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032-2070-10-001 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law. 5.15.04 (1)(m)]. Permit Holder's Name. Ciy village Township RW Rivard Revocable Trust TOWN OF SOMERSET CST BM Elev: Insp. BM Elev: BM Description' TANK INFORMATI10 ON ELEVATION DATA TYPE MANUFACTUR ` CAPACITY Septic Dosing 750 Aeration TANK SETBAdK INFORMATION TANK TO Pjl WELL BLDG. vent to Air Intake ROAD Septic Dosing G- I7 J \ 15- 05 7.Z Aeration Holding PUMP/SIPHON INFORMATION ICI- f I UrtiLcv 32.. Manufacturer J 1 / Demand b-C�-/ L12-el GPM Model Number XI5 Z .d "lc) TDH Lii e Fri ; A Systerp Nea�c TTP` ' It Forcemain Len 15, Dia.2 to Dist(. to Well f SOIL ABSORPTION SYSTEM (� �_M�03� �m-mm ---_ BEDITRENCH DIMENSIONS Width l Length l/fc_C�� s 5 PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO ii.�l ij P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufaany�ru+rer:( -fMT1 I Tyg�„pJ Syst¢m: ...i-✓i �No y.. t / f� ^-� � Q` Model Number. Z- Ftills I0I011MIOV IIVIY JTJ I C191 leader/Manifol' I DDisterisution t t x Hole Size 5 �` x Hole Spacing ` Ve to Air Intake Zy 2' p() 4 I-k— _ _ength Dia Length Dia _Spacing_ �t'L �15 T«y( SOIL COVER . proaa,,.e s .t— Only vv Mnu A M n Depth Over BedlTrench Center 1 ��i Depth Over Bed/Trench Edges �% 1 xx Depth of Topsoil T xx Seeded/Soddetl © N m Mulched o COMMENTS: (Include code screpericies, persons preszxiS44 lrnj Location: 287 OLD SCOUT sI�gedion#� L � y( 'afE ��" Inspe n,#D2.:�� vi-i" �P6 - Q� CAMMP� RD _ 5_ 1.) Alt BM Description = �k II•+t'1 s �(ptr 2.) Bldg sewer length = 1I1• — G� �N� L,- _ I .U,l tOV C%-0'4° � [ PI I V +4 1 %. - amount of cover = E%1i7111� 1 lu n' v 4 t'1 {1 7 1 zI'1 (�' �+ soil ��� E-2 - ftli Plan revision Required? Yes No J {� Use other side for additional informatio SBD-6710 (R.3/97) Date Insepctoes rignatItre Cert. No. l e n— (I tea t e. balez$aP) GA-J -202.0 - lSS r Industry Services Division County St.CnmX Sanitary Permit NuMer (to be filled in by Co.) $ '- ! ` 1400 E Washington Ave . P P.O. BOX 7162 S ` JUL U L 202 Madison, Wl 53707-7162 62 tl f 85-9 „-Permit Application State Transaction Number C§ fd In accordance with SPS . Codm am of this form to the appropnate governmental out &YIFS — 01W O 130 is required prior to obtaining a sanitary permiL Note. Application forms for state-owned POWTS are submitted to Project Address (if different it= mailing address) the Department of Safety and Professional Services. Personal information you vide may be used for secondary 287 old Scot[ Camp Road purposes in accordance with the Private Law, s. 15.04(1)(m Stats. 1. Application Information - Please Print All Information Property Owner's Name Parcel s RW Rivard Revocable Trust 032-2070-101 3 0. a0 7 618 Property Owner's Mailing Address Property Location 287 Old Camp Road Govt. Lot NE '/., NE S:, Section 13 City. State Zip Code Phone Number Houlton. Wl 54092 Uarcle une) ^1 T JON R20Eor"�' 11. Type of Building (check all that apply) Lot 3 N ® 1 or 2 Family Dwelling- Number of Bedrooms NA Subdivision Name NA ❑ Public/Commercial - Describe Use Block ❑ City of ❑State Owned -Describe Use ❑ Village of ('SM Number ® lawn of Somerset Ill. Type of Permit: (Chqg%;n'ly one box on line A. Complete line B if applicable) A. ❑ New System ®R lacement System ❑ Treatment/lioldmg Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Charge of '❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S ste Com nenuDevice: Check all that apply) ❑ Non-Preswrind In-Gro ® ressrmmd In -Ground ❑ AI-Gradc ❑ Mound> 24 in. ofsuitahle soil ❑ Mound <24 m. of suitable soil ❑ Holding Tank ❑ Other 0iWirsal Component (explain) ❑ Pretreatment Device (explain) 1 V. DisersaVfrestment Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (s0 Dis set Area Proposed (50 in "all ` 450 Rate(gpdsO 1125 •� 96.50' 0.4 VI. Tank Info Capacity in Gallons p coat—�X PP .J a, Total Gallons a of Units Manufacturer New Tanks Eznnmg Tanks Septic or Holding Tank 1060 1060 1 Infiltrator Losing Chamber 1 750 750 1 Wiescr Concrete VI I. Responsibility Statement- 1, the undersigned. *swine responsibility for immIllatioa of the POW78 shown on