HomeMy WebLinkAbout020-1047-70-100Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Persanal mlormabon you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m))
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTUR R .c
Y
Septic
`e5�er R r 3.5'Gb0
LCAPACITY
Dosing
b P
6so
Holding
TANK SETBACK INFORMATION %kT V °rI n5
TANK TO
I
WELL
91-H.
All —lib
Vent to Air Intake
ROAD
Septic
-2,Z6 %
>5c0 '
'
15
—
Dosing
7 `-J`
>5b,
Z),
31,
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
���
Dema
yPM h
Model Number
C S
1- 35
TDH
Lift, O 3
Fraction I oss
System Head
TD}4j Ft
(}
Forcemain!
Lenthj, %
Dia, ,.
Dist to Well \ 5O
SOIL ABSORPTION SYSTEM
St. Croix
!rmit No
631249
ID No.
No
020-1047-70-100
.vnlRange/Map No:
20.29.19.185D-01
-7,
STATION
BS
HI
I FS
ELEV.
Benchmark
(�• �
)ol..
Jvo
AIt4BM
Ir v
7.15
y8. 7
Bldg. Se er
11' 7
9Y. 97
SVHt Inlet
13,o t
F3.4,y
SVHt Outlet
Dt Inlet
Dt Bottom
IL-7
01 95
He Q' Mapes--
/
)0.
/5.7 /
DS. Pipe
AlaJ ;n
1
�'
z.11.
O. e
Z-
-7r—
3
Bot. System
't' I
Z•
Final Grade
Q
GO
St Gov ✓
95
c
S $7
y7. 78
% * 7 E Z
BEDfTRENCH
DIMENSIONS
Width 3 r
Length No OI Trenches
76 ' Z
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/LVVLy
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufactgrgr:� /` • / /
--i1-- i'� 7` /'V
T e Of System
�e J
On.Uevt f1'd�W f
'J
`�✓`
53 r
Model Number
DISTRIBUTION SYSTEM
Header/Mamfo'd `� t 1
/
Distribution
Pipe(s)
x Hole Size
I x Hole SpaQm
Vent to Air Intake
Length (0 Dia
Length Dia Spacing
VASE. X^t
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Bed/Trench Center y, 5 -� `
((
Depth Over )
Bed/Trench Edges > / Z r�
xx Depth of
Topsoil
xx Seeded/Sodded
No
xx Mulched
�es : No
COMMENTS: (Include code discrepencies, persons present, etc.) 1 Inspection #1'
Location: 499 CTY RDA Je n-'-3 Cthu a 6:s,-,r vn41onS
1.) AIt BM Descnption =v[V h"P �bw,,e- V-?,At�5 e hkl) -R-s -�' -C VIA ,
2.) Bldg sewer length = 2,
- amount of cove q •`
Inspection #2:
;raw, rNjs.
Plan revision Required? ❑Yes No
Use other side for additional informati n.
SBD-6710 (R.3/97) Date Insepctofs Signature
Cert No.
,.:,,,•,
I . -
'
Industry Services Division
County
St.Cmix y�J—a a . 03,
=
1400 E Washington Ave
P$
P.O. Box 7162
Sanitary Permit Number (to be filled in by Co.)
FEB 11 2021
Madison, WI 53707-7162
? I Z . 1 G
"f
a 3o
J /
5t `$e nit Application
State Transaction Number
Cammun
In accordance .. ts. m. C'ok, submission of this four to riate gov it
is required pnor to obtaining a sanitary permit_ Note: Application forts far statebwried sabot d to
P%ject Address (if different than mailing address)
the Department of Safety aeon Pmfessional Services. Personal information you provide may be us condary
purposes in accordance with the Privacv Law, s. 15.03 I m Stars.
499 County Road A
1. Application Information - Please Print All Information
Property Owner's Name
parcel s
William Welbes & Cheryl Sykora
020-4047-70-100
Property Owner's Matting Address
Property Location
499 County Road A
Govt Lot
NE'/, NE'6. Swim 20
City, State
Zip Cole
Phone Number
Hudson, WI
54016
circle one)
T 29N Ri9G
II. Type of Building (check all that apply)
Lots
_
®1 or 24aaiw)aa(iing-A tents �-� Eip�
I
Subdivision Name
NA
Block s
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned- Describe Use
❑ Village of
CSM Number .30' .(070
ZoN F— X
10 601b5 S
® Town of Hudson
Ill. Type of Permit: Check only one box on line A. Complete line B if applicable)
A.
® New System
❑ Replacement System
❑ Treatment/Holding Tank Replacement Only
❑ Other Modification to Existing System (explain)
B.
