Loading...
HomeMy WebLinkAbout030-2149-06-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 579062 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. State Plan ID No: Permit Holder's Name: City Village Township Parcel Tax No: Scott & Quinette Hotchkin TOWN OF SAINT JOSEPH 030-2149-06-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: r It buh 0 36.30.20.3031 TANK INFORMATION ELEVATION DATA TYPE MANUFACTU ACITY STATION BS HI FS ELEV. Septic ~2< D cit a I Benchmark •b 101. q9. 2- G J Alt. BM7 r b3.7 I~- Z O -ISO Cili Bldg. Sewer 6.71 '75.6- Li Fe-li Irri.A- Holdeno St/Ht Inlet 7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO CP/L~ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ` ~O• 1 YEW= . j 3J Pl88i ti g ♦ Header/Man. I 0 Z Aeration Dist. Pip .,y .l 1 a' Holdin Bot. System Z 7• , . PUMP/SIPHON INFORMATION Final Grade 3. 2.5, M , 7 Manufacturer Demand Cover GPM 1 /0 Model Number 6N '5S I T TDH Lift 3~ Friction Lois ~ System Head TDHS ~ Ft I . C ~ i 1 t~ Forcemain Length 7 % Dia. „ Dist. to well , t I .1 An SOIL ABSORPTION SYSTEM 'v BEDITRENCH Width t Length No. Of Trenches PIT DIMENSI S No. Of Pits Inside Dia. Li uid Depth DIMENSIONS 1 It / Q ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION yp A T Of System: CHAMBER OR -g stem: ~ pN~ N UNIT M el Nu r: / is ~A/ DISTRIBUTION SYSTEM W Its ~ Header/Manifold Fistribution ix Hole Size i x Hole Spacing Vent~o Air In ~ ipe(s) 5 Length Dist ength is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ( Depth Over xx Depth of Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil T Yes Q No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 232 124TH AVE V jt 1 1 `bJ - 1.) Alt BM Description =I I43X 4 1& ik ! 2.) Bldg sewer length= I - amount of cover = ' J.~~/_ U e WC-wl4 • 14 Sd6}h h G ~ / )qj 0 D. W1 3' &D A-4 D-C; Plan revision Required? RM Yes No [10 UVM se other side for additional informan. (~y SBD-6710 (R.3/9 Date Insepctor's Signature Cert. No. ACT 1 Zp1 Count), r a Safety and Buildings !Don S s ~T, CR01 C, i0 TY 201 W. Washington Ave., 7162 Permit Nnmber (to be shed in by Co.) R MMUNtTY DEVELOPM NT Madison, Wi 53707-7162 Sanitary Permit Application StateTtonN In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate govemmemal unit -Vired prior to obtaining a sanitary permit, Note: Application forms for state-owned POWTS are submitted to Project Address the Department of Safety and Professional Servies. Personal information you provide may be ( ent than mailing address) Stets. use for secondary ses in accordance with the Pri law, s. 15.)4(1)Cm L A !cation Information - Please Print All Information J 2- 11, L /[~A Property Owaces Nam V r1 I T Parcel # o3a~ ~yq-6~ -~dC Property Owner's Mail" s J !!;7- Property Location Gove Lot C' State Zip Code- phone Number ¢ rrcle one) Type of Building (check all that apply) Lot # / T 0 N; R Z E or W 1 or 2 Family Dwelling - Number of Bedrooms S onName / ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSMpNumber' ~ C ❑ Village of Z l J I 1 V 17VN CCU tj 2 Z Z& C H l"16 E15 Town of J11• Type o ermit: (Check only one bo on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Dii9ing System (explain) B. ❑ P t Revision ❑ Change of Plumber ❑ Permit Transfer to New Lrst Previous Permit Number and Date Issued Before RViration owner iV T ofPOWTS S stem/Com onent/Device: Check all that apply) r Pressurised In-Ground ❑ Pressurized lh-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ 4 ❑ Holding Tank ❑ Other o e soil Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis al/Treatment Area Infor lion: Design Flow (gpdy Design Sol] cati dsf) Dispersal Area Required (sf) Dispersal Pro Posed . (s/) El "on i V r Tank Info Capacity in Total # of ufaoduer Gallons Gallons Units 8 $ New Tanks Existing Tanta n~E U Q 0. CA » y rL Septic a Holding Talc ~ I7Z ~ ~ ~ b' ~ ~ ~ a Dosing