HomeMy WebLinkAbout032-1098-60-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 582043
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:
Dorene Ziemer TOWN OF SOMERSET 032-1098-60-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/o d 3M I SST 35.31.19.459C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Z 4 Benchmark 14. 4;1 AD (!I
Alt. BM
2 AT 4/41
Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 64
TANK TO Aqq P/L WELL BLDG: ant Air Intake ROAD CiWplet-
Septi
75 0rf- 3 d j,?
l O / 23 7 / Header/Man. Z(y g5 . 3
Aeration Dist. Pipe p. / 9S • 79
Z. 4f
Holding Bot. System /Z - Z F .Y.
13. V 3 a
Final Grade
PUMP/SIPHON INFORMATION Z.
Manufacturer Demand St Covererr
GPM f"i/ Z•~{f ~~~•T
M Number
TLift Friction Loss System Head TDH Ft
Forcemain th Dia. ist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 7 Z
v
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Z ~'la
INFORMATION ~j Ty Of Sy CHAMBER OR
L75 UNIT Model Number:
DISTRIBUTION SYSTEM e 4 -7 +-7 /
Header/Manifold i Distribution Hole Size Spacing Vent to Air ntake Q
o~ J Pipe(s) ~ / d ~4L t a
Length Dia ~f Length Dia Spacing ix x Hole
I
1~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Q 7 Bed/Trench Edges Topsoil Yes to No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 564 PLOURDE DR
1.) Alt BM Description
2.) Bldg sewer length = L~
-amount of cover= t~X l vp' ~ lJ 4;7
Plan revision Required? Yes , No ' S $ S
Use other side for additional information.
SBD-6710 (R.3/97) Date InsepI s Signa a Cert. No.
c+ex"ATr 6 County
ds St. Croix
Industry Services Division
0 $ 1400 E Washington Ave P P.O. Box 7162 Likanitary permit Number (to be filled in by Co.)
$a,<~ Madison, WI 53707-7162 g2
Ati .C)'J "l ,Y
~qv. . *14 Ail
~,1`M ermit Application e r sactionNu b r
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 (i different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stars. Same 5
1. Application Information - Please Print All Information a a r G /IC/f~7
Property Owner's Name Parcel #
Ziemer, Dorene 032-1098-60-000
35.S). 19, 4590
Property Owner's Mailing Address Property Location
*Plourde Drive
Govt. Lot
City, State Zip Code Phone Number SW '/4, SW'/4, Section 35
Somrerset , WI 54025 le one)
TXN R19Eo~
II. Type of Building (check all that apply) t # 31
® 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name
❑ Public/Commercial - Describe Use * Block #
❑ City of YIN ❑ State Owned - Describe Use
CSM Number ❑ Village of
7 Cj G^ ® Town of Somerset
III. Type of Permit: Check onl one box on line A. Complete line B if applicable) d "Ok.C-
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
IV. Type of POWTS System/Component/Device: (Check all that a 1)
® Non-Pressurized In-Gr un ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
Holding T c Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
_LJ V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Prop ed (sf) System Elevation
450 Rate(gpdsf) 643 700 94.8', 93.0'
0.7
VI. Tank Info Capacity in
Y
Gallons Total # of Manu cturer 2 0
n o °
New Tanks Existing Tanks Gallons Units a U ~ i ~ w a
Septic or Holding Tank 1000 1000 2000 2 teser ! known ® ❑ 1:1 El El
Dosing Chamber ❑ 1:1 1:1 1:1 1:1
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) L Plumbe ' atu 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. Coun epartment Use Only
WApproved 0-Dim" pre e Permit Fee Dat Issued ~j Issuin ent Signal
❑ ven Reason for Denial $ Z tJ
IX. Condi#W Reasons for Disapproval
1. 5ept~ ank; effltlent f~ter tcnd
dispersal cell must all be eery':: / maintaired
as per management plan provided by plumber.
