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018-2011-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 584792 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: T City Village Township Parcel Tax No: Oevering Homes LLC TOWN OF HAMMOND 018-2011-50-000 CST BM Elev: Insp. BM Elev: BM Description. Section/Town/Range/Map No: /oo M\ 1 Gs S 30.29.17.1065 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV. Septic Benchmark / tf- /000 I'Le Dosing Alt. BM Ga 1.6 /d3-1 P,ecat~on Bldg. Sewer /O--7 U Holding St/Ht Inlet `~o _ _ 0 V tP TANK SETBACK INFORMATION St/Ht Outlet TANK TO ' P/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet Septic 0 / A JA- Bottom 1 '7_7 - -7 Dosing un i /v~e; ) Header/Man. Y/ 7.3 14Z .3 Aeration Dist. Pipe z 3 6Z, Holding Bot. System Final Grade A31 r~ ? PUMP/SIPHON INFORMATION W Manufacturer e, L-k GPM Demand St Cover c: 4.s. C, /G J r,5 I63 Model Number ' /j I 1 z- z ~D ~ 3--5 d-MWk TDH Lift Friction oss_ System Heald TDH~ ft ~a Forcemain Length ! Dia. /I Dist. to Well 9 5_ z SOIL ABSORPTION SYSTEM BED/TRENCH Width 7 Length No. Of nch PIT DIMENSIONS No. Of~Pits _ Inside Dia' Liquid Depth _i DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Q INFORMATION CHAMBER OR Type Syste . t • 3 5 / -J N UNIT Model Number: DISTRIBUTION SYSTEM l.Jt~a- Header/Manifold ID istribution / Hole Size 3z / x Hole Z Spacinp Vent t Air Int Pipe(s) QQl Length Length a U Dia 2" Spacing ix A 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 -~7 Bed/Trench Edges Topsoil 1 4-1 1,, es E No es 7DN COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /e In ectionA2: t1, b ' ~,1 I L(S t~J~ ~ ~ ; mss, l Location: 794 154TH ST a11""PT 1.) Alt BM Description j 2.) Bldg sewer length = ~ b y ~ M.- C) - amount of cover = (I l) J Plan revision Required? E] YesNo Q C~ r Use other side for additional information. U V ' Y Date Insepctor's Sign ure Cert. No. SBD-6710 (R.3/97) 5 - ~ 16 to ft_ -7 W County r ' rF Safety and Buildings Division ii D q 201 W. Washington Ave.; P.O. Box 7162 Sauimry Permit Number (to be filled in by Co.j ~p w jQ 16 Madison, Wl 537 162 r~;}C t.OUhI1Y 14 T1 2- 1 SSJAGSJNTSKXY ansactionNumber anrtary Perm>t Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit .27 # / 72-9 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 Departmcat of Safety and Professional Servies. Personal information you provide be used ondary purposes in accordance with the Privacy Law, s. 15.04 1) m , Stats. / S_V4 G, L Application Information - Please Print All Information I Property Owner's Name ( Parcel # r~; c._, Property Ow=-,s Mailing d Property Location Govt Lot City, State Zip Code Phone Number / y. Section ICE o W T)v T L N; R II. ype of Building (check a I that apply) 1 or 2 Family Dwelling-Number of Bedrooms -Subdivision Name 10 ak.. B n /t . r ❑ Public/Commercial - Describe Use - ~ ~ ❑ City of G ❑ State Owned - Describe Use CSM Number 11 Village of wn of X III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) A. ,A,, System ❑ Re acement System List Previous Permit Number and Date Issued B- ❑ Permit Renew Permit Revision Change of Plumber ❑ Permit Transfer to New Owner Before Expiration S Y W. Type of PORTS System/Com Device: Che all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground Yt-k-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)❑ Pretreatment Device (explain)V. Dis ersal/Treatment Area Information: Desi- Flow (gpd) Design Soil Application Ratfgpdsf) Dispersal Area Requir sf) Dispersal Area Propose (sf) System Elevation 44~ ~ - ~ 71~) VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 New Tanks Existing Tanks U o V, ~ a_ m rn va G Septic or Holding Tank I Dosing Chamber VII. Responsibility Statement- the undersigned, assume onsibility for installation of the POWTS shown on the attached plans. Pow2ber°s Name (Priit~ Plumber's e MP/MPRS Number Business Phone N berr 1./ Plumber's Address (Street, City, State, Zip Code) Ile County/De artment Use Only A roved is rove Permit Fee Da Issue Issuin. t Signature y 8 5 PP ❑ en. - Reason I to s/ s DL Condi ' onMor Disapproval Q~ Jt /e 1. eptvstark etflt3ent e* 8nt7 3) 1&JA4,/,&e1, U3 44A disperxsi cell must atl ix swytcas.! niaintair / / A as per management plan provided by plumber. 