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HomeMy WebLinkAbout022-1065-30-000Wisconsin Department or Commerce Safety and Budding Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law. s 15.04 (1)(m)I Quentin L. Everson and Kristen N. Rob CST BM Elev I Insp SM El ' c.T/ . O I TANK INFORMATION TOWN OF KINNICKINNIC if PvC P - C-STB H t # TYPE F TURER L 4P--nWV— CAPACITY Septic 155 C 8ba bi� Dosing ) Aerati TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic y l Z b f ^— Dosing it Lt. U 3St f AeratiorL H;pPg— PUMPISIPHON INFORMATION 1 <\ C3P` nryu, Manufacturer L IeER(`r De an GPM /7r Model Number * � Z TDH Lift Friction Loss System Head TOHo�—/ Ft g•2r2 1./1 3.3 Forcemain Length�sr Dia.2 11 Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County St. Croix Sanitary Permit No 645451 Stare Plan 10 No. Parcel Tax No 022-1065-30-000 Section/Town/Range/Map No 23.28.18.355A STATION BS HI FS ELEV. Benchmark Yr .ro r All BM /^ Bldg. Sewer SUHt Inlet s 3 l] 09 9�. i�r SIMI Outlet Dt Inlet Dt Bottom 73.yD Header/Man. 1 D /r 62 Dist. Pipe y, �U a,s.D 1D/r (DoI B System Gr de l3 Vyall tipq 12ri- woe Lac.) St Cover rZ0 /Do, yo Cv- .{TU% 3,tS� /Do.(oDy BED/TRENCH DIMENSIONS Width [Z r Length I 90 No. a ranches I I PIT DIMENSIONS No. Of Pits Inside Die i uid Depth SETBACK SYSTEM TO P/L L G WELL LAKE/STREAM LEACHI Manufacturer INFORMATION S Type Of stem /' �a f 120, CHAMBE el Number DISTRIBUTION SYSTEM Header/Man `r Length Die 2 Distnbutb()n1- c7 `t 1-ongt , D� L �� Length Die Spacing x Hole Sue 3I1(p h x Hole Spacing �� rr Vent to Au Intake SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil `—', . I . Yes No Yes No C MMENT tin luge code diglcrepencies, persons present, etc ) Inspection till -%Z/2"3 Inspection s2. Lo atlon: 1346 OAK DR a e 1.) Alt BM Description = 2 ) Bldg sewer length = It [( ` -amount of cover = z �rr 56;;"c :0 \ \ • Of f" Se. - ?M S'l �n\ w C [ I �2 L.Ol1ve(�dl . 3.or r:iwSt7...�. 1'�/ i Di_w�wnit 1 ➢v"^ t.Ik�.i r+F� 610c 6! . Plan revision Required? Yes % No s1/ `p n :74s�J 1� Use other side for additional information. SB0.6710 (R 7/97) Date Insepct�o+r's Signature Cent No tf\Ll_jr' p uwu «.we" Wr [en•�`✓1Plilws iMpaa�trn . �en�✓ s� a drtAite-m fi re n1 4Ahl-rev a0 , 2 9 Q' �rxaTM �9', Industry Services Division Coun JL ys 4822 Madison Yards Way Sanitary Permit Number (to be filled in by Co.) 4 't ZZ Madison, W 153705 0c11 P.O. Box 7162 Madison, 537qk716IJ I•� "l r ntY St. rmit Applicati Stale Transaction Number Dmm 0C 0 In accord .2l(2), Wis. Adm. Code, submiuion of this form to the a governmental unit /10 Project Address (ifdifk. an mailing address) is required prior to obtaining a sanitary permit. Note: Application forma for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide maybe used for secondary purposes in wcordaneo with the P15.04( J �— 1. Application Information -ePrant Ail Property Owner's Name , Parcel q Property Owner's Mailing Address Property. Location Govt. Lot Z3 �''/.'action City, State Zip C a Phone Number 3,0 (� y���� T /oj N R E or of IldinQ (check t Lot a .1 ;ype all ply) Subdivision Name Family Dwelling- Num Bedrooms_ �� [JublicJCommercial - Describe Use _ Block e w� ❑City of 0tate Owned - Describe Use illage of CSM Number ?- 2 V� 1/ �- r1� l own of f \ i .'1 n I l fLi Or Ill. