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Home My WebLink About020-1157-80-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 633950 Personal information you provide may be used for secondary purposes [Privacy Law, s 15.04 (1)(m)] Peonit Holders Name. CRy Village Township Parcel Tax No: Michael Barrett & Rebecca Kamitz TOWN OF HUDSON 020-1157-80-000 CST BM Elev. Insp. BM Elev BM Description Sect1on/Town1Range/Map No 26.29.19.885 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Se tic 4D sing 000 Aeration Holding TANK SETBACK INFORMATION IyJ�}a fLnf.tn TANK TO P/L WELL BL15G Vent o Air Intake ROAD Sep kl , ka Dosing ;2 [ 7�oy 7/ C Aeration Holding PUMP/SIPHON INFORMATION AN_._r.A.r% 'fe Manufacturer CiCrC.4'{.✓ errand GPM Model Number I y 35 TDH Lift 9� Fnc . tigirk Loss Syste Head TD Ft Forcemain Length t Dia. p Dist to Well t SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV Benchmark �0(•� F 0 o Alt BM P•r(avav Bid Sewer i Lk St let �x iS1i SUM Outlet 77RR • QJ /� • l Dt Inlet Dt Bottom b. Header/Man. Dist. Pipe Bot System 8 Final Grade T •O �ver •(Ig q9��f, 0 / f RMZ /�•�1 BEDrrRENCH DIMENSIONS Width I 3 Length b 0 1 u� No. Of Tre es PIT DIMENSIONS No. Of Pits Inside ia. Liquid Dep h SETBACK INFORMATION SYSTEM TO P!L BLDG IWELL LAKE/STREAM LEACHING CHAMBER OR UNIT Me is turer: T e Of System, 1 5� / 100t �710 ' o e r DISTRIBUTION SYSTEM HeaderfMani old Distnbuhon Hole Size le Spacing Ve ' Pip s) Length Dia Lengt is Spacing SOIL COVER x Pressure Svstems Only xx Mound)Dr "rade Svstems Only �\ Depth Over BedlTrench Center �-L t J Depth Over .% Bed/Trench Edges I epih of To oil xx Seede dded Yes N ❑ Mulched o Yes o COMMENTS: (Include code discrepancies, persons present, etc.) Location: 704 MEADOW LN 1.) Alt BM Description 2 ) Bldg sewer length - -amount of cover = G Inspection #1. Inspection #2: �ti� �s �0�� in a� oar h eat aF pie 10 ,X104 U�2�b� A Plan revision Required? ® Yes *No Use other side for additional information. SBD-6710 (R 3/97) Date a tor's Signature Cert. No. N'.Zaoi 1 R �y1, Coumy Industry Services Division St C'mt. D 1400 E Washington Ave q $ P 20 L' P O Boz 7162 $ SEP 21 Madison, W{L537(7-7162 Sanitary Permit Number (to be filled in by Co 1 / 3 la 39� State IransacuonNumber tit /, Cor i ` 1C`dtl d°I I mtta4J In accordance with S S383 2112) Wis Aden Code subon of this form In opria the apprte I unit is requited prior to obtaining a sanitary permit Note Application forms for statcowned POWTS are submitted to the Department of.Safery and Professional .Services Personal information you provide may he used for secondary Project Address (ifdilTerenl than mailing address) purposes in accordance with the Privacy Law, s I s 04 I Uri , Stats 704 Me:skm Lane 1. Application Information— Please Print All Information Propcn\ Owner s tame Parcel d Michael Barrett & Rebecca Kamnz 020-1157-80-000 Propene Owner's Mailing Address Pro en Location C ��, q 8�7 704 Meadow Lane . Govt Lut SW/.. SL A. .Section 16 City, State Zip Code Phone Number 1 ludsc n, W l 54016 (circle om) T 29N R191-od IL Type of Building (check all that apply) r Lot # Sundt .,aon Name ® I or Pamily Dwelling —Number of Bedrooms 25 I hgh Meadow Il Block # ❑ Public/Cominercial Describe Use ❑ Coy of ❑ Statc Owncd - Describe Use ❑Village of / l SM Number ✓ ® Town of Hndatn III. Type of Permit: Check only one box on line A. Complete line B if applicable) A ❑ Nev, Svstem i ® Replacement System ❑ 1 reatmentl lolding Tank Replacement Chily ❑ Other Modification hs Existing System (explain) a. ElChange of ❑Permit Transfer to New List Previous Penns Numlcr and Date Issued Cl Permit Renewal ❑ Permit Revision Before Fxpvatton Plumber Owner 102806; 11/4/1987 IV. TYPe of POWTS Svstem'Com onent'Device. (CheIN ck all that a Ir _ O W� _ on-Prvvs ... i4ed ln-'ru ❑ Pressun,ed In -Ground ❑ At -Grade ❑ Mound N,n ofomablc sod ❑ Mound �24 in ul suitable soil LJ Holding Tank LJ Other Dispersal Component Iezplam) ❑ Pretreatment Device (explanu V. Dis rsalll'realmen Area Information: Design Plnw lgpdi Uestgn Sail Apphcutioi Dispzrsal Area R ed (sf) Dispersal remposed (s0 System I I-`atan (0) Ratc(gpds0 858 900 93 9', 93 2'. 92 7' f17 VI. Tank Info C'apaca) in Gallons fowl # of a ;± c u Nc,. ixnk� [,uiu,p Teak. Gallons LmLs Mantic I rer t,^ �� l m 5 = 2 1. 1 6 ,J V h V: LL J Septic or l holding rank 1200 '-- 1200 1 Midwest Precast ® ❑ ❑ ❑ ❑ Dosing Chamber 1000 %SD -- t --- -- W iescr Concrete Vll. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POIN I S shown on the attached plans. Plumber's Name (Print) Plumb, ', i at MP/MPRS Number Busmen Phone Number John Schlfltn i7 // %z�Z� 221760 71 ;-7604A86 Plumbers Address (Street City State, 7ip Code) 586 Valley View rm 1. Somerset, Wf 54025 ll Count /De artment Use Only Approved ❑ Disapproved Pe or Due urn Z� Issuing Agent Si ❑ (Tuner (liven Rqpson for D nual Ia. C1. 5"16 for Disapproval 7� V y1i1 %V V�`F— PiiTl74 ✓t't��r 1. Sir+<' r ,,,fEBbproval/Reasons t'+n#, of uent filter and Ip�C�' P rwa l(rl�� ri7 N/♦a/ Yj, 1 IV d <rersil t,411 must 02in sary rarided'by a ' e prrnMad by ptained. � �J�,(,(♦ 41 plum 4 ,,mb ck r uiren,an 7 A" t:et6aca raqulremwgrs must be maintained as per SPOICYble (vile/ordinarn es, Attach m complete pions for the ),I rid uhout Io ilia ( ".or) only tin paper not h, ma s 1,1 x I I loch,, miz se f �2 04. r r�&vs4 �er i ex, S a-ar'kS . S B D-6398 (R03/ 14 ) SYSTEM PLOT PLAN Barrett 4 Bedroom Septic System Deai9n Flow 6WGPo AOach design Bow calwlalan3 for commercial plans. ProleQ AOtlmss. 704 Maedox lam BMt Syr l . 81,18in,anlenIN00' Pipe Materiels IA5TM Slanoard BM Descri llon: Top of 2" Ps Papa Tables 384.30-3 6 384 3P5 13102 Symbol 0 BM Elevahon. -90d1' --' - -- —. z'SCH a0 PJC Pipe ' 75T6f: D26657— - BM Desc lion x on new, well 4' 3034 PVC ppe I ASTM-030M Slope Gradient 0f Tested Area I10% 2' 8CM 40 WC pM ASTM-017B5 Well SymD01(11 appLtable) SEE' CSM for complete map T1- 5k70' Rock d Pipe Trench T2- 5k70' Ro & Pipe Trench T3- 3'x60' EZ Flaw Trench El -93 9o' T4- 3'x60' EZ Flow Trench El -93.20' TS- 3 x60' EZ Flow Trench El =92.70' Property Line i � T4 ■ES7�__ / 081 3 i \ i / BM1 100' / / 98' / i 96' 94' 220'2' Force main 40 PVC Proposed WLP1000-MR Force Dose tank `WJ Ezlsling 750 gai dose tank vaW Null Exls6ng 1200 gal septic to k BM2 Emsling 4 Bedroom Hausa Retam ng Wall CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Barrett 4 Bedroom Replacement Septic System Owners Name: Mike Barrett & Rebecca Karnitz Owner's Address 704 Meadow Lane Hudson, WI 54016 Legal Description: SW1/4, SE1/4, S26, T29N, R19W Township Hudson County: St. Croix Subdivision Name Lot Number: High Meadows II 25 Block Number Parcel I.D. Number 020-1157-80-000 Plan Transaction No. Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Attachment 1 Index and title Plot Plan Existing Tank Certification Bull Run Valve Diagram Dose Tank Specifications Dose Tank Cross Section Pump Curve & Specifications Effluent Filter Information System Sizing & Cross Section EZ Flow Information Management and contingency plan Sanitary System Ownership/Address Form Warranty Deed CSM or Plat Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 9/20/2021 Phone Number: 715-760-0486 Signature: j>T �7lL I -Ground Soil Absorption Component Manual Version 2.0 5BD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Barrett 4 Bedroom Set PrOIect Address 70410eaco Lane - BMISym1,01 . SMEmabon 'XU BM Descnptlor Too m 2 Fr ore BM25ymbol A BMEevatlo9 Kfl' BM Description a-nei..I Slope Gradient Quested 4rea ;10"1 Weil Symbol (it appacablel SEE CSMforcomplette map nealgn FInw 600GPD Altach design Ilo calcu aeons for dommerdal plans Pipe Materials ATM Standard 7ni 384 30 3 & 38 30-5 .1 I CI 90 120 ,/W//'/rAFAR i'— ®% 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 an&or dose tank presently serving the following residence: (Street address)704 Meadow Lane located at: sw ;, SE ;Section 26 Town 29 N, Range 19 W. Town of Hudson St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system'? Ye (if no, skip next line.) Approximate volume or length of time: Tank Capacity: 1200, 750 Construction: Prefab Concrete x Steel Manufacturer (if known): Midwest Precast Age of Tank (if known): 1 t/4/1987 Permit number (if known))/102806 ? /z j +, John Schmitt (Li sed Plumber Signature) (Print Name) MPRS (Title) /t' 17 - � � (Date) 223760 s Nox gallons minutes Other (License Number) MP/IPRS 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 3 Home About , Site Map Order Info Videos & Literature Contact Drip Systems Design Guidance Treatment Controls Products Downloads s- The Bull Run ValveT" Is designed to split flows to septic fields or systems In addition to the advantages of longer life and easier installation It is the most public health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak -proof and external operating characteristics. The change over from one drainage field to another can be accomplished in less than a minute by simply turning the valve without digging or contact with wastewater. Field No 1 Valve Positioned on No 1 during Odd Years Septic Tank Field Field Field No 2 No 1 No 2 �i Valve Positioncl on No 2 dunng Septic Tank Even Yeas ITEM DESCRIPTION BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE 8 KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVKEY78 BULL RUN VALVE KEY 28" BRVKEY36 BULL RUN VALVE KEY 36" BRVKEY48 BULL RUN VAl VE KEY 48" f Ir TV - WATER -TIGHT ACCESS CAP RISE F CAP ADAPTER RISER TUBE VALVE DIRECTION HANDLE 4" OUT PORT 4" OUT 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 BRVCIR1SER - 4" ADJUSTABLE TO 28" HIGH Page 4 0 a n WLP1000—MR TANK SPECIFICATIONS a o _ 8.