The auaehed plain. Norther's Name (Print) Plu s a rc MP/MPRS Number Business Phone Number John Schmitt C 1 [f1 L 223760 715-7664156 Plumber's Address (SUWL City. Some, Zip Code) 586 Valle} View Trail. Somerset. WI 54025 VIIL County/Department Use Only Approved ❑ Dis ved Permit Fge _ (�GWt ate Issued s ng Agent S' n tare C Ow rve easam for Denial $ IX. Conditions of Approval/Reasons for Disapproval '3� QfilrI1 TEMOWNER: sRc ted� *_bjOL eptic tank, effluent filter and y(� 36� t, y �y $ dot«. tsY�S S YSta•d ispersal cell must be serviced 1 maintained 2 n � p s per management plan provided by plumber. y) 4, 6— av6at j""-k r�++` OdPj,Of I �O1° nosy for the ats4n ubpir to a Canary Daly �_ a Slate Ins 11 Inehgie s l 5<7l TLeJ P ttV'Q f111LL1. �[4 +vWMc-Q la'1�-n1AW'eeA1 s 8(R03(aW S �&V.. / r,'sy 4 Q �X25, �edkk tarps tv.F�QRIC7i �5&r Valli iAeq�! , � �to+�e� exF� *t `_] �" ' trL n. County ��E IndustryServcesDivison St.cre" S N' 0 0 s - P a = JUN 0 2 2020 1400 E Washington Ave a P.O. sox 7162 Sanitary Permit Number (to be fined ®by Co., Madison 53707-7162 County e 1. Comm ermit Aplie OI] : Stare Transaction Number In accordancewi SPS 383.21(2), W is. Adm. Code, submission of this form to the a governmental unit .-- is required prior to obtaining a sanitary permit. Nola: Application farms far state-owned PO bmined to Project Address (ifdiffcrem than mailing address) the Department of Safety and Professional Services. Personal information you provide ay be used for se ndary purposes in accordance with the Privacv Law, S. 15.04 I m Suits - 287 Old Scout Camp Road 1. Application Information - Please Print All Information Property (Tuner's Name Parcel e RW Rivard Revocable Trost 032-2070-10-001 Property Owwr's Mailing Address Property Location 287 Old Camp Road Govt. Lot NE %., NE 'A, Section 13 tine) /r City, Slate Houlton, Wt ne Number T 30N R20 II. Type of Building (check all that ly aIm2Family Dwelling-NumberofBed SubdivisionNNA ❑ Publid(bmmercial - Describe Useck CAMDlett g ❑ City f/M ❑ State Owned-Desenbc Use ❑ Y of `n Number SomIII. T e of Permit: Chec 1 one boif applicaft ®Rlplaccmcm System ❑ TN ent/Holdin Tan a lace 8 P ❑Other Moth n toExisting System lax la!) ■` A. ❑ New System B. ❑ Pemtit Renewal Before Expiration ❑ Permit Revision ❑ Change a [IPermit'I r to New I Permit Numhtt Dale tie Plumber Owner IV. T of POWTS System/C ce: Check all 1 ❑ Non -Pressurized In -Ground ssunzed InGround ❑ At c ound > 24 in. of suitab i] Moun suitable ❑ Holding Tank ❑ Other tsal Component (explain) ❑ Pretre nt Device (explain) kT t V.DispersaVrreatment Area Information X ispersal Area Required (s Dispe Area non Design Flow (gpd) Design Soil Application 450 Rate(gpdsf) t 125 0' 0.4 VI. Tank Info Capacity in Gallons € Total Gallons or Units`' Mat urer € 2 u New Tanks Tmks mg Septic or Holding Tank I 1060 1 Infiltrator Dosing Chamber 750 750 1 Wieser Concrete VII. Respoosibillity Statement- 1. We and ned, assume raponsibillity for installstiw of We POW" shown on the attached plauts. Plumber's Name (Print) Plum s ign re MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street City, State, Zip Code) 586 Valley View Trail.. Somerset, WI 54025 Vlll. Court ]!/Department Use only ❑ Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denia! S 6a7 IX. Conditrona of ApprovalfReasons for Disapprov, c4c L S7 SYSTEM OWNER: Pr.�J`�t J 1. Septic tank, effluent filter and 5"f519w. K D _ _��95 — �° dispersal cell must be serviced / malntained t S � 4 t,, Az. 3(, ^ ^�!" as per management plan provided by plumber. mil( r as per applicable cod6"r) f 69! a edsabmit to C attaly °�a/yayer nor lku 8 Irt a 11 i° es is a aer IjY�I/ P111'Vt%IG(!L SHD-6398(1103/14) SYSTEM PLOT PLAN Rivard 3 Bedroom Septic System Project Address: 297 Old Smul Camp Road SM1 Symbo M Elevallom XSPU SM Descdpt Bogom W sitting on detached garage SM2 Symbol: 0 SM Elevation: 91.34' SM Description: Top of plesdc manhole cover of existing septic lanl Slope Gmdient of Tested A": 00%) Well Symbol (d applicable) Notes: See Plat Map for complete map Design Flow. 450 GFD Attach design flow calcutabons for commercial plans: Pipe Materials /ASTM