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HomeMy WebLinkAbout018-1009-80-220Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you Provide maybe used for secondary Purposes IPnvacv Law s 15 04 (1)rrr g P y Holder's Name City Village Township Wyatt Porter 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 PIL WELL BLDG. Vent to Au Intake ROAD Septic Dosing Aeralion Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia Dist to 'Nell DUIL AGJUKY I IUIN JTJ I tM STATION BS HI FS ELEV Benchmark Alt BM Bldg. Sewer SIIHt Inlet St/HI Outlet DI Intel DI Bottom Header/Man. Dist Pipe Bot System Final Grade St Cover BEDITRENCH DIMENSIONS VAdth Length No Cf Trenches PIT DIMENSIONS No Of Pits Ins,de Dia Liquid Depth SETBACK INFORMATION SYSTEM TO PIL BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer Type Of System Model Number UIS I KIII I IUN iYJ I tM HeaderiMandold Distribution x Hole Sae x Hole Spacing Vent to Air intake Pipe(s) Length Dia Langrh Dia Spacing SOIL COVER x Pressura Svstems Only xx Mnrrnrl (Or At-r;radc Rv.rnm. nnhr Depth Over Depth Over xx Depth of xx Seeded -Sodded xx Mulched Bed(Trench Center BedrTrench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepancies, persons present. etc) Location: 1612 110TH AVE 1 ) Alt BM Description 2.) Bldg sewer length - amount of cover = Plan revision Required? . Yes No Use other side for additional information. Date SBO-6710 (R 3197) Inspection 01 Insepctcr's Signature Inspection #2 Cen No In accordance Ait" SPS 3IIT:210 is required prior o a tl t the Deparlment o and Prol purposes in acwrdance with the P I. Application .Information - Properry Owner's Name W Property Owner's Mailing AVjks 40-�Z Scse Industry Services Division 4822 Madison Yards Way Madison, WI 53705 P.O. Box 7162 Madison, WI 53707-71�2 -Adm. Code, submission of this form to permit. Note: Application fortes for slat is] Services. Personal information you pi Law, a. 15.040)(n). Slats. a L4 ,,Q,,, Zip Code propmenial unit m PQ are submitted to may be used for secondary 5& -.-L4a - ab County Sanitary Permit Number (to be filled in by Co.) &gy7`?`9 Sticir b80,900104 D 0, 000�j um-1, Proiect Address (if diffexnl than roailina addre i7/6 SIM i` `Q Pro any Location .z A- i7-76C Gon Lot _ e r. ` L/P/ .._.._.._...__.yti Sections/ I1. ype of Building (check all that apply) Lot a T N R F o W I or 2 Family Dwelling - Number of Bedrooms Subdivision Name Oublic/Commercial - Describe Use Block g ��- ity of �-1� I plate Owned -Describe Use u CSMNumber2 _logillillageof OO�j Plown Za%,� X - of 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable online A. Check one box o' lineS. Complete line C If applicable.) A. ew System ❑Replacement System Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. O11oldin Tank g ❑ In -Ground El -Grade Mound �1 I Individual Site Design Bo Other Type (explain) YP P (conventional) Z �lJ C. 011enowal Before Revision hange of Plumber Orransfer to New Owner List Previous Permit Nurtberand Dale ued � Expiration ` o J �� vtc� r A IV. Dlspersalffreatment Area and Tank Information: vest n wow tgpa) Uest n Soil Application Ie(gp sl) Dispersal Area Requi s0 Dispersal Area Pro ed (so System Elevation >17 01 V jD // 2_5 2IJ-0 D Capacity in Total d of Manufacturer Tank Information Gallons Gallons Units / �� J- New Tanks Existing Tanks t �F y A to u N 1% C7 iY �• �� , .� r�c�rr nOM ter.: • �.