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HomeMy WebLinkAbout032-2179-01-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578912 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hanson, Susan 1. Somerset, Town of 032-2179-01-000 CST BM Elev: Insp.BM Elev: BM Description: � Section/Town/Range/Map No: 46 13 44 6.5r 16.30.19.1520 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ;�:f CAPACITY STATION BS HI FS ELEV. Septic I , Benchmark .0G 17 Alt. BM A."', 3 .55 c,,1.�� ��- zo r�� Low 3 /az, Ae�ect n / k LL S Bldg.Sewer l o o J -->� •a Holding Ll St/Ht Inlet I TANK SETBACK INFORMATION St/Ht Outlet 97,1$ TANK TO �eP/L WELL BLDG. Vent it intake ROAD Dt Inlet 3ZO _r^_ Septic Dt aottom /0 . L(p /b? g/ Z14 — 3Y& odd- "7 5 Dosing (ry Header/Man. `-� g � 3 Aeration Dist. Pipe /3 6 177 c�T Holding Bot.System 1Z. to V 9'3 3'79 PUMP/SIPHON INFORMATION Final Grade 9. a5 '77 , a ( Manufacturer Demand St Cover GPM �/ 3 .,F:51 /aZ • I Model Number TDH Lift Friction Loss System Hea TDH Ft Forcemain Length la. Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width ( LengthG No.Of Trenches , IA� PIT DIMENSIONS No.Of Pits Inside Di� Liquid Depth DIMENSIONS 3 /V Z -1/tv�.L,'.R C) SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f System: UNIT Model Number: DISTRIBUTION SYSTEM A)x(4-L,_ 4%t- HeaderMlanifold� Distribution x Hole Size x Hole Spacing Vent to�ntals� Pipes) /v l a l-� Length Dia Length Dia \ Spacing\ \\ \� L•^� �f^� SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 20 Fd- PA, !%,A4_, Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 5 BedlTrench Edges �� Topsoil g Yes � No � Yes 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 573 155th Ave.SOMERSET,WI 54025(NE 1/4 SE 1/4 16 T30N R1 9W) Narnia Nook Lot 1 Parcel No: 16.30.19.1520 1.)Alt BM Description= I L, 6 2.)Bldg sewer length= �uti-LI -amount of cover= Plan revision Required? ❑ Yes No Use other side for additional information. �I J -- - Date Insepctor'VCe Cert.No. SBD-6710(R.3/97) "' e$.4 li C � County d `'a": . e Industry Services Division St.Croix f �'. Tr 1 00 E Washington Ave 0 li S i 13 1 ��. i.l t P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.) '� S IX COUNTY `t Madison,WI 53707-7162 5-1 [ 2 ,.,, Nun'DEVELOPMENT Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit t /k- is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address(if different than mailing address) purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. Same it 5/ 5 155 f Ave I. Application Information-Please Print All Information Property Owner's Name () Parcel# Hanson,Susan 032 X179-01-000 Property Owner's Mailing Address Property Location 573 155'"Avenue 1/ , 15 Z()) Govt.Lot l City,State Zip Code Phone Number NE 1/4,SE'/4, Section 16 Somerset,WI 54025 trcle one) T30N ; Rl9Eor II.Type of Building(check all that apply) /� A Lot# ® 1 or 2 Family Dwelling Number of Bedrooms J , „dl, ✓ Subdivision Name Narnia's Nook ❑Public/Commercial-Describe Use l ryM, AA Block 4 U' G f � - ❑ City of 10 rY E]State Owned-Describe Use ❑ Village of l^ �//DCSM Number-2 0151111.b ti on COS W/ q C h ni//` (j ® Town of Somerset 2_011-e X' III.Type of Permit: (Check onl i i • ,I. 