Loading...
HomeMy WebLinkAbout032-2174-06-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 597342 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: OEVERING HOMES TOWN OF SOMERSET 032-2174-06-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 22.31.19.1461 TANK INFORMATION ELEVATION DATA c CAPACITY STATION BS HI FS ELEV. TYPE MANUFACTURE i Septic 4r !y o 0V&3 d Benchmark Dosing Alt. Bh& Bldg. Sewer Ho ding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ven o Air Intake ROAD Dt l Inlet Septic q t 1 7101 Dt Bottom Dosing 1 r~ a iti U v : u ► Header/Man. , L (1 wall Aeration Dist. Pipe Holding- Bot. System / L. T-s F 199,3 1 PUMP/SIPHON INFORMATION Final Grade 3•9p Manufacturer Demand over J J GPM [ f Model Number 1 rn TDH Lift 1 Friction Loss System Head TD L Ft TL 91 d ~ Forcemain L.enngth, Dia. Dist. to Well SOIL ABSORPTION SYSTEM 1 BED/TRENCH Width Length ( No. Of Trenches PIT DIMENSIONS No. Of Pits Insi Liquid- tGl@p h DIMENSIONS SETBACK SYSTEM TO P/L BLDG < WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR y'_ Type Of System c 116, 0A UNIT Model Number. I" DISTRIBUTION SYSTEM 0 15 4 16 4- 1,5 Header/Manifold Distribution x Hole Size x Hole Spacing Vo Air Intake 1 tl 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 BedrFrench Edges Topsoil >K E] No Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2006 57TH ST c Q, 1.) Alt BM Description 2.) Bldg sewer length = 2 - amount of cover Plan revision Required? ❑ Yes ❑ No Use other side for additional information. Date nsepc or g Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County 1 .7 r 201 W. Washington Ave P.O. Box 7162 Sanitary ermit Number (to be filled in by Co.) S j K F x"11 Madison 537 -71 °°uNv iansaction Number AF7H08PVERJWM ermit App in accordance aitSt9YS 383.21(2), Wis. Adm. Code, submission of= form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary Ce, , i, Z, ores in accordance with the Priv Law, s. 15.04-(l m) Stats. 7t~ ~L A lication Information - Please Print All Information P cel ~ 1J ~ Parcel # Property Owner's Name Property Owner's Mailin ess t ~ Property Location Govt Lot _ Zip Code Phone Number t/4, Section C State ~ II. Type of Building (check all that apply) Lot # -ti Subdivision Name a -or 2 Family Dwelling-Number of Bedrooms , :.1T9 r z . Fri Block # J ❑ Public/Commercial - Describe Use _ a"~ ❑ City of CSM Number ❑ Village of ❑ State Owned - Describe Use own of _ r v J ( (1-11 5 +-1 r2 t III. Type of Permit: ( eck only one box on line A. Complete line B if applicable) ew System ❑ Replacement System L] Treatment/Holding Tank Replacement Only ❑ Other modification to Existing System (explain) A. Chan List Previous Permit Number and Date issued B. ❑ Permit Renewal 'evision El ge of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. T of POWTS System/Component/Device: Check all that a iv efuxy-yvs n Pressurized 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 ersalflreatmentArea Information: Design Flow (gpd) Design 3oi1 Application Ratc(gpdsf) Dispal Area Required (sf) Dispersal ArearPr^oposed (sf) System Elevation 47 VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanta ° = a. U cn P C~ Sepue or Holding Tank 1 Dosing Chamber VII, Responsibility State nt y the undersigned, ass r ponsibility for installation of the POWTS shown on the attached plans. P s Name (Print) Plumb i afore MP/MPRS Number Business Phone Number Plumber's Address (Street, City: State, Zip Code VIDE IL artment Use Onl / Permit Feer~ Date Issued Issuing Ag t Signattue Approved S 7/1 -Wl Owner Given for Denial DL Conditions of Approval/Reasons for Disapproval i Attach to complete plans for the system and submit to the County only on paper not less than 8 r2 z 11 inches in size SBD-5398 (R. 11/11) System PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4S 22 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 99.8/99.5 1.7' below grade 7/11/17 BEDROOM 3 DATE CONVENTIONAL AT-GRADE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # EZ-Flows 45 BENCHMARK V.R.P. Top of SE Lot corner ASSUME ELEVATION 100' Filter Lifetime Filter -E ]BOREHOLE O WELL *H.R.P. same as benchmark 57th St. 3-3' X 62' cells with >3' spacing 101.5' 100.5' B-2 40' Pro 3 Bedroom 5' House 75' -3 5' 35' 3% Slope 65' B-1 B.M.