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HomeMy WebLinkAbout040-1303-00-059 RECEIVED : ~ 1 ocl 14 NI Safety and Buildings Division a 201 W. Washington AVe.; P. 7162 Permit Number (to be fined in by Co.) K I(Outar Madison, wl 53707-7162 a r 3 MUNII `t` iraVMLOPM~ T State Transaction Number Sanitary Permit Application In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the approprtato governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if d• went than mm'ling address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary r oses in accordance with die Privacy Law, s. 15. 1 m Stats. L Application Information - Please Print All Informal Parcel # property Owner's Name a I 3 0-90- 5 63 - 6o - 051 (J V C ) Propetty.Locatior la .;R, • Property owner's Mailing Address ; fl z✓ City, State Zip Code Phone Number r/4 Section 27 (circle ~ ` r C Imo---)1 T N> E W II of Building (check a at apply) Lot # Subdivision N e 2 Farnr7y Dwelling-Number of fcirN 61G ~ ~ B' (ST I #t", ~ ❑ Public/Commercial - Describe Use - ❑ City of CSM Number ❑ tllage of ❑ State Owned - Describe Uy Oven of N Jr7 ,r III. Type Permit (Check only one box on line A. Complete line B if applicable) d h~ A. aw System ❑ Repitccemertt System ❑ Tra mentaolding 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 S stem/Com nentJDevice: Check all that a l d r ❑ Non-Pressurized I1G10und ❑ Pressurized in-Ground ❑ At-Grade ❑ Moll 2:24 in. of suitable soil otmd < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Protreatm ce (e xplaia) V. Dis rsaffreatment Area Information: Design Flow (gpd) Soil Applicati Dispersal Area Req ' (sf) Dispersal Area Pro st) System Elevation s osb ~ZS 2b1 ✓ n Total # of Manufacwrer , Capacity in VL Tank Info o Gallons Gallons Units o' ' • l t' o New Tacks fixisan8 Tanks W , a a iz En ri. C7 C. Septic or Holding Tank Dosing CW=ber 31 VII, Responsibility Statement- 1, the na assume sibility for installation of the POWTS shown on the attached plans. Plumber's >dme (Print) Plumber's Si mpimyr-, Number Business Phone N bes Phmtber's Address (Street, City, suite, zip Code) ' 52 ! VIII. Coun /Department Use 01111 Permit rot; Date Issued Issuing Ag Signature 6Z5.~ is 15 ~S en Reason n 1X Condit ns for Disapproval 3> / • ~t`~ i +b1 ~~4J IT 4"W A00tw, 4 > ` Septic 1ank, l call efuent f iltbi and disposal -must all be serv a / rrlaihlai atper managernent plan provided by plumber, 2: Aii soWc;t; iecl remerAs must Ow q*nt1i6ed 1 as per ...code / ordlnanaa Attacb to complete plans for the system and sabmit to the ty only on paper not less than 8 12 z I I ineha in sic SBD-6398 (R. 11/11) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 100.9' 1.4' sand lift 9/29/15 BEDROOM 3 DATE CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 1/2" conduit ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Walnut H i l l 'day Scale = 1/4" = 10' All piping shall be ASTM SDR 30/34, within 1 Acre Lot 10' of tank, piping shall be ASTM F891 Wel I is to meet al I VY'DNR setbacks Property Line Pro 3 Grading is to be done to divert run-off Bedroom away from system Ho use Huffcutt Combo Tank B.M.* B-1 100' 99.5' B-2 99' Tank is to be properly bedded and B-3 provided with lockdown covers 98' with approved warni ng labels 4% Slope Area 15' below system is to remain undisturbed Property Line ~r r' pi • ~~9eraxr,~FNT DIVISION OF INDUSTRY SERVICES os 10541 N RANCH RD HAYWARD WI 54843-6462 3 S P~ Contact Through Relay hftp://dsps.wi.gov/programs/industry-services www.wisconsin.gov 'ssroNN Scott Walker, Governor Dave Ross, Secretary October 13, 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 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/13/2017 Identification Numbers Transaction ID No. 2621456 SITE: Site ID No. 818235 Oevering Homes Please refer to both identification numbers, 209 Walnut Hill Way above, in all correspondence with the agency. Town of Troy St Croix County SE1/4, SE1/4, S22, T28N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1560663 Maintenance required; 450 GPD Flow rate; 20 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: Reminders • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. 