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018-2011-60-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597383 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: McCabe Homes, Inc. TOWN OF HAMMOND 018-2011-60-000 CST BM Elev: In. p. BM Elev: IBM Description: I Section/Town/Range/Map No: a , to L) Sift cc 30.29.17.1075 TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR CAPACITY STATION BS HI FS ELEV. :2 Septic pump 7 l /000 Benchmark j47 I • I W' V Dosing Alt. BM on Bldg. Sewer ~+Q G~ IUD ` 9 L;f-f*'1ke_ 107 01-it Inlet C(75- SUHt Outlet TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I N''J Dt Bottom Dosing ~ Header/Ma 7 S 2 • b /02. A ration Dist. Pipe Holdin Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer I Demand St Cover` n 'a c• U UAL GPM Model Number TDH Lift Jj Frictio, ; I„p s System Hea" Vp Ft W Forcemain 2in I Dia.Zl ) Dist. to Well (V I SOIL ABSORPTION SYSTEM BED/TRENCH Width ( Lengtl No. Of hes ~,OVCA PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dept DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE REAM LEACHING Manufacturer: INFORMATION , CHAMBER OR _ Type Of System: _ 156 N UNIT Model Num K: DISTRIBUTION SYSTEM dr2 Z~ r"I p He anifold ID stribution ` x Hole Size ' Ix Hole Spacing IVe t Air Intake Length Dia Length Dia Spacing to P ipe(s) 1 I' ' ' ~1/•l SOIL COVE x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth O er Depth Over xx Depth of xx Seeded/Sodded Bed/Tr h e Bed/Trench Edges `jTopsoil ❑ J Yes P No j*"f,,-(es No COM TS: (Include code discrepencies, persons present, etc.) Inspection #1: 7~ I 0 Inspection #2: "I (I Flov Location: 788 157TH ST _ ~uv~ • ~p 0. W? M M 1.) Alt BM Description C l 1. S14 {f v 1 2.) Bldg sewer length =5n ( ~k5W MCAJ(0, ~ b - amount of cover = Ghalns o), Plan revision Required? ] Yes No I Use other side for additional informati cl, SBD-6710 (R.3/97) Date Insepctor's a ure Cert. No. Count Safety and Buildings Division fr~~ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Tb Macon, j 5-7162 " wry Permit ~ppjjL,,.,.„State TrinsactionNumber *Adm Code, submission of this form to the r m*ulg a sanit appropriate governmental unit ~3 Permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than in address) Wartment of Safety and Professional Servies. Personal information you provide may be used for secondary oses in accordance with the Pri Law, s. 15. 1 m ,Stan. L A lication Information - Please Print All Information 79/ C~ Property Owner's Name J Parcel # Pr t2:( operty Owner's Mailing Address :-7 -S7 ' - I : Property Location ,5. 1J f City, State J Zip Code Phone Number I Govt Lot rf J Section ircle o II. Tp Building (check all that aPpiy) Lot # T=1--N> R E W or 2 Family Dwelling - Number of Bedrooms Subdivision Name C ill/// f = Block # J ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owmed - Describe Use CSM Number ❑ Village of own of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Iew System Replacement System ❑ Treatment/Holding Tank Replacement only ❑ Other Modification to Existing System fexplain) B ❑ Permit Renewal ❑ Permit Revision Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Owner IV. T of POWTS S stem/Com onent/Device: Check all that apply U r* ❑ Non-Pressurized ln-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 rsal/Treatment Area Information: Design Flow (gpd) . Design Soil Application Rate(gpdsf) Dispersal Area R uired s e4 (f) Dispersal Area Proposed (sf) System Elevation VL Tank Info Capacity in Total # of Gallons Manufacmter New Tanks Gallons Units c Hoisting Tanta • Septic or Holding Tank , - U L - Dosing Chamber 1 VIL Responsibility Statement- the undersigned, assu possibility for installation of the POW7'S shown on the attached plans. Plumber' (Print) Plumber' azure r MP/IvIPRS Number Business one Number 1-7~ Z,6+f v J . Piumber's Address Street, C tare, - J , n3': LA- A < l VI)I County/De artment Use Only ` Approved ❑ Disapproved SS mill Fee Date Issued Issuin= Agent Signature ❑ Owner Given Reason for Denial DL Conditions of ApprovaVReasons for Disapproval l SYSTEM OWNER; 1. Septic tank, otfluent filter and dispersal cell roust f e_~eryiCed /maintained Il as per management plan provided by plumber. _ ~y imp p / - i - as per appiica Ie COdB/Of InBnCeSeNSrtemandsnbmrtzotheCuunn' ony oa e Y p per not less than 8 tr z I1 inches in site SBD-6398 (R- 11/11) o y a1.F~r DIVISION OF INDUSTRY SERVICES \o~ \ 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 