HomeMy WebLinkAbout036-1079-20-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 584708
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: T City Village Township Parcel Tax No:
Christopher & Becky Roberts TOWN OF STANTON 036-1079-20-200
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
locD.0-0 roa• 0~ lb(D OC 5.% L-/P 31.31.17.488B
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
EXISrA/61, ! Etz (C~oO JDP 6x. 5.r Ul 2•(oo /o2.6 ~vo-oo
6e3"q Alt. BM
ZAT s•r. NEW
Aeration (.11 POLYGo~ NSF/G Bldg. Sewer
Holding St/Ht Inlet
Z l (L/SE~S
TANK SETBACK INFORMATION Sti1~ Outlet
Eau s W6. /JX s 7f • $ ~
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD $t`Inlet w j S.;r ,-.,97 73
Septic owTGGT 5- _
E IS"/ a~ w (OLDS ;ee/W --W S•-r 6.~N l('p• c~/
Header/Man. exlsliA)ty (1.2-4
,var± (p , $
.73 ?57 9
Aeration Dist. Pipe
55-
Holding Bot. System I -7.5-V
~ISIc~
Final Grade
PUMP/SIPHON INFORMATION ~.2v f7 y0
Manufacturer Demand, St Cover
GPM \ t;xl T/(JCsr S.( Z,~ ~OD•oO
Model tuber
TDH Lift c ion Loss System Head TDH Ft
Fof ain Length Dia. Dist. to Weu
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 611 ACW (Z EXIS))
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR 6_21 FG
Type Of System: UNIT Model Number:
6C, A; VCAM4141,4L I r
DISTRIBUTION SYSTEM
Header/Manifold Distribution ix Hole Size x Hole Spacing Vent to Air Intake
/ Pipe(s) / ) z~
Length Dia u Length Dia Spacing (9 J
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth over xx Depth of 1xx Seeded/Sodded xx Mulched
Bed/Trench Center + I Bed/Trench Edges 4 Topsoil
Yes No ] Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1851 OAK RIDGE TRL
1.) Alt BM Description =
2.) Bldg sewer length = 5~
- amount of cover = Vol',
Plan revision Required? Yes V No
Use other side for additional information.
Date I sepctor's Signature Cert. No.
SBD-6710 (R.3/97)
.grtxAr}ra r~ County
Industry Services Division St. Croix
D Y 1400 E Washington Ave
S Q APR w yy P.O. Box 71 Sanitary Permit Number (to be filled in by Co.)
ST. CROIX CO N Madison, WI 537 1 ~Q/J Q
0QMM
Sanitary Perml placation StateTransacti°n/N►ymj~er
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit / `JTl
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 Informatio - Please Print All Information
Property Owner's Name Parcel #
Christopher & Becky Roberts 036-1079-20-200
Property Owner's Mailing Address Property Location ~
1851 Oak Ridge Trail
Govt. Lot
City, State Zip Code Phone Number NW ''/4, SE '/4, Section 31
New Richmond, WI 54017 (circle one)
T31N Rt7Eoio
II. Type of Building (check all that apply)
® I or 2 Family Dwelling - Number of Bedroom (3 2 Subdivision Name
❑ Public/Commercial - Describe Use Block #
❑ City of
❑ State Owned - Describe Use
i~ //~A~ tt L CSM Number ❑ Village of
0;--)* Uktll t~ / i T • 47,4:0 V6, 3773 ® Town of Stanton
111. Type of Permit: (Check only one box on line A. Complete line B if ap licab e)
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 Numd ~t ssued
Before Expiration Plumber Owner 3 ~9
a
IV. Type of POWTS System/Component/Device: (Check all that apply)
® Noon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
Holding Tank Ot er ispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treat nt Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation
450 Rate(gpdsf) 1125 1150 94.90'
0.4
VI. Tank Info Capacity in
Gallons Total # of an acturer
Gallons Units o a; -
New Tanks Existing Tanks 16 ; C7 q
Septic or Holding'fank 320 1000 1320 2 Wieser C Crete ® ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' tg 'ture MP/MPRS Number Business Phone Number
John Schmitt 7 ~ 1 223760 71s-76o-0486
