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Home My WebLink About032-2125-50-000 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Charles & Christine Gaikowski I TOWN OF SOMERSET CST BM Elev Insp�M El; BM Description: O ^ vt- TANK INFORMATION ;n, s = 3.G-F ELEVATION DATA TYPE MANUFACTURM � f CAPACITY Septiceo K I Dosing Wires- el- 750 Aeration TANK SETBACK INFORMATION GllA�kre.T4 TANKTO P/L WELL BLDG. Vent to Air Intake RG4D Septic rx; Dosing \ %�60 A 30 { _ Aeration Holding PUMP/SIPHON INFORMATION pir VL—L. 37,+I Manufacturer // Demand �6 t'lLr GPM Model Number 571 T zl7 TDH 1- Fri n Lo System H . TDL-I Q//Et j !, 5. Forcemain Le gg, A Z Dia{{ Dist to Well & 71 STATION BS HI FS ELEV. Benchmark / .q/ I'Or s Alt. BM Bldg. Sewer 1 St Ht Inlet j' Dt Inlet ✓ Dt Bottom P -15 2. 9I b Header/Man. 8 r OG3 . 64 1 Dist. Pipe Bot.System 11 ,2 777 IDT-73 Final Grade u r Z / 10( St Cover SOIL ABSORPTION SYSTEM tf t- b + Y3 bZ F/ot. 5 BED/TRENCH DIMENSIONS Width \ Length ` No. Of Trenches ,/.( PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO T e Of S stem' DI'{ yN�(dr{�{ PIL q I JBLDG �1 WELL /2-0 LAKE/STREAM LEACHING BER OR� UNIT Manufacture (Jr Modal Number. Z Flow DISTRIBUTION SYSTEM Header/Manifold t \ Length Dia Distribution PiPe(s) Length Dia r { x Hde Sae �� x Hole Spacing I Ven Air Intake 6 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Bed(Trench Center �i �.� Depth Over Bed/rrench Edges :�P/ t xx Depth of Topsoil 1xx Seeded/Sodded xx Mulched COMMENTS: (Include code discrepencies, persons present, etc..) A Inspection #1: Inspection #2: LLocation: 429 172ND AVE c L' L—t) !+ ,T (�2 / 1 r 1.)AIt BMDescdption=£x{5�I`{ ' `nl< `6vv �1ey\47 oh � 2.) Bldg sewer length = EX \41 y(q 06C 50.VOLY bv. A- Y LY1 �J � Of � �" ' 7� - amount of cover = J rt r p�arn� � -Prov�/dKy�VyPew ("Os S�+i� `i�wk Plan revision Required? Yes [A No 1 0 - — �� ✓ Use other side for additional information. i{ O 4� SBD-6710 (R.3/97) Date Insepotor's Signature Cart. No. D county jaJ It t' r ` Industry Services Division St. Cmix Av aoo _ 138 j i E 1 �Y 25 2020 1 400 E Washington Ave P.o 71 2 Sanitary Permit Number (to be filled in by Co.) s � � ¢ Madison, 37 —7 / r1 2 Count (OI Community D ent Permit App icatio state Transaction Number In accordance with SPS 393.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application (brms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you pmviJe may be used for secondary Project Address (if different than mailing address) Purposes in accordance will) the Privacy Law, s. 15. 1gm),Stag. 429 172nO Avenue I. Application Infortnation - Please Print All Information Property Owner's Name Parcel a Charles & Christine Gaikowski 032-2I25-50-000 Property Owner's Mailing Address Property Location 429 172n0 Avenue Gost. Lot SW A. SE Y:, Section 5 City, State Zip Code Phone Number Somerset. W1 54025 rcle one T 30N R19Cor �Z3 11. Type of Building (check all that apply) � Lot a Subdivision Name ® I or 2 Family Dwelling -Number of Be wins \ IS eMf Chatim Block a ❑ Publi✓Commercial - Describe Use f o � //f ❑ city of ❑ State Owned - Describe Use ❑Village of CSM Number ® Town of Somerset III. Type of Permit: Check ojdv one box on line A. Cnm fete line B if applicable) A. ❑ New System Re lacement System ❑ Treatment/Holding 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 Expiration Plumber Owner 395100, 7/16r2001 IV. Type of POWTS S ste m ne vice: Check all that apply) ❑ Non -Pressurized In-Gmu surimd In -Groan ❑ AtwGrade ❑ Mound > 24 in. ofsukable soil ❑ Mound <24 in. of suitable soil ❑ Holding Tank ❑ Other i!i persel Compor ) ❑ Pretreatment Device fexplam) r V. Dis ersaVrre_a_tment Area Information: — Design Flow (gpd) _ Design Soil Application Dispersal Area Required i Dispersal Area Proposed (st) System Elevation 600 Rate(gpdsf) 1200 i 1200 103.00, 0.5 Vl. Tank Info Capacity in EiG (ytl Gallons Totai a or f E. , Nev, Tanks Exiling Tanks Gallons Units M1 enufaclurcr r c y 3 S g m 6 U N H H i O a Septic or Holding Tank 1 1260 1260 1 Week's C. P. Dosing Chamber 1060 11060 1 Infiltrator VII. Responsibility Statement- 1, the uadersigsted, assume responsibility for installation of the POWTS shown on the attached plans, Plumber's Name (Qriot) Plumber, �Aishrrc ! MP/MPRS Number Business Phone Nmmber John Schmitt .j/ ;.' j�'/ft�! 223760 715-760-0486 Plumber's Address (Street. City. State. Zip Code) , 586 Valley View Trail. Somerset, W154025 Vill. CountylDepartment Use Only Approved 1 ❑ D�e}`sVepppeeeev Pertn Fee4ss�uedjI su' g Ag�t Si at El OsTnerRvven R n for Denial S 8IX, Conditions of ApprovallReasons for Disapproval 3) ,-- -. SYSTEM OWNER: 1 , tM 1. Septic tank, effluent filter and / od (Qt Bulwt2nal�fDC dispersal cell must be serviced / malntalned as per management plan provided by plumber. as per applicable code mfBlfF@Sp. ate p Ins for me system and spbnit to We C n oa piper ao. 1. to a in a 11 inch" in sue SBD-6398 (R03/14) SYSTEM PLOT PLAN Gaikowski 4 Bedroom Septic System Project Address: 429 172nd Avenue BM1 ymbol: L BM Elevation: 98.e5' BMDescriplion: Existing Septic tank outlet BM2 Symbol: Q SM Elevation: 103.5' BM Descdptlon: Top of walkout doorsill Slope Gradient of Tested Area: (3%) Well Symbol (if applicable) Notes: See Plat Map for complete map 105 T6 T5 T4 106 A, Design Flow: 600 GPD Atla& design flow calculations for commercial plans: Pipe Materials / ASTM Standard Tables 384.30-3 & 384.3G-5 4" SCH 40 PVC pipe ASTM- 02665 4" 3034 PVC pipe ASTM-03034 R/W 172nd Ave aAlwal, 1 r 40 .r :r T1- 3'x68.75' Infiltrator Hi -Cap chamber trench El.