❑ Permit Renewal
❑ Permit Revision
❑ Change of
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration
Plumber
Owner
IV. Type of POWTS S s em/Coo onent/Device: Check all that apply) . r
® Non-Pmssurized d ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable sod ❑ Mound <24 in. of suitable sod
Lj Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
a
V. Dispersal/Treatment Area Information: 5 o(-j x.
Design Flow (pit)
Design Soil Application
Dispersal Are equired (if) Dispersal PropaseW (s0
System 6levatn
450
Rate(gpelsf)
643 700
93.30%94.30'
07
VI. Tank Info
Capacity in
t7(j�y�ok 52.5 �1-)-cr
a
Gallons
Total
Gallons
to of
Units
Manufacturer
c�
New Tanks
Exv;hna Tanks
J
it N
H
s :7
Septic or Holding Tank
1000
1000
1
Wieser Concrete/ituficutt
Dosing Chamber
650
650
1
Wieser Concrete
V II. Responsibility Statement- 1, the undersigned, assume responsibility for installation of thr POWIS shown on the attached plans.
Plumber's Name (Print)
Plamber' i are
MP/MPRS Number
Business Phone Number
John Schmitt
L,�/71-t.-
223760
715-760-0486
Plumber's Address (Sued. City. State, Zip Code)
586 Valley View Trail. Somerset, WI 54025
VIII. Court /De artment Use Only
Approved ❑ Disapproved
PermitFee
Date Issued
Issuing Agent " 'tore -
❑ Owner Given Reason for Denial
$ i p gc O
'p
I�CY�T ti_"stofApproval/Reasons for Disapproval 3 i'T �fr y 3s % (opam, rM5 ��
1.Septictank effuentrdtera-d ir..�� rs. dueW7�w
r o
dispersal cell must be . ma nt'lrn�d
as per management plan po% de' by) i titer II
2. All setback requirements must be maintained-��p(�LCLWIa✓!7- of H k,,54- t1C rt rv-ed
as per appncauie coSlPeiFliF'78'eN7nfirTe plans for the aye u nit the Canary only on paper mot loss taut a in x 11 inches in xfxe /
SBD-6398(1103/14) %rryor/haY'rteN '�+ Pr^q�rlCs� oW{ne��
SYSTEM PLOT PLAN
Welbes 450GPD Septic System
Project Address: 499 County Road A
BMt Symbol: & BM Elevation: 100,00'
BM Description: Top of steel lot marker
BM2 Symbol: Q BM Elevation: 98.23'
BM Descdption: Top of telephone pedestal
Slope Gradient of Tested Area: (7%)
Well Symbol (If applicable)
, Notes: See Plat Map for complete map
COPV
1002" Sch 40 PVC Force Main
8 2
7%5k1pe - ---_�
Driveway E82
96'
Garage \ Office
1 D011I650 gal
septic/dose
tank
m
c
Work Area
94'
Design Flow: 450 GPD
Attach design flow calculations for
commerdal plane:
Pipe Materials f ASTM Standard
Tables 384.30-3 8 384.3M
4' SCH 40 PVC pipe
ASTM- D2565
2' SCH 40 PVC pipe
ASTM- 01765
3094 Al' PVC pipe
I ASTM-D3034
00'
RAN County Road A
0
TI- 3'x7d' EZ Flow Trench El.=94.30'
T2- TxV EZ Flow Trench EI.=93.30'
Property Line
N
Scale: 1" = 50'
0 50 75 100
2.
I le
Garage
W
House
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Welbes Accessory Buiding Septic System
Owners Name: William Welbes & Cheryl Sykora
Owner's Address 499 County Road A
Hudson, WI 54016
Legal Description: NE1/4, NEl/4, S20, T29N, R19W
Township Hudson
County: St. Croix
Subdivision Name:
Lot Number: 1 Block Number
Parcel I.D. Number 020-1047-70-000
Plan Transaction No.
