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HomeMy WebLinkAbout038-1235-02-000 (4)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)] Michael D Green TANK INFORMATION TOWN OF STAR PRAIRIE TYPE MANUFACTURER CAPACITY Septic V Co?4 JZF>b Dosing Aemtion TANK SETBACK INFORMATION M®Mm® • • ®MW190_-- M■AWAMi PUMP/SIPHON INFORMATION Manufacturer Demand GPM Mode Num TDH ift 11'rijon Los ystem Bad TD t Force in L g Dia Dist. ell lotM-r- lsiq- ELEVATION DATA STATION BS HI FS ELEV. Benchmark �-`� 103. Ioo.23 AI(.fdAlv\�' Sewer •KB 15.&5 Bldg- SUHt Inlet SVHt Outlet G- J 16 41 • 7 7 LfP Dt Inlet D o T 10 9.55 94 . 5$ Header/Man. 5 T -7.90 45 33 Dist.w& V50y,7• D Bot. System T IC) • 5 13. %3 3. F' T3 q.O 14. t 4.4 VCL`iivt, SOIL ABSORPTION SYSTEM 4-1, 6 -F- Ll 15 J4, 5 t- ,5 Ea 'FlOIa) FA BEDrrRENCH DIMENSIONS Width,.-- , 5 Length � t [./� No. Of Trenches PR DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L 5 BLDG WELL LAKE/STREAM LEACHING Manufacturer: --1- (� INFORMATION Type Of System: 1 �, 1 �� , ` �(� CHAMBER OR UNIT .lk'Y1 Model Number. F-7 ,0� l/.CA'_L VY'4. DISTRIBUTION SYSTEM Header/M+vVanifcjd_� ihA i` Leng h Dia Distribution Pipe(s) Length Oia pacing x Hole Size x Hole Spacing Vent to Air Intake SOIL COVER x Pressure Systems On Iv xx Mound Or At -Grade Systems Only Depth Over Bedrrrench Center% '7 Depth Over %\ Bed/Trench Edges � I xx Depth of Topsoil xx Seeded/Sodded xx Mulched — S\ !� G r — No Yes ®No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1036220TH AVE 1 1.) Alt BM Description = Vol, �►(� 2.) Bldg sewer length = - -amount of cover= Plan revision Required? [j Yes x No Use other side for additional information. SBD-6710 (R.3/97) —,l1 ov\ SST El -a6serva4o.-% tkfes S it.,/ I�tr�3 I in. - &N Yakre uscrl -10 useexisi�rr� S.�S� umF5 0 ,, V, 4% ad x t)m:N,`L Si Date Insepctors Signature Can. No. S 1. 2. m ate lens for Me system a d sobm' tom Ctwe snl m r not than R is x l l in V _ � ,as per applicable codelo /� (,�N, i s pnn` Q �prr�a�jFe-`�t ec el ,rltlpt�J `5� �7t �$� �r -U , sr�leQa fsr wt0.. A�L7�t4A� i,nVlMaW&h County Indus ices Division 1400 E Washington Ave P.O. SLCmix o�(1ag r Sanitary Permit Number (to be filled in by Co.) Bo; 7162 Maatson, Wl 53707-7162 O2O oil &.2 1 it Permit Application rSinteTnnsacnon Number In acco ce wiiht5��Mtlm Code, submission of this form m 1 e pi{�,�vemmental unit is pemii[. Note: Application forms fur store -owned POWTii. !'lebrutted to theDe Sat Ihp enl of Safety and Professional Services. Personal infomuawn you prov may be used for secondary Project Address (if different than mailing address) m accordance with the Privac Law s. ) 5.04 1 m Status 1036 220'a Ave I.A licaIto01 formatan-PkasePrint All Property Owtiei s Name Parcel a Michael D. Green 038-1235-02-M Property Owner's Mailing Address Property Location 1036 220ih Ave. Govt. Lot SE i, SW Y., Section 9 City, Stale Lip Code Phone Number New Richmond. W1 W17 �ir'rcle one) T31N RISE or() 11. Type of Building (check all that apply) Lot a Subdivision Name ® I or 2 Family Dwelling- Number of Bedrusms... _ 2 Green's Rolling Acres Block N ❑ PublidCommercial - Describe Use ❑ City of ❑ State Owned - Describe Use ❑ Villageof C'SM Number ® Town Star Prairie of Ill. T e of Permit: Check onlyone hot on line A. Coro let, line B if applicable) A. ❑ New System ® Replacement System ❑ TreatmenUHolding'I ank Replacement Only ❑ Other Modification to Existing System (explam) B. El Permit Renew,) ❑ Permit Revision ❑ Change of ❑ Permit I'rarWt r w New List Previous Permit Number and Date Issued Before Expiration, Plumber Owner 463015, 10/4Rd14 IV. T of POWTS S stern/Com nent/Device: Check all