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HomeMy WebLinkAbout030-2153-05-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 605085 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3120523 Permit Holder's Name- City Village JOSEPH Parcel Tax No. 030-2153-05-000 Nickickoli & Jessica Alenov CST BM Elev: linsp. M Elev~ BM Des iption: / Section/Town/Range/Map No: 17. rrVV~~ L 20.30.19.3075 TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER _t CAPACITY STATION BS HI FS ELEV. .J- Septic Benchmark Dosing Alt. BM w..bv 0 3 4. tt~~Bldg. Sewer at Holding St/Ht Inlet -7• TANK SETBACK INFORMATION St/Ht Outlet TANK TO A P/L t k WELL BLDG. ent t Air Intake ROAD Dt Inlet Septic ~ Dt Bottom y50 7L ff 92_Z Dosing "7 5e/ 7,/ 4 Header/Man. /1 011 Aeration Dist. Pipe ~l• L 9g • 01 Holding Bot. System 's !W'? 1 Final Grade ~Qd PUMP/SIPHON INFORMATION 3 ' O ,k Manufacturer ~ ~ . Model Number GP Demand St Cover b t TDH Lift Friction L7607-1 s System Head TDH Ft ~i•~ . T1110. Z•7 W 1.a /82 •Z Forcemain LengthA Di Dist. to Well 7~ (0-7 t- i SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tr nches PIT D MEN NSIONS No. Of Pits Inside Dia. Liquid DIMENSIONS 7 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typ System: 1 17 CHAMBER OR UNIT Model Number: DISTRIBUTI N SYSTEM It A [He8der/Manifold Distribution j~ x Hole Size / x Hole Spacing Ve Air Int Pipe(s) 7 ength 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 7 Mulched Bed/Trench Center • Bed/Trench Edges Topsoil es No N. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Vs-A018 Inspection #2: Location: 479 146TH AVE PCVW % 010(o6w,11na kcd L" 1.) Alt BM Description = p 2.) Bldg sewer length = 91~ -amount of cover = of ytL ~C> Plan U r ? other revision side for Required? -7 additional inYes XNo formation. /Signature SBD-6710 (R.3/97) Date InsepcCert. No. r System PLOT PLAN PROJECT Nickoli Alenov ADDRESS 377 Pine View Road N. Hudson Wi 54016 SE 1/4 NE 1/4S 20 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 99.0' DATE 6/12/18 BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 •0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of PVC Pipe ASSUME ELEVATION 100' Filter Lifetime Filter O BOREHOLE O WELL *H.R.P. same as benchmark 146th Ave Scale = 1/4" = 10 ~ Property Line 3 Acre Lot W I is to meet all WDNR setbacks Area 15 below system is 13% Slope ~ 9 to remain undisturbed 9 ~I 98, 100, -3 B-1 Grading is to be done to divert run-off away from Up system 1 Huffcutt Combo Tank Pro 4 Bed Hous c./ County Safety and Buildings Division 0 t K 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) F 3 201 Madison, W1 53707-7162 /n _ ermit Applieati State Transaction Number or,~,rnur~i, L r7 4- In accordanccewii21'V'S 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govemmen1 I ' L ~ unit 'J is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ? purposes in accordance with the Priv Law, s. 15.04(1 m , Stats. (/fl / L Application Information - Please Print All Information Property Owner's tame Parcel 4 X - Z~S -os-fop Property Owner's ding Addy Property Location i ~ Govt Lot City, state Zip e Phone Number : Section (circle e) 11. Type of Building (check all that apply) Lot # T_ N; R E W ' I Family Dwelling - Number of Bedrooms Subdivision Name Block # j n ❑ Public/Commercial - Describe Use `S 1o►ut t s~C C!i t ❑ City of ❑ State Owned - Describ(e~ 'se CSM Number ❑ Village of ~c of III. Type of Permit: (Check only one bo fine o pee me pp ica A. System 