Page 1
Index and title
Page 2
Plot Plan
Page 3
Septic & Dose Tank Specifications
Page 4
Effluent Filter Information
Page 5
Dose Tank Cross Section
Page 6
Pump Curve & Specifications
Page 7
System Sizing & Cross Section
Page 8
EZ Flow Information
Page 9
Management and contingency plan
Page 10
Septic Tank Maintenance Agreement
Page 31
Warranty Deed
Page 12
CSM or Plat
Page 13
Accessory Building Affidavit
Attachment 1
Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 2/1% Phone Number: 715-760-0486
Signature:
In- round Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Palle 1
SYSTEM PLOT PLAN
Welbes 450GPD Septic System
Project Address. 499 County Road A
BMt Symbol: AL BM Elevation: 10000'
BM Description, Top of steel lot marker
SM2 Symbol: 0 BM Elevation: 98 23'
BM Description: Top of telephone pedestal
Slope Gradient of Tested Area (7%)
Well Symbol (Rapplicable)
Notes See Plat Map for complete map
10 i 2" Sch 40 PVC Force Main
a 2
B 83
Tt
_ T2
7% Slope
BIN ------ \�
98,
Driveway `— NB2
L
96'
Garage Office
Work Area
94'
1/300/650 gal
septiddoss
tank
Design Flow 450 GPD
Attach design flow calculations for
commercial plans:
Pipe Materials 7 ASTM Standard
Tables 384.30-3 8 384.30-5
4" SCH 40 PVC pipe
ASTM- D2685
2" SCH 40 PVC pipe
ASTM- D1765
3034 4" PVC pipe
ASTM-D3034
00
RAN County Road A
T1- 3'x78' EZ Flow Trench El =94 30'
T2- 3'xV EZ Flow Trench El -93 30'
Property Line
N
Scale: t" = 50'
050 75 100
12.5'
Garage
W
House
d
w
A
u
WLP1000/650-MR
TANK SPECIFICATIONS
12'-2" DIMENSIONS: �+ o
WALL: 3' a a
4" CAST -A -SEAL 4" CAST -A -SEAL BOTTOM: 3'
COVER: 5'
MANHOLE: 24" I.D. PRECAST CONCRETE RISER a
----------i _!� HEIGHT: 541/2' o
lul a I r LENGTH: 12'-2'
WIDTH: 7'-0'
4tiA - li it o r 7 i BELOW INLET: 43'
LIQUID LEVEL: 38' o E
WEIGHT: 14,940 LBS.
a o 0
T ,
II _ Ii �i ��__�-11 INLET AND OUTLET: Y o 0
II iII II II 4" CAST -A -SEAL BOOT OR EQUAL GASKET m o t FILTER OR- II II II S n
3
BAFFLE II 111 INLET AND OUTLET BAFFLE AND FILTER:
j WISCONSIN, SEE DETAIL /10 o o
(OTHER STATES SEE CHART) W n
LIQUID CAPACITY., 26.32 GAL/IN (SEPTIC)
N
17.00 GAL/IN (PUMP)
TOP VIEW
LOADING DESIGN: 8'-D' UNSATURATED SOIL CC m
TANK CAN BE USED AS: G.7 o I
o SEPTIC/SEPTIC, SEPTIC/PUMP, N
w OR SEPTIC/SIPHON M
a a 4" VENT COVER: MIX DESIGN #8 (NO FIBER) o
W TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
i�v0'
eUv y
CUSTOMIZED TANKS:
--- FOR CUSTOM TANKS CONTACT WIESER CONCRETE
INLET -�-- OUTLET �O�
it
ZN Q
-L__- o
,
I �
REVIEWED BYo
$ c�
^� PUMP PAD REVIEW DATE a
SIDE MEW DRAWINGS SUBMITTED u)
FOR APPROVAL
APPROVED BY: SHEET NO.
APPROVAL DATE: j
PRODUCTS NEEDED BY:
TANKS ARE MANUFACTURED TO MEET OR EXCEED AS7TA C-1227 REQUIREMENTS � �
,nr
a•arahaR3 v u+r+;.•a'✓,:.,7agn 13L�1
P1-5255 f1fluetnt Filter
PL-52.5 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.
it:.�turo.a:
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 bail when filter is removed.
Alarm accessibility.
Accepts PVC extension handle.
I'll -;2-5 ln�L¢liatiun:
Ideal for residential and commercial waste flows up to
10,000 gallons per day (GPD).
1. Locate the outlet of the septic tank.
Ifif"" I illratitolr � itrt5 f
� Alarm Switch
1O,OO(i GPD `-� (Optional)
2. Remove the tank cover and pump tank if necessary.
3. Glue the filter housing to the 4" or b" outlet pipe. if Acnpts 4" & 6"SCt1D 40 pipe
the filter is not centered under the access opening use a
Polylok Extend & L.ok or piece of pipe to center filter. -
4. Insert the PL-525 filter into its housing.
5. Replace and secure the septic tank cover.
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 inserted.