Chamber VII. Responsibility Statement- I, the undersigned, ass a responsibility for installation of the POWTS shown on the attached pleas. Plumber's Name (Print) Plum s gnaame MP/MPRS Number Business Phone Nom ~s P 's A~ (Street, City, State, < VIII. Coon /De artment Use On Permit Fce~ Date lssu suing Agent Si ❑ Owner for , lO 27 !mot/ IX. Conditions of ApprovaUReasons for Disapproval 2 , n OWNER: v~ V POOL U1 S (,lS~/t/1 1 sic tank, effluent filter and d+ wrsal cell must be serviced I maintained dra4,11a Ca~ / a: .ar management plan provided by plumber. r maintained WSJ- / system and submit to the Conn o us per applicable cock o n►y a. pop- per LV s L12~ p Q Ve41- 611 SBD-6398 (R. 11/I1) , Wisconsin Department of Commerce SOIL EVALUATION REPORT Page --L of Division of safety and Buildings in accordance with Comm 85, Wis. Adm. Code County LJ / Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must / /Y include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. tJ Z~ /fiI r D / Da Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3o - 7 _ CD _ Please print all information. Revie b Date tfl Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 Z Property Owner Property Location C.r Govt. Lot 1/4 1/4 S T N R E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# city State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if an ~ble ft. General oomrr,eMs a t:l d ()n o ~'l~AW J~ and recommends System Type s: •~~/s rVi c k~ 5 I / d ltefw) V System Elevation /UL q Boring # Boring 9 Rd'; Pit Ground surface elev! ft. Depth to limiting factor y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPEM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 - .30 s C o l~ /Y1 I F-1 - 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 GPDAf in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 J F-7 • Effluent #1 = BOD. > 30 < 220 mg1L and TSS >30 < 150 mg/L • Effluent #2 = BOD. < 30 mg/- and TSS < 30 rixyL CST Name (Please Print) Sign CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 ,,2 715-246-4516 Property Owner _ Parcel ID # Page of F-I 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring # ❑ Boring F-I ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. F-I ❑ Pit Soil A-pplication 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 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. seD-9330 (e.6/00) Soil Test and System PLOT PLAN 2b~~ PROJECT Scott Hotchkin ADDRESS 265 Canvon Pass Hudson Wi 54016 NE 1/4 SW 1/4S 36 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 94.5/94.2 5' below grade 10/8/15 BEDROOM 4 DATE CONVENTIONAL IN-GROUND PRESSURE CONV TIONA LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT K ZE765 DOSE TANI HOLDING TANK SIZE LOAD RATE .7 PTION AREA 891 # of h bers 45 ,BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as ben mark All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Highway 35 Pro 4 Bedroom , ^1 House Scale = 1/4" = 10' 20' Huffcut Combo tank Vent >6„ Quick4 Standard of Cover Leaching Chamber 2-3' X 90' Cells with >3' sp g with 20.0 ft2 of Area ft 2/pair of end caps B-4 Long 12" r~ • 2 34" Grade at System Elevation 50' Vents at end of cells 80' 99' 98 Area of Poor soils B-1 Drainage eas ment, surveyed and ked B-3 80' 35' 3% Slope B-2 35' M * 01 Property Line 70' r Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Pum Model Number 'ra-nk Model Number u P Alarm Manufacturer / Total Tank Capacity 2-55 - Max. Bury Depth Alarm Model Number Z_ c./ Z- Switch Type Filter Manufacturer Total Dynamic Head (TDH) -Feet -1-4. ti Filter Model Number Elevation Head - - - Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss Ft TDH Total I i outlet Manhole 1V1!:im 4" Above Grade With Manhole Min. 4" Above Grade Locking De~ice. Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted Weather-proof Junction Box - - Finished Grade r.. Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter - - - - Inlet. Baffle - - Inlet Switch Se yngs and Reserve Capacity A y~' Weep Tank Volume GPI Hole Dimension. Inches Volume Gal. A d „S yw. (reserve) Off ation C (alarm) B 2 3 Ft (dose) C 7 S a2 Bottom (dead) D Iii 3 D Elevation Ft Total 8~--~ `YS11 ~ I~t~~~t~ T1;1,< 1 i~ ,i,1 lr•i1. Y > 'r'Y > ~ > > > 1 f I >'+~>'>'>~>;\;>'1'I'I't'1'! !'>'r; 1;l,l;i;> ,>;>,>,.,1,.,11'l't IIY / 1'1'1'>'/'>'1't'1'1. GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may riot be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected 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 U Page of -LS59 L' L5 V or-, e _4 < - r i _ f _ I - 4 ,3 _ITERS c - i o - J - - C Variable level float switches available. Variable level long cycle systems available. - T Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. Duplex systems available. 6~ T Single Seal T Control selection _ Listings Model Volts Phase Mode _ Amps Simplex Duplex CSA UL 1. Integral float operated mechanical switch, no external control squired. M53/55&M57/59 115 i 1 Auto 9.7 I 1 Y v 2. Single piggyback variable level float switch or double piggyback variable level N53/55 && N57/59 115 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FM0477. - - - - BN53 115 1 Auto y 9.7 Y Y 3. Mechanical alternator "M-Pak" 10-0072 or 10.0075. BN57 115 1 Auto 9.7 N Y - 4. See FM0712 for correct model of Electrical Alternator. r SE53/57 230 1 Auto 4.8 Y _Y [_D53/55 & D57 59 230 1 Auto a 8 t Y Y 5. Variable level control switch 10-0225 used as a control activato with Electrical - E53 55 & E57/59 230 y 1 7 Non 8 F 2 y 3 or 4 & 5 Y Y Alternator (3) or (4) float system. Single piggyback switch included. o cnuTioe For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase a<. Simplex Pump Control/Alarm Systems, FM0732. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.0. BOX ,F?.,7 Louisville. KY 40250 . Manufacturers of, O L/ SHIP TO: 3649 Cane Run Road 9 p Louisville, e, KY (800) 40211-1961 Z ~ ® Vi7L/TYPUMPS ~/iNCE ~/~p / http.lAvww.zoeller.com PlJMP !O. (502J 77FAX (502) 7874-36248 PUMP 1 © Copyright 2002 Zoeller Co. All rights reserved. ,EcEiVED Wis `pTy -ommerce SOIL EVALUATION REPORT Page / of 3 '0MMUN1 M in accordance with Comm 85, Wis. Adm. Code County , Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ) include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 C~ - d 0 CG Please print all information. Re Y Date Personal inforrnabon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner F+ r Property Location t~ J OC. D I Govt. Lot ;,,C-~ 1/4. 1/4 S 36T 30 N R 2- (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# cJ City State , ode Phone Number ❑ city ❑ Village P'Town Nearest oa &r"dd'&YL-" I Lt-/) 1 -A~ ( ) ~~s ✓ a Construction Us esidential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public % commercial - Describe: Parent material 6 c [t/~ / Flood Plain elevation if applicable General comments and recommendations: System Typed I t' System Elevation ZZ, 2:~h MBoring # O Boring spit Ground surface elev. -ft. Depth to limiting factor in. L_SL' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 4- 415, a Boring # ° Boring /9-2it Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30:5 150 mg& • Effluent #2 = BOD. < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address -Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 r Property Owner _ Parcel ID # Page IZ- of a Boring # E] Boring 'Z-1 Pit Ground surface elev99~ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munselll Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1\ fqt M Boring # ❑ Boring F-1 ❑ 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 F Bodng ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 Effluent #1 = BOD, > 30 < 220 rrg/L and TSS >30:< 150 mg/L ' Effluent #2 = BOD, < 30 