11 Replacement System El Treatment/Holding Tank Replacement Only D Other Modification to Existing System (explain) k ~ OtJnJQ R. ❑ Permit Renewal ❑ Pemtit Rev' o Change of Plumber ❑ P ra isfer to New L' vious Permit Number and Date Issued Before Expiration Owner ©J` y_ 4 / W. Type ofPOWTS System/Component/Device: Check a a ❑ Non-Pressurized In-Ground ❑ Pressurized )n-Ground ❑ At-Grad ound > 24 in. of suitable soil ❑ Mound < 24 in. of itable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment 'cc (explain)=~~~ V. Dis ersal/Treatment Area Information: Design Flow (gpd) ign Soil Applic ~pdsf) Di ersal Area uired (st) Disperlsai Area Pro 74d (sf) Systp~rt Elevation'_ /W VL Tank Info apacity in To #t of Manufacuuer l Gallons Gallons Units ' L o o New Tanks / f ~ y~ ' m c J Ex siing Tanks "~G ? e ~ ~ a m R 0 Septic or Holding Tank Dosing Cbamber _ - i VII. Responsibility Statemen I, the undersigned, • u respousibiiity for installation of the POWTS shown on the attached plans. P s Name (Prmt~`f Plum rgnature MP/1vtPRS.Dtttmber Business Phone N er Plumber's Address (Street, Cit7, State 'p Co VIII.. County/De artment Use On] proved Disapproved Permit Few f Date Issued ~j issuing . ignal rl/ iven rDenial DL Conditions of A pprovaUReasous for Disapproval / f SYSTEM OWN~R: 3 624WI i7W S /h ZOle-a9z aT /lam 1. Septic tank. effluent filter and f dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable c6n'F i2fil' for the system as submit to the County only oil p rot less thaa 8 1 x 11 inches in size / SBD-6398 (R. 11/11) ` `ptitisRTFtir~ DIVISION OF INDUSTRY SERVICES 3824 CREEKSIDE LN HOLMEN WI 54636-9466 Q* ~~~I Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~l f S'SIpN A~ Scott Walker, Governor Laura Gutierrez, Secretary July 18, 2018 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD SELF STORAGE ST CROIX COUNTY SPIA 1432 120TH ST l 101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/18/2020 SITE: Identification Numbers Nickolai & Jessica Alenov Transaction ID No. 3120523 479 146TH Ave Site ID No. 843220 Town of Saint Joseph Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SE1A, NE 1/4, S20, T3 ON, R19W FOR: Description: Four Bedroom Mound System \ Sloping site Object Type: POWTS Component Manual Regulated Object ID No.: 1782319 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/O1, 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 CON requirements. A No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT O stats. PROFESS The following conditions shall be met during construction or installation and prior to occupancy or use: "'VISION OF I Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. rc~ ma CR • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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 SHAUN R BIRD Page 2 7/18/2018 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. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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, Gerard M Swim Please Include a Copy With Your POWTS Plan Reviewer, Division of Industry Services Payment Submittal. (608)789-7892, Mon - Fri, 7:15 a.m. - 4:00 p.m. WiSMART code: 7633 jerry.swim@wi.