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HomeMy WebLinkAbout018-2009-64-000Wisconsin 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)(m)] Permit Holder's Name: city Village Township DLH Consulting TOWN OF HAMMOND CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA 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. to Well SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 641933 State Plan ID No: 042200551-C Parcel Tax No: 018-2009-64-000 Sectionrl"own/Range/Map No: 04.29.17.1048 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Hl Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution z Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedrirench Center Bedrrrench Edges Topsoil [F Yes E No ® Yes ® No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Location: 1781 111TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? n Yes E No Use other side for additional information. Date Insepctoi's Signature Inspection #2: LL_I Cent. No. osr""r"'8v �0 Industry Services Division 4822 Madison Yards Way County tv l t y:-.. Madison, WI 53705 x 7107- Sanitary Permit Number (to 6e filled in by Co.) APR 012022 MadisoO.rBI 2 19 3 3 • ,. t A lica ri . pp St�jstmCode,submissionoftbis State Transaction Number r .. In accordance wi S� form t pprier governmental unit p 9aabo5,5 Project Address (if different than mailing address) is required prior to o taining a sanitary permit. Note: Application forms for state-owned PZT S are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary n purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. I.Application Infotmation=PleasePrintAllInformation- Property Owner's Name Parcel q Property Owner f jailing Ad Its/, rodress Prty Locatio b�. �1 • � 0`�8 llj y LeZg. ` / �G 1 /., Section City, State t Zip Code Phone Number /-, rCS"—" lJ T C - N R E W ��Lyy.Type of$ulding,(check all that. apply) - 2 Family Dwelling- Number Bedrooms f� Lot k / C. Subdivision Name ryCII or of 6 ^ Block # ❑Public/Commercial - Describe Use I ❑City of ❑State Owned - Describe Use illage of CSM Number 0fown of 1 III. 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 applicable.) A' New System ❑Replacement System ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B' [:]HoldingTank ❑In -Ground at -Grade ound gn yp (ex 1 in Individual Site D i Other ' (conventional) C. ❑ Renewal Before [:]Revision ❑Change of Plumber , ❑rransfer to New Ow List Previous Permit/Number and Date(IIsssued k Expiration e � X _Ts t� C /e l/net (' Z, 6 1V. Dispersal/Treatment Area and Tank Information[ f Design Flow (gpd) Design Soil Application ate(gp)d/st) Dispersa rea Requir stj Dispersal Area Propos (sQ ystem Elevation C) O , a `1 �/ O 0o (� U Tank Information Capacity in Gallons Total Gallons N of Units Manufacturer �' 4 1� U New Tanks Existing Tanks Y� d U iA w N `— 4L V M Septic or Holding Tank Dosing Chamber A' "7 ❑ Yr R„' p 6,nsibHity.Statement-.1, the undersigned, assume Ability for installation of the POW'PS shown on the attached plans. Plumbp s ame (Print) 1 � Plumbe ' lure MP/MPRS Number Business Phone Nu er - r? Y-� 1-7 G�� 6 l Plumber's Address (Street, City, State, Zip de) 7 C,1 7 7 ' C.W / L/ VI, County/Department Use Only Approved ❑ Disapproved PermitFeeDat $� it/� c�o Issu d 1 ZZ Issuing Agent Si ure 13 Owner Given Reason for Denial • -L Conditions of ApprovaUReasons for Disapproval 2 �0 1` f Oks 'h T s-ei 4i AflPro ✓Q t / ' SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must eo lla icamaialairted Q J ) r f L by plumber as per management plan provided 2. All setback require rents must be maintained /`Wc0.