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HomeMy WebLinkAbout040-1303-00-064 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579056 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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 Troy, Town of 040-1303-00-064 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 1162. L 61 - 22.28.19.1799 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 14I ev CAPACITY STATION BS HI FS ELEV. Septic Benchmark /Z60 7. d / 6 9 . /b Z • Z Dosing Alt. BM a vv,. L a Fa `'S 800 3. /off. Bldg. Sewer L-i a t< S.f /a3. TS Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. a to Air Intake ROAD Dt Inlet of Septic 8 A) A$ Dt Bottom 13.3 9S . Dosing Header/Man. - Aeration i ~a ~ 5 Dist. Pipe 44-7 1,64-6 Holding Bot. System . g 3 PUMP/SIPHON INFORMATION Final Grade 3.7 65. Manufacturer Zar I GPlm~and St Cover`~ ~ Q~ 3.1 166.1 cr, ~ ~ 6- Model Number l SZ Ifu 6.5 N,"U G• 5 ADZ -7 TDH Lift Friction Loss System Head TDH t y 14 1 I Forcemain Lengt Dial / Dist. to well lot SOIL ABSORPTION SYSTEM BED/TRENCH Width f ength No. Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -75 1 - SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR _ 7fflfern: Of e J /47 UNIT Model Number: DISTRIBUTION SYSTEM o Header/Manitid /t Distribution Alf x Hole Size , r x Hole Spacing Vent o it Int e L Leng(h) Length Dia Length Dia ~ Spacing 515 Z 7 - SOIL SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only r Depth Over Depth Over x; _Depth of xx Seeded/Sodded A/ xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil , Yes ® No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection # k (J Location: 229 Walnut Hill Way Hudson, W~ 154016 (SE 1/4 SE 1/4 22 T28N R19W) Walnut Hill F aka The Tribute Lo Parcel No: 22.28.19.1799 1.) Alt BM Description = ` '•1%A 2.) Bldg sewer length = - amount of cover = / Plan revision Required? Fs Yes ZNo b , 1!) Use other side for additional information. Date Insepctors gnature Cert. No. SBD-6710 (R.3/97) cAtmtyC ~ s?° A 4 Safety and filding ivisi n c~~• J p $ ~ 201 W. Washingt e. O. B 71 Sanitary Permit umber (to be filled in by Co.) no- a Madison, / O►X COUNTY MW 7 S l0 ` Sanitary Permit Application State Transaction Number tIS 3 43 in accordance with SPS 38321(2), Wis. Adm. 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 submitted to Project Address (if different than mailin4add-s) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ses in accordance with the Law, s. 15. 1 m , Stars. L A lication nformation Please Print All aParcet # 06 z Property Owner's Name 136 3 R[J 0 Qw e l n~ •~f cJ Property Owner's Mail' ess ~tty Location Q 1 Govt Lot --T Ala- r Zip Code Phone Number '/4, City State Section ( CffCIC O Nc~ 01-7 Lora T N; FJ4 E w II pe of building (check all that apply) Subdivision Name 41 1 or 2 Family Dwelling -Number of Bedroom / % (S}C. GSA ~!J'S.Q, Blo ❑ Public/Commercial - Describe Use aZion, ❑ City of CSM Number ❑ Village of El state owned - Describe Use L_ Of. _LL7 X 75 C✓ III. T of Permit: (Cbeck only one box on line A. Complete line B if applicable) b 0I A. System ❑ Replacement System ❑ Tmatment/Holding Tank Replacement Only ❑ timer Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer, tto New Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that apply) v ❑ Non-Pressurized In-Ground ❑ pressurized ln-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device V. Dis rsal/Trea ent Area Information: Design Flow (gpd) Design. Soil Applicati f) Dispem Requir f) Dispersal Area Pro (sf~ System Elev / 6'0 0 /0 61 CD 56`b , 7 VL Tank Info achy in Total # of Manufacturer v Gallons Gallons units a 2 j 3 New Tanks Existing Taa16 Septic or Holding Tank Dosing Chamber j I VII. Responsibility Statement- L undersigned, assum sibility for installation of the POWTS shown on the attached plans. Plumber's (Print) Plumber, a MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zrp ` VIII. un epartment Use Only Permit Fee Date Issued Issuing t Signature P~,ed twe $ V,- _A~ er Given Reason for Denial ' DL Conditi ftltb@11T or pproval i .7V f -R IPA psal ctrl tltiI tae Garvtcss (tgaintained CkT~ % C 1rC iGT)^'~'' ` ' it. >+ss~'nM f fi r. It4i ooa~ oi!11i1RNlt d,,;1 c#t.~t,(o a ~J: ~e nc~1 Attach to complete plans for the system and submit to the County only oa paper not lead than 8 in z 11 ' es in size vwve SBD-6398 (R. 11111) Pd(-AA ^ 4`~dA PLOT PLAN PROJECT Oeverino Homes ADDRESS 1A 3 Cernohous Ave Suite A New Richmond Wi 54017 SE 114 SE 1/4S 22 /T 28 N/R 19 TOWN-Troy COUNTY ST. CROIX 4 SYSTEM ELEVATION 102.7 1.2' Sand lift! ~ DATE 7129t15 BEDROOM r CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TAN 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 755 MOUND XXX SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RA'P'E 1.0 ABSORPTION AREA 600 # of chambers none - BENCHMARK V.R.P. Top of 1./2" conduit J49't1!2` ASSUME ELEVATION loo, Filter Lifetime Filter BOREHOLE ~ WELL * H.R. P . same as benchmark All piping, shall be ASTM SIR 30/34, wits in 10` of tank, pipi.nq shall be ASTIVI F891. 1001 (riot to scale) r ropert} Line B-? Kalnut HiI1 Grading is to be done to di'* ert run-off away from SysteaM Tank is to be properky Rr ~~ert1~ bed,ed anvJ provided. Line with lockdove n covers F'rr.~ {pith p ref;<> d warning Bedroom iabelJ Ho use Hi,;fcutt Combo Tank 7% Slope Area 15' below s_,,stem is to remain undisturbed B-2 'Y%eeI I is to meet a!I `DNP set bao k. PrntEert,~ Li ne ~ (riot to scale} Scale - 1/4'1 - 10' RTF DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD \s HAYWARD WI 54843 kf/ p ~9R Contact Through Relay 3' S P I http://dsps.wi.gov/programs/industry-services S / www.wisconsin.gov 'ssror~tisro Scott Walker, Governor Dave Ross, Secretary August 11, 2015 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 Identification Numbers PLAN APPROVAL EXPIRES: 08/11/2017 Transaction ID No. 2583496 Site ID No. 815704 SITE: Please refer to both identification numbers, Oevering 229 Walnut Hill Homes Way above, in all correspondence with the agency. 229 Walnut Town of Troy St Croix County SE1/4, SEIA, S22, T28N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1549691 Maintenance required; 600 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); 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. 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 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 inspectors. 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. 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. SHAUN R BIRD Page 2 8/11/2015 ` Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, *Carl ert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART' code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm SHAUN R BIRD Page 2 8/11/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. 