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. Cover Page RECEIVED JUN 14 2018 Shaun Bird INDUSTRY SERVICES Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/12/18 Owner:Nickoli Alenov Location: SE1/4 NE1/4 S20 T30N,R19W 479 146th Ave St. Joseph 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 ~ ~ JCS 4. Pipe Cross Section/Pipe Layout Q y V 5. Pump Chamber Cross Section 6. Pump Curve qk S 4A(II) 7-8. Maintance and ContigencY plan ~~PS~~YSV C V/CAS 9. Filter Specifications and cross section Attachments: Soi~, Test Shaun Bird Signature License numb r 26900 Page 1 of 9 System PLOT PLAN PROJECT Nickoli Alenov ADDRESS 377 Pine View Road N. Hudson Wi 54016 SE 1/4 NE 1/4S 20 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 99.0' 6/12/18 4 DATE BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of PVC Pipe ASSUME ELEVATION 100' Filter Lifetime Filter BOREHOLE O WELL *H.R.P. same as benchmark 146th Ave Scale = 1/4" = 10' Property Line 3 Acre Lot Well is to meet all WDNR setbacks Area 15' below system is 13% Slope 9 to remain undisturbed 9 98 100' B-3 B-1 Grading is to be done to divert run-off away from system B.M.* B-2 Huffcutt Combo Tank Pro 4 Bedroom House 0f~ Mound System Cross Section and Plan View 77 7~7!77 Dimension Feet i- J . t D 1 T t •NM:K%~Y•rV •rYY•rY•rV.r.r•r•rY•r1 ~r•rM41NrM\f:f:f1fi1:f.1:1:f~t:lti i ~J:t~ :l•f:fYY•rWY•r ; fYNYYYNh••.•YY4Y YLrY~•4•h E r•f•f•r•r•fY•r•~fYY• YY•!• f YY A ~ : •4~ti~4•h~•`L• h•1.4~4•h•Yh•Yh•h•4•NNMlM y41 r!••.•h h h YL•h• h L 1 Y11YY4• - M• Y•!•f• YY• Y• Y•f•f•!Y•t•J rM r r•r M• Y• Y M rYY•;' T lY•~r•r+~Y~NfK•NY•tif~fRf f~•f~t •YRJN'1f~f~ N~•!Y.V•~fhiw•1Fi Y•hf1JYh!hr•Y•1lyJ~h••~r'rh•'Y•1N •h•h•h•h•h•h•L•h•4•L•YL•4•L•L•4.4.444•YL•L•Y44A•L•L•YNY41•YYL•L•L•Yh•L•L•L•L•LM•Yh•L•Yr \•L• , e f•FJY•r•r•h J . •r•Mr•r•r•r.r.r•r.Fr•r.r•r•hr•r•r•r•j•r• r•r•r•r•rY•rY•r•r•r•f•r•r•Nr•f•r• •r f•r.f•r•r W 1 t F~ t, G t t ,t H ~ 1 I 7 I . . . . . . . . . . 1 J J 1 K K 1 B -1 Z r L Slope ~j% 1- =Topsoil = ASTM C-33 =Clean aggregate = 4 in. sch. 40 pvc i Cap Material i'r4r: sand fill 1/2 to 2 1/2 in. dia. ~ observation pipe Geotextile G H Fabric - t-- h Y ~ YNh! F ir:r hrfhi:r`•i:r Ft .w.• i.4:~.4.4.4 h h r•r-r-r•r. r r- D E 0 Ft Contour Plowed Surface Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/071gj Page of J-- i Septic-Dose Tank Cross Section And Pump Performance Specificanons . Tank Manufacturer Pump Uanufacturer X; Tank Model Number ' "17 Pump Model Number Total Tank Capacity fa 5 S Alarm Manuhctim 61m, S Max. Bury Depth j % Alarm Model Number Switch Type Total j)ynatntc Head (TDM - Feet Filter Manufacture? Filter Model Number ? Elevation Head Distal Pressure 3 - Network Loss MinimumP'erfor~mance lZequired Force Main. Loss 1 Gp Ft TDH Total 4" Above Grade With Manhole Min. 4" Abo~ile ~6 Outlet Manhole Min. Locking Device. We Manhole With Locking Device < t" Below Grode Sealed WatertiP. t Securely Mou ated Weak paoof Junction Box . >a aa• _ _ - s ' w - ` ass - Fidished Cie t Vert Min. 12" Disconnect Above Grade Means With Vent cap > Outlet Filter _ - inlet Bale ; ; Inlet A and gVeaaity Weep Switch Settings GPI Hole Tank Volume = B Dimension : Inches Volume Gal. (reserve) A' Elevation C {alarm) B; 2~ Q>9 Ft Bottom (dose) C D Elevation O D Ft ><><Y<>~ f> <•f>lfi i < <fl < < < < t < t t < < < < t < < t <<i t < . Mod in accordance with the INSTALLATI4l~: The septic/dose tank is bedded, ~ b -by *0 ~nfacturer may not GEC ifications. Maximum depth ofY device (padlock) specifW. be manu exceeded c's product :apprp have an effective locking without pior $pproval. Manhole covers exposed to grade tank with. Wight fittings, and t t qp PVC to bridge the tank force t material, ~ cis smected leeved v to ~ 1b 2Y. installed. Piping at the inlet and ou~#let is of approved laid on stable soil to