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HomeMy WebLinkAbout018-2013-09-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 584793 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2716014 Permit Holder's Name: City Village Township Parcel Tax No Oevering Homes LLC TOWN OF HAMMOND 018-2013-09-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 08.29.17.1110 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER-` , CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~j ct . Dosing Alt. BM $ ~7 Ve Z_ O n~> r.°ty ;u V Relation Bldg. Sewer G , g ` Holding St/Ht Inlet , TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent o Air Intake ROAD Dt Inlet Septic Dt Bottom 73- Dosing / A)A- /3 Z4 Header/Man. 2.1 qZ • 7 Aeration Dist. Pipe 2. 7 9Z Z. Holding Bot. System 3, 7 11. f PUMP/SIPHON INFORMATION Final Grade • -7 013. Z„ Manufacturer Demand St Cover --q GPM4. 710 Model Number •7 r t f III, 6z__ TDH Li Friction Loss System H TDH Ft 5.~ Z.o S- Forcemain 1 Length I Dia. Dist. to Well 470 Z SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS z 40 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Typg Of System.. / Model Number: e, DISTRIBUTION SYSTEM Z Header/Manifold DistributionQQ Ix Hole Size Hole Spacing / Vent to Air Intake Pipe(s) Z, Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges a Topsoil ` h Tom, Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection2: Location: 1019 167TH ST 1.) Alt BM Description = 2.) Bldg sewer length = /~lJ amount of cover = 6JA IL f-~G~LS Plan revision Required? ❑ Yes Xqo _1 Use other side for additional information. I LQi~~ SBD-6710 (R.3/97) Date Insepctor's nature Cert. No. County _ Safety and Buildings Division f 201 W. Washington A P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 7-7 2 J_ I w NTY I- ~Kl -~~2-->COL ;OM UNTY DEVELOPME"Sanitary Permit Application StazeTransactionNumber in accordance with SPS 383.21(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 Depart ncnt of Safety and Professional Servies. Personal information you provide may be used for secon purposes in accordance with the P= Law, s. 15. 1) m), Stats. L Application Information - Please Print All Inform n 7 s' Property Owner's Name / Parcel # Ito i 3 Property Owner's Mailing Addr 15/ Property Location -7 G T.. A nK_i G~ .~/1.~°~-~ - CTQ^l.Ot nY, StarE Z Code Phone Number ^ ~j f Section ~Q 1,0 c~(11 rcleo l T N; R/ or W II. Type of Building (check all that apply) Lot # 3 - - Subdivision Name or 2 Family Dwelling -Number of Bedroo Bloc t- L? r °'/9 7 J C~~ ❑ PubliclCommercial - Deseribe Use akC a% 4 L f* ~'^(`/z 1000 -j )wAA. ❑ City of CSM Number ❑ Village of ❑ State Owned Deyribe Use own of z- f2. x ~ r III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ew System El 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 issued Before Expiration Owner IV. Type ofPOWTS System/Component/Device: Chec .all that a 1 (f Non-Pressurized 1n-Ground 11 Pressurized In-Ground t-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rat Dispersal Area Required (sf) Dis al Area Proposed s S ' r ( Ystern/Elevati ( '15- 21-, 7 7 VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a E o ~ New Tanks Existing Tanks m 2 u ' ~ o m - U cn v ;n C7 Septic or Holding Tank Dosing Chamber E VII. Responsibility Statement- I the dersigned, ass-14 r ponsibility for installation of the POWTS shown on the attached plans Plumber's a (Print} f. Plumber' afore vIP/MPRS umber Business Phone N bee r- Pirnber's Address (Street, City: Stale, Zip c C~ J~± tk ountyfDe artment Use Only 17 pproved ❑ pprove