Loading...
HomeMy WebLinkAbout040-1135-40-000 County: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Sanitary Permit No: Safety and Building Division INSPECTION REPORT 592193 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)] Parcel Tax No: city Village Township 040-1135-40-000 Permit Holders Name: Matt & Alexandra Ferguson TOWN OF TROY Section/Town/Range/Map No: CST BM Elev: Insp. BM Elev: BM Description: 3'55,28,1 9.5565 ELEVATION DATA TANK INFORMATION CAPACITY STATION BS HI FS ELEV. TYPE MANUFACTURER j Septic ^0<50 Benchmark 37J ( (!v 1 ~ ~ Alt. BM r _ Bldg. Sewer Q St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION v TANK TO P/L WELL BLDG. Vent to it intake ROAD I Septic , 1 aO l t >l00 c~ ,v l Header/Man. C~ 9 ~3 • d Dist. Pipe . f frer~ierr Bot. System 1-10 ~ 1' 7 ~ t l•D, Final Grade PUMP/SIPHON INFORMATION Demand St Cover Ma cturer PM Model Number ~U TDH Lift tion Los System Head TDH Ft I!D •a ~3•c:~ 7• For ain Length Dia. Di . Well 1 93. q SOIL SOIL ABSORPTION SYSTEM /'f`✓eMt~~ 70 r BED/TRENCH Wid Inside Dia. Liquid Depth Length No. Of Trgnches PIT DIMENSIONS No. Of Pits t~~ 7 ~ f"'If DIMENSIONS p LAKE/STREAM LEACHING Manufacturer: =L SETBACK SYSTEM TO P/L BLDG WELL CHAMBER OR INFORMATION ( UNIT Model Number. T e Of Systeml: . - L ► ~~/~I ~rrllJe+tti'~~ ,~T W DISTRIBUTION SYSTEM x Hole Spacing [Vent to Air Int e 115 Is V1 n 7 x Hole Si Header/Manifold Distribut' `u Pipe(s) 707--- Vt Dia -1 Length pacing Length SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ,a Mulched xx Seeded/Sodded Depth Over ~Depth Over xx Depth of Topsoil Yes No Bed/Trench Edges L] Yes L~ No Bed[Trench Center Inspection 02i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: CZ~~~LL__ Location: 44 PINE RIDGE TER G 1ect w~. 1. Alt BM Description 2.) Bldg sewer length L - amount of cover = L4 t ~ Plan revision Required. D- Yes No Cert. No. Use other side for additional information. Date Insepc 's Signat SBD-6710 (R.3/97) County Safety and Buildings Division° 201 W. Washington Ave., p.0. Box 7162 Sanirary Permit Number (to be filled in by Co.) Madison, vin 53707-71 62 2 1 3 A SaCt30Il N 'S'anitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govetntnental unit is required prior to obtaining a sanitary permit Note: Application fors 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 ores in accordance with the Privacy Law, s. 15.Q4(1 m), Stars. . L A lication Information - Please Print All Information Parcel # Property Owner's Name Property Owner's Mailing Address Property Location Govt- Lot City, stare Zip Code Phone Number section _ ? e on (7 N; R E W _Iq 11. Type of Building (check a that apply Lot # Subdivision Name or 2 Family Dwelling-Number of Bedroo DY ~ Block # i ❑ Public/Commercial - Describe Use ❑ City of /J r v CSM Nwriber ❑ Village of / t ❑ State ved - Describe Use AT own of 4 611 e17 111. Type of Permit: (Check only on box on line A. Complete ILIAC B if aQplicable} A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal t Revision ❑ Change of Plumber ❑ Permit Transfer to New ' Before Expiration Owner TV. T of POWTS System/Component/Device: (Check all that apply) A Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-GTade ❑ Mound >24 in. of suitable soil ❑ Mound < 24 in. of suitable soil r ~a ❑ Holding Tank El Otber Dispersal Component (explain) El Pretreatment Device (explain) T~ S V. Dis rsallTreat ent Area Information: Design Flow (gpd) Design Soil Application Rate f) Dispersal Area Required (sf) Dispersal AProposed (sf) System evation 4 - i r.