HomeMy WebLinkAbout020-1280-30-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m))
Pewit Holders Name: _ — I City Village Township
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
Poi
2 t �t'r-
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
IF
gNumbe
dction LosSy
tem He
TDFt
t
Dia.
Dis o Well
TOWN OF HUDSON
ELEVATION DATA
STATION
BS
HI
FS
ELEV.
Benchmark
5•Z3
t�5.�z3
po
Aft. BM
Bldg. Sewer
St1Ht Inlet
_
St/Ht Outlet
--_
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bot. System
Q'OQ
Il iJ
7
77r)50
Final Grade
• o
lbo. 23
St Cover
U alvt
5 e3
W. yo
17648o TN
%•a7
TOY
4
H
SOIL ABSORPTION SYSTEM Zd FZ F)ow Ll ti}5
BEDURENCH
DIMENSIONS
Width
3 �
Length
6a
No. Of Tres
n/�c,Jhe
1
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Li
SETBACK
INFORMATION
SYSTEM TO
I P/L
BLDG
IWELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer:,
1
Type Of System:
I
10'
I.3` I
> t OO
„ �
Model Number E-2�
DISTRIBUTION SYSTEM
Header/Manifold
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
QQ / "
"1
Pipe(s)
Length._`_( Dia
Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only c , Ls
Depth Over
Depth Over
>x Dep[h of
m Seeded/Sodded
Mulched
Bedrrrench Center
\
Bed as
Ye s
C No10KY6s
Q No
COMMENTS: (Include code discrepencies, persons present, etc.) L`J Inspection #1: i.: 1 `/p70 �Inspection #2:
Location: 682 EDIE LN �/G'� t� �e� B�SCCIr•4-@ipn ` 't�T- �1� rv0''�� ""`�'
1.) Alt BM Description =
2.) Bldg sewer length -
-amount of cover= GTE
Plan revision Required? ❑Y Yes #,No
Use other side for additional information.
SBD-6710 (R.3l97) Date Insepctors gnature Cert. No.
oK-lint 5V1*gr."" CST zozo-a 4-f
op+'"*rlavrFCC
County
9.
Industry Services Division
ST. CROIX
t
i r i
' Pg APR '0 3 2020
1400 E Washington Ave
P.P. Box 7162
Sanitary Permit Nwnbtt (to be filled in by Co.)
p f
Madisotni, WI 5 —7
��q
� l 1
a71it
. 2n2.o - O
cons t Application
State ansauion Number
In accordance with SPS 383.21 2), W is. Adm. Code, submission of this form to the
( appropriate govemmen[al unit
—
is required prior to obtaining a sanitary permit Note: Application forms for state-owned PO WTS are submitted
to
the Department of Safety and Professional Services. Personal information you prov' a may be used for secondary
Project Address (if different dim mailing address)
u es in accordance with the Privet Law, s. 15.04 1 m , Stats.
682 EDIE LANE
1. Application Information - Please Print All Information A.)
Property Owner's Name
Parcel A
BRADLEY & JENIFER JONES
020-1280-30.000 S 6(. Zq . 1 9 .1
Property Owncr's Mailing Address
Property Location
682 EDIE LANE
Govt. Lot
SW 'b, NW '/.. Section 34
City, State
Zip Code Phone
Number
HUDSON. WI
$4016
(circle one)
T29N R19 Eorg-)
11. Type of Building (check all that apply) Lot
a
® 1 or 2 Family Dwelling - Number of Bedrooms 3 6
Subdivision Name
CHERRY HILL ADDITION
0
❑ Public/Commercial - Describe Use Block
❑ Cityof
❑ State Owned - Describe Use
❑Villagege of
CSM
Number
® Town of HUDSON
III. Type of Permit: Ch«Lpaly one box on line A. Complete line B if applicable)
A.
❑ New System
placement System
❑ TrentmenUHolding Tank Replacement Only
❑ Other Modification to Existing System (explain)
B.
❑ Permit Renewal
❑ Permit Revision
❑Change of
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expirmim
Plumber
Owner
IV.
