HomeMy WebLinkAbout018-2011-71-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 552364 0
GENERAL INFORMATION State Plan ID No:
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 Parcel Tax No:
Oeverin Homes LLC, aka Oeverin Pro ertie Hammond, Town of 018-2011-71-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
cis f B , Z 30.29.17.1086
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ,may CAPACITY STATION BS HI FS ELEV.
i
Septic Benchmark
5.6 1611 `l F
Dosing ( J 3 t. B ~1 6.j Z Z 146 . l
Wwrratierr r r- er & SP~J c7~
Holding St/Ht In et
St/Ht Outlet
TANK SETBACK INFORMATION \
TANK TO P/L~ WELL BLDG. vent to Air Intake ROAD Dt Inlet `
Septic Z* 4k 54 Dt Bottom /6,4 ~
Dosing Header/Man.
Aeration T Dist. Pipe y, Z Ct IT
Holding Bot. System 5.5 9
Final Grade g
PUMP/SIPHON INFORMATION -3, Z `I1 • ~l
Manufacturer / Demand St Cover 1
4 GPM t"; 6 {dn_ c~ Z Z
Model Number ~~`+I^ ~ ~oA•~^'C<. ~ ,
• 3
TDH Lift Friction Loss System Head T DH Ft
Forcemain Length Dia.7 Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length INo6f(~ Tre hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~6 ) 7
SETBACK SYSTEM TOO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION T O S ste u1 Q CHAMBER OR
Model Number:
Y Y r~ . 7Z v N ~ UNIT `
DISTRIBUTION SYSTEM GJp
Header/Manifold Distribution Ix Hole Size x Hole Spacing / Ve//'J
nt SgAir Intake
\ Pipe(s)
Length Dia Length Dia Z Spacing Z
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched
Bed/Trench Center Z • Bed/Trench Edges \ Topsoil I LL Yes 0 No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Z / Z Inspection #2:
Location: 782 157th Street Hammond, WI 54015 (NW 1/4 NE 1/4 30 T29N R17yv) Emerald Acres 1st Add Lot 71 Parcel No: 30.29.17.1086
1.) Alt BM Description ne,y41L&C 11a U
2.) Bldg sewer length = 66 1..1
- amount of cover
S
Plan revision Required? Fw~ Yes No -7 Z_
Use other side for additional information.
A- - - -.1 6~ ~ wf~~ J
Date Insepct s Sign re Cert. No.
SBD-6710 (R.3/97)
commer e.W1 afety and Buildings Division County i t
201 Washington Ave., P. ox 7162 Q 1
' Isc S' ~ adison, WI 53707 2A Sanitary Permit Number (to be filled in by Co.)
~epartmerrt ~ 5 5z ~ (o
OUN 'Y 5 QS 3$3 . Z(( npl lication rate Transaction Number
In accordance with s. Co 81.2 7 ston of this form to the appropriate governmental„ 0 t 1 7~
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. p ~r'1 S
I. Application Information - Please Print All Information 0 1 f (Pam yy~
Property Owner's Name Parcel ~ t ~ ~ ^
Oeoo ; O I
Property Owner's Mailing Add ss Property Location
+O
Govt. Lot C ~ ~J
City, State Zip Code Phone um er N y, Y,, Section
1 t EtV
2 t.J Zt 1 SY 01 --7 T -1 N; R 1-~ - Et V
II. Type of Building (check all that apply) 2 up Lot #
or 2 Family Dwelling -Number of Bedrooms Subdivision Name
f`04j~ Block # F,,PAJJ L
❑ Public/Commercial - Describe Use ❑ City of dd
❑ State Owned - Describe Use CSM Number ❑ Village of
Town of ~a Yw
III. Type of P (Check only one box on line A. Complete line B if applicable)
A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that apply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Grown t-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain ❑ Pretreat /Tent Device (expl
i
V. Dispersal/Treatment Area Information: Grh?k
Design Flow (gpd) Design Soil Application Rate(gpdsf) ' persal Area Re uired (sf) Dispersal Area Proposed t) System Elevation
✓b Iv ✓ .2 - 46,91 A
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units _ ^t n v o
New Tanks Existing Tanks G~, o y a
a U rn va w C7 a
Septic or Holding Tank
Dosing Chamber 630 / 1 J +
VII. Responsibility Statement- 1, the undersigned, assume r nsibility for installation of the POWTS shown on the attached plans.
