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HomeMy WebLinkAbout018-1041-70-000 an: SEWAGE SYSTEM a, INSPECTION REPOP.T erm; N5- .-4:;" Tai- vi" -171 7~ 5 'SEVERAL INFORMATION ~ e-sora IITOMWID- V--L. prov,uc 1--ay oe .:sac it se=naarr ncroese: (ter .aa ~v, s ._.:r -)(m). f -2+(o 99 I-armr. HJIOe-S N8. T i%IGacn X -ownsnrc Ic-ame a;. NC TaA.4L W41 # o _ alp--/a ~i_ ~a- 3hS 'ms[ 5G9 Ea'.: KIJ =r^s.nGtror. [ Nc. i.,=_c2tDn~Gan:=:aGnc_:A^a/7. Z61? TANK INFORMATION ELEVATION DATA Ty-n:: Iv1~;NU=A -U~c A~, 74TIDN - - - hex C 3ancnrr arr 17.6 I ' qp COIL i 4J 3 r CP 1 5 a dog 3.5 ~r/Z2. 7 c I31ac awe- b o t~-- I`;;,131n^ ,SERI Inl.; i 1 _,4NK SET6AC INFORMATION I L ~ 16 r,Nh; , _ V~r=! - SLUG . Win- - rnrte - ~Q4L IJ: uile: ~ ~ I I _~rrnc / ~ / I ~ IHaaoarR✓:a- I , 3 T7' r 93 71ob ~ 3-/5 1161 4ara?1Cr, Q4 I n 17~idrnc ~ ~ Iso: Sys o~ I I PUMP/SIPHON INFORMATION =rnai Graoe 12. I'S A64, Z5~ 1.1anu a:7mrer Derranrr ,S ~w..,• i L- Ylwl _iF i u 5 1 TJ e 5 =-,rea,air iLer,jtl / IDa It ID!s; r vvel f SOIL ABSORPTION SYSTEM =DTR-=NCB IV61- ~Fm?t• / No J'irron IP7 DIMENSION, N-- w rnsio=_ D;r -Qui- DeGt-, 7rrn-NSIONS r 1_ qd 1j, I SETBACK I c `I`f ~z~'L b 1 IN _r Cif', =AM - ACHIN= f."a^. I3Ct'urer. WFOhMAT10N' _ CHAMB°_P. OR T v . ~:•=terra q~ ~ ~ UNF Pjixip a DISTRIBUTION SYSTEM I~ca7er,TJ.anirG~c (JStICL71nc d ) t, Hoi=_ Sin -1GIE soa=.^.c v c 4r ~~a S cog 2 1_en?tr Ga I_~npt~ G: S::a-„~c /3Z Z SOIL COVER z Pressure System- Oniy ) z: Mound Gr A`Systems Onq • I _ _otc :)V_ Iu~atr "r, z~ .'erdn n` ;b ERea>d'Soao~c z: blurneC 4ed,-I renor ,Rnte IEsediranc Ecp~r ioGsoi N. N. - ~ I .OMMENTS: ;'rn :rude COO- til5rra7enZ:la~ :)e-sons or=.;en_ rr1I - msoectior: Z\I ,oration: gr 5 ; L a11Y` ar-el Nc: - 3hJ Jes~nptrnr _ b ar revai c _ cre;.. des ~W, otner side ro- aaditrona. ulrorrnai V✓ Date insepo or . ; r;n;urr S BI-6-11- lR.3G- ~ Nc. Mcnr-l County t Safety and Buildings Division , 201 ''W. Washington Ave., P, 0. So 2 S Permit Ntiirtber .S (to be filled in by Co) P l Mad.son, %'dl 113707-7152 ST. CRO% COUNCT ME 5f4 765 Sanitan, Permit Application slant `m vtttnber in accordance with SPS 383.711(2), Wis. Aden Code, wbmusion of this form to the appropriate cove mroentil unit is required prior to obtawtng a saruta:y PC= Note' Applicaiwu forms for state-owned POWTS are submi ted to Pmiec dr s (if different than mailin-, address) the Deparsncul cf Safety and Professional Scn ies. Persnrial information you provide may be used for seain,4--y I purposes in acwi dance w;th the Yrec aCy ; aw, s 15.04{ t)'cri, Stare. - - - L Application Information - Please rint All Information Proper,} Owner's Name - `1 Parcel) n / F-ropery Owner's mailiag Address , Ptrgrer y LOCatlan Govt Lot it Stare } tp Code Ytane Vttmba Section _ i yyl~~, J T X /R (cucl or W Type of Building (check all that apply) Lot # f -2J`amlyD.cl1ing-Number of Red y / Subdivision?"amc I3~nck Pubbcjcoiri ercial - Describe T_Tse - ❑ City of- - ❑ State Owned - Desonbe Use CSM Number ❑ Village of / , - -P of X Vol $Z III. Type of Permit: (Check only one box on line A. Complete line B if applicabl A. - - LA )dew System acenlcnt System U Trcaumeob_3uldiag :'ank Repla=mcnt Only ❑ Other Modification to Existing System (explain: B. ❑ Pettrtit Renewal Permit Rtvuiott J Change of Plumber ❑ Putt Transfer to New List Pm-ioas Permrt Number and Datt ssucd Before cXp