= 97.17' T2- 3'x81.25' Infiltrator Hi -Cap chamber trench El.= 98.38' Driveway T3- 3'x93.75' Infiltrator Hi -Cap chamber trench El.= 98.45' T4- 3'x80' EZ Flow trench El. = 93.00' T5- 3'x80' EZ Flow trench El. = 93.00' ce*t T6- 3'x80' EZ Flow trench El.= 93.00' m Ill @g Garage Well a ° 4 Bedroom o ---- House B2 BM2 Porch i Existing Week's 1260 gal Septic Tank ProposedIM-1060 Pump Tank (pCO CONVENTIONAL COMPONENT DESIGN Reside,iva� Application INDEX AND TITLE PAGE Project Name: Gaikowski 4 Bedroom Replacement septic system Owners Name: Charles & Christine Gaikowski Owner's Address 429172nd Avenue Somerset, WI 54025 Legal Description: SW1/4, SE1/4, S5, T30N, R19W Township Somerset County: St. Croix Subdivision Name: Chabre Lot Number: 15 Block Number Parcel I.D. Number 032-2125-50-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 Valve Information Page 6 Dose Tank Specifications Page 7 Dose tank Cross Section Page 8 Pump specifications & Curve Page 9 System Sizing & Cross Section Page10 EZ Flow Information Page it Pressure Distribution Network Page 12 Distribution Network Specifications Diagram Page 13 Management and contingency plan Page 14 Septic Tank Maintenance Agreement Page 15 Existing Tank Certification Page 16 Warranty Deed Page 17 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 5/17/2020 Phone Number: 715-760-0486 � 1 Signature: '/` l il/ iZ,71tZ1 i In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P IN. 01/02) Pressure distribution Component Manual Version 2.0 SBD-10706-P IN 01/01) SYSTEM PLOT PLAN Gaikowski 4 Bedroom Septic System Project Address: 429 172nd Avenue BMt ymbol: A BM Elevation: 98.85' BM Description: Existing Septic tank onset BM2 Symbol: 0 BM Elevation: 103.5' BM Description: Top of walkout door sill Slope Gradient of Tested Area: (3%) Well Symbol (if applicable) Notes: See Plat Map for complete map T 05 106 B5 T5 14 Design Flow: 600 GPD Attach design flow calculations for commercial plans: Pipe Materials I ASTM Standard Tables 384.30-3 & 384.30-5 4" SCH 40 PVC pipe ASTM- D2685 4" 3034 PVC pipe ASTM-D3g34 R/W 172nd Ave 1 r 40 .r :r T1- 3'x68.75' Infiltrator Hi -Cap chamber trench El.= 97.17' T2- 3'x81.25' Infiltrator Hi -Cap chamber trench El.= 98.38' Driveway T3- 3'x93.75' Infiltrator Hi -Cap chamber trench El.= 98.45' T4- 3'x80' EZ Flow trench El. = 93.00' 1 T5- 3'x80' EZ Flow trench El. = 93.00' > ce T6- 3'x80' EZ Flow trench El.= 93.00' jT Garage VN 11 L ° 4 Bedroom a --- - House ■ B2 BM2 Porch i Existing Week's 1260 gal Septic Tank 1 ProposedIM-1060 Pump Tank commerce.wi.gov isconsin Department of Commerce April 8, 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 ITV: Contact Through Relay Jim Doyle, Governor Richard J. Lainenkugel, Secretary Re: Description: SEWAGE TANKS, CONCRETE Manufacturer: WEEKS CONCRETE PRODUCTS Product Name: SEPTIC, HOLDING OR PUMP Model Number(s): 1260 (58 IN. L.L., 21.76 GAL/IN. CYLINDER, 84 IN. MAX. DEPTH OF BURY, 604 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; TANK DIMENSIONS = 80 IN. INSIDE DIAMETER X 58 IN. H) Product File No: 20100129 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 AUGUST 2015. This approval is contingent upon compliance with the following stipulation(s): • This tank 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 departments 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. • This product is approved to use the following: - Two inch schedule 40 PVC cast in riser for electrical wiring. - Pipe materials constructed in conformance With Table 84.30-2 or 84.30-11, Wis. Admin. Code poured into tank cover or access cover. - Department approved effluent filter designed to be installed in a four inch diameter tee with extension and installed in accordance with the product approval for the filter including a properly sized and located access opening for service and maintenance. - Department approved EZ Set and Polylok Inc., 24" riser cast into the tank cover. This approval supersedes the approval issued on 8/30/2005 under product file number 20050675. SBO-10564-E (N.10/97) File Ref: 10012902.DOC Page 3 PAGE 2 or 2 The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fail to the bottom of the tank. If your filter contains a SmartFilter® alarm, you will be notified by an alarm when the filter needs servicing. Step 1: Locate the outlet of the septic tank and remove the tank cover. Step 4: While holding the cartridge over the access opening, rinse off the cartridge with fresh water, being careful to rinse all septage material back into the tank. Step 2: Remove the tank cover and pump the tank if necessary to prevent any solids from escaping to the the drain field when the filter is removed. Step 5: Insert the filter cartridge back in the case, making sure the filter cartridge is properly aligned and completely inserted in the case. Replace the septic tank cover. Step 2: Firmly pull the filter handle and slide the cartridge out of the case. Residential Applications Certified to ANSIMSF Standard 46 Copyright 2014, Polylok, )nc. All rights reserved Produc(s) covered by one or more US and/or lnternehonal patents. Other U,, S. and international patents may be pending. 