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HomeMy WebLinkAbout032-2044-20-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 605019 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 3101754 Permit Holder's Name: City Village Township Parcel Tax No: Oevering Homes TOWN OF SOMERSET 032-2044-20-200 CST BM Elev: Insp. BM Elev: BM Description.- Section/Town/Range/Map No: 162 ( 12.30.19.647C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i Dosing ~a Z O Alt. BM ' ~ 1641, Bldg. Sewer C• ~ ~ ~ ~ ~ r Holding St/Ht Inlet Y. ~!p lab 3 yl TANK SETBACK INFORMATION St/Ht Outlet e TANK TO P/r WELL BLDG. ent Air Intake ROAD Dt Inlet ~t Septic' Dt Bottom ry b~ c) 7, Dosing Header/Man. Z /Q3 72-) Aeration Dist. Pipe 16 3 4 Holding Bot. System PUMP/SIPHON INFORMATION Final Grade rr y A 4/ 8 Manufacturer Demand St Coverer GPM -3'9 Id8 ~~~7 Model Number TDH L4 - rd 6 -55 1*7 Friction Losss1,7 System Head , TDH6 t' it Forcemain Length Dia Dist. to Well t1116 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of nches PIT DIMEK31ONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CI'AMBER OR Type S steem:i• ( ~ UNIT Model Number: DISTRIBUTION SYSTEM t!"/-~ e Header/Manifold Distribution x Hole Size_ /1 Ix Hole Spaciny VInta o Pipe(s) VZ 1(0/1 ~ Length Dia Length _ Dia Z Spacing / lp 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 aZ Bed/Trench Edges Topsoil Z • ~o0 1 4 Yes 1-1 No Yes No r COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: '11spection #2: Location: 853 170TH AVE+~ 1.) Alt BM Description = 2.) Bldg sewer length = 7 - amount of cover = ~OGJC b a Plan revision Required? ❑ Yes No L-7 t Use other side for additional information. Date Insepctor' ignature Cert. No. SBD-6710 (R.3/97) County z~r°q J l 1~ D Safety and Buildings Division 1 J - in b Co. by ) 2 Sanitary Permit Number to be filled . ~ 1 W. Washington Ave., P.O. Pox 716 ~ Madison, Wl 53707-7162 MAY 2 5 2018 SYpNA~ ^ S ctionNumber Come pU Alicatio c i in accordance with SPS 383.21 Sion of this four, to the appropriate governmental emit (2),Wis' emiit Note: lieation forms for state-owned POWTS are submitted to Project Ad dress if different than mailing address) is required prior to obtaining a sanitary p APP for secondary the Department of Safety and Professional Servies. Personal information you provide may be used ~ / ~a purposes in accordance with the Privacy Law, s. 15. 1) m), Stats. ~~J M, L Application Information - Please Print All information pazcel Property Owner's Name l f~ 241 property Location , 1.3 Property Owner's Mailing Address < Y Govt Lot Zip Cede Phone Number Section city, State _ C ircle o T N; R ur e of Buildia check all that apply) Lot # II. TYP g ( CTI ' Subdivision Name or 2 Family Dwelling -Number of Bedrooms At 1 A V Block # of city ❑ PubIiclCommercial _ Describe Use At G■ ❑ t} rviji~ Number ❑ illage of El State Owned -Describe Use SM / own of G7nt j n S 3bs<v 6613 J11. T ofPermit ox on line A. ComFlete tine applicable} ~AQ~ Check only one b 3'Pe , o Tank Replacement 1J Only Other Modification to Existing System (explain) System 1-1 A. ❑ Replacement System El Treahnent/Holdrna List Previous Permit Number and Date Issued / B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. T e ofPOWTS System/Component/Device: Check all that a 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground At-Dade El Mound > 24 in. of suitable soil 11 Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsai/Treat ent Area Information: system elevation Deli Flow (gpd) Design Soil Application f) Dispersal Area Required (sf) Dispersal Area Proposed (s / r/ - / 4 / C~ - VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 'E j U y d v N New Tanks Existing Tanks 1 o - a: a m tO r m v I va L Septic or Holding Tank r Dosine Chamber 