Plumb 's Name (Print) Plumber's MP/MPRS Number Business Phone Number
Plumber's Address Street, City, State, Zip Code)
Z ,Z
VIII. oun epartment Use Only
Permit Fee Date Issued I wing Agentrgn
Approved ❑ Disapproved $ ❑ Owner Given Reason for Denial 4425
, a o / / 20
Ix. Conditions of Approval/Reasons for Disapproval 0 J44z.eq(---
SYSTEM O1.'VNPk:
1 Septic; tank. effittent filter and t2~ `
dispersal cell must all be serviced / maintained ( vyt
as pel manorgement plan provided by plumber. 0,
S~
2. All seta: .l: c , r;er7ts must be maintain
as per appiicableAftde*x*larl!rha*,ps for the system and submit to the County only on paper not less than 8112 x 11 inches in size
SBD-6398 (R- 02/09)
PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave New Richmond Wi 54017
NW 1/4 NE 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 97.2' BEDROOM 3
CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none
Ilk BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEST GF10-8
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Scale = 1/4"= 10'
Property Line (not to scale)
Well is to meet all
WDNR setbacks
2 Acre Lot
Pro 3 Bedroom
House
Huffcutt Combo Tank Grading is to be done to
divert run-off away
from system
B.M.*
B-2
98' B-1
97.2'
9 6'
94' ❑
Area 15' below B-3
system is to remain 10% Slope
undisturbed
150'
Tank is to be properly bedded and
provided with lockdown covers with
approved warning labels
157th e
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.vARTMg~l Safety and Buildings
3824 N CREEKSIDE LA
o$ HOLMEN WI 54636
3 S < Contact Through Relay
P $ www.dsps.wi.gov/sb/
92~ `~w www.wisconsin.gov
~O sSION?, Scott Walker, Governor
Dave Ross, Secretary
May 29, 2012
CUST ID No. 226900 ATTN.- POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/29/2014 Identification Numbers
Transaction ID No. 2090942
SITE: Site ID No. 779845
Oevering Homes Please refer to both identification numbers,'
157TH Ave above, in all correspondence with the agency.
Town of Hammond
St Croix County
NW1/4, NEIA, S30, T29N, R17W
Lot: 71, Subdivision: Emerald Acres
FOR:
Description: At-grade / Three Bedroom / Sloping Site
Object Type: POWTS Component Manual Regulated Object ID No.: 1374017
Maintenance required; 450 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade;
System: At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07),
Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
component manuals listed above.
The changes made in red to this plan on 5/23/12 by this reviewer were acknowledged and approved by the
system designer.
k _ b'I
W' l+
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and a
dispersal are prohibited. OF
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption 4 ~
area. chs. NR 811 & 812c SEE COR
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
SHAUN R BIRD Page 2 5/29/2012 '
• Inspection of the POWTS 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. Stat
• SPS 383.22(7) A copy of the approved plans specifications and this letter shall be on-site during construction
and open to inspection by authorized representatives of the Department which may include local ins ectors
Owner Responsibilities:
• SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
SPS 383.54(1).
• SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. SPS 383.54(4) shall be considered a human health hazard.
• SPS 383.55 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.
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 Safety & Buildings 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, Fee Required $ 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Charles L Bratz Please Include a Copy With Your
POWTS Reviewer II , Integrated Services Payment Submittal.
(608)789-7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633
charles.bratz@wisconsin.gov
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be
modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the
relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety &
Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future
reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366.
,
C"VED
IMAY 1 7 2012
Cover Page & ` UILDINGS
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715-246-4516
Date: 5/14/12
Owner: Oevering Homes
Location:NW1/4 NE1/4 S30 T29 N,R17W Lot 71 Emerald Acres Hammond
System type: At-Grade
Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07)
Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01)
Page#
1. Cover Page
2. At-Grade Plot Plan
3. At-Grade Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7-8. Maintance and Contigency plan
9-11. Soil test
12. Filter Specific>tion ~:~nally
Shaun Bird - Jt vED
Signature
License num er 26900
~1rG
At-grade System Sloping Site Cross Section and Plan View
Dimension Feet
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.5+~.
basal area ~ti~ti■ Vito 2 '/2 in. dia. observation pipe
Lateral with 2" Topsoil Cap
aggregate over pipe
Observation Pipe
Geotextile
G With Cap
Fabric c
r•~~'{~~. ' 7, 7 Ft Lateral Invert
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Slope Direction
GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing
vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a
moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to
form a 'f4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is
covered by clean aggregate deposited overhead by a backhoe.. Special care must be used when
placing the aggregate to minimize compaction of the plowed surface. After, the topsoil cap is placed,
the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect
from freezing. The observation pipes are perforated in the lower 6 inches and secured in place.