Permit Fee Da Lssue issu t Signature ~~IL2-Qavner iv en Reason for Den' S ~J -W ` WQ V 1 / l( 1X Conditi o" for Disapproval o n 1. Septo tank effluent filter and 3 I,v,l•r., ~e V ► d1.e, disper ai cell must all be sa.Ifcps ! mr!nllr ; wi o-.4. ~ as per management plan provided by plumber, 2. J9kitft * i0 an must,t a maintzinad ,r n as per sppli mWe c~ / ordinamm. T Cp ~JC i ~-i oM~ a~ ~b r hG~K~. arG Attach in complete plans for the system and submit to the County only o aper not less than 8 is 11 inches in size _ SBD-6398 (R 11/11) ~I 5~ 7 3oa A-, s PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 114 SE 1/4s 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 91.0' 5/27/16 BEDROOM 3 DATE CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 63 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' Filter Lifetime Fil ❑ B REHOLE 928'Property WELL *H.R.P. same as benchmark B.M.* Line Scale = 1 /4 = 1 Of 2 acre Lot All piping shall be ASTM SDR 30/34, within ur adi ng is t0 be done tb 10 .,f tank, piping shall be ASTM F891 divert run-off away from system B-2 Tank is to be properly bedded and provided with lockdown covers with approved warning labels B-1 91 .5' Huffcutt Combo tank 91' 90.5' B-3 5% Slope ~U Area 1 5' below system is'( -emai-n=undisturbed Pro 3 Y Bedroom Ho use 440' Property Line WeiI is to meet all WDNR setbacks 1 67th st. vtie~RTnrE,ti, DIVISION OF INDUSTRY SERVICES 51~ roe PO BOX 7162 MADISON WI 53707-7162 3 1 Contact Through Relay http://dsps.wi.gov/programs/industryservices Gw www.wisconsin.gov s ~Ossior +LS~ Scott Walker, Governor Dave Ross, Secretary June 01, 2016 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMIC14AEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL, PLAN APPROVAL EXPIRES: 06/01/2018 Identification Numbers Transaction ID No. 2716814 SITE: Site ID No. 824773 Oevering Homes Please refer to both identification numbers, 1019 167TH St above, in all correspondence with the agency. Town of Hammond St Croix County SE1/4, SE1/4, S8, T29N, R17W Lot: 9, Subdivision: Corner Stone Ridge FOR: Description: Three Bedroom At-Grade System / 5% Slope Object Type: POWTS Component Manual Regulated Object ID No.: 1605162 Maintenance required; 450 GPD Flow rate; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. DON No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, A stats. DEPT 4 The following conditions shall be met during construction or installation and prior to occupancy or use: PROFESS Note: Total Dynamic Head (TDH) is now 15.3 It instead of 16.3 It because there was a calculation error. However,DIVISION OF t this change in TDH does not affect the overall plan. Reminders L • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. SHAUN R BIRD Page 2 6/1/2016 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. S' erely, - Fee Required $ 250.00 r- 1~ ~tC This Amount Will Be Invoiced. When You Receive That Invoice Tiffany Marshall Please Include a Copy With Your Wastewater Specialist , Division of Industry Services Payment Submittal. (608)261-6722 , WiSMART code: 7633 tiffany.marshall@wisconsin.gov SHAUN R BIRD Page 2 6/1/2016 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.