2 AN set c requ0*YWn s mkt be maintained
as
per qVilicable code / ordinances.
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: Ziemer Replacement Septic System
Legal Description: SWIM, SW1/4, S35, T30N, R19W P.I.D: 032-1098-60-000
Subdivision Name: NA Lot
Township: Somerset Parcel Size: 2.00 Acres SCALE: 1" = 50'
County: St. Croix
Slope: 22/0 System Elevation: T1=94.80' Proposed 70' EZ Flow Trench
BM1 Elevation: 100.00' To of 1" PVC conduit T2=93.00' Proposed 70' EZ Flow Trench
0 BM2 Elevation: 104.49' To of existin se tic tank cover Existing Drain Field= Rock Bed
Backhoe Pits: S1=Existing 1000 gallon Septic Tank
S2=Pro osed 1000 gallon Wieser Septic Tank
NOTE: See page 11 for a complete view of the parcel.
1 4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
s
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Page 2
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Ziemer Replacement Septic System
Owners Name: Dorene Ziemer
Owners Address 564 Plourde Drive
Somerset, WI 54025
Legal Description: SW1/4, SW1/4, S35, T30N, R19W
Township Somerset
County: St. Croix
Subdivision Name:
Lot Number: Block Number
Parcel I.D. Number 032-1098-60-000
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&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: 11/17/2015 Phone Number: 715-760-0486
Signature:?
In- round Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1
PLOT PLAN N
Project Name: Ziemer Replacement Septic System
Legal Description: SWIM, SWIM, S35, T30N, R19W P.I.D: 032-1098-60-000
Subdivision Name: NA Lot
- SCALE: 1" = 50'
Township: Somerset Parcel Size: 2.00 Acres
County: St. Croix
Slope: 22% System Elevation: T1=94.80' Proposed 70' EZ Flow Trench
A BM1 Elevation: 100.00' To of 1" PVC conduit T2=93.00' Proposed 70' EZ Flow Trench
BM2 Elevation: 104.49' To of existin septic tank cover Existing Drain Field= Rock Bed
Backhoe Pits: S1=Existing 1000 gallon Septic Tank
S2=Pro osed 1000 gallon Wieser Septic Tank
NOTE: See page 11 for a complete view of the parcel.
4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
5-14
`!J
0
a
BM''
CD \ i I
S Zl I
WELL /
o► 8 ♦ 83
y~ r 2Z% Sty ter
R
,/SO -
Page 2
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Dorene Ziemer
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 gpd/ft2
450.0 gpd Design Flow _ 0.7 Soil Application Rate _ F5 EISA = 128.6 Feet of EZ Flow
F 72trenches 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 Slotted and Anchored Vent/Observation Pipe
■
94.80ft with Cap
~ 11 93.00 ft Infiltrative Surface
>36 inch
90.83 ft Limiting Factor
■ ' ' ' ■ • . r ■ . ■ R9.20 ft Limiting Factor
Plumber/Designer Signature:
License MPRS 223760 Date: November 17, 2015
Page 3
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Page 4
POL -
Inc. T
Innovations in Precast, Drainage Zabel' PL-525 Effluent Filter
& 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 wont leave the tank.
Features: 1/16" Filtration Slots
• Rated for 10,000 GPD (gallons per day). Alarm switch
,p
10 000 GPD (optional)
• 525 linear feet of 1/16" filtration. r
• Accepts 4" and 6" SCHD 40 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.
PIr525 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.