03/051gj Page 3 of l2
Pressure Lateral Layout
One Lateral - End Manifold
4--- Threaded
Cleanout
Lateral Turn-up Plug
Force Main
X
L Long
Sweep
90
Bend
ressure System Construction
FLoaepIs ce~CQ- Cep p~~ - A 5~1~1 D 1(~o S vt
Distribution Network S ecifiionIn eraare constructed of Schedule 40 PVC
Lateral Diameter In . Orifices are drilled perpendicular to
orifice Diameter the pipe with a sharp drill bit and face down.
X Orifice S acin In.
Ft. Lateral turn-ups terminate with a threaded
L Lateral Length) In cleariout plug and are enclosed in a 6-8 inch
Force Main Diameter Z Ft diameter lawn sprinkler valve box accessible
Force Main Len th from finished grade.
• • • • Grade
6-8 Inch Lawn
Sprinkler Valve
Box
i
Page_ of
03/OS lgj
cSpecifications
Septic-Dose Wank: Cross Section And. Pump Performance
Pump Manufacturer
Tank Manufacturer e~ p Model Alumber
Tank Nlcx~l umber Alarm Manufaatxirer
Total Tank Capacity 3
Max. Bury Depth Alarm Model Number
Switch Type
Manufacturer Total Dynamic Head (TDH) Feet
Filter ~ ~
0a- Elevation Mead L~_---
Filter Model Number C~
Distal Pressure -
Network Loss
Minimum Pump f erfornumce Required Force Main Loss
f _ GPM, Ft TDH Total S~
Outlet Manhole holin. 4" Above Grade With Manhole Min. 4" Above Grade
With Locking Device
]looking De~iice. Inlet Msryhole ,
< 6" Below tirade Seated Watertiitht Securely Mounted
Weather-proof
Junction Box
.r Fipished Grade 1. .....1......
ftw
Vent Min. 12" Disconnect
Above Grade Means
With Vent Cap
at • s r; . s s lal1Y •.1: a:ii [ 1,1~ . 11 1,1 {,1 r ,,a,a a, tY 1 Y• i
♦ 1 r
Qutlet Filter
Wet Baffle
Inlet
liwitch Sgs and Reserve Capacity A V4"
:t 11
`Tank Volume / GPI weep
"
Dimension ; Inches Volume Gal. B Hole
'
(reserve) A a. S .3,67-5-
(alarm) B 2 3o Off Elevation C
7, Ft
'
(dose) C l7°~ Do Bottom
,
(dead) D
,;4 Total D Elevation
, Ft
,rte rs-rsrrc-rri-rs > •
a: t i t 1, 1 1 1 t,1 1{ I< I I f t,1 1 1 t 1 1,. i,f t 1 t f ita f,1 < 1• I a a a t a a a a a o f a,t • 1•f •i 1l: ♦ :.It•I i•11 1.1:::::•1 ::I:a:
•a : < 111:•1•:1 ~ l IY1l:1": 11111 <ttfl {'{+:ft<II•f•1:11:t1:</1/•1: 1•:a1f 11 11< IIi i S i a>
GENERAL INISTAiLLATION: The septic/dose tank is bedded and back fitted in accordance with the
manufacturer's product approval specifications' Maximum depth of bury as speoifed by the manufacturer may not
be exuded without prior $pproval. Manhole covers exposed to grade have an effective looking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connea6ed to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4°' Sch. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28.
