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HomeMy WebLinkAbout018-2007-34-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 641973 State Plan ID No. Personal information you provide may be used for secondary purposes (Privacy Law. s 15 04 (1)(m)]. Permit Holder's Name: age Township Parcel Tax No Zachary & Ricci TumCity Vill m TOWN OF HAMMOND 018-2007-34-000 CST BM Elev: Insp. BM Elev. BM Description: Section/Town/Range/Map No: 05.29.17.973 TANK INFORMATION F1 FVATlnm nATA 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 131ul Dist. Pipe Bot. System FS BEDITRENCH Width Length No Of Trenches PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO JPIL JBLDG IWELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System: Model Number: UNIT L/1J I KICiU 1 IUIV JTJ 11_111 Header/Manifold Distribution le Size x Hale Spacing Vent to Air Intake Pipes) T Length Dia Length Dia Spacing QUIL 1L UV rK x Pressure Svstams Only xx Mnunrt Or Af_rrnrin Svcfome nniv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1. Location: 1165 167TH ST 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑Yes 0 No Use other side for additional information. L _ SBD-6710 IDate Insepctor's Signature Inspection #2: i I Cert. No. r�ri=rarF=n�\ni-r=w:�\ BAN-;)n), INS �ocrexnrryr _..._ n7 jt Industry Services Division 4822 Madison Yards Way County ,,j �v ✓4 9022 Madison, WI 53705 Sanitary Permit Number (to be filled in I�CO.) MAY O 9 IYIM 4 LL P.O. Box 7162 Madison, WI53707-7162/g3 'axrnt Com%.q!h4&mlReMit Application a sactionNuummbber r . M �r In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate gove It �'^ Project Address (if different than mai 'ng address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are pitted to the Department of Safety and Professional Services. Personal information you provide may be or secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. t > %_ �S{ Q "( 1. Application Information- Please Print All Information-- Property Owner's Name �_ n f Parcel # V Property Owner's Mailing Address Property Location c3 t/Vi Govt. Lot / '/. L '., Section City, State Zip / r ;, �(,/� Code Phone Number CA," v L %Q T " / N R E W JI. Type of Building (check all thatappply)`.. 6.or2 Family Dwelling B�dr Lot # Subdivision Name -Number of � � Fet rµ, v Block # ❑Public/Commercial - Describe Use Cityof State Owned - Describe Use illage of CSM Number wn of 11 III. Tv of POWTS Permit:::( eck either "New" or "Replacement" and other applicable on line A. Checkone box online B. Complete line C if A. a System ❑Replacement System Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. [-]Holding Tank ❑ In -Ground E�t-Grade M n Individual Site Design Other Type (explain) (conventional) 7 2 C. ❑ Renewal Before Revision ❑Change of Plumber to New Owner List Previous Permit Number and Date Issued Expiration jorranskr IV. Dispersal/Treatment Area and Tank Information: 14 ,o Q Z Desi It Flo (gpd) Design oil Application Rate(gpd/sf) ispersal Area Required (sf) Dispe al Are Proposed (st) System levan00� Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units o $ o New Tanks Existing Tanks 0 Q. U in H rn w V iL Septic or Holding Tenk Dosing Chamber .� V: Responsibility Statement- , he undersigned, u responsibility for installation of the POWTS shown on the attached plans. Pli ryu e s Name (Print) P s Signature M'PP//MPPPRSS Number Business Phone Nu r 7 Plumber's dd s (SIre�Ity, State, Z' Code)" %A",/'2 -it - S` 1. ir VI. County/Department Use Only" Approved ❑ Disapproved ' Permit Fee Date Issued �(• 2/ZOZ-Z I suin Agent Signature`- J�J. ❑ Ow en n for Denial Conditions pro / Wt S V �� YSTEM OWNER: ��,f _t,l�' �L Septic tank, effluent filter and 4Jii tt xc �r�l dispersal cell must be serviced / malntained J 1 ����( by l as per management plan provided plumber. / .All setback requirements must be maintained l�ii�rlMal -Eo as per applicable code/ordinances. Attach to complete plans to the system and submit to the County only on paper not less than 8 1!2 x 11 Inches in size SBD-6398 (R. 03/21) PROJECT Zach Tumm NW 1/4 SE 1/4S -5 SYSTEM ELEVATION 101.2' System PLOT PLAN ADDRESS 1433 Cemohous Ave Suite A New Richmond Wi 54017 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX 4/26/22 BEDROOM 3 DATE _ CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND X)OC SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 BOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone IL BENCHMARK V.rW. