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HomeMy WebLinkAbout036-2001-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600252 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: DANIEL & DAWN HAZZARD TOWN OF STANTON 036-2001-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: da Y1/1 ( G 31.31.17.620 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ; S CAPACITY STATION BS HI FS ELEV. 9 Septic Benchmark , c~.J Dosing Alt. BM GcraMerr Po l0 Bldg. Sewer Holding r St/Ht Inlet ,t 11 TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL LDG. Vent to it Intake ROAD Dt Inlet Septic ;_4 Dt Bottom g~ a Dosing 2~4 / Header/Man. "793 5 Aeration Dist. Pipe Holding Bot. System 7 PUMP/SIPHON INFORMATION Final Grade 2.44(o ~$-or, Manufacturer \ Demand St Cover O V ~ Model Number .67061 TDH Lift Friction Loss System Hea TDH3 i I Forcemain I Lengt4> Dial Dist. to Well SOIL ABSORPTION SYSTEM, BED/TRENCH Width Leng~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ✓ 2 776V -4 ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactures c INFORMATION Type Of System: A CHAMBER OR /►T' Ge A~a $ l UNIT Model~e'~ ~'1R 'k 4 ' DISTRIBUTION SYSTEM 8 0J 4A, 1-7 /16 / (o L3 (y ~~Jb Header/Manifo? Distribution x Hole Size Ix-Hole Spacing Ve tAir Intake Pipe(s) ® V Length Dia Length \ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only s Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center I / ,it Bed Trench Edges Topsoils Noss No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1815 144TH ST 2- jr 1.) Alt BM Description = C..Ov Gt Q,,J.,j - &k-2.) Bldg sewer length = 15 ' 10 - amount of cover = /I ~I Plan revision Required? Yes bQ Nc (-7 2 Use other side for additional information. ! ® J SBD-6710 (R.3/97) Date Insepctor's S ature Cert . No. 1~,1-, i, ~ ~ - 3 (v c ECE- County ,a Safety and Buildings Division 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) SP OCT 2 7 2017 Madison, WI 53707-7162 j~e 7 ST. CROIX COUNTY V✓«// G . State Transactio Number anrtary ermit Appli~~+- A 6Z65a , In accordance with SPS 383.21(2), Wis. Adm. Code, submissiono. n GY J v~--,.late governmental unit is required prior to obtaining a sanitary permit. Note: Application I `G -..,c-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal inforn.ation you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1815 144th Street L Application Information - Ple int All Information A Property Owner's Name Parcel 4 Daniel and Dawn HazzardI 036-2001-30-000 Property Owner's Mailing Address i Property Location 1815 144th Street Govt. Lot _ City, State Zip Code Phone Number Section 3_ New Richmond W. 154017 T 31 N, R 17 (e`TeIEoIIe) H. Type of Building (check all that apply) r23 Subdivision Name 29 1 or 2 Family Dwelling -Number of Bedrooms_ - H ooks 2nd Addition ❑ Public/Commercial - Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use 't ❑ Town of _..Stanton - .3 III. Type of Permit: (Check o ly one box on line A. Complete line R if applicable) A. ❑ New System t l Replacement System g ❑ 'I'reatment/IIoldin Tank Replacement Only Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POWTS S stem/Com onent/Device: Check all that apply) IX Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrf rea ent Area Information: Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required f) Dispersal Area P posed (sf) System Elevation 450 .70 643 660 92.5 VI. Tank Info Capacity in Total # of Manufacturer Q? Gallons Gallons Units U lylo~ 525 New Tanks Existing Tanks o y a O 1 G a U v H cn is., C7 A.. Septic or Holding Tank 1000 1000 1 Wieser X Dosing Chamber 600 600 Combo X VII. Responsibility Statement- 1, the undersigned, assume, esponsibihi for insta-Hati of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' S nature MPIMPRS Number Business Phone Number Keith Knudtson ; z 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th Street Roberts Wi. 54023 VI oun /De artment Use Only pproved Permit Fee Date I ued Issuing nt Signature e) Slk $ g5 o 1-7 v_;_ 1~~~ Keaslyp eason for Denial on 0e) IX. Condit t rI,Ilisapproval (iiS~,12t:::n cell must dll as per maragement plan p!a iiaerl bV plumber. . 