Standard Tablas 364.30-3 & 354.30�5 4' SCH 4C PVC ppa ASTIi 02665 2' 6CH 00 PVC pps ASTM-01785 30344"PVC pi pe ASTM-0ae34 �i N Scale: 1" = 60' 0 60 90 120 15' RNMid Scout Camp Road w J Q C J LY n 0 Well n Dav< e p. Dd away 3 Bedroom House Parch Garage Existing eptic Tank Existing Dr/well In Tt - 3'x60' EZ Flow Trench El. = 96.50' BM 2 abandoned T2 - Tidily EZ Fbw Trench El. = 96,50' T3 - 3k:W EZ Flow Trench El. = 96.50' T4 - 3'x60' EZ Flow Trench El, = 96.50' VAP750-MR T5 - 3'x60' EZ Flow Trench El. = 96.50' Dose Tank QS 92' 96' -- 98' — Garage I JI BN11 PropeM Llne 0 R CEN D JUL 02 2020 St. Croix County Community Development July 1, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-07-01 Plan Review: PWTS-072001305-C JOHN F SCHMITT 616 150th Ave Somerset WI 54025 SITE: RW Rivard 3 Beroom In -Ground Pressure 287 Old Scout camp Road Town of Somerset Saint Croix County Total Amount: $250.00 FOR: Description: 450 GPD Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/programs/industryservims www.wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES f/.t4.Q.CO (iT/Q�ILGt SEE CORRESPONDENCE In -ground Component Manual - Ver. 2.0, SBD-10705- P (N.01101, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be copsowted and located in accordance with the enclosed approved plans and with any component maau_al(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Abandon the existing system components per SPS 383.33 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewers beyond 30 feet per SPS 382.30 (l l)(c) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Travis Wagner POWTS Wastewater Specialist, Division of Industry Services (608)598-0715 travis.waener@W.eov CONVENTIONAL IN -GROUND PRESSUE COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Rivard 3 Bedroom Replacement Septic System Owners Name: RW Rivard Revocable Trust Conditionally Owner's Address 287 Old Scout Camp Road APPROVED Houlton, WI 54082 SAFETY—ANDDEPT. OF PROFESSIONAL Legal Description: NE1/4, NE1/4, S13, T30N, R20W SERVICES DIVISION OF INDUSTRY SERVICES Township Somerset County: St. Croix Subdivision Name: NA Lot Number: NA Block NurADtrE CORRESPONDENCE Parcel I.D. Number 032-2070-10-001 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 Dose Tank Specifications Page 6 Dose tank Cross Section Page 7 Pump specifications & Curve Page 8 System Sizing & Cross Section Page 9 EZ Flow Information Page 10 Pressure Distribution Network Page 11 Distribution Network Specifications Diagram Page 12 Management and contingency plan Page 13 Septic Tank Maintenance Agreement Page 14 Existing Tank Certification Page 15 Warranty Deed Page 16 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/22/2020 Phone Number: 715-760-0486 .1 Signature: In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Pressure distribution Component Manual Version 2.0 SBD-10706-P IN 01/01) Page 1 SYSTEM PLOT PLAN Rivard 3 Bedroom Septic System Design Fbw. AKGCC Mist. --won no. Uicolmrs for Project Addesa 2a7 Old Sind Camo Road comenewl rl pans BMl Symbo M Elevation. Ap0x Pipe Metenets /ASTM Stallard BM Dauset Bottom of atlmp on detached garage Tables 384,30J a 384.30-5 BM2 Symbol. o SM Elevation-. 91.34' 4-SCH 40 PVC pwa ASTM-02aa5 BM Dexngbn Top q plastic manhda Writer q esletpp seplb T SCn 40 PVC pq AS _ 'D 18a Slooe Gregent q Tested Nee. i10%) b rliiJC pya AHTM�. Well Symbol Id apppreble) Notes See Plat Map for complete map N :1 r :r go 120 —"ti♦��� ®% 0 o.px e a Bm—ly J 89da cq House Exubnp pbc Tank T1 - YAW EZ Ftow Trench El = 9650' BM 2 Existing Drywall b T2 - 3'x80' EZ Flow Trento EI = 96 50' lea abandoned T3 - 3'x80' EZ Flow Trench EI . % 50' T4 - 3'x80' EZ Flow Trench El = 96.50' VVLP7504AR T5 - 3'x80' EZ Flow Trench El = 98 50' Dose Tank H2' ♦ —♦ %♦\ �. \ % `' %. \ \ Garage \ j t / 1 / BM 102 I I Property Line 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 seam clips. The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. Must be backfilled and installed in accordance with Infiltrator Water Technologies, Infiltrator IM-Series Septic Tank General Installation Instructions and for shallow ground water conditions reference the Infiltrator IM- Series Tank Buoyancy Control Guidance. Please visit www.infiltratorwater.com/images/pdf/ ManualsGuides/7ANKO1.pdf for the latest information. II Working Capacity 1 D94 gal (4141 L) Total Capacity 1287 gal (4872 u Airspace 16.50A Length 127"(3226 mm) Width 62.2" (1580 mm) Length -to -Width Ratio 2.3 to 1 Height 54.7" (1389 mm) Liquid Level "" (1118 mmi Invert Drop 3" (76 mm) Fiberglass Supports 2 Compartments 1 or 2 Maximum Burial Depth 48" (1219 mm) Minimum Burial Depth 6" (152 mm) Maximum Pipe Diameter 6" 1152 mm) Weight 320 Ibs (145 kg) 1axasPakoe RO Ior P.O Bo7a Sa 5aWrook.