6"4- 2. ` AN` Gk requirements must be maintained t n per sKlicable code I awdinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 is x I1 inches in size 4,6 ; ",Ik. row. SBD 6398 (R 11/11) f1h., C.41 g;A PaA"4-. System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 NW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.6' 7/12/16 3 DATE BEDROOM At-grade XXX CONVENTIONAL LIFT HOLDING TANK MOUND 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.P. Top of survey iron ASSUME ELEVATION loo' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark County Road TT Well is to meet all WDNR setbacks 1.88 Acre Lot Property Line B-3 Huffcutt Combo Tank YO r o BB -1 ?d ~ Pro 3 B - 2 ❑ Bedroom House 0% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels 154th St. 00Scale = 1/4" = 10' B.M.* 410' Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 ~~nRT~1\ DIVISION OF INDUSTRY SERVICES NT 2331 SAN LUIS PL STE 150 I os GREEN BAY WI 54304-5211 Contact Through Relay DS I1 y1 ~ P S http://dsps.wi.gov/programs/industry-services www.wisconsin.gov A ~OFFSS~o N~ Scott Walker, Governor Dave Ross, Secretary July 29, 2016 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 07/29/2018 Transaction ID No. 2741729 SITE: Site ID No. 826720 Oevering Homes LLC Please refer to both identification numbers, 794 154TH St above, in all correspondence with the agency. Town of Hammond St Croix County NE 1/4, NW1/4, S30, T29N, RI 7W FOR: Description: Residential At-grade-New Construction Object Type: POWTS Component Manual Regulated Object ID No.: 1613879 Maintenance required; 450 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Items(s)- POWTS Design Approval • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P cc (N.01/01). • This system is to be constructed and located in accordance with the approved plans, and the "At-grade Using DEPT Pressure Distribution Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10854-p- PR E! P(N 03/07). 1~1, 10 0 • Fence off dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction, it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. c =E • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. SHAUN R BIRD Page 2 7/29/2016 • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Provide surface water diversion around the treatment tanks and at-grade dispersal component. • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS) in accordance with SPS 383 and the approved management plan • The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or secured except for inspection, evaluation, maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left-addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. a 1 '`1 When You Receive That Invoice, Mark S Finger Please Include a Copy With Your POWTS Wastewater Specialist, Division of Industry Services Payment Submittal. (608)574-1189, M-f 7:00AM - 3:45PM WiSMART code: 7633 mark.finger@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm JUL Cover Page ► ~ 1 ; I- Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/12/16 Owner:Oevering Homes LLC Location:NE 1/4 NW 1/4 S30 T29 N,R17W 794 154th St. 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 WDITIONALL APPROVED 4. Pipe Cross Section/Pipe Layout O AFETY A. , 5. Pump Chamber Cross Section T O AL SERVICES D T Y ERVICES 6. Pump Curve 7-8. Maintance and Contigency plan r9. Filter Specification O E E Attachments: Soil es Shaun Bird Signature License number 2 9 0 Page 1 of 9 System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 NW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.6' 7/12/16 3 DATE BEDROOM At-grade XXX CONVENTIONAL LIFT HOLDING TANK MOUND 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.