thatapply) ® Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitablesoil ❑ Moud <24 to of suitable soil ❑ Holding Tank ❑ Otter Dispersal Component (explain) ❑ Pretreatment Device (explain) _ t ti, V. Dis rsai/Treatment Area Information: r Design Flow (gpd) Design Snil Applicatio Dispersal Area Requited (sf) Dispersal Area Proposed (st) System Elevatio 6W Rem(gpdsq R57 900 95.9', 95.2', 94.5' 94A' U.7 VI. Tank Info Capacity in aie 4-44 a /(, Gallons Total a of 1eJY� urer '-o' $ ,tar New Tanks Existing Tans Gallons Units Septic or Holding Tank 1200 1200 1 Huffcutt Dosing Chamher VI 1. ResponsibilityStatement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PlumbCr"%Si tare r 1 MP/MPRS Number Business Phone Number John Schmitt C. �*�' 223760 715.760.0486 Plumber's Address IStreet. City, State, Zip Code) 586 Valley View Trail. Somerset. WI 540 VIII. County/Department Use Onl Appmved ❑ Diseeow.ep-� \eason Permit Fee Fee Qar� Issued ng Agent Si re i 'VeS OwnerGiven R fur Denial IX. Conditions of Approval/Reasons for Disapproval -3` �e . TEM OWNER: // r� e- Septic tank, effluent filter and Ns+�— z �&✓�rr„& a �e��1�pe {�/ nsn✓ u. y ispersal cell must be serviced / maintained -4� f -'etz / O as per management plan provided by plumber. At _ wt�6Laa I t SYSTEM PLOT PLAN Green 4 Bedroom Septic System Pro)eci Mares%: 1038 22MA. BM1 Symbol:. SM Elevation: 100.00' BM Descrtpibn: Top of Septic tank mane cover BM2 Symbol: Q BM Elevaemr: 100.23" BM Desaipllon: Top of vent pipe Slope Gradrenl of Teeleci Pies (10%) Well Symbol (a applicable) Notes: Sae Plat Map for cwnplWe map P'� \�r\Go . Well ezvz Design Flow: WDGPD Akach design flow calculations roc 40mnvaelel plane: Pipe Material, / ASTM Standard Tables 384.30-3638430-5 -SCHM WC POO I ASTM-D2695 3034 4' PVC I ASTMZ3034 M Tt- EA" 3'43' BMdrTuse benches EI. =93.6' T2- Ep90ng 3WT BlodiBuse trenches E1.=94.0' T3- Eldsbng 3kAT Biodahlse trenches EI =94.38' Existing 4 T4-Proposed 3 A45' EZ Flow Trench EI.=95 9' Bedroom 06"" T5-Proposed 3k45' EZ flow Trench EI7 Hm" T6-Proposed 3VV EZ Flow Trench EI=94.5' T7-Proposed TAF EZ Flow Trench EI.=94.0' • Bird boning T4 85 \ //^W ■Schmib honing T5 / Property Line T6 SM7 E1ds6ng 1250 gall _ HWiwh septic tank .BM2 83 , • B7 `IS rj 9B 108 Slope 82-` % 94' �i�\ \■B4 � T1 C Bt P Line �\ \ 94' OF Yl /y CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Green 4 Bedroom Replacement Septic System Owners Name: Michael Green Owner's Address 1036 220th Avenue New Richmond, WI 54017 Legal Description: SEl/4, SW1/4, S9, T31N, R18W Township Star Prairie County: St. Croix Subdivision Name: Green's Rolling Acres Lot Number: 2 Block Number Parcel I.D. Number 038-1235-02-000 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 Diagram Page 6 System Sizing & Cross Section Pagel EZ Flow Information Page 8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Existing Tank Certification Page 11 Warranty Deed Page 12 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/12/2020 _ Phone Number: 715-760-0486 Signature: In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Green 4 Bedroom Septic System Design Flaw. e00 GPD Prokol Address. 1936 220t,, Aortae Affar%1 demon flow calculations for commercial plans. BM/ Symbol . BM Elevator 100 W Pipe Matenels r ASTM Standard BM DexnPeon. Top of Septic lank manhole cow Tables 384 303 6 384 30.5 BM2 Symbol: 0 BM Elevafon 100 23" e-SCH 40 PVC Ppe ASTM. D266: BM Descnp0un. Top of vent pipe Slope Gre"M of Tesleo Ares'. (10%) 3034 4- PVC ppa I ASTM.03031 Well Symbol (8 applicable) Notes: See Plot Map for complete map ®J k 1 .1 •1 120 vrd— ®% T1- Existing 3'x63'Biodiffux trenches FJ =936' T2- Existing XAT Bodi fus s trenches El =94.0' T3- Existing 3'x63' Si0diffuse trenches E1.