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HomeMy WebLinkAbout024-1033-10-200 (2)Wisconsin Department of Commerce Safety and Budding Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPrivacy Law, s,15 04 (1)(m(] Permit Holder's Name City Village Township Adam & Rachel Amaro TOWN OF PLEASANT VALLEY CST BM Elev Insp. BM Elev: D ptionIooIBM 0 o-VVC, I ANK I141-UKMA 11UM TYPE M7UFACAJRER Uiii CAPACITY Septic t G � r 1 Dosing C6N�b0 Qvk Aeration Sk -l�tJ TANK SETBACK INFORMATION L46A 4 Nn"A-- TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Un Dosing 7 v t Aeration Holding PUMP/SIPHON INFORMATION tM to cl Manufacturer Demand GPM Model Number TDH Lift Fri tion L s Syster}� He� TDH� i l Forcemain Lerllk Dia. a Dist to Wei SOIL ABSORPTION SYSTEM , ELEVATION DATA County -- St. Croix Sanitary Permit No 645465 State Plan ID No Parcel Tax No 024-1033-10-200 ! rSec tion/Town/Range/Map No 29.28.17.209E STATION BS HI FS ELEV. Benchmark Q � O�y / 100 'n ALL e U*v Bldg. Sewer 1 33 q 3 SUHt Inlet SUHt Oullet Dt Inlet DI Bottom r� '1[ l J?� 11-1 Header/Man. Dist. Pipe -„/ (� • ,r � ID f Bot. System L V O Final Grade Cover J 5 1a3.1� l� �v Ilti 1 0 0 Ic na k l (• b5 ��- o BED/TRENCH Width Length No Of ea PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth DIMENSIONS SETBACK INFORMATION SYSTEM TO P!L , JBILOG IWELL IAKEISTREAM LEACHING CHAMBER OR UNIT Manufacturer iy Sysem n+ b � Model Number DISTRIBUTION SYSTEM Header/Mandold g } I/It Len th DIa Q Distribution I I Len h 0 - Dia 5 m Le gth Q I �t l g 7Sze, �7 7 t( x Hole S cin t lVenl to Air Intake SOIL COVER x Pressure Systems Only xx Mound Or Al -Grade Svstems Only n. i nt. , .Mt lruJ Depth Over t\ Depth Over �� xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center .1161}� Bed/Trench Edges Topsoil ? I 1r Yes No Yes No COMMENTS: (Include code discrepencies. persons present. etc.) Inspection #1: Inspection #2. Location: 188 17DTH ST — C��a�no�+'1VA �� tt�`—/�..�ypyv� dowI 2.) Bldg ewer ength =spy O� `��v""" 11`(VSI�t ,_1\1 amount of cover w"A 'AA' Ott 06 I k VV t.AQ Plan revision Required? Yes No I$ �]�, Use other side for additional information. _ _ _ _�0_�_ , ! __ 11 I OlY Date n e r•s Signature Cen No SBO-6710 (R.W97) •V i .'� 48n Madison Yards Way ' `'.� 4. = •. t•� � pC.� t tv ��t nudism, w153705 P.O. Boo[ 7162 Ptatait way (to be mlad : y co.) `� .,•;. C�fl�'�0OQ e��p� Msd0.R►I53 I ��5#��� ernait Application SUM ii'°"`t'°°� In accordance with VS 3U.2 i Adta. Code, whmissim of this form to the unit is requited prior to obtritting a sadtan, pt,®R Mole Appiicadw firms for sta,00w pOWPS are sobauittad to the Dgmrtmant of Selbty and PtollemimW Sow - p �- C Project Addrcas (if ttilltttmtt dom mailing thddtea) pamnal ion you provide may be used for secondary PUQXM ;n accotdaooa with the Privacy Law. f is LAK1*4 Stet: Pkm h'fet s/ /g8 / 74 � Sr, Proparty reidirt•aitjw- Nim- Ptttccl M &,0A.Vf ICA�N�4 A A.cv QaY-/033-/o-.26o Property Owner's Mailing Address Property Location 3 y90 �E.IOEEK �, 4I.irr /a City, Stale GuvL Lot 1jdE.e v��s L�J1:76-10(10.72 p Code PboaeNoaba 77'1 yoa- SSt I - Y" /YE Y, seetim IT. Type of BuMug (check an that apply) Lot! 8 /T ©t of 2 Family Dwelling -- Number of%&ootm Gii p¢.t bsti. T ai R Subdivision Name Lll t li&Commercial — DeswlbeUsc BiOdt 0 �` fate OvAlcd — Describe Um ty of CSIrt Number 3 o - G 7,7 iitlme of t ��� p (�C ; O own of SAdr UAt6EY III Type of PQgr! g I`m�h: ((3wk doer `clew- or "Replacement" and other applieabie am 1lae A. Cho& aaee baz en Mw B. Cat a lice te. pkte Ilne C if "- x ew System s Yam Other Modification b Existing System (explain) ddirianl P[eaeuasdst Unit {explain) & ❑liatdiwg Tank [n.Gry[md QA[�lrade X Mo®d (moo lsedividual Site Deem Otter Type C. IZ=Flb- �Rerisim0 of Ptoo bee Drsfer