Type of POWTS S stem/Com nent(Device: Check all that apply)
an -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -(rode ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
Ll Holding Tank ❑ Oda Dispersal Component (explain) ❑ Pretreatment Device (expl " )
f t
V. Dispersaffinestment Area Information/
Design Flo
Design Soil Applica'
Dispersal Area Required (st)
Dispersal Area Proposed Isf)
System Elevation ✓
s'Q
Rate(gpdsf)
750
1000
97.20'
0.6
Vl. TARIArnlfio
Capacity, in
/ PL - 5
d
6
Gallons
Total
Gallons
a of
Units
Manufacturer
E
O '8
1
Z
New Tanks
Existing Tanks
h
A
V
d
Septic or Holding Tank
1000
1000
1
WEEKS C. P.
®
❑
0 1
El
❑
Dosing Chamber <
1
El
❑
❑ I
El
❑
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shows on the attached plans.
Plumber's Name (Print)
Plumber's i tore i /,,// �i/ /
V�1itd7
MP/MPRS Number
Business Phone Number
John Schmitt
L?i J4
223760
715-760-0486
Plumber's Address (Street, City, State. Zip Code)
586 Valley View Trail, Somerset, W154025
County/Department Use Oat
�Vill.
IA1 Approved ❑ Disapproved
rm a
tg s d ng Ve it S' re
` ❑ Owner Given Reason for Denial
$
/
IXW&W1itibfii(AINE&rovaI1Ressons for Disapproval vezt-& • V
1.Septic tank, effluentfilter and y,,,•,, it „ffte cL �mA !� "f2g�
�`^''''`_ "f�''
dispersal cell must ba serv_iqed I maintained
as per management plan provided by plumber. a{� �1 f 5 �IGQ 1`/ya✓
1
2. All setback requirements must be maintained
GJ P., aFP""`^""' "'A'keeb-to complete plans for the system and submit to the Cdunry n1y no paper not lees faun 8 in s 11 inches in sin
of
SBD-6398 (1103114)
SYSTEM PLOT PLAN
Jones 3 Bedroom Septic System
Pmoct Mdresaae2 EEle tam
BM1 Symbol:. BM Elevation: 100.W
BMDesulptlan: Toacif nepdntimalpipe
BM2 SyrtWal: Q BM Elwa T—
BM Descdptkn: Top mAne p t eleal Moe
Slum Graobnt of Tested Mal ON
Well Symbd fd applicable)
Notes: Shc absorytm aria up to< baamOns(aaJgpd)
Design Flow: e00GPD
Leach design tbw r Ialions for
canmwcial plans:
Pipe Materials / ASTM Standard
A- 303a PVC pae
Useng 1000 gallon
Septic Tank
Existing Filter 100'
canisterwl
Polylok 525
slope
T1- 5760' rock & pipe trench
T2- S'x50' rock 6 pipe trench
T3- MM' rock & pipe trench
T4-3'x50' EZ PI" hand) El.- 97.20'
T5-3'x50' EZ Rim trench El = 97 20'
T6-3'x50' EZ Flow trench El = 97 20'
T7-3'x50' EZ Flaw trench El.- 97.20'
3 Bedroom
Garage House
0
I
pmpaMse/
P-19
W
Property lira
15,
,-C�Co
9A
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Jones 4 Bedroom Replacement Septic System
Owners Name: Bradley & Jenifer Jones
Owner's Address 682 Edie Lane
Hudson, WI 54025
Legal Description: SWl/4, NW1/4, S34, T29N, R19W
Township Hudson
County: St. Croix
Subdivision Name: Cherry Hill Addition
Lot Number: 6 Block Number
Parcel I.D. Number 020-1280-30-000
Plan Transaction No.
Page 1
Index and title
Page 2
Plot Plan
Page 3
Septic Tank Specifications
Page 4
Filter Canister Specifications
Page 5
Effluent Filter Information
Page 6
System Sizing & Cross Section
Page 7
EZ Flow Information
Page 8
Management and contingency plan
Page 9
Septic Tank Maintenance Agreement
Page 10
Existing Tank Certification
Page 11
Warranty Deed
Page 12
CSM or Plat
Attachment 1
Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 4/3/2020 *!/ Phone Number: 715-760-0486
Signature:
16-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P IN. 01/01)
Page 1
SYSTEM PLOT PLAN
Jones 3 Bedroom Septic System
Project Address: MEdialam
BMISymbotA BM Elevation: 100 W
BMDescription: TOPdAmpointaledpipe
BM2 Symbol: Q BM Elev a loy6 ----
BMDesciptbn: Toporsnspo latselpipe
Slope Gradient OfTested Mae (5%)
WeR Symbol (dappliceble)
Natea: Sdi ebwpilon use up so W to a bedrooms WX),pd)
2
m
2
e
G.
