HomeMy WebLinkAbout018-2021-14-000
%Nsoors n Deon9ment 0, CC:-^erce PRIVATE SEWAGE SYSTEM Cc.,ny: St. Croix
Safely and Bdllcing D visu-
INSPECTION REPORT San Cary Perrot Nu
605157
GENERAL INFORMATION (ATTACH TO PERb11T) Stale Plan IC Ns
Pe,sonal Irlon im on yr,, pro'; de -eq oe used for se✓oncary pjrpuses (P• vacs Lave s 15 ee 3142128
Per-rt Holder's Narrre. C ly V Rage. 7owns`.ip Parcel lax No.
Chris Pizzi TOWN OF HAMMOND 018-2021-14-000
CST Bro! Ele, Ini E31.1 Flev ?N. Descript on .I Se:XTIrlownl Ranga+R!a. No.
08.29.17.1295
'dam 4J ; .
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURFR :tit j CAPACITY SIATION BS HI FS ELCV.
Septic _ .k^ .5 Benchmark
V, it°5r'. dt /Z~1 °x v. " IdL-J OLl
Dosing - G _ At Bid y ILI
11 Aeril Bldg Sewer
S, a
Ir,
Holding SVHI net
j f L$ r 3
SO it Outlet
TANK SETBACK INFORMATION
LANKTO r (V "VI-It GLU3. Jc toArInta.e ROAD 0: Inlet \
Septic G I 01 Bottom
z
2 19 Y
7 S
Dosing Heade16
_ o Y , . ~p
I J ti l /I _ r 7 C . 9
Aeration Dist Pize 2, U* d3
Hold rg Bot. System
~ -1.70
~OZ . .
PUMPlSIPHON INFORMATION Final G'ade
Manufacturer _ Demand St Cover/ 1 /
GPM 7•fL
c~
Model Number (r14. ZO 1 n
TDH Left Friction Loss System Head I DH Ft
Fo'cema r Length Dia I Dist to :`ic;[ A
_
SOIL ABSORPTION SYSTEM
BEDITRENCH IA-cl- ~enct- Vo iNlrarcres PIT DIMENSIONS Nc.GIPds Ira do L`s Lip_id.UCatn
DIMENSIONS Q 75 `
SETBACK SYSTEWI 10 Pi BLDG 4."I-LL LAKE!STRE-' LEACHING f•'ar' u•ocrurer
INFORMATION True :'f fri".tem CHAMBER OR
UNIT Mucul NL°Oe,
DISTRIBUTION SYSTEM
I .eotl~r71a 'lrc P I( J mU•,n x Hole S.zc. I r t x ime Snob nn Vep!I 3 t=is
I Jr. / Pipperth i,'h-75r /I I ry I(J✓-T_("~]
L n,l'-. . ~1ZP Y I' a 47 Spacil
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
wh Over n.eptr Over a aenlh at SeededScdJ:•d a P,I~Iched
°vc; trerc-rCe^ler Be tl:l•e nlcges feu°ml J ves _ No Yes No
COMMENTS: rlnclude code dbsciepenctes persons present, et Inspection R' Inspection a2.
Location: 16321021JD AVj~ - .xtO ~t' f 7 i r
1 i Alt BM Descr pion 2. i Bldg server length = 3~ //-,I - 1~ f)~ }IOW lJ !
-amoum of cover= )r {./•`C"1'SS V`^~~-I 6/N/
Plat revision Requ red? Yes No
_ 11J
Use other side for additiol information
Date Insels Slgra:u-e Cert No.