to New P�tovs Pe®t Nt®bor and Date Issued IV. D I rrftttrsaot Area and Took Information: / Dart now (god) Design Soil Appliotea Rale(lFsd/s Dispersal Area RapioW (,sf)u 134coal Area Ptopoaed (slj System Efenatioa Gad /.o capacity Goo 6aa /6/.17 Tank lafbin atron Calloosm tdar 7aa� Taal To Gallons f of Units IVEsnaBamer ' " d Bas+ � F-ro tf e r e � 4 [.l o a, 3 '43 °' lidil.ti3rst[ >�mg at.,trw aSo _ 1 Sc G%�E S ER Lc.u. E rE t- m L6 4 ZLO V. ResponslbUlty Stashes T the aade[sipna, asstsee ty for insbMadm of l t rages atraw Plumber's Name {Print) w tie`,C+'�� =PM1u-Zmb-&r'— MPftAWM Alus6er Busoen Ptrwc Nt®beeNA' ELK ��/�((�C/CCJ Phanbees AM— rc. _. r � �— . _ ,?3!�!L 71'i Z77- ," IF- Ar 7¢ ter. ore S w e GJI Sfr73 coon use Approved ❑ Permit Pee L art: }� D sl¢Agehu Sips�rrte 0r 0 su Conditions o !�I OWNER:%7(i¢�flS� I'�1s+L Septic tank, effluent filter and dispersal cell ' 4` Ut `Ch�S 4-( �� t must be serviced 1 maintained as per ) management plan provided by plumber. Oil setback requirements must be maintained as Pal applimole IV i 10 �� l tee systers sad saaper iob to the C-0ty only m peat I.w than a to , 11 leer! in the A02.SBD-6398 (R 03121) O'l S. 0 Q N. w GQ Pal G Wisamsin fkpamarl of Safely and Prufcrsional Services - `� ,�• Division of lnduslry ,ScMct.s 4822 !\Sadism Yards Wa} , _ - PO t3ox 7302 = � IP Madison. WI 53707 October 18, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-10-18 Plan Review: PVVTS-102202608-C JOHN PELKE N6298 State Highway 25 Durand WI 54736 SITE: Adam & Rachel Amaro 188 - 170th Street Town of Pleasant Valley St. Croix County NE, NE, S29. T28N, R17W Total Amount: $250,00 Phme. 608-266-21 t 2 Wetr help d,p, m uo% Email' d,p,u %%I.curl,nt grn Tow.,Evers, Governor Dan Hereth, Secretary Cond,f—dfly APPROVED DEPT OF SAFETY AND PROFESSIONAL %&Rvtc&s DIVISfON OF INDUSTRY SERVICES SEE CORRESPONDENCE FOR: Description: Four Bedroom Mound System , Sloping site Mound Component Manual - Version 2.1 (May 2022-2027), 600 GPD, 16" depth to limiting factor, Maintenance required, Effluent fitter, New construction 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 10%1.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or worts at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. 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. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),'Wis. Stats. • A copv of the approved plans, specifications and this letter shall be on -site during construction and Men to inspection by authorized representatives of the Department, which may include local Inspectors. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M Swim POWTS Plan Reviewer Dept. of Safety & Professional Services Division of Industry Services (608)789-7892 RleL- I :IT �) Pmate Onsite Wastewater Treatment "i'v1steill Index aiu: 'i'lle P:.Ls: Pluiccr Samc Q%vf)e:.,s Namc- Owner'3 Address 7,7 Tuwii, County bl.hA Subdivision Namc. CondWonally P'-Irce" 1 APPROVED DEPT OF SAFETY AND PROFESSIONAL njc.� aml TRI IC PA".. SERVICES DIVISION OF: INDUSTRY $GRVICrSS ?nge P�u, P!z-n CrOSS Seccloli &- 'Plan -,'tciv SEE CORRESPONDENCE 'age ;'Inc 1-,atcra: LLN,-!li-. page PLL-11;) (JMtPt%C7 lurnp Performance Inio)miaizoll flnge TIQW7S & -)Wl N-lourd c-oniPoiicnt Man"for PON%7S Vcxslon -Pre*surr i)iitnburion Com"rent manta i,-,r i Nla,, 202." ,\uac,flrllc.lI p.),o. soil T-vall-larior, Pep"n Page 1 of 2 Private Onsite Wastewater Treatment System Index and Title Page Project Name: I f c,vEc rY.fo- Owner's Name: It" Owner's Address: 3Y8a Zdcf4EFN �L, 61vir /O IVE4 F.•« s 77Y Y66 - SSL I Legal Description E E wQ ,figN / 7 Municipality: Town, VUlage, C4 of t E,f SAA r lI,iciFr County: S r, L-aa,x Lot Number. a? Block Number: CSM Number. 