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HomeMy WebLinkAbout026-1096-20-100 .^i scrnlar- Depaltrne-t of Sommer'? PRIVATE SEWAGE SYSTEM ;our1,' St. Croix Safer, anr. Bu d -g Division INSPECTION REPORT Sur' [at-, PC'nnt No GENERAL INFORMATION (ATTACH TO PERMIT) Slate Plat) IC No 605151 Persc,ai nler^aanr you provide -ay ou used fur wvj,tearr p_iposes IPri.•acy Law, sr5.CA (I;(mil 3142109 Pe•n1C IiVCur s N4 -'C- City Village Te»rship Parcel Tax No. Eric Becker TOWN OF RICHMOND 026-1096-20-100 CST BM Ele.•. Insp RM Flev Rrvl Descr ptlc°. Sactin^'oaMRa-.ge!Map No. 5 33.30.18.5140 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER - CAPACITY STATION BS HI FS ELEV. Septic 7 5 Benchmark x Dosing ti.5 Alt BM Ae:ahon Bldg. Sewer Ilulding Sill Inlet bZ TANK SETBACK INFORMATION SW Outlet TANK TO P;4~~ ~ :^f'eLL 3LCG. 'ee¢ to Ai- 'n:a •:e ROAD Dt Inlet l D J~'W Septic V N..;. _ Dt Uo'tom -4 7 Uos~ny Header;Man Aeratior Dist. Pipe is Hold rg - Bel System 16 Z- - 'Tii PUMP/SIPHON INFORMATION Fral 1 2•-7 /G(&Manalaceurer Demand St Cover, 6atl GPM f .Iw 3 g5 /d3. ^/7 Model Number tY' TDH Li)' 15 Nict on Lcss Syslern I lead TDH O j 17• / Foicemain Lerc,i I Dip L`s!to We SOIL ABSORPTION SYSTEM BEWTRENCH rAVCIr Le•rg:h No 0.' I,e°orex PIT DIMENSIONS Ne OI Pits Ii Licuic Del DIMENSIONS C, IZG l SETBACK SVSTEPA TO / Pt BLDG A'ELL LAKE; STREAM LEACHING D,lansfa ct:rer INFORMATION a C, `r s•e^ / J CHAMBER OR T rylo9el Namter. lux DISTRIBUTION SYSTEM j L III-._a:c'r"danlao BsAWolf I HaleSiie I it xHule Spacing Vegt to Ai•,nlaae Plpeisi q 5 - 7 ✓ 11 ` Lu',0i D a l e-gth _V yJ C 3 Spa: n9 ' 3 Z. SOIL COVER if Pressure Systems Only xx Mound Or At-Grade Systems Only r -r h ?ve- Dcp:h Ove, xx Bepin cl xx SeededSnC ded xx Mu chef Red!'-Pf':nCe-'ler l BeC.!Trenc-Fdges No Yes No COMMENTS: prclude code disc•eperc es, persons present etc; Irsoect or s' Inspection K2 Location: 12'311UTH ST~I` j~~ t.J r a) ' ;Alt Btd Descnotion = 2 } Bldg sewer ergth = ; 1 - amour) of cover = t I 71S v. 0_204J c C',k Plan Use other revision s de for additional information. No Date Irsep c's Sig tore Ce•t Nc SBD-6--e (R 3 ,Crr, Safety and Buildings Division U 201`W Washington Ave . P.O. Box 7162 X- S '~Q ,nl irvlu+i'. A'nI+{tn h; tll;d wbt'Cn~ PS Mladlson. WI 53707 7162 - ~ 3 51 Sanitary Permit Applic,atidn C ~ 3 t 11CR ~ tt '1 pna r A t:i~.:u : + I' n' I ~ \d.ac.. I . tin r .:JJi..~,? ' 1 l d pplinrl m It t our - Cal 3 I l o'` Sf uu~.nc 1 nd "I I'd", I~' c ~3_ xt 33.3`\.. mac" Sw S[ti i IT, 33 I I 1 n le of Building (check all that ap ph II +.tlieft'ai + I L. v. 1'Or~r1Vp-~►_(- R[. - j(.yor~ryjoO _ I L9 11 11. I )_pc nl l u mil: (Check Doll one hos on line.( (ongdn_ e line B it applicable) I ~+'-~y'f'w I<i. I J.. IC r. ~ I . r.: Uu ~ Oli... A1~odil2lc:.ll~if', lu fvslin; SN.uo(c vp?,:irl , I - ( v.~ i,i i;, li•I I.r.V .+c l`crnl \ mLsuu:d DV.C•dtd _ ~ IP.7) Ife of 1O1% 1ti_S~elcm/( nuLnnellul) ci,e: ll beck all that allh - i\m.-14... , t; cl. ofurl.hlt xnl 1\7, nI - m, i.,dre mil - : I'm: -tmutt I)nir -n1 \ oDls fpu n:rlllrudnnnt Itclln(m nrthnn ~'i S LI 1/~(1 IT'lank hill, 011 t, ' ` ~ I J L >o~~ - vo~> ~ I X1(7 % 11 Ncsponubdlh Slater cill I, the undrnlgncvl, ;unumr resyomihdth fonnH:dhurm ol'Ihr I'U%) IS ho»n on fl,"Itarhrd plan, N.1 ff-I I,~ Ino Vunaw+ 1 35__7 5--.'7 60) 13-9Y 4 C~~ 13 fpm, i-~ [cJ 6-4001, % I I I. Cnuoh lhp t Inc C) 0 IX. Conditions of Appnls alrNeasons fi)r Uisnpprocal - i - - - - YS I Septic tic laank, effluent nk. ~ Ca..