7! > , /t t) VII. Responsibility Statement- 1, th ersigned, assu es onsibility for installation of the POWTS shown on the attached plans. Plum N e (Print) Plumb t e MP/MPRS Number Business Phone Number - --7 i 71 Plumb s Address (Street, City. State, Zip VIII. ountv/De artment Use Only Permit Fee Date Lssu Lssu ent Signature 11 Approved Disapproved S G Q er Gwen Reason for Denial v IX. Conditi ons r D'ssipproval 1 E~AC v z.cr~ , 2. # ft4WF*tVM inu>t 4 . p. ,x „ . iopmr yppocohcam:!L:rdilin,a . Attach to complete plans for the system and submit to the County only on popes not less than 8 12 z 11 iochcs in size SBD-6398 (R. 11/11) PROJECT Oeverina Homes System PLOT PLAN ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NE 1/4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 101.5' DATE 4/30/18 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of telephone box ASSUME ELEVATION 100' Filter Lifetime Filter r❑ BOREHOLE O WELL *H.R.P. same as benchmark 85th St. B.M.* The soil test was reevaluated and found to be suitable for a at-grade system. (;nntnurs were orooerly established Scale = 1/4" = 10' 100, 101, Well is to meet all WDNR setbacks 170th Ave 1 1.5' 6% Slope 102' B-2 B-4 Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away from system B-3 ~B-5 _ Pro 3 Bedroom B-1 House 533 ' Property Line H ffcutt Combo Tank • '7 Z~ ~ DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 U ~9r. GREEN BAY WI 54304-5211 Contact Through Relay ~~1 s http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ()F`SI(7V Scott Walker, Governor Laura Gutierrez, Secretary May 22, 2018 :.0VED T O SAFETOUST ID No. 226900 ATTN: POWTS Inspector ^;A SHAUN R BIRD ZONING OFFICE BIRD SELF STORAGE ST CROIX COUNTY SPIA 1432 120TH ST 1 101 CARMICHAEL RD j NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/22/2020 Identification Numbers Transaction ID No. 3101754 SITE: Site ID No. 849196 Oeverin2 Homes Please refer to both identification numbers, Lot 3 170TH Ave above, in all correspondence with the agency. Town of Somerset St Croix County NW 1/4, NE1A, S12, T30N, R19W FOR: Description: At-Grade (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1761716 Maintenance required; 450 GPD Flow rate; 85 in Soil minimum depth to limiting factor from original grade: System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from the POWTS Dispersal area. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil Proper soil moisture content can be determined by rolling a soil sample between the hands If it rolls into a 1/4- inch wire the site is too wet to prepare If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. • Divert surface water from POWTS Area. SHAUN R BIRD Page 2 5/22/2018 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (1 1)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan Anv chances may result in pump resizing to meet TDH and GPM Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide Sufficient infiltrative arca. • SPS 383.54(l)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located 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 shal I receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions Should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the addres, on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services Wyment S code: 1. 7633 (920)492-2214 , Mon- Fri, 6:00 a.m. - 3:30 p.m. tim.vander1eest1(_i)wi.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. Cover Page a-~ Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date:4/28/18 Owner:Oevering Homes Location:NW 1/4 NE1/4 S12 T30 N,R19 W Lot 3 170th Ave Somerset Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# r 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specifications /I A Attachments: Soil Te Shaun Bird Signature License nu 226900 M _ Page 1 of 9 System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NE 1/4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 101.5' DATE 4/30/18 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of telephone box ASSUME ELEVATION 100' Filter Lifetime Filter D BOREHOLE O WELL *H.R.P. same as benchmark 85th St. B.M.