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HomeMy WebLinkAbout040-1073-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 582003 Personal information you provide may be used for secondary purposes [Privacy Law, S.15.04 (1)(m)]. Permit Holder's Name: city Villa a Township Nathan Zimmer 9 Parcel Tax No: TOWN OF TROY 040-1073-50-000 CST BM Elev: In~.v: BM Description: -f- ~ ~ Section/Town/Rangemnap No 18.28.19.28O F TANK INFORMATION ` ELEVATION DATA TYPE MANUFACTURE `PACITY STATION BS HI FS ELEV. Septic Benchmark I T1 !T W, 1DOl~ q8. (jC to qLq VV I Alt. BM E3 ~25V Aerat Bldg. Sewer FM - Hekhng L'fQ.; > S'L~ St/ t Inlet 5 ~2 r (0 / TANK SETBACK INFORM 60N S t outlet `Z,r 92 ' ~2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic a 10 1 I W, 51, Dt Bottom Dosing lJ !!ad" an. Aeration Dist. Pipe W S 1 Holding t r 9, 5 Bot. System 4,54.- 71 ID 5 $e,)~ sr~ PUMP/SIPHON INFORMATION Final Grade Manufacture'vDemand St Cover , GPM D I ` W Model Number TDH Lift Friction L stem Head TDH Ft nn For main Le Dia. Dist. to r l SO ABSORPTION SYSTEM BED/TRENCH Width 2 1 Length 'l No. Of Trenches DIMENSIONS IT DIMENSIONS No. Of Pit Inside Di~ Liquid Dept SETBACK SYSTEM, TO (I((// P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR E2 Z. FLO W T 10"o N VI )3)%l O V I UNIT Model Number: /t 2b3 H 6/ D RIBUTION SYSTEM Noy-+-h ader/ anifold -7 Distribution x Hole Size x Hole S acin r r [ Pipe(s) P 9 Vent to it Intake Length' Z Dia Length Spacing SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only We Depth Over xx Depth of Seeded/Sodded Mulch~WYes d enter Bed/Trench Edges Topsoil ~ es ~ No ❑ No COMMENTS: (Include code discrepencies, persons, present, etc.) Inspection #1: Inspection #2: Location: 328 CTY RD Fr ; Cv1 CIS-7 ~N(r DP-yWe ll aJQ(,l./l db" d pet✓ 5P-5 3g3 1.) Alt BM Description = T L c~~ covEl L k-S on f 2.) Bldg sewer length = c -amount of cover = I S 1 1 O O 1 Z- ` ~O WZ 50, 14 Plan revision Required? ❑ Yes In_f No Use other side for additional informati'ob.' ~J > oO'VA SBD-6710 (R.3/97) Date LWrni.ep to Cert. No. PLOT PLAN Project Name: Zimmer Re-placement septic System N Legal Description: NE1/4, SW1/4, S18, T28N, R19W P.I.D: 040-1073-50-000 Subdivision Name: NA Lot Township: Troy sc-ASE== ao- Parcel Size: 0.70 Acres County: St. Croix System Elevation: T1=88.65' Proposed 60' EZ Flow Trench Slope: 4% T2=88.15' Proposed 60' EZ Flow Trench BM1 Elevation: 100.00' Bottom of siding on the house T3=87.65' Proposed 60' EZ Flow Trench BM2 Elevation: 9 To of 2" PVC pipe Backhoe Pits: d y y--7 , &f ~S 1 NOTE: Drywells to be aban oned as per c e 4 inch Sch 40 -ASTM D2665 NOTE: See page 11 for a complete plot of the parcel. 4 inch 3034 - ASTM D3034 D© LL I Y3 iZ "ft( ~i f1 Su3►Mr~' 1 6 A2i4Ge <a p~~L c~ ® 1 -1 ` - PEcr y &L)e-ovk owKi j $Z DQ~►~i~s 'j t ~ X `S i t is v ®g j~ ~ CtG l~>0LP ® U" PL99LI Lc I-4~ sip j t 5M i S' 97 ?Copv Page 2 L< , ~e++cekr County Industry Services Di St. Croix D®~ 1400 E Washington At P.O. Box 71 anitary Permit Number (to be filled in by Co.) Pa $ P MUNIv Diva OPM'ENT Madison, WI 53707-71 (I 5-<g2 002~, °~sskriA Sanitary Permit Application tate Transaction 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 1. Application Information - Please Print All Information Property Owner's Name Parcel # Zimmer, Nathan & Leah 040-1073-50-000 Property Owner's Mailing Address Property Location 328 County Road