-54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 260.00 This Amount Will Be Invoiced. When You Receive That Invoice, Tiffany Marshall Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (608)261-6722 , WiSMART code: 7633 tiffany.marshall@wisconsin. gov MAY 31 2016 Cover Page INDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/29/16 Owner:Oevering Homes LLC Location:SE 1/4 SE 1/4 S8 T29 N,R17W 1019 167th St. Hammond Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) 9 Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) P a e# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross section i ;`IONALLY 4. Pipe Cross Section/Pipe Layout ?ROVED 5. Pump Chamber Cross Section SAFETY AND DNAL SERVICES 6. Pump Curve ADUSTRY SERVICES 7-8. Maintance and ontigency plan 9. Filter Specificatio s 11 Attachments: So' Test ~~RESPONDENCE Shaun Bird ' Signature License ber 226900 Page 1 of 9 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 91.0' 5/27/16 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK , MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 631 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' Filter Lifetime Fil ❑B REHOLE o WELL *H.R.P. sameasbenchmark B•M.2B' Property Line Scale = 1/4" = 10' 2 acre Lot All piping shall be ASTM SDR 30/34, within \ Grading is to be done to 10 of tank, piping shall be ASTM F891 divert run-off away from system B-2 Tank is to be properly bedded and provided with lockdown covers with approved warning labels B-1 91.5' Huffcutt Combo tank 91' 90.51 B-3 5% Slope 4 Area 15' below system is to remain undisturbed Pro 3 Bed roo m House 440' Property Li ne Wel I is to meet al I WDNR setbacks 1 67th st. 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L•1.1.1.1•L•1.1•'L•L•'L•L•1.1.1•L•1.1•L•1•L L•1•L•L•1.1•'S.•tir•1•L•1.1•L•1•L•L•L•L•L•L•L I r•J.r•r•r•r•r•J•r•J•r•r•r•r•J•J•r•r•J•r•r•r•J•J.r•r•r•J•1'•J•J•J•J•J•J•J•J•r•J•J•r•J• I F 0.5 1•L L•L•L•L•L• 1 L•L•1.1 1•1.1.1.1.1•L 1•L•1.1•L•1.1.1.1.1•L•L• •1•L•L•1•L•L•L I 1•J J•J•J•J J. l J•J•J•J J J•R.- JJ•J•J•r'•J•J•J•J•J•J•r•J• •1•L L•L•L•1 1• •1 1.1.1.1 1.1L•1•1•1•L•1.1•1.1•1•L•1•1?ti Lr{ tirtirti ti tirLf'L<I G 1.0 E 2_~- 1 E B 1 L % Slope I' = Plowed j; • = Clean aggregate Q = 4 in. sch. 40 pvc basal area % . '/z to 2 '/2 in. dia. observation pipe Lateral with 2" Topsoil Cap aggregate over pipe / Observation G Pipe Geotextile With Cap Fabric L•1~LrLJL tir Ft Lateral Invert - J•r•r•J•J J J• J•J~r~J J J•J:J•J• *Fc - ~ . 1•L•1.1.1.1.1•L•1• '•.•L•L L 1 1.1.1•L•1•L Topsoil Cap J•J•J•JS rti~'•J•J•J•J ••J•r•r•d'•1 J J J J J 1 L•L 1 r 4f~ ~•r~r ~s~ Y Y J•J J J•J•J J ~ •J•J•r•J•J•J~ J: J•JY•J~ ~ ~1 ~yt~±4 kr s -'-1.2ti+P J'•r jL~tir, fL F L j : ~ f• ~ J r= 1 ~'F~~K 'Ll!L!S 1•'L~ti• L•' Ft Contour LJLJL 1.1 L L 1• •J J•J•J•J•J•J•J J e,.;.a:•. j J:J:J J J: L•1.1•L•1 L L L 1.1.1• }•1•1•1•L L 1 1 1.1.1• Plowed Surface 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 (L 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 'A 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 gro,v#, , limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches. and secured in place. 03/05 lgj Page S of Pressure Lateral Layout One Lateral - End Manifold f- Threaded Cleanout Force Main Lateral Turn-up Plug X L Long Sweep 90 Bend $ U t i - f' G. 1 Pressure System Construction Distribution Ne ork S ecifications Lateral Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X (Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral 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 Length Ft. diameter lawn sprinkler valve box accessible from finished grade. Grade •••••••.,Q::: 6-8 Inch Lawn Sprinkler Valve Box 03/05lgj Page of Septic-Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Z✓ Tank Model Number Pump Model Number Alarm Manufacturer ? Total Tank Capacity f ~ 6 3 o Max. Bury Depth y Alarm Model Number Switch Type , e `c ` Gr Filter Manufacturer - Total Dynamic Head (TDH) Feet Filter Model 'Number Elevation Head l