rng/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. SM4330 (8.6100) Property Owner Parcel ID # Page of Boring # g n PPit Ground surface elev.991 ft. Depth to limiting factor Z in. Soil Application Rate Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 S A l n/ F-1 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 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Iepth Dominant Col 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/L ' 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. sBD-8330 (86/00) Soil Test and System PLOT PLAN 6-" PROJECT Scott Hotchkin ADDRESS 265 Canvon Pass Hudson Wi 54016 NE 1/4 SW 1/4S 36 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 94.5/94.2/93.9 5' below grade 10/8/15 4 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT )00( HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 45 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Highway 35 Pro 4 Bedroom House 30' Huffcut Vent Combo tank >6 Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long 3 4" Grade at System Elevation 50' 99' 98 Area of Poor soils -1 B-3 3-3' X 62' Cells with >3' s ing 80' 35' Sl 35' B-2 Vents at end of cells 0 Property Line LM-70' Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Vent Typical Installation 99.5' AVI Grade Lvent 4' 4„ ~~30/34 Septic Tank 4' ' Long 1 " 5' 4' Long 14 4 3 4" Grade at System Elevation Grade at System Elevation 3 4,W, Spacing--_5L S~ 3-3' X 72' Cells Observation tubeNent Same on other end To be located on end of Cells A B System elevations: C A_94.5' B 94'2 15 chambers per cell C_93.9' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # ~J Septic Tank Manufacturer ❑ NA 13ESIGN PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA i Number of Public Facility Units 4NA Pump Tank Capacity al ANA i Estimated flow (average) q Q~:) gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) GG gal/day Pump Manufacturer NA Soil Application Rate gal/day !ft2 Pump Model NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) I :_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) <_30 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 1530 mg1L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 51 Q4 cful100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size k in dia, ❑ NA Other: ❑ NA Other: Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA ~IIAINTENANCE SCHEDULE Service Event Service Frequency month(s) (Maximum 3 years) 11 NA Inspect condition of tank(s) At least once every: 3 -4m-year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third {t) of tank volume ❑ NA iInspect dispersal cell(s) At least once every: _3 ❑ month(s) (Maximum 3 years) ❑ NA ;year(s) !lean effluent filter At least once every: Q month(s) ❑ NA ear(s) .nspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) :lush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) ether: At least once every: ❑ month(s) NA ❑ year(s) tither. 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 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 :ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be Asually 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 (X) or more of the tank volume, the entire contents of he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 1411 other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION nting or othe For new construction, prior to use of the POWTS check treatment tanks} if hihh po Centrations'are detecdtedthave they ontents lof{the may impede the treatment process and/or damage the dispersal cell(s). 