F Govt. Lot City, State Zip Code Phone Number NE 1/4, SW'/4, Section 18 Hudson, WI 54016 le one) 28N R19Eo~ O 11. Type of Building (check all that apply) Lot # T Z ® I or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use Block # City of El State Owned - Describe Use rs-M N umber ❑ illageof ® Town of Troy III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Z dnlE X A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner V Tl 70 IV. Type of POWTS S stem/Com onent/Device: (Check all that apply) ® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: D 67,-f~LO"151 (010' 19 , Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sfl System Elevation 600 Rate(gpdsf) *M 900 88.65', 88.15', 87.65" 0.7 VI. Tank Info Capacity in C Gallons Total # of Manufacturer `2 Gallons Units ,w, o " ° n New Tanks Existing Tanks 2 U i n i C7 Q Septic or Holding Tank 1250 ? (OV U 674 1 1250+ 2 Wieser / Unknown ® ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum s gn re 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 VIII. Count epartment Use Only ❑ Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial $ 7~w 0,5-15 IX. Conditions of Approval/Reasons for Disapproval (1/~~lEl Ow/ (dip ~G/~f OF LJ" "r 3E #&#A PWeD p~(L <X 383.33 (ZG&w%?cn/L4XN- um s s i s NAG erg oaf - /ti§&Lno 1 Attach to comple a 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: Zimmer 4 Bedroom Replacement Septic System Owners Name: Nathan & Leah Zimmer Owner's Address 328 County Road F Hudson, WI 54016 Legal Description: NE1/4, SW1/4, S18, T28N, R19W Township Troy County: St. Croix Subdivision Name: Lot Number: Block Number Parcel I.D. Number 040-1073-50-000 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 Effluent Filter Information Page 6 EZ Flow Information Page 7 & 8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM or Map Page 12 Existing Tank Certification Page 13-17 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 8/28/2015 Phone Number: 715-760-0486 Signature: / In Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 16 PLOT PLAN N Project Name: Zimmer Replacement Septic S stem Legal Description: NE1/4, SWIM, S18, T28N, R19W P.I.D: 040-1073-50-000 Subdivision Name: NA Lot SCALE: I* 40' Township: Troy Parcel Size: 0.70 Acres County: St. Croix System Elevation: T1=88.65' Proposed 60' EZ Flow Trench Slope: T2=88.15' Proposed 60' EZ Flow Trench A BM1 Elevation: 100.00' Bottom of siding on the house T3=87.65' Proposed 60' EZ Flow Trench BM2 Elevation: 94. To of 2" PVC pipe Backhoe Pits t,b~~nd 7 NOTE: D rywells to oea asp Cgde 4 inch Sch 40 -ASTM D2665 NOTE: See page 11 for a complete plot of the parcel. 4 inch 3034 - ASTM D3034 r , . i ~I^ l li / T3 'Ti r I Sw'~MM►NG G A2Aro n I I Pool- cY t _ pEcr y 8OeQcm W~Lt_ 3 ® ^ 1 t 62 t i=x~sT~r, ® are ~ oc. ` 5o C Lq S ® 97 Page 2 S011 A0Cr%0M71 K1 CYCTCAA r%CTAl1 / ^f~GS~ ~C~►L1.=11►1/_` I IAIIT ~I- ~uvvI%r ■ wIV v v 1 L-1W v" a r.IL- 1 v ■ uw vlv' Project Name: Nathan & Leah Zimmer Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EL12U3H-5ft 3.U` ZS.U EZ1203H-10ft 10.0' 50.0 System Sizing Flow Rate 600 gpd EISA Rating per Foot of EZ Flow ft2 Soil Application Rate 0.7 gpd/ft2 600.0 gpd Design Flow _ 0.7 Soil Application Rate = ~ EISA = 171.4 Feet of EZ Flow F73trenches 60 feet long each 3 No. of Cells 6 Per Cell 3 ft Cell Width 18 Total No of 1203H 60 ft Cell Length 300 