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018-2009-15-000 (2)
Wtaconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s 15 Oo (t)(m)) 'errnit Holder's Name City Village Township Lawrence & Pamela Reimer TOWN OF HAMMOND .ST BM Elev Insp BM Elev JBII Description: 98.D 1 6FAAe- 9 B1 I ANK INI-UKMAT ION TYPE MANUFACTURER y CAPACITY Septic G- l o0 0 Dosing f oY TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic Dosing 3 I t Aeration Holding PUMP/SIPHON INFORMATION m 1 , Manufacturer I f I L11TIL Gi�hT e and GPM k3�- Model Number q 9EM TDH LiftIS.3 Friction Los O.toS`� System He d •`� TDH Ft Jq,zsB ro—rcemain Lengthy? • Dia Z t% Dist to well �Z t SUIL ABSORPTION 5Y5TEM ELEVATION DATA County St. Croix Sanitary Permit No 645446 Stale Plan ID No 102202416-c Parcel Tax No 018-2009-15-000 SecuonrTown/Rangelmap No 04,29.17.999 OG 8WcH STATION 19Z4#1 EIS HI FS ELEV. Benchmark 'Dr 6.15 2- cavelit. Alt. SM Dr Luca 1.36 1 b0- toZ. Bldg. Sewer 9,5 92.5 St/HI Inlet 9 --14 9Z. 2to St1HI Outlet DI Inlet DI Bottom 13.2 ft`K Header/Man. Cis - Dist Pipe z -S I 10 Bot System Final Grade pf Cover V 13$ /vo- (,02 eV .3{ 2 IJew I' w� O 8� 2= Il o -Far ,F {ruuon*sw O B�fd%n� Se.i..� 2 o 100 . o BED/TRENCH DIMENSIONS Width t Langth / tLul t 74' No Of Trenches ?-- 7 PIT DIMENSIONS No Of Pit Inside Dia. IlLiquid Depth SETBACK INFORMATION SYSTEM TO PIL BLDG VVELL LAKE/STREAM LEACHIN CHAIUNI OR UNIT a acturer T Of System Type Y t (o1 V� t t JiL,1 17 Mo l Numb U14I Mlt$U I IVN bTb I r-m rgs iL M - crivas no�uJ Gis —► -" r/MandId Distribution ( x Hole Size x Hole Spacing Vent to Air Intake E Pipets, % 3 h Dia Length / pia Spacing SAdn L=FT. x Pressure Svztems Only xx Mound Or At -Grade Svstoms Only Ar�tz Dt t1M9{;V apth Over N Depth Over xx Depth of xx Seeded/Sodded xx Muiched Bed/Trench Center r 5 O1F Bad/Trench Edges Topsoil I I •L Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #t %mks Illoa) 2ozz 63 Inspection #2 Location: 1133 178TH ST Dc -BM 1 D--6rkcgP4F0, 66.+ ra6e. 0 '8o4;-9 Z 1 � Nn�^r Lon S1rvca-Cd and reev6tlol:shed "BM 1.) Alt BM Description = Dr Cov", - Ae wall al � 4+ ,: e� Saslzc; i°n 90A 'snai� 11ec(. 2.) Bldg sewer length = z� Bel IN nF Dr covr� - amount of cover = = )s Plan revision Required? �s Eik] No 6/b/20 3 Use other side for additional information. d q-�' ^"� SBD-6710 (R.3/97) Date / Insepctors Signature oMe ^ei -hk- loca�r'or, chanzq.d. P)Uw6N n,4y need % ,ke ran e i%>li'i�s� borrl,�q qat{ P�sA coK�vvr vQo. Sb-6 fK Vss-1j = y/60Z3 lhovin y mound -f{ta ea.s-. (4,5,o—+ n —. l Cart No 5AAI - 2 022 -316 ��" �� 0 � /*l CIF M Safety Buildings Division Countyc ^• Cam, and 201 W. Washington Ave., P.O. Box. 7162 r� r / X SanitwY Permit Number (u be filled in by Co.) Ps~I r� Madison, W 53707-7162 MAR 31 2023 / t, 1San1 t Application State Transaction Number pit^Sty In accordance with SPS 3s321(2), Kris. Aim Z o3^iission of this form to the appropriate governmental unit ',y ( — ' 3Z3 3(O2 ` QS Proiev, Address (if different bran [mailing add[ ss) is required prior to obtairike a sanitary permit_ Note: Application forms for state-owned POWTS are submitted to to. Department of Safety and Professional Sen ies. Personal information you provide may be used for secondary purposes in accordance with the Priv=- Law, s. 15-0411)(m), Stals. ` Q� ' ` ✓ �� L Application Information - Please Print All Information Property Owner's Name 0 Parcel t t/ Property Chvnneer's Mailing Address PropeM Location -79 (J f ( eGle I/ve-- t Govt. Lot -4--E---- y s' , S L/ a, ection Ci State Zip Cod: Phone Number LAJ z7 _.L. L (y mcle one) iT N; R IL Type of Building (check all that appi}) Lot V Subdivisitm Name ❑ I a. 2 Fami)}Dwelling — Number of Bedrooms Bloa- II It k ❑ Public/Commercial — Describe Use it Ciz`, of ❑ State Owned — Deszdbe Use CSM ❑ Village of Number �oNC -------� Towz of III. Type of Permit (Check only out box on lip A Complete line B if applicable) A'7a:711== ❑ Replacement Sti•stem ❑ Treammerit/Holding Tani: Replacement Only ❑ Other Modification to Existing System (eaviain) l ermit Revision ❑ Change ofPlumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Ch;ver IV. T� e of POWTS System/Component/Device: (Check all that a ly) ❑ Non -Pressurized in -Ground ❑ Pressurized In -Ground ❑ Ai -Grade 4s buao? ❑Mound <24 in of suitable sor7 Ll Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersalareatment Area Information: 1,' X3S Me cx -li, ---N> /' = 6-Sb 6 +r Design Flow (god) Design Soil Application Rme(gpdsf) Dispersal Area Required (sf) Dispersal Ares Proposed (sf) System ElcyaAon t NIL Tank Info Capacity in Gallons Total Gallons € of Units Ivlantrfa.-turer ✓ u o u o r �N u c^ u d _ e — m New Tanks Existing Tanks ... U it c - Septic o: holding Tank 00 ` (.V £ S [r (� Cc, Dosing Cnamuc 0i VIL Responsibility Statement- L the undersigned. assume responsib' ' , for installation of t OQPTS shown on the attached plans. PlutabW Name (Print) Plumber's S gnattmt I MPIMPRS Numb= Business Phone Number '11, �.� 4, k' -962 Pitmmb caress (Strew City, State, Zip Code) NU. Countv/De artment Use Only Approval El rsappmved Perini*Fee Per Date issued Iss a Agem Signim e on o. enia 2o2 DL Conditions pprova ov MSC �teU�1tII ( rtueaQ srsnaam+ra ) `^S RPaFCsten is�rwt ortbfM OSPS "4a, (jq�4��— huff 1. SffWb9gwA.ddiM.afOmpuaalai 1 ° 'VQ't-'� SD•l T-�'o "W ` t'�!r (i, MOunA�t��//�� � mxleStaNcedlnuiMalxduper MU%%T"0W prormed by pinata• f1Q:x� Y1N7"+^�• �il r' `. •.