ration I Owuer TV. Tvpe ofPOWTS Svstem_/Compouent/Device: (Checl all that apply) don-Press==d ln-Ground L l PTessurtzed in-Ground -Grate ❑ ?.4otmd > 24 in. of suitable soil n Mound < 24 ir.. of suitable soil Holding Tank C' "Dispersal mapon- (explain)--- Prctrratnunt De-Vice (explain; V. Dis rsat/Trea nut Area Information: f I ~Ecjgn Flow' (,pd) Dcsi~t Soil piicatitm R+tei dsfl speroal Area Required l Ds rrsal Aura PropL~ (sf) System Elevatton~ IL I Vi. TankLtfo Capacity in Total a of Manufa~~rurcr irallons -salluns Units Nc*Tanks ExtsongTanla o Sepoe or HOtdinF Tank - ' n ' Dos~ag Cbaabcr ~11 - ` _ VII. Responsibility StateL-~ L. undersigned, assu r ponsibitity for installation of the PORTS shown on the att.ched plans. Pltmt s `~amc (Print] e Phnnb i c MPIMPRS?frmber Business Phone N bet 14 Yltnnb 's Adttress (I C t <2 onntv~De artme t Use ODIV - --~PPruvcd tsappr Perini, fee 3 Date sued lssuin. t Simature Owner riven R~son fo- L S %1 I L W/o 1X Coaditi&tlfa56?Etl"~1~?Wwns for Disapproval + t. Septin tank, effluent fitter and d h t O 1^ f F.G tlisper:Di cell must all a set leas ! rub nta rg4; 1' / t a>s per management plan pre tided by plumber. q G la"'• 2. 'Jkijobj~k raquiretaents must Lm rnaint~ ir,Ed _ ilk per opFMCWe Cott! / xdinaxej. .Anach to u,mpine plans for dac ".s and submit v the Comity only oa paper oat less than 8 is x 11 inrloes in sin SBD-o;9S t:iL 111,1' PLOT PLAN PROJECT Bacnel Waish ADDRESS 1592 US Hiahwav 12 Hammond W 54009 SE 1,14 SE l r 4 S 16 IT 29 N!R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.9' 4!16/16 3 DA'I'S BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons 1,111* TANK SIZE DOSE TANK SIZE 630 HOLDLNG TANK SIZE LOAD RATE •5 ABSORPTION AREA 900 of chambers none BENCHMARK V.R.P. Top of 1!2" pipe ASSUME ELEVATION 100' Filter SI1v1-TEC BOREHOLE O IATLL +H.R.P. sameasbenchmark 99.5` B. 1 00.5, Property Line 101.5' B-3 101.9' US Highway 12 8%. slope Area 15' beIow 10 system is to remai in Scale =1/41' = 101 B-1 undisturbed 2 Acre Lot Verl$ Ex isti ng System fai led Grading is to be done to divert B 2 run-off away from system Huffr.utt Case Tani; T~3rlk: is try be proper _4, brd,Jr:- ST and provided with Iockdown cover with approved warni n-, Existing 3 label Bedroom House I 'Well 0 All piping shall be ASTNI SDR 3 4, within 10' of tank, piping shall be aSTNI F891 ZJ~~ a'~tcc r?%~~:,. DIVISION OF INDUSTRY SERVICES 233' SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 - Contact Through Relay s ps http:lldsps.wi.govlprograms.lindustry-services www wisconsin gov Scott Walker, Governor Dave Ross, Secretary Mav 1]. 2016 COST ID No. 226900 ATTV: P0 147.5 hisf?cclor SHAUN R BIRD ZONING OFFICE. THIRD PLUMBING INC ST CROiX COU\TY SPiA 14,2 1201H ST 1 101 CARMICHALL RD NEW RICHMOND VVI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/11/2018 Identification Numbers 'Transaction ID No. 2699198 SIFE: Site ID No. 823332 Rachel Welsh Please refer to both identification numbers, 1592 L.s Htiiti 12 above. in all corTespondence with the agency. Town of Hammond, St CWJX County SL 14, SE 1,4, S18. T29N. R17W FOR: Object Type: POWTS Component ivlanual Regulated Object ID No.: 1597914 Maintenance required; Replacement system: 450 GPD Flow rate; System(si. At-_rade Component Manual. Version 2.0. SRD-10854-P (N.03r071. R. 1'12). Pressure Distribution Component Manual - Vcr. 2.0, SRD-10706-P (N.01 01, R. 10 12): Pffluent Filter The submittal described above has been reviev.,ed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDI I IONALLY 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 plumbin;, in the state unless licensed to do so by the Department per s. 14 5.06, stats. The folloxving conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and installed in accordance with the approved plans and with l,r hlic.,o wn 1 1[M- 10854-P(N. 03:0', • The pressure network i s to be constructed in accordance with publication SRD-10706-P I i l l I: (i entitled "Pressure Distribution Component Manual for Private Onsite Se\%a,e Systems" and ba,:,_i I: I methods contained in Small Scale Waste lvfana(ement Project publication 9.6 entitled "De,i r: Distribution Networks for Septic Tank - Soil Ahsorbtion Systems." 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 mad include local inspectors. All permits required by the state or the local municipality shall be ohtained 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 makin" them necessary for code compliance, As per state ,tats 101.12)(2). nothin , in this reviC%k shall relieve the designer of the responsibility for desi,nin) 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. ~IIN R BIRD Pax? ~'l1 2016 The above IetT addressee ,hall provide a cope of this letter and the POW I'S management plan to the owner and any others who are responsible for the installation. operation or maintenance of the POW'TS_ Sinccrrly. Fee Required S 250.00 - This Amount Will Re Invoiced. When You Receive I hat Invoice, %Iatthetir A Jansen Please Include a Copy With Your POWTS lead , Division of Industry Services Payment Submittal. (715) 340-0407 WiSMART code: 7633 matthew.janzen1aa isconsin.-,ov iVEL) ,APR IS 2016 Cover Page Shaun Bird Bird Plumbing Inc. ~Y CC' , T-, I 1432 120th St. CC'`` ` pV ED P YA New Richmond Wi 54017 CcQT OF S ALESER~'N CIS DES , ~FESSIO pVSVM ScRvl 715-246-4516 pF Its i CEO Date: 4/16/16 Owner: Rachel Welsh Location:SE 1/4 SE 1/4 S18 T29 N,R17W 1592 US Highway 12 Hammond Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specifications Attachments: Soil Test Shaun Bird Signature License number 226900 Page 1 of 9 PLOT PLAN PROJECT Rachel Welsh ADDRESS 1592 US Hiahwav 12 Hammond Wi 54009 SE 1/4 SE 1i4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 101.9' 4/16/16 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL. LINT HOLDING TANK 1LOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE •5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.F. Top of 1/2" pipe ASSUME ELEVATION 100' Filter SIM-TEC ❑ BOREHOLE O WFLL * H. R. P. same as benchmark 99.5' B M * 100.5' Property Line 101.5' B-3 101.9' US Highway 12 876 slope Area 15' below 10 2.5' system is to remain Scale =1f4" = 10' B- undisturbed 2 Acre Lot Very Ex isti ng System fai led Grading is to be done to divert B-2 run-off away from system Huffcutt Dose Tank Tank is to be properly bedded ST and provided with lockdown cower with approved warning label Existing 3 Bedroom House Well O ~J All piping shall be ASTN1 SDR 30/34, within 10' of tank, piping shall be ASTM F891 2°-~~ At-grade System Sloping Site Cross Section and Plan View E Dimension Feet I rtil•J~J•~L•ti'L'L•L•L•L•S••..L•L.ti•ti•L•L•L•ti•L•L•L•L•••.L•: :•L•L•ti•L.L•L'• ••L•L I l•r : J•r•r•r•l•J•r•r•r•: •J•r•r•l•r•J•J•r•r•r•: . r•r•r-r•r•J•l:r•f. L•L•L•L.L..,•L•L•L.L••,•L.L.L•L•'.'