HomeMy WebLinkAbout032-1011-70-025
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
579092
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village Township Parcel Tax No:
Wayne Shakal TOWN OF SOMERSET 032-1011-70-025
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
1(w~~ 05.31.19.69B
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER t/~ g CAPACITY STATION BS HI FS ELEV.
i
Septic Benchmark
~ z /ood -3 S8 jai, /ZZ~
Alt. BM(--
r, 1 Pa, d S r,. % ~o d. 75 /0,7.
g
Aeration Bldg. Sewer 3 .3 166.7-%
Holding St/Ht Inlet 3.191 99,77
TANK SETBACK INFORMATION St/Ht outlet 4.10-7 51
TANK TO . 4eP•//L~ WELL BLDG. Vent Air Intake ROAD Dt Inlet
Septic (OV k-7 / Dt Bottom
~P
Dosing Header/Man. Q7
Aeration Dist. Pipe 't 7.
I.03
Holding Bot. System 7.O • S
~;6 .
PUMP/SIPHON INFORMATION FinalMde , v~p, • Z
Manufacturer Demand St Cover
GPM 0. 715 Ad Z. O
Model Nu r0 a O /•05 / Z
TDH Li Friction Loss System Head TD Ft
Forcemain Leng Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pit Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuf urr
INFORMATION #4 CHAMBER OR 1
Type Of System: L• ~Z UNIT Model fj~{Inbe.:
cd we VV-i -d W%A 5911
DISTRIBUTION SYSTEM 14 4x-l 9 .3g IJ5
Header/Manifolr~ / Distribution ix Hole Size x Hole Spacing Vent to Air Ink
iLength_- Dia~ L ngth ` DiaSpacint`~
SOIL COVER W4msure Systems Only xx Mound Or At-Grade Systems Only
Depth Over epth Over xx Depth of xx Seeded odded xx Mulched
Bed/Trench Center Bed/Trench Edges O Topsoil Yes No Yes No
COMMENTS: (Inclu a code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
<<~5 d~ /~Of1-l►- G,rd 5
Location: 341 POLK/ST CROIX RD
1.) Alt BM Description = • 'J - ~OJ~~- I a
2.) Bldg sewer length
- amount of cover
~v
i
Plan revision Required? ❑ Yes No q I r _ 3 s
Use other side for additional information. ( vI
Date Insepcto Signatur Cert. No.
SBD-6710 (R.3/97)
County
y Safety and Buildings Divi St. Croix
~S~rry
®ayEp U L~ 201 W. Washington Ave., P.O. 7 Sanitary Permit Number (to be filled in by Co.)
P $ Madison, WI 53707-7162
ST. CROIX COUNTY c ~9 7
0MMUNITY DEVCI-OPME T
Sanitary Permit Application le Transae"°° 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 Project Address (if different ailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary urposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats.