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark County Road TT Well is to meet all WDNR setbacks 1 88 Acre Lot Property Line B-3 Huffcutt Combo Tank ~ B-1 Pro 3 B-2 ❑ Bedroom House 0% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels 154th St. 200' Scale = 1/4" = 10' B.M.* 410' Property Line 00 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 2, o~--9 kevL ( At-grade System *g Site Cross Section and Plan View I 'L•L•L•L•L•L•L•L 1•L•L•L L•L•L•L L•L•L•L L•L•L•L L L•L•L•L•L•1•L•'L•L••.•L•L•L•L•t L•L• ; rtir'•~ti ti ti LrL~L~L tirL•L•ti ti ti L~L~ti~ti L~LrL:'.jLjLr'L%L~ti L?L:L:L:L•L?L•% ti LPL+LrL•L• I r•r•r•r•r•r•r•r•r•r•r.r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r.r•r•r•r•r•r•r• E i~ Tt L•L•L•L•L•L L L•L L•L•b5~•L•L•L•L•L•YL•L•L•L•~•L•L•L•L•L•'••L•L•L•L•1••L•L•L•L•L L•L• W A ~ti '.:L~LrL~L~L~L?1 LrLrLrL:L~L~Lrti LrLrLfLrLrLrLrL?LrLrLrL:LrL~LrLrL?L ti~L_?L~L?L:L?L I F 0.5 I r.r•r•r•r•r•r•r•r•~•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r•r.r•r•r•r•r r•r•r•r•r• G 1.0 L•'L•L•L•L•L•L• L•L L•L•L•L L L•L•L•L L•L•L•L L•L•L•L L•L•L•L•L• L L•L•L•L•L•'L•. I" :ti 5~jtij'tirti~~•j1• rL?Lrti L?ti tirLjLrL: LiLrL~ti L~LrL~L•L•LrL•L•L•L.L jLrLtL?Lr'LjLrL L E 1/6 B ~i W E LI B ~T Slo e L - = Plowed • = Clean aggregate 0 = 4 in. sch. 40 r~vc RR basal area r1rZ 1/2 to 2 1/2 in. dia. observation pir;c L -j Lateral with 2" Topsoil Cap aggregate over pipe Observation Pipe Geotextile -G With Cap Fabric's _ r' r•r• ' L•ti' ~ l'd,~ Ft Lateral Invert LrL ti:~rti Y 47 - Topsoil Cap r r r•r•r•r• r•r•r•r•r:r:r•r r y 'L•L•L•L•L•L•L•L• 'S.•L•ti.•L•L•L•L•L L L L r"' ~ c r r•r•r•r•r•r•r•r•r r•r•r•r•r•~•r•r•r r r r• L•L L L L•L•L L• L•L•L•L•L L•L•L L L L L•L~, a' r r r r•r r r•r•r •r r r•r_r: r: r: r: r. r. t'. ?;r r ti~ L,L, VU - MLK L L•L• L `~1/-~--~ Ft Contour •r•r•r r r r . .r. r, _ L•'.•L•L•L•L L L L• , -._,=s;l r r r~r r r•r•r•r•r•r•r r r r•r r•r ; .....,-,~..'4..L L ~L LPL j~ f~ f~ j, j~• j~ f; f~ j , r ~ D Plowed Surface _ C D C, anon _ 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 1/4 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 observation pipes are perforated in the lower 6 inches and secured in place. 03/05lgj Page J of Pressure Lateral Layout One Lateral - End Manifold f-- Threaded Cleanout Lateral Turn-up Plug Force Main X L Long Sweep 90 Bend y f Pressure System Construction Distribution Netw7U4 Lateral Diameter Laterals are constructed of Schedule 40 PVC Orifice Diameter pipe. Orifices are drilled perpendicular to X Orifice Spacing) the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded Force Main Diameter 2 In. cleanout plug and are enclosed in a 6-8 inch Force Main Len Ft. diameter lawn sprinkler valve box accessible from finished grade. • • 00 • • • • • • • Grade 6-8 Inch Lawn Sprinkler Valve Box L G 03/0519) Page l of / Septic-Dose Tank Cross Section And. Pump Performance Specifications Tank Manufacturer ' Pump Manufacturer Tank Model Number Pump Model Number 2- Total Tank Capacity b 3 0 Alarm Manufacturer S Max.. Bury Depth Alarm Model Number Switch Type Filter Manufacturer Total Dynamic Bead (TDH) - Feet Filter Model Nuanber Elevation Head lU Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss - ' - • GPM> @ 1J Ft TDH Total Outlet N[anhole Mim 4" Above Grade With Locking Min. 4" Above Grade ocking I>exice. Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted 1 Weather-proof Junction Box - - Finished Grade 0 - -W Wft ?on - Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet - ---1 hnlet Bale - - - - - - - - - Switch Settings and Reserve Capacity `4 1a" Weep 40 Tank Volume = / j GPI Dimension , Inches Volume Gal. B Hole (reserve) A; 406 -5 367,3 (ate} g 2 Off Elevation C X: Ft (dose) C • Bottom (dead) D ( D Elevatiion Total Ft r< GENERAL INSTAiLLA.TION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without plrior 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 aid the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28, 