Design Flow: 600 GPD
Mlach design Raw rxladabons for
commercial plans:
Pipe Melepais / ASTM Standard
E,dsdng tDDD gallon
Septic Tank
Exiehng FSkr
cenisterw/ 100'
Polylok 525
slope
NO
T1- Sh50' nook 6 pipe bench
T2. S)cW ro& 8 pipe bench
T3- Sk50'rock & pipe bench
TI-Sk50' EZ Ffow bench EA.- 97.20'
T5-3k50' EZ Flow bench El.- 97.20'
TO-3k50' EZ Flow bench EI = 97.20'
T7-3'x50' EZ Flow bench El.- 97.20'
0
3 Bedroom
House
WIA
Scale: 1" = &Y
Property Lim
152
commeme.wl.gov
rolaPartreentsconsin of commerce
February 16, 2010
WEEKS CONCRETE PRODUCTS
RAY WEEKS
1832 215TH STREET
NEW RICHMOND WI 54017
SAFETY AND BUILDINGS DIVISION
Plumbing Product Review
P.O. Box 2658
Madison, Wisconsin 53701-2658
Try: Contact Through Relay
Jim Doyle, Governor
Richard J. Lelnenkugd, Secretary
Re: Description: SEWAGE TANKS, CONCRETE
Manufacturer: WEEKS CONCRETE PRODUCTS
Product Name: SEPTIC, HOLDING, OR PUMP
Model Number(s): 1000
(49 IN. L.L., 21.76 GALAN., 84 IN .MAX. DEPTH OF BURY 511 G.P.D. WHEN USED AS A
SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL
WASTEWATER;. TANK DIMENSIONS = 84 IN. L X IN. W X 49 IN. H )
Product File No: 20100040
The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with
chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes.
The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This
approval is valid until the end of JUNE 2015.
This approval is contingent upon compliance with the following stipulation(s):
• This lank must be designed to withstand the pressures to which it will be subjected.
• The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's
stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the
department.
• When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent quality
with a maximum monthly average value for BOD5 of greater than 30 mg/L and less than or equal to 220 mg/L TSS, or
greater than 30 mg/L or less than or equal to 150 mg/L TSS, and F.O.G. of less than 30 mg/L.
• Approval is issued for this product as being equivalent to a floor outlet water closet when the fixture drain is installed
in the vertical position. The design meets the intent of s. Comm 82.32 (5) (c) and 84.20 (5) (n), Wis. Adm. Code, which
requires water closets to discharge through a minimum diameter 3" drain pipe or fitting and the bowl to conform to ANSI
Standard At 12.19.2M. The intent of the code is met since this product provides the same functional performance as water
closets that meet ANSI Standard At 12.19.2M.
• BEDDING: Bedding material shall be used to provide a uniform bearing surface. A min. of 4-Inch base of
sand or granular bed on top of a form and uniform base is recommended. The tank should not bear on rocks. Sites
with high ground water tables should have specially designed bedding. Soils should be compacted under the tank.
This approval supersedes the approval issued on 4/21/2005 under product file number 20050106. This approval letter shall
be incorporated with your previously approved plans and/or specifications approved under product file number 20050106.
As of May 15, 2008, a copy of a successful water tightness test report for this product must be AVAILABLE FOR
INSPECTION AT THE MANUFACTURER'S PLANT prior to this product being used as a POWTS holding or treatment
tank in Wisconsin.
The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may
result from its use.
Sincerely,
Jean M. MacCubbin, CST
Engineering Consultant --Plumbing Product Reviewer
Commerce; Safety & Buildings Div.; PO Box 2658; 201 W Washington Ave.; Madison WI 53703-2658
Phone: 608.266-0955; Fax: 608-283-7456; E-mail: Jean.MacCubbin@wisconsin.gov
SBD-10564-E IN.10197)
File Rel: 10004003.00C
Page 3
10
W
A
A
DETAIL 13
FILTER
CANISTER
DETAIL
p
s
WARNING LABEL
LIFTING HOOKS
APPROXIMATE LOCATION
$
SEE DETAILS 1-2-3
m24
0
\t
\.
N
t
Y
n
a
W ~
CONCRETE
SEALANTS TYP.
gip'
OR EQUAL FOR ALL JOINTS
°
(SEE DETAIL
5)
s
TOP VIEW
s
0
0
W^
STEEL CHAIN
ZINC PLATED
PAD LOCK SEE DETAILS, 1-2-3
W �
[V
N
d.
