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HomeMy WebLinkAbout008-1064-50-000 (2)nDepartment of Commerce SafetyPRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you promde may be used for secondary purposes (Privacy Law. s 15 04 (1)(m)] Permit Holder's Name Crty Village Township Don BormannNerlin Falde TOWN OF EAU GALLE (`CT mx cis.. TANK INFORMATION TANK SETBACK INFORMATION TANK TO P/L WELL BLDG vent to Au Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Loss to Well avlL ADJVKY I IUN SYSTEM ELEVATION DATA jBldg IMR Pipe ISt Cover BEDITRENCH DIMENSIONS Width Length No Of Trenches PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO I P/L jBLDG WELL LAKE/STREAM LEACHING Manufacturer Type Of System CHAMBER OR UNIT Model Number. 111CTDIDI ITtA�1 evert-.. Header/Mandold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Cr111 1`A1/C0 _ .. • . aro nyawnm unry xx mound Ur At -Grade Systems Only Depth Over Depth Over xx Depth of zx Seede&Sodded xx Mulched BedRrench Center Betl/Trench Edges Topsoil _ _ ,Yes No - Yes No �.vnnnr-l" 1 0: (Include code discrepencies, persons present, etc.) Inspection #1 Inspection #2. Location: 229 CTY RD BB 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. SBD-6710 (R 3/97) Dale - ---Insepctor-s Signature - - - — -- - - -- — Can No -- f Industry Services Division Yards Way County C N AU q 822 Madison 2 5 L �2 Madison, WI 53705 c� f Senir.ry Permit Number be filled in by Co.) i7 2 P.O. Box 7162 (to y WLia707 5 (� b Z OUN1,tNWJ)on, I St. n ComrnunitY ermit Application State Transaction Number 0&-/ , G In accor S 383.21(2), Wis. Adm. Code, submission ufthis form to the ap a govemmental unit Project Address (if diffcenl than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for slatme wined P WTS are submitted to the Department Safety Professional Services. Personal informelTryou$ ide be for of and may used secondary purposes in accordance with the PrivacyLaw, s. I5.04(I)(m), Slats. �J 1. Application Inormation - Please Print All Information Property Owner's Name -10 s Parcel g ' -boo ,.. ��� PropertyOwner's Mailing Address Property Location / ,j (D Z L 43 C n 44-- S I . N Govt. Lot 7 T Z O] N R E o W City, State Zip Code Phone Number I .Type of Building (check all that apply) Lot a y Subdivision Name 1 or 2 Family Dwelling -Number of Bedrooms OPublic/Commercial - Describe Use Block k tyof Slate Owned - Describe Use kCiT illage ofZor4 CSM Number x 3Z— 7/65 Town of 111. Type of POWTS Permit: (Check either"Neiv" or "Replacement" and other applicable on line A. Check one box o1 line B. Complete line C if applicable.) A. Dew System eplacement System ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B' ❑Holding Tank ❑ In -Ground U't-Grade ound ElIndividual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before []Revision hange of Plumber 'X Dramafer to ew Owner List Previous Permit Number and Date Issued i Expiration 8 S_T wuv f' e li IV. Dispersal/Tres ment Area and Tank Information: z Design Flow (gpd) Design Soil Application e( $0 Dispersal Area Requir (sQ Dispersal Area Propose (sD S stem evasion - Tank Information Capacity in Gallons Total Gallons K of Units Manufacturer /, /"r( T V $ u New Tanks Existing Tanks / K4,�� V U25 $ to Lc U G. Septic or Holding Tank Daring Chamber / y c LJ V. Responsibility Statementlis the undersigned, es responsiblliity for installation of the 1'OWTS shown on the attached plan Plumber's Name (Print) a Plu s Signature MP/M PRS Number Business Phone Number Plumber's Address (Street, City, Ste ,lip C de 2—S-t- w> VI. Count /De artment Use Only Approved O Disapproved Permit Fee Dale sued Issuing Age gnalure -7 �� 9 // 't OOwnerGivenReasonforDenial Conditions of OWNS oval/Reasons for Disapprovijl.,1 i x � v,� Al („� P/�� t/1 R SVS1E"dOWNER: 7 ��`j T�'r / -( I. SepFc tank, effluent filler and 1 d.spersal ra11 must be so icedimaintainad I ( coKv J I ) _bH, y SA � vflov--4 / l.