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HomeMy WebLinkAbout036-1099-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578923 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: Village X Township Parcel Tax No: City Horsman, Scott Stanton, Town of 036-1099-10-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 9 814 . 4 5 198q. 1-15 1 1V W CO KALAK /U O9 5)d, /1 31.31.17.598 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic U11 know XIS `��� Benchmark �,�� �$b.8 9Q�• / s(DiL c,p i 1J 7� L/ U p-1 UUt pl_ mg J 1. '� �t��Z� L�V Alt. BM Tl.r 1t' . 4.41! 9'6 1. (D Bldg.Sewer �,y5 9191- 39 }}OW" StWWInlet TANK SETBACK INFORMATIO 6�'W SWA Of- k6liSt StN*0utlet ,.O U7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD WInlet b� q"�p•-1 E q57' 'tsc� 32 D { _! Septic t 'Sbl ids, Dt'BeEtea� w+ese� 2a cv+�I (� °I• to Header/Man. v -1 w; �c s-r q3' ' Zy . _ 8,10 °►�8 . /amWq Dist.Pipe ILI Q -� Ing Bot.System N ci.46 q.y/ 1l'1.3� 977,E S A. 1911L °177.9 Q PUMP/SIPHON INFORMATION Final Grade b Y--� IO.SC) $b•b Manufacturer Deman St Cover "i q Q -1 tV . Model umber TDH Lift Friction Loss Sys ead TDH Ft Forcem ' Length la. Dist.to well SOIL ABSORPTION SYSTEM BED/TRENCH Width 3j ILpgth No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS G, SETBACK SYSTEM TO P/L JBLDG WELL 1A4tE1STREAM LEACHING Manufacturer: j5Z FI-6t J INFORMATION :F— CHAMBER OR ype Of System: CO�I"cN�oAl ��► 3l�' �/� 1 1 UNIT ModelNum e�O DISTRIBUTION SYSTEM ,v l� ��kt 1z: I Un i -kL� Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake,2 Length —7 / Pipets) C�� Dia� Length Dia Spacing I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Tren opsoi es COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1434 181st Ave.New Richmond,WI 54017(SE 1/4 SW 1/4 31 T31 N R1 7W) Hook's Addition Lot 1 Parcel No: 31.31.17.598 1.)Alt BM Description= -�� +! (,D`Pei� FYI 7tA k5, G-d doh.�d /�-✓ Cam. 2.)Bldg sewer length= &3 1 1 n /„ ,bG�s -amount of cover= ^�1 C GM b n p� , C/ -4 n S Plan revision Required? Ed Yes No l�j 1 Use other side for additional information. /� F/Z Date Insepctor's Signature Cert.No. SBD-6710(R.3/97) ;;ci.Hrti,rti r'e"' ,i County !A "t Industry Services Division St.Croix 0 1400 E Washington Ave A P s F T P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 5—1-5 tom+ O4 a 1?,O, . m y anrtary Permit App State Transactio Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit 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 / � Q I. Application Informa ' n—Please Print All Information /O /ZI Property Owner's Name / Parcel# Scott Horsman 036-1099-10-000 � O Property Owner's Mailing Address Property Location 1434 181st Avenue Govt.Lot City,State Zip Code Phone Number SE'/4,SW%4, Section 31 New Richmond,WI 54017 (circle one) T31N R17EorW U.Type of Building(check all that apply) e Lot# I or 2 Family Dwelling—Number of Bedrooms 1 Subdivision Name Hook's Addition El Public/Commercial—Describe Use Block# E] City of ❑State Owned—Describe Use Village of ' l CSM Number 2 'S +- c-ew ,5 +-J"'. S 0, e4 A Town of Stanton III.Type of Permit: Check only one box on line A. Complete line B if a licable A. ❑New System ❑X Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV.Type of POWTS System/Component/Device: Check all that a 1 ❑X Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil LJ Holding Tank Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Treatme Area Information: Design Flow(gpd) Design Soil Applicatio K Dispersal Area Requir (sf) Dispersal Area Pro d(sf) System Elevation 450 Rate(gpdsf) 643 650 978.00',977.50' 0.7 VI.Tank Info Capacity in w °o Gallons & A. Total #of Manufacturer Gallons Units u New Tanks Existing Tanks J� 7--_' U Septic or Holding Tank 320 1000 1320 1 2 Wieser/Unitnown ❑ I ❑ 10 1 ❑ ❑ Dosing Chamber I I ❑ ❑ 10 1 ❑ ❑ VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plu r ign MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address(Street,City,State,Zip Code) 616 150th Ave.Somerset,WI 54025 V111,County/De artment Use Only KApproved isapprove Perm,i/t Feee Date I sued L� Issum t Signature Ow &� en Reason for Denial $ IX.CondiUSFIEM114)"WReasons for Disapproval 3) a t 5y�Z.v.. 4-b At' eu 1.' Septic tank,effluent flfter and J / '�11 dispersal cell must all be services I maintained L �+ (_ ^ �rlaa0' Q(�,.f as per management plan provided by plumber. lf' A DANI h tr lJ�� �O f 2. s11Ck l9attir®menu fntsst be ita►ntaified / i of ininces. 5 b S! Z Attach to complete plans for the system and submit to th ounty only on paper not less than 81/2 x 11 inches in size 6398(R03/14) PLOT PLAN N Project Name: Horsman Replacement Septic System Legal Description: SE1/4,SWIM,S31,T31 N,R17W P.I.D: 036-1099-10-000 Subdivision Name: Hooh's Addition Lot#: 1 SCALE:1"=40' Township: Stanton Parcel Size: 0.75 Acres County: St.Croix Slope: 8% System Elevation: T1=978 00'Proposed 65'EZ Flow Trench Flood Plain El. 979.00' T2=977.50'Proposed 65'EZ Flow Trench A BM1 Elevation: 984.45' Bottom of Siding NW corner of garage BM2 Elevation: 981.92' Top of existng vent pipe Backhoe Pits: 4 inch Sch 40-ASTM D2665 4 inch 3034 - ASTM D3034 q�1 ✓ ��'� 8�,� 5c�pC 4K S r"ti's r 62- \ le .5ZO irk .50ric r4A. e� �1 3 .8E®ev��w1 � }Rlar✓r o Houk ArA W EL a A-s P 6a Cale �rvt� � j1si Av JCjCOrII Page 2 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Horsman Conventional In Ground Owners Name: Scott Horsman Owner's Address 1434 181 st Avenue New Richmond, WI 54017 Legal Description: SE1/4, SW1/4, S31, T31N, R17W Township Stanton County: St. Croix Subdivision Name: Hook's Addition Lot Number: 1 Block Number Parcel I.D. Number 036-1099-10-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross Section Page 4 Septic Tank Specifications Page 5 Filter Information 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: 4/24/2015 Phone Number: 715-760-0486 Signature: In round Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN 7N Project Name: Horsman Replacement Septic System Legal Description: SE1 14,SWIM,S31,T31N,R17W P.I.D: 036-1099-10-000 Subdivision Name: Hooh's Addition Lot#: 1 SCALE:1"=40' Township: Stanton Parcel Size: 0.75 Acres County: St.Croix Slope: 8% System Elevation: T1=976 00'Pro osed 65'EZ Flow Trench Flood Plain El. 979.00' T2=977.50'Proposed 65'EZ Flow Trench BM1 Elevation: 984.45' Bottom of Siding NW corner of garage BM2 Elevation: 981.92' Top of existng vent pipe M Backhoe Pits: 4 inch Sch 40-ASTM D2665 4 inch 3034 - ASTM D3034 a 63 8M Z 320(A c1 1000461 t_ c� B sOrit 74 K OA- deft DECK 3 geD2c%oM b�,Jf fA 6ARfAG6 Nvus b� WELL OV Av°i_ Page 2 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: SCOTT HORSMAN Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 System Sizing EISA Rating per Foot of EZ Flow F-5" ft2 Soil Application Rate 0.7 gpd/ft2 450.0 gpd Design Flow_ 0.7 1 Soil Application Rate_ � EISA= 128.6 Feet of EZ Flow trenches F6-5-]feet long each 2 No. of Cells 6.5 Per Cell 3 ft Cell Width 13 Total No of 1203H 65 ft Cell Length 325 sq ft EISA Per Cell 3 ft Cell Spacing 650 sq ft Total EISA Typical Cross Section Finished Grade 980.5 ft Observation Pipe with approved cap or vent Soil Backfill 36 Inch ' ' Geotextile Fabric h • " Slotted and Anchored Vent/Observation Pipe 12 Inc O �) ' ' with Cap 978.00ft O 977.50 ft Infiltrative Surface >36 inch <976.00 ft Limiting Factor ■"®®"r a-l-r.