HomeMy WebLinkAbout026-1306-00-003
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary
Permit : Z
('1 im 25 Z
GENERAL INFORMATION (ATTACH TO PERMIT) State Ian 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:
Set in Stone Countertops LLC TOWN OF RICHMOND 026-1306-00-003
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
18.30.18.1610
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type Of System: CHAMBER OR
UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold jistri
bu
tion x Hole Size x Hole Spacing Vent to Aiipe(s)
Length Dia ength Dia Spacing
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 Bed/Trench Edges Topsoil
Yes No Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 988 154TH AVE
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information.
Date Insepctor's Signature Cert . No.
SBD-6710 (R.3/97)
~ , C3 y
- County
1~,, nrerey St. Croix
Industry Services Division
r,I 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
Vie.. anti,
~$P $ JAN 05 2018 Madison, P.O. 7162
, WI Box 537707 07-7162 Cp~ 3~.2-
\zf~.~
q q~1im~,3~ St. Croix County
om ni y eve op It Ayxr+I~„~4- t" State TransacnNumb er
3all i
in accordance with SPS 383.21(2), Wis. Adm. Code, submission o Z45SPRMQN08YP
o arc suumutea to project Address (if different than mailing address)
is required prior to obtaining a sanitary permit. Note: Application _
the Department of Safety and Professional Services. Personal information you provide may be used for secondary 988 1540' Avenue
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats.
1. Application Information - Please Print I ormation parcel #
Property Owner's Name Parcel 06-00 003 026
Set Stone Countertops LAC/Anthony Hayes -13 Property Location
Property Owner's Mailing Address
882 167°i Ave Govt. Lot
City, State Zip Code Phone Number NE 1/,,, SE 1/4, Sectione,--/Ir
(circle one)
New Richmond, WI 54017 T 30 N ; R 18 E otl&
II. Type of Building (check all that apply) Lot #
3 Subdivision Name
®1 or 2 Family Dwelling- Number of Bedroom Glens of the Willow /
F-1 Public/Commercial -Describe Use [10 ock #
❑ City of
❑ State owned -Describe Use ❑ Village of
CSM Number
S~ r1o ®Town of Richmond
~ ~ ~6~ Gel,{5 W S ~z
ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) Existing System (explain)
A. ® New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to
❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
B ®Permit Renewal ❑ Permit Revision
Before Expiration Plumber Owner 582095 3/21/2016
IV. Type of POWTS System/Component/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
F1 Holding Tank ersal Component (explain) El Pretreatment Device (explain)
e
V. Dispersal/Treatment Area Information: Dispersal Area Propose sf) System Elevation
Design Flow (gpd) Design Soil Application Dispersal Area Required 500
300 Rate(gpdsf) 429 CC)
0.7
VI. Tank Info Capacity in o
Gallons Total # of Manuf cturer Y a ~ E -C Gallons Units l U ~ i,., C7 w
New Tanks Existing Tanks V
Septic or Holding Tank 1000 1000 1 W eser Concrete ® El El ❑ ❑
El ❑ ❑ ❑ ❑
Dosing Chamber 1
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
MP/MPRS Number Business Phone Number
Plumber's Name (Print) Plu is ignature J`' 223760 715-760-0486
~
GX
John Schmitt _
Plumber's Address (Street, City, State, Zip Code)
616 150th Ave. Somerset, WI 54025
VIII bunt /De artment Use Onl
Approved Disappro Permit Fee Date I ued Issum ent Signature
ven Reason for 1 + e~
IX. Condit. tRea110S I Disapproval 3)
1.
(,islet -,u cell must all be s 4 ' r't'n
As per mar.39emen' plan pro•tided by pluinbet.
2. _AII > r~r k t+ U10Ie "M5 muotm<rant wa-
0 pu jw icrth CAY10 / w^rdlllsn AI-
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I t inches in size
SBD-6398 (R03/14)
~~~y+na r ~rf 1 r County
Industry Services Divi St. Croix
1400 E Washing ton
$ Sanitary Permit Number (to be filled in by Co.)
