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HomeMy WebLinkAbout026-1161-24-000 Sirrr-nsin Department of cor, n,ercr PRIVATE SEWAGE SYSTEM "ty a`y and Buildirg Dlvisicn S St. Croix INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 582097 Stare Plan i D F.n personal information vot. r'ovide may be used for sex'idary purposes (Privacy Law, s.15.04 t1 i(mil Permit Holders Narte: ;;,p, Village `ownshiP Parcel Tax No ST BM Ela ng Homes LLC TOWN OF RICHMOND 026-1161-24-000 CST BM Ele : Insp. BM Elev 6M Description Sectior7own;Range'Map No: ~ot) 15.30.18.1247 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r;APACITY STATIGN RS H FS ELEV Septic 79- Benchmark nn. BM /Aeration • 'f P.Idg Sewer 5 Holding StrHt Inlet J s.g s~r7 TANK SETBACK INFORMATION SVHt Outlet TANK TO PAL VJFLL BLDG. rent t Air Intake ROAD Dt Inlet So j 6 \ Septic tDc Mid-- 7- ~ 9 r Dt Bottom ~ Dosing Header!Man Aeration Dist. Pipe 7• 9L 7 c7 Holding Bo.'. System g •g 95. -7 95 PUMP/SIPHON INFORMATION Final Grade ~.Z /dn , 3 Manufacturer Demand St Cove- / f I Model Number-- GPM 14'n' 7 TDH Lift rrc'ion I riss System Head 1 DH rt Forcema n Length I I Dia Dist to Well SOIL ABSORPTION SYSTEM BEDITRENCH 'Nid.h Lergo Nn C` Trenches PIT DIMENSIONS Nc Of Pds Inside Dia Liquid Depth DIMENSIONS 3 P , / -2- f f SETBACK SYSTEM TU P1L BLDG 4VFLL LAKEiSTREAPd LEACHING Manufacturer INFORMATION Type Of System CHAMBER OR UNIT blocel Number DISTRIBUTION SYSTEM jp o r~ 7 Z U Z-? J _01_:t T- Header,'MwirfAdy r Distnbr.bc'' ix Hole Sire Hoe Spacing vent Ic Arr take Length /G' Ripe(s, Dia 'T Length Dia Spacing - C P~1 r< SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~epih Over xx Depth of xz Seede Sed.7rencnCe'Ner dlSocded xx Mulched ©edTrer r Ecges opsc Yes Nc -des r.o COMMENTS: (Include code discrepenc,es persons present, etc. i Inspection #1: 'Inspection #2: Location: 1545 126TH ST ^ a 1 i Alt BM Description = i'-; I" Ca J-~ f I 2 } Bldg sewer length = Z4 / a ct„ ~ 4- L. p cX~ O r-, amount of cover = r Plan revision Required? Yes >~o I Lz Use other side for additional information. (o .J Darr_ nsepc:nes natu'e Cert No S B D-6710 1 R .1i 97 ) _rtmt ~r (:.xcnY w Safety an-- B.:ildings Division ✓ J 51 i .8 ys) 201 W. 'trt'ashmgtor Ave., P.U. Sox 7102 Sani:a Permit Number (to be filled in by Co.j S G APR I Z. U i Madison, VVI 53707-7152 ST. CROIX COU ~ c° COM .Staix- Trees oqo Number ~rmi Application in accordancewith STS 133 ' l A15 Ada :'.ode, submassior of this fora to the appropria(: govcrorneotal unit L rcq:lircd pr'or to olrainine a sanitarv permit Note. Appti.ation :bans for staze-ov.-ted PGWTS are submiaze to Projec:.4ddrss fV difterent than maiiir,~ au~asi tie Depar~~t of Safety and Professional Servieti_ ?rrsonal t.•tforrnation you provide may be used for sccon - I pwposes in a: caraan.c with the Privacy I jw s Stars. Y;/ J it 1 r I. Application Information - Please Print All Information (J Prop-—' c !Hine s Name Pal cel * - 0eL),e /-s,,,- ~7 6 - a Proper y Owne 's hlazling Ador ~s Property Loca"ou GOvL Lot _C► /Z C: State r, Zip Cade T Phone N=iber section Ma C n II i' C fl. ,Type of Building (check all that app ) Lot ti Fa-,ily OW-el:ms -Number of Scar Subdivisitm game 1 i Blak . L~~ ❑ Pubtic/Commercial - Descnbe Use i ar 1 ❑ city 0-- - - Stale Ow-ned - Describe Use GSM Number L Village of - Cells W I ~wn ,f M. y a of Permit: (Check only line A. Complete line B if applicable) A' Svstem ❑ Repla-meet System Iimaimearg4oldingTank Rcpla:_-mCw Only tither Modification tr Ex:stlng- System (explairl 1 ' PC,= Renewa vi irtt Lis1 Previous, Permit Number and Date Issued - Charge of Plumber J Permit Transfer tr New i Before Expiration, IV. Type of POWfiC SvstemiCompooen~Device: (Check all that apply) - - - _ AiQo-Prascizcd L:-Crronnd ❑ P ras uizec In-Ground At-Cnade Mo,m:i - 24 ul cf suita_ele soil J Mound < 24 in. of suitable soil C Molding Tank C7 (tier Di;persa: Component (explain)-_- 7 ❑ Preacatrncn' ` ice (explain) _ V. Dis rsah'TreatmentArea Information: TkI tgm Fow (gpd) Design Soil Ap:)Li atunm f .vtu, dsf) Dispersal - .a Rcq irtd -.