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HomeMy WebLinkAbout020-1063-60-000 (3)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. EDWARD M QUINN RVCBL TRS I M •o' 1 100,01 TANK INFORMATION TYPE MANUFACTURER CAPACITY Se is WEE See, acao sing L7 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic r y / 1 / Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Fllon Loss System Head TDH Ft ForcemaIn Length Dist. to wen SOIL`ABSORPTION SYSTEM TOWN DATA STATION BS HI FS ELEV. Benchmark 61 :r 0. 100 '4 l�ofl Alt. BM Bldg. Sewer St/HtInlet f S� 7 l .' 1 SUHt Outlet / DtInlet Dt Bottom J Header/Man. Dist. Pipe Bot. System G Final Grade St Cover 3-10 r10rM44a:���i:�� BRUJITRENW DIM NS Width f 3 Length r No. Qf Trenches C� PIT DIMENSIONS No. Of Pits Ins Dia. Liquid Depth SETBACK SYSTEM TO P/L IBE57 WELL LAKE/STREAM LEACHING Man ufaryyer INFORMATION CHAMBER OR UNIT Type Of System: A O � � f f 7 Model N er ot►� DISTRIBUTION SYSTEM 4 w Header/MVa, Distribution x Hole Size x Hole Spacing Vent to Air Into f 0q Pipe(s) 1 / / t0 Lengthia Leng Dia Spacing t SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedfrrench Edges Topsoil Yes 0 No El Yes � No COMMENTS: (Include code discrepancies, persons present, etc.) /Inspection #1: 517'g17P22' L1 SY V• Location: 815 BRADLEY DR -n r • $•� 1.) Alt BM Description = 2.) Bldg sewer length �2 amount of cover = c c 1S Plan revisionRequired?Yes No No 5 Use other side for additional information. Date Insepctor s Signature Cert. No. SBD-6710 (R.3/97) U b v�l,.,,� FxQeq ►�nn�i' l a i,�.. ,eye. .(�►P,vp,�.� �P.tn6�� d� Vim'. t t Sr;, l.6 I�C�Lll ((vv" County Industry Services Division St. Croix P $ 18 2022 1400 E Washington Ave P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) MAR =, , Madison, WI 53707-7162 Community rTnit Application State Transaction Number In actor 1 PS 383.21(2), Wis. Adin. Code, submission of this form to a vemmental unit �— is required prior to obtaining a sanitary permit Note: Application forms few state-owned POWTS7MrSubnolacd to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Protect Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04 I m Stals. 815 Bradley Drive 1. Application Information - Please Print All Information Property Owner's Name Parcel # Edward & Pamela Quinn Revocable Trust 020-1063-60-000 Property Owner's Mailing Address Property Loco 4n Z ,6 /) `'f'.�� 815 Bradley Drive Z3.*.) - . Govt. Lot SE'G, SE'b, Section 23 City, State Zip Code Phone Number Hudson, WI 54016 circle one) T29N R19Eorit II. Type of Building (check all that apply) /1 Lot # Subdivision Name ® 1 or 2 Family Dwelling - Number of Bedrooms % 1 NA # ❑ Public/Commercial - Describe Use Block ❑ City of ❑ State Owned - Describe Use ❑ Village of ,A- CSM Number 2 — 5^� ®Town of Hudson III. Type of Permit: Check only one box on line A. Complete line B if applicable) A. ❑ New System ® Replacement System ❑ TreatmentlHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of CO Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 135431, 2/23/1990 V. TvDe of PO m/Com onent/Device: Check all that apply) Non Pressurized In Ground ❑Pressurized Inl,round ❑ At -Grade [I Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil o mg Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreatmea es Information: Design Flow (gpd) Design Soil Application Dispersal Area Requued Dispe Ara posed (sf) System Elevation 600 Rate(gpdsf) 857 ✓ 900 85.25', 94.35'. 83.4L,,,,-- 0.7 VI. Tank Info Capacity in Gallons Total # Gallons of Units Manufacturerk c N 2 y New Tanks Existing Tanks 55!