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL * II. R.P. same as benchmark 290' Property Line Scale = 1/4" = 10' i Area 15' below system is B -1 to remain undisturbed Huffcutt Combo Tank Well is to meet all WDNR setbacks 167th St. Pro 3 Bedroom House ��j 0' 40' 80' B-2 99.5' 100.2' E3-�'B-3 100.5' 5% Slope Grading is to be done to divert run-off away from system Property Line; DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54647-6M Contact TNmLo Relay Mtp:pdepswl.gowpropraffdwuaby-aaviaee wwwoftonsin.Q6v t#x r Tony livers • Governor Down Crim • hare/ary May 9, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-5-9 Plan Review: PWTS- 052200787-C Shaun Bird 1432 1201" St New Richmond, WI SITE: Tumm 1165 1671h St Town of Hammond St Croix County NW % SE %S5 T29N R17W FOR: Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Description: 3 Bedroom-450 GPD —30" to limiting factor- Effluent Filter - Maintenance required. i 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. SPS 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, Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 813-9111 Joshua.rowley@wisconsin.gov Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond WI 54017 715-246-4516 Date: 4/24/22 Owner: Zach Tumm Location: NW114 SE1/4 S5 T 29 N,R17W 1165 167th St. 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 Conditionally APPROVED 2. Mound Plot Plan DEPT. OF SAFETY AND PROFESSIONAL 3. Mound Cross Section SERVICES DIVISION OF INDUSTRY SERVICES 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 /�I 1 Shaun Bird Signature License number n6900 Page 1 of 9 SEE CORRESPONDENCE PROJECT Zach Tumm NW 1/4 SE 1/4S 5 System PLOT PLAN ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 /T 29 N/K 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.2' 4/26/22 BEDROOM 3 DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK XXX 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE BOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of Chambersnone BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime BOREHOLE O WELL *II.R.P. same as benchmark 290' Property Line Scale = 1/4" = 10' i Area 15' below system is to remain undisturbed Huffcutt Combo Tank Well is to meet all WDNR setbacks i Pro 3 Bedroom House 167th St. 0' 40' 80' L B 1 B-2 99.5' 100.2' 0--"B-3 100.5` 5% Slope 1 Grading is to be done to divert run-off away from system Property Line Mound System Cross Section and Plan View ice------------- ..-..---�%. = Topsoil t _ ; Cap Material Geotextile Fabric 1117, __ Ft Contour = ASTM C-33 sand fill G `s$;,j = Clean aggregate # '/: to 2 % in. dia. rrh;:r. F Surface Slope Direction `y Dimension Feet $ J ,O ,.. I Y. 2 A B D E G H K L 5'G W Z Slope S% O = 4 in. sch. 40 pvc observation pipe lal, Z' Ft 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 (1, x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/, inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page — D of� Man l V1Vl 11AU111 Distribution Nefwi Lateral Diameter Manifold Diameter Orifice Diameter X (Orifice Spacing) L (lateral Length) M (Manifold Length) Force Main Diameter Force Main Length Pressure Lateral Layout Two Laterals — End Manifold �' i t t�v40 t�A* ifications _ In. In. 3 ((, In. `� _ In. Ft. Z.. In. 7 Ft. 1 ded lout g �g 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 —t oil — ;:••••••• 03/051gj • Septic -nose 'Wank Cross Section Pump Performance Specifications Tank Manufacturer Tank Model Number Total, Tank Capacity ! Max. Bury Depth " Filter Manufacturer Filter Model Number ,' � Minimum Pump performance Required Q GPM I @ Ft TDH Outlet Manhole 4n. 4" Above