02/05 U Page 5 of TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPA.CiTY CURVE EFFLUENT AND DEWATERING MODEL 152/153 MODEL I 152 t53 ~r I I 5 w ` 2t 16{eters Go!. 1 Liters G01. , Liters 50 Fe 1 69 261 77 291 153 I 10 3. i 61 231 I 70 265 --I 12 40 152 15 4.6 53 1 201 61 231 0 70 6.1 44 167 52 197 _ 25 7.6 34 129 42 1 159 30 ~ a 8 30 I 9.1 I 23 87 31, 125 22 85 11 Q 20 I 42 40 ° X33.0 (1?.6m) 44.0 Ft ( .1.4 LOCK Valve: 4 074508 i 10 i Q 20 40 60 80 100 GALLONS 6 r/4 LITERS O 80 160 240 320 - 3 27/2- 4 5/6 FLOW PER MINUTE 3 27,/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS o 3 27/3.' • Timed dosing panels available. supplied with e Electrical alternators, for duplex systems, are available and an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable -F-- I~ level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FN11420. • Over 130°F. (54°C.) special quotation required. j 12 1/15 1521153 Series W Control Selection i 1521153 MODELS Model Volts-Ph Mode Am s Sim lex Du lex i N152 115 1 Non 8.5 t 2 or 3 sKZOe4 BN152 115 1 Auto 8.5 Inducted 2 or 3 E152 230 1 Non 4.3 1 2 or 3 I SE152 230 1 Auto 4.3 Inclu'ed 2 or 3 N153 115 1 No 10.5 1 2 or 3 SELECTION GUIDE BN153 115 1 Auto 10.5 inclu ed 2 or 3 back variable level float E153 230 1 Non 5-3 1 2 or 3 1. Single piggyback variable level float switch or double piggy BE153 230 1 Auto 5.3 included 2 or 3 switch. Refer to FMO477. FA- CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. duplex 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 (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 70: P.O. BOX 16347 Louisville, KY 402560347 ManuMctwersof.. SHIP 70: 3649 Cane Run Road L' oO Zo ^ e ` ' ® Louisville, KY 40211-1961 Q2Ld1/T~ ~Uti1PS ✓/hCf ~~J~/ u d - PUMP !O 021718-2731.1(800) 928-PUMP FAX (502) 774-3624 hitp://www.zoell er. corn © Copyright 2000 Zoeller Co. All rights reserved. FLOW TS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner v e r i ty Septic Tank Capacity /&70 gal 0 NA Permit # Septic Tank Manufacturer ❑ NA 3ESIGN PARAMETERS Effluent Filter Manufacturer s t ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units A Pump Tank Capacity V J al ❑ NA aVda Pump Tank Manufacturer ❑ NA i Estimated flow (average) On) q i Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate` aUda lftz Pump Model ❑ NA I Standard InfluentlEftluent Quality Monthly average' Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L ❑ round (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L >I<NA rade ❑Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: !Maximum Effluent Particle Size lk in dia. ❑ NA Other. NA (Other: NA Other: "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: 3' ❑ 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) on ❑ NA Clean effluent filter At least once every: ❑ear((ss) ) rY: ar(s) month(s) 11 NA Inspect pump, pump controls & alarm At least once eve ❑ NA l=lush laterals and pressure test At least once every: ❑ month(s) ,year(s) ether. At least once every: ❑ month(s) NA ❑ year(s) ether: IfIl 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 immbined 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 (36) or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin 14dministrative Code. INN 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. 0 ~ Page of START UP AND OPERATION OWT'S check treatment tank(s) for the presence of painting products or other chemicals thElt For new construction, prior to use of the P If high concentrations are detected have the contents of the may impede the treatment process and/or ddamapg of he dispersal cell(s). tank(s) removed by a septage servicing operator System start up shall not occur when soil conditions are frozen at the infiltrative surface will bo surface discharge ofreffluen~ . exce During power outages pump tanks may fill above normal highwaeer cell(s) and levels. When power is restored may result in the backup the discharged the dispersal