prevent settling or saw' l~ with NEC 3U(} and Comm : E excavation and the .sleeve. is seated *aterfigbt- of 005 U 280-SERIES 112 hp Submersible Effluent(Sump Pumps The Liberty 280-Series provides a cost effective "mid- Performance Cum 280-Sedes range" pump for on-site waste water systems, liquid 40 12 waste transfer and commercial heavy-duty sump pump 35- applications that require higher head or more flow. 11 Designed around Liberty's unique "Uni-Body" casting, 30 9 I NJ the 280-Series will provide years of reliable performance. 25 8 ^ All Models Feature; U! 20 6 • Vortex style impeller permitting passage of solids Co 15 up to N 5 • 416 stainless steel rotor shaft = 10 3 • Permanently lubricated upper and lower ball bearing 5 2 • Epoxy powder coat finish 0 0 • All fasteners - corrosion-resistant stainless steel 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 • 1 Y Discharge U.S. Gallons Per Minute • Stainless steel bottom screen - easily removable 0 38 78 114 156 192 228 270 • Maximum fluid temperature: 140* F. Liters Per Minute 280-Series Cord Lengths Model 10' 251(_2) 50,05) Dimensional Data: 280 Standard Optional Optional Optional Wight: 29 lbs. Height; 13" 281 Standard Optional Optional Optional Major Width: 10" (model 287) 283 Standard Optional Optional WA ~ 287 Standard Optional WA WA Minimum Sump Diameters: 10' cord length standard on all models. For optional lengths, Model 281, 283...14" add "-2,-3 or-5" sutfbcto model number. Model 287 VMF...10" Example: for model 280 with 35' cord, order 280-3 Factory switch Model 281,283 Model 287 settings VMF Motor Specifications Turn on level 13" 9.5" '/z hp 60 Hz 3450 RPM Turn off level 7" 4.0" Oil filled, thermally protected (PSC) Permanent Spilt Capacitor The Model 283 features a fully adjustable wide-angle float Differential 8.0 amps (115V) adjustments can be made easily by tethering the float to the dis- 4.0 amps (208/230V) charge pipe or other mounting point vertical float model 287 is not adjustable. CMU Model 280 Model 281 Model 283 EAU Model 287 RnMo anual, Wide angle Wide angle VMF-Series switch float switch float switch Vertical mag- with quick- with series netic float for disconnect (piggy-back) smaller pits - plug will operate in a 10" diameter sump Ro~ C cuous Certified Spmficab-are -ttect to dw„)e w-ut r10bm Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • phone 80o-543-2550 Fax (585) 494-1839 www.liberfypumps.com copn;yM a Ubedy Pumps, tr,a 2M7 An m#ft reserved. u.rr 2000 Roam ~J d~ POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page`-of Fit-ONFORMATION SYSTEM SPECIFICATIONS -Z'o I Permit Septic Tank Manufact urer Owner L Septic Tank Capacity M--~'al' DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms ❑ NA Effluent Filter Model Number of Commercial Units jjWA Pump Tank Capacity Estimated flow (average) o aUd Pump Tank Manufacturer Design flow (Peak), (Estimated x 1.5) aVd Pump Manufacturer Soff Application Rate , Vd fle Pump Model ❑ Influent/Effluent Quality Monthly average' Pretreatment Unit Fats, Oil & Grease (FOG) S30 mg/- 0 Sand/Grdvel Filter 0 Peat Fitter Biochemical Oxygen Demand (BODS) 5=0 mgA- 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 m 2 0 Disinfection 0 Other. Manufacturer Pretreated Effluent Quality monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (GODS) 530 mglL ❑ In-ground (gravity) ❑jn-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L 0 At-grade ound Fecal Coliforrn (geometric mean) 510' cfu/100m1 