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. SHAUN R BIRD Page 2 10/13/2015 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, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f7AM - 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: 9/29/15 Owner:Oevering Homes Location: SE1/4 SE1/4 S22 T28 N,R19W 209 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 CGNDI r LY 5. Pump Chamber Cross Section DEEPT OF '.IFS 6. Pump Curve PROFESSIONAL SL, Z i C -::5 DIVISION OF INDUSmy :s`LkVICES 7-8. Maintance and Contigency plan 9. Filter Specifications and cross section Attachments: Soil Test S PESPOiVDENCE Shaun Bird Signature License ber 226900 Page 1 of 9 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 100.9' 1.4' sand lift 9/29/15 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 1/2" conduit ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL * H. R. P. same as benchmark Walnut H i l l '1{5ray Scale = 1 4" = 10' All piping shall be ASTM SDR 30/34, within 1 Acre Lot 10' of tank, piping shall be ASTM F891 Well is to meet all WDNR setbacks Property Line Pro 3 Grading is to be done to divert run-off Bedroom away from system House Huffcutt Combo Tank B.M.* B-1 100' 99.5' 5B-2 99' Tank is to be properly bedded and B-3 provided with Iockdown covers 98' with approved warning labels 4% Slope Area 15' below system is to remain undisturbed No. Property Line C ~ ~ M l Mound System Cross Section and Plan View " - - - - - ` Dimension Feet A ' 1 L Lr r r r .r:i'F}~}~tir4rLf 1 1 1 r Lr1f 1r1r E T ~D f J f•r•f r_f., .r, ti ,f; r1ryflr 1fL 11f• L 1 ♦ j41: 'r r1 r r.{LrL r r ' A 1rti~'..vL1}r}r:i~{~:;.:• :;i.S:.1 ti •..L.1• r r1r r r.r1r'iii:r`f.. :{1iLr r ' f f•T• f r J,~f r r f f.r f r1r; l~fif4:irLr1 ~1 r r 1 L 1 L L L ' : J 'f1 r.. r ; • ' 111 % - W G d T Z ~T d, K L -713 . W K -T B Z / - Slope % L - 1 =Topsoil = ASTM C-33 = Clean aggregate = 4 in. sch. 40 pvc Cap Material sand fill '/z to 2 `/2 in. dia. observation pipe L - J Geotextile G H Fabric r;? r1r.rM1rlr.r.r.r:. 1 r 1r r 1 F r t D E. ~ r t J Z Plowed Surface h Ft Contour; Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing 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 foot 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. -7 a 10/071 gj Page of _ Pressure Lateral Layout Two Laterals - End Manifold 4 Threaded Cleanout Lateral Turn-up Plug Manifold M X - - I Long Force Main Sweep 90 J Bend f yq n ~j `j Distribution Network Specifications Pressure System Construction Lateral Diameter In. Manifold DiameterIn. Laterals are constructed of Schedule 40 PVC Orifice Diameter - In. pipe. Orifices are drilled perpendicular to X (Orifice Spacing) - In. the pipe with a sharp drill bit and face down. L Lateral Len th) Ft. 