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HomeMy WebLinkAbout042-1090-20-620 ant of commerce PRIVATE SEWAGE SYSTEM County: St .vision Sanitary Permit No: INSPECTION REPORT 600218 _ INFORMATION (ATTACH TO PERMIT) State Plan ID No: irmation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)) City Village Township Parcel Tax No. Ader's Name: 042-1090-20-620 ,HARD STOUT TOWN OF WARREN i BM Elev: Insp. BM Elev: BM Description: Sectionrfown/Range/Map No: ~'S~ ~ ~rpn 32.29.18.497A-80 TANK INFORMATION ELE ATION DATA TYPE MANUFACTURE APACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Bldg. Sewer SU t Inlet O St/Ht Outlet TANK SETBACK INFORMATION 003 / LdL TANK TO W(11, WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Head r/Ma (5ok~ _ qt- v~M Aeration Di ..Pipe rkyM4' , q Holding _ Bot. System / 7~/1CJ /IQ Final Grade PUMP/SIPHON INFORMATION Manufacturer tw /1 Demand St Cover / U 8 GPM 7 Model Number TDH Lift a Friction Loss System Head TCII/r 8 Ft r Forcemain LenotbL- r Dia. /t Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengtyr / No. Of Trenches PIT DIMENSIONS No. Of Pits I side Dia. Liquid Dept DIMENSIONS 0 SETBACK SYSTEM TO P/L BLDG WELL LAK TREAM CHLEACHING AMBER OR Manufacturer: 'u 4/j/ INFORMATION Tyl~t//• ! I[//r~/~.. A ` n UNIT Mode mbl a /Ma ifold Distribution x Hole Size x Hole Spacing Vent to Air Intake / Pipe(s) /rl Length Dia Length is Spacing J 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 > a Topsoil es No Yes No ' ' s cti Wtl/ C P COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: In Location: 694 104TH ST J / J 1•~~ 1.) Alt BM Description 2.) Bldg sewer length = I 4ll d C /~/~~,y - amount of cover= O~ fnlDl `vim ~n~ 11vs`" cv f~ y e~ ors a y Plan revision Required? ❑ Yes No I JeL I Wf- B 3 Use other side for additional informatioRj Date Inse s Signature Cert. No. SBD-6710 (R.3/97) T IBUTION SY(((S///(((TEM c.~ _ {mss y rs1 .r ECEIVE® Safety and Buildings Division Count < fl 201 W. Washington Ave., P.O. Box 7162 Sanitary Perrah r Number ( be filled in by Co.) Madison, Wl 53707-7162 M NOV 21 201 ~yp4 P 41 7RH(; State Transaction Number ;QM ZUNI yw i" QF65p6 In accordance wit SPS 383.21(2), Wis. Adm. Code, submission of this tuiw SF~2 unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned PU v. :d to Pr " rf different than mailing address) r the Department of Safety and Professional Servies. Personal information you provide may be used for secu.idary purposes in accordance with the Privacy Law, s. 15.04(1 m , Stats. ~ j 1 L Application Information - Please Print All Information U Property Owner's Name Parcel # 070- Property Owner's Mailing /Address Property Location Govt. Lot City, State Zip(JCo 0 1 Phone Number ~ 1/4Section (circle o Type of Buil ding (check all that apply) Lot # . or W Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial -Describe Use Q City of Q State Owned - Describe Use CSM Number ❑ Village of r r 'PrTb'wu of III. Type of Permit: (Check only one box on line A. Complete line R if applica A. ew System Q Replacement System ❑ Treatment,'Holding Tank Replacement Only Q Other Modification to Existing a System ( pl -Pefink B- ❑ Permit Renewal Permit Revision Q Change of Plumber ❑ Permit Transfer m New List Previous Number and u BeforeExpiration s Owner W.-Ty-pe of POWTS S stem/Com onent/Device: Check all that apply) A -Pressurized In-Ground Q Pressurized In-Ground Q At-Grade Q Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Q Holding Tank Q Other Dispersal Component (explain)- Q Pretr°..atment Device (explain) _i_ V. Dis rsaVTreatment Area Information: _ l Des} Flow (gpd) Design Soil Application Ratc(gpdsf) Dispersal Area Required (sf) Dis al Proposed {st) System El VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units I s, 2 o _ o New Tanks Existing Tanks 2 o H ' y Septic or Holding Tank Dosing Chamber ~'1 /j E t~ n VII. Responsibility Stat t- I the undersigned, assume r p sibility for installation of the POWTS