%t' I t, -,er ,i -A.:~ Pr•>po d'st) Svsi=. t~_7 VL 'l'ank Info Capacity in Tuca. u of Mannfazurti i / o iral lotrs itaaoas Units a a ~ Tmlt ~ g Tanis m m W o P Sep x Iloidl: TeLr Dosiug VII. Responsibility Statement- 1, plli-F~niersigneda&%su _poosibiiity fur installation of thePOR"I'S sbown on the attached plans I ?lumber's 'a,ac (Aiut Plumb mature \iHMPRS ? umber 1 Bastoess Phone Number - Pimlber~s?.ddtes-(Strezt,Ci:y.Stnte, hp-codcc~) V" . C ntv,'De artment Use Only ~ / - l App*ovcd nsappms S Permit Fee Date sued suing i Sir seine - even Reason for Datial Q I t zz, ,I t M Conditicoos for Disapproval . 5 1, tank, etfltxnt filter end 3 LCA 1 ~btM duper.-5i cell roust all a aericas! rc& me:rec as per management plan pro nded by plumber. 2. A*y1"I 4*qykemwft must Oe nnaitttzined n lt7 / as psr aAppNcabMlode ! erditn+icas. A v;t dL~ [ X e p Auacb In mropkte places for tike system and submit the Comfy only on pa;kr not ksa than 12 : I I Z*61 in ' - fhbt~~ 0, t..) ,^A ~ la..~ ! VIA4 1141~E ^ al AL CQ SBD-6398 (R. I LT) t(&1~0 (rte o. ~-i 6y\- Soil Test and System PLOT PLANT PROJECT Oeverina Homes A R4;SS 1433 Cernohcus Ave Suite A New R ichmond Wi 54107 NW 1/4 SE 1,14S 15 rr 30 NrR 1 Nv TOw~b Richmond COUNTY ST. CROIX SVSTE'M ELEVATION X198.8/98.4 6j low 4!12116 3 yi DATE BEDROOM CONVENTIONAI. IN-GROUND PRF,SSY " CONVFNTIONAi. LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Ions LIFT TANK SIZE DOSE 'TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1158 # of chambers 55 BENCHMARK V.R.11. Base of survey stake ASSUME' ELEVATION 100' Filter Lifetime Filter El BOREHOLE O WYLL *II.R.P, sameasbenchmark Scale = 1/4" = 10' All piping shall be ASTM SDR 30134, within To 126th St. l0' of tank, piping shall be ASTM F891 Property Line Replacement area. Tom Nelson original soil test location way up the hill Pro 3 30' Bedroom B 4 10' House 30' 101.5 S 1 3' X 114' cell 1 and 1-3' X 1] 8' cell 40' 7~i -lope B-3 ent Quick4 Standard o iC1, Vents ofC:over Leaching Chamber ith 20.0 ft2 of Area Vents B-2 5' 5.6W,21/pair of end caps , Long l2" 10 f3.M.* Grade at System Elevation 40 104.5' 3 100' 102.5'103.5 ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County - ^ Attacn complete site plan on paper not less than 8 112 x 11 inches in size. Plan must t include, but not limited to, vertical and horizontal reference point (BM), direction and Parcel I.D f percent slope, scale or dimensions, north arrow, and location and distance to nearest road. y- Please print all information. Ravi by Date Personal information you prorde may Oe used forsecondary purposes (Privacy Law, s. 15.01 (1) (m)}. Z f P Owner Property Location p r Govt. Lot 114 C 1;4 S T 4-N R I E ( Property Owner's Mail" Address Lot # Block # Subd- Name CSM# City to Ztp Code Phone Number _ city C1 V illlpge rT Nearest Road r Z,/ 1 21- New N. c f Construction Use 54Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Descnbe: Parent material 1) - Flood Plain elevation if applicable General carments , and recommendabions: , System Type_ System Elevation !1 ? 