* Huffcutt Combo Tank Vents 15' 96' 579' Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/18/17 Owner: Oevering Homes Location: SW 1/4 SE 1/4 S22 T31 N,R19W 2006 57th St. Somerset System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. EZ-Flow Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Secti 9. Pump Curve 10.-12. Soil Test Signature License numbe;/4226900 _ fit,` Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ftA2 pair of end plates To be >1' above grade Finish grade elevation ~ Typical Installation ~ 101.8' ent Vent G rade 431 4, ~~3 0/34 Septic T:an ,jV 4' L ong 1 34" Grade at System Elevation 34" Grade at System Elevation Spacing 5' 3-3' X 90' Cells Observation tube/Vent Same on other end To be located on end of Cells ~%A B System elevations: C A-99.8' B-99.6' C--99.4' 15 chambers per cell BmLanmS purl RIPS sns!a GSe/9ar~~nsao~•q~ny NV-ld 1503NV1S 3Sf10H _ j p 30418 AMVH 2J3AN '9 10l ® 9NIOV3H 6Z-L[ S3W0H ON183A30^ w N a 4 Z ? r rn Z a ~ z w IN3ISAS 3.LVNIQNOOJ g o Z p w> LL w A1Nf100 XIONJ W W w IIj IS 3HI Ol O3JN3N333N LL ~ J i O? ~ m w Z F o m 3NV SJNfdV39 a ¢u~ w w O W z w 0 a U O w¢ O 7 = N D 2 O Z m a w< oz mJ w O O H- _ - - o G o a O O2 O O t~ ~NN°y~~N sca W o o W I w d I < SS Z90 .'OQ 89~` . b i p98 X ® OF O i a 'moo 0 ~ > OU 0 t 0 FwX 09H / N I o E wzo 0 U 0 p E E Z m N Q > o O.~F Q F m N O n F Y Iu a ao U LL J y 0 w z B5 - o o n Y+ / ~ 3 v M ~ a o , / j SEp SE,,XG > o v ~ v o pROPO / - w / o ` o O Q o I v 3 s \ ~Ey sza e~ ° 0 70' ti a o6a °8 \ 55' ~ 3 . °ti d~ r \ o I r G N \ N 3 r O .ten \ ~ O ' I Y• W Z ~ y O N tDU W v' W H o f• Q I~ p O Of \ O+10- N QW~ w J O N \ y N_ w O Vl a ui \ 858 \ a~N 0 , j e'L 3 f Q~ P ST. CROIX COEINTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Qev~, ~f K; Mailing Address Property Address'_sy+~ 7 (Verification requered from Planning & City/State Zoning Department for new construction.) - _ Parcel IdentificatiotZ N LEGAL DESC umber U,J~- ° t Property Location V s ` C- !/4, Sec. C_ Subdivision TN R W, Town of Gu a r _ Certified Survey Map # - - Lot # Warranty Deed # l~ f Volume , Page # Volume Spec house~ ~ Page # Yes nQ SYS~TEM~ Lot lines ideitifiiabl yes no NANCE AND OWNER CER MCATIOIV Improper use and maintenance of your s maintenance consists of eptic pumPtng system could result in its the SYsteiii can out the Septic fault every three P1eimature failure to affect the fimetion of the y Years or sooner, handle wastes- Proper a esPonsibilities are specified in Co eptank as a treatment f needed, by a licensed § cunt. 8311,-52(j) stage in the waste disposals st 12 pumper, what You and in Chapter - st. CroixCoun Y Owner put into The grope ty Sanitary ordinance. maintenance o rt e owner agrees to submit to St uance. and by a master plumber Croix Co wastewater disposal ' journeyman Pliunber, r'x C d"' u l~lg & Zoning Department a certification fo system is less than l /3 full of sludge. condition c and/or ted P mber or a licensed pumper verifying that l ~ Segued by the (2) after inspection and pumping (if necessarY~the septic tank is l/we, the undersigned have read standards set to the above requirements agree to nth, herein, as set by the ~ maintain th Certification statin that ePeat of Commerce the and and the Depart private sewage disposal s Loring Department within 30 days of the three year expiration tained date. ment of Natural Resot,rce