02/05 LJ Page S of 11
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3 H-W 509340 WW Are 230 341 6.5 1000 70 64 55 41 32 119 20' 24 9.11 x 11.64 t 6.94
91114* 0 509350 OUC6A 410 115 34 13.0 1000 70 64 55 41 32 13.8 ar 27 9.11 x 11.61 16.04
014AFF9 I= MCA _ go 290 314 M 1JE .70 64 55 41 82 13.8 20 27 6.11 x 1l.601121
CorAtnsous DotyRnrd--tans G14ntVY+p9mps~reuocominnausdnryasAlnpastryarsralwmapeleolabneuratlltOstprtnsep~mpa "
FLOW- LITERSMOW Construction
o 1000 2000 woo Motor Housing Epoxy Coated Cast Iron
Impeller Material Poly Carbonate
1o Impeller' a Closed Vane
Volute ADS
Power Cord _ S 1TW A
7.50(
Mechanical Shall. Seal N itrile with carbon and
s T.. ceramic faces
W " Fasteners Stainl4 Steel
to _ -
Shat Stainlecm Steel
-2.5 Bearings - - - - Upper Sleeve and lower
i Ball Bearings
n TTTr 0
0 20 40 60 so
FLOW- GALLONS/!1TNUTE
PUMP PERFORMANCE CURVE Little Giant Pump Co.
115V MH2
RU Bntc 17019 • Uk31tlt41s1t City, Q3S 73157
rbene: 4@S.%7MU • Fru: 405320.1956
• &maB custeumno Vje*@"ttj8gkNt CM
www Little[3ientPu3np.4 ont i3 Form 995236--07103
POWTS OWNER'S, MANUAL, & MANAGEMENT PLAN page 7 of FILE NORIVIATION Z
f
Owner SYSTEM SPEGIFICAT(ONS
D Soptic Tank Capacity
Permit # yet CJ NA
S Septic Tank Manufacturer
DESIGN PARAMETf;RS L L7 NA
Effluent F(It6r Marls facturer _ ❑ NA
Number of Bedrooms
Cl NA Effluent Filter Model
Number of, Public Facility Units _ (S / ❑ NA
A Pump 'rank Capacity
Estimated flow (average) ❑ NA
gal/day Purnp Tank Manufacturer
Design flow (peak), (Estimated x NA
'-I cal/da Pump Mdnu'facturer
Soil Application Hate/ NA
Standard Influent/Effluent Qudlit 8dl/day/ft;, Purnp Model iJ NA
1 Monthly avo..rage I PI'e'treiAment Unit
1=ass, Oil Grebse (FOG) X30 nlg/L CIA
Biochemical Oxygen Demand (BODb) X220 mg/L ❑ Sand/Gravel Filter !:j Paa~t Filter
Total Suspended Solids (TSS) 5160 mg/L ❑ Mechanical Aeration ❑ Wetland
{'retreated Effluent Qualfty_ Monthly average Di Dersal Cel)( L`J Other.
Dispersal Cell(s)
Biochemical Oxygen Demand (BOpG) 530 mg/L , U NA
❑ In-Ground (gravity) L1 In-Ground (pressurized)
Total Suspended Solids (TSS) 530 rng/L
Fecal Coliform (geometric mean) 510" cfu/100ml Drip-Line L) Other:
Maximum Effluent Partiols Size Ye in dia. 0 NA rOth
Athor: NA
NA Velu~as tYI' Ica) for domostic wastewater &nd septic 'Ca.nk i~ffluant.NA
A
MAINTENANCE SCHEDULE
Service went
Service Frequency
Inspect condition of tank(s) At least once every: month(s)
C. ear(s) (Maximum 3 years) q NA
Pump out contents of tank(s) When combined sludge and scum equals ono-third (Y) of tank volume
a ❑ NA
Inspect dispersal cell(a) At least once every. y onthis)
J s) (Maximum 3 years) ❑ NA
year(
Clean effluent filter At least once every: month(s)
~ Vedr(sl ❑ NA
Inspect pump, purnp controls d,. alarm At least once every: d n onthk) '
earls) ~ O NA
Flush laterals and pressure test At least once every: ❑ month(s)
Other: year(s) U NA
At least once every: ❑ month(s)
other: El year(a) NA
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspec't'or; POWTS Malntuiner; Septage Servicing Operator. 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 back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surfaca, The pondin9 of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority-
When the combined -accumulation of sludge and scum in any tank equals one-third (Ys) 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 chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer-
A service report shall be provided to the local regulatory authority within IQ days of Fornpletion of any service event.