7 Boring # ❑ Boring 7 Pit Ground surface elev. ft. Depth to 4miting facto in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Efyt2 5V Ja ?v A Z'/ Banng# Bores c7 Pit Ground surface elev. R. Depth to limiting factor - in. Sol Applicabon 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 •E"2 1-14 44 Effluent #1 = BOO. > 30 < 220 rnq/L and TSS >30 150 an ' Efttuent #2 = BOO, < 30 mA and TSS < 30 m.gjL CST Name (Please Print) Si u CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Dato Eval Gun Con~lucte Telephone Number 1432 120th St, New Richmond, WI 54017 y-- ~r7 715-246-4516 Parcel ID q Page of Property Owner ❑ Borirx~ ' ( Boring # in. Pit Ground surface elev. (l k- ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh- 'Eff#1 *E"2 ❑ Boring 4 4/1 Boring # Pit Ground surface elev.~ft. Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 z - A1 u r_ ❑ Boring ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in, ❑ Soit ication Rate Horizon -)epth Dominant Color Redox Description- Texture Stricture Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. t',olor Gr. Sz. Sh. 'Eff#1 '01#2 Effluent #1 = BOD. > 30 < 220 rrxy"L and TSS >30 < 150 mgt ' Effluent #2 = BODS < 30 mgt. and TSS < 30 mglL 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 Lie department at 608-266-3151 or TTY 608-264-8777. SNUEJ}0 fa.Nl Kit County uild afety and Bing07-Qi7 vis 8'°°=`+ K MA 20~ Washington Ave.; Box 2 t 18 Sanitary Permit Number (to be filled in by Co.) ' J ` ' g 6 Madison, V4 537 cOMMUN/7-y Cp 5~sz oc~ Sanitary Pe NW!4plieation Stale Transaction Nu mer In accordance with SPS 38321(2), Wis. Adam Code, submission of this form to the appropriate governmental unit /v 4 is required prier to obtaining a sanitary permit Note: Appligtion forms for stare-owned POWTS are submitted to Project Address (if di£Ferem than naffing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondar purposes in accordance with the My= Law, s. 1 m , SW. ` L lication Information -Please Print t All Information cJ Property Owner's Name 5- z/~-, Parcel # Property Owners Mailing Address f Property L---:6 0n CI ~ IS&61 4Z-~ . 30, iS. 1a4l 3 Govt Lo City, State zip a Phone Number Section l T-/ c one EL Type of Building (check all that apply # -31 0 N> R E Family Dwelling - Number of Bedrooms SubddLivisi Name v C' ❑ Public/Commercial -Describe Use Bloc # ❑ City Of ❑ Sta Owned - Describe Use CSM Number 11 Village of J1 Z own of- III . Type f Permit: (Check only ne box on line A. Complete line B if applicable) A System 0 Replacement S ystem ❑ Treatment/Holding Tank Replacement Onlv D Other Modification to Existing System (explain) B ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T ofPOWTS S stem/Com nent/Device: Check all that a 1 -Pressuuized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound->24 m. of suitable soil ❑ Mound < 24 in- of suitable soil ❑ Holding Tank Otber Dispersal Component G ❑ Pretreatment Device (explain V. Dis alPfreatmentArea Information: Desi Flow (gpd) / Desip Soil Application Rate(gr Dispersal Area Required (sfJ , Dispersal Area Pro ✓ posed {s ystem ev "o ,27 t 7~ Z VL Tank Info Capacity in Total # of mama cnuer 7, Gallons Gallons Units o New Tanks Exisang Tanks , o ~ m `i W 'W• ~tl f1^~ l',.( y V a°~i a m is » C7 Septic or Holding Tank { - Dosing C}ramher VII. Responsibility Statement- 1, the undersigned, me responsibility for installation of the POWTS shown on the attached plans. PluarbrrIs Name (Print) P1 s Signature MP/IvfPRS Number Business Phone Number P s Address (Street City, tate, ZilaCode J J~ 7 32- ~Aq nty/De artment Use Only proved Permit Fee Date sued r _ Issuing t Signatwe en Reason for D IS 4 w v• 3! lX. ConditiiiYtfi'XE p@ll6tsAiB i-mns for Disapproval 1. Septic tank, E:flGent filter and ~ J\ a~ Q e~ (%a "I AeA4j O N" dupers cell must all be seivtc-s !