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HomeMy WebLinkAbout018-2011-49-000 ,consin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix afety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 592112 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2765714 Permit Holder's Name: City Village Township Parcel Tax No Daniel & Teresa Salves TOWN OF HAMMOND 018-2011-49-000 CST BM Elev: Insp BM Elev: IBM Description: Section/Town/Range/Map No: t 0u , ~ 4F 1 30.29.17.1064 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. INLT's Septic IN T I , C CBenchmark Dosing Alt. BM ,I b V Bldg. Sewer 103 . t Inlet 0 i izavo, Li 1!T St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom V i / Head r/Man o J G U S i~0 Aeration Dist. Pipe jCq l H Ing Bot. System Final Grade PUMP/SIPHON INFORMATION [ i Manufacturer Dema St Cover i GPM i t, ~U~• Model Number ; -j \AI TDH Lift- Friction Lpss System Head i TDI~ ~Ft Forcemain Length Dia. 1i Dist. to Wet t SOIL ABSORPTION SYSTEM, Ll BED/TRENCH Width I Length No. Of Tien l$6s PIT DIMENSIONS No. Of P~s Inside Dia. Liquid Deptpt DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/„S REAM LEACHING Manufacturer: INFORMATION T O S ste CHAMBER OR yam' UNIT Model Number: DISTRIBUTION SYSTEM NO Fkl c 11 t ' Header/Manifold Distribution x Hole Size- ! x Hole Spacing I Vjm,,~l nt to Air Intake Pipe(s) / Length Dia Length f 1 Dia_ Spacing L ' t (,E SOIL COVER x Pressure Systems Only xx Mound OrAt-Grade Systems Only Depth Over FBed/ Over xx Depth of xx Seeded/Sodded xx Mulched Depth O ch Center rench Edges Topsoil f f 1(es No Yes E] No AIMA COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 o . Z-7- a Inspectio~• c& omr n6f- i!1 toi t'GI Cv Il?~('L17U~1 ~~V' " Location: 790 154TH ST `~11 Ip + : p 7p 1.) Alt BM Description = to (OVA MtiwtA be`*e PLA4 i' 2.) Bldg sewer length amount of cover = "Is X12" 0- Cover 00 Ok1\', Plan revision Required? ❑ Yes No . L ~ k d Use other side for additional information J I J ` -Jj f . _J L -71 SBD-6710 (R.3/97) Date I/~sepctor's Signature Cert. No. Conn =<I Safety and Buildings Division n 8 SO 08 2016 201 W, Washington Ave., P.O, Box 71 fit Sanitary Permit Nfmtber (to be ed in by Co.) _r son 5 x ST: CROIX COUNTY " ✓ ~ f I Z MMUNI Y DEVELOP Saul Staff Transaction Number Permit Application ~`Y i In accordance with SPS 38321(2), Wis. Aden Code, submission of this form to the appropii&, governmental unit Z7 ~S is required prior to obtaining a sanitary permit, Note: `i, lication f the App forms for stare- ov, r POWTS are submitted to Project Address (if different than mailing address) Dcparimeut of Safety and Professional Servies, Personal information you provide may be used for secondary oses in accordance with the Pri Law, s. 15. I m), Stats. L A lication Information -Please Pri t All Information f Property Owner's Name e~+L Parcel Sct~ 611- 26 it- cob Property O 17 r) wner's Mailmg Address Property Location I 5 ~-4 I , Govt Lot /640 4 City, Starr Zip Code Phone Number Section -s 0 trclc o M Type of Building (check all that apply) Lot # T 7 9 N; R E W) or 2 Family Dwelling -Number of Bedrooms Subdivision N 0 eA Bloc ^ 9 ❑ PublicJComntercial - Describe Use ❑ City Of_ ❑ State Owned - Describe Use' CSM Number ❑ Village of _ 2 :pr 90 of III. T of Permit (Check only one box on line A. Complete Tina B if applicable) Aew System ❑ Replacement S ystem ❑ Treamrent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) 13- Q Permit Renewal ❑ Permit Revision ❑ Change of Plumber Q Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type ofPOWTS S stem/Com onent(Device: Check all that a 1 Q Non-Pressurized In-Ground Q Pressurized In-Ground de ❑ Mound 24 in of suitable soil Q Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersanreat ent Area Information: Design flow (gpd) D-F Sol] Application Rate(gpds Dispersal Area Required (s Dis s- persal Area Pro d (sf) System Elevation ~ VL Tank Info Capacity in Total of Manufacturer Gallons Gallons Units 2 New Tanks E, ySting Tanks m U Septic or Holding Tank 1 U v L, Dosing Chamber i VII. Responsibility Statement- I, the undersigned, me responsibility for installation of the PO Plumber's Name (print) Pl WTS shown on the attached plans. Signature MPR IPRS Number Business Phone Number G Z 6 S+~/ Phnnber's Address (Street, -S , tateZip Code C C ~ . v VIII untv/13 artment Use Onl Approved Permit Fee Date sued Issuing ent Signature eason for Denial S 446 • °c) 44 IX Conditi' tank, a ons„fpr Daii~pproval A- 5 dtepr mai cell must atp~~i~. 