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HomeMy WebLinkAbout018-2011-88-000 (2)Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) lersonal intormation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m Permit Holder's Name: City Village awusl* o0SENS I -�92 15r -,;I- SST BM Elev: Insp. BM Elev: BM Description: I wi MfbZ, , 6--P W of sysrFt TANK INFORMATION TYPE MANUFAC U'1R-E-R CAPACITY Septic Dosing _ M-D 1 t Aerat;on Holdi TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 2 1 ' S 0 I , /� /) o aI Dosing �t It It s Aeration Holding PUMP/SIPHON INFORMATION G!� Lie Manufacturer Demand �LOCLLEP- GPM 0 Model Number TDH Lift Friction Loss ISystem Head TDH Ft }-10 n .-- 3.25 o.9S Forcemain Length Dia. Dist. to Well I 2, > L Sa SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix anitary Permit No: s��- 2023 - Icy Sl2 fate Plan ID No: uJTS- 01424-6 Parcel Tax No: —20t I —w-000 Section/Town/Range/Map No: 30. 29. Q STATION BS HI FS ELEV. Benchmark &.(a Alt. BM so,", 8� Lnsr t (p.�5 10(,•1S Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. (D00 100 -5 Dist. Pipe L.oa A0( 100. 5 00.�4 Bot. System Q lP �� �` •r`o � 6. � �D0 .0 / Final Grade U-(( be « lz'+ IL& St'Cover p; c� 3•6 �' loz•9y� iiD3 BED/TRENCH Width Length No. Of Trenches PIT DIME IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 13' � ° " 131 b 1 SETBACK INFORMATION SYSTEM TO I P/L JBLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer:�/ y(� Type Of System: Lack \iP� Model Number: I n UNIT UIS IRIBUT ION SYSTEM Header/Manifold n tL Length e iDie Distribution Pipe(s) Length Dia Z Spacing x Hole Size 1 1 x Hole Spacing Vent to Air Intake SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over IJ BedRrench Center 7 ✓\uc� aK Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sod ded xx Mulched 1:1 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 91142123 - Inspection #2: 1'ILNO-L Location: 1595 32ND ST ®h (r 1.) Alt BM Description��y2� �(JtW S� 2.) Bldg sewer length=Xrsa�/I SpT 9 - amount of cover = 6) S7 CeA e Z t Pi h� - �,S �t.�, �. �-2 s (( ��- k . z 5i /3 Plan revision Required? 0 Yes M No02, �/ Use other side for additional information. __ SBD-6710 (R.3/97) Date Insepctor's Signature Cart. No. Y)ScH-40 P�pcpc �'*�• S,r: IIIIsr�(n I10- 20 of wc. (�Ne. P t.h.�c/ s1 44-'Qt44 fs t�5+��-t'r. W-V j� -� C.k2oa8 we?M-("o 5 Y1o+ '(nS�alte `WecWe I� - Ll Safety and Buildings Division County • .' P 201 W. Washington Ave., P.O. Box 7162 9 Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) t � AUG 2 8 2023 Alow `airF - it Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if diffeTrenethan mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15. 1 m , Stats. /,AA' I. Application Information - Please Print All Information t/`�" _,, Property Owner's Name G CPO .s s it 14 S. `. Parcel # ` O ^ 1 8$ - W D! 8 2RO ^ Property Owner's Mailing Address Property Location 7 Te:Z 5- 7 Govt. Lot is w /., � , ll r ,Q /., Section City, State Zip Code Phone Number L 0 LE• I" +S � Y0�3 7 F►�r � S % At Y 1' 2 7J / iY�- c,trcle one T �� N; R E or& II TT pe of Building (check all that apply) Lot # Subdivision Name s CJ 1 or 2 Family Dwelling - Number of Bedrooms S % Block VA "It l e� a C # ❑ Public/Commercial - Describe Use ❑ City of CSM ❑ State Owned -Describe Use ❑ Village of �� Number 3 II Town of M e[sNd III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. ❑ New System Repl ern nt Syste [ITreatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber [IPermit Transfer to New List Previous Permit Number and Date Issued Before ExpirationP Owner SjJ `B IV. Type of POWTS System/Component/Device: Check 1 that apply) ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation / . 4 P.t s-g 1 :X "Cre l �X50 VI. Tank Info Capacity in Total # of Manufacture Gallons Gallons Units d Z o o New Tanks Existing Tanks !ice a U v" .2 n z 7 Septic or Holding Tank w / Qi G Dosing Chamber VII. Responsibility Statement- L the undersigned, assume responsibility for installation of the POM"TS shown on the attached plans. Plumber's Name (Print) k � �. Plumber's Signature MP/MPRS Number Business Phone Number =74r9 332�- F N F' 4PR C ve �� 7 �•� IS/ 71 S Plumber's Address (Street, City, State, Zip Code) fc� T sy�3 «II. CountyTe artment Use unly Approved ❑Disapproved Permit Fee Date Issued Issuing A ent Signature El Owner Given Reason for Denial �j IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be serviced ! maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 in % I inches in size SBD-6398 (R. 11/11) m 1S y o ° N r m c D C T d ID ID w N W Y N � '� N x €� I� Q t7 f LA S M o '° / ,Y c Q o W o Q N N ob C) Z Q) w O 00 04 e b d a o Y T O � �F s c 0 0 °' ° x� 03C)3u V) KV 3zv)�o O (o ui n L i GE O M �� ri ru to p II f J _N < o` p 4-, Q a`m p 22 '—' � $ / E O O 22 O T CI� O Ln a)N L 3~ru O O 'v b L a N � � a _ 0 " L o O V O� rn / V) 0 N a D ' Q) O O O �0 0��2(n(n m� / boa � �. 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CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following re'dence: (Street address) �9 L J V S­k located at: N u)_ 1/4, �j 6_ `/4, Section _, Town 29 N, Range j W, Town of N-IO .wee Mrs , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No /' (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /,2 T D Construction: Prefab Concrete Steel Other Manufacturer (if known): .�#�-- Age of Tank (if known): An j Permit number (if known) :St r, l b -4,- () .erg (�) R L MA 11_FLdVT i-1 F (Licensed Plumber Signature) (Print Name) (Title) '?