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.T_ stem/Component/Device: (Check all that apply) Non-Pressurized In-Ground Pressurized In-Ground ❑ At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil ijl-Fj HrG -tjl/ ii -o ding tank Other Dispersal Component(explain) ❑Pretreatment Device(explain) �Z 20 r_/ 3H- /0 , V.Dispersal/Treatment Area Information: 7"D In Design Flow(gpd) DesignSil Application Dispers Area Required(sf) Dispers ea Proposed(sf) System Elevation 450✓ Rate(g sf) 900 900 93.45'&91.80' 0.5 VI.Tank Info Capacity in Gallons Total #of Manufacturer a V 0 .2 New Tanks Existing Tanks Gallons Units W/ a U 1 4 2 3 P. w �nl�1 o�,k 525 Septic or Holding Tank 320 1000 1320 2 Week's&Wieser ® ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb ' ig tore Busine MP/MPRS Number Business Phone Number John Schmitt ,i 223760 usine0-0486 Plumber's Address(Street,City,State,Zip Code) 616 150th Ave. Somerset,WI 54025 VIII.County/Department Use Only n 0 Approved d' Permit Fee Date I Issuing Agent Signature \ wner Given Reason or enial $ N 7 5 . site/ v) IX.Conditittnise,f01504.14easons for Disapproval ?, b x'Mao C I/S�M V e& 'v 1. Septic tank,effluent filter and ✓ l•�e'1 J �J`S/l J�1(bed dispersal cell must be serviced/maintained 'V as per management plan provi Jed by pluM:*er. 2.All setback requirements must be rnairuained as per applia to pt the system and submit to the County or 7 on paper not less than 81/2 x 11 ink--in size SBD-6398(R03/14) • CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Hanson Conventional In Ground Owners Name: Susan Hanson Owner's Address 573 155th Avenue Somerset, WI 54025 Legal Description: NE1/4, SE1/4, S16, T3ON, R19W Township Somerset County: St. Croix Subdivision Name: Narnia's Nook Lot Number: 1 Block Number Parcel I.D. Number 032-2179-01-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Filter Information Page 5 System Sizing &Cross Section Page 6 EZ Flow Instructions Page 7&8 Management and contingency plan Page 9 Existing Septic Tank Certification Page 10 Septic Tank Maintenance Agreement Page 11 Warranty Deed Page 12 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 4/10/2015 Phone Number: 715-760-0486 c72(-047 Signature: Z/1-047C-•-;61 In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 , PLOT PLAN N Project Name: Hanson Replacement Septic System Legal Description: NE1/4,SE1/4,S16,T3ON,R19W P.I.D: 032-2179-01-000 Subdivision Name: Narnia's Nook Lot#: 1 SCALE:1"=40' Township: Somerset Parcel Size: 3.56 Acres County: St.Croix System Elevation: T1=93.45'Proposed 90'EZ Flow Trench Slope: 16% T2=91.80'Proposed 90'EZ Flow Trench A BM1 Elevation: 100.00' Top of 2"PVC pipe L\ BM2 Elevation: 103.12' Top of Well Backhoe Pits: 4 inch Sch 40-ASTM D2665 NOTE:See Page 4 of Soil Evaluation Report for a complete plot of the parcel. 4 inch 3034 - ASTM D3034 l Z6Z / i 1 I' I / \ / ... rte q3 `-1 SLOP- "b cj 7_,, r 3Ze SAC r 2 • — 99 OM H-, g2 .i — . �4, • LX/5Y1t%)G _, --.- �_ l�©c GAL SEnr is .TNN< P g4lai. wit Page 2 € a6ed -I D z x Cn > m -? m AS n > z 58 — READ D -1 > I C) 4" „ >1 I 46 „ m 50" m 0 - 2 73 r lE O 70 m m se -r1 NV- M UP 48 " 11 ' rrn I I m 4" CAS 0 I I II '0 3" M *IF II o m 5 _ m II 0 m UP 48" j 1LrMil1 ' -I y 4" CAS H. • N 1 .1. iv a 46" - N co r v -mi 7 m 0 -P C T n m > z---i z I u) >1 0) m > r C1 c >0 -, g - z D _C m m m D �NI C) z ° ^ D 046> r-03 0> y_i my CO 0 -0 in An° =0* 0==2) 0(0 y M°0 M>0 =gip•• X F- J4- z� \ C z NZr-1 p j c''‹mO0�• I• LI m N z = N -I. m D m 00 a N -iN O r^ D oor�p n 0 0 x o 6 D o o ccnm> 11y or-I'4'• .O.-' 71 I v > v N NZ p in a G7 Nv�r1 Dr N ' O n•o a 0 Vp \ C r m-1m mvp \ D 2J `� a o > 05" c D z =�Z r0 O NI n z v o 0 H 0 A� Div Cpp ° 0 v m < A Z > -4O?1 p73 -1 z m (1 m M v r O-4 m 0 ° D (/1 u► CO c_n 0 xi O C 00 w -0 m m 10 M> 0 .. T) V1 m = O m r xi O 00 z Z r c Ft « 0 r xi D H m m I- 1 F m M ID \ m W320-MR IIIIESER COOCAETE DRAWN BY: SME SCALE: 1 4 3 0" PRE-POUR: REV.0 -1 � SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2012 DATE:. 