cell(s) in one large dose, overloading controls to restore normal levels To avoid this is 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 within the pump tank. compact, the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or comps 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 nt h performance diapers; disinfectants-, pr long t fart foundation the oOn dra antibiotics; baby wipes; cigarette butts; condoms; cotton swabs, degreasers; d rd Tali ; (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting P pesticides; sanitary napkins; tampons; and water ABANDONMENT Comm 83.33 ice the following stAdministrati s shaCoeeaken to insure that the system is propel y When the POWTS fails and/or is permanently taken out of and safely abandoned in compliance with Ali 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 compli;~n absorption replacement system: placement telm ❑ A suitable replacement ea area has been evaluated and may be compaction and shouldenot be infri ged upon by equ ed from disturbance and utilized The replacement ent area should be protected with the rule:{ in nt area will setbacks from existing and proposed structure, l table replacement area, t Replacem nt sylstemsemust comply suit in the neied for a new soil and site evaluation to establish a so effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS techno ogV a holding tank may be installed as a last resort to replace the failed POWTS. soil and as sit ~he site has not been evaluated to identify a suitable rreplafceem nt are area. Upon failure of he aOholTS tank may beeinval alua~on ' must be performed to locate a suitable replacement a last resort to replace the failed POWTS. structed place ~8- A(lound and at-grade soil absorption ems must complynthe rules in effect atlthat trremoval of the biomat at the infrltra'five with surface. Reconstructions of such systems <<WARNING>> INSUFFICIENT NOT SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES TANK UNDER ANY C RCUMSTANCES.! DEATH MAY RESULT. RESCUE O1 A ENTER A SEPTIC, PUMP OR OTHER TREATMENT PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. - ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER / t Name Name S Phone -21 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY c ' ~ Name - Name ~q Phone Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. 0 1 FLA = iW {2 N I n ch 1 S~~ I llli i ' i. ~ I 1 I I I I- o O j. L.i-1 .17 i EO a Q o s o 3 S Z L v N 1 i i - RECEIVED r. JUL 18 Zow r Department of Commerce ST. cR8Q~ckuATION I E482XgpNAANOM Page of n, of SafetyandBuildings COMMUNITYDEVEkOufE in accordance with Comm 5, Is. K .Code County St. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must J l include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. C percent slope, scale or dimensions, north arrow, and location and distance to nearest road. v Please print all information. Re a ed by Date L Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). $ 5 Property Owner Property Location T f~ N R E ( W Govt. Lot /4 .)0 P rty Owner's Mailing Addre Loot # Block # Subd. Name AJr 1,7/1' l City State Zip Code Phone Number ❑ City Village own Nearest Roa New Construction Us esidential / Number of bedrooms . - Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial -Describe: Parent material 7 11~_J~c Flood Plain elevation if applicable _ /t.- i(!- ft. General oomments and recorwwnendations: pp r System Type System Elevation L• Bori E] Boring Mng # 59- pit Ground surface elev. eft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -Eff#2 J ,.3.