��®""""®""•®"■"" <974.50 ft Limiting Factor Plumber/Designer Signature: License#: MPRS 223760 Date: April 24, 2015 Page 3 an-oa `3ii� 99te-5Z2-009 ZIOZ •Ndf 03SIA38 ° \ OSLtiS IM ON N30lVW Ol AMH Sn 9LL£M Z Nnod-lsod al oz £ 31v0 zloa ,avnNVr 31V0 ib'nN`dW 3Ild3S w o £_ON 'A3N 31 LLJ :8nOd-38d «0-,1-«b t •31VOS 314S *A 380000 8 NMVNO 13131M aW—Mm r- \ Ld f� Ld W Q Z m0 w o O U V1 d U Q� N d W W d m O O° ° (n m w N Q °w V) U Wo J .. ¢ w J N 0 m LU w z 0:0 Mom O ^Q � Z w c c z N m _ v o �J °Z = 2 w�F Q 3 U. o a F— W = °Q QQU � CL Mj Z Q a N O W 4J< J Z O a c Q a \ N mN J W W Q O \ O� U Q Q a o m Q a LLW��°f/I C9 a !n Z .Zip (n �¢ n� QW(n o O Q Y O U X00°H JIFa m(f) �} m w O 4k� Q N W M a N�N0J>Nj FaU �ZN M- Z OZ YO a �liJ �Z� .. O I- -- =)V) U U \ (n� a O M JO F- •• r OQW OOw Q W m F WpW F-V) ZJ� �Z°°�°°° °UN °c°n� Q ° z (L x° wU Y °QO QWZ°wo �i—I ZQ�UQ' Q$0 U U Q (n �x ND: z U5 3c co-) S�J` 3mJ ° 0 U Oo Y w�w •• Q J J d O Z >Z N Z ? J J H VF U J Q W N Q F- II W Q W U � D d• O W Q J N F- N ° M 9� U rl a N SVO «ti Q II II ,9-V do 3 W w 5 0 II I a 1 «l9 £ W w II II o -n .2-0 •b svo « ° o � _ -� ~ „ 9t do N U- W Lj Q m O w o J ° W Z « 9� � W F- 0 „OS J 1 '� «� a a i LL. a 40321 „99 a sv g w Q N Y Z Q F Page 4 P0LYA0tX---Inc. P L-525 Effluent Filter Innovations in Precast,Drainage Zabel® 1 &Wastewater Products A Division of PoMok Inc. PL-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 wori t leave the tank. Features: 1/1.6" Filtration Slots Alarm Switch • Rated for 10,000 GPD(gallons per day). 10 GPD (optional) • 525 linear feet of 1/16"filtration. ' � Accepts 1"PVC • Accepts 4" and 6"SCHD 40 pipe. Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. Rated for • Alarm accessibility. 10,000 GPD • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to of 1 Linear Ft. of 1/16" 10,000 gallons per day(GPD). Filtration Slots 1.Locate the outlet of the septic tank. 2.Remove the tank cover and pump tank if necessary. Accepts 4"&6" 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. Certified to 5.Replace and secure the septic tank cover. NSF/ANSI standard 46 PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring � .v .. 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 Gas Deflector needs servicing.Servicing should be done by a certified septic tank pumper or installer. Automatic III Shut-Off Ball 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. hNAW 6.Insert the filter cartridge back into the housing making Outdoor SmartFilterl�n Alarm Extend&I the filter is properly aligned and completely inserted. Polylok Zabel&Best filters accept Easily installs 7.Replace and secure septic tank cover. the SmartFilter®switch and alarm. into existing tanks. Polylok,Inc. 3 Fairfield Blvd. Wallingford,CI' 06492 Toll Free:877.765.9565 Fax:203.284.8514 www.polylok.com Page 5 Wisconsin Department of Commerce,Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow(GPD) and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84,Wisconsin Admin.Code,and Chapters 145 and 160,Wisconsin sizing can be used in Wisconsin, resulting in a 40% smaller Statutes. All sites must meet the Site Soil Conditions&Locations dramfield. &Isolation distances as noted in local regulations. The approved products are 1203H(3-12" bundles with pipe in cen- 6. Place EZflow bundle(s)in the EZflow configuration approved ter bundle in 5'or 10'lengths)and 1203 HP(3-12"bundles with Pipe by system design permit specified for the particular site.The in each bundle in 5'or 10'lengths.g