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HomeMy WebLinkAbout020-1161-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579018 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)]. c- _ Permit Holder's Name: City Village X Township Parcel Tax No: Kahler, Charles & Judith Hudson, Town of 020-1161-00-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: $Jf~~11 ~D61' a 76(7 or P °iv 0' 16.29.19.917 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark W t~'~ lDa~ D$ /al • lam, ~ 6•I/l~SC~ oJYLv ow Alt. BM $offAWs 1.N r p Aeration 3.77 ! 7 Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet wo lS. Z S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Inlet 1New p Y ,/~Q p Z Septic 4F sawm -5 -r our AJEW S~ • f Header/Man. 7 Aeration 93.Y Dist. Pipe Holding Bot. System L l l 116TW G EELS ~ O [ l PUMP/SIPHON INFORMATION Final Grade f7 6g M ufacturer Demand St Cover GPM - Model ber TDH Lift riction System Head TDH Ft Forcemain ength DWell SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ? SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: 11 O NA/j )C'~''v ) fo UNIT Model Number: lpN UG ~`J 1Z031~ DISTRIBUTION SYSTEM LHe,ader/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake *7 Pipe(s) gth Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only rBed/Trenc pth Over f Depth Over I xx Depth of eed /Sodded 1xx Mulched __T h C enter S Bed/Trench Edges q^ Topsoil Yes No ~ Yes 'No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 I Inspection #2: Location: 575 Spurline Circle Hudson, WI (54016 (SW 1/4 NE 1/4 16 T29N R19W) North Line Station II Lot 26 Parcel No::/16.29.19.917 1.) Alt BM Description b`pu/ Avb Ct4 2.) Bldg sewer length - amount of cover = Plan revision Required? ❑ Yes No T Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ARTr E County q ,I Industry Services l~sio St. Croix S 1400 E Washing PS~ J U L 10 2015 P.O. BOX 7162 anitary Permit Number (to be filled in by Co.) d d ST. CROIX COU Madison, WI 537=Tt6~.,,q 76t/ 3 5 77 Z) / O anitary ermi Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit /V lA- 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 1. Application Informat' - Please Print All Information ~75 w ~ Cr~C Property Owner's Name Parcel # Kahler, Charles & Judith 020-1161-00-000 17 r Property Owner's Mailing Address Property Location 575 Spurline Circle Govt. Lot City, State Zip Code Phone Number SW '/4, NE '/4, Section 16 Hudson, WI 54016 circle one) II. Type of Building (check all that aPP1Y) _LQL# T 29 N R 19 E o 2 ® 1 or 2 Family Dwelling - Number of Bedroom ✓ 26 Subdivision Name North Line Station II ❑ Public/Commercial - Describe Use 2Q' e. C&AMC Block # ❑ City of ❑ State Owned -Describe Use n CSM Number ❑ Village of 2 1J ~S4- A Li 741 i~g rI ® Town of Hudson III. T e of Permit: (Check only one box on line A. Complete line B if a licable) A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) g, ❑ 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 ) GK ® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tan c Other ispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Requir (so Dispersal Area Prop ed (sf) System Elevation 450 Rate(gpdsf) 643 700 92.50" & 91.50' 0.7 VI. Tank Info Capacity in Gallons Total # of o° a M n cturer New Tanks Existing Tanks Gallons Units :57-5 o y a p :57-5 P. v , iw C7 a Septic or Holding Tank 320 1000 1320 2 Wieser / eek's ® ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ignat e MP/MPRS Number Business Phone Number John Schmitt 'r 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 616 15Wh Ave. Somerset, WI 54025 VIII. Count /Department Use Only Approved Permit Fee Dat Issu Issuing t Signatur Own en Reason Denial 75. m 7 5 IX. Condi e s for.Disapproval &0 .1 a uen~ i er and ,dispersal cetl.must all a se IC s / maintaine Asper management plan provi 4 d by plumber. L AD-sottisek requi Oments must be: maintained as perappliottble code / ordinarms. