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HomeMy WebLinkAbout018-2011-79-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) State Plan ID No: 592256 GENERAL INFORMATION 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: KERNON BAST TOWN OF HAMMOND 018-2011-79-000 CST BM Elev: Insp. BM Elev: BM Description. Section/Town/Range/Map No: 30.29.17.1094 8 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration- Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to)Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System I Final Grade PUMP/SIPHON INFORMATION ✓ ` Manufacturer - Demand St cover __~k Th . GPM Model Number / ^4 TDH Lift Friction Loss, System Head TDI I Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System:. UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution ! x Hole Size ix Hole Spacing Vent tp Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched - Bed/Trench Center Bed/Trench Edges Topsoil a.. Yes N. n~] Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: S5 Inspection #2: Location: 1525 78TH AVE / o~ 1.) Alt BM Description 2.) Bldg sewer length = y P~QW - amount of cover = C i- 'I Required? Plan ❑ O yy Yes Use otheI side for add tional information. No Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) l~ ~ a V 0 o~ %V0 County L- r< Safety and Buildings Division j 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 4 ?M1 F Madison, W1 53707-7162 cROUC coin' 3 --_1 1 ~J' g ZZ ~P Sanitary Permit A ransaction Number 7 In accordance with SPS 383.21(2), Wis. Adm. Code, submission or mts toiw is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Addr (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provid be ~n .9 or secondary urposm in accordance with the Privacy Law, s. 15.04(1) m), Stats. I 5" ~ ~ f i t L Application Information - Please Print All Information Property Owner's Name Parcel # ffr i / - & 6,4- Property Owners Mailing Address rty Location Q .ci j 7 J09 y .r Lot City, State n O Zip Cod 5y o i 4 ~'aone Number loom W(,/4, yc Sectin emote 11. T e of Building (check all that apply) Lot N; l E W ,XZ2 Family Dwelling-Number of Bedroo 1-3 r-71 6K okb P,-"7 Subdivision Name Block / ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of _ Town of r [A 9b ; III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 4 System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only Q Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type ofPOWTS -System/Co m onent/Device: Chec all that apply) El Non-Pressurized In-Ground 11 Pressurized In -Grade ❑ Mound 124 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (expl ' j V. Dis rsaUTreat ent Area Information: Design( ow (gpd) Design Soil Application odsf) Dispersal Area Required (s Disppersal Area Propo d (s, S /etrr levation_ VI. Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks c 2 m rn (/tip. 1~ a C7 Septic or Holding Tank Dosing Chamber L l / VII. Responsibility Statement- the undersigned, ass4Q responsibility for installation of the POWTS shown on the attached plans. Plum Name (Print) jZXgn:-.e MP/MPRS Number Business Phone Number _-p 1 ` J , ! Plumber's _Address tree[, City, State,' ` VIII. _Coun"epartment Use Only Approved Permit Fee Date u edo Issuing. Signature > 66 1 v eason for Denial s (A 7 IX Condttl Approval n ' ~ f3,►;1~..,.. ( ~a of i ne,~.~ (I(+Y~7AR'ai ot* rntst all _e sPt lcos ! roE mt~ ; ec 1 Wpff naragement plan pro,ideriJbv plu r ber. 1,Ji ~f IM~~ 1 in.~i!(w•o~~-l .umrsem,s must tx r ^a,rt~ ir:E 2 'AN i tit rec as,pe+ *Kknbl¢ cod- I :rdi, anr;c:. c Attach to complete plans for the system and submit to the County only ao iess than 8 1 1 inches in size SBD 6398 (R 11/11) 5 SY ~b i A- A116: J t J I System PLOT PLAN PROJECT McCabe Homes ADDRESS 935 Osorev Drive BavDort Mn 55003 NW 1/4 NE 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 100.3' DATE 3/7/17 BEDROOM 3 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 1" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 78th Ave Property Line Scale = 1/4" = 10' 2 Acre parcel Area 15' below system is to remain undisturbed Pro 3 Huffcutt Bedroom Combo Tank House B-3 Well is to meet all WDNR setbacks Tank is to be properly bedded and B-2 provided with lockdown covers ~ 1% B.M.