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 Length from finished grade. - • • • • • Grade • • • • 6-8 Inch Lawn Sprinkler Valve Box - L. 1/7 Page - of 03/0519) Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer ( - Pump Model Number ~ r ~ L Tank Model Number Alarm Manufacturer no 1, ank Capacity Total B ry Depth Alarm Model Number L F! Max. u ~c? Switch Type Total Dynamic Head (TDH) -Feet Filter Manufacturer %r Filter Model Number' Elevation Head Distal Pressure a, Network Loss Minimum Pump Performance Required Force Main Loss GPM: Ft TDH Total S: Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Securely Mounted With Locking Device < d" Below Grade Sealed Watertight Weather-proof Junction Box Finished Grade t Vent Min. 12" Disconnect Above Grade Means With Vent Cap IX X Outlet Filter Inlet Inlet Baffle - Xk. A Switch Settings and Reserve Capacity Weep Tank Volume GPI B Hole Volume Gal. Dimension inches (reserve) A T r Off El vation C (alarm) T/ L Ft Bottom 7 (dose) C D Elevation (dead) D Ft Total :t i~ ,a;• a,ai , : a~:Y'a~:y;Y` ;a•Y♦ia ~>i>{ . +>a•>+la: a .•,aaa:.:1>/ V : • is bedded and -hack filled in accordance with the GENERAL INSTALLATION: The septic/dose teak manufacturer's product approval specifications. Maximum depth of burs' as specified by the manufacturer may not seeded without prior approval. Manhole covers exposed to grade have an effective rtl~ (padlock) t fittings, and be ex roved material, connected to the tank installed. Piping at the inlet and outlet is of app or saggutg• The force main is sleeved with 4" Sch. 40 PVC to bridge the tan laid on stable soil to prevent settling service complies with 11EC 300 and Comm 16.213. excavation and the sleeve. is sealed watertight. Electrical of Page 02/05 U p ~ R UV'J E Ci1'; ~t4'dA1I~!v no ~~rD CA.~FCiTY J Y,c - - T ULL wit- cc 50 2 Ill ,J 3 4 0 - 4 _ L - 30 l - I !f 20 U I - _ LiJ5G5 4Ji - - - 0 i ? V 6 i; 0'0 , LITERS 8C FO _ - _ - u~ CONSULT FACTORY FOR SPECIAL APPLICATIONS e e - Timed dosing panels available vith , for duplex systems, are available ono supp !e Electrical alternators an alarm. Variable level control switches are availab e for con roiling single phase systems. - - I • Double piggyback variable level float switches are availab e `or vanab''e level long and short cycle controls. - Seated Qwik-Box available for outdoor ms al aticns. See t 4" • over 130°F. (54°C.) special quotation reel red. 152J153 Series control selection ~ 1521153 MODELS 1' Duplex Model Volts:Ph - Mode Am s SF ;ex Nor N152 T115 t 8 S - - - . 1 AOto 8-5 I Inc!uaed 20 BN152j 115 _1 43 2c_ Non E152_ 3 i In1u_ec 13E1521 230 N~~ ± u5 2°r 3 SELECTION GUIDE 2 _ Single piggyback variable level float switch or double piggyback var able level float rBN1531 117 5 Auto nci :eo u J E153 ! 230 Non i 5 3 - I iuoao ~ sw'itc^ Refer to ct.10477 auto - - `BE153 23C FA _c 2. See`Ir'3712 For correct mooel of Eiectnca! A!temator E-Pak _-A -1 recent National Electric Code (NEC) and control Sw'tch 10-0225 used as a control activator, specify duplex ~o; All installation of controls, protection devices and and safety codes wiring be followed'mclud including he most licensed electrician. All ele 3. V vanl float SySle,,. ctnca the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. aOX 76347, _ Aa - !S1 LOw vile r i 4056- 7 facrarersor . SHIP TO 364, Cane r n ~y Lo !svi(e vY 4021 "61 QLdUTr ' ✓.Y,PS .~~NCc" t502) 778-27i31 • 1 iK0,1 9_3 pJMp A f'VMf !O. , '74.304 httpa/www•zoeller. com - G Copy right 2000f Zoeller Co All rights reserved. 6 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of FILE INFORMATION SYSTEM SPECIFICATIONS al ❑ NA owner Septic Tank Capacity Permit # Septic Tank Manufacturer , ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS Number of Bedrooms ❑ NA Effluent Filter Model ~ ❑ NA Number of Commercial Units ANA Pump Tank Capacity i~_ ~ al ❑ NA Estimated flow (average) al/da Pump Tank Manufacturer NA k), (Estimated x 1.5) `f ...;i-'J al/day . Pump Manufacturer Design flow (pea ❑ NA I Pump Model v"❑ NA Soil Application Rate 1(--2 al/da /ftz Monthly average- Pretreatment Unit A Influent/EffluentQuaiity C1 ❑ Sand/Grdvel Filter Peat Filter Fats, Oil ii< Grease (FOG) 530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODS) 420 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s Biochemical oxygen Demand (BODS) s30 mg/L ❑ In-ground (gravity) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade and ❑ Other. Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Dri ine Maximum Effluent Particle Size K inch diameter Values typical for domestic (non-commerclaQ wastewater and septic tank effluent Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every c. a ❑ months ar(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s At least once every ❑ months r(s) (Maximum 3 yrs.) Clean effluent filter At least once every f ❑ months r(s) Inspect pump, controls & alarm At least once every ` ❑ months r(s) ❑ NA Flush laterals and pressure test At least once every o months ear(s) C NA Other: At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS of the following licenses or Inspections of tanks and dispersal cells shall be made by an individual carrying one certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, 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 surface. The ponding 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 (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. price local regulatory authority within 10 days of completion of any service event. be provided to the report shall b p . A se 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. F it ~ /r page of thr';t START UP AND OPERATION painting roducts or other chemicals s are detected have the contents of th;a For new construction, prior to use ofahe POWTS check treatment tank{s} for the presence of p and/or damage the dispersal cell(s). If high concentration may impede the treatment process riot to use. p tank(s) removed by a septage servicing operator darn uen.t, is restored te e System start up shall not occur when soil conditions are frozen at the infiltrative surface. xcess During power outages pump tanks may fill above normal highwater levels. When p owe in the backup oh surface discha ge ofreffl will discharged the dispersal cell(s) In one large dose, overloading the cell(s) by and may the er controls to restore normal Ieve's To avoid this is situation on have the contents of the pump tank as istdibymanuaUy operatngng OpPr P r prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Boa not drive or park over, or otherwise disturb or compact, the area wit rlr 15 feet down slope of any mound or at-grade soil absorption a or elimination of the following from the wastewater stream may improve improve dental the floss; performance diapers; and prolong disinfectants; the fat; fife foo{ n9 he RP ad ctls; Reduction foundation drajln antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; grease; herbicides; meat scraps; medications; oil; par (sump pump) water; fruit and vegetable peelings; gasoline; line; g 9 pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service e the following steps s ativehalCodl to insure that the system is propel y and safely abandoned in compliance with chapter Comm 83.3 Sealed. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings • The contents of all tanks and pits shall be removed and properly disposed of by Servicing Operator. the void space filled with suiil, j • After pumping, all tanks and pits shall be excavated and removed or their erS gravel or another inert solid material. CONTINGENCY PLAN I iinr If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code camp replacement system: D A suitable replacement area should be been tecevaluated and may be utilized for the ted from disturbance and compaction and should not be infringed upontby system The replacement area sho hell p setbacks from existing and proposed structure, lot lines and wells. 