shown on the attached plans. PI 's Name (Print} Plumber's kAs&e MPJMP,RCS,Number Business Phone Nun er, (1,4----' Phim~ber's Address Street, City; State, Zip e) ? ~F' ! i VIII. Count.. a artment Use Onl Permit Fee Date Issued Approved Disapproved $ Issuing Agent Signature Q Q Q Owner Given Reason for Denial _ IX Coo}Itg fA goyaMeasons for Disapproval j Li y ` . ':r . > ✓D ✓ C lY 1 u r / ; tc l1LY) //i t~ /r?Gt % C! i 11. Septicta s. EifoWIT Hl- lit' Mme' Wia~, r~3~u20t~SYlQ2 dispersal till rt i. t 1 t as per manager ant po Ca e G fb ~/PSP~-y 2. All setback as per app 1 Ca ' ` Ib 'fcr the system and submit to the County only on paper not less than 8 in z 11 inches in size ' SBD-6398 (R 11/11) ~~~?Rae - " ECG' E 7RHGQF65P6SH2 r Wisconsin Department of Com @;~ 2 1 &J j SOIL E Page of Division of Safety and Building ST CROIX Ci"3r nce with Comm 85, Wis. Adm. Code County ¢ /Attach complete sits,p "bWr t l 1 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. !/J~ C~ n id 0 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location /f" t {:2 ' Govt. Lot~J ' 1/ J„~~IA S N E f'. Property Owners ailing Address' Lot Block # Subd. Name or CSM# 21 City -State p C e Phone Number City/ ❑ Village own J Barest Road L/I A 121 L_ I New Construction Us esidential / Number of bedrooms Code derived design flow rate ; GPD 49, ❑ Replacement A ❑ Public or commercial - Describe: Parent material ~ ~c e-JI Flood Plain elevation if applicable n~ l ft. General comments - andreconwnendations: System Type C ~9 lr''~ [ System Elevation F Boring # E] Boring Q pit Ground surface elev._LV' J ft. Depth to limiting factor Z~) 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 'Eft#2 k n Boring # ❑ Boring LJ Pit Ground surface elevl 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 Effluent #1 = BOD. > 30 < 220 mg& and TSS >30 < 150 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) a re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address D to Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 'f - r` 715-246-4516 -7 -r Property Owner _ Parcel ID # Page of ❑ Boring /i Boring # ® Pit Ground surface ele ft. Depth to limiting factor - IZL 'n. 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 17 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 a Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtff 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 = 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 -2-- of Boring Boring # 11 Pit Ground surface ele ft. Depth to limiting factor n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 C CJ Boring # ❑ -"rim t' ❑ F-1 Pit round 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 = BOD, > 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. SBD0.8330 (8.6/00) r Soil Test and System PLOT PLAN PROJECT Roscon Properties ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NW 1/4 NW 1/4S 32 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 96.5/ .0 4'below grade DATE 11 /20/17 3 BEDROOM CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK 111~~~ MOUND SEPTIC T K SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 80' B.M.* 60' . Property Line B-1 15' Scale 1 /4" = 10' a , Originally, I thought this was 0 0' the lot line, it is not, original 3 soil test begins 60' north of this location, and the soils are 70' much better in this new location 6% Slope Huffcutt Combo Tank Original location B-2 50' U r ~ ~Z GX cr. 2-3' X 66' cells with >3' spacing Po3 B droom H use All piping shall be ASTM SDR 30/34, within eaching Chamber jE, Quick4 Standard 10' of tank, piping shall be ASTM F891 ith 20.0 ft2 of Area .6ft^2/pair of end caps Gr ade at System Elevation 104th St. 34" Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer r Pump Manufacturer LAH- Tank Model Number Pump Model Number s Total Tank Capacity 3 0 Alarm Manufacturer c Max. Bury Depth Alarm Model Number Switch Type Filter Manufacturer Total Dynamic Head (TDH) - Feet Filter Model Number l Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM @ , C` Ft TDH Total J Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof 1 Junction Box . - - " Finished Grade - - Depth of Cover Vent Min. 12" kD connect Ft Above Grade Means With Vent Cap S S{ S S t i{ S t{ t i S S S S S S S S S S K S S S S S< Outlet Outle t Filter Inlet Inlet Baffle Switch Settings and Reserve Capacity %4" Weep an Volume GPI <ys I- Oslo Dimension Inches Volume Gal. B Hole > { >t> (reserve) A Y O/fff Elevation C >i (alarm) B 2 30 4 4 ?t? (dose) C - f/i J Ft P_ -4 Bottom (dead) D I,? j {>S Yt } } } D > Elevation Total ✓2 <'< Y>>>>>>> ~Ft > > > 3 > > s > > > } Y } s > Y > } 3 > } > > > } > > 3 Y > > > a a > a > > r > :i= ai : t: r > > > > Y S t<_<_{ i= t t{ t{ i S{< t<= i= i i={ t t i= i<<= i t i i t t i t t i > S S} Y}} Y Y Y Y Y Y> S Y S Y} Y Y Y S Y Y} Y Y>> Y S>>} 3>}> Y Y S Y>> Y Y Y} 3 Y>}>>>> GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of TOTAL DYNAMIC HEAD/CAPACITY w HEAD CAPACITY CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENT AND DEWATERING 25 Mocel 53/55/57/59 6 LO Ft. Meters Gal. Lt r5. a a I 0 1.5 43 63 5 Imo. r + 29 i z 4 .5 4.6 19 72 Shut-eff Hecc 19.25 ft. (5.9rr) 2 ~ 5 y 3 I V 161,-- 6 5/32-+ 4 5/8 /2 /2 NP! c-1- ' i U.S. GALLONS j 10 2 30 40 50 l _iTERS 3 15/16 80 oG + Q a _ FLOW PER MINUTE 009897 --T ai I r ~v >-4",q'o'a SAC Variable level float switches available. Variable level long cycle systems available. Available with special cord lengths of 15', 25', 35' and 50'. i Alarm systems available. 10 Duplex systems available. •I 'v I 3 3,/32 ' iV1 SK858 Single Seal Control Selection Listings _E ICE`' ' Model Volts Phase Mode I 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 N53155 & N57/59 115 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FM0477. BN53 115 1 Auto 9.7 Y Y 1 Mechanical alternator "M-Pak" 10-0072 or 10-0075. BN57 115 1 Auto 9.7 N Y BE53157 230 1 Auto a.8 Y Y 4. See FM0712 for correct model of Electrical Altemator. 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 3o r 4&5 Y Y Alternator (3) or (4) float system. Single piggyback switch included. O CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches, FM0477; e Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump)Sewage Basins, FM0487; and Single Phase -nd Simplex Pump Control/Alarm Systems, FM0732. C, - ` -c-, 3 S ' For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOY 599 1 - / Louisville, KY 40250 Manufacturers of.. ri7 SHIP T0: 3649 Cane Run Road 7O Louisville, KY 402111961 QLIAL/TY PUMPS SHOE I~dc/ " ® (502) 778-2731 - 1 ( 08-PUA1P http://www.zoeller.com ' PMMf' !O_ FAX(502)774-3624 © Copyright 2002 Zoeller Co. All rights reserved. Saw- ~q 01-7 - 3 sS Corm I y r~I Safety and Buildings Division < ' ' p ' j 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) OCT ~ > P Mad' , W1 3707-7162 CROD(COUNV pMOPMENT Sanitary Perrp.. F#fW,TCXA yp StateTransaetion ber In accordance with SPS .383.21(2), Wis. Adm. Code, submission of this form to the apy,.,r. _ r T/~ p u6it AM is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are suvi--ed to r Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be ed for secondary r j purposes in accordance with the Privacy Law, s. 15. 1 m), 5tats. r q I ' U 1 L Application Information - Please Prin 1 Information Property Owner's Name Parcel # -L -//?,Yo -,;o W61 Property Ownrs Mailing Address ~o e Property Location 3). 3 s~, Govt Lot C~ , state - Zip Code Phone Number 1/., 21211., Section le o IL T pe of B/~ing (check all thatlappl Lo T N; R W 2 Family Dwelling-Number of Bcdroo Subdivision Name oK ❑ Public/Commercial -Describe Use ~ 3-~~ ❑ City of ❑ State Owned - Describe Use CSM Number Village of 71 1!* Ce&6 L~~ AA III. Type Permit: (Check only on box on line A. Complete line RVi*Rdablef o ~r A S stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List evious Permit Number and Dare Issued Before Expiration Owner .a 41 IrV.Aype of POWTS System/Component/Device: (Check all that apply) -f- dc-t.