Pol St. roix Road GS (f -14, 4 -
1. Application Information - Please Print All Information
~je;
Property Owner's,(Name Parcel # O 9 ~ -
Rarn,+~il;, i^ Shakal 8^2 i o f i *2.0" I (J
S 5 1, I q ~8-
Property Owner's Mailing Address Property Location C)
`q
.46055 79th St., Govt. Lot
City, State Zip Code Phone Number -NW = N W 1/4, Section 05
(circle one)
Janesville, MN 56048 (507) 330-1949 T 31 N; R 19 W
II. Type of Building (check all that apply) Lot #
J. Subdivision Name
or 2 Family Dwelling -Number of Bedrooms 2
6k ~ Block # CSM Vol. - , P -
L1 Public/Commercial - Describe Use Na
b Coax- ❑ City of
❑ State Owned - Describe Use Q CSM Number ❑ Village of
t b ~ W ~ ` ~ ~ G ~ $ ~(v~ town of Somerset
III. Type of P rmit: (Check only o e box on line A. Complete line B if applicable)
A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
❑ Change Previous Permit Number and Date Issued
B. El Permit Renewal 11 Permit Revision of Plumber [;E]Permit Transfer to New
Before Expiration ner
IV. Type of POWTS System/Component/Device: (Check all that apply)
on-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: 38 Infiltrator Quick 4 Standard Plus ch bers & 4 end ca s, Pol Lok PL525 effluent filter
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Ar Proposed (sf) System Elevation
300.0 Gpd 0.4 Gpd/Sq. Ft. 750.00 sq. ft. sq. ft.. 94.50' & 96.50'
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units fl U
New Tanks Existing Tanks o Y t; 1 ~
Ci. U in rn u.. C7
Septic or Holding Tank 700/300 Na 1,000 1 Wieser Concrete X
Dosing Chamber
VII. Responsibility Statement- I, the u dersigned, assu a responsibility fo tallation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's . ign re MP/MPRS Number Business Phone Number
James K. Thompson 5- - MPRS 30021 (715) 248-7767
Plumber's Address (Street, City, State, Zip Code
340 Paulson Lake Lane, Osceola, WI 54020
VIII. unt /De artment Use Only
Approved isap Permit Fee Date ssued Issuing in Signature
❑ rven Reason for Denial $ x}75 Z~
IX. Condiatrl5 Q /ReaSonS for Disapproval
1 Septic tank, effluent filter and
.dispersal cell must all t 1391ylces i maintained ~Y f
as.per management plan provided by plumber. L) s-Z..
2. Ate setback lequiremant* must be meintairiod ~f S ~V I h•~d~ /
as per applicable code / ordinances. 1 t
Attach to complete plans for the system and submit to the County only on paper not less th in x 11 inches in size
SBD-6398 (R. 11/11)
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Conventional POWTS Index & Tilte Sheet
Project Name: Bernie & Joe Shakal 2 Bedoom Conventional POWTS
Owners Name: Bernie & Joe Shakal
Owner's adress: 46055 79th St., Janesville, MN 56048
Site address: Polk/St. Croix Road
Project Locat3ui•,:
Subdivision: Lot , CSM Vol. Pg.
Legal Description: NWv4 NWi/4, Sec. 05 T.3 IN., R. 19W., Town of Somerset, St. Croix Co., WI.
Parcel ID 032-101 1- -000
Page I Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell & treatment tank Sizing CaICUaltions &
Infiltrator "Q-4" chamber cross section
Page 4 Dispersal Cell Cross Section
Page 5 Filter Specifications
Page 6 Septic Tank Cross Section
Page 7 System Management Plan
Page 8 Septic Tank Maintenance Agreement
Page 9 Parcel Map
Page 10 Waranty Deed
Attachments: Soil Evaluation Report
Mater PI ber Res 'cted Service: James K. Thompson, DSPS. Credential #30021
Silnnature: Date: Page I Of 10
Desisn pursuant to In-Ground Soil Absorption Component Manual fbr POwTS. Nersion ZO SIM-10705-1) (N.01/01)
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Shakal 2 Bedroom Dispersal Cell Sizing Calculations
1. (2 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 300.00 Gpd design flow
2. Infiltrative capacity of native soil = 0.4 gpd/sq. ft.
3. Absorption area required: 750.00 sq. ft.
4. Absorption area as proposed: 771.60 sq. ft. (38 chambers + 4 end caps)
Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end caps = 5.80 sq.ft, EISA/pair
750.00 sq. ft. - (2 pair endcaps)(5. 10) = 738.40 sq. ft.
738.40 sq. ft./20.00 = 36.92 chambers required
Number of trenches: 2 (iD, 19 chambers per trench (d (chambers total)
Trench width: 2.83'
Trench length: 79.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 12.00'x 79.00' TM
-Quick4
STANDARD CHAMBER
52"
Quick4 Standard Chamber 48"
(EFFECTIVE LENGTH)
e e e
12°-_°
WIN&
a)M a
34" SIDE VIEW
SECTION VIEW
MultiPort End Cap
12" \ 16" A )
L
34"- SIDE VIEW TOP VIEW
FRONT VIEW
Quick4 Standard Chamber Nominal Specifications MOW ort End Cap Nominal Specifications
Size (WxLxH) 34"x52"x12 Size (WxLxH) 34°x16"x12
Effective Length 48" Invert Height 8" or 1.25
Invert Height 8,
Pg. 3 of 10
Soil Absorption System Cross Section
97.25
99~ft
4" Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap 9TSa ft
Leaching 9 f~$D k
Charr:ber g6, 5-0' ft
System Elevation
3 ft ft
i
Soil Absorption System Plan View
79 ft
3 ft
ft Vent Or Observation Pie Leaching Trench 1
p ~ Chambers
ilprrr
4" Dia.