• as management plan provided by plumber. Y-/ t`C per 2. All setback requirements must be maintained 4a�{ rsr) ep l_ •� to per applicable cone/ofdinamel. s11s'r<'tln'f for Ovv�l-e •� W 1 � - Attach to complete plans for the s fern n nbmll to the County a on p er not less than 8 to t I I Inches In size b) � � vim;MU e.., g�rro 120ZZ . SBD-6398 (R. 03l21) r �� �Ze S /2_zl2-Z M TI Q AA Su System PLOT PLAN PROJECT Don Bornmann ADDRESS 1026 Monroe St. N Hudson Wi 54016 NW 1/4 SW 1/4S 22 /T 28 N/R 16 W TOWN Eau Galle COUNTY ST.CROIX SYSTEM ELEVATION 97.5' 1.5' sand lift 8/9J22 DATE BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT BOLDING 'TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # or Chambersnone BENCHMARK V.R.P. Top of well ASSUME ELEVATION 100' Filter Lifetime BOREHOLEO WELL *H.R.P. same as benchmark 700' Property Line Area 15' below system is to remain undisturbed 10% Slope B - 3 B-2 94' 96' 98' Huffcutt Combo Tank Scale = 1/4" = 10' 0' 40' 80' 1 1 1 B - 1 Grading is to be done to divert run-off away from system O Pro 3 Bedroom House Old system is to be pumped and buried Well c� +`COPY `ar�Mnu� q- i August 18, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-8-18 Plan Review: PWTS-082201943-C Shaun Bird 1432 1201h St New Richmond, WI SITE: � " Bornmann/F a.�cJ� 237 County Rd BB Town of Eau Galle St Croix County NW'/. SW'/. S22- T28N — R16W FOR: Description: 3 bedroom-450 GPD— 18" to j limiting factor- Effluent Filter - Maintenance required. DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD wl 5454344a2 Contact Through Relay http:/Aftpe.vA.gov/p")gremsAndustry-wrom www.whlcontun gov Tony Evora - Governor Dawn Orlm - 6aorala Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Mound Component Manual — Ver. 2.0, SBD- 10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual —Ver. 2.1 (May 2022-2027) 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, j /2d-Lvl �y Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)634-5124 Joshua. rowlev(@wisconsin.gov Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/9/22 Owner: Don Bornmann / -F, , l cL Location: NW1/4 SW1/4 S22 T 28 N,R16W 237 Cty Rd BB Eau Galle 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 Attachments: soil test Shaun Bird Signatu License nutfiWr 226900 Page 1 of 9 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES � -Gr 9-� SEE CORRESPONDENCE System PLOT PLAN PRoiwi, Don Bornmann ADDRLSS 1026 Monroe St. N Hudson Wi 54016 NW 1/4 SW 1/4s 22 rr 28 Nllt 16 W TOWN Eau Galle COUNTY ST.CROIX SYSTEM ELEVATION 97.5' 1.5' sand lift _ BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons I,IFI' TANK SIZE DOSL TANK SI'LE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone BENCHMARK V.It.P. Top of well ASSUME ELEVATION 100' Filter Lifetime ❑BOREHOLE O WELL •ll,lt,P, sameasbenchmark 8/9/22 DATE. Area 15' below system is to remain undisturbed 10% Slope B - 3 B-2 94' ❑ ❑ 00' 96' 98' Huffcutt Combo Tank Scale = 1/4" = 10' 01 40' 80' 1 1 Cty Rd BB B - 1 Grading is to be done to divert run-off away from system N O Pro 3 Bedroom House Old system is to be pumped and buried Well Mound System Cross Section and Plan View i — = Topsoil = ASTM C-33 Cap Material sand fill L J E ®= Clean aggregate %s to 2 '/2 in. dia. ' Slope Direction Dimension Feet A S B D E j, ,3 , $ Ile .S J ?, 30 g Q r G H I lei J K L W Z Sloe = 4 in. sch. 40 pvc O observation pipe GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'''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 se red in place with rebar or a closet flange. 