� I 2Ncetrk rogiaarts mulberta5{aYaE 'jYt�,S im�'yb1.r eoprreppkabkcaaemasnam. tf\ 1 /'_ `�' raA , S t"6 a Atta to complete plans for the Sy met and sahmirto the County onh' ontpaper not less that E it i 11 inches in size r SBD-639S (R. 11/1I) COPY COPY L ko Te a ni r� • O% 0 a w 0 M =^ A 4 d a H O a Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 March 30, 2023 CUST ID NO.: 224199 KENT HOKE PO BOX 10 COLFAX, WI 54730 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/30/2025 MUNICIPALITY: TOWN OF HAMMOND ST. CROIX COUNTY SITE: LAWRENCE REIMER 1133 178TH STREET HAMMOND, WI 54015 NE 1/4 SE 1/4 SEC 4 T 29 N R 17 W FOR: Design Wastewater Flow Value: 450 Bedrooms: 3 Limiting Factor(s): 32" Maintenance Required: Effluent Filter ' �� • Phone: 608-266-2112 Web: http://dsps.wi gov Si Email: dsps n,wisconsin.gov P Tony Evers, Governor Rzt,•...,., 5s Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-032300362-C Application No.: DIS-122258386 Site ID No.: SIT-107439 Please refer to all identification numbers in each correspondence with the Department. REVISION to POWTS-102202416-C CONDITIONALLY APPROVED DEFT' OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE COORESPONDENCE Mound 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: • This is a revision to PWTS-102202416-C — the mound has been relocated from original plan • Verify property line prior to installation and maintain proper setbacks from any neighboring wells and buildings. • Care must be taken to set the dose volume as approved in the plan design. If the minimum tether length of a single switch mechanical float does not allow the proper dose volume, two separate floats must be used. • 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. • The dispersal cell 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 dispersal cell site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. 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(l). • 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, 1(9 CeCe Rudnicki Division of Industry Services Phone: 608-400-3186 Email: elizabeth.rudnicki@wisconsin.gov Fee Required: $330.00 Fee Received: $330.00 Balance Due: $0.00 Refund Expected: $0.00 Private ®nsite Wastewater Treatment System Page 1 of 9 Index and Title Page y Project Name: %w rs Owner's Name: Owner's Address: 7 98 �E,t EG RI.JE r'i�_ z 5, W I .SYa.?.? Legal Description: /V E SE 5y R q I/ /7 GJ Municipality: Town, Village, Gity of ,(� - /�,4/*y0d0 County: Lot Number. — JS Block Number: CSM Number: Subdivision Name: /�/ll SiA£ /(�rs //33 /79 & ,i r Parcel I.D. Number: O/8 000 REVISION to POWTS-102202416-C CONDITIONALLY Pagel Index and Title Page DEPT OF SAFETY AND P OFESDSIONAL SERVICES Page 2 Plot Plan DIVISION OF INDUSTRY SERVICES Page 3 Cross -Section & Plan View Page 4 Pipe Lateral Layout SEE CO ESPONDENCE Page S Septic Tanis /Pump Chamber Cross -Section &Specifications Page 6 Pump Performance Information Page 7 POWTS Owner's Manual & Management Plan Page 8 POWTS Owner's Manual & Management Plan Page 9 Filter Information Name of Designer: /1111lk uT`, / f 6 K, Signature: License #: _ /%0- Date: IR- 3 •• _� �..,.,, �nGn�lvianual andllSPS 381-38 "Mound Compon Manual for POWTS" Version 2.1 (May 2022-2027) "Pressure Distrib 'on Component Manual for POWTS" Version 2.1 (May 2022 2027) Attachment: Soil valuation 1? no r.V a � r �e M rh a4 h 4 4 0. I EZ flow kit, slotted pipe w/water closet collar, or 3/8" dia, bar c 4; s :0 o W q H W tD, CIS X XO O � v ' Cs EF Cr 2: b El t fn O [2 m rn r® F o SOD X m Crm C.CD m `�h4 D 0 q Cr w Er us :3 -On 1 .p CD d CL O V) e a Cr O r i' (D 7 CD 11 E m O ►^� h l�� rn� a m o W 6 N W 0 1�1- [ m C: M II 03, 0 cr T z 0 < m C.0 ID to m X it it bmo) > 30 x CD 41 + C\ CD If ry > a r- -r If CD C: 0 ig to , M m m O 0 0 :2� 1; to cri 0 r- :1 0 o >Cl —Z- m 0 n -V rn a M z �mwtd N o 141- if it if if 05Z 0 =21 0) su �, 0 cn 0 k We '-01 Q-1 C) m --I,, 0 1-0 Page_ 5 of q co SE TANK CROSS-SECI[ON (DRAWINGN , voujill.) FINAI (.,PAne= MANHOLE RISER & COVER (00r SPRNPA 94M A IM 4' Min. Sch. 40 PVC Tank Vent located 12ObOve grade or 24' above Regional Flood Elevation MINIMUM OF 3' OF SUITABLE BEDDING BENEATH TANK & MAXIMUM BURY DEPTH OF 96- Anchoring of tank may be required per SPS 383-43(8)(g) Tank Manufacturer: Septic/Pump Size: 0 allons Alarm Manufacturer. Model Number: Switch Type: Effluent Pump Manufacturer. 41 rne Model Number: "?&e Minimum Discharge Rate: — -1,T 08 _GPM Vertical lift (PUMP Off to lateral invert) ............ .176 ft System head (distal pressure ell Y X 1.3 ft): 3ft ft Force main x _Z. V /100 friction factor ft Filter friction loss ft Total Dynamic Head (TDH): —4)A- 7 ft FORCE MAIN OPTIONS Daily Wastewater Flow (DWF): VS6 GPD Number of daily doses: 5. g -q, T. Force main volume: I/ _ 5 ft x /o/3 gai/ft 7 3 gal Actual dose volume: 93. ? gal - 7.3 gal = 9,./, d gal (total dose volume --Volume of force main) AQKIANC GAP GtTi��: Reserve above alarm , 2 6. q in gal (D) Alarm float above on float_. Al in gal (C) On/Off float measurement_5. G in = 93- '1 Off above tank bottom gal (B) gal (A) DOSE TANK DIMENSIONS - Length in Width in Outlet height 3.9 in Gallons/inch .74 1 9EC OA-0 9E(-(IA-RF B E a c - 9K-0M 9EC-CIA-SFS: `,_-,;11g•(30D'miN'':..