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HomeMy WebLinkAbout032-2153-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592127 GENERAL INFORMATION 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: City Village Township Parcel Tax No: Oeveri Homes T TOWN OF SOM RSET 032-2153-60-000 CST BM Ele . Ins BM Elev: BM Description: Section/Town/Range/Map No: p 10a 15.31.19.1329 TANK INFORMATION r ELEVATION DATA TYPE MANUFACTURER „ys CAPACITY STATION BS HI FS ELEV. Benchmark . • 6 Septic T,1 2.6 Zoo Alt. BM 1 [ L Aeration Bldg. Sewer Holding St/Ht Inlet r5 Q TANK SETBACK INFORMATION St/Ht Outlet 4It/o ` TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet ® Septic 7Z r Dt Bottom ® oo,~ Dosing Header/Man. • LO Aeration Dist. Pipe qG S 9 Holding _ Bot. System q S/ 14. PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GP 3 Z- ModelNumlaeby T Lift Friction Loss System Hpad- TD Ft ForCy~hl2tfr~--- la. Dist. to Well - SOIL ABSORPTION SYSTEM BED TRENCH Width ngth No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 790 Z, Lk, 13 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur INFORMATION CHAMBER OR r-M ~Iti+ Type Of System: UNIT Model~~IIumber l /"ay 6v5 Co"e~n~-1o A~ 2.4 ACS /V#+ DISTRIBUTION SYSTEM ZZ- Z Z 4,44 *ft_Q, Header/Manifold 1 Distribution x Hole Size x Hole Spacing Ve t to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only U~✓s~~'"~s Depth Over Depth Over xx Depth f xx Seeded/Sodded xx Mulched Bed/Trench Center 4 y{ Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection 112: Location: 594 217TH AVE A- 4 ~_k 1.) Alt BM Description J6 rJ 2.) Bldg sewer length L - y - amount of cover = CCU Plan revision Re uired? Yes No Use other side for additional information. I_ Date Insepctor's Signatures Cert. No. SBD-6710 (R.3/97) tf 2~l ~ r RECEIVE Safety and Buildings Division County` { ® - ' 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, W1 53707-7162 OCT o7 zw a~ ~~2I Z7 s~~ ~ EI -0mm ~'pplic~ati 99QR ~ State Transaction Nuq~b[y~]. In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form t, 4EBKSS84 is required prior to obtaining a sanitary permit. Note: Application forms for state-~... FG roject Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be w_ oses "n accordancewith the Pnv Law, s. 15.04(1) m), Stats. L Application Information - Please Print All I a p~ /ft i Property Owner's Name / Parcel 4 Property Owner s Mailin n,,, Property Location 13 VI Govt of C J City, State Zip Code Phone Number y, Section ! S- l/ TN' R ~circlEo II. Type of Building (check all that ap y) Lot I _1 kW) / 2 Family Dwelling-Number of Bed, ms _ Subdivision Name QK AD Ont~~ ck# ~c" - d tl ❑ Public/Commercial - Describe Use / - ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of _ &.'S Lt ~iZ•~'ZG.. C e Town of qi ra! 1Z III. Type of Permit: (Check only one b x on line A. Complete line B if applicable) A. 2_ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing system (explain) B. ❑ Permit Renewal ermit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner- TV. T essofPOWTS System/Component/Device: (Check all that apply) J t~ Prurized In-Ground ❑ Pressurized In-Ground ❑ At-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/Treat ent Area Information- j 7 Des" Flow (gpd) Design Soil Appli cation (gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevati n VL Tank Info Capacity in Total # of Manufacturer a Z Gallons Gallons Units F, New Tanks Existing Tan} 1/^s~`• ~V Kr~771AII~ i • vi ~n Ci Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- a undersigned, assu ponsibility for installation of the POWTS shown on the attached plans. Plum s Name (Print) . Plumb ature MP/MPRS Number Business Phone N`be~e - 7 PI bersAddre (Street City, State, Zip Code) 4 -2- 5 VIII nntv/De artment Use Only Approved is ruin Fee Date Is ed suing. t Signature vet Reason for IX Cond' tic i J)isapproval 4 Will loo; 00 divpsnssl C *N must A f a~ nef e;,L.Gl~'4 . as'~,W plsn trrovfdstl by pktmbrr. 2 i 4 h Ir li*#r~t ntr Rust be, Omfte insd ss pa Wplo" M& I Ofd ilaw - d, Attach to complete plans for the system and submit the Coon only on paper not less than 8 w z 11 inches in size SBD-6398 (R. 11/11) Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4S 15 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX A SYSTEM ELEVATION 95.4/95.3 , below qrade 10/8/16 BEDROOM 4 -L . E(7 1 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK f MOUND SEPTIC TANK ZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 Ilk BENCHMARK V.R.P. Base of rention pond stake ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE (DWELL *H.R.P. same as benchmark Property Line Scale = 1/4" = 10' 2% SSlope 130' B-1 B-2 aQSl. n~ ,M' c~ Vents 10' T a 5 1 7' 30' B-3 10' S~-a Pro 4 B.M.