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HomeMy WebLinkAbout018-1096-02-000 county St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM - Safety and Building Division INSPECTION REPORT Sanitary Permit No. 597437 State Plan o: GENERAL INFORMATION (ATTACH TO PERMIT) G.~ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] LL Village Township OF Permit Holder's Name: 01$'1 096_02_000 Oevering Homes TOWN Parcel Tax No: o CST BM Elev: Insp. BM Elev: BM Descn on: c i !Town/Range/Map No. 'fD 09.29.17.777 TANK INFORMATION ELEVA ION DATA TYPE MANUF ER CAPA STATION kl FS ~ELEV~ t Septic. } g R - ti Benchmar ?J 10 2 Dosing Alt. BM Bldg. Sewer ' Aeration... ~tj r ~7-- t Inlet 'j ! St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet - Septic 44 f , Dt Bottom 1 N (v Dosing eade~IMan. , y Aeration Dist. Pipe Holding Bot. System l , 1 . rf ./t~~: Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number AA TDH Lift l =Friction Loss S stem Head TDH Fi kk`i y9 LY" ~y,)1 1t!~ l t! v+ Forcemain Length Dia.yj Dist. to Well w. y~5 zo SOIL ABSORPTION SYSTEM ZZ) BEDfTRENCH Width Length No Tr nch PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~,..l- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer. INFORMATION Type Qf System UNIT Model Number. DISTRIBUTION SYSTEM to Air Intake V Header/MatI to ) x Hole Sizr x Hole Spacing Y Distribution e 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 yes No `I Yes No COMMENTS: (Include code discrepencies, persons present, etc.) ffnppection #1: Clmj-A Inspection #2: . Location: 1090 174TH ST 1.) Alt BM Description= 2.) Bldg sewer length amount of cover = Plan revision Required? 7 Yes ❑ No Use other side for addi y 8I71nfor ation. ~;p[~ t Date U L ~0 Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~A r&-6% At, -6-~ se- -ounty i Safety and Bw' dings Division - t18 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Numbs (to be filled m by Co.) Madison, W1 53707-7162 L437 IV Stalc el W37YSHKCH2GWG m ~w v SPS 38321(2), Wis. Adm. Code, submission of this form to mew, -tal unit is required prior to ob>ammg a sanitary permit Note: Application forms for state-owned POW I snbmhxed to Project Address (if differcat than marling adds) the Department of Safety and Professional Semes. Personal information YOU provide may be used foi sw&dary 1 i-„G1 j !7e.,A G purpows in accordance with the Privacy Law, s. 15. 1 m Scats. 1 lJ L A lication Information - Please Print All Information Property Owner's Name Parcel 0A2 tJ~7 "I /7z Property Owner's Mailing riY Location 7 Govt- Lot /71 Y State Zip Code Pbone Number 17V_ 1/4 cit, FK ' T~ N. R E W IL pe of Building (check all a pply) r~ F of # /r S r 2 Family Dwelling-Number of Bedrooms 1- Block i ❑ PublidCommerciai - Describe Use ❑ City of ❑ Stare Orwned - Describe Use AA i' ❑ V Ee of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A Systeat ❑ Replacement System ❑ TroatmertVHolding Tank Replacement Only ❑ Other Modificabon to F- sting System (explain) List Previous Permit Number and Date Issued B. ❑ PermitRenewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New / Before Expiration Owner r1 91.0 IV. Tvpe of POW'TS S stzm/Com nent/Device Check all that ap 1 ❑ Nom Presnaizsd in-Ground ❑ Pressmued in-Ground ❑ At-Grade of suitable ❑ Mound < 24 in. of suitable soil N ❑ Holding Tank ❑ other Dispersal Component (explain) ❑ Device (explain) t V Dis reafiment Area Information: Desrgn Flow (gpd) ! DaigttSo7 APpli Rate(gpdsf) Dis Area Requged (sf) FisPet sal Pr°posal (St) SY Bli VL 'l'ank Info ' Capacity in Total # of Manufacauer Gallons Gallons Units /r S r j ~(J.am. ° o as N in New