'BPS ! mbint~~e~ ~ r►G ispN a ftagarent plan provided by plumber. ewer ,14- . 1 MW be mahU fined M petltt~p Attach to tach ack to o code I ordhVHW W. complete plans for the system and submit to the Cowry only os papv not less than 812 z ] 1 inches in srce SBD-6398 (R. 11/11) I System PLOT PLAN PROJECT Daniel Salves ADDRESS 790 154th st. Hammond Wi 54015 NE 1/4 NW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 103.5' 8/17/16 3 DATE BEDROOM CONVENTIONAL 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 154th St. Property Line Well is to meet all WDNR setbacks Scale = 1/4" = 10' Pro 3 ~1r Bedroom 2 acre lot House Grading is to be done to divert run-off away from system 104' 10 .5' h& uttCombo Tank B - Tank is to be properly ® 103' bedded and provided with lockdown covers with approved warning 102' labels B- Area 15' below system is to remain undisturbed B-1 B Property Line 2% Slope Lo DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 Contact Through Relay ` http://dsps.wi.gov/programs/industry-services P Z, S www.wisconsin.gov \~OFE,ssroN~ti'wC Scott Walker, Governor Dave Ross, Secretary August 29, 2016 qpp CUST ID No. 226900 ATTN.' POWTS Inspector [31=PT OF pF~OF T OF OI°✓e.iON OF INT 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 5401.6-7708 CONDITIONAL APPROVAL S E C01 PLAN APPROVAL EXPIRES: 08/29/2018 Identification Numbers Transaction ID No. 2765714 SITE: Site ID No. 827909 Daniel Salves Please refer to both identification numbers, 790 154TH St above, in all correspondence with the agency. Town of Hammond St Croix County NE1/4, NW1/4, S30, 1-29N, RI 7W FOR: Description: At-Grade (3 Bedrooms -New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1619616 Maintenance required; 450 GPD Flow rate; 40 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: • Preserve 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. • 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. • 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. All loose organic material to be removed from mound 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. SHAUN R BIRD Page 2 8/29/016 • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan. Arny changes may result in pump resizing to meet TDI4 and GP1N1 Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be cut off at around level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • SPS 383.54(1)(e) The management plan for a PO WTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2, The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. 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 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. 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 S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander I.eest Please :Include a Copy With Your Private Sewage Plan Reviewer , Division of Industry Services Payment Submittal. (920)492-2214, Monday - Friday 6 am To 3:30 pm WiSMART code: 7633 tim.vanderleest!rLwisconsin.gov I SHAUN R BAD _ Paae 2 8/29/2016 - • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified Der approved plan Any changes may result in pump resizin2 to meet TDH and GPNI Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. 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 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. 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 pet 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 ° ~ l/ 4~ This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Private Sewage Plan Reviewer, Division of Industry Services Payment Submittal. (920)492-2214, Monday - Friday 6 am To 3:30 pm WiSMART code: 7633 tim.vanderleest,c wisconsin.gov Cover Page ~IONALLY LOVED AFETY AND Shaun Bird AL SERVICES Bird Plumbing Inc. STRY SERVICES 1432 120th St. New Richmond Wi 54017 'Z 715-246-4516 III Date: 8/17/16 Owner:Daniel Salves Location:NE 1/4 NW 1/4 S30 T29 N,R17W 790 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 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Coptigency plan 9. Filter Specifications Attachments: Soil Tes Shaun Bird Signature License numbe 220900 G2 Page 1 of 9 System PLOT PLAN PROJECT Daniel Salves ADDRESS 790 154th st. Hammond Wi 54015 NE 1/4 NW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 103.5' 8/17/16 BEDROOM 3 DATE CONVENTIONAL 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. 