GM1N (4/01)
STAkT UP AND OPERATION Page of l Z
2L
For new construction, prior to use of 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 detecte
of the tank(s) removed by a septage servicing operator prior 'to use. d have the contents
System start up shall not occur when soil conditions aro frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the oell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POW'I'S Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette bu't'ts; condoms; cotton swabs; degreasers; dental floss, diapers; disinfectants; fat;
•
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the systern is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed,
• The contents of all tanIQ6 and pits shall be removed and properly disposed of by a Septage Servicing Operator.
e After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another 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:
❑ : 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 proppsed structure, lot lines and wells. Failure to protect ilia replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ 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.
The site has not been evaluated to identify a suitable replacement area. 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.
%[Q/ Mound and at-tirade soil absorption systems may be reconstructed in place following removal of the biomat at the
fil'trative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNING> >
SEPTIC, PUMP AND OTHER TREATME11Qt'TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR 01: A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name --C Name
Phone/.~
Phone J b
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
L Name
F Name
• ~c~ o!G
~
Phone Phone
V
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIRCATIQN FORM
Ownermayet O e
Mailing Address 3 3 j
Property .Address ---.C. X _2-
(Verification. required from Fl
anning & Zoning Department for new construction.)
City/State parcel ,dent,.6cation Number Q
EGAL
C>~Tt~rrnly
E
Property Location /V0-1 y,, y4, Sec. v
" j N W, Town of
Subdivision
77 0i.J Lot #
7; .
Cerdfled Survey Map #
Volume
- .5 - Page #
Warranty Deed # -G C
Volume ~ Page Spec house/ Y~ no S / y 20/
Lot lines identifiable ye no
SYSTEM M&_WTENANCE AND OWNER CERTIFICA ON
improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of'pumpin$ out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, ,jounteyniau plumber, restricted plumber or a licensed er verifying
wastewater disposal system is in proper operating condition and/or (2) after inspection lm and d pumping (if that a the ansept
less than 1/3 felt of sludge. necessary), the septic tank is
I/we the
undersigned have read
the shave requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix, County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all staterrrents on this form are true to
the best of m y /our knowledge. Uwe am/are the owner(s of the
property described above, by virtue of a wwr )
antty deed recorded in Register of Deeds Office.
Number of bedrooms-z
IGNAT F .APPLICANiT S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application 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.
(REV. 08/05)
yam."'.
Wisconsin Departm t of Cbrflm'erce SOIL EVALUATION R -T'_ Page/ of 3
Division of Safety an Buildings 114
dance ' h Comm 85, Wis. Adm. Code
County
Attach complete si plan on paper NinN 1 inches in size. Plan must r
include, but not limi to.. v"CI point (BM), direction and Parcel I.D.
percent slope, scal or dire and location and distance to nearest road. 71`~T/
se print all information. eviewe Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
06P~<< Govt. Lot 1/4 1/4 S pT Z N R E (o W
Property Owner's Mailing Adffr-e-Ss Lott #7 Block # Subd. Name or CSM#
A/Is -S 47
City State Zip Code Phone Number ❑ City ❑ Villag own Nearest Roa
S d ( ) a .5
'2F, claz'*6 New Construction UseX.Residential / Number of bedrooms 7, Code derived design flow rate .nom GPD
❑ Replacement Public or commercial - Describe:
Parent material -z4z Flood Plain elevation if applicable y/' ft.
General comments -i_~ &AlC
and reconunendations: O !J
System Type r System Elevation
Boring # Boring
I Pit Ground surface elev. i /..-ft. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in.Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
J' /L-
/
10111- ~J(Z Z
"
# ❑ Boring
® Pit Ground surface elev.. (ft. Depth to limiting factor V in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
0'12-
Z z- s- r--, s O
3-0 DS o~~,0 _ZZ -7
- ti
• _ BOD > 30 < _ 220 mglL and TSS >30 < 150 nxjjfl _ • Effluent #2 = BOD <30 m9~ and TSS < 30
Effluent #1 mg/L
CST Name (Please Print) S' re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 J ~~L - 1d G 715-246-4516
Property Owner _ Parcel ID # Page of
n
Boring # ❑ Boring
gL Pit Ground surface elev. 3 , ' ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 4*Eff 0 'Eff#2
Z Y 1 fo s ,
3 , D~ / `t z -Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
a Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
❑
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BODS < 30 mg/L 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.