=94.38' 4 T4-Proposed 3'x45' EZ Flew Trench El =95.9' swirocint 0n'�ay, TS-Pmpoaed 3'x45' EZ Flew Trench EI.15.2' 1 Hcusa T6-Proposed 3'x45' EZ Flew Tr ench EL=94.5' (/ T7-Pmpod 3'x45' EZ Flew Trend, El =94.0' se 96 • Biro bong 1\ n00 III Schmitt toning T4' 95 T5 � Property Line T6 BMt Exisit 91250 gallo _ _ `� HuflcuIt septic tank yy+ 96"'— BM2 83 B ■ 87 B6 a ve �/ $ to%Scoa U 82 � \!84 _ Ti 96 0 A WARNING LABEL EMBEDDED INTO CONCRETE COVER READS AS FOLLOWSt CAUTION DO NOT ENTER WITHOUT PROPER VENTILATION. COULD CAUSE DEATH... DANGEROUS GAS. NOTE, ADDITIONAL LABEL FOR GREASE INTERCEPTOR. INFORMATIONAL LABEL READS AS FOLLOWS, GREASE INTERCEPTOR 29' DIAMETER CONCRETE COVER (TYPICAU SEE 'ACCESSORIES• FpR OTHER COVER OPTIONS NOTE, THIS DRAWING REPRESENTS A SEPTIC TANK, SEE ACCESSORY #11 FOR OPENINGS LOCATED IN THE TOP OF A HOLDING TANK. NOTE, ADDITIONAL BAFFLE FOR GREASE INTERCEPTOR, DIMENSION EQUALS 1/3 LIQUID LEVEL. (ONLY FOR GREASE INTERCEPTOR) o� 9 mdS lko I oNAS owl TH s PAGE 2of2 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 fall to the bottom of the tank. If your filter contains a SmartFilter® alarm, you will be nofified 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. 0 Residential Applications Certified to ANSIINSF Standard 46 Copyright 2014, Polylok. Inc All rights reserved Prodoct(s) covered by one or more U.S. andror International patents, Other U.S. and International patents may be pending. 1-877-765-95651 WWW.polytok.com Page 4 Home F About Site Map Order Info Videos & Literature Contact Drip Systems Treatment Controls _ Products Downloads Deslon Guidance The Bull Run Valve T" 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 DESCRIPTION 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" f ,I - MER CAP ADAPTER faGER TUBE 4 OLfrPOHr ACCESS CAP VALVE DIF EMON ►ANDLE Ir OUT POFr r IN PORT 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" I IIGI-I Page 5 ;2 IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) Geotextile Cover — SOIL COVER 12' min. trench depth (typical) Highest Trench System Elevations = 95.9' ft; 95.2' min 12' (typal) SUVME ft; Septic Tank(s) Manufacturer Huffcult Concrete, Inc Septic Tank(s) Volumes) 1250 gal gal gal gal Effluent Filter Manufacturer Zabel Effluent Filter Model #: A-100 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) — Lowest Trench (as applicable) It, 94.0 ft; TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW 4a0 Obsematron ppe shall ce na lied at yncton between live unit (No Scale) Perforated Lateral Observation Pipe (typical) (typical) r- — — — — — — — — — — --------- B = 45 ft (typical) INSTALL PER TRENCH. 4 10-ft bundles @ 50 ftEISA/unit = 200 W + 1 _ 5-ft bundles na 25 fF EISA/unit = 25 ft' 10 ft Provide minimum 3 ft separation between trenches. OBSERVATION PIPE DETAIL (No Sink) ft Sae* Type or Shp Cap (loose) �� �'✓ 41e PVC Pica fop of ppe to termnate al or above 6mshed grade (4)1 a'.112' X 6' slots ee apen Anrhonng Device A=3.0 ft (typical) EZ1203H Bundle (typical) (mfd by Infiltrator Systems.. Inc) Install pursuant to manufacturet's instructions = Proposed EISA per trench = 225 ft2 Required Infiltration Area = x 4 trenches = Proposed Total EISA = �nvehed Grade Ached & seeded) Tweet Cover (mn 1 foot) Infiltration Svdece 857 ft` Distribution Method: 900 ft' drop boxes m W O n Installation Instructions for �1EZown EZfl w Systems in Wisconsin by INFRTgATOR ............................................................................................ Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the 5& smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12' bundles with pipe in lar site. The top or center -most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12' bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, should be tutted against the other aggregate -only bun - A single pipe bundle contains a four inch perforated pipe sur- dies and do not require any type of connection, rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre - only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positioned upward and is • EZflow Bundles in contact with the fabric contained in the adjacent cylin- • EZflow Geotexhle Fabric der before backfilling. • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84. Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles, tribution box and trench bottom elevations before instal- lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered. that this is not a problem when systems have a minimum of 6' of soil cover as recommended by manufacturer. 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 1203H-GEO down along the sides of the product to a point at least six inches from the bottom of product. Geotextile Barrier Material 4. When installed in a trench, the trench should be dug to AL a width of 36 inches. This not only saves labor in excava- tion, but also provides better load -bearing capacity after backfilling is complete. Page 7 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 = 600 gpd; BODE 5 220 mgL"; TSS 5 150 mgL"; FOGS 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use c age of system o nuisance factors (i.e. odors, user complaints, etc.) mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) e, 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) c neglect or improper use (i a., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing 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.) 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. Stats. when the volume of solids in the tanks) exceeds one-third (113) 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 filters) 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 8 ST. CROIX COLITY SEPTIC TANK M. AiNTENANCE .AGREEMENT AND OW-NIERSNIP CERTIFICATION FORM Oumer'Buver Michael Green. Mailing Address 1036 220th Avenue, New Richmond, WI 54017 Property Address 1036 220th Avenue lCeriftcation required from: Planning & Zoning Department for new construction.) City state New Richmond parcel Identification Nttmbcr 038-1235-02-000 LEGAL DESCRIPTION Property Location SE t} SW ,4. see 9 T 31 NR 18 ��. T�xx.n of Star Prairie Subdivision Plat: Green's Rolling Acres Lot = 2 Certified Survey Alap Volume . Pa¢e = Warranty Deed # _ 1before'UO-)N'Olutlte . Pagc = Spec house❑yescao Lot lines identifiable 0>cs0ro SYSTEM :1LtINTENANCE AND OWNER CERTIFICATION improper use and tttaintertance of your septic s3 sten could -esuk is its pr multure faLure to t.andl: na:;rs Proper maintenance con.rst, of pumnirg out the septic tank cx c:y three yeaa or .00ner. if needed, by a I:ceirsed pumper. What rou put into the s'.'sEem cart affect the function of the septic tank a- a treatment stage in the %-, sie df>posai sv-stent nwater maintenance :espon,tbihtics arc specified in SSPS. 383.5_1 i i anu in Chapt n I: - bt Croix County Sanitan Ordinance. The property owner agrees :o submit to St. Croix County Pltm•ti;t_ & 7on+ng Department a certification form. signed b.1 th. owncr and by a master plumber. journeyman plumber. reiu•tcted plumber or a hectfsed pumper +crifying that I 1 t the on -sic wastewater disposal s} stem is in proper operating condition and or i 2 r afty inspection and pmnping j if necessan 1. the septic tank is Icca than I ? full of dude,,. L