0 Drip-line 0 Other. Maximum Effluent Particle Size Ya inch diameter Values typical for domestic (non-commercial) 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 SO months7r'l-gear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (@ of tank volume Inspect dispersal cell(s) At least once every 0 months ar(s) (Maximum 3 yrs.) Clean effluent filter At least once every 0 months ar(s) Inspect pump, pump controls & alarm At least once every ❑ months r(s) 0 NA Flush latl'rals and pressure test At least once every month ar(s) 0 NA O At least once every 0 months O year(s) NA Other: At'least once every ❑ months 0 year(s) NA MAIN'T'ENANCE 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 tracks 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 (X) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code_ The servicing of effluent fitters, mecical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at ' als of 12 months or less shall be performed by a certified POWTS Maintainer. A servtc,P 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 conoe~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 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thEit may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of tha 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 bye 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. POWTS Maintainer c to removed by a assist in manually operating the pump controls to restore normal level To avoid this ump or contact as Plumber contents of the effluent s 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 POW N: 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 propeoy 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 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 compiupnt replacement system. ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and' should not be infringed upon by requiried 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 rule; in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS teehnologi/ a holding tank may be installed as a last resort to replace the failed POWTS. site has not been evaluated .to Identify a Suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed/ as a last resort to replace the failed POWTS. % ound and at-gmde soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name ~a✓ Phone / J Phone f = SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORy AUTHORITY Name c Name /D K Phone a Phone j This document was drafted in ourmliance with chapter SPS 383.22(2)(b)(1)(d)&(f and 383.54(1), (2) & (3), Wisconsin Administrative Code. 760 It ~ W i N A A A 3=1 t t a }},,l~F! 7 f Q Op W 5 ~ o ~ I 0 a Z Q ~ c L L 3 ~ i "-'-r_ o L V _ r :snare 6UP _4 SOIL EVALUATION REPORT safety Wd • 4 ! alBe rvioes 047% in accordance with Comm 85, V41& Aft. IoW Page _ i of 4 Profession Schmitt Solt.Testfag, Inc. Attach oort~isya site tan ,on ir4rde. btrt.rrrrt d trr , itran areftr ust Coumv- St Crobf Pent slope. scsb and location aiiddtsfasrCp-to MQad. Parcel I.D. * p-j 5 rollrtor>ltatlcn 030-2153=1?5.OQQ , NOV 0 Personal 6cmravoon` a~Y be oast for ssoorWary prxppaes (PiAraq t av s 1fS:~W U„?)