system with the must be completed and returned to the Croix County Planning & , State Of Uwe certify that all state property described above, by ments on this form are true to the best virtue of a wart of Y deed recorded in Ite my/our knowledge. I/we am/are the owne a NUraber of bedrooms gister of Deeds Office r(s) of the r TGNA OF APPLICANT(S) ***Any information that's misrepresented may result in the sanitary Permit being revoked DATF Include with this application a recorded warranty deed by the Planning & Zonin De reference is made in the warranty deed, from the Register of Deeds office g pai'frnent. and a copy of the certified survey map if (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r'' ` Permit # ` Septic Tank Capacity - ❑ NA al Septic Tank Manufacturer ❑ NA 7ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms f ❑ NA Effluent Filter Model 1 Number of Public Facility Units ❑ NA rIR] NA Pump Tank Capacity c7 al ❑ NA Estimated flow (average) r , aVda Pump Tank Manufacturer ❑ NA 1 Design flow (peak), (Estimated x 1.5) j aUda Pump Manufacturer ❑ NA Soil Application Rate auda /ft2 Pump Model 1 7 11 NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) :220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (I-SS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average s ersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) S30 mg/L Di ln-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids JSS) 530 mg/L XNA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: iMaximum Effluent Particle Size Ya in dia. p NA Other. ❑ NA Other: Other: NA ❑ NA "Values typical far domestic wastewater and septic tank effluent Other ❑ NA [AINTENANCE SCHEDULE Service Event Service Frequency (Inspect condition of tank(s) At least once eve ❑ month(s) every: r> ears (Maximum 3 years) ❑ NA I.Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Ilnspect dispersal cell(s) At least once eve ` ❑ month(s) ry' year(s) (Maximum 3 years) ❑ NA I~;lean effluent filter At least once every: ❑ ont ❑ NA ~ ..year(ss) ) Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) 1=1ush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Dher. ❑ month(s) At least once every: ❑ year(s) ❑ NA ~7ther. ❑ 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 iinciude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of i=mbined 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 regulatory 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. l~il other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, find any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. i, 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 other chemicals tI*t may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thla 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 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 fife of the POW antibiotics; baby wipes; cigarette butts; -condoms; cotton swabs; degreasers; dental foss; diapers; dis'itfectants; fat; foundation dralin (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producgs; 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 safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code;. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and 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 comp6ont 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 requi*d setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neied 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 replant 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. 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 surtace. 