ue. the undersigned have read the above requirements and agree to maintam the prnv arc >e"age disposal s', st,,m u nh :hc standards set forth. herein. as set by the Department of Safet% And Professional Sen'ices and the Department of Natural Resources. State of Wisconsin. Certification stating that your septic system has been maintained mint be completed and rerumed to the St CrolN CountPlanning & Zoning Department within 30 da%s of the titre,, year expiration date. I .ve ceriifv that all statements on this form are true to ncc Lest of me ow knowledge. t we am are the owner(s) of die prnperty deli robed abo%e. by rirtuc of a Nvarrann deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE OF APPLIC'ANT(si _Lz_ 2c'- DATE •`":1m information that is misrepresented max resuh in the sanitar, permit being rvokcd by the Pianning & Zoning Department '14 * Include Kith this application a recorded warranty-decd r'rom :he Register or Deeds Oflice and a cop', of the cerulicd sun e% map of reference is made in the warranty deed (REV. 04112) Page 9 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 1036 220th Ave. located at: Se y4 Sw �'/4, Section 9 Town 31 N, Range 18 W, Town of Star Prairie 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 7 /5 —;( C7 Did flow back occur from absorption system? Yes_ No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1250 Construction: Prefab Concrete x Steel Other Manufacturer (if known): Huffcutt concrete Age of Tank (if known): 10/4r2004 Permit number (if known) 463065 John Schmitt (L' nsed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS _ / 0z b (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 Page 10 GREEN'S ROLLING ACRES zt=j k: 4r z�1,44 7,7q FVP mi= 1. IM r Page 12 erattme SOIL EVALUATION REPORT Sp '_ _ S crugg5ir-rl fiery:`>S --. .tar:-= .. . _ ,1. . .. ,- rtr� a2 'n'"! Sob Tes; ra ., r« acn ccm re ve Man cn "ape r 1c less tr ar , n. z� _ � ,, I _'ude r ! -.;r :.-,red to .ec ca ac-?-,,ae e _-ce oc .. _ c n. - arc c-e"eri s;o.' s_we'r-nril' a'•^,t anc cca;�r.•• an.-- =7..-c •e 3r�.::__� _ .L :-�.1ti Please print allintormaj5j — A« ilor. ate r :. ` :14 r'.9. r.. yw. rr.., RP' d ... ..:o ♦ '° . •a.. .. .. . .,� a ..... .. 3reen dicta=i vew Rrerrsrd o4:i I f.ew Cons:•,rct.or „ge ?esiderUa °'u- .. c . A .,_ - "arent matenalriiaCial?ili�Amert-L'rGmtr=1-Sa'C,L:arr General comments -^-e'. •e^c,rme^cwwns 4 : :? 7.5yr4'4 i I D516onr q 60r.ny ,. - - Gg �:r ,.,cn sr!a[e 2�ed'. 98.28 �.eGl". ,r��. - �-or:zcr Depm ..omrar!lnzc. Rec:<ues;. i - 4 Z7-R4 :Cv(Sib Gne 05q ':, .J:25S _T.�l: iGll �<sl,:.q i..Y .,, _.:...�. _ ._n. 'p,i.:' ':b•-.�.q. Parse: to it 038-1235-02-000 Page 2 of 4 Property ewne• Green, Michael D. Boring 6 Boring # Pit Ground surface elev 95.88 it Deptr to--m.Ung `actor 8(;_ ,q And AIZI=6nn Ome. Horizon Depth Dominant Colcr Redox Description Texture Structure Consistence Bou ,daro Roots GPOrB' in fvtunsell Du. Sz. Cont, Color Gr Sz Sri *Eft! 'Efw : 0.8 10yr3/3 none sl 2mgr mvfr as 2vf 0.6 1.0 2 8-28 7.5yr4/6 none sil 2msbk mfr aw 1vf 0.6 0.8 3 2a;�7h loyr5;6 none s Osg mi as ------ __9-7_ 1.6 4 76-86 7.5yr4/6 none si Om mfr ---- ------ 0.2 0.6 7 Boring # Boring ., Pit -round surface elev 95.78 tt �eplh ;d :mid ,:rig �aClcr %2. :n :Soil Application Rate Horizon Depth Dominant Color Redox Descnpuon Texture S!ructure Consistence sou -dal Qoots GPD rx :n Munsel: qu Sz Cont Caor Gr Sz Sh Vein'. =--#_ 1 0-9 :Oyr313 none sii 2mgr mvfr as 2m.2f 0.6 Q-8 2 9-17 10yr3/4 none Sri 2msbk mfr gsv 2m,2f 0.6 0.8 3 17-32 7.5yr4/6 none sci 2msbk mfr g•rr lvf 0.4 0.6 4 32-84 5yr4/4 m2d 7.5yr6;6 7 5vr6/2 SO lmsbk mfr .... ------ 0.4 0.6 Bonna # Boring `-n --- Pit Ground surface elev ft Depth to limiting facto• .n Soil r.ppl�hon Rate %pph Horizon Depth Dominant Color Redox Description Texture 3tr,icfu•e Consistence Boj�oa-, Roots P2^= in. Munsell 7u Sz Cont Cc or Gr Sz Sh E"- -. I , Effluent #1 = BOO,> 30 t 220 mg" and'99 130 - :5r- mg L ' Eiltueri #2 = 8'?t;•, - 30 ^c L and TSS < 30 mgl the Duparunern of (i.immerc i, un equui orporrunt nr,.