- I 0j ILI Qressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 m. of suitab]e sorl/~/~ e 0-HolaingIME ersal Component (explain) ❑ Pretreatment Device (=-plain) r''~j J V. Dis rsaYrreat went Area Information: % r Design Flow (gpd) DesiP S .1 Appli cation e(gpdsf) Dispersal A,-Q- Required (sf) Dis opose sf) S errr Elevation VL Tank Info Capacity in Total # of Manufacnaer Gallons Gallons Units J $ y ]new Tanks Existing Tanta Septic o Holding Tank Dosing Chamber l VII. Responsibility State - 1, the undersigned, a e responsibility for installation ofthe POW TS shown on the attached plans. Pl' s Namentl Plunt Signature MP/IvTRS Number Business Phone N er L le, )(V L6 Plumber's Address (Street, City: State, Zip VIJI ounty/De ar•tment Use Only Approved Permit re Date Is ued Issuing t Signature Reasons f~o~r~ enial 001 17 as LX Cond eplgor,l~approval ~tJr~14,~, A (iiSper'sti cell must d11 be S~t`.1Ca~S / rt?~ in±a. •ec ~ ~ _I a as per, Itar:agement plan p! o tided by pluinbe;~. M4 ~ 0~'~"~ rv~+0 2. Ail mftck rec,,Uretren,s mu t,Oe i-a6rd,rir.Ed n go per Wilotlbilt cox r ! ~.rdinmcr i. yy ~d✓l Attach to complete plans for the system and submit to the Couyty only on pa less 8 u1 z I1 inches in si It SBD-6398 (R. 11/11) 0 ~ f~5~ System PLOT PLAN PROJECT Richard Stout ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NW 1/4 NW 1/4s 32 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 96.5/95.5 3.5' below grade 10/3/17 BEDROOM 3 DATE CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 131 # of chambers 56 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark L\B.M.* 60' 269' Property Line 15' Scale = 1;4" = 10' Vents -2 30' 40' 2-3' X 114' cells with >3'spacing B-3 Area of poor soils 12% slope 10, Scale is F9 = 40' unless otherwise 60 noted Vent >6" Quick4 Standard of Cover Leaching Chamber 96 with 20.0 ft2 of Area B-1 98 5.6ft^2/pair of end caps 12" Long Grade at System Elevation 34" 40' Huffcutt Combo Tank 25' 70th ave Pro 3 Bedroom House 332 Property Line 9~ f 0; dv'All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/3/17 Owner: Richard Stout Location: NW 1/4 NW 1/4 S 32 T29 N,R18W lot 6 e Warren 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. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specificatio Sheet 8. Dose Tank Cro ection 9. Pump Curve Signature lF L License nyWer #226900 System PLOT PLAN PROJECT Richard Stout ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NW 1/ 4 NW 1/4s 32 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 96.5/95.5 3.5' below grade 10/3/17 BEDROOM 3 DATE _ CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1131 # of chambers 56 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark ~\B. M. * 60' 269' Property Line Vents 15' Scale = 1/4" = 10' -2 30' 40' 2-3' X 114' cells with >3'spacing 13-3 Area of poor soils 12% Slope 10, Scale is F = 40' unless otherwise 60 noted Vent >6„ Quick4 Standard of Cover Leaching Chamber 96 with 20.0 ft2 of Area 5ft .6^2/pair of end caps v B-1 98' 4' Long 12" Grade at System Elevation 34" 40' Huffcutt Combo Tank 25' 70th ave Pro 3 Bedroom House 332' Property Line ` All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99.0' Vent A C-11, Vent 3' 4" 3' X30/34 Septic Tank 5' Long 1 5' 5' Long 1 Grade at System Elevation 3611 Grade at System Elevation Spacing 5' 2-3' X 114' Cells Same on other end Observation tubeNent At end of cell A B 28 chambers per cell System elevations: A 96.5' B-95.5' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE.,'AGREEMENT AND OWNERSHIP CERTIFICATION FORM ~r Owner/Buyer Maihng Address QQ~ cc-4 't~ Property Address 4- ~ q4 9--.