2. -g# serow* ree;Wwt::encs mtritbft ,",dintc it, (I as per P41imbl±t c xk ! i~ ~ per not than 8 112 x 11 inches to size Attach to complete plans for the system and su 't t e o only on pa / AS SBD-6398 (R. 11/11) J U3 ~ O ~ b Cl) ,Lf) Z31 N C- Lc co o M ~0 -MQ u c ~ n 42 Y M * ma ca ti n1 "r Q' Z1 v ~1 O y N ~ M ,a O C-1 -1 Ol Q W cr p 0 0 TI) o n A Q o \ n ~ r CID Q) o n a !1 o m o c~a rn ~ 2 x E- Z. M q~iro L° ^ d' N O N VS « C~r-06 n n n o o S W Ai C4 Ga fA w E.. c 0 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Hazzard Replaceent Owner's Name: Daniel and Dawn Hazzard Owner's Address: 1815 144th Street New Richmond Wi. 54017 Legal Description: S 31, T31N, R17 Township: Stanton County: St, Croix Subdivision Name: Hooks 2nd Add. Lot Number: 23 Parcel ID Number: 036-2001-30-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Keith Knudtson License Number: 648443 Date: 10/27/2017 Phone Number (651) 470-1737 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWrS Version 2.0 SBD-10705-P (N.01/01). Page 1 M o ~ m z ar .r n ~ CC w u co r.mOU n z of ~ n fi ~ ~ V ~o a r O~ w ~~~V v T~ 3 cy E A ~ q o a o d W g \ W spy w V q a C4 3 as x U J Ln z J \ 4 ~ CL~ q o z ti h O O n rn II o as o m rn ~ ~ x n m a~ H v to co quo"vo d:NO a~rn C ON r oo T! ON 0\ o\ n n n o ccal it u :2 AA wen en MM a~ e.. 0 '_1 0_7j"'_ PL-525 EFFLUENT FILTER -525 Filter is rated for '0,000 GPD (gallons per day) 1/16° Filtration Slots Awtm , ^-,=_'7g it one of the largest filters n ,r , _iass. It has 525 linear feet % filtration slots. Like the A=ptsPVC Exterd ^Han& . A PL-122, the Polylok ~ =25 has an automatic shut x, nail installed with every filter. ars e~ the filter is removed for - Vii= r nng, the ball will float up and ; porarily shut off the system so ' effluent won't leave the tank. 525 Litrear Ft of 7/1G ether filter on the market can ua,Slots _<e that claim. Hated for am ~atmo cro ACCWM 4& 6' v ~ u a ~ l3 ti ~vw o SCHO. 40 Rpe PL-525 Effluent Filter should erate efficiently for several years - - -der normal conditions before 0 -=puiring cleaning. It is recom- T Tended that the filter be cleaned every time the tank is pumped or flows between least every three years. If the ' 400 - t,500 stalled filter contains an optional VVnife this filter aiarm, the owner will be notified Can handla!arge' flows be and ' by an alarm when the filter needs servicing- Servicing should be z Wcertiffedfor done by a certified septic tank R --__O Clas reSiden'tial pumper or installer. Autonuft Shut-Off 1. Locate the outlet of the U.S. Patent No# 6,015,488 ~ is 5,871,640 septic tank. 2. Remove tank cover and pump tank if necessary. 3. Glue the filter housing to 3. Do not use plumbing when the 4" or 6" outlet pipe. If filter is removed. Ideal for residential and com- the filter is not centered 4. Pull PL-525 out of the housing. mercial waste flows up to under the access opening 10,000 Gallons Per Day (GPD). use a Polylok Extend & 5. Hose off filter over the septic Lok or piece of pipe to tank. Make sure all solids fall 1. Locate the outlet of the center filter. See page back into septic tank. septic tank. 19-21 for Extend & Lok 6. Insert the filter cartridge back 2. Remove the tank cover and information. into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter the filter is properly aligned into its housing. r and completely inserted. 