••i,ta, and amply, er iY, nil •.ided ,i•-I.t, 1W, aiLO i+r nBed material in an aiccumtc tt:rnint. 0,; d"rLIrinieni a' 1: 1 or i I•n.,,q-'i,l-X--" a r r k I � tir 4 I e 1' 13 M f c St Croix County, WI Conducted for Michael D Green Legend 1036 220th Ave, New Richmond, WI 54017 PID 038-1235-02-000 SE114 SWV4 S9 T31N R18W -- Town of St Joseph Conducted by T mas J "cl)nlitt CST �2"7429 511812020 L " I W 2, L .I C,iru�;ati Roiin'¢t Arres O M O '...i Ili.l.ltr{f It '+It.iii I"il 13 ti � V o nl r:0 G�,,, •� \li, ..Ax I.,.n.n^. rY.YWIr .rN..r:.InI,:Y'rlrl,i- NOTE There is an existing Zabel A-100 effluent filter �• but the pipe entering the septic tank has settled down tipping the filter this pipe will need to be fixed ........_ 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 semndary purpm ss [Privacy Law, s.15.04 (1 gm)]. Permit Holder's Name: City Village 1(Tovmship Green, David I Star Prairie Townshi CST BM Elev: Insp. BM Elev: BM Descrip ion: Ti, cm TANK INFORMATION ELEVATION DATA ,A.-Y. I, TYPE MANUFACTURER CAPACITY Septic 140 geeing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vemta Airintake ROAD Septic fi I Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Model mber fTDH TDH Friction Loss S Head Ft Forcemain Dia. Dist. to Well SOIL ABSORPTION SYSTEM SED/TRENCH Width r Length s No. aTrtnches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ^, SETBACK SYSTEM TO PA- JBLDG IWELL LAKE/STREAM LEACHING ManufaGurer: INFORMATION CHAMBER OR UNIT r rtt-JS.f/� Type Of System: �cv'v1ZJ�l0 R r �2 / IV�t' / lr= Model Number. � 1V a� a � oar DISTRIBUTION SYSTEM - /0"-/6 30 dafz.t�— HeaderlManifdd // Distribution z Hole Size x Hole Sparing Vent to Air Intake 4 \ Length Dia Length Dia Spacing \ SOIL COVER z Pressure Svstems Only " Mound Or At -Grade S"In ms ONv Depth Over Bedrrrendt Center 11 —t Depth Over BedfTrench Edges \ in Depth QQQf Topsdl xx Seeded/Sodded xz I Yes & No Yes allNo COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_/_/_ Inspection #2:_/_I_ Location: 1036 220th Avenue Star Prairie, WI 54026 (SE 114 SW 1/4 9 T31 N R18W) Green's Rolling reen'sRolling Acres Lot 2 Parcel No: 09.31.18. 1.) AASM Description = `1i rc� 4,Jt� PtPt4ce1�Z�`` `��tt.... It�i..' 2.) Bldg sewer length = Z ( Of, amount of cover = r f ]�' I V 4 Plan revision Required? I% Yes No Use other side for additional information SBD-6710 (R.3/97) Date Inse s Inatum Carl. No. Safety and Buildiogs Division County as Visconsin 201 W. Washington Ave., P.O. Box 7162 t L �� Madison, W153707-7162 Sanitary/ Pennit Mud=(to be filled in by Co.) De artment of Commerce (608) 2663t51 -- Sanitary Permit Applicitionmm 'PN� , State Plan[D.Number In wmrd with Co83.21. Wis. Adm. Code, personal iufomapon you I . Project Address (if different Om tml"mg adthen) may be used for secondary purposes Privacy 1Aw,si 5.04(IXm) 1. Application Information - Please Print All Information � 0 ZZO M9-- Property Name - Parcel# Lot Blacks ProKAy owncesMaRmS Address section City, Sate Zip(C�ode Plrone Nurobrr ! of7 2 nro> N; a W IL q/' of Building (check all that apply) n SubdrvisiooNt L96ta4m4t� �CLpr2Parmly Dwdit- Number of Bedrooms /.