* The soil test was reevaluated and found to be suitable for a at-grade system. Contours were properly established Scale = 1/4" = 10' 100' 101, Well is to meet all WDNR setbacks 170th Ave 1 1.5' 6% Slope 102' B-2 B-4 Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away from system B-3 ~B-5 Pro 3 Bedroom B-1 House 533 ' Property Line Huffcutt Combo Tank ~.0~ At-grade System Sloping Site Cross Section and Plan View t Dimension Feet L•L•1•L•L•L•L•1•L•L•1 L•L•1•L L L•L•L L L 1•L L L•L•L L 1•L•L L L•L•L 1 L•LK 1 YL A r r•r•J•r•r•J•J•r•J•J J•J•J•r r J•r•J•J r•r•J•J J•r•J•r r•r•r•J r ~•r•r r r•J•r r J ' A ' •,•L•'S„ti„ti,,L,L,L,1,,L~•L•L•L•L•L•LK•L•L•'L•1•'L•'.•L•L•L•LK•L•LK•L•L L•L•L•L•L•L L L L r j.J,.r,r.J,j.j•j•j.j•j.j.J.r•J•J•J•J•j.j.r.j.j•J.j.j•j•j•j•j•J•J•r•J•r•j•r•r•r j r l V yf" L,,,.,,y~•L,L,L,L,L,L,L,L,L••.•S.•'L•'L••.••.•L•L•L••.•L•1~•'L•L•L•L•1.L•L•L•L•L•L•L•L•L.L•L L L B ,J r•J•J•J•J•J•J•r•r•J•J•r•JY•r•r•r•j•j•j•j•J•r•r•J•r•J•J•J•J•J•J•r•J•r•r•r•j•r r r ~1 L•L•'L•L•L•'L••••L•L•L•L•L•L•1•L•L•L•L•L•L.L•L L L L ••,L•L•1•L•L•'L•L•S.•'L•S•L•L•L•L•1.1• 1~ 'j.j.j.j.j.r•j.J•r•j.j.r•j.j.j.j.j.j.j.J.j.j.j.j.t.r•r.r.J•J.j•J.r.r•r.J.J.J•r.J r r L,,L,,ti•L,L•L•L,L•L.L••..L•'L•ti.•L•1•'L•L.L•L.L•L•L•L•5i•L•L•'L•L•L••.•L•L•1.1•L•L•L•1 1 L 1~ 1/6 B J•J•J•J•J•J•r•J•r•r•r•r•r•r•r•J•r•J•r•r•r•r•r•J•j•j•j•J•j•j•j•r•r•J•J'J•r•r•J•r r r L•L•L•L•L•L•L•L•L•L•1•L•L•L••L•L•L•L•L•L.L•L•L••.•L•1•L•L•L•L•L•L•L•L•L•1•L•L•L L L L.. 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Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/a inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe.. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative; grgWth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches. and secured in place. 03/05 lgj Page a of Pressure Lateral Layout One Lateral - End Manifold f-- Threaded Cleanout Lateral Turn-up Plug Force Main X Long L Sweep 90 Bend c r Pressure System Construction y~ b k Distribution Netw k S ecfications Lateral Diameter In. Laterals are constructed of Schedule 40 PVC Orifices are drilled perpendicular to Orifice Diameter In pipe. In the pipe Orwith a sharp drill bit and face down. Orifice S pac' g) L a threaded L Lateral Leng Ft. Lateral turn-ups terminate with In cleariout plug and are enclosed in a 6-8 inch Force Main Diameter Force diameter lawn sprinkler valve box accessible Main Len t. from finished grade. Grade Q 6-8 Inch Lawn Sprinkler Valve Box 03/05 lgj Page of Septic-Pose Tauk Cross Section And Pump Performance Specifications r Tank Manufacturer Pump Manufacturer e / Tank Mode1 Number Pump Model Number V _ Total Tank Capacity p Alarm Manor 0 e L Max. Bury Depth Alarm Model Number v Switch Type m c Filter Manufacturer Total Dynamic Head (TDH) - Feet Filter Model Number Elevation Head L7 Distal Pressure o Loss , Network • erformance Required Force Main Loss Minimum Pump I? lo GPM: Q , Ft TDH Total _ Outlet N[anhole Min. 4" Above Grade With lanhoie Min. 4" Above Grade Locking Device. Islet Manhole v WA Locking Device < 6" Below Grade Sealed Watertight Securely Mo Weather-proof --1, Junction Box - Finished Grade Vent Min. 12" Disconnect Above Grade Hearts With Vent Cap Outlet Filter - Inlet .a.