9 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. highwater excess restored pow s. When wastewate During power outages pump tanks may fill above o er oladinng he cell(s)land may resu ten the backup olr surface discha ge ofreftlulen t. discharged the dispersal cell(s) in one large dose, To avoid this is situation have the contents of the pump kto assist dibymanuea yoperating theOpumpocont orls~oeestore normarl levels effluent pump or contact a Plumber or POWTS Manltaine 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 n 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 POW 3 ; diapers; disinfectants; fat; foundation drain antibiotics; baby wipes; cigarette butts; condoms, cotton swabs; degreasers; dental floss (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 Comm 83 33 i e the following steps s eaCoe taken to insure that the system is propel y and safely abandoned in compliance with pt • 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 snail, 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 repia ment system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. uld not be infringed upon requii,ed The replacement area should be protected from o m i es and wells.dFai Failure to compaction otectt theoreplacement area will result in the ne+,ed setbacks from existing and proposed structure, a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulev 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. must comply with the ruees in effect at that t mremoval of the biomat at the infiltraiive ❑ Mound and at-grade soil asorption systems ay be reconstructd in place surface Reconstructions o <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NO BE DIFFICULT OR IMPOSSIBLE. DEATH MAY RESULT. RESCUE OF A ENTER A SEPTIC, PUMP OR OTHER TREATMENT PERSON FROM THE INTERIOR OF A TANK M ADDITIONAL COMMENTS t S INSTALLER POWTS MAINTAINER ame 7 Q i L/ Name hone - S Phone ~ I J` SEPTAGE SERVICING OPERAT PUMPER LOCAL REGULATORY AUTHORITY c Name I, Name f al j Phone ~7 = C/ 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, r ~ ~ _ 999 ` el g 5 ~ x ~ j 11 f, C \ f ST. CROIX COUNT'y SEPTIC TANK MAINTENANCE hGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address S' C Property Address (Verification required from Planning & Zoning Department for construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location,&,t~:: V4 .6~~Z 1/. , Sec. 3 Z, T .30N R Z L) W, Town of Subdivision P•~t ~I T~ _ Lot # . Certified Survey Map # , Volume Page # Warranty Deed # J , Volume Page # Spec house yes no Lot Iine identifiable 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, ii= 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 was t e disposal system Owner maintenance responsibilities are specified in §Comm 83.52(]) 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, 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. Vwe, the undersigned have read the above 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 Departinont 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 statements on form artthe best of my/our knowledge. I/we am/are the owner(s) of the property d 'bed iE7 d in Register of Deeds Office. Numb of bedSDATE ***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) Exhibit A Legal Description Lot 6, Plat of Seven Oaks in the Town of St. Joseph, St. Croix County, Wisconsin. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 St. Croix County 1009816 Page 3 of 3 I I I I ~i ~ - I I I I I I I N, I I I I II I 8 I 11 I I ~ I i I I I li I I I II ~ I I II j i~ II I I i II Nk I i I I . . I II r7j II I I ~ I I s = i1 ~ 1;t ~ I _ Ott ~ I ,I s I I I ~ I III I II INA I I III ~ b I I ~ LI ? I III 31 l ~a I ~ i III 7 !1 1 I ~ II I II I 00 I' t'i I~ II I I s ( I I I ~ I 1;`i I i I I I~ 'I I I II Cl I~ I I I I 111 i r =E~ I~ I I I I4,-11 I I I I Cq, I I I ±~_Ni I N ~l Q i _a I - - Ti ~ r I i I I I I II LL- ! I I~ a I I I. Q ~ ,I I I ;I ~ I ,I II I ! I; CA ! I ! I ! -I I i~ I n0 } -r51 n0 ~ np~ , . , o °0 _J i In ssrtal~ 00 tfl o so I Q 'p ' 00 cc If- M. f-- 1/ i 00 r-- M o r i '1Z 9E ~ ' iV of S r „p. / u iL i i til I T I I I I bo I i I I i I I I I` I I 77 p I I ICI ~ f7 °n{ iJ I: Q lV I ~I -T- 72 .t I °-7c o. a z T= 30 l I" ~ 1 X y1 I N ~ I (1Z ~ °a~i ~ j a l~ U NN = P 2 U N X N ~ ~ rn I N !e ~MaV"T F'I ~ , ~ ~a I i „o £ i z ~ a i i 0 -z - vko / O OD 1 / I f t ' ' to I tU x • ~1 1 t ~ ~ 1 t It 1 ~ tl ~ OI X 1 It w r w ' o n ~ X tl ~ ~ co ~ 'r !1 tl 91 t t t t it tt 1 V W X 0% t •'t ' tt In (D x .pp~ppi t t CDr• ~ i i t 11 i . 