~tha.a 8~a~t App,,~,,~a e~~-- . GIIer and -{k,,tS disprrsal cell mast Ge serviced ? rnnh~fahroc " PCxM`~• I as per manage nc nf plan Pn a Jed bl 10 1 t rr [dl 5elbacP ~gtmer is ( n1 t.:_li I dal < as pw 2prtl~ ~\r..A.1 •C~,. i_- -ca ll _ _ - . i w w w ~r r LJ~ JI) Z,j , 7 GI i r" v, w I C,L F~ DIVISION OF INDUSTRY SFRVICES 10541 N RANCH RD FIAYWARD WI 54AW!-64.52 S ,I= Contact Through Relay PS, hllp::dsps.•ni.goviprogramsiindustry-services ` ••vnvr wiscons r gov ` Scott Walker, Governor Laura Gutierrez, Secretary August 10, 2018 CIIST Ill No. 220:57 4TTV POHTS hair ecror BRADY J UTGARD ZONING OFFICE U I6ARD PLUMBING K HLAIIN6 S I CROI.X COON I SPIA PO BOX 411 1101 CARMICHAIA. RD A\lFR)' WI 54001 HUDSON 1l•1 54016-7708 CONDITIONAL AI'I'ROVAL PLAN APPROVAL EXPIRES: 08+10!2020 Identification Numbers Transaction ID No. 3142109 SI'Z'E: Site ID No. 852355 l ri, Recker Please refer to both identification numbers, 1 10111 St above. in all correspondence wilh the a,,ency. Town of Richmond St Croie County S%k I.`1, S W I l4. S33, 'I 'W R 1311' FOR: Object Type: POWTS Component Manual Regulated 01 ject ID Xu.: 1790089 Maintenance required: 450 (;PD Flow rate: System(s): At -grade Component Manual, Version 2.0, SBD-10854-P IN.03?07, R. 1!121: Llilucnl Filter CORD 'I'hc john, a it described above has been reviewed for conformance with applicable Wisconsin Administt• rve Codes AP and l1'isconsin Statutes. '1 he submittal has hccn CONDII ZONALLY APPROVFD. this system is th be4W3'uQM SAFETY AND and lu at cd in tlccordance with tL•c enclosed approved plans an! with any ennlponent nlamiallsl refeOlced aboee.L"ISION OF I I'ic owner, as defined in chapter 101.01(10), W'iseonsm Statutes Is responsible for compliance wl l all code rcqulruneats. A cupv of the adproved plans, specifications and this letter shall be on-site dal mg construction and pen to inspccttoa by authorized rcpr sent ative- of the Depattnlent. which may include local inspector's. A permits required by the state or the local mmIIiclpality shall be obtained prior a, commencement of f construction installation%operation. i. SE 1 In grantin this dpproual [tic Division of Industry Services reserves the right to require changes or additions should conditions arise malim, them necessary for code compliance. As per state stats 101.1212 nothing in this review shall relieve the dcsi finer of the responsibilil• for designing it sale building, structure, or component. Inquiries concerning this correspondence mac be made to me at the telephone number listed below, or at the actress on this letterhead. 'I he above kli addressee shall provide a copy of this letter and the POW'I S managcnunt plan to the owner and am) others who are responsible Ibr the installation, operation or maintenance of the t'014-I'S. SinccreIN. Fee Rcgaircd $ 250.00 Fee Received S 250.00 1 t - Balance Ihle $ 0.00 F(b\ A..'I-a1'lor - W'astew'ater Specialist , I )k 11611 of lndustr) ServicuS WISMART code: %6 33 (7I5 )6?4-3484 . Mon-fri, 8:00 a.m. - 4:30 p.m. edw i n.lav loriuw i.vm RESIDENTIAL AT-GRADE DESIGN ~nv'1GE5 INDEX AND TITLE SHEET