Loading...
HomeMy WebLinkAbout032-2163-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 579064 GENERAL INFORMATION 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 Township Parcel Tax No: Andrew Schmitt TOWN OF SOMERSET 032-2163-05-000 CST BM Elev: Insp. BI~EI v: BM Description: Section/Town/Range/Map No: / ; L a 14.31.19.1397 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1.07 104• /a S. -7 9"1* 0g Alt. BM a z ~ A-/60 Aeration Bldg. Sewer i ct JL Holding SVHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 4-11 Septic Dt Bottom T Dosing Header/Man. 9rAll, 9G•98 Aeratio Dist. Pipe $ 96 .yq 9 •$4 Holding Bot. System 9t* . e PUMP/SIPHON INFORMATION Final Grade `],g I)`f Manufacturer Demand St Cover Model Number ' TDH L Friction Loss System Head TDH Ft Forcemain Lengt la. Dist. to Well SOIL ABSORPTION YSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 '7x L ~j ft SETBACK SYSTEM TO C~ P/L BLDG Y WELL LAKE/STREAM LEACHING Manufacturer: /z INFORMATION / CHAMBER OR G Type NJZ v~ 1 ~ d 3G, /VS 2 i ~ M- UNIT Model Number: 6 DISTRIBUTION SYSTEM oC -7+7 = / Header/Manifolp Distribution x Hole Size x Hole Spa Ven ~ Air take Length / Dia Length Dia Spacing- \ SOIL COVER f x Pressure Systems Only xx Mound Or At-Grade Systems Only 'B Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center h~ Bed/Trench Edges\ Topsoil 3.1)4 Yes ~ No ~ Yes R No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 Inspection #2: Location: 2128 62ND ST S t-i C(- C6 J 4. I e*- ti 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover .64 2-No Plan revision Required? Yes 7-4 f 5 Use other side for additional information. ! SBD-6710 (R.3/97) Date Insepctor's Stature Cert. No. County ~"""r'"~r Croix ECEI Y Industry Services Di n (a D 1400 E Washington ve Mary Permit Number (to be filled in by Co.) Y} ' S P.O. Box 716 C~ ~yb / L P S At1G Madison, WI 53707-7162 crrtii~k IXcouN`1'Y :,ommUNl~Y ary ermit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission ofthis form to the appropriate governmental unit AV is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to project Address (if different than mailing addT the Department of Safety and Professional Services. Personal information you provide may be used for secondary Same ng purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. (Q n 1. Application Inform - Please Print All Information Property Owner's Name / Parcel # Schmitt, Andrew 032-2163-05-000 Property Owner's Mailing Address Property Location 2128 62°d Street Govt. Lot 1/397) City, State Zip Code Phone Number NW 1/4, SW 1/4, Section 14 Somerset, WI 54025 (circle one) T31N R19EorW II. Type of Building (check all that apply) # ® 1 or 2 Family Dwelling - Number of Bedrooms 5 Subdivision Name I4GQ.rwcr~. Gavin's Acres LTS ❑ Public/Commercial - Describe Use Block # ❑ City of ❑ State Owned - Describe Use CSM Number El Village of 7, b ' I2 O~ ® Town of Somerset III. T e of Permit: Che=Aonneb A. Com lete line B if ap licable) 0,¢-_ ~ A. ❑ New System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) F] Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued B. Before Expiration Plumber Owner 420795 4/15/2003 IV. Type of POWTS System/Component/Device: (Check all that a ply) ® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (expl n) ❑ Pretreatment Device (explain) V. Dis ersal/Treatm t Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Re71 ed (sf) Dispersal Area Prop (sf) System Elevation 450 Rate(gpdsf) 643 700 94.27' 0.7 VI. Tank Info Capacity in Gallons Total # of Manufacturer 2 U " Gallons Units ^ o New Tanks Existing Tanks ft t-C J p. U : ) C10 P. C7 a Q 144 /M Septic or Holding Tank 1000 1000 1 Week's C. P. ® ❑ ❑ ❑ ❑ 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 i lure A MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 616 15Uh Ave. Somerset, W154025 VIII ount /De artment Use Only ALI natur Sig Approved 3=~~n PermitFee Dat Issued Is4't Reason for Denial $ /J' Da g Z~ l s IX Conditions oOrp, l/RPfs7o~19 1 s'V11&1V 16 5 6 h s ~WL ~ l _WigluteW Isnw sluewajinbaj Moegi I Z 3 t!l~ 3 iat}wrtld Aq pap!Aoid ueld luawabeuew tad se aq lie ;snwpao lesiadslp A 4h_- sawoo 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) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Schmitt Conventional In Ground Owners Name: Andrew Schmitt Owner's Address 2128 62nd Street Somerset, WI 54025 Legal Description: NW1/4, SW1/4, S14, T31N, R19W Township Somerset County: St. Croix Subdivision Name: Gavin's Acres LTS Lot Number: 5 Block Number Parcel I.D. Number 032-2163-05-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Filter Information Page 5 EZ Flow Information Page 6&7 Management and contingency plan Page 8 Existing Septic Tank Certification Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 8/24/2015 Phone Number: 715-760-0486 F Signature: v.,A In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Schmitt Replacement Septic System Legal Description: NW7/4, SW1/4, S14, T31N, R19W P.I.D: 032-2163-05-000 Subdivision Name: GAVIN"S ACRES LTS Lot 5 SCALE: 1" = 60' Township: SOMERSET Parcel Size: 3.01 Acres County: ST. CROIX System Elevation: T1=96.64' Existing 68.31' Biodiffuser Trench Slope: 6% T2=96.64' Existing 62.10' Biodiffuser Trench A BM1 Elevation: 111.64' Walkout door sill T3=94.27' Proposed 70' EZ Flow Trench BM2 Elevation: 105.77' Septic tank cover T4=94.27' Proposed 70' EZ Flow Trench Backhoe Pits: 4 inch Sch 40 -ASTM D2665 NOTE: See page 11 for a complete plot of the parcel. 4 inch 3034 - ASTM D3o34 i TZ T; r j ' I 4~ I f ~;4 z l t 3 s ~ !c?E~cJE~YL 0 S,t.W1~R$ L bI VV FLL f t©B A-'l /L 0 Page 2 PLOT PLAN N Project Name: Schmitt Replacement Septic System Legal Description: NW114, SWIM, S14, T31N, R19W P.I.D: 032.2163-05-000 Subdivision Name: GAVIN"S ACRES LTS Lot 5 SCALE: V = 60' Township: SOMERSET Parcel Size: 3.01 Acres County: ST. CROIX System Elevation: T1=96.64' Existing 68.31' Biodiffuser Trench Slope: 6% T2=96.64' Existing 62.10' Biodiffuser Trench A BM1 Elevation: 111.64' Walkout door sill T3=94.27' Proposed 70' EZ Flow Trench 0 BM2 Elevation: 105.77' Septic tank cover T4=94.27' Proposed 70' EZ Flow Trench Backhoe Pits: 4 inch Sch 40 -ASTM D2665 NOTE: See page 11 for a complete plot of the parcel. 