* Bedroom o house Rention Pond Clearly staked! 2-3' X 90' cells Vent with >3' spacing 200' >6°' Quick4 Standard All piping shall be ASTM SDR 30/34, within Leaching Chamber 10' of tank, piping shall be ASTM F891 of Cover with 20.0 ft2 of Area 5.6ft^2/pair of end caps 12" Long Grade at System Elevation 34" 217th Ave RECEIVED C ST--3)- i 4 L ~ i • 9 OCT 0-1 Wisconsin Department of Commerce SOiI Y EV/ 9QR4EBKSS$FG Page of Division of Safety and Buildings $T. CROIX COUN 3om a"rDF MFaNTNis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must :C'3 61 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. d 7. Z 5,3 Please print all information. Revi ed by Date GL Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 161171)(0 Property Owner Property Location IF I - Govt. Lot 5 1 /4 F 1 /4 ) S T `j N R I E (o W Property Owner's Mailing Add ss Lot # Block # Subd. Na or CSM# City State Zip Code Phone Number ❑ City ❑ Village own Nearest Road ZN( ~ ( ) Sc, s- 1 f New Construction Use:)Residential/ Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Pu c or commercial - Describe: Parent material Flood Plain elevation if applicable A 6T ft. General cornments and recommendations: System Type O / Y)(?-j tf^4- System Elevation J' ❑ Boring Boring # F T1 4, Pit Ground surface elev. l, ft. 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 Il 1~ tt l Z .L Boring # ❑ Boring p-0 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 in. /M)unsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 C/i r T '7 it r t yti l l~ 1 too • Effluent #1 = BOD. > 30 < 220 mg/L TSS >30 < 150 Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) n CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 ~G''' 715-246-4516 Property Owner _ Parcel ID # Page of Boring Boring # El L Z ❑ ~it Ground surface elev. ft. Depth to limiting factor 2,0 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 lot _ t r c- 67- J a Boring # ❑ Boring ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ 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 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 30 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 (8.6/00) Property Owner _ Parcel ID # Page of ®Boring # ❑ Boring &Pit Ground surface elev. &L~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 60 2 ❑ Boring # ❑ Boring ❑ 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 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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6100) Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4S 15 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX -A SYSTEM ELEVATION 95.4/95.3 . below qrade 1 0/8/1 6 BEDROOM 4 / I DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK aZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 Ilk BENCHMARK V.R.P. Base of rention pond stake ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property Line Scale = 1/4" = 10' 2% Slope 130' B-1 90' B-2 Vents 20T25' 10' T 30' 7RentionPond Pro 4 Bedroom B B house Clearly staked! 2-3' X 90' cells Vent with >3' spacing 200' >6" Quick4 Standard All piping shall be ASTM SDR 30/34, within Leaching Chamber 10' of tank, piping shall be ASTM F891 of Cover with 20.0 ft2 of Area 5.6ft^2/pair of end caps 12" - 4' Long ~-GJCO P- Grade at System Elevation 34" 217th Ave ~r e. County ~ Safety and Buildings Division rs / Cpl OUNTY 201 W. Washington Ave., P.O. l3nx 1162 ~ E.LOPMENT i sanitary Permit Numbet (to be filled in by Co J i Madison, WI 53707-7162 za ✓!~Z ,l HBSB _'tate Transaction tier Sanitary Permit Application PDETj, In accordance with SPS 383-21(2), Wis. Adm. Code, submission of this form to the appropriate govemmental 1 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 may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. L Application Information - Please Print All Informa Xve, Property Owner's Name - - Parcel # r I Jd- 3 ITT Property Owner `s Mailing Address - Property Location fJ. 31. i9~ i ~~1 (r ~J 1 n ~Jl_ Govt. Lot , T 3 2 (f Loa. City, Stare Zip Code Phone Number I _ - y., Section L T31 N; R E W II. Type of Building (check all that apply) / Lo" 4 2 Family Dwelling -Number of Bedrooms r Subdivision Name ( Q 6K Block# r;" ❑ Public/Commercial - Describe tJse lit - ❑ City of T 1 ❑ State Owned Describe Use CSM N ❑ Village of { Town of rte(' ,S t-J Z ~-Z 2 ,-A, III. Type of Permit: (Check only one ox on line A. Complete line B if applicable A" [pew System ❑ Replacement System ❑ Treatrnent/Holding Tank R Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Peanut Revision G Ch g f Plumber it Transfer to New List Previous Permit Number and Date Issued Before Expiration ~'uar _ 14 V~ W. Type of POWTS System/Component/Device: Check a h t _ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At Sound > 24 in. of suitable soil 11 Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) J ❑ Pretreatment Device (explain)_ V. Dis ersaVTreat ntArea Information: Desi Flow (gpd) Design Soil Application Rate dsf) Dispersal Area Required (s DDs er'al Area Pro sed (s f) S -tem Eleyati96 L VI. Tank Info Capacity in , Total # of Manufac-turcz Gallons Gallons Units c v 2 New Tanks Fa:isting Tanks U ; U rn in "r m I R 71 Septic or Holding Tank 4/11 Dosing Chamber i VII. Responsibility Statement- I, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans. PI tier's Name (PrinZrS Pan S'_ ature N IP/MPRS Number Business Phone Nber Plumber' mess (Sate, Zip ) VII. ounty/De artment Use Only 11 pproved ❑ D lam' Permit Fee Dat Issued Issuine nt Signattue LLe' n R~son for Denial $ GD 1 Z 3 IX. ConditF# p easonf~lor Di approval ` S~C.~ nmk nt e* end a a~ ` 1 dlsper yi cell must all be services ! m int~°r_eS /l /t as per rtiar:agement plan provided by plumber. A~~ e-ftA oo---ja,,,,, 2. ` Alt se%ack regorer-lents mustl le t laiW,.iried q, as per applicable code / crdinancsg. / 1 i Attach to complete plans for the system and submit to the County only on r not not less than 8 ra z 11z 11 inches p1m 4) se AR-4- 4-6 s>3~3ss (IL I vI l) u; System PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4S 15 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 96.1/95.6' 3.5' below grade 9/21/16 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1250gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 10' Pro 4 Bedroom house 30' ST Vent B-2 B-1 >6" Quick4 Standard 30' of Cover 1-eaching Chamber 100' with 20.0 ft2 of Area 8% Slope 12„ 5.6ft^2/pair of end caps Long Grade at System Elevation 34" 100' B-3 2-3' X 90' cells B-1 is not to be used for design or installation, with >3' spacing it is a low depression filled with silts, it does not match B.M. 50' the other borings and the system is being installed over 40' from it. 60' 15' 20 1) B-4 Vents All piping shall be ASTM SDR 30/34, within 70' 10' of tank, piping shall be ASTM F891 -YJ C 217th Ave Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/21/16 Owner:Oevering Homes Location: SE1/4 NE1/4 S15 T31 N,R19W 594 217th Ave Somerset Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance an Contingency Plan 7.Filter Cross Sectio Signature. License nu be #226900 System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4S 15 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 96.1/95.6' 3.5' below grade 9/21/16 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1256)gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL, *H.R.P. same as benchmark Scale = 1/4" = 10' Pro 4 Bedroom house 30' 30' eaching Chamber ST B-2 B-1 jE----,-Grade Quick4 Standard 100' ith 20.0 ft2 of Area 8% Slope .6ft^2/pair of end caps at System Elevation 34100' B-3 2-3' X 90' cells B-1 is not to be used for design or installation, with >3' spacing it is a low depression filled with silts, it does not match B.M. 50' the other borings and the system is being installed over 40' from it. 60' 15' 20' B-4 Vents All piping shall be ASTM SDR 30/34, within 0' 10' of tank, piping shall be ASTM F891 217th Ave Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 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 99,5° Len 11 Vent Grade 3' Septic Tank Grade at System Elevation 5' 3 6Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-96. 1' B-95.6' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ILI Property Address I..)c~ (Verification required .from pi e t for e c attning & Zoning llepartmn for new construction.) City/State Parcel Identification Number .O 3Z--Z/!r LEGAL DESCRIPTION 3 d --Gip Property Locatior2 V4, Sec. 