��C/v as per appliubtetsda/®rdirktn€®§r Attach to complete plans f the system and submit to the County only on paper not less then a vz z I i mcnes in size jP we5-F �- Sov-F t, Pro fCry l SBD-6398 (R. 03/21) SAC, v 5 ,5 � / r µ April 1, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-4-1 Plan Review: PWTS- 042200551-C Shaun Bird 1432 12011 St New Richmond, WI SITE: DLH Consulting 1781 1111h Ave Town of Hammond St Croix County SE X SE X S4 T29N R17W FOR: DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 Contad Through Relay hnp:IkWLV V.gDWpMpramaAnduetry-WtNcee www,wleconein,gov Torry hors • Governor Dawn Crtm • leoretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Description: 4 Bedroom-600 GPD —22" to limiting factor- Effluent Filter - Maintenance required. 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: Reminders • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. if necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SIPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, joslucal/?owley Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 813-9111 Joshua.rowlev@wisconsin.gov System PLOT PLAN PROJECT DLH Consultino ADDRESS W1132 435th Ave Prescott Wi 54021 SE 1/4 SE 1/4S 4 /T 29. N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 99.9' 1.2' sand lift! DATE 3/28/22 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of Chambersnone Ilk BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL *H.R.P. same as benchmark 111th Ave Scale = 1/4" = 10' 0 40' 80' 1 1 1 Property Line 2% Slope B-3 C 98.5' Pro 4 Bedroom House 98.7' B - 2 Huffcutt Combo Tank 1!ci copy Well is to meet all WDNR setbacks Grading is to be done to divert run-off away from system Area 15' below system is to remain undisturbed Property Line me Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/28/22 Owner:DLH Consulting Location: SE1/4 SE1/4 S4 T 29 N,R17W 1781 111th 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 r' Signature License nu r 226900 Page 1 of 9 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE System PLOT PLAN PROJECT DLH Consultina ADDRESS W1132 435th Ave Prescott W! 54021 SE 1/4 SE 1/4S 4 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 99.9' 1.2' sand lift! 3/28/22 BEDROOM 4 DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFT MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 T HOLDING TANK DOSE TANK SIZE 765 # of Chambersnone BENCHMARK V.R.P. op of ; pipe ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL *H.R.P. same as benchmark 111th Ave Scale = 1 /4" = 10' 0' 40' 80' 1 Property Line 98.5' 2% Slope B-3 � o Pro 4 Bedroom House / 98.7' B - 2 Huffcutt Combo Tank Well is to meet all WDNR setbacks Grading is to be done to divert run-off away from system Area 15' below system is to remain undisturbed Property Line ,:,2o4, 9 Mound System Cross Section and Plan View = Topsoil = ASTM C-33 �_ Cap MaterialEl sand fill Ft Contour = Clean aggregate '/2 to 2 '/Z in. dia. Slope Direction Dimension Feet A �- B 7� D �L E F G _� S' �J H I a 1 ,2. K L ..J I�W F'i' Z_ Slone :C O = 4 in. sch..40 pvc 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''/4 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. 10/071gj Page — 7�L of L / Man FVI VI. LY1Cll Ll Lateral Diameter Manifold Diameter Orifice Diameter X (Orifice Spacing) L (Lateral Length) M (Manifold Length) Force Main Diameter Force Main Length 03/05 lgj Pressure Lateral Layout Two Laterals — End Manifold r Z. In, . ZFn. KIn. A,Ft. 4� Ft. In. Ft. ided lout 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. Grade • • • • • 6-8 Inch Lawn Sprinkler Valve — Box Page—, — of Septic -Dose Wank Cross Section Andl n 1 Tank Manufacturer T A-4 - L _ Tank Model Number 2 Total Tank Capacity i Max. Bury Depth Filter Manufacturer Filter Model 'Number l Minimtun Pump PerformanceRequired — q 0 GPM j Ft TDH Outlet Manhole Min. 4" Above Grade With Looking Device. Inlet Manhole < 6" Below Grade Sealed Watertight %I, . — — "1 — Finished Grade Outlet Filter Inlet � • „r.