Plumber's Address (Street, City, State, Zip Code)
616 150n' Ave. Somerset, WI 54025
VIII. C_uunty/ De artment Use Only
Approved Permit Fee Date ssue /I - Issuing nt Signatur
ven Reason for enial $ ~5 . OQ y V
IX. Condit WAJi# iIixl4RReasons for Disapproval
1. Sep0r. tank, a flt zn Bite, t,nd
disper•° cell mvtu t all be s i Ic ! r rota;rec (n~
as per marAgament plan pto nded by plumber. ,h
2. AU soUck rsglait;o►r1t; nts must t,p rtasrlt. Ir~Fd
as per Ilotlbla 04& / udAn
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
G 5T- Zo!(fl -o Z.tZ
SBD-6398 (R03/14)
PLOT PLAN N~
Project Name: Roberts 3 Bedroom Repacement Septic System
I
Legal Description: NW1/4, SE1/4, S31, T31 N, RI 7W P.I.D: 036-1079-20-200
Subdivision Name: NA Lot 3
Township. Stanton Parcel Size: 2.0 Acres scAL 40'
County: St. Croix
System Elevation: T1= 94.96 Existing 100' Sidewinder HI Cap
Slope: 0% to the south T2= 94.94 Existing 100' Sidewinder HI Cap
A BM1 Elevation: 100.00' Top of existing S. T. manhole cover T3= 94.90 Proposed 115' EZ Flow Trench
0 BM2 Elevation: 97.61' Top of existing N trench vent cover T4= 94.90 Proposed 115' EZ Flow Trench
■ Backhoe Pits: Existing Tanks Wieser Concrete WLP1000-MR
Proposed Filter Tanks Wieser Concrete W320-MR
NOTE: See CSM for complete plot of the parcel Filter Pol lok 525
4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
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Page 2
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Roberts 3 Bedroom Repacement Septic System
Owners Name: Christopher & Becky Roberts
Owner's Address 1851 Oak Ridge Trail
New Richmond, WI 54017
Legal Description: NW1/4, SE1/4, S31, T31N, R17W
Township Stanton
County: St. Croix
Subdivision Name: NA
Lot Number: 2 Block Number
Parcel I.D. Number 036-1079-20-200
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Existing Septic Tank Specifications
Page 4 Filter Septic Tank Specifications
Page 5 Effluent Filter Information
Page 6 System Sizing & Cross Section
Page 7 EZ Flow Information
Page 8 & 9 Management and contingency plan
Page 10 Septic Tank Maintenance Agreement
Page 11 Warranty Deed
Page 12 CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 4/5/2016 / Phone Number: 715-760-0486
Signature:
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1
PLOT PLAN N
Project Name: Roberts 3 Bedroom Repacement Septic System
Legal Description: NW1/4, SE1/4, S31, T31N, R17W P.I.D: 036-1079-20-200
Subdivision Name: NA Lot 3
Township: Stanton Parcel Size: 2.0 Acres SCALE: V _
ao'
County: St. Croix
System Elevation: T1= 94.96 Existing 100' Sidewinder HI Cap
Slope: 0% to the south T2= 94.94 Existing 100' Sidewinder HI Cap
BM1 Elevation: 100.00 Top oxistin S. T. manhole cover T3= 94.90 Proposed 115' EZ Flow Trench
0 BM2 Elevation: 97.61' Top of existing N trench vent cover T4= 94.90 Proposed 115' EZ Flow Trench
■ Backhoe Pits: Existing Tanks Wieser Concrete WLP1000-MR
Proposed Filter Tanks Wieser Concrete W320-MR
NOTE: See CSM for complete plot of the parcel Filter Pol lok 525
4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
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Page 4
T
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Inc. r~ 7
PZ)LYAkO
Innovations nPiecast, ra al,V Zabel" PL-525 Effluent Filter
Ga. to a-ater Frvduers A Division of Polylok Inc.
PL-525 Filer
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 Slats
* Rated for 10,000 GPD allons er da Alarm switch
(g p y) 10 OOO GPD (Optional)
5 525 linear feet of 1/16" filtration.
* Accepts 4" and 6" SCHD 40 ~ Accepts 1" PVC
pipe, Extension Handle
a Built in gas deflector.
Automatic shut-off ball when filter is removed.