Contact Through Relay P ; http://dsps.wi.gov/programs/industry-services www.wisconsin.gov R~F~s~io f% Scott Walker, Governor Laura Gutierrez, Secretary June 16, 2017 APPROVED CUST ID No. 226900 ATTN POWTS Inspector d EPT OF SAFETY P 71 OFESSIONAL SERI FFICE SHAUN R BIRD STOC O~XOCOUNTY SPIA . -N I N®tlSTRY 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/16/2019 Identification Numbers . Transaction ID No. 2953329 SITE: Site ID No. 839251 Kernon Bast Please refer to both identification numbers, 78TH Ave above, in all correspondence with the agency. Town of Hammond St Croix County NW 1/4, NE 1/4, S29, T29N, RI7W FOR: Description: Mound System Q Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1712469 Maintenance required; 450 GPD Flow rate; 25 in Soil minimum death to limiting factor from original grade; System(s): Mound Component Manual - Ver.`2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced abovv_ 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 • Divert surface water from POWTS 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 6/16/2017 the site is too wet to prepare If it crumbles site preparation can roceed If the site is too wet to prepare do not proceed until it dries. • 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) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(t)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan Anv changes may result in pump resizing to meet TDH and GPM Specifications. • 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 mound 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 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.vanderleestCwisconsin.gov SHAUN R BIRD Paae 2 6/16/2017 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. • 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) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Anv changes may result in pump resizin2 to meet TDH and GPM Specifications. • 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 mound 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 - This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Private Sewage Plan Reviewer ,Division of Industry Services Payment Submittal. WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim. vanderleest@wiscorlsui. gov r Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/18/17 Owner:Kernon Bast Location: NW1/4 NE1/4 S30 T29 N,R17W Lot 60 78th Ave Hammond Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound 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 Od, cross section Attachments: Soil TeO Shaun Bird Signature License numb 26900 Page 1 of 9 ~I pY 2 4 System PLOT PLAN PROJECT Kernon Bast ADDRESS 948 LaBarae Road Hudson Wi 54016 NW 1/4 NE 1/4s 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.3' 5/18/17 BEDROOM 3 DATE CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of steel fence post A ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BORE O WELL *H.R.P. same/as~'benchmark 354' Property Line 99' Scale = 1/4" = 10' 100' B-3 6% Slope To 78th Ave 2.0 Arces " 1 1 C Area 15' below syst is to remain undisturbed c~1 ❑ B-2 100.3' Huffcut ombo Tank Grading is to be done to divert 1' Tank is to be properly bedded and provided with run-off away from system lockdown covers with P 3 B droor a proved warning labels H Well is to meet all WDNR setbacks 78th Ave J, Mound System Cross Section and Plan View - - - - - - ~ Dimension Feet J ~ - - I , B of 1 ir.r~rLr. .r L .r.r. L.LjLjL.L.4.. L L I D _ rL 4jtirL• LjLrLrL•L•Lrtirti. r r r r r• L L•YL•L•L•L•L•L•L•L-L.L•L•L•L•L•L•L•L:L•L•L•L• /y A i r r r~rL:~r~r r~•ti.i.~r'%' L?~r~r;-~r r1:~ri~~:;ri?iii?ti~:rti~ir~r~r.r...r...r.r•r.r _ L :?iri+1?i +yi~iLiL~L Lr{r1rti;ti.y.{.ti`v{r{?;:i:i%.1:ti~{?. L ti:i: ? L 5 r rL~L~L~ti~•~ L 1:1: yt•: .~~r.r.r.. E JII 1rL%Lit% LJtilyl1r.Yy~•~rFl Lr1~~: I L.LrL:ti:'r L S r'J: y1 G W - J F i I i G Z I H i 7 c. I i i I i i 1 L s, Z L Slope l % 1 = To soil t p = ASTM C-33 Clean aggregate O = 4 in. sch. 40 pvc Cap Material sand fill '/2 to 2 '/2 in. dia. observation pipe Geotextile G Fabric H rr F D E Ft Contour Plowed Surface Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/071gj . Page of Pressure Lateral Layout Two Laterals - End Manifold Threaded Cleanout Lateral Turn-up - Plug Manifold M X L Force Main Long Sweep 90 Bend Distribution Network S ecifications Pressure System Construction Lateral Diameter - In. Manifold Diameter In. 1 Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) ' In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M (Manifold Length) X Ft. ceanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main Length from finished grade. Grade •••••••.:d ••o•••• 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 l9j I Septic-Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer ? 