4 inch 3034 - ASTM D3034 ~ a, t3 m 2 ~ Tf, I 1 SLePt -Q, ~ N 6AQ~~~ V va ( PM .z 3 ego i i4oU S 1 l t?C}U6AL 5.1. W 17A95L D KNELL N -j ~nZ Page 2 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Andrew Schmitt Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating EZ1203H-5ft 5.0' 25.0 Infiltrator EZ1203H-10ft 10.0' 50.0 System Sizing EISA Rating per Foot of EZ Flow 5 ft 2 Soil Application Rate 0.7 gpd/ft2 450.0 gpd Design Flow _ 0.7 Soil Application Rate = [ 5 1 EISA = 128.6 Feet of EZ Flow trenches 65 feet long each 2 No. of Cells 7 Per Cell 3 It Cell Width 14 Total No of 1203H 75 It Cell Length 350 sq ft EISA Per Cell 3 ft Cell Spacing 700 sq ft Total EISA Typical Cross Section Finished Grade 98 ft Observation Pipe with approved cap or vent Soil Backfill i ■ r i ■ + ■ i ■ . . Geotextile Fabric 36 inch ■ ■ 12 inch O b O Slotted and Anchored VentlObservation Pipe with Cap .LD 94.27 ft Infiltrative Surface >36 inch 90.00 ft Limiting Factor Plumber/Designer Signature: License MPRS 223760 Date: August 24, 2015 Page 3 . .rile MAINTENAIN-ICE A100'", A300'", A600*"-12 Series Filters " TM The intmal for s rrxirig septic tar0r:s s s.,--t by state aril L~ a code. Throughout de United States ttvfe :s a wJe ~f`cc._nc d op rjon on %that this interval should be, bt.A most regulatory agencies sugg<wst Nvo to five years. the label' filter, which d,-vs rM increase the, fretlwncy d servicing for the tank, should be clear"-ti ,nccst the septic tank is ncxmally inspected and purnped. I lovie Lei. our filter is virtually sell cleaning. The contintA action d the anaerobic org&*-,ins on the label fil<cf causes lodged particles to disirdeTate and fall to ttge L•rttom rf the tark. r,cu lifter ccfU41s a Smartf Acs alarm, you Mil be notifi ,C by an Alm when Le liter noodis seroxiag. To senvke the rater. 'Sxvidng aq mtrI firer sbou d cord be done b ya tt'ri4d septic tart tpupw, 0rrnso I Mat E Mt, STEP OLUI C4 the STEP STEP septic tack Pc-move the to-ik covet t rmty pul the fitter aM Nrrp the tank if handle and skxie the rxxessar^ to prevent any cartridge out of the 64:ls rrun Escaping to case. ,te fF is Wt cr Or Ater is r€rrved. STEP` STEP , inert the liter cartridge back Mile halding the cartridge rover the - ir? case making sire the ac €sa ccr€-rnr rinse off car~idge fhc~r cartridge is pr w& fr€r~ti ruatE. bp-hg carefu to rinse at5r►~ and coq*" nserted i t the case- at seFt»ge T €rial back itxo tank. Rcpiace the septic tank cow. Wes: toe. A rxr,, it }eu i re a Mitered *vtrs " lbdel Fitec be sLre and sera, cl ear the outlet cq;-nin9 bebre replacing Firer . 'rt i S.rvt St: snltt. nx ynf :J'. ...+:•tt.: -N om y M:tC Cali for a free ZABEL ZONE` • 1-800-221-5742.Or Order Online: www.zabeizone.com Page: Installation Instructions for AEZfl 7M EZ flo2v Systems in Wisconsin 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. 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 . r Barrier Material 4. When installed in a trench, the trench should be dug to r 12° a width of 36 inches. This not only saves labor in excava- tion, but also provides better load-bearing capacity after backfilling is complete. f-- 36" Page 5 l POWTS OWNER'S MANUAL & MANAGEMENT PLAN page-of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Andrew Schmitt Tank Manufacturer: Week's c C. P. NA Permit # El Septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete R' NA Number of Bedrooms: 3 IA C: Septic 7 Dose Holding Volume: gal Number of Public Facility Units: CIA 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: Zabel NA Fats, Oils & Grease (FOG) s30 mg/L Effluent Filter Model: A-100 Biochemical Oxygen Demand (BOD5) 