Project BECKER Owner ERIC BECKER Address PO BOX 324 NEW RICHMOND WI. 54017 110TH. ST. Legal Description SW / SW / S33 / T30N / R18W Township RICHMOND County ST. CROIX Subdivision Name N/A Lot No. 1 Parcel ID Number PENDING T101",ILLY Plan Transaction Number COVED PROFESSIOM1IAL SEPV:CES Index sheet page 1 DUSTRY SERVICES Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 / -SP N ENCE i Designer BR FY UP ARID - License Number 220357 Signature i --Z I Phone Number 715-760-0946 Date 07/29/(1 Designed pursuant to. At-grade Component Manual for POWTS SBD-10570-P (R 6/99), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01181) Version 3.11 (05r01i Page 1 of 6 PRESSURIZED AT-GRADE DESIGN Flows and Site Data Entry. r Residential or commercial? 300.0 Estimated wastewater flow (gpd) 450.0 Design wastewater flow (gpd) 5.00 % Site slope 100.00 Contour elev. below lateral (ft) 42.00 Depth to limiting factor (in) 0.40 In-situ soil application rate (gpd/ft^2) Distribution Cell Information 1 Influent wastewater quality 4.50 Linear loading rate gpd/ft 9.00 Effective absorption width (ft) 10 00 Max. effective width permitted (ft) 125.00 Aggregate length (ft) Pressure Distribution Data Entry c Center or end lateral connection 21 Number of laterals 0.156 Orifice diameter (in) e g 0.188 1.95 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 3511 Forcemain flow velocity (ft/sec) 100.00 Forcemain length (ft) y Does Forcemain drain back? 90.10 Pump tank elevation (ft) y Are laterals at highest point? NA 4.55 System head (ft) x 1 3 16.3 Forcemain drainback (gal) 9.57 Vertical lift (ft) 56.5 5x Lateral void volume (gal) 2.50 Friction loss (ft) 72.8 Minimum dose volume (gal) 16.62 Total dynamic head (ft) 34.4 System demand (gpm) elli 1 Lateral Diameter Selection Gallons/Inch Calculator Pipe diameter Di iyn onrans Dcwyn r",cp. Total Tank Capacity (gal) 1 in total Working Liquid Depth (in) 1.25 in F----]Gal/in (enter result in cell G46) 151n x X 2 in x Treatment Tank Information 3In x 1000 Septic tank capacity (gal) WIESER Manufacturer Effluent Filter Information Dose Tank Information POLYLOK Filter manufacturer 600.0 Dose tank capacity (gal) PL-525 Filter model number 9.8 Dose tank volume (gallin) WIESER Manufacturer Project: BECKER Transaction Number Page 2 of 6 AT-GRADE PLAN VIEW 1+6 R Observation pipes (2 typical) A 9.00 ft T u B 125.00 ft I r♦ • 116 B 20.83 ft W • C 11.00 ft C D 5 00 ft E 200ft r- . u L 135 00 ft B W 21 00 ft A x B 1125-00 ftA2 L .I_ Cap Typical obs. pipe. = Total aggregate cell A x B Slotted in the lower l Plowed area L x W 6". and anchored 1securely. I 6AT-GRADE CROSS SECTION Synthetic fabric cover 101.79 ft Finished grade Lateral elevation invert clev 100.50 ft f~ Observation pipe at aggregate toe E---- / i 5 % Slope Surface contour A and system 100 00 ft elevation ® = 12 in. topsoil and subsoil Plowed layer over aggregate and tapered to toes. below L x W 6 in aggregate below pipe(s), and 2 in above pipe. Project- BECKER Transaction Number Page 3 of 6 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection I P I IE X-~ IExl2 I xl2~I Laterals & force main of PVC Sch 40 Last hole driled next to end cap (per COMM Table 84.30-5) Holes drilled on the bottom of the lateral. equallg spaced • = lurn-u p wy ball valve or cl eanoutpl