-8" u I DIMENSIONS: WALL: 2 1/2" a- a 4` CAST A SEAL r4' CAST -A -SLAT BOTTOM 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1/4" LENGTH: 8'-B' WIDTH: 7'-2" w � BELOW INLET: 42" - LIQUID LEVEL: 36" .c WEIGHT: 6,790 LBS, _ < _ INLET AND OUTLET: a d Y ^ \v FI'TER uB % 4" CAST -A -SEAL BOOT OR EQUAL GASKET m` 6 HAIF_L INLET AND OUTLET BAFFLE AND FILTER: i WISCONSIN, SEE DETAIL #10 4 (OTHER STATES SEE CHART) W TOP VIEW LIQUID CAPACITY: 27.83 GAL/IN W :, 3 HOLDING TANK OUTLET HOLE PLUGGED C �P ACTUAL CAPACITY: 1,085 GALLONS C 1z LOADING DESIGN: 8'-0" UNSATURATED SOIL } c J 7 TANK CAN BE USED AS: W c� SEPTIC / HOLDING / PUMP OR SIPHON 7 11� 3 C a COVER: MIX DESIGN #8 (NO FIBER) r cis W L_ TANK: MIX DESIGN PO (STRUCTURAL FIBER) � CUSTOMIZED TANKS: z 1 INLET —— �- 1 OUTLET FOR CUSTOM TANKS CONTACT WIESER CONCRETE _ ___ _ _ 1 y Q I I-- < I 2," - --1----- _----' of a REVIEWED BY c) ,..,- F'UMI' RAC REVIEW DATE a DRAWINGS SUBMITTED w N SIDE VIEW FOR APPROVAL APPROVED BY: ;uCCT ND APPROVAL DATE: ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: OF j I PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"0 Vent Poe a10ft ho, i ding E ectil mug w np7 'n',tr 12'Mm or 20 ft above COMM 16 a,d NEC 300 Estabi shed Food Elevallo, VJeat"rproo' bPinC Aporovec .unclon Box IMPORTANT. \TM Vent Cap Anchor tanks) as necessary I _Condo i pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES @ 27.83 gal/in Depth (in) Volume (gal) A 15 41745 B 2.0 55.66 [C] 5 139.15 D 15 417.45 *Pump Tank Liquid Level = 37 in Force Main Diameter = 2 in I> � 4, 26orce Main Length = 230 ft Force Main Void Volume = 37.49 gal Aidighl Seal n a . Ederd manhole riser as necessary Approved Locnrg Merhoie wth Warning Labe Aliached 1y0'oa) N'eep LI(]nl(I "tole A Depth Force Main Filter 9� Ala, on C Pi rnp 2Ch! D — 3" Approved Bedding Mail Be neeN Tank [C] T5X Dose Volume TDV = 139.15 gal/dose total lateral void volume g TOM < 0.2X design flow) + (force main drainDack volume) MIN. PUMP DISCHARGE RATE = 0 gpm 4' Mir or 2 Ott above - Established Flood Elevation (typical) Disconnect e" Mir (typ'rap n're � IMri9 A'il^ 4pomved Ppn d N xo .rya Install and maintain pursuant to manufacturer's instructions PUMP -OFF ELEVATION = 81.25 It INSIDE BOTTOM ELEVATION = 80.00 ft 13.90 + Min. Supply Head = 4.46 ft + FM Friction Loss = 0.5 ft + Fitting Loss' = ft R(;hi supoly head v 0 3. + filter loss i = TOTAL DYNAMIC HEAD = 18.86 ft PUMP TANK: SEPTIC TANK(S). Volume = 10000gal Total Volume = 1200 gal Manufacturer: Wieser Concrete ManufactureMidwest Precast r(s): Pump Manufacturer: Zoeller 98 Install approved force main filter pursuant to manufacturer's Instructions Pump Model: ;See attached puff ocurve) Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Sim/Tech Controls/Alarm Model: AB Filter Model: STF-100 Float switches containing mercury are prohibited. rage b w w � LL 25 0 w 6 20 r U a 15 i d 0 r 0 0 2 5 0 GALLOP LITERS PUMP PERFORMANCE CURVE MODEL 98 20 30 140 50 60 80 160 240 FLOW PER MINUTE 80 TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 98 Feel Meters Gal Liters 5 15 72 273 10 30 61 231 1s 46 45 170 20 Ti 25 95 23 IL 7 0m) Shut-off Mead a 71 Electrical alternators, for duplex systems, are available and Variable level Float switches are available for controlling single supplied with an alarm and three phase systems Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available for with or without alarm switches variable level long cycle controls Refer to FM1922 and FMO806 for temperatures above 130'F 95 Series control Selection Model volI Mod. Amps Slmplez 111uplez M98 115 1 Aum 94 1 — - 4 N9B 115 1 Non 9 4 2o,3 4 D98 230 1 Aulo 47 1 4 E98 j 230 1 Nan 47 2 or 3 4 1. Integral float operated mechanical switch, no external control required 2 For automatic use single piggyback variable level float switch or double piggyback variable level float switch Refer to FMO477 3 See FM 1228 for correct model of simplex contro panel 4 See FM0712 for 'Affect model of cl controt panel or FM1663 for