-10T(21)mm) aA'(114mm), 9EGCIA•RF 11.0'(280mm) 89'(226mm) 8 `(21Amm) 9EGQM - RO'(280mm) 89'(226mm) 8A•(2Mmm) INNEEMM& 4' k N 10 15 14 s 0 UU'nU I Y-GPM "- * Franklin Electrlc IbIkIF 11OO]O 7m I mm EFFLUENT PUMPS 9 ommommmm Cover Epoxy -coated castt•fmn MechmkaBhaftseat I. Bearings Power Cord On 59 noft On3D'9[GOA;IFud%f.Q9mW b POWTS! VVNER'S MANUAL ilN MANAGEMENTPLAN Page 7 of q, FILE INFORMATION Owner L.4 cd,eyC�/�R Permit # DFURIGNPADA 7;1YY,-a Number of Bedrooms Number of Commercial Units -- Estimated flow (Ave) (100 gpd/bedroom) Design flow mv-'PN = estimated x 1.5 yr Soil Application Rate In#luent/Effluent Quality (® NA) Monthly Average Fats. Oil & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (B0175) _<220 mg/L Total Suspended Solids (TSS) < ISO mg/L Pretreated Effluent Quality (0 NA) Monthly Average Biochemical Oxygen Demand (BOD$) <_ 30 mg/L Total Suspended Solids (TSS) 30 mg/L, Fecal Coliform (geometric mean) { 10 cfu/j00mL Maximum Effluent Particle Size 1/8 inch diameter Calculations; Dispersal Unit Mfg,/Model Number: Soil Dispersal End Cap DWF - Application Rate = Area Required - EISA .To /, d = Si.So ya1. 13 NA (Dispersal Unit EISA) or (Trench Width) _ # Units or_ Total Length of Trench(s) 6 = 7.5' 0 "At -Grade Component Manual forpOiVW, (pressure or Gravity. Version 3.0 (May 2022-2027) 13 "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems," Publication 9.6 (SSVAV Manual) 13 "EZ Flow Mound Component Manual" Version 12/15/2017 (April 2018-2023) "In -Ground Soil Absorption Component Manual for pOWTS" Version 2.1 (May 2022-2027) 91 "Mound Component Manual for POWTS" Version 2.1 (May 2022-2027) 13 "Pressure Distribution Component Manual for POWTS." Version 2.1 (May 2022-2027) ® Other: least unit — .ss acaaa vuVc GYCr u mOntnS tad 3 ears START UP AI+IA E TFt�1d, 13 NA For new construction, prior to using 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. System startupshallnotoccur when soli conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports, he quantity and quality of We wastewater stream will aged the performance and longevity of your POWTS. The installation of water -saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume, Also the brine or waste from water softeners, iron removal.urtits, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this donot es include laundry waste, showers, dishwater, etc. This system Is designed to handle domestic strength wastewater; however, the disposal of food based greases, seeds, bones, and food solids, suchas those produced by garbage disposal should beminimized. Toilet oils, vegetable/fruit peels, tissue is the only be discharged into the system. Other non -biodegradable items, such as babywipes, paper that should p tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs, should not enter the system. Chemicals, such as petroleum products, paint, disinfectants, pezfie;des, antibiotics, solventc,etc.,abouldnot beflushed into thesystern becausethey can seriously damage yourPOWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle 'traffrc over all system components. Compaction ofsnow overthe dispersal unit may cause it to freeze up. drinking water supply. Maintain arco )ar steady flow byp spreading laundry Pag--8 of "U washing throughout the week. Ave oid vehicle traff-7ic over all system components. Compaction ofsnow over the dispersal unit may cause it to freeze up. INSPECTIONS ' & MAINTENANCE* Inspection shall be made by an individual carrying one of the following licenses or certifications: lviaster Plumber, M'aster Plumber Restricted Sewer, POWTS Maintainer, or Scpla-e� Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware. identify any cracks or leaks, measure thOVolulne of combined sludge and scull) and check for any backup or ponding of effluent to ill' c ground surrace and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings treater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1 /3) or more ol'the tank volume, the entire contents of the lank shall be removed by a Septagc&I'Vicilig Operator and disposed or in accordance with Ch. NR 113. Wisconsin Admin. Code. Specific servicing mechanics must be provided if vertical is >1 5 feet or if horixontal�1s >1 50 feet and instructions to be provided beloiv. The outictfilter(s) shall be inspected and cleaned to removeany accumulated solids accordingto manufacturer's specifications. Solids washed ftom the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. if an alarm sounds, contact an individual licensed to service P OWTS, There is normally a I day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABAND ]INVIE- El :1.- When the POWTS fails and/or is permanently taken out of service the 110110Ving steps shall be taken to ensure that ,he system is properly and safely abandoned in compliance with Ch. SPS383.333- Wisconsin Admin. Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings scaled. • 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 soil, gravel, or other inert solid material. CONTINGENCY PLAN: If the POWTS fails and Cannot be repaired the 110110-ing- measures have been. or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption System. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks l'i'0111 existing and Proposed structure, lot lines and wells. Failure to Protect the replacement area renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement. C3 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technolo.y a holding tank may be installed as a last resort to replace the filled POWTS. 