u g Lateral Specifications 0.156 Orifice diameter (in) Center Lateral connection point X 1.95 Orifice spacing (ft) 2 Number laterals 32 Orifices/lateral P 61.43 Lateral length (ft) 17.2 Lat. discharge rate (gpm) 1.50 Lateral diameter (in) 2.00 Forcemain diameter (in) 34.4 Sys. discharge rate (gpm) 100.00 Forcemain Length (ft) 16.62 T D H (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof waming label and locking device junction box ' r Final grade 4" disrAnnecl Tank component is Ahernate properly venlcKl 111111 . outlet location 18" min. Electrical as per NEC 300 and s Approved outlet Comm 16.28 WAC joint - Tank full c M7.47Y8 JA Provide 1/4" o A Alarm on weep hole (it m B Pump on B antisiphon E C deuce. 0 D 90.93 ft C Totals -10 Pump off D Bedding under tank - - ♦ 90.10 ft GOULDS Pump manufacturer LEVEL Alarm manufacturer EP05 Pump model number DLV Alarm model number Project: BECKER Transaction Number: Page 4 of 6 At-grade System Maintenance and Operation Specifications Service Providers Name UTGARD Phone 715-760-0946 POWTS Regulator's Name ST.CROIX Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1125.0 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauencv Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Inspect and clean at least once ever 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(q Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84. Wis. Adm, Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction 7 All other construction details are as per the at-grade component manual SBD-10570-P (R. 6/99). Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn - Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution I ateral 6, r Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: BECKER Transaction Number Page 5 of 6 At-grade System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall tw. operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISHD-10570-P (R. 06!99) and SSWMP Pub. 9.6 (01!81)] and local or state rules pertaining to system maintenance and maintenance reporting No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm Code when the tanks are no longer used as POW l S components Septic or pump tank manhole risers, access risers and covers should be inspected for watertightness and soundness Access openings used for service and assessment shall be sealed watertight upon the completion of service Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48. Stats The contents of the septic tank shall be disposed of in accordance with NR 113. Wis. Adm. Code. The operating condition of the septic lank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall he cleaned as necessary to ensure proper operation. The filler cartridge should not be removed unless provisions are made to retain solids m the tank that may slough off the filter when removed from its enclosure- If the fitter is equipped with an alarm, the filter shall be serviced it the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic lank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the lank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank 1 he pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation If an effluent filter is installed within the lank it shall be inspected and serviced as necessary . At-grade