1=allure to protect the replacement area will result in the nE~ec for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:; ii effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS techno ogjJ holding tank may be installed as a last resort to replace the failed POWTS. the soil POWTS and The site has not been evaluated suitable replacemlentlar a. if no ereplacementpareaailure ail ble a ho d ng t nk may be installed'g must be performed to t 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 infiltrali, surface, Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO Ni ENTER A SEPTIC, PUMOTHER A TANK MAY sE DUFF CULT OR MPOSSIMSTANCES DEATH MAY RESULT. RESCUE ON PERSON FROM THE INTERIOR ADDITIONAL COMMENTS _ POWTS iNSTALLE POWTS MAINTAINER _ Name r J - 01/ Name _e-; E Phone Phone Al - SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATO Y AUTHO iTY T~ F Name - Name Phone ~ Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. a 0 > f P O~ G C I~ j i P Mp~ x ~ ~ 1 vv A nJr/ L LL: co "too" V qt CD 'en lip / Ir 1~ r~ Vf V h to ' / rp \ \ (1x i / ` y \1 1 r` N 03'0`C3l' W nt sIx \ \ W 197.T9T. ' R~ l *ti r I n f' ~ Q p s. ~ r •WI' .g _ ~ ~ N'1 ~ 1 f N t • . a Zi ~ iv ~ F>•'6Yg4 ~ ~ \ r 89 ~l~ .9~•y~ I t ~ I ~ w 1~1 MQI ~ \ n ! ~ ~ci'k `O,Str. ! 3•~~L~`o ` 1y 110'3 w t p~ I ~"1 '`'f N O~ ` SOS .fir 'fr f o ~ ci aol W 1 ,LSYft 3 N - f t" r xr- h f►~ LL: 40 ci ~ ~ ap ! •j~ 'O~ ' ~ ~ ~ P'o P'o fro 00 N t~! S' Z $ ~ ~ _C) O fI I r r [r'S i+ 2 / •1 ~ w ( Z 2 i^ I ~ ~ ' ~r w 0\ n ~Z (VA Z X H p Z li !L LA- ~ gE3 WZ_OOONU~ Lo ST. CROIX COUNTY ~ SEPTIC TANK MAINTENANCE AGREEMENT AND OWNER.SHW CERTIFICATION FORM Owner/Buyer Mailing Address l . -2 - ProPerty Address 2 6//1 (Verification required from Planning & Zoning D for traction.) City/State Parcel Identification Number 06- LE AL ESDCRIPTION g Property Location % , Sec2"Z , T ~ 9 N R w, Town of _T (Q Subdivision r~cL 1 M..~ Lot Certified Survey Map # Volume page # Warranty Deed # ~ ~ Volume Page # Spec house no Lot lines identiliab ye no SYSTEM MAufmANC pWNER CERTM--CATIUN Improper use and maintenance of your septic system could result in its maintenance consists of p MVm~g out the septic tank ev PTe~ature failure to the system can att'ext the 'three years or sooner, if handle wastes. Proper function of the septic tank as a treatment stage in the wastes ~ a Pwnper" What yon put into dis responsibilities are specified in §Courw, 83.52(l) and in Chapter 12 - St. Croix Coup SP~aI Mftn Owner Wince ~~y Ordinance. The Property owner agrees to submit to St Croix County pig & Zonm owner and by a master plumber, journeyman plumber, restricted g Department a certification form, si 'w'astewater disposal system is in propel. Plumber or a licensed pumper verifying that (1}the on-s by the less than 1 /3 fill of sh*e. Operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is I/we, the undersigned have read the above r standards set forth, herein, as set by the D t e9utrernents and agree to maintain the private sewage disposal system with the Certification stating that your septic system C0~rce and the Department of Natural Resources, State of Wisconsin. Tozring Depatrtnent within 30 days of the threhas been e year retained must be completed and returned to the St Croix County ping & expiration date. Uwe certify that all statements on form are hue to the best of my/our lmowle:dge. Uwe am/are the o property described above, by virhre 0a deed recorded in R wuners) of the egieter of Dads Office. Number of bedrooms ~IGNA~ OF APPLICANT(S)/ * DAT 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) LW U)z °m ¢ Z mW 11 It,iI I1,]11 FIT i f Will u a :I a I I dYr I I I ; I ' w~ W I1 1 1 4 I t I j ~ I I 1 1 1 11 ~ I I I I 0~ ~ II 1 5 I i ~7€f.1y 1 ~ RQ y 1 I i III,,~~ i a$~Te t\\ 111 ' I S~■ I I ~ I~ I I R ~ i ; I 1 I I C Sb I I I I ! ~ ~ I I e~~ i I ; .s•uon~nzx. ! ~ T-- . 