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Typical Cross Section Finished Grade 92 ft Observation Pipe with approved cap or vent I - Soil Backfill 36 inch Geotextite Fabric • >3 ft O > 3ft: Slotted and Anchored Vent/Observation Pipe 12 inch P-v;zN with Cap 88.65 ft~ I) ■ / 187.65 ft Infiltrative Surface >36 inch 88.15 ft ( man Plumber/Designer Signature: c License M MPRS 223760 Date: September 28, 2015 Page 3 8fl-MM :31nd 95 8-5Z~-008 0 z :31v0 OSLvS MY "A'30ci N3uiv'ri O L i ivmi l W l 9 LL£M ~ n3a i`df1NtIW OIld3S W \ :anOd-36d 0-,l= tL :31VOS d3M A8 NMVaO 31380000 J3531M NH-OSZ L& M W a Z Q D cc z cC LLI J w V) vo) = W (A CL } Z p D: Z D_ m V) m O O FW- OJ pp ) i-L W LA Q W U W 0 J_ co LL. C z N Wo LL. OF < Z w in o z a O m p ~a z n. W < H O 8-j Un 1- aoo o mN aQU < WM Z Z CL o~ v a o G CC wF-w a o L Ih QUA O~m QQpfn JI}- Z) (/7U p~p~ y Q d O LL x F x p`tMO V) mNW M D.a O Q Q fn W OD W Q W N ~ \W NwNOwJ00 W I ~FiQ- o< m 0z YM W x tn~d J>pp 0 I 0KV) ~ Z U 052 ZO r m W OD Z W H fn S O O I-z N:j LW~~ JI- OQw OOW Q ZF-Q (n WU pW in < J z~l- >Z~O~05 pUVY) pvo)F- Q ~ ~ p m~ Xx pwU OQOO<MLLI w 7~i1 Zx Q Z O U OOU p ZW N z `?3mU~2J3mJw3 ~dC9 ~~v p QOQ Q U m mO Q J J 0 0 Z >Z N < O : v J W N I Q N Q F- U W 62 O' I Z W w w D W y l f o! I J/ o~ 1` I I N I U I a W m I' wl I WI I Q f >I s~ > Q cli 1 N I CL I uj W Q W cn X ,I N W C) f, L\ C)rxN~~ /J: II I w i L IT - L o 0 w x w ~ N i Z Q Z 0038 a „tie SV xZS wU a N Y Z Q F Page 4 0111PI No ME TM inc. PL-525 Effluent Filter Innovations in Precast Drainage Zabel & Wastewater Products A Division 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 Switch • Rated for 10,000 GPD (gallons per day). Alarm 1 ona D • 525 linear feet of 1/16" filtration. 10'0W GP G • Accepts 4" and 6" SCHD 40 ~ Accepts 1" PVC pipe. 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. PIS 525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. 10,000 gallons per day (GPD). of 1/16- P Filtration Slots 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet If Accepts 4" & 6" pipe. 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 13a11 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. ~T LY 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Outdoor SmartFilter0 Alarm Extend & Lok 1 Qt 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, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 5 Installation Instructions for to"EZ OZUTM EZflow Systems in Wisconsin flbyF1~TRATOR 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 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- 12" tion, but also provides better load-bearing capacity after ' backfilling is complete. f- as" Page 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Nathan & Leah Zimmer Tank Manufacturer: Unknown NA Permit # Septic E Dose E: Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA Number of Bedrooms: 4 NA !✓Septic Dose E Holding Volume: 1250 gal Number of Public Facility Units: NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 400 gai/day Horizontal Distance Tank(s) to Serivice Pad: ft Design (peak) Flow = estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/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) 530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand (BOD5) 5220mg/L ( NA Pump Manufacturer: ✓ NA Total Suspended Solids (TSS) <_150mg/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 NA r- Mechanical