�f�KGt ;y /,�X{�j S ftLUJU Pub_lidCommuaal-Describe Use State Owned -Describe Uu 6ty7VBlageI'wnshipo l tII. Type of Permit: ((beck only me box on line A. Complete Bate B if applicable) A' ew System Replacement Sypern TrnuumVHoWiog Tank Replacement Only Other Modification so Existing Sysem B. Permit Renewal Penmt Revision Change of Permit Transfer to New list Prcvrom permit Number and Date Issued Before Expiration Plumper Owner - IV. Type of POWTS S Check all that apply) co-Pn� InGmand Mound 2t 24 in. of suitable soil Maud <24 is of suitable and At -Grade Single Consu ctcd Wedand Pressurized rn Holding Tank Rat Frffer Aerobic TreaCacat Unit �piO�g Sand me. Recirrn S ndmfic Media Filter Clamber Line Grevel4m other (ex ,(�C.V V. Dispersalffreatment Area ormation: Design Row (gpd) Design Soil Application Rak(gpdtt) Osspusel A[ea Regaued (sU DnwW Am Apposed (aUsylaw 6ao 8�� 3 VL TaIl k bdo Capacity in TOW Number Manufacturer Prew site Sled Plastic Gallons CiaHons of Units Cornett Compacted New Evadtg Tacks Tada - Seprc w NoldosTaak S� AadttTteatmms Uws - Doeeg CTambea VD. Responsibility Statement- I, the aresponsib dity for installation of the Powls shwa oa the attached Flam flu Name (Fria) flamhef MP Nurubtr Business Phone Number �r �z6 Plumber's Addree (SUM try, Sh_m, / /(f %'J 0 VID. t Use only Appro Disapproved &uPermit Fcc Cudoda Grmndwaw surduy Date tmwd Ageat Si�gnsm (No save) Owner Given Reason for Denial Sd- a Fee) �.y� � 7v � ZQD IX. Conditions orApprov"easons for Disapproval (x; 1 1�"+wha- SYSTEM OWNER: n r 1 Septic tank, effluent filter and 34P a "w dispersal cell must all be serviced / maiatdnad as per management plan provided by plumber, 2. All setback requirements must be maintained�`/ sj.- as per applicable code/ordinances. 6a� ',.`���- AJ Attaet. cwgikk pram (to she C-ady o*) for the sys" ad paper act tea than SW a 11 aches b aloe PROJECT David Green SE 1/4 SW 1/4S 9 �OT PLAN ADDRESS 1047 220th Ave New Richmond Wi 54017 /Tjff N/R 18 W TOWN StarPralrle COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE9128104 BEDROOM 3/4 CONVENTIONAL XXX IN-GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 i of chambers 30 BENCHMARK V.R.P. Topof 1/2" Pipe ASSUME ELEVATION lea' Filter Zabel A-100 ❑ BOREHOLE O WELL a H. R.P. Same as Benchmark Plans Designed Using SYSTEM ELEVATION 96.5/96.1/95.7 5' below grade Conventional Powts Vcut Manual Version 2.0 >6„ Standard Biodiffuser Alternate Benchmark Top of 1/2" pipe @ 100.ObfCover Leaching Chamber with 31.1 ft2 of Area Well is to meet all setbacks required by WDNR I ale is 1" = 40' lnless otherwise toted 721' Property Line B-2' ST 30' 3-3' X 63' Cells with >3' soacine 10' 9% Slope 330' 30' 6' 111 Long „ 3 bedroom [se, being sized a future 4th System Elevation 30'FA To 220th Ave 10 1010perty Line C 57-- Zoe- 12ce rig Department of S IL V t Safety and ► ) in ord ce o i D r= rs Professional Services r V #2042 Page 1 of 4 Schmitt Soil Testing, Inc. -b,..•.- ]1 JTv, r- m es in s' PlamMbtll 12 Z Attach complete site plan on paper not less titTreference include, but not limited to: vertical andlhorizonpoint (BM , direction and percent percent slope, scale or dimensions, north arrocation and di ance t�2.roix C u print all inon. COmmunity Devel Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.0/(1) (m)).12020 u nty LIJ St. Cron (Parcel I 038-1235-02-000Please yye� ay(6 Property Owner Green, Michael D. Property Location Govt. Lot SE1/4, SW1/4, S9, T31N, R18W Property Owners Mailing Address 1036 220th Ave. Lot # 2 Block # 1 Subd. Name or CSM# Green's Rolling Acres City State Zip Code Phone Number New Richmond WI 1 54017 1 715-497-2594 ❑ City ❑ Village [-I Town Nearest Road Star Prairie I 220Th Ave. ❑ New Construction Use: IN Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ® Replacement ❑ Public or