4 When You Receive That Invoice, Carl ippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-50--15, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.,gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/ 29/15 Owner:Oevering Homes Location: SE1/4 SE1/4 S22 T28 N,R19W 229 Walnut Hill Way Troy Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specifications and 0,ross secti n CONDITIONALLY Attachments: Soil Test APPROVED r10 DEPT OF SAFE SERV'IC'ES PROFESSIONAL Shaun Bird DIVISION OF INDUSTRY SERVICES Signature License number 226 00 ESpONDENC SEE Page 1 of PLOT PLA PROJECT Oeverino Homes ADDRESS 33 Cernohous Ave Suite A New Richmond Wi 54017 FYV SE 1/4 SE 1145 22 lT 28 N/ R 19 ~IV TOWN ; Troy COUNTY ST. CROIX SYSTEM ELEVATION 102.7 1.2' sand lift! 7129115 4 . , DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK. ,v. 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 MOUND XXX SEPTIC TANK SIZE HOLDING 'T'ANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 1.12" conduit ,5~•~~ ASSUME ELEVATION 1007 Filter Lifetime Filter C=s f ❑ BOREHOLE SWELL +H..R. P. same as benchmark All piping shall be ASTM SLR 30/34, within 101 o tank, piping shall be ASTNI F891 I 100, 101.5' I 102' (riot to scale) Property Line S-1 Sred itag ins to be done to Walnut Hill 'Y'S'ay divert run-off away from Property system Tank is to be properly Line bedded and provided Pro 4 with lockdovn covers Bedroom with approved warning labels Huffcutt Combo Tank House 7 Slope Area 15' below y ste m is to remain undisturbed B-2 Well is to meet ,III WDNR set bac k.-:, ~.t'1.~ Prat~ert.~ Line (not to scale) Scale = 1/4" _ 10' Mound System Cross Section and Plan View Dimension Feet A I i B ' L L r f- L, f. L L L L L tf : r L L : J _L f l ~L.y. ...L ..L Lr L.L . .:.r.r E i A I L L L L;y.h.L..,,L.}..,,.,.....L.L.L..,.L.L. .L.•,. L:•,: L J•r•Jy1:: r { ..1•:.r.r;r.:.r.:::~:.r.r.r•:~:~f.f.::r::. r; r; :yr: : r ' 'tir~~ti"r{ Y' '•~L~Lr~~}r•-•• rti:~{:.r; ..r.r•r.r.:.r.r.r:::i::.}:i ' rL r L .rL t 1.1 ..L. . 95 W i 1 7 1 i i C 1,0 K lot w--- G'6,,. K T B 1 Z ~I ~ - L Slope [ -.1 =Topsoil =ASTM C-33 =Clean aggregate = 4 in. sch. 40 pvc - ; Cap Material sand fill / to 2 1/2 in. dia. observation pipe Geotextile G H Fabric rLJ / D '.z,,Plowed Surface Ft Contour Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Fxisting vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one loot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth. limit erosion and protect from freezing. "The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 ID Page 3 ofq Pressure Lateral. Layout Two Laterals - End Manifold 4 Threaded Cleanout Lateral Turn-up Plug Manifold M X - L - Long Force Main Sweep 90 Bend Distribution Network Specifications Pressure System Construction Lateral Diameter 2 In. ln. Laterals are constructed of Schedule 40 PVC Manifold Diameter _ Orifice Diameters 3 in. Pipe. Orifices are drilled perpendicular to X (Orifice Spacing) c _In. the pipe with a sharp drill bit and face down. L (Lateral Length) Lateral turn-ups terminate with a threaded M (Manifold Length) _-Ft. cleanout plug and are enclosed in a 6--8 inch - Force Main. Diameter In. diameter lawn sprinkler valve box accessible { Force Main Len th Fi. from finished grade. • • • • • tirade 6-K Inch Lawn Sprinkler Valve Box l • ~ Page - of - 03/0.5 l9j Septic-Dose Tank Cross Section And Pump Performance Specifications Pump Manufacturer Tank Manufacturer pip Model Number MZ4,_"odel r j-L~ Alarm Manufacturer Total Tank apity Alarm Model Numbej Max. Bury Depth r Switch Type << Total D ynamic Head (TDH) -Feet Filter Manftt~e L A Head Filter ModElevation Distai Pressure Network Loss ~ oanance Required Force Main Loss mp ~'erf , Minimum PGPM Ft TDH Total f 0 ! outlet manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Securely Mounted With Locking Device < 6" Below Grade Sealed Watertight Weather-proof ----i. _ Junction Box - Finished Grade Vent Min. 12" Disconnect Above Grade Means With Vent Cap outlet Filter Inlet Baffle Inlet A 1/4" Switch Settings and Reserve Capacity Weep ' Hole Tank Volume ° GPI B H Dimension: Inches Volume Gal. (reserve) A 26 p Elevation C (alarm) B 2 v` J Z Ft _ Bottom C Elevation D (dose) . ` Ft (dead) D Total > . , . r,! t><a>a s f a l tic/dose tank is bedded and back filled in accordance with the GENERAL INSTALLATION: The seP asspecified by the manufacturer may not product a roval specifications. Maximum depth of bey device (padlock) manufacturer's pp . M anhole covers exposed to grade have an effec be exceeded without poor tive locking roved material, connected to the tank with watertight fittings, and installed. Piping at the inlepp rovai et and outlet is app The force main is sleeved with 4" Sch 40 pVC to bridge the tank laid on stable soil to prevent se t sagging- leave is sealed ed watertight. Electrical service complies with NEC 300 and Comm 16.2t- excavation and the s C Page J of _1__-. 02/05 U • P i EAG CAPHCIIY ~~RwL - - ~LI_ JL i 'i - - 5e _ 243 - - - T ~ 4 rl C~--- G•` ~C'; lug GALLC!~S 1 - _'ERS CONSULT FACTORY FOR SPECIAL APPLICATIONS , Timed dosing panels available. o h~ - - • Electrical alternators, for duplex systems: ,.re avalla0,., and suPp td an alarm. Variable levei control switches are avaiiab e for controiline single phase systems. T • Double piggyback variable level float Switches are available for v3nab.e - level long and short cycle controls. . Sealed Qwik-Box available for outdoor ins aliKO',s. See - --M111,42,0 • over 130°F. (54°C•) special quotation req a.red. - 152j153 Series Control Selection- _1521153 MODELS Ct lox t"'' I M d I Volts_ Ph Mode Ames N. 152 5 } { No s'rc2oGa i N152 - _ 9 4 Auto -_~L, clu,ed _ 1 or= i 8N152j 115 1 ?_or LEi' 52 ' 230 , Non ! 43 43 Inchu SE1521230 e_ 2cr3 . Auto _ 1C 5 2 cr 3 SELECTION GUIDE N15Non 3Tt 5 r- ti-r 0.5 no ,ed I 'evet float s'/etch or double piggyback va able levy float _3N 53 115 Auto } Non 5-3 _ ` 3 singe c ggyba" r ;30le E15230 5J rte 'wcU LgE153 i 23~ 0_' Auro - - 5ro~,tc Refer to 1G477. 2 See 12 fc erect model of Eectncal,Aitemator E-Pak A CAUTION All installation of controls, protection devices and wiring should be done by a qualified 3 'v griap e level c .t o. Skit. 10-02"; used as a control activator, Specify duplex licensed electrician. Ai electrical and safety codes should be followed including the most Or j ~'i float system recent National Electric Code (NEC') and the Occupational Safety and Health Act 10SHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 70: P.0 BOk 153a; 40256- SHIP ,l/ac er ^r TO 643'- b% QV/L/TY PUM 5 /N `4 _9„ Z~ \ 5 o „2731 ildCO 9219-Puas° ~u f" - PUMP CO_ -a:fsr2i 7-4-362 http://www.zoeller.com z _ v Copyright 2000 Zoeller Co. A11 rights reserved. ~~9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of INFORMATION SYSTEM SPECIFICATIONS FILE r I F Septic Tank Capacity / Si al ❑ NA Owner Q' I f?Septic Tank Manufacturer ❑ NA Permit # Effluent Filter Manufacturer 1-p' c ❑ NA DESIGN PARAMETERS Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA NA Pump Tank Capacity