SBOF../t3tR'JY / :
.1 Safety and Buildings Division l YY)
OS 201 W. Washington Ave., PA BOX 2162 Sanitary Permit Nunllnl (tv U: Glled I by Co )
P Madison WI 53707-7162
Sanitary Permit Application "°"\t"a'"
Incund utl nipt til'ti iAi>IU) 1\_. Adt t t sutra t d Is la'm In lM1r zpproFu dV busym t:aW3 unn J `LI
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I U l I nn t tin r - r ! o v r.d S,;,;--, tr I ! , i:- r.on you vrtn I Id m. r h u•.d tins a toq ft~
I Application lnformahon- Pried Ul information i I `CZ_ tt
~1,( r < ~ ' - - ~CNS-:foal a)~f-6~o ~ II
ilur\tq U:u' } \f -lur, Addrass - _ _ I I4. lx nr I.o.a!iun
r l~/~ L
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J( I N, It 1 -1
rll 1 y pe of Bmldmg (check all that apple) J/ Lot P
1 n1 21 ..nl r 1-IlAtr1e1- I I7 $uh ht lt!on \~.m' y.1I
'l.~lut'licLonm r al-U,arib. L...: ~i Ctgoi
III 1 y pe of permit: (Check only one bo% on liuc A Complete line B if applicable)
y.,lnt .:1 0 1 iy l.)Other
)lodttita aa,nl[ruinr Sysitnt (capiaot) '
I
' :..!t unit I tan,h,r to Nca last Pm0m,.c Pcmw Namb.na:d Ua:t i1-i
I~ 7s) 1iof
' O t PO,\ fS Ssmernicam onenUDeslce: (Check all that apply %A hi~r- Art
)
I \nr. I r j<7o nd 2 to of nIat , wit ❑ \lo J 14 m of u l tblc so
1(90
1 1 Hol it i; U .r 1)[ 1 ( J t t ail t o t U vc (xp fn) _ _ IT; 11
\ Dlcpcl st-rcaloc \ten Ifol makort - - Y
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VI. Tank Llfo i Golsen I
to I n, ` \,anuC cLncr l
call";
L Ilot ~ rat.
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75 ~L_SS<1 I Cu /c _
VII Responsibility Statement- 1, the undcrweltrd assu raspumil» lily for inslallation of the PON% IS. town on the attached plaa~
Inn. -cS.;t (I nr.D Pin.h:r- ;O~ttu~i - tli\11`I]\t most I I3!ir...t Piro _\uathal---
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ls v, t/+S1a`. /.ip 0.dt1
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. \ 111 Counhll)cLrtmcnt
t sited ,I7 li Palnll I-T-151CI xt;d Is.u.n„ Cnl Sign urc
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_ (AyTUUn oit.at t in U.n,: f
IX. Conditions of Approeal(Rensoas for D•isa~~~ r
SYSTEM 0- ANE It: -S"
(fivokhI
i. Septic lank, eftlacnt f4el and Lt.lt tvur , t
dispersal cell trust he ser._ice:i i mainla n<:d p"\b
as per management pla') piovbd(:d by pluri b•r.
I.9 All crNhar4 - - ai
tequg •urnwy2t`5n-CU`:(u¢st-tv.
as Per eppl ICaD° :;Od:"•':'~f7~'l:i~cu.'S.le[e *to far Iht s).In:, mid snuvait to the Ca.n4, ndy on pya•r not kss Than 81.2. 11 indwr 1. 4,1,
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>~'f DIVISION OF INDUSTRY SERVICES
10541 N RANCH RD
D HAYWARD Nl S4g43- 462
S. Comae: Through Relay
P http+Asps m gov1prcgraTs11duS!ry-SerwceS
` S •mwe vascorsm gcs•
~"•~ir~ Scott Walker, Governor
Laura Gutierrez, Secretary
:Auctl St I 1 2018
CI : ST I D No. 2_'03 .•I TT:V: Poll *T,S Lrspec•1or
BRADY J U'I GARD ZONING OTI ICL
CTO~IRD 111LMBI\G R HEATING ST CROIX COUNTY SPIA
PO BOX ~I 131 1101 CARMICHAFI. RD
AMERY \A'I 54001 HUDSON W1 54016-7,703
CONDITION AI, APPRO\ AI.
PLAN APPRO\ ,A1. EXPIRES: 08A 1 20211 Identification Numbers ~
--Transaction ID No. 3142128
SFI F: Site ID .No. 852356 ~
Chris flwi Please r,6:r to both identification numbers.
I632. 102\I) Ave above. in as correspondence with the agency.
I omi of Hammond
St Croix County
NF.14, SW I4, S3, T29N, R I Pk
FOR:
Object I ypc: POW IS Component Manual Regulated Object ID No.: 1790090
Maintenance required: 600 GPD Flow' rate; Syslem( Mound Component Manual - Ver. 2.0. SBD -10691-P (N.01 0I.