- G8 - ;7-'3�' (Date) (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 July 18, 2023 CUST ID NO.: 1330832 RYAN GARY BECHEL W 11932 560TH AVE PRESCOTT, WI 54021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/18/2025 MUNICIPALITY: TOWN OF HAMMOND ST. CROIX COUNTY SITE: STACY & ANNA GOOSSENS 792 157TH ST NEW RICHMOND, WI 54023 LOT 88 CSM 24-5637 NW 1/4 NE 1/4 S30 T29N R17W TOWN OF HAMMOND FOR: Design Wastewater Flow Value: 750 Bedrooms: 5 Limiting Factor(s): 62" Maintenance Required: Effluent Filter Phone: 608-266-2112 Web: http://dsps,wi. oovv Email: dsps(a wisconsin.povv Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-072301424-C Application No.: DIS-062330274 Site ID No.: SIT-] 18278 Please refer to all identification numbers in each correspondence with the Department. 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. • 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. • 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. • Abandon Existing System per SPS 383.33 • Puma Floats to beset and verified per approved plan. Any chances may result in pump resizine to meet TDH and GPM Specifications. • Divert surface water from POWTS Area. • 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) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • 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 POWTS Dispersal Area 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 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, Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Tim Vander Leest Refund Expected: $0.00 POWTS Plan Reviewer Division of Industry Services Phone: 608-516-6134 Email: tim.vanderleest@wisconsin.gov 44 ADVANCED E N V I R O N M E N TA L Property Owner/Client: Stacy & Anna Goossens PIN: 018-2011-88-000 Site Address: 792 157TH ST Roberts, WI 54023 FLOW.- INDEX Pg. 2 SITE PLAN Pg. 3 SOIL DISPERSAL COMPONENT Pg. 4 EFFLUENT DISTRIBUTION LATERALS Pg. 5 EXISTING TANK SPECIFICATIONS Pg. 6 NEW COMBO TANK SPECIFICATIONS Pg. 7 DOSING AND PUMP SELECTION Pg. 8 FILTER MAINTENANCE Pg. 9 MANAGEMENT PLAN DESIGN PARAMETERS Wastewater Type: Residential Estimated Wastewater Flow: 500 gpd Design Flow: 750 gpd SOIL & SITE EVAL UA TION.- POWTS Type: At -Grade Limiting Condition Depth: 62" Maximum System Depth: 26" Contour Elevation: 100.00' Limiting Condition Elev: 94.83' Land Slope: 6% Comments. County: ST Croix Pg. 10 MANAGEMENT PLAN Pg. 11 SOIL TEST Pg. 12 SOIL TEST Pg. 13 SOIL TEST Pg. 14 SOIL TEST Pg. 15 AS -BUILT EXCERPT Pg. 16 AS -BUILT EXCERPT Pg. 17 AS -BUILT EXCERPT # Bedrooms (residential) : 5 # Occupants (per capita flow) : _ Public Facility Flow: NA Treatment Level: Effluent 1 Code Required Separation: 36" Soil Texture: SIL In -situ Soil Application Rate: 0.6 gpd/ft2 Dispersal Cell Loading Rate: NA POWTS DESIGNED PURSUANT TO: At -Grade Component Manual (Version 3.0) Pressure Distribution Component Manual (Version 2.1) Replacment system for existing 5 bedroom home. No home business. No sewage ejector/grinder pump. Existing trenches to be abandoned per SPS 383.33. C O IyS�N,,�� RYAN G. --------------------------------------------------------------------------------------------------------------------- - SIGNED: 6/30/2023 ADVANCED ENVIRONMENTAL LLC W11932 560TH AVE, PRESCOTT, WI 54021 (651) 327-0074 BECHEL D-2263-7 PRESCOTT \VVI m 1S y o ° N r m c D C T d ID ID w N W Y N � '� N x €� I� Q t7 f LA S M o '° / ,Y c Q o W o Q N N ob C) Z Q) w O 00 04 e b d a o Y T O � �F s c 0 0 °' ° x� 03C)3u V) KV 3zv)�o O (o ui n L i GE O M �� ri ru to p II f J _N < o` p 4-, Q a`m p 22 '—' � $ / E O O 22 O T CI� O Ln a)N L 3~ru O O 'v b L a N � � a _ 0 " L o O V O� rn / V) 0 N a D ' Q) O O O �0 0��2(n(n m� / boa � �. O o > O a \ y a +I vim) oM �\ U °; N O U `{I o Q Q) i p c Q _ Off' CM v O 34- O / �° LL B Cl) 4,1 Ln`�° n' °' rNi n II N> OCL 3 0 co 1 ,i 'i O / // N co CL L) '-' , t \ -11�", C: N U) N Z /1-1 / m — C ? lJ l a) Ei N O I �_ N '0 N yl m w p) n V5 r 'FA A T-GRADE DISPERSAL AREA W L D1 if C✓ --r-- ��----------7-- l----, / zb/,/'f--D2 Observation D3 pipes A 10.0' B 125.0' C 2.0' D1 5.9' D2 5.5' D3 5.0' Observation Pipes (1/6th of B) 20.8' L 136.0' W 22.9' Dispersal Area Required: 1250 ft2 Dispersal Area Proposed: 1250 ft2 100.83' 101.83' 100.67' Topsoil & seed Geotextile fabric Q SD%/ CO AggM " A W 6% 100.00, OBERSVATION PIPES Screw -type or slip -top cap 4" SCH 40 PVC pipe Top of pipe to terminate at or above finished grade 4" - �, x 6'. slots spaced 90' apart Anchoring Device (Toilet flange) Observation pipe at aggregate toe Finished Grade (mulched & seeded) Topsoil cover (V minimum) Infiltrative surface Plow 6% 8" deep (min.) prior to placing aggregate D3 Page 3 / `° `° o °� �U rn� X L ° N \\ cq ° ' toto I? , N M 0 � O O 4 w R 'A (V N N v, Z_ v � O o� �0 V ate-+ +�+ ♦�.+ a j v O ci C O 4, E E E o 0 W G C C v� 3 p cx U, rk------------------------------------ o O 'le � Q ' 14ce- � N � o Cal. ' Q � O C m z � ' o 14 LZ 'Z cp a � l'V CO q ' C ' O NEW COMBO TANK SPECIFICATIONS r • Minimum cover = 6 inches; Maximum cover = 8 feet (unless specified by manufacturer) • All manhole covers shall extend 4 inches above final grade • If the tank is within 2 feet of final grade, insulate the lid to an R-Value of 10 • Minimum 18" of cover required over building sewer,' Insulate if greater > 30' long and < 42" from grade or if < 60"from grade under all high troffc/snow cleared areas (driveways etc.) • If forcemain will have a "J-Hook" assembly, drill a weep hole in the "hook" • Building sewer: No 90's, keep 3 feet between 45s, maintain 1 inch in 8 feet (1%) slope, install cleanouts at the building connection and every 100 feet at a minimum Watertight control box with 107.25' 100.70' separate pump and alarm circuits Quids Disconnect Sleeve forcemain in 4' SCH • 104.37' 97,92' 40 PVC