7. Replace and secure septic tank cover.
-cepts 1" PVC
tension Handle
Rated for
iotmo c;rD
525 Linear Ft.
of 1/16"
Filtration Slots
Certified to
NSFlANSI Standard 46
Qu Deflector
Automatic
Shut -Off Ball
E `u:.lnm bn n+} iiha . nr t �bmd n l ob'
Polylok, Zabel & Best filters accept Easily installs
the smartFilterll9 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 4
PAGE 5 OF 6
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
a-o vent Pipe
>10 6 from
Building Electdml must pol with
1 T Min. or 2 01 some BPS 316 and NEC 300
Established Flood Elawtlon Weelherpmof Extend manhole nser as nab,t;wry.
(typical)as
Junctron Box
Vein Cap Approved Locking Manhole
IMPORTANT win Waming Label Attached
Anchor tank(s) as necessary (typical)
pursuant to SPS 383.43(8)(g)—cond a
P a• Min. or 2 c +t above
/� Established Flood Elevation
F nished Grande
CAPACITIES @ 1.�� gaNin
Depth (ln)
Volume (gal)
A
18
306.00
B
2.0
44.48
[C]
6
102.00
D
12
204.00
-*T
IA
B l�
B
I I�*Pump Tank Liquid Level = 38 in
D
Force Main Diameter = 2 in
Force Main Length = 100 ft
Airtight Seel
Hole
ow
Block
3' Approved Bedding Matensl Beneath Tank
Z
Disconnect
18' Min
(typ taU
I-
- Appnoved Joints Win
Approved Pipe 3 a onto
Sotld Gmund
(typical)
PUMP -OFF
ELEVATION = 89.00 ft
INSIDE BOTTOM
ELEVATION = 88.00 ft
X
5.5
Force Main Void Volume = 16.30
1 ao
Vertical Head =
ft
��gal
+Min. Supply Head =
0 ft
[C] Total Dose Volume (TDV) = 116.30
gal/dose
+ FM Friction Loss =
0.92 ft
(5X total lateral void volume <_ TDV < 0.2X design flow)
* (force main drainback volume)
+ Fitting Loss' =
0 ft
'(min, supply head x 0.3)
MIN. PUMP DISCHARGE RATE = 20
gpm
= TOTAL DYNAMIC HEAD =
6.42 ft
PUMP TANK:
SEPTIC TANK(S):
Volume = 650gal
Total Volume = 1000 gal
Manufacturer: Wieser Concrete
Manufacturer(s): Wieser Concrete
Pump Manufacturer:
Zoeller
Install approved effluent filter at the septic tank outlet
Pump Model: 53
isee attached wtTp wive
immediately upstream of the pump tank inlet.
Controls/Alarm Manufacturer:
SJE Rhombus
Filter Manufacturer: POLYLOK
Controls/Alarm Model:
AB
Filter Model: 525
Float switches containing mercury
are prohibited.
Page 5
rn
W
WLU
ins 20
U
U
4
15
0
10
0
~z
5
0
GALLONS
LITERS 0
PUMP PERFONCE CURVE
MODEL 5315/57/59
10 20 30 40
80 160
FLOW PER MINUTE
50
CONSULT FA" —OFT'
FOR SPECIAL APrL',CATIONS
Variable level float switches available
Variable level long cycle systems available
Available with special cord lengths of 15', 25', 35'. (50' 230V only)
Alarm systems available
Duplex systems available
3EILL C 110N �_'JIDF
i Integral float operated mechanical switch, no external control required
2. Single piggyback variable level float swath of double piggyback variable level
float swath. Refer to F1,10477.
3. Mechanical altemator'M-Pal" 10-0072 or 104075.
4 See FMO712 for correct model of Electrical Aftemator.
5, Variable level control switch 10-0225 used as a control activator, with
Electrical Mercator (3) or (4) float system.
bin 6ul Cannot se1betion
_ Me" _'. Volts Phan Mods Amps i bini T OupNx
Li
CSA
UL
Y
M W It M5me
115
1 Auto
97
1
1 —
Y
5
tt
1 Non
97
2
3a485
Y
Y
'BN53
1/5
1 flap
i 97
•_
Y
V
' BN57
115
1 Auto
91
1
N
Y
'utbybr
230
1 Auto
49
1
Y
Y
05355 S D5759
230
1 AtAo
/ a
49
i
2
Y
Y
E5$553 E57154
, 230
1 Non
3a465
Y
Y
-.vq/e ptlgyeace awem ncsweo
For eMnnabon on additional Zaae pmMds reler to catalog on Pygybeca Van" Lead
F1 Swidn,FM0477.EWncalAkemaw..FM0086 MechancalAkematn, FMO4955wrpf
Sewage Bases. FMO487, and Single Phase Swplex Preip Cor"Ainm Systems. FM0732
TOTAL DYNAMIC HEAD/FLOW
PER MINUTE
EFFLUENT AND DEWATERING
MODEL 53/55/57/59
Feet Meters
5 1.5
10 —3.