10/07 lgi Page of Pressure Lateral Layout Two Laterals — End Manifold Mail rurcc tviam �y S n ` Distribution N ateral Diameter X L Force Main Diameter I Force Main Lennth ns In. In. In. In. Ft. Ft. In. Ft. Pressure System Construction ded lout 9 ag oweep 90 Bend 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. • • • • • <_;radc • • • • • • 6-8 Inch Lawn Sprinkler Valve Box Page —L of 03/05 Igi Septic -Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer Total Tank Capacity p b3 Max. Bury Depth _ Filter Manufacturer Filter Model Number Minimum Pump Performance Required o (1 GPM. f 5 . —Ft TDH outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight %% —Y — Finished Grade Outlet Filter �y Inlet ; Inlet Baffle Switch Settings and Reserve Capacity Tank Volume _3 GPI Dimension. Inches Volume Gal. (reserve) A• �_ (alarm) B 2 30 T_ (dose) C ; 7 (dead) D - Total </) _-2, 1? Pump Manufacturer Pump Model Number Alarm Manufacturer !Lf-LACSfy Alarm Model Number ,e--✓ _ Switch Type ` Total Dynamic Head (TDH) - Feet Elevation Head Distal Pressure Network Loss Force Main Loss fl� _ Total J'� Manhole Min. 4" Above Grade Device Securely Mounted With Locking Weather-proof 1 Junction Box Vent Min. 12" Above Grade With Vent Cap Off Elevation J Ft A B D f_ — Disconnect Means �4„ Weep Hole Bottom Elevation 2'7. Z 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 servic omplies with NEC 300 and Comm 16.2M. 02/OS W Page S of - 280-SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Unl-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature: Vortex style impeller permitting passage of solids up to'A" - 416 stainless steel rotor shaft Permanently lubricated upper and lower ball bearing - Epoxy powder coat finish All fasteners - corrosion -resistant stainless steel 1 yz" 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 yz 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 40 TAT- -n-7-r-1-712 35 30 25 ILL 20 15 = 10 rol ) .5 10 15 20 25 30 35 40 45 50 55 60 65 7r U.S. Gallons Per Minute 11 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 I settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" Tho 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 Manual, Wide angle Wide angle no switch float switch float switch with quick- with series disconnect (piggy -back) plug SSPM✓-� S CERTIfIEO c us Certified ��. apeelllcattemro// cn e sublect to s"pe without notice. l� �1 y Model 287 VMF-Series Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump i Liberty Pumps - 7000 Apple Tree Avenue - Bergen, New York 14416 - Phone 800-543-2550 Fax (585) 494-1839 www.11bertypuinps.com Copyright O Uberty Pumps, Inc. 2017 All rights resorved. LLIT 2000 H05/17 /,A f�' +'." -t- " /k.lk,/ v6 z Q U LLJ LI) POWTS OWNER'S MANUAL & MANAGEMENT PLAN page �of_ evoTcu coFCIFICATIONS FILE�NFORMATION Owner Permit # m &I^Ikl oADAUCTCBC Number of Bedrooms 3 ❑ NA Number of Commercial Units >0 NA Estimated flow (average) 7-0gal/day Design now (peak), (Estimated x 1.5) 0 al/da Soil Application RaM. te J al/da /ftz Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) !;30 mg/ - Biochemical Oxygen Demand (BODs) 5220 mg/ - Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ❑ NA Monthly average" Biochemical Oxygen Demand (BODs) s30 mg/ - Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) s10' cfu/100ml Maximum Effluent Particle Size Y. Inch diameter Septic Tank Capacity 6Vv al ❑ NA Septic Tank Manufacturer NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity al 014A PumpjTankEManufacturer NA Pumpcturer ❑ NA Pumpel v ❑ A Pretreatment Unit 7EI NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Manufacturer