3/20/12 POST-POUR: \ P REVISED JAN. 2012 800-325-8456 FILE: W320-MR POId. o Filters PL-525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of accessibility -.(""– e Accepts PVC — the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122,the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning,the ball will filtration slots .*--; _e Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't x leave the tank. No other biter on the market can make that claim! Accepts 4"& 6" " SCHD.40 Pipe PL-525 Maintenance: , The PL-525 Effluent Filter should -� operate efficiently for several years under normal conditions before 4......: requiring cleaning. It is recom- mended that the filter be cleaned , every time the tank is pumped or at least every three years. If the ' installed filter contains an optional NSF® iiiiikt alarm, the owner will be notified by an alarm when the filter needs Certified to Gas deflector servicing. Servicing should be anrsinvsr46 done by a certified septic tank '°°' 1 Automatic shut-off pumper or installer. ball when filter is removed 1. Locate the outlet of the U.S.Patent No#6,015,488 septic tank. 5,871.640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose if filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6" outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. 10 Page 4 • SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Susan Hanson Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 40 50.0 System Sizing EISA Rating per Foot of EZ Flow 5 I ft2 Soil Application Rate 0.5 gpd/ft2 450.0 gpd Design Flow_ 10.5 Soil Application Rate_ 5 EISA= 180.0 Feet of EZ Flow 2 trenches 90 feet long each 2 No.of Cells 9 Per Cell - 10 3 ft Cell Width 18 Total No of 1203H 90 ft Cell Length 450 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Typical Cross Section Finished Grade 98 ft Observation Pipe with approved cap or vent +-- Soil Backfill ^ �.. 36 Inch • Geotextile Fabric X Tee , • Slotted and Anchored Vent/Observation Pipe 12 inch V •-Q , p with Ca A 93.45ft >' red EN" a 91.80 ft Infiltrative Surface >36 inch V !!!!!!!m! !!!!!!!!!!!!!!. !!!!!!!!moms !!!!!! 'T!�°!!!!!!!■■!!!l l..� 0 L !!!ft!!Limiting Factor Plumber/Designer Signature: License#: MPRS 223760 Date: April 10,2015 Page 5 Installation Instructions for EZ Ow'" EZflow Systems in Wisconsin by INFILTRATOR Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area(SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow(GPD)and product and determined it to be in compliance with chapters : the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160,Wisconsin Statutes. All sites must meet the Site smaller drainfield. &Soil Conditions &Locations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5'or 10' lengths)and 1203HP(3-12"bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, • should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- • dies and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ehtylene netting.A single aggregate bundle contains aggregate • 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positiioned upward and is • EZflow Bundles in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric : der before backfilling. • EZflow Internal Pipe Couplers • • Pipe for Header and Inlet • 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator • level trench in all directions (both across and along the • trench bottom)and should follow the contour of the ground Installation Instructions • surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160,Wisconsin Stat- utes, as well as the local health department's current design • 9. The trench top shall be graded such that water will not manual. • pond. Backfill should be seeded or sodded immediately • after completion to reduce erosion. 