--- Wet Baffle Switch Settings and Reserve; Capacity Tank Volume — GPI Dimension; Inches Volume Gal. (reserve) A; , 5— yam, (alarm) B 2 _ TI . (dose) C ; ;— . /a 1 s' (dead) D : .3 Total �> r Pump Performance Specifications t f— GENERAL INSTALLATION: The septicldose tank i manufacturer's product approval specifications. Maximum del be exceeded without prior dpproval. 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 and the sleeve is sealed watertight. Electrical servic 02105 U Page �— Pump Manufacturer b _ Pump Model Number Alarm Manufacturer ��—�7 ✓ _ L tc — Alarm Model Number c'—,/ Switch Type P at Total Dynamic Head (TDH) - Feet Elevation Head / (� Distal Pressure ? _ Network Loss Force Main Loss l -2 Total e . S - - Manhole Min. 4" Above Grade Securely Mounted With Locking Device Weather-proof Junction Box �-- Vent Min. 12" Disconnect Above Grade Means With Vent Cap A y4» Weep B Hole on C Ft Bottom D Elev "on Ft bedded and back filled in accordance with the i of bury as speoIfted by the manufacturer may not grade have an affective looking device (padlock) connoted to the tank with watertight fittings, and is sleeved with 4" Sch. 40 PVC to bridge the tank . comnlles with NEC 100 and Comm 16.28. 280mSERiES 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 upto%" • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1 y2" Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature:140° F. 280-Series Cord Lengths Model 10' 25'(-2) 351(-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 %2 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 4C 3E 12 11 9 8 5 I I I 1 1 1 1 1 1 i l l l l l 1 l l l l 1 1 1 1_I I I 1XI 0 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 U.S. Gallons Per Minute IC 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... 10" Factory switch Model 281, 283 Model 287 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. l 281 -.�T�.,���;' Model 283 t Manual, o•- - i--(J�� - •- �=-. -I no switch , �T•i=J�i1 float tch T��yJ with quick- _ disconnect . (... .. aI 1 plug SP SMMJ�► CERTIFIED cS Rus Certified Specifications are subject to change without notice. Model 287 VMF-Series Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New YOr 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libetlypumps.com Copyright* Liberty Pumps, Inc. 2017 All rights reserved. LLIT 2000 R06/17 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa9a-of- FILEINFORMATION Owner L tt p 17/ Permit #. nKetr_IJ PARAMFTFRS Number of Bedrooms ❑ NA Number of Commercial Units J&NA Estimated flow (average) d. (%gal/day Design flow (peak), (Estimated x 1.5) tJ aVda Soli Application Rate - v galtdaytfe influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) S30 mglL Biochemical Oxygen Demand (BODE) 420 mg/L Total Suspended Solids (TSS) 5150 m !L Pretreated Effluent Quality A Monthly average" Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510, cfu/100ml Maximum Effluent Particle Size Y, Inch diameter u A I•ITC\Ie kff r-Ce-UCni rl G gvcTFM SPFCIFICATIONS Septic Tank Capacity at O NA' Septic Tank Manufacturer NA Effluent Filter Manufacturer 1 ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity at ❑ NA Pump Tank Manufacturer NA Pump Manufacturer / ❑ NA Pump Model ?(J NA Pretreatment Unit . NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration 0 Wetland ❑ Disinfection ❑ Other. Manufacturer Dispersal Cell(s) ❑ In -ground (gravity) ❑ In -ground (pressurized) ❑ At -grade Mound ❑ Drip -line ❑ Other. • Values typical for domestic (non-commerclaQ wastewater and septic tank effluent. `• Values typical for pretreated wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months A-year(s) (Maximum 3 yrs.) Pump out contents of lank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every ❑ months year(s) (Maximum 3 yrs.) Clean effluent filter At least once everyXX ❑ months ear(s) Inspect pump, pump controls & alarm At least