30 - 67,rd Subdivision Name: 7o C^' Sr. Parcel I.D. Number. a J3 - a - Page 1 Index and Title Page Page 2 Plot Plan Page 3 Cross-Sccinon & Plan View Page 4 Pipe Lateral Layout Page 5 Septic Tank / Pump Chamber Cross -Section & Specifications Page 6 Pump Performance Information Page 7 POWTS Owner's Manual & Management Plan Page S POWTS Owner's Manual & Management Plan Page 9 Filter Information Name of Designer. .Toh+.v /lr L K r Licensc #: IVW- Signature: am Datc: 9-079 -.7a.2 2 VeSI ua o thc hollgw-inR POWTShollow-int Manual "Mound Component Manual for POWTS" Version 2.1 (May 2022-2027) "Pressure Distribution Component Manual for POWTS" Version 2.1 (May 2022-2027) Attachment: Soil Evatuation Report Z K V V Yi 4 a tia o n h V V . r� ,VL "= v Rlb au 43 4-1 +J 4J 41 w w w w w ��j%4)id O M W a m %� I Y c ` m � x x O O — � m � n N n m 1. W �. c 0 a Q — n O o o � z D O � o O �00 �� LU 0 �— En �x ' Z a � V O in Q o a EC— m � � n ao � S 0 0 V y -P -0 V 4-1 4J 4-JI 44 44 W W W 44 44 n II 11 II If If II II �c g� Ui o C � $ T �eq �P .BIE to '�e110-r lasalo JaleWm adld PeAQIS 'U5I MOD Z3 a > o v U w C C C G n Ik a II 11 Q II 4 +> 4J u 4J w w 4.4 w a H 0 M �' a- x r°z a X X _r a s o s >o s�o / m ' K► A> 1 X X � 4J/ z w Lli a_ ill a O ti O a 0 0 o K J Q (n m w Z J O 0 w Q w 2 J o U. uj % fn w o c 41 z a C7 u v � ')f II Qw O = n O to O x v � � E u Q o la p Il V4 y J W F- to _ ui ui q z w a 0 It w N m `m - m � J J x u w � J >o 1L1 a � a Page .f of COMBINATION EPTIC/D TANK CROS TI N (DRAWING NOT TO SCALE) MANHOLE RISER 3 COVER FINAL GRADE (par SPS 384-25(7) a (8). approved {,rope grorrrd wrfwm avmy rrom48bow bcturrg Berke, 3 warning label: Extend m-*vW&) for prop- drainage)mard�oia dear as necessary.) A' mhn. Sch. 40 PVC Tank Vent ELECTRICAL k3caW 12' above grade or 24' k. 40 PVC Tank Vent JUNCTION BOX �'g Reg nnat F4md EevM= BUILDING SEINER2' abom grade or 24' „ o SPS 316 J Qper SPS 382.30(t 1)) gbnat Flood Bwalion {mid NEC 3001 MAraior_� s 6 cover BOTTOM OF W&Er f—v" rvarc: j—Lr3- _�\ i,wr«rrr IM11—� , .rsj br-/o r WET p Appfwed EOWWO Fa` prr«o+y "ParW@Bes a.qr d On aura —WIN MUM I ME�teld� M AMW OF 3- OF "TABLE BEDDM BENEATH TANK & K&J IMUM BURY DEPTH OF BB - Anchoring or tank may be required per SPS 383.43(8)(g) Tank Manufacturer: 4)14sE-C 6° jz,-. SepticJPump Size: _ Zf SO / 7So gallons Alarm Manufacturer: I. ear-d•s Model Number. irfMK �Act.er ! Switch Type: ,Yf"✓A."gA& Effluent Pump Manufacturer: r i-x u Model Number: /51 1p_'Minimum Discharge Rate: .3y 32 GPM Vertical lift (pump off to lateral invert)............ /0.7 ft System head (distal assure ?. S x 1.3 ft): 3. .?S ft Force ma' x j. L 1100 friction factor . 6 ft Filter friction loss- ft ....................... "' Total Dynamic Head (TDH): /f , d ft 0 FORCE MAIN OPTIONS t��ir \1A main any 602Md .rwr nx vEN Fboal On Rant Of Roar ae.. • 3LE■ Daily Wastewater Flow (DWF): GPD Number of daily doses: S. ,2 Force main volume: r7f ft x , /l'J gaUft = y. / gat Actual dose volume: //?,3 gel - Y./ gal gal (total dose volume - volume of force rnaln) DOE TANK CAPACI Reserve above alarm 3o. 6 in = 11913 2 gal (D) Alarm float above on float ? . in = 31. ^7 gal (C) on/Off float measurement 7 Y in = //9. 3 gal (B) Off above tank bottom 8 in = _ Z�j gal (A) DOSE TANK DIMENSION:. Length_ in Outlet height $_ in Width 8.1 in Gallonslinch /6. /l P- w 50 PUMP PERFORMANCE CURVE MODEL 15111521153 GALLCM -- UTeRS4 G-- ,C C T20 ,eo Zio z4;0 no m r:OtYPet MWItE O"Mm CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available • Electrical alternators, for duplex systems. are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. Double piggyback variable level float snitches are available for variable level "and short cycle controls. • Sealed Qw1k-Box available for ouldoor installations. See FM1420. • Over 130°F (54°C) special quotation required. 