Rated for
* Alarm accessibility.. 10,000 GPD
Accepts PVC extension handle.
alga
I'1.,-525 Installation: t a, k.
Ideal for residential and commercial waste flows up to 525 Linear Ft.
of 1/16"
10,000 gallons per day (GPD). Filtration 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. NSFIANSI 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
Gas Deflector
needs servicing. Servicing should be done by a certified
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.
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
sure the filter is properly aligned and completely inserted. Outdoor nnartl filter;{; Alarm Extend & l.okT'
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
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Roberts 3 Bedroom Repacement 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 F-5 ftz Soil Application Rate 0.4 gpd/ft2
450.0 gpd Design Flow = 0.4 Soil Application Rate _ F 5 1 EISA = 225.0 Feet of EZ Flow
F2-]trenches 115 feet long each
2 No. of Cells 11.5 Per Cell
3 ft Cell Width 23 Total No of 1203H
115 ft Cell Length 575 sq ft EISA Per Cell
3 ft Cell Spacing 1150 sq ft Total EISA
Typical Cross Section
Finished Grade 99.25 ft Observation Pipe with
approved cap or vent
Soil Backfill
36 inch Geotextile Fabric
12 inch O II O Slotted and Anchored Vent/Observation Pipe
with Cap
94.80 ft Infiltrative Surface
>36 inch
91.27 ft
Plumber/Designer Signature:
License MPRS 223760 Date: April 5, 2016
Page 6
Installation Instructions for idlEZ W111
EZflow Systems in Wisconsin flbyFILTRATOR
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- dles 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 positiioned 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 (5) (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
bo 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-- 36"
................................................................................Page 7.....
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: Christopher & Becky Roberts Tank Manufacturer: Wieser Concrete ❑ NA
Permit # E] Septic ❑ Dose ❑Holding Volume: 1000 gal
DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete ❑ NA
Number of Bedrooms: 3 FZ] NA 0 Septic ❑ Dose ❑-folding Volume: 320 gal
Number of Public Facility Units: NA Vertical Distance Tank Bottom(s) to Service Pad: ft
Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft
Design Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if
In Situ Soil Application Rate: 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:
Total Suspended Solids (TSS) 5150mg/L Pump Model:
High Strength Influent/Effluent Monthly average Petreatment Unit Ld NA
Fats, Oils & Grease (FOG) 530 mg/L Manufacturer:
Biochemical Oxygen Demand (BOD5) 5220mg/L NA ❑ Mechanical Aeration ❑ Peat Filter
Total Suspended Solids (TSS) 5150mg/L ❑ Disinfection ❑ Wetland
❑ Sand/Gravel Filter ❑ Other:
Petreated Effluent Monthly average
Biochemical Oxygen Demand (BOD5) 530mg/L oil sort on ystem
Total Suspended Solids (TSS) 530mg/L ❑ NA In-Ground (gravity) ❑ In-Ground (pressure)
Fecal Coliform (geometric mean) :5104cfu/100MI ❑ At-Grade ❑ Mound
Maximum Effluent Particle Size: % in dia. A ❑ Drip-Line ❑ Other:
Other: NA
Other:
MAINTENANCE SCHEDULE
Service Event Service Frequency
When combined with sludge and scum equals one-third ('/3) of tank volume
Pump out contents of tank(s) When the high water alarm is activated
month(s)
Inspect condition of tank(s) At least once every: 3 ears (Maximun 3 Years) ❑ NA
Inspect dispersal cell(s) At least once every: 1.5 month(s) ✓ ears (Maximun 3 Years) ❑ NA
At least once every: 1.5 month(s) ❑ NA
Clean effluent filter ear s
Inspect pump, pump controls & alarm At least once every: month(s) Ej NA
year(s)
Use T3 & T4, and rest T1 & T2 for 5 ❑ month(s) ❑ NA
years, First 5 year(s)
Alternate between old & new systems ❑
annually or as indicated by inspection 1.1 ❑ month(s) NA
❑ year(s)
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank
inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The
dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumualtion of sludge and scum in any treatment tank equals one-third (Y) 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 5512 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.
Page 8
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are
detected have the contents of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will
be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely
abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for
a code compliant replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil
and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their
permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ 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.