commercial - Describe: Parent material Glacial Till (Amery -Cromwell Sandy Loam) Flood plain elevation, if applicable NA ft. General comments Replacmenl area is suitable for a conventional in with a 0.7 atxllsafl rate- Possible system elevation for the replacent area is and recommendations: (4 - 45' stepped trenches) 95.9, 95.2, 94.6 7 01. of area is 10%. ,wry! 6A- o*- l ale 3a 4] Boring # L' Boring A4cv / ti r 2t 2. jCr7S . [ , PR Ground surface elev. 96.23 it. Depth to limiting factor 84+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM' •Elf#1 •EW 1 0-8 10yr3/3 none sl 2mgr mvfr as 2m,2vf 0.6 1.0 2 8-22 7.5yr4/4 none sl 2msbk mvfr gw 2m,2vf 0.6 1.0 3 22-84 7.5yr5/6 none 1s Osg ml — -- 0.7 1.6 ELI Boring # ❑ Boring ® Pit Ground surface elev. 98.28 ft. Depth to limiting factor 84+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ConsistenceBoundary Roots GPDW2 •EmPt •Elr#8 1 0-8 10yr3/3 none sl 2mgr mvfr as 2vf 0.6 1.0 2 8-16 7.5yr4/6 none grsd 2msbk mfr gw lvf 0.4 0.6 3 16-27 7.5yr4/4 none girls Osg ml gw -- 0.7 1.6 4 27-84 10yr5/6 none Is (I ml -- --- 0.7 1.6 'Effluent #1 = BOD s> 30 < 220 mg1L and TSS >30 < 150 mg/L ' Effluent #2 = BODE c 30 mg/L and TSS S.30 mg& CST Name (Please Print) Signature. CST Number Thomas J. Schmitt oz�227429 Address Schmitt Sal Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, W154017 5/18/2020 715-760-1978 S13134330(x07N0) Property Owner Green, Michael D. Parcel ID8 038-1235-024M Page _4_of 4 a Boring 0 ❑ Boring Q Pit Ground surface elev. 95.88 ft. Depth to limning factor 86+ in. oil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/W 'Eftal 'E1s{2 1 0-8 10yr3/3 none sl 2mgr Will, as 2vf 0.6 1.0 2 8-28 7.5yr4/6 none sil 2msbk mfr gw lvf 0.6 0.8 3 28-76 10yr5/6 none s 0s9 ml as — 0.7 1.6 7.5yr4/6 none sl Om IT* — --- 0.2 0.6 Of 9Y0 104 Boring 8 ❑ Boring ® Pit Ground surface elm. 95.78 ft. Depth to limiting factor tin. Soil Application Rate Fbnzon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM2 *Eaai •EI1W2 1 0-9 I0yr3/3 none sil 2mgr mvfr as 2m,2f 0.6 0.8 2 9-17 10yr3/4 none sil 2msbk mfr gw 2m,2f 0.6 0.8 3 17-32 7.5yr4/6 none sd 2msbk mfr gw lvf 0.4 0.6 4 5yr4/4 7. yr6/6 7.5 /2 sill im�k mfr — — — 0.4 0.6 ❑ Boring BOnng # Pil Ground surface elev. ft. Depth to limiting factor in, ❑ Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. !Consistence Boundary Roots GPDIft' -EfW •EI/a2 I Effluent Ml = DOD? 30 < 220 mg/L and TSS >30 < l50 mg/L ' Effluent #2 = SODS <- 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 format, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. SBD,8330 (R07N0) SdWW SDI Texarg, Inc. Conducted for: Michael D Green 1036 22Oth Ave. New Richmond, WI 54017 PID: 038-1235-02-000 SE1/4 SW1/4 S9 T31 N R18W Town of St. Joseph Conducted by: Thas�J-. �rL��rrCt� C` ST 2 42;1 5/18/2020 PROPOSED DRAINFIELD 4 (3' X 75 TRENCHESI faT: •\ 87 10%Slone 94' LOT 2 Greens' Rolling Acres WELL / AGM 1 100.9 Top of 2' Menthols over on Septic Tank MOUSE v By 2 100.23' Top of fadnsat Nola Fast vent pipe on ending tlroinfield ■ Soil Rodrigo, by Tom Schmitt • Sod Bonngs by Shun BiN or \ EXISTING SEPTIC TANK 31 NOTE There is an existing Zabel A-100 effluent filter\ but the pipe entering the septic tank has settled down tipping the filter. this pipe will need to be fixed. 220TH AVE St Croix County, WI Legend lakes and RNan Rlvana W Streams — IMantHes US Higtmays State Hlg"s County HVImM s Local RoaCe Rustic Roade Ramps Road Right of Way rna v..e R•btl v<.a vewe vwv Railroads — Conveyance Division 0 20 40 60R DISCIAIMER: This map is not gua mead to be a=Mde commt, currant, or complete and oundusiuns drawn are Me responsibility of to uaer. �>OeVAa ww . d`