C O Ln
K 00
0z0
CAST -A -SEAL
`� o I
CAST IN RISER FILTER
SEE
s N
DETAIL 6
4* CAST -A -SEAL
W = I
CAST IN RISER
o
W
00
`*�
m
n
W Q
24"
K Z
U
U F
a
N
SIDE VIEW
J
SHEET NO.
�OF 1
TenI m"AWubwk°Yc
PL-525 Effluent Filter
PL-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok P1r525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tank.
Features:
• Rated for 10,000 GPD (gallons per day).
• 525 linear feet of 1/1V filtration.
• Accepts 4" and 6" SCHD 40 pipe.
• Built in gas deflector.
• Automatic shut-off ball when filter is removed.
• Alarm accessibility.
• Accepts PVC extension handle.
PL-525 Installation:
[deal for residential and commercial waste flows up to
10,000 gallons per day (GPD).
1. Locate the outlet of the septic tank.
2 Remove the tank cover and pump tank if necessary.
3. Glue the filter housing to the 4" or 6" outlet pipe. If
the filter is not centered under the access opening use a
Polylok Extend k Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing.
5. Replace and secure the septic tank cover.
PL-525 Maintenance:
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. if the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
needs servicing. Servicing should be done by a certified
septic tank pumper or installer.
1. Locate the outlet of the septic tank.
2 Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserted.
7. Replace and secure septic tank cover.
1/16" Filtration Slots
10,000 GPD �
Adepts 4"6
SCHD 40 pipe
Alarm Switch
(optiotW)
°ccepts 1" PVC
tension Hardie
Rated for
10,000 GPD
525 Linear Ft.
of 1/16"
Filtration Slots
®Certiflsd to
NSF/ANSI Standard 46
Gas D¢Flcrtnr
Automatic
Shut -Off Ball
Outdoor SmartFilter.+ Alarm
Polylok Zabel & Best fitters accept
the SmartFilter® switch and alarm.
Extend & I.okr"
Fasdy mstans
into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, Cr 06492 Toll Free: 877,765.9565 Fax: 203.284.8514 www.polylok.com
Page 5
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down -sizing credit)
Geotemle
Cover —
go SOIL COVER
tr
min. trench
depth
(typical)
System Elevation = 97.20 ft.
(typical)
mkt. tr
(typica0
Septic Tank(s) Merwfacstrer
Weeks Concrete Products, Wieser Concrete Canister
Septic Tank(s) VoILT*s):
1000 gal gal gal gal
Efhmnt Filter Manufacturer
Poylok
ERNent Filter Model #: 525
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
Provide minimum 3 ft
separation between trenches.
TYPICAL TRENCH (show location of inlet / outlet pipe connection on plan view.)
PLAN VIEW
(NO Scale) 4" out un PN. Nrl be nerrtl
Perforated Lateral etunpgneat.eent.aunr
observation Pipe
— (typical) — — (typical)
0f-------
I__—::—======= _--=: =t
L— — — — — — — — — — — — — — — - 7�z ------------- —
= B = 50 ft
(yMcal)
INSTALL PER TRENCH:
5 10-ft bundles @ 50 R' EISA/unit = 250
a' + 0 5-ft bundles Ril 25 ff EISA/unit = 0
OBSERVATION PIPE DETAIL
(No S"le)
Strewp OW,a •w'„ FlnbMtl ertle
SIiP CaP (Imw) (mokhetl d seetletl)
4'0 PVC Ppe •'1 `, Topaor Cover
Top or pip. r runner (min. t loot)
etwabomfrit"dgretle .
(0)1/4 Xe' "
AA1 .pr
AtXilW ev4Yeq eInfiartlon
.' s.d.o.
10 ft
�A=3.al ft
J (typical)
`— EZ1203H Bundle
(typical)
ft2 (mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturers Instructions.
ft2
= Proposed EISA per trench = 250 fit Required Infiltration Area = 750 ft2
x 4 trenches = Proposed Total EISA = 1000 ft2
Distribution Method:
distribution box
m
W
O
n
Installation Instructions for
EZflow Systems in Wisconsin
Wisconsin Department of Commerce, Safety and Buildings
Division, has reviewed the specifications and/or plans for this
product and determined it to be in compliance with chapters
Comm 82 through 84, Wisconsin Admin. Code, and Chapters
145 and 160, Wisconsin Statutes. All sites must meet the Ste
& Soil Conditions & Locations & Isolation distances as noted in
local regulations.