�. � r�r� r����oc�� v. icesponsimu State t- rli the undersigned a responsibility for installation of the POWTS shown on the attached plant, PI is Name (Pr� Icity ber's Sigliature MP/MPRS Number Business Phone Num r J Z P mber's Address St, Stale Zip � 5 � /� �� - A -e�r L Approved 0 Disapproved r"crnn rcc vats ie issuing Agem aig r 40 fJ Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval �( I CO / l� ) S y r/���'� it SyMi'A OWNER: 1. cri:r.c r.3nk. efflueMfiller and • A���'e'rSal rell Must be Se rvleid/rM 'M a- I'er management plan provided by plum 2. L-. `.:'IU3(k reQUirements must be maintai as • ` VYj, r W`" v /ter&v/' per applicable code/orA�na rates. - /n / 7� Attach to complete plans for the system and submit to the County only on aper not ess than a IJA 11 Inches In size SBD-6398 (R. 03121) u System PLOT PLAN PROJECT Wvatt Porter ADDRESS 332 Soo Line Road Hudson Wi 54016 SW 114 SW 114S 5 /T 29 NIR 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 103.8' 1.3' sand lift DATE 8/16122 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 BENCHMARK V.R.P. Top of survey pipe ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL s11 p, same as benchmark CO P Scale = 1 /4" = 10' 0. 40' 80' 1 1 110th Ave Pro 3 Bedroom Shouse (shed house) HOLDING TANK DOSE TANK SIZE 630 # of Chembersnone Grading is to be done to divert run-off away from system Huffcutt Combo Tank Area 15' below system is to remain undisturbed a 3% Slope Property Line 103' Well is to meet all WDNR setbacks B-2 B 1 102.5' 1 02' B.M.* -4 O♦ �plei 7-7 ��� OFynnTt4 Wisconsin Department of Safety and Professional Services Phone: 608.266.21 12 Division of Industry Services Web: hanal gls.wi.aov 4822 Madison Yards Way 3 Email: dsps(4wisconsin.aov PO Box 7302 Madison, WI 53707 �� Tony Evers, Governor Dan Hereth, Secretary August 25, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-08-25 Plan Review: PWTS-082202020-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE; Wyatt Porter Lot 2 110th ave Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: Mound Component Manual - Version 2.1 (May 2022- 2027) Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) Deserilodon: 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 be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that arc 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 offal ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval 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. 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, Tua r/'lew�.&eel' POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services Email: tim.vanderleest(),wisconsin.gov Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/16/22 Owner: Wyatt Porter Location: SW1/4 SW1/4 S5 T 29 N,R17W Lot 2 110th Ave Hammond Manuals Used: Mound Component Manual Version 2.1 (May 2022-27) Pressure Distribution Manual Version 2.1 (May 2022-27) 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 nt Page 1 of 9 PROJECT Wvatt Porter SW 1/4 SW 1144 SYSTEM ELEVATION CONVENTIONAL System PLOT PLAN ADDRESS 332 Soo Line Road Hudson Wi 54016 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX 103.8' 1.3' sand lift DATE 8/16/22 BEDROOM 3 AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT "TANK SIZE DOSE TANK SIZE. 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of Chambersnone BENCHMARK V.R.P. Top of survey pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL •11.R.P. same as benchmark Grading is to be done to Scale = 1 /4" = 10' divert run-off away from system 01 40' 80' Huffcutt Combo Tank Pro 3 Bedroom I \ Shouse (shed house) B - 3% Slope Area 15' below system is to remain undisturbed Filter Lifetime Property Line 1 03' Well is to meet all WDNR setbacks 110th Ave B-2 13 B 1 11 102.5' 102 Mound System Cross Section and Plan View iiI----------------------------- - - - - -- 1 = Topsoil = ASTM C-33 � Cap Material 1:1sa �nd fill _, Geotextile G Fabric -- r"QZ—. �— Ft Contour = Clean aggregate `f '/z to 2 % in. dia. ■ Dimension Feet A /-Q s q, D , E F G H �. p I is. L W 2_.Z__ z Slo e = 4 in. sch. 40 pvc O observation pipe H Ft Plowed Surface Slope Direction 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. 10/07lgj Page of�— Ch< Signed: License Number: dater P•rforal*0 Plas 001011 s LOC412E On 8011*0", EauOny 6oecee rIRDT 14OLL 14%XT re Genn*c" Distribution Pip* Layoul P, 't. R3.