pipe across tank • excavation to prevent pipe settling 4" SCH 40 Bldg. ewer < Effluent Filter Y 1 "-1.5" PVC Float Tree I �-- + - 120 ' 95.25' Off) (Pump Weep Hole 94.00' 4" Pump Block ------------------------------------------------------------------------------------------------------------------------------------------------- Tank Manufacturer/Model: Wieser - WLP650/1000-MR ------------------------------------------------------------------------------------------------------------------------------------------------- Filter Manufacturer/Model: Polylok - PL-525 ------------------------------------------------------------------------------------------------------------------------------------------------- Panel Manufacturer/Model: SJE Rhombus - Tank Alert 1 NOTE: Special order tank (WLP 1000/650 with inverted inlet/outlets) 8�" 34}" (2-2 Ts- ,e " (1 EA.)WLP650/1000—MR 4" CAST -A -SEAL r4' CAST -A -SEAL W It TANK SPECIFICATIONS /f a t Illl DIMENSIONS: ' " Irl I r WALL: 3" > BOTTOM: 3' i 1 mti a r� 1 COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER 'I HEIGHT: 54 1/2" 'I • 111 I LENGTH: 12'-2" � ' o it WIDTH: 7'-0- Y II llj Ir BELOW INLET: 43" IJ JYI LIQUID LEVEL 38- i}� r-----s111 --_--------__T� WEIGHT: BOTTOM 9.615 LBS. — -- --- < < k W COVER 5.325 LEIS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET ; TOP VIEW INLET AND OUTLET BAFFLE AND FILTER: i s AS SHOWN _ LIQUID CAPACITY: 26.32 GAL/IN (SEPTIC) W 17.00 GAL/IN (PUMP) N� �= < 4" VENT LOADING DESIGN: 8'-0" UNSATURATED SOIL yy C � COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) ----T s I. LET LJ W x �) v Q 0 LI z m ; I a3. -, N 5 Z N a RENEWED BY w w � -PUMP PAD RENEW DATE c~i a w � 55�yE�Co�yEW DRAWINGS SUBMITTED FOR APPROVAL a APPROVED BY: SHEET no. APPROVAL DATE: TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTSPRODLKT5 NEEDED BY:] / OF ' Page 6 EXISTING SEPTIC TANK SPECIF/CA TONS • Minimum cover = 6 inches; Maximum cover = 8 feet (unless specified by manufacturer) • All manhole covers shall extend 4 inches above final grade Watertight control boa with separate pump and alarm circuits 108.60' 107.25' \L- NV __---Clean Out ( I 104.62' —,,, r, r i 100.37' —� ---------------------------------------------------------------------------------------------------------- -Tank--Manufacturer/Model: Huffcutt - 1250 LP ------------------------------------------------------------------------------------------------------- filter - Not Applicable - Filter to be installed in second tank --------------------------------------------------------------------------------------------------------- Panel-Manufacturer/Model: - Not Applicable - -------------------------------------------------------------------------------------------------------- WARNING LABEL EMBEDDED INTO CONCRETE COVER READS AS FOLLOWS CAUTION DO NOT ENTER WITHOUT PROPER VENTILATION COULD CAUSE DEATH_DANOEROUS GAS. . NOTE- ADDITIONAL LABEL FOR GREASE INTERCEPTOR. IKORHATIOYIL LABEL READS AS FOLLOVS, r- GREASE INTERCEPTOR L_ (TOP VIEW) 29r DIAMETER CONCRETE COVER (TYPICAL) 104.37' -Effluent Filter 1 "-1.5" PVC Float Tree !SM THIS DRAVING REPRESENTS A SEPTIC TAN(. LIFTING 1000 SET F ACCESSORY #J1MR QEMtOEAKD----------------------- .------ I DIN TO, OF EXISTING SEPTIC a— TANK: SEE SANITARY I I -HILT - ,M PERMIT #515102 GAL. PCR INCH 31.06 LIQUID GAP- 1,305 GAL. I I I NA%. LIQUID CAP. • 1.367 GAL. I ( T) I I I I I_._. -._._.-.-.-.-.-._.-.-.-.-.-._.-._.I TArrLE r NOTE- ADDITIONAL BAFFLE rOR GREASE INTERCEPTOR. SECTION (TANK BASE, TOP, & COVER) DIMENSION EQUALS 1/3 LIQUID LEVEL. (ONLY rOR GREASE INTERCEPTOR) N� a` Ng 3 Page 5 N a O n O O rl VKM��Mr cn N LA ,J N N N I ' f0 f0 b ' 1 M O J L�LnI 4 en i 001 I i N M 1.- 111 in 1 q* 00 W N N C1 0) 01 01 01 _ E F- o GO 10 N O O pj O d <n C o N N C cry O Z o o o c 0 W bra O Fu bu0 N p W N m M W¢ rn Lo N M m 0 o N + U > Q O U- W W w' c W LL c Z 0 0 0 0( p" >` o Co O o QEo2 E E o'er a Cco z3 U J �_ Z N U p p O w l0 O H 'x p o LL N LM ei O N 00 M a� O N :=■■■�%%/tit ■■�%III■■■ g P- y m g a 0 0 0 1333 W U W U 00 rn 0 W xO LU 0- a X; n it POLY OK. -Inc. Innovations in Precast Drainage ®A DvAsiZ & lNasiewater Products Division of Polylok Inc. INSTALLATION INSTRUCTIONS Step 1: (A) Locate the outlet of the septic tank. (B) Remove tank cover and pump tank if necessary. 0"Certifi.d MAINTENANCE INSTRUCTIONS Step 1: Locate the outlet of the septic tank. D• 111211 15L it'll-41RIE&IU REMOVEDWHEN FILTER IS USE RUBBER GLOVES WHEN CLEANING FILTER INSTALLATION INSTRUCTIONS PL-122/PL-525/PL-625 FILTER Center filter with opening a0 w� J 7 LLO S e Additional pipe or Polylok Extend & Lok' I for centering. Step 2: (A) Before installation, place the filter housing on to the outlet pipe (B) Make sure that the housing is positioned so the filter can be removed from the tank for maintenance and service. Step 2: (A) Remove tank cover and pump if necessary. (B) Pull the filter out of the housing. (C) Hose off the filter over the septic tank. Make sure all solids fall back into the septic tank. Step 3: (A) Glue the filter housing on the outlet pipe. (B) Insert the filter cartridge in the housing, making sure the filter cartridge is properly aligned and completely inserted in the housing. Step 3: (A) Insert the filter cartridge back into the the housing making sure the filter is properly alighed and completely inserted. (B) Replace septic tank cover Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.Wag e 8 MANAGEMENT PLAN The owner of this Private Onsite Wastewater Treatment System (POWTS) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. This management plan identifies operation and maintenance activities necessary to ensure long-term system performance. Tasks that should be performed by the homeowner are identified. Professional management tasks shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code, however, it is the homeowner's responsibility to ensure all tasks get accomplished in a timely manner. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. ► Keep this Management Plan with your Septic System Owner's Guide. ► Keep copies of all pumping records, maintenance activities and repair invoices with this document. ► Review this plan with your POWTS Maintainer at each visit; discuss any changes in product use, activities, or water -use. MANAGEMENT FREQUENCY Design Parameters System Specifications Number of Bedrooms 5 Septic Tank Manufacturer Huffcutt/Wieser Design Flow (gpd) 750 Septic Tank Capacity (gallons) 1250 + 650 Soil Loading Rate (gpd/ft2) 0.6 Effluent Filter Manufacturer Best Standard Effluent Quality Effluent 1 Effluent Filter Model GF-10 Biological Oxygen Demand (BOD) 220 mg// Pump Tank Manufacturer Wieser Total Suspended Solids (TSS) 150 mg// Pump Tank Capacity (gallons) 1000 Fats, Oils, Greases (FOG) 30 mg// Pump Manufacturer Per Installer Treated Effluent Quality Pump Model Per Installer Biological Oxygen Demand (BOD) - mg// Dispersal Cell Type At -Grade Total Suspended Solids (TSS) - mg// Fats, Oils, Greases (FOG) - mg// Pretreatment Unit Description NA Max Effluent Particle Size (in) 1/8 Homeowner Management Tasks Check (listen, look) for leaks in toilets and dripping faucets. Repair leaks promptly. Regularly check for wet or spongy soil around your soil treatment area. Contact service provider if issues arise. Control burrowing animals (gophers, groundhogs, etc.) Keep bikes, vehicles, snowmobiles and other traffic off treatment area. Alarms - Contact your service professional if any alarm signals. Lint Filter - check for lint buildup and clean when necessary. If you do not have one, add one after washing machine. Caps - Make sure that all caps and lids are intact and in place. Inspect for damaged caps often. Fix or replace damaged caps. Professional Management Tasks Effluent Screen - Check and clean per manufacturer recommendations. Liquid levels - Check sludge/scum/effluent levels in all system tanks. Recommend if tank(s) should be pumped. Pump all compartments every 36 months at a minimum. Inspect tank inlet and outlet baffles (if applicable) Check drainfield effluent levels (if applicable) Verify pump and alarm system functions (if applicable) Inspect wiring for corrosion and function (if applicable) Clean drainfield laterals (if applicable) Check event counter/elapsed time meter and evaluate water usage rate compared to system design flow. Check dissolved oxygen and effluent temperature in tank. Check for surfacing of effluent or other signs of problems. Verify inspection pipes are capped and intact. Provide homeowner with list of management results and any action to be taken. Septic system replacement area: Protect secondary system site from traff1c, compaction, etc. (if applicable) ......................................................................................................................................................................................................................................... POWTS REGULATOR., Sr Croix County Zoning Office ADDRESS.' 1101 Carmichael RD, Suite 1200, Hudson, Wl 54016 PHONE: (715) 386-4680 ......................................................................................................................................................................................................................................... Page 9 STAR T-UP& OPERAT/ON For new construction: Prior to system operation, check septic/pump tanks for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cells. If high concentrations are detected, have the contents of the tank removed by a licensed septic professional prior to use. System start-up shall not occur when soils are frozen at the infiltrative surface. During power outages: Pump tanks may fill above normal high water levels for system utilizing pumps. When power is restored, the excess wastewater will be discharged to the dispersal cell in one large dose potentially resulting in overloading of the cells. Backup or surface discharge of effluent may also result. To avoid this situation, it is highly recommended to have the contents of the pump tank removed by a licensed septic professional or have a septic professional manually dose the system to return the pump tank to normal operating levels prior to restoring power. Do not drive or park vehicles over any septic system components. Do not drive, park over, or otherwise disturb or compact the area within 15 feet downslope of any mound or at grade system or secondary septic system site. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an appropriately licensed individual or business. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum, and to check for any backup or ponding of effluent on the ground surface. Access openings used for service and assessment shall be sealed watertight upon completion of service activities. Any unsound/defective access openings shall be replaced immediately. 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. Ponding of effluent on the ground surface may indicate a failing condition that requires immediate attention by a licensed septic professional. Tanks must be pumped when sludge accumulation is within 12 inches of the bottom of the outlet baffle, or whenever the scum layer is within 3 inches of the bottom of the outlet baffle. In no case shall total sludge and scum volume occupy greater than 25% of the tank liquid capacity. The effluent filter shall be cleaned as necessary to ensure proper operation. The filter should not be removed unless provisions are made to retain solids in the tank that may slough off the filter during removal. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm and should be evaluated by a licensed septic professional. Pre-treatment components shall be maintained and serviced by a licensed septic professional according to the manufacturer's recommendations. CONTINGENCYPL4NS If the septic tank, or any of it's components, become defective the tank or component shall be immediately repaired or replaced according to the original system design specifications. If a dosing tank, pump, pump controls, alarms, or related wiring becomes defective, they shall be immediately repaired or replaced with components of equal performance. If the soil treatment component fails to accept wastewater or discharges wastewater to the ground surface, it shall be repaired or replaced by; increasing basal area (if toe leakage occurs), rebuilding the component at the secondary system site (if identified), or removing and replacing biologically clogged absorption and dispersal media and associated piping. If repairs or rebuilding is not possible, a new soil and site evaluation must be performed to locate a suitable replacement area if one has not already been identified. If no replacement area is available, a holding tank may be installed as a last resort replacement POWTS. ABANDONMENT If the septic system fails and/or is permanently taken out of service, the system shall be abandoned according to SPS 382-384, Wisc. Admin. Code abandonment regulations. Requirements include: - All piping to tanks shall be disconnected and abandoned pipe openings sealed. - The contents of all tanks shall be removed and disposed of by a licensed septic professional. - Tanks shall be crushed & filled, or removed. - A septic system abandonment notification shall be submitted to the appropriate local governmental unit. WARNING/1 SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC TANK, PUMP TANK, OR OTHER TREATMENT COMPONENT UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ALWAYS CONSULT A LICENSED SEPTIC PROFESSIONAL BEFORE DOING ANY WORK. Page 10 ST. CROI LINTY SANITARY SYSTEM File #: 1 h i.�rrzrr,�ru Office Use Only OWNERSHIP/ADDRESS FORM Created212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer .S%_� /�` /y/►/�► oo S S b1 S Mailing Address 7 ?-1 Z.S 7 A e ' City/State/Zip �0�� Phone Number (required) 4 Email Address (required) Parcel Identification Number 600 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location �W1/a , RA ,Sec. OJ T N R � Town of ,io h2 dA CIC Subdivision Plat: Lot # g� . Certified Survey Map # F? p G 75- Volume ;:Z 41 Page # 6--6 3 7 . Warranty Deed # (before 2006)Volume Page # Number of bedrooms _ s Spec house ❑ yes M'no Lot lines identifiable L°lyes ❑ no OFFICE USE ONLY New Property Address (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 cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.sccw1.a0v DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-2003 WARRANTY DEED THIS DEED, made between Mindy M. Birr and Adam J. Birr wife and husband ("Grantor" whether one or more) conveys and warrants to Anna Goossens and Stacy L. Goossens a/k/a Stacy Goossens, wife and husband ("Grantee", whether one or more), the following described real estate in ST CROIX County, State of Wisconsin: Lot 88 of Certified Survey Map filed July 8, 2009, in Vol. 24 of C.S.M., pg. 5637, as Doc. No. 899675 located in part of the NW'/, of the NE'/4 of Section 30, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin; being Lots 61, 62 and 63, Plat of Emerald Acres 1st Addition. I l l l l l l l l l l l l l l l l l l l l l{ I I I I I I I 8287130 Tx:4235494 1008511 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 03/02/2015 2:35 PM EXEMPT#: NA REC FEE: 30.00 TRANS FEE: 867.00 PAGES: 1 RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parcel No: 018-201 1-88-000 Thi, is is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded casements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2015 real estate taxes. Dated this 27th day of February, 2015. AUTHENTICATION Signatures authenticated this day of 20 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Robert L. Lobery / Lobere Law Office 1521536 / alm q{� (Signatures may be authenticated or acknowledged. Both are not necessary.) wARRAINTY UEED Adam 3. Birr ACKNOWLEDGMENT STATE OF WISCONSIN COUNTY OF ST CROIX I ss. Personally came before me this 27th day of February, 2015, the above named Mindy M. Birr and Adam J. Birr, wife and husband to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public County, My Commission is permanent. (If not, e`reIaW�riIi�r : ° r ••�-• 0 ••DorpmSo Iw-2003 'ra r. •tll1s���, . �"��<dHen11��6w St. Croix County 1008511 Page 1 of 1 Wisconsin DepeA+Rent-of Safety and Professional Services Division of In t€fo�i �eipes r� 1 I SOIL EVALUATION REPORT ZQ�3— I f G5 �- JUL 1 0 2023 In�accordancewith SPS 385, Wis. Adm. Code Countv Attach completejsite plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, ST Croix but not limited td: vertical and horizontal reference 4oint (BM), direction and percent slope, Parcel I.D. scale or dimension north anr6w,'a19&Id6i#ion and Oistance to nearest road. 018-2011-88-000 oml7lunity Develop�lAii Reviewed b Date ----PteaseM eormation. Y Personal information you provide may be used for secondary purposes Privacy Law, s. 15.04 1 m Property Owner Property Location: Stacy & Anna Goossens Govt. Lot: NW �/. NE /< 30 T 29 N R 17 W Property Address Lot # Block # Subd. Name or CSM# 792 157TH ST 88 CSM 24-5637 City State Zip Code Phone Number ❑ City ❑ Village ❑■ Town Nearest Road Roberts WI 1 54023 1 1 1Hammond 157TH ST/CTY RD T ❑ New Construction Use: ❑■ Residential/Number of bedrooms 5 Code derived design flow rate 750 GPD ❑■ Replacement ❑ Public or commercial — Describe: Parent material Loess over loamy till (Jewitt sil) Floodplain elevation if applicable NA ft. General comments and recommendations: Recommend at -grade or minimum 6" sand -lift POWTS mound on 100.00 contour with 0.6gpd/ft2 loading rate. LF = 62" (Redoximorphic features) 1❑ Boring # ElBoring ❑■ Pit Ground surface elev. 98.35 ft. Depth to limiting factor 68 in. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' *Eff#1 *Eff#2 1 0-11 7.5YR 2.5/2 sil 3mgr dsh cs 3f-vf 0.6 0.8 2 11-23 7.5YR 3/3 - 1 3mabk dh gs 1f-vf 0.6 0.8 3 23-32 7.5YR 4/4 - sl 1 msbk mfr-mfi gw If-vf 0.4 0.7 4 32-45 1 OYR 4/6 - Is Osg ml cs 0.7a 1.6a 5 45-68 1 OYR 7/4 *banded sand* Ifs Osg ml gs 0.5 1.0 6 68-80 1 OYR 7/4 c1 f 1 OYR 5/8 fs Osg ml - 0.5 1.0 ❑ Boring 2 Boring # F❑■ Pit Ground surface elev. 100.00 ft. Depth to limiting factor 62 in. Snil Annliratinn Ratp Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz *Eff#1 *Eff#2 1 0-8 7.5YR 2.5/2 - sil 3mgr dsh cs 3f-vf 0.6 0.8 2 8-25 7.5YR 3/3 - I 3mabk dh gs 1f-vf 0.6 0.8 3 25-37 7.5YR 4/6 - sl 1msbk mfr-mfi gw 1vf 0.4 0.7 4 37-62 7.5YR 4/4 - sl Om mfi cw - 0.2 0.6 5 62-74 1OYR 7/4 cld 1OYR 4/6 Ifs Osg ml 0.5 1.0 *Horizon 5 wz s banded sa d CST Name (Please Print) Signature CST Number Ryan Bechel (Advanced Environmental LLC.) 1330832 Address Date Evaluation Conducted Telephone Number W11932 560TH AVE, Prescott, WI 54021 06/22/23 (651) 327-0074 za5U-0,5ju kNU4/lo) U ❑3 Boring # ❑ Boring ❑■ Pit Ground surface elev. 99.60 ft. Depth to limiting factor 65 in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots QV11MPPi1LdL1UJ1 Mdic GPD/Ftz *Eff#1 *Eff#2 1 0-12 7.5YR 2.5/2 - sil 3mgr dsh cs 2m-vf 0.6 0.8 2 12-25 7.5YR 3/3 I 2mabk mfi gs 1m-vf 0.6 0.8 3 25-38 7.5YR 4/6 sl 1 msbk mfr-mfi cw 1 c-vf 0.4 0.7 4 38-65 10YR 7/4 *banded sand* Ifs Osg ml gs 1m-vf 0.5 1.0 5 65-81 10YR 7/4 c1 d 10YR 4/6 Ifs Osg ml - 0.5 1.0 El Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Oon Mppiicaiion Kaie GPD/Ftz *Eff#1 *Eff#2 5❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 <_ 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, > 30 <_ 220 mg/L and TSS > 30 5 150 mg/L M• 1S v Est Q Cn 2 rn y W 1D M N W "yy 10 co ry N In N 0 v N \1, E ai Q V/ I"" �•' C O W c O o .off W C Q M o (n ZZ2 i `n Z L in Co U"t N O e m ' t•" o� i o g w o' .� .�i Vj J Z V) F '•� .u. E o o L E E F' E ac o g v W O •Q s o o v 0 GE O h O \ Qj O C 22ii C o N N N10 Q a $ / 3 0 ra o� f . 11 } 0 / .� \� L a chi m 5 CD 0 0 W ¢ ri Y O J c� LL // a � \ CN o oNe a // // Cori _ O; p/// m o Lr) �a''i \ 8 t m ry so CD 4 co ` X LLJ w� a)'Da) rn� o U o C ERTI FI E0 S V RVEY MAP LOCATED IN PART OF THE NW1/4 OF THE NE1/4 OF SECTION 30, T29N, R17W, TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN; BEING LOTS 61, 62 AND 63 OF THE PLAT OF EMERALD ACRES 1 ST ADDITION. OWNER SURVEYOR KERNON BAST EDWIN C FLANUM 948 LA13ARGE ROAD NORTHLAND SURVEYING, INC. HUDSON. WI 54016 P.O. BOX 14 ROBERTS, WI 54023 MmpL%v4GD L%mNt ---------------------------------- - -- ­180.03-- -- i ,�A I Q± 1 ;. t e� + 4l 0'00 pti�� qS I 71 r ��4 IIIII! I�tlf'""''III IIlII IIIII IIl1 IIIIII Ilfl If !I 899675 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 07/08/2009 11:30AM CERTIFIED SURVEY MAP VOL: 24 PAGE: 5637 REC FEE: 13.00 COPY FEE: 3.00 PAGES: 2 NOTE: THIS LOT IS PROHIBITED FROM DIRECT ACCESS TO COUNTY TRUNK HIGHWAY'TT' - 1 1'33"E 1380.66' Te6T 1a1.9s c ----T---- a� DRAINAGE AREA TO ; $ HIGH WATEIR LINE ---- 23870, I yy_e St��3ar4'W OO 4004 QID 0� a LOWEST BUILDING Z OPENING ELEVATION - - _ _ _ _ �� I •• 105500VA I L�`J� ��- .•• LOT I L�0_ 4 � I e NOTE THE PROPOSE OF THIS MAP IS TO COMBINE LOTS 61. 82 AND 63 OF THE PLAT OF EMERALD ACRES 1 ST ADDITION. NO NEW LOTS ARE CREATED BY THIS MAP I i? ems. I I �- I I N cu M I I W I CD c IV I 4 Cal i o-d_0- I F- Z Z uja I C4 I [�(Dv M / 157TH STREET ti/ � NOTE' NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE OPERATION OF THE APPROVED COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION PLAN FOR THIS PLAT. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON. OBSTRUCTING, ALTERING, FILLING, OR EXCAVATING OR PLANTING IN ANY DRAINAGE AREAS OR EASEMENTS, WATER DRAINAGE DITCHES. WATER RUNWAYS. WATER CULVERTS. BERMS OR GRASS SEEDINGS. ��\GNU\N�0. �:I.•1!1':�ry� EDWIN C. FANUN LANUJA _ # •� : 5-2s87 ^MER %%IIS sy �� � ----------------- --- U 1 � / LOT 88 _ . a- 6.66 ACRES S D 290,092 SQ.FT. M LEGEND 3/4' IRON REBAR FOUND 50 ROADWAY SETBACK LIN (UNLESS OTHERWISE SHOWN) 12' UTILITY EASEMENT CURVE DATA TABLE NUMBER C1 C2 C3 C4 ADIUS 180.00, 80.00' 80.00 80.00, CENTRAL ANGLE 94'04'23- 24'21'43' 20'59'13' 48'43'27' CHORD BEARING S42-45'48.5-W S77.37'08.5'W S54.56'40.5'W S20.05-20.5-W CHORD LENGTH 117,09' 33,76' 29.14' 66.00, ARC LENGTH 131.35' 34,02' 29.30' 68.03, TANGENT IN S89'48'00'W S89'48'0O'W S65'26'17'W S44.27'04'W TANGENT OUT SO4'16'23'E S65-26'17'W S44'27'04'W SO4'16'23'E THIS INSTRUMENT DRAFTED BY KEVIN REED SCALE IN FEET 1' — 150' JOB NO. 07-24 DATE 03.07-07 DRAWING1 Sr1 SHEET 1 OF 2 SHEETS 150 0 150 Vol. 24 Page 5637 Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code Countv Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, ST Croix but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 018-2011-88-000 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes Privacy Law, s. 