Gal. Liters
43
163
3
34
..
129
15
4.6
19
72
Shut-off Head:
19.25 ft.(5.9m)
37M -- e3ne
_ ,A
x�
"Easy assembly"
Ipmp Is dadwge pipe
•� roi ntludee
P,TIONAL PUMP STAND P N 10-2421
Reduces potential clogging by debns
Replaces rocks or bricks under the pump
Made of durable, noncorrosive ASS
Raises pump 2' off bottom of basin
Provides the ability to raise intake by adding sections of 1'b'
of 2" PVC piping
Attaches securely to pump
Accommodates sump, devastating and effluent applications
NOTE Make care float is free from obstruction.
( _ED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
® Copyright 2011 Zoeller Co. All rights reserved.
Page 6
IN -GROUND DOSED -GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down -sizing credit)
1 mi . 12'
C r
c tFe 1 (typical) TYPICAL TRENCH
ca
SOIL COVER CROSS SECTION VIEW
it (No Scale)
min. trench ;
depth ba�
(typical) ,
Highest Trench Lowest Trench (as applicable)
System Elevations = 94.30 ft; 93.30 ft; ft; ft;
TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.)
PLAN VIEW
(No Scale) 4a 0 omenaon p",hall aaaaa
at rynmoo heM en units.
Perforated Lateral observation Pipe
(typical) (typcai)
---------------��---
1.
f� R = 70 ft
(typic")
INSTALL PER TRENCH:
7 10-ft bundles @ 501 EISA/unit = 350 f12
+ 0 5-ft bundles @ 25 fP EISA/unit = 0 W
Provide minimum 3 ft
separation between trenches.
OBSERVATION PIPE DETAIL
a sop)
Stl -TypeFnabed Grade
ft Sap Cap (hose) (nWdiedB aeedeel
<"O WC Pie
T
l % .ffi
ilor 1=9 ®
(4)1R"-1/7 % 6' Sbh
An .ng Device
10 ft
(typical)
��. I Bundle
(typical)
(mid by Infiltrator Systems, Inc.)
Install pursuant to marwfaclurees Instructions-
A = 3.0 ft
(typical)
Topaod Cover
(mn 1 rmt)
Infigrobn
surface
m
W
O
h
01
= Proposed EISA per trench = 350
ft2 Required Infiltration Area = 643
ftZ
Distribution Method:
x 2
trenches = Proposed Total EISA = 700
ft'
distribution box
El
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, Wsconsin Statutes. All sites must meet the $11&
& 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-
ehtydene 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-
ation 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), Ws. 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.
*1EZf ,owV
!y INFILTRATOR
5. The Absorption area (SF) necessary for a given site shall
be sized based on maximum daily sewage flow (GPD) and
the Permeability for the site. If certain criteria is met, the
EISA sizing can be used in Wisconsin, resulting in a 40%
smaller drainfield.
6. Place EZflow bundle(s) in the EZflow configuration ap-
proved by system design permit specified for the particu-
lar site. The top or center -most bundles containing pipe
are joined end to end with an internal pipe coupler. Any
additional aggregate only bundles that may be required,
should be butted against the other aggregate -only bun-
dles and do not require any type of connection.
The top of each GEO cylinder contains a filter fabric pre -
manufactured in between the netting and aggregate. The
fabric is inserted to prevent soil intrusion. The installer
shall make sure the the GEO is positiioned upward and is
in contact with the fabric contained in the adjacent cylin-
der before backfilling.
8. The EZflow Drainfield Systems should be installed in a
level trench in all directions (both across and along the
trench bottom) and should follow the contour of the ground
surface elevation (uniform depth), with all continuous
adjoining 10-foot cylindrical bundles placed end to end,
with central bundle distribution pipe interconnected,
without any dams, stepdowns or other water stops.
9. The trench top shall be graded such that water will not
pond. Backfill should be seeded or sodded immediately
after completion to reduce erosion.
10. EZflow EPS bundles are flexible and can fit in curved
trenches as may be necessary to avoid trees, boulders, or
other obstacles.