�F{, x � Inches Y 30 Inches Hole Diameter 3N Inch Lateral Inch(es) Manifold Z Inches Force Main — Inches N of holes/piped Invert ElevAtion of Laterals Ft. 10y13 Septic -Dose 'dank Cross Section And Pump Performance Specifications Tank ManufacturerAP Tank Model Number ':I Iry7o I Max. Filter Manufacturer Filter Model Number r Minimum Pump performance Required C 3 GPMi S. Ft TDH outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight Finished Grade Outlet Filter Inlet f--� Inlet Baffle Switch Settings and Reserve Capacity Tank Volume = GPI Dimension. Inches Volume Gal. (reserve) A' (alarm) B 2 3 J (dose) C , S— (dead) D f' Total YZI Pump Pump KTypel,,71 Alarm AlarmG— Switch ' t Total Dynamic Head (TDH) - Feet Elevation Head Distal Pressure , Network Loss Force Main Loss Total _ Manhole Min. 4" Above Grade Securely Mounted With Locking Device Weather-proof l Junction Box Vent Min. 12" Above Grade With Vent Cap ff Elevation c .3 Ft Disconnect Means ou - V 11 "I'l C 4pt Bottom D Elevate n ' 3 s�Ft GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 LJ Page --;' ofq 280=SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides 0 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 e 1 yd' Discharge Stainless steel bottom screen - easily removable Maximum fluid temperature: 140'F. 280-Series Cord Lengths Model 10' 25'(-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 y: hp 60 Hz 3450 RPM Oil filled, thermally protected (PSG) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Tv FMN00N00N0001E_N_I10-1N ' r 35 30 25 LL 20 3 15 = 1C 111 9 8 6 5 3 2 V 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 U.S. Gallons Per Minute 0 38 78 114 166 192 228 270 Liters Per Minute Dimensional Data: Weight: 29lbs. Height:13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10" =Factoryh Model 281, 283 od1287 VMF Turn on level 13" 9.5' Turn off level 711 4.0" The Model 283 features a fully adiustable 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. Mode1287 Model 280 Model281 Model 283 VMF-Series Manual Wide angle Wide angle Vertical mag- no switch float switch float switch netic float for with quick- with series smaller pits - disconnect (piggy -back) will operate in plug 4k a 10" diameter sump SSPMM�� S�` � CER1a1ED c us Certified SpodeMblions aubjt to h W w"hout nulloe. Liberty Pumps a 7000 Apple Tree Avenue a Bergen, ew yor 14416 • Phone 800-543-2550 Fax f585) 494 1839 www.Ubertypumpa.com Copyrleht O Llberly P"TPe. Im. 2017 AN rights reserved. LUT 2000 905117 8 WS 5 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page .of_ FILEINFORMATION owner C Permit # SYSTEM SPECIFICATIONS Septic Tank Capacity at ❑ NA Septic Tank Manufacturer NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer NA Pump Manufacturer / ❑ NA Pump Model 0,NA Pretreatment Unit A ❑ Sand/Gravel Filter O Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Manufacturer Dispersal Cell(s) O In -ground (gravity) O)n-ground (pressurized) ❑ At -grade Mound ❑ Dri ine ❑ ther. • Values typical for domnstic (non commerdSD wastewater and septic tank effluent. .� Values typical for pretreated wastewater. IAINTENANCE SCHEDULE Service Event Service Freque Cy Inspect condition of tank(s) At least once every " ❑ months ear(s) (Maximum 3 yrs.) _ When combined sludge and scum equals one-third (Y,) of tank volume Pump out contents of tank(s) O months ear(s) (Maximum 3 yrs.) Inspect dispersal cell(s) At least once every Clean effluent filter At least once every ❑ months ear(s) Inspect pump, pump controls & alarm At least once every ❑ months ear(s) O NA Flush laturals and pressure lest At least once every ? O months ear(s) ❑ NA rHhec Al least once every O months ❑ year(s) NA At least once every O months O year(s) [p NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following llce6eS 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 cells) shall be visually inspected to check Q e(fl effluent on the in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding 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. ment