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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 '/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. 03/0519) Page 3 of Pressure Lateral Layout One Lateral - End Manifold f- Threaded Cleanout Lateral Turn-up 10 Plug Force Main i X L Long Sweep 90 Bend `I S ► a4.- 4V Pressure System Construction Distribution Network S ecifications Lateral Diameter 'L 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. 12 L Lateral Length) g 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 Length Ft. diameter lawn sprinkler valve box accessible from finished grade. Grade 6-8 Inch Lawn Sprinkler Valve Box 03/051gj Page of Septic-Dose Wank. Crass Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer - _Tank Model Number d Pump Model Number a Total Tank Capacity Alarm Manufftatcw'er v P Max. B, Alarm Model Number Switch Type i'Y1 v Filter tM141-Numb cturerT otal Dynamic ead (TDH) - Feet Filter er Ile' ' Elevation Head Z 1-2 Distal Pressure . Network Loss Minimum Pump performance Required Force Main Loss - 2- Lj 3 GPM: @ j, 3 Ft TDH Total S j 3 Outlet ).Manhole Min. 4- Above Grade With Looking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box Finished Grade - - Vent Min. 12" Disconnect < Above Grade Means With Vent Cap Outlet Filter - -.__y - _ - - _ - Inlet inlet Baffle - - - - - - - Switch Settings and Reserve Capacity A %a" <<< Tank Volume = ? Weep jpj Dimension: Inches Volume Gal. 13 Hole (reserve) A 02 Y' Z67 _5' (alarm) B' 2 -3 C7 Off Elevation. C (dose) C Z, s' Ft 9 3 j (dam) D Bottom ' l D Elevation Total <<<r<<<r.r<r<<,. GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior 4.pprovai. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertigh#. Electrical service complies with NEC 300 and Comm 16.28. 02/05 U Page 5 of TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATER(NG MODEL 152/153 I Z w i MODEL i 152 153 Ww I 50 I Feet t4eters Ga,. Liters I Gal. Liers 5 1 5 j 69 251 1 77 291 153 10 i 3.1 1 61 231 1 70 265 12 40 15 15 4.6 53 i 201 61 231 ° 20 l 6., ' 44 167 52 197 w i 1 42 159 30 25 7.6 34 129 8 30 9.1 1 23 87 33 1 125 M 0 3, I j 22 85 a 20 11 42 12.2 i P I 40 ! 4 Lock wive: X38.0 =i. (1 6-n 44.0 ft. ('3.4n ) \ n o~asoa i \~'1~~i'xkYt I G 20 40 60 80 100 GALLONS 6 r/4 LITERS O S7✓ 160 240 320 - 3 27/32------ FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS ! _ • Timed dosing panels available. 3 27/32 Electrical alternators, for duplex systems, are available and supplied with I i 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. - i i • Sealed Qwik-Box available for outdoor installations. See FM1420. I • Over 130°F. (54°C.) special quotation required. 12 1j5 ~ 152!153 Series ~ (-I i t MODELS --T Control Selection ry 1521153 J I r~61 I Model 111111 Volts-Pfi Mode Am s Sim lex Du lex r/o N152 115 1 Non 8.5 1 2or3 ! sKZOSs 8N152 115 1 Auto 8.5 Inducted I 2 or 3 t E152 230 1 Non 4.3 1 2 or 3 BE152 230 Auto 4.3 lnclu; 2 or 3 N153 115 1 Non 10.5 1 2o r3 SELECTION GUIDE BN153 115 1 Auto 10-5 inclued 2 or 3 bade variable level final E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggy LBE153 230 1 Aulo 5.3 Included 2 or 3 switch. Refer to FM0477. n CAunoN 2. See FM0712 for correct model of Electrical Aftemator 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. All electrical and safety codes should be followed including the most or (4) fbat 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 40256-0347 Man,&crurersof.. Zo a SHIP TO: 3649 K Cane Run Road p~7 u ~ Louisville, , KY 40211-1961 QvauTr PUMPS ✓/NCf ~iJcri9 » ® (502) 778-2731. 1(800) 928-PUMP a f hifp://wwwzoeil er.com ~"I/Mp ~O FAX (502) 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. 0 -g POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 1 al ❑ NA Permit # Septic Tank Manufacturer ❑ NA 3ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units 63-NA Pump Tank Capacity al ❑ NA j Estimated flow (average) 3 Pump Tank Manufacturer i gal/day ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer Jam` ❑ NA Soil Application Rate al/da /ftz Pump Model ❑ NA 1 Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) <220 mg/L ❑ NA ❑ Mechanical Aeration IJ 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 ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L A At-Grade ❑ Mound Fecal Coliform (geometric mean) <_104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Yin