11. EPS aggregate is lighter than water, therefore, it might
be expected that natural buoyancy forces would tend to
cause EZflow assemblies to float out of ground when
ponding occurs. Field experience has shown, however,
that this is not a problem when systems have a minimum
of 6" of sod cover as recommended by manufacturer,
1203H-GEO
r f-odd,
r Matenal
Page 8
In -ground Dosed -Gravity Management Plan PAGE 40F4
IMPORTANT:
The owner of this in -ground dosed -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 Maintalner in
accordance with SPS 383.52 (3), Wisc. Admin. Code,
Maximum Dispersal Area Operating Limits:
Design Flow = 450 gpd; BOD' 5 220 irri TSS 5150 mgL''; FOG 5 30 mgL`
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches. Floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.)
electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids In the 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 fliterfs) 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:
John Schmitt
Phone: 715-760-0486
Local government unit: St. Croix County Community Development Phone: 715-386-4680
Local government unit address: 1101 Carmichael Road, Hudson, WI ZIP: 54025
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 9
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer William Welbes & Cheryl Sykora
Mailing Address 499 County Road A, Hudson, WI 54016
PropertyAddress499 County Road A
(Verification
required from Planning & Zoning Department for new construction.)
City/State Hudson, VVI Parcel Identification Number 020-1047-70-100
LEGAL DESCRIPTION
Property Location NE �q NE , a Sec. 20 , T 29 N R 19 W. Town of Hudson
Subdivision Plat: �t . Lot # 1
Certified Survey Map # I tgc( 6SC/ Volume _30 Page # (070&
WarrantyDeed # 1089657
(before 2007)Volume , Page #
Spec house 0yes0no Lot lines identifiable Byes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic sy stem 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 SanitaryOrdinance.
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.
/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.
1/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 bedro s �50gpd
Gl/
SIGNATURE OF APPLICANT(S)
DATE
*$*Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. •"
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
Page 10
St. Croix County
Accessory Structure A Idavit
CHERy� AS. I1a81a1
William F. Welbes & ehertr A. Sykora
being duty sworn, states, [order oath, that:
He/she is the legal owner of the following parcel of land located in St.
Croix County, Wisconsin, recorded in Document Number 1089657 St.
Croix County Register of Deeds Office,
being duly described as follows (include lot no. and subdiN ision/CSM or
detailed Legal description):
See Attachment "A"
H111111111111191111111p5 4
1122782
BETH PABST
REGISTER OF DEEDS
ST. CROIX Co., WI
RECEIVED FOR RECORD
02/08/2021 09:22 AM
EXEMPT N:
REC FEE 30.00
PAGES: 2
vast and Reform Address a
Wdlurt Wclbes
499 Count) Road A
Hudon. Wl 54016
As owner of the above described property, 1 acknowledge that the Private Onsite Wastewater Treatment System
(POWTS) services an accessory building on this lot and is sized for a design flow of 450 gpd. This accessory building
may not be used as a second residence on this parcel. I also acknowledge that I will disclose this information and
stipulation to any future parties interested in purchasing this property.
Dined this day of
r
AUTHENTICATION
sivusurt(t)
lnahesdieamd this day of
In
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not.
adgrind by i 706 06. W is. Sum.)
THIS fKMtIMENrr WAS DRAFTFD By
John Schmitt
(Si may be m4hcnucmcd w acknowledged Both arc"
nemamy.)
STATF OF WISCONSIN I
ss
SL Croix County I M1 NGr
_ PeraotW A" tame before me Nro 29! day of
ale
0
NourS Public. Sure of$'Jgca"g
MN Cnmtnissinn is ppeermanent. If not, aWe cxpbafron dale
Datc ..5pg 2A 2.o22—
the
St, Croix County 1122782 Page 1 of 2 Page 13
ATTACHMENT"A"
A parcel of land located In the NE 1/4 of the NE 1/4 of Section 20, T29N, R19W, Town of Hudson, St. Croix
County, Wisconsin, being more particularly described as follows: Commencing at the NE Comer of said Section 20;
thence S 0"30'56" E (bearings referenced to the monumented East line of said NE 1/4 of Section 20, and also to the
St. Croix County Coordinate System as based on NAD '83-'91 Adjustment) (previously recorded as S 0"48'42" E)
198.03' along said East line to the Point of Beginning, thence continuing S 0"30'56" E along said East line 38.73';
thence S89"14'55"W 368.00'; then N 0"3056" W 236.76' to the North line of said NE 114; thence N 89014'55" E
148.00' along said North line; then SO"30'56"E 198,03 (previously recorded as South 12 rods); then
N 89014*55" E 220.00, (previously recorded as East 13 1/3 rods) to the Point of Beginning; containing 43,560.7
square feet (or 1.00 acres), more or less, and being subject to County Trunk Highway "A' rightofNway, and also
being subject to all other easements, restrictions and covenants of record.