_mil6ta nee • n ~ as per mnaragement plan provided by plumber. P, 1. S #UAL, E~ A.tiC~, , ~ ✓w 2. t 'seal 9s Sjtait st"len4s s 'l^ta!r4ttirisd s per4ficaas oocli iadil'k1n'M' . ( ~e_ le-Serue Attach to compte3e plans for the s}stem and submit the C-Pty only oa paper not less than 8 vt z ] t inches is silt SBD-6398 (R. 11/11) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New R ichmond Wi 54107 NW 1/4°SE 1/4S 15 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 97.0/96.5/96.0/95.5 3' below 3/16/16 BEDROOM 3 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .2 ABSORPTION AREA 2262 # of chambers 112 Ilk BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 126th Ave Scale = 1/4'1 = 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Pro 3 Bedroom House Property ne 20' Please note: further testing will be done and soils will S be verified prior to installation. 15' 104' 98' 100' B-2 96' 36' 4-3' X 114' cells with >3' spacing 8% Slope Vent >67' Quic 4 tan and B-3 - 132 nt of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" B-1 34" Grade at System Elevation B.M. * I Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/16/16 Owner:Oevering Homes Location: NW 1/4 SE 1/4 S15 T30 N,R18W 1545 126th st. Richmond Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintenance a ontingency Plan 7. Filter Cross Sec Signature License nu r #226900 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New R ichmond Wi 54107 NW 1/4-SE 1/4S 15 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 97.0/96.5/96.0/95.5 3' below DATE 3/16/16 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .2 ABSORPTION AREA 2262 # of chambers 112 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 126th Ave Scale = 1/4" = 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Pro 3 Bedroom House Property ine 20 Please note: further testing will be done and soils will s be verified prior to installation. 15' 104' 98' 100' B-2 96' 36' 4-3' X 114' cells with >3' spacing 8% Slope Vent >6„ Quick4 Standard B-3 132' Vents 43 of Cover Leaching Chamber with 20.0 ft2 of Area 5002/pair of end caps 4' Long 12" B-1 34" Grade at System Elevation B.M. Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 4 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 Typical installation 100.0' Vent Grade Vent 4' 4" 4' X30134 Septic Tank 4' Long 199 5' 4' Long 191 3419 Grade at System Elevation 3415 Grade at System Elevation Spacing 5' 4-3' X 114' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A-97.0' B 96.5' D C_96.0' 28 chambers per cell D 95.5' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ILE INFORMATION SYSTEM SPECIFICA71ONS Owner ~ Permit # J e I Septic Tank Capacity ! ❑ NA Septic Tank Manuf urer ❑ NA IGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms .-3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units Pump Tank Capacity t NA. Estimated flow (average) Vda Pump Tank Manufacturer NA i Design flow (peak), (Estimated x 1.5) [ J0 gal/day Pump Manufacturer NA Sal Application Rate ' Z gal/day /e Pump Model i Standard Infl . enUEffluent Quality Monthly average• Pretreatment Unit 3 NA Fats; Oil & Grease (FOG) 530 NA Biochemical 13 Sand/Gravel Filter E3 Peat Filter Oxygen Demand (BODs) s22o mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetand Total Suspended Solids (TSS) 5150 mg/L CI Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dis I Celt( s) Biochemical Oxygen Demand (BODs) 530 mg/L ❑ NA XW round (gratify} ❑ In-Ground (pressurized) Total Suspended Solids (TSS) q0 mg/L ❑ At-Grade ❑ Mound Fecal Co6fonm (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other. (Maximum Effluent Particle Size in dia. p Other Other. 