'I' -RI N N R ~ W. Town of S~ Subdivision ~ ~ ~ ,Lot # Certified Survey Map Volume Warranty Deed # _ / Page # _ Volume Page # - - Spec house yes no - Lot lines identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic maintenance consists of pumping out the s system could result in its rerra failure system can affect the function of the s septic tank every three years or sooner, pf needed, by to handle wastes- Proper responsibilities are s septic tank as a treatment stn Y a licensed pumper- What you put into specified in §Comm. 83.52(l)and stage in the waste disposal system. Owner in Chapter 12 - St. Croix Coun Sari maintenance The property owner agrees to sub ~ ~ Urdinance- owner and b submit to St. Croix County Pla by a master plumber, Journe being & Zoning Department a certification to wastewater disposal system is in proper epler' restricted plumber or a licensed nn signed by the less than 1/3 full of sludge. p condition and/or (2) after inspection and ppur verifying that (1) the on-site roping (if necessary), the septic tank is I/we, the undersigned have read the above requirements and a ree to standards set forth, herein, as set by the Department of Co g maintain the private sewage disposal s Ystem Certification stating that your septic system has been rnmerce and the Department of Natural Resources, State of Wisconsin. Zoning Department within 30 days of the three maintained must be completed and returned to the St- Croix County Planning & Year expiration date. I/we certify that all statements oil this form are true to the best of my/our knowledge. I/we am/are property described above, by virtue of a warranty ed recorded in Register of Deeds Office the owner(s) of the Number of bedrooms_~. TGNA OF APPLICANTS /oZ ***Any information that is misrepresented may result ill the sanita DATE r"S'permit being revoked by the Planning 8t 'Coning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certifie reference is made in the warranty deed, d survey map if (REV. 08/05) POWI'S OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM PECIFICATIONS Owner P J E? t- Septic Tank Capacity s - 3- al ❑ NA Permit f! f Septic Tank Manufacturer ❑ NA ESIGN PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms G ❑ NA Effluent Filter Model ❑ NA i Number of Public Facility Units )?~NA Pump Tank Capacity al NA Estimated flow (average) L) (I gal/day Pump Tank Manufacturer NA i Design flow (peak), (Estimated x 1.5) i al/day Pump Manufacturer NA Soil Application Rate _ avda /ft' Pump Model 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) 6220 mg/L ❑ NA 11 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L El Disinfection O Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (fSS) 530 mg/L ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: (Maximum Effluent Particle Size 3k in dia. ❑ NA Other. ❑ NA Other. Other: 13 NA i -1 )54 "Values typical for domestic wastewater and septic tank effluent Other. D NA IAINTENANCE SCHEDULE Service Event Service Frequency linspect condition of tank(s) At least once eve z; ❑ month(s) ry: ears (Maximum 3 years) ❑ NA (Pump out contents or tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA (Inspect dispersal cell(s) At least once every:month(s) ar(s) (Maximum 3 years) ❑ NA ~6-ye (Olean effluent filter At least once every: El month(s) O NA ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA . ❑ year(s) :lush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) )then. ❑ month(s) At least once every; D year(s) DNA ether: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Jaster (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 I-egulatory authority. I,Nhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of f:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin 14dministrative 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. 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 oth er chemicals t t may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thO tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble discharged to the dispersal cep(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 poster to ttde 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 withln 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; d'is'infectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produc0s; 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 propetly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a 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 falls and cannot be repaired the following measures have been, or must be taken, to provide a code compy*nt replacement system: X_A,suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. e replacement area should be protected from dishubance 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 ruled in 7h1ftn at that time. able relacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologl/ a g tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal 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. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative 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 LName Name . Phone Phone O~ SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORITY i - C7- 1 Name k Name 1 12 Phone Phone J'- C This document waa drafted in compliance with chapter SPS 383.22(2)(b)(%d)8(f) and 383.b4(1), (2) & (3),1Msconsin Administrative Code. 1 P Li P I ~ I C v ~ P O { I , J i l I ~ i' 1 }__.J vial I i 41 . \ Q CID Y Z c.~ SNOIIVIOOSSV 313NONOO 1SV038d NISNOOSIM V 1VN011VN = ~ ~ WOD'l}nDd3nLl*mmm I IIIL-EZL (SIL) XVd m o UV 313 Z! U 0 801633831NI 3SV38D ?10 30 2138W3W N a a 9ISI-426 (008) 964E-EZL (SID O3 3 I~ DNIQ-10H 'OI1d3S 'dWITd N ° 62LVS IM 'SllV3 VM3ddIH0 3lI3(JNd AM '-lV9 oSZ'T o 1NVld 031JI1830 '`d'O'd'N o 133diS p-AEZT 1791v N m ~ ~1~3ro~d a 0 D ly N Q J W w l7 > a W 1 a. J CK ° q ° w H ~a w C3 W J U w J w w Q M Y W ~ " Z J W Q q ¢ J U U ~ ~ w F U ~ W LD a ° q W J q Z a' V) Vi Q w Z Q Z Y LO W Z} E3 D! 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ILHR 83.09, Wis. Adm. Code Attac'i complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest:road. Parcel I.D. # ,7 ~ ~I S ~'(ljll-~sLJIJ APPLICANT INFORMATION - Please print all information. Reviewed,by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Richard Stout Govt. Lot SE 1/4..N 1/4,S 1 5 T 3 1 N,R 19 E (or)b/ Property Owner's Mailing Address _ Block; a 1353 Awatukee Trail ?6 Ines is city State Zip Code Phone Number ity ❑ Village K] Town Nearest Road l p L~ Hudson W' 5 016 (715)549-6731 Somerset 60th Street New Construction Use: Residential / Number of bedrooms 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate . 5 bed, gpd/ft2_-6--trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate . 5 bed, gpd/ft2_s_L_trench, gpd/ft2 Recommended infiltration surface elevation(s) See l- ot- pl an ft (as referred to site plan benchmark) Additional design/site considerations Class 2-alternate Parent material C 0 C 2 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT Grade System in Fill Holding Tank U = Unsuitable for system [3S 0 U ER S ❑ U ® S ❑ U Us ❑ U ❑ S U U ❑ S M U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 1 0-10 1 0yr4/6 is 1 A ,,(4-1 mfr cs 1 f .7 :.8 2 10-30 1 0yr3/4 sil 2 MA6K mfr cs .5 ' .6 Ground 3 30-80 1 0yr4/6 sil 2 m,40 mfr cs elev. 95.80 ft. Depth to limiting factor 8 0 in. Remarks: Boring # 1 -22 1 0 r2 1 it 1 ivl mfr cs if .5 ~.6 2 2 2-8 10yr4/6 s os ml cs .7 ~.8 Ground elev. 9 8. 6 0 ft. 11 ~ Depth to limiting factor 8 0 in. Remarks: CST Name (Please Print) Signature / Telephone No. l/ ,l m J'?/ Address Date CST Number F I Richard Stout SOIL DESCRIPTION REPORT Pageof.? PROPERTY OWNER - PARCEL I.D.# Horizon Depth Dominant Color Mottles Structure 2 Boring # Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0-12 10 r4 6 is 1Yy)a,l. mfr cs if .7 .8 2 12-30 1 0yr3/4 is 1 mfr cs .7 . 8 Ground 3 30-85 1 0yr4/6 s osg ml cs .7 • 8 9 6 . ~lev. ft. Depth to limiting factor 85 in. Remarks: Boring # 1 -20 1 0yr2/1 it 1 yj; A mfr cs if .5 '.6 4 2 0-8 10yr4/6 s osg ml cs .7 A Ground elev. 99.60 ft, ~t Depth to limiting factor 80 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 1 0-1 2 1 0yr4/6 is 1,i~c (a 1i mfr cs 1 f .7 . 8 5 2 12-30 1 0yr3/4 is 1 yrr, d~/C mfr cs .7 ' . 8 3 30-85 10yr4/6 s osg ml cs .7',.8 Ground elev. 96.20 ft. Depth to limiting factor 85 in. Remarks: Boring # i Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) PROPERTYOVINER Richard Stout SOIL DESCRIPTION REPORT Page 1 of.3 T PARCH I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 0-12 1 0 r4 6 is l yylab/Y mfr cs i f .7 .8 2 12-30 10yr3/4 is 1 jrwb~, mfr cs .7 .8 Ground 3 30-85 10yr4/6 s osg ml cs .7 -.8 6 . 51ev. ft. Depth to limiting factor 85 in. Remarks: Boring # 1 -20 1 0yr2/1 mfr cs 1 f .5 6 4 2 0-8 10yr4/6 s osg ml cs .7 .8 Ground elev. 99.60 ft. Depth to limiting factor 8 0 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 0-1 1 0yr4/6 is 11s>~bi~ mfr cs 1 f .7 . 8 5 2 12-30 10yr3/4 is 1 y►z~~~t mfr Cs .7 .8 3 30-85 10yr4/6 s osg ml cs .7 '.8 Ground elev. 96.20 ft. Depth to limiting factor 85 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) l 4 a / L