1-877-765-95651 www.polylok.com Page 4 a fy1 Nome About Site Map Order Info Videos &literature Contact Drip Systems Treatment Controls Products Downloads Design Guldance I The Bull Run Valve'" is designed to split flows to septic fields or systems. In addition to the advantages of longer life and easier installation it is the most public health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak -proof and external operating characteristics. The change over from one drainage field to another can be accomplished in less than a minute by simply turning the valve without digging or contact with wastewater. d n ITEM DESCRIPTION BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE 8 KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVKEY28 BULL RUN VALVE KEY 28' BRVKEY36 BULL RUN VALVE KEY 36" BRVKEY48 BULL RUN VALVE KEY 48" k M t, R EER CAP ADAPT9i RISER TUBE V OUrPOPrf MTe3-TIOKT ACCEM CAP VALVE DIREM ON FMNDLE * OUT PORT C IN PDRr The Bull Run Valve is available in 4" sch 40 pvc and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated periodically to direct effluent to one or the other of two septic fields. After removing the screw cap at the top of the riser tube, the valve handle can be turned with the valve key furnished. BULL RUN VALVE Complete Valve Kit Contains 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter 4. Watertight Access Cap BRVCIRISER - 4" ADJUSTABLE TO IS" HIGH Paee 5 4" CAST —A —SEAL TOP VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP750-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1 /2" BOTTOM: 3' COVER: 4" MANHOLE: 24' I.D. PRECAST CONCRETE RISER HEIGHT: FLAT COVER 54" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL: 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: 4' CAST —A —SEAL BOOT OR EQUAL GASKET, CAST —A —SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WSCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS OUTLET HOLE PLUGGED LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN /8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: r a ME Z b a L � U F a w :1 IM-1060 General Specifications and Illustrations The IM-1060 is an injection molded two piece mid -seam plastic tank. The IM-1060 injection molded plastic design allows for a mid -seam joint that has precise dimensions for accepting an engineered EPDM gasket. Infiltrator's gasket design utilizes technology from the water industry to deliver proven means of maintaining a watertight seal. The two-piece design is permanently fastened using a series of non -corrosive plastic alignment dowels and locking s clips. The IM-1060 is assembled and sold through a ne rk of certified Infiltrator distributors. Must be backfilled installed in accordance witA�, Infiltrator Water Techn ies, Infiltrator IM-Series Septic Tank General Installation ructions and for shallow ground water conditions refe ce the Infiltrator IM- Series Tank Buoyancy Control G . ante. Please visit www.infiltratorwater.co ManualsGuides/TANK01.pdf for the I, I Working Capacity 1 994 gal 44141 L) -_— Total Capacity 1287 gal (4872 L) , Airspace 16.50A Length 1 __-_ 127" (322 m) { 62.2" 580 mm) 2.3 to 1 Width Length -to -Width Ratio HeIgM__ 64.7" (1389 min) Liquid Level 44" It118 min)Invert Drop3" 6 mm Fiberglass SCompartme Vth 1 or2 —� Maximum B48" Minimum Bunal Depth 16" Maximum Pipe Demeter _ _ (1219 mm) — -- — (152 mm) 6" (152 mm) Weight 320lbs (145 kg) j 4 INFILTRATOR' 4 eueress Park POW P.O. Box 7M Oki Saybrook, CT C16475 860-577-7000 • Fax $W-577 1001 1-800.221-4435 wwwl MiXrataewatn.cOm rwrwdaR4R R6LRCp41LC1[M rtwlcw L1F7a1G SiMY J� 17ywcK1 END VIEW ///� ON 16to7 KCF550RFNwfS WITH LIXIetY IOSp) \ I I-10]{3M1{RIFFW111D � 4B5I IOUILFTIFF Pal TANKTOP HALF TANK INTERIOR ALIGNMENT DOWEL i tee wa �I cCIN I1118I II fWL,gtASs Lpuo suwoar oFv1H trrncw �' w1M euHF ww wiut SIDE VIEW CONnN' GASKET SEAM CUP TANK BOTTOM HALF MID -HEIGHT SEAM SECTION U.S. Patent, 4.75865t, 5,017.041: 5,l M8 488, 5.A76,017; 5.401,116. 5,401,459; 5.511,903. 5,716.183, 5.588.778, 5,B39.84.1 CmrndWn Pstses. 1,329,959.Z1,564 Omer parents perWilg InfiaUlpr, Eguafzs, Cx l . and SldeWwkr se regials9d barrishsks of th th or Water Techndogm. Mr,hig, s, a U9s1eUd IU[IwmM r Franm klfillraln Water TepMipbgm is a regitlersd 4atlsrwh in Mexico Contwr, Mlorol-e9ealip, %tyTA, ChsMirSpacer• MuaR'orl. Pasit o (&k kGa. W&Pgy, SnapLock and SbayltLock se Vednnmka or meeratm Wars, Tecnralogm. PolyLok is a baROsruik or Polylek, Inc. TUF-TnE 4 a regwtered trademark or TUF-TITE, INC Ubra_Po is a trademark of tMX Mc. 0 M161nIMtrWur Visits, TecMlobgm, tl.C. All right, ra,erved. Poorest in U-SA Milt nth I t,UnLacL Inntuatur waxer lecnnoioglesiecnmcal services Department for assistance at 1-800-221-4436 Page 6 October 08, 2015 CUST ID No. 1316956 DAVID LENTZ GOVT AFFAIRS DEPT INFILTRATOR WATER TECHNOLOGIES LLC 4 BUSINESS PARK RD PO BOX 768 OLD SAYBROOK CT 06475 PLAN APPROVAL EXPIRES: 10/31/2020 DIVISION OF INDUSTRY SERVICES PO BOX 7162 MADISON WI 53707-7162 Contact Through Relay http:/Idsps.vA.gov/programsfindustry-services w .vdsconsin.gov Scott Walker, Governor Dave Ross, Secretary Identification Numbers Transaction ID No. 2602108 Site ID No. Please refer to both identification numbers, above, in all correspondence with the agency. Re: Description: SEWAGE TANKS, THERMOPLASTIC Manufacturer: INFILTRATOR WATER