-F 09 8X, 4wu."3s'�SnM1 INFILTRATOR www.InlaVatoraaptar.com uElrronksE ....wP�n w�r<a.acPoa \ rvw[su �I+ro1Nl � r�+¢w 0. t ILI N 11 I I 11Zalulel LYifaga {FxGrx 01nm1 P MNIS METRE uFTeeo sTwv ITTPxAII wll Tw YIEW END VIEW W u3nl EYleb011 IEK♦tT e:.Ialol ecassonExa+<swlm lxxelc Eaa;n �.im 1lMfl EliElWaO—aglgll EVCR i assoullEr TEE e 3D ITaI- F91 I I COOP ro flnel NgGEA56 yslEsawss-_� Eglwc--MFvdrt SUNMI Rv1� IiyA(K1 11ye1<N) NTM4JRE — w.uMela[ ME011E® SIDE VIEW TANKTOP I \ CONTINUOUS GASKET TANK INTERIOR SEAM CLIP _� ALIGNMENT 11 DK TANK BOTTOM HALF MID -HEIGHT SEAM SECTION U.S.PaaM:4M,W1,5.017,0a1,5,155.49a:5336.017,5.101,E16;S.Q1<5G.5,511,9M.5.T16,1M.S.W.."11. 5.539,11,41 Gautllal Pasta-. 1,3 959].001561O IY1exh wKikv.e i,Jr, Equ er Qtl .a1d SdWdaw badirr�rbd 1110sOa Wssa Tsd—iOgba. kdseab e:a IajaNaO irsderriarkn FrarKa hAe Was Tshadges uareg awW haamaM1n Meam. callow. M sstAslg P*T0. OwrEsrSPsosr. M xpW PDelLock o iGN. o jAW. &Jso di ad SbagkLLocs era CeEsreAs d 9iNkala Wets Ta Wes PalyLae is a hsds n d PdyLdr. Inc. TUF-TITE is a regulsi bsiIiii of TUF-nTE, INC. Ma -Fun 4 a t(a Jura d IPEx Inc. 0 N161nMrala Wats Ted1n014,M LLC. NI ngde ravened. P W n U SA _ - "- f Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-duu-zz1-443b I Vla per. �x lnc hr.j cns ni Pm r, Omnatr Zabel' a N>stewataz P.apxrs VO AD ...... PI. 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-525 installation; 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 Polytok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Nlaintenauce: 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. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserte 1. 7. Replace and secure septic tank cover. 1/16" Filtration Slots Alarm Ssaihh 10,000 GPD (optional) <j� Accepts i" PVC ? Extension Hindle Accepts 3" & SCHD 40 pipe Rated for 10,000 GPD 525 Linear Ft. of 1/ 16" Filtration Skits ®certinea to NSF/ANSI StaadarA 48 Gas m Deflecr Automatic Shut-off Ball t Juidoortimartl titer Alarm I<tend&Ink Polylok, Zabel & Best filters accept Favly installs the SmartFdter® switch mid alarm into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CC 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com a m f N 4" CAST -A -SEAL TOP VIEW in INLET - _ OUTLET o 24' I a s J nI L PUMP PAD 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: WISCONSIN, SEE DETAIL 010 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS a r 0 o o S 0 o W OUTLET HOLE PLUGGED W LOADING DESIGN: B' 0' UNSATURATED SOIL Y TANK CAN BE USED AS: C o SEPTIC/ HOLDING/ PUMP OR SIPHON m z CD o COVER: MIX DESIGN /8 NO FIBER) TANK: MIX DESIGN 010 (STRUCTURAL FIBER) Wo CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE a J Q o_ M 7 Z o a � U F o_ LLJ DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 PRODUCTS NEEDED BY: /OF PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) IMPORTANT: X ve,` p Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Fii Dade CAPACITIES @ 20.28 gal/in Depth (in) Volume (gal) A 18 365.04 B 2.0 50.56 [C] 5 101.40 D 12 243.36 *Pump Tank Liquid Level = 37 in Force Main Diameter = 2 in Force Main Length = 140 ft Force Main Void Volume = 22.82 gal EbrJntai must Campiy with SPS 316 and NEC 300 WUlner{Ytn1 �unClron Box Cordml /— Y *T ` IjA e IIll Pulp T Weep Aidight Seel Hole Bloc Extend mamole nser as necessary. APPavad Lafkmg Neonate win Wemmg Label A1teUred Irywm9 3' Mm. orL01 above E stablished Food Elevation MPKel1 Quick 8'MmNPimp 1 - `Approved Joints, wen Approved Pipe 3 R onto Solid Ground (ryoiraq PUMP -OFF ELEVATION = 84.34 ft INSIDE BOTTOM ELEVATION = 83•34 ft 3" ADPmveC Bedding Malenel Beneath Tank [C] Total Dose Volume TDV = 61.50 gal/dose (SX total lateral void volume <_TDV < 02X design tkrva) + (force main drainback volume) MIN. PUMP DISCHARGE RATE = 32.3 gam Vertical Head = 13.66 ft + Min. Supply Head = 3.5 ft + FM Friction Loss = 3.12 ft + Fitting Loss` = 1.05 ft '(min. supply head z 0.3) =TOTAL DYNAMIC HEAD = 21.33 ft Infiltrator PUMP TANK: SEPTIC TANK(S): Volume = 750 gal Total Volume = 1000 gal Manufacturer: a"Willill Manufacturers): PUMP PERFORMANCE CURVE MODEL 1511152 I53 x 2-M — — x p I B. e ID 2- a-- 4 K 'M 1W 2d0 24 2M 310 W haw KRn m o1.50M CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available • Electrical alternators, for duplex systems, are available and supplied with an alarm • Variable level control swAdles 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 151k1521153 Senes 11. TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 feet Men 0n. 1 u n On tlwx Gn. 1.441e 5 is 50 in M 261 Ti 291 10 30 4 170 51 231 20 265 ,s 46 3s 1M M 201 61 ni 20 GA 29 Ila M 167 52 is? 25 76 1s 51 3x 129 Q 1S0 m 91 23 el 37 125 35 102 22 9s M 122 SN"nroao 3011 to1e1 70A t11.6m1 Mani nn) ol.SveB Model 151 Models 152 1 153 I I 1 llro /l )ln 11 ca-I r j11RWI I i m r 11u 115 1 Non , 60 1 2m3 115 1 1 WD '' A_ 60 Include ar 23-- 230_ 1 Nan 1 3.2 1 2o,3 230 1 Auto 32 Include I 2a3 175 1 i Nat a5 1 2a3 f155 1 Aub as Include � 2o,3 231 1 Non 4 3 1 7- 2 a 3 230 1 Auto � 4.3 - hickided - - 2 a 3 115 _' 1 _Non 106-�._.1 ! 2a3 HS 1 Auto - 10.5 Included 1 a 3 230 1 Non 53-- 1 2a3 230 1 Auto - 53 ' Incluhkd Ia7 SELECTION GUIDE 1. Skgle phgg iblea variable level AM switch a double pggyback variable level float switch Refer to FM0477. 2. See FM0712 for coned model of Electncil Alternator E-Pak, 3. Variable level control swddh 10-0743 used as a corrbol actvafor, specify duplex (3) or (4) JIM system • CAUTION Gi v\ 'Easy assembly" /, �� 101r1105d'stiv9a POe F. �t rid,rrelWdJ �ro OPTIONAL PUMP STAND PM 10-242' Reduces potential dogging by debris Replaces rocks or bricks under the pump Made of durable, noncorrosive ABS Raises pump 2' off bottom of basin Provides rile ability to raise intake by adding sections of 1 %' or 2' PVC piping Attaches securely to pump Accommodates sump, dewatering and effluent applications NOTE: Yaks sun Mori is free from obstruction. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. O Copyright 2010 Zoeller Co. All rights reserved. IN -GROUND DOSED -GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) Gootextile (typical) TYPICAL TRENCH SOIL COVER Cover CROSS SECTION VIEJ min trench depth System Elevation 96.50 ft Provide minimum 3 ft s• • between TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW (No Scale) 4nn Ohsarva0on pipe shall be Inewlap 1CI at )unNon balween Mo unpa. Perforated Lateral Obgervaticin Pipe (typical) (typical) ----�-------- ----- A— p= so ft (typical) INSTALL PER TRENCH: 6 10-ft bundles Q 50 ff EISA/unit = 300 ft' + 0 5-ft bundles @ 25 ff EISA/unit = 0 ft, OBSERVATION PIPE DETAIL (fib scab) Screw-Typew - ski, Cep (oo®) a-e PVC Ppe — Top of ppe to Mnwteb at or shove foaled grade (A) 1ai• 11 x 6• slp` — Anchoring Device --+ 10 ft (typical) roared Grade Ached 6 seeded) Iopsotl Covw I. I[w) nfMrallw Surface I � I A=3.0 ft D (typical) G) _I m w EZ1203H Bundle Q (typical) TI (mfd by Infiltrator systems, Inc.) C.71 Install pursuant to manufactures instructions. = Proposed EISA per trench = 300 ft, Required Infiltration Area = 1125 ft, x 5 trenches = Proposed Total EISA = 1200 ftr RESET Distribution Method: pressure manifold Q Installation Instructions for EZ#on. 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 Sit & 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 pope 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. 46EZfow- 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 siring can be used in Wisconsin, resulting in a 40% smaller drainfiekf. 