St. Croix County 1089657 Page 2 of 2
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DepartmAnrinn.
t of
!_ SafetJ SOIL EVALUATION REPORT
-
CSt-Qua i - 03 3
Ili
�! Profess' I Servtl:�O 11 in accoreance wan m a vets dm a
.Yv _� =
2021 Schmitt Soil Testing, Inc
Attach complete site plan o paper not bsslb4+l. 8Y. x 11 inches in size. Plan must aWd County
St. Croix
include. but not to W l tgference poi t (BM), dall-9CRffifl - -- -- — ---
-
percent slope,to�� r1t,b"ain nd distance to nearest road. Parcel I D
scaleO dknve ensions,
020-1047-70-100
Please print all Information. - -
-- --- -
Rev By
Personal information you provide may be used for secondary Durposea (Privacy Laws 15 W (1) Imp -� /
Date
Z- / - Z
h T� 1
Property Owner
Property Location
Welbes, William & Cheryl Sykora
Govt Lot NE1/4, NE1/4, S20, T29N,
R19W
Property Ownefs Mailing Address
Lot a Block It Subd. Name or CSMs
499 Cty Rd A
1 - - CSM 30-6706
City State Zip Code Phone Number
City Village Town Nearest Road
Hudson WI j 54016 715-386-1980
Hudson I Cty
Rd A
New Construction Use, Residential / Number of bedrooms 2 Code derived design flow rate
300 GPO
_
Replacement Public or commercial - Describe
Parent material Outwash (Burkhardt-Sattre Complex) Flood plain elevation, if applicable
NA h.
General comments Area is suitable for a conventional system with a 0 7 gpd/sgft rate. Possible system elevation for Area 1 is 94 30' High trench, 93 30'
and recommendations Low trench. Slope of area is 7%
a Boring A .Boring
Ground 96.33
Pit surface elev. fl Depth to limiting factor 120+ -in
Soil Application Rate,
Horizon
Depth ; Dominant Color Redox Descdpon i Texture Structure IConsrsten Boundary Roots
1 G_PD/N'
In. ! Munsell Do. Sz. Cont Color Gr Sz. Sh.
'EfM1 -EMM2
1 0-13 1 10yr3/3 i none sl 2mgr ni _ as 2m
- - ' - --- - _ ---- - ,
. 0.6 1.0
-
2 13-20 10yr4/4 none sl 2msbk mfr gw 2vf
0.6 1.0
3 20-38 10yr4/4 none 511 2msbk mfr gw 2vf
!i 0.6 0.8
--
4 38-46 7.5yr5/6 none grcos 0s9 ml as lvf
0.7 1.6
5 16-120, 10yr6/4 iron grs Osg ml ---- -
0.7 1.6
Ann 9
Borings , Boring
96.33. hmding factor 120+
Ground surface elev. ft Depth to in
Soil Application Rate
Horizon
Depth Dominant Color Redox Description Texture Structure . Consistence Boundary Roots
_ G_ _PD_M'_
in. Munsell - Co. Sz. Cont. Color Gr. Sz. Sh
'EMi --
1 0 9 10yr3/3 none sl 2mgr mvfr as 2vf
1
0.6 1.0
2 9 24 10yr4/4 none SI 2msbk mfr gw 1vf
0.6 1.0
3 24-48 10yr4/6 none sd 2msbk mfr gw 2f 2f
0.6 0.8
4 48-56 7.5yr5/6 done grcos OSg ml 1 as
0.7 1.6
11}—
5 56-120' 10yr6/4 none grs Dsg ml -
0.7 1.6
-
_ S` lou bra
Effluent N1 = BOD s> 30 < 220 mg/L and TSS >30 - 150 mg/L ' Effluent 02 = 50D5 < M mgrL end 1 sJ < Ju Mg/L
CST Name (Please Print) Signature. /f CST Number
Thomas J. Schmitt 227429
Address Schmitt Sod Testing, Inc Date Evaluation Conducted Telephone Number
1595 72nd St. New Richmond. WI 54017 12/11/2020 715-760-1978
SBn 3101x 07WI
. Propr!Ry Owner Welbes,William &_Cheryl Sykora._. ParcanD# 020-1047-70100
Page 2 of 4
7 8onng #
Boring
Pit Ground surface elev.
99.30 A.
Depth to limiting factor 120+_ in.
_--
_ _
Solt Application Rate
Horizon
Depth 1
Dominant Color . Redox Description
Texture
Structure
Consistence Boundary Roots
GPE/—w
In.