„) irl �, V) Septic or Holding Tank 1000 1000 2 Wieser /Weeks 0 ❑ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PlumbeP; i "" ore !, MP/MYRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 586 Valley View Trail, Somerset, W154025 Fl!k Count /De ar'tment Use Only Approved ❑Disapproved Fee Date su� Issuing Sign Ej Owner Gi $it O O 3 Z 1XgtigllitMlglWApproval/ Reasons for Disapproval 1� 1. Scot c tr*,-. effluent fitter and / A+s!�tYsal rat! mast be serviced/maintained ,,, t� / plan provided by Plumber. 2.Ali re•to+tM 41kiltpmanNmustbemaintained Q �1M�t t 4las tWkn / per appal( e eode/willunm OV Attach to complete plans for the system and submit to the County only on paper not less tangs 1/2 Ill omen to size SBD-6398 (R03/14) / 1)•�o w� Y r � '"- SYSTEM PLOT PLAN Quinn 4 Bedroom Septic System Design Flow: 600GPD N Attach design flow calculations for Project Address: 815 Bradley commercial plans: BM1 Symbol: & _ BM Elevation: 100.00' Pipe Materials / ASTM Standard Scale: 1" = 60' BM Description: Top of existing septic tank manhole cover Tables 384.30-3 & 384.30-5 0 60 90 120 BM2 Symbol: Q BM Elevation: 87.05' 4" SCH 40 PVC pipe ASTM- D2665 BM Description: Top of vent pipe on existing drainfelid. 4" 3034 PVC pipe ASTM-D3034 Slope Gradient of Tested Area: (14%) 15' Well Symbol (if applicable) Notes: See CSM for a complete lot view if r �. 1 Copy Garage Existing Well Existing e 4 Bedroom House l Deck Existing 1000 gallon Septic Tank i 92'--_____ 14%Slope 90'_ _ t B2 _1irS T1 q— —'3%� 88'--�T T3 ` 86'---- o Proposed WLP1000-MR Distribution Box ____ -- 84"— Existing ITxU' Drainfe8d CONVENTIONAL COMPONENT DESIGN ip;�Hcati_ INDEX AND TITLE PAGE Project Name: Quinn 4 Bedroom Septic System Owners Name: Edward & Pamela Quinn Revocable Trust Owner's Address 815 Bradley Drive Hudson, WI 54016 Legal Description: SE1/4, SE1/4, S23, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Lot Number: 1 Block Number Parcel I.D. Number 020-1063-60-000 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 Attachment 1 Designer: John Schmitt Date: 3/2/2022 Index and title Plot Plan Existing Tank Specifications Existing Tank Certification Proposed Septic Tank 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 Licnese Number: MPRS 223760 Phone Number: 715-760-0486 Signature: L 1/i// LL- In round Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Quinn 4 Bedroom Septic System Design Flow: 600 GPD Attach design flow calculations for Project Address: 815 Bradley commercial plans: BM1 Symbol: - BM Elevation: 100.D0' Pipe Materials I ASTM Standard BM Description: Top of existing septic tank manrwle cover Tables 384.30-3 & 384.30-5 BM2 Symbol: 0 BM Elevation: 87.05' 4" SCH 40 PVC pipe ASTM- 02885 BM Description: Top of vent pipe on existing drainfeiid. 4" 3034 PVC pipe ASTM-03034 Slope Gradient of Tested Area: (14%) Well Symbol (if applicable) Notes: See CSM for a complete lot view. Existing 1000 gallon Garage Septic Tank Proposed WLP1000-MR Existing Well Existing 4 Bedroom M1 House Dedc / / / Dis 14%Steps �� / r 82 / / ! _ i / Ti $a'' 72 / ! T3 / / as'---- B3 — // BM1 / . _ _ — _ . 64- Existing 12'42' Drainfeild Box commerce.wl.gov isconsin Department of Commerce February 16, 2010 WEEKS CONCRETE PRODUCTS RAY WEEKS 1832 215TH STREET NEW RICHMOND WI 54017 Re: Description: SEWAGE TANKS, CONCRETE Manufacturer: WEEKS CONCRETE PRODUCTS Product Name: SEPTIC, HOLDING, OR PUMP Model Number(s): 1000 SAFETY AND BUILDINGS DIVISION Plumbing Product Review P.O. Box 2658 Madison, Wisconsin 53701-2658 TTY: Contact Through Relay Jim Doyle, Governor Richard J. Leinenkugei, Secretary (49 IN. L.L., 21.76 GAL/IN., 84 IN .MAX. DEPTH OF BURY 511 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER;. TANK DIMENSIONS = 84 IN, L X IN. W X 49 IN. H ) Product File No: 20100040 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval Is valid until the end of JUNE 2015. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent quality with a maximum monthly average value for BOD5 of greater than 30 mg/L and less than or equal to 220 ni TSS, or greater than 30 mg/L or less than or equal to 150 mg/L TSS, and F.O.G. of less than 30 mg/L. • Approval is issued for this product as being equivalent to a floor outlet water closet when the fixture drain is installed in the vertical position. The design meets the intent of s. Comm 82.32 (5) (c) and 84.20 (5) (n), Wis. Adm. Code, which requires water closets to discharge through a minimum diameter 3" drain pipe or fitting and the bowl to conform to ANSI Standard At 12.19.2M. The intent of the code is met since this product provides the same functional performance as water closets that meet ANSI Standard Al 12.19.2M. • BEDDING: Bedding material shall be used to provide a uniform bearing surface. A min. of 4-inch base of sand or granular bed on top of a form and uniform base Is recommended. The tank should not bear on rocks. Sites with high ground water tables should have specially designed bedding. Soils should be compacted under the tank. This approval supersedes the approval issued on 4/21/2005 under product file number 20050106. This approval letter shall be incorporated with your previously approved plans and/or specifications approved under product file number 20050106. As of May 15, 2008, a copy of a successful water tightness test report for this product must be AVAILABLE FOR INSPECTION AT THE MANUFACTURER'S PLANT prior to this product being used as a POWTS holding or treatment tank in Wisconsin. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Jean M. MacCubbin, CST Engineering Consultant --Plumbing Product Reviewer Commerce; Safety & Buildings Div.; PO Box 2658; 201 W Washington Ave.; Madison WI 53703-2658 Phone: 608-266.0955; Fax: 608-263-7456; E-mail: Jean.MacCubbin@wisconsin.gov SBD-10564-E (N.10/97) File Ref: 1r4l 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) 815 Bradley Drive located at: SE '/4, SE '/4, Section 23 , 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 3— a Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: Tank Capacity: 1000 Construction: Prefab Concrete x Steel Manufacturer (if known): Weeks concrete Products Age of Tank (if known): 51411990 Permit number (if known) 135431 .L_�✓l�/ John Schmitt (101censed Plumber Signature) (Print Name) MPRS (Title) (Date) 223760 gallons minutes Other (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 4 vi 4" CAST- WLP1000—MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1 /2" 4" CAST -A -SEAL BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1 /4" LENGTH: 8'-8" WIDTH: 7'-2` BELOW INLET: 42" UOUID LEVEL: 36" WEIGHT: 6,790 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) O w ao w INLET - _ OUTLET e N Ln I U N II "1 O I 7 sf I I I 2�,.---J-------- r - �- -PUMP PAD (TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1 LIQUID CAPACITY: 27.83 GALAN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8'-0' UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED 8Y REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: w a 0 /OF/I PaL��.��c~I�r !nnooatiaminV ust,Drainage Zabel" 6 wasaexate(Ro]uif5 A auttxi of Pcy ok Inc PL-525 Effluent Filter Pt-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won t leave the tank. Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 1J16" Filtration Slots Alarm Switch 10,000 GPD I°p`7OIIdll 2. Remove the tank cover and pump tank if necessary. Accepts 4" & 6" =t�>' 3. Glue the filter housing to the 4„ or 6 outlet pipe. if SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. 