a residential alternator system For information on add0om, Zoe4er p'oo,cis refer to rata109 or P;gybark Y anable Level Switches. FMO477, Electrical Alternator, FM0486, Mechanical Al ema'or FM0495, Sump Sewage Basins. FM11487, Single Phase Simi Pump Call FMi596 Alain'. Systems FM0732 a cnunoN "Easy assembly' �1'a��a„} s� Vuma Q ins ner9a WPo Reduces po:enhal cogamg by debris Replaces rocks or bncks under the pump Made of durable, noncorrosive ABS Raises pump 2° off bottom of basn Provides the ability to raise make by adding sections of 1'4' or 2' PVC piping. Attaches securely to pump Accommodates sump, dewatenng and effluent applications NOTE. Make sure float la free from obstruction. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL r0' PO BOX 1"7 Z Lourvr k x cars Mdn o f O L/�/ / SNIP r0. 76r8 Can Rvi 4ratl p Lornsnik NY 40211.1961 www zoe/lac corni5G41776]»f (am)pI8PUMP y[/ rr PUMPS S%NCF 19.79 fAYMP 774-36N G Copyright 2C12 Zoeller Cc All rights reserved. Page 7 FILTER 1455 Lecamar Dnve aoync City. MI49712 PRESSURE FILTER INSTALLATION & SERVICE INSTRUCTIONS Toll 6rrr 888-949-3?90 O^:-,-�.!-"a>.�,".� Fay 211-582-7124 c.. INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe -hread. Pumps with a smaller discharge port maybe adapted to fit When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter (end opposite of the cap) to the desired height and a 2" union will need to be added to the outlet end (the end closest to the cap & on the side of the filter). Always install the filters in a position where they can be easily serviced. "Always use caution when starting threads to avoid cross threading Plumb force main into the 2" sch 80 PVC union. '"We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring or sealing surface" ,:. . . .- SERVICE: Service of filler screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks (600 micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need for service. If system is equipped with a "pump on light" that stays on longer than normal, this also may indicate a need to service filter. To service filter screen, unscrew the 4" cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be washed later at the shop. Note that in cold conditions the filter cap may be difficult to remove. Keep the filter in a warm area or pour warm water over the cap before removing Once the filter is installed in the tank it maintains a stable temperature and removing the cap will not be a problem. If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on SIMITECH FILTER systems, remove %" plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 alien Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within it's range (3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged Filer so that you can make sure the alarm switch is working correctly. "TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and installation. Made of PVC plastic. WARRANTY All products are warranted against defects in material and workmanship for a period of two years from the date of purchase. In no event shall GAG SIMfTECH FILTER, INC. be liable for any consequential damages or any labor, material, freight or expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair or replacement of the part. All warranties are void if the product has been improperly modified, applied or installed, subjected to misuse or abuse. Except as stated herein, there are no warranties expressed or implied, including the warranty of merchantability or warranty of fitness for a specific purpose. EFFECTIVE September 13, 2005 Page 8 w m T IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) IIL�III IIi�I1� I G Cove, Cnver — I 12' min trench aepm L Np,ran Highest Trench System Elevations = 93.9 ft 932 1 � min 12' (typnnp ft; 92.7 Septic Tank(s) Manufacturer Midwest Precast Septic Tank(s) Volume(s) 1200 gal gal gal gal Effluent Filter Manufacturer Sim/tech Effluent Filter Model # STF-100 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft Lowest Trench (as applicable) TYPICAL TRENCH (Show Inration of inlet 1 outlet pipe connection nn plan vlewJ PLAN VIEW 4e0 PDierveennpryechai1 rn9llec at prelx+r [wlw�cn Iwo urns (No Scale) Perforated Lateral nhservannnPipe (typical) (typical) L------------— �f------- — — — B = 60 ft (tinral) INSTALL PER TRENCH: 6 10-ft bundles @ 50 If EISA/unit = 300 ft` + 5-ft bundles @ 25 ff EISA/unit = R' = Proposed EISA per trench = 300 ft= ft, 10 ft Provide minimum 3 ft separation between trenches OBSERVATION PIPE DETAIL i Np Sc lin — ft rew-Type to I er,,rk Slip Cap (loose) (mulrtred & seMedl 4"0 PVC Plpl! InpSnll t'nvflr lop of qpo to term inn1. (mrn 14w1) nl ar 'hive fmrshed g mce (4)1)4' 112'X6'Sble - [a g apart Mchnnng e" cc > I'tlritmpnn 1l/��ii Sud:nr �A=3.0 ft (typical) EZ1203H Bundle (typical) (mfa by Inffltratnr Systems, Inc ) Install pursuant to manufacturers instructlons Required I nfi Itration Area = 858 x 3 trenches = Proposed Total EISA = 900 W Distribution Method: ft! distribution box -D m w O n Installation Instructions for EZOZU'" EZflow Systems in Wisconsin by INFILTRATOR .......................................................................................... Wisconsin Department o' Commerce, Satety end Building, Division, has reviewed the specficators an„ a, plans for this product and determined r to be it zomphance :v!th chapters Comm 82 througi- 84, Wisconsin Admin. Ccde. anc Chapters 145 and 160, Wisconsin Statutes. All sites must meet the S e & Soil CondGions & Locations & Isolation distances as noted in local regulations. The approved products are 1 203H (3-12" bundles with pipe u, center bundle in 5' or 10' lengths) and 1203HP (3-12` bundles with pipe in each bundle in 5' or 10lengths. .A single pipe bundle contains a four inch perforatec pipe sur- rounded by EPS aggregate and is held together with pc!y- ehtylene netting. A single aggregate bundle contains aggregate only and is he'd together with polyetnylene aett,r.g Materials and Equipment Needed • EZflow Bundles • EZflow Geotexble Fabric • E71`ow Internal Pit a Couplers • Pipe fcr Header and Inset • Back ro-:Ercavat, Installation Instructions The insrructons for installation o' EZflow products are given below. This product must be installed in accordance with state Vies defined in chapters Comm 82 through 84, Wisconsin Ad- mirdstratrve Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the [oral health department's current design manual. After the local health department has determined sizng configura tor. and layout for the EZflow s,-tems stake or mark w;fn paint to locator. cf tmrcres and'!nes. Be careful to se; correI-t tank, invert pipe header line or du- :rioution box and trench botom elevabors before i"atai- ation of pipe bundles. 2. Remove plastic EZflow snipping bags prior to placing bundles in the trenches). Remote any plastic bags :n the trench before system ,s covered. 3. this prnduct must have gectexttle fabric trial meets re- gwrements of s Comm 84.30 (6) 11 Wis. Adm. Dude installed directly on top of the product and edendrny down along the side- 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. 5. Tine Ab=crpt,cn a•ea ;SF) ne2e_s3ry for a given site snal be sized based cn max!m.;m daily sewace flow (GAD) anc the Pemeab li-y for The site. It certa IT cater a is met, the EISA sizing can he u:ed In Wisconsin, resr.lt ng in a 40/, smaller drainfield. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified fo, 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 connector. 7. The top of each GEO cylinder contains a filter fabric pre- marufactured ir. between the netting and aggregate. The fabric is inserted to prevent sod Intrusion. The installer shall make s.,re the the CEO is posda,,neJ uowaiJ and is in contact with the fabric aortained in the adjacent ct,lin- der before backfid ng, 8 `he EZ9ov. D-al-f9eln Sys'ems shoo-d he in—alled 'n a level ti er,d, r' adJirocOo a (butte a_ius_ and alu,g the hendr ocher: and _hold follow the contour of the ground surfa.:e elevation (un form depth), with all continuous adjoining ' 0-font cvincncal bundles placed end to end, with central bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 9. The trench too shall oe graded such that water will not pond. Barkfill should be seeded or sodde.i immediately after completion to reduce erosion. 10 EZflow FPS bundles one flexible anc can fit ,n curved benches as tray be necessary to avoid trees, boilders. or other 3lnstades. 