15111521153 Series 16IM52H53 MODES f:mrrsl SalacSorl Iledel--rllb4►�'A M6d6 Mips '. SieP1Q��Du11L- NA 5 1 60 7 aN 151 115 _Non 1 A4so eD trldlydad _2or3 2 or 3 E151 230 1 Non ' 12 1 2 0r 3 BE151 230 1 AM 3.2 hduded 2 ar 3 N152 - 115 1 - Non 8-5 t 290 BN152 6 1 Auto es YN1bd 2 0r 3 E152 231] 1 Non 4.3 ! ( 2 Or 3 BE152 230 1 Aft 4.3 k,ckrdtd 2 ar 3 41 11 5 1Non 10,3 Ior3 BN t 53 115 1 1Wto� 10.5 M1tltp6ri 1 ar J E153 230 1 I Non 53 1 203 BE163 230 1 I Aab 5.3 WaLANd 2 or 3 SL�C.^TiOI� n,iirF 1. Single piggyback variable level kQt switch or double pippybaek variable level float switch. Refer to FM04T7. 2. See FM0712 for mrred rrn 'al of EWcLncal Attemata E-PWt- 3 Vanable evel control s ft 10-0743 used as a control acshow. spa* duplex (3) or (4) noel system - alp it,flettelloo 0 corlrols Proteelia• xrc» and ,w+,eyl snc_i n t. 1"13rj C%mtrrw A vlw-v.ed rta ►.vet, "dta a+k kj C. •vJpwen� �e.;...o�w ,•,. I'll" reCW N1111afW :e60M IN :.act Cult::, N .•C_lrnr4: 1, :+rMt1, rf,; Act Q.%iAi. TOTAL DYNAMIC HEAD/FLOW AL DF 9 PER MINUTE ✓-- EFFLUENT AND DEWATERING MODEL 151 152 153 Fat Recces Gs, lien Get. U10115 (eel uwg 6 15 50 lag 69 261 T7 70 291 tD 1 3.0 46 171) 61 231 265 4 e 36 144� 29 170 j 20, 61 231 OIL f M IF52 197 25 TA 16 61 34 129 42 150 30 9.9 - - 23 87 33 125 35 ID? - - - - - - - 22 a5 40 12.2 11 42 ShAmA Dead. 30 6 1 m 38a 11 am 44 R 13.4m) Model 151 - 4rvr 374 + St •- �+ �_ - , 3,74 u - 1 146M Models 1521153 r � l - i I � I - - 4 rs'1e l y� - Il'T� '' 5 1 s SK2444 "Easy assembly' i \ ` I pump id 17iSCS-w awe `.t not rKh4W.l 1 OPTIONAL PUMP STAND P'N 10-2213 Reduces potential dogging by debris. Replaces rocks or bricks under the pump. Made of dtrabte, nOnClDrrosive ASS - Raises pump 2' off bottom of basin Provides U1e ability to raise intake by adding sections ol 1Y,' or 7 PVC piping. Attaches securely to pump. Accommodates sump. dewatering and effluent applications. NOTE: Make sure float is free from obstruction. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyrlflht 2UO8 Zoeller Co All rights reserved. S K:J6, POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner p n f I A4f/Et A Permit # Calculations: Soil /DVIF j Ayplication rate `60 -- /Q — Dispersal End Cap Area Required - ETSA Goo - epticTank � /E ,c Gx4. NA Effluent Filter Manufactura ES it ❑ NA E�uent Filter Model A-/o NA pun Tank Ca aci 7�e NA D....,., -r."t, Mmmifar-4 rer AIfAr5AA ❑ NA Model 5.2 ❑ NA treatment Unit ( ® NA) Sand/Gravcl Filter r ❑ Peat Filter Mechanical Aeration 0 Wetland Damon ❑ Other. Soil Absorption Component ❑ In -ground (gravity) ❑ At -grade (❑ NA) ❑ In -ground (pressurized) ® Mound ❑ Dispersal Units --- Matrufactunr ❑ Aggregate Cells) Model (Dispersal Unit EISA) or (ImUdLW # Units or Total_ Lcttath ref Trcnch(sl '3Vl\ VLYliiiYla ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "TCC Flowtech Mound Component Manual" Version 1.2 Cl "EzFlow Mound Component Manual" Version 12/15/2017 ❑ SBD - 10954-P (R-1/12) "At -Grade Component Manual Using Pressure Distribution" Version 2.0 ❑ SBD - 10705- P (N_01/01) "In Ground Soil Absorption Component Manual" Version 2.0 IM SBD - 10691--p (N,01101) "Mound Component Manual" Version 2.6 ❑ SBD - 10657-P (R.6199) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10706-P (N.01/01) -Pressure Distribution Component Manual" Version 2-0 ❑ Other - MAINTENANCE MONTTOMG SCHEDULE - MAINTENANCE AND MANAGEMLN-1 Service Event Servke Fr tie PumWinsped s inspect dispeold cells clean filter At ]east once 13 months R 3 years ❑ Other - cpptrp omit At least once months ®3 ears ❑ NA Flash and M=R1 a test laterals _ At least once . ❑ months 3 ears NA gJAM UP AND 01PERA11ON: For new construction, prior to use of the POWTS check treatment tank(s) for the presence of