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HomeMy WebLinkAbout032-2064-40-110 (3)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)] Permit Holder's Name: I City Village Township sepn Laurolx I TOWN OF SOMERSET SM Elev: Insp. BM Elev: IBM Description: r r , 1. — - r .1 TANK INFORMATION 1 ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic sa •r t'r P A g Wle� C�?N�s'f�w dal I�kSLS— TANK SETBACK INFORMATION EINEsS:�St I OLLS C PUMP/SIPHON INFORMATION TANK TO PIL WELL BLDG. Vent to Air Intake FROAD Septic Dosing Aeration i IbUI 7�r t M actur D and PM odel Number T Lift Friction Loss Sy ead TDH Ft Forcem Length Dist, to Well SOIL ABSORPTION SYSTEM-• 'j•, ST -ION BS HI FS ELEV. Benchmark 3,2-4 I ���• �• Alt. BM ih BI .Sewer �1 -n S nlet I11:1, •S .1 sY r}• �Z1.34 StMitOutletCox\, S�e2 It c�, 121. 3`{ Dt Inlet Dt Header#hmr" A 9 27 Q 1 Dist. Pipe Bot. System I O 1 4 T7- Final Grade St Cover �2e•9ymp 1o9. o 19.8r-f 2.5b BED/TRENCH DIMENSIONS Width I Le th 1 o. ff Trenches PIT DIME IONS No. Ohs / Inside Di Liquid D SETBACK SYSTEM TO I P!L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer: .{„U INFORMATION CHAMBER OR UNIT r T(We Of System r��p A f �IOVI \ 1*Ut \ i� Mod ber' 1.�1A1 V M1�t1 V DISTRIBUTION SYSTEM L& 4. rent. 1 m Naar vwf. . Ln I- ILI{,J Header/old /1 Length Dia IDistnbution Pipe(s) Length Dia Spacing x Hole S acing Vent to AifiLLr Intake I EN SOIL COVER (,^ INN x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over pp t Bedfrrench Center, qs� .. vv Depth Over BedJTrench Edges I {I g > xx Depth of xx Seeded/Sodded to Mulched To s p � Yes ©No � Yes ■ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2: Location: 380 150TH AVE �j +0 a>� ST inlrr 1.) Alt BM Description = 2.) Bldg sewer length = (V N - amount of cover = Plan revision Required? ®Yes y�UI' No ('DAJja�tlle'//r Use other side for additional informatiofi V �1C, _ _ __It.esS SBD-6710 (R.3197) Insur Cen. No. M*"mn4v> 4 Industry Services Division County St.cmix 54N-0 (� 3 T ) 0 ?= MAY 26 2020 1400 E Washington Ave P.O. sox 71s2 Sanitary Permit Number (to be filled in by Co.) Madison, VA 5 -71 2 (o Zt f SZ Z St. Croix County it Application% State Transaction Number In accordance with SPS 383.21(2). W is. Adm. Code, submission of this form to the appropriate g rhd unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are sub to the Department of Safety and Professional Services. Personal information you provide may be used for secondary P%lect Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1 m Stars. 380 1500 Avenue 1. Application Informaition — Please Print Ali Information Property Owner's Name Parcel p Joseph LaCroix 032-206440-110 Property Owner's Mailing Address Property Location 380 1591 Ave Govt. Lot SE''/., SE'/4, Section 18 City,State Zip Code Phone Number Somerset, WI 54025 le one) T 30N R19Eu� II. Type of Building (check all that apply) Lot p ✓ Subdivision Name ® 1 or 2 Family Dwelling - Number of Bedrooms 3 1 NA Block f ❑ Public/Commercial - Describe Use ❑ city of ❑ State Owned - Describe Use 33) ❑ Village of SMN bar Town of Somerset III. TvDe of Permit: Ch one box on line A. Com fete line B if applicable) A. ❑ New System ® lacement System ❑ TreatmentMoldin Re B Tank Replacement Only El 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 148999, 4/2S/1991 e of POWTS S stem/Com nent/Device: Check all that apply) on -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable suit ❑ Mound <24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) r I V. Dispersal/Treatment Area Information: t Design Flow (gpd) Design Soil Application Dispersal Area Required (s0 ispersal Area Proposed (s System Elevation v/ 450 Rate(gpdsf) 643 700 92.6',90.V 0.7 Vl. Tank Info Capacity in Crmlom Total Gallons a of Units Matmfaamer New Tanks Existing Tanks Septic or Holding Tank Filter Canister 1000 1000 2 Wieser Concrete Dosing Chamber Vil. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans Plumber's Name (Prim) Plum MP/MPRS Number Business Phone Number John Schmitt ,/,[/� /�%%Z`'" "' 223760 715.760.0486 Plumber's Address (Street, City, State, Zip Code) 586 Valley View Trail, Somerset, W1 54025 ounty/Department Use Only itVxIII. t�1 Approved ❑ D/1 d Perm' Fee' a Issued I ug AgcAt Si at r ` ❑ lAa r Give n for Denial $ � 'L OZp II IX. Conditions of ApprovallReasons for Disapproval 3) �t`UV Wu tom 4 �S SYSTEM OWNER: �( r a�� r 1. SepW tenk, effluent Alter and l b�aetprovi /,rd 4%� g6t Lii� y I t adispersal mcell must �f as management by lium P41� T _ by plumber. per plan provided plumber dM.i+^•�:P.('<Q n co ete plans for the system and submit the Ce my oaly on paper not less Mans in. 11 inches is size as per applicable c e r loan s. SBD-6398 (R03/14) ) -jts P CZ1'C9tayNpr r SYSTEM PLOT PLAN LaCroix 3 Bedroom Septic System Pmject Address: 380150th Avenue 8M7 Symbol:. SM Elevatiom loom BM Description: Top of 2" PVC pipe BM2 Symbol: A BM Elevation: 101.80' 81VIDescription: Top oh electdcal box on fence post Slope Gredlent of Tested Ate: (20%) Well Symbol (if applicable) Notes See Plat Map for complete map Shed Sam w, ]cO Design Flow: 450 GPD Attach design flow caloulebons for commercial plans: Pipe Materials f ASTM Standard Tables 384.30-3 & 384 30.5 4° SCH 40 PVC ppe ASTW D2ti85 303a 4"P/C pipe 1 ASTM-03034 aIfflum", / / \ 20% %go / y T T3 /� ■ 94' 90.92 '�, / BM2'98. \ T2 T1 T1- 5A50' Rock & Pipe Trench \ T2- 5560' Rock & Pipe Trench T3- 3X70' F2 Flow Trench El.=92.60' T4- 37t70' EZ Flow Trench El.=80 .90, Filter Canister w/ Poiylok 525 \ Existing 1000ge1. Septic Tank Existing 3 Bedroom House Driveway Gemge Well ff]CO P`Y CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: LaCroix 3 Bedroom Replacement Septic Sysyem Owners Name: Joseph LaCroix Owner's Address 380 150th Avenue Somerset, WI 54082 Legal Description: SEl/4, SEl/4, S18, T30N, R19W Township Somerset County: St. Croix Subdivision Name: NA Lot Number: 1 Block Number Parcel I.D. Number 032-2046-40-110 Plan Transaction No. Designer Date: Page 1 Index and title Page 2 Plot Plan Page 3 1:100 Plot Plan Page 4 Septic Tank Specifications Page 5 Filter Canister Specifications Page 6 Effluent Filter Information Page 7 Valve Information Page 8 System Sizing & Cross Section Page 9 EZ Flow Information Page 10 Management and contingency plan Page 11 Septic Tank Maintenance Agreement Page 12 Existing Tank Certification Page 13 Warranty Deed Page 14 CSM or Plat Attachment 1 Soil Evaluation Report John Schmitt Licnese Number: MPRS 223760 5/26/2020 Phone Number: 715-760-M6 r' Signature: 7 In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN LaCroix 3 Bedroom Septic Project Address: 380150M Avenue BMt Symbol:. BM FJevailon: 100.00' BM Description: Top of 2' PVC pipe BM2 Symbol: Q SM Elevation: 101.90' BM Descnplion: Top oh electrical box on Slope Gredient of Tested Area120%) Well Symbol (d appliubla) Notes See Plat Map for complete map tined seen Design Flaw: 450 GPD Attach design flow calculations ror commercial plans. Pipe Materials / ASTM Standard Tables 384.30.3 6 384.30.5 4" SCN 40 PVC owe ASTM- D2885 OEM .1 1 .1 tl 120 / / rT3r--;8t ■B�.