Tanks ExuiingTaaks '`F.n• ' R U ~n in s 2 M Septic os Holding Tank ( L- Dosiag awnha VII. ResponsibUify Statemen the undersigned, a responsibility for in&U111tion of the POW'I'S shown on the attached plans. Pl s Signatlae MP/tvIPR.S Number Busint ss Phone Nupber sNano Plumber's Cry, Stale, Z-PFQ~fy D 'l I r. 1 1J IL- O_ej, t- : _ j VIII. County/Department Use O Approved ❑ ' ved Perm[ittFee Date. Issued Issuing t Signattut a -(~-l Given Re 1970_ 0`' DL Conditions of Appro for Disapproval CoriePi k ovu ill -C wtEi~ ,~nlS to"" L a Ausrrt tiKe' t`nd i t \ / 1..Sev!" ,led art be- , t~tc : rtl q) t rfacts dish r,e'' tan'ded b ~ti;rttflr. F'ro>t, do r:Ed _ to A_ AS 4p - 2. All to _ the C-uuncy only oa paper sot kss tt*n S W z 11 inches is sin to pot 4 ~I1rMI~+~prirwl SBD-6398 (R. 11/11) !#M~~h~MM 2 ~~III~+I~WA~i~M~N1~MMii~Mf MGr~r~IMif q* /,71MIrNNi., . ST. CROIX +COUNli'y - SMIC; TA.N K 1lttAMENAN(M AGREEMENT ANT) OWNFILSMP CER.UFKCATION FORM 4 Owner/Buyer O~y~1-) /1 f Mailing Address _~i" ~ ~~t~GO ' G 1~ n / fL f f ~W r ~ Properly Address~~ (Verification required from Planning & Zoning Department far new conshudion } City/State Parcel Identification Number 4 LEGAL DESCIIIPTION l Property Location / t4 ,/l C Cja , Sec. T __N 2 W, Town of A~f 4~21 Subdivision V, C Lot Cet'tffied Survey Map # Vollune +'"`page # Warranty Deed # Volume Page # Spec horsee!~/ no I.ot lines identifiab ye no SYS EM DANCE AND OWI IER CEItTgFICATION doper use and maintenance of your septic system could result in its ~e consists of ptunpiu;g out the septic teak every three years or premature failure to handle wastes. Proper the system can affect the fhn twn of The septic tank as a treatment sooner, if neeby a licensed pumper. What you gut int<~ responKibitities are specified in §Comm. 83-52(1) stage in the wart, disposal sy em Owner maintenance sad in chapter .1.7 - St. Croix County Sanitary ordiname. The property owner agrees to submit to St Croix County Y'l owner and The a op Pier, lumber ailing & Zoning Department a certification fo jomwynUn P, reskicted plumber or a licensed pumper v signed by the i waslatw Tsai system is is proper operating condition and/or (2) after inspection and P~nng (ifnec tess(atq)the septic tank is Ywe, the undersigned have read the above re u standards set forth, herein, as set by the Departmmeur# o f ommercann. agree a maintain of dAe private sewage disposal system with the Certification slating that your tic ice and the Deparhmeat ofNai Resources, State of wiscomin. system has been maintained must be completed and returned to the St. Croix County PIanning & ,ZDnMg Department within 30 days of late tbree year expiration date. I/we certify that all statements on this form are true to the bvt of TAY/Our Ply destarbed above, by vmne of a warranty deed recorded ut PC knowledge. t/we am/are the owner(s) of the Mter of Deeds Office. Number of bedrooms IGNA F APPLICANT(S) ~ / ~ / ~ ~ DATE *'"*ALny information that is misrepresented may result in the sanitary petit being revoked by the Planning & Zoning Department include with tins application a recorded warranty deed from. the Register of Deeds Office and a copy of the certified survey reap if reference is made is the warranty deed.. (REV. oW) rr~R~1rF DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 o/, GREEN BAY WI 54304-5211 }+I Contact Through Relay http://dsps.wi.gov/programs/industry-services 2 / www.wisconsin.gov ~O~Zssio v + Swr/ Scott Walker, Governor Laura Gutierrez, Secretary August 03, 2017 "a VE I_'T OF SPTE' CUSTIDNo. 