Grade With Looking Device. Inlet Manhole < 6" Below Grade Sealed Watertight Finished Grade Inlet GENERAL INSTALLATION: The septic/dose tank manufacturer's product approval specifications, Maximum d be exceeded without prior Approval, Manhole covers exposs installed. Piping at the inlet and 'outiet is of approved meter laid on stable soil to prevent settling or aagging. The force n excavation acid the sleeve is sealed watertight. Electrical sery Pump Manufacturer Pump Model Number X0 _ Alarm Manufacturer Alarm Model Number Switch Type ( �� Total Dynamic Head (TDH) - et Elevation Head (� Distal Pressure Network Loss Force Main Loss TotaE 1 i46 securely Mounted Weather-proof Junction Box Vent Min. 12" Above Grade With Vent Cap Ft Manhole Min. 4" Above Grade With Locking Device 1 r Disconnect Means A %4" Weep B 'Hole C Bottom D 7� Elevation ..:.•.•;..:•..: Ft bedded and back filled in accordance with the t of bury as specified by the manufacturer may not 3 grade have an effeolive 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 16.211. 02105 U Page 280-SERIES 1/2 hp Submersible EffluenUSump 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 up to %" e 416 stainless steel rotor shaft e Permanently lubricated upper and lower ball bearing e Epoxy powder coat finish e All fasteners - corrosion -resistant stainless steel e 1%" Discharge e Stainless steel bottom screen - easily removable e Maximum fluid temperature:140° F. 280-Series Cord Lengths Model 10' 251(-2) 35'(-3) 501(-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 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 n F if) it; 2n 25 30 35 0 45 50 55 60 65 7( 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... 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. Model 280 Model 281 Model 283 Model 287 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 SSPM,�� S CERTlFIEp c us Certified specifications ne asublett to change without notice. Liberty Pumps a 7000 Apple Tree Avenue a Bergen, New York 14416 a Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com Copyright O Liberty Pumps, Inc. 2017 All rights reserved. LUT 20M R05/17 r 2 4$A t ��.3u POO 9 ��r •�✓�• lam✓ • • :.. ' i}iLL}IY S:w SECTION A -A POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa9c`_of- FILE INFORMATION Owner g. VV Permft # DESIGN PARAMETERS Number of Bedrooms - ❑ NA Number of Commercial Units NA Estimated flow (average) a TU at/da Design flow (peak), (Estimated x 1.5) X5V aVda Soil Application Rate f0 galtdayff? influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) s220 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality A Monthly average" Biochemical Oxygen Demand (SODS) 530 mg/L Total Suspended Solids (TSS) s30 mg/L Fecal Coliform (geometric mean) s10` cfu/100ml Maximum Effluent Particle Size Y. Inch diameter MAINTENANCE SCHEDULE SYSTFM SPECIFICATIONS Septic Tank Capacity / al ❑ NA Septic Tank Manufacturer r ❑ NA Effluent Filter Manufacturer / ❑ NA Effluent Filter Model ❑ NA Pump Tank CapacityQ at ❑ NA Pump Tank Manufacturer ❑ NA .Pump Manufacturer `� ❑ NA Pump Model ❑ A Pretreatment Unit NA ❑ Sand/GMvel Filter ❑Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Manufacturer Dispersal Cell(s) O In -ground (gravity) ❑ I -ground (pressurized) ❑ At -grade ound ❑ Drip -line ❑ Other. • Values typical for domestic (non-cornmerdat) wastewater and septic tank effluent. Values typical for pretreated wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months year(s) (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 ears) (Maximum 3 yrs.) Clean effluent filter At least once every ❑months years) Inspect pump, pump controls & alarm At least once every ❑months ears) ❑ NA Flush laterals and pressure test At least once every ❑ months ,19Qear(s) ❑ NA Other. At least once every ❑ months ❑ year(s) 1P 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, pretreattmenl 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. STARTUP 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 thrit may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of