~ 1 Boring # ❑ Boring ~ ~-7 P pit Ground surface elev.. Depth to limiting factor I- 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 I A-> ~r 12 A _~5-1 /f Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ture CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Condu ed Telephone Number 1432 120th St, New Richmond, WI 5 17 715-246-4516 Property Owner _ Parcel ID # Page of Boring #❑t Boring a pit Ground surface elev. le I ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 VV4 r1L k OC e, s-1V 00n S / ' F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc,a Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor pit in. ❑ Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BODS > 30 < 220 rng1L and TSS >30 < 150 mg/L • Effluent #2 = BODS 130 mg/- 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 altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330(RAW) Property Owner _ Boring Parcel ID # Page of Boring # pit Ground surface elev. ~ ft. Depth 40 limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Or t YZ -2 ❑ Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisternela Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F-1 0 Boring # Ground surface elev. ft. Depth to limiting factor in. pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS 130 mg/- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6/00) Soil Test Plot Plan flame Oevering Homes Shau ird ess 1433 Cernohous Ave Suite A New Richmond Wi 54017 C #226900 Lot 50 Subdivision Emerald Acres 1st. Add Date /12/16 NE 1/4 N W 1/4S 30 T 29 N/R17 W Township Hammond F] Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 101.6' *HRpSame as Benchmark County Road TT 1.88 Acre Lot Property Line B-3 0% Slope ❑ B-1 B-2 ❑ 154th St. 200' Scale = 1/4" = 10' B.M.* 410' Property Line ~9es a IF F__ 6.V County 2~ I " 4 Safety and Buildings Division t ! 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, Wl 537 7162 G IX COUNTY Z- C DEVELOPMENT ~J V Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm Code, submission of this form to the appropriate governmen unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide be used for secon purposes in accordance with the Privacy Law, s. 15. 1 m , Stars. I. A lication Information - Please Print All Information J Property Owner's Name Parcel oe~) e Property Owner`s Mailing Address Property Location - jLt (9P 1 / A.6 ' V Govt Lot city, state Zip Code Phone Number 1/ ~ Section T / N: R E W N II. Type of Building (check all that apply) le cly'O' Subdivision Name or 2 Family Dwelling -Number of Bedrooms 11 Public/Commercial -Describe Use aF Y YW• O ❑ City Of ❑ State Owved - Describe Use CSM Number ❑ Village of 3 +-r Town of NLC' 11I .Type of Permit: (Check only lone box on line A. Complete line B plicable) A' Iew S stem Z-4 Al- El Y Replacement System ❑ Treatment/Holding T acement Only ❑ Other Modification to Existing System (explain) B- ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ P Transfer to New List Previous Permit Number and Date Issued Before Expiration T . V fV. Typ~ of POWTS System/Com onent/Devi : ( ck all that a •H~ , IL , . on-Pressurized In-Ground ❑ Pressurized In-Gro d At-Chad and > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain ` ❑ Pretreatment Device (expl V. Dis rs.nreat entArea Information: cv< DesFlow (gpd) Design So)] Application e(gpdsf) al Area Required (sf) Dispersal Area lJT0pos4.,!d (s Elevatio' raw UVIA [415/ VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks / : c y ° -y u V m 1 UO ao A m ca y 4&hM4- Septic 3, a or Holding Tank 1 w _X1_ osing Chamber w 1 D VII. Responsibility State t- I, the undersigned, - e responsibility for installation of the POWTS shown on the attached plans. Plum's Name.(Pri~t) PI Signature MPIMPRS Number Btusmess Phone N bgr Z Phmtber's ddress Street, ity, State, Zip , 'Y 17 ountv/De artment Use Only Approved ❑ D~Vea Permit Fee Date sued Issuing t Signature oD 71 for Denial DL Condi ' asons for Disapproval t 1. Sept--, t", erflUnt f*! and ciisEtemai cell must aq ei lc=ss !_ntamta;rec.' aim management pip pro sided by plumber. V% C, V.&C OI~t~. 