R. 10 12): Effluent Filler
I he subminal described above has been reviewed for conformance with applicable \Visconsin Administrative Codes MVD)
and Wisconsin Statues. 'fire submittal has been COCDITIONAI.LY APPROVED. 'This syaem is to be constructed APP
and Iocatal in accordance with the enclosed approved plans and with any component manual(s) rele;eocet#PYe0F SAFETY AND
The owner, as defined in chapter 10 1.0111 (1). Wisconsin Statutes, is responsible for compliance walh'all code DIVISION OF Il
requal'enients.
A copy of the apprcrord plan., spccilications and this letter shall be on-site during construction and o era to
inspection by authorized repres.m moves oldie Departum:t, which may include local inspectors. All •noits j
requved by the state or the local municipality shall be obtained prior to commencement of
construction installation. opcrabon. tt <
In lirantn, th s approval the Division of Industr Sera ices reserves the right to require change, or additions should
conditions arise making. them necessatq for code eonfpIiance. As per state star; 101.121_'), nolhine in ihis re%icw
shall eel is y;: the cics ig,ner of the responsibi 16 for designing a sa fv building,, structure, or component.
Inquiries conccrnin_• this correspondence may be made to life at the telephone number listed below, or at the address
on this Iclterhcad.
1 he above left addressee shall provide a copy of this Teller and the• PO" I S management plan to the owner and any
others who are responsible fix the installation. operation or maintenance of the POINTS.
Sincerely, Fee Required $ 250.00
Bat Received S .'0000
r Balance Due S 0.00
(
I•dwin A A a\ lm'
\k aslewatcr Specialist . Division of Induslrv Services WiSN1ART code: 7633
(715)6;4-;134 , Mon -tai, 3:00 a.m. - 4:30 r.m.
edwi n.taylord w'i. soy
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: PIZZI \~v~STR~ SERV\CES
Owner's Name: CHRIS PIZZI
Owner's Address. 1575 100TH. AVE. HAMMOND WI. 54015
1632 102TH AVE.
HAMMOND WI 54015
Legal Description NE/ SW/ S8 / T29N / R17W
Township. HAMMOND
County ST. CROIX
Subdivision Name: HAMMOND HILLS ESTATES
Lot Number: 14 Block Number:
Parcel I.D. Number: 018-2021-14-000 T' 0AALLY
Plan Transaction No.: ZOVED
PROFESSIONAL SERVICES
Page 1 Index and title ;DLISTRY SERVICES
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance specifications
Page 6 Management and contingency plan
Page 7 Pump curve and specifications SpOND NCE
Page 8 PLOT PLAN
Page 9 SOIL EVALUATION
Designer: BRADY UTGARD License Number 220357
Date 07/29/18 one Number: 715-760-0946
Signature. i
i
JIresigned Pursuant to the
Mound Comport Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181)
Version 3.11 (R. 06/01) Page 1 of 9
Mound and Pressure Distribution Component Design
Site Information
R Residential or Commercial Design Note Sand fill (D) calculations assume a
400.00 Estimated Wastewater Flow (gpd) t able 83-44-3 in-situ sod treatment for fecal
1.50 Peaking Factor (e. g. 1.5 = 150%) coliform of c= 36 inches
600 00 Design Flow (gpd)
7.00 Site Slope
101.80 Contour Line Elevation (ft)
36.00 Depth to Limiting Factor (in)
0.40 In-situ Soil Application Rate (gpd/ft`)
Distribution Cell Information
75.00 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate (gpdift)
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Disribution Information network?