Munsell Qu. Sz. Con[, Color
Gr Sz SR
IERiI--
EfiM2 "
1 0-11
10yr3/3 none
I sl
2mgr
mvfr as 2f,2m
0.6 '', 1.0
2 11-24
10yr4/4 none
sl
2msbk
2vf
mfr 9w 2nr0.6 1.0
-
_
3 24-30
10yr4/6 none
Is
lcsbk
mvfr gw lvf
j 0 7 1.6
q30 36
-1
7.Syr5/6 -
none
grcos
Osg
ml as
0.7 1.6
_
.6
5 3� -
10yr6/4 -none
grs 1
1
0sg
ml _
-- -
0.7 I 1.6 -
Boring #
Boring
Pit Ground surface elev -
it
Depth to limiting
factor in
Soil Application Rate
Horizon Depth Dominant Color
Redox Description
! Texture
I
Structure
Consistence Boundary Roots
GPDMV
in. i
Munsell
Du Sz Cont. Color
Gr Sz Sh
_
•ER#1 •Etr#2
Bonng is
Bonng
Pat Ground surface elev
----- _ fl
Depth to limiting
factor n
- --
Soil Apphcelwn Rate
Horizon Depth Dominant Color Redox Description
Texture
Structure 'Consistence! Boundary Roots
i GPD/_M
in.
Munsell Qu. Sz Cent Color
Gr Sz Sh
_
E •Eff#2
,
I
i
I
i
I
EML#ent #1 = BODS> 30 < 220 mg/1-and TSS >30 < 150 mg2 ' Effluent 02 = BOD5 c 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 formal. please contact the department at 608.266-3151 or TTY 608-264-8777.
SB"330Ia )7M) Schmitt Sod Tes", Im.
St Croix County, WI
Conducted for: 4919 C Rd Aes & Cheryl Sykora Conducted by: Th�nas J m'tt
ty Legend
Hudson, WI 54016 CST 29
12-11-2020
PI D: 020-1047-70-100 Rivers and Streams
NE1/4 NE1/4 S20 T29N R19W
CSM 30-6706 Lot 1
Town of Hudson ~-~
NOTES: Installer,
1. Maintain 5' from property lines and Rite -of -Way.
2. Maintain 50' from wells.
3. Verify property lines before installation.
tar
1"=60'
Nl
`4
1
0 20 40 60R
0iSC"MER T .maps. puarant mEe
e tt,ate arced. cVrrent,o comVere,"
m°dusians drawn a . me MPWMdply W m.
111 m � I n .
N
i 'Yr!d
■I
St Croix County, WI
Legend
Lakes arN Rivera
Rrvers and Streams
lrfl tales
us
Hoermys
stale HgMvays
County Hgewsya
Local Roads
Rustic Roads
Rumps
Road Rtget o1 Way
or,—w
ur,w
aoe
Rad Dade
N`
I
t
0 200 400 E00h
DISCLAIMER. The reap is not guaranteed to ue
ae vrate. m P&. wn oz ar wonpWle and
muclualune drawi are the raspo dlly W me
February 15, 2021
Town of Hudson
Board
546 County Road UU
Hudson, WI54016
RE: Building Addition on Property at 499 County Road A
The Property at 499 County Road A has been extended South and West with the Addition of an acre of
land. The intent is to construct a building in the western most area according to residential standards.
The building is being constructed to house my home office, bonsai hobby —greenhouse, workshop, and
bonsai tree winter storage area; and Bill's model train layout that he is planning to construct, and a
garage for cars. The existing parking area will be made unusable and blocked. The plan is to move our
driveway west to accommodate use of the garage. It will also have an area to be used for officing so
that I transfer my home office to it and a small kitchen style area to make coffee and store some snacks.
The building will have a well and septic system and will be heated and air conditioned. The plan is to
purchase enough land behind our current land to comply with the 1.5 acre requirement for residential
property and split our land into two parcels prior to making any changes that would accommodate
residential Irving in the structure. The additional space will be a guest house and possibly, depending on
the timeline, may be used to house the one elderly parent we still have. There is no intention to use the
building as rental property.
ACKNOWLEDGEMENT
/1,�5/ai
Date
a -�7
Date
NOTARY
11GIh
Personally came before me this f 5 of 156mr o 12021 the above named
Chelru l Sy korz P '�l�
I,li�l��arn I�l.7el�es
Person(s) who executed the forgoing instrument and acknowledge the same
BERNADETTE KIM NOARD
Notary Public -Minnesota
My CommiWon Wm Jan 31, 2W
Public, State of Minnesota.' My commission expires
Date: 4Xi 3t . 2_0Z2,