SOD-8330 (R.60))
• Soil Test Plot Pla
Project Name Oevering Homes Sh kird
Address 1433 Cernohous Ave
New Richmond Wi 54017 S M #226900
Lot 71 Subdivision Emerald Acres 1 st. Ad Dat /14/12
NW 1/4 NE 1/4S 30 T 29 N/R17 W Township Hammond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 2" pipe
System Elevation 97.2' *HRpSameas Benchmark
Scale = 1/4"= 10'
Scale is 1" = 40' Property Line (not to scale)
unless otherwise
noted 2 Acre Lot
B-2 B.M.*
9 8' 91
B-1
9 6'
94' ❑
B-3
10% Slope ` • /
150,
157th Ave
Np
gig
a~ -
51
12
.1 I 2.02 ACRES Z
60 19 88,155 SQ. FT C
2 0O ACRES
S 87,162 SQ. FT. I 26 NI °
~I
FT.
2 NM614'E465.83
29R~L110
f ~a r LOT 68
ss n j ` 2.00 ACRES
40 87,201 SQ. FT.
,2
A? f i 8~ <
m _ 14
N89°2614'E490.41'
2-12
,a \
15 LOT 69
2.00 ACRES
; \ 9a \ 87,153 SQ. FT.
LOT 72 LOT 71 ; 33` ~j r47\ N89°2614'E 420.E
33
L87 N
2.00 ACRES A 2.00 ACRES
87,122 SQ. FT, p 87,146 SQ. FT.: iw I I
/ ~ \1aa \ \ LOT 70
2.00 ACRES °
8 87,312 SQ. FT.
f ' cn
! I I / e
89.98
827.75 229.45 66 00 329.1T 419.15
212.85
L80 L79 L78
NE114 N89°26'14"E 1312.90' 80• RADIUS TEMPORARY CUL-DE-SAC
EASEMENTTO BE EXTINGUISHED
NJGrI~°PRACTt'~D L, I~ilD@ UPON SOUTHERLY ROAD EXTENSION
SHEET 2 OF 3 SHEETS
WARRANPY DEED 8 0 5 6 7 3 6
Tx:4042248
956274
Document Number Document Name BETH PABST
THIS DEED, made between Westconsin Credit Union ("Grantor," whether one REGISTER OF DEEDS
or more), and Oevering Homes LLC a Wisconsin limited liability company ST. CROIX CO., WI
("Grantee," whether one or more).
05/ 14/ 2012 11.34 AM
Grantor, for a valuable consideration, conveys to Grantee the following described : NA
real estate, together with the rents, profits, fixtures and other appurtenant interests,
in St Croix County, State of Wisconsin ("Property"): REC FEE: 30.00
Lot 71, Emerald Acres lat Addition, Town of Hammond, St Croix County, WI TRANS FEE: 25.50
PAGa& 1
Name and Return Address
St. Croix County Abstract &'Tldo
219 S. Knowles Ave
Now Richmond, W154017 1210386
018-2011-71-000
Parcel Idcauflestion Nwnber (PM
This is not homestead property.
ExcbptiOA to warranties:
Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and
municipal services, recorded building and use restrictions and covenants, general taxes levied in the year of closing and
Dated this day of May, 2012.
Westconsin Credit Union
By: Leo V. Schindler, Chief Lending Officer
AUTHENTICATION ACIQVUWLEDGMENT
)
Signature(s) STATE OF WISCONSIN
y~ ) as.
authenticated on 4/H r ~l l COUNTY - )
+ L1
Personally came before me on this day of May, 2012, the
TITLE: MEMBER. STATE BAR OF WISCONSIN abovo-riamed Westconsin Credit Union, by Leo F. Schindler,
(Ifnot, Chief Lending Officer to me ]mown to be the person(s) who
authorized by Wis. Stat. § 706.06) executed the forego' instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY: e
Robert L Loberg Notary ublic, State W' nsin
Loberg Law Office aim/& My Commission (is. Imanent) (expires: t
e (Slgaalures may be sathendested or acknowledged Both are not necessary.)
*Type Hama below signasues
x,01 A 91
: 2
OF W\SG
11nttlttt
FORM 140.1.2003
WARRANTY DEED
1 Of 1