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 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 Drainfieki 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. Fielo 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 Geotextiie Barrier Material ♦ OY1'- PRESSURE DISTRIBUTION NETWORK 1. Distribution pipe sizing • Soil Absorption Area (4-3'X75' EZ Flow Cells) • Lateral per area: 5 • Lateral spacing: 6.00' • Lateral length: 60 • Lateral size: 1 • 15t orifice location 2.5' from end • Orifice size: 5132" • Orifices per lateral: 12 • Lateral discharge rate: 6.46 qpm • Distribution network discharge rate: 32.3 qpm 3 laterals x 13 orifices/lateral x 0.66gallorfice = 34.08 qpm 2. Manifold • Location: End • Length 24.00' • Diameter 2" • Friction loss: 24' x 2.23f /100ft = 0.54 ft 3. Force main: • Diameter: • Length: • Flow rate: • Friction loss: 4. Total dynamic head: 2" 140.00ft 32.3 qpm 116' x 2.23ft1100ft = 2.58 ft • Minimum supply pressure: 4.55 ft • Vertical lift: 13.66 ft • Friction loss (forcemain) 2.58 ft • Friction loss (manifold) 0.54 ft • Total dynamic head: 21.33 ft DISTRIBUTION NETWORK SPECIFICATIONS FLUSH VALVE DETAIL (No Scale) Orifice in — — I Valve Box Center of Threaded Cap (insulation optional) for Head Testing (optional) r � I Ball Valve I \ \ (optional) / _\ Onfices equally spaced: _ I (check a) OR b) below) a)la along bottom of lateral 1-1 b) r - r along top of lateral Flush Valve J 6 th hole Assembly with every _ (typical - see detail) facing down (No Scale) Laterals to be level Schdl 40 PVC Lateral 0 = (typical) Shield orifices for gravelless applications Last Orifice (typical) LATERAL INVERT ELEVATION = 97.00 ft (typical) OBSERVATION PIPE DETAIL (No Scale) Screw -Type of •;� .�,. Finished Grade Slip Cap (loose) + (mulched & seeded) 4.0 PVC Pipe �' , Topsoil Cover (min. 1 foot) Top of pipe to terminate at or above finished grade (4) 114" lr X 6' Slots 0 apart Anchoring DeviceInSuurfaacece on First Orifi:e 2 "0 Schdl 40 n (typical) - PVC Force Main (riser pipe /(slope pump tank optional) for drain -back) Orifice Spacing (X) = 60 in (typical) Lateral Length (P) = 60 it Number of Orifices per Lateral = 12 Orifice Discharge Rate = .54 gpm Number of Laterals = 5 Lateral Discharge Rate = 6.46 gpm TOTAL DISCHARGE RATE = 32.3 GPM Orifice Diameter = .156 in (typical) First Orifice (typical) �-- X — -i END MANIFOLD (typical! 0 CONNECTION Check applicable box. Manifold (riser pipe optional) D First Odfice (typical) G) m �--- x--E--xfz xiz--}--x - -I (typical) (typical) O CENTER MANIFOLD T1 Manifold EJ CONNECTION (deer pipe optional 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 = 450 gpd; BODB 5 220 mgL-'; TSS 5150 mgL-'; FOG 5 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS type of use age of system nuisance factors (i.e odors, user complaints. etc.) mechanical malfunction (i.e.. pumps, valves, switches, floats, etc.) material fatigue (i.e., leaks, breaks, corrosion, etc.) solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) extent of ponding in distribution cell prior to dosing dosing irregularities (i.e., pump re -cycling, float switch settings, etc.) electrical components (i.e, wiring, connections. switches, controls, timers, alarms, etc.) 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 leaned when necessary to remove any accumulated solids according to manufacturer's specifications A servicing period will always be greater than 12 months. 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 Local government unit: Croix County Community Developement Phone: Local government unit address: 1101 Carmichael Road, Hudson 715-760-0486 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. Contingencv 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. Owner/Buyer ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM RW Rivard Revocable Trust Mailing Address 287 Old Scout Camp Road Property Address 287 Old Scout Camp Road ( Verification required from Planning & Zoning Department for new construction.) City/State Somerset, WI LEGAL DESCRIPTION Property Location NE '/a Subdivision Plat: Certified Survey Map # Warranty Deed # Parcel Identification Number 032-2070-10-001 NE ,,4 see 13 T 30NR 20W To�,tof Somerset Spec house 13yesMno Volume . Page # (before 2007)Volume , Page # Lot lines identifiable (ayesono SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # 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(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 (I I 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. Vwe, 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 National 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. Itwe am'are the ownetts) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu er 1 edroo 3 //' c ✓ SIGNATURE OIF APPLICANT(S) DATE ":'Any information that is misrepresented may result to the sanitary permit being revoked by the Planning & Zoning Department. ••• Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV, 04/12) r^•opery owner RLV Rivard Revocable Trust. 'aPage 2 e4 4 ... ..... I .,., ...,.,. -.. - -- ,. nuNnwnw, haw -ionzon Depth Dcmmant Co*c -eoox ; uo- -e-:r,e Sv=:U-e Lonss-er-e a0,,.;r 4acts GPD it' Munse0 C, Sz ".rt ^_ jn E' 'E•'=- 1 0-7 1Cyr3+3 ncne ;d 2mgr n,,fr a� 2m,2v� 0.6 0.8 2 7-18 l0yr51ll ncne sit 2fsck o'vsr g' 3 18-30 10yr4r4 no'.e Su ',sbk 4 30-67 7.5yr4,a cone si ir-sbK -ofr g., :vf 0.4 0.7 5 67.90 5yr4r4 none 0:n mrr 0._ 0.6 Bor no 4 sJ° :� tt PR. G'Ju'!G Sd'rd:EEEr 92 97 -Io'Zon Dem. --c, ins'!Co C' osd D' Descr._•:_^ �<vIc•o .r Mursel Ou sz Con: 1 0-8 10yr3 3 nono stl 2 8-18 loyrs/3 no-e S:n f 3 18.31 :Ovr4 4 ;I,e Sn 4 31-42 Syr-,4 5 42.72 5Yr4'4 Sc: Aeco;.atm^ :ate _, .,. :.ra -.,,^Siicroe SC.. Tdrl 400•c GorJ s.. C_ c 'E'•e• cr's: ,mar -,. ,,. 2n•.2f 7.6 0.8 2f_st)K r o : 2 .:f 0.6 C.8 2nSbr, nrr y': 1':f 36 0.8 'rn S.-R n'r „ . ...... 14 0.7 Etrlient e+ = B:.:C , nr -. =25'+t0 _ a-c -SS ,, } ' L3 2 = 6`_ 7jc < 3C me _ 1 he U:I`JtlnKri a', m":•.: -.w :y.:,: i.� .i ..�im:'�q-:,. .. ..�... ... ✓.,..-,•� f � z.\ w\ ¥ wA/.�. 100 \.�� i :1 q St Croix County, W1 Legend lot NVlFrvnrd l•rwu,dlyr 11tv.1 :W Old sco.;I -.'m r I"''d I iaAlm WI',,;I IrIU II32-2111r IIio1II NL IA N[ 114 -.1 1 i"ll PAW low. 111 Sonrri .. r t ru xiul led by II r,ll HNI 1 II ll l tW! Ij 7I I n1 1 ,. r r.ntillnrl r� o� 0 . 1.1 •♦ ,_ .x.. '\• .\� I •�.♦ 11' .e, it 1 ., r r��rr. ..l'.. M1r r.,11r. r't.4 rli r,ti... r+i1�'rrWr.A!!�r, rl�.. ' Ir A,1 .r r• r, 1 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) 287 Old Scout Camp Road at: NE y4, NE y,, Section 13 , Town 30 N, Range 20 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 located W, 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 Steel Other Plactic Manufacturer (if known): Infiltrator Age of Tank (if known): Permit number (if known) John Schmitt (L' nsed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS :7 as (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 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer RW Rivard Revocable Trust Mailing Address 287 Old Scout Camp Road Property Address 287 Old Scout Camp Road (Verification required from Planning & Zoning Department for new construction.) City/State Somerset, WI Parcel Identification Number 032-2070-10-001 LEGAL DESCRIPTION Property Location NE '/. NE /, , Sec. 13, T 30 N R 20 W, Town of Somerset Subdivision Certified Survey Map # 4c , Volume — , Page # Warranty Deed # h () 19 � (before 2007)Volume , Page # Spec house Oyespto Lot lines identifiable 0yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # 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(t) 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 andior (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. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu e f edroo 3 SIGNATURE OV APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV, 04/12) Kq ���� IL EVAL _►_ in ccordanca with Comm 85, Wis. Adm. Code fessional Servigpfs�n�n Csr dcg _ /d #203 Page 1 of 4 Schmitt Soil Testing, Inc. MN1 .0. Attach complete sit plan on paper not less than'Y x 1 inches in size. Plan must include, but not lim' to: verf opal refs ce point (BM), direction and percent slope, scale r dimeSdio�pienM 1 lion and distance to nearest road. nt all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). County St. Crobt Parcel I.D. 032-2070-10-001 ev 2�?D Property Owner RW Rivard Revocable Trust Property Location Govt. Lot NE1/4, NE1/4, S13, T30N, R20W