and Pressure Distribution System No trees or shrubs should be planted on the at-grade Plantings may be made around the at-grade's perimeter, and the al-grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the al-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at- grade be heavily mulched as protection from freezing. Influent quality into the at grade system may not exceed 220 mg+L BOD5 150 mg/l. TSS, and 30 mgrL FOG for septic tank effluent or 30 mgrL BODS 30 mgfL TSS, 10 mgfL FOG., and 10" Cfu!100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure lest is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent pending. Ponding levels shall be reported to the owner, and any levels above 4 inches oorsidered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area it toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project BECKER Transaction Number: Page 6 of 6 ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Total Nead Gallons Per ttem (ft. of water) mnste No. Dwription EP04 EP05 t Impeller f M14 2 I.._ 3 Pump Casing 4 Mechanical SPal 5 Ball Bearings 6 0-im3S 7 fOd Cord g - _ 8 d Motor nusingl 3 ss embly t -re'st' t0 Motor Cover - METE RS FEET ic- g 30. I~scsr's~_- R ' EI 25-_ G 6. 20 < / Q 4 EPOS 3 10 - 2 - - EP04 5.___..___ 0 10 20 30 40 50 GPM 0 2 4 6 8 10 12 mVh CAPACITY I~ ~~l'~ 3q wtrm~.aawaxaadoo..am/ SOL, EVALUATION REPORT OIM/rdsaabaaMauNga ~M~_d__ anaadM=WftC/arWWAVW . AOL Omb Aft*=1 aydb~a awMMl1Rx11YWlx»adW~PrgnWal ~b POMWdt%s=ba/meww/Odn0a0/xaWldurr/WaW/ara~y .a 0/wrt.lep., .edvaY~.r1e,.,naA,.~4.n/ao~/On.~edwn.m.M.~,wd °0ip1' In Pb//a P /a lallarautlWm ft*w d Wy pw I~~w+Ir•FaW w~IMMYwq~/'y~~~4Vr.a RM(AP~L ~01/If Pq~laillbn f 1 c. Lot 1N S T N R E 11i°'o Lox /sae lawWor ~ lan/d 12. obwcwAftdko UaK811aMraadfMnaWrdbaOWOSr ON-b-dwW R•NaoaAla D Naxa/rmWwrrdd_p~r dxabW/WwaY fiPD Praraaaladd Rooewr,.rwioer./pl q. A114 t uamwaW/moWe © au1~R PS f P. aa.a..iwwM.,e, oapemwr/armr yZ~ Iis1aW ~r Dalhnal Radar DwapoTeam 8mran Carr4aWOW Rana 4aara CaaL Cad. Cdr or OL un Ea12 bmm// a aaaa° p ewiwmbwdgw. llarbm kk ~ Dnwb" Team or Rbeb am OPDAi Rasa z - ? er' e.r -D 'Eau~Wp.a0ll,>9/5~7/WOOL~yTa6~a/s 1Q/ CST Npa~i.N..~(P%mo P&O ~txQ s 9pOls 30 agll udTBS <lD WOOL Bird ' .-MW% kM ShBW BW CST lh6xb/r Aaal/y 22MM 143E 12011 SL Now Richmond, wt 9401 on. ErdrralW CmaWaa 715-246-4616 7 paOwowr a] 64 0 ~ ~or~, P•o• _a Ps stiwrWrufoosbr. /QD It HodM D" oese,a NidoRDaagm Teen eevor.. 8w MEMO a. az anc ooeor or ss sh `0•r•"p souses wear 'es~ Asa egi 7G-/ .n , s f ~ / eoe+o, 0 ~+v 0 nnwyra.bv. n Dipnbairyauor Eba~ Ddrbrrt k ~OrlrrO Team ~sOw srmes Ibrb ~ GPOA~ . Ihb ChLaL Om oft Dt.B[sk 'E•1 ❑ Sahp, ❑ ~V ❑ PR ft"U m4bv L Wghbs *y~ Nuba~ '"a Domm" NrecDoook". T sal VA"M &L ski" OLSL Coacdw Ceylrpr Ibob tt° '~0_7Z0aSLU14T~'VS152WOt ~ a ° sDD,: mims~sdT58-„~ ~f ofCasserce$ I4reowekt ~ Vswepee/wiwrpb=cc=ntvbaor x SJ _X6.315, or Try 60,4s14M. awo Soil Test Plot Plan Address 1394 Shaun B' New Riclsrwnd W 54017 Lot gtddlvblon C91K #226900 Date 4x21/17 SW 1/4SW 1/4$ 33 T 30 - N/R18 W Township FAhmond [:)Boring Q W0u 11opa4j IJae County ST. CROP( BM or VRp Assume EbVsUon 100% Top of &,V Pipe System Elevation TBD •HRPS@ms as 8%xh park Scale is 1" = 40' unless otherwise noted 100' B-3 25' 99' 35' B-2 70 Z 110th u. 5% Slope B-1 300' 30 B.M.