E Center or End Manifold
4.00 Lateral Spacing (ft) If N above, enter the elevation (ft)
2 Number of Laterals of the highest point.
0.125 Orifice Diameter (in) (e.g. 0.25)
3.00 Orifice Spacing (ft) = 12.00 ft`/orifice
2.00 Forcemain Diameter (in)
150.00 Forcemain Length (ft) Does the forcemain drain back? Y
go.oo Pump rank Elevation (ft)
tem Head (ft) x 1.3 24.47 Forcemain Drainback (gal)
H20 j / 50 Sys
30 Vertical Lift (ft) 46.79 5x Void Volume (gal)
45 Friction Loss (ft) 71.26 Minimum Dose Volume (gal)
25 Total Dynamic Head (ft) 20.60 System Demand (gpm)
I Lateral Diameter Selection -Manifold Diameter Selection
in dla options choice in dia options choice
0.75 1.25 x x
1.00 1 50
6,\ 1.25 x x 2.00
1.50 x 3.00
2.00 x
3.00 x
Gallonslinch Calculator
Treatment Tank Information Total Tank Capacity (gal)
1250.00 Septic I ank Capacity (gal) Total Working Liquid Depth (in)
weiser Manufacturer gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
750.00 Dose Tank Capacity (gal) POLYLOK Filter Manufacturer
16.12 Dose Tank Volume (gal/in) 525 Filter Model Number
weiser Manufacturer
Project; PIZZI Page 2 of 9
I
i
i
Mound Plan View
1/~1........ J
'Ob rv
scabon Pipe .'Q'.
K
O ❑5 A
W
B l-}
t
3
. i
L
Mound Component Dimensions
A 8 00 ft E 12.72 in H 1.00 ft K 7.65 ft
B 75 00 ft F 9.25 in 12.00 ft L 90.31 ft
D 6 00 in G 0.50 ft J 4.39 ft W 24.39 ft
600 00 (ft2) Dispersal Cell Area 1500.00 (ft) Basal Area Available
8 00 (gpd/ft) Linear Loading Rate 7 50 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 104 07 (ft) 0_
F Dmpersal G ell 102 80 (ft) Lateral
102.30 (ft) - Invert
Dispersal Cell ~t
Elevation E D Q'
l n
L
101.80 (fl) Contour Elevation
7.0 % Site Slope
Geotextile Fabric Cover
Shading Key m a 1 Dispersal Cell See lateral details on
Q 0 Topsoil cap o n 1.5 It Page 4 for number, size,
❑ ~ F and spacing of laterals.
Subsoil Cap .
Q ASTM C33 Sand 0 ° O Laterals are equally
Q Tilled Layer e 0 0.5 It typical Lateral spaced from the
[5] r Aggregate a o r511 distribution cell's
centerline in the
A - M distnbution cell (AxB).
Project. PI771 Page 3 of 9
End Connection Lateral Layout Diagram
Laterals centered over the A&B dimen=ion 1ur it-up m'bal l valve or clean out plug
(e P
I All laterals are identical I(- X-~I Holesddlledon the bottom of the lateral
Fplde nidln CunneCllon Ina tae or Gloss to manifold at ang point- Laterals & force mnin of Pvc ',,h40
(pr•r i OMM T.IDI.• t14.3U-bj
Number of Laterals 2 Orifice Diameter 0.125 in
Lateral Diameter 1.25 in Orifice Spacing (X) 3 06 ft
Lateral Length (P) 73.44 ft Orifices per Lateral 25
Lateral Spacing (S) 4.00 It Orifice Density 12 00 Wilorifice
Lateral Flow Rate 10.30 gprn Manifold Length 4 00 ft
System Flow Rate 2060 gprn Manifold Diameter 125 in
Total Dynamic Head 2025 ft Forcemaln Velocity 2.10 fUsec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC :300 and -
Comm 16.28 WAC4 in. min.
Disconnect
tank component is properly vented < Alternate outlet
location
rorcemain diameter
Weiser Manufacturer 2 in.
Capacityl 750.00 Gallons
Volume 16.12 gal/inch A
Weep hole or anti.