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box o ' line B. Complete line C if a ilas A w System I--lJ []Replacement System �Olher Modification to Existing System (explain)Additional L❑ln-Ground Pretreatment Unit (explain) B. �Nolding Ten k t-Grade Mound Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before Revision hange of Plumber 1--� l '1 rensfer to New Owner 'st Previous Permit Number and Date Issued Expiration ) z • t - (%/ rus IV. Dla erssiVrratment Area and Tank information: Flow (gpd) Design Soil Application Rate(gp(lsf) Dispersal Area Required (so DisUml Area Proposed (sf) Sys kn Elevation /b J O t) (/r—(r/] Tank Information Capacity in Gallons Total Gallons H of Units Manufacturer Lr�� New Tank& Existing Tanks Septic or Hawing Tank / Dosing Clamber (y/ a V. ResponsitiW Star ant- 11 the undersigned, a responsibility forimtallatlonrof the,P.OWTS shown on the attached plantir Plu ber's Name (Print) Plu Signelure MPIMPRS Nu r Business Phone Number �J 2Z6 ;1=d�� Plumber's Address (Street, City, S te, Zip Code) �L� � trf/ -Tl _� I. County/Department Use Only Approved O Disapproved Permit Fee Date issued Issuing Agent Signs O Owner Given Reason for Denial Conditions of ApprovaVReasons for Disapprove _ �5 ✓h 'r Gt SYSTEM OWNER: T 1. Septk tank effluent 11Rer and a� r � -e��' dispersal cell MustkiLMvkLtlfIDd�Gd es per manaperment plan provided by pb n , �1Vyt1 2. All setback regWrMtents must be MAMlbi ��c K,k Vrj T �� vI ����✓X-/.,J O w (n( or as per applicable coM/OrdIMmCM J�SIT Wr �/%IArHYiY1 aHtiG /h�ril'(C(7�7��'1. AtIach to complete plans for the system and submU to the County only on paper not Ina than a I Ill Inches In size SBD-6398 (R. 0321) PROJECT Quinn Everson SW 1/4 NE 1/4S 23 SYSTEM ELEVATION 100.6' System PLOT PLAN ADDRESS W753 610th Ave Sarina Vallev Wi 54767 /T 28 N/R 18 W TOWN KinniCkinie COUNTY ST. CROIX 10/2/22 DATE BEDROOM 3 CONVENTIONAL AT -GRADE X00( CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE •5 ABSORPTION AREA 900 # of Cbambersnone IL BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL •H.R.P. same as benchmark 1320' P�jperty Line AL Scale = 1 /4" = 10' '� ` d 4 � O'O Wieser Combo T nk 3 2004 B.M.` Area 15' below system Is to 1'�0 remain undisturbed 0. 40' 80' I 1 650' 100' Grading is to be done to divert run-off away from system B-1 n B-2 100.6' 101' Wen Is to meet all WDNR setbacks Oak Drive Pro 3 Bedroom House . G0?1 cc Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 October 13, 2022 CUST ID NO.: 226900 SHAUN R BIRD 1432 120TH ST NEW RICHMOND, Phone:608-266-2112 Web: haml/dws.wi.aov Email: dsusCawisconsin.sov Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-102202556-C Application No.: DIS-102249094 WI 54017 Site ID No.: SIT-107954 Please refer to all identification numbers in each correspondence with the Department CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/13/2024 MUNICIPALITY: TOWN OF KINNICKINNIC ST. CROIX COUNTY SITE: QUINN BVMtSON 1346 OAK DRIVE RIVER FALLS, WI 54022 SWI/4 NEI/4 S28 T28 N,R 18W FOR: Design Wastewater Flow Value: 450 Bedrooms: 3 Limiting Factor(s): 36" Maintenance Required: Effluent Filter Condtabndty APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE At -Grade Component Manual - Version 3.0 (May 2022-2027) Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) SITE REQUIREMENTS • A full size 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. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. 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 he 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 are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger 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. 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 and Wis. Admin. Code & 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 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 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. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, datr UameweC.tt47 Tim Vander Leest POWTS Plan Reviewer Division of Industry Services Phone:608-516-6134 Email: tim.vanderleest@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date:10/22/22 Owner:Quinn Everson Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Location: SW1/4 NE1/4 S28 T28 N,R18W 1346 Oak Drive Kinnickinic Manuals Used: At -Grade Component Manual version 3.0 (May 2022-27) Pressure Distribution Manual version 2.1 (May 2022-27) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications 8.-9. Maintance and Contingency Plan Attachments: Soil Test Shaun Bird License number Page 1 of 9 System PLOT PLAN PROJECT Quinn Everson ADDRESS W753 810th Ave SDrino Vallev Wi 54767 SW 1/4 NE 1/4S 23 /T 28 N/R 18 W TOWN Kinnickinic COUNTY ST.CROIX SYSTEM ELEVATION 100.6' DATE 10/2/22 BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 p of Chambersnone BENCHMARK V.R.P. Top of 314" pipe ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL •H.R.P. same as benchmark 1320' Property Line Scale = 1/4" = 10' Wieser Combo Tank JB3 M B..' B-1 200' Pro 3 Area 15' below system is to Bedroom 1'�0 House undisturbed 650' 0. 40' B 0 ' 100' / B-2 100.6' 101' Grading is to be done to Well is to meet all WDNR setbacks divert run-off away from system Oak Drive At -grade System Sloping Site Cross Section and Plan View .- ---------------------- 1 It — = Plowed Mt = Clean aggregate basal area % to 2'/: in. dia. Geotextile Fabric Lateral with 2" aggregate over pipe 0 0 = 4 in. sch. 40 pvc observation pipe Topsoil Cap G r.fti Ft Lateral Invert Ft Contour . M, 101 0I F&M 0VAM Slope Observation Pipe With Cap Topsoil Cap Plowed Surface Slope Direction __♦ GENERAL INSTALLATION: The at -grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and 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 ;he palms of the hands.. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. Afterrthe topsoil cap is placed, the entire at -grade is seeded and mulched to promote vegetative grow$, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. ? 03/05 Igj page .3 ofL R& Force Main L (Lateral L Force Main Force Main 03105 lgj Pressure Lateral Layout One Lateral — End Manifold In. In. Ft. Lateral Turn -up —� f-- Threaded Cleanout Plug Long 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 q of 0 Septic -nose Tank Cross Section And Pump Performance Specifications Tank Manufactmw Tank Model Number Total Tank Capacity Max. Bury Depth Filter Manufacturer ; Fitter Model Numba Inlet Minimum Pump m%rmaoce RaryirW t3Pi1 Ft TDH Outlet Manhole 4in. 4" Above Grade With Looking Deyioe. inlet Manhole < 6" Below Oritde Sealed Watertight � � � I � Ftrtre W Wide Outlet Filter _---- inlet Boma switch 9a and Reserve C aoity Tank Vohune — QPI Dimenaion, hwhes Volume Gal. (meatus) A: - 2 alarm B 2-3 V (don) C (dead) D: � Total Pum Manufacturer Model Nutnbm 161 Alamt Manufacturer s� Alarm Model Number 5witoh Typo �!I! ?iG Total D temic Head (TDB - Feet Bleyedon Head Distal ure � Netwow :Main 1 Force Loss , v--- Total Manhole Min. 4" Above Grade Securely Mounted with Lockbig Device weather-proof runation Baas it vent Min.12" Above tirade with vat cap Elevation Ft Dieconnect Means A K :y weep .r B Hole C •ti Dottom D Q�E avvaag'ion •� �F-'-f-- GENERAL INSTALLATION: The sepWdow took is bedded and book filled in w4orda ce with the manufachaer's product approval speoifiations. Maximum depth of bury as speoified by the manufrtctomr may not be exceeded wittwut prior slpproval. Manhole coven exposed to grads have an effective koking device (pedlo&) installed. Piping at the Wet mW'atd et is of approved material, ootnrected to the tank with watertight Stooge, and laid on stabl soil to prevart setding or sagging. The force main is sleeved with 4" gab. 40 PVC to bridge the tank excavation a6d the Weave is sealed watertight. Eleotricall ice Has with NEC 300 and Comm 16.28. 