11.EPS aggrecate s Iig-ner tba-i water, tterefore, It might be expected that natural buovancy forces would to-d to cause EZfnw assemblies tc tioat ou- of gm,und when pondme occur, geld e�pencnce has shown, however, that tl„s is not a problem when systems have a minimum of 6' of set cover as recommended by manufactu,er. 1203H-GEO Gcok:Ale r Material Page 10 In -ground Gravity Management Plan IMPORTANT: PAGE 4 OF 4 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; BOD5 5 220 mgL-'; TSS <— 150 mgL"; FOG 5 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS type of use o age of system nuisance factors it e odors, user complaints, etc.) mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) material fatigue (Le., 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.e.. exceeding design capacities prohibited activities, etc.) extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (ee . pump re -cycling, float switch settings, etc.) I electrical components - if applicable p e wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral onfice plugging (measure lateral distal pressure — compare to design specification] 11 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 tanks) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Effluent fllter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer s specifications A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Schmitt & Sons Excavating, Inc. Phone: 715-760-0486 Local government unit: St. Croix County Community Developement Phone: Local government unit address. 1101 Carmichael Road, Hudson 715-386-4680 ZIP: 54016 Any defective part of this system shall be repaired replaced, or removed pursuant to SPS 383.51 (1), Wisc Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. 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 11 uN'l'Y SANITARY SYSTEM File#: OWNERSHIP/ADDRESS FORM Crea=e212021 y Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the ProA�erty_Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Michael Barrett & Rebecca Karnitz Mailing Address 704 Meadow Lane City/state/zip Hudson, WI 54017 Phone Number (recuired)414-336-1955 Email Address (required)mike.barrett73@gmai1.com Parcel Identification Number 020-1157-80-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW U< , SE 'A, Sec. 26 T 29 N R 19 W, Town of Hudson Subdivision Plat: High Meadows II Certified Survey Map # 382418 Warranty Deed # 1128087 Number of bedrooms 4 Volume 5 Page # 1 Lot # 25 (before 2006)Volume Page # Spec house 13 yes ■ no Lot lines Identifiable ■ yes ❑ no OFFICE USE ONLY New Property Address 6�1 C )4 r ` ��p 1 (VenficatlOnQLAQW address required from Community Development Department for new construction.) / 1 (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form o 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. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center cdAlsccM aov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax wwW S.CCW1go_v Page 12 A - HIGH MEADOWS IT A SVONV1910N LOC]TEO IN INC S.". OF TNC Ill., NWI/1 OF THE 9El- AN. TNF SEI/. OF INE 4N1/C OF SECTION 2O, T29N, RIOW, TMN OF NWSON, ST CNOIX COUNTY, WISCON91N .9.E �NM.- ice.,—y _ �r tom —_ ___— _✓a,f_ t. _ UNPLATTED LOVES a 9)'1tlS5'F fRTi ti —„vla,— laZ fA n w mwn. na. re..aa. � .w .ru nxNry .rn A 25 26 _ 95YJftiL_la].4A' .1 i 6541 Nw w�wr...`�11W 1)I.wwb4 xi�� v+4 woN ��x h`l M CA 00 N5_ .9 24•�' 14 15�k+ V 27zeZ %;. 23 A �T n 24 k Is _----- -.Ay O .erz .o.a .....,m:.......,. .o-ur .a..a INTERSTATE NIGHWl1_Y •94' IT YoE <w[cxs. i.a � gp �g51 A 9 C4V .Ei NO[L WNNG NUJ CON]IN9 ATCJNM6 TN ♦ 01 5[tt[x9(N BJ TZ r N �M M� j NCMCED T. 91N MAY OC pF11E, mar l LM1 P NmS wf o,N m1 w xv ne1 `bw0 + NrH� HIGH MEAD01VS 21 22 n.mmn � 6 i Tf9 MS'9ux[ni murto Nr mNN N NCIANN SHEET I Df 2 SHH.ET5 39Z41a CSr,aea(- 36.E } ss = Safety SOIL EVAk k ATtOU REPORT '= in arcordance with Comm 85, Wig Adm. C L f v_�� Prnfession�l rv$ `s� Z021 s r" #2180 Page 1 of 4 Schmitt Soil Testing, Inc. "• yr .J r ounry Attach complete site plan on paper not less than 8Y x 11 inches in size Plan must St. Croix include, but not limited to: verticat and horizontal reference point (BM), direction and percent slope, scale pi dimensfbns,.north-errow-and"Tocahon and distance to nearest road Parcel I D 020-1157-80-000 Please print all information. Reme By / Dale fom-aoon Personal in you Provide may be used for secondary purposes (Privacy Law, s 15 04 (1) (m)) I! O B -Z I Property Owner Property Location Barrett, Michael & Rebecca Karnitz Govt. Lot SW1/4, SEt/4, S26, T29N, 19W Property Ownefs Mailing Address Lot # Block # ' Subd Name or CSM# 704 Meadow Lane 25 High Meadows II City State Zlp Code Phone Number City '`_ Village Town Nearest Road Hudson WI 54016 Hudson Meadow Lane New Construction Use ! Residential / Number of bedrooms _ 4Code derived design flow rate 600 GPD Replacement Public or commercial - Describe 2 Parent material Outwash (Burkhardt Series) �4+� _ Flood plain elevation, ifapphcabteD . General comments Replacement area is suitable for a conventional system with a 0.7 gpd/sgft rate Posiible system elevation for replacement area is and recommendations: 93.90' (High trench), 93.20' (Middle trench), 92.70' (Low trench). Slope of area is 10%. Boring Boring # _ Pit Ground surface elev 99.56 ft. Depth to limiting factor _100+ in SojApplicationHorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 'none sl 2mgr mvfr as gw 2m,2vf 2f,1vf 2 15-24 10yr4/4 none Sid 2msbk mfr 3 24-39 10yr4/4 none sit 2msbk mfr gw lvf 4 39-50 10yr5/6 IGyr6/4 none Is Osg ml gw ------ .. 