The approved products are 1203H (3-12" bundles with pipe in
center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles
with pipe in each bundle in 5' or 10' lengths.
A single pipe bundle contains a four inch perforated pipe sur-
rounded by EPS aggregate and is held together with poly-
ehtylene netting. A single aggregate bundle contains aggregate
only and is held together with polyethylene netting.
Materials and Equipment Needed
• EZflow Bundles
• EZflow Geotextile Fabric
• EZflow Internal Pipe Couplers
• Pipe for Header and Inlet
• Backhoe/Excavator
Installation Instructions
The instructions for installation of EZflow products are given
below. This product must be installed in accordance with state
rules defined in chapters Comm 82 through 84, Wisconsin Ad-
ministrative Code, and Chapters 145 and 160, Wisconsin Stat-
utes, as well as the local health department's current design
manual.
1. After the local health department has determined siring,
configuration, and layout for the EZflow systems, stake
or mark with paint the location of trenches and lines. Be
careful to set correct tank, invert pipe, header line or dis-
tribution box and trench bottom elevations before instal-
lation of pipe bundles.
2. Remove plastic EZflow shipping bags prior to placing
bundles in the trench(es). Remove any plastic bags in the
trench before system is covered.
3. This product must have geotextle fabric that meets re-
quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extending
down along the sides of the product to a point at least six
inches from the bottom of product.
4. When installed in a trench, the trench should be dug to
a width of 36 inches. This not only saves labor in excava-
tion, but also provides better load -bearing capacity after
backfilling is complete.
EZftouwu
by INFILY"TOa
5. The Absorption area (SF) necessary for a given site shall
be sized based on maximum daily sewage flow (GPD) and
the Permeability for the site. If certain criteria is met, the
EISA sizing can be used in Wisconsin, resulting in a 40%
smaller drainfield.
6. Place EZflow bundle(s) in the EZtlow configuration ap-
proved by system design permit specified for the particu-
lar site. The top or center -most bundles containing pipe
are joined end to end with an internal pipe coupler. Any
additional aggregate only bundles that may be required,
should be butted against the other aggregate -only bun-
dles and do not require any type of connection.
7. The top of each GEO cylinder contains a fitter fabric pre -
manufactured in between the netting and aggregate. The
fabric is inserted to prevent soil intrusion. The installer
shall make sure the the GEO is positioned upward and is
in contact with the fabric contained in the adjacent cylin-
der before backfilling.
8. The EZflow Drainfield Systems should be installed in a
level trench in all directions (both across and along the
trench bottom) and should follow the contour of the ground
surface elevation (uniform depth), with all continuous
adjoining 10-foot cylindrical bundles placed end to end,
with central bundle distribution pipe interconnected,
without any dams, stepdowns or other water stops.
9. The trench top shall be graded such that water will not
pond. Backfill should be seeded or sodded immediately
after completion to reduce erosion.
10. EZflow EPS bundles are flexible and can fit in curved
trenches as may be necessary to avoid trees, boulders, or
other obstacles.
11. EPS aggregate is lighter than water, therefore, it might
be expected that natural buoyancy forces would tend to
cause EZflow assemblies to float out of ground when
ponding occurs. Field experience has shown, however,
that this is not a problem when systems have a minimum
of 6" of soil cover as recommended by manufacturer.
1203H-GEO
xtile
r Material
Page 7
In -ground Gravity Management Plan
IMPORTANT:
PAGE 4OF4
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow = 450 gpd; B0D5 <_ 220 mgL-'; TSS —< 150 mgL-'; FOG <— 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
c neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tanks) exceeds one-third (1t3) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Schmitt & Sons Excavating, Inc.
Phone: 715-760-0486
Local government unit: St. Croix County Community Development Phone: 715-386-4680
Local government unit address: 1101 Carmichael Road, Hudson
zip: 54016
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
Page 8
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Bradley & Jenifer Jones
Mailing Address 682 Edie Lane, Hudson, WI 54016
Property Address 682 Edie Lane
(Verification required from Planning & Zoning Department for new construction.)