2. ~1l~lrl'MIf$1'lc}intElrEd 11M pK 4pit W0 00& /*dNlr0Jl, 4) se► Ls cQ cwt-- &P 1 art Attacb to complete plants for the system and submit to the County only on paper not less than 8 it ^111 inches `size A 5 mean en 41- b0 6,,,, r7 t 0~4~ 1 t~ S ~ SBD-6398 (R 11/11) 1 J M`e 'Oef Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/1/16 Owner:Oevering Homes Location: NE1/4 NW1/4 S30 T29 N,R17W 794 154th St. Hammond Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. MaintananV 7. Filter Cross SSignature License numbe PROJECT Oeverina Homes PLOT PLAN ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE' 1/4 NW I/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.0/100.9/100.8' 2.4' below 6/1 /16 3 CONVENTIONAL XXX DATE BEDROOM IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1157 # of chambers 57 BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION Ioo' Filter Lifetime Filter ❑BOREHOLE O WELL *H.R.P. same as benchmark County Road TT 35' All piping shall be ASTM SDR 30/34 within 102.5' 10' of tank, piping shall be ASTM F891 B-3 Soils will be 3% Slope Vents verified prior to installation. 60' 103.5' Cale = 1/4" = 10' 30~ 40' 60' B-2 10' B-1 3-3' X 78' cells with >3' spacing 20' v 30' L Pro 3 Bedroom House >6" Quick4 Standard 3 4Vent of Cover Leaching Chamber with 20.0 ft2 of Area 12 " 5.6ft^2/pair of end caps 4' Long „ Grade at System Elevation B.M.* N Property Line 154th St. 00, -7 Cross Section of Quick 4 Standard Leaching ChambE r Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation ~ 103.4' Vent Grade Vent 4' 4 4' ~~30/34 Septic Tank Long 1 5 4' Long 1 Grade at System Eleva4n 34" Grade at System Elevation 34" Spacing- 5' 3-3' X 102' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A-101.0' B 100.9' C 100.8' 19 chambers per cell ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ` AND Owner/Buyer e, O"ERS'DP CERTWICAMN FORM Q~ ~ - g Address ~ tcLl~ f Mai lin Property Address - B C~GO~~%~ _ IL I l Venfication re ~ C,► quire from Plannin & n City/State g Z°rzang Department for new cans truction.} LEGAL, DESCRIPTION Parcel Identification Neer f .Property Locatioxi~ltL ' W!14 Sec. T Subdivision -/N R/__? W Qwn of Certified Survey MaP # - Lot Warrauty Deed # Volume 'page --Volume Spec house yes no , Page # iAlA SYSTEM M Lot Iires identifiablt ✓ yes no ENANCE AND OWNER GERT Improper use and IF7CATION maintenance consists of maintenance of g out the septic uld result ' y° septic system Could h system can affect thep J~Pin function of the are specified in §Co s tank every three m its prernat~ a fail esponsibilities year. or sooner, failure to handle wastes. Proper 83:52(1) ptan]' as a treatment stage in the wasif Cote needed' by a licensed pumper. What and in Chapter 12 - gt disposal system. Owner rnaink You put untc) The Property owner agrees Croix Coup Hance owner and b to submit to St. tY Sanitary Ordinance. y a master plumber Croix county wastewater disposals ste ' Journeyman Plumber Planning & Zo less than i!3 Y m is to Proper opera ' , restricted plumber or a Tt wng Depa~ent a certification fo fWI of sludge, condition and/or 2 pier veri ~ sired by the ()after inspection and Ong that (I) the on-site standards the undersigned have p~mg (ifneeessary), the septic tank is ands set forth, hereln, fias set read the above by the D requirements and a cation statin ePartlneat of gree to maintain tl~e C:erti and the D,pall Zoning De g that your septic system has°mrnerce private sewage disposal Ptrnent within 30 een maintained merit of Natural Resources, State system with the days of the titre must be completed and re ~ tale of Wisconsin. T/we year expiration date. tinned to the St. Croix certify that all statements County planning & property described above, by virtue of a on ~ w s form are true to the best Of' iy deed recorded in R my/om knowledge. I/we "'are the o Number of bedrooms guter of Deeds Of,-ce, wner(s) of the IGNAT OF APPLICAI~NT S **'Any information that is misrepresented may result in the sanitary Permit being revoked by the planning gL Include with this application a recorded w reference is ,made in thearrantY dead from the nmg (REV, 08/05) DePai'tment. warranty deed. Register of Deeds office and a copy of the certified survey rMp if