* with approved warning labels Slope Grading is to be done to diver - f system 1 00.3' B-1 it, 1 Property Line 100.5' 100' 1~J ~ ~rtt DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 543p4-5211 Contact Through Relay http://dsps.wi.gov/programs/industry-services 1 P www.wisconsin.gov 4 Scott Walker, Governor S 10 Laura Gutierrez, Secretary March 22, 2017 jF Sr` rES 3 €(`1.I. CUST ID No. 226900 ATTN: POWTS Inspector r SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/22/2019 Identification Numbers Transaction ID No. 2923021 SITE: Site ID No. 836409 McCabe Homes Please refer to both identification numbers, 78TH Ave Lot 71)- above, in all correspondence with the agency. Town of Hamrno!,'. St Croix County NWI/4, NE1/4, S3U, 129,N, it i '/'v! Lot: 79, FOR: Description: At-Grade (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1697163 Maintenance required; 450 GPD Flow rate; 42 in Soil minimum depth to limiting factor from original trade; 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.01i01, 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, SHAUN R BIRD Page 2 3/22/2017 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. • 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. Anv changes may result in pump resizing to meet TDH and GPM 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. 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 $ 250.00 a This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services Wyment S code: 1. 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleestr wisconsin.gov SHAUN R BIRD Page 2 3/22/2017 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. • 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 Any changes may result in pump resizin2 to meet TDH and GPM 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. 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, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer ,Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim. vand erl e e st@wis c on s in. gov Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date:3/7/17 Owner:McCabe Homes Location:NW 1/4 NE 1/4 S30 T29 N,R17W Lot 79 78th Ave 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 Contigency plan 9. Filter Specifications Attachments: Soil Te Shaun Bird Signature License num r.226900 ECEIVE", MAR 0 g ZO'' 1W t ST Page 1 of 9 System PLOT PLAN PROJECT McCabe Homes ADDRESS 935 OSDrev Drive BavnOrt Mn 55003 NW 1/4 NE 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 100.3' DATE 3/7/17 BEDROOM 3 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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J~rpJ_r J L L L•L L L L•L L , ~ r r!.r~J r J.J.r ;J JLr. 1.• t ti.L L L L• L Ft Contour L L L L• / 1• r J r r•r r J•r•J ~:l J r~r~J r r:J•r•r•J•J•r•J•J•r•r•J•J ~•J•r~r JtJ •:•J r•r T~ D Plowed Surface } ' C Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After, the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05 1 12) g1 Page -of Pressure Lateral Layout One Lateral - End Manifold .4 Threaded Cleanout Lateral Turn-up Plug Force Main i X L Long Sweep 90 Bend ~j 1 p cX Pressure System Construction Distribution Network S ecifications Lateral Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter Z In. pipe. Orifices are drilled perpendicular to X Orifice S acin) In. the pipe with a sharp drill bit and face down. L Lateral Len th Ft. Lateral turn-ups terminate with a threaded Force Main Diameter 2. In. ceanout plug and are enclosed in a 6-8 inch Force Main Length Ft, diameter lawn sprinkler valve box accessible from finished grade. Grade O 6-8 Inch Lawn Sprinkler Valve Box LI 03/051gj Page o - Septic-Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Tank Model Number ~ ~ Pump Model Number Total Tank Cflpaeity j n Alarm Manufacturer Max. Bury Depth Alarm Model Number j Switch Type Ice ;Filter Manufacturer Total Dynamic Head (TDH) Feet Filter Model Number Elevation Head Distal Pressure _ Network Loss Minimiun Pump Performance Required Force Main Loss vL ` GPM'. @ 'z-3 3-- TD-H--1 Total ; Outlet ).Manhole Min. 4" Above Grade With locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof J unction Box ~ - w• t - L.ishedGr.ade Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter ~ Inlet - Inlet Baffle diwitch SetOngs and Reserve Capacity A Tank Volume = j GPI Weep Dimension : Inches Volume Gal. BB Hole (reserve) A; Y (alarm) B 2 Off Elevation C (dose) C r17 . , Ft Bottom (dead) D ; D Elevation. Total y . 