Dimension Inches Gallons B siphon device
A 34 11 549 78
C
B 2.00 32.24 pump off elevation (ft)
C 4 42 71 26 t 90.50
D 6 00 96.72 D
Total 46 53 750.00 11 ~
Dose tank elevation (ft)
T Bedding un er tank 90.00
Alarm Manuafacturer LEVEL
Alarm Model Number DLV
Pump Manufacturer GOULDS
Pump Model Number EP05
Pump Must Deliver 20.60 gpm at 20.25 ft TDH
Project PIZZI Page 4 of 9
Mound System Maintenance and Operation Specifications
Service Provider's Narne UTGARD Phone 715-760-0946
POWTS Regulator's Name ST CROIX Phone 715-386-4680
System Flow and Load Parameters
Design Flow - Peak 600 gpd Maximum Influent Particle Size [Mcfu/1 in
Estimated Flow - Average 400 gpd Maximum BOD5 mg1L
Septic Tank Capacity 1250 gal Maximum TSS mg/L
Soil Absorption Component Size 600 ft' Maximum FOG mg/L
Type of Wastewater Domestic Maximum Fecal Coliform 00 mL
ServiceFrequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Should 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
INSPECT FILTER ONCE A YEAR
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 mound component manual.
2 Dispersal cell aggregate conforms to Comm 84 30 (6)(i), 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 mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn-up Detail
Finished
Grade
6-8" Diameter Lawn - 10 - - Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Lateral
~i ~ ~ T-- -Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project PIZZI Page 5 of 9
Mound System Management Plan
Pursuant to Comm 83.54, cos. Adm. Code
General
This system shall be operated in amordance with Comm 8284 Wis- Adm. Code, and shall maintained in accordance with its'
component manuals ISBD-10691-P (N.01101) and SSWMP Publication 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
POW1 S components.
Septic or pump tank manhole risers. access risers and covers should be inspected for water tightness 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 In failure must be replaced Exposed access openings greater than 8-inches in diameter shall be secured by an
effective locking dovice. 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, Slats The contents of the septic
tank shall be disposed of in accordance with NH 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessaryto ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm,
the (Ater shall be serviced if the alarm is activated continuously. Intemnitent fitter alarms may indicate surge flows or an impending
continuous alarm.
The septic tank 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 tank 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 lank 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
The 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 fitter is installed within the lank it shall be inspected and serviced as necessary
.
Mound and Pressure Distribution System
No trees or shrubs should oe planted on the mound Plantings may be made around the mound's perimeter, and the mound 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 mound 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
mound be heavily mulched as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/L BOD;, 150 mg/L TSS. and 30 mg/L FOG for septic tank effluent or 30
mg/L BOD„ 30 mg/L TSS. 10 mg/L FOG, and 104 ctu1100 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 test is performed it should be compared to the initial test
when the system was installed to determine if onfice 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 ponding. Pending levels shall be reported to the owner, and any
levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Continency 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 lank, 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 mound component fails to accept wastewater or begins to discharge wastewater to the ground surface , d will be repaired or
replaced in its' present location by increasing basal area If toe leakage occurs or by removing biologically clogged absorption and dispersal
media. and related piping, and replacing said 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. PIZZI Page 6 of 9
TT GOULDS PUMPS
Wastewater
PERFORMANCE RATINGS COMPONENTS
Total Head Gallons Per Item
(ft of water) Minute Nn Demnplion
6P04 EP05 1 Impeller
5 53 2 Rase 10 I, _ -6
lv AG 62 3 Pump Ca4ey 8-_---
15--- 36 ii 4 Me<hawral Seal
20 21 46 '
5 Ball Rean95 -
L` 0 33 6 0-Rings
30 9
7 Power Cord 5 _ - ~ v
8 04 rifled Motor 4
Moto, llousmg; 3
9 Stator Amembly I ~PF
10 Motor Cover 7
METERS FFFf ------i
10
9 30ir_ _ GPM _
Q 2
u _
p I_PUS -
1
- --rte
- -
0 0 0 10 20 30 40 50 GPM
0 2 4 6 8 10 12 mafi
f APACIIV
3
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNT:RSHIP CERTIFICATION FORM
t ,
Owner;"Buyer
Mailing Address J (4.p2---- J G d - l~ Q J~a v~ yr S c/a ref
Property Address 4 try
(Verification required from Planning & Zoning Department for new construction.)
City!State __L4_ ~r-v-.rK Parcel Identification Number
LEGAL DESCRIPTION t
N R ! < W, To Am of lT~ .
Property Location ,5 GK ,Sec. C. T,_
Subdivision Plat: Lot # J .