- _-4,-, - (Verification required om Planning & Zoning Department or construction.) C s City/State Parcel Identification Nur:aber LEGAL DESCRIPTION Property Locatio/4 ,Sec., T~N R~ W, Town of Subdivision Lot Certified Survey Map Volume 2, Page Warranty Deed Voltune Page # Spec house yes Lot link:; identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, ii needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal systern •with the standards set forth, herein, as set by the Department of Commerce and the Departrrtent of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three ear expiration date. I/we certify that all statements on s form are true to the best of my/our knowledge. I/we an/are the owner(s) of -the property described above, by virtue of a wa anty deed recorded in Register of Deeds Office. Number of edr i11& /3 / ATURE OF APPLICANT(S) DATE **Any information that is misrepresented may result in the sanitary permit being rr:voked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (.REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity r ❑ NA Permit # Septic Tank Manufacturer ❑ NA )ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 112 O NA i Number of Public Facility Units j9ZNA Pump Tank Capacity j al qAA i Estimated flow (average) Uda Pump Tank Manufacturer f NA 3 Design flow (peak), (Estimated X 1.5) / .1 alida Pump Manufacturer Z MA ❑ NA Soil Application Rate aUda /ft2 Pump Model / S 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) 5220 mg/L ❑ NA Cl Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other. iMaximum Effluent Particle Size Ya in dia. ❑ NA Other. ❑ NA Other A Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other ❑ NA IAINTENANCE SCHEDULE _ Service Event Service Frequency -:5 Q linspect condition of tank(s) At least once every: month(s) (Maximum 3 years) ❑ NA ear s (Pump out contents of tank(s) When combined sludge and scum equals one-third (36} of tank volume ❑ NA llnspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) ❑ NA ear(s) Clean effluent filter At least once every: oath(s) ❑ NA /j _ ear(s) Inspect pump, pump controls & alarm At least once every: month(s) _ ear{s} ❑ NA I=lush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) 7)ther. At least once every: ❑ month(s) NA ❑ year(s) jXher: 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 linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of i~;ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local -egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (f6) or more of the tank volume, the entire contents of j:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. IIii other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION products or other chemicals ttu(t For new construction, prior to use of the POWt S check treatment tank(s) for the presence of painting detected have the contents of thO may impede the treatment process and/or damage the .dispersal cell(s). If high concentrations are tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are from at the infiltrative surface. will bls During power outages pump tanks may fill above norrnal highwater levels. When power is restored the excess wastewater To avoid this s situation have cell the s in one contents of large the dose, pump tank the removed cell(s) and may result in the backup or surface discharge of effluent discharged the ttion dispersal i Servicing operator prior to restoring power to thle Septage the pump controls to restore rumrnnal 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. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife 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; gasofine; grease; herbicides; meat scraps; medications; oil; ping Produc4s; i, pesticides; sanitary napkins; tampons; and water softener brume. 