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MOayoe prov+~~Ywuoee ru..ecanOVrwPo»sI •r taYr. s. a:.,, ~1}tm)i. L(/~Yln-•-- !D L7 propertfomwer ropp Ci3ERST~f~T`" % 7-*PQ Property flM GovlLot .41 G ss1a S21" T N R /9 i(ar)w NOwr s DAddre Lot # Mock # Subd Name or CSM# oly ca t~~ckess ~}ve 59 IVAIVOT- Kill FA'Je~( (p ~ CKY SAIMP smla Code Phare IG ❑City Ooh GaTOwn SO 6,100ek (rt'oUF q T ; MN 5So7G (t,5(a ~y8' 99 TR y New ConWucWn Use: EA Resideroal t Number of bed oars code derived aecign flow rale 0 Oa CPO H [l Replacemwd ❑ Public or oomrrwcial -Describe: Parent materi~ /DE5 S o l7~ 7-7,7 ]Q7~y1~ - Food Plate aiavelon a applicable Genwaicwmrrwes l7014,G4% 11. Vi and reoaranendebms: • f1',~F,,~- TESTED iS Svrji1,61,C-_ MW SyST. ty ZISr'~v 6, Ito S,g,vv F111- N Oo S. S. S : P M B°rin° # ®Plt Grae,d autaoa elev. d _ Oepar>D wimiarp fader z D sa Rate GM - Fortran Deph D-*-tCdw Red= Desafpaon To&eo Stracaae hence BaodaY Roots in. Mused Qu. SL Cam War Gr. SL Ste •Hf#1 'EMT b / /o 100 31 T x s h nMfR w 3 s 8 z 0.20 i0 5/L S L i~R c S 4 2 S/ < S k r"`-E! a S 2 3 3 D 7S iP mn, io YA f, 0 n Z M /3.'e eo""0 # ®pf e18 &*UM aurtaCe elev. 9 7.6 R. Dept to *nbv tacor in• gd Rate tialmn Dptb Dwftia Cder Redax Descripaen Texeee Stnrcdee CaraWderree Bou+dwy Roams r' in. Murksell Qu. Sz Cont. Coon Gr. SL Ste ? `1 /►„'Fj2 W c7 F S N / 0 Q /0 3 a f S r- z T. T/ ~o 1L z s ,>M _1C i s N 3 8 2 75Yk SQL ccv NY 1. 2.27 ~.S SQL a 2 Z-,1;4.,, ~c- DlOfl~ i i • EML wit #1 a BOD > 30 _ 220 mall and TSS >30 150 "BOIL ' Efauerd #2 = BOD 130 mall end TSS 131) nviL CST Noma one- Prlna t~ Zi R i G ~`~'e 3x5 Addreaa ~C Dale Evakelim ZRR~ Tewptwns MAWK Ulbricht & Ass9ciates SST 21 _ ~a 71 f. 7.7A • 3 yy Z-- i t 2812 10th Ave. Spring Valley, WI 54767 Pin15' fok* 4P?Rox . 2 yo '4dte3; oyo. lags. So • 07M oyo • /o ply • /o • arm oyp /DIG a0. Oro oyo•/o~G- GO•~ oyo /orb 70-600 ~~1~,L oyp i08~p 8D oi~ TODi2 /.3 JE o 5 T,L-,oT PropartyOwner Parcel 10 0 G a f Sy ~ z~ 3 Boft tJ B-V !3 R ~-1 t Gnu swaceelev. ~~.(Oo ry OepthIDWM betur . T irL Fiottaon a Dominant Color Redox ,Oesaip6m Texure Struekae Coracistanoe lloardary Roata Sail tlPQilf Rabe in. n. Munseti Qu. SL Cant Color Gr. Sz Sh. 10'5 /D S n„f2 W 3 f . S L9 7S ^r' G c s SQL ~F~' Q S s ❑ Fit &.,r d surface elev. _ fl. Depth to *F*r p factor in. Itodzon Oe Don:-ant Col. 5d Rate Redox Mse ipGon Texture Strudur Cor"Wence goer~ty Roots GPW f 4ufse6 Qu. Sz. cant Color Gr. Ss. Sh. . . I I Raring # ❑ ❑ pit GrgnxS surface elev. fl, Oepttn to factor kt -Amkom SW Rafe QePlh boffin Redrnc Description- Texive C.or BrlC¢ BourKlary Roots In. Mtmsetl Qu. Sz. Cont. Casa Sh. *awl -Efl7R2 .s. Roing # ❑ eonn9 ❑ pit Gn~ard soface elev. fl. Lkptln to iadtirrig factor in. Suit Rule! Horizon DaPar t]ortdrant Cdo, Redact i)esaipliv,.. TexWe Shudwe Canoe Baadsy ttoob aPDIR in Mansell Qu. Sz Cont. Color Gr. Sz Sh. 'Ef t 'EfGf2 • EflU,am rff = BODs> 30 ~ 220 +nflfl. and TSS >3D < 150 rngft • Eflkeerri /12 = BODs < 30 ngll. and TSS a 30 mplL 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, seoifnnA~tme L SLOT PLAN WALNUT HILLS FARM. LOT Pg. 3 of 3 © = Contour elevation lines. • = Backhoe Soil pits. Q = Benchmarks set, maRRED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE : lit _ 30 y o , s~ y ~~s T~ faR~► •~o~~~ sysr~~ W gvy5e5 7~ 1410440,0 sJ'srtiTiav /00, A Piz P lA yob ~g i F - d 98, u o Qg a ~O 7' 5, w /GoT ~O~~l et fz~ v,~ p - S ~~P vE yolk 'S - Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, Wl 54767 ,t Wrsoo~sin Department of Commerce SOIL EVALUATION REPORT Page f of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST G,@ 0/)(-- Attach coml include, but EROSION CONTROL PLAN must be oad Parcd I.D. 4 P © t pefcentslw completed before sanitary permit issuance JA~ wed Date Peraaw 6donnabon you provide may be used for secondary purposes (Privacy Law, s. vo.v kf) (m)). ?2 Property owner r Propertyr ©a J~p T-00P ZjERS T-e7U T- 10 0d l~M corr. Lot Al era 5 1/4 s ZL T 2.