panting products or other chemicals that may impede the treatment process and/or damage the dispersal eell(s)_ If high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are from at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of rognircd reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POW M The installation of water -saving appliances and fixtures along with prompt repair of leaf rednees the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation 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 wastVWattr, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal show be minimized Toilet tissue is the only Paper that should be discharged into the system. Other non -biodegradable items such as baby wipes, ta*nponZ, sanitary napkins condoms, cigarette butts, dental floes, and cotton swabs should not eater the system Chemicals such as petroleum products, Paint, Page 7 of 9 disinfectants, pesticides; anlibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water.supph . Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle Iraffic over all system cumpancnts. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS St -IAINTENANCI~: Inspection shall be made b an individual ca Y trying one of the following licenses or certifications: Roaster Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attachccl Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or teaks, measure the volume of combined sludge and scum and cheek for any backup or ponding of effluatt to thr ground surface and test all electrical equipment such as pumps and alattns. 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. Whets the combination of sludge and scum in any tank exceeds one-third (113) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operarnr and disposed of in accordance with Chapter NRl 13, Wisconsin Administrative Code. The outlet filters) shall he inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from 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 POVV"I'S, 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 dxvcllmg 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 Administrative Code. - All piping to tanks and pits Shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septagc Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, travel or other inert solid material. CONTINGENCY PI AN: If the POWTS fails and cannot be repaired the following tnt:asures have been or must be taken, to pmvide a code compliant replacement systen: 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 render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. 0 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, X The site has not been evaluated to identify a suitable replacement area, upon failure of the POWTS a soil and site evaluation must be pertortned to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace Litt failed POWTS. X Mound and at -grade soil absorption systems may be reconstructed in place following removal of the hiomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES Alta/OR INSLIFFIC_IENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name TOArN IE[KE Phone s' SEPTAGE SERVICING OPERATOR Punt rl Name Phone POWTS MAINTAINER Name Phonc 7i S _ 6 yj - ".i I LOCAL REGULATORY AUTHORITY A enc Sr CAarX ' ,ey ►doolrr Arvrieex u r Phone 7/1 396 - f4CS6 Papa 8 of 9 fb F,�j 7 C^ S T 7 N Grp rd rp �D �4 rJ It !C fll Vi rr � any° a c� 3O O L %-C: b .. Ila L'- ., Ceti i 7,°c,' u A s ►' a s a ^ v i x 3$tiVIn o I!) i m n cn b n^ o u O 6 7 C- o1 O. O C O G N `C _ •c c J O O - n 7 - ro a n � � C 00 R Ss ° . p O l i A ro �^"1f W Division ofIndusby Servicas and Profeasi0nal Services SOIL EVALUATION REPORT In s000rdance with SPS 3B5, Wia Adm. Coda County Attach corrode site plan on paper