1 Tank Model Number Pump Model Number ' tJ 1 Total Tank Capacity Alarm Manufacturer Max. Bury Depth j Alarm Model Number Switch Type :c Filter Manufacturer. _ Total Dynamic Head (TDH) - Feet Filter Model Number j /Z.2 Elevation Head Distal Pressure Network Loss Minimum Pump er€ormance Required Force Main Loss • ~ GPM: - p , Ft TDH Total Outlet Manhole Min. 4" Above Grade With Locking Deice. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof ~FiairshedGrade Junction Box w . ! rr Vent Min. 12" Disconnect Above Grade Means With vent cap Outlet Filter --,.~i - - - - - lnlet Wet Baffle - t`t > A Switch Settings and Reserve Capacity r 1/ Weep Tank Volume = GPI Hole B Dimension Inches Volume Gal. (reserve) A'. - 6 , ; - : Off Elvation C (alarm) B 2 (dose) C 1" t 7, Ft Bottom (dead) D l a D ElevatiGu Total r { t< a< t< t a t t<< t a i t< a t< a t a art>t t`t t`a'< 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. 4U PVC to bridge the tonic: excavation and the sleeve is sealed watertight. Electrical service ~omplies with NEC 3110 and Comm 1b.2. Page of 02/05 LJ ' TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 i MODEL i 152 153 i W Li ~Uj 50 l Feet I Meters I GoL I Liters I Cal. , Liters 153 ' L- 5 1 5-- 9 251 77 291 12 40 152 10 t 3.i 61 231 70 265 0 15 4.6 r 53 201 61 231 = 20 .1 6.1. 44 167 52 197 30 i z 8 25 7.6 34 129 42 159 30 1 9.1 23 87 33 ! 125 r. 20 11 35 - - 22 85 r- 40 122 11 I 42 Lock 'Vcive: X38.0 Ft.l(11.6.444.0 Ft. ('3.4 G'i 450a I I 20 fO 60 80 100 GALLONS ; LITERS a 0 80 160 240 320 3 27 32 ; 5j8 ~ FLOW PER MINUTE 27 CONSULT FACTORY FOR SPECIAL APPLICATIONS 2 e _ • Timed dosing panels available. OO 3 27/32 Electrical alternators, for duplex systems, are available and supplied with T an alarm. - • Variable level control switches are available for controlling single phase ! systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. - • Over 130°F. (54°C.) special quotation required. I I ~ 1521153 Series 12 ti` 1521153 MODELS Control Selection ! Model Volts-Ph Mode Am Rs Simplex Duplex 1/5 N152 115 1 Non 8.5 1 2or3 5 ~ i BN152 115 1 Auto 8.5 Included 2or3 1152 230 1 Non 4.3 t 2 or 3 1 sKZOSa BE752 230 Auto 4.3 Inclu;ed 2 or 3 r N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto t0.5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float LBE153 230 1 Auto 5.3 ncluded 2 or 3 switch. Refer to FMO477. & CAUTION 2. See FM0712 for correct model of Electrical Attemator 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 recent National Electric Code (NEC) andthe Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, Louisville, KY 40256-0347 =~i SHIP TO: 3649 Care Run Road L~ qp M'7- KY 40211-9967 QUfrL/TYUifPS JiNCE ~~Jd / (502J 7752731 ~ 1(800) 928-PUMP httpJ/www.zoelier.com 119, ! FAX (502) 774-3624 C Copyright 2000 Zoeller Cc All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS rp, wner Septir, Tank Capacity*~' ' al :NA r mrt Septic Tank Manufacturer :~7 ❑ DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units NA Pump Tank Capacity > al ❑ NA Estimated flow (average) al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) aVday- Pump Manufacturer ❑ NA Soil Application Rate avda /ftz Pump Model - r,:, ❑ 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 ❑ Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 m /L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-ground (gravity) ❑ n-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade -.Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ rip-line 0 Other Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non-mmmercial) wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE F Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every ❑ months "year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ mon year(s) Inspect pomp, pump controls & alarm At least once every ❑ months ar(s) ❑ NA [Flush Iatl-~-rals and pressure test At least once every ❑ months AD-year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other I At least once every ❑ months ❑ year(s) ❑ 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 regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch- NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatfinent components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. 