A~ 17 P.O. Box 7162
a ; Madison, WI 5370 -
uatisy
CROIX COUNTY
o ~t F' pplication to Transaction umber
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(i)(m), Slats. 988 154th Avenue
1. Application Information - Please Print II Information
Property Owner's Name 1 Parcel #
Set in Stone Countertops LLC / Anthony Hayes 026-1306-00-003 g of JO X10
Property Owner's Mailing Address Property Location
882 167°i Ave
Govt. Lot
City, State Zip Code Phone Number NE ''/G, SE '/4, Section 18
New Richmond, WI 54017 (circle one)
T30N RI8EorW
H. Type of Building (check all that apply) Lo
® 1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name
Ne>L-ka;Ss_
❑ Public/Commercial - Describe Use Bloc # ~GtX:° 5 P r /E~- r ~L La^ C4-)
s
❑ city of
❑ State Owned -Describe Use
n CSM Number ❑ Village of
Z 1S~- ~e u w 6+6 Ez F7ajt ® Town of Richmond
III. Type of Permit: (Check o ly one box on line A. Complete line B if applicable)
A. ® New System ® Replacement System ❑ Treatment/Holding Tank Replace ut 11y El Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Chang W ransfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber V, 04'z aD r~
IV. Type of POWTS System/Component/Device: (Check n,
E Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Gr ound > 24 in. of suitable soil F-1 Mound < 24 in. of suitable soil
Ho ding Tank Other Dispersal Component (explain) retreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Req d (st) Dispersal Area Propose (sf) System Elevation
300 Rate(gpdsf) 429 500 95.00'
0.7
VI. Tank Info Capacity in
U U
Gallons Total # of L E Manufacturer U
New Tanks Existing Tanks Gallons Units Y I A Id1fC , 5Z 5 L Y Y L
i✓ U v~ ~ vl u:, CJ 0..
Septic or Holding Tank 1000 1000 1 Wieser C Crete ® ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumb 's Sigpature MP/MPRS Number Business Phone Number
John Schmitt yZ17Lr 223760 715-760-0486
Plumber's Address (Street, City, State, Zip Code)
616 15othAve. Somerset. W1 54025
VII ount /De artment Use Only
Approved Permit Fee Dat Issue ff Issuin gent Signatur
ven Reason for Denial $ $5 3 Z' 1 `Q
IX. Condiot7~A'~,A1Reasons for Disapproval
eptar. rk, effluent filte* and 3) R~a~2. a ~ Sef ~
disper:",i cell must all be spr ic.?s ! nia
intairec'
as per management plan pro tidediby plumber.
2. Ah Wlbllli~* regWWY eats MUst,O M, aiMa.iriid
as per Wftable code t ordinawea.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 1I inches in size
SBD-6398 (803/14)
PLOT PLAN N
Project Name: Hayes 2 Bedroom Septic System
Legal Description: NE1/4, SE1/4, S18, T30N, R18W P.I.D: 026-1306-00-003
Subdivision Name: The Giens of Willow River Lot 3
Township: Richmond Parcel Size: 1.566 SCALE: 1" = 40'
County: St. Croix
System Elevation: T1=95.00' Proposed 50.00' EZ Flow Trench
Slope: 1% to the south T2=95.00' Proposed 50.00' EZ Flow Trench
BM1 Elevation: 100.00' Top of 2" PVC Pipe
BM2 Elevation: 97.61' Top of NW lot corner pipe Tanks Wieser Concrete WLP1000-MR
■ Backhoe Pits: Filter Pol lok 525
NOTE: See page 11 for a complete plot of the parcel. 4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
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Zvi? Page 2
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Hayes 2 Bedroom Septic System
Owners Name: Set In Stone Countertops LLC
Owner's Address 882 167th Avenue
New Richmond, WI
Legal Description: NE1/4, SE1/4, S18, T30N, R18W
Township Richmond
County: St. Croix
Subdivision Name: The Glens of Willow River
Lot Number: 3 Block Number
Parcel I.D. Number 026-1306-00-003
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 Plat
Attachment 1 Soil Evaluation Report
Attachmemt 2 House Plan
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 3/17/2016 Phone Number: 715-760-0486
Signature: -,7,( r
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1
PLOT PLAN N
Project Name: Hayes 2 Bedroom Septic System
Legal Description: NE1/4, SE1/4, S18, T30N, R18W P.I.D: 026-1306-00-003
Subdivision Name: The Glens of Willow River Lot 3
Township: Richmond Parcel Size: 1.566 SCALE: 1" = 40'
County: St. Croix
System Elevation: T1=95.00' Proposed 50.00' EZ Flow Trench