3 pQ Ft ' Am X, 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 approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 U Page -5 of9 TOTAL DYNAMIC HEAD/CAPACITY PER ViINU. HEAD CAPACITY CURVE EFFLUENT AND DEWATFRING to MODEL 152/153 I I CL MODEL 152 153' 1 w w , I w r- 50 FeeL K,leters Go- Uters 1 co l. Viers 5 1.5 j 69 251 i 77 291 153 I 10 1 3.1 61 I 231 70 2657, 40 12 152 1i5 4.6 I 53 1 201 61 231 o 20 J 6.1 44 167 52 197 30 25 7,6 34 129 1 42 159 z g 30 9.1 23 87 33 125 ° 35 22 85 20 40 12.2 I - - 1 - - 1 1 42 4. _K Jaive j390, (11.6m);44.0 Ft. L'3.4mJ 1 C 0)4508 I i D ZD 40 60 80 100 GALLONS -----1--- l~ 5 )/a LITERS p 80 160 240 320 3 i7/32 - _ FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. OO 3 27/32 Electrical alternators, for duplex systems, are available and supplied with e i an alarm. • Variable level control switches are available for controlling single phase i systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. II • Sealed Qwik-Box available for outdoor installations. See FM1420. f • Over 130°F. (54°C.) special quotation required. 12 1/9 1521153 Series 1521153 MODELS Control Selection I I 1 Model Volts-Ph Mode Amps Sim lex Du lex 5 1/8 i ~ I N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 t t~ I _1_ sK2064 E152 230 1 Non 4.3 1 , 2 or 3 BE152 230 Auto 4.3 Inclu ed 2 or 3 Ivl '153 115 1 Non 10.5 1 2or3 SELECTION GUIDE BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 No 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. L CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most Or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - MAIL 70: P.O. BOX 16347 Louisville KY 40256-0347 Manufactorersof.. SHIP 70: 3649 Cane Run Road /7 q L~ L Louisville KY 40211-1961 Q~r2/TY/ UMPS /NCF ~~c1~ (502) 778-2731.1(800) 928-PUMP httpJ/www.zoeller.com f'!!MP !D FAX (502) 7.74-3624 © Copyright 2000 Zoeller Co. All rights reserved 9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ,FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA i - - ~3ESIGN PARAMETERS Effluent Filter Manufacturer p NA i Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ONA Pump Tank Capacity L7 ❑ NA al Estimated flow (average) ^ l al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) J U al/day Pump Manufacturer ❑ NA Soil Application Rate a ailda /ft2 Pump Model ' 1^ ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L ❑ in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L N ' t- Grade ❑ Mound Fecal Coliform (geometric mean) :5104 cfu/100m1 ❑ Dri Line ❑ Other: Maximum Effluent Particle Size in dia, ❑ NA Other: ❑ NA 'Other: _ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA NIAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve . month(s) ry: ✓ ASyear(s) (Maximum 3 years) ❑ NA !Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) ,9year(s) (Maximum 3 years) ❑ NA -lean effluent filter At least once every: ~f earth(s) ❑ NA nspect pump, pump controls 8 alarm At least once every: D month(s) ,year(s) ❑ NA :lush laterals and pressure test At least once every: ;moo nth ❑ NA Ether: -❑D month(s) At least once every: ❑ year(s) ❑ NA ether: ❑ 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 ,combined 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 !•egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of 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 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. Q Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals th-.It may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thja 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 be 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 POWTl3: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dram (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and 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 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 compliipnt replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requilled 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 rule$ in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 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 infiltrative s rface. 