------ wet Baffle ~ : - - r. . . Switch Setti~tgs and Reserve Capacity A %a" W > eeP Tank Volume = GPI Dimension : Inches Volume Gal. B Hole 06 • (reserve) A; ' 567, (alp) B 2 0 Off Elevation C (dose) C -7, o Ft . . Bottom (dead) D D Elevation Totat 2 Ft. X:X GENERAL INSTALLATION: The scl)Wdose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as spcoi&d by the manufacturer may not be exceeded without prior,aproval. Manhole covers exposed to grade have an effective locking device (padlock) installed Piping at the inlet and'outtet is of approved material, commted to the tank with watertight fitthtgs, and lead sagging. on stable soil to prevent settling or . The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation add the sleeve is sealed watertight. Electrical service mplies with NEC 300 and Comm 16.28. 02/45 Ll Page 5 of o=SERIES 1/2 hp Submersible Effluent(Sump Pumps The Liberty 280-Sedes provides a cost effective"mid- Performance Curve: 4sedes range" pump for on-site waste water systems, liquid 40 12 waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. 35 11 Designed around Liberty's unique "Uni-Body" casting, 30 9 the 280-Series will provide years of reliable performance. m 8 All Models Feature: 20 6 m ~ m • Vortex style impeller permitting passage of solids m 1 5 up to 1G° = 10 3 • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing 5 2 • Epoxy powder coat finish 0 IR 0 • All fasteners - corrosion-resistant stainless steel 0 5 10 15 20 25 35 40 45 50 55 60 65 70 • 1,V " U.S. Gallons Per Minute • StainleDischarge ss steel bottom screen - easily 0 38 78 removable 38 78 1 114 4 156 19 156 192 2228 2 8 Z 70 • Maximum fluid temperature. 14T F. Liters Per Minute 280-Serves Cord Lengths Dimensional Daft: Model 10' 25' - 35-(-3) SD-CA 280 ~ ~ Weight: 29 lbs. Height: 13- 281 Standard q*onal Optional Optional Major Width: 10" (model 287) 283 standard Optional Optional WA Minimum Sump Diameters: 287 Standard Optional WA WA lengths, Model 281, 283...14° 10' cord length standard on all models. For optional add"-2, -3 or -5" suffbc to model number Model 287 VMF 10" Fxarnple: for model 280 with 35' cord, order 28o-3 Factory switch Model 281, 283 Model 287 settings VMF Motor Specifications Turn on level 13" 9.5" % hp 60 Hz 3450 RPM Turn off level 7" 4.0" Oil filled, thermally protected (PSC) Permanent Splint Capacitor Th Model a ~ adjustable by ~ float. 8.0 amps (115V) charge pine or other mourning point vertical float model 287 Dftrential is not 4.0 amps (208=014 adustable. Model 280 Model 281 Model 283 Model 287 Manual, Wide angle Wide angle VMF-Series no switch float switch float switch Vertical mag- with quick- with series natic float for disconnect (piggy-back) smaller pits - plug will operate in a 10" diameter sump c us Certified Spec~cationc ~ abiecc m ~,a"ye wn,aa rwtica Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (580 494-1839 www.iH3ertypumps.com copyrightaL ,ertysumps,kr-2017 Al rWft reserved. LLIT2000 R%M7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of •FILE INFORMATION SYSTEM SPECIFICATIONS Owner O Yo~ T l r Septic Tank Capacity go) 0 NA Permit # Septic Tank Manufacturer ❑ NA ]ESIGN PARAMETERS Effluent Filter Manufacturer NA tilt ❑ Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units >C~NA Pump Tank Capacity al ❑ Estimated flow (average) avda Pump Tank Manufacturer A I. i Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer 0 NA i Soil Application Rate al/da /e Pump Model n p 0 NA Standard Influent/Effluent Quality Monthly average'` Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter 13 Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L 0 NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L Cl Disinfection 0 Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BODs) 530 mg/L 0 In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/LNA -Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml 0 Drip-Line ❑ Other. !Maximum Effluent Particle Size Y8 in dia. ❑ NA Other. 