not leas than a 1/2 x 11 inches m Moe. plan must inckl ST Croix but not Waited to: vertical and horizontal reference point (BM), direction and pervert slop,, Parcel I.D. scale or dimensions, north arrow. and location and distance 110 nearest road. 024-1033-10-200 Mae* print aI iMormanon- Reviewed by paw 1d2 Date - -- - - Lew IL' 04 1 m Prnperry Owner Adam Amam Property Location: Govt Lot NE `/. NE Y, S 29 T 28 N R 17 W Property Addrem Lot # Biodr # Subd. Name or CSM# 188 170TH ST 02 CSM 3MT26 City State Zip Code Phone Number ❑ Cihr ❑ Village 0 Town Nearest Road IMnnrnonod IN 1 W15 (774) 400-5W1 I PieMW Valey 170TH ST E New Cron ion Use: Reddm*W / Nrxnbar0f bedrooms 4 Code derived design flaw rats SM GPD ❑ Replacerrt # ❑ Pudic Of commercial — Describe: Parent malerid Loess over loa^ry till (Froea- sl) NA FioOdpdn elevation x appinble n General Comments and reoommerldatforls: Raoownwd nAMMM 2r smm6-IMt POWTS rnawnd cn 100.00 C0n10ar wih 0.4ppdW inaa•q raw LF -,Ir (RedmworpNe %Oka a) ' Max Gr wM drrausm, Dad o.can.nmd.o am to PndWWdrly w *'WU awrfd WAUM are a*aurbm sock. aBoring # ❑ Baring Pit Ground surhos elev. 99.10 ft. Depth to IIrrlldng factor 16 In. Sol Amlication Rate Horizon [-Dj� Dominant Color MANN l Redox Desaiption Qu. Az. Cant Color Texture Structure Gr. Sa Sh. Corte Boundary Roofs GPD/Ft' •Eff#1 •Eff#2 1 (540% rock) 0-8 7.5YR 3/4 _ 1 2Prosbk n* ce 2rlrvf 0.6 0.8 2 8-16 7.5YR 5/4 - I-d 2fabk Mfi 98 1m-vf 0.4 0.6 3 18-211 T.5YR 6/4 red 7.5YR 5M a 7.5YR mi 1d 1CW* gs 1vf 0.4 0.7 4 27-U 7.5YR 4/4 c2f 7.6YR a+s a 7.5YR 611 st 1 Cabir _mfl mfi 9w - 0A 0.7 5 34-46 7.5YR 414 co 7.SYR &a a 7zm art ed Om mfl - - 0.0 0.0 F2 ❑ Boring pit Ground surface elev. 98.30 IL Depth to Iwnitiny factor 18 in. Horizon Depth In. Dominant Color Munaall Redox Description Qu. Az- Cont Color Tvxlurs Structure Gr. Sz. Sh. Conmisnce Boundary Roots • PWAPFICaluon rare GPD/Ftr •Efl#1 •Eff#2 f (sto% fod) D-9 7.5YR 3/4 - I 1 nu bk dah-dh Cs 2m-vf 0.4 0.6 2 9-18 7.5YR 514 - d 2fabk mn 93 1 f•vf 0.4 0.6 3 18-29 7.5YR 5/4 red MYR 44 A 7.m tin cl 1 mabk mfi gs 1 Vf 0.2 0.3 4 2943 7.SYR 5/4 c1d 7.5YR 44 a 7.M 5/1 d Om mfl - - 0.0 0.0 ___ -__-_ CST Name (Please Print) --- --- .--... -.....v, n--uvv Signature -w+-n 1aof 1OJ- 11a 1�7U L Ryon Sochal 949 CST Number 1 7330832 Address 779 Spring Creek RD S. Red who, AAN 55066 Dale Evvkmtion Telisphne Nun ber OW21/22 (651) 327-0074 bou-cm; (M04/15) ElBoring N ® P Gmund wrfwa e1w. 100.00 IL Depth to limifirg factor 22 in. Horizon Depth In. Dominant Color ktK*d Radox Description Ou. Am Carts_ Color Taxm+e Strt,cture Gr. Sz. Sh. Corm atence Boundary Roots boll APPOCOW Rate GPD/Fe 'ERNS 'EffN2 t (s to% Mal 2 0-9 9-22 7.5YR 4/3 7.5YR 5J6 - - I I I nubk 1 f-mabk dsh-dh dh cs 93 2m-vf 1 f-vf 0.4 0.4 0.6 0.6 3 22-36 TM 514 nd 7.SYR 44 a IF-" sn I-d 1 mabk mfr-mfi 9w - 0.2 0.3 4 36-45 7.5YR 414 ct d 5YR are a 7.5YR 62 q Om frlfi - - 0.0 0.0 Boring 9 ❑ Borky ❑ Pit Ground surface elev. 1t. Depth to ftft g lector in. Sod Application Rate Horinon Depth I Dominant Color Red. Description Texhrre I Stn tw, Conelsience Boundary Roots GPD/Fe In. filurtser Ou. Az. Cont Color Gr. Sz. Sh. •ERN1 'EffN2 F] Boring N 1:1 Boring El Pt Ground surhwe. dev. rt Depth to Ornftktg factor im ' Efl ua M R1 = BOD. > 30 s 220 nV& and TSS > 30 s 150 nVL ' Effkient 02 = BOD. > 30 s 220 mg(L and TSS > 30 S 150 mg/L ST. CRo NTY SANITARY SYSTEM File #` S!20'? 