226900 ATTN: PO WTS Inspector -E5Zrd NAL ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/03/2019 Identification Numbers Transaction ID No. 2978737 SITE: Site ID No. 841281 Oevering Homes Please refer to both identification numbers, 1090 174TH St above, in all correspondence with the agency. Town of Hammond St Croix County NEIA, NW1/4, S9, T29N, R17W Lot: 2, Subdivision: Pheasant Ridge FOR: Description: Mound System (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1720835 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from orilzinal 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 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. • 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 olling a soil sample between the hands. If it rolls into a 1/4- inch wire, 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. SHAUN R BIRD Page 2 8/3/2017 • 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(l)(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. Any 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(l). • 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.vanderleest@wisconsin.gov Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 0 Date: 7/11/17 Owner:Oevering Homes Location: NE1/4 NW1/4 S9 T29 N,R17W 1090 174th St. 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 and cross section Attachments: Soil Test Shaun Bird Signature 0 License number 2269 v i Page 1 of 9 _ OL 14 2011 INDUSTRY SERVICES System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE '1/4 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 100.0' 7/11/17 DATE'. BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00( 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 1" pvc pipe ASSUME ELEVATION 100' Filter-Lifetime Filter -E ]BOREHOLE O WELL *H.R.P. same as benchmark 110th Ave B.M.* B-1 Scale =1/4" = 10' ° 2 Acre Lot ! , - ` t 353' Property Line Grading is to be done to divert run-off away from system B-3 r Huffcutt Combo Tank lope Pro 3 Bedroom House L,,5~'BB - 2 99, 98' Area 15' below Tank is to be properly bedded with system is to remain 174th St. lockdown covers with approved undisturbed warning labels Well is to meet all WDNR setbacks C2 V Mound System Cross Sectionand Plan View t _ - , 77. Dimension Feet J r - A - B 1. D A W1•Y NYMy'~YY-JYW.fYtifY•hfYMtir•r~•ti•YYYLKKKK•YWYYYYYY4 . . . - _ j• fYKK•YYYY~K•1•LK•Y1K• 1•tK•5iK•tiKKw~Yf4M1•YYYti:tif~•.MWh•M.•.f ~ I E IV: F - Y•f•fY f~rY•f•fY rY•fY•f•rY~hhf.f f fY hr r•rYYY•lYWr.f f f f•! f f 1V.NY.J J J:hJ J J; W 40 1 I I. G i Q p H 1 I 1 F 1 J K L - F _--40' J^ K'T g - 1 Z v W L Slope Topsoil = ASTM C-33 = Clean aggregate = 4 in. sch. 40 pvc Y•MYJ• Cap Material sand fill Y 1/2 to 2 %i in. dia. observation pipe Geotextile H Fabric 1fY1•~Y•.w ~1: w Y YYt1Yti ti•Y4h F - fYY•.••JY•h • f 1K•1KK•\•YY jw.~fwM. E L.- &-7 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 V) 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. 10/07 lgj Page of 1 Pressure Lateral Layout Two Laterals - End Manifold 4 Threaded Cleanout Lateral Turn-up Plug Manifold - M X--* L Force Main Long Sweep 90 r Bend ~ a r Distribution Ne ork S ecifications Pressure System Construction Lateral Diameter In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 3f/ In. pipe. Orifices are drilled perpendicular to Orifice Spacing) d 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) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main Length d Ft. from finished grade. Grade 6-8 Inch Lawn Sprinkler Valve Box Page ofl- 03/051g1 i Septic-Dose Tank Cross Section And Pump Performance Specification$ TaBk Manufacturer Pump Manufacturer Tank Model Number /-Pump Model Number K Ail -5 Total Tank Capacity Alarm < Max. Bury Depth _ Alarm Model Number Switch Type /97 C Filter Manufacturer 9 Total Dynamic Head (TDH) - Feet Filter Model Number Elevation Head 162 Distal Pressure Network Loss Min m)j Pump Pw&rmance Required Force Mai. Loss le) GP .S S Ft TDH Total J + Oudet Manhole Min. 4" Above Grade With Locking Do4ke. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking bevice Weather proof Junodon Box Finished Gracie ~ - i f & Vent Min. 12" Disconnect Above Grade Means With Vent Cap V.; a<> <s<><.f,<i i ,<a',+a+a'i i i a<>+a->S<><aasr r`,+i'i i a : ,r Outlet Filtw Inlet Baffle Inlet :<< Switch Set*p and Reserve Capamty s1 Tank Volume = /-j' ON Weep Dimension: Inches Volume Gal. B Hole (reserve) A S- 3 {sla=m) B: 2 3 V Off Elevation C (dose) c .Battatn > (dead) D / D Elevation Total csZ ,3 ':.:v: < > >Q. Ft ':<::,+s•<'<'s'i s:'<aa:>: a <a:<'< :><'<a<': +::,::.a:':: , :'al'as: a'i i': s•: < <•:::< sal <:a,a; Y, l.'<•'::d::<• a's'::I GENERAL INSTALLA'T'ION: The. sep&Jdose ft k is bedded and.bw* filled m accordance with the manufacturer's prodcrct.approval specifications. Maximum depth of bury as. specified by .the manufaamr may not be exceeded without plior. approval. Manhole covers exposed to grade have an a tctive 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 swing. rn force main is s1ePVO WidI C Sch. 40 PVC to bridge the tank 1b.ZY. excavation and the .sleeve. is sealed waytight. Elect cal. se vi ties with NEC-300 and Comm P ©f 02/05 L3 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING ^ N MODEL, 152/153 MODEL 152 153 W U3 Feet Meters Gol. Liters I Gal. liters ti 50 261 77 291 5 1.5 1 69 1'53 10 3.', 61 231 70 265 12 40 152 15 4.6 53 201 61 231 o ZO - 6.1 I 44 167 52 197 w 42 159 _ 25 7.6 34 30 129 8 30 9.1 1 23 87 1 33 125 { - - 22 85 Q f' s 20 , 40 J 12.2 11 42 I{ 0 i Lock Voive: 13$.0 Ft. (11-5-n)144.0 Ft. ) 4 orawa 10 I 0 20 40 60 80 100 GALLONS 6 1/4 LITERS 0 80 160 240 320 - 3 27/32-1 -4 5/8 FLOW PER MINUTE I I 3 27/32 L CONSULT FACTORY FOR SPECIAL APPLICATIONS ® 3 27/32 • Timed dosing panels available. . Electrical alternators, for duplex systems, are available and supplied with 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 shat cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. i • Over 130°F. (54°C.) special quotation required. 12 1/8 ' 152f153 Series : I 1521153 MODELS Control Selection I f i I Model Volts-Ph triode Sim ex Du lex 1/8 8.5 1 2 or 3 I sKZOes 15 115 1 Non Included 2 or 3 i -L EBN152 115 1 Auto 8'5 E152 230 1 Non 43 1 2 or 3 BE152 230 1 Auto 4.3 Inclined 2 or 3 N153 115 1 Non 10.5 1 2or3 SELECTION GUIDE BmS3 115 1 Auto 10.5 Included 2c r 3 Ipgc variable level float E153 230 . 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggy BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. o CAU-no 2. See FM0712 for correct model of Electrical AlWmator E-Pak. All by 3. Variable level control switch 10-0225 used as a control acbvator'specify duplex (3) installation of controls, protection deuces and wiring should be done b a qualified licensed electrician. AA 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 402560347 Manllachxers . . St UP 3649 Cane Run Road L lazwl-f ~N6F (502)) 778-2731 le, K KY 402N 2961 .1(800) 928-PUMP FAX (502) 774-3624 httpl/wwwzoeUer.com © Copyright 2000 Zoeller Co. All rights reserved. V POWTS OWNER'S MANUAL & MANAGEMENT PLAN page_ or i FiLE INFORMATION SYSTEM SPECIFICATIONS J Owner Septic Tank Capacity al ❑ NA Permit. Septic Tank Manufacturer NA DESIGN PARAMETERS Effluent Filter Manufacturer 13 NA Number of Bedrooms E3 NA Effluent Filter Model E3 NA Number of Commercial Units Nq Pump Tank Capacity v ai 13 NA Estimated