tho tank(s) 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 effluent, To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the 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 P0W1 1i: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produeil5; 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 properly 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 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 compiiilint replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the neled 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 IlmitatlOns. Barring advances in POWTS technologN a 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 tailure of the POWTS a soli and site evalual;ion / must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installedl 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 blomat at the Infiltralive 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 NOl ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF y PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Phone POWTS MAINTAINER r— Name Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY r-- _Name f� / Name �. Phone 0 vim' Phone This document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)&(t) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Wisconsin Department of Commerce SOIL EVALUATION REPORT Pege of Division of Safety and Buildings in accoroanw wnn Comm oo, vvis. Mum, uooe Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must Parcel I.D. �,7 - 3 (z include, but not amited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �� (JC.� 7' Reviewed Date . Please print all Information. Paraanal inf r Uon you provide may be used far tecandarypur"os ( rva TV 1 15.01 (1) (m)). --.r Ile Property Owner �� �� i Property Location //�� a 7 "Govt. Lot 1/4 1/4 S T N R E (or W Property 07, fling Address t Lot # Block # Subd. or CSW , d � AL- v-e,,) 2 Gty State Zip C e eU ❑ City [:)Village Town Nearest RoNd 1 New construction Us Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: �4,.- Parent material ..Gcp.B[1 ->t- �y,(7Q. S � Flood Plain elevation If applicable General comments and recommendations: 5yb�0t e I�r7 j Z / LJ L/ Pit Ground surface elev. .'191 L ft, Depth to limit" factor 30 in. ©�r�mr� rv��r��►�c�rA�,arrr� aIM WAMiIME MI MWA ,rc LI! M001JJ• • Effluent #1 = SOD > 30 < 220 mgrL and TSS >30 < 1 Effluent 92 a BOD < 30 mgrl. and f --;5 _ ao niWL CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 S_ F--J / 715-246-4516 J Property Owner Parcel 10 # /0� /3y Page (� of J , • • • ■�/ � 1I I I© � �IfY1...1-I�■ ■-�IL7.��\ MA\NNI M �i INOMM�1 IMM - .. , %ire■�I ■; Ar.MMJ MM ■..... Boring 0 Lj Boring DPit Ground surface eiev. . Oo ; :.. . Effluent #1 • BOD` > 301220 nVL and TSS >30 < 150 n)WI *Effluent #2 = BOD, _< 30 mg& and TSS 130 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 M 608-264-8777. se"M(s W) Soil Test Plot Plan ;� project Name P.C. Collova Bidrs. Inc. Shaun Bird/ Address P.O. Box 489 Somerset W1 54025 CSTN , , 2 900 Lot 34 Subdivision Farm View Ridge Date 5/8/04 NW 1/4 SE 1/4S 5 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 100.2' *HRpSameasBenchmark Alternate Benchmark Top of 1/2" Pipe @ 100.2' si Ul n( File #: ST. CRo ccass SANITARY SYSTEM office use only OWNERSHIP/ADDRESS FORM creaWZ12oz1 Community Development Department will utilize this information to provide the property owner with information regarding operation and rnaintenance 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. (found on the property tax bill) Property LocatioWLX O/4 �E Y4 , Sec. T rLN Certified Survey Map # Warranty Deed # (before 20 Number of bedrooms Spec housEytes O New Property Address // hJ 4 h IYICiA- (verification of ew address required from 2- (Staff Initials) ( te) Volume Page # . Page # Lot lines identifiabl res 0 no Development Department for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and o 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 cdd@sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi�v 1 PIAN INFORMATION JOB INFORMATION BNEET INFORMATION OEVERiNG HOMES z:s.z.emo�N�+Ne.m+ 5ry WT 1 OF S ELEVATIONS COFTRJONT NOTICE vzeo.rt rRaeerr. zo-sl m.0 xea, een ���' e.ayson. 