components, and any The servicing of effluent filters, mechanical or pressurized POWTS components. prd by as certifi d POWTS Maintalner. other maintenance or monitoring at I ervals of 12 months or less shall be pe A servirse 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 OPERATIONfor chern For new construction, prior to use of the POWTS check treatment tank(s) If hihh concentremGorta fare detectedthave then contents ofCals tthJ3 may Impede the treatment process and/or dem8ge the dlsperssl cell(s). g tank(8) removed by a septege servicing operator prior to use. System start up shall not occur when Boll conditions are frozen at the infilIMtiVe StI fliCe. result In the backup or surface discharge of effluenit. During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will p discharged to the dispersal cell(e) in one large dose, overloading the cell(s) and may controls to restore Hormel levels To avoid this situation have the a Plumber contents of th, POWTS pump to esalsltank din manuePly opera Servicing the pump r prior to restoring power to the s effluent pump or within the pump tank. ark over, or otherwise disturb or compact the area within 11Do not drive or park VOI over tanks and dispersal 5 feet down slope of any mound or t-grade soil absorption not drive or p n area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the It; of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton gasoline; swabs; clegre herbicides;nal 1) scraps; medlcaoons;toil; painting �n (sump pump) water; fruit and vegetable peelings; peatlddes; 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 propel y and safety abandoned In compliance with chapter Comm 83.33, 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 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 loll, gravel or another Inert solid material. CONTINGENCY PLAN hi nt If the POWTS fells and cannot be repaired the following measures have been, or must be taken, to provide a code comp h replacement system: I] A suitable replacement area has been evaluated and may he utilized for the location of shouldIon and replacement Boll absorption sys he d The replacement area s uld be beer 9tected f lot Ili eta a d c ell nd cure ct rotect the eplaceme t area will red esult In the nffed setbacks from existing proposed with the rule:I In for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at that time. 13 A suitable replacement area Is not available due to setback and/or sole limitations. Barring advances In POWTS technology a 40h'a' ing tank may be Installed as a last resort to replace the felled POWTS. on tsite has not been be performed to locate aa suitable reted to p al cemlenttiarea. If no replacemen nt area, Upon failure Its available a0holding tank may beMS a soil and eInstalled as a last resort to replace the failed POWTS. such nistructed ltlhaln;revel of the biomat at the Infitraifve Mound daradesoil abotionsystems maybee surface. at-grade e must with the rules effect lace ett © <cWARNINOa> INSUFFICIENT GEN. DOn( ENTEIR , PUMP AND OTHER TREATMENT TANKS A SEPTIC, PUMP OR OTHER TREATMENT TAANK UNDER A YAY CONTAINTC RCUMSTANCES./ DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS PPOWTS MAINTAINER POWTS INSTALLER Name C. r Name �? Phone i Phone J'� SEPTAGE SERVICING OPERATOR P MPER LOCAL REOULATO Y AUTHORITY *7 Name /?> ` Name Ephone f� Phone �,fi' This document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)W and 383.54(t), (2) & (3). Wisconsin Administrative Code. 9��- q r WsoontM Depararlent of Safety and Professional Services Dwlslon of Industry Services SOIL EVALUATION REPORT Page! Of 4 In accordance with SPS 383, Ws. A Im. Code County ST, CROIX Adech complete site plan on paper not loss than 8 12 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 018 - 1009 - 80 - 200 percent slope, scab or dimensions, north arrow, and location end distance to nearest road. Reviewed by Date pleasq print , f Persona Wwmy arwn you We mus ay 6e ed fwaamndWy D qM" (Pdv Y Lew. a. 16.04 (1) (m)) Properly Owner Property Location WYATT PORTER GovL Lot SW 1/4 SW 114 S 05 T 29 N R 17 E❑O Lat M Bbdt N Subd. Name or CSW Property Ow^era Mailing Address 2 — 13/3575 332 SOO LINE ROAD �, to p ode hone u ity �Milage own Nearest Road HUDSON, WI 540161. 