- 94,92'9�9• 98' T2 T1 T1- S'X50' Rocks Pipe Trench \ T2- 5'x50' Rod & Pipe Trench/ T3- 3'X70' EZ Flaw Trench EI.592 so' T4- 3'X70' EZ Flow Trench EI.a90 .90' Filter Canister w/ Polyld 525 Existing 10009al. Septic Tank Existing 3 Bedroom House Driveway I Garage e Well SYSTEM PLOT PLAN LaCroix 3 Bedroom Septic System Design Flow: 450 GPD Attach design flow calculations for Project Address: 380 t50M Avenue commercial plans, SM1 Symbol: • BM Elevation: t0000' BM Description: Top of 2" PVC pipe BM2 Symbol: Q BM Elevation: 101.80' BM Description: Top on electrical box on fence post ^�^� Slope Gradient of Tested Area: (20%) Well Symbol (if applicable) Notes: See Plat Map for complete map Am.nu. d Pipe Materiels / ASTM Standard Tables 384,303 & 384.30-5 4" SCH 40 PVC qpe ASTM- D2665 13034 4" PVC pipe I ASTM•133034 1 TI R9b IWe. nac s�..... T,.a `iFR FZ 1. T. F191® rxm ri re. n.� e.anv S.pYtTw W rt 1 IDO 150 211 3 d A A u a W d w TOP VIEW WLP1000-MR TANK SPECIFICATIONS DIMENSIONS: WALL- 2 1/2' BOTTOM: SEPTIC 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: FLAT COVER 53 1/4" O.D. LENGTH: 104' O.D. 4" CAST -A -SEAL WIDTH: 86" O.D. BELOW INLET: 42' 0.0. LIQUID LEVEL: 36" WEIGHT: 6,790 LBS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL /10 (OTHER STATES SEE CHART) LIQUID CAPACITY. 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1.085 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN /B (NO FIBER) TANK: MIX DESIGN /10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: /OF 1 `" DETAIL 13 FILTER CANISTER DETAIL WARNING LABEL LIFTING HOOKS a APPROXIMATE LOCATION a� SEE DETAILS 1-2-3 0 4q4 YW W CONCRETE SEALANTS TYP. 4' / OR EQUAL FOR ALL JOINTS s ° (SEE DETAIL 5) Y z TOP VIEW 0 o as W � STEEL CHAIN ZINC PLATEDLo PAD LOCK SEE DETAILS, 1-2-3 r �' W d 0 Lo CAST —A —SEAL CAST IN RISER FILTER \— SEE DETAIL 6 4' CAST —A —SEAL = ON] M �, o CAST IN RISER W= co N M M a ai c a� w Z N 24' Q a > z SIDE VIEW J SHEET NO. 1 OFF / 1 PZ1L �� Inc M".nons in Precar! Ora ujp Zabel' & Wasrew>h1 Pr A Cwwon ul Po,4ck Inc 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 PL-525 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 1/16" 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-5251 nstal lation: Ideal 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 & Lok or piece of pipe to center filter. 4. Insert the FL-525 filter into its housing. 5. Replace and secure the septic tank cover. PI: 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 PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Iruert 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 I Accepts 4" & 6" -:C--* SCHD 40 pipe e Alarm Switch (Optima) Accepts 1" PVC Extension Handle Rated for 10,000 GPD 525 linear Ft. of 1/16" Filtration Slots ®Certified to NSF/ANSI Standard 46 Gas Deflector Automatic Shut -Off Ball l h,4luur ~mart) titer Alarm i:xtend & lok"' Polylok, Zabel & Best filters accept Easily installs the SmartFilter® switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 6 Mome About Site Map Order Info videos & Literature Contact Drip Systems Treatment Controls Products a 4'f fi k' The Bull Run ValVeT" 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 I n ITEM BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE & 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" Guide 4, *14. ROER CAP ALM rMR FiGEq TILDE !' OUT PORr CA:I%..17 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 28" HIGH Page 7 IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I Geotextfle Cover 12" min. trend depth (hpicaO Highest Trench System Elevations = 92-6 ft; 90.9 ft, min 12' (typical) Septic Tank(s) Manufacturer Wieser Concrete Septic Tank(s) Voluma(s) 1000 gal Filter Ca gal gal gal Effluent Filter Manufacturer Poylok Effluent Filter Model #; 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft: Lowest Trench (as applicable) TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW 4a0 Ohservationpipe shall cemstaled (NO Scale) al mnclwn hefwean t unit Perforated Lateral observation Pipe (typical) (typical) r-- B = 70 ft (typical) INSTALL PER TRENCH: ro °0 7 10-ft bundles @ 50 ff EISA/unit = 350 ft2 + 0 5-ft bundles @ 25 1 EISA/unit = 0 ft2 ft, 10 ft (typical) Provide minimum 3 ft separation between trenches. OBSERVATION PIPE DETAIL (No Sca Wl ft Spew Type or Sup Cap Ppose� 1"0 PVC Fna Top of pipe to tannnate atorarovefnishedgade -. (a) swan• x s• swta � 90 span Anchonrg Devoe j— A = 3.0 ft 1 (typical) EZ1203H Bundle (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's Instructions. = Proposed EISA per trench = 350 ft2 Required Infiltration Area = 643 x 2 trenches = Proposed Total EISA = 700 IF n¢ned Grade (mulled seeded) Topsoil Cover fnsn. t foch monaeon Sudace ft2 Distribution Method: ft2 branched manifold G) 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 $jk & 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 capacity after backfilling is complete. EZfoow- by 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. 7. The top of each GEO cylinder contains a filter fabric pre - manufactured in between the netting and aggregate. The fabnc 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. i I. 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 page 19 r-+w+r?xtile r Material Page 9 PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: 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; BODE 5 220 mgL"; TSS 5 150 mgL"; FOG 5 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system c 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 - 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) 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. Slats. when the volume of solids in the tank(s) exceeds one-third (1/3) 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 Developement 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 10 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Joseph LaCroix Mailing Address 380 150th Ave, Somerset, WI 54025 Property Address 380 150th Avenue (Verification required from Planning & Zoning Department for new construction.) City/State Somerset, WI Parcel Identification Number 032-2046-40-110 LEGAL DESCRIPTION Property Location SE '/ SR y, Sec. 1 $ T 30 N R 19 W. Town of Somerset Subdivision Plat: -t , Lot # t Certified Survey Map #_. Y} q33 Volume Page # Z32tio Warranty Deed # Spec house ❑yesQto (before 2007)Volumc 9g70 , Page # 5-6 / Lot lines identifiable p yes❑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. 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) 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 St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of ro ms 3 T 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 11 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) 360 lsoth Street located at: SE '/4, SE %4, Section 16 , 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): Weser concrete Age of Tank (if known): 29 Permit tnnumber (if known) 148999 (Licr,"(ised Plumber Signature) MPRS (Title) (Date) John Schmitt (Print Name) 223760 (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 12 i °ems SOVan LUSafety rid anV 97 I Nwah Comm 85_Wis. Adry� Code CS aaao - joh Page 1 of 4 nulessrcxteloerwcearr+r .. , -- � Schmitt Soil Testing, Inc. County less W511�8V81 i size. Plan must St. Croix Attach complete site plan on pLI;"; include, but not limited to, verti al M), direction and percent slope, scale or dimensi w, and location and distance to nearest road. Parcel I.D. 032-2084.40.110 Please print all information. �qviewed By (pa/ps Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.134 (1) (m)). `o/s ZoZp Property Owner Property Location LaCroix, Joseph Govt. Lot SE1/4, SE1/4, SIB, T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 380 150th Ave. 1 I CSM 8/2296 City State Zip Code Phone Number ❑ City Village ❑ Town Nearest Road Somerset WI 1 54025 1 715-549-5541 Somerset I 150Th Ave/Heron Lane ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or commercial - Describe: Parent material Outwash (Chetek-Onamia Series) Flood plain elevation, if applicable NA ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for replacement area is 92.6' (high and recommendations: trench) 90.9 (low trench) or 3' below grade on Contour. Slope is 20%. C.