Dispersal Cell(s) ❑ In -ground (gravity) ❑fin ground (pressurized) ❑ At -grade ound ❑ Dri ine ❑ Other. • Values typical for domestic (non-eommerdal) wastewater and •• septic tank effWenl. Values typical for pretreslod wastewater. MAINTENANCE 5crit:uut-t Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ear(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 arts) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ month earls) Inspect pump, pump controls & alarm At least once every ❑ months ear(s) ❑ NA Flush laterals and pressure test At least once every ❑ months years) ❑ NA Other. At least once every ❑ months ❑ y ar(s) q NA Oliver. 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 II nses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POINTS Maintainer, Soptage Servicing Operator. Tank inspections must Include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identity any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface. The pending 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 lank 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, meth��??nical or pressurized POWTS components, preireatFment components, and any other maintenance or monitoring at irifervals of 12 months or less shall be performed by a certified POINTS 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 POINTS 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 ince of For new construction, to and/or damage the dispersaltcal ($). If high c iank(s) for the rest may Impede the treatment ncentrations painting detected have the rcontents Chemicals tofhip p 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. a excess During power outage erpu c tanks ayl ill dose, overloabovladingWheecell(s)ls. When power is restored th and may result In the backup or surface diachargeaof eftluleh discharged to p rotor prior to restoring Power to the controls to restore normal levels To avoid this situation have the contents of the pump tank removed by a Septage Servicing Pe effluent pump or contact a Plumber or POWTS Meinlalner to assist In manually operating the pump within the pump tank. Do not drive or park vehicles over tanks end 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. flora; diapere; disinfectants; fat; foundation drain Reduction or elimination of the toilowing from the wastewater stream may Improve the performance and prolong the life of the POW7� antibiotics; baby wipes; cigarette butte; condoms; cotton swabs; degreasers; dental (sump pump) water; fruit and vegetable peeliltgs; gasoline; grease; herbicides; meat scrape; medications; oil; painting pfOdll pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When nthe pOWTS falls andifor Is ly abandoned In compliace with permanently tek Comm 93 service r i e the ollowing stetrallveaCodeaken to insure that the system is props Y and • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pile shall be excavated and removed or their covers removed and the void apace filled with S011, 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 Complil'n replacement system;arm ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption ey ui The replacement area should be protected from disturbance and compaction and should not be Infringed upon by q for a setbacks from existend albs and evaluatio n t deatebllah elot lines and suitable replacems. ent taelure rea.t Replacetthe ment sylstems must compment area lresult In y with thehrulell Ir effect at that time. ack and/or soil Ilmilati.