0 NA Other: NA Other: 0 NA `Values typical for domestic wastewater and septic tank effluent. Other 0 NA IAINTENANCE SCHEDULE Service Event Service Frequency rY~ ❑ oath(s) (Maximum 3 years) ❑ NA linsp ect condition of tanks At least once eve ~ ear s (Pump out contents of tank(s) When combined sludge and scum equals one-third (Yj) of tank volume ❑ NA !Inspect dispersal oell(s) At least once every: ❑ on r sjs) (Maximum 3 years) 0 NA Clean effluent filter At least once every: onu(s) 0 NA e r(s}s) 0 NA Inspect pump, pump controls & alarm At least once every: Dpnonth 1=1ush laterals and pressure test At least once every: 3 ❑ ea h(s) O)NA ether. At least once eve 0 month(s) NA ry: 0 year(s) tither: 13 NA MIAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made `by an individual carrying one of the following licenses or certifications: aster !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 loombined 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 I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (36) 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. tail other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, 13nd any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. 1a 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 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 thO. tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater, levels. When power is restored the excess wastewater will ble discharged to the dispersal cell(s) in one large dose, overloading the dell(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 this effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT$:, antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation 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 propeily and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS 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 systeim. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nOed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:i in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring 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 soil and site evalua>ion 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. ',i 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 ANWOR 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 I POWTS INSTALLER POWTS MAINTAINER Name_ Name Phone ` j Phone lj SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY E Name Te2 Name Phone Phone ~J This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. ce 9 -f- 11 ~ 1 P _f\ c7 f ; f t, P 7 Ijfi 1 S i i e } Il`i~n I I P C-5 mom- P i L_J i~ % lL '0 /p C i -m j Q p. O N N N H 70 T C s o Q N U Q Q c z v O C, LU 0 ~ cn Cta I ST. CROIX COUNTY - SEPTIC TANK MAINTENANCE AGREEMENT - AND OWNERSHIP CERTIFICATION FORM _ Owner/Buyer (~2e c-~ef 1,~ Mailing Address Property Address 1.2 OW, ('Verification required from planning & Zorung Department for new construction.) - City/State Parcel Identification Number c/ j? all ity'_`~7 LE AL DESCRIPTION l Property Location %a , Sec./-L- T SL?N R W, Town of Subdivision ? Loth Certified ed Survey Map # volume ,Page # Warranty Deed # A9; ~ l' ;d, ~ 7 , VO)UIl1Y page # Spec house yes no I-at lines identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIECATIOV 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- the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner ma What you put into responsibilities are specified in §Cormu. 