• R - u~c►~„~ l~ Property van Zee, Jamie cowl;, Lott SE V4, NE114, S20 T30i f, R1 w 47P y5 s hi~p:Address Lot tF &**a * I 5ubd: Name or CSbtt City 7 _ 5 Pioneer Ridge 4 State Zip Code Phone IJumber 1 -1 Ctty M Village 0 Town Nearest Road Say Pat MN 55003 St.Jose h I q7 148711 Ave Now Cw~ use. Residenttat Number of bedrooms 3 Cade derived DAwwoement d.siy,t how rare 4513 rpp Q Public or aontmercial - Descritte,: Parent marariat Glacial tin' (A 5-y Series) t~ Flood plain elsvafion,. rt appOoeble NA fl. Gansrat ft recotamendafiorn: kea a suaabie tint a mound system. System eiavadnn X99.74' based off a contour ilnsestab!fattedat 98:74'. Sipe at atja is and M. Depth to Ming factor is 24`, Pit Ground surface also. 100.43 R Depth to tiMMV factor 25 In. AppYratioru tbrtzarr t]eptli E]orrxirtarrf color RedorDftcr lion Texture Structure $ xuvWy Roofs GPDfif in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'f lost 'Efp2 1 0-11 10yr3/4 stone sin 2nmr Mfr as 2vf 0.6 0.8 2 11-25 10yr4/4 none Sid 2msbk Mfr 9w 1vf 0:4 0.6 3 25-53 2.5yr4/6 red 10yr5/9 i imsbic Of cs - 0.2 03 4 53-70 2.5yr7/4 m2d 10016 At Om mft cs 0.2 0.5 5 70-96 2.5yr6/4 none t Os9 mi 0.5 1.0 Pit Ground surface aim 99.67 ft. > to Ii tRg factor 25 im Soii App ton Rags Hortton Daptf► Dominant Coirx in. MunsrMl Rsdox Deacript>orr Texture Structure floats Qu. sr_ Cont. Color Corers t3ourtde Gr. 3z. 3h. ~ t 'Eter2 1 0-7 1OW313 note sit 2mgr mfr as 2vF 0.6 0.8 2 7-14 7.5yr4/6 none 9rsf 2msbk mvfr 9w 2vf 0.6 1.0 3 14-25 7.5yr4/6 none 9N imsbk mfr 9w 1vf 0.4 0.7 4 25-33 25yr4/6 cif 1 6 sid 2f5bk mfr - 9w 0.4 0.6 5 33.49 7.5y14/6 m210yrOyr6/2 J$ si 0m r'nfl cs - 0.2 0.6 6 49-67 2.5yr7/4 m2d 1 6 1 1 vfSl Om mfr - 0.2 0.5 • EfBue t #I a WD > 30,c WD? 220 mart, and 75S >30< 150 mglt. • Ettlrrenttr2 = BODs X30 mgrl and TSS X30 ma1L CST Name t;Pfease Prr}t Signalura: TCST homas J. Schmid 227429 Address SdwrA Soo Tes-u-M inc. Date Ewatnation Conducted Telephone Number 15N 72nd Street New Rtrhmond. %M 54017 5/912013 715-760-1978 ssa-a3wAtorroor Frady Owner Van Zee, ]amie Marcel id 030-2353-05-ooo F3 • # Q aorft ? of Q Pit Gmm+nd surface elev. 94.48 ft. Depth to i& &V lade 24 App#cetion Rate ► r, Death Domkwnt Cotor Redox aoecript;ar, Textuw SUU t3oturdary Rools GPDW In, ~~4tr" Qu. Sr- Cont. Color Gr. Sz. Sh_ `Etf t 1 0-7 10yr3f 3 none 59 2mgr mfr as 2vf 0.6 0.8 2 7-13 10yr4f6 none ski 3fsbk mfr gw lvf 0.4 0.6 3 13-24 5Yr4f4 none sid 3msbk mfr 9w 0.4 0.6 4 24f4 2.SYMf6 m2d10yW6 1 sid lmsbk n* 0.2 0.3 1 Cj Boring ❑ Pit Ground Wks elev. S: Depth to lknftft factor Im Application Re f orfaoh Dom Dominwt Color Redax Descr on Texture SttucWre ifaundary Roca Gear in. Mur>seY Ott Ss. Cont. color Gr. Sz- 5h. .EM2 M g ❑ eoft EJ Pit Ground surface elev. ft Depth to ern" factor Horizon Depth DoMhw # Gotor Reroc Description Texture Stn zwm cs boundary . Rods GP17VR' K iYuma flu. ft Cont. Color Gr. Sz. Sh. .E .EW2 j r t Etfttamt #r1 • SODS> 30,S 220 maot and TSS >30 c t 50 mWI ` Effluent #2 BWS 30 mg& and TSS-s30 mgtl. The. Department of C4umxm)e is an equal opportunity service provider and eWloyer. Ifyou need assistance to access services or need n>aterial in an.a#amme format; please contact the department at 608-266-3151 or TTY 608-264.8771. ~wuots.mrar) sdnrt sd restlap. fit Conducted by. Page 3 Of 4 Schmitt Soil Testing, Inc, Conducted For: Thomas J. Schmitt, CST 227429 Name: Jamie Van Zee 1595 72nd St. Address: 470 S Sth St. New Richmond, Wl 54017 COY, State, Zip: Bay Port, MN 550W Phone: ~ 711. 