Slope: 1% to the south T2=95.00' Proposed 50.00' EZ Flow Trench
BM1 Elevation: 100.00' Top of 2" PVC Pipe
BM2 Elevation: 97.61' To of NW lot corner pipe Tanks Wieser Concrete WLP1000-MR
■ Backhoe Pits: Filter Pol lok 525
NOTE: See page 11 for a complete plot of the parcel. 4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
132 ~
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Page 2
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Hayes 2 Bedroom Septic System
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
300.0 gpd Design Flow - 0.7 Soil Application Rate _ F 57 EIS, = 85.7 Feet of EZ Flow
F 27 trenches 56 feet long each
2 No. of Cells 5 Per Cell
3 ft Cell Width 10 Total No of 1203H
50 ft Cell Length 250 sq ft EISA Per Cell
3 ft Cell Spacing 500 sq ft Total EISA
Typical Cross Section
Finished Grade 98 ft Observation Pipe with
approved cap or vent
Soil Backfill
36 inch Geotextile Fabric
12 inch I~ O t. Slotted and Anchored Vent/Observa
with Cap
(0---
95.00 ft Infiltrative Surface
>36 inch
92.00 ft
Plumber/Designer Signature:
License MPRS 223760 Date: March 17, 2016
Page 3
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Page 4
X1.
Inc.
POLYANOrwo,
Innovations inPrecast. Dairage Zabel` PL-525 Effluent Filter
& Waste:vater Prodacts 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
Alarm Switch
• Rated for 10,000 GPD (gallons per day). (optional)
• 525 linear feet of 1/16" filtration. 10,000 GPD
• Accepts 4" and 6" SCHD 40 Accepts 1" PVC
pipe. Extension Handle
• Built in gas deflector. z "
• Automatic shut-off ball when filter is removed.
• Alarm accessibility. = hated for
10,000 GPD
• Accepts PVC extension handle. t41 t
1'L-525 Installation:
- 525 Linear Ft.
Ideal for residential and commercial waste flows up to
10,000 gallons per day (GPD). Filtration of x ratio
n Slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.
Accepts 4" & 6"
3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing. -
Certified to
5. Replace and secure the septic tank cover. 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
Shut-Off Ball
1. Locate the outlet of the septic tank.
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed. f
4. Pull PL-525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all llp q
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
Outdoor Srrtartlilter Alarm Extend & Luke','
sure the filter is properly aligned and completely inserted. Polylok, Zabel & Best filters accept Easily installs
7. Replace and secure septic tank cover. the SmartFilterO 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 EZ OZUTM
EZflow Systems in Wisconsin by1NFILTRATOR
Wisconsin Department of Commerce, Safety and Buildings : 5. The Absorption area (SF) necessary for a given site shall
Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and
product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the
Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40%
145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield.
& Soil Conditions & Locations & Isolation distances as noted in '
local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap-
proved by system design permit specified for the particu-
The approved products are 1203H (3-12" bundles with pipe in lar site, The top or center-most bundles containing pipe
center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any
with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required,
• should be butted against the other aggregate-only bun-
A single pipe bundle contains a four inch perforated pipe sur- dies and do not require any type of connection.
rounded by EPS aggregate and is held together with poly-
ehtylene netting. A single aggregate bundle contains aggregate : 7. The top of each GEO cylinder contains a filter fabric pre-
only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The
fabric is inserted to prevent soil intrusion. The installer
Materials and Equipment Needed shall make sure the the GEO is positioned upward and is
• EZflow Bundles ; in contact with the fabric contained in the adjacent cylin-
• EZflow Geotextile Fabric der before backfilling.