•''L'L'ti'L'ti•L'L'L•L•L.ti.L.L.ti L•L•L•L•L.L•L:ti.. . I r•r•r•r•l•l•J•J•r•1•r•r•r•r•J•J•r•r•J•l•l.r•r•r•r•r•r•r•J•l •l•r•r•r•1'•J•r•J•J•l•J.l• I A IL L • L. . ti..•, L, L , L, L, L ~ L L • L . ti. L. L.., . L • L L. 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L•L• •L•L••.••.•L•L•L •l'r•l' r•J•r•r•r•:•r• G 1.0 •L.L.L L,.,,L,L,ti,L,LI t E x l L - t-- 1/6 B - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E B L % Slope T ~ = Plowed rtiJ.. - Clean aggregate 0 = 4 in. sch. 40 pvc. basal area fto 2 '.11 in. dia. observation pipe Lateral with Topsoil Cap aggregate over pipe ~ Observation Pipe Geotextile - + / Fabric (j With Can Ft Lateral Invert Ar-" nj ~l~l:: :rL•L•'•L• L•L=L ~L:L:Lr ti: t:1.•, _ t Y r•r•r. r.:.r•r•r•r•r•J. Topsoil Cal' ri z'-'j . rLr r•r.. ti~L~•J r• F . rL:. J,r r lLf J:r rtir~.%tirtiJ '•f , _ r; rLr.J.r r., . •r r•J~~Q Ft w / ti.L.L....L..•. r.J - ontour rti fLrL L- ''~'.'=r: r•f•r~J•r.r•l. r. r.r.l.r.l•.•:l r -"-.f r r•: r r f:fLJ D Plowed 5urfacc~ C Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (I. x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a V4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After-the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative- growth, limit erosion and protect from freezing. The obsen,'ation pipes are perforated in the lower 6 inches and secured in place. 03i051gj 3 Page of Pressure Lateral Layout One Lateral - End Manifold f - Threaded Cleanout Lateral 't'urn-up Plug Force Main i X _ - L Long Sweep 90 Bend S U Pressure System Construction Distribution Network Specifications Lateral Diameter _ Z In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 51L_ In. pipe. orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length Ft. Lateral turn-ups terminate with a threaded Force Main Diameter _ In. cleanout plug and are enclosed in a 6-8 inch Force Main Len Ft. diameter lawn sprinkler valve box accessible from finished grade. Grade T 6-8 Inch Lawn Sprinkler Valve Box 1 W- : 03/05 lgj Page Ll of I - Dose Tank Cross Section And pump performance Specifications Tank Manufacturer Tank Model Number 63 0 Minimum Pump Perfiormance Required Total Tank Capacity 3 °2 GPM _ Ft TDH Max. Bury Depth -----f - -J Total Dynamic Head (TDH Pump Manufacturer z J~~ ) - Feet Elevation Head Pump Model Number Distal Presswe . ~ Alarm Manufacturer „ - Alarm Model Number Network Pressure Loss J Force Visin Pressure Loss Switch Type Total /rv y() Manhole Min. 4" Above Grade Vent Min. 12" With Locking Device Above Grade Weather-proof With Cap Junction Box ♦ - ► ! - Finished Grade Depth of Cover - 44- - Ft ~ lliscnnn";t. l Means , < Outlet inlet r; Switch in-s, d nReserve Capacity Tank Volume - GP1 - - - - ! ' Dimension > ! ` InchesTolume Gal. ' < A ' (reserve) A a s ! 4 1/413 (alarm) B 2 J B ;s Weep (dose) C 6 , T -s Hole ` (dead) D c, Off ev, t > 1 Total Z ` < ~ v D ! Bottom of Tank Elev. Ft ` F>`><><><><,<><><> > > > > G G<<< i t c L< < <'L'tl< GFAFRAL INSTALLATION: The 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 not 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 excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05 lgj Page_ of hEAD; CA?aC 1Y 70TAL DYNA -4o PER Ytluu'E H EA-- A_ ~Hi'h.( I T 1 V ` ~ EFFLUENT AND 071RA ERING MODLL. 