• PMPCty Use ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIDP CERTIFICATION FORM Owner./Buyer al ,0 e e- t- Mailin Address PropertyAddress S41(11 (Verification required from Planning & Zoning Deparmcnt for new construction.) City/State ✓ __~r_ Parcel Identification Number LEGAL DESCRIPTION Property Location i V-~ t/4 , .5 U,614 , Sec. , T C'N R ~ PW, Town of - - - Subdivision Plat: Lot # Certified Survey Map # U 2~L) Volume - C-)- , Page # Warranty Deed # 7 7 ? (before 2007)Volume _,Page # Spec house C yesKno Lot lines identifiable ayes , no SYSTEM MAINTENANCE AND OWNER CEKFIFICATION Irnoroper use and maintenance of vour 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 tiSPS. 383.52(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, jottmeNman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and'or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I; wc, 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 Safety And Professional Services and the Depamnent of Natural Resources, State of Wisconsin. Cerrification 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 this form are true to the best of my/our knowledge. Uwe ant are the owner(s) of the property described above, by virtue of a warranty decd recorded in Register of Dccds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE "'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. 04112) ~ I ~I i Ili C ,r CQ,l I _ I . ~t FB r I . P 1- MIZE ,r I d IT- 7 i7 a r I I t I I IM n IM a o~ a I I 5}~ s?tli 3 ti o m T c:, r f o f ~ I I I I I 1f I I I i J . . 5 Y II t , y j J.r n7 !Fr I I [ •~tl. Iny _ . ~ ~ . I~ Z= ~ III ~I ~ f c ~ ti 6 ~ III rp9 wo[ teem O ildlt_ fly i E I - , , 4 r . - z~ c pr S.. Y^ ~ • •w l - .r E~ci a r ~ I ~J ; 4t - - - r .•-rn, rz o°'f t , fi p n, Z a i~ I c t~qf i o a r m ~ ~r1 m II W m F mill I ~r Ej< BS"m 'S t s« _ I • Iii ~ i I` Y'. oto ( ,z },r ~ 9 ai x a sr fc• a-.. , x `f4~`s$$s ' , f'zS`•S 7;t s s' s Ufa ' I hI- y i - }RF~fsl 3 I I I I ~ za ~ a' i" f3 L J .L 1 S ( fii ~ Y I ?EK l r SEs k~I i f. j~ 1 ( E i - F O a [ d F; I - psi ~ ? ff ! ~ . R ir'fi i F ~ t s 4j L•. ~ «E f f I' I I E i If. ~I .i I i I e I~ 'j~ fsit. N sl t(E t[fE i jfi5i lfFV t'Efl~_ t~ _ III I y `s ml I ~ I . s ~ tfs eft fft fft ~ I v ' ~ ~ ~ IE ' I s r2 ~i j u. t III o' s;' ~ a i N ~ , ,x ~ r o l' G~- ao lZ - OS~ RECEIVED - Wisconsin Department of y ZO11 Sl mcPORT Page of Division of Safety and Build ngs ` ST. CRO X~CSl11tNb idance w th Comm 85. Wits Adm Code Cou Attach complete ll{~ hdIT9Si-thann$1..12 x 11 inches in size. Plan must ntY`~~' include. but not ad to verucal and horizontal reference point (BM), direction and 10 . Percent slope. scale or dimensions, north arrow, and location and distance to nearest road 9 Please print all information. Revi by Dat PsOOnu rMpmergn you pleY De 40/~~ print for s. 15.e4(11 fmlL ~s Property Owner Property Location t>~.:_ Govt. Lot cC., 1i4 1 ,114 -y 'TO N R E for W Property Owner's Mailing Address Lot Block it Subd or CSM# r. 7{s 4` city Slate P C e Phone Number ❑ City ❑ Vdlage I T• Nearest Road B Now Construction Use-r'3 Residential I Number of bodrasns-`ICode derived design flaw rate j GPO ❑ Replacement ❑ Public or commercial - Describe. Parent material lF x _ Flood pain elevation i' applicah lv ft. General