al ❑ NA Number of Commercial Units NA al/da pump Tank Manufacturer Estimated now (average) ~ ❑ NA Design flaw (peak), (Estimated X 1.5) aVda . Pump Manufacturer ❑ NA Soil Application Rate aIlda V Pump Model f pretreatment Unit InfluenUEffluent Quality monthly average' ❑ SandlGrdvel Fitter ❑ Peat Filter Fats, Oil & Grease (FOG) 530 m9n ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids JSS) 5150 m /L Manufacturer Pretreated Effluent Quality A_ Monthly average" Dispersal Cell(s) ❑ I r nd round (pressurized) Demand (GODS) 530 mg/L ❑ In-ground (gravity) Biochemical Oxygen ❑ At-grade a Total Suspended Solids (TSS) 530 mg/L ❑ Other. Fecal Coliform (geometric mean) 510` cfu/100ml ❑ Dri ine Maximum Effluent Particle Size Y, inch diameter values typical for domestic (non-commercw wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event At least once every . O months iris) (Maximum 3 yrs.) inspect condition of tank(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ months r(s) (Maximum 3 yrs.) Inspect dispersal cell(s) At least once every At least once every ❑ months ❑ year(s) Clean effluent filter NA At least once every ` j ❑ months ar(s) _ Inspect pump, pump controls 8 alarm Flush laterals and pressure test At least once every U months ear(s) NA Other At least once every ❑ months ❑ year(s) NA otr,ei At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS ollowing Inspections of tanks and dispersal cells shall be made by an individual carrying one of the POWWTS Mainicense Septage certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector-, 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 check the level or ponding of effluent on the ground surface. The dns cell(s) on thetground slurface~Tthe Ponding of effluent on then in the observation pipes and to check for any po 9 of effluent ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. mor the volume When the combined accumulation be remsludge and scum in any tank equals one-third Y,) ovved by a ptage Servicing Operators and disposed ofi noacco dance vAi h ch ~ NR entire contents of the tank tank shall b 113, Wisconsin Administrative Code. The servicing of effluent filters, mai mechanical of 12 months or less shall be performed by a certified POWTS Maintainer. other maintenance or monitoring A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION 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 detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page of or othe h,t painting START UP AND. OPERATION presen For new construction, prior to use of the POWTS hthe dispersal ant ells s) if high c scent ations are detectedthave therconten'ts loftt may impede the treatment process and/or damage tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are 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 t Septge result Servicing Operator pr'ordoc restoring power of °f e to fflueo t. . discharged to the dispersal cell(s) in one large ds umVeiank removed cell(s) band may controls to restore normal IevE.'e To avoid this situation have the contents of the p p the Operator effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating pump 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 wit Flu 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewatterast e deg may improve ;dentalthe nerf or apers;and prolong the life of the oOn dr an antibiotics; baby wipes; cigarette butts; condoms; cotton (sump pump) water; fruit and vegetable peelin brine