13 NA Other. ❑ NA "Values typical for domestic wastewater and 690c tank effluent Other. ❑ NA NTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ nth(s) ~ s (Maxmttmr 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one4hird (36) of ferric volume ❑ NA Inspect dispersal cell(s) At least once every: D month(s) f($) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: l ❑ onth(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 13 3 month(s) NA I=1ush laterals and pressure test At least once every: ❑ month(s) ❑ r{sj NA At least once every: ❑❑~s) r. r- NA NA MAINTENANCE INSTRUCTIONS (inspections of tanks and dispersal calls shall be made.by an individual carrying one of the following licenses or certifications: Master iPlumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer; Septage Servicing O liindude a visual inspection of the tank(s) to identify any missing or broken hardware , the l must dam` any cracks Rerator. Tank inspections iombined sludge and scum and to check for any back up or ponding of effluent . leeks, measure the volume of 'visually Inspected to check the on the ground surface. The dispersal cell(s) shag be 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 Yegulatory authority. WVhen the combined accumulation of sludge and scum in any tank equals one-third (35) or more of the tank volume, the entire contents of j:he tank shag be removed try a Septage Administrative Code. Servicing Operator and disposed of in accordance with chapter NR 913, Wisconsin All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, pnd any servicing at intervals of 512 months, shalt be performed by a certified POW!"S 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 for the presence of painting products or other chemicals theft For new construction, prior to use and/or P damage 1he..disPersadcell( )s} If high Corittations are deter have the contents of the tank(mays) impede removed the by y a septageptag treatment re servicing operator prior to use. System start up shall not o=w when soil conditions are from at the infiltrative surface. will ble During power outages pump tanks may fill above normal highwater levels. When power is restored the excess surface discharge of wastewater will rt. close, overloading the oeli(s) and may result in the backup to restoring power to the discharged to the dispersal cell(s) in one large To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator l~ restore normal levels effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to within the pump tank. the area within Do not drive or park Vehicles over tanks and dispersal cans. Do not drive or park over, or otherwise disturb or compact, 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 POWT$: condoms; cotton swabs; degreasers; dental floss; diapers; dis rft fat; foundation drain antibiotics; baby was; it cigarette butte; (sump Pump) water, fruit and nd vegetable peelings; gasoline; grease; herbiddes; meat scraps; medications; on; Ong produc#s' pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT shall be taken to insure that the system is prope(ly When the POWTS fails and/or is permanently taken out of service the following steps and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a SW&ge Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space