02/05 Ld PW J 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. AU Models Feature; • Vortex style impeller permitting passage of solids a up to i4" (2 •(o z—� • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing n R • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1 ye" Discharge • Stainless steel bottom screen - easily removable 0 38 78 114 156 192 • Maximum fluid temperature: 140'F. Liters Per Minute 0(+7 C-APrV, Dimensional Data: 35 30 25 20 280-Series Cord Lengths Model 10' 25'(-2) 361(-3) 501-5) 280 Standard Optkotai Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional WA 287 Standard Optional WA WA 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffbc to model number. Example: for model 280 with 35' cord, order 2W-3 Motor Specifications 'A hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (2081230V) 10 lUNNiiiii ot 11 9 8 8 1 5 ■ommmra,,,;;I.m. ■■■■■moon\\■■■■ m■n■■m■n■■mam■■ r :r s Weight: 29 lbs. Height-13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281, 283...14" Model 287 VMF... 10" Factory switch Model 2810 283 Model 287 setting; VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 283 features a fully adjustable wide-angle floaL 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 VMF-Series Manual, Wide angle float switch Wide angle float switch Vertical mag- no switch with quick- with series netic float for pateerate disconnect (piggy -back) will operate In will op plug a 10" dlameter sump WT�GO% c Certified ap.N•o.um... ap•at to shove vAlhmd nodca. Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New _— York 14416 - Phone 800-543-25M Fo (585) 49 -1hic3 www.lfbertypumps.com Ailrights rt•ssrved. u.IT2000RM7 01 2o'.40048A SECTION A -A , . 8 6 C ^.: 921 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Papa,`of_ FILE INFORMATION Owner Permit # ESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units �4NA Estimated flow (average) gal/day i Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate gaildayle Standard Influent/Effluent Quality Monthly average Fats, 01 & Grease (FOG) 53o mg/L Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA Total Suspended Solids (TSS) St 50 mg/L !Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg& Total Suspended Solids (TSS) 530 mg/L A Fecal Coliform (geometric mean) 5104 cfu/1ODm 1Maximum Effluent Parlicle Size 1161n dia. ❑ NA Other. ❑ NA 'Values typical for domestic wastewater end septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity t ❑ NA Septic Tank Manufacturer P - ❑ NA Effluent Filter Manufadurer ( ❑ NA Effluent Fker Model �� ❑ NA Pump Tank Capacity get ❑ NA Pump Tank Manufacturer P _ ❑ NA Pump Manufacturer Gv ❑ NA Pump Model U O NA Pretreatment Unit ❑ Sand/Gravel Fitter O Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other. :�(NA Dispersal Cell(s) ❑ in -Ground (gravity) -Grads ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other. Other. ❑ NA ❑ NA Other: ❑ NA Service Event Service Frequency Insped condition of tank(s) At bast once every: � m a e) (Maximum 3 years) ayesr ❑ NA Pump out contents of tank(s) When combined sludge and scum equals oredhird (SS) of lank volume ❑ NA Inspect dispersal oel(s) At least once every: rr arMs(e) (Maximum 3 years) (3NA Clean effluent filter At least once every: i ❑ month 9) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ s(s) ❑ NA Flush laterals and pressure test � wary: At least once wa 7 O morrtfr(6) � e 8 ❑ NA At best once every: O❑ month(s) NA er. NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: 4tester (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Seplage Servicing Operator. Tank