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. a-cepis 1" PVC tension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration Slots 0 Certified to NSF!ANSI Standard 46 rAuto GasDeflector matic Shut -Off Ball OutdoorSmarttiltee�''Alarm Extend&- LokI" Polylok, Zabel & Best filters accept Easily installs the SmartFilter® switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 6 IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) ..._..._ .�...min 12" - IIL..SOIL COVER Cover 12* min. trench depth Septic Tank(s) Manufacturer. Weeks C P/ Wieser Concrete Septic Tank(s) Volunne(s): 1000 gal 1000 gal gal gal Effluent Filter Manufacturer. Polylok Effluent Fitter Model #: 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Highest Trench Lowest Trench (as applicable) System Elevations = 85.25 ft; 84.35 ft; 83.45 ft; ft; TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW Orr 0 Observation pipe shall be installed (No Scale) Perforated Lateral atjunchonbetween two units. 10 ft Observation Pipe (typical) (typical) (typical) - -/` — — — — — — — — — — — — — — — — — — — — — 1 r (typical) o INSTALL PER TRENCH: to v 6 10-ft bundles @ 50 ff EISA/unit = 300 ft2 + 0 5-ft bundles (a. 25 fF EISA/unit = 0 ft2 Provide minimum 3 ft separation between trenches. OBSERVATION PIPE DETAIL (No Scale, _ ft Screw -Type or Slip Cap loci . 4"0 PVC Pipe Top of pipe to terminale at or above finished grace (4) 114Slots @J 90 90 apart t Anchoring Device I �A=3.0 ft -D m _ J ctypical> VEZ1 203H Bundle W (typical) O (ndd by Infiltrator Systems, Inc) 71 Install pursuant to manufacturer's instructions. 'P F,rushed Grade ulched & seeded) Topsoil Cover (min- 1 foot) if ltrafon Surfaw = Proposed EISA per trench = 300 ft2 Required Infiltration Area = 857 x 3 trenches = Proposed Total EISA = 900 ft2 Distribution Method: ft2 distribution box Installation Instructions for EZf Dunn EZflow Systems in Wisconsin Jby INFILTRATOR ........................................................................................... Wisconsin Department of Commerce, Safety and Buildings Division, has reviewed the specifications and/or plans for this product and determined it to be in compliance with chapters Comm 82 through 84, Wisconsin Admin. Code, and Chapters 145 and 160, Wisconsin Statutes. All sites must meet the Site & Soil Conditions & Locations & Isolation distances as noted in local regulations. The approved products are 1203H (3-12' bundles with pipe in center bundle in 5' or 10' lengths) and 1203HP (3-12' bundles with pipe in each bundle in 5' or 10' lengths. A single pipe bundle contains a four inch perforated pipe sur- rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate only and is held together with polyethylene netting. Materials and Equipment Needed • EZflow Bundles • EZflow Geotextile Fabric • EZflow Internal Pipe Couplers • Pipe for Header and Inlet • Backhoe/Excavator Installation Instructions The instructions for installation of EZflow products are given below, This product must be installed in accordance with state rules defined in chapters Comm 82 through 84, Wisconsin Ad- ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design manual. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake or mark with paint the location of trenches and lines. Be careful to set correct tank, invert pipe, header line or dis- tribution box and trench bottom elevations before instal- lation of pipe bundles. 2. Remove plastic EZflow shipping bags prior to placing bundles in the trench(es). Remove any plastic bags in the trench before system is covered. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending down along the sides of the product to a point at least six inches from the bottom of product. 4. When installed in a trench, the trench should be dug to a width of 36 inches. This not only saves labor in excava- tion, but also provides better load -bearing capacity after backfilling is complete. 