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R03/14) PLOT PLAN N Project Name: Kahlers Replacement Septic System Legal Description: RHudsonn 16, T29N, R19W P.I.D: 020-1161-00-000 Subdivision Name: ion II Lot 4 Township: Parcel Size: 3.520 Acres SCALE: 1" 50 ' County: System Elevation: T1=92.00' Proposed 70' EZ Flow Trench Slope: 5% T2=91.50' Proposed 70' EZ Flow Trench BM1 Elevation: 100.00' To of existing drainfield vent pipe Existin Drain Field=18' X 36' Rock Bed BM2 Elevation: 97.14 Top of concrete in front of walkout door Backhoe Pits: 4 inch Sch 40 -ASTM D2665 NOTE: See Aerial Photo page 4 of Soil Eval. for a complete view of the parcel. 4 inch 3034 -ASTM D3o34 r i \ TI Ira J j 3W &AL s: r 010k t40"9 6M~ VALU X 5'; f rv to l 00 Q rl L \ L TANM SF0iI Page 2 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Kahler Conventional In Ground Owners Name: Charles & Judith Kahler Owner's Address 575 Spurline Circle Hudson, WI 54016 Legal Description: SW1/4, NE1/4, S16, T29N, R19W Township Hudson County: St. Croix Subdivision Name: North Line Station II Lot Number: 26 Block Number Parcel I.D. Number 020-1161-00-000 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 Information 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: 7/9/2015 j Phone Number: 715-760-0486 Signature In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Kahlers Replacement Septic System Legal Description: SEIM, NE1l4, S16, T29N, R19W P.I.D: 020-1161-00-000 F t7l Subdivision Name: North Line Station II Lot 4 Township: Hudson Parcel Size: 3.520 Acres SCALE: 1" = 50' County: St. Croix System Elevation: T1=92.00' Proposed 70' EZ Flow Trench Slope: 5% T2=91.50' Proposed 70' EZ Flow Trench BM1 Elevation: 100.00' To of existing drainfield vent ipe Existing Drain Field= 18'X 36' Rock Bed BM2 Elevation: 97.14 Top of concrete in front of walkout door Backhoe Pits: 4 inch Sch 40 -ASTM D2665 NOTE: See Aerial Photo page 4 of Soil Eval. for a complete view of the parcel. 4 inch 3034 -ASTM D3o3a Lt: U~ i i 3 0/0 CC J~ 3Z &AL S. T ~e r y Le I~rwSr~n.c } 00 Page 2 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Charles & Judith Kahler 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 5 ft2 Soil Application Rate 0.7 gpdtftz 450.0 gpd Design Flow _ 0.7 Soil Application Rate = F 715 EISA = 128.6 Feet of EZ Flow F2 ~ trenches 65 feet long each 2 No. of Cells 7 Per Cell 3 ft Cell Width 14 Total No of 1203H 70 ft Cell Length 350 sq ft EISA Per Cell 3 ft Cell Spacing 700 sq ft Total EISA Typical Cross Section Finished Grade 97 ft Observation Pipe with approved cap or vent . ■ Soil Backfill 36 inch Geotextile Fabric ■ 12 inch O II Slotted and Anchored VentJObservation Pipe 92.00ft with Cap O 91.5 ft Infiltrative Surface >36 inch 88.80 ft Limiting Factor ■ • ■ ■ ■ ° 88.25 ft Limiting Factor Plumber/Designer Signature: License MPRS 223760 Date: July 9, 2015 Page 3 M-MA :3'113 99tl8-5Z2-008 ZLOZ 'Nv 43SIn38 0 OSLtiS M 'NOON N301VW OL AMH sn 9LL£M z \ anod-isod zL oz £ -31Va zLOZ AavnNVr 3iVa ivnNdW 0I1d3S :8nod-3Hd „0-,L= b L :3lVOS 3ws -A8 NMVHG 31313113 M3131M Nw_Oz2M = w w V) w HQ Q z o m _ U OC Li 55 0 Q re cn = W V) a co 0 z 0 _ a m > U) U W H N LA- W V) Q Z F ~Op LO F- Q 0O J i z m F C O V p Ohm 0%< Q °w o a I- w oQ <=o z D m~ 3 L- ° > v Of 0 w C/) \ mN LJi F w J Z (L O Q a ce o Q 0 W w Q O U a o. CD, V) LL. .00 co wa aw( o 0 a Z V) a s dt* U) mw O W ~ C14a F Wi WQ¢ W~¢ W I¢- a d ..