5. Replace and secure the septic tank 7. Replace septic tank cover. cover. Soil Abs melon S twn Cross Section It 97.50 ft V Schedule 40 Final Grade PVC Vent Pipe 93.50 With Vent Cap ft Leaching Chamber ~ 92.50 ft System Elevation 3.00 ft 3.00 ft ft Soil Absomtion Svstem Plan View ft 3.00 ft ~ I 3.00 Leaching Trench 1 ft Chambers IIIIMIIII 4' Dia. Trench 2 Header Vent Or Observation Pipe liiiiiiiiiiiiiiiiiiiiililillimillI I Trench 3 Leaching Chamber Specifications Manufacturer And Model EiSA Rating 20.00 sq ft per chamber Soil Application Rate 0.70 gpolsq ft 450-CS gpd Design Flow - 0.70 Soil Application Rate 20.00 EISA = 33.00 Chambers 3 rows of chambers each. Page of Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Wieser Pump Manufacturer Gould Tank Model Number MR 1000/600 Pump Model Number EP 04 Total Tank Capacity Alarm Manufacturer SJE Rhombus ! Max. Bury Depth Alarm Model Number Tank Alert Switch Type Filter Manufacturer Polylok Total Dynamic Head (TDH) - Feet Filter Model Number 525 Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM Ft TDH Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box Finished Grade i ~ ® Depth of 1 Vent Min. 12" Cover Disconnect Ft Above Grade Hearts With Vent Cap ' rt Outlet Outlet Filter Inlet Inlet Baffle rc' 'i A Switch Settings and Reserve Capacity t/4y' > Tank Volume = GPI Weep Hole ai> Dimension Inches Volume Gal. < B (reserve) A 20 335.20 < (alarm) B 2 33.52 OffFIevation C ;R > > , >j> (dose) C 5 83.70 Ft Bottom (dead) D g 150.84 D F'--lion Total 36 603.26 <'< < < < < < Ft > > s > > > : a s a > > a > a > s > a > s > a > a a > > > > a a<><><><>`><><><>i'<aiy<'SySy<><><at'<><'<'Sa<><'<y<'<}<><><><><><'<y<><><><'<>ta<><a<><yty<y S}<,<><><a S><><><a<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. 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 MGOULDS PUMPS Submersible Effluent Pump MODEL EP04 & EP05 r' Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermo- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for plastic enclosed design for heavy duty ball bearing con- following uses: lubrication and efficient improved performance. struction. Effluent systems heat t ansfe; i Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion manual operation. Automatic Canadian Standards • Heavy duty sump resistance. Association • Water transfer models include Mechanical E Motor Housing: Cast iron for ce us File # LR38549 • Dewaterin Float Switch assembled and g preset at the factory. efficient heat transfer, strength, and durability. Goulds Pumps is ISO 9001 Registered. SPECIFICATIONS FEATURES ■ Motor Cover: Thermoplastic • Solids handling capability: ■ EP04 Impeller: Thermo cover with integral handle and 3/4" maximum. plastic semi-open design with float switch attachment points. • Capacities: up to 60 GPM. pump out vanes for mechanical 0 Power Cable: Severe duty Total heads: up to 31 feet. seal protection. rated oil and water resistant. Discharge size: 1 /z NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: METERS FEET - - 1040 F (4011 C) continuous 10- 14011 F (600 C) intermittent. • Fasteners: 300 series 9 30. - - - .I - - - -►~~-5 GPM - stainless steel • Capable of running 8 ! ~2-5 FT dry without damage to zs- components. a 7 w 6- 20* Motor: " - • EP04 Single phase: 0.4 HP Z 5 - L _ - - 115 or 230 V, 60 Hz, 1550 15 RPM, built in overload with Q 4 automatic reset. o EPOS • EP05 Single phase: 0.5 HP, 3 10~---- - - - 115 V or 230V, 60 Hz, 1550 Ero4 - RPM, built in overload with 2 - - - - - automatic reset 1 5' • Power cord: 10 foot standard length, 16/3 0 00 10 --so ao - s SJTW with three prong o GPM grounding plug. Optional 20 foot length, 16/3 SJTW with o 2 4 6 8 10 12 m3/h three prong grounding plug (standard on EP05). CAPACITY I Goulds Pumps ©200517 Water Technology, Inc. ITT Industries Effective January, 2005 ~~~JJJ 83871 Page 7i 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 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or:must be taken, to provide a code compliant replacement system. ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T aluati r a o ing ank be i e ai e T fZ0f-/ 115 TTY D Q /Ja'j Cahrs77~ct D ❑ Mound 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 ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Names Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name UIV 2UA~j~ Phone _ Phone `7 / S- 3 (I (O This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Daniel Hazzard Septic Tank Capacity 1000 gal ❑ NA Permit # Septic Tank Manufacturer Wieser ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer POlylok ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units NA Pump Tank Capacity 600 gal ❑ NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer Wieser ❑ NA Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer Gould ❑ NA Soil Application Rate .7 gal/day/ft2 Pump Model EP04 ❑ NA Standard Influent/Effluent Quality Monthly averages Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Conform (geometric mean) 5104 cfu11 DOmI ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other. ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA D year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA . Inspect dispersal cell(s) At least once every: 3 ,jy year( month(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: / ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: I ❑ month(s) ❑ NA V year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 (Y3) 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 2 4 ,.e_ L- a <AZ 91 a, kc- I? X74' !3 a. Mailing Address / e16- Property Address Oq~ (Verification required from Planning & Zoning Department for new construction.) t City/State PQe~ CO/Parcel Identification Number LEGAL DESCRIPTION Property Location 1/4 , 1/4 , Sec. 31 , T ~$/N R_ZZW, Town of $Tc~ ~ Subdivision S r~tG , Lot 4~ Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiab 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, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements /t' rm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a deed recorded in Register of Deeds Office. Numbe of bedrooms SIGNA F APPLICANT(S) DAT1J ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) • • 9 q - pv N . "tea' O., gy, 1f 000 J. \ f o p~ 69037. h0 ~ O 4' iq 30\ 16 2 173 36' 14 o T g5~ 17 i B 2 0„ o - o h ~e O 1 0 ° O n ♦M 9 SSO 2 ~ 6♦ _ ° ~ ♦ J J e B n 3 :r Eg p T° r. fY N 6~ ..11 i'. 6 00' 9 136. E4' 2 _ 6' 0 0 ♦ e.y♦ n gg 90e 567053 W ;6 trJ //..s 64036' -1180g r'~H3. L gti~y e e , 22' to a. 0 cD T0 ?e,, 8 0 ~ 29' 0 E. = 2 3, 1 p N In W; N PS h '59 0 '0 B3 ° ' ° ° a, 0 /V *N ejO % -s. f 90 141.88' 2s• 3' e a X33 30 4 O ~ .Np ~ ♦ '~Oo S 67°53 W e2b 2 ~ ^ - o Ch t, O a • P2 9 0 ° 22 o w 86+00 our a g° 160.00 Oe N m o a- N 9 687 53W 90 N m p Oe - 9 in eM Z N 6a 167.67' 900 9~ 163.46' TB o4 N S N ' y S87°53'W Je 9 90e S 87°33' W 0 O (D QD -C> > 15 o n o ° n 0 23 iv = 2 - D 4 - ° N P3 - m P4 Te0 aka 900 0 ,60.00 800 A866.00'°° 9° 183.30' ~0, 2 4' C 6A 179. 04' 9 88705eW 590.34' 1 Point of beginning 2035.62'East 5 618.83'North UnplotHd londa •0 V ' of SW corner of Sectloar 31, T. 31 M.,R.17W. Elevation data Nov 13, 1963 surface level 6 high rater 977. 