top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler.Any additional aggregate ed by EPS aggregate and is held together with polyehtylene net- only bundles that may be required,should be butted against ting.A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filter fabric pre-manu- • EZflow@ Bundles factured in between the netting and aggregate. The fabric • EZflow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZflow Internal Pipe Couplers sure the the GEO is positioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation Instructions 8. The EZflow Dramfield Systems should be installed in a level The instructions for installation of EZflow® products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom)and should follow the contour of the ground surface defined in chapters Comm 82 through 84,Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code,and Chapters 145 and 160,Wisconsin Statutes,as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing,con- figuration,and layout for the EZflow systems,stake or mark 9.The trench top shall be graded such that water will not pond. with paint the location of trenches and lines. Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe, header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10.EZflow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZflow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed EZfIot„assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown, however,that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6"of soil cover as bottom of product. recommended by manufacturer. 4. When installed in a trench, the trench should be dug to a 1203H-GEO width of 36 inches. This not only saves labor in excavation, Geotextiie but also provides better load-bearing capacity after backfill- Barrier Material ing is complete. 12" low c�,v�x"urvw�s wmi w�u ewacxwaiwc 38" IN Top r_ '�� Ring Industrial Group GG P: 1-800-649-0253 30 Industrial Park PERFORMANCE. QDOES IT. F: 1-866-279-9203 Oakland,TN 38060 � Ringlndustrial.com 1044-101008 ©2006 Ring Industrial Group,LP Page 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page—of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Scott Horsman Tank Manufacturer: Uknown NA Permit# E Septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA Number of Bedrooms: 3 NA I_ Septic E Dose Holding Volume: 320 gal Number of Public Facility Units: rP'$JA Vertical Distance Tank Bottom (s)to Service Pad: ft Estimated (average) Flow: 300 al/day Horizontal Distance Tank(s)to Serivice 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: 0.7 al/da /ft2 horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok NA Fats,Oils&Grease(FOG) s30 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand(BOD5) 5220mg/L NA Pump Manufacturer: rk– 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 f✓NA r' Mechanical Aeration r Peat Filter WNA Total Suspended Solids(TSS) 5150mg/L 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 PNA fv'In-Ground(gravity) T"' In-Ground(pressure) r NA Fecal Coliform(geometric mean) 5104cfu/100m1 At-Grade r Mound Maximum Effluent Particle Size: %a in dia. NA r Drip-Line other: Other: Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third ('/3)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 IV year(s) (Maximum 3 ears) NA month(s) Inspect dispersal cell(s) At least once every: 1.5 r/ year(s) (Maximum 3 years) NA month(s) r° Clean effluent filter At least once every: 1.5 year(s) 1 NA month(s) Inspect pump, pump controls&alarm At least once every: year(s) W NA mont s Flush laterals and pressure test At least once every: r years) 1710 NA month(s) Other: Shut off existing drain field Use T1 and T2 for 5 I`✓ year(s) r NA Other:Alternate Systems After 5 years use existng drain field for 1 year, then trenches for 2 years, 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('/)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 s12 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. Palms.1805) 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) 1434 181st Avenue located at: SE 1/4, SW 1/4, Section 31 , Town 31 N. Range 17 W, Town of Stanton , 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 14, 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: Construction: Prefab Concrete X Steel Other Manufacturer (if known): Age of Tank (if known): Permit number (if known) aA 4"__In4�e John Schmitt (Vdensed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS April 24, 2015 (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 Scott H o rs m a n Mailing Address 1434 181 st Avenue Property Address Same (Verification required from Planning&Zoning Department for new construction.) City/State New Richmond, WI Parcel Identification Number 036-1099-10-000 LEGAL DESCRIPTION Property Location SE 1/4 , SW `/4 , Sec. 31 T 31 N R 17 W Town of Stanton Subdivision Plat: Hook's Addition , Lot# 1 Certified Survey Map# , Volume , Page# Warranty Deed# (before 2007)Volume , Page# Spec house❑yes[Dno Lot lines identifiable Dyes❑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. I/we certify that all statements on t is fornty m are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a ra deed recorded in Register of Deeds Office. Nu r of bedrooms 3 04/24/15 SIG ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) Page 10 i�111f1�IIII IIIII IIIII IIII111111141I I�III�1II4 1114 * 8 7 8 9 6 3 1 878983 STATE BAR OF WISCONSIN FORM 1 -2000 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Susan M. McGill, an unmarried person, RECEIVED FOR RECORD Grantor,and Scott T. man, C(p6rSon Grantee. 07/25/2008 03:OOPM Grantor, for a valuable consideration, conveys to Grantee the following / WARRANTY DEED EXE described real estate in St. Croix County, State of Wisconsin (the J 11 "Property"): REC FEEE:: 11.00 p '�): TRANS FEE: 465.00 PAGES: 1 Lot 1, Hook's Addition to the Town of Stanton, St. Croix County, Wisconsin. Recording Area Name and Return Address: St.Croix County Abstract and Title Co.,Inc. 219 S.Knowles Ave. New Richmond,WI 54017 Together with all appurtenant rights,title and interests. Parcel Identification Number(PIN) 036-1099-10-000 This j S__homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements,covenants,and conditions of record. Dated this 1 J day of July,2008 () - "-MeLry-71 a C (�U *S s n M.McGill * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) COUNTY St.Croix )ss. authenticated this Personally came before me this 4C day of July, 2008 the above named Susan M. McGill to me known to be the * person ) who executed the foregoing instrument and TITLE:MEMBER STATE BAR OF WISCONSIN ac o ed a same. (If not, authorized by§ 706.06,Wis. Stats.) J ,.� * w THIS INSTRUMENT WAS DRAFTED BY Nolary Putlic,State of Wisconsin My commission is permanent. (If not,state expiration date: AeRobert L.Lober Lober Law Office "•: �� (Signatures maybe authenticated or acknowledged. Both are not+lect;s"sa *Names o£persons signing in any capacity must be typed or printed bel; `. � W .1 ' a a WARRANTY DEED STATE BAR OF WISCONSIN FORM No.1-2000 1 of 1 • a ldi � ad JJ NaoaOa foil .i ad r1 ap ae 0. 