dia. NA Other. ❑ NA Other. A Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency Ilnspect condition of tank(s) At least once eve ❑ month( s) ry' ears (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA IInspect dispersal cell(s) At least once eve ❑ month(s) ry: Ayear(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: eras s) ❑ NA -1 )Kyear(s) Inspect pump, pump controls & alarm At least once every: Q month(s) ❑ NA gear(s) 1=1ush laterals and pressure test At least once every: month(s) NA .year(s) ether. At least once eve ❑ month(s) NA ❑ year(s) ?ther: NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master IPlumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing 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 iz;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 Iegulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of lbe tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 10,11 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 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thElt 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 by 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,b: 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 productis; 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 compiii~nt replacement system; O 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 requirjed setbacks from existing and proposed structure, lot lines and welts. 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:l in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologV a holding tank may be installed as a last resort to replace the failed POWTS. 34-IThe site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. *~A Iound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltralive surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT 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 ` 2 Phone r L j Phone J~ IF I SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHORITY Name ~0- Name c r Phone J 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. W 1 N ass s i''E+ I#', , i V P O ~ ) V - nw) Oo < f a N Qy ~ N Q SS C ~ co v zo Ci U i i i i ST. CROIX COUNYY SEPTIC TANK MAINTENANCE.AGREEMENT AND WNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address _ 7 Q (Venfcation required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location V., -'/4 , Sec. , T 2-- 91 N R ?_W, Town of Subdivision Lot # ` Certified Survey Map # Volume Page # Warranty Deed # Vo lume , Page # Spec how yes no Lot line, identifiable y no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if 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 waste disposal system. Owner maintenance responsibilities are specified in §Comm 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 pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the tic tank is less than 1/3 full. of sludge. Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retuned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements onj0fis form are true to the best of my/our k:aowledge. Uwe am/are the owner(s) of the property described above, by virtue of a kranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. 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S- Aijal q uea 'SRAJe9 »i uano,~soo~ u~a-e z wl . iaroosaa namna - - o~Cw _ <=go ~s~ age o<~~~NO ~s"-o ="C ~ N~~p~oKw 'oi C:; 3S3a w~ OSo _ FiwsaoorcS ~g°~¢Nqq ~¢GCO O3ux '~^a ,Zll C.OZ ,Ul 0-,BZ ,Z f .B'.VZ ,bZ v 'SSSevl'... „Ul E,OZ ,Zll 0 O~ ~O > UU' .UI L-fil l0-S --,OC ~~L \\r ~l Z L-C ~ Q G v I O SZ I p Z I I I I ~ I I w m L: a I I I ,>l I __~I v 8 v s r .P w ¢ bZ .0-.9Z 1 + Fa - pg3 =m- AFO~ of 5 t 3 4' 0'-B' 11-10 1l2' 6 4q2 ~ 808 t 2' I I to'I I F2'6' 6-a t/2' I 12 O H _ b I ~ I w < a o,, Oalm 3 0 D 2 v Ti Z pn may 8 r^ - ~rt1~ 1 a--~•~a a Oli ID01011 '7 a g n E 12 I I - I I 6•-t1 J _ I I I I I I I,. I IK I n~+ I¢ I I. I Ir ygn I: I I I ~ I ~ a .s I I 2a'-3 t/Y _ I I v I I 1 I I I I . J II 2'28'-a 1" 24.01/2" - 9 Pgpc o~rn", m z s^n oNx cs= mo;nr ff"ono ='S~=g ~.f ~~A~ Easo~~gi 4iy ~`AnBN~in ~i of'^^mi oso H. P7~~m a>vnOR: _ z Salves, Dan DESCRIPTION re e-Dirt COnst-t- LLCr 1a. o. I a Andrew Ranweiler Y ~,p~~ryry ' ti 418-820-5736 Ex1 ~,E pt Y W ndrew@b-dlrt.COm7 1108 Wyoming _ 0) ~S IVE G78Y3N7YYY4JT Wisconsin Depa"tlof ~OJmRlefGe SOIL EVALUATION REPORT Page of Division of Safety and Bui 701"bUNTY in ccordance with Comm 85, Wis. Adm. Code