once every 5' ❑ months ears) ❑ NA Flush laterals and pressure test At least once every �5 ❑months par(s) ❑ NA Other. At least once every ❑ months ❑ year(s) NA Other: 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 Restricted Sewer 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, pretreatfinent components, and any other maintenance or monitoring at Aervals 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 cell(s). if 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 theft may Impede the treatment process and/or damage the dispersal celi(s). If high concentrations are detected have the contents of thl) tanks) 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 wastewater will by discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenit. To avoid this situation have the contents of the pump tank removed by a Septage Servicing operator prior to restoring power to thI0 effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park 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 POW113: 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 producis; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is property and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • Ali 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 property 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 soil, 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 compliipm replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system The replacement area should be protected from disturbance and compaction and should not be Infringed upon by requiiler setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the ncle< for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruleti it effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technologN holding tank may be Installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaivaijo must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installedl a a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrafiv 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 GASSES AND/OR INSUFFICIENT OXYGEN. DO NIO ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Oi PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAt_LFR Name 5 Phone POWTS MAINTAINER Name IZ0� Phone --7 r— < , r— SEPTAGE SERVICING OPERATOR PUMPER LOCAL, REGULATORY AUTHORITY Name Name ter, �_ �G Phons % 1' — ` — Phone This document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)&(f and 383,54(1), (2) d (3), Wisconsin Administrative Code. ?('�) -t//1 /o/ ST CRo '"IA SANITARY SYSTEMF'ie#` Office Use Only OWNERSHIP/ADDRESS FORM Cr@OW Zr2021 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 appiroved, this completed form and educational information will be sent to you by email. Owner/Buyer Mailing Address�— City/State/Zip Pr Q 5 Ggqym? Phone Number (required) 6-5-1— d Email Address (required)_ Parcel Identification Number 0 (found on the property tax bill) C� Property Location G 1/4 5 'A , Sec Subdivision Plat: Z 0-b T Cam( N F�VvlU Town of Lot # Certified Survey Map # Volume Page #_��, Warranty Deed # ����9 L (before 2006)Volume r--� .Page # . Number of bedrooms Spec house;gly-es a �10 Lot lines identifiable 0 yes;ilC New Property Address g� (Staff Initials) IV / 141yfrL (Verification of gew address required from (Date) Development Department for new construction.) This form must be submitted with all Private Onsite Water Treatmfnt System (POWTS) applications. New System: Include with this form a recorded warranty deed from the 0egister 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 SC Croix County Governmenli Center 715-245-4250 Fax cddCwsccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwiaov LLA1 xax. � LEFT ELEVATION 1/8 = 1'-0 -Tp s• mm FRONT COLUMN DETAIL 3/8 - 1-0 xm�e x pmmG m w Mer plm. meuie me ,nue.a Mn[o W .uww tll egi4 Pa pion mw�a w,rwda�d ro.nua� mW na Ma.is+d>mped e.a m°v „e,r •ALL DOOR a WINDOW HEADERS �nex.eaweMw^d.