15.04 1 m . Property Owner Property Location: Stacy & Anna Goossens Govt. Lot: NW % NE Y4 S 30 T 29 N R 17 W Property Address Lot # Block # Subd. Name or CSM# 792 157TH ST 88 CSM 24-5637 City State Zip Code Phone Number ❑ City ❑ Village M Town Nearest Road Roberts WI 54023 1 1Hammond 157TH ST/CTY RD T ❑ New Construction Use: ❑■ Residential/Number of bedrooms 5 Code derived design flow rate 750 GPD 9 Replacement ❑ Public or commercial — Describe: Parent material Loess over loamy till (Jewitt sil) Floodplain elevation if applicable NA ft. General comments and recommendations: Recommend at -grade or minimum 6" sand -lift POWTS mound on 100.00 contour with 0.6gpd/ft2 loading rate. LF = 62" (Redoximorphic features) F-11 Baring # ElBoring Pit Ground surface elev. 98.35 ft. Depth to limiting factor 68 in. Snil Annlicatinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-11 7.5YR 2.5/2 - sil 3mgr dsh cs 3f-vf 0.6 0.8 2 11-23 7.5YR 3/3 - I 3mabk dh gs 1f-vf 0.6 0.8 3 23-32 7.5YR4/4 - sl 1msbk mfr-mfi gw 1f-vf 0.4 0.7 4 32-45 10YR 4/6 - Is Osg ml cs 0.7a 1.6a 5 45-68 1 OYR 7/4 *banded sand* Ifs Osg ml gs 0.5 1.0 6 68-80 1OYR 7/4 c1f 10YR 5/8 fs Osg ml - - 0.5 1.0 2❑ Boring # ❑ Boring ❑� Pit Ground surface elev. 100.00 ft. Depth to limiting factor 62 in. Soil Aonlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-8 7.5YR 2.5/2 - sil 3mgr dsh cs 3f-vf 0.6 0.8 2 8-25 7.5YR 3/3 - I 3mabk dh gs 1f-vf 0.6 0.8 3 25-37 7.5YR 4/6 - sl 1 msbk mfr-mfi gw 1 of 0.4 0.7 4 37-62 7.5YR 4/4 - sl Om mfi cw - 0.2 0.6 5 62-74 1OYR 7/4 cld 1OYR 4/6 Ifs Osg ml - - 0.5 1.0 *Horizon 5 wE s banded sa d - 1-trluent ill = tlUU_ > 3(I 5 Y211 mall. and I S5 > all 5 96t1 mn/I - F-ttli lent Jp = H( 11 ) 5 311 mo/1 and I tiff 5 :it) mn/L CST Name (Please Print) Signature CST Number Ryan Bechel (Advanced Environmental LLC.) 1330832 Address Date Evaluation Conducted Telephone Number W11932 560TH AVE, Prescott, WI 54021 06/22/23 (651) 327-0074 , -t5JJU (KU4/15) Page 11 ❑3 Boring # ❑ Boring ❑■ Pit Ground surface elev. 99.60 ft. Depth to limiting factor 65 in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots aou /Appitcavon rate GPD/Ft2 *Eff#1 *Eff#2 1 0-12 7.5YR 2.5/2 - sil 3mgr dsh cs 2m-vf 0.6 0.8 2 12-25 7.5YR 3/3 - 1 2mabk mfi gs 1m-vf 0.6 0.8 3 25-38 7.5YR 4/6 - sl 1 msbk mfr-mfi cw 1 c-vf 0.4 0.7 4 38-65 10YR 7/4 *banded sand* Ifs Osg ml gs 1 m-vf 0.5 1.0 5 65-81 10YR 7/4 cld 10YR 4/6 Ifs Osg ml - - 0.5 1.0 ElBoring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Son /Appiication mate GPD/Ft2 *Eff#1 *Eff#2 5❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Son Appocation Kate GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L Page 12 -�S F A O " t iD c �..� LU . O E �O aEZ s Q y E E 000 Q h y Z h 0 O o0 E F Ell yE _ v Eay'? c0 z g v a LO N CL N O ° OC C r a o (fin W 2 Om Z Z Q i rMv co U O w N cd d1 oC in `n 00 pM 00 � ~ T a c V-d m K�E 0 3 C) o u vi J Z (n F- v u a)0 p o 0 a cn j i u M �� o / N O (Co tD II E C m (� \� o �� r ) O o �o in U /M05 N -0 p 10 22 N `D a� t0 O E B ^ -0 O ab / 3 O ry L S, O rro ,-� ate.+ B a / z o o F: Q m F _ V) V) t o 4 ` N `\ m Z) i acUa i ' oWQ �°''oo / // oY� o �. ru LL Ln E a // // // r "' . b � ,, 1 w C: 6 CL = v z m� >,=w � C O � � � � Y 0 U 0 ' . Wis-onsin Department of Commerce PRIVATE SEWAGE SYSTEM i �!y and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Birr, Adam & Mindy Hammond, Town of CST BM Elev: Insp. BM Elev BM Description: LoTG 00. TANK INFORMATION IfLEVATION DATA TYPE MANUFACTURER CAP CITY -7 Septic , � S IOU Dosing��� Aeration Holding TANK SETBACK INFORMATION ®MW- W—am® - • • . R PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Numbe TDH Lift Friction Loss Head H Ft Forcemain #Dia. Dist. to Well Cnll ORSnRPTInN SYSTFM --7,C-re St. Croix rmit No 515102 0 D No: Vo: in/Range/Map No 30.29. STATION BS HI FS ELEV. Benchmark /o-/'v gg 0.1, /00-6 Alt. BM sT M /o -d Bldg. Sewer pl /a�•9 SIMt Inlet Ht Outlet i�• D Dt Inlet Dt Bottom Header/Man 0 0 ' Dist. Pipe .v o� Bot. System Z Final Grade VII V ►- sc —BZ Vol St Colver 2 / r ./ 09.p 2.6 BEDITRENCH Width Length No. No. Of Trenches PIT DIME NS O No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 �6 i 3 SETBACK SYSTEM TO P/L BLDG IWELL KE/STREAM LEACHING M tur [1 LV INFORMATION CHAM R �1 II��U T f System YP y �On/+y ^ {/ / Model Number/ NIT IBUTION SYSTEM n •i_ ..Rt- /I- /nnA Header anifold Distri ution x Hole Size x Hole Spacing ent to Air Intake �,y. i btlr uvr, J Length Dia Length Dia Spacing SOIL COVER Y Praaarrra Swatamn Only vy Mnrrnd Or At -Grade Svstems Only Depth Over y Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center I Qy.i Bed/Trench Edges Topsoil Yes - No f ] Yes j' No i COMMENTS: (Include coded crepencies, persons present, etc.) Inspection #1:/�/ Inspection #2: Location: 792 157th Street Roberts, WI 54023 (NW 1/4 NE 1/4 30 T29N R17W) NA Lot 88 Parcel No: 30.29,17. 1.) Alt BM Description S! 2.) Bldg sewer length amount of cover 3 a� 10tk, > I9h014 L _ _ s S � /J„'- d�+d-y*�er Plan revision Required? �] Yes No / 7 I �/ G L - Use other side for additional information. z::_ _ _ 5BD-6710 (R 3/97) Date Insepct&s Signa Cert. No. CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1/4 OF THE NE1/4 OF SECTION 30, T29N, R17W, TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN; BEING LOTS 61, 62 AND 63 OF THE PLAT OF EMERALD ACRES 1 ST ADDITION. OWNER SURVEYOR KERNON BAST EDWIN C FLANUM 948 LABARGE ROAD NORTHLANO SURVEYING, INC. HUDSON, WI 54016 P-O. BOX 14 ROBERTS. WI 54023 NJ[n]PL�La44GDD L%HD�3 --------- ------------------------ m h W O Z C.T.H. 