7 Mona 441 - 0762 I IOTH AVENUE 4 600 GPD rrwmmmsndS1JQns: ubuction UseQ Residential / Number of bedrooms Code derived design Pow rote rlent Public or corrzrrerctal - Describe: R. rial SANDSTONE Flood Plain elevation s applicable *;,A ments MOUND SYSTEM -- 1.25 FT. SAND FILL - 0.6 LOADING RATE PROPERTY ADDRESS: (WINTER CONDITIONS: 4" FROST/MOSTLY SUNNY) prgPo,*j0 FT]Boring tl Boring Spit Ground surface elev. 102.44 ❑ l Color Redoz Description k. Depth to limiting fader 2l ln' Texture Gr. Sz Sh. ure Consistence Boundary Roots Soo litation Re PD �ifa1 •EIH2 ll Ou. Sz. Cont. Color 2vf co 0.6 0.8 W21-285YR4/4 1/2 sit 2f-msbk mvfr cs 0.6 0.8 sil 2fabk mfr cs 2vf co 4/4 4/4 m]f5YP.4/6 s Ogg ml ❑ Boring 103 25 Boring M pllGroundsuRaceelev. ,19 R Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture structure Consistences In. Munsell Qu, Sz. Cont. Color or. Sz. Sh. I 2f-msbk mvfr 1 0-12 7.5YR3/2 sil 2fabk mfr 2 12-I8 7.5YR4/4 — 3 18-25 1OYR7/6 fs Osg ml 4 25-30 10YR7/3 m1d7.SYR3l4 fa11 Ogg 11ml • Elf uerd S1 = BOD > 30 —< 22D nV& and TSS >30 < i 6O mWI Name (Please Print) Sig Y 30 HUPPERT (Hollistees Soil Tcstinq & Dcai on 28497 ICING ARTHUR'S CT., DANBURY, WI 54830 _, In. Sol Boundary Roots < •E1fa1 cs 2vf-co 0.6 cs 2vf-co 0.6 aw I of--m 0.5 _ 0.5 0.8 0.8 1.0 1.0 int BOD <_ 30 np/L snd TSS S 30 r^ati f C5T Number 224832 ptiortruonatim Tolaplwne Number 12 - 20. 2021 715 - 426 - 1775 Prol;adyowner PORTER, Wyatt (Lol2) ParcellD0 nBona g f ��na 3 * 102.19 a 018 - 1009 - 80 - 200 Denth to Iimilln° factor 34 In. Page 3 of 4 I_I Horizon Depth in. u rn _.__.____ DondnenlColor Munsell _.- Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots _. GPDRFEffk2 •E 1 D-12 7.SYR312 sil 2fa&sbk mvfr as 2vf-co 0.6 0.8 2 12-22 7.5YR4/4 sil 2fabk mfr cs 2vF-m 0.6 0.8 3 22-26 IOYR5/4 fs Ogg ml as lvf--m 0.5 1.0 4 26-34 1OYR7/6 — fs Ogg ml cw — 0.5 1.0 34-till nBoring # R Boring ,.._.._. _...___ -,-.. a Mntn to lintein° (actor _ In. ww r. F Boring Boring N Ground surface atev. R. Depth to Iimiting factor In. ' ou SeaSea Ae°I Rate w . Effluent N1 - BOD, > 30 < 7.20 rng& and TSS >30 < 150 rn%tL es°-e77o pt071111 Effluent N2 - BOD, <_ 30 nV& and TSS 130 "V& Plot Plan Page 3of�/ PROPERTYOWNER: TTp �- 1" == 40 FT. 'o (except where noted) Legal Description:_Ia r OF sW/ DF ?}I� sy�� SAC 05 7 ZgN R )7yi 41, 0 == backhoe pit 'Tow/3 OF 4-%,AA MCt3D ST, `KVI X (: Wt I h ; \jIt ( (0Acrz�.s _ Lo7 Z C. % `�, W North p,opmsz LOT IL k s 2 �yot ,m3, iq S S d � C ft6�fl� p �� J e,r rj X IoZAy' $M�►L`7op of gpi� U-?D gE ♦lO'AWVb 090titlp vi • i 75 FROM SfJ'tic. 7AN< FROM MounD SWEA% Site location • ,-A c Top or S,P. Assu,ikso Im,ty, u IIIIIIIIIU IIIlllllllllljlllllllllllliiiiiii�°p°!!!!!iiuo uiuiiuu_ ;;;;.;;jlllllll�.•..•. gIIII III I II IIIIIIIIIIIIIII ;�ligl_ ..... =1111 IIIIIIII IIIIIIIIII �������� ���� ���� •���� IIIIIIaellllllllllllelllllllllllalll � - mumuuumul�'1 i®is�i®��� i�miiiiimummiommiimmummumr�? ii�umimmmommimmimmmoimmmmmimmmiinnmimio�� --��/' III � � •� • • • IIIIIII ���aumnuuuuumuu�uuuumiitumnmi p.:.