Distal Pressure Network Loss , Minimum Pump Performance, Required Force Main Loss GPM: a , Ft TDH Total IS. 3 Outlet Manhole Min. 4" Above Grade With Manhole Locking Device. Inlet Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof 1 Junction Box. Fruished Grade r. , Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet rT- - Inlet Baffle : - - - - - - - - - - - » Switch Settings and Reserve Capacity A 4 Tank Volu j~ OPI Weep .11 4& X Dimension ; Inches Volume Gal. :t:: B Hole (reserve) A, f 5 (alarm) B 2 L7 Off Elevation C G. j Ft (dose) C : 6"S' 7 > Bottom (dead) D : D Elevation Ft <;`; Total ;•i s". . <>.>.>< t a '','r~,, r,a a ,,t.> , > > > a > , > ,•a•,<y > > i .<>°,'>•a a•i . t`i a a > ,a . • . < • < < <>1>. < . < t < a a a < < a . , < < < t < t t { t t < t>1><'1.1>t/•1 ,>,>1•<><>i ,>1•i 1>s z GENERAL. INSTALLATION: The septicldose 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 tank excavation ahd the sleeve is sealed watertight. Electrical service mplies with NEC 300 and Comm 16.28. 02/05 U Page ~ of TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING MODEL 152/153 MODEL i 152 153 L~j 50 Feel Meters Go!. Liters I Goi. , Liters 5 1,5 j 69 261 77 291 153 ! 10 I 3.i 61 231 1 70 1 265 12 40 152 15 4.6 53 I 201 61 231 20 -1 6,1 1 44 167 52 197 w i 2 30 25 7.6 34 129 42 159 30 9.1 I 23 87 i 33 I 125 0 35 G 7 20 0 40 12.7 11 42 4~ j Lxk 'doive: 136.0 =i. 1,6-n) 44.O F[. ('3.4rn) 10 of+sos I I 0 20 40 60 80 100 i GALLONS LITERS 0 80 160 240 320 _ 3 27/32 4 FLOW PER MINUTE j 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ • Timed dosing panels available. J 3 Electrical alternators, for duplex systems, are available and supplied with j r an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. i I • Over 130°F. (54°C.) special quotation required. 1521153 Series 2 1 /5 I` ~ 1521153 MODELS Control Selection ! ! I i I Model Volts Ph Mode Am s Sim lex Du lex I 5 1/8 ( j N152 115 1 Non 8.5 1 2o,3 SN152 115 1 Aura 8.5 Ifwlcdl 2o r 3 sKZOS+ E152 230 1 Non 4.3 t 2 or 3 BE152 230 Auto 4.3 Inclu-Jed 2 or 3 N153 115 1 Non 10.5 1 2or3 SELECTION GUIDE SNI53 115 1 Auto 10.5 Inclined 2 or 3 E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Inclutled 2 or 3 switch. Refer to FM0477. o cAUT1ON 2. See FMO712 for correct model of Electrical Alternator E-Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician AD electrical and safety codes should be followed including the most or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256-0347 Manufactwersof.. Z SHIP TO: 3649 Cane Run Road ~7p u Q ® Louisville, KY 40211-1961 QVQL/TYPUMP5 NGf 19,79 ` /°UMP !O. 021778-2731.1(800} 928-PUMP FAX (502) 774-3624 htYp;//www.zoetler.com © Copyright 2000 Zoeller Co. All is reserved. 6©T9 ©n9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA 3ESIGN PARAMETERS Effluent Filter Manufacturer ` ❑ NA Number of Bedrooms ~3 ❑ NA Effluent Filter Model y f° ❑ NA i Number of Public Facility Units 74B NA 'Pump Tank Capacity 2) al ❑ NA Estimated flow (average) J aUda Pump Tank Manufacturer 11 NA Design flow (peak), (Estimated x 1.5) ~Jv gal/day Pump Manufacturer aD ❑ NA i V Soil Application Rate -D gal/day/ft Pump Model 2- ❑ NA i Standard Influent/Effluent Quality Monthly average" Pretreatment Unit §~NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) X20 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_l50 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) G10 mg/L KNA At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ rip-Line ❑ Other: Maximum Effluent Particle Size X in dia. ❑ NA Other. NA (Other. Ot NA her: NA *Values typical for domestic wastewater and septic tank effluent- Other. NA IAINTENANCE SCHEDULE Service Event Service Frequency linspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear s (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA (Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) (Clean effluent filter At least once every: ❑ month(s) ❑ NA l ,year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) J ~year(s} ❑ NA 1%sh laterals and pressure test At least once every: ❑ month(s) NA -J year(s) 1)ther. At least once every: ❑ month(s) NA ether: ❑ year(s) 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 linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of ic;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 visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local 1-egulatory 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 j:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land 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. ?9-~ Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals th.1t 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 bye discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt. 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 POVv7$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requhled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule$ 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. X 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 installedl as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiftra(ive urface. 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 ANWOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone 2 O` -7J~ Phone 1 72 > j SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY AUTHORITY Name Name Phoned 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. 9 ^ f r~ `W N P ,will i t t t~~ 1p i v P ri1 O v 1 P O 1 Q m ~ o o Q N M N V ~ O U S ~ Q c U uj o ~ 1 r-- I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERS111P CERTIFICATION FORM Owner/Buyer (~ev~✓ Mailing Address Property Address City/State ( enficatio required orn Planning & Zoning ll _ epart ment for n construction.) _ Parcel Identification Neer LEGAL DESCRIPTION 11~ j^ r'19- Property Locatiog.~ Y~ , la , Sec. ~ ~ Tl op W, Town of Subdivision Certified Survey Map # r---- - - Lot # , Volume Page # Warranty Deed Volume Page # Spec house yeS no Lot lines ideatifiabl Dyes no SYSTEM MAINTENANCE AND O 'E'~'NER CERU NCATION Improper use and maintenance of maintenance consists of purnpin~g out the yaur septic system could result in its the system can azect the function of the septic tank every three years or sooner preif needed ~ ld"fe to handle wastes. Proper ~'esponsrbilities are specified in tonic as a treatment stage in the waste disposal system Owner ~er. What you. Put §Cor m. 83.52(1) and in Chapter 12 - St. y Croix m~nance into The proPerty owner agrees to sub County Sanitary Ordinance. owner and by a master plumber, join submit to St. Croix county pia wastewater dispos al system is in proper operating Planning & Zoning I~ePat7ment a certification fo Yn~au Plumber, restricted plumber or a licensed pumper verify signed by the less than 1/3 full of sludge. condition and/or (2) after inspection and mg that (1) the on-site pumping (if necessary), the septic tank is I/we, the undersigned have read the standards set forth, herein, above requirements and agree to Certification Stating that as oursesetptic by the Department of Conurn maintain the private sewage disposals stem with system has been commerce and the Depar