> S. ~iiu VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ° _ v y v/ U ' N v New Tanks Existing Tans ~..1 /t/1.t~ , a a m / U rn v G Septic or Holding Tank Dosing Chamber VII, Responsibility StatewA~V L the undersigned, a e esponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI s " ature MP/MPRS Number Business Phone Nltmber Plumber's Address (Street, City; State, Zip. l~ ' VII1 ounty/ )e artment Use Only Permit Fee Date Is ued Issuing. tSi~tature Approved S a CO / -7 eason for Denial D{. Condit>~tas i~r t~}pproval 3e fJ G c;ispet::s,i cell must ill be sai~fcas ! t. int4,ie~ 3 as per „lar:agement plan p!o iiaeh by plwnbe.. l 2. AU .k rec4U".I`^,an',S MWI;t>w: inu tt ieE,'f as per PWksb1i!b c4d* 1. rdinanrsa. Attacb to complete plans for the system and submit to the County only on paper not less than 8 1f1 x I1 inches in size SBD-6398 (R. 11/11) Soil Test and System PLOT PLAN PROJECT Matt Ferausson ADDRESS 526 N. Dallas St. River Falls Wi 54022 NE 1/4 SE 1/4S 35 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 95.5/95 R /95.3/95.2 6' below grade 3/7/17 BEDROOM 4 ATE CONVENTIONAL XXX I-,-- ~ C,~~~ CONVENTIONAL LIFT HOLDING TANK 1255 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1542 # of chambers 76 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter Lifetime Filter BOREHOLE O WELL *H.R.P. same as benchmark Property Line , Scale = 1/4" = 10' Pine Ridge Terrace 80' ST 100' 0' -1 100' 40, Pro 4 Bedroom House 20' B-3 50 0' 2% Slope B-2 Y 1 Vents y 4-3' X 78' cells with >3' spacing Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6f A2/pair of end caps 4' Long 12 37 Grade at System Elevation All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 275' CSC-~Ir~-r~ C, Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 7 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LD. , percent slope, scale or dimensions, north arrow, and location and distance to nearest road. j - Please print all information. Review Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Le (CI /-2- 51 Govt. Lot114 /114 ./,1, N R E (or W Property is Mailing Address ~L Lot # Block # Subd. Name OF CSNW J Z, T AU, City State Zip Code Phone Number 0 City ❑ Village Town Nearest Road c TIJ ( New Construction User Residential/ Number of bedrooms Code derived des n flow rate 6 J GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _A7 i Flood Plain elevation if applicable General comments and reconxnendations: System Type ~171.~J ^.wc ° System Elevation S, > / J ( 5 V Boring # ❑ Boring 5:~pit Ground surface elev. ft. Depth to limiting factor /.2 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#2 511- j , 02 lk if, 4 Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor l 0' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -Z.~ a~ 'r 111 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) Ae re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 7 w 715-246-4516 Property Owner _ Parcel ID # Page of © Boring # ❑ Boring Pit Ground surface elev. ~t fit. 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 'E'fff##2 4AIL G 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 F-1 Boring # ❑ pit Boring ❑ Ground surface elev. ft. Depth to limiting factor 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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' 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. S®0.8330 (Rb/00) Property Owner _ Boring Parcel ID # Page of © Boring # pit Ground surface elev. ~ fit. Depth to 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 Aq, r LI 15 ar~>i F Boring # Boring Z> -I ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring E-1 Boring # pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon 'lepth 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 mgA- ' Effluent #2 = BODS < 30 nxA and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Soil Test and System PLOT PLAN PROJECT Matt Ferausson ADDRESS 526 N. Dallas St. River Falls Wi 54022 NE 1/4 SE 1/4S 35 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 95.5/95#95.3/95.2 6' below grade 