� .,.. :. a� a. � aa� a� � File #: ST CKo , - LINTY SANITARY SYSTEM File Office use only 'I- .'rrrr.'"r OWNERSHIP/ADDRESS FORM created212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addr( City/State/Zip Phone Numb( Email Address Parcel Identification Number _ Of ` /001? (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Locat,o OMWI1 Aaf 1/4 , Sec�'T' �41NF-R, Town of Subdivision Plat: Lot # Certified Survey Map # Volume �'> Page # 3�75 Warranty Deed # M03,59 (before 2006)Volume Page # Number of bedrooms Spec house O yes)q'no Lot lines identifiable E3 yes�no OFFICE USE ONLY New Property Address ¢ �lY L%%i v"i��Y% I l0 1 Z mz� f IN (Verific pion qPnew address required fror co unity Development Department for new construction.) cflb�Zz (staff Initials) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey 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 cdd0 sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov I I coo _ �"7 u�� u MOM Wyatt Porter ELEVATIONS ��1 — ----------------- - ?t_ t W,.W i__, -_-___-_ _____ O w O I --------------------- 5 _____——_—_—_—_—_ - - - -- - -- t ------------------ '• Yam--- - -_- - -- ---- S �� �i9 r13 � +� r 1 : 1600 SQ. FT. MAIN LEVEL 30 DESIGN uc NuuIt1.'s fall,.. I NOTICE! I UM.oerrim Dep.rl,n.rrt p 4 f � Dk tom of brdustry JAN 10 2022 S IL EVALUA_ T��N RFP AT Page I of 4 ao in cordance with PS 383, Vft. Adm. Code pn pa Attach complete site plan peri5 ounty At in size. Plan must County ST. CROIX include, but not limited to: point (BM), direction and Parcel I.D'018 - 1009 - 80 - 200 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all in/onnation. �/1� j �jp[(_� 2 Y 1 Date Personal inrormauon you probe may be used for secondary purposes (Privacy Land', s. 15.04 (1) (m)). / 1 .. W ""11 ,( 1 / 1.f1 ! Property Owner Property Location J ' ❑ El WYATT PORTER Gout Lot -- SW 114 SW 114 S 05 T 29 N R 17 E (or) W Property Owner's Mailing Address Lot Bloke I Subd.Nam orCSW�'6ti1 332 SOO LINE ROAD 2 - Y313575 City State Zip Code Phone Number arty Village own Nearest Road HUDSON, WI 1 54016 ( 715 ) 441 - 0762 HAMMOND I IOTH AVENUE ONew Construction tlseEj Residential / Number of bedrooms 4 Code derived design flow rate - - 600 GPD Replacement Public or commercial - Describe: Parent matenal SANDSTONE Flood Plain elevation if applicable AlA?iM�X, It General comments j MOUND SYSTEM - 1.25 FT. SAND FILL - 0.6 LOADING RATE and recommendations: PROPERTY ADDRESS: (WINTER CONDITIONS: 4" FROST/MOSTLY SUNNY) PtupoeBb l,ot Z- Boring >« ❑ ling a Pit Ground surface elev. 102.44 R. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Stricture Gr. Sz. Sh. Consistence Boundary Roots GPDAF 'Etff1 •Eff#2 1 0-14 7.5YR3/2 sil 2f-msbk mvfr cs 2vf-co 0.6 0.8 2 14-21 7.5YR4/4 sil 2fabk mfr cs 2vf-co 0.6 0.8 3 21-28 5YR4/4 mIf5YR4/6 s Osg ml - lvf-f 0.7 1.6 21 Boring e ❑ Boring 103.19 25 Qp)( Ground surface elev. ft. Depth to krrfirg factor in. Horizon Depth in. Dominant Color Munsell Redox Desorption Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Effi1 'EfW2 1 0-12 7.5YR3/2 I 2f-msbk mvfr cs 2vf-co 0.6 0.8 2 12-18 7.5YR4/4 - sil 2fabk mfr cs 2vf-co 0.6 0.8 3 18-25 10YR7/6 Is Osg ml aw Ivf--m 0.5 1.0 4 25-30 1OYR7/3 m1d7.5YR3/4 Is Osg m1 - - 0.5 1.0 Ef xKt 01 = BOD > 30 < 220 nVIL and TSS >30 < 150 m g/L ' Effluent = BOD < 30 rtglL and TSS < 30 mg& CST Name (Please Print) CST Number MARY JO HUPPERT Hollistees Soil Testing& Dcsi Sg 224832 Address Date Eval acted Telephone Number 28497 KING ARTHUR'S CT., DANBURY, WI 54830 12 - 20, 2021 715 - 426 - 1775 SHL14330(R07113) as _ 727/633 018-,00 80-00� 73A _Y N 018-1012-80-000 5 96 JOB 01 B-10400 018-1009-80-100 009�" 75B 75C OT2 � cot 100 Y not puarenteeA b tM a cormb4i to o4 t 3 " tin 61..Cnax courvnr NO. 644798 STATE SANIT�RY PERMIT lb/z No' Ak �A�SF£R/KCRCFA7. PIi6Yi�[TSR� OWNER W *4 P PLUMBER TOWN SEC S 9T ? N, AND/OR LOT Z PERMIT EXPIRES 2Zs !ao BLOCK SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the unitary permit is to allow Installation of the private sewage system described in the permit. (b) The approval of the unitary 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. In) Changed regulations will not Impair the validity of a sanitary permit. (e) Renewal of the unitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (1) The unitary 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. OFFICER - DATE S RENEWED POST 1N PLAIN VIEW -21t THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R] 1/20)