Trench 2 Header
Leaching Chamber Specifications
Manufacturer And Model
F EISA r'.<.:ting -Zo_cwsq ft per chamber Soil Application Rate 0.Y0 gpd/s,q ft
3DD,cO gpd Design Flow = 0.5/0 Soil Application Rate - 90.60 EISA Chambers
2 rows of chambers each.
Page of lo
Technical Specifications
PL-525 EFFLUENT FILTER (COMMERCIAL)
6 1!2'BkL CHECK -
EXCEPTS 6'SHO 40
FOR IN-ET EXTENTION 14,75
11 57
WT.EBUSHING EXCEPTS-
SCH40aoSCHO 6~6
- 529
- ~ ~ 73'02 "#j it M
ii
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PL-525 FILTER HOUSING 6 34
PART NO -30142-525 MATERIAL:' Ll'
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HOUSING - POLYPROPYLENE
OUTLET BUSHING - PVC
6.5BALL -HDPE -j~
- SOCKET EXCEPTS E.oarswrcH
~ - D ,0.-3
E XCEPTS P SCH Ju
. FOR HANDLE
EXTENlION - "~gn- ! j~ j 10.64
n6'SLOTS 624
`.-6.47
SOCXFTEXCEPTS 604
-
BALL PUSH ROD OPENING
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POLYLOKPL-525 FILTER CARTRIDGE I II
PART NO. - 30141-525
M ATERI A- - POLYPROPYLENE
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T DRAWN BY. WCP SCALE: 1 4°=1'-0' PRE-POUR:
REV.
° m SEPTIC MANUAL MIEGER conCIETE DATE: 00/00/00 D
ATE: POST-POUR:
W3716 US HWY 10 MAIDEN ROCK, WI 54750
\ p 800-325-8456 FILE: MIPIODD-AIR
06. (0
Conventional POWTS Management Plan
Pursuant to SPS 383.54, Wis. Adrn. Code
General
The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system
should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the Polk County Zoning Department at
(715) 485-9279.
Septic Tank
Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
_Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October-March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSB, aiw 3() m» I I t)t";. Intlti,:nt 11OV,
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Continzency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Pg. 7 of 10
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Bernie & Joe Shakal
Mailing Address Unknown
Polk/St. Croix Road
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State Osceola, Wl Parcel Identification Number 032-1011 -80-000
LEGAL DESCRIPTION
Property Location NW '/4 , NW Y4 ,Sec. 05 T 31 N R 19 W, Town of Somerset
Subdivision Plat: Na , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume Page #
Spec house 0yesEjno Lot lines identifiable El yes[] no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature lailurc 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. O«ncr 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 torn, 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 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 t)'
State of Wisconsin. Certification stating that your septic system has been maintained must be coy
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. ~~ill. ai I tug 11~111cl ~ „1 u,e
properly described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 2
09/11/15
4~yz~ GNATURE 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)
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Wisconsin Department of SOIL EVALUATION REPORT Page 1 of 3
CommerceST. CROIX COUNTY pSp3 _
_ in accordance with CB5, Wis. Adm. Code County A.C.E. Soil & Site Evaluations
JI~`4tlITY~VEt4PEViEfVT ~
Attach complete site plan on paper not less than 8/2 x 11 inches in size. Pla
include, but not limited to: vertical and horizontal reference point (BM), directio St. Croix
percent slope, scale or dimensions, north arrow, and location and distance t( Parcel D.