3/7/17 4 ATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK 1255 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1542 # of chambers 76 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property Line Ilk. Scale = 1/4" = 10' Pine Ridge Terrace so, SST 100' 0' -1 1 100' 40, Pro 4 Bedroom House 20' B-3 50 0' 2% Slope ~g 6~ B-2 Vents 4-3 X 78 cells with >3 spacing Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 12" 4' Long Grade at System Elevation 34" All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 275' ST. CRO~IX C w.UNTY ST CROIX COUNTY ~ twN, ON-SITE VERIFICATION ` FORM E Prop?rtyD,aner Property L ocation Govt. Lot 1.W 1A S T N R E (or Property 0 wier"s Mailing ArJdress Lot # Block # Sued. Nance o CSr%ly+ Civy Sttinte Zip Code Phone Number ❑City ❑Village ❑Town Nearest Road f ~ GPD ❑ t1e,w Construction Use: ❑ Residantial i plumber of bedrc>oms Cie den•dr--l d€slrgn flaw rate-___ ❑ Replacement Public or commercial - Describe: Parent material Float Plain ele•,ration if applicable - ft. (general a mm5nt;- f~ and r~~commendatl ns: ~ A! t Brrl n ❑ Bcriny ❑ pit Ground surface elan. ft. Depth to Iirn GN_i J factor _ in. Sol Application Rate H+_irizon Clopth Cr,minant Color RNJox De-srriptim Texture Structure Consistence Boundary Rods GPB,ff, in. Alunscll Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Being A ❑ Boring ❑ Pit Ground surface ek~'a. ft. Depth to limiting factor _ in. soil A - ,lication Rate Horizon CUpth E%ominant COx Reclox Descripkion Texture Structure Consistence Boundary Rods GPDrfr in. r,lunscal Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 r W 1 \ d Y 7 1 5-386-4680 ST. CROIX COUNTY GOVERNMENT CENTER 71 5-386-4686 FAX CDD@CO.SAINT_CROIX_WI US 1 101 CARMICHAEL ROAD, HUDSON, WI 54016 WWW.SCCWI.Uslcdd s:Acdd\zonshare\sanitary & soils\soil reports & on-sites Comm 85\on-site forms & letters\county soil on-site form.doc 3V -7 S 1 10 Y7 WisconsRuLppJft- iier~dfr" a4j d Professional Servi Division of Industry Services 1, Q~ I i i ) r a I SOIL EVALUATION REPORT Page 1 of 3 <~ll,t1f~ g in accordance with SPS 383, Wis. Adm. Code County ST. CROIX A(thipiefespl8h o(►e lr t less than 8 1/2x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1 04 -11 5 - 40 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev' ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 01 ROSEMARY LYNCH (Buyer: Randy Heil) Govt. Lot NE 1/4 E 1/4 S 35 T 28 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 48 Pine Ridge Terrace C City State Zip Code Phone Number ity OVillage • Town Nearest Road River Falls, WI 54022 ( ) Pine Ridge Terrace n New Construction LlseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD El Replacement 0 Public or commercial - Describe: ft Parent material sandy outwash Flood Plain elevation if applicable NA General comments Conventional In-ground Trenches 0.7 loading rate and recommendations: F] Boring # Boring Q Pit Ground surface elev. 99.64 ft. Depth to limiting factor 100 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 1 0-16 10YR3/3 1 3fa&sbk mvfr cs 3vf-co 0.6 0.8 2 16-24 10YR4/6 I 2fa&sbk ds cs 2vf-co 0.6 0.8 1OYR6/4 S Osg dl as lvf-m 0.7 1.6 3 24-32 4 32-100 10YR7/4 s Os ml lvf-m 0.7 1.6 F 2 Boring # Boring 96.70 96 Q 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 1 0-16 10YR3/3 1 3fa&sbk ds cs 3vf-co 0.6 0.8 2 16-24 10YR3/3 I 3fabk ds cs 2vf-co 0.6 0.8 3 24-35 10YR4/6 1 2fabk dsh cs 2vf-co 0.6 0.8 4 35-44 1OYR6/4 s Osg dl cs lvf-m 0.7 1.6 5 44-96 10YR7/4 - s Osg ml - 0.7 1.6 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30..