tment of Natural Resources, State of Wisco the Zoning Department within 30 days of the three year exnatio ]maintained mast be co usin. mpleted and returned to the St. Croix County planning & '/we certify that all statements ?W4 property described above, by virtue of a rm are true to the best of my/om I/we arn/are the o deed recorded in Register of Deeds O knowledge- owner(s) of the Number of bedrooms ~ TGNAT OF APPLICANT(S) 67-(;vl- / 6 DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Plannin Include with this application a recorded warranty deed from the Register of Deeds office g Zoning Department. reference is made in the warranty deed, and a copy of the certified survey reap if (R)SV. 08/05 78285 S. F. L80=1032.50 h`~ N 1.80 Ac. ° goo _ to r. o HF =1029,1 L8o=1031.1° a LOT 8 102663 S.F. o 31 2.36 Ac. P' 5 S. F. C4 ` as f Ac. 00 2s'00 o 3o.ar f6" 440.05 ~ t r ! LOT 9 '06.92. 75629 S.F. t r 1.74 Ac. a t 1 BM MP OF N 81*47,3g^ 1 1/4" IRON PIN r 1 W 4(93.74" / ELEV=1047.87' LOT 10 Q (IV $ 6121 S. F. co 03 41 Ci , 1.98 Ac. c~ w 76 43 4g" ~ cu t yoG N g ~a< z a'Fe W: O U-j N > @ ~eF W R ig° g 2 ,u 1is, 8 N. -0 z B; O Wi0 JI- W -0 o J11 U I~C I~ ~ y 7 ~I I Oj 17 lI Q'i wI J:4 qi >.c W - ~ Q I t=I z z 91 F z' O Qi UJ WI§ W:. Q JiM p WII, IL Q O i dos N N O of d Y u ~~es ~ ~ o A 4 W N: H a ~i 59AY:O+tM~J5 D2i ~ (Ltl'XX/J D'6 . Bl iWA BNN I , - L ' Tors, umaoc~.v - - _ C 29 H ra I, I I Z i I - I I ~ i~ 3$3$ ~I ~ I ! O I I I! I I/ ;I i I 3 - - - .,Do - - g - I ? 1~ s ~ I I e - - - - - - q mm...®rnDC i 9~~ . y 9S vl . _ v: Fzg w N c a4~a+ W vgg• RM W'I IL J 0PP L. 0 Z dos N m ~ ~o= os~~g l o, ~ ~ of S gB S 011 5 Ni 12 u -ij N ga ~ A`NA St 4r. S6ilY:p2 LkpJ .,zc2: i ail ♦ ^ R~ i,h e ti r, 9 b 9, vl ryz o 0 LU U o W - - m~ I I l7i I Fr c~ on amrM SZ i ` SOIL EVALUATION REPORT Page of 3 Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must ' C C f include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I-D. r percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed Date q Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)(, Z / O Property Owner Property Location - . Govt. Lot i 1/ 114 S T N R E( r) Property Owner's Mailing Address Lo # BName or CSM# iY 170 Z2 Cfty State Zip Code Phone Number ❑ City ❑ Village own Nearest Road ]`]j: t !ra J~ f3;~7 w_i , j G~ ( 71 1 3 _ . ! M 1~ < a7 'f G.) ti~ t✓ New Construction Use Residential / Number of bedrooms ' Code derived design flow rate "K ri (Y GPD ❑ Replacement ❑ Public or commercial - Describe: - - - - - Ffoad Plain elevation ii applicable Parent materiak 7f~-e rwL f v'~ t- General comments r ns: and recommendatio 7 Boring / Boring # t=r Ground surface elev. ft. Depth to limiting factor a 71-Pit 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 - L f f .r' j > G 1~2~ f j ; i 9 r ® ring Boring pft Ground surface elev. 6(< 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 F i. S/~ j % ns / Z-- rr) l©, y S s 1 c 7 pt and TSS < 30 mg/L Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg1L EfBuen = BOD < 30 m< CST Name (please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 715-246-4516 1008 192nd Ave, New Richmond, WI 54017 ~ s Property Owner _ Parcel ID # Page of FZ1 Boring # F1 Boring •pit Ground surface elev. + ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture i Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. 