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Josue_ n PROJECT M: 2049 ^-gyp MAIN LEVEL faN mn mrrwa xnaw. P SCALE, AS 5"0" onrouu6 66� bb£ 6b9 bb$ a n.• tlt )t; ! ttt O Cl Liv ' � c I tot a i y , R E w.-.a.�w�s�a. •.I v PLAN INFORMATION JOB INFORMATION SHEET INFORMATION o`sa .wwn mamwwnrwsa.i eae.w: amva. HOMES QEV-.ING ......"'.. SHEET er,aP 'm.usne r�x raxuuveoie xirt i uarz.ow��... x< r, i�a..R...cad. «: woi> z r s.aa.ma i lan�g+�.m. 4 OF 5 2ND LEVEL COPYRIGHT NOTICE w¢.n aa.xin ..mew.so.ra.mw.wrca.rn. wm: uvn: ... en.. assxin. FROJECT F. 20-31 ...r.d;,...,.o a:. score: assnowN 66514 S.F. / 66:5I A 1.53 Ac. / CO r co 4(C)) 2 4,�, , � / 72161 S.F. .N/N / \ 1.66 Ac. / GyCO 32 �o/ 79961 1.84Al co �f--- <ti S 33 \�D 88149 S.F. \ 5tj 2.02 Ac. \2�9 \ \->S' 34 1 664 S.F. I S 89 1.53 Ac.00 EAST 0 /j ,� ,,,�N75 o 'SS ►9 S.F. / % �,4 W 33 G / 35 66591 S.F. A\ tip` / , / �. L N 88'35154" E ,tK tK KZ°� 36, 111321 S.F. 2.56 Ac. N 8 7'28' 13" W 492.26' 636.09' 1 �0 N jr- : 0 Ln LO EEO PO 0 co 0 0 U) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page -/- of a - in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �y r )�o J UL/ 3 Yj U percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed Date . Please print all information. Persol iMomwtbn You W'iw ue may be used for seeondery purposes ( ry 15.1M (1) (m)). —ntna Property Cwner P operty Location Govt. Lot /�9 1/4 1/4 S T Q(9 N R E (or W Property Mailing Address Lot # Block # Subd. or CSM# city State Zip C de e ❑ City ❑ village Dg Town Nearest Ro New Construction us Resid Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: — Parent material Y- 12P_ -< S-' Flood Plain elevation if applicable ✓�� fl. e ons: 1, 8-sG r 4:4L4- EDBoring # ""g _ p Ground surface elev. � / I ft. Depth to limiting factor .•.5 � in. Soil Application 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 'Eff#2 (9-9 1Qv,- 3/2- 7 z o ,-s >� ' - 4 r I 9 Boring # Boring /y� ➢Y Dit Ground surface elev. LL ft. Depth to limiting factor Z) in Mc'ji n r,rrgw r, R2ro UM Mr M 0 Effluent 01 = BOD > JO < 4N mgrL ant) 1 a> >.w . r 1- ^� - • - - - • • y- _ -- -CST -- t) Fill CST Number Bird Plumb , IW Poem nc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 -� / 715-246-4516 f /L)� 51 Property Owner Parcel ID # Page —gi— of 1ng #EJ Boring `,T pit Ground surface elev. � v � t ft- Depth to linvting factor `T_in. Soil gmliranm Raga Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDKF 'Eff#1 'Eff#2 L 2'f-3Y r ' - 5l tJ 7 Ll 3 -L0 1, c r Mo ! -�►- a 2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. t Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/if 'Eff#1 -Eff#2 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Anolicatiar Rate Horizon Depth in. Dominant Color Munsell Redox Description. Qu. Sz. Cont. Cola Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIff 'Eff#1 'Eff#2 Effluent #1 = BOD. > 30 < 220 mg(L and TSS >30 < 150 mglL ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 riglL 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. seo-ux (n woo) . L. Soil Test Plot Plan ' Project Name P.C. Collova Bldrs. Inc. Shaun Bird -% Address P.O. Box 489 Somerset Wi 54025 CSTM 2 9C Lot 34 Subdivision Farm View Ridge Date 518/04 NW 1/4 SE 1/4S 5 T 29 N/R1 7 W Township Hammond ❑ Boring 0 Well PL Property Line County ST. CROIX 4 M or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 100.2' *HRpSameasBenchmark Alternate Benchmark Top of 1/2" Pipe C 100.2' SI ul nc ( 3 — bekea Kt ) MIX -COUNTY NO. 641973 STATSANIT RY PERMIT //bps /6�� srNo. .. OWNER 00' 1wWAI kwxi0oo w L lINS i kyArej • LAC.# 226100 SUBDIVISION Hro CHAPTER 145.135 (2) WISCONSIN STATUTES Ea) 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 contact the county authority. =]]N&UjMQRIZED ISSUING OFFICER - DATE 7 / PERMIT EXPIRES LESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1/20)