Certified Survey Map # , Volume Page K
Warranty Deed # (before 2007)Volume ~t'' Page 9
Spec house D yekno Lot lines identifiab4 yes C no
SYSTEM MAINTENANCE AND OW'1TR CERT'IFICATIO'N
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and or (2) alter inspection and pumping (if necessary), the septic tank is
less than U3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of mylour knowledge. Uwe am'are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds 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 tlys 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 decd.
(REV. 04/12)
Wbmnser Doutriat of Cownams SOIL EVALUATION REPORT Pace d..
Division d safety ad Bndanpe
i Socardanre with Comm 8S. Vft. Adrn. Code
qtr 5
Attach oorpbts sM plan m papal not Iws am 8 72 x 11 enones in side. Plan muss
irckxle. bra not innlwd to: vertical and holzorta flrft ca poet (BM), dreaion and Patcd LD. p
perrenlalopa. scabordelarnsiaw•10111 arrow. W4 location and to rMwest food.
plan" print a9 Ldbmsaflon. by
r1e1rrw ammrrarypr,r rsw/tieeeeafar 1s. 0>eret 1I lZ ]
Pmpstyoww Prop"Loubm
l Q 7 q
0eop1- R O Govt Y~ IMSt-~H V T G/ N R/ ( W
pia Maillift AdOress ju, Lot 0 Block* Name a
O , O~ 7 / &,A ` S
CNY ❑ ❑ vitapa Toth Neared Road
(j 5rlvl ( o Ave-
NewCoreeucdan Use)MResider"/NnxWwrofbedtocM Cods deiced detign0ow wta GPD
❑ Repbnmrt ❑ Pt pc or camnmda - Dpsai~o: - -
appY®de i1'//~ R
ParrsnaterW ri~- o - • G •~~Y.t flood Maki dwallim if
Grraloamwa ' /
and recanwondollarm
Systr Ebvatbn
Vy BorY p
a Pit GlondsLrboseW.R DvMblit" terJOr~is Sol AppICAM Rata
"IM Dsph DontYtak Color Redot Desapm Tsonftta ShurAaa Cam 8outday Roofs GPDR
in IAnss1 Oa Sz Cons Color Gr. Sz. -EM1 -EW
I 0-1310 L ► r 'r
C l s m~i '
z. 3-orU;s .2 (o
7. ~S ; SI r m n'1 /v 1,4
a p Baetg i
. E pit Ckou daafaca Wv. r fL Depan ID Wnft fbr 3 n ~ Awksbon PAS
Harmon Deplh DmWwt color Red=Desawion Taft" sbuck a Carsiatarnca Baruch; Roofs GPM
iti Mhxwet CKL Sz. Corr. Color Gr. S¢. Sh. 'E1 lew
f7-I 3/i 1
Z 1L- S/ e I at l^'
M
•Malt•1-BDD>30<aao myL and MS W<_150 'EW"vf2-BOD<30rrpd.and TW490myL
CST N.na Obese PrhO CST faaebw
Bird Plumbing, Inc. Shaun Bird 226900
Ad&M 1000, Evaluation CoMnaed Teieptnone Number
1008192nd Ave, New Richmond, WI 54017 715-246-4516
- o
Pnp"owrw t IDa_~ Page -d_-
131 ROWIG
tiafmn Depth DwWwd COW Redotc Desoripom Vona Strurare CaW"m eaadwY Rows GMW
h Woo W. Ss Coa cam Gr. Sz Sh 'EI 'EM
Q- ~O 3 c O
7.5 Y/~ F/F Y~ S i - i 6
F-I eoews ❑ ea,*tn
❑ Pe GrandwfaosNw.-___R Dplh lo knttg factor Sd AWkMm Rate
tkxtcm Mph Duniure Cokw Redw Desarip m Truce sll d Cotuiures BaumY Root GPOR
h Muusa au. SL Cat Odor Gr. Sz SK $I 'Saf2
aee,roa ❑ S-im
❑ Pn G1a.,d aafsce ebv. 0. Deplhb0raYtp taaor in.