• EZflow Internal Pipe Couplers
• Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a
• Backhoe/Excavator level trench in all directions (both across and along the
trench bottom) and should follow the contour of the ground
Installation Instructions surface elevation (uniform depth), with all continuous
The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end,
below. This product must be installed in accordance with state with central bundle distribution pipe interconnected,
rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops.
ministrative Code, and Chapters 145 and 160, Wisconsin Stat-
utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not
manual. pond. Backfill should be seeded or sodded immediately
after completion to reduce erosion.
1. After the local health department has determined sizing,
configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved
or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or
careful to set correct tank, invert pipe, header line or dis- other obstacles.
tribution box and trench bottom elevations before instal-
lation of pipe bundles. 1 1. EPS aggregate is lighter than water, therefore, it might
be expected that natural buoyancy forces would tend to
2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when
bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however,
trench before system is covered, that this is not a problem when systems have a minimum
of 6" of soil cover as recommended by manufacturer.
3. This product must have geotextile fabric that meets re-
quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extending 1203H-GEO
down along the sides of the product to a point at least six
inches from the bottom of product. Geotextile
JJJ
Barrier Material
4. When installed in a trench, the trench should be dug to 1 l
a width of 36 inches. This not only saves labor in excava- 17, tion, but also provides better load-bearing capacity after
backfilling is complete.
f-
.
Page 6
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: Set In Stone Countertops LLC. Tank Manufacturer: Wieser Concrete NA
IPermit # 77 Septic - Dose i- Holding Volume: 1000 gal
DESIGN PARAMETERS Tank Manufacturer: NA
Number of Bedrooms: 2 3_.. NA_ Septic r- Dose Holding Volume: gal
Number of Public Facility Units: -'NA Vertical Distance Tank Bottom (s) to Service Pad: ft
Estimated (average) Flow: 200 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft
Design (peak) Flow = estimated x 1.5: 300 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) S150mg/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 r/ NA Mechanical Aeration / Peat Filter NA
Total Suspended Solids (TSS) :5150mg/L Disinfection Wetland
Petreated Effluent Monthly average Sand/Gravel Filter Other:
Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System
<_30mg/L ii?-NA <i/ In-Ground (gravity) ~ In-Ground (pressure) F NA
Total Suspended Solids (TSS)
Fecal Coliform (geometric mean) 5104cfu/100m1 F At-Grade + Mound
Maximum Effluent Particle Size: Y. in dia. 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
j month(s) r-
Inspect condition of tank(s) At least once every: 3 p~ year(s) (Maximum 3 years) NA
Inspect dispersal cell(s) At least once every: 1.5 ✓ month(s) (Maximum 3 years) NA
month(s)
Clean effluent filter At least once every: 1.5 t - year(s) NA
month(s)
40
NA
Inspect pump, pump controls & alarm At least once every: r" year(s) '
month(s)
Flush laterals and pressure test At least once every: year(s) NA
month(s)
Other: r- year(s) NA
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 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: Owners Choice 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.
Pcl@e 005)
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Tony Hayes
Mailing Addres 882 167th Avenue
PropertyAddre 988 154th Avenue
(Verification required from Planning & Zoning De ent for new construction.)
City/State New ~ir,hmond, WI Parcel Identification Number 026-1306-00-003
LEGAL DESCRIPTION
Property Location NE ,4 SE '/4, Sec. 18 , T 30 NR 18 W, Town of Richmond
Subdivision Plat: The Glens of Willow River Lot # 3
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house 0yes0io Lot lines identifiable Byes[] 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. 353.52(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 thi form are true to the best of my/our knowledge. I/we arn/are the owner(s) of the
property described above, by virtue of a wary my deed recorded in Register of Deeds Office.