inspectbrts 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 (X) or more of the tank volume, the entire contents of the tank shell be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wieconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, hnd any servicing at Intervals of 512 months, 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 Page __ of _, START UP AND OPERATION POWTS check hElt For new construction, prior to use and/orthe damage the dispersal tcell(s). if high concentrations fare detected thave the rcont nts chemicals t ofthh eas may Impede the treatment porator prior to use. tank(s) removed by a septaoperator servicing p P System start up shall not occur when soil conditions are frozen at the Infiltrative surface. er levels. When power is restored the excess wastewater will by During power outages pump tanks may fill above normal highwat discharged to the dispersal ceN(a) In one large dose, overloading the cell(s) and may result In he be Servicing ackup oor r surface discharge of of fl the To avoid this affluent pump situation uconact have the contents or POWTS Maintainer to assisf the pump tank t In manually by a operating the pump l controls t rresttor to rre normal levels or within the pump tank. Do not drive or park vehicles over tanks and dispersal eels. 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, and prolong the life of the POWT$: Reduction or ellminetlon of the following from the wastewater stream may Improve the performance antibiotics; baby wipes; cigarette butts; condoms, cotton swabs; degresser•; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producgs; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails andlor is permanently takeOn O oservice omm the following Administrative shallbetaken to Insure that the system is prope y and safely abandoned in compliance with chap • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with sibil, 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 comp lien replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systemm. The replacement area and proposed o protectedstructure, lot lineturbance s and ells dFaaiillunreatoiprotect the eshould placement area will upon result In thequifled e net d setbacks soil existing end pr posed with the ruled In for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limtalions. Baiting advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. upon re of Me S a soil and site evaluation The site has not performed been locate aevaluated liable replacement to Identify ace unable replacement e aarea. nt area aisuavailable a hholding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soli absorption systems may be reconstructeds in place in effect follows that lime remove of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP O OF A TANKMBE DITHER FFICULT N UNDERR AN CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O� A PERSON FROM THE INTERIOR ADDITIONAL COMMENTS pOWT61NSTALLER POWTS MAINTAINER Name S Name — Phone Phone j = OiC SEPTAGE 8ERVICING OPERATOR PU PER LOCAL REGULATORY AUTHORITY Name Name C' f Phone Tits document web drallbd in oomplance with chapter SPS 383.22(2)(b)(1)(d)&M and 383."1), (2) 6 (3), WNoarr+ Administrstiwl Coda. WwoxWn Depertrneru or Ct wrwm SOIL EVALUATION REPORT Papa _ a_ Dmsm of Safety and &11drlpa In traardw= VA Comm 05, Wk. Adm. Code Couty Aftech ow"to Mo ow on paper not tew OW 0 M K t t InrNee In ohm. Plan must hc*+do. W not pn hod to: veraeal end hodsonw refrartoa poht MK, d ttobn and Parcel ID. percent elope, aisle or dhwolorx, ncM arrow, and Iocodon and dloteme to naarw mad. Qa a 6 30 ^WV Plaaaa prim all ln/ormadom RavNwd by W4 ►Mm" Ywwmeooe mu mewm Rw bo w.o for ..oenevy ►apow Mwoor far, e. t{At (i) (W4 • Pmpertyowrw r PmparyLeem•bn, 12 Q"/ipr YV GM LA sW i 1N SZ� T N R E ajw O 7 a I,tafrg Addrr. g � Lol M No* d 5" Nutt a C9AN Li t �. vr�pa OW11 Naareat t /47 V r_ A....p_ n �JL7 F01 m MR1MURAM��lroa" ©�, , r,J��'>f�'91J191'1l:1WmfAm /'!;�i '�R'/ r�7 mm 0PAPMN�l-TWAF?M 4o 4a®'MWMF 17■ ..