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 Phone /`J f ~ Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY UTHORITY Name Name - -Phone ~ ie Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(t) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Is {i i = W~ N P ~ fs E f iff~19 I 1 1 i i r p cq P o ' co FF , ~j 11 L 41 1i o Q co Q y Z I 3 O ` c U t7 LU f i f i i I i ~ i { 1 I t ~ 1 NB9°45'02'E 723 42 ~ E 211 47 211, 47 33' 33' i t LOT 80 LOT 7$ LOT 78 E 0 r 2,00 ACRES 8,00 ACRES 2,00 ACRES 11 m z 87,125 SQ, FT, 87,185 SQ. FT~ 87,125 SQE FTt U z w 100, i p C E 616 E • E - ca - - - I f 211.47 EASE°''-ENT 45 06211.47' 86.02 125-45` C° 211-47 66 D0 r4 1 9045'02"E 2677.35',. tai a - 0 111 ° ~ sly ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Kernon Bast Mailing Address 948 LaBarge Rd., Hudson, WI 54016 1525 78th Ave., Roberts, WI 54023 Property Adds (Verification required from Planning & Zoning Department for new constructio City/State Roberts, WI Parcel Identification Number 18-2011-79-000 LEGAL DESCRIPTION Property Location NE '/a , NW '/a ,Sec. 30 , T 29 N R 17 W, Town of Hammond Subdivision Plat. Emerald Acres 1 st Addition ,Lot # 79 Certified Survey Map # , Volume , Page # Warranty Deed # _ '}(o(o Oq 91 (before 2007)Volume , Page # Spec house DyesQro Lot lines identifiable ❑ yesono 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 §SPS. 383.52(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 septic tank is less than 1/3 full of sludge. I/we, 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on th' form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a rranty deed recorded in Register of Deeds Office. Numb f bedrooms 3 0-1 4/3/17 1K'1& TURE OF LICANT(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. (REV. 04/12) 9x[O L9h499 xZ1Y0 ww'~bH W+O ✓aMWrtiMfxYC G rf((, I/M^N' a9 low r H 31441 `V..IOS3N,NII „ -Mc low ai Y LSawa u u. a 1111 "C~NOL,1W't7'f-t "~3d1~'4` GJ7'9'Z13W3 "6L 10"1 ~ .o Q ~ 77 } S 1 ~ _ 4f Q ~ T ~ ~l 1. LLI { LIII Lv ! j F t_: t_1 L_.1 LI U ~ LL ~ LL ac r JF;❑[1 El. -j re 4 o L 0C1C~[;(? Leo q~ o LI all m C1 0 -Ij t- tK } LL E3 W 1 a N IF o I- i t 'w LLJ jo t ~s v jai-H S Z,7 ~ i . 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S ~ 7 b LJ LL - a~ oX W ~D 0 01 ~h 0 ~i „vm ry 1 s q r p4 I!I 4 an ro 00 'R ? v 111 w or b ,h .o O 8 ill )x „ b I U ~i ao .bL , /tea n ' tl( E-~ 1 ~r,~ct+s r p 4 I ~ IN ~ > sassria.:. 9^u ,o-,e a I Ill ~ ~ N N ~yz ..[.zi .a•5 ,9~z .rz~ ~ U N . N u•sr ~ ~ ~ On _ uiz> Z r-wo zoo' v G CT a WF:calsi) Pepartmetltof Commerce SOIL EVALUA-I-ION REPORT L lvision of Safety and Buildings page 'if in accordance wiar Comm a5, Wis. /1dm- Code Attach complete site Counly {3,1a3mnw{+epe>` trot less mar, o 112 x I I metres in siz©. Plan roust 1- - Include, tt•rt !1d horizontal referance point (BM), directitm and - - percent rjupe~ ~lorlh arrow, and location and dlslance w nearest road. f cruel I.D. OIO Please flit all liifoiIlia (foil. oviewe- - - Date Personnl ,(ormallp~f prpyid~ mf7sj~ .d 1o'Recondary purpoaos (Frivacy Law, e. 15.04 (1) (m)). Ploperlyowr r - v, v~ Plopefty Location .j4{ E . _ Govt. Lot (I;C~- 114 1/4 S x~ F N It 17 E (arf g) Pruperty (Jwr 'A Moss - l ot . # Block # Subd. Name or C,SN11-f - _ E"~1~ IS, T ~1- 1 f l~ r City state Z1p Cade Phuna Number U city LJ Village 4-q i awn Ifear est Roa fit' d i ► ~~l 1 - T_ W construction Use' flesidential / Number of bedrooms - - Cvdo derived design Iluw rate ----G PD Replacement 0 Public or cumnleruat - Describe Pefent material / - Fhod Plain elovalion it al!Irlicablo ft. General coniments; and recommendations: Y T-" VyL s et -e v -3 J 2 2/ a b s~(r?-1~ c` rr ~i ~7 1rb.s - yto rtrn a rkP rS o~ 3~1/j S P~ I A Boring # Bunny m3 by Pit Ground surface elev. _Ltl~!_ IL Depth to Ihnitiny lactor - - - Rate I lorizon Depl11 Uonlinanl Color Redvx Descri riivn - - - - I Texture Sructure Consistence Bnundmy Knots GPD/IP in. Mansell tau. S7_. Cont. Color - Gr. Sz. 11 'Elfit 1 'EIft12 2- j- Z)y- ® t 1 - - - - - - 14 1- 4/, - - C) P Baring # El Boning F'it Ground surface elev. I CO•c{Q_- ft. Depth to limiting factor ( - _ in. Horizon 6eptl1 Uaninarn Color _ - Sod Application Rate Redox Description texture Structure Consistence Boundary Roots GPDlftr in. Mansell C7u. 5z. Cont. Color Gr. Sz. Sir. TIM 'Eff#2 144 -AIL- 4fr - -4- Q-Y K~z - - - - - Effluent #1 = 601'1~ > 30 < 220 nx3tL aril TSS >3U < 1W my /11 ' Elllur_nt N2 = BOD < 30 niy/l_ and 1 SS < 30 my/L- rCST Name (Please rirrt Signature CST Number dless - (fL iV" L!1 Uate Evaluation Conducted I eiEphormbsr 7 ~ - - -C~~z /ail 0 N#,jj OkK