Aeration I Peat Finer 'NA Total Suspended Solids (TSS) 5150mg/L r Disinfection ; Wetland Petreated Effluent Monthly average r Sand/Gravel Filter Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L ✓NA In-Ground (gravity) In-Ground (pressure) Fecal Coliform (geometric mean) 5104cfu/100m1 I At-Grade r Mound NA Maximum Effluent Particle Size: % in dia. N r Drip-Line Other: Other: r Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Inspect condition of tank(s) At least once every: 3 rpe year(s) (Maximum 3 years) NA r month(s) Inspect dispersal cell(s) At least once every: 1.5 f ✓ year(s) (Maximum 1 years) NA month(s) Clean effluent filter At least once every: 1.5 I year(s) NA Insect um month(s) p p um pump controls & alarm At least once every: r year(s) NA f month(s) Flush laterals and pressure test At least once every: ( year(s) NA - month(s) Other: year(s) Other: 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 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: 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. (Rev. 2/05) Page 8 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buver Nathan & Leah Zimmer Mailing Address 328 Cty Rd. F Property Address 328 Cty Rd. F (Verification required from Planning & Zoning Department for new construction.) city/State Hudson, W1.54016 Parcel Identification Number 040-1073-50-000 LEGAL DESCRIPTION Property Location NE 1/4, SW 't4 , Sec. 18 , T 28 N RW W, Town of Troy Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume Page # Spec house ❑yes0no Lot lines identifiable ElyesQno 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. 383.5(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 (I ) the on-site wastewater disposal system is in proper operating condition andeor (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. Uwe, 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. Ilwe 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 4 gj8X15 SIGN. " E OF APPLICANT(S) DATE ***An,, 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) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) i This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 328 County Road F located at: NE 1/a, SW 1/a, Section 18 , Town 28 N, Range 19 _W, Town of Troy , 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 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): w t 5 E ~C' Age of Tank (if known): Permit number (if known) John Schmitt (L' ensed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS Ia--12- l (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 RECEIVED 1!-A ir ~ss °=;°01~ SOIL EVALUATjON REP #175: P in accordance with Comm 85, a Page 1 of +A~, ` peb* 1 "bwy Schmitt Soil Testing. in MPYNITY DEVELOPMENT I County Attach comply e p an 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. Parcel I. D. 040-1073-50-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 6 016 , ; yy r ! Property Owner Property Location N v /V Zimmer, Nathan& Leah Govt. Lot NE1/4, SWIM, S18, T28N, RW Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 328 Cty Rd F City State Zip Code Phone Number ❑ City ❑ Village E Town Nearest Road Hudson WI 54016 yS ST 0876 Troy C Rd F L] New Construction Use: ( J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material Outwash Plain (Pillot Series) Flood plain elevation, if applicable NA ft. General comments Replacement area is suitable for a