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 code conPiint If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption syste . The replacement area should be protected from disturbance and compaction and should not be infringed open by roll ►►e 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. Replaeemerd systems must comply with the mule:/ in effect at that time. 13 A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technologN 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 sal and site evaiuaoon 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 biornat at the infiltrative surface. Reconstrac bons of such systems must comply with the rules in effed 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 O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name '/77 Name r cam, Phone i Jr t J Phone SEPTAGE SERVICING OPERATOR (PAimpER) LOCAL REGULATORY AUTHORITY Name Name ~Z j-4 Z Phone (L ;7 Phone ` j (J (a 1 -0 1 sy 4- This do=rat was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.64(1), (2) & (3), Wises Ad mInWhative Code. i 1 a 11. 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I ~ § !'/fu-A .M/nA'r fir fiA A I i -'t~----- i R i II _ - - - x ~ 0 0 - I ig s A.A T IH~ IQ ti I- I - - - I I I ( to firs R R H i R AL Ae F ~i 5-.11 1-A S[SJ I - ---------C------ I I A x i _ a _ § n Y _ a - PI-S I n L i P-F Q - - - - - - - I 4 x F"F1 A~-F i ~3 7 b ~ 53S31kLL iKKJli .tl - - ~m 1 5 R R ,A( AI Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings 19, in accordance with Comm 85, Wis. Adm. Code County Attach complete sir not ss than 8 1/2 x 11 inches in size. Plan c~ j include, but not limcal orizontal reference point (BM), direction and ftz~ PkW I.D. Z~ ~JG~ percent slope, north arrow, and location and distance to te~a/rest road. ease print all information. rP 26 R '.wed ~D/at Personal information you provide maybe used for secondary purposes (Privacy Law, tp_04 (1) (m)). O/ / l oil 3 Property Owner Prope lktion r7<,"Govt. Lot1/4 4 S N R E (or i Property Owner's Mailing Address ? Lott Block # Subd. Name CSkW 1W 14 7_ City State Zip Code Phone Number ❑ City ❑ Villa Towr~ Nearest Road New Construction Use;Z~Residential / Number of bedrooms. 5 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments iD~r+.~ 5c0",'e, /jfJy~,~~ > and recommendations: f~N rJ 5~ ~ /'1' 3'` Ao,^; t(A,~ w ~ System Type System Elevation Boring # El Boring C F 7 i E~, pit Ground surface elev. Q ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. /My unsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 0 - o," Jl_ yr r t~ Rbj Boring Z . Boring 4 J pit Ground surface elev. 9 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 Z - l0 s/ c M 31, k -F,~ r., r F Y . ri ~i a" rsv ~5 QS rnJ n in A) Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL r` ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ; s_ 715-246-4516 s Property Owner _ Parcel ID # gage of F31 ❑ Boring" Boring # ® pit Ground surface elev. ft. Depth to limiting factor in. I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP /if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z Z_ '1 G m~ r ~S r,Wy~ 7., S f 4 F-1 Boring # ❑ Boring ❑ Pit Grou d surface elev. Depth to 'samiting factor in. Soil Applica4i6 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 lication 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 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. SBD-8330 (R.6/00) Property Owner _ Parcel ID # page of Boring # ❑ Boring e Pit Ground surface elev. ft. Depth to limiting factor in. YY 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 tn FY 2 `I GI rhFr .a ' r T S WY 1 n r f- I ! I I 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/fr in. Munsell Qu. Sz. Cont. Color f Gr. Sz. Sh. 'Eff#1 'Eff#2 i Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. El Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/lT 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 = 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. SBD-8330 (x.6100) Soil Test Plot Plan Project Name Richard Stout Shau ' ird Address 1353 Awatukee Trail Hudson Wi 54016 CS #226900 Lot 7 Subdivision Date /24/13 NW 1/4 NW 1/4S 32 T 29 N/R18 W Township Warren ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD * H R pSame as Benchmark B.M.* 60' 269' Property Line 15' B-2 30' 40' B-3 Area of poor soils 12% Slope 10' Scale is 1" = 40' unless otherwise noted o' 96' B-1 98' 70th ave 332' Property Line