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 TAN ' UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0 A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS _ POWTS INSTALLER POWTS MAINTAINER E Name , . Name ~j Phone Phone SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORaY Name Name Phone / f Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f) and 383,54(1), (2) & (3), Wisconsin Administrative Code. I 17- T I r r f 1 i 1 d p 1 a I p j I L. ty;, i Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer c.. PUMP Manufacturer a Tank Model Number Pump Model Number < t J Total Tank Capacity Alarm Manufacturer Max. Bury Depth Alarm Model Number L,,- Switch Type Filter Manufacturer Total Dynamic Head ('1DH) -Feet Filter Model Number Elevation Head f Distal Pressure Network Loss Minimum Pump ~'erformance Required Force Main Loss GPlvf j'', • ` Ft TDH Total outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Dkee. Inlet Manhole Securely Mounted With Locking Device < 6" Below G~de Sealed Watertight Weather-proof 1 Junction Box ° Finished Grade + Vent Min. 12" Disconnect Above Grade Means • With Vent Cap Outlet Filter --.~_i - - Wet Bale Inlet ,t A i/<» Switch Settings and Reserve Capacity Weep Tank Volume = GPI Hole Volume Gal. Dimension Inches (reserve) A off Elevation C (alarm) B 2 , r O t? Ft Bottom o. -4 (dose) C G> - i < Elevation {dead) D D n~ 17 Ft ' Total tank is bedded and back filled in accordance with the GENERAL INSTALLATION: The septic/dose the manufacturer may not royal specifications. Maximum deptl► of bury as. specified by manufacturer's product .app an effective looking device (padlock) be exceeded without Prior 4pproval. Manhole covers exposed to grade have watertight and installed. Piping at the inlet and outlet is of approved material, connected to the tank with fittings, maul is sleeved with 4 laid on stable soil to prevent settling or sagging- T~ force " Sch. 44 PVC to bridge the tank Lion and theeve. I is sealed watertight. Electrical service complies with NEC 300 and Comm 16.2. excava Page of - 02105 U I EAC~CAPACIiY 10TAL DYNAMIC HEAD CAPACITY CURVE PER MINU T E MODELS;~53/~5/57/59 E~~LUENT AND DEWATER!NG 25 Model 53/55/57/59 i 6 20~t. Meters Gal._trs. '.63 5 1.5 43 34 29 z 4 1 4.6 1 19 712 r I I- 10 _ y I Heed 19.25 f±. (5.9 r. S'-,ut-of. 2 5 3 ? 5/15! 6 S/32 -j I c 5/8 '/2 -1 /2 NP? U.S. GALLONS 10 2 30 40 50 LITERS T- ~ 15/16 80 160 FLOW PER MINUTE 009897 i 4 '/16 Variable level float switches available. Variable level long cycle systems available., Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. 10 / 6 s Duplex systems available.' 3 3/32 ~~IL(llr1=~'1~u1~ SK858 w.~ _ Single Seal Control Selection Listings Model volts Phase Mode ! Amps Simplex Duplex CSA uL 1. Integral float operated mechanical switch no external control required. M53/55 & M57159 115 1 Auto 9.7 1 - Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53/55 & 1457/59 115 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FM0477. BN53 115 1 Auto 9.7 Y Y 3. Mechanical alternator "M-Pak° 10-0072 or 10-0075. BN57 115 1 ! Auto 9.7 N Y 4. See FM0712 for correct model of Electrical Alternator. r BE5357 230 1 Auto 4.8 Y Y D53/55 & D57/59 230 1 Auto 4.8 1 Y Y~ 5. Variable level control switch 10-0225 used as a control activator, with Electrical E53/55 & E57/59 230 1 Non 4.8 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system. Single piggyback switch included. a caur~or+ For information on additional Zoeller products referto catalog on Piggyback variable Level Float Switches, FMO477 y_ Electrical Alternator, FMO486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase Simplex Pump Control/Alarm Systems, FM0732. U - For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 'F247 7 fi,h -'a Louisville, KY 40250 Manufacturers of.. SHIP TO: 3649 Cane Run Road qp ZD 1~ Louisville, KY 40211-1961 gWIrY PUMPS FINCE 1,,7c/J ® /7 (502) 778-2731 - 1 (800) 928-PUMP http://`www.zoeller.com /PUMP ~L/- FAX (502) 774-3624 © Copyright 2002 Zoeller Co. All rights reserved- LOT 5 V. J. o3.t acres TU 0. H. W. M. ssA.