grease; herbicides; meat scraps; medications; oil; painting praduciis; pesticides; sanltary napkins; tampons; and water softeners ABANDONMENT When the POWTS fails and/or is P ltaken Comm 83 33i a Wisconsin Administrative the following steps haCoderken to insure that the system is propel y and safely abandoned in compliance with chapter • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with 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 comp'alrn replacement system-, ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systeirr The replacement area should be protected from disturbance and compaction and should not be infringed upon by require acement area w th the ruse~~e the setbacks from existing and proposed structure, t alrea. to prote the Replacement sylstems must complyresult for a new soil and site evaluation to establish effect at that time. ❑ A suitable replacement area is not available due to setback and/or soli limitations. Barring advances in POWTS technologN holding tank may be installed as a last resort to replace the failed POWTS. e site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluatic must be performed to locate a suitable replacement area. J no replacement area is available a holding tank may be installed i a last resort to replace the failed POWTS. ound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the inf0trali, surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARN I NG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO Ni( ENTER A SEPTIC, PUMP OR OTHER OF A TANK TREATMENT MAY BE DIF CULT OR IMPOSSIBLE. CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 01- -PERSON FROM THE ADDITIONAL COMMENTS _ POWTS INSTALLER POWTS MAINTAINER n _ Name Name Phone Phone ~J r SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY jName Ph e r Phone ~~,1' This document was drafted in compliance with chapter SPS 383.22(2)(b)(^)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code, r~ V01 i I 'r.. i A~ \ ' iy ` ~ ~ 0. ~ \ , ,~z, / . _ ~ ~ _ ~ s .-r { ~ ~ ~I i 'I - - _ r _ _ _~T v 4 _ _ - ii , _ y , ` I j ~ f 1, 5 L i' ~ 1 ~ ~ ~ ~ s ~ of ,5', 4 1~~~~ti i-' ` ' ti 2 ~ ~ ii; ' yr r.~~~`c ~J,:~:'. _ - _ l _ ~ ~ - _ _ _ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bu er 4 17 Mailing Address -Property Address (A/ccc~l - (Verification required from Plannin & Zo uP ' - - g tig l)epa nt for new constn 'cut.) City/State Parcel Identification Number LEGAL DE5CRIPTIOIV Property Location y, , 5 %4 , Sec. 2 _2~ T N R ] W, Town oI Tv' + - - Subdivision - _ u..' cc,/ l Lot #_6Y Certified Survey Map # , Volume Page Warranty Deed # Volume Spec house des no Lot lines identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping 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 Wonun. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning owner and by a master plumbe & Zoning Department a certification form, signed by the r, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage dispersal systern witlu the s tandards 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 Plannin Zoning Department within 30 clays of the three year expiration date, b I/we certify that all statements on this forr are true to the best of my/our knowledge. I/we andare the owner(s) of the property described above, by virtue of a warranty eed recorded in Register of Deeds Office. Dumber of bedrooms ONIA~ ~V - OF APPLICANT{S} DAl ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department, fnelude 