'Eff#1 'Eff#2 Zme C 2 r Z'~ S/ C I 215 1 Yf Y" c J r r y ct~ )c c 0 F] Boring # E] Boring ❑ 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 F-1 ❑ 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/ft 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 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. SBD-8330 (8.6/00) Soil Test Plot Pla;j3 Proj6ct Name Cornerstone Properties LLC Sh i A ddress _ 1025 170th Ave Hammond Wi 54015 -STM #226900 Lot 9 Subdivision Corner Stone Ridge Dat4 8/11/05 S 1/2 SE 1/4S 8 T 29 N/R17 W Township Hammond E] Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Fence Post System Elevation 91.0' *HRpSame as Benchmark Alternate Benchmark is Top of Survey Iron @ 95.4' B.M. 228' Property Line Scale is 1" = 40' unless otherwise 100' noted -2 91.5' 5' 20' B- 60' 40' 90.5' 20' B-3 5% Slope 440' Property Line PROPOSED DRIVEWAY NOTES: DRAMAGE EASEMENT ® PROPOSED JOINT DRIVEWAY ALL BUIt"M TO BE CONSTRUC7M IN PRcD:uTY OF N0m1Pte. HIGH WATER ELEVATION SHALL HAVE A LOWEST NO OWNER OR RESIDENT SHALL DO ANYTHING WTICH HW'E HIGH WATER ELEVATION iHEPHGHGWAOTT~ THAN SL01O 2) FEET WOULD KIEM31E WITH OR CHANGE THE OPERATION aF THE APPROVED COMPREHENSIVE WATER DRAINAGE ]RENT LBO LOWEST BUILDING OPENING S AA FRONT - W (UNLESS OTFERWisE NOTED) AND SOIL EROSION PLAIT FOR THIS PLAT. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, SIDE - 25' CO"..TW1C r ALIE3ING, FILLING. EXCAVATING, OR COUNTY SECTION MONUMENT (COMBINED) DRAINAGE DrFCHM H O A LATER (FOUND AS NOTED) CULVERM FIERIA OR GRASS IMS SET 1 1/4" BY 18' IRON GENERAL NOTICE PIN Wr. 4.172 LBS./FT. STATEMENT: 'r SET 314 BY 18- IRON PIN EACH PARCEL SHOWN ON THIS MAP (PLAT) IS WEIGHING 1.50 POUNDS SUILECT 70 STATE, COUNTY. AND TOWNSHIP LAWS PER LINEAR FOOT AT ALL RULES AND REGULATIONS O.E. METLAND& MINIMUM OTHER LOT CORNERS LOT SUE. ACCESS TO PARCEL, ETC.) BEFORE PURCHASING OR DEVELOPING ANY PARCEL OF LAND, CONTACT THE ST. CIM COUNTY ZCNNG OFFICE AND THE APPROPRIATE TOWN BOARD FOR ADVICE UTILITY EASEMENTS: N0 POLE OR BURIED CABLES ARE 70 BE PLACED AM THAT THE INSTALLATION WOULD DISTURB ANY SURVEY STAKE, OR OBSTRUCT VISION ALONG ANY 465.51' - - - - - - - - LOT LIE OR STREET LINE THE DISTURBANCE OF A N 8431'05' E SURVEY STAKE BY ANYONE IS A VIOLATION OF pp EA~123&3 LEPoO VIRTU UTILITY ARE THE y~ L( W70FIE5 HA~OVkIGBAA WSGFLT~TD AYE TLE EA. DECEIVED LOT 7 87590 S.F. AUG 2 3 2005 2.01 Ac. 59a9 HWE-1030.60 1;1 o LBO=103Z601 5ry N a9LP y ST. CROIX COUNTY LOT 8 ZONING OFFICE 102663 S.F. c 2.36 Ac. W m ail ~1®1 O I 66' I O ' N 758 -E 440.05' • I / LOT 9 E 1/4 COR SEC i 7 d 75629 S.F. • ^N 8 T29N R17W 1.74 Ac. *5 • `L FOUND P.K. NAIL I = V UNPLATTED LANDS I alO alo I N 81'4739• W 483.74• N 89'20'10' E 610.00' I o u I~ LOT 10 577-00' If 86121 S.F. Too' 1.98 Ac. ° I I °o LOT 18 I of 116164 S.F. i 2.67 Ac. °I 33 3 ''I N 7643- I I y m 49. W 513,61, o I I D 8 OT F. z N 89'34'21' E 585.59' I O 10 1.84 Ac. 93.46' Z 492.13'. Q r k~m 6ryh o I a/ o W 10 IZ r- ~a o LOT 17 m~I> 2 ~'S o 93446 S.F. OD 95• ow Im 1 N 89'35'14 E 230.17 `s 2.14 AC. I m I" I N Le.o.-la1.o y~ ml g LOT 15 88639 S.F. /3~5Ly cA'% I I fo I Ip Iz N"~ I I N i N a LOT 14 z 2.03 Ac. -40 IN O 70135 S.F. o 0 ~Iz ors HWE=10.75.27 ysT~j~ % N 89'41'34 E 439.12' N 1.61 Ac. Jo Le.o.-1o3zz7 I 100' 1-4 LOT 16 I I j=I~ 90914 S.F. /Iww A>H1 Z LB.O.-1041.0 N I Y/I - - 9 o -C°wm~"i-.T 2.09 Ac. - J °m - l °i- - , Tr u'r~ov --'k/- - - - - - - - CO m N _ °I Im AANAQ tA.YLFNf --1388.84'--Pi $ °i Js( vL~ ~ I M eawYT E 61SIQ Y+ s 6' u1 1~ 8I O 4 w - _ _ _230_72' r^:245.82' f _ - - _ - - - 429.84'_ 33 33'L 41 S 89'04'17' W 1796.45' w _S89ro4'17•W1830.54' 100TH A_VE_NUE__ ENE OF SECT - 8, T.29N, R.17W -T- ~SE COR 1 I _LOT 29 LOT 1 I LOT 2 I I I SEC 8 AGRICULTURE-RESIDENTIAL i CERTIFIED SURVEY MAP I CERTIFIED SURVEY MAP T29N :UN R17W SHEET 1 OF 2