3. Glue the filter housing to the 4" or 6" outlet e. If Accepts 4" &
pip SCHD 40 pipe
e
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. A matic
1. Locate the outlet of the septic tank. Shut -of f 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.
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
ls
sure the filter is properly aligned and completely inserted. Polylok, Outdoor
Zabel & B ell & Best filters lt)errs s Alarm accc cept Extend Easily installs
1staaltls
7. Replace and secure septic tank cover. the SmartFilter® switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CF 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com
Page 5
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: Dorene Ziemer Tank Manufacturer: Wieser Concrete NA
Permit # 2:: Septic I_ Dose Holding Volume: 1000 gal
DESIGN PARAMETERS Tank Manufacturer: NA
Number of Bedrooms: 3 NA Septic Dose E Holding Volume: 1000 gal
Number of Public Facility Units: NA Vertical Distance Tank Bottom (s) to Service Pad: ft
Estimated (average) Flow: 300 al/day Horizontal Distance Tank(s) to Serivice Pad: ft
Design (peak) Flow = estimated x 1.5: 450 al/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) s30 mg/L Effluent Filter Model: 525
Biochemical Oxygen Demand (BOD5) 5220mg/L NA Pump Manufacturer: fv'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 NA r, mechanical Aeration I Peat Filter NA
Total Suspended Solids (TSS) 5150mg/L Disinfection r Wetland
Petreated Effluent Monthly average Sand/Gravel Filter r Other:
Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System
Total Suspended Solids (TSS) 530mg/L (-V'NA 0/in-Ground (gravity) In-Ground (pressure)
NA
Fecal Coliform (geometric mean) 5104cfu/100m1 At-Grade r Mound
Maximum Effluent Particle Size: Ya in dia. N Drip-Line Other:
Other: 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 V year(s) (Maximum 3 years) NA
r month(s)
Inspect dispersal cell(s) At least once every: 1.5 W year(s) (Maximum 3 ears) NA
r month(s)
Clean effluent filter At least once eve : 1.5 year(s) 17 NA
month(s)
Inspect pump, pump controls & alarm At least once every: I- year(s) NA
month(s)
Flush laterals and pressure test At least once every: r- year(s) NA
month(s) 1~°
Other: year(s) i . N
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.
I
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
Page 6 (Rev.2/05)
START UP AND OPERATION Page of
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: 715-3864680
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.
Palo. 17/05)
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)tKPiourde Drive G~(t located
at: SW 1/4, SW 1/4, Section 35 , Town 30 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 11/6/2015
Did flow back occur from absorption system? Yes No X
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity:
Construction: Prefab Concrete X Steel Other
Manufacturer (if known):
Age of Tank (if known):
Permit number (if known)
John Schmitt
( ensed Plumber Signature) (Print Name)
MPRS 223760
(Title) (License Number) MP/MPRS
11/17/2015
(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 8
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Dore n e Ziemer
Mailing Address 814 Plourde Drive 6 yp
Property Address4 Plourde Drive 5kA
(Verification required from Planning & Zoning Department for new construction.)
City/State Somerset, WI Parcel Identification Number 032-1098-60-000
LEGAL DESCRIPTION
Property Location SW '/4 , SW '/4 , Sec. 35 , T 30 N R 19 W, Town of Somerset
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house' yesx Lot lines identifiable Elyes❑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 is 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 arranty deed recorded in Register of Deeds Office.
Number of bedrooms 3
ABI~& 1
"SIGN T RE PPLICANT(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
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apartment of
~ af:mend SOIL EVALUATION REPORT 0 ( #1so4
in accordance with Comm 85, Wis. Adm. Code age 1 of 4
~ nal Services
Schmitt Soil Testing, Inc.
."'(51)(C 4/ OPfvEIVT County
10e) le an on paper not less than 8% x 11 inches in size. Plan must St. Croix
''c ude, 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.
0 -10 -6Q-000
Please print all information. Re wed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Ziemer, Dorene L Govt. Lot SW1/ , S 14, S35, T30N, R19W
Property Owner's Mailing Address Lot # Block # Subd. N e or CSM#
564 Plourde Drive
City State Zip Code Phone Number
City Village EK Town Nearest Road
Somerset WI 54025 715-222-6673 Somerset Plourde Drive
L] New Construction Use: Ll Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Z Replacement i Public or commercial - Describe:
Parent material Outwash Sand Flood plain elevation, if applicable NA ft.