5- 2", 153 I WIG MOCEL 152 7 . fi--.--- ly ~ Ect ~ Meters ~ Ga:. i uL-rs ~ (col. Late, s t 153 5 i.5 59 251 %7~291~ I .3 231 70 265 4 12 40- I 52 - 15 4.6 i 53 20' fil 2?'. 20 6.1 44 167 I 52 197 30 ~ G5 .-c } 34 129 42 159 1 8 30 9.1 23 I Ei I 125 n 21' I - - 83 i o 42 12 2 11 42 - I 4- i 4 Voive 138.0 (11 'nl 4"-i) Ft 4r,, ! 10 - 014505 I 2C 4J no SO 100 GALLONS LITERS ~ b tjo 0 80 160 2`0 320 rLOW P-~; VINL-C -j -T- CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing pane's avai:ade. \ 3 2',32 - Electricai alternators; for duplex systems. are available and supp:ied with T an alarm. Makable level control switches are available for _oniroliing single.chase systerrs. • Double piggyback variable level float switches are available for variat'e level long and short cycle controls. L11 Sealed Qv-Box available for outdoor install See ~M1420. f • Over 130'F. (54°C.) special quotation rK-xred. l j ! 152M53 Series 1521153 MODELS cc, I ntrol Selection I l I Nodes ! Volts-PA _ M0 6a Am s Sim lei Dualez_ 5 1"p, i----?- 1N 15- 1 Non 8.5 1 20'6f 33 BN152 115 1 Auto B-5 Indu,W ' 2or3 _ SK2064 E152 230 1 Non 1 43 t 2cr 3 - t.- BE152 230 1 Aa:u 4.3 Inclu:ed 2cr 3 N153 115 1 Non 10.5 t 2 --or 3 BN153 115 A„ro 10.5 lnclu:ed 20.3 SELECTION GUIDE E153 230 1 Nor` 5.3 1 20!3 1 Single pcJ9gCark variable l~.el 1oat TMtCh cr do0le PSgybaCK variable level float BEM 230 1 Auto 5.3 lndLded _ 2 or 3 cwftch. Refer tD FM04t7. o CAUTION 2. See 'N'0712 for correr, model of ElectriealMernaior Erak. All installation of controls, protection devices and wiring should be done by a g6jali5ed 3. V anable leve! control switc`i 1'}3225 Lsed as a contr0i of tivatw, sVecify duplex (T. licensed elearician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and L1e Occupational Safety and Hea* Act (OSHA). cr 141 float svs em. RESERVE POWERED DESIGN For unusual conditions a reserve saety factor is engineered in;; the design Ct evely Zoeller pump. - MAIL TO: P.0- sox 1614? !J L xzwts, KY 40256.035? Ma,~fiactrrasel. . r f S.rr1PT0: 3649 Cane Run PcaJ pO Z u ' 1 LouisrJte KY 40211.1561 ~lL4'JrY P✓ti1F5 ~`J/NCf i1~/ 1 5021 77 6 2 731. I I'BX) 928-PUMA httpzllwww.zoefer.com cAXf562,'7743624 O Copym;ht 2000 Zoeller Co it rights reserved. POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of FILE INFORMATION Owner SYSTEM SPECIFICATIONS Permit # Sept Tank Capacity gal ❑ NA Septic Tank Manufacturer ~n~ C NA 7ESIGN PARAMETERS Effluent Filter Manufacturer X11 U NA Number of Bedrooms - v ❑ NA Effluent Filter Model STS ❑ i Number of Public Facility Units NA Pump Tank Capacity Estimated flow (average) gal C' c~ al/da Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) - ~J?> al/daPump Manufacturer ❑ NA Soil Application Rate gal/day/ft'- IMluentlEffluent Quality / PMonthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/LNA Biochemical 11 Sand/Grave! Fitter O Peat Filter Oxygen Demand (SODS) ~220 nI ❑ NA O Mechanical Aeration ❑ Wetland _ Total Suspended Solids (TSS) 5150 m g/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Month avers e g Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L C-3 Total Sus In-ground (gravity) ❑ In-Ground (pressurized) pended Solids (TSS) S30 mg/t- NA At-Grade O Mound Fecal Coliform (geometric mean) x104 cfuJlQbml - ❑ Drip-Line ❑ Other. 