fined with soil, gravel or another inert solid material. CONTINGENCY PLAN code com~int If the POWi'S falls and cannot be repaired the following measures have been, or must be taken, to provide a rep system: stable replacement area has been evaluated and may be utilized for the location of a ► irddnged upon by requiled The replac8ment area should be protected from disturbance and compaction and should will result in the ailed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement in e:i for a now soil and site evaluation to establish a suitable replacement area. RePlaoement systems must area Pb with the the effect at that time. 13 A suitable replacement area is not available due to setback and/or soil limitations. Baiting advances in POWTS technologic a holding tank may be installed as a last resort to replace the failed POWYS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be perfom>9d to locate a suitable replacement area. If no replacement area is available a holding tank may be instailw as a last resort to replace the failed POWTS. 0 Mound and at-grade son absorption systems rimy be reconstructed in place following removal of the biomat at the infittrafive 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 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANW UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0 A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POW rS. INSTALLER POWTS MAINTAIN Name Name r Phone Phone 7_S---a - /J L SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY lame . Name 22&4-' .2 - F Phone 7/j-- c' Phone This docxanerdwas dratted in compliance with chapter sps 383.22(2)(b)(1)(d)&(t) and 383,54(1), (2) & (3), Wls~ Administrative Code. ~t W 1 ; 47 1 I Q ° P o po 1 I ' t I i i o 3 - h Z L ~ S L v7 i ST. CROIX COE7NTy SEPTIC TKMA'NTENANCE AGREEWNT AND ()VNRRSHiP owner/Buyer Q~ CERTreATt SN FORM Mailing Address :Property Ad _ dress (Verification required fro City/State ni Planning & Zoning Uep nt for new construct ion. Parcel .tdenti~catio0 ~ LEGAL .Dri,SCRrpZ 70N Number ~ la - ~ ~ r--~~ Property LIV, ocation t/a , Sec. Subdivision C ' T e ON R C, Y r ~ ----`.W, Town of I Certaifted Surve p Lot # Warrau ty ]Deed V - 6 0 Page # Spec house es no VOll1[110 Page # STEM Lot Imes idetrtifiabl ~ENANCE AND OWNER Ye no Improper use and ER QRJIR ~ maintenance the ~eacottsists ofpumpin oof Your septic system can erect the the septic tank ever could result in its Premature pecified immn of dw s t as d tr athree mature failure are s eptic Years or sooner if are to ndle wastes §Cotnm. 83.52 i tment stage in the needed, by a licensed . Proper The Prope ()and in Chapter ,l2 _ St. Croix waste disposal system, Owner What on put owner and by a 11Y powner l nr agrees to S weer mainte Y to master submit to St. ""'tY anitary Ordinance. Hance wastewater disposals ' journeyman 1 Crow County Planu~ less than I/3 ~g m is to proper ope condition icted Plumber or a li O'Mg DeParhWj1t a ce full ofslu rtehcation for an", (2) after inspection aped er verifying that 1 m, signed by the I/we> the Pumping (it- th s) the on site standards set to undersigned have read the se herein, as set by the btlre Wove Ptic tank is Certification sfatin requirements g that your 9'~ent of Co nd agree to main g bePar6uent wi tic system has been mmerceaand the D' the private sewage Lq disposal thin 30 days of the three year expiration ePariment of Natural Resoyr system with the completed and re ces, State of W' Uwe certify that all statements ou this form xpiration date, must be furred to the St_ Croix Co la unit' e Planning pToPertY described above, by virtue of a are hue Warr deed rec ordto the best ofmy/om. Imowledge. I/we a Numtber of bedrooms~ d in Register of Deeds office, mare the owner(s) of the IGNAT ~O~FAPP~LICA~NT(sl~~ ***Any information Brat is misrepresented „may h2clude result in the sanitar DAVE With dlis application a r Y Permit being revoked 6 reference is recorded Warr by the Planning made in the warranty deed,tY deed from the Register of Deeds of£tce and a cop rung Department (REV, 08105) Y of the certified survey map if r ' Itch, ' % ~r -~NOI-08`3fl I IM --d r~ 299.45 . 5rz~~ S~ W~ E W lilt 11112! 111111 W Z ~ t x, a oc J J ~ J f. 30 J W F gy G U Z I I I I e _ I I g I I I x TYM WTJ/M ~ ~ ■g atsl V 1. 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Adm. Code Attach complete site plan Z I A..s in size. Ptah must County St. Croix 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. QZ 4? - -01:9, Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7 ~ Q Property Owner Property !WW f -01 Steve Derrick Govt Lot 1/4 SE 1/4 S 15 T 30 N R 18 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1438 County Rd G 24 - Cherry Knolls 1st Addition City State Zip Code Phone Number dy ®V'lilage E]Town Nearest Road New Richmond WI 54017 ( ) County Rd G E] New Construction Use Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD 0 Replacement Public or commercial - Describe: Parent material Loess over outwash Flood Plain elevation if applicable 404 ft. General commends This site is suitable for a conventional below grade system, recommending that a pressurized system with equal and recommendations: distribution be used so as to distribute the effluent over the entire available area due to the massive(Om) fsl. This is not a code requirement, but rather a suggestion. F7]Boring # 0 Boring U n Pit Ground surface elev. 99.90 ft. Depth to limiting factor ~:`90 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-9 10yr3/3 - sit 2msbk mfr as 2f .6 .8 2 9-24 7.5 4/4 - Is Osg mvfr c 7 1.6 3 24-59 7.5yr4/4 sl .6 --0191-- Mq 4 59-90 7.5yr4/4 - is Osg mfi - - 1.6 r.7.7 F 2 Boring # 0 Boring 100.25 >90 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "EfF#1 *Eff#2 1 0-14 10yr3/3 sit 2msbk mfr as 2f .6 .8 2 14-23 1 4/3 Is Osg mvfr cw If .7 1.6 3 23-66 10yr4/6 - s Osg ml cw _ 1.6 4 66-90 7.5yr4/4 fsl Om mfi - - 5 ~~p ►c i► 1 1 • Effluent #1 =13OD > 30:s 220 mg1L and TSS >30:5 150 mgA- Muent #2 = D < 30 mg& and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 4/1/04 715-246-2454 Property Owner Derrick Parcel 1D # Pending Page 2 of 3 Boring Boring # pit Ground surface elev. ~4'~ ft. Depth to limiting factor >9Q 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 1 0-26 10yr4/3 - is Osg mvfr as 2f .7 1.6 2 26-45 1 5/4 - mvfr cw if .7 1.6 3 45-57 7.5yr4/4 - sl Om cw .6 4 57-72 10yr5/8 - fs Osg mvfr cw - .5 1.0 5 72-90 7.5yr4/4 - sl ft mfi - - .2 .5 ❑ Boring # HBoring Ground surface elev. ft. Depth to limiting factor in. Soft 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 H Boring ❑ Boring # Ground surface elev. ft. Pit 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 * Effluent #1 = BODS > 30:5 220 mglL and TSS >30 < 150 mgA- * Effluent #2 = BOD5 < 30 mglL and TSS < 30 mglL 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-8330Te9 (X07/00) Cherry Knolls 1st Addition. Lot 24 r. N lot corner BM2 iw 106' 04' B2 136' Scale 1" = 104' BMi top of ' ipe 300.00' BM2 top of iron p' a 105.50 8% B 199.90' slope B2 100.25' B3 94.00' 132' 43' 102' B3 B1 100' 98' BMl 96' SE lot corner 94' Thomas Nelson 227387 L