3C X W ! / i i 1 i 100 to t I i t t 1 ' 1 4 t t t 1 i it t ! ato, tl t ~t e 1 1 t , 515 Ilk A I County Safety and Buildings Division p 17(OOUN` Y 094 W. WashingleR Ave , P.O. Box 7162 Sanitary Permit Number (to be filled in by Co-) DEVELOPMENT Madison, W1 53707-7162 ay s9 n 5 77n(o Z- Sanitary Permit Application State Tr on Number 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 mailing address) the Department of Safety and Professional Servics. Personal information you provide may be used for secondary oses in accordance with the Privacy Law, s. 15. 1 m , Stats. Z -7~.~„~ L Application Information - Please 11rint All Information ~ Property Owner's Name + 01 qcAwt-l i Parcel 4 ti 0 3o- 9)y9-o~-oo6 Prop s Mail' dress Property Location -3 ~-5-- Govt Lot City Zip Code Phone Number AL~ % ~'i, Section L ( ' cle on T N; R E o/ -SType of Building (check all that apply) Lot or 2 41--ily Dwelling-Number of C/J subdivision Name 61k Ae, t-'Cty Blo Sea' a,/ <r ❑ Public/Commercial- Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Z i d LZ+- Townof ers IIi. Type of Permit: (Check only one b z on line A. Complete line B if applicable) 2ov~Q A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issuedf~ Before Expiration Owner ~~f7a 0✓i 1 IV. T ypotPOWTS System/Component/Device: Check all that a 1 $ tJ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil 5 ❑ Holding Tank ❑ other Dispersal Component (explain)! ❑ Pretreatment Device (explain) V. Dis rsaVTrea ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required ( Dispersal Area Pr posed System Elevati n VL Tank Info Capacity in Total it of Manufacturer Gallons Gallons Units o S A~ 3 .0 2 New Tanks Existing Tanks w c y 2 a ~t rG, `,Ati~, l"'~ t• P~. V v~ in Septic or Holding Tank Dosing (umber IA4- I VII. Responsibility Statement undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Pl Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Pltmt (Street, City, State, Zip Code) 2-11 VIII. Coun /De artment Use Only Approved isapp Permit Fee Date Issued Issuing ent Signature n ial $ 4-76- °d B ZS IS s for Disapproval ,1 c ~~1 filter~d, ND ra,~- t~6 Y'b r tC- III be seN"s / maintained J t plan provided by plumber. l rrletstl~e"i~n2tiMairtad. ide / Ofd11T8t1COS. ` mplete plans for the system and submit to the County only an paper not less than g to x 11 inches in sift Y~ J PLOT PLAN PROJECT Scott Hotchkin ADDRESS 265 Canvon Pass Hudson Wi 54016 NE 1/4 SW 1/4S 36 /T 30 N/R 20 w TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 103.3/101.8 27 below grade DATE 8/24/15 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1255 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑BOREHOLE O WELL *H.R.P. same as benchmark SCL 285' Prooperty Line Scale 1/4' 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Town Road ' 102' 98 Pro 4 2-3' X 90' Cells with >3' spacing B-1 106 Bedroom House 5 18% Slope 35' 25' -3 ST 6 28 20' B-2 46' Vents 66 BM.* 16' Vent Property Line >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 89, S.6ft^2/pair of end caps 4' Long 12 34 Grade at System Elevation, Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/23/15 Owner:Scott Hotchkin Location: NE 1 /4 SW 1 /4 S36 T30 N,R20W Lot 6 Seven Oaks St. Joseph Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contin ncy P ri 7. Filter Cross Section Signature License number #22614 V-V PLOT PLAN PROJECT Scott Hotchkin ADDRESS 265 Canvon Pass Hudson Wi 54016 NE 1/4 SW 1/4S 36 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 103.3/101.8 2.7' below grade DATE 8/24/15 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE WELL *H.R.P. sameasbenchmark 285' Prooperty Line Scale = 1/411 = 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Town Road B-1106' Pro 4 2-3' X 90' Cells with >3' spacing 102 98' Bedroom House 5' 18% Slope 35' 25' -3 ST 6' 28' 20' B-2 46' Vents 66 B.M.