'Maximum Effluent Particle Size _ lk in tits, ❑ Nq other. - IOther: - ❑ NA NA Other. *Values typical for domestic wastewater and septic tank effluent C1 Other. ❑ NA MAINTENANCE SCHEDULE ~ Service Event Service Frequency linspect condition of tank(s) At least once every: ZZ, ❑ month(s) __,~ayear(s) (Maximum 3 years) Cl NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ,Inspect dispersal cell(s) ❑ ~ At least once every: a (S~s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: morrth(s) ear(s) ❑ NA Inspect pump, pump controls & alarm At isast once every; J nth(s) 0 NA i=lush laterals and pressure test At least once every: geants(s) 7thec O NA At least once every: Q month(s) 7ther: ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS ❑ NA 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 linclude a visual inspection of the tank(s) to identify any missing or b okenh hardware, denttify any Servicing ~rombined sludge and scum and to check for any back u or k orrlleaks, measure the vole a of visual! ins y p ponding of effluent on the ground surface. The dispersal cell(s) shall be the, effluent in the pipes for The ponding of effluent on the groundlevels surface may obsindicaervatite oa failingacondind to n and requireessn hregimmediatetno -he ground surface. Regulatory authority, trficaUon of the local When the combined accumulation of sludge and scum in any tank equals one-third or more of tank the tank shah be removed by a Septage Servicing Operator and disposed of in accordancee with chapter t R 113, Wisconsin Administrative Code. INI other services, including but not limited to the servicing of effluent flters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of s12 months, shall be performed by a certified POWTS Maintainer. Ik 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 new construction, prior to use of the POVJTS check treatment tank(s) for the presence of painting products or other chemicals th.'jt 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT , antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins-, tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is prope fly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail 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 Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compilorrt replacement system. ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requbjed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the n09d for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruler. In effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technolagV 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 last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following re-m wa' c` the bicmai at 'hr infiltrative , Reconstructions of such systems must comply with the rules in effect at that timf . «WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE:. ADDITIONAL COMMENTS _ POWTS INSTALLER POWTS MAINTAINER Name Phone 71 _ - Phone ~J ~j - SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY AUTHORITY p Name _ r Piame l Phone Phone 7 /J = This document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f, and 383.54(1), (2) & (3), Wisconsin Administrative Code. i I -1-4 - q1? ( r't, 1 f L. ~ i I ~ r'1 ~ I l i -I i ~ I I li i II ~ j( Pr ~.i!, it 1 I' , i i I IJ L ~`,I I 1•~ t i 1 T ~vl I EL ` '137 HYTDN BAY NORTH RD I ; YIJ~ CITY, MI 4971 , i -88-9-330 FAX ? ! 