0 N The site has not been evaluated to identify a suitable replacement area. Upon failure or the POWTS a soil and site evaluation must be Performed to locate a suitable replacement area. It'no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 Mound and at -grade soil absorption systems may be reconstructed in Place following removal of the biomatat the infiltrative surface. Reconstructions ol'such systems must comply with the rules in effiectat that time. "VARNING1111 SEPTIC, PUIMP, AND OTM:R TREATMENT TANKS iN-LAY CONTIAN LETHAL GASSES AND/OR 1NSUPITICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUWjP, OR OTHER TREATMENT TANK UNDER ANY CIRCUjw-ST'ekNCES- DEATH MAY RESULT. RESCUE OF A PERSON FROM THEINTERIOR OFATANKMAYBED[FFICULT OR iMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER blame: �'-' � 5- V—) -- - 1 /-/-40 111"a- ?,? v P � Phone: 2 - 4// 4-C SEPTAGE SER WICING OPERATOR (Pumper) 2 POINTS MAINTAINER Name: /�"� Phone: -zLr LOCAL REGULATORY AUTHORITY Name: Sr LjPhone:� 713- Me B :° I::Effluent . G Oto ilea7: To ensure your effluent filter is functioning properly, it should be inspected eve effluent filter will function for several years before cleaning is necessa clogged enough to re N Year. Under normal conditions, your g normal flows out of septic tank At a minimum, the filter should be cleaned wbeneverthe tank is pumped, rY The filter should be cleaned when it becomes Most people preferto have a septic tank service providertake care of filtermaiMenanceond cleaning. You can septic tank service provider in the yell' pages, underSeptic Tanks & Systems." or you can contact your coup health deparimetrt{�ra lists find a if You wish to inspect and/or clean your effluent %ryourself, be sure to dress ro erl , Wear full-lengthtY hit shoes, gloves, and goggles or glasses. Than follow these instructions p p Y pants and shirt, 1. Remove the access lid to your septic tank by unscrew- ing the stainless steel lid boles with hex head wrench Provided. ifyour lid is abova ground, itwill be easy to find. If it is buried below ground, find the markerthat indicates its location. 2. Remove the fitter cartridge by grasping the tee handle and lifting it out of its housing (see photo 1). S. Spraythe cartridge tubes with a hose to remove any material sticking to them (see photo 2). Ensure the three orifices in the optional flow modulation plate inside the filter are clear of any debris. Make surethe rinse water runs back into the tank; but do not allow solids material to fall into the open filter housing. 4- Firmly place the carhidge back into the housing. 5. Some effluentiutors come with an alarm that activates when the filter needs cleaning. If You have an alarm, check to make sure it is working by lifting the float with a stick. An audible ham should sound. The alarm panel is normally mounted on the side of the house or in the garage. Mote. If your effluentfilter doesn't have an alarm system and you would like one, call your local septic system installer. Record the data that you inspected and/or cleaned yourfilter on the form thatfollows. If you checked the alarm or made:any other observations aboutthe tank or system, include that information under -Notes. - Attach access lid by placing it on the riser, matching the openings in the lid with the bolt catches Insert lid bolts into catches and tighten with hex head wrench provided. housing. �•� •� „net carrrmge by Mpg it out of ft ,,,,.,,p ""urage tubes with a hose. rei".rr4r_j ROW22. M4 Fags 3 at 4 Wisconsin J)QP8TtM0adf Sel* and Profes*nal Services Division of IndLoy Sim = Page of ML EVALUATION REPORT Inaccordancewith SP8386,Ws. Adm. code cou* --I AftchcomPletaolto Plan on paper not [sea than 8 ii2xii Inchas In size. plan must Include, but ftOt UnItted t(Y, Ivattleg and hoftntaii M%11811W point (8q, direction and percent slope, Parcel I.D. scale or dimenalm, north 91TOW, and location and distance to aaamt mscL r 111983-a print all InfoTmau0ii. Rvis P r8on a 11h Tflikont — Drovids i be used for secon'da y osetl Pava Lahr a, 16, Jymp'. awad by We PWpatly (114nor Property Location QovL Lot Y, Y. S 0/ T PtOsdy Own8es M811ingAddress Lot# 810,akg y N R E (or) W -1 Subd. Naple, rosmo, StaL- 7JP Gode Phone Number city WISP ATown Nee oad I Gads derived design ilow rate GpD MCI red recOMM Idatto a Flood Plan elevation it applicabie&L ft "'M Q7, 75c, t (1-n -0- Boring Pit GmUnd surface eley/el-1. Depth tQ JIMItIng factor -EL fn. !!on D'p" Dominant In,. Textureno aietence 80�unO�w �RO DIS 0 soriog it Ground surface eiA4 Do '�th -- Wc)—r-zort T ��j CST Name, seass, -prin Addteaa W3503 Hemlock 7 15) S't 5 8 4 Depth to limiting factor In, latencD 1BOUndary jRoots "r 11umba Telsoholle N Bating 4 M7 Wg PR Dam to IlmitingfRow'. _31Z--ift. Hwlwn DOPfn iAF Damtn= Golor MILlobil Redoxoeure Qu. A---- Cor& o'clar SOIL�an Rob 62 Boundary Roots GPD Gr. Sz Sh, U: 0 C""_ i 671 1/4 Lj Boring 9 L-1 Boeing Ground Sum -ace Slev. —,ft. Dept to Jbiling factor .. j_1r, Horizon Depth Duraluntcolor I Texture Q U=re C nsistermboundary iftot AGPDI* 'Saos QU, ' Ogn4A Boring# Pit Graz nti surfaOs eim _'L. Deptil to 11MIng ft0w_ in,* Pth Red= Descriptiol —taxture Stricture = Gonslutunce Soundaq Roots GPDW In. s xunseli Qv, A7_ Cont. Col., sGr.. SE, OEM 42M - EMUSnt#1:2 SOD,> Mg 22OWqlL jand TSS> 30..; iao mtvii_ ' Efrlu6nt#2 = 800, > 30S 220 rng/L and TSS :, 30S 950 mg& L a Cl) 0 Q (D cZ5 5N G�3GCC NED 5,; SAN ZoZZ- -5ILo n.,r. , rk �'} l 422 N=Xwgmay sr., C,corx St. Croix County S Community Development Madison WI53705 P.O.Bm7162 Madiaoq W153707-7162 pra � �tMaaabar { 1to be�lyd�byCa) Sanitary Permit Application Stab Triminction MIR* m toawdaooa wil6 SPS 383.21(Z), VVia AduL Code, m6mWen d" foam to t6a appropriase Sovenammol urA n+4 Prtar ID OWMW a sen uiMy NOW f ! 