oomnents arid recommendations* System Type f~ 1✓ Z YrfO 1 lj~ ystcrn Clcdaho•r 4 M Boring # Boring yn ;^I r t ~3- Pit Ground surface elev. ft . Depth to limiting factor in - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD.ff In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eftla •Eff#2 Z- /Y- V) - 7,9 v F _ i / Boring # Boring ` Z' Pit Ground surface elev.. _ ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •E", •Eff#2 AL L Effluent #1 = BOD. > 30 < 220 moll and TSS >30 < 150 • Effluent #2 = BOD• 30 mg.4 and TSS 130 ni MAI CST Name (Please Print) Si taro CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation CCnduvei Tntnphnne Number 1432 120th St. New Richmond. WI 5401 j / - j 715-246-4516 Proporty O.vner _ Parcel .D # /Page of ,l Bonng# r❑ Aanny J Ground surface elev. I1 . Depth to limi6rug facia ~(n, Sod Apptill Rafe i I (4 pit L - / 1{onion Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPD/ff in. Munsell Ou. Sz. Cont. Colon Gr Si Sh. q 'E##t 'EfFk2 n. L- J,' J O ~ ~ ~ ` z zz~ i ❑ Boring # Bering pit Ground surface elev. It. Depth to limitng factor in. Soil App4cabon Rate t{oizon Depth Don-rant Color Redox DesorPton Texturo Structure Consrsteoce Boundary Roots GPDIIf in. Munsell Our. Sz. Cent_ C0101' Gr. Sc. Sh. 'Eff#t 'Effp'2 Boring # ❑ &:nny pit Ground surface elev ft. Depth to limiting factor m. Soil Applicabon Rate NonZefl '-eplh Domnant Color Redox Desorption. Texture SuWure Consistence Boundary Roots GPD#f in. Munsell Ou. Sz Cont. Color Gr. Sz. Sh. 'EB#1 'Eft#2 F'nuent #t = BOD, > 30 < 220 mg A- and TSS >30 < 150 mgt ' Effluent #2 = BODE 130 rrxy'l and TSS < 30 mg'l- The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altematc format. please contact the department at 608-266-1151 or TTY 608-264-8777. vu>v~~n x e. Property Owner Parcel ID # Page o! _ _ Boring # ❑ Boring 51 F4 Pit Ground surface elev. _/u? _ P. Depth to Irmitinq factor -Z-/-//,n , Soil Applicator Rate Hovnn Depth Dominant Color Rodox DescefNion Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Ou Sz Cont. Color Gr. Sz. Sh _ •Eff#1 I 'Etw -31 ❑ Boring # ❑ Boring ❑ Pit Ground surface e,ev ft. Depth to limiting factor in. SOII AnplrGa}IOf. Rafe Honzon Depth Dominant Col Rodox Desorption Temuro Structure Consistence Boundary Roots GPDM m. Munsell Ou Sz. Cont. Car Gr. Sz Sh. I 'Eff#1 •Eff#2 I ~ I ❑ Boring # ❑ Boring ❑ Pit Ground surface elov. ft Depth to Ixntting factor in. Soil Application Rate HorI 'lepth Dominnanl Color Redox Description. Texture Structure , Consistence Boundary Roots GPD/ff in Munsell Ou. Sz Cont. Color Gr. Sz. Sh ' •Elf#t 'Eff#2 I I I i i I ' Effluent #1 = BODr > 30 < 110 nxy'L and TSS >30 < 150 mgfL • Effluent #2 = SOD, < 30 n9,2 and TSS < 30 mryL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at ti0S-266-31~I or TIN 608-264-$?7 , sn tl}JUrx NW, Soil Test Plot Plan Project Name Eric Becker Shaun B' Address 1394 Osprey Ct. New Richmond Wi 54017 (''STI #226900 Lot Subdivision Date 4/21/17 S W 1/4 S W 1/4S 33 T 30 N/R1$ W Township Richmond F1 'Boring 0 Well Pl. Property Line County ST. CROIX BNtor VRp Assume Elevation 1oo ft. Top of 3/4" Pipe System Elevation TBI) •HRpSame as Benchmark Scale is 1" = 40' unless otherwise noted n_3 100' 25' 35' B-2 40' 70' Ski Slopc R-1 11001 St. 30 B.M." 3 00' Property Line