TECHNOLOGIES LLC Product Name: SEPTIC, SEPTIC/SEPTIC, PUMP OR HOLDING (trans id 2602108) Model Number(s): IM-1060 (1060 GAL. ONE- OR 2-COMPARTMENT THERMOPLASTIC SEWAGE TANK; 1247 GAL. ACTUAL CAPACITY WHEN USED AS A HOLDING TANK; 713.3/356.7 GALS.; INJECTION MOLDED POLYETHYLENE OR POLYPROPYLENE RESIN, 2- SECTION TANK WITH MID -LEVEL SEAM) [44.0 IN. L.L., 6 IN. MIN. AND 48 IN. MAX. DEPTH OF BURY; 507.6 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; SEE TABLE I FOR TANK CAPACITY IN ONE - INCH INCREMENTS; TANK DIMENSIONS (OD) = 127 IN. L X 62.2 IN. W X 54.7 IN. H] Product File No: 20150226 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, 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 October 2020. This approval supersedes the approval issued on 4/10/2012 under product file number 20120143. This approval is contingent upon compliance with the following stipulation(s): • This tank 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. • Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of the manufacturer's installation and servicing instructions must be given to the owner of the system. 2602108 DAVID LENTZ Page 2 10/8/2015 • 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 greater than 30 mg/L but less than or equal to 220 mg/L, TSS greater than 30 mg/L but less than or equal to 150 mg/L and F.O.G. less than or equal to 30 mg/L. • Before this product is installed a warning label meeting the requirement of SPS s. 384.25 (8) (b), W is. Admin. Code must be securely attached to the manhole cover. This tank is approved to use the following: . The tank is provided with 3 ports on each end (one from each side, one for the tank end) used for inlet and outlet piping, depending on site configuration(s); Four -inch diameter inlet and outlet piping, Schedule 40 or SDR 35. Department -approved effluent filter installed in accordance with the product approval for the filter including a properly sized and located access opening for service and maintenance. . Inlet/outlet pipe water tightness is provided through the use of a rubber gasket, Serco Septic-Tite gasket. See tank wall penetration detail in attached document(s). . Mechanisms for pump electrical connections from riser lid or other locations in riser must be completed in conformance with the riser manufacturer's instillation instructions. . Compatible risers include 24-inch-diameter riser products —Infiltrator TW Riser, EZset by Infiltrator, Polylok®, inc., and Tuf-Tite® Corporation; other state -approved risers recommended by Infiltrator. Maximum riser height is as per the state -approval and riser manufacturer's installation instructions. BEDDING: Tank bedding consisting of native soil (without rocks or protrusions) or 4-inch depth of granular material —pea stone, sand or gravel. Anti -buoyancy control measures may be required if the IM-1060 tank is to be installed with less than 16 inches of soil backfill cover and the seasonal high groundwater table has the potential to rise above the elevation of the tank bottom. Otherwise, no control measures are required. If the seasonal high groundwater is higher than the elevation of the tank bottom at the time of installation, coverage with at least 16 inches of soil backfill cover will eliminate the need for anti -buoyancy control measures. For backfill depths of less than 16 inches, the need for anti -buoyancy control measures must be determined based on backfill cover depth and height of groundwater above the tank bottom. If the groundwater table has the potential to rise above the elevation of the tank bottom, see the attached document(s) for information on the types of controls and applicable backfill and groundwater conditions. • BACKFU L: Backfill with suitable native soil. If native soil is unsuitable, replace unsuitable fraction with suitable soil. Suitable soil includes soil textural classes defined in the United States Department of Agriculture soil triangle. Suitable soil textural classes are based on the tank installation depth, as measured from finished grade to the top of tank. See detailed information on backfill suitability in the attached document(s). • Additional information is included as attachment(s) to this letter; see attachment A, B and C. 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, Glen Jones, M.S. POWTS Product Reviewer phone: (608) 267-5265 fax: (608) 267-9723 email: glen.jones@wi.gov The DSPS is committed to service excellence. Visit our survey at: www.surveymonkey.com/sldspsiscustomersatisfaction PAGE 5OF6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4'0 Vent Pipe NO It from Building 12" Min. or 2.0 ft above Established Flood Elevation (typical) IMPORTANT: Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES @ 20.28 gal/in a Depth (in) Volume (gal) A 20 405.60 B 2.0 40.56 [C] 6.5 131.82 D 8.5 172.38 *Pump Tank Liquid Level = 37 in Force Main Diameter = 2 in Force Main Length = 130 ft Force Main Void Volume = 21.19 gal Eltictdcal must comply with SPS 316 and NEC 300 Weatherproof Extend manhole near as necessary. Junction Box Approved Locking Manhole with Warning Label Attached (typical) 4' Min. or 2.0 ft above Established Flood Elevation (typical) Seal Quick Disconnect ' 18'Min. (typical) 1 *TWeep Hole l IjA B _Alan 10—on 1'`C] Pump I _O( 3" Approved Bedding Materiel Beneath Tank [C] Total Dose Volume (TDV) = 131.82 gal/dose (5X total lateral void volume 5 TDV < 0.2X design flow) + (force main drainback volume) MIN. PUMP DISCHARGE RATE = gpm . I �—Apprcved Joints with Approved Pipe 3 ft onto Solid Ground (typical) PUMP -OFF ELEVATION = 94.85 ft INSIDE BOTTOM ELEVATION = 93.85 ft Vertical Head = 9.65 ft + Min. Supply Head =.5ft + FM Friction Loss = 3.25 ft + Fitting Loss' = 1.05 ft (min. supply head x 0.3) = TOTAL DYNAMIC HEAD = 17.45 ft PUMP TANK: SEPTIC TANK(S): Volume = 750 gal Total Volume = 1260 gal Manufacture Wieser Concrete Manufacturer(s)Concrete Products Pump Manufacturer: Zoeller Install approved effluent filter at the septic tank outlet Pump Model: 152nawwasaa (Sea attached pump curve.) immediately upstream of the pump tank inlet. Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Existing Zabel Controls/Alarm Model: 1036378 Filter Model: A-100 Float switches containing mercury are prohibited. PAGE 5OF6 SEPTIC / PUMP TANK SPECIFICATIONS ^ (No Scale) Anchor tank(s) as necessary Pursuant to SPS 383.43(8)(g) Ali � Finished Grade CAPACITIES @ 4.86 gal/in Depth (In) Vol a (gal) A 24.5 609. B 2.0 49.72 [C] 5.5 136.73 D 12 298.32 Electoral must comply With SPS 316 and NEC 300 Weatnerprtwt :unction Box —Cuntlmt �Ilrll mo B I tC] 'Pump Tank Liquid Level = 44 in Pu-p Force Main Diameter = 2 in Force Main Length = 13��ft � Force Main Void Volume = X19 [C] Total Dose Volume (TDV)gal/ �ose �otal lateral void volumnfbw) + (force maindr 3.5 TE _ Weep Hole o Block Extend manhole near as necessary. Approved Locking Manhole vnth Weming Label Attached INpca9 J" Min. or 2,0 R above Established Flood Elevation (typical) N I W. Disconnect 18' Min. roved Joints with wed Pipe 3 ft onto Solid Ground lNara9 PUMP -OFF ELEVATION = 94.85 ft INSIDE BOTTOM ELEVATION = 93.85 ft Bedding Matenal Beneath Tank \3 • � Vertical Head = 9•65 ft + Min. Supply Head = LIMP ft � + FM Friction Loss = ft � + Fitting Loss" = 1.05 ft— (min. supply head x 0.3) =TOTAL NAMIC HEAD = 17.45 ft TANK: SEPT TANKS Volume = 1094 gal Total Volume = Existing 60 gal Manufa rer: Infiltrator Manufacturer(s): eek's CP. Pump Manufacturer: Zoeller Install approved effluent filter at the septic tank outlet Pump Model: 152 (See attached pump cunre.) immediately upstream of the pump tank inlet. Filter Manufacturer: Existing Zabel Controls/Alarm Manufacturer: SJE Rhombus Controls/Alarm Model: 1036378 Filter Model: A-100 Float switches containingFloat switches containing mercury are prohibited. Page 7 PERFORMANCE CURVE MODELPUMP MENEM ME Lq HN�I� 40 In IN 160 269 tie An 010 tso 0145 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available • Electrical alternators, for duplex systems, are available and supplied with an alarm • Variable level control switches are available for controlling single phase systems • Double piggyback variable level float switches are available for variable level long and short cycle controls • Sealed Qwik-Box available for outdoor installations - See FM1420 • Over 130°F (54°C) special quotation required 151'152.151S�I1c<_ 1511152MS3 MODELS Control Sslea ion Model N151 8N151 volts -Ph 115 t Mode • Amps Non 80 Simplex Duplex__ 2m3 _ 2ar3 _ 2m'3- 2 ar 33 1 Intludad 7 I Irwiuded 115 1 _-_ Auto 60 E151 BE1511 l 230 1 230 1 —Won-T 32 Auto 3.2 N152 115 1 Non 8.5 1 2or3 EIN150. 115 1 Auto 8.5 1 IntllMed 2or3 E152 1 1 230 1 an 4.3 'T1o1 0. 7 nduded ors or N153 1 1 Non 10.5 1 2or BN153 115 1 Auto 10.6 1 Included 1 2 a 3 E153 230 1 1 BE153, 230 1 5.3 . 1 _2a3 2 or 3ar 3 _Nan Auto 5.3 Included SELECTION GUICIl- 1. Single p5gyback variable level float switch or double piggybarh variable level float switch. Refer to FMO477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0743 used as a control activator, specify duplex (3)or(A)III system. • CAUTION TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 Feel Nelen GN, Lxv6 Go Wig W. lxen 189 fib 261 17 201 10 30 45 1 170 61 231 70 265 15 4 8 3B 144 53 201 In 2]t 27 61 28 110 44 167 52 107 25 76 t6 01 34 129 42 159 3D 90 - - 23 67 33 125 35 107 - - - _ 22 85 40 12.2 - - - - 11 42 shwoffH W 300,(91m)) 381 (11.6m) 44n t134m) Model 151 0146050 Models 1521153 6: ±1 -i 3?e 4W I b f 4 irn SN2 "Easy assembly" (lump s (NICANge pbe 1\ �\ not included.) i OPTIONAL_ PUMP STAND P'N 10-2421 Reduces potential clogging by debris • Replaces rocks or bricks under the pump Made of durable, noncorrosive ABS • Raises pump 2" off bottom of basin - Provides the ability to raise intake by adding sections of 111V or 2' PVC piping • Attaches securely to pump Accommodates sump, dewatering and effluent applications NOTE: Make sure float is free from obstruction. RESERVE POWERED DES: G--N For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ® Copyright 2010 Zoeller Co. All rights reserved. Page 8 IN -GROUND PRESSURE DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) 09 SOIL COVER Geoteztile I m:,. 12• (typical)cow` TYPICAL TRENCH CROSS SECTION VIEW 12" min trench M__ (No Scale) depth L �.