flow (average) and Pump Tank Manufacturer J~ Pump Manufacturer p NA Design flow (Estimated x 1.5 aUd - Soll Application Rate aUd /Q2 Pump Model 1 mot//J Z-- ❑ InftuentlEffluent Quality Monthly average' Pretreatment Unit Fats, Oil & Grease (FOG) S30 mg/L ❑ Sand/Grwel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/1- ❑ Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 /L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODS) 530 mg/- ❑ In-ground (gravity) _.p0o -ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade and Fecal Coliform (geometric mean) s1W cfu/100ml ❑ Dri ine ❑ Other. Maximum Effluent Particle Size Y, Inch diameter Values typical for domestic (non-commerclaQ wastewater and septic tank effluent Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every months ar(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 ar(s) (Maximum 3 yrs.) Clears effluent filter At least once every 4/6 month year(s) Inspect pump, pump controls & alarm At least once every ❑ months ear(s) ❑ NA months r(s) ❑ NA Flush la6rals and pressure test At least once every oe~er At least once every ❑ months ❑ year(s) NA c omr 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 pond'utg 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 1 T3, Wisconsin Administrative Code. The servicing of effluent filters, m nical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at ervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servic,0 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 conc&trations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page of START UP AND OPERATION painting Products or other chemicals thslt For new construction, prior to use of the POIA/TS check treatment tank{s} for the presence of detected have the contents of the may impede the treatment process and/or damage lithe dispersal cell(s). If high con tank(s) removed by a septage servicing operator prior to use. System start up shall nat occur when soil conditions are frozen at the infiltrative surface. will ble During power outages pump tanks may fill above normal highwater levels. When power is restored the excess vas effluent. discharged to the dispersal oll(s) in one large dose,: overloading the cell(s) and may result in the backup or Servicing Operator prsurface o d aag a ofer fl tnt To avoid this situation have the contents of the pump tank removed by a Septage Servicing tir the pump controls to restore normal levels effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating within the pump tank. the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, 15 feet down slope of any mound or at-grade soil absorption area. the life of the POWT: Reduction or elimination of the following from the wastewater stream may improve the performance, der ` ffep~ectargits, tat foundation draj.n antibiotics, baby wipes; cigarette butts; condoms; ;cotton swabs; degreasers; dental floes; dial (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; Painting produl pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be takers to insure that the system is propety 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 cornpW replacement system. ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelem. The replacement area should be protected from disturbance and compaction and should not be infringed upon by q setbacks from existing and proposed structure, pot lines and wells. Failure to protect the replacement area Will result in the neled must comply with the rule:: in for a new soil and site evaluation to establish a sortable replacement area. Replacement systems effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technologl/ 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 sibs evaluation j~ 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~rade soil absorption systems may be reconstructed in glace following removal of the biomes at the infiltrative ~rface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNIll 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 i-- z Name dame 6 - Phone Phone SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Name Name - Phone 2 Phone 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. ~9 U i '3 Y W N a y r c7 ~ i-- s 2 i F 11 is i q o CIO 4 P Cs ! ,C LU 0.- c m o P N ~ h y V =O 5 ~ Q co y Z W s :z o N ~ I f Wisconsin cep tt of Cor fnarce. SOIL EVALUATION REPORT Page I of 3 Division of safety and Buildings In accordance with Comm 85. Wis. Adm. Code Attach complete site plan on paper not less than 8112 x 11 inches In size. Plan must _ lndu de. but not limited to: vertical and horizontal reference point (Blot). *edion and Parcel I.D. p bent slope. scale or dimensioM north arrow, and location and distance to newest road. all, Piease print all informatfon. by Date PersorlM irfenrwrion You provide MY be used YLw 1) (m)). ~al 3 Property Owner Location E (a Lot f N E 114 N vu 114 S T Z9 N R 1-7 Property Owner's Mailing Address 7 . Block # Subd. Name or CSM# P + City State Zip Cod e Phn@ FFICE ❑ City ❑ VWage %Town NeareW Road I bjrrn na -1W k IS4015 (-U5) `tt~~ - 2 TI B New Construction Use: ff Restdendal / Number of bedrooms A-, j Code derived design Clow, rate 4,S6 11. &-2 GPD ❑ Rr nent ❑ Public or cominercial - Desak e: Parent material 't ( Flood Plain elevation If applicable tL General comments /OU• O 0 and recommendations: eke-v, gq,oo u/~~/ S~!-Bg~t ~-a f~iCo~ex~ L~.J-E,a.T` nloz~r-r ~•/a Boring # Ground surface elev. fL Depth to Wnitlng factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consist-erwif Boundary Roots GPD/W In. Munsed Qu. Sz. ConL Color Gr. Sz Sh. -Ett#1 -E f#2 f o-kZ (p 312 - '511 Zrra& Mfr C I v& .6 • 8 2 I2 - Zj .10,4(-q Iq St C-I Zmshk r c.5 _ `-f - 3 z - $ ~0 r sly( C-3P -1.5 S c f < -fir • - L Fq # Boring pit Grand surface elev. ~9. z y ft. Depth to limiting tailor a 0 in. Soil Appikation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflF in. Munseil Qu. SL ConL Color Gr. &L Sh. -Eti#1 •Eff#2 ( o- zo to s12 3i t k c 1 vT .5 8 2o- ( 411 5i c r CS Ll - ~ 3 c 1. Sca 3m - Effluent #1 = SODS > 30 < 220 mg1L. and TSS- >30 < 150 rng/L ' Effluent #2 = BOOS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Ada , 2 Address Date Evaluation Conducted Telephone Number 2lj3_$D?- S~a•,-,erSc,~t1% ~yQZS _~-S'~o Z ~~15~zy7-5'vv~' r 3 Property D►rrsr ~_.t 1~ Parcel iD # Z pap 2- of ©soft ❑ BorkV Pit hand surface elev. 7. 71) ft Depth to IinitlrW fads G. EL I Sal Application Rate Hodxm Depth Dominant Color Rector Description Texture Struc6we Consistance Boundary Raab GPDO h Mans" flu. Sz Cont. Color Gr. Sz IM `EM 'Etf#2 I l2 Se 12 k c l J, z tz k ti 3 V-On6 c .5" lihn Sit - - q 0 BorbV N` j Btxing ❑ pit Grout-d surface etev. , ft. Depth to 6rrdting factor in. Sal Appieadon Rate Horizon Depth Dominant Color Rector Description Texture Stricture Consistence Boundary Roots GPD/W Tn. Mtnsed Ou. SL Coat color Gr. SL SN. •Eff#1 •Efl#2 s ❑ Boring # ❑ Bor❑ Pit Grand surface elev. tt Depth to Gmi6ng factor in. Soil Application Rate Hatt= Depth Dominant Color Redox Description Texture Struch" Consistence Boundary Roots GPDIW in Munsell Ou. Sz. Cant Color Gr. Sz Sh. •Eff#l •01#2 • Ef6uent #1 = BODs > 3o < 220 mglt. and TSS >30 < 150 mgt. • Efftuent /t.2 = BOD, < 30 mgll and TSS < 30 ffv& I 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. SMM30(R07" PAGE_Z>_OF 3 NA T e T OT#~ LEGAL _ DFscguyTION ti E ~iAU!