- .. e•- 1432 120th St. NOW RWVnond, property owner Parcel ID R I . Pape _ d UM ,/� a° Bakrp a ❑ Pit P11 Omar? at+taoe elev. R• Horton 'lepth Dornirl tat cdor Pa&* Description. In Was" Ou. U cort Odor Depri to gird" factor In. Eliwa e1 • BOO, > 30 < 220 n rat arid TS8 >30 < 150 mp4 ' Effluent e2 • SOD. 130 fig& ud TSS <_ 30 nV 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 altemate format. please contact the department at 608-266-3151 or TTY 608-26-4-8777. SVD.93 0(R O ) Soil Test Plot Project Name Quinn Everson Address W5753 8101h Ave Bird Spring Valley Wi 54767 UCSTM #226900 Lot -------- Subdivision ------------ Date 4/5/22 S W 1/4 NE 1/4S 23 T 28 N/R16 W Township Kinnickinic ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft, Top of 3/4" pipe System Elevation TBD *HRPSame as Benchmark ST. C RO 1 NTY. SANITARY SYSTEM File #: IlJ �vui�vii Office Use Only OWNERSHIP/ADDRESS FORM Creareda/zo2t 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 Numbi Email Address Parcel Identifi�4,, (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location-�/, Azc /4 , Se T N R_W, Town of hln 17 Subdivision Plat: Lot # Certified Survey Map # Volume Page # Warranty Deed # I (before 2006)Volume . Page # Number of bedrooms Spec house O yes--o Lot lines identifiabl yes O no New Property Address gw- (Staff Initials) OFFICE USE ONLY (Verification of new address required from Community Development Department for new construction.) (Date) 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 cdd sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.sccwi.gov �4hV Wyk 1,43 TX - Vie AYt:. ` Li �• �I. .IItIl0Iti111 _, �IKiWUVIh\\UU' y: - 1NIA111111111111off 1111 y`k il rs a. I iJ1 \\ � ji,�f'.��.x �'uN11 �tN11111tllllllllllll/llll�,h tyfi �•s KY � R { ! ! 4 I }I 4 �! Q a ah-� . aoo,w wrw ma rr•�,w uw ���� r uo 3,+aOgM 4410 yld JOLT alOd7i GN0786 N N NQ MT KIZI- 4 N N N N ' MAN m �=1 -NOIlOMA19N00 3bk>jfl 9N1.G0 ► 93M 9N000d TM A MA 01 21017VtI1N0? 0310VdLI00 - 3N019 03N9VQI ,f/6- WVOZI Q#RJ1X3 .& 28RRlV6 bk?c A AlOci MW OI- QVIg 313btONC'O >I0I41 vlu ,Y- '9310N NOUVOMPIA OVIO MOd NV I" sI001W NIVW 339 o� •..n Ewa. NOLLVONf10� _Q sror.o . eaae . nrR a+aurae ' .rosa�•.wre i f.A/Rtl d rC! . W.A WaD C - �p Li Ore.W MfIi.M b1 vM�RrC...AM M. -` ` aWOeep IeCC1 AMtl r �Ir9 eM rYA.U. rgLO pr a0E rYtal� IVD• rwu ��.�..ara .arnirw TOP f JYr M!)iL GN wT WM IWNL�i, Mi Te1Q10.r aN MVrCIe I r- _ • rMfr, r MYLY1 rGR. � { — • — • — aawa n riw car.rr �ui rT-4�7.�.�.M•..row . areewrae' uw. Y OMt era e^• r �0 �� � oaa a► e�ae TOP OF PLI, M. egCF- MYe .ve..e7 rowel . rrtu F.FRn — . — . _ ♦ ra T v .�atw Srr P+WKJ� _ RTi ^ T ♦Oe0 raeral ro u.ec.r, T w• or Wu wn..n _TOP Cr M +warm ri+n ro ee re:� e. f cow.w,ecrau - _. _TOP -9Y I.Y�RD YL Fl.LR .pY. YL YYQ C � r -. ! 1 4 awnoe r enay.c rre r.�� xo.m yr roe roe. ru.er .aa+enn.n ' � } Ma n a• neo. nrv.cruRi ,w•We�aare COveem rri.. raRR rreua ■ �. _. 1 I (-� n � li �i I If I . LLM V Y �eJ TOP OF ELA6 L. L JI TQ caoeev rowwrwa.p�ro-s6 et'—'—• '-- ,.> .— xw.ao e. cownuc+w uarrwwr weswe n rrorw - CROSS SECTION A TOP TOP OF TOP CE 1 ..UW' UU u_L _ —TOP OF ®CROSS SECTION 5 ecrr� -0 3k u " �D wiswnsT Depsrtrnent d1 OIL EVALUATI R CRT Pape _ ol_ Dmssor & Safety and r ' Corn. en 86. All$ Aam Code ACsct. complete arte AVR'0'5 r, or paper not less than E 1. 