>ns. Barring advances In POWTS technology t ❑ A suitable replacement area Is not available due to setb 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 evalualja must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be Installed) a as last resort to replace the failed POWTS. suound Aace e Re aconataructlonls ofauChlisyatemta muaems mcomply with the rube ses In effect ad in piece cllowing that limn moval of the blomat at the Inflltraily <<WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O� . PERSON FROM THE INTHRIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name` Phone 91a, POWTS MAINTAINER �— Name Phone SFPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Name Name /Q / `Phone = --d Phone �p ` This document was drafted In compliance with chapter Spa 383.22(2)(b)(1)(d)&(I) and 383.54(t), (2) & (3). Wiscwwin Administrative Code. Wisconsin DepertmeruofConxnerre SOIL EVALUATION REPORT Page _of_ Division of Safely and &dldin2s rr, axoroance whir, Cornet cz, rvrs. r,07. �v htu ch complete alto plan on paper not less than 6 112 x 11 inches in size. Plan must Include. but not limited to: vertical and honzontW reference point (BM), direction and percertt slope, scale or dimensions, north arrow, and location and distance Ic nearest road. Pleaaa print all Information. Per t NMrmsuon yeu prewa may be us" fm ekonoeR Wks (Pnrecy Uw, t 16,04 (1) iml). - - 0County 1`� Pares I.D. Reviewed by Date property Owner J Property Location GovL Lot 1/4 1A 5 ZZT Z g N R E( W Properly Ownses Malkng Address IL?Z Lot N Block N Subd. Name or CSM# z3 4a3 ClIv State Zip ( fi ❑ City ❑ Village 01own Nearest Road rr✓ [3 New Construction Use:fi!�.,Residenbal / Number of bedrooms Code derived despn how rate qs-n GPD �gaament /1',] Public a commercial • Describe Parent ntstor al ��kajz Flood Plain elevation It apple — A/ / H --�----- R General con.,wps and raomirnaindatlons: System type /i IO 4P / sc (SL (/l / ! System Elevation J \ l a ❑ Boring 14,u n {f EIS Pit Ground surface alev� r R Depth to thlltlrtg facto �o h. Sol Application Rats lit tzm Depth In. Domlrtent Color Mussel Redox Description, Qu. Sr. Cont. Color TeAn Sh mire Gr. Sz Sh. Consistence Boundary Roots GPDff 'Eft#1 'E j D--3 8 - 8 -- �' ® ❑ Boring � a WPit Ground) surface elev. z' t1. Depth to limiting factor � in. Sol icetlon Rom horizon Depth h Dominant Color Mor"l Redox Description Ou. Sz. Con. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPD/fP -Eff#1 'Eff#2 Z — — L[% 1 /,56 - Effk)$M 111111 • 5W. > W 5 ZW nWL WW f 5b >JU <— - rMu WR et - GW. a .au "W 6 W ti ,. _ . ,,,y • CST Name (Please Print) nature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evelueaon Conducted Telephone Ntrnber 1432 120th St, New Richmond, WI 54 7 -7- 715-246-4516 Property Owner Panel ID # Page _ of ❑ 6onry 0 ° Baring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. sm�ail ON ' EIIMrent 01 • DOD, > 301220 mglL and TSS >30 1150 mg& ' E8luent lit - BODr < 30 mWL and TSS 130 nVL 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. ssaulO(RAM) ' EIIMrent 01 • DOD, > 301220 mglL and TSS >30 1150 mg& ' E8luent lit - BODr < 30 mWL and TSS 130 nVL 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. ssaulO(RAM) Soil Test Plot Project Name Donald Bornmann Address 1026 Monroe St N Hudson Wi 54016 Lot ----- Subdivision N W 1/4 S W 1/4S 22 T 28 N/R16 W Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft. CVSTM #226900 Date 4/30/22 Township Eau Galle County ST. CROIX Top of well System Elevation TBD •HRPSame as Benchmark �d��tl'sa5etly�� �� meaee z co ST. CRO L�.NTY SANITARY SYSTEM File #: l,Office Use Only 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 INFO MAT ON Owner/Buyer Mailing Address Citv/State/Zi DA Phone Number Email Address D Z (o Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL /DESCRIPTION f� Property Locatiop�i/�a�( cam. A , Sec?Z. T -7 '?N f b W, Town of . v Subdivision Plat: Lot # Certified Survey Map # ((yy . Volume%S Page # Warranty Deed # ��/J (before 2006)Volume Page # 3 Number of bedrooms Spec house 0 yes-'Ano Lot lines identifiab1e4yes O no New Property Address Z N - (Staff Initials) % C Z � Z 1eay (Verification of noWaddress required /6 / 2022 ate USE ONLY Community 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 a copy of the certified survey mop if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 71S-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov IPA G3 w�rlsm Deoartrnern of ,ym 03 2022 S IL EVALUATION REPORT DNwoi- a Sateq anc sue . �,qµgy' t l / 6 St. Clrot p"" T;, . n, E6 Wls Adr. Code courm f /� AU compiete site pan - n E 11 x ' inches in size. Plan rust include. W not Mmited to vertical and honzonta• reference Dour, BM; direction anc I Pam* I : A/`} 04 Li9 - Paroem siope, sceie or dimensions, north arrow an: bcation and distance tc nearest road. Please print aH lnformatior,. Re we? tv Perwmv WOWM@bw Yet Prcv,oe nut be wee fm sewrw rn P�rp� iPrwahLow.l. ■ 1<_.O4 !+.; (m);. T _ GOA. Lot 1!4 L ',4 S GzT N R Lot siock N Subd Name or CSW 07 r ❑ City 0 "Hage 01own Nearest Ros iONew Cons +cam use Resider>da ; Ntmtber o! bedrooms Code derived design flow, rate GPO � /,nA 0 Public Of cer`nme-aa - Describe _ rarg lsrtta material LY.�, A, n J� Son. I [ Flood Piain elevation r< applicabie Ga and rocormnndabons: / L ��� System type Z%ID. Scot �i 7 S,vstem Elevation 'J \ ) Own I* RPiBoring Grand surface Nev. 22 ` it Deph to kmiting factor in. - - - - - - • W M FY, ii MM®?,M ©W � -4 MIPIMMMMIMEME Me CAW W MM • - wv. - w _ �v rry� i u aJ +JV i - rmuent ;ve • tlVu, < W rnyL RIG T S5 :s 3u mWYL CST Name (Please Print) nature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54 7 �2 -2— 715-246-4516 7 r Property Owner _ Parcel IDBooi# ❑ Boring a� # Pit Ground surface elev.aIj— R. Depth to Icrdting factor in. Page of Sol Application Rate �MMNA��/,AM��I %%!icefi MEM Boring # ❑ Boring ❑ Pit Ground surface elev. k Depth to limiting factor in- Soil Aopic7 Rate . Effluent #1 n BODE > 30 < 220 rng/L and TSS >30 < 150 Rg& ' Effluent #2 = BOO, 130 rig& and TSS < 30 rigiL 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. SBD4370 (RAW) Property Owner Ej ❑ Boring ,Iil Boring ]�-�l Pit Parcel10 # Ground surface elev.q 311 ft. Depth to limiting factor al F in. Page ___ of Soil Anoltrarirv. Q�t. Redox Description Cu. Sz. Cont Color a MIMIMM ❑ Boring # ❑ Boring ❑ pit Ground surface elev ft. Depth to limiting factor in Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Cu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDHF 'Eff#1 'Ef1#2 ❑ Boring# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon I 'lepth in. I Dominant Color Munsell Redox Description- Cu. Sz. Cont Color Texture Structure Gr, Sz- Sh. Consistence Boundary Roots GPD/ft 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg(L and TSS >30 < 150 mg1L ' Effluent #2 = BOD,! 30 mg& and TSS :5 30 mguL 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. SBM330 (N 6=) Soil Test Plot PI Project Name Donald Bornmann Address 1026 Monroe St. N Hudson Wi 54016 Lot ----- Subdivision NW 1/4 S W 1/4S 22 T 28 N/R16 W ❑ Boring 0 Well PI, Property Line BM or VRP Assume Elevation 100 ft. CXTM #226900 Date 4/30/22 Township Eau Galle County ST. CROIX Top of well System Elevation TBD *HRPSame as Benchmark CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 22, TOWNSHIP 28 NORTH, RANGE 18 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN WEST DUAR7ER CORNER SECDON 22, T28N, R18W FOUND SURVEY MAC NAIL �I gl+ 50. 