7.L4 ! HOWER" 1 STF-104 ' 1/27 ~Q, S0/Z0 3 d 03 dWfld Q36d3d36d 898LPZ.8g7L ~t 0T TTOZ/90/~0 ST. CROIX COUNYV SEPTIC TANK MAINTENANCE AGREFIYMW AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ 6,jj, Mailing Address r c (mac ~y s Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Numb 7 LEGAL DESCRIPTION Property Location t 14a 'E Vo , Sec T 4 N IV2 w, Town of Subdivision , Lot # I Certified Survey Map # Vc,lume Page # we i/ Warranty Deed # Volume Page # Spec house yes no~ Lot lines identifiable y no i SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and mainoenance of your septic system could result in its promature faihure to handle wastes. Proper nuunknante consists of pumping out ilre septic tank every three years or sooner, i] 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 wasfle disposal system. Owner maitrteaance responsibilities are specified in §Connn 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumpa verifying that (1) the on-Rifle wastewater disposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undorsigod havc 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 Department of Natural Reaou men, State of Wisconshi. 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 this orm are true to the best of z y/our knowledge. Uwe am/are the owner(s) of the properly described above, by virtue of a warr deed recorded in Register of Deals Office. Humber o ms \qW4AnJR'k 6t APPLICANT(S) DATE ***Any information that is misrepresented may result m 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 rcfm=e is made in the warranty deed. (REV. O&V5) ST- CROIX COUNTY ZONING CF:RTIF3"CATjc)N STATEMENT .rcE O FOR UTILIZATION OF AN EXISTING SEPTIC TANK to certi Cy t t I have crving the 0 / n pected the septic tank resc , ~tl.y residence lo,atec, upon i /-7- W, `Town the tank and baffles nspection I certif tab Y that I ha in ve f=r}~lr:c1 f~-rnctioning prop,,.,, good Condition and it appear.•s t:<~ be ast time serviced: bacJc occur i rom a Yes _ No sorption system? (If no, skip nc~ line}. Appro rt ximate volume or length of time: apaci.t gallons construction: Prefab Concrete Mar~ufact ~ Steel Other urer : (It known ,~.;c of T ~k (I f. known) .i ignatur~-) ( me) Please prim _ t 1' 1 t l e) Z l - (Lice Number) - i.1 t e - t''ulm to be completed b Statutes) or License Y i.icensed plumber C~-ode} d disposer (s. 145. 06, W.isco;rs ~ rr - (NR 113 Wisconsin Administrat."VC, 'aunber (aPPlyinq for sanitary permit Certification: r aCCeptiny the above statement re ,,onditi.on gardin r I certify that the tank t , /existing septic ta;jk c_unfOr-m to the re PIE of my knowledge wil..l Iri5pect.io opening ments of ILHR 83, W'. Adm. Code (except for ~ 9 f'~r r outlet baffle) , Signature J MP/MFRS L "uu"4z rinl IL'riJI_KX Part of the Southeast 1/4 of the Southeast 1/L of Section 18, Township 29 North, Range 17 West, Town of Ha7mnd, St. Croix Count.;, Wisconsin. "VSO d CPO' 00 6 00. 