- -• (typical) ->l •' System Elevation = 93.00 ft s' (typical) Provide minimum 3 ft Lateral Invert Elevation = 93.50 ft separation between trenches. (typical) TYPICAL TRENCH PLAN VIEW (No Scale) (Show force main, manifold, and flush valve locations on plan view.) 0 Schd140 Observation nlne shall be,natallad at rynaon not n two unea. PVC Lateral (typical) ---------- - 20, - — — — — — — — r g = 80 ft (typical) INSTALL PER TRENCH: 8 10-ft bundles @ 50 fP EISA/unit = 400 ft, + 0 5-ft bundles @ 25 if EISA/unit = 0 W 10 ft Bundle (typical) (mfd try Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. A = 3.0 ft (typical) = Proposed EISA per trench = 400 ft, Required Infiltration Area = 1200 ft' x 3 trenches = Proposed Total EISA = 1200 ft, MED m W O n rn 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 & 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 sizing, 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 geotextile 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 rapacity after backfilling is complete. 4*EZf,own Ey INFILTRATOR 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 EZflow 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. The top of each GEO cylinder contains a filter 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 Geotextile r Material Paae 10 PRESSURE DISTRIBUTION NETWORK 1. Distribution pipe sizing • Soil Absorption Area (3-3'X80' EZ Flow Cells) • Lateral per area: 3 • Lateral spacing: 7.00' • Lateral length: 80 • Lateral size: 1 y," • 1st orifice location 2' from end • Orifice size: 5/32" • Orifices per lateral: 20 • Lateral discharge rate: 10.80 qpm • Distribution network discharge rate: 32.40 qpm 3 laterals x 20 orifices/lateral x 0.54gal/orfice = 32.40 qpm 2. Manifold • Location: End • Length 14.00' • Diameter 2" • Friction loss: 14' x 2.25ft/100ft = 0.32 ft 3. Force main: • Diameter: • Length: • Flow rate: • Friction loss: 4. Total dynamic head: 2" 130.00ft 32.4 qpm 130' x 2.25ft/100ft = 2.93 ft • Minimum supply pressure: • Vertical lift: • Friction loss (forcemain) • Friction loss (manifold) • Total dynamic head: 4.55 ft 9.65 ft 2.93 ft 0.32 ft 17.45 ft Page 11 DISTRIBUTION NETWORK SPECIFICATIONS FLUSH VALVE DETAIL (No Scale) Orifice in — — Valve Box Center of Threaded Cap (insulation optional) for Head Testing (optional) I \ Ball Valve ) \ (optional) / Orifices equally spaced: Y [check a) OR b) below] nalong bottom of lateral _\ ✓n along top of lateral Flush Valve with every 5 M twle Assembly ( -see detail) facing down LATERAL INVERT ELEVATION = 93.5 (typical) (No Scale) Lateral Spacing S= 7 Lateral Length (P) = 80 ft Shield orifices for gravelless applications Last Onfir (typical) OBSERVATION PIPE DETAIL (No Scale) Screw -Type or ','r :�- Slip Cap (loose) W Finished Grade (mulched & seeded) 4"0 PVC Pipe t Topsoil Cover Top of pipe to terminate (min. 1 foot) at or above finished grade (4)1/4--t/7 X 6- Slots ® to apart �s Anchoring Device q t Infiltration Surface Q —� 2 '0 Schdl 40 — PVC Force Main (slope to pump tank for drain -back) `0 Schdl 40 PVC Manifold + /(riser pipes optional) irst Orifice (typical) Laterals to be level 40 PVC Lateral 0 = 1.5 in (typical) Number of Orifices per Lateral = 20 Orifices equally spaced Orifice Discharge Rate = .54 gpm along bottom of lateral Number of Laterals = 3 Orifice Spacing (X) = 48 in (typical) Orifice Diameter = 5/32 in Lateral Discharge Rate = 10.8 gpm TOTAL DISCHARGE RATE = 32.4 GPM (typical) First Orifice (typical) —X--� [kiEND MANIFOLD (typi1) CONNECTION Check applicable box. Manifold (riser pipe optional) First Orifice D (typical) 0 m i---X---�"^X/2 X/2--}�X�i —' (typical) (typical) O CENTER MANIFOLD -1 Manifold ❑ (riser pipe optional) CONNECTION PAGE 6OF6 In -Ground Pressure Management Plan IMPORTANT: The owner of this in -ground pressure 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 = 600 gpd; BOD5 5 220 mgL"; TSS <-150 mgL"'; FOG 5 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) o 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 (i.e., pump re -cycling, Float switch settings, etc.) o electrical components (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 tank(s) 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. o Distribution laterals shall be Flushed once every 3 years or when necessary. 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: Croix County Community Developement Phone: Local government unit address: 1 101 Carmichael Road, Hudson 715-386-4680 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. Contin-gency 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 13 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Charles & Christine Gaikowski Mailing Address 429 172nd Avenue, Somerset, WI 54025 Property Address 429 172nd Avenue (Verification required from Planning & Zoning Department for new construction) City/State Somerset, WI Parcel Identification Number 032-2125-50-100 LEGAL DESCRIPTION Property Location SW '/, , SE '/. Sec 5 T 30 N R 19 W, Town ol. Somerset Subdivision Plat: Chabre Lot # 15 Certified Survey Map # Warranty Deed # Spec house ❑yesOto Volume , Page # (before 2007)Volume , Page #. Lot lines identifiable 8yes❑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 rank 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(l) 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 1 /3 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 SL 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. 