< 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) V~& CST Number Ma Jo Hu ert Hollister's Soil Testing &Design) Y-2 6d-1 224832 Address _ Date Eva a n Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 05 - 05 - 15 715-426-1775 3BD-8330 (807/13) Property Owner LYNCH Rosemary(Buyer:Heil) Parcel ID # 040 - 1135 - 40 - 000 Page 2 of 3 / Boring ✓ 171 Boring # Pit Ground surface elev. 99.15 ft. Depth to limiting factor 102 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10YR3/3 1 3fa&sbk mvfr cs 3vf-co 0.6 0.8 2 6-19 1OYR3/3 1 2fabk ds cs 2vf-co 0.6 0.8 3 19-36 10YR3/6 1 2fabk dsh cs 2vf-m 0.6 0.8 4 36-46 10YR6/4 s Osg dl cs lvf-m 0.7 1.6 5 46-102 10YR7/4 s Osg m1 0.7 1.6 s ' A 00 E Boring # E] Boring 9 85 100 Pit Ground surface el Pv 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 1 0.3 1OYR2/2 I 2fsbk mvfr cs 3vf-m 0.6 0.8 2 3-20 10YR3/3 1 2fa&sbk mvfr cs 2vf-co 0.6 0.8 I 3 20-39 10YR4/6 A 2fsbk ds aw 2vf-m 0.6 1.0 4 39-49 1OYR3/4 s Osg dl cs 1vf-m 0.7 1.6 5 49-100 10YR6/4 s Osg ml 0.7 1.6 Horizon 3 has some gr 1%. Boring V-pth ❑ Boring # Ground surface elev. to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description extur 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 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-8330 (R07/13) Hof Plan Page 3 ofd Propeimy. Owner &Lm-A►zy C Ly ~c E-------I &yr,ke: R-AI~tw fl c( 1» = 40 ft Legal Description ,g. hKau /A) TF•fC NCA or- Tttr- (except where noted) 156 I/g, - -TbWQ oF- + 5~ G = Packhoe pit 0-0LkNL wilco M,5 1,,4, I, Sao AGwaf> North p, o ti. i $Z LD 6 %.7D' 43 k r rPRDX 2-7.r i TD `til Q •--y ~ ~ _ . y SPIfcE rnJ 'Tr 6TZCL!A.D SkAKF,+Ce fi ~ZO.,l'j ~ - AJCE post i=ce F&ACe Site Location: s i« ,x Sic- • ~ 35 T~ o~ «oD Duo A °2 E E o ~$o N T " O n N ~ ~ (n N L D ~ ~ N C N V a u X o ~ ~ m 3 rn 2 0 ~ rn ~ ~ Z---4,j~~,y m 9 0~ x C Q. a m 0 'o U _rn 2 " o. a o E" `m d x 3 m U s m y = d c co E m c O y d c m o m ? m o' o m o m 'o o 'n C1 m v> n w o_ v m v ~o' 1 of CC y. co VGM cj L r,N CS L LL_ it1 O t. t'. u J ALL Q£ L C Ci =Nld cJ 09L 9L z en CO OQ - ti +r u 0 LO (alp try MVl) y~}+ G " mr-aml 0 IL 16- %d County e°°~~~ 2~1 - Safety and Buildings Division r a V NOV 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, Wl 5-11`17-7162 l~~ 59Z l 93 UNITY F Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit j ~Vt't is required prior to obtaining a sanitary permit Note: Application forms for state-owned POW TS are submitted to Project dress (P11i, fferent than mailing address) the Deparhncut of Safety and Professional Servies. Person) information you provide may be used for secondary I purposes in accordance with the Privacy Law, s. 15. 1 m , Stats. PC n / L Application Information - Please P int I formation mca. Property Owner's Name A, Parcel # ~f' r S t/ r1.~ o y o- Property Owners Mailing Address Property Location ~ ~ ~ . s se s Govt. Lot city, state Zip Code Phone Number AIL_Y4, Section 'Ls T N; R cle one I )~23 EQru J I 11.Type of Building (check all that apply) Lot # r 2 Family Dwelling -Number of Bedrooms Subdivision Name Block# ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of c~ Ce, 5~ Z+44- LZ S Town of - III. Type of Permit: (Check only o e box on line A. Complete line B if applicable) A' ew System ❑ Replacement System ❑ Tr ent/Holdina Tank R lacem o ep ❑ Oilier Modification to Existing System (explain) i R- ❑ Permit Renewal ❑ Permit Revisiou ❑ Chan~e of Plumber cansfer to New List Previous Permit Number and Date Issued Before Expiration X ~7 ` , r rj►~ y IV. Tv ofPOWTS S stem/Com onent/Device: Ch a tha 16 1A Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑';F de Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil G ❑ Holding Tank ❑ Otber Dispersal Component (explain) ❑ Pretreatment Device (explain) I J V. Dis ersal/T'rea ent Area Information: r - e a Tee tgn Flow (gpd) Design Soil Application Rate(gp Dispersal Area Required (sf) Dispersal Area posed f) System Elevation V7 Tank Info Capacity in Total # of Manufacturer ' ice, I' Gallons Gallons Units o GGGflQ7dli~LLPww