conventional system with a 0.7 gpd/sqft rate. Possible system elevation for replacement area is and recommendations: High Trench 88.65', Mid Trench 88.15', Low Trench 87.65'. Slope is 4%. Boring # ❑ Boring Pit Ground surface elev. 92.65 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-11 10yr3/3 none sl 2msbk mvfr as 1vf 0.6 1.0 2 11-20 10yr4/6 none Is Osg M1 Cs ivf 0.7 1.6 3 20-100 10yr6/4 none s Osg ml 0.7 1.6 F21 Boring # ❑ Boring Ej Pit Ground surface elev. 91.60 ft. Depth to limiting factor 104+ 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 mfr as 2vf 0.6 1.0 2 13-21 10yr4/3 none si 2msbk mfr gw 1vf 0.6 1.0 3 21-27 10yr5/4 none Is Osg M1 Cs ivf 0.7 1.6 4 27-104 10yr6/4 none s Osg ml - 0.7 1.6 0 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS s.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, W154017 8/28/2015 715-760-1978 SBD-8330 (R.07/00) l Property Owner Zimmer, Nathan& Leah Parcel ID # 040-1073-50-000 Page 2 of 4 Boring 3 F Boring # Z Pit Ground surface elev. 93.40 ft. Depth to limiting factor 108+ 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 0-23 10yr3/3 none sil 2mgr mvfr as 2vf 0.6 0.8 2 23-36 10yr3/4 none sil 2msbk mfr gw ivf 0.6 0.8 3 36-45 10yr4/4 none sl 2msbk mfr gw 0.6 1.0 4 45-51 10yr4/6 none Is lcsbk mvfr Cs 0.7 1.6 5 !W/108 10yr6/4 none s Osg ml 0.7 1.6 ❑ Boring Q 4 Boring # X Pit Ground surface elev. ° ft. Depth to limiting factor 104+ 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 0-23 10yr3/2 none sil 2fsbk mfr Cs 2m,2vf 0.6 0.8 2 23-45 10yr4/4 none A 2msbk mfr gw 2f lvf 0.6 0.8 3 45-56 10yr5/6 none sl lmsbk mfr Cs 0.4 0.7 4 56,69 10yr6/4 none s Osg ml 0.7 1.6 ❑ Boring 5 Boring # pit Ground surface elev. 91.90 ft. Depth to limiting factor 102+ 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 0-13 10yr3/3 none sil 2mgr mfr as 2vf 0.6 0.8 2 13-20 10yr4/4 none A 2msbk mfr gw 2m,2vf 0.6 0.8 3 20-36 10yr4/6 none sl 2msbk mfr gw 2vf 0.6 1.0 4 36-41 7.5yr4/6 none gris lcsbk mvfr CS 0.7 1.6 5 ,4f-102 10yr6/4 none s Osg ml 0.7 1.6 * Effluent #1 = BODS> 30 <220 mg/L and TSS >30 <_150 mg/L * Effluent #2 = BODS < 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 (8.07100) Schmitt Soil Testing, Inc. I r , Page: a or g COnoucto h*: - ~ - - i t- CbndII + oT- . Schmitt Sbns excavating. Inc.. Name: Nat4an& Leah ~immer - Thotnas J. Schmitt, CST 227429 Address: 328 Ctv'Rd 586 Valley View Trait City, Sate; ;Zip ? Hudson WI 54016 - Soniersit,W 54025 Phone: 71 - 0197$ _ Pll. 040-1073-50-000 - L , y LzSt No: . Legal Description.: ;_NEj/4_S,W114 S] S T?~l~ilt14 _ ■ 13ackho16 Pit' Township, County < Troy Township, St. Croix County : f -Bench mart-l Et. 100.00' Rottoth f sWng on the hbuse 7_ i r enhk 2 Et.`t'Ly1i lop of.~1,/Ciipe - - r - - , Slope= ! 4% _Scale_ 17w- 40'_ , , t , i : L _ 1 i , i 1 r : y , 4 j { 1 t F i : { i ? t { I' t j I i t , i r f i , /►'1M Nb j3 ~a~M pmt, I y.' Y ;3e? 1 t---. r N t B3 b' I ' aL s I, 01 r , 01 t , I~ , , z i ~ I , i I s i r , i . < t . ► t> C . tT: l fi N ~ (.J CC W N 1w ,w. ~ O Cl) ~2n 4 C oIFm ° gs P? 0 " -ram- Z N a a pp s P` l a q i O^ A ~ ~ N m ~ ~ W m m 0 3 - SOIL PROFILE DESCRIPTION _ CST: G Owner: ft Syst. Range%S.4gft to $744;ft Ld Rate: , System Elev. Proposed: 6 # Elevation: ~3 z/f # Z Elevation: # Elevation: l Z 6~ -3 o Boring o Boring o Boring M Pit Pit Pit g~ - o~ QZ - - 51 ~o ~s - gg,6S 5y57,W ~z o Po 5ED - s~ __~,q.72 ~Y 8Z9 ~Dl `