1. : , Office Use Only OWNERSHIP/ADDRESS FORM CnraW Za021 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 Pro e�rty Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Adam & Rachel Amaro Mailing Address 3480 Aberdeen Place, Unit 10 City/State/Zip River Fats, W1,54022 rlIV1�IC IVUifmbef (required) 17741-4nt -5561 Email Address (required)-adam d,anlarO@gmail.com Parcel Identification Number 024-1033-10-200 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Prop" Lnration NE i/, , NE ,�, . Sec_ 29 T 28 Subdivision Plat: CSM 30-6726 024-2019 Certified Survey Map # 30-6726-PLEASANT VALLEY Warranty Deed # 1157657 1 Nur-nber of bedrooms 4 New Property Address ( to Initials) N R 17 W, Town of Pleasant Valley Lot # 2 OF , Volume . Page # 6726 before 2006)Volume . Page # Spec house ■ yes 0 no Lot lines identifiable ■ yes Q no s Nerific ion of new address required from Community ueveiom pment Department for new construction.) 2Z (Date) OFFICE USE ONLY �-olf' ST , This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. tIaw stein: iircivcrc with tails tzflrm a iecordrd i�viiur3i J f `f ' f -a =-- r.r._ —:cr_a ]i ! y d£z,, iiOr`i7 the �i�ytSr2i Oi c�e2d5 r�urid u cvNy' Ol tr�r ccr erJreu survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-46BO St. Croix County Government Center 715-245-4250 Fax sdl@sccwi aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwigov l 12 Or x 11'- i' BR MBR "O FAMILY 12-8a i6' 16-WX177 s �i • - ON a DINING I � GARAGE 21 s x 23.7 56 0 Redefining the Building Experience IFComstock Model N234R BR3 LS 12-0'x I1' 1' Main: 1 674 Sa. Ft. Total: 1 574 So P. sOCKke relm Orgom?O 481 `0 j e9 D 51\vj �Wisgonsin Departtnorto,, essional Se"s Page 1 of Division of Indust OIL EVALUATION REPORTCrp1x�pullt�o a�a with 5PS 385. Wis- Adm_ Cade Attach complete site inches in size. Plan must includebut STounty Croix not limited to: verrence point (BM), direction and percent slope. Parcel I.D. scale Or dimensions, location and distance to nearest road. 024-1033 10 200 Please print all Information. a ewed by Da rDt�Q A Personal information you provide may be used for secondary pur=poses Pnva Law. s 15.04 1 m Property Owner Property Location: Adam Amaro Govt. Lot NE /4 NE /. S 29 T 28 N R 17 W Property Address Lot Block # Subd Name or CSM# 188 170TH ST 02 CSM 30-6726 City State Zip Code Phone Number ❑ City ❑ Village ❑■ Town Nearest Road Hammond WI 54015 1 (774) 400-5561 1 1 Pleasant Valley 170TH ST ❑■ New Construction Use: © Residential I Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercJal -Describe: Parent material Loess over loamy till (Freeon sit) Floodplain elevation if applicable NA fi. General comments and recommendations: Recommend minimum 20' sand -lilt POWTS mound on 100.00 contour with 0 4gpd/fl2 loading rate LF - 16- (Redoximo"ic reatwes) "Max 6 wide cistribution bed recommended due to predominanty weak -structured surface and subsurface soils a Boring 0 ❑ Boring 10 �6, ❑■ Pit Ground surface elev. ft. /�/ Depth to limning f or __I 6Z,AS& x i I Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr Sz Sh. Consistence Boundary Roots GPDIFt' •Eff#1 'Eff#2 1 (5.10% rock) 0-8 7.5YR 3/4 1 2f-msbk mtr cs 2m-vf 0.6 0.8 2 B-16 7.5YR 514 I-cl 2fabk mfi gs 1 m-vf 0.4 0.6 3 1 -27 7.5YR 5/4 f1d 7 SYR_Q3.3.ZSYR611 sl lcabk mfi gs 1v! 4.4 07 4 27-34 7.5YR 4/4 c2f 7.5YR 5I8 6 7 5YR 611 si 1 cabk mfi gw 0.4 0.7 5 34-46 7.5YR 414 c2f 7.5YR W 8 7 5YR 5/2 scl Om mfr 0.0 0.0 2❑ Boring # ❑ Boring ❑■ Pit Ground surface elev. 98.30 ft. Depth to limiting factor 18 in Snit Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff81 -Eff#2 1 (5-10%rock) 0-9 7.5YR 3/4 - 1 1msbk dsh-dh CS 2m-vf 0.4 0.6 2 9-18 7.5YR 5/4 - d 2fabk mfi gs if-vf 0.4 0.6 3 18-29 7.5YR 5/4 f1d 7 5YR 416 b 7 5YR 6N CI 1 mabk mfi gs 1 of 0.2 0-3 4 29-43 7.5YR 5/4 c1d 7.5YR 416 3 7 5YR 511 cl Om mfi 0.0 0.0 CIIItlCI11 #I - Owu. I ova ccV 11 al Ir.l - - .ry a ­W rrr �•••.-v... ..- ---. -- - --- - - CST Name (Please Print) Signature CST Number Ryan Bechel 1330832 Address Date Evaluation onducted Telephone Number 779 Spring Creek RD S. Red Wing, MN 55066 09/21/22 (651) 327-0074 cnn o��n rolLfH l:� n A+8 Boring # ❑ Bocutg ❑■ Pit Ground surface eles. t 00.00 ft. Depth to limiting factor 22 in. .