OOOVVNN U ` New Tanks existing Tartl;s 16 Septic or Holding Tanis Dosing Chamber i i _ .y VII. Responsibility Statement- I the undersigned, - e responsibility for installation of the POWTS shown on the attached plans. I Plumber's Name - i (Print) t) Pl Signature MPlMPRS Number Business Phone NttJnber I GC.c~ ? J / r Plumber's Address (Street, Zi e ` Jl J~J VIII. ounty/De artment Use Only Approved ❑ Dis, Permit Fee Date sued Issuing ent Signature . tt' 2S /(p rven Reason for Denial ' IX Conditi esous for Disapproval - 1.. is tank, el9lt nriiRer and dispertsd cell must all a sal! r~z'nr~ 3~ ~~e,L as per maragement plan pro,rided by plumber, tom` 2. Alt atetbeick rwuiver wncs must to maintt,leied as per appiicabie soar= 1w raln2►nce3. Attach to complete prams for the;}; m and submit to the County only on paper not less than Sir x 11 inches in sue SBD-6398 (8 11/11) System PLOT PLAN PROJECT Matt Ferausson ADDRESS 526 N. Dallas St. River Falls Wi 54022 NE 1/4 SE 1/4S 35 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 94.2/93.0' 5' below grade 11/14/16 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 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 spike in tree ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE (DWELL *H.R.P. same as benchmark Scale 1/4" 10' Pine Ridge Terrace = = Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 19 Long 12 34" Grade at System Elevation 99' 97' t. B-4 10' 20 6 Pro 4 ST Bedroom House 11% Slope Vents 2-3' X 90' cells with >3' spacing B-3 100' B-2 01 + C 0 15' 2 -1 5' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 5' B.M.* 275' Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11/14/16 Owner:Matt Fergusson Location: NE1/4 SE1/4 S35 T28 N,R19W Pine Ridge Terrace Troy Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Secti 4-6. Maintanance and nt' gency Plan 7.Filter Cross Sectio ' Signature - License nu er #226900 System PLOT PLAN PROJECT Matt Ferausson ADDRESS 526 N. Dallas St. River Falls Wi 54022 NE 1/4 SE 1/4s 35 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 94.2/93.0' 5' below grade 11/14/16 BEDROOM 4 DATE CONVENTIONAL X00C CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 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 spike in tree ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 10' Pine Ridge Terrace Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long 34" Grade at System Elevation 99' B-4 10' 20 Pro 4 ST Bedroom House 11% Slope Vents 2-3' X 90' cells with >3' spacing B-3 100' B-2 0' 15' 2 -1 5' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 5' B.M.* 275' 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 Vent ~ Typical Installation ~ 99 .2' Grade Vent 3' 4" 3' ,A;,~30/34 Septic Tank 5' Long 1 5' " 5' Long 1 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A 22 chambers per cell B System elevations: A 94.2' B-93. 0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION _ SYSTEM SPECIFICATIONS Owner Permit # Sl~~ Septic Tank Capacity ~r - al ❑ NA Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer ! NA ~ Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ;E~A Pump Tank Capacity j Estimated flow (average) al ~ 7 avda Pump Tank Manufacturer NA i Design flow (peak), (Estimated X 1.5) - G 0 al/day Pump Manufacturer NA Soil Application Rate ' al/da ge Pump Model Standard Influent/Effluent Quali tY Monthly averagex Pretreatment Unit NA Fats, Oil & Grease (FOG) s30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection !Pretreated Effluent Quali ❑ Other. ty Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) S30 mg/L In-Ground {gravity} ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L -XNA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ya in dia. ❑ NA other. !Other: ❑ NA NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent Other. ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency !inspect condition of tank(s) At least once every: 0 month(s) ears (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (f) of tank volume ❑ NA Ilnspect dispersal cell(s) A~At least once every: ❑ month(s) ears (Maximum 3 years) ❑ NA Clean effluent filter least once every: 1:1 month(s) ear(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ m nth(s) ❑ year(s) NA I=lush laterals and pressure test At least once every: ❑ month(s) ~0tner. ❑ year(s) NA At least once every: 0 month(s) ether: ❑ year(s) ❑ NA ❑ 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 !include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of ixmbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be ivisually 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. I,Nhen the combined accumulation of sludge and scum in any tank equals one-third (X) 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 Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 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 ducts or other chemicals tt*t For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products impede the treatment process and/or damage the dispersal cell(s). If high Concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble discharged to the dispersal oefi(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$- antrbiotics baby wipes; cigarette butts; -condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation drakn (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producils; 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 safely abandoned in compliance with dWfer Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sued. • 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 fined with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 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 requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the noed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rrle:l in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technologlr a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installedl as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the inftltralive 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 TAN1~ 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 r. n ` Name -7 Phone , v Phone F7/J i 75 SEPTAGE SERVICING OPERATO (PUMPER) LOCAL REGULATORY A Name- lam// , Name Phone Phone This document was dratted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), WlsCOnStn Administrative Code. a \ I ~ , I~irQn Li~h ~ P i - - - - _ i j i i -JO i LL. y ST. CROIX COUNI-y SEPTIC TANK MAINTENANCE -AGREEMENT AND OVINERSHII' CERTIFICATION FORM OwnerBuyer Mailing Address /U. S - arty Address - \ (Venficatlon requn ed from Planning & Zoning Department for new construction.) City/State Parcel Identification Nwaber LEGAL DESCRIPTION Propert3' LoccatiionA- /4 C' 1/ 1 , Sec J , T OLN R W, Town of /za c - Subdivision Lot # Certified Survey Map # - , Volume `Page # Warranty Deed # 0 ~ ~ cf V , Volume , P e # Spec house yes no Lot line,, identifiable eno 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, ii 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 ins ction and less than 1/3 full . of sludge. Fe Pumping (if necessary), the septic tank is I/we, the undersigned have read the above requirements and agree to maintain the private se standards set forth, herein, as set by the Department of Commerce and the Department of Natural Reso ge disposal system with the Certification stating that your septic system has been maintained must be completed and returned to the S~tro;~x State of ply & Zoning Department within 30 days of the three y expiration date. 8 Uwe certify that all statements on this orm are true to the best of my/our know! e• Uwe property described above, b virtue of a am/are the owner(s) of the y deed recorded in Register of Deeds Office. TS bedrooms I OF APPLICANTS OTE ~ } ***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. (RE'V'. 