1 x -. ' ' in size. Plan grist �� ` ��`�•, x rrrlude, but not 6rnfled pen'ent slope. scale or verG;al aron ' A fSM1, direction and ' nsioyi5, ice) and distance tc nes-est road. Parcee I.^ i oa a ^ ; p 6 30 —000 mm�n� tip_ !Sant all lnformatior. R wed by Date Passim •tlorrnaeor ya; pr ' inn be aces for eac rf ourpw (Pmaq Lag. a •S.Oe :'; (m):. i / ^7 f ♦ L 3 �-C� 'roparf< Downer I Properh' Lowtwn _ Goa. La SIB/ 1;4 I- SZ� TG N R E o J� 7operty Owners Mailing Address I Lot # Block # S 7 S-3 SM Subd. Narne or CSWO Oct. 41- oty Cartstrj*K Use ej;�oenoa , Number of bedrooms �_ Ca -le deriveb desigr: bay rate b oei 3aD j ❑ Rep acement CJ P -.ormmeraa - Desoibe _-- ---- _ I Prart material A lgz,'-i c.e ! / Ste„ Ficoa Plainelevation r` applicabie /✓/— canral ofl!/tC SC rt� ON r.conrnraanona: i ^ r0- Sl�sten. Type i'/ � 7 � System Elevation � i aBa*p # ❑ soriN 7 -- p Pit Ground surisce elev 10V I ft. Depth to WrAM fa J in. Sal Rate H t w DaW Dominark Redox Desrtipom Talixe , SMickre Consistence I Botmdary Roots GPD1rt Tfr#2 c�-M Ma ► JW. M0 ARIMWNMIsERMNO95 MiAJ MIWAMI ®° # ®1r Ground stsface efev./l �R DerM b Ymifkq raptor Z �. c..a e.,.d:.row,,., tam. ©® • • ... ®®®©MMOILM 11111116=1d Ijd .4M®MWooMM Ir10 Efkwt #1 s BOD. > 30 5 220 n%YL and TSS >30 f3p mpfL ' F-Mism Q : KU. < $u "WL am t bo < 3ll "WL CST Name (Please Print) ra CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address / Dat 7 Conducted Telephone Number 1432 120th St, New Richmond, WI W17 715-246-4516 Property Owner Boring # ❑1_r�� ring Plt Parcel ID # Ground surface elev/ZQ, 7 ft. Depth to Wnriting fads 3 / in. Page of METTRM ©r■ ..c mom■ c6�IC�J�'lA Iiol rM / &MPNM"M 1910M Boring # ❑ Boring ❑ Pit Ground surface slev. ft. Depth to limiting factor in. Soil Aodiration Rate ❑ Bonn° # ° Bong ❑ Pit Ground surface elev. ft. Depth to knifing factor in. Sod Aodication Rate ' Effluent #1 - BOO, > 30 5 220 mg1L and TSS >30 < 150 mgA- . EMLwt #2 - BOD, < 30 mg& and TSS < 30 nglL 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. sa61330 (RAM r Property Owner_ Parcel ID # Page _ of Boring # ❑ Boring �7 'pit Ground surface elev �! ft. Depth to limiting factor n. C•til ArWirnK..., o�._ fIFO=MMwIWARA_ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. c.,a e"•ar,-tee.,., a�ro Horizon Depth in. Dominant Color Munson Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDlff 'Eff#1 'Eff#2 Boring # El El ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Sod Application Rate Horizon 'tapth M. Dominant Color Munsell Redox Description. Qu. Sz. Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPD/ f 'Eff#1 'Eti#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg& ' Effluent #2 = BOD, 130 ntgll. and TSS < 30 mg1L 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. saD-1370 (R6w) Soil Test Plot Project Name Quinn Everson Address W5753 810th Ave Bird Spring Valley Wi 54767 U CSTM #226900 Lot -------- Subdivision S W 1/4 NE 1/4S 23 T 28 N/R18 W ❑ Boring Q Well PL Property Line BM or VRP Assume Elevation 100 % Date 4/5/22 Township Kinniddnic County ST. CROIX Top of 3/4" pipe System Elevation TBD *HRpSame as Benchmark S &dro�m couNn No. 645451 STATE SANITARY PERMIT 15,014 .�A� P�e No. OWNER PLUMBER Silptvyl Brae)dZZ6LIC.# 96n TOWN OFJt SEC 23 ,T_ AND/OR LOT 76N9 RIS—E& THIS PERMIT EXPIRES BLOCK SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit (b) The approval of the sanitary permit is based on regulations In force on the date of approval (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of ■ 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 e. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER -DATE AD ZS/ZZ UNLESS RENEWED BEFORE POST IN PLAIN VIEW T DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)