/4 q T Zq ,N.R, E(or SCALE: I"= y0 BM I ELEVATION 42. O BM I DESCRIPTION ¢aP o-~ I J`~ O* e BM 2 ELEVATION Q & O BM 2 DESCRIPTION P 4 1 OvG P'D P P' q SYSTEM ELEVATION /OG - O SYSTEM TYPE M 1) c) n d, S~5{e rn CONTOUR ELEVATION QO O VA- a b 0• .C , 3 ~ p p-3 6 p SIGNATURE DATE - 9 - oZ Y - I' ~ 4 I I I ' I _ ~ 1 I I ~ l um m Ohl 9~ ~I $~4~' z !III Mill III I I ~ II'lll'ilI III; M IIIpIIII'IIIII~ IIIIIII': L ~ II III II~IIII 'II III III "~a'r~~~~ III I I II I II I ~IIIII~Ii ~I ~IIII' a~ I n II I IIII~I ~I I I Ills ~Il~li,. l I I I~ III ; I I I I II III:' VIII I II Illy. III II III IIII~iI .b '9 I III I I IIIIII I „III ~ 11 k" IIII II~III~I ~ II VIII -t'~II1IIII i~~I i sx~ 11,1 IIIIII ~ ! { ~ I I ~ICI i , I ~~'77--_~~ I I c {l z~ o m I li i ' tom, c>W g~ mN DO 9D ~O m P. - r z Wig m CD I I zz fri'1 I s `a~ t cn CD p ~ F U 01 cx J Q o a 4). r` gi$fi C Z S p m2g LL33Gg°a 0 ~ a n W 3 r, l z ~g .,$8$~ ~ W E~ ~ W 8c's Q as a z w $r9 i t $ C i muwmTwaem~vu°~~ ~ ° 0 O N O m li ~e All I xfj~ •b~ ~m 'I au+aoavv~.n t r rnTMronvr I i € a ~ d;S~9 N Z s o E a~e~ I E O a 04 Cl) E U~qQ Hglfi$d OI M Q Q o o ~ W ~ ~3E ~ o Y Wa 333~l 111h] him 111111 1111. WE a a J J_ ri~i tn~z~ as ja 3O c I ~ Ww 1 y 88E8 1 a I I 1 ~ #E3 I ~ I I I I R 6`S 4e I I I ~e E:F ~ I • I ~ I I I ~ I I ~ II name o. «.axw~sxc I I I I «u l i_-_______-__ O o I I I I I I I -F I 1 III I zor«asmwwov ai I i $ I I s II I . i I I I s I < 11 I 3 O ~ ~ ~ I I I I , ~ I I I I 1 O ,e I I I y & ?1 i t I $ I I z II - I I 'J.^• L______. I El r F ~ 1 , sip A a z I ~ ~ I I I~ I b I I ( I I I I ~ -x I 1 r~.~ a I I r~ y3~snwwoan I I k ~ ~ rnisM«I it I 1 II I I ~ < I I , I I I i I I ~ I I I I I w I~ ~a BENCHMARKS: (SEA LEVEL DATUM) _ NW CORNER OF SECTION 9 - 1082.21' ~,;Ii SW 1/4 i SE 114 N 1 /4 CORNER OF SECT I ION 9 - 1069. 63' I ADDITIONAL BENCHMARKS ON PROPERTY IRONS "!I AS SHOWN, 1 ; 1 - ------------_:--.-J 1 TOOTH - ;;7E (NO SCALE) . UNPLATTED LANDS NORTH LINE OF THE NW 114 - - - - - - - - - - - - - - - - - - - S89°41' 59'E 2627.77' W THE w UE PUBLIC S01°47' 24'W I NOI'47'24'E ,S89°41' 2060.26' 36.63' 38. 71' r----------------- - r---'-' - 7 242. 64' 174. 18' 253.01' 413. 17' a+ I I e 240. l9' ro S N IR. lp LOT `A`Pfl' 40 140' 8 ¢ u' L 50 ACRES `i•'. a r.~. ~ . 65,394 S0. FT. ~ ; i - . CO 0. 47: p, OT i L LOT 7 LOT 6 0". i ,o. 1.51 ACRES 1.57 ACRES 1.65 ACRES LOT 2 ; 65, 98 1 SO. FT. HWE 1062" 72, 050 SO. FT. ?.10 ACRES 3 68,396 50.FT. 91, 582 S0.FT. LFE 1064'' o~ y p2 Q, y , m~~s 0'3 s Y A. / s lp, \V• I A s'9 ' /2'x'1' p' ~O. 3~2i O 354°59' 54'E y ° F ~O F 108. 14' Or 30 ~y v p5:' 02~ j~ ~f. X1.63 ACRES LOT 5 ,Fes' j / 5y0 y0 71, 184 SO. FT. HKE 1062' o Q I y 1.90 ACRES ©/y~4.1'~5 LFE 1064' . \ 82, 716 50. FT. y gg' 0 2 LOT 3 JOf LOT 29 moo. 30 ` 6 1.50 ACRES Q 65,409 S0. FT. 9°' 1.57 ACRES i ' G3~6• + 68,524 S0. FT. i `9i :i . p4 W s 6~~ 6 HWE 1062' ~ •6s, n+r x..39. Iyp.76T3Tg. F9\I ppS / b ~YS/o LFE 1064' ' 90 yp 003 6 / Jo.: /B, ~b° PG (L~ 70P OF 1' 1 ' o IR s. ON P\~ ,~o PIPE I.,. 5o' s 5' OO D. LOT 4 ~aR D", 2)o c ' i 5 I a 1.56 ACRES o \ ~0 L OT 28 7 ? B Q: REM, 9 O~ 67,804 S0. FT. 1.54 ACRES i ss, 4 0. F 9, \ \ 67, 027 SO. FT. 5'}:;Q 50+ RES 0. FT. I Z I m 0~' /w ~p ' Q',1, 7 4~• d G Q m p ~6 /s i FP Jae VOID= a~ v, ~2T1 m m OO / ' - i PAGE OF NAM~~~`,~ LOT# ~ LEGAL DESCRIPTION L'r X Y,S T 2' N R .(Qr SCALE: 1"= BM 1 ELEVATION l,(( BM 1 DESCRIPTION L40 ( / w' BM 2 ELEVATION C1 BM 2 DESCRIPTION -r ~ SYSTEM ELEVATION C' SYSTEM TYPE rd<~ C y r;~r ~z1 CONTOUR ELEVATION '/~,C)C Try- c pa-3 i SIGNA'T'URE DATE ~ - ~ - oZ