^nil Annlirafinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPD1Ft' 'Eff#1 'Eff#2 1 (5-10%rock) 0-9 7.5YR 4/3 1 1msbk dsh-dh cs 2m-vf 0.4 0.6 2 9-22 7.5YR 5/6 - I if-mabk dh gs 1f-vf 0.4 0.6 3 2 - 6 7 5YR 5/4 f1d 7 5YR 416 8 7 5YR 611 1-cl 1 mabk mfr-mfi gw 0.2 0.3 4 36-45 7.5YR 4/4 c1d 5YR 518 8 7 5YR 612 Cl Om mfi 0.0 0.0 4] Boring # ❑ Boring ❑ Pit Ground surface elev ftDepth to limiting factor in. Snil Annlirafinn Rate Horizon Depth In Dominant Color Munsell Redox Description Ou Az Cont. Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPD/F1' 'Eff#1 'Eti#2 5 Boring # ❑ Boring ❑ Pit Ground surface elev. fl Depth to limiting factor in. Rnil Annlirafinn Rafe Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az Cont Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPDIFI' 'Eff#1 'Eff#2 Effluent #1 = BOD. > 30 5 220 mg1L and TSS > 30 5 150 mglL ' Effluent #2 = BOD. > 30 5 220 mg1L and TSS > 30 5 150 mg/L M F-3-1 Boring * Boring v m Pit Ground surfaceelegy 100.D0 ft- Depth to limiting factor 22 in. Snil Annliratinn 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 (`r10%TOO) 0-9 7.5YR 4/3 - 1 1msbk dsh-dh a 2m-vf 0.4 0.6 2 9-22 7.5YR 5/6 - 1 If-mabk dh gs if--vf 0.4 0.6 3 1 2 - 6 7.5YR5/4 fId7.5YR4A&7.5YR8/1 I-cl 1mabk mfr-mfi gw 0.2 0.3 4 36-45 7.5YR 4/4 cld 5YR 518 d 7.5YR 8/2 cl Om mfi - - 0.0 0.0 4 ] Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Snil AeeiVatinn Rate Dominant Color Munsell Redox Description Ou. Az. Cont. Color F5 ] Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Annliratinn Rai., Redox Description ` Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 s 150 mg/L • Effluent #2 = BOD, > 30 s 220 mg/L and TSS > 30 s 150 mg1L vi `a qA� � H F C pig[ s + + + 1 o m + + + + 1 +! �, .__ + + + Ln+ v 8+ ! arn> Qom + ! + 1 Q + W ! 0' _ + o 4 �1A 1+ roLn Cv o0 + + o N � N C 10 N T. t a > C EL Sc Qt Nci 1� O i ASA pp� OD f0 � N sF., g 1S HIOLT n > I" I" I S LU q 5 W 2 vn/ r� l � � o i ZZ d bUZm N 7 N 0 4p a ~ G O W N 0 I- II ri o Q ^. E N J Z In CADJ , � 1 / I f 1 f I I . I M o s aV i o z — —-i Lj\ III sr 0 \0 86 (a) Certified Survey Map Timothy R. and Wanda S. Wells The Northeast % of the 1ortheast % North, Range 17 West, of Section 29, Township 26 Town Of Pleasant Valley, St. Croix County, Wisconsin. OWner's Address: 1665 18n' Ave. Hammond, Wl 54015 N VI COr. See 29. T 28 N, R 17 W (8edxgn Alum. Mon. Fd ) 4.1 � I2 H ti 06003, Unpfatted Lands S 69'56.18•E 26eo.10 SROW'IS-E 1320.06- N(mn N£1.V Lot 1 n 79 $02 Acres or 002.575 Sq F1. 19Q 119 Acres or 833,417 Sq Ft EX0I W Rood k9m Ur Way C�2 1787 OS' J 1092318 EETH PABST REGISTER OF DEEDS ST. CROIX Co., WI RECEIVED FOR RECORD 21/13/2019 09:59 AM CERTIFIED SURVEY MAP VOLUME; 30 PAGE:6726 REC FEE: 30,00 PAGES: 2 I NECOr Sec 29. F2aIV R17W, .; (Bvmhen Noe Fd , </I 627 02' 3300 I 660 02' 2of 2 98W01 Acres a, 86 q_ F100.582 Sq Ft. EMWdW9 Rood Rph1 of we), g ,aUdnuill y scoffs uU o� Vt rnr = H4i WEp FALL Shed A' Oe0 I® Dated September 29, 2019 1 Woe n ��I"1 Gerep. N 89'3637Z 126a. 10' K «Mar 62rss 78Th Ave. I� -- 6s0.Sf' S Unv NE im NE 1/e N 8e'6.e•06-W 1321.01• -- RIS 69'37'10-W 1321.017 N Lot 1, C.S.M. Vol. 6, Page 1677, Doc. No. 414077 E $14 Ca, Svc, 29, T 26 N. R 17 W ~� 3 Legend: O Indicates 1 V1A• p D. x iB' win pipe set, i m ,mr $ w weighing 1. 08 lbs., Hn lit. • Indicates 1 5/16"0.1). iron o QQp N e SCA! E nv FEET i n pipe found. R (10.00) lnOicalas previously recorded data. D" 1ndlcate3 location of SCAN" r - 270' g t, In existing drtmway (A'cposed residenael access point). STS' o So' 100 200 300• `o South of North tine Lot 2. Sheet 1 of 2 Sheets 3b - {a7�7c '"JVF Ln , W t 1 q / Y qq- ko CA1 nA �7 d a a 4 H O a