0.7 1.6 5 50-100 none s Osg ml 27 Boring # Boring Ground 96.46 Pit surface elev. ft Depth to limiting factor 98+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consislen Boundary Roots _ GPD/fl' in Munsell Qu. Sz. Cont Color Gr Sz Sh 'Eff#1 •Eff#2 1 0-19 10yr3/3 none sl 2mgr mvfr as 2m,2vf 0.6 { 1.0 10yr4/4 none 2 19-32 sic, 2msbk mfr gw 2f,2vf 0.4 0.6 3 32-40 10yr5/6 none sil 2msbk mfr gw 1Vf 0.6 0.8 4 40-46 1 r5 6 0Y / none Is I Osg ml 9`w ------ I 0.7 0.7 1.6 5 46-98 10yr6/4 none s Osg ml --- ------ 1.6 Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt .�, 227429 Address Schmitt Soil Testing, Inc Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 9/8/2021 715-760-1978 $ar}8ll0 (R OL00) Property Owner Barrett, Michael & Rebecca _- Parcel ID # 020-1157-80-000 Page 2-of-4 ]Boring # Boring — Pit Ground surface elev -_ 96.76 ft. Depth to limiting factor _96+ in. Sod Application Rate Horizon Depth in Dominant Color Munsell Redox Description Ou Sz Cont Color Texture Structure .Consistence, Boundary Gr. Sz. Sh ! Roots GPDV •Eff#t •Eff#2 1 0-12 10yr3/4 none sl 10yr3/3 none sl 10yr4/4 none sid 10yr6/4 none s O G 2mgr mvfr as 2m,2vf 0.6 1.0 2 12-28 2msbk mfr gw 2f,2vf 0.6 ! 1.0 0.4 0.6 3 28-40 2msbk mfr gw 1vf 4 40--9fi Osg ml ---- ------ -- - Z.-7 !-7 Boring 4 Boring # - Pit Ground surface elev XX.Xx ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description in. Munsell Ou Sz Cont Color Texture Structure Gr. Sz Sh Consistence! Boundary Roots GPDrft' 'Efr#1 •EfW 1 0-5 10yr3/4 FILL Is 2 5-48 1Oyr5/6 FILL Is 3 48-52 10yr3/3 none sl 1 4 52-65 1Oyr4/4 none sl --1- l -- 6 80 96 10yr5/6 none s L Multiple pits were evaluated in the area shown on the site plan lcsbk mvfr as 2ni 2f,2vf 0.7 1.6 0.7 1.6 icsbk ml as lmsbk mfr gw 1f,ivf 0.4 0.6 0.4 1 0.7 1.0 — - 0.7 2msbk mfr gw lf,lvf imsbk mf Igw ------ 0sg 0sg ---- - _ 0.7 1.6 area. and all were very similar in the amount of fill over the BoringBoring # Pit Ground surface elev. fl Depth to limiting factor in. --- - Sod Application Rate Horizon. Depth Dominant Color Redox Description Texture. Structure ' In Munsell GU Sz Cont. Color Gf. $2. Sh. Consistence Boundary Roots GPDlft' •E(M`1 •E111112 I • Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg[L • Effluent #2 = BODs < 30 mg/L and TSS < 30 m9/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 608-266-3151 or TTY 608-264-8777. SBP8330M 07100) Schmitt Shc Te Ixj, Inc. St Croix County, WI 25' O86' 41' 15' 33' ee' - Q Z 65' ' 32' '\ W Q �•"43' /98' i 6' \7\DRAINFIELD NG J �3 96' �•It B1 �• 3' 91' 74if94 ALL PITS WERE 36' / THIS AREA HAS B4 VERY SIMILAR IN 59'� BEEN FILLED SE FILL AMOUNTSEXISITING1200 GAL SEPTIC 3M 1 100/ \. B4 OF REPORT FOR OVER A BURIED % TANK & 750 GAL P C. SLOPE — **;. REPR=SE=TATIVE PROFILE A HORIZON 100' / .....•�' WELL 96' ; B2�/ [HOUSE BM 96' 94' 1"-60' RETAING WALL Conducted for: Michael Barrett & Rebecca Karnitz SEE PAGE 4 OF 4 704 Meadow Lane I FOR FULL VIEW OF LOT Hudson, WI 54016 LOT 25 HIGH MEADOWS II PID: 020-1157-80-000 SW1/4 SE1/4 26 T29N R19W Town of Hudson LOT .2 5- BM 1 100.0' Top of 2" PVC Pipe BM 2 90.81' Top of farthest Northwest retaining wall rock, has an X marked on it with BM written beside the X Conducted By: Thomas J. Shmitt � CST 227429 9-8-2021 Legend Lakes and Roars Rivers send Streams Conveyance Divlsron N 0 20 40 60ft DISCLAIMER This map Is not guaranteed to oe accurate, coned, wren, or complete and canclusrons drawn are the respunsibdlrty of the user w eaw l; 14 I I I I St Croix County, WI Legend Lakes and Rivers Rivers and Streams n.ms.n IMoretetas US Highways State Highways County Highways Local Roads Rushc Roads Ramps Road Right of Way Railroads Conveyance Dwrsron NI _ 4 I 0 100 200 300ft DISCLAIMER This map rs not guaranteed to be - _ - accurate. mned. mHent. or complete and conclusions drawn are the rasponsilblay of the 54, �AceYl�.tn 4" 1, �Qiti�X COUNTY e P NO. 633950 STATE SANITARYyIPERMIT 704 ' L¢��WE6'IOUS NO. _ Rcb«<> Zew X OWNER M,", a PLUMBER J VIA" Sc%h \ - LIC.