City/State Hudson, WI Parcel Identification Number 020-1280-30-000
LEGAL DESCRIPTION
Property Location SW '/, , NV'/. , Sec. 34 T 29 N R 19 W, Town of Hudson
Subdivision Plat: Cherry Hill Addition Lot # 6
Certified Survey Map # Q Volume =I image #
Warranty Deed # 43 3(p (before 2007)Volume E&b S Page #c.
Spec house ❑yesdto Lot lines identifiable Dyes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 393.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 113 full of sludge.
I/we, 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 my/our knowledge. 1/we antiare the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 3 l
G ^ RE OF ICAN (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 storey map if
reference is made in the warranty deed.
(REV. 04112)
Page 9
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 682 Edie Lane located
at: SE '/a, NW '/., Section 34 —,Town 29 N, Range is W,
Town of Hudson , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes_ No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 1000
Construction: Prefab Concrete x Steel Other
Manufacturer (if known): Weeks concrete Products
Age of Tank (if known): 29 years
Permit number (if known) 128847, 376/1991
L;261i X/41e� John Schmitt
(LicqRsed Plumber Signature) (Print Name)
MPRS 223760
(Title)
qi-/�-z'o
(Date)
(License Number) MP/MPRS
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
Page 10
EDOWEDD Qsr—Zesaa-044,
4
AN 0 3 2020 DeP gent of A p , A_i _n_ ti #2030
R SOIL EVALUATION REPORT P
Sys S ty and in aocordance with Comm 85. Wis Adm. Codtr
St. crolxcountyProfess nalServices tt lTe ,Inc.
Immunity Development ot County
r e p an on paper nless Than BX x 11 inches in size Plan must St. Croix
include, but not limited to. vertical and horizontal reference point (BM), direction and -- - - --- -- - --------- -
percent slope. scale or dimensions. north arrow. and location and distance to nearest road Parcel 16.
020-1280-30-000
Please print all information. Rr/Wed----'—
non By
Personal mrorma you provide may oe used for secondary Purposes (Pnvacy Law s t 5 Oa (t) (m)) -- -- O -- • J Ha y�A/
Jones, Bradley & Jenifer Govt. Lot SE1/4. NW114, S34, T29N, R19W
Property Ovmer's Mailing Address Lot # Block # Subd Name or CSM#
682 Edie Lane 6 Cherry Hills
--------- ------ -- - ---- zip -bode -hi - fl --- ---- -------_ Town- ---- ------__ -
City State Phone Number City Village Town Nearest Road
Hudson WI 54016 651-338-6477 Hudson Edie Lane
New Construction Use Residential / Number of bedrooms 4 Code derived design flow rate 6W, GPD
Replacement Public or commercial • Describe. -
Parent material Outwah Send over Limestone _ Flood plain elevation. if applicable NA -- ft
3eneral comments Area is suitable for a conventional system with a 0.6 gpolsgft rate. Possible system elevation for replacement area is 97.2'. Slope
and recommendations: of area is 5%, Trenches will run north�south /
Boring #
Boring
ptt Ground
surface elev.
102.1 ft.
Depth to limning factor
99
in.
ISoil Application Rat,
Horizon
Depth
Dominant Color
Redox Description
Texture
Structure
Consistence Boundary
Rook
GPDW
in
Munseti
Ou. Sz Cont Color
Gr. Sz Sh.
•Edat I
-Efla2
1
0-10
10yr3/3
none
nil
2mgr
mvfr
as
2m,2f
0.6
0.8
2
10-17
10yr4/4
none
sil
- - ---
2fsbk
mfr
gw
2f,lvf
-
0.6
- - -
0.8
. -
3
17-36
10yr4/6
none
grsl
2msbk
mfr
gw
1vf
0.6
1.0
l •'
4
36-68
7 5yr4/6
none
grls/sl
2msbk
mvfr
gw
-
0.6
1.0
5
68-99
10yr6/4
none
cos
Ogg
fill
as
-
0.7
1.6
6
99+
10yr8/3
Umestone
-
-
NP
NP
-
-
36-68" is a --- my sand (him sand content} bur rated as sandy team
Boring #
Boring
Pa
Ground surface ekv 101.47 ft.