0 7,-,7� Peojaet Ad&M (if diffn=1i= eri ka fie.) permit Ap otpn Aem Lor a ft.. W P01 n are uAmL1od to tba Dapaauaet of Safety and Pnbuiooai Swvlew. Personal iadi mden 3w ptv*ide mW be shed br--caft) in a000 bium witb thePdvwy law, s.13 1 XmBbft 1133 /78 r� Sr Property 9w !!a - rum / ,/ L� 1JA GF f /� !9►ELA irlNCC Preppty Ownn's Mal1Lg3 Addreaa 0/�8�-07009-/S-ddd City. soft Zip Code Phew Member dd-A f ttf W X sf�d,�� NE ST w, wade. Y T kJ It 17 E U. T W of Ba Nftg (dW& dl that apply) LA N © i or 2 Fwnflyy Dwening - Numbc efiioaroome 3 ` viokm Nam / ✓ -Deambetbe 041E SiO'r WszewTS B1od`i of f P:Z�,-d-nbe Use CSlwt Mudar of / !!'B.pdeaaaal- of m. Type of POW1'S PttrdE (Cheek dtrw -Now- oar atad at>Yatr sprillieable on Ilae A. Cbedt aue box aal iee IL Camph" 6e C A Syatea �OtyQ y0' ff�OO d �L 37� Prroaatmeot lJ>rit (cspain) �Ia-C"°'sad [3u4 & Wood bwivibal sae Deem Ty" (eapleo) (ao.m6Xal) kAmmATa C.❑ of Ptt mbw i rmafa to Prnriam Per.YiI Numbm and Due knadrv-k Laeaatla a: omp Flow WM Limp soil Applicadao DbpsaW Ana (d),5 Dispenrl Ara (t� S7atmr FJavado. VSO /,0 D• YSo I/c4.tro. Tank bidibn adoo Q ans � TOW f of NOWab �� Ualloas Uaia Q I"-C11 <r ua sanarydW 1040 — /000 / GJ(EsE,c 4,JeA. v DwaCJta.b4 — 6C0 � aA►dd V. $ aaieslpad� aaat�a r1Q.... 1Yr attic sintra M f!e atbaeiatl Niw. Pklmiar's Name (Print) Plmobe es M[PAmsQ Number Basineas Pbme Noro6er � wr K Tic 9sa- y1sS Plsanba': wddras (so,eoe, {Sty, � Zip r„�) PO. /9ex 4 eimejog, W.9 J-F7To APPr O Disapproved ParWe Fee Data �L s G � 0e / j 4 13 Oaaer aim ltea Aw De.isl V Cotditims of ApprovaVIRaimm 1br- �L ! �Or i! I r si��t SYSTEM OWNER: 1. Septic tank a11>uent filter and ,p,�j Qom' f dispersal ctll must t-V/ Cr A 17 as per management plan provided by� 2. All setback r MNt►anH must ba ma �l r(�wl " prb LS us. �nan M t� appllcablo tode%►d� � � Z T Ass& • eaaalr..r. a..&........... - • -.. j SBD-1' 98 (R. 03f21) 5 0Dj-� ~ �>^ )J'b..k !� �S¢ SA �J f nJ-r. ; � 5 /y � M .t h it 0 Opl c kk� ay Wiscqnsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 October 3, 2022 CUST 1D NO.: 224199 KENT HOKE PO BOX 10 COLFAX, WI 54730 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/03/2024 MUNICIPALITY: TOWN OF HAMMOND ST. CROIX COUNTY SITE: LAWRENCE REIMER 1133 178TH STREET HAMMOND, WI 54015 NE I/4SE 1/4SEC 4T29NR 17W FOR: Design Wastewater Flow Value: 450 Bedrooms: 3 Limiting Factor(s): 35" Maintenance Required: Effluent Filter Phone: 608-266-2112 Web: ht1P:1S1w u�.gnl Email: d.-*%4wltl,'( 11 I11 b Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS- I 02202416-C Application No.: DIS-092247108 Site ID No.: SIT-107439 Please refer to all identification numbers in each correspondence with the Department. CONDn7ONALLY APPROVED DEFT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE COOLSPONDENCE Mound 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: • 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 roiling 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. • The dispersal cell 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 dispersal cell site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • If the Force main is to be installed in the downslope area, the trench for the force main may not be wider than 12 inches per the Component Manual. • Care must be taken to set the dose volume as approved in the plan design. If the minimum tether length of a single switch mechanical float does not allow the proper dose volume, two separate floats must be used. 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 manuai(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, scats. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instai lat ion/opemtion. 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 stets 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, CeCe Rudnicki Division of Industry Services Phone. 60"0-3186 Email: elizabeth.rudnicki@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: S0.00 Private Onsite Wastewater Treatment System Index and Title Page Project Name: Owner's Name: ° � /'14 M =, Owner's Address: 798 �E,cF�ai,�E Cic. $ 3 i UCA F�/tcs [JI Sya.�.7 Legal Description: /V E SA- 9 N / Municipality: Town, �r of 14lizge, County;5- 51 r- eaorx Lot Number. Subdivision Name: Parcel l.D_ Number Page I Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page g Name of Designer Signature: Page 1 of 2 CONDITIONALLY APPROVED DEBT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES t 6 & (k SEE COF&ESPONDENCE -�s Block Number. CSM Number. /LL Side E/LNfs - 1133 /7.8 /8 - oa 9 /S- 000 Index and Title Page Plot Plan Cross -Sidon & Plan View Pipe Lateral Layout Septic Tank / Pump Chamber Goss -Section & Specifications PumP Performance Information POWTS Owner's Manual & Management Plan POWTS Owner's Manual & Management Plan Filter lnformation 'E License #: /'fib- ?�Y1-?? "Mound Comp at .. 22- r sal -j sS Manual for POW I'S" Version 2.1 (May 2022 2027) "Pressure Distn ution Component Manual for POWI'S" Versiom 2.1 (May 2022-2027) Attachment_ Soil Evaluation Report o � � �s4 L h s el �a t R S ti+ O 3y `3 �y t �Q M o� o h z r a m —co ci W C1 O a m Z j m O� o O s' A \ _ w w w w w n d n u u G w N U' m I a en a r., o r .o � Y N j 4 CL Qr � 0 :.ti; N Wl .r ,r X O 4� C w W w w w� w Q. � op O u u e u u n n tn U) ! >ID Q a a jai o� v� � m Jo 'Aum 19SW jawWm adid pwis VN MOO Z3 tm W a z a � W Q F 4 o J LL. W � U O W O J m o go r 11 z r J lei I I ti i1 N m O V + m \ r- x Z i� a 11 w Q W 0 r N 8 LU zr- O o x w o a. a z ap I p E m m Lu E n 25 U. Ael m m J N x O to 11 LL CD w J 0 w a a Page _ 5 of 9 comall N SEPTIC./DOSE TANCROSS-SECTION PRAINING NOT TO FINAL GRADE MANHOLE RISER & COVER (dope Wo-W sul" awey hnm m-hda(s) for prow dnika a) (Psr SPS 3o,4 25M & (e)• apprawd � W � dww+o reek F_+�rd adoddedryl BUILDING SEWER 4' 60L Sek 40 PVC Tads Vet ELECTRICAL i0caudtrdxwegeasorar JUNCTION BOX tvr aPs �ez.,ot„n .cw. w,ib� wood Elydder (m�o+r wl, sPs 3,es e,d NEC 300) ,_. e, r, rr f e' {Ort � • rr r, WaMIpL[ re e, r, .r r I---1 evnnl Cr st.