Sol AwAallm 07aae
ltodmn -ape, mmCda Red= Desmvkn. Twue Saiceas Cauwwm Bantry Root GPM
ML Ohaua~ QL SL cat color or. SL Sh 'IN" Iers
'EAUr-#I- ODa>3D MugllaWMT 30<150ugL 'EfMtersit=B0Dr<30mpa.andTSS<30ngIL 1
Mw Depnmomt of Cmmc= is w equal eppwumiiy service Pv~idK cad cm*ycr. if you Deed &aim== to access services or
mud.mraial in w altercate knnat pkase wmaa the depntmmt at W&266-3151 or TTY 60&2644777.
ssouwpaq _
Soil Test Plot PI
Project Name Oevering Homes LLC S*h)il
Address P.O. Box 179
New Richmond Wi 54017 #226900
Lot 14 Subdivision Hammond Hills Estates Date 6/2/07
NE 1/4 S W 1/4s 8 T29 N/R17 W Township Hammond
Boring Q Well PL Property Line County ST. CROIX
BM or vRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 101.4' *NRpSame as Benchmark
150' Property Line B.M.
102'
45'
B-3 Scale is 1" = 40'
B
unless otherwise
250' 50' s'
noted
30'
90'
100' B_1
7% Slope
Please note: survey was not
complete at the time of testing,
installer must check all setbacks
prior to installation.
j
I
444' Property Line
1 nd ve
WismrsmDepartmentofCommerce SOIL EVALUATION REPORT Pa;e__'., of
Divi m of Safety and Buildings
in accordance with Comm 85. Wis. Min Code c /
CWny 5J C
Attach complete site plan on paper not :ess than 8 1:2 x t inches in sae. Plan must
irudtxie, but not limited to. vertical and horixnral reference point (W), direction and Parcel LD. r 7 1 ? ? -
percent slope. scale or dimensions, north arrow, and location and distance to nearest roac. uF " i I I --C
Please print all information. Re ' by _ - D/a
Psrtonol inlomuwn you o w." may ee uaeo for , s t5 (1) (m)). /1 1 Z 7
Property Owner Prop cry l.ocahon Q '7 q
Dt t~ P .'I y / O />"tA~C% i Govt vl r 114 J l 1. 14 U T G/ N R, 7E ( w
Owners Ma' Address Lot # Block # Name or
City rate p Code e ❑ C' ❑ W Rage Town Nearest Road
Uo !c cl ; `~lvl 7 ( c, ti ,
New Constnxtion use'~I Residential / Number of bedrooms _,3._ Code derived design Row rate GPD
❑ Replacement ❑ Pu is or commercial - D/SQs'a~ibe:.
Parent material _,gC?ufeeiq~- Flood Plain elevation if applicable /f//~ _ ft.
General eorrlrrreras
and raconnlendatens:
System Type__ Z' v System Elevation
? -L n
Pil Ground surface elev._ R. Depth b timmrg factor _y in. Soil iraoon Rate
❑a~
Horizon Depth Dominant Col Rodox DesaipUOn Texture Structure Consistence Boundary Roots GPDJW
1(1. MtmseR Qu. Sz. Cora. Color Gr. Sz. Sh. t 'ERii/t 'ERrr2
Z 0 ?J., is ~si~r= ~r)L/ `Jc
Boring # Bon ✓
pit Ground surface elev. _ rt. Oepth to Waling tacu:r - ~~>in. Soil pol~uon Rate
Horizon Depth Dominant Color Radek Description Texture Structure Consistence Boundary Roots GPDIM
in. Mtauell Qu. Sz. Cont Color Gr. Sz. Sh. 'EfM.t i 'ERp2
C~ - i 3/-2- - I c- / -
Z((, / L' SL / c t 6 n
`.J lF" ~V 7. (uf/~~ t 'J. y~(o 1 - y'rn' ~ rz- 4
t
r
• Effluent #1 = BOD > 30 < 220 n1g4 and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg & arld TSS < 30 rns
CST Nafna iPlease Pi" Sig CST Number
Bird Plumbing, Inc- Shaun Bird 226900
Adtlr2~ Uric =:•2.luatior. Cand~cted Ir ~CG7ore PJUm car
715-246-4516
1008 192nd Ave. New Richmond, WI 5401? o r
II
I ,
Property Owner Parcel ID # Page - of
Bonng 7
®Bonrg # Ground surface elev. Depth to limiting factor- in-
Pit Sal Application Rate
Honwn Depth Dtxranant Color Redox Description Texture Structure Consistence Boundary Roots GPDHf
in. Munsell Ou. Sz. Cant Color Gr Sz. Sh. 'Efl#i •ERri2
7 c. . NBC,- S
❑ Borirg# Boring
❑ pit Ground surface elev. _ R, Depth to limiting faCter in Soil l=ba on Rate
t-brizon Depth Dominant Redox Desaipdon Texture Stnuture Consistence Boundary Roots GPD#Y
in. Munsell Ou Sr. Cont. Cola Gr. Sz. Sh. 'Eft#1 'Etflt2
Boring # ❑ Boring
Pit Ground surface elev. R. Depth to lertitcg factor
Sal Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIIt
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. -Eff#1 'Ert#2
r
Effluent #1 = BOD~> 301710 rrq'L and TSS >30 _ 1.50 m91L ' Effluent t2 = BODr 130 ffXA and TSS 130 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-2648777.