~ 1 Qj~ ° \ Q 1 -P- LOT 6 \ 1 3 OSf acres ~ 0 0. H. W. M. ` SOUTH LINE Of THE SE 1/4 OF SEC. 22'; \\i, - - -N 89 2549' E o O 3 Z ~~a 4 3 U ~p3od'~~ S 2 c F- ~ 0 Ism g ssg ssa .s SsE gS o g a uj ps ggs m J LL w > C) J 1 m I d~ f. - it W L❑❑❑ I; W - ~f o w T y j,l/11ti1' fill, a~t 1b r r~ ~ II wa I I II I!I'f~'' I i VIII I Y , i' ,III c wb ¢b i ~ C7(lCi~ I ("It7CC ~ ' ~ ~I CCCC 1 "'CO I i Irlrirl I i zvs va f.,r rr J~II ~rtJ1~l{N I~1 ~I ; II t{~ I lt~J r.ljl v„l o w~ ?$s ~~#oQggCpp~ I ~ ~ 0 0 g o✓R~4q~3 p LD to a € uJ c,gb~ qw4 O F- ,a s U i~ 'Wggo Q^ yy t Q i~,c O ~ $ ~ ~xg G~8gg3~~ d~ II ~ n Z t 66 [ p ~ OK a C ~ ~7 U- 2 Ep x ~ ~$$~°F g$$~:F 3$$8$f 9_y< 17~JGa$~d LL. ~ LL F ypp.b a, on ~a IJ Z a q yy J f wg~ 4 ;Y O w 3 ~ Oz 's m $n q o~l~coa i ~ - 1 I ---11 I 7 I I~ I 1 II I I I pp oos¢is q r. mov s~ $ II ie 4 O i $ 1 1 F 1 z ~ OLL ® 1 ~ 1 ~ 1 I z J~ I ~ I "I - a 1 I I 1 - - - I x6 I - a I 1 I 1 Q -I X 1 I I I I I I ~ I I ~ y ~ I - - J- _ _ - - _ - _ 1 _ 1 Y I I i I I ~ Ix ~ L~;~ 1 I I I L J L J I I E 1 I Ltv n: I - I I~BB§: ~oz¢~s3sawttgovsi I - ~ « S I 9 i i i 1 b m r a o~ q g$ e3 ~a~~d 159 g wb - - - e qo ' m - 4 p aWU, q gdo`~ ~ ~ m - ~a io O ~ oix ~6$~Yg~~ N y W mpg SIM, co O e~ ~g- ~ v c Z_ 3Y~hl !Uhl !Uhl !Uhl ~Hi Y~~~g ~ N C ~ d Y mH ~ g~ I w a, pa Z ~ N N J ~Lu pJ I I I w Z I I i `s I oros¢n ~9. I _ I =a ~a o ~ ~LL I ,3 _ ® $ s a k n^ I - d e i 00 r= R +i I N F s~b sz Iwr m i R g _ ape i I a 79 o _ - I s - - a mrraam ,..1ou~ rv e 5 - _ - - - _ - - - - - S m I .g. o ~a I I ~~e7 I I ~~s ie ~n~y I i ~a w~ Wisconsin Department of Commerce m; IL VALUATION REPORT Page-2-of Division of Safety and Buildings in accordance with Com 85, Wis. Adm. Code U T~ County Attach complete site plan on piper not le 4. 1 inches n size. Plan must include, but not limited to: vertic8i-and-t M), direction and Parcel I.D. / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3 ( Ob-COL Please print all information. viewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Own~c Property Locatio rx Y Govt. Lot 1 /4 l 1 /4 S_ T N R l E /(or) W Property Owner's Mailing Address Lot # BI # Subd. a or G6W City Stat Zip Code Phone Number ❑ City ❑ ~Ilage J3Town Nearest Road New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: J I Boring # ❑ Boring I / I R] pit Ground surface elev. IL"' / L ft. Depth to limiting factor . f in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 r" << i , ~l Z( 'I S~7 -IT Boring # El ring (J r i~ a 1~ 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 c Al/ j f 9l°1-7 = )d , /.rCo 7& Effluent #1 = BOD > -An :E 22 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) i naturei CST Number Address ~j Date Evaluation Conducted 7 (Telephone Number 14 C Property Owner=-- Parcel ID # Page of 31 1 Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor T in. JZ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. ont. Color Gr. Sze. Sh. `Eff#1 `Eff#2 . Zlf' X1$•!0 ~ ❑ 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 F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 Effluent #1 = BOD5 > 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 (R.6/00) Property Owner f r i c Parcel ID # Page of _ - 24 1,31 Boring # ❑ Boring f~g Ground surface elev. ft. Depth to limiting factor Pit ~ ~5- 7 in. Soil ~Appficafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. ont. Color / Gr. Sz. Sh. 'Eff#1 'Eff#2 i A i 6-- -,:5- 7 , i G'~ lam, ~ m r a Boring # ❑ Boring ❑ 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 i ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Descripti on. 