General comments Replacement area is suitable for a conventional system with 0.7 gpd/sgft rate. Possible system elevation is 94.80' (High trench)
and recommendations: 93.0' (Low trench). Slope of area is 22%.
Boring
F1 Boring # Pit Ground surface elev. 98.83 ft. Depth to limiting factor 96+ 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 *Eff#2
1 0-10 10yr3/3 none I 2mgr mvfr as 2m,2vf 0.6 0.8
2 10-15 7.4yr4/4 none grsl 2msbk mvfr gw 2f 0.6 1.0
3 15-27 7.5yr4/6 none grls lcsbk mvfr gw 2vf 0.7 1.6
4 27-43 7.5yr5/6 none Is Osg ml gw lvf 0.7 1.6
5 43-75 10yr5/6 none s Osg ml Cs 0.7 1.6
6 L75-96 10yr6/4 none grs Osg ml 0.7 1.6
9 1P
Boring # Lj Boring LL~ .
Pit Ground surface elev. 98.3 ft. Depth to limiting factor 92+ 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. *Efr#1 *Eff#2
1 0-10 10yr3/3 none sl 2fsbk mvfr as 2m,2f 0.6 1.0
2 10-18 7.5yr4/4 none scl 2msbk mfr gw 2m,2f 0.4 0.6
3 18-36 7.5yr4/6 none grsl 2msbk mvfr gw 2vf 0.6 1.0
4 36-46 7.5yr5/6 none grls lcsbk mvfr gw lvf 0.7 1.6
5 46-92 10yr5/6 none grs Osg ml 0.7 1.6
r1
* Effluent #1 = BOD? 30 < 220 mg/L and TS >30 < 150 mg/L * Effluent #2 = BOD5 <_30 mg/L and TSS S.30 mg/L
CST Name (Please Print) Sign atu CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd St. New Richmond, WI 54017 11/6/2015 715-760-1978
SBD-8330 (R.07/00)
Property Owner Ziemer, Dorene L Parcel ID # 032-1098-60-000 Page 2 of 4
5 Boring # L Boring
Pit Ground surface elev. 97.03 ft. Depth to limiting factor 94+ 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 0-7 10yr3/3 none SI 2mgr mvfr as 2m,2f 0.6 1.0
2 7-18 10yr4/4 none scl 2msbk mfr gw im,2f 0.4 0.6
3 18-28 7.5yr4/4 none grsl 2msbk mfr gw 2vf 0.6 1.0
4 28-35 7.5yr4/6 none grsl 2msbk mfr gw 1vf 0.6 1.0
5 35-59 7.5yr5/6 none gris Osg ml gw ivf 0.7 1.6
6 59-94 10yr5/6 none s Osg ml 0.7 1.6
4~'
Boring 4~
F-1 Boring # E] Pit Ground surface elev. ft. Depth to limiting factor 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
Boring
Boring # Pit Ground surface elev. ft. Depth to limiting factor in.
F-1
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
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS - 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00) Schmitt Soil Tesft, Inc.
Page.
Con,
--c -b3': Cbuducted-Pow:;
Schmitt Sons Exc_aivating Inc.. , Name Dorene L Zemgr
ThoinassJ. Schmitt, CST 227429 Address: 564 PIobrde Drive
,
586 ValleY Nfiew Trail - - ty State,'Zip, - So
Ci ' - - - a -
WOW, ~iT 54025
$onjers t,W 54Q25
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7 0 197 _
Phone: 715-7
$ PI [J: 032-10980-000
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■ ' ~ . _ Leal I)esc~iption: SW-V'4 4SW1l4 S35T_30y >tt9W
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Backhoe Pit' -
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orvnship, Couthty: `Somerset Tdwnship, $t. Croix County
{ Beii6h ar - - -
El. 10.00' Top of 1 PVCjcofiduif.
bench llAarls±2 El. 104.49' T4A ex#stirg-septici tarp cover
Slope= 22% Septic Tank'Oul,et E#. 100.03'
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