1. After the local health department has determined sizing, •• configuration, and layout for the EZflow systems, stake • 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- • other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 11.EPS aggregate is lighter than water, therefore, it might • • be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the : ponding occurs. Field experience has shown, however, trench before system is covered. • that this is not a problem when systems have a minimum • of 6"of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 1203H-GEO down along the sides of the product to a point at least six • inches from the bottom of product. • Geotextile ° Barrier Material • n u� �n a u_ 4. When installed in a trench, the trench should be dug to =11=11=0=I1=r�441=11=11=11=1,= n a width of 36 inches.This not only saves labor in excava- 12 � ;11=11 1114Tn��u���r��n��a� V.°• tion, but also provides better load-bearing capacity after . backfilling is complete. • . ..._ 36" �.. • • • Page 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Susan Hanson Tank Manufacturer: Week's C. P. NA Permit# Et Septic Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete r NA Number of Bedrooms: 3 r NA ° Septic E Dose r:Holding Volume: 320 gal Number of Public Facility Units: r NA Vertical Distance Tank Bottom (s)to Service Pad: ft Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s)to Serivce Pad: ft Design (peak) Flow=estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.5 gal/day/ft2 horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok r NA Fats,Oils&Grease(FOG) 530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand(BOD5) 5220mg/L l NA Pump Manufacturer: r NA Total Suspended Solids(TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 530 mg/L Manufacturer: / Biochemical Oxygen Demand(BOD5) 5220mg/L P7 NA r Mechanical Aeration r Peat Filter t-'" NA Total Suspended Solids(TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r Other: Biochemical Oxygen Demand(BOD5) 530mg/L Soil Absorption System Total Suspended Solids(TSS) 530mg/L y'.NA B In-Ground(gravity) r In-Ground(pressure) r NA Fecal Coliform(geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: %in dia. N, r Drip-Line r Other: Other: r Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third (%)of tank volume Pump out contents of tank(s) When the high water alarm is activated ✓ month(s) Inspect condition of tank(s) At least once every: 3 or year(s) (Maximum 3 years) NA ✓ month(s) Inspect dispersal cell(s) At least once every: 1.5 op year(s) (Maximum 3 years) r NA ✓ month(s) Clean effluent filter At least once every: 1.5 i year(s) r NA ✓ month(s) Inspect pump, pump controls&alarm At least once every: r year(s) )r NA ✓ month(s) Flush laterals and pressure test At least once every: r` year(s) NA ✓ month(s) Other: Shut off drywells Use T1 &T2 for 5 IM year(s) NA Other:Alternate Systems * After 5 years use drywells for 1 year, then trenches for 2 years, then drywells for 1yr. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber;Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface.The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third('A)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,Wisconsin Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page 7 Page of ' START UP AND OPERATION For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels.When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells.Do not drive or park over,or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics;baby wipes;cigarette butts;condoms;cotton