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,-lt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will 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 effluenli. 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;$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; 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 properly and safely abandoned in compliance with chapter Comm 133.33, 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 s<iA, 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 compliant replacement system: 13 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 requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled 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 technologiV a 'holding tank may be installed as a last resort to replace the failed POWTS. e site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaiuallion mu 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. nd and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Oj A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Blame Phone l i:~ - rj~ 7 Phone (mac! .J -r SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Name Name Phone Phorie71 V This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. - - - I _ a M t ~k ~ t i ~ tp") t ~ r- o d I Q 3 Z ILI 4 E-- ~ a L j 1 i E { ST. CROIX COUNYY SEPTIC TANK MAINTENANCE YLGREEMENT AND O /WNERSI3IP CERTIFICATICN FORM Owner/Buyer CAS Mailing Address s' if ,e dCr)'- . o. ✓ ✓ ~ 5~~ Property Address / s. (Vert cation required from Planning & Zoning Department for new construction.) City/State Parcel Identification Nlnnber LEGAL DESCRIPTION Propert y Locatio Y. , ✓ Y. , Sec. , 4,N R~( W, Town of Subdivision Lot # C' 0 Certified Survey Map # Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot liner identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its prermture failure to handle wastes. Proper maintenance consists ofpunmpmg out the septic tank every three years or sooner, ir'needed, by a licensed punsper. 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, signet} by the owner and by a muster 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 tame i less than 1/3 full of sludge. Vwe, the undersigaod have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Deparhmnt 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 Depa t ment within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property ed abov , by virtue of a warranty deed recorded in Register of Deeds Office. N r of b /RIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. IwInde 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 time warranty deed. 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CROIX SYSTEM ELEVATION 101.3' 5/18/17 3 DATE BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BORE O WELL *H.R.P. same as benchmark 354' Property Line 99' Scale = 1/4" = 10' 100' B-3 6% Slope To 78th Ave 2.0 Arces B-1 6~ 1011, ❑ Area 15' below system is to remain undisturbed B-2 100.3' Huffcutt Combo Tank Tank is to be properly Grading is to be done to divert bedded and provided with run-off away from system lockdown covers with Pro 3 Bedroom approved warning labels House Well is to meet all WDNR setbacks 78th Ave ` Wisconsin Department of~BrceIVE~/ JV IL C V nLVr% %)T Page of Division of Safety and Bu in N T2220 r7accordance with Comm 85, Wis. Adm. Code County J Attach complete sig'plCM PlAr,t less than 8 1/2 x 11 inches in size. Plan must include, but fvto F"~X111 I rital reference point (BM), direction and Parcel I.D. r f i percent slope, scale ar~ n d location and distance to nearest road. - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r Property Owner Property Location ' Govt. Lot 1 /4 1 /4 S (1 T r N R E (o ; W Property Owner s Maili Address Lot # Block # gt)d. Name or P Z City State Zip Ubde Phone Number C3 City (3 'Village JgTown Nearest Rod 0, /1 New Construction Use: Residential / Number of bedrooms _a Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material s Flood Plain elevation if applicable ft. General comments and recommendations: r / System Type System Elevation ✓ Boring M ❑ Boring # ® pit Ground surface elev. C 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 Y/ V, ~0,% 7 Boring # ❑ Boring Q pit Ground surface elevX r , 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 