Please print all information.
Rev ed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s.
Property Owner Property Location r
Wayne Shakal (Bernie& Joyce Shakal) Govt. Lot NW !4 NW !4 S 5 T 31 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Nam or CS M#
337 Polk/St. Croix Rd.
City State Zip Code Phone Number City Village ✓ Town Nearest Road
Osceola WI 54020 (507) 330-1949 Somerset Polk/St. Croix Rd.
✓ New Constructior Use: ✓ Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD
Replacement Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable na
General commentE
and recommendations: Soils suitable for conventional dispersal cell at 0.4 gpd. Recommended linfiltrative surface to be 30 " - 36"
below grade & "stepped" down hillside at 96.50'&94.50'.
❑ Boring # Boring
✓ Pit Ground Surface elev 99.45 ft. Depth to limiting factor >92" in.
Soil Application Rat
Horizon I Depth Dominant Redo. Description Texture Structur( Consistence Boundar Roots GPD/ft"
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
1 0-8 1Oyr3/4 none fsl 2fgr mvfr cs 2vffm 0.4 0.8
2 8-15 1Oyr4/6 none ifs Osg ml cs 2vffm 0.5 1.0
3 15-24 7.5yr4/6 none ifs Osg ml cw 1vffm 0.5 1.0
4 24-77 1Oyr4/6 none s Osg ml gw 1vffm 0.5 1.0
5 77-92 10yr416 none s Osg dl cw - 0.7 1.6
Horizon #4 cotains 1/8" - 2" irregular band of 7.5yr4[6 Ifs at 1" - 6" intervals. Loading rate adjusted to reflect reduced permeability of horizon associated wi
q banding.
❑ Boring # Boring '
✓ Pit Ground Surface elev 99.42 ft. Depth to limiting factor >75„ in.
Soil Application Rat
Horizon I Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ff'
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
1 0-8 1Oyr3/6 none sl 2fgr mfr as 2vf,fm 0.6 0.8
2 8-22 7.5yr4/6 none sl 1 msbk mfr cs 2vf,fm 0.4 0.7
3 22-57 T5yr4/4 none sl 2msbk mfr cw 1vf,fm 0.6 1.0
4 57-75 7.5yr4/4 none sl 2csbk dsh - 1 vf,fm 0.6 1.0
N
* Effluent #1 = BOD F 30 < 220 mg/L a TS5 >30 < 150 mg * Effluent #2 = BOD5< 30 mg/L and TSS < 30 mg,
CST Name (Please Print) Signat e: CST Number
James K. Thompson -C 36ft2 30021
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 5/21/2015 715-248-7767
r
Property Owner Wayne Shakal (Bernie& Joyce Parcel ID # 032-1011-80-000 Page 2 of 3
❑ Boring # Boring
✓ Pit Ground Surface elev 91.60 ft. Depth to limiting factor >82" in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPDJft'
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
1 0-10 10yr3/6 none sl 2fgr dsh as 2vf,fm 0.6 0.8
2 10-16 1Oyr4/4 none sil 1thinpl ds Cs 1vf,fm 0.4 0.6
3 16-32 7.5yr4/4 none sl 1msbk mvfr Cw 1vf,fm 0.4 0.7
4 32-40 7.5yr4/6 none Ifs Osg ml ci 1vf,fm 0.5 1.0
5 40-73 7.5yr4/4 none sl 1m&csbk dsh aw 1vf 0.4 0.7
6 73-82 1Oyr4/4 none s Osg dl - - 0.5 1.0
H#6 contains banding as in B-1 H#5. Loading rate adjusted to reflect reduced permeability of horizon associated with banding.
❑ Boring # Boring
Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ftz
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
❑ Boring # Boring
Pit Ground Surface elev ft, Depth to limiting factor in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft; 1
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
* Effluent #1 = BOD 30 <220 mg/L and TSS >30 < 150 mg Effluent #2 = BOD 5< 30 mg/L and TSS < 30 mg.
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SM-8-130 (R.01/00)
A.C.E. Soil & Site Evaluations
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