REI@E2/95)
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Christopher Roberts
Mailing Address 1851 Oakridge Trail
Property Address Same
(Verification required from Planning & Zoning Department for new construction.)
City/State New Richmond, WI Parcel Identification Number 036-1079-20-200
LEGAL DESCRIPTION
Property Location NE '/4 , S E '/4 , Sec. 31 T 31 N R 17 W, Town of Stanton
Subdivision Plat: , Lot # 2
Certified Survey Map # 615844 , Volume 14 , page # 3773
Warranty Deed # 826464 (before 2007)Volume , Page #
Spec house Elyesl]no 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 w rranty deed recorded in Register of Deeds Office.
Number of bedrooms 3
In 3/ 31 /16
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
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) 1851 Oak Ridge Trail located
at: NW 1/4, SE 1/4, Section 31 , Town 31 N, Range 17 W,
Town of Stanton , 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 4/11/2016
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 1000
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): Wieser Concrete
Age of Tank (if known): 17 Years
Permit number (if known) 353197
I Al
s 'G y 1 -A41L,,:- John Schmitt
(Lice o ed Plumber Signature) (Print Name)
MPRS 223760
(Title) (License Number) MP/MPRS
4/11/2016
(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
R~QgftD
SOIL EVALUATION REPORT 74 ~l #1816
P $ pDSa t an+d~ - in accordance with Comm 85, Wis. Adm. Code ° Page 1 of 4
Pi
al83Si k~'S Schmitt Soil Testing, Inc.
Attach cor~~l t t t 1 s than 8% x 11 inches in size. Plan must County
include, t*itLA St Croix
tal reference point (BM), direction and jpercent sbpe, scale or dimensions, north arrow, and location and distance to nearest road. PPlease print all information. Ry
Daje
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). s[
Property Owner Property Location
Roberts, Christopher & Becky Govt. LotNE1/4, 1/4, S31, T31N, R17W
Property Owner's Mailing Address Lot # Block # Subd. Name CSM#
1851 Oak Ridge Trail 2 ! ! CSM 14-3773 036-99
City State Zip Code Phone Number City Village : Town Nearest Road
New Richmond WI ; 54017 I 715-410-6564 Stanton Oak Ridge Trail
New Construction Use: , Residential I Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash (Antigo Series) Flood lain elevation, if applicable NA -
General comments Replacement area is suitable for a conventional system with a 0.4 gpd/sgft rate. Possible system elevation for replacement area is
and recommendations: 94.90'. Area is flat (0% slope).
Boring
a Boring # -
Pit Ground surface elev. 99.21 ft. Depth to limiting factor 96 in. ISoil Application Rate
Horizon ! Depth Dominant Color Redox Description Texture i Structure i Consistence' Boundary i Roots GPD/ft2
f in. Munsell Qu. Sz. Cont. Color ! Gr. Sz. Sh. E 'Eff#1 `Eff#2
1 0-9 10yr3/2 none sil lmpl mfr as lvf 0.4 0.6
2 I 9-24 10yr4/6 none sicl 2msbk mfr gw ivf 0.4 0.6
3 24-37 7.5yr4/6 none I sl lmsbk mfr
gw 0.4 0.7
4 37-53 7.5yr4/4 none Ivfs lcsbk mfr as 0.4 0.6
5 53-91 ! 10yr6/4 none fs Osg ml cs ! 0.5 1.0
6 96-102 7.5yr4/4 none sil Om i mfr ! I 0.0 0.2
Alli
Boring # Boring ~f j
ti
Pit Ground surface elev. 99_06 ft. Depth to limiting factor 101 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure ! Consisten Boundary i Roots F GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, ; Eff#1 'Eff#2
1 ! 0-11 10yr3/2 none ! sil 2mgr ; mvfr J as lvf 0.6 0.8
- t
2 11-30 1 10yr4/4 none sc1 2msbk mfr gw ~ 1vf 0.4 0.6 -
3 30-40 10yr4/3 none sl lcsbk i mfr ( gw ! ! 0.4 0.7
f
4 40-60 7.5yr4/6 none Ivfs lcsbk mfr a j 0.4 0.6
- - - - - - - - - t - -
5 60-101 10yr6/4 i none fs Osg ml cs 0.5 ! 1.0
6 101-107 5yr4/4 c2d 10yr6/6 stl Om mfr
5 0.0 0.2
---10yr6j1-
'Effluent #1 = BODS> 30 < 220 mg/t and TSS >30 < 150 m ' Effluent #2 = BODS: 30 mg/L and TSS 30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing, Inc valuation Conducted Telephone Number
1595 72nd St. New Richmond, WI 54017 4/4/2016 715-760-1978
~ni).slift')~tk i
Property Owner Roberts, Christopher & Becky Parcel ID # -036-1079 20-200
Page ___,2,,---of 4
3 Boring # Boring
Pit Ground surface elev. Depth to limiting factor 97+ in.