Tr y Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 1 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) I CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54 , 715-246-4516 Property Owner _ Parcel ID # Page of a Boring # Boring < J 3 ,pit Ground surface elev.37 ( ( 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 ° 7 I v V, t l i✓ f a Boring # ❑ Boring F-1 ❑ 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 Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Property Owner _ Parcel ID # Page of 7 Boring # ,❑~11 Boring 30 f lr' TPit Ground surface elev. ' t ft. Depth to limiting factor j~ 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 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 30 mg/- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Soil Test Plot Play Project Name Kernon Bast S un Bird Address 948 LaBarge Road Hudson Wi 54016 ~CSTM #226900 v Lot 60 Subdivision Emerald Acres 1st. Add Date 5/17/17 N W 1/4 NE 1/4S 30 T 29 N/R17 W Township Hammond Fj Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel fence post System El tion 101.3' *HRpSame as Benchmark 354' Property Line 9 9' Scale = 1/4" = 10' 100, B-3 6% Slope l~~J _ To 78th Ave 2.0 Arces B-1 101' ❑ B-2 78th Ave r Wi :corlsirl Department a Conn ~l ~ - -7 SOI L EVALUATION REPORT Page _ I _11 Division of Safety and © fld'nrgs in accordance willr Conan 05, Wis. Adm. Code _ County ~ n an r AttactI Corn mete site i { p, ~k~l ~tc)~;tcos uran Q 112 x 11 6rc,-ires er size. Plan moist hicitxfe, b-it not [finite to: vertical and horizontal leromm;e point (UM), direction and Panrl I.D. / percent r lope, scale el dimegsioi r 0110 t aj1uw"F,rld location and distance to nearest road. Ple x'W( aft lrrfumiallum It mvoJ Date f PerwMel Informn0on you provide may be used ror secondary purposos (Privacy Law, s. 15.04 (1) (m)). PropertyOwner T Piupoity Location Govt Lot 11 tq 111 S I N 11 -,e' E (or~W Pruperty Owners Melling Address L t # Block v Su-W-- Name U CSM# j~ ,\iLIAL' kec Ti.- City Slate lip Curio Phone Number -LJ City -Ll Village Down Ne best Road u t.; t 1 I t:v. I i t l(G) I (I h }`7f j -&7- I I- --1-~ r- %1 . TT - 4h New Construction Use: 4j _flesidelllial / Number of bedmoms Code doiived design flow rate ~ GPU L~j Replacement ❑ Public Or corimleluial - Describe: Pamnt material Flood Plain elevation d applicable _ - - R. General oornrnenis~ anJ reconnnendatiars: 7 Boling # 11 During ~c LPit Ground sutlace elev It. Depth to Illnlling factor in. Soil Ay' ticalien Rate - - - - - - - - --J al lle4ZOn Depttr Dominant Colul Redox Description texture Sbuclure Cottsistem,e Boundary Rools in. Mansell Uu. Sz. Cont. Color Gr. Sz. 5h. 'Effttl 'Elf#2 ( 3 If- Lj ~l During # U Doting J pit Ground surface elev. C) C_ it. Depth lu limiting factor Sog Application RaIp llotizal Deptls Uaninarri Color Redox Description l exlure Shucluio Consistence Boundary Roots GPDtfe in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sir- 'Eff#1 'Eff#2 i [?1 ~ L ~ i l L)tl~`~ It )9f C j I v.( ~J Z Imo/ ~ 4L Effluent #1 = DOD,> 30 < 220 ing(L and ISS >3U < 150 rng/L ' Effluent #2 = BOD5 < 3U mg/L and -1 SS < 3U mg/L CST Name (Plea Print) Signature CST Numh r Address - _----------~i=~.~ - Dale Evaluation Conducted I elephon o Number jj i t~'rlW v ar it Faye of I'arccl IL) It - - Properly Owner o [J Boring --e Borirtg # 1 , ~'C to fimitirtg tactur l in. Sol A rplication Rat Pit Ground surface it. Depth elev. - Horizon Uepth DominantColol RedoxDesctgrtion lexlwo Structure Consistence Boundary Roots .EfIRGPD1IFEIf#2 Qu. Sz. CrmL Color _ in. Mmtsell --r L~ r L I ❑ Boriny l~ Bonny # - - ❑ pit Ground swiace elev. It. Depth to limiting tactur Soil Applie;alion Rate Horizon Deptlr Dorninnnt Cokx Redox De3cF4)tion Texture Structure Consistence Boundary -Roots _ GPD/fF Gr. Sz. Sh. 'F.If#1 '[If#7 in. Munsell au. Sz. Cont. Cobr I~ Bodrty U Boring # El Ground surface elev. It. Ueplh to limiting factor plication Rate Pit Horizat DepUt DnhtantColor RedoxUescriptiun texture Stiuclure Consistence Boundary Roots GPD/fF El r Munsell Qu. Sz. Cont. Cokx Gr. Sz. Sh. 'Eff#2 ' Effluent #1 = BODS> 30 < 220 tnglL and TSS >30 < 150 ntyll- ' Ellluent 02 = BOD, < 30 mylL and TSS < 30 ntyll- The Dcpatiment of Con►u►erce is an equal opportunity service provider and employer. If you need assistance to access services or need material in all alternate format, please contact the department at 609-266-3151 or "ITY 608-264-8777. SoPA7100t 07W)