swabs;degreasers;dental floss;diapers;disinfectants;fat;foundation drain (sump pump)discharge;fruit and vegetable peelings;gasoline;grease; herbicides;meat scraps;medications;oil;painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: •All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. •The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. •After pumping,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been,or must be taken,to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. • The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name:Owners Choice Name:St.Croix County Zoning Phone: Phone:715-386-4680 This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. PRIge 205) 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) 573 155th Avenue located at: NE 1/4, SE 1/4, Section 16 , Town 30 N, Range 19 W, Town of Somerset , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service April 10, 2015 Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Age of Tank (if known): 30+ Permit number (if known) 4 John Schmitt (L. ' nsed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS April 10, 2014 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 9 • ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Susan Hanson Mailing Addreb's 573 155th Ave. Property Address (Verification required from Planning&Zoning Department for new construction.) Somerset WI 032-2179-01-000 City/State Parcel Identification Number LEGAL DESCRIPTION Property Location NE '/4 , SE 'A , Sec. 16 , T 30 N R 19 W, Town of Somerset Subdivision Plat: Narnia's Nook , Lot# 1 Certified Survey Map# , Volume ,Page# Warranty Deed# (before 2007)Volume ,Page# Spec house Oyes Cho Lot lines identifiable ri yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. Uwe certify that 1 statements o this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above, ',y virtue of a w. anty deed recorded in Register of Deeds Office. Number of bedroom• 3 Marl 4 10 15 SIGNATURE OF APPLICANT(S) DATE ***My 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 SE 1/4 ��±� /- ! 42n W. • L 134 01 ° `, '4•. ',1`.. • • bl \'?< .. /,-,‘;':-'1‘t:2? —_ -- — — -- — ------------ —i ^a�`93` .F.X10/ ^ ef ,�.fig'' ey Map `� �y - � �•;: age 4335 �`� °�b. -:, . 71,4 o -E•a �� =:'as.,,�374*. Lot 1 (� ,' s:, '� o�w>'<,, T // 3,*Attesorl ti / A:- ,, ,:G 3 a0a ' j; -' 4)/ ,tea' • ■_,_ El ; ,,e LOT',.2,/-;<eL 63.1,E I >'� 3 2 `E -. ;Z't' 6626A resb(264272Sd:,Ft 49' AA• t ,,/ I. Lot 3 rR_N � ' 1'{i _,N a+e� ai m : 4 ;► :;; ;,t pp 00` v00.��h \ Ise ., .00•- Y 02� . s/3.560 Acr r 155,066 Sq.Ft. %.6 ../. \\ , ' 'L \\A. (LBO=953.0) 'o ��`'� L� Existing o // ° / ✓o \ , r Dwelling r. N .yo' p 9Nead gC-� �'/ SAM a,/ '°= , � E. P �? / yp &g� �,� Nbs. O O v ?�I �r Eizr , Y---- + ZtTr I Drainage .--/ N `� _ Drainage Easement l :''$11 Q N ei I South Line NE 1/4-SE 114 S ` South Line NW 114-SE 1!4 Section 16 1 t r ,t Iron Pipeis°44 N 89°43'2T' W South o(PmPerty tine on would disturb I Each parcel shown on this map is subject to State,County, (R=N89°53'51" ine.The I and Township laws,rules and regulations(i.e.wetlands, AND N 89°53'26" 236.32 of !minimum lot size,access to parcel,etc.).Before purchasing LTNPLATTED LANDS OWNED 'the use of I or developing any lot,contact the St.Croix Zoning Office and ve the area. I the Town of Somerset. JI. J NOTE- I with or change the i A special exception use permit is required for the I soil erosion plan I disturbance of slopes 20%or greater not identified istructing,altering,I on the approved plat.This permit is applied for r drainage ditches,I through the zoning office and is reviewed through I a public hearing process by the St.Croix County J `Board of Adjustment. 