Num r of bedrooms 2
I'44 3
SI AT RE 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
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Wisconsin SOIL EVALUATION REPORT #1488
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings -Schmitt Soil Testing, Inc.
Attach complete site plan on paper not less than 8Yz x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and -
r e
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 330)
Please print all information. Revi -4 603
d By Date
Personal information you provide may be used f sewn aw, s 15.04 (1) (m)). ~b 9 b
Property Owner Property Location
Sienna Corporation i Gov Lot NE1/4 SE1/4, S18, T30N, R18W
Property Owner's Mailing Address f~
- ' ----6 Lot Block # Subd. Name or CSM#
4940 Viking Drive Suite 608 The Glens Of Willow River
- Q1414
City State Zip de h City Village 'I, Town Nearest Road
Minneapolis MN 55435 Richmond 100Th St.
New Construction Use F Residential / Number of bedrooms 3 _ Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash Flood plain elevation, if applicable na ft.
General comments
and recommendations: Area is suitable for a conventional system with a 0.7 gpd/ sgft rating. Possible system elevation for Area
1 is 95.0'. - -
F-11 Boring # _ Boring
Pit Ground surface elev. 98.49 ft. Depth to limiting factor 115+ in.
_ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-12 10yr3/1 none sil lfsbk mfr as 2m,2f .6 .8
2 12-18 10yr4/4 none sil 2fsbk mfr gw lvf .6 .8
3 18-26 10yr4/4 none sl 2msbk mfr gs lvf .6 1.0
4 26-45 7.5yr5/6 none s Osg ml as .7 1.6
5 45-90 10yr5/6 none grcos Osg ml as .7 1.6
6 90-115 10yr6/4 none I s Osg ml .7 1.6
Boring # -1 Boring '41'
Pit Ground surface elev. 99.03 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-10 10yr3/1 none sl 2fsbk mfr as 2m,2f .6 1.0
2 10-22 10yr4/4 none sl 2msbk mfr cs 1vf .6 1.0
3 22-32 7.5yr5/6 none grs Osg ml cs lvf .7 1.6
4 32-88 10yr5/6 none cos Osg ml as .7 1.6
5 88-115 10yr6/4 none s Osg ml .7 1.6
e
.a _
Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: r CST Number
Thomas J. Schmitt L 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond, WI 54017 9/15/2006 715-247-2941
SBD-8330 (R.07/00)
Property Owner Sienna Corporation Parcel ID # 3 Page 2 of 3
Fil Boring # Boring
1 Pit Ground surface elev. 98.44 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
*Eff#1 *Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-9 10yr3/2 none I 2fsbk mfr as 2f,ivf .6 .8
2 9-23 10yr4/4 none sl 2msbk mfr cs 1vf .6 1.0
3 23-51 10yr5/4 none grs Osg ml as lvf .7 1.6
4 51-84 10yr5/6 none grcos Osg m1 as .7 1.6
5 84-115 10yr6/4 none s Osg ml .7 1.6
i
D ~i
' 12g~ 2
❑ Boring # Boring -
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#1 *Eff#2
❑ Boring # Boring
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#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 (807/00) Schmitt SW TesbN, Inc.
Page-? of
Conducted by: Conducted For:
Schmitt Soil Testing Inc. Nanle: Sienna Corporation
Thomas J. Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608
1595 72nd St. City, State, Zip: Minneapolis, MN 55435
New Richmond, Wl. 54017
Phone: 715-247-2941 Subd.Name: The Glens of Willow River
Signature:b c s"'~ r~ f Lot No.:
Date: Legal Description: /1&1/4 SE l /4 S18 T30N R18 W
Backhoe pit Township, County: Richmond, St-Croix
Bench Mark El. 100.00' Top of 2" pvc pipe
Alternate Bench Mark El. 17 ' Top of % S~r~ ✓`o ~<<~~~~ ~LJ~~'~~'~~
Slope= (z t) Contour Line El. Contour Line Length
Scale 1" = 40'
~v
yS_
This Soil and Site Evaluation was comp I a zoning requirement. It may or may not be in a location suitable for you se.
1