08/05) dIHS-NM~O-L J,ONI 1J DS 661 Noaod d - r ~ ~'gp€ ].,,I l ! zz01O'S IM 'S I-7V ~ aEgAI O l~'b5 0LCl 1N3W3SVB - m g w O ~ jilt! €3a P 'ld '06699 ~3OVaVO - ~ ~ ~ ~ ~ - ~ S ~ ~ a pge a a B b g yp~ $ ~ 'S ~ J RO~ ~Q I aN`Iyld y~yyl '"'09 9290 :JNIAII Wi01 - ~SNOISIA38 i 1 0' p 35 igb 51E' p g~ z R NOT J C.i ~y . 9151 :13A31 a3ddn OV-sm :),g NMtlaO o ~O = LL g ogn a8lt JIM '14,06 OLM :13A31 NIVW 910C/OVII ~030SSI u ~ ~ L 4 F 9 O NOI1VWa03Nl 901' SOHO 30V1003 38tl005 NOI-LVA80ANI NV1d .L-.51 .9-,9 .0-,61 .i-.4 b- 9 ,Lli O-,XI~ 10-.4' f in "v I - ry 4 S r Ih A IA r Q 'I S~ ~ 01 4 n M n i- 0 4 -4 I " z kYG H1V6 v = at z A .W Ir 0 4 9 -l <1 9 cl • rv rv , I~' ~ ~~7 m 9 0-[ W m T, I nnp 4 I S ,I,y/ m3J n N3l1i n K v O YS LIMJ LL ' I v n _ ~ 5~ n ,~.r-,14-4 I - a LL JQ~ g " tui J in to K I x4 I - s w a m B4 g rv ~4~~ - I o I I I I I I I I .01-.9 .6-.CI .9-,LI .9-.bl O, .OF,L Q Q - - - - - - - - - - - - - - - z -1 J ~ ~ 41m~~ jww~ ; Q Q «d l~U n~pi-< •ng~ U g~ F, -1 a~a IIH1~SNM ~,01 IO `'Il I f cg g@~ gt22$$ d J. l~ !75661 NOMOd'j - Io '1105 OLCI :l.NMV6 - w qng` n ZZO•OG IM 'G-17Vd 'aGAIJ NwIll 3 n P! 'ld '06 699 :3Ob'aVO - $d i T - E g a u'd 2 F„ c 9 g 'a 39Q I J 3N I d y Y '1-1 'D6 966L :ONIAll ltl101 - :SNOISIA3i1 ? r Z O A b!! Nosnoa4aj 'ld '!Yi 9161 13A31 il3ddfl OVSI'1 :AS NMVHa ]5 w !d '05 OLLI 3h31 NIVW 910L/OI/II 03OSSI tt NOI1VWtl03N190f SOlV03OVlOOd 3Wnt)S NOI1VVYHOJNI NVld .P.bL .P,e o-,64 .0-16 .6-.L PS .6-.L ,II-.6 9 .UI O-, I06,6-* UI 0-,D4UI 0-.G-'O's W, , .UI O-.914 IO-,6~Oll 06 'M/V F♦S S 1 q 4m ~ I 61.9 cR4 g ~ a Qr~~ ~ _ I I I m ~ ~ o 9 x l I x m Q rc rc A 'oo.Lbl • mss mu aom~ .ei q I r I II'~r' - S - • r " IZ ~ GI I 'r e - - - - - - = ~ 4 'I~w o-L (L) ~T~ ql SSfItl1 ~tll9 " w0ou 91 v dim .8-.61 J ni, Xnt, L-.6 ~,P1.OI ~ I I .Lno-.~ 1o-.6~ob kk. 0.61 .4.L .4.1 ~ ~ nR y - ~ 4 H t9 c ~ I ' ,Cj _ - g 9NVH»E3/ - - L O / 4.6 4 XF ~ 1 I 0 0 ppyy~~ 1~{1 Vy7 /y MQ FZ I ry t. ~ N m m O Q 9 d oo Lbl • " 9 I n ~l O~ sassrau NOO'W.el 1 - 1 x Im - yl 1X3 Ol IN3A ~ ~ 4 I Q i 1L T/OOId .BI -0-9 O ;OG n 0 P. .6 .4.61 c9il I - - - - !-L X111 0 yJ Q S! I m ~ R ~~r~rlal aarta .fir'-' JJrr11 1r 1~ II J m r-, 1 S la In .6-3, .b-.6 .b•.L .6-.L FO~ a a i r ~ 9-L fA I oa a m ,o-,L .01-.L .L-.bl .o-.6 .P.LI .P.LL P. .0-.9 0 JQ d N< LL Q ---I IImII~~ y~ • N Y0 .~~00~~Y 000 ~ O O k+$ 9 5@ 7 y cJ 1 HG-7NMO.L J,O/NI ld 'D5 651 N~aod'd - gr 6 P ZZOS IM 'S I~ V O /CIO l~'l9S OLLI IlN3W3SVB - w F W S w O i pry $ ° P S Y E3 $a Fp pa ~I`'~ 1 `I I ,y~y,~ 'id 'os 6993JVavJ - ? - ~m r E gn SS 5$ ~V 0031 ~7QI0 ~NIO yy 9999'L :ONIA11 IVIO1 - SNOISIA3a O y $5(y dp 2 2 ~ o° a LL P 4 i' e yg p 'Fill 'Jd '09 9161 :13A31 a3ddn av-sm All NMVHG w O W rg ae ¢ a 0 0 3 U _ n @ a e $ No S n, 'ld •O6 OLLl :13A31 NNW 910L/0I/I I 0WSSI Q h S 0 NOUV"UOdN1 SOf 901VO 3OV100d 3aVO05 NOI1VWtlOdNI NVId .04 .0-496 .o-,9 .L-,Ql a r-------------- I I 4 I I 4 I I iC I I I I I v I I a I I K- ~ I I Q I I R I I x~ I I I I Q I _I I I - - - - - - - - - - Oil 4 I I- -I a I u ~1 "v I I - I I 1 X; i 1 Fl L I y 63997a I LU ~ v_ L_J L -JI i6~ r X w l el {o X z 1 I ~ nl V/ -i J - I Q CID .9-411 z b .9-461 Q it sJgw&L WOId .91 b m m ~ "I a1 II I ~ I I P ry N ~I ry B W k r G W 1 L-- II I ^ 4 Q I I-- I I F I i ~ I Y I I v x14 I ~ ~ II I gg I I F- I 0 4 I ~ g I ~ X ~'O I I ~Qg I ~a P Zug aooa01ado x 'r 1` nl9 ~ ~ 5t ~ ~ II I ~ I I ~L in - iv m 7 o G I Q I I W I I I 4 ~~fl I~-- - =JJ I I I i 4 ~ v m - - - - - - - - - - - - - - - - I I I 1 I ~ ~ I I I Y ~ I I Ir 1 4 a I I I I ~ I I p l I I I pI 6Y -a" I I - L- ' OW .II-4C Q a ~ 2° Q ~~<O