(a to — CnC2 ko Del &AJE x ❑ Bomrg 17 Boring # Pit Ground surface elev. 95.10 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/' 'Eff#t •Ema2 in. Munsell pu. Sz. Cont. Color Gr. Sz. Sh. 1 0-9 10yr3/3 none sit 2mgr mvfr as 2m,2f 0.6 0.8 2 9-19 10yr4/4 none sl 2msbk mfr gw 2vf 0.6 1.0 3 19-33 10yr4/4 none girls lcsbk mvfr gw lvf 0.7 1.6 4 33-96 10yr5/6 none grs 059 all -- - — - 0.7 1.6 qol` -3-A ❑ Boring Boring # ® Pit Ground surface elev. 96.0 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ConsistenceBoundary Roots GPD/ft' In. Munse9 pu. Sz Cont. Color Gr. Sz. Sh. '001 •Eaa2 1 0-10 10yr3/3 none sl 2mgr mvfr as 2m,2f 0.6 1.0 2 10-20 7.5yr4/4 none grsl 2fsbk mfr gw 2vf 0.6 1.0 3 20-27 7.5yr5/6 none grills lcsbk mvfr gw -- 0.7 1.6 4 -96 10yr5/6 none grs Osg well — -- 0.7 1.6 ` Effluent 01 = BOD5> 30 < 220 mg/L and TSS-s30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS 1.30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 4123/202O 715-760-1978 SBD4330(a01N0) Property Owner LalxoMx, Joseph Parcel ID # 032-2064-40-110 Page 2 of Boring # E]ng Pit Ground surface elev. 95.0 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Cu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' 'Elf#1 -Ee#2 1 0-7 10yr3/4 none sl 2mgr mvfr as 2m,21F 0.6 1.0 2 7-17 7.5yr5/6 none grsl 2fd* mfr gw 2vf 0.6 1.0 3 17-3 7.5yr5/6 none Is 1(sbk mvfr gw -- 0.7 1.6 4 39 9 10yr6/4 rode grs Osg ml -- - 0 1.6 .s/�Y•8 /Ss L Z2.3 - 4 ❑ Boring Boring # Pit Ground surface elev. 95.30 ft. Depth to limiting factor q4 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou, Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDfft' 'ER#1 •En12 1 0-12 10yr3/3 none sl 2mgr mvfr as 2m,21F 0.6 1.0 2 12-18 10yr5/3 none sit 2fsbk mvfr gw 2vf 0.6 0.8 3 18-44 10yr4/4 none Sid 3msbk mfr gw -- 0.4 0.6 4 10yr4/4 M' 7.Syr6/6 Z5yrfi/2 sid 3msbk mfr -- -- 0.4 0.6 rnsE' %-n.+�Qa. 5 Boring Boring # x Ph Ground surface elev. 92.60 ft. Depth to limiting factor 96+ in. � Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. ConL Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDff •EfWl •ErM2 1 0-10 10yr3/3 none sl 2mgr mvfr as 2m,21F 0.6 1.0 2 10.21 10yr4/4 none SO 2msbk mfr gw 2vf 0.6 0.8 3 21-38 10yr5/6 none gris lcsbk mvfr gw -- 0.7 1.6 4 38-96 10yr6/4 rove grs 059 ml - -- 0.7 1.6 ' Effluent #1 - BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate forma[, please contact the department at 608-266-3151 or JTY 609-264-8777. SFI 8 30 (a.07ro0) srhrrat Sal TesMV, sic �3.sL Conducted for: Joseph LaCroix 380 150th Ave Somerset, WI 54025 PID: 032-2064-40-110 SE1/4 SE1/4 S18 T30N R19W ED Town of Somerset Conducted by: Tho as�J Sc tt CST 227429 4/23/2020 i 6 slop`. �.\ A '\ y� \ 92 g 4 94' BM1&2 E.,sang 5x 50' Trenches SeplicTank RAN Heron Liars, 511 ry BM 1 100.00' Top of 2" PVC Pipe 1, _50. BM 2 101.80' Top of electrical box on fence post St Croix County, WI Legend Lakes and Rivers Rivers and Streams — Interstate. US Highyes s - State Highways County High"th; Local Roads Rustle Road. Ramps Road Right of Way Reirnads -- Conveys. Division T 0 20 40 60ft DISCLAIMER: This map is not guaranteed to be accurate, mrre current, or complete and mntlusions or. are she fesponvCity of the user. I U'; 07 Conducted for: Joseph LaCroix 380 150th Ave Somerset, WI 54025 PID: 032-2064-40-110 SE1/4 SE1/4 S18 T30N R20W Town of Somerset Conducted bvThomas J. Schmitt St Croix County, WI Legend takes and Rivers Rivers and Streams Interstates US Highways State Highways County Highways Local Roads Ruiit [ Roads Ramps Road Right of Wry Railroads Conveyance Division I 0 100 200 300R DISCLAIMER. This map is not guaranteed to be accurate, coneµ currant, or complete and conclusion drawn are the responslNlity of the user. =. n FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER JOCEPN `.4 GeoeX TOWNSHIP Sim cl SET SECTION_Zlf T 32D N-R2-?