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 W,, NA I ' Mechanical Aeration IW Peat Filter NA Total Suspended Solids (TSS) :5150mg/L r' Disinfection Wetland Petreated Effluent I Monthly average r Sand/Gravel Filter Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L NA J% In-Ground (gravity) Iv In-Ground (pressure) NA Fecal Coliform (geometric mean) s104Cfu/100m1 f` At-Grade Mound Maximum Effluent Particle Size: Ye in dia. A NA 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 eve : 1.1 year(s) (Maximum 3 years) NA month(s) Clean effluent filter At least once every: 1.1 year(s) NA month(s) Inspect pump, pump controls & alarm At least once eve : year(s) ✓ NA month(s) At least once eve : year(s) ` NA Use T5 - T8 for 5 years then alternate myna (s) NA At least once eve : with T1 - T4 Annually or as indicated mont s b ondin r year(s) 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 6 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. 06 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: 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. P"e2ih) 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) 2128 62nd Street located at: NW 1/a, SW 1/a, Section 14 , Town 31 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 8/7/15 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): Week's Concrete Products Age of Tank (if known): 12 Permit number (if known) 420795 ,/~4 ZAI~4 John Schmitt ( censed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 8/7/15 (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 8 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Andrew Schmitt Mailing Address 2128 62nd Street Property Address Sam e (Verification required from Planning & Zoning Department for new construction.) City/State Somerset, W1 Parcel Identification Number 032-2163-65-666 LEGAL DESCRIPTION Property Location NW '/4 , SW 1/4 , Sec. 4 , T 31 _NR 9 W, Town of Somerset Subdivision Plat. Gavin's Acres LTS Lot # 5 Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yesOno Lot lines identifiable ❑yes0✓ 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 this 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 warranty deed recorded in Register of Deeds Office. Number of bedrooms 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) Page 9 T 1 o6ed I =r 2 io N ~ < pl j[ e ! ; f StlYs ~ I .oat~r~aafNauw o.oa~~;~lavrNeu ~ •SLWY ~.wpcww u,.crx ~ ~ U I> I.._ ~~q I I QI I os8 a 1 Wppg4 jy I ~`N E I Jy8 ~S-~~~ >vl ~a5 # I I ~ I III I' ~ .1raw y I i I I 1 I Q~ zff'Y ~;xwr I III a V!3 Jig a&k A w' ~d~ I - - - - - - - - - - - - out fee 'nil all HIS I 111 I I I ~ I n l Aim* i e. w - - lI D iMtC..fa. L I SONY 7031 J ;77 TNn a1r ~''II ~ _ i ~ 6-MA- ,,8 I..._--_. C, ~ ~ ~~Y ~7 dIYOY ~ I I ~ ~q{ Ipw~~~N''11YmYIIU0m0 I I ~ ~A✓~ Yyyrro M c` ~•1 .7W7 rV 3A N - --.lC4YCS 3.bf.CRIOIF- alwolaw>.et ,v KKA9ul3 W AM ~ SONY 7 0 3 J 1 Y 7 d N /1 1lG116Y3 JYS-3O-7M17 ~ I £9FZ }JYE '8'XN MJ 501Y!/M.g6 dWMGA/A].QlIY AYq.1.fL 717wYY.d ! J07 I iMQ/J11446YC/aw NNgY aat7 c71av ~ I I y 1 I ac, 1117 Wisconsin Depftwt.of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete srte plan on paper not less than 8%x 11 inches in sae. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix puuroord slope, scale ordimemsions, mft arrow, erxlJe sow and distance to nearest road. Parcel J.D. Please print all i ~y . Rev By Date Personal inronnarton you Phi f be used for 6,915.04 (1 (m)). {s ' ~ Property Owner P.ro Location Grand Properties, LP JUN j- 9 govt. NW 1/4 SW 1/4 S 14 T 31 N R 19 W Property Owner's fling Address Lot # Block* SuW..Name-or CSM# 712 Rivard Streeet, Suite 300 ST. CROlx COUNT Gavin's Acres City State Zip Cc ja FFK E City Viliege V Town Nearest Road SQmenaet WI 54025 715.247-5900 Somerset 60Th St. to New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, If applicable na General comments and recommendations: Area is suitable for a conventional system with a 07 gpd/sgit rating. Possible system elevation for Area I is 98.50` Slope is 8%. 1 Baring # Boring ✓ Pit Ground Surface elev. 100.05 ft. Depth to limiting factor >95 in. Sal AppiicadOn Rate Horizon Depth Dominant Color Redox Descr"on Texture Structure Consistence Boundary Roots GF Me in. Mureeli ou. Sz. Cord. Color Gr. Sz. Sh. `Eff#1 `E 1 0-7 10yr3/3 none sl 2mgr mvfr as 2f .5 .9 2 7-15 10yr414 none sl 2fsbk mfr 9w .5 .9 3 15-22 7.6yf416 hone Is Dag fnl gw .7 1.2 4 22-95 10yr5/6 none ms .0stg mI .7 12 _ qu; •Sa/ Boring # Boring ✓ Pit Ground Surfaoe.elev. 100.05 ff. Depth to limiting factor >97 in. Sol Application Rate Horizon Deo Dominant Color Reft Description Texture Structure Consistence Boundary Roots WWI! irr. Munsell tlu. Sz. Cont Cola Gr. Sz. Sh. 1 0-8 10yr313 none al 2mgr mfr as 2f .5 .9 2 8-22 10yr5/3 none sl 2fsbk mfr gw .5 .9 3 22-34 7.5yt04 none le 1.msbk mvfr di .7 12 4 34-97 10yr514 none ms Osg. ml .7 1.2 2•b • Efflmmnt #1 = BODS> 30 < 220 ma/L and TSS >30< 150 mg1L • Effluent 02 m BOD !.30 mg/L and TSS 1.30 mg/L CST Name (Please Print) Signature: CS Number Thomas J. Schmitt 227429 Address Tom _S_chmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset WI 54025 6/12/02 715-549-8651 Property Owner Grand Properbesy LP P8row to # Page 2 of 3 3~ F Boring.# Boring ✓ Pit Ground Surface elev. 97.85 ft. Depth to limiting factor >95 in. Sod Application Rate Horizon Depth Dwrdrerd Color Redox Description Texture Structure Cot m Bowxtary Roots UMM. in. Munsell Qu. SE Cord. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0-9 10yr3/3 none st 2mgr mfr as 2f .5 .9 2 9-19 10yr5/3 none si 2fsbk mfr 9w .5 .9 3 19-31 7.5yr4/6 none Is 1 msbk mvfr gw .7 1.2 4 -31-95 10yrsm none ms Osg rd .7 1.2 l F-1 Boring # Pit Boring Ground Surface elev. fl. Depth to limiting factor in. Soll Application Rate Horizon Depth Dormant Color Redox Description TOM" Stnx tuure Cw$Mw oe BowxWy Roots GPOW in. Mw" Qu, Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 10182 I i T__ ❑ Boring # Boring Pit Ground Surface elew ft. Depth to limiting factor in. Sok Applfeatior Rate Horizon Depth oamtilard color Redox Dew ipliat Texture Structure Cgeewence Bocsldery Roots in. Munsell Qu. Sz. Copt Color Gr. Sz. Sh. "EfT#1 'Eff*2 `Effluent #1 = .BOD s>.30 < 220 mg/L and TSS >30 < 150 mg1L "-Effiuent-#2.;.SODS - Xmg& and TSS L30.nV& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access Services or n..w1 .norr+.:ol in an nltmm~tc.. fnrms+t -6... nn.~turt tMP rlPno.•tmant at AAR_'Kt_Z 191 -'r rV AAV_')AA_ 'T'1'! J ~ 13 13F~ 3y 98 D~'awr~r~ Y~~ ~Itiar+d 1rraP~'eS ~r~.s~~y LY'• aS ~L~'"'4l yrz ~e;~d s,~• ~sY a~ ~1a9 4 & s.e-, t,> soar-' Lam. s-Yo~f