1' !4. v� '� Dep ""'"���11 SOIL EVALUATION REPORT #1773 ,�k$ Safe Page 1 of 4 P `. in accordance with Comm 85,Wis.Adm.Code 9 +,4 $ 4 Professional Sery{e s\/ , Schmitt Soil Testing,Inc, • Attach complete site plan on paper i tfia`K 8 4xx°1+ - -i -. -an must St. Croix include,but not limited to:vertices dr or+zoatel erene p i nd percent slope,scale or dimensipfs ortt'arrow,and location and distance to nearest road. Parcel I.D. �<< 032-2179-01-000 Plea-is print all information. Revi rE `1Bnvf�` -- (D.fat �f 2615 Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). ` '/X/ 17 // Property Owner Property Location '! �� Hanson, Susan, Govt.Lot NE1/4,SE1/4,S16,T30N, R19W (• )�ZO) Property Owner's Mailing Address t Block# Subd.Name or CSM# 573 155th Ave 1 Narnia's Nook City State Zip Code Phone Number r City _Village ❑ Town Nearest Road Somerset 1 WI 1 54025 1 Somerset I 155Th Ave. ❑New Construction Use: ❑ Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial-Describe: Parent material Till over Outwash(Santiago-Antigo) Flood plain elevation,if applicable NA ft. General comments The area is suitable for a conventional system with a 0.5 gpd/sqft rate. Possible system elevation for(3)80'long stepped treches is and recommendations: (T1)93.45, (T2)91,80',(t3)89.5'. Slope of the area is 16%. 1 Boring# I Boring X Pit Ground surface elev. 98.45 ft. Depth to limiting factor 102+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. •Efr#1 *Eff#2 1 0-15 10yr3/3 none grsl 2fsbk mfr as 2c 0.6 1.0 2 15-22 10yr5/3 none fsl 2fsbk mfr gw 2vf 0.4 0.8 3 22-60 7.5yr4/6 none Ifs Osg ml gw 2vf 0.5_ 1.0 4 60-102 7.5yr5/6 �� none s Osg ml ---- 0.,_ 1.6 CO 2 Boring# Boring ®'Pit Ground surface elev. 98.45 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz,Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sl 2fsbk mfr gw 2c 0.6 1.0 2 8-19 10yr4/4 none sl 2msbk mfr gw 2vf 0.6 1.0 3 19-48 5yr4/4 none sl Om mfi gw 1vf 0.2 0.6 4 48-72 7.5yr4/6 none Ifs Osg ml cs lvf 075-- 1.0 5 72-100 10yr5/6 stone s Osg ml cs 0.7 1.6 Effluent#1 =BOD5>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 �_�s �� I 227429 Address Schmitt Soil Testing,Inc. / Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond,WI 54017 3/30/2015 715-760-1978 SBD-8330(R.07/00) Property Owner Hanson,Susan, Parcel ID# 032-2179-01-000 Page 2 of 4 -3 [I Bori ng 3 Boring# Z Pit Ground surface elev. 93.90 ft. Depth to limiting factor 172+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10yr3/3 none sl 2fsbk mfr cs 2c 0.6 1.0 2 12-36 10yr4/4 none sicl 2msbk mfr gw 21vf 0.4 0.6 3 36-44 7.5yr4/6 none sl 2msbk mfr gw 1vf 0.6 1.0 4 44-60 7.5yr45/6 none Ifs Osg ml gw 1vf 0.5 1.0 5 60-104 10yr6/4 X 90 nq�e s Osg ml ---- 0.7 1.6 %tJ [I Boring 4 Boring# E Pit Ground surface elev. 105.22 ft. Depth to limiting factor 102+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10yr3/3 none sl 2fsbk mfr as 2c 0.6 1.0 2 12-21 10yr5/3 none grsl 2msbk mfr gw 2vf 0.6 1.0 3 21-56 7.5yr4/6 none sl lmsbk ml gw 2vf 0.4 0.7 4 56-92 7.5yr5/6 none Ifs Osg mfr ---- 0.5 1.0 5 92-172 10yr6/4 none s Osg ml ---- 0.7 1.6 ❑Boring Boring# Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<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. SBD-8330(R.07/00) Schmitt Soil Testing,Inc. Page 3 of 4 --Conducted-by: - . Conducted For: • _._ Schmitt Soil.Testing, Inc. Name: Susan Hanson _ — -- -_-_—_— ---- • ' Thomas J. Schmitt, CST 227429 Address: 573 155th Ave -1595-72nd St _. City, Stated Zip: Somerset W154017_ New Richmond,.WI 54017 ' _, ... 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