~~o-j 0) U 0Z Z~ ~i V) ..o Mo~(. 3:0 X: O0Y oow ¢ w m F ow ~v~i Y ~QQ pQwZ~O00 ZE'a ZNO U O z w X0 wWV N w w - ~~i,,11 Q er c~ ¢ cD ¢ Ln x W3m US2J3mJ3 F 0 Q U Z 20 Q J J a Q z ~Y Ow I- o z z of oz¢ OF U J Q W N I Q N F I- z N Q m U w cr M O w W N P-j _N ~g U cn sv0 II \ II 3 "8v Mn d_w w II 1 I > ~ ~s ' X Lo w II II W o sd0 ".v ° o „s. do L` w ¢ m 0 J J Q Zoos 0 N o5 FW- n9-V J_ a Ll- H1 ¢ N LL. L) asv „g9 Q 1 2 w Ln Y z Q F- Page 4 Inc. Innovations in Precast, Drainage ( Zabei~ PL-525 Effluent Filter & Wastewater Products V A D v s on of Polylok 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 won't leave the tank. Features: 1/16" Filtration Slots • Rated for 10,000 GPD (gallons per day). Alarm Switch 10,000 GPD (Optional) • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. Accepts 1" PVC Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for 10,000 GPD • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. 10,000 gallons per day (GPD). of 1/16° 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. 5. Replace and secure the septic tank cover. Certified to NSF/ANSI Standard 46 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 Gas Deflector septic tank pumper or installer. Automatic 1. Locate the outlet of the septic tank. Shut-off Ball 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. .y 5. Hose off filter over the septic tank. Make sure all - solids fall back into septic tank. I _e. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. PolylokOutdoor Zabel & Best fit fi a lters Alarm Extend i Lok , Zabel & B accept Easily installs 7. Replace and secure septic tank cover. 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.eom Page 5 Installation Instructions for EZ our Systems in Wisconsin 46EZfl TM FILTRATOR 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 positioned 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. 1 1. 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 down along the sides of the product to a point at least six 1203H-GEO inches from the bottom of product : - - - Geotextile Barrier Material 4. When installed in a trench, the trench should be dug to a width of 36 inches. This not only saves labor in excava- 72 tion, but also provides better load-bearing capacity after backfilling is complete. V1711 _71V 11 11 I'll • 36" • Page•6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Charles & Judith Kahler Tank Manufacturer: Week's C. P. NA Permit # l Septic E Dose C Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: NA Number of Bedrooms: 3 NA E~ Septic E: Dose E 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 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/day/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 (8005) :5220mg/L NA Pump Manufacturer: 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 Mechanical Aeration r Peat Filter VNA Total Suspended Solids (TSS) 5150mg/L r' Disinfection Wetland Petreated Effluent Monthly average Sand/Gravel Filter Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L NA IV In-Ground (gravity) I In-Ground (pressure) Fecal Coliform (geometric mean) 5104cfu/100ml At-Grade Mound NA Maximum Effluent Particle Size: %a in dia. N Drip-Line Other: Other: Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third ('Y) of tank volume Pump out contents of tank(s) When the high water alarm is activated Inspect condition of tank(s) At least once eve 3.. month(s) ry: f year(s) (Maximum 3 ears) NA Inspect dispersal cell(s) At least once every: 1.5 month(s) ry: year(s) (Maximum 3 years) NA Clean effluent filter At least once eve 1.5 I"` month(s) ry: year (s) NA