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) I z r r 5 009'390 E 358.85' S 0CM9'39" E S QD'X19'39" E 359.47' - - S DO'D9' 39" E 2' 66 0' S& 71 ` 156.21' _ 33'f33' j _ 237.13 "f I :r ~ in 1 r vs ~ ~ ~ ° ~ N I t` Q0 of-- ~y •t s It Q0 I r C I aD _ ~ .gym Q IM Iw t G 4 l rNIN ,4E'4CZ 3 •.0-,00•00 N 224.71' - r _ tooN, IN LL: d cv rc%44 ~3•.ss'.j 109.36' 243.91 .1 It 1~1!4 r' 110001". t+- `„s y ' y~a5 .o. u Va~7 S~. k ' r 3 I r K w F I,,YY I r H ~ F 1 I 1 I a s~3rvve o-rnn a3n.yns•.u[ ~ _ a3umoau aa~vue+rx I I I en3xn nvx. a3>v~e I L_ I I 11 ~ If ~ ~ 6~ I I I ❑ I I I a 0 I I _ i i ii I ; OI i x p$ I 1 a I' rv II I 1 yy t I .n~...a a-r l n~.rT ..xx u I i 4 11 Y I I--_-_-_ - i 1 1 & I 1 d6v \/00~ O I1 d/^ \ I I j' I 1 I ~ i _===~1~ e II 1 3x pp' e i l II^ pll 1 I 32 . a - 1 ~ _d I I II :B bdl~ 1 I 3p ~I J I m I I 2 I I rxr y i 1 I L J L 1 E~NI I 1 I _ J ~ 1 b I I ~,~1 rAl I Ie g I I I-s I r____ I _J I~+ 111 I i Igi oozes s3ssnuiewvs~ I I 1 1 I I 1 g i 1 I i' ~ I ~i34 I 1 I I- ®f_____ I I ~'3 I 8 Y:•~' ~ I I I LL I I zm I I I ~ ` I i I w oa 1 I I I 1 -ucvsn___._ I ' _ F___ ___®I I r r+a.va n.~x. oanmre.cx vnaxI rnMae ~o j n O ~ -~c LLg£~'€3: O ~ g ui ~o e;up~ 2 m W Cy, tub, y !Uhl a' o a lit 3 lual HM y "u w z Y ri t z. .o ce J J 1 ~ I I o~w o~ ~ oz a Z Y a ~W ¢a a Nzw ; I I ~ ~ I I I „rma3~rue ~ owc,cn = p ui C I IBS -~I O ' O ® o El y~_9_ f+~ 0 0 I ~ 3 I V~e,xn nvm o3~vw li I I I I ~N J• "e (i .EE I Y I • ..xni3~oannrn i I _ 'il ~o d I b. ~8w q G m m e $ 5'. ° ogx PmUNi E z $ ~ a J A 7 ~ 1-Lgq ~~Fg C m Q N_ Oil 0 > Q) w Vie? ~FE. tRge: 9¢€. 9"~ "$3$ O w ° s m II~If 111 ~ ~I,I (w z w O I II' I r C w f 4. ' ~ ~ °v~ ~ I I I I 'f C ~ rJ.-..- 1 I W~ t III I ~r L.4.r.,. 31 L y~n4, .L L1 ~ I t 1 V I I 'h z "Will wb i a H Y> ' ~ i _ _e Wsao~n Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Ssfety and Buildings in accordance with Comm 85. Wis. Adm. Code C«i* ST." C-A 4l X •V Attach compt include, but o EROSION CONTROL PLAN must be Parcel I.D. Z- 07 IN percents" completed before sanitary permit issuance R - by Date ;z. Persons! kdormetion you provide may be used for secondary purposes (Privacy Law. s.15.04 (1) (m)). IItN ^✓G7~-~ O o~! Q Property Owner TovO 'J Property Location 'T-•O PC> T,3ERS T-e7v T- ~d A//0 HA Govt. Lot #411 $i S S1/4 S ZZ' T 2-6 N R /9F & (or) W Property Ownees Mailing Address Lot # Block # Subd. Name or CStM tC'OI S CA W LL ,4vz (0 CRY cvA~~vvr ~}i I1 f,4~~f ~ . SN(lE/Z State 2 Code Phone Number ❑ city ❑ Village R Town Nearest Road I&PPOE HT% MN 5So74#(&5t) zyff• toff ?-Roy SD. 6-100ek 0 New corrstruc6on t1se: 19 Residential 1 Number of bedrooms Code derived design flow rate D r ~D GPD ❑ Replacement ❑ Public or commercial - Describe: _ tut Parent material 10rS5 002? d ir-,A ' ~i Z/ Flood Plain elevation ff applicable General conwrients and recommendations:/¢ 7`~S T C9 f 'T// ~i~ ~~/c~ /4 G4~ U L~•V r/O•tJ L F/ I # Boring G N Boring ® Pit Ground surface elev. ! O fL Depth to lirtiting factor 1 0 in. SoN A; pplication Rate Horimn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots FGP Ddf'f' b in. Mtmsefl Qu. Sz. Cont Color Gr. Sz. Sh.. -Eff#2 o-& Idyie3l? Z- it) z .6-11 ./v x y/ Z, S cur f • < -2k 00 ip, al S 71 CI A tzo r-S leL D jo o a a Idyl lZ v 9 •L V# Boring ®pGround surface elev. ft. Depth to Bnitirg fade Z ` in. Horizon Depth DominantColor R Soft Application Rate edgx Description Texture Structure Consistence Boundary Rods GPD/ff? Its in. Mtnsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 •IN~ 0`'7 /O 938 L z S T S W -f- S S N ~Qvw • ~SiL h,~ C / 7G . z //o l G D © o /a Ve el, lz EtflueM #1 = BOD > 30 < 220 mglL and TSS >30 < 150 rrglL ' Effluent #2 = BOD < 30 mglL and TSS < 30 rrglL Signature Number CST -F~Z4 Qall~~ Name (Please Prig -4143 R l C i T- z2 31 Address Ulbricht & Assgciates Date Evaluation Conducted Telephone Number Private s f • ~I~' ~O3 715- 77A • 34Y41 2- 2812 1 Oth Ave. Spring Valley, WI 54767 Piers ~FPo~v X . z yo ~ ~s d yp • /t7~~o - 2d • ~ oyo-~oBG- ~0•~ oyo • io - 70 • oM Q yo . ,o~~ ~'o • o~ URIGINAL r i TODD f3'le p s rare - Gfl l Z 3 E31 I'' Bcci•~# ~ f~r3rirxT G ~ S.S.S Pit Gro~md surface elev J €t. Depth to N nltM factor z ~ kL Soil Rate Depth Uanirranf Color Redox DescrtpCon Texture Stnocfure COFWstence Boundary Roots GPDM Munseti Qa. SZ Cont. Color Gr. Sz. Sh. `EW Yl? o S io 3 ~4sh s w f. s v o ~ c 4~ . (o D~ < ~Fs L, c .s /o ~ G~ ~ M S~cL p o o o Z. F-I L-- j Q Pit Ground surfaace elev. tf. Depth to f iticg factor ;n Sod Rate ' Horizon Depth Donur►ard Redox Desaiption Texture She Consistence Boundary Roots GPcat in Mfrsssett tau. Sz. Cora Color Gr.,Sz. Sh. `Efl#1 °lrP#€~ # t~-a Lt Pit Grourrxl surface elev. R. Depth to limitincl factor irr Sod RAje Horizon Dapth Dm*namt Golan Relax Description- Texture Sbucture ConststeMe Root GPDM in. MasrseR tau. Sz. Corti. Color 2 of Sz Sl. •E##3 'Ef# .x: 3 1 r it Grou;-W surface elev. ft. MM/41 WW" factor In. F-I El El A llcadw Rate Horizon Depth Domkwt Colm Redox Description- Texture ft~ ConsWence Boundary Roofs GPOftF lr11#2 rff in. Mum f~ut Sz.. Cam. Color Gr. Sz Sh. #1 ° e " Effluent #1 = BOO, > 30 1220 mg& and TSS 30:E 150 mgtt. ° Effluent #2 = SOQ6 < 30 rrKA and TSS 5 34 rngIL The Department of Commerce is an equal cap artrtnity service provider and employer. if you creed assistance to access services or treed material in an alternate fo€~at, please contact the department at 608-265-3159 or TTY 608 254-8;77. r I Tool? 13 le eSTEDT- 4 Rope y Owner Parcel NJ a Gd Page z d 3 e«;nna E7 S.SS . 3 rt surface etev. ft. oepo) to Ii rAmv team z WL Sail Rate Appicabon 1{ataDn Depth Gan its,,= Oesaiptl- Texture Strucga,a Ccnsistenoe Sour"y Roots GPQgf in. Mume unseN ou. Sz Card. C.ciar Gr. Sz. Sh. 'EM 0 8 JOYR311 L )4shie -5 s w/ f. 5- k y o c Y ~ I, o< < -Fs ! S 1 M S'/CL 0 6m ke o co D L S ~ saw tr ❑ ❑ pit Ground surface elev. 1L Depth to Nmi ft factor in. Rate Horizon Depth Application Dominard Cokf RedDxDesaiption Textue Shucpae Corx3atenoe Boundary floats GPDVff kr IAtnseN oe. Sz Com color Or.,Sz. Sh. 'Em 2 F-I boring fl ❑ Borag ❑ Pit O" -f- elev. ft. Depth to knrWV factor kL Sd ApOkoolon Rate Horl- Depth DaW." Cal. Redox Desa(pbon. Text" Svockwe Comae floats GPDff In_ MtarseN ou. Sz Cord. Cdar GI• St Sh. •EMI 'Eff#2 Bodng ❑ Pit Groundsurfaae eriev. fl. Degh Ntrhlirg factor in. Sae Avpkmgon Rate Rao~b APDBI Hatton Depth Do *Wt CUIDr Redox Desoiption_ Texture Car>siatence BouWery in. Munwl Qu. SL Cont. Color Gr. Sz. Sh. `eVI '012 i . OWN At = SOD, > 30:s 220 mg& and TSS 30 < 150 mgll • EM-4111= SOD, 30 uKA and TSS < 30 niWL The Dcpattment 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. 58Dt3le{R6A0) PLOT PLAN WALNUT HILLS FARM. LOT# Pg. 3 of 3 = Contour elevation lines. • = Backhoe Soil pits. O = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. z _ 3tA SCALE: 1" 2- LO - i AID 407- Li ~vR 5 S ,oVA Go,~uR g ASS s ~v /40 u ti, S ys T, +/,P u ria 20 ,fly 3 ` Flo M 7L- 6 v ~ . G p t Co 5 /©D~a