'TT' 899675 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 07/08/2009 11:30AM CERTIFIED SURVEY MAP VOL: 24 PAGE: 5637 REC FEE: 13.00 COPY FEE: 3.00 PAGES: 2 NOTE: THIS LOT IS PROHIBITED FROM DIRECT ACCESS TO COUNTY TRUNK HIGHWAY'TT' 11'33"E 680.66' 1B6T -__--- 141.93'-c N - - 180.03'.r..,__.. ).__-..-.F-`t 20.60'-- -- _ 1 E 1. DRAINAGE AREA TO �!A $ n I CL HIGH WATER LINE I y '9T/Ory�'a•�,"bS- ' gp0^1314'�N 1 `�r,'3 'ia� Lu 1 IV 7 I 20000' M' 1 �9 5 \ I L!.OD 4 69 o L OO 4 Cal i Z --- ---- 0F3'� p ---- - ----- LOWEST BUILDING I '�� JP�\ I `` O I S"' OPENING ELEVATION 1055.00�y i L LOT I dOO lI' _ z .J ----------- w d04 �� 4 40'1'V A NOTE C4 THE PROPOSE OF THIS MAP IS TO I COMBINE LOTS 61 • 62 AND 63 OF I THE PLAT OF EMERALD ACRES 1 ST ADDITION. NO NEW LOTS ARE I I�OO 4 0 0 CREATED BY THIS MAP. I j / LOT 88 a- 1$7TH STREET--_ 6 66 ACRES o D _ __.-180.03 + __ NOTE: NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE OPERATION OF THE APPROVED COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION PLAN FOR THIS PLAT. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, ALTERING, FILLING.N OR EXCAVATING OR PLANTING IN ANY DRAINAGE AREAS OR EASEMENTS. WATER DRAINAGE DITCHES. WATER RUNWAYS. WATER CULVERTS. BERMS OR GRASS SEEDINGS. EDWIN C. �s FLANUM , 3 .4' S-2487w AMERY SE` [s � > 6 ,sa [HIS INSTRUMENT DRAFTED BY KEVIN REED JOB NO. 07-24 DATE 03-07-07 CRAWING1 COSM2 ------------ ---- -- Y6' 2%.09250.FT. g M LEGEND 3/4' IRON REBAH FOUND 50 ROADWAY SETBACK LINES (UNLESS OTHERWISE SHOWN) 12 UTILITY EASEMENT CURVE DATA TABLE NUMBER C1 C2 C3 C4 ADIUS 80.00' 80.00, 80.00, 80.00, CENTRAL ANGLE 94'04'23' 24.21'43- 20.59'13" 48.43'27' CHORD BEARING S42.45'48.5'W S77'37'08.5'W S54.56'40.5'W S20'05'20.5-W CHORD LENGTH 117,09' 33.76' 29.14' 66,00' ARC LENGTH 131.35' 34.02' 29.30' 68.03' TANGENT IN S89'48'00'W S89.48'00'W S65.26'17'W S44.27'04'W TANGENT OUT SOa•16'23'E S65'26't7•W Sao 27'Oa'W SO4.16'23'E SCALE IN FEET 1' - 160' SHEET 1 OF 2 SHEETS 760 O 160 Vol. 24 Page 5637 conynair,cy.M.9ov Safety and Buildings Division Y t ` 201 W. Washington Ave., P.O. Box 7162 r / J Sanitary Permit Number (to be filed in by Co.) -On i Madison, WI 53707-7162 SC Vent s n 5 5 /o Sanitary Permit Application Sate Transaction Number In accordance with a. Comm. 8321(2), Wis. Aden Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Projedx Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provaeon in accordance with the PrivacyLaw 15. 1 m Stats. R" s. I. Application Information - Please Print All Informs Property Owner's N J U L 2 0 2009 Parcel # U, property Owner's Mailing Address PLANNING ST CROIX COUNTY & ZONING OFFICE G t �.� �P (> i, Govt. Lot r, JQLJ y., Al '_ Y., Section City, Zip Code Phone Number I41r � -- (CIICIe O T L N; RISE W II. ype of Bnikling (Check all that apply) O iC Lot # Subdivision Name or 2 Family Dwelling - Number of Bedroo S�Mrnnn�1��l Bloc �J_ ❑ Public/Commercial - Describe Use ��```��Or%'S� 1 O1 v 1 `J El City of ❑ State Owned - Describe Use ❑ Village of - CSM Number �� Z 5 Z 5 �Z 5 757 "16Town of ,N III. Type of Permit: (Cheek only oile box on Has A. Complete line B If applicable) A' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Oder Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Owner List Prewous Permit Number end Date 1uuod X- (�-{, Before Expiration IV. Type of POWTS stem/Com ent/Device: Check all that apply) 0091�on -Pressurized In -Ground El Premurized In -Ground ❑ At -Grade [IMound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdef) Dispersal Area Required Dispersal Area Proposed (tf) System 1 eviEfion VI. Tank Info Capacity in Gallons Total Gallons Manufacturer New Tanb Existing t %/1 $ � Sepdc or Holding Tsnk S Dosing Qurnber VII. Responsibility Statement- 1, the undersigned, assa pomslblllty far lestanadom of the POWrS shown on the atnehad lass. Plumber's Name (Print) Plum atute MP/161PRS Number Business Phone Number Plumber's Nam (Print) 7�ature Plumber's Address (Street, City, State, Zi /r VVIIII.. Coun /De nt Use Only Permit F%ee� Date Issued Issuing Sigtrawro I�Q�pproved ' appr $ " ' � Own t Reason ial IX C0uditi%9"%6Wgons for Disapproval7� b � t t� 1, Septic tank, efttulnt finer and dispersal cell must all be services 1 maintained �ra.1n.� e4A as per martapement plan provided by plumber. 2. AM aslbeckraquiosms nts must be maintained axes PR ap�ntass sa�sarnpaserrawas sywe sae wo>•n m .r s a rt.n.r ..v .. r•r SBD-6398 (R. 01/07) Valid thru 01109 PROJECT Adam Birr NW 1 /4 NE vas 30 /T 29 ._L P// T PLAN ADDRESS 1404 Sweet Grass Hudson Wi 54016 /R 1_ 7 W TOWN Hammond COUNTY ST. CRov MPRS Shaun Bird 226900 7/15/09 4 DATE BEDROOM CONVENTIONAL )= IN•GR06J PRESSURE CONVENTIONAL LIFT HOLDING TANK _ 1255 gallons bIOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 517 # of chambers 75 kk BENCHMARK V.R.P. Top of Ste Fence Post ASSUME ELEVATION 100' Filter BESTFilter ❑BOREHOLE O WELL *H.R.P. SameasBenchmark Well is to meet all setbacks required by SYSTEM ELEVATION 99.5/98.7/98.0 5' below qrade WDNR 180'B.M, S <<d Ctv Rd TT 580' Property Line --' i 3-3' X 102' Cells with >3' spacing Plans Designed Using Nrr•T►�s'Te>b� B-3 2%Slope Conventional Powts Manual Version 2.0 150' ents 20' IF 30' Scale is 1" = 40' unless otherwise ,,yB-2 s� noted o' 100 , 3,;q T 0 1 30' sG� L I m1Kkok� Property Line 612' Property Line """' Lven >6„uick4 Standard-W of Covereaching Chamberith 20.0 ft2 of Aream�+4' Long8ft^2/pair of end caps L� CGrade at System Elevation M N -1 ,Ln W C w p ° a L h Lcl O V ,9 a Q y VL •; H V .0 ... h � e+ C O• R � R V� 0 7 3 L ri, LO 9 C u L u C N V p y � V O p u • V x L O ^ O� V d •� V� H y u p n•� y V t" d C 'C •L ^C 3 S :: � td C 7 p r d F vF RFC,-..UyCL�y �F L v 2 i .`''. 6. •O H .u. L u � .�. Z .L. W a z a �Mmm� H O a