* 16' Vent Property Line >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area , 5.6ft^2/pair of end caps 89 Long 12 Grade at System Elevation 34" Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Vent Typical Installation 106.0' Grade Vent 3' 4„ X30/34 Septic Tank 3' 5' Long 1 " 5' S' Long 191 __4 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A 22 chambers per cell B System elevations: A_103.3' B_101.8" 4, z lSl SOI ATION REPORT #1759 Page 1 of 3 Department of Comme~ GV I in acco ance~tp~Or~65rWf1e. mL Division of Safety and Buildin 0 ~~v~-~ V CU Steel's Soil Service, Inc. Attach complete site plan on paper not less r~$ZJ~c 11 i ches irj#e.I rr~}}~t,5 St. Croix include, but not limited to: vertical and horizont reference point (B J'di on41J) \ percent slope, scale or dimensions, north arrow, and locati n and distance to nearest road. I.D O& c',"-~y}-Pv) Please print all information. ST. CROIX COUNTY JJVV ZONING OFFICE d By Date Personal i nformation you provide may be used for secondary purposes L✓ ` c Property Own Property Location J Piri erry ..&/L' Lew Govt. Lot na NE1/4 W S36, T30N, R20W Property Owner's Mailing Address L *Qt # Block # Subd. Na or CSM# 400 South 2nd ST. na Seven Oaks L6T City State Zip Code Phone Number ty ❑ Village ® Town Nearest Road Hudson WI 54016 715-386-0252 St.Joseph 125Th St ❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: na Parent material Knolls of pitted outwash plains Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 103.00ft. Trenches spaced and depth to code 3.00ft below grade. and recommendations: dA Boring # ❑ Boring / . ® Pit Ground surface elev. 106.00 ft. Depth to limiting factor 100 ✓ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/1 none I 2msbk mfr cs lc .6 .8 2 5-14 10yr4/4 none sl 2msbk mfr cs if .6 1.0 3 14-60 7.5yr4/4 none cos osg ml cs na .7 1.6 4 60-100 7.5yr4/6 none cos osg ml na na .7 1.6 ~ I iA.1 "t 42 it 3 32 ~ ❑ Boring / Boring # Ground surface elev. 106.00 ft. Depth to limiting factor 69 ✓ in. ® Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/1 none sl 2msbk mfr cs 1c .6 1.0 2 8-54 10yr4/4 none Is 2msbk mfr cs if .7 1.6 3 54-69 7.5yr4/4 none cos osg ml cs na .7 1.6 4 69-88 7.5yr4/4 none sil om ml na na .0 .2 J l~ d► Effluent #1 = BOD > 30 < 22, mg/L and SS >30 < 150 mg/L ' Effluent #2 = BOD5 <30 mg/L and TSS < 30 mg/L 4 7 CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 7/27/2005 715-760-0347 SBD-8330 (R.07/00) Propelty,Owner Plrius, Terry Parcel ID # pending Page 2 of 3 Fil Boring # ❑ Boring 3 b1-3 ® Pit Ground surface elev. 100.40 ft. Depth to iting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/1 none I 2msbk mfr cs 1c .6 .8 2 8-31 10yr4/4 none Is osg mvfr cs 2c .7 1.6 3 31-87 7.5yr4/4 none Is osg ml cs na .7 1.6 4 87-100 7.5yr4/6 none ms osg ml na na .7 1.6 I1 3 ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure --J Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * 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. SBD-8330 (R.07/00) Steel's Soil Service, Inc. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Terry Pirius 994 200t' St. CST-POWTSM NE1/4,SW1/4,S36,T30N,R20W Baldwin, WI 54002 Lic. #248956 Town of St. Joesph, St. Croix Co. Direct 715-760-0347 Lot, 7 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1" = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 99.15 ft ❑ Top of 3/4" pvc pipe = Borings Boring Elevations BI = 106.00 ft B2 = /106.00 ft B3 = 100.40 ft 4 = 0.00 ft J,. 07 i, C49