Insect Um month(s) p p um pump controls & alarm At least once every: year(s) NA 17 month(s) Flush laterals and pressure test At least once every: year(s) 170 NA Other: Turn off Bed month(s) Use T1 & T2 for 5 year(s) NA Other: Alternate Drainfields Alternate Drainfields every 1.5 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 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: Marko Septic Name: St. Croix County Zoning Phone: 715-749-3404 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. Page 8 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) 575 Spuriine Circle located at: SW 1/4, NE 1/4, Section 16 , 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 7/7/2015 Did flow back occur from absorption system? Yes No (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): week's Concrete Products Age of Tank (if known): 31 Permit number (if known) 49446 a John Schmitt VKensed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 7/9/2015 (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 Charles and Judith Kahler Mailing Address 575 S p u rl i n e Circle Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Hudson, Wl Parcel Identification Number 020-1161-000-000 LEGAL DESCRIPTION Property Location SW '/4 , NE '/4 , Sec. 6 , T 29 N R 19 W, Town of H u d s o n Subdivision Plat: North Line Station II 26 ,Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 0yesEho Lot lines identifiable ByesOno 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 's form 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 w ranty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) y' 400~bo b 200 00 0 _ { 00 . g4n5b p~"W 2.34 Pp RE5 by yr~ \ti>f /~,C Zoo I05.53 S b" Opp y? f 1.. 5 43390.. Ory~ •~bhti \ lJJ ,.~eo , k, O ry ' ~b ry„ l Y \ /~~C x/89 12• j ro°ti~ l' OI b~ X60 > j/ o 2 9 ARE`' - P n _ x• ? pbry 92 ~j J,. s43a PARES v 39p " NOTE 2- N{ ay /1 J W O N o ~c 26~~gga 3g 2~. °d I '1 N , O % "29 ° - 26 J1 9 s PcRES t'. J a3, ~a~ ~0 P% t E21 3 0a -LEGEND- ~ aa` + EXISTING 3/4"DIA. ROUND STEEL BAR -t7p 3g _ + + EXISTING 1 IRON PIPE f. - -s 62*0901 E ur ~4P. SECT'ION CORNER MONUMENT, BE RNTSEN . CAP ` ~ W'a" a°p 9fO J 3- ,p~ 12' UTILITY EASEMENT PARALLEL TO t -"a e04 of", LOT LINE - ,t l 5 <a t y~ a u °ifl PN t{1, v- t 2 0 127" X 30" GRADE 60 ROUND STEEL REIN- - %4 % FORCING BAR WEIGHING 4.303 LBS./L FT.. 3Sa - - / SET r ES eezd / ALL OTHER LOT CORNERS STAKED WITH ,75"X T A' 25+1 ""'Es i f Z i 24" GRADE 60 ROUND STEEL REINFORCING BARS WEIGHING 1502 LBS / L.FT. NOTE: THE ERECTION OF ALL LINEAR MEASUREMENTS HAVE BEEN MADE ,g_ o BUILDINGS FOR HUMAN HABITATION TO THE NEAREST ONE HUNDREDTH OF A FOOT. g!`- pe . , °o• ' IS PROHIBITED, AND CONSTRUCTION ALL ANGULAR MEASUREMENTS HAVE BEEN La u eN 8ge41 OF PRIVATE SEPTIC SYSTEMS MUST MADE TO THE NEAREST 20 SECONDS AND 4-5 J COMPLY WITH WISCONSIN STATE ,LAKds - ' AOMNISTRAnVE CODE H62.20 ON COMPUTED 70 THE VALUES SHOWN. j. OUTlO7 2. / f f1 THIS INSTRUMENT DRAFTED BY RECEIVED p pr =TVUlb P A SOIL EVALUATION REPORT q `7 y S #1793 in accordance with Comm 85, Wis. Page 1 of 4 n( Schmitt Soil Testing, Inc. Attach COMMUNITY DEVELOPMENT County complete site plan on paper not less than 8%2 x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ParYw- Please l Iprint all information. 