5 It 900 s \ `O f0 o J. �Jde dw d �,a6 n4 pd 00 10* �e a lf1' dlevatroa Osta `LO oI 94 Nay '0 19410 !'"toss Iavo1 a Also wol marl 911.041 J' /1 0`4 c Era tiaweed Lt. Wolfer Karel 974.30` p "► `e� BNvetiaea aav+ad tram U.9- Oee•. survey O D.W eam"t 4-90 (1931) Elay.99y' N 413 x s 40e 14 ' DO e dOa N$9 47 W m �0 n # a n 9t9.041'� q O w 4 o "w M O a N � W . �a`ie 3• p— N r0 ~ o p• n a, qj"'�`'� 04' 3D' 90 140.00' z 1C; a '1d', •je w ht O. eA d!e er+� d ei T7r 00*14 9 3411.11' a 0, Vefn-Lain Dfive $ ° a W re it �r �t UPRlA2ibd.J9MOI v v w w w V4-SW 1/4 Po d d0. IM N91lfroN0 w941e416's +994.90'11,00 41M ssyae1,Iasa.b!,T.31M..LTV. SOIL �i 'vch REPORT #177$ ety and ., +"'� in ac�oYtla_ce tti m 8 ,Wis.Adm.Code Page 1 of 4 ProfessioRk84r" { ) --- --- ._._ __._.._ Schmitt Soil Testing,Inc. .,�... r County Attach complete site plan on ppl� �� c#tot I"s.tFt9n 8%x 11 inches in size. Plan must St.Croix include,but not limited tc>i1etf W and-h6rizontal reference point(BM),direction and percent slope,scale or*igsi6ns,north arrow,and location and distance to nearest road. Parcel I.D. ,,T�;,• 036-1099-10-000 Please print all information. Rev' By Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 7i 7 115 Property Owner Property Location Horsman, Scott Govt.Lot SE1/ , 1/4, S31,T31N, R17W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 1434 181 st Ave. 1 Hook's Addition City State Zip Code Phone Number City []Village ❑ Town Nearest Road New Richmond WI 1 54017 1 1 Stanton 1 181 St Ave New Construction Use: ❑ Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial-Describe: Parent material Outwash(Sattre Silt Loam) Flood plain elevation,if applicable 979.00' ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for replacement area is(Step and recommendations: Trenches)Upper 979.00',Lower 978.50'. Slope of area is 8%. � Ad t.` ?72 AsL Boring# 1 F-- Boring [�pit Ground surface elev. 980.24 ft. Depth to limiting factor +75 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 0-9 10yr3/3 none sl 2mgr mfr a 1vf 0.6 1.0 2 9-19 7.5yr4/6 none grsl 2msbk mfr gw 1vf 0.6 1.0 3 19-36 7.5yr5/6 none grcos Osg ml cs ------ 0.7 1.6 4 36-52 10yr6/4 none s Osg ml Cs ------ 0.7 1.6 5 52-66 7.5yr5/6 none cos Osg ml cs ------ 0.7 1.6 6 66-75 10yr5/6 none s Osg ml ---- ------ 0.7 1.6 d F2 Boring# �]Boring 201) ❑pit Ground surface elev. 980.0 ft. Depth to limiting factor + 5 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 2mgr mfr a 2vf 0.6 1.0 2 8-14 7.5yr4/6 none scl 2fmsbk mfr gw 1vf 0.4 0.6 3 14-38 7.5yr5/6 none grcos Osg ml cs 1vf 0.7 1.6 4 38-71 10yr6/4 none s Osg ml cs ----- 0.7 1.6 5 71-75 7.5yr5/6 none grcos Osg ml Cs ------ 0.7 1.6 1 � H 1 "Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/Ly "Effluent#2=BODS<30 mg/1 St<_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 4/14/2015 715-760-1978 SBD-8330(807/00) Property Owner Horsman,Scott Parcel ID# 036-1099-10-000 Page 2 of 4 r Boring 3 Boring# pit Ground surface elev. 979.35 ft. Depth to limiting factor 79 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#t *Eff#2 1 0-9 10yr3/3 none sl 2fsbk mfr as 2vf 0.6 1.0 2 9-12 7.5yr4/6 none grsl 2msbk mfr gw lvf 0.6 1.0 3 12-47 7.5yr5/6 none s Osg ml cs ------ 0.7 1.6 4 47-79 10yr6/4 none grcos Osg mi cs ------ 0.7 1.6 5 79-86 10yr6/4 WET SAND grcos Osg ml Cs ------ 0.7 1.6 6 86-92 10yr6/4 H2O SEEPING grcos Osg ml ---- ------ 0.7 1.6 4-74 A 77• Boring It1 Z I F-1 Boring# P8 Ground surface elev. � Depth to limiting cRor in. ❑ � Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 [�Boring F-1 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 GPDM2 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. SBIM330(R.07 100) Schmilt Soll Testing,Inc. 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