=r Oman •...d,►� � � 4' MrL WL 44 PVC TarNa vend d"M R690W flEudEle allon FORCE �r MAIN ,4• OPTIONS �1 Faron l I . • Mike I WPM�1 LL� y� fraBAJ-�+d J .:::. c �dtaoe,.l MOM AF 9' OF SUrrABLE BEDDING BEWATH TANK a MAXIMUM BURY DtplH OF W Antirorvp of tank may be m- q * d per SPS 383.43(e)(9) .ftwfta.w AhMMM . Or Real Of Am SM., BGod Tank Manufacturer. �✓f �•ac.c i r Daily Wastewater Flow (DWF): VS0 GPO Septic/pump Size: Ooo 0o alone Number of daily doses: X, Y /8.7 i. Alarm Manufacturer. E le c.ai Model Number rTf Switch Type: Effluent Pump Manufacturer. Gi r Model Number. 3�vlinimum Discharge Rate: JS. 08 GPM Vertical lift (pump off to lateral invert) ............ _/'Y. a ft SY3teM head (dea prressure Z .f x 1.3 itk 3_ ft Ga ft Force main x !. fI /100 frlctlon bow 8 R Filter friction loss ............... — ft Total Dynamic Head (TDH)- 18 ""I ft Force main volume: CD A x . A3_ gan - 9. a gal Actual dose volume: 93,9 gal - 9 a gal = SY. / gat (total dose volume - volume of force main) DOSE TAN CAFACr s,- Reserve above alarm jo. Al in = 3W 9 gal (D) Alarm float above on float _ 4? in = 33. S gal (C) On/Off float measurement 5, G in = 91. `7 gal (B) Off above tank bottom in = 3'Y. / gal (A) DOSE K DIMENSIONS: Length --- /SO in Outlet heighl J6 ill Width 9 Y in Gallonslinch /6.744 la s-" m■�i ==I WIN - m I NWIM * 1 lr n iboftft moftl m3m i wmm%l.tm EFFLUENT PUMPS & / Oc 9 VK-ok* covir cot km cad km sted ftmcm S""s" POWTS OWNER'S MANUAL AND MANAGEMENT PLAN Page 7 of 9 FHJ WFORMATIOIN Oweer LA�,c rE E/rr�.t Pemit ik DMGN PARA1l�R'r erg Number of Bedrooms 3 Number of Commercial Units — Estimated flow (Ave) po Dedp Sow (DWF) a estimated x 1.5 y5_0 Zpd Soil Application Rate , d MXW Infltteat/E$lu c= Quality (O NA) Montbly Average Fats. Oil di: Grano (FOG) 5 30 ing/L Bioche nid Oxygen Demand (SODS) :5 220 mg/L Total Suspended Solids (TSS) :5 ISO mg/L Pretreated Effluent Quality (11111 NA) Monthly Average Biochemical Oxygm Demand (BODs) 5 30 mg/L TOW Suspended Solids (TSS) c 30 mg/L Fecal Colifam (geometric mean) r 10 cfu/100mL Maximum Effluent Particle Size IA inch diameter SYSTEM SPECIFICATIONS Septic Tam d0 gal O NAJ Septic Tank Manufacturer /if r ass. O N Effluent Filter Manufacturer OA60,ca O NA Effluent Filter Model fr6022- /yd O N Pump Tam .400 ON Pump Tak Maiusfiscturer &1fliedc O N PMMV M2110fiCtUM < rres blewr ON Pump Model 9Ee O N PrObutinmit Unit (B NA) O Sandtoravel Fib= O Mechanical Aeration O Disinfection fir. O PeatFdW O Wetlaad O odder. Model: Soil Absorption Component (O NA) O In -ground (gravity) Cl lo-ground(pressur=d) O At -grade ■ Mound O Drip -lime O Other. Vortical Distance Tank Bottom to Service pad Honzoqta1Dista=eTaqWtoSomcsPa& ft ft Gkalatioas: ungmw to URK M2VModd ]Number: O NA Soil Dispersal End Cap DM 4- ApRliration RaArea Required - IyMA So t /, d SD - DESIGN CRrrF.RiA (Dispersal Unit EISA) r T it Units or Total Length of Trenehfs) 6 I e 73 O "At -Grade Componeai Mammal fOrKWnS' (Pramwe at Gravity. Version 3.0 (May 2022-2027) O "Design of Ptanire Distribution Ndwarb for Septic Tsnk_Soill Absorption Systems." Publication 9.6 (SSWMP Manual) O'M Flow Mound Compost Manual" Version 12/15M17 (April 2019-2023) O "In-� Soil Absorption Component Mamral flat pC)W'TS- Vetsioa 21 (May 2022-2027) 10 "Mom>d Component Manual for POWTS" Vasion 2.1 (May 2022-2027) O "Pressme Distribution Component Manual for POWTS.- Version 2.1 (May 2022-2027) O Othw.. MARWERNANCE MONTTORI NG SCHEDULE - MAHWMNANCE AND MANAGEMENT Barden ltiastt Service dispeadowal clean Mier At least acre cyery 8 13 months A 3 vem O Other. R Unit Fhnh and pmwm test httasis At least once every, O months ■ 3 years O NA At least once TM. O months ®3 years D NA a t AK 1 Ur AzW VPEKABON: For new construction, prior to using do ?OWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the tutment process and/or damage the dispersal cell(s). If high Concentrations are detected have the contents of the tanks) removed by a septage servicing apessaw prier to use. Sysfes starttipira0 aatsuu wren soil oaa�ittlNs are frozen at the infiltrative surface. The property owns is responsible fof the operation and maintenance of the POWTS and submission of required reports- Tlse quantity dad quality of the wastewater sb cam will affect the pcxfotmarrct and longevity of your POWTS. The install on of watchsaving appliances and fixtures along with prompt repair of leaks redacts the wastewater volume. Also the brine or waste from water softeners, iron removal.units, other clear water trestrnent devices sad famdation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however, the disposal of food based seeds, bones, and food solids, suchas those produced by a di lfsis oils. should be discharged into the system. Other non-bi lid �°� should bemiaimizcd. Toilattiswe is the only paper that slt,oald dental floss, and motion swabs, should not enodegegmda�ble items, such as baby wipes, tampons. sanitary nVh= condoms. cigar ew butts, system. Chemicals, such as pctrolcum products, paint, disinfectants, pesticides, antibiotics. solventts,� &a-.. othoum not he A,j.h_ i ;n#_ o j._ u-- _-- -.� _ '- _.� & yam,,,, X�10.w,=o ,. J �,_•,. Wye drinking water strprty. Mamtain a regular steady flow by spreading laundry washing throughout the weds. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. drinking watuSupply. Maintain are regular flow Page 8 or 9 8u y by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components_ Compaction ofsnow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds ona-third (1 /3) 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 1 13, Wisconsin Admin. Codc. Specific servicing mechanics must be provided iPvertical is>15 feet or if horizontal is > 150 feet and instructions to be provided below. The outletfilter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturct'sspecitications.Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more lirquent intcrvats than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a I day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Admin. Code: All piping to tanks and pits shall be discormected and the abandoned pipe openings sealed. • 'Me 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 soil, gravel, or other inert solid material. CONTINGENCY PLAN: if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 9 The site has not been evaluated to identify a suitable replacement arts. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 9 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstnictions ofsuch systems mustcompl_v with the rules in effectat that time. N%'ARNING'.!!! SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTLAN LETHAL GASSES AND/OR iNSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHF,R TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OVA PERSON FROM THE INTERIOR OVA TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER POWTSMAINTAINER Name: eAE /W- 1 9 Name: t Div i�i Phone: 21T / Phone: 7'/ - 94C.2 - 5// s- SEPTAGE SERVICING OPERATOR (Pumper) Z• LOCAL REGULATORY AUTHORITY Name: Name: Phone: Phone: 7/5' 3AC - YLBn Maintenance InstructionsON =rl- 1-800-348-900 Biotube° Effluent Filter How to Clean Your Effluent Miter To ensure your effluent filter is functioning properly, it should be inspected every year. Under normal conditions, your effluentfiltor will function for several years before cleaning is necessary. The filter should be cleaned when it becomes clogged enough to restrict normal flows out of the septic tank. At a minimum, the filter should be cleaned whenever the tank is pumped. Most people prefer to have a septic tank service provider take care of filter maintenance and cleaning. You can find a septic tank service provider in the Yellow Pages, under'Septic Tanks & Systems.' or you can contact your county health department for a list If you wish to inspect and/or clean your effluent fitter yourself, be sure to dress properly. Wear full-length pants and shirt, shoes, gloves, and goggles or glasses. Then follow these instructions- 1. Remove the access lid to your septic tank by unscrew- ing the stainless steel lid bolts with hex head wrench provided. If your lid is above ground, it will be easy to find. If it is buried below ground, find the marker that indicates its location. 2 Remove the filter cartridge by grasping the tee handle and lifting it Ott of its housing (see photo 1). 3. Spray the cartridge tubes with a hose to remove any material sticking to them (see photo 2). Ensure the three orifices in the optional flow modulation Plate inside the filter are clear of any debris. Make sure the rinse water runs back into the tank, but do not allow solids material to fall into the open fifter housing. 4- Firrily place the cartridge back into the housing. 5. Some effluent filters come with an alarm that activates when the fiber needs cleaning. If you have an alarm, check to make sure it is working by lifting the float with a stick An audible horn should sound. The alarm panel is normally mounded on the side of the house or in the garage- Notw If your effluent filter doesn't have an alarm system and you would Eke one, call your focal septic system installer. 6. Record the data that you inspected and/or cleaned your filter on the form that follows. If you checked the alarm or made any other observations aboutthe tank or system, include that information under"Notes.' 7- Attach access lid by placing it on the riser, matching the openings in the id with the bolt catches. Insert lid bolts into catches and tighten with hex head wrench provided. Photo 1. Remove die filter ceit lodge by frfPong it our of Ifs housing. Photo Z Spray the cartridge tubes with a hose. mM474r-1 aft zz Ter P"O]Mf Wmwnsn Dqwtirwt of Conrnerw SOIL EVALUATION REPORT Division of Safety aria B jdngs in a0cordan0 MAIN Comm 05, Wis. Adm. Code Attach Complete s4e plan on paper not less than a 112 z 11 b%t" in stza. Plan must C4L+xy irlduds. but not limited to' vertical and horizontal ntsrence Point (SM), direction and Percent slope, scale or dimensions, north arrow, end location and distance to naaraat road. Parasf L D , Please print SM lnfornladon. Reviewed by PW W lmdm etaat you Wvvidt aruy be used br seeentmy p nom try Lair. e. 16.04 (1)(m11. mpwly owner Property Location GatrL Lot jP 114 mP*q OwnWe Ma&g Addreas Let a Z+ � I A ll � On u -A. 1� 1 l r * LL' h Ckyi l ❑ vagge Page of 7'L Zq— 15—crtr0 Date 114 Sy T'.I N R (IE w.wuuuun UEe: 1NWbWol bedoontswnAO - -- a Code derived design flow "M app ❑ Raplsmow Public Or om"morcial - Desabe; _ Parent rvwvwal Flood fn elevation K applicable R ou1wW oomm«tfs—�-------- and Mawitntsrrdesgx; System Type Boring P 0,Pil (3rotald surtax atay. � R System Elevation Deom 10 1ifkb b *v -/ I? in 0 it Ground atiiatae alev��I tt r_ A. c..,,w... 0 7 MIR N W La M I E-M! k' 4 11 =7 MA A ---. — - _- .