8.3.52(2) and in Chapter 12 - St. Croix County Sanitary maintenance ty tary Ordinance. The property owner agrees to submit to St. Croix County Planning owner and The a master lumber ty anning & Zoning Department a certification form, p ,journeyman plumber, restricted plumber or a licensed ser veri signed by the wastewater disposal system is in proper operating condition and/or (2) after inspection and fYif that the on-site less than 1 /3 fall of sludge. PurnP~g (if necessary), the septic tank is I/we, the undersigned have read the above requirements and agree to rnaintain 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. I/we certify that all statements on 's form are true to the best of my/our ]mowledge. I/we am/are the owner(s) of the property described above, by virtue of a arty deed recorded in Register of Deeds Office. Number of bedrooms ~I&A OF APPLICANT(S) DA TE ***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) e,iavso a~ m„,sr Mums Pu7 NNS MLIPONT/2111 sao~•q~nw NV-ld 1503AViS 3Sf10H _ ~MU+•w1•n4~ ~'R_ •r~v J' (~N: IS ISl ,✓'I('l ~ ..s o assn u',~•. 0 -w ~ 3-n3M 30 NVA £t-81 S310H 9NI83A30 ~ ,Zo'osz 0 n a o ~n e m O s H H o" 00 g5! 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Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and r z, / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # L) - arJV~' APPLICANT INFORMATION - Please print all information. Ravi wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 6/ 1/4,S T ,N,R E (or Property Owners Mailing Address Lott#'' lock# Subd. Name r CSM# City State Zip Code Phone Number El Road ❑ City ❑ Village Town N ,J<New Construction Use: residential / Number of bedrooms _ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: r~,,// Code derived daily flow pd Recommended design loading rate _cc// bed, gpd/ft2 i trench, gpd/ft2 Absorption area required bed, ft2 Z~ trench, ft2 Maximum design loading rate gibed, gpd/ft2 - trench, gpd/ft2 Recommended infiltration surface elevation(s) ft as referred to site plan "mark) Additional design/site considerations Parent material Flood plain elevation, if applicable 1 ; f ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system P4 S ❑ U J F * S ❑ U JWS ❑ U C J S ❑ U ❑ s .R U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure qG%/ft2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / Ground Depth to limiting ~C ON ; M 1A, fac in. 3, n Remarks: Boring # -51 f _ M1 J~z Ground ale Dc(Rh to - limiting factor ]~'S in. Remarks: CST Name (Please Print) S' ature Telephone No. Address D CST Number SOIL DESCRIPTION REPORT PROPERTY OWNERS Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground ele y, r Depth to limiting factor uin.ff ' t U Remarks: Boring # ell, Ground f~ Depth to o limiting factor F,, f in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I., w Boring # /I 441- _117 17 / qGrovvuu~nd `~,C eoCft. Depth to limiting ~D factor / in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) c . 1 I 'ROPERTY OWNER CCZL4'-'- / '^'j~ ~ Nage of .A.:_ , V i r 'ARCEL I.D.# ; 30ring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 i tn. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Y)S' , l"J l s r around /o Aft. s Depth to s imiting actor ~in. J Remarks-. Boring # n N t, D ~ . id Y~~L (/~J , 't aw 7 F Ground /aft. Depth to Limiting i actt t Remarks: Horizon Depth Dominant Color Mottles Texture Structure G D It2 s Consistence Boundary Roots Bed Trench in. Munsell Qu. Sz. Cont. Color f Gr. Sz. Sh. Boring # © >'I Z / i Cf' dry- 157~ Ground Depth to limiting factor Remarks: Boring # Ground t elev. ft. Depth to limiting factor in. Remarks: ' 6 SBD-8330 (R. 07/96) y i A • Soil Test Plot Plan Project Name White Pine Inc. ShauB~ird Address P.O. Box 504 Hudson Wi 54016 CSTM #226900 Lot 3 Subdivision Date 3/28/99 NW 1 /4 NE 1/4S 12 T 30 N/R 19 W Township Somerset Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Telephone Box System Elevation 96.7 * H R P Same as Benchmark Alt. B1M Top of Survey Pipe @ 96.0 B.M. ~iR M* 90' Property Line 85th St. 157' 130' 1% Slope B-2 40' B-4 v, w 30' i% 20' B-3 65, 3% a rr Slope Slope 35' Rep A Pri A B-1 40' B-5 40' Pro 3 Bedroom House