00' 3 oT o0 2 6 0.00' o►~ a L 07- 2 -"r4 c REs 0 0 v In 0 Q.1 LOT/. ~Zo.4vw,gY) X00 0 r! ' fn 95 .4C.QE 5 m n `nJ . ~lJ OM 1 10' N FtC*I43,gWCff :z 0) 1% VI/ mm ^r~ 5239w,nt i uJ \9 0 p• * • a ~ s e9 sg'2~'i~• M oa 2 ~ J 0 ~ Q c e20..w© 85. z6 2 so o 5.sr~ 40.9 ~ S T MO^tuti^~tiT 9~ `g S CpR. S CALF S.T. NA iL NCTE: All bearings based on the South line of ~`+'OR s~ C ~`•'.4 Q T the SE 1/+ of Section 18 assumed due East, West. ,4 RECEIVES y~- Wisconsin Department of L~orrnmerrk l" SOIL EVALUATION REPORT Page of Division of Safety and#riltW)1X coUW" ante with Comm 85, Wis. Adm. Code ';OMN1UNITY DEVELOPMENT County 5 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. Please print an Information. Revie by Date Personal information you prov de may oe used for secondary purposes (Privacy Law, s. 15 04 (1) (m)). 5 / Property Owner Property Location _ i f c ` ' Govt. Lot Sc V4 jC 114 S T l~ N R E to W Property Owner's Mailing Address Lot # Block q Su bd Name CSkW State Zip ode Phone Number ❑ City ❑ Village Town Nea est Road Y%, f ❑ New l:orlstructon Use esidential !Number of bedrooms. Code derived design flow rate GPD Replacement Public or commercial - Describe. Parent material 4 2 Flood Plain elevation if applicable /f✓ ! i ft. General comments and recornmendations: a System Type System Elevation a Boring Boring / # it Ground surface elevl ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1lf In. Munsell Qu_ Sz. Coat, Color Gr. Sz. Sh. 'Eff#1 •Eff#2 n Z-7 > Boring # C] Boring Pit Ground surface elegy Cpl' , ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 z' n 70 Effluent #1 = BOD. > 30 < 220 mglL and TSS >30 < 150 • Effluent #2 = BOD, < 30 rngA- and TSS < 30 rnglL CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird - 226900 Address gate Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54 - j 715-246-4516 Property Owner Parcel ID # Page of Boring p Boring a Pit Ground surface elev. Z, ft. Depth to limiting factor 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 'Eff#2 n L] Boring BOnng # ❑ p,t Ground surface elev. ft. Depth to limiting factor 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 'Eff#2 Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ pit Soil ication Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluenf #1 = 130D, > 30 < 220 mgrL and TSS >30 < 150 rng,1 ' Effluent #2 = BCDS < 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 contart the department at 608-1166-11 51 or TTY 608-264-8777 SBD 8110 (R. btY) Property Owner Parcel 1D F3-1 Borng Page of Boling t, Pit Ground surface eleIt Depth to limiting factor in. Sot] Horizon Depth Dominant Color Redox Description Texture Structure Consistence boundary Roots GP Rate in.. / Murrell Qu. Sz- Cont. Color Gr. Sz. Sh. Boring # ❑ Boring ❑ Pit Ground surface elev. ft- Depth to limiting factor in. Horizon Depth Dominant Redox Desai Sal Rate Pty Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. fl Depth to Wnititing factor in. fioriaon 'lepfh Dominant Color Redox Sod Applocaticin Rate Desaipbon- Texture Structure Consistence Boundary Roots GPD/PF in, Mimser Ou. Sz- Cont Color Gr. SL Sh. 'Eff#1 •Elf#2 Effluent #1 SOD, > 30 < 220 mg/L and TSS >30 < 150 ffwA ' Effluent #2 = BOD,130 mgll- and TSS c 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. W4330 (lUM) Soil Test Plot Pla Project Name Rachel Welsh sh Bird Address 1592 Hwy 12 Hammond Wi 54009 _ M #226900 Lot 1 Subdivision pa 4/15/16 SE 1/4 SE 1/4S 18 T 29 N/R17 W Township Hammond F-I Boring (:D Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 101.9' -HRpSame as Benchmark 99.5' B.M.* 100.5' Property Line 101.5' B_3 US Highway 12 102.5' 8% slope Scale =1 /4" = 10' B-1 2 Acre Lot Ver} Existing System failed F ST Existing 3 Bedroom House Well 0