— --- , - tummim are a tivu. 5 Ju mpiL and TSS < Jp mglL CST Name (Please Print) ro CST Number bird Plumbing, ]no. Shaun Dird 226900 Address Date Evakiabon Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 — 3; ZD 715-246-4516 Property owner ® S.tV K ❑ Boong —Pit Parcel ID 0 Ground surt" Mw.ZZ2&_L-,L Depth to ktna factrx -) m Pep of ©A w�� G�c• iRM rARfJCJ1��i,�� RUMS- rmLVIA ��a� no ❑ pit Ground uittace elev. R. Depth to WrAm factor The Depar>rttent of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need nuterial in an alternate format, please contact the department at 608-266-3151 or TfY 608-264-8777. Solt Test Plot P i Project Name Lawrence Riemer Address 950 Morgan Rd. ird River Falls Wi 54M Lot 15 5 Subdivision Hillside HeightsDat NE 1/4 SE 1AS 4 T 29 NIR17 W —. Township Hammond ❑ Boring C) Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 fL Top of 314" pipe System Elevation TBD *HRPSame as Benchmark "I -Q. �o h ••r •r r -r HL i A Ir ____-____- 5 A Q rn Rlemer Residence [111. .�..! NEW RESIDENCE! mm r � "c EAST 1 /4 OF THE NORTHEAST 1 /4, SOUTHEAST 1 /4 ALL IN SECTION 4, WISCONSIN. r2 I SCALE: 1 " 100' FM iiiii 0 25 50 100 200 � 1 723131 S.F. 9 �`c� cob / \ B o c 15 tK 91873 S. F. 2.11 Ac. A 14 \ s9 90140 S. F. \ �} 2.07 Ac. ` �cD B .M. ELEVATION = 1119.11 \ \1 13 �a - 65425 S.F. 1 �J7�= 1.50 Ac. ` N 89.06'00" W �367.43'� V t S.F. �D�°�gl 0 79,18' _ 288.25' Ac. j ,�� b.7 l B.M. ELEVATION = 1125.72P r. 75151 S.F. 1.73 Ac. ��of 1.53 Ac. LLJ 10 0 ' i ��/ i 7 68106 S.F. �i :' j r � � 67565 S.F 1.56 Ac. LIA i o 1 �f 1.55 Ac. LD k r I 5:3' 1 16 0' 0 LLJ Q Lij O rl%.i ST CRo PINTY SANITARY SYSTEM File #: Office Use 1p OWNERSHIP/ADDRESS FORM owmw2,awyOnly 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 y Lau)un ce, (-i em ems' Owner/Buyer er Mailing Address -Ict Perpnn�� ►� c, , City/State/Zip lU�%`eJr 1-- Q S . t& Z GL-i�o�� Phone Number (required) —I 195 - LA Z Lp - f MS Email Address (required) `rLy(Y'1.1 r1 em e�+r @ [Q1m c0a , Y\, 4 ' Parcel Identification Number a p I d • a� dC)q - 15 - 00 0 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location ,l/h '1/4,Sec. 1�1, T N R I W, Town of Subdivision Plat: / �� / kc� 4 h�{ hA Lot* Certified Surrey Map #_ J Volume , Page # Warranty Deed # P ] 7 & � q (before 2006)Volume , Page # Number of bedrooms _3 Spec house O yes 0 no Lot lines identifiable E3 yes © no OFFICE USE ONLY New Property Address 1 ( l { -� J -7e � .5/— (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (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 715-245-4250 Fax cdd@sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov A SEP 04 2020 FU trasoonsm Department of SOIL 14VALUATION REPORT �, t Division of Safety and Buildings 15` l j 1(t eoGOrdainG9 wittl,G�nm I , W.S. Adm. Cade Attach complete site plan an paper not less than 8 112 x 11 inches in size. Plan must r irldude. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ] percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Reviewed by Personal Wo"natan you praywe -By be used ror secandwy purpose+ (Prascy Low. I. 15.04 (1) (m)) Property Owner Property Location Cam- 2QZO S�Page of Date l � 107 f Govt. Lot N � 1 /4 :5-r 114 S T 2? N R PE Property Owners Mailing Address Lot 0 Block ft Subd. Name a Mq CS �V r-Qe� I ` :5 t City,I Ll Vlkage M�AlewConstucdcn use;gResidential / Number of bedrooms 3 Code derived design flow rate -?a GPD ❑ Replaoement Public or conxnercial - Describe: Parent mate" flood Plain elevation if applicable General oormlerMs and rroonrrwrtdetiorls: System Type System ElevationT ! _ Boring 0 Baring it Ground surface elev. �0- ft- Depth to limiting factor �(LR in. Soil Application Rate ww�= I ff -7 ffiwi@- . . RMIAMAN ■i WIN HVV � WM FMAn 7r4MWJJ M A =W4A BON fit soritlg M le it Ground surface ev L 1 f1. Depth to limiting factor -fP- in. Sod Application Rate , . MF MPIMI • M, 02MPRE M- WA / r EW WWWWNW,�I�WMMWM�- • Effluent 01 - BOO, > 30 < 220 mglL and T55 >30: 1 I-ffkM tt W.Z M t3w, IC JU UVL ana 1-Ma � JV rrcyc CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 , 5— 2-0 715-246-4516 I r Property fawner Parcel ID # Page of ❑ ® Boring � # j..pit Ground surface elev.ZAM- �. Depth W lirr*V factor 5 in. MMM= W���Wffiq �a .1111111111MMM W-A MV MM = VM. W, ARW IMI /A�rLf ffl LWA *.�Ji:A '.mil ' Bing 0 ElBo ing F� ❑ Pit Ground surface elev. R. Depth to limiting factor in. Qu. Sz. Cont. Color Bonng# ❑ Bing ❑ Pit Ground suface elev. R. Depth to limiting factor in. Snil Amlirrtirn Ratty 'Effluent #1 = BOOS > 30 < 220 mg1L and TSS >30 < 150 rngk • Effluent #2 = BOD, < 30 mglL and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sa04330(R-W) Property Owner _ Parcel ID # Page __ of ❑ Boring 13 Boring # �J�� Y l pit Ground surface eiev.6.,-t. Depth to lirtuting faG30f Soil AaDIiCBUOn Rale wa==� Cont, DescriptionRedox Color ®® M:1 Fr7! BotingOE] Boring ❑ pit Ground surface elev. It. Depth to limiting factor to Soil Ano{iration Rate Horizon Depth in. Dominant Color Munsell Reclox Description Qu. Sz. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots GPD1fl' 'Eff#1 'Eff#2 ❑ BoringBoring # Ground surface elev. ft. Depth to limiting factor h. Cl Pit Soil Application Rate Horizon ')epth in. Dominant Color Munsell Redox Description. Qu. Sz Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 'EfW • Effluent #1 = BCD, > 30 1220 mg1L and TSS >30 1150 mg1L ' Effluent #2 = 800, < 30 mg& and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TIY 608-264-8777. sao-8330(SLAM)t Soil Test Plot Pla Project Name Lawrence Riemer Sh ird Address 950 Morgan Rd. River Falls Wi 54022 Lot 15 Subdivision Hillside Heights NE 1/4 SE 1/4S 4 T 29 N/R1 7 W Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft. System Elevation TBD 100, TM #226900 Date 9/3/20 Township Hammond County ST. CROIX Top of 3/4" pipe *H R PSame as Benchmark r_� M9 Z D 0 U 4 0-4 04 aLla z` 4 H O a