08 7 Estimated lo,w v,ater level 974.50' C _ Elevations from U.S. Boo Survey B.M. A-50(1934) Elev. 997' 56.00. it Wiss~n De partrnent of Safety and Dh;'slon of tniittstry Senn * 'IIL EVALUATION REPORT #3195 Page 1 of 3 ~,q t1i ~a~ in accorc ia. `aS 385, Wis. Adm. Code Keith Stoner CST County Attach complete site plan o ~/z x 11 inc.. Plan must St. Croix include, but not limi t~ ference poin, ion and 4t - - percent slope, sca s rt arrow, and location and 9arest roa ~Q~ 2 1-3 000 Please print all InformaSon. DaQ Personal information you provide may be used for secondary purposes (Privacy Law, s. Property Owner Property L, in Daniel & Dawn Hazzard Govt. Lot 114 /4 31, T31 N, R17 Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 1815 144th Street 23 Hooks 2 D Addition City State Zip Code Phone Number [ City [ Village [%j Town Nearest Road New Richmond WI 54017 Stanton Same New Construction Use: [XI Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD [;I Replacement Public or commercial - Describe: Parent material Sandy Outwash Flood plain elevation, if applicable NA ft. General comments Propose 3 dispersal cells 3 x 45' located across a 2% slope. Centerline of 1 st/North cell staked at well and structure setback. and recommendations- System elevation for all cells of 92.50'. *1' rule applies to Boring #1 - SPS 385.30(3) tq / Baring # 1-1 Boring X1 ptt Ground surface elev. 97,46_ _ ft. Depth to limiting factor _ >12_0 _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/_f_t2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-10 10YR3/4 Fill SO 2msbk mvfr cs 3f-co 0.6 0.8 2 10-20 10YR3/2 Buried A sit lmpl mvfr gs 3f-co 0.4 0.6 3 20-28 10YR414 - sil 2msbk mvfr gs 2f-co 0.6 0.8 4 28-36 10YR4/6 - sicl 2msbk mfr gs 2f-co 0.4 - 0.6 5 36-48 10YR4/6 c2d5YR5/8 sicl 2msbk mfr gs if-co 0.4 0.6 - - 6-- 48-51 - --10YR4/4 Is - - Osg ml gs if 0.7- y! 1.6 7 51-120 1OYR4/4+5/4 s OSg ml - - 0.7 1.6 Boring # Boring oft I Pit Ground surface elev. 97.24 ft. Depth to limiting factor >118 _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Ef1#1 "Eff#2 1 0-9 10YR3/4 Fill A 2msbk mvfr cs 3f-co 1 0.6 0.8 2 9-18 10YR3/2 - sil 1mpl/2fsbk mvfr gs 3f-co 0.4 0.6 3 18-21 10YR4/4 - Sicl 2msbk mfr gs 2f-co 0.4 0.6 4 21-44 10YR4/6 - sic/ 2msbk mfr gs if-co 0.4 0.6 5 44-118 10YR414+5/4 s Osg - ml - - 0.7 1.6 Effluent #1 = BOD s> 30 < 220 mg/L and TSS 30 150 m E uent #2 = 8005 <30 mga. and TSS r30 mg/L CST Name (Please Print) Signature: CST Number Keith Stoner I; 224059 - - - Address Keith Stoner CST Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 412412017 715-566-0900 son-9330 (rt.07113) Property Owner Daniel & Dawn Hazzard Parcel ID * 036-2001-30-000 Page -2--of 3 Boring F3 Boring # Pit Ground surface elev. 98.00 - ft. Depth to limiting factor > 123 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10YR3/4+4/4 Fill sl 2msbk mvfr cs 3f-co 0.6 1.0 2 13-24 10YR3/3 Fill sil lmpl mvfr gs 2f-co 0.4 0.6 c2d5YR5/8 3 24-46 10YR4/4 - Sid 2msbk mfr gs if-co 0.4 0.6 4 46-52 10YR4/4 - Is Osg ml gs if 0.7 1.6 5 52-128 IOYR4/4+5/4 s Osg ml - - 0.7 1.6 *By comer house disturbed by excavation and sewer line Boring F-I Boring # F- ,Pit 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring F-I Boring # -t 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent *1 = BODs> 30 < 220 mg/L and TSS P,c& * Effluent #2 = B0D5 < and TSS < 30 mglL o lc~ O 00 ~ H II rz O 0 M n O ? O N _ a o r., Z, C~ C3 r q O i O D~j ~ ~-CZ) U ~ ❑ w C~ q `ti n cry Cv o~ x U ~ T Q, c~ W O Q o \ ~ ~ ~ II A a t O O J ~ 1N ~ W `l s ti oG ~ eoen~ II eVl H t ~ U Q) 0 i ors •s vs - Kn) Ac`}v°c ~cn W `ten v W C f 00 ~ 'O N ~ N ~om > II N c~ R 7L 4t Wt 0 1