jMTY DEVELOPMEW, County Attachl~5hioete 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. I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ( Lf(7 - Please print all information. Revi by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , I Property Owner ~i Property Location o /A C-) - t VL Govt. Lot 1 /4 4)/4 S ic) T N R E ( j W L% Property Owner's Mailing Address Lot # Block # Subd.NName CSM# 1? City . State Zip Code Phone Number City. ❑ Village wn Nearest Roa N- iv, t.t'a i-,4 s r.L/ i l l ? KNew Construction Use: sidential / Number of bedrooms Code derived design flow rate a~ r GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: System Type C C System Elevation 5 117 Boring # ~ 11 Boring Ch pit Ground surface elev.2 ft. Depth to limiting factor. in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 4 # Boring Boring W-Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff ,ry in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 72-2 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD, < 30 mg& and TSS < 30 mg/L CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 'ZI Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 540f7 / 715-246-4516 Property Owner _ Boring Parcel ID # Page of Boring # & ~ ❑ pit Ground surface elev. (A Z~ft. Depth to limiting factor f 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 C 2- sw" 4J i AZ F-T ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil liration Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Property Owner Parcel ID # Page of Boring # ❑ Boring LJ it Ground surface elev. V P Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 tJ. r l s C~;- ; gyp ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 F-1 Boring # E] Boring E] Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon ')epth Dominant Col Redox Description. Texture Structure Consistence. Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 720 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 30 mg/l and TSS 130 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 608-2648777. SBD-8330 (8.6/00) Soil Test Plot PI Project Name Daniel Salves `dun Bircj Address 790 154th st. Hammond Wi 54015 CSTM #226900 Lot 49 Subdivision Emerald Acres Date 817/16 NE 1/4 N W 1/4S 30 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 103.5' *HRpSame as Benchmark 154th St. Property Line Scale = 1/4" = 10' 2 acre lot 104' B-3 103' 102' B-2 B - 1 B.M.* Property Line 2% Slope vvi misbnDepartmentofCommerce SOIL EVALUATION REPORT Page_ .0 Division of Safety and Buildings j,__ in ac, rdarn: i GF.;j~ " ,Adin. Cudo County Attach complete site plan on Impel wt k,-s3 Ur 0 1/2_ x 1 1 nn,hos in nize. Plarrf rst __~1 `-4 - - f.ap7'e'o(rit (BM), direction mild Paurl I.U. f1 hncluda, hrrt not (tallied to: vertical and horizon 1 iefoiN~L"T'q percent!- lope, scale or dimenslons, nor III alt (J Please pile[ alr oviawed Date / Fmserw kifominikm you fnevide mny be unod nor earr'tivpcy Lnvr, n. 1 4 ( Y' D Property Owner V ff - P, ettyT tu) 6An& Govt. Lot ~ 1l4 Nei 114 S ~ I 2q N II /7 E (oCVV Property Owner's Melling Address Lot # Bluck # Sunni. Name or CStvl# City State Zip Cale Phone Number City ( Village town Nearest Road I to O-New Construction Use: esidenlial! Number of bedrooms _3::j - Coda derived design fl(rvv rate GPU Replacement L] Public or commercial - Describe: Parent material _ • Flood Plain elavalion Or appiicabla general comments 4.firt/\ , c) J D and recwnnnendat"is: SY5 r/CyJ~~ ` Cke GILL 5-0 ~ col 'a ma Boring # ❑ Boring ITO 16-Pit Gruwrd Surface elev. /ac, -it. Depth to Ilrnlling factor 1- - in. Soil A jpli- calion Rate horizon Deptil Dominant Color Redox Description I extolo Structure Cunsistence Romldmy Ruuls _ GPD/It' in. Munseli Qu. Sz. Cont. Cok>r Gr. Sz. Sh- 'Eff#1 'Eff#2 2 I13`1 ICS 1-119 SZ j , h. c 5 (o I 3 3q-j3 )o l5 S ig - k - - Cw' icy -~s/z L1 P _7,5 FZ]- Boring # ❑ 19-i-it Ground surface elev. )(j • 46 _ it. Depth to limiting factor Soil Application Rate Norizo) Deptln Doninarri Color Rodox Description Texture Structure Consistence Boundary Roots _ GPD/fF in. Munseli Qu. Sz. Cunt. C01or Gr. Sz. Sir. r _ 'Elf#1 'Eff#2 l IL !2 _ S r I ~ ~k rr ~r~ _ C I v f J 7- r,1 C L2 EfIl rent #1 = BOD$> 30:< 220 my/L aiml TSS >30 < 150 my/L • Effluent #2 = BOD < 30 my/1-mid TSS < 30 mg/L CST Name (Please Print) Stynatu CSTNurnbm ZS_ 3_L Address Dale Evaluation Conducted Ielephuim Number ` (715)-7t.,6) C179