$ N R (or} w Property Owner's Mailing Address W# Block # Stud. Name or CSM# t'OOIS CA ItiLL AV-0- - 57 CVAL"Or w If iFARAf city --CMWR State Code Phone Number ❑ City ❑ Village (jd Town Nearest Road 6op#VE7 K73 M,v 5S07(P &S() aY8• Of -rRoy so. G1o0e:R Ov New CMAbuction Use: C9 Residential ! Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material %OFS S O Vet-R R-5 /0Flood Plain elevation if applicable ft. General oonunents D/D 1'74. and recommendations: • 4,ft - ?~ST~D i S Sv~'T~,6/E ~-D,e /f- /~Iov vp 5YS7 M Boring Of ❑ Boft j j• *0 s. ss . ® Pit Ground surface elev. ft. Depth to running factor D in. Sod Application Rate Horizon Depth Dominant Color Redox Description Te)d" Structure Consistence Boundary Roots GPn ff In. Munsell Qu. Sz Cont. Color Gr. Sz Sh. -011#1 'Eif#2 b 10 /o 1490 313 s hx A,%-rP- 3 . s N z 0.20 AI 51L S e &r PR C S .9 %A 3 0 -7- SW y io Z -51 ` ~ S hg tM=F! 6L S . Z . 3 0 1't i~ Bor1ng# ❑ t3orirrg If.go 13-k . !_J ® Pit Ground surface elev. ft. Depth to liffi g factor in, Application Rate ttt,~~~ I Sol Horizon Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roble GPDlIf In. Mt n Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 . / a • /0 3 G- 24,5hL I%,-FR w f .5 N 3 8' 2 -7:5 W 51L C40 /f - P25 IM-Ft, -40 2.27 7 •S S /L lit • Z Effluent #1 = BOD > 30 1220 mg& and TSS >30 1150 rrg& ' Effluent #2 - BOD 130 mg& and TSS 130 mglL Signaftse CST Name (Please Print) •R --ALB k I C i T -2-63-75; Address Ulbricht & Assgciates Date Evaluation Telephone Number Private S?T • 21 - boa 715- 77a. • 3 yy 2-- 2812 10th Ave. Spring Valley, WI 54767 FOR 4APROK. 2-1110 46te5 oyC~ • /erg S • S©• a~ o yo . fQ . ~d . oao dyp • z®• o~ 0 y0-/0*6 - 70. ~ oy0. N ' % TODl7 l3 ~E ~ 5 TEDT- I Parcel tQ # G f page Z -Of 3 t Ground surface elev. ft_ depth to rnlfrnt~ factor 2 (e ka soil ~ Rate dJeptfa }ominant Color Redox Demon Texture structure corWdence So intFary Roots GPtDM Munsell Qu. Sz. Cont. cow Gr. Sz. Sh. `t=ff#1 'Eff#2 l ~ ' S /D G 2-FS ~bvt~2 ~J 3 f . S . ~ Z o S /hl c ( . S Cv ?s R SiL ,F~' ~S s g# 0 pit Ground surface elev. ft. Depth to limiting facer in. Sod it~ian Rate ' Horizon Depth I3vmireaM Redox Desa#*on Texture stye Consistenm Boundary Rotes GPUIPE< #s Mi ll tau. Sz. COnL COW Gr. Sz. Sta. S # l~ Q Pit Ground surface elev. ft. Depth to factor in. lz~te Horizon Depth f9orr*aarat Redox 0escr"on_ Texture strucl4re consistence Boundary Roots G lra. Munson Ou. Sz cunt color Sh. 1 'Eff#2 3 ~ x tl F-I Soring # Boring _l Pit Ground surface elev. ft. Depth to fx'+vf V fates in. Soil Rate Hortzon Depth f?Oin1[mm CO&x Redox Description. Texture St€ixchare stenee =--vtooft GPM in. Munsefl fiat. Sz. cont. cdorr Gr. SZ. Sh. 'Eff#1 'Eff#2 6 Effluent #1 = BOO, > 30 1220 rngk and TSS >30 < 150 mglt. " Effluent #2 = 8OD, < 30 naglt, aid TSS < 30 mWL The Department of Commercc is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate fortnat, please contact the department at 608-266-3159 or TTY 609-264-9777. seoaauo ~u+n~ ♦ r u h JILOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 d = Contour elevation lines. Backhoe Soil pits. O = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE : 1" 3o = 75 T 74dv: FOR /VoU,uQ 5 y57z f 74 Ito r ' 15 J~ /00 ~A yid ~JWi a Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley; WI 54767