+gx wu.o„[ue wx• TO BE S.P.F. -2 OR BETTER ..mm mm.e or ab�m NII, tic © Planco MN, Inc. 2022 REAR ELEVATION 1/8 = I -0 FRONT ELEVATION 1/4 . I -0 9' CEILING ® FIRST FLOOR S' POURED FOUNDATION W/ 2 PLATE 6 _ - • 0 _ •r° RIGHT ELEVATION 1/8 = 1-0 WDW. GRIDS FRONT ONLY MILGARD WINDOWS VINYL SIDING ALL SIDES TRIM FRONT ONLY 16l FLR, 1,054 50. FT. 2nd FLR. 1,012 60. FT. TOTAL 2.106 Sa FT. 022-010 _ 4 1 3-25r22 1 1 SE'-P b b ns rc FP. r-- 4 I 1 Ya I 91 d ` Al, L _J b waLL I I I I w rFs FrG. 1 I I I I I C I p wau , I I I I I I I I I I I I I I 1 I I L I BASEMENT PLAN 114 . I -0 8' POURED FOUNDATION W/ 2 PLATE Planco MN, Inc. 2022 022-010 7 ]I P 3f P 14 P 11'fY � Ir___ I I I I 1 I I I 1 I I I I 1 I I I __ __l 1 I I I I I I I W W I I � s UNFINISHED 9 I I �Q � s I Go I I I I I I w'.so^.u' — I wKD. Pao Fro. I I I I I I In wau q�T• YET BAR I I I VY r— � R.I. fllYldNG I I I 3A LVL N!!M �l 1 I r. r 1 r r I �,31 I I �' � I 3' LEDGE I f.6• / IlG. • BLK. � �I , 3 FTG. _f% = w�luHieumORAGE I UNIXCAVATED i 1P1 I rise lase 13'd- 9-Y �/ I O 414 I i� , d — I QQ UNFINISHED � WWW r ________ ______________ T ]" LEDGE I I I I I 1 UNIXCAVATED I 1 I I I I I b 1 I 1 l 1 L _ _ IY-0' 146' 3�'6' )1'd' Wd 56'0' ]zd ud lad 1sd 4T a4 TC Td }a L6R5H aH D/O 6 Fx a6RD/6 aH 11 iDP � Ye" n 4 • YN, YIy 4 F l4 � x DINING VIA ,N /6 :X 2/6R5/6 EH µ1ppJ TOP • 1$" b D P 1P 1'v ba 0 ,.,,,: --3a68 Yp' (P GREAT ROOM _ 6 � dQ o •o � -j ^ I g I o- KITCHEN t t� rc I ab RAIL } I/]' LVL PU,. MIGROu00D i I 0 a6 p4. 10 I b L" b ' F; A9E 3-MIO m 60'6ENCN 9DbB 0 p F FIRE 4" �a v F b n MUD a b RM �IVti .n 1. I ]eae I •MUD GARAGE f b W/LL I M" CONC. :LOOK EDGE ]'p' •]xb WALLS ab 3O6B g FOTER 8 $ uboD a I •LV.T. a, tz ad I Yd 0 ]'eO I �, OFFICE � Q 3069 ��s=Ea� I j •cARPEr a. DL b DL L6�A108H 16n4108N L"O.G I Q. p c }all 3-3ytl I g 2 j F eTa> IN CONC. PORCH I o e STOOP ]-a W' LVL 3-9 V3' LVLb l o _____ I•� 3/01M _J Tp66' TOP 77-91— m] Bpm OFF T.O.F. OFF T.O.F. O'LANT. ].Wo COWIM 9lOr510 8N a/O.610 9H ]-al0 3-310 1TP ivy 21-V T)- )1'b ]1'p' )e'd FIRST FLOOR PLAN 1/4 = I -0 1.094 SQ. FT. 9' CEILING ®FIRST FLOOR Planco MN, Inc. 2022 »22-010 5r7A117 >ra ur xa ss- Ti' Tr s1' Ra' r--------------- I I I I I }MI'J bL•p e +Y Ar I o I PIASTER BEDROOM a a16s iv.r. s ull I I— uarEr $II I ------- I a w.lc. i e I p$ 0 r I L g,w�pw I uI I I sot mo F a v.v.•. � I EDGE r.1P 17 ]/6 UK _____------- b N b GIbE ]64D ]66B y 4 p b Cv 1r z1P IP-IT 5D BEDROOM 3 1 y E •G pR b 1 lets n66 '�B m66 1 � I I 8D1y rP V AO I iv.T. I I GIRDER I i i i i i 16.Mb w 3/0.5/0.1 w m ]1.p sa,p 1 1 _ BEDROO I 1 caerEr F I I *Busses NAIL ALL INSIDE t ` 3 OUTSIDE INTERIOR CORNERS 3/Or5/e-3 BH 1 I 1-7rp _____________ __________J SnP !•I- L 5-11• 5'-r bP 0'P T9r 1Z-1' :.P ma SECOND FLOOR PLAN 1/4 . I -0 aza 1,012 SQ. FT. 4 (C) Planco MN, Inc. 2022 022-010 7 IVL/, JL ✓" yr / / f / I 88.14' TO CENTER 61.45 i 64� OF EASEMENT 7\4 33 _ 6p 26.19' E -too C3 \ o TOWN RO AD n C2CID N 89'S1 4fi" W _ — _ — — _ `60 04`7 /W JJ Pam LOCATION lu �E 64 ' 1 0 1/ ' HWE = 1076.5' a� 74627 S.F. 1.71 Ac. O ' IT NOTE: i "'� i L��� N 87_01'09" W 342.16' 2; � i 3 t SHALL 1LD - — _' 104054 S.F. ? 4GE THE B.M. ELEVATION = 1077.97 i C I 2.39 Ac. \ WED )RAINAGE �� r) 65 I FOR THIS 66828 S.F. ' I UPON, 0) 1.53 Ac. I o 0 r ` '�—� I FILLING, 0) W � � I c.a LBO = 1078.5' JTING IN l ! _ 3 HATER N 87'01'Q9" W zX) v 1544 WisconsinDepa ntoitr , SOIL EVALUATION REPORT Page 1 of 3 Division of Safe and Buildings / 2004n a rdance with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. County Attach a sits gn papal 1idl�essthan 8 x 11 inches in size. Plan must St. Croix include, but i r rizontal rence point (BM), direction and percent slope, scale or dimems w, nd location and distance to nearest road. Parcel I.D. Please