020-1 61-00-000 Personal information you provide may be used for secondary Purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner Property Location Kahler, Charles & Judith Govt. Lot E1/4, E1 , S16, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name r CSM# 575 Spurline Circle 26 North Line Station 11 City State Zip Code Phone Number City ❑ Village ❑ Town Nearest Road Hudson WI 54016 Hudson S ursine Circle New Construction Use: E~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD X Replacement ❑ Public or commercial - Describe: Parent material Outwash plain (Sattre Series) Flood plain elevation, if applicable NA ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Posslibe system elevation for replacement area is (High trench) and recommendations: 92.0' (Low trench) 91.5'. Slope of area is 5%. F-11 Z Boring # ❑ Boring Pit Ground surface elev. 98.14 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Efff~2 1 0-16 10yr3/2 none I 2mgr mvfr as lvf 0.6 0.8 2 16-27 10yr4/4 none siI 2fsbk mfr gw 2m,2vf 0.6 0.8 3 27-32 10yr4/4 none grsl 2fsbk mfr gw 1vf 0.6 1.0 4 32-59 7.5yr4/6 m2d 10yr6/8 sit lcsbk ml 10yr6/2 gw 0.4 0.6 5 59-100 7.5yr4/6 none s Osg ml gw 0.7 1.6 Doesn't Meet 2' rule for Redox Features. 21 Boring # ❑ Boring Pit Ground surface elev. 95.59 ft. Depth to limiting factor 96+ 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 •E02 1 0-11 10yr3/3 none sl 2mgr mvfr as ivf 0.6 1.0 2 11-22 10yr4/4 none sl 2fsbk mfr gw 2vf 0.6 1.0 3 22-31 7.5yr5/6 none grsl 2msbk mfr gw 2vf 0.6 1.0 4 31-62 10yr5/3 m2d 1 sit 2fsbk mfr as 10yr6/1 /i 0.6 0.8 5 62-96 10yr6/4 none s Osg ml 0.7 1.6 Doesn't meet 2' rule for Redox features. * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD5 <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 7/7/2015 715-760-1978 SBD-8330 (R.07/00) Property Owner Kahler, Charles & Judith Parcel ID # 020-1161-00-000 Page 2 of 4 73Boring # ❑ Boring Z Pit Ground surface elev. 97.29 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 0-13 10yr3/3 none sl 2mgr mvfr as 2vf 0.6 1.0 2 13-29 10yr4/4 none grsl 2fsbk mvfr gw 2f,2vf 0.6 1.0 3 29-50 10yr4/4 m2d 10yr6/8 sil 2fsbk mfr as 2vf 0.6 0.8 10yr6/2 4 50-84 7.5yr4/6 none gcos Osg M1 CS 0.4 0.6 5 84-102 7.5yr4/6 none s Osg ml 0.7 1.6 Meets 2' rule for Redox Features. ~L rl T F4 ❑ Boring Boring # Pit Ground surface elev. 97.29 ft. Depth to limiting factor 103+ 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 0-10 10yr3/3 none sl 2fsbk mvfr gw 2vf 0.6 1.0 2 10-20 10yr3/4 none sl lfsbk mfr gw ivf 0.4 0.7 3 20-30 10yr4/6 none grsl lfsbk mfr gw 1vf 0.4 0.7 4 30-45 10yr6/4 none s Osg ml as 0.7 1.6 5 45-50 10 r5/3 m2d 7.5yr6/8 y 7.5 2 sit imsbk mfr as 0.4 0.6 6 50-103 10yr6/4 none s Osg ml 0.7 1.6 Meets 2' rule for Redox Features. yZ 5 ❑ Boring ♦1 5 Gl Boring # Pit Ground surface elev. 97.00 ft. Depth to limiting fal 02+ 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 1 0-17 10yr3/3 none grsl 2fsbk mfr as 2f,2vf 0.6 1.0 2 17-31 10yr4/4 none sil 2fsbk mfr gw 2vf 0.6 0.8 3 31-48 10yr5/6 none grcos Osg mI cs 1vf 0.7 1.6 4 48-54 10yr5/3 m2d 7.5yr6/8 7.5yr6/2 sit imsbk mfr as 0.4 0.6 r 5 54-105 10yr6/4 none s Osg ml 0.7 1.6 t Meets 2' rule for Redox Features. f LI * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 , 30 mg/- 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 SW Testing, Inc. - - Conducted by: Page 3 of 4 --Conducted For: _ Schmitt S©ns Ex~~vsating,_~nc _ - Thomas J. Schmitt, CST 227429 Name: --.Chart a i nditl►-K$Wer ~ _ Address: - - 575 Sporlinje Circle zip, -SomP_ rse ldl1~4025 - - - - Phone: 715-7W-1978 Subdivision - North Line Station 11 signa a,-..r. Jam'" LotNo: Dal- Legal lass 4A( 1,4516 ~~N 119R~ - - ■ Bac khoe Pit _ Township, County Troy To ch M a r.- i wnship, St Croi$ County ,Benk 1-EI. 1p0.00' Top of existing dramfield.vent pipe.. ~e+ich AAafk 2-~l~ ~~.14' Tflpef c©nG+~ete slab-itt-ffer}t-©#-waFk-cxit door-- _ Slope= 5% - - -Scale 1°'= 50' - - - NOTE: SEE AERIAL PHOTO FOR FULL VIEW OF OT' GE 4 OF 4 - - - - II V~ - - - - - r lei - - - ~ - Pie - - -