# Z z3 TGo TOWN OF Wi Sow SEC ,TAN, R14E/0 AND/OR LOT , ZS BLOCK In EXPIRES POS SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (i) The sanitary permit is transferable. History: 1977 c. 168, 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER - DATE UNLESS RENEWED AIN VIEW S THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20) PUMP CHAMBER Manufacturer:n/ s� /,er- .IsrLiquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: l ' , dL Bottom of tank elevation: 'es_6_6 Pump off switch elevation: 9 `J�4/ Gallons per cycle: /6/,0 6l1z- Alarm Manufacturer: 6, Alarm Switch Type: ,-rl 6 ;YOcier' i Number of feet from nearest property line: Front, O Side, ® Rear, 0 Ft�S Number of feet from well:�S Number of feet from building: 7� 7 (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed • Trench:__ Width: Length: 2a Number of Lines:�t1A Area Built: Fill depth to top of pipe: ,�� ' — 3e2 " Number of feet from nearest property line: Front, O Side, O Rear, (0Ft. Number of feet from well: Number of feet from building: O 7R (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems4 (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Form- ST C- 104 AS BUILT SANITARY SYSTEM REPORT OWNER .Jurnr- - �/epiti;C-� TOWNSHIP Ain SEC. 026 T,�N-RW ADDRESS �JeY fyiG Acd1qX.t:=ST. CROIX COUNTY, WISCONSIN SUBDIVISION ��st/!i//�h�rc✓ LOT �� LOT SIZE /-T� /16e6E�f PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM DJARTMEUT OF INDUSTRY, LABOR & HUMAN RELATIONS P.O. BOX 7969 MADISON, W 153707 SW14, SE'4, S26,T29N-R19W Town of Hudson Afo�Hnra T.v F. TIr;,To INSPECTION REPORT FOR SAFETY& BUILDINGS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING k2CONVENTIONAL ❑ALTERNATIVE sHn. n.�lD rvomee. uI Fe.IP�.aI ❑ Holding Tank ❑ In -Ground Pressure ❑ Mound Q NAME OF PERMIT HOLDER RESS OF PERMIT HOLDER INSPECTIONDATEgDD James S rin ett Route 5 Box 17F Hudson Wl 54016 i e20 �? BENCH MARK IPeemanem N@,F,a palm) DESCRIBE IF DIFFERENT FROM PLAN REF PT ELEV STREF IT ELEV Nameai PW,Hr1 MP/MAPS. NO !rv_., IW. HumE.r 6219 lc_. St. Croix 102806 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INELEV TANS OUTLET ELEV WARNINGL B L PROVIDED LOCKING COVER PROVIDED (/� 2 EYES ONO DYES ON BEDDING VENT DIA VENT MATL RIOR WA ER NUMBER OF RDAD flCPERTY WELL UILDING VFNTTO FRESH AURM FEET FROM LINE r Al. INLET s :YES ❑NO DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURE BEDDING n11 LIOUIO CgPACItY PUMPM EL PVMPISIPHDN MqN FACTUHE LOCKING COVER ROVIDED 5 ❑VES ❑NO ❑YES NO "'� NO GALLONS PE R CYCLE, PUMPgNOCUNI1ULsoPERATIONAL NUMBERO L BVILiHNG vEF(DIFFERENCE AIR INLETPUMP BETWEEN FEET FROM ffLABEL ON AND OFF) ❑YES NO NEARESTSOIL ABSORPTION SYSTEM. Check the Bol mmstweat the depth of plowing LENGTH OIALquoMANKw(.or /J excavation, ( If Sal can be rolled Into a wore, construction shall cease untilFORCE /! the soil is dry enough to continue.) MAIN 7 rn IdUFNTIF%MG1 CYCTFM- WIDTH LENGTH NO OF DISTR PIPE SPACIryG CUV N rv'BOF 01q aPllS LIOVIU BED/TRENCH / a "�l THE rvcyis I MATERIAL PIT DEPTH DIMENSIONS .i (p of Rq VEL DEPTH FILL DEPTH M1H PIPE DISTR PIPE DISTR PIPE MqT RIgL NO OISiR NUMBEq OF RDPE Tv WELL BWLOING V NT TO LHESM BELOW PIPES ASO VE COVER ELEV INLET ELEV END PIPES FEET FROM LINE qIH INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslopemound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA. meets the criteria for medium sand TIONS MEASURED. DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH DIMENSIONS MANIFULU PUM ELEV ELEV ELEVATION AND DISTRIBUTION INFORMATION HOLESIZE HOLE SPACI :D. Sketch System on Reverse Side. DILHR SBD 6710(R. 01/82) al I—, YES LINO H OF TDvsrnL SnODEO IT OLo DYES ❑NO ❑YES C LATERAL SPACING (rHAYEL Of V TH BE LOW PIPE 'ILL OISTN VIPE MANIFOLD Mq fNIAL NoIIISiH IIISIR IPF DISLIII ELEV PIPES DIA IECTLY COVFRMATERIAE VERTI PLANS S ONO oasERvgnory wEusl`, NUMBER FR M O ❑V LINO NEA S 4Z sal Retain in county file for audit SIGNATURE LI L 1 Zoning Administrator 1 INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1 This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable, 3 All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4 Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation, 5 Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 it permit is for tank replacement, reconnection or repair; IV Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; Vlll. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve, pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill GrounCa�or included the creation of surcharges (fees) for a number of regulated practices which Wiscocan effect groundwater The surcharge took effect on July 1, 1984 All of the water that buriedis used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBn-639811103/86)