1 u, I I I I I UNPLATTED LANDS S87' 17' 18 E 406.96' LOT I TOTAL AREA: 131,381 SO FT 3.016 ACRES EXCLUDING R-O-W 113,666 SQ FT 2.600 CCRFC I I$ X I� f I� I� I� I R'SKW'A _L I I I �— a �,uwro_ ^1 i I N87' 17' 18 "W 231.39' l u UNPLATTED LANDS SOUTHWEST CORNER SECWN ZZ 728N, R18W FOUND SURVEY MAG NAIL Each parcel on this map Is subject to State and County laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcels, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and Town Board for advice. JU( 0 5 2022 sr. C alx C. y OWNER: VERLYN FALDE 229 CTY RD BB BALDWIN, WI 54002 SURVEYOR: RONALD D. JA5PERSON AUTH CONSULTING & ASSOCIATES 406 TECHNOLOGY DRIVE E. SUITE A MENOMONIE, WI 54751 X X O� 1UU• k� Qs/ LEGEND 0 — SET 1' O.D. x 78' IRON PIPE WEIGHING 1.13 LBS. PER•UNEAR FOOT 0 = GOVERNMENT CORNER AS NOTED X — BOREHOLE LOCAT70N BEARINGS REFERENCED TO THE WEST LINE OF THE SW 114 OF SECTION 22. MEASURED AS NOO75'17'E. (WTe. CRS ST. CROIX COUNTY ZONE NAD 83 (91)). OOAFO Y10FTIX SWU496 Tekd o ftd A 0 40' 80' Sheet 1 of 2 Sheets (Pro/ /1440-001) BORNMANN Field work completion date: 06-07-2022 MwarA*, VA MM TTd 77Ly 0Z-11190 el�p+u�tlnFmm AUNT • COASIIft25SOdBleS CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 22, TOWNSHIP 28 NORTH, RANGE 18 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN SURVEYOR'S CERTIFICATE: I, Ronald D. Jasperson, Professional Wisconsin Land Surveyor, hereby certify that by the direction of Dan Stansbury, I have surveyed, divided and mapped part of the Northwest Quarter of the Southwest Quarter, Section 22, Township 28 North, Range 18 West, Town of Eau Galle, St. Croix County, Wisconsin, described as follows: Commencing at the West Quarter corner said Section 22; Thence S00025'17"W 420.87 feet along the west line of the Southwest Quarter said Section 22 to the point of beginning; Thence S87°17'18"E 406.966 feet; Thence S0002S'17"W 182.04feet; Thence S78031'18"W 100.00 feet; Thence S30'59'31"W 143.67feet; Thence SO4°42'03"W 60.42 feet; Thence N87°17'18"W 231.39 feet to the west line said Northwest Quarter of the Southwest Quarter; Thence N00°25'17"E 393.63 feet along the west line said Northwest Quarter of the Southwest Quarter to the point of beginning. Containing 131,381 square feet (3.016 acres) and is also subject to the right of way of County Road BB and all other easements, restrictions and covenants of record. I also certify that this Certified Survey Map Is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin State Statutes, Chapter A-E7 of the Wisconsin Administrative Code and the Land Subdivision Ordinance of St. Croix County and the Town of Eau Galle in surveying and mapping the same. Ronald D.Jasperson PLS #2564 Date TOWN BOARD APPROVAL APPROVED BY: James Lund, Chairman Amy Shafer, Supervisor Kevin Larson, Supervisor ATTESTED BY: Nicole L Olson, Clerk/Treasurer COUNTY TREASURER'S CERTIFICATE State of Wisconsin) County of St. Croix)SS I, Denise Anderson, being the duly elected, qualified and acting treasurer of St. Croix County, do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of affecting the land included on this Certified Survey Map. Denise Anderson Date County Treasurer Sheet 2 of 2 Sheets 3 �d !Sj - C couNrY No KI STATSANITAR # 23} c�1' Rfl Bf EWAL PREP OWNER PLUMBER,%IA,m 9,%t-d LIC.# ZZ600 TOWN OF SEC Z Z ,TAN, R E AND/OR LOT BLOCK r_S 04 SUBDIVISION No* 645402 PERMIT s CHAPTER 145.135 (2) WISCONSIN STA (a) The purpose of the sanitary permit Is to allow installation of the private sewage system described in the permit (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (a) 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. (I) 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. AUTHORYLED ISSUING OFFICER - DATE ZZ THIS PERMIT EXPIRESI/ UNLESS RENEWED B400 THAT DATE POST fN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (Rl1/20)