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 - dies and do not require any type of connection. 7. The top of each GEO cylinder contains a filter fabric pre - manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer shall make sure the the GEO is positioned upward and is in contact with the fabric contained in the adjacent cylin- der before backfilling. 8. The EZflow 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 soil cover as recommended by manufacturer. 1203H-GEO xtile r Material .......................................................................................... Page 8 PAGE 4 OF 4 n-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; BODs 5 220 mgL''; TSS:5 150 mgL"; FOG 5 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system 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 i drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) 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 tanks) 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 (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 and Sons Excavating, Inc Local government unit: St. Croix County Community Developement Local government unit address: 1101 Carmichael Road, Hudson Phone: 715-760-0486 Phone: 715-386-468 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 9 File #: S-r. C�i- UN-FY SANITARY SYSTEM Office Use Only OWNERSHIP/ADDRESS FORM Created212021 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 Property Files Scanned weblink. Owner/Buyer OWNER/BUYER INFORMATION Edward & Pamela Quinn Revocable Trust Mailing Address 815 Bradley Drive City/State/Zip Hudson, WI 54016 Phone Number (required) 715-222-5944 Email Address(reqt,ired)peskyroyalwin@gmail.com Parcel Identification Number 020-1063-60-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SE 1/4 , SE 1/4 , Sec. 23 T 29 N R 19 W, Town of Hudson Subdivision Plat: NA L t # 1 Certified Survey Map # 346224 Warranty Deed # 1049878 Number of bedrooms 4 o Volume2 Page #541 (before 2006)Volume , Page # Spec house 13 yes ❑ no Lot lines identifiable 0 yes ❑ no c OFFICE USE ONLY New Property Address rJa n4(— (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POINTS) applications. New System: Include with this form 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. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center -cdd._@scc_wi.aov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax Nww,Sccwi,_qt!y Page 10 Soy G Department 2021 SOIL EVALUATION REORT ,. ' S P S Saf��r�an inlaccordance wW ZomF1M, W-eA m. Code s Professional Servic�unty ' , ,-,-n x -It 65F aca 1—;44 #2181 Page 1 of 4 Schmitt Soil Testing, Inc. '�_,.... y�. �•- ��,..,._ Dev'e County Attach complete site ply SS than 3%: x 11 inches in size. Plan must St. Croix include. but not limited ertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 020-1063-60-000 Please print all information. Re ' of By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z Z Property Owner Property Location Quinn, Eward & Pamela RVCBL Tt2S Govt. Lot SE1/4, SEV4, S23, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 815 Bradley Drive 1 I I CSM 2/541 City State Zip Code Phone Number ❑ City F1 Village Q Town Nearest Road Hudson WI 1 54016 I 715-222-5944 Hudson I Bradley Drive New Construction Use: Q Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement C' Public or commercial - Describe: Parent material Outwash (Burkhardt Series) Flood plain elevation, if applicable NA ft. General comments Replacement area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for replacement area is and recommendations: 85.25' (High trench), 84.35' (Mid trend)), 83.45' (Low trench). Slope of area is 14%. Z O /'4 ❑ Boring Boring # u pit Ground surface elev. 88.95 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color j Redox Description Texture