ®®®®®®� "A��� - rmuem 91 = nuu. > ,YJ < zeu mg/L and I tiS >3u < 150 ' Effluent 92 = BOD. < 30 mg/L and TSS < 30 nxyL CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird a 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 � 2 715-246-4516 J 4S rourt� Property Owner _ Parcel ID # U Boring # r❑r Bonng 1G1 pit Ground surface elev. �� ft. Depth to limitina factor -'t' � in. Page _?--of 3 =,maim Me J Bonng # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots iw.nnr�aia GPD/ff 'Eff#1 'Eff#2 a Bong # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. craw-..._... . Effluent #1 = BOD5 > 30 < 220 mg L and TSS >30 < 150 mg/L ' Ef bent #2 = BODs < 30 mg/L and TSS < 30 n-4L 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. SBD4330 (R.bW) N Soil Test Plot Project Name Edward Folitti Address 1894 110th Ave Baldwin Wi 54002 Bird >TM #226900 Lot 10 Subdivision Dee 11/22/19 S W 1/4 N W 1/4S 9 T 29 N/R1 7 W _ Township Hammond a ring Q Well PL Property Line County ST. CROIX BM r VRP Assume Elevation 100 ft. Top of survey iron iys em Elevation TBD *HRPSame as Benchmark 04 301' Property Line 01.5' 102.5' 288' Pronertv Line so' B-2 Scale is 1" = 40' unless otherwise 4 noted 4% Slope 5,16 ( 3 smaw rotwl) "OOUNTY NOS STAT OWNER PLUMBE�� T TOWN O SEC ,.'� N, AND/OR LOT, 10 PERMIT EXPIRES RI rA#Y P /oCT raevioua� LIC.# 4%900 ST SUBDIVISION It. 642283 ERMIT NO. CHAPTER 145.135 (2) WISOONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.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 countyputhority. ISSUING OFFICER - DATE UNLESS RENEWED BEFO POST IN PLAIN VIEW Wzz THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)