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 4 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 trap if reference is made in the warranty deed. (REV. 04/12) Page 14 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) 429 172nd Avenue located at: SW ''/4, SE /4, Section 5 Town 30 N, Range 19 W, Town of Somerset , 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): week's C. P. Age of Tank (if known): 19 Years 7/1 6/2001 Permit number (if known) 395100 > John Schmitt (Lic sed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS G- I -P (Date) 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 pavp 15 E SWt/4 OF THE SW1/4 AND PART OF THE SE1/4 OF THE SW1/4 3W, TOWN OF SOMERSET. ST. CROM COUNTY, WISCONSIN. LOT r \ LOT r ` LOT t C&AL IM VOL. 0, x. 15" �.oxx u,w wtw enYwn.t wnw • 4 t tk t 3 fin` 111 LGO•YiYx ,>,.a� a 6 r.e� Ifrprt bWlpR .••Is�•prt ARTS 01 !i 300 fO�pR rs�.rx A 14M110� L .e,Mrr t s ' c EIT C • � rtwi.. pam t .s'ew. a t (I WN RW x � � p � w vxN 10 r.w 16 14 �� r i•� Ir�prt + 1517 — .Aprt vRert x.W.l e M.p A �p n ara•olrR tewa¢» e,..�x•Mx.,. QA.T. NOI®iBl iYN83A N wr I N.py r.qY, Y 4b x.tl 9o-L off H m sw�, poxben. i.., rrr varv„nn,rvl n.,. vy ro. a u.d.xmr �9.b wnayr b xy My..OMa •xn,. AY4d xy d m..nn rVr•rat a ar. � xb., m n rd mxn rtip:,..p�v,. IYtl.E MI H rMAx m•MY.+e� b r. �M d /• Pd<� Pa•bJ �.LMAI dr...rH xxl f..yvu.d. N'h E.rTxrt x b rl�x. Tlx tY d H bV Yibn xy xmxbo rcr x x.r xo.M1p Ix MY, F a lixx.O1D.. TIY �. T,xb M.Y w Ob.E m YOxY rvxa ()rp a,xw w.. x.pvH, b Yr•Q mr ros• x pra Hr ion s� r or s s�srs 7 r Y m 13 PAOPOstD s6 ! @4 sTAT6 rmiff !i/ "Ar KCAL! IN FMIT V . t00• ,p o ,p too aao Ilxll.YrwA EYx.x�M1W w � wMn xre.ci ron.gmwn,.w v,sT ,.a wta xormanmv,e.. wmvu, rrv.r iwe.®ro..ra r�4 IOR IVOMMILIR.GLWQ x,. r.,�lI1MTm,xCIMr QS�WIm IIIMP.iS Mu.lnt,V..ui �awpw.a.Mi ti \ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings /ik accordance with Comm 85. Wls. Adm. Code - " Cour Attach complete site plan on papa(I t Uien 8h all inches In size. Pkn musl include, but not limited to: r�elq6sdce M" (BM(, direodon mid percent slope, scale or drone a L� location and distance to nearest road. Pero 1056 Page I of 3 Tom Schmitt �U PleaaO _ � t allllnfonnatlon. 8j, - — _ D e Peemel1116MEdanrW 00 r used4 purPaar(Pms:r Lm.a 5.04(1)(m)(. ytAtt"r b Property Owner Tp Property Location Stout, Richard j. u. GOVIL tot no SE1/4 SWI04S 5 T 30 NR 19 W Property Owner's Marling Address / Lot a Bledt • I Solid. Name or CSW 1353 Awatukee Trail - 15 no Chabre CiH Ststs Zip r' j City J Village to Town Nearest Road Hudson I WI 154016 i Somerset 172Ndi IM New Construction We: je Residential / Number of bedrooms _ 4 Code derived design Raw rate�._,,.� Replacement Public or commercial • Describe: Parent materiel Pitted glacial drill _ - Flood Plain elevation, It applicable ., 1"n1na ., General comments n 'and recommendatlons: Area suitable for a conventional system with a 0.5gpolsgft rating. Possible systear`414ypti�xst41Q trenches for primary area are 97.53', 97.09'. 8 99.68'. cpf' G i FilBorng a j Boring Ig Pit Ground Surfaoe elev._ 1 DD.03_ R. Depth tolimiting factor . >114 \.lrt^ Irallon Rate ' Horizon Depth In. Nirinenl Color '�Redos Description Murrell I Ou. SL Cant Color Tmdule structure Gr. Si. Sh. Consistence Boddm y Ro* •Effi1 1 0.7 10yr3n none all 2mgr mfr cs 2m .5 .8 2 7-21 5yr4/4 none eI 3msbk mfr OW 1f .5 .9 3 21-114 5yr4/4 none al 2mabk mfr — .5 .9 Boring s A Boring jy Pit Ground surface elev. 103.62 n. Depth to lirrigrg factor > 116 in. Soil Appareflon Rale Horizon Depth in. Donilwrt Color Munsdl I Reft 0wor"on 0u. Sz Cont. Color TeduR Stnmhse Gr. St. Sh. CanYbuoe BMW" Rode 1 1 0-8 10yr3/3 none all 2mgr mfr cw 1f .5 .8 2 8-24 10yr4/8 none ail 2fabk mfr gW 1f .5 .8 3 24-49 5yr4/4 none sl 2csbk mfr gW — .5 .5 .9 .9 4 49-118 5yr4/4 none sl 2mabk mfr — 7 -91 o� s% - Effluent 81 - BOD? 30 c 220 mg/L and TSS 130 < 150 mgA. • Effluent Ant - BOD < 30 mglL and TSS <30 mg/L CST Name (Please Prim) Sig to: / CST Number Thomas J. Schmitt _ �.L� 227429 Address Tom Schmitt Dale Evaluation Conducted Telephone Number 586 Valley View Troll Somerset WI 54025 5l25/01 716-54943861 Proopp&4owner Stout, Richard pawl Bodna I! Boring Page 2 of, 3 1_ I AS Pit Ground Surface elev. W roo it. txpcn w iammng Taaor > 118 in. Sol APOCMbn Nate Hodson Depth in, Dominant Color Maeel %dox Dew"onl Qu. St. Cont. Color I Texture SWehee Gr. St. Sh CoreY9xxx Boundary Rook 'ERii 'EM12 1 G-10 1Oyr3/3 none I 3fsbk trlfr as 1f .5 .8 2 10-29 5yr4/4 none sl 2csWc mill, 9w 1f .5 .9 3 29-118 5yr4/4 tone sl 2msbk rnfr -- .5 I .9 i r a Boring if J Boring Li/ Pit Ground Surface elev. 106.48 ft. Depth to limiting factor >120 in. 8al App %*w Rate Iiortzen DeDQi in. Dominant Color MM" I Redox Deacnption Qu. St. Coe. Cola TsMure Structure Gr. S=. Sh. Caeirkrics Boundary Noah GPOW 'Etff1 'Efh12 1 0-4 1DVW none I i 2fsbk mfr cis 1f .5 .8 2 4 38 5yr4/4 none sl 2msbk rn/r 9w — .5 .9 3 38-120 5yr414 none at 2msbk mfi — — .5 .9 I Boring • J Boring -_- JO Pk Ground Surface elev. 106.21 ft. Depth to limiting factor > 115 in. Sod ApIkafion Rate Horizon Depth In. Wrilent Cola I Mixed I Redo, Dewoon Qu. Sz. Cont. Color TeWore Stmdae Gr. Sz. Sh. I CoreYknce Bounday Rook GPDW 'ERA1 'Eff#2 1 0-6 10yr3/3 none I 2msbk mfr cs I 5 8 2 &21 5yr4/8 none 51 2msbk mfr 9w 3 21-116 5yr4/4 none 31 2msbk mfi Effluent 01 m BOO? 30 < 220 mg& and TSS >30 < 150 mg& ' Effluent a2 = BODa < 30 mg& and TSS < 30 moll. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or n..A,Tar.,:eli..