print all information. (O Reviewed By Dates Personal irrfonnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). tiv Property Owner Property Location ' Cutting Edge Four, LLC Govt. Lot n/a SE 1/4 SE 1/4 S 4 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# E976 170 TH Street 64 1 n/a I Hillside Heights City State Zip Code Phone Number J City _j Village 16 Town Nearest Road Hammond WI 1 54015 715-796-2793 Hammond I Cty Rd T ✓_f New Construction Use: e Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement _j Public or commercial - Describe:n/a Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable n/a General comments and recommendations: Mound design, system elevation 99.97 ft. based on contour line elevation 98.80 ft. Boring # I Boring ✓J Pit Ground Surface elev. 98.90 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDtW -Eff#1 I -Eff#2 1 0-8 1Oyr3/1 none sil 2msbk mfr Cs 1f .6 .8 2 8-24 10yr4/4 none sicl 2msbk mfr gw n/a .4 .6 3 24-60 5yr4/4 f1d7.5yr5/6 Sol om mfr n/a n/a .0 .0 Boring # I Boring t/ Pit Ground Surface elev. 98.90 ft. Depth to limiting factor 24 in. Sod Application Rate Horizon Depth in. Dominant Color Munsell Redox Descipton Qu. Sz. Cont. Color Texture Stmcture Gr. Sz. Sh. Consistence Boundary Roots GPDW 'Eff#1 I -Eff#2 1 D-9 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 9-24 10yr4/4 none Sid 2msbk cfr cs 1vf .4 .6 3 5yr4/4 c2d7.5yr5/6 scl om mfi n/a n/a .0 .0 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5: 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 9/10/2004 715-684-5680 Property Owner Cutting Edge Four, LLC Parcel ID # Pending Page 2 of 3 3] Boring # Boring Sol Pit Ground Surface elev. 98.40 ft. Depth to limiting factor 22 in. Sod Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz, Cont. Color Texture Structure Gr. Sz. Sh. Consistence urdary Roots GPDjff *Eff#1 'Eff#2 1 0-10 10yr3/1 none sil 2msbk mfr cs tf .6 .8 2 10-22 10yr4/4 none sicl 2msbk mfr CS 1vf .4 .6 3 22-48 5yr4/4 f1f7.5yr5/6 scl om mfr n/a rVa .0 .0 ❑ Boring # I Boring SolApplication Rafe 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 GPDM *Eff#1 *Eff#2 ❑ Boring # I Boring � Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Stricture Gr. Sz. Sh. Consistence Boundary Roots GPDM *Eff#1 *Eff#2 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOO <_30 mg1L and TSS < 30 mg/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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 994 200 St. CST-POWTSM Cutting Edge Four, LLC Baldwin, WI 54002 Lie. #248956 SE1/4,SE1/4,S4,T29N,R17W Bus.(715) 684-5680 Town of Hammond, St. Croix Co. Fax.(715) 684-3449 Hillside Heights, Lot 64 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend 1" = 40' ♦ = Benchmark Ele. 100.00Ft Top of 3/4" pvc pipe I< \ \ \ \ N.B. N.I 6a\ \ I \ 67753 S.F. \ \ �5457 S.F. \ °' \1.56 �Ac. \ \ ���� Ac. \ N.B�6\753 S.fr- \ \ \ \ LEI L N.B. 1.56 Ac. \ \ (X X 60530 S.F.-' 7 \ N2 N.B. 1.39 Ac,— 00 o \ 9 .84� x - 3 4 \ +IIF i I EASEMENTATOY \\\ SE REMOVED Z \ 68868 S-F' , UPON ( WESTERLY \\ 1.58 Ac. \ �/ / \ XTENSION OF / \ � I OAD AY. NAB. 68868 S.F. / \ I-B. 1.58 Ac. / I64 61 45'�Wy o — _ N 89051 W _ i /V N 89'51' W a I F— 47 — 74627 S.F. 111 I i 1.71 Ac N.B. 69J(SO S.F. N,�1.60 Ac. 'r _ 87191--Gg IAA \ / 3 on 65 - 3�f 66828 S.F. + 5s9 s 0 ) 1.53 Ac. .- � I CO ( i LBO = +b; O N.B. 66828 S.F. \ I _ I(� N.B. 1.53 Ac. �s2-32' ' co I� __ 66 n �� /I z� , 65341 S. l� Ibol� C couNn NO. 641933 STATE SANITARY PERMIT PRFSVI1 OWNER DLIwl ZL PLUMBERS rt vn TOWN OF SEC 11 _,T_ AND/OR �,OT 'N LICX ZZ &900 N, R 17 EAW %i/ BLOCK SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.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 authority. AUT ZED ISSUING OFFICER - DATE / T�Z THIS PERMIT EXPIRES y ZaZ UNLESS RENEWED B O THAT DATE POS IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)