Depth to limiting factor
92
in
Soil Appliahon Ra
Horizon
Depth
Dominant Color Redox Description
Texture
Structure
Consistence Boundary Roots
_ _ G_PDtW _
in
Munsell
Ou. Sz. Cont Color
Gr. Sz. Sh
-Errat -Eda2
11d
1
0-9
10yr3/2
none
sit
2mgr
mvfr
as
2m,2f
O.6 0.8
2
9 26
10yr4/4
none
NI
2mst11t
mfr
gw
2f,2vf
0.6 018
�' ST
3
26 56
7.5yr4/6
none
gris
lcsbk
mvfr
gw
2f,lvf
0.7 1.6
4
56.92
10yr6/4
none
grs
------
059
mvfr
gw
0.7 1.6
5
92+
10yr8/3--
Limestone---
--
-
--
--
NP NP
- -
--
IN.y?'t-
' Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < ISO mg/L " Effluent #2 = BODs < 30 mg/L and T55 4_54.mpa_-�
CST Name (Please Print) Signature I CST Number
Thomas J. Schmitt` 227429
- - - --- — -- -- v --- _ "- — - ---- -- -- --
4ddress Schmrtt Soil Testing. Inc Date Evaluation Conducted Telephone Number
1595 72nd St. New Richmond. WI 54017 3/31/2020 715-760-1978
wn.a»nlse-u<�
Property owner Jonees&adle)&Jenifer Parcello# 020-1280-30-000Page _2_of 4 -
3
Boring #
Boring
Pit
Ground surface elev. -
99 35
it Depth to limiting factor 72 -
is
Son Application Rate
Horizon
Depth
Dominant Color Redox Description
Texture
Structure
Consistence Boundary
Rods
in
Munsell
Qu. Sz. Cont. Color
Gr. Sz Sh
_G_PD_HP _
•EBJn - •Effs2
f 1
0-7
10yr3/3
none
sil
2mgr
myfr as
2m,2f
0.6 0.8
2
7 15
10yr4/4
none
sil
2msbk
mfr gw
2f 2vf
0.6 0.8
3
15 23
7 5yr4/4
none
grsl
2msbk
mfr gw
2vf
0.6 1.0
4
23-40
10yr5/6
none
grls
lcsbk
mvfr gw
0.7 1.6
5
40-72
10yr6/4
none
grs
Osg
ml as
—
0.7 1.6
—NP
6
72+
10yr8/3
Umestone
—
-
NP
Boring #
Boring
Pit
Ground surface elev.
ft Depth to limning factor
In,
[Soil Application Rate
Horizon
Depth
Dominant Color Redox Description
Texture
Structure
Consistence Boundary
Roots
GPDM-
m
Munsell
Qu Sz. Cont. Color
Gr Sz- Sh.
_
'Elor1 'EtrJ2
Boring #
Boring
pit
Ground surface elev _ --
--
ft. Depth to
limiting factor _ _
in,
Soil Application Rate
Horizon
Depth
Dominant Color Redox Description
Texture
Structure
Consistence Boundary
Roots
GPDM'
in.
Mansell
Qu. Sz. COm Color
Gr. Sz- Sh.
_
=Emil -Eeit2
Effluent #1 = SODS> 30 < 220 mg& and TSS >30 < 150 mgfL , Effluent #2 = 800< < 30 mg/L and TSS -00 malt.
the Department of Commerce is an equal opporitmit� wrx ice prof ider and emplcn er. If %ou need assistance to access sen ices or
need material in an alternate format. please contact the department at 608-266-3I31 or "FTY bull-264-9777.
1613.e lic Igq-;.}I SchmRt SW Teri ax
ci
M
UM
❑MI�
am
Conducted for &alley 8 Jenrter Jones
662 Erne Lane
Hudaal WI 54016
PID 020-1280-30-000
Lot 6 Cherry Hills
❑Xr
fill., rank
Sanlx: l.nM
EXI511W
FINI It It,
h,
' •�
L102
5"n 5loyu •�
Td
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uy
NA
I�Jumv
GAkA(1
Conducted by Thomas J. Schmill
HOUSL
CS1 227429
3-31-2020
O
W(LI
St Croix County, WI
Legend
u,leruWe '
U!, Hryhwaya
Sldu I4yfnv:rys
GuaNY Nrfrwnv�
L, L,W RuaU
OwlKNoal,
Ranrpn
ko:ulk"Id nl Vvl:ry
IWrknxds
r .m.yancn nrmrion
BM 1 10U' 1" Lu1e Pont steel pipe (soulh)
BM 2 100.52' 1" Line point steel pipe (north)
Filter tank outlet pipe El. 100.25' N
Top of manhole weer on a ephc lank El. 102.90'
0 20 40 6011
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