--.nr.mae. fn...,ar..fre...n—,I..A...uw.w..n..1 141...ITV fdl1_1RA_41"I Propeeyowner Stout, Richard Parcel ID0 aBoring # Lj Boring Pape 3 of 3 j� Pit Ground Surface elev. 105.10 n. ueptn to nmmng lector >110 _ in. Sol gDNkatiOn Rate Haiton DeW h. Dwrinarit Color mww Redox Desaiptbn 0u. Si Cont. Cola Tedin Structure Gr. SL Sh. CombOence Boundary Ro* 'E1101 'Eff#2 1 0-8 10yr313 none I 2fsbk Or CB I .5 .8 2 8-16 5yr4/6 none al Jrnabk f * CW -- .5 .9 3 16-110 5yr4/4 none el 2msbk mTr — .5 .9 0 i I 2 z I I Rorino f j Boring 1-7 Boring # _] Boring J Pit Ground Surface elev. fl. Depth to limiting factor in. �p AWbc w Rate Nodmn NO Dw*wt Color Redoa Description Teawre SrSh CorWsWre Boudery Roob in. Munsell Ou. Sr. Celt. Cdor Gr. St. Sn. 'EfN1 'EfW2 I i Effluent #1 - BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent 02 - BODE < 30 mg& and TSS 41.30 mg& The Deparunent of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or nnnA ,tva riot in en aft mmtm fnrme, nl..uea non,am rk. A.no.rmnnr at f 9.144-11 i 1 — TT 6ne_1AA_a111 6AIX 2'' Pvc, EL, ld�,Od' Al I i' 31 Ob�0 I to a ' 1 / jo �p o r 11l�o RL9 e 3o f.3 19.0 F17Z 1 � Ar. ,2,t A.,d 54,.t ��,, wx syoi6 Lof- /S— cflt .4re .SEl 3G✓ 5 S- 73a1y e1FW Yi.> Z'. , of Gs7�ln V Wy SW Z/A //,. 14e j 7_rw / CAI S) sY9_ «s/ 0°( r1B ldinOB1n osloin afe PRIVATE SEWAGE SYSTEM .'aalaty and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) P61110011al rramxaon you PMVN O may be used far s000ndaty purposes [Pdv—y Law. s.15.04 (1 Xrn)). Somerset msy. om c,ev_: nm uescnp[,on: ,00o �oo-n/ * d PyLttPt =CST L'"^'*1 I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic l J2 Dosi ng Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG_ Vent to Air Intake Septic ? 5-0A4 �' -- Dosing rNNA Aeration Holding 0 PU P / SIPHON INFORMATION Manu urer ema t Model Nu r M TDH iction SysteI_Lm TDH t Forcemain Lengthsl_ FI e I STATION BS HI FS ELEV. Benchmark M , () BM �F.SZ 0-5-Si, BIdg.Sewer $—•`f� oZ•63' StIHt Inlet St/Ht Outlet 9. Z,'2.- 9$•es' Dt Inlet Dt Bottom Header/Man. ro-L %B tfSr Dirt. Pipe .(u91 c18.3Q Bot. system ID. 0 :.- r+ Final Grade 07 over (/,5 SOIL ABSORPTION SYSTEM BED /TRENCH width , Length f Trenches PITfflNo.0fPits Inside Du. Liquid Deptl 1 N I N 3 .2 3 IMLEACHINGSETBACK SYSTEM TO P/L BLDG WELL LAKE 'q,,VINFORMATION CHAMBER Type r f a Num S em �OR UNIT cr. DISTRIBUTION SYSTEM He e</Iv ini '' /I y Distribution Pipe(s) x Hole Size x HoeSpa<ing Vent Ta Air lntak Length �Q� Dia. Y Le Dia. Spacing SOILCOVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over I xx Depth Of xx Seeded/Sodded xx Mulched SedlTrench Certer Bed/Tech Ed^ Topsol ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons presenlrtoction#1: 0`11101`10l Inspection#2: --4—_ Location: 429 172nd Avenue, Somerset, WI 54025 (SE 1/4 SW 1/4 5 T30N R19W) - 0530191123 Chabre - Lot 15 h- / _ 1-F4 S 1.) Alt BM Description = s'tll- 2.) Bldg sewer length = 21 • /((11 C11 9' l� �8 P -amount of covrer Plan revision required? ❑ Yes A No tyFTT Use other side for additional information. D1 r T` S8D710(R.397) Date Inspector's signature Cert Nc $ ('VX 0'08.3kS0 J 3 21 Sanitary Permit Application Safety & Buildings Division S In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. `�seonsin See reverse side for instructions for completing this application PO Box 7302 Madison, WI Box 7302 Department of Commerce Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1 xm)) (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8-1/2 x I I inches in size. County State Sari Permit Number El Check if revision to previous application State Plan 1. D. Number sr. C"%X 39�1 UD e L Application Information - Please Print all Information �21 Location: Property Owner Name ...—._ �plvtT. fJAL 6'" 'V-- Perry Location Or T Property sMailing Address -. ...ti.. ,, VL Li r Block umber r h NA- CiTy, Stale Zip Code Phone74umber - ?1191 S . ion Name or CSM Number O 1VAS ,T :;ROIX ( ) couN v �� AdgE IT. Type of Building: (check one) z NIN 1 or 2 Family Dwelling - No. of Bedrooms :_ Public/Commercial (describe use):_ - -- - rllage , own of ❑ State-owned — Nearest Road L Parcel Tax N r(s) IIL Type of Permit: (Check only one box on line A. Check box on line B if applicable) 0 3 '�k - 21 S - SO -00 O A) 1. Q New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 5, 3 0 .l q. 11 Z3 6. u Addition to System System Tank Only Existing System B) Permit Number Date Issue ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) (00 E - 61 Non -pressurized In -ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: - n' V. DispersaVrreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. evation 7. Final Grade Required Proposed Rate (Galslday/sq. ft.) (MinJinch) y�, S3 Elevation 6G7 6 �1ki iay.-0 99. KZ Capacity in Total N of Manufacturer Prefab Si Fir-- Plastic VIL Tank Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks e ric E ❑ ❑ ❑ ❑ ❑ VIIL Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on hed plans. Plumbers Name (print) PI s Signature (no stampsy Business Phone Nurnber o cy !S - f - COY lumbers Address (street, City, State, Zip o CE IX. County/Department Use Only • Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss g Agent Si (No stamps) Approved ❑ Owner Given Initial Adverse Surch a Fee) ap Determination Z.Z. �b/ Z Lp) X. Conditions of Approval /Reasons for Disap rollva1. r I 40 5e: Kr ,[.K ze.&:GoI9� ap.s�Sle.,ce+ �{ sed Ae AU IS 'k& t i--K& U"tr t SBl}6 8r 11�ntnnOt-/ NAG,ti�t, ttl a.® de p-e✓. ✓�0�� rt�[.t_st+-t rvvYMdXO. T1 $, t v