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 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. SBD4330 (8.6(00) Page 3 of 3 :1121 -Jt~,, r Brian Parnell Irc s - CST 231314 Date . f> L~J S011 t", FII'40, dal ; , oil- I L-0 t i v I - - L ✓ -1^ - O& - ~ T i i I i i r ' I , I ! r I t ~ I i I i ' I !1 e CE'VED Safety and Buildings Division 201 W. Washington Ave., P .O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, Wi 537 7162 AY 22 2011 t Z State Transaction Number ,OMMUNITY D ermit Appw,,,,,_,,., In accordance with SPS 383.21(2), Wis. Adm_ de, submission of this form to the appropriate governments, --it d 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, uses in accordance with the Privacy Law, s. 15.04(1) m), Staes. ~ I L Application Information - Please Print All Information.-' ~Q L f { Property Owners Name Parcel 1 ar Z A4, o , ~"tJ Property Owners Mailmg Ad s Property L.ocanon 3 I F ► Govt city, State Zi Cvde Lot o P Phone Number 4, Section .tJ t / sclc o II. Type of Building (c eck all that apply), 1 ' Lot; T N; R E W or 2 Family Dwelling-Number of Bedroo~s ) Subdivision Name _ 5k 77 r ❑ Public/Commercial -Describe Use City of ~ El State Owned -Describe Use - CSM Nv her ❑ Village of own of III. Type of Permit: (Check only one box on line A. Complete line B ' ppl able A Aew System ❑ Replacement S ~ ~ ` yytem I L1 Treatment/floldi a T cplacement Only El Other Modification to Existing System fexplain) B- ❑ Permit Renewal ❑ Permit Revision ❑ Change o f I Permit Transfer to New Lis[ Previous Permit Number and Date Issued Before Expiration i Owner rvV.'kype of POWTS System/Component/Device: Check all t a I -Pressurized In-Ground El Pressurized lu-Gromtd ❑ At Grade El Mound > 24 in- of suitable soil ❑ Mound < 24 in of suitable soli - - - ❑Holding Tank ❑ -Other Dispersal Component ex ltin ( P ) ❑ Pretreatment Device (expiain)_ _ V. Dispersal/Treatment Area Information: - Design Flow (gpd) Design S plication Rate(ropdsf) ispersal Area Required (sf) Dispersal Area , Proposed {s fl $ygteri) levati V n f 7 VL Tank Info Capacity Total # of Manufacturer w i Gallo Gallons Units ° g T hew Tanks xisting Tanks m U q d U Septic or Holding Tank 1 r P i ~ j Dosing Chamber * i ! I - VII. Responsibility Statement- I the undersigned, respomsibiiity for installation of the POW TS shown on the attached plans Plumber's Name (Print) Plumb S' attrrt MPINTRS Number Business Phone Number Plumber's Address (Street, City; S te, `Lip Code) / ii ount_v/Departmeot Use Only _ CkApproved El Disa{+grov~d ~Per,[mJ~it{'cee~e Da Issued/ Issuing Agem iatwe - r eason for Denial / 7 Y0✓ IK Ch ~e°rk, R~ ?,approval - J tL I Qt1 ulsper. ai cell must all be sirlc>s ! rn %nf~rec 8i ss;per glaragement plan p!otided by Nlwnbe'. W{ S 'd L 2, "/IAN ~'r'aQWY9r"• ftnW RtUat 4e Mae V E tie pK ~~lbla c+xttr / crcitlsinc~=. Attach to complete plans for the system and submit to the County only oa paper not less than 8 m z l l inches in size SBD-6348 (R. 11;11) System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/45 22 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 99.8/99.5 1.7' below grade DATE 5/18/17 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # EZ-Flows 18 BENCHMARK V.R.P. Top of SE Lot corner ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 57th St. Pro 3 Bedroom House Huffcutt Combo Tank 20' 101.5' 100.5' 40' B-2 40' 5' 75' B-3 2-3' X 90' cells with >3' spacing 5' 3% Slope B-1 B.M.* Vents 15' 96' 579' Property Line System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4s 22 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 99.8/99.5 1.7' below grade DATE 5/18/17 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT XXXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # EZ-Flows 18 r, BENCHMARK V.R.P. Top of SE Lot corner ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 57th St. Pro 3 Bedroom House Huffcutt Combo Tank 20' 101.5' 100.5' 40' B-2 40' 5' B-3 75' 2-3' X 90' cells with >3' spacing 5' 3% Slope B-1 B.M.* 15 Vents 96' 579' Property Line