_W ADDRESS�o'e v,s< '9r n/ Aer. for ST. CROIX COUNTY, WISCONSIN SUBDIVISION ^/q LOT .VA LOT SIZE NA PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A,. y/OGIRTY�/JCS Br£P moo' �1v. %FC/W L.hNE C'�Lf I'�So' �I ------ /Sa Avc. c�✓EaP 350' SoP ss 'PVC E:rw.gur Y41i1 I IJNL 'To Seu rH 109 Gro.x nLE ,FREV. /oo' / o /000 -.A, SGrc 'r. < T Sc N Jo A/C SGu<P 4 .UC lkoaf.Cp weac �r�cc..rf MAGC /�o SC.rc6 INDICATE NORTH ARROW FF ' nfARE:Elevation and description: d&, /ao' Alternate benchmark A/A SEPTIC TANR:Manufacturer: Liquid cap.icoo &,tr Rings used: 9 Manhole cover elev:z11 2q' Final grade elev: //R-VG' Tank inlet elev.: /0727 Tank outlet elev.: lo�•o No. of feet from nearest road:Front_, Side ✓ , Rear —Ft. ALL' From nearest prop. line:Front_, Side ✓, Rear —Ft. No. of feet from: Well !�' , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size_ Elevation of inlet: Bottom of tank elevation Pump on elev.:—Pump off elev.:Gallons/cycle: Alarm: Man.: _ Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear —Ft. Distance from: Well Bui SOIL ABSORPTION SYSTEM�aySw SE, Bed: Trench: B ., g�•S"Seepage Pit: Width: S Length So' Number of Lines: f Area Built S007 R Fr. A 91/.co. A 93.7s' Exist. Grade Elev. 6 90•�0' Proposed Final Grade Elev.6 90.95" Fill depth to top of pipe: Y, S No. feet from nearest prop. line:Front / Side_, Rear_Ft.—�vc No. feet from well: /-?o' No. feet from building ia9' HOLDING TANK Manufacturer ty No. of rings used:_Elevation of bottom tank: a Elevation of inlet No. feet from nearest prop. line:Front_, Side_, Rear _ Ft. _ No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE:3 PLUMBER ON JOB: LICENSE NUMBER: AJAPS 3395 6/90:cj 9/Bp 139 'DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY A BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES S APPLICATION Swie Plan I.D. ec.18,Y30-R19 (Knuilllned) NVmee. Town of Somerset CONVENTIONAL ❑ ALTERATIVE T _—_ n 1-Inlrlinn Tnn4 ❑ In-rrnnnd Pressure ❑ Mound a NAMNAM EOFPERMII HOLDER: ADORE SOFPERMITHOUDER: INSPE ION GATE: Jose h LaCroix 208 WI St. N #105 Hudson WI y-2S BENCH MARK(Permanenl relerenee point) DESCRI IF DIF N MPLAN: REF. .:S` T�R.P.' ) ze Nameol Plumper MP/M No, Co Sonlot"A^aa M~: Gary Zappa 339S St. ix 148999 acr r n. URER MANUFACTURER: LIWID CAPACITY' TANK INLET .: TANK CAI. Lt. WARNING LABEL LOCKING CO PROVIDED: PROWOED: �"� OG.S D a YES ,� NO YE BEGGING: VEM91A.: ypN��ATL.: HIGH WATER UM ER OF ROAD: P110PE WE BULDING: VENT T.H AIRI T C.O. C.�• ALARM: FEET FROM L� ;� DYES NO '4 DYES O NEAREST-1 veEDRRENCN •'WIDTH:•v LENGTH: NO.OF DISTR. PIPE SPACING' COVER INSIDE DIA: P LIOUID DIMENSIONS 5 SD TRENCHES: a n T Or M AC GRAVELDEPTH BELOW PIPES' FILL DEPTH ABO ER: DISTR. PIPE ELEV. INLE DISTR PIPE E V. ENO: DISTR PPE TE`�,A I/yr� // r• ptr r V 0 PI R NUMBEROF FEET FROM LI C L UIL ' / AIF INLET: r I'- / eZ NEAREST MOUND SYSTEMY r q.�p Mound site plowed perpen Icular t Check the texture of the fil I material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslopa. mound systems to make certain that it ON REVERSE SIDE. SHOW r-I vcR n Nn I meets the criteria for medium sand. ELEVATIONS MEASURED. NO SED/TRENCH DIMENSIONS ELEVATION AND DISTRIBUTION HOLE SRE: HOLE SPACING�DRILLED CORRECRV' �, INFORMATION 70 COMMENTS: ._.__...._...__.....__ - FEET FROM LINE: ❑ YES ElNO ❑ YES ❑ NO NEAREST P, J.C. �<S 40 CaZO r., o---d Ui�'B-K Sketch System on Reverse Side. SBD-6710 (R. 00/88)