Structure Consistence Boundary Roots GPDNe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfM 'EfW2 1 0-9 10yr3/3 none sl 2mgr mvfr mvfr as gw 2vf 2f,2vf 0.6 0.6 1.0 1.0 2 9-19 10yr5/6 none grls lcsbk 3 19-48 10yr6/4 none s Osg ml as - -- 0.7 1.6 4 48-96 10yr6/4 none grs Osg ml ---- ----- 0.7 1.6 qqv +r , ❑ Boring 2] Boring # Pit Ground surface elev. 88.95 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t •Eff#2 1 0-11 10yr3/3 none sl 2mgr mvfr as 2m,f 0.6 1.0 2 11-22 10yr4/4 none sid 2msbk mfr gw lf,lvf 0.4 0.6 3 22-31 10yr4/4 none grsl 2msbk mfr gw ivf 0.6 1.0 4 31-38 10yr5/6 none girls Osg ml cs ------ 0.7 1.6 5 38-96 10yr6/4 none grs Osg ml -- — -- 0.7 1.6 a 5 IZ6 1 I! . Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mglV ' Effluent #2 = BODS a 30 mg/L and TSS <_30 ri 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 SBD43300 07/00) Property Owner Quinn, Eward & Pamela RVCBL Parcel ID # 020-1063-60-000 Page 2 of 4 3 ❑ Boring Boring # ❑ Pit Ground surface elev. 86.20 _ ft. Depth to limning tailor 96+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' 'Eff#1 •Eff#2 1 0-8 10yr3/3 none sl 2mgr mvfr as 2Vf 0.6 1.0 2 8-14 10yr4/4 none sl 2msbk mfr gw 1Vf 0.6 1.0 3 14-23 10yr4/4 none vgrsl 2msbk mfr gw 1Vf 0.6 1.0 4 23-29 7.5yr5/6 none s Osg ml gw -- — 0.7 1.6 5 29- 10yr6/4 none grs Osg ml -- --- 0.7 1.6 Boring Boring # El Pit Ground surface elev. ft. Depth to limiting factor in. �_ Soil Application Rate Horizon Depth Dominant Color in. Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDfie Tff#1 •Eff#2 i ❑ Boring Boring # Pit 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 GPD/ft' •Eff#1 `Ef #2 . Effluent #1 = B0D5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = B0D5 < 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 608-266-3151 or TTY 608-264-8777. SBD69330 (R.07/00) Sdwy t Sill Tesft, Inc. Conducted for: YQV Edward 8r Pamela Quinn Revocable Trust 815 Bradley Drive Hudson, WI 54016 Lot 1 CSM 21541 SE1/4 SE S23 T29N R19W Town of Hudson 163' Exisitng 1000 Gal Septic Weeks tank HOUSE BM 1 12' WELL /92 90, 171' 116 / 84' 90' '•:` Slope •/• B2 ; till' �•^. Proposed 3' X 60' Trenches i 86'� 3 (STING 12'xa4'OF BM?�.r• LD BM 1 100.00' Top of existing septic tank man hole cover BM 2 87.05' Top of vent pipe on existing drainfield Septic tank outlet pipe. 96.55' lit =60' 321' Conducted By: Thomas J. Schmitt CST 7429 9-8-2021 St Croix County, WI Legend Lakes and Rivers Rivers and Streams Interstates US Highways State Highways County Highways Local Roads -- Rustic Roads Ramps Road Right of Way •e•renra arias mrse.e sr•»e vry Iro+i Railroads Conveyance Division 0 20 40 60f1 DISCLAIMER: This map is not guaranteed to be accurate, correct. current, or complete and conclusions drawn are the responsibility of the r St Croix County, WI Legend 4t Lakes and Rivers Rivers and Streams 0 l } ,ted�' C r qr eY.m:ryn, xi ddl�^'Yn .a Interstates � nw US Highways a � - ' ' R �f�P � State Highways I County Highways Local Roads +" Rustic Roads Ramps Road Right of Way -' rmrem.e n.um.e wvy.aoM 1 �1' P Railroads t 1f $1 Conveyance Division d 4 eR r N j 0 50 100 150ft . �s+a �:ua awl "la;•t�ra.w,+rar��m, �,�sx+trF DISCLAIMER: This map is not guaranteed to be eaurele, corral, current, or complete and conclusions drawn are the responsibility dike user. iT � oe,n. eze ra a• e 15 courvrir OWNER K,#vo&&6Lc TrtJS-F' ;mj I/ bra NO. 641911 ARY PERMIT PREVIOUS NO. 136 nn PLUMBER Told. Stkw,44-LIC.# ZZ3 7G6 TOWN OF AL jJcer% SECZ:� ,T_Zft_N, R M E/W AND/OR LOT i BLOCK CSI(M 7- -'5q) SUBDIVISION PERMIT EXPIRES 20kA, 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. (f) 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 3 UNLESS RENEWED Zi// Z.Z AIN VIEW THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)