Property Owners Mailing Address 287 Old Scout Camp Road Lot # NA Block ill# Subd. Name or CSM# City State Zip Code Phone Number Houlton WI 1 54082 1 612-581-2909 ❑ Ciry � ,, Village ❑ Town Nearest Road Somerset I Old Scout Camp Road ❑ New Construction Use: ❑ Residential I Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material Glacial Till (Amery Series) Flood plain elevation, d applicable NA ft. General comments Area is suitable for a shallow conventional replacement system with a 0.4 gpdtsgft rate. Possible system elevation is 96.5'. (5 and recommendations: trenches) Slope of area is 10%. Fi-IBoring # ❑ Boring G,') Pit Ground surface elev. 100.11 ft. Depth to limiting factor 89 in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Be. Sh. ConsistenceBoundary Roots GPDtft' •Eff#1 •Efr#2 1 0-9 10yr3/3 none sit 2mgr mfr as 2m,2vf 0.6 0.8 2 9-18 10yr4/4 none sil 2msbk mfr 9w lvf 0.6 0.8 3 18-25 10yr4/4 none sId 2msbk mfr 9w lvF 0.4 0.6 r 4 25-36 7.5yr4/4 none sI lmsbk mfr 9W --- 0.4 0.7 5 36-55 10yr4/6 none grs Osg ml cs - 0.7 1.6 6 55-72 7,5yr4/4 none A imsbk mfr s ---- 0.4 0.7 7 72-89 5yr4/4 none sl Om mfr -- -- 0.2 0.6 2] Boring # ❑ Boring Pit Ground surface elev. 98.56 f1. Depth to limiting factor 92 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ConsistenceBoundary Roots GPD/R' •ERe1 •ERa2 1 0-9 10yr3/3 none sit 2mgr mvfr as 2c,2vf 0.6 0.8 2 9-19 30yr5/3 none sit 2fsbk mfr gw lm,lvf 0.6 0.8 3 19-28 10yr4/4 none sit 2msbk mfr 9w 2vf 0.6 0.8 4 28-36 7.5yr4/6 none grsl lmsbk mfr gw lvf 0.4 0.7 5 36 69 7.5yr5/6 none Is lcsbk mvfr CS -- 0.7 1.6 6 69-92 Syr4/4 none sl Om mfr -- -- 0.2 0.6 • Effluent #1 = BOD s> 30 < 220 mg1L and TSS >30 < 150 mg1L ' Effluent #2 = BODs < 30 mg1L and TSS <30 mg1L CST Name (Please Print) Signature: ���JJ CST Number Thomas J. Schmitt L/i-- 227429 Address Schmitt Soil Testing, Inc. Dale Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 4/22y2020 715-760-1978 MD-8330(R07/00) t3� Property Owner RW Rivard Revocable Trust Parcel ID # 032-2070-10-001 Page 2 of 4 Z BoringBoring # Pit Ground surface slay 97.51 ft. Depth to limiting factor 90 in. Soft Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDJR' •E11111 •EIf/2 1 0-7 10yr3/3 none sil 2mgr mvfr as 2m,2vf 0.6 0.8 2 7-18 1Oyr5/3 none sit 2fsbk mvfr gw im,lvf 0.6 .8 3 18-30 10yr4/4 none Sit 2msbk mfr gw 2vf 0.6 0.8 4 30-67 7.5yr4/4 none sl lmsbk mfr gw lvf 0.4 0.7 5 67-90 5yr4/4 none sl Om mfr — -- 0.2 0.6 lt4 7 a.Q�l erJC ❑ Boring (� varies o. CQtrC/. Boring # pit Ground surface elev. 9 31 in. 92.90 ft. Depth to limiting factor Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM2 'East �Etp2 1 0-8 10yr3/3 none sit 2mgr mvfr as 2m,2f 0.6 0.8 2 B-18 1Oyr513 none stl 2fsbk mfr gw 2m,lf 0.6 0.8 3 18-31 10yr4/4 none A 2msbk mfr gw lvf 0.6 0.8 4 31-42 5yr4/4 flf7.5yr6/6 7.5 /2 sl lmsbk mfr gw --- 0.4 0.7 5 42-72 5yr4/4 c17.5 5yr6/6 51 Om mfr — -- 0.2 0.6 Boring Boring # J Pit Ground surface elev. ft. Depth to limiting factor in, Soil Applicatlon Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure ',Consistence Gr. Sz. Sh. Boundary Roots GPDM2 •East •Etpz i r Effluent #1 = BOD? 30 S 220 mglL and TSS >30 < 150 mgA. • Effluent #2 = BODs < 30 mglL and TSS -s30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TIY 608-264-8777. SBD4330 (R.07100) SClmat Sou Tesuiv, bn w 0 cM 3V RM Old Smut camp Road Conducted for: RW Rivard Revocable Trust 287 Old Scout Camp Road Houlton, WI 54082 PID: 032-2070-10-001 NE114 NE114 813 T30N R20W Tom Of Somerset Conducted by: Thpgas J. U C�aST 227429"' 4-22-2020 BM 1 100,00' Bottom of siding on detached garage BM 2 91.34' Top of plastic manhole cover of existing septic tank o WON Drveww Fbuae 437,89' 440. T'a2e E amry Septic Tank �M2 EmI ng Dry Well � •\'\ .\. ... �.\ (.enga •\ 10%SbA i 1 _ w .1Gfl:. \. 2 3914 �. 1 eM 1 12' 12' a ice. 30' 18' 1Y 5g• 3(xY St Croix County, WI Legend lakes and Rivers Riven and Streams o� 0 20 40 soft DISCLAIMER. T w rriep is nd guamoveed to be amunte, mired, current or complete and mIK1YSlOde tire" an Me nspenHbllty of Me Waf. mpp, If 0 100 , M200 300f DISCLAIMER: not guararteed anod De .-ILRSEN SCTO=P�ofthe OCAMp TRL