setuuolacrooi '
Soil Test Plot Plan'
Project Name Oevering Homes LLC Shaun iri
Address P.O. Box 179~~';~('~,-~i
New Richmond Wi 54017
GSTI #226900
Lot 14 Subdivision Hammond Hills Estates Date`' 6/2/07
NE 1/4 S W 1/4S 8 T 29 N/R17 W Township Hammond
Boring Q Well PL property Line County ST. CROIX
Bbi or VKP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 101.4' *HRPSame as Benchmark
150' Property Line B.M.
102'
45'
Scale is 1" = 40'
B unless otherwise
Aso so' noted
25'
30'
90'
100' B _ 1
7`9o slope
Please note: survey was not
complete at the tithe of testing,
installer must check all setbacks
priorto installation.
444' Property Line
102nd Ave
AA7C D..1 el 144.CC
JNTY PLAT OF _ r
I`'; l 1. L- J I "IYt
11._? 1r7 ri LO'L 16
C It rART:.~T FKW Vt II IL L' I u
F : W. I,< .:N.II a L'no - ,IL I ::r,-Th.r, - 11011 17
N'L. 9:V•1 Cr N4V VDNli IL 'N IN L'J'.IA I UI Y:CF$N. r
LOT 18
NAGE I_'ASEMENT NOTE:
µ 511 I'T34ALI._in..;nL`lr. C:f•::H V.ti.1. :1 NicKlI,N V 14
r IF I :N A Ilt: II ~1!Alr 1Et :nc~,
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tl PP.-,-.411 k 1~ L Ir. n='iLLIIlA1Lv'. 'A'A1CR
QCf(CI i 11 I'.I F`1 !p' l
'RAL NOTICE STATEMENT:
1I r.-, : I r) V .-I I e :A IO N I AII.
u nr wr -J .",7F r
: u u r ::r rl rie "T. _
1 rIr ur : ur1 ur .:r.u wLl:.J:•1
•:u vL . s I L rv_. i ill
TY EASEMENT NOTE:
- , = t r . 1 1, 1 .ls I I T I.0
I I . A: 1 1 r 1 r.,,, IK, ` . .16 ~ _ 1~ r .orr l.oT r i
Aft.-ANN TI r,G -.TV1 11 -Ill i]_,1'tN r<:} 1'1 1' ~r
r 1; sln8 1 .`I'tlr._ f r r ^,v n.-5rr Irnl ,5! 1i
6=. v 5vvL i6' ul_II1 J.._ au. ^.I _HITV3C TIMM
R 4F K I AN fl PJOLIC -
tily lceh NI 1..,I 1L:. II Al -
p Irol 10
Jr I A Ili: ' ~
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T(A.N-il. - [ Ni'NLCI " jj
L
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LT A NIJ IL t !I-A_ LL 111 11.1 11 V •-t ti, i.l deb , dI 1L , ri, 1
CIC...TI'V 51 ] ~ I l I ' G'l ~ Jr
e
L4iE! 21r~I'~ LOCATION MAP: - - it
88888YYYYY ~~~~~~~~_(((C(( I r
I VIITTJ :,IT r,or s
l~, y ^I <nor n I aN < JJa ,
110
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