8 Plo7 Part oti 030-2153-O&W _ Lot No. 5 Pioneer Ridge Dow Legal Description: SE114 NZIA 20 T3ON R19W Ra Township, County: St Joseph, St Croix County nc M Bench Mark 1 El. f0o.o0` 'iOp of PVC pipe. Bench Mario 2 El. 92:89' top of 2" pvc pipe Scope= 15% Contour Line El. 98.74' t Contour Line Length 75' 1"=40' 0P) te/e RIDdL LOT 5' i I` z _ ~ ~ too s- i 1 t S S ~ let aF_rrit ti7 - _ D County . ' ~ .C Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) PJ JA O 2018 Madison, WI 53707-7162 8 ] ~w3j 316~ n G State Transaction N umber Corr` Sam # n mi YWNJ78~/FEN2J In accordance `837,1(2), W' is. Adm. Code, submission of this form to the app, N..._ o ttal unit 66 S 7 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for seconda purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 479 146 h Ave. 1. Application Information - e Print All Information Property Owner's Name ' Parcel l - - G Nikolai & Jessica Alenov ' 030-2153-05-000 Property Owner's Mailing Address Property Location 377 Pine View Rd. N Govt. Lot City, State Zip Code P one her _SE _NE _ v, se ion 20 * (circl o e) Hudson, WI 54016T 30 N; R 19 `o W If. Type of Building (check all that apply) Cot # 1 or 2 Family Dwelling - Number of Bedrooms 4 05 Subdivision Name neer R ge ok Bloc ❑ Public/Commercial - Describe Use ❑ Na ity of ( , ❑ State Owned - Describe Use No her ❑I Villag o r' wit T (►L . / J✓ f 1 Town of S OSe 111. Type of Permit: (Ch k only one box o' line om to li B icable) d~ A. ; New System ❑ Rep ce ent System ❑ TreatanrUHolding Tank Replacement Only ❑ ther difica on to Existing System (explain) s v r r B. ❑ Permit n al Il Permit Rev ion ❑ Change ott,Plumber 11 Permit Transfer to Lis Pre ous Permit Number and Date Issued ~ Before Ex ratio Owner IV. T e of PO!WTS stem/Com onent/Device: Check a t at 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground 1t-Urade Mound > 2 in. of so able oil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) 6' ❑ Pretr at nt Device (explain) V. Dis ersal/Treat ent Area Information: Pol Lok 5 effluent filter at ST out Design Flow (gpd) Design S it Application Rate(gpdst) Dispersal Area Require Dispersal Area Proposed (st) Sys tion 600 Gpd 1.0 G ASTM-C33 sand 1,500.00 ft. 2,028.XSq. Ft. 99.7 t 12" above 4 G pd native soil 8.74' contour Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c .D New Tanks Existing Tanks f P. ro 0 U J )w/ a {d~7C a`U v ~c7 c septic or Holding Tank 1,200 Na 1,20 1 Wies Concrete Dosing Chamber 800 Na 800 1 Combination ST/PC VII. Responsibility Statement- 1, the undersigned, assume responsibility for installati n of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Jim Boumeester MPRS 222904 (715) 386-9020 Plumber's Address (Street, City, State, Zip Code) 1070 Hwy. 35, Hudson, WI 54020 VIII. Count /De artment Use Onl pp ved d Permit Fee Date Issued Issuing Agen ignatu e r v n or Denial O/8 who IX. Condit 3 g.f disappr;0-- ce" por l !rust ill! bE s "'~'J ^Tl)~as. pK i nar,r3 yemlplan o ,roe nG~'L 'AN T. BE If'k tt+c.tiMi~l~m mart rr.E •i Jilxlbk 006e -alin lict.T. nt 7DI - ✓ Attach to complete plans for the system and s mit to the County only on paper not less than 8 1/2 x 1] inches in size SBD-6398 (R. 11/11) t7 perm!-F. CIOslW! (g*[ EXi.S ~i n c, c~~w~r ~ ~G (~~dPasr~ }N(oc,~d a~3/•~9X 95.35 oik,'t ors - .41-ail' cX75 d,,V4CSa/~e!/, 7~ret~aJ 377~~e ✓ eev Cd. /I. ! l~ (S./~1.: T~od1 S~0 /~wdsor:, SS'C/6 ✓,C. 14; L+S S /~/a t o{ bn.cr C? ~~C Z'h~/fray.'✓eSu~, ce e(-e✓. ~vbr 5 .s,_ G;2 T, 30,11. 9y.yt' ~i~ /z 46ode 9~?'"s►+r , / - p Q m; T, c/ # Goo -.z i5.3 lec / 1.7Scrcref i t ~ ~ 3 pia • a.e.d cl.)~ c ur ~'o+o erz.~( ~ j .4ssvine,r' Flu!' = u~ PP/,zca/~;OCAS~'ib:aa-i' ba; /c : n StuJ r Zo - 5~.Wool d. C. t Owl r r i Uo P,-. ;C, -cr~~ ~.v~ov end. i-S ~ ~-~jv~~rarl~ . f~~oQostd /oy.OS , l t( E,GdYaprn A, '64 efAc 2 / l/