HomeMy WebLinkAbout032-2089-70-000 (2)
'A'scorsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety anc Building Division
INSPECTION REPORT San tary Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) State Pan ID No: 5$4712
Perscna information you provide may be used `cr secondary purposes [P wady Laws 15 04 (1;;m;1
Permit I•older'8 Name :;,ty V rage Township Parcel Tax No:
Leslie & Nancy Zell TOWN OF SOMERSET 032-2089-70-000
CST W Elev In M li BM Desc Thor SeoLOn!rcanlHanyelh^ap ND
L C G VC=~ 15.31.19.884
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION RS HI FS FLFV.
Septic Benchmark I MKS
Dosing ` r Alt. BIv1
J
Aeration Bldg. Sewer
Holding SUHt Inlet /I V
TANK SETBACK INFORMATION S HtOutlet 8• (p$ 93.28
TANK TO ii WELL RI DG `tent to Ai' intake ROAD Dt Inlet
Septic Dt Bottom
Dosing 1 T ° Headeri an.
Aeration i Dist. Pipe a $"'7 0(3,09
Holding Bol. System
.-7 Q2, 2Ca
Final Grade
PUMP/SIPHON INFORMATION 5. _1
Manufacturer ti 15emand St Cover
GPIM
M6del Number
TDH Lift Friction Loss Head TDH Ft
Forcemain Length 0i11. Dist to .Jell
SOIL ABSORPTION SYSTEM
BEDlTRENCH Width t Len , INo Of Trenches PIT DIMENSIONS_ No C^ Piss Inside Dia. Liquid De
DIMENSIONS
SETBACK SYSTEM TO RL RI nG ///V`JELL LAKF/STREAM LEACHING M n f u e .
INFORMATION CHAMBER OR
I; Of System
r I UNIT ht I ber.
i ~ b b N cw
RIBUTION SYSTEM 0 j lWet
I •ead "Manifold 1 I Dslr Dutron x Ho a Size x Hole Si e o r~tak 1
(n/~~(//\
Pipe(si
Length? Dia~ Length Spacng /f 1 (/l
i .,~I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only i)
Cepth Over 1 epth Over xx Depth c` x Seede,Scddrd jXX Mulched
Bed.,Trerch Censer eed;'Trencn Edges > Toosoil ~!J Iles No -es No
1
COMMENTS: (Include code discrepencies, persons present etc } Inspertion 01 Inspection #2:
Location: 557 UP 216TH AVE
1 All BM Description =
2.; Bldg sewer length =
- amount of cover = I ST IN I
Plan revision Required? _ Yes No n I I
Use other side for additional information __l/l All ~i
C y
I sepc ure
SBD-6710 ,R 3197; at e isSig ~
L
I `rA~r1r County -
"P. Industry Services Division St. Croix
RECEIVEDi 1400 E Washington Ave
s, , l $ ~<I
P P.O. Box 7162 Sanitary Permit Number (to he tilled in by Co }
APR Madison, WI v53 71
oFR
CS 712-
~J
ST. hf.43111f1 ~.4 i
$4'4&T~. t Application >~t) I State Transactio~~~tltltl111Number
In accordance wit`'.R
hPS33tJ'I i. ~4t, Adm. Code. submi,sion of di is form to the app oLt, `2 17,111a a .~rl}
,s required prior to ohtainirg a sanitar, permit Note Application terms Im Stale-on~ tlMll0ted to
: h