Soil Application Rate
Horizon Depth i Dominant Color f Redox Description i Texture ! Structure ;Consistence Boundary Roots j _GP_D/ft2 _
in. Munsell j Qu. Sz. Cont. Color ( Gr. Sz. Sh. ! 'EffA 1 'Eff#2
!
1 ; 0-10 10yr3/3 none sil 2mgr mvfr as Ivf 0.6 0.8
- -
2 10 26 - 10yr4/4 none std- 2msbk mfr gw i._ 1vf f 0.4 t-0.6-
- f
3 t38-52 6-38 7.5yr4/6 none sl I 2msbk mfr cs 1vf 0.6 1.0
4 10yr5/6 j none I fs Osg ml cs 0.5 1.0
5 52 66 1 7 5yr4/4 I none tvfs icsbk mfr cs
--I-0.4 t 0.6
6 66 97 1 10yr6/4 none- fs Osg~ ml j 0.5 1 1.0
= - -----ILI
F 4 Boring # Boring Pit
Ground surface elev. .__99-01 ft. Depth to limiting factor 102+ in.
ISoil Application Rate
Horizon , Depth ' Dominant Color I Redox Description ( Texture Structure (Consistence Boundary Roots GPD/ft2
in. Munselt Qu. Sz. Cont. Color ! ry
Gr. Sz. Sh. i I`Eff#1 `Eff#2
I 0-10 10yr3/3 none f I
A 2mgr mvfr as 1vf 1 0.6 1 0.8
2 10-25 , 10yr4/4 none std 2msbk mfr gw lvf 0.4 0.6
-
3 25-36 I 7 5yr4/6 none sl 2msbk
r - - - - ~ mfr gw 0.6 1 1.0
4 1 36-49 10yr5/6 none fs 0 i ml cs - 1 0.5 1.0
5~ 49 61 + 10yr4/6 - .-none - I t~ lcsbk i mfr cs 0.4 0.6
6 61-102 10yr6/4 I none fs
ml t t ( 0.5 1.0
OS9
- - - IG► - -
I ;
Boring
❑ Boring # Pit
Ground surface elev. ft. Depth to limiting factor in f------
Soil Application Rate'
Horizon Depth ! Dominant Color Redox Description Texture Structure 'Consistence) Boundary j Roots f _GPD/ft2 _
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I• "Eff#1--- `Etf#2
- _
- ---I--- _
Effluent #1 = BOD,> 30 < 220 mg/L and TSS >30 150 mg/L Effluent #2 = BODS < 30 mg/L and TSS <.30 mg/L
I he Department of Commerce is an equal opportunity se" ice proN ider and employer. If you need assistance to access serti ices or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
S80-8330 (R 07100)
• Conducted by: Conducted For: Page 3 of 4
Schmitt & Sons Excavating, Inc.. Name: Christopher & Becky Roberts
Thomas J. Schmitt, CST 227429 Address: 1851 Oak Ridge Trait
586 Valley View Trail City, State, Zip: New Richmond, Wl 54017
Somerset, W l 54025
Phone: 715-7 0-1978 PID: 036-1079-20-200
signatu Lot No.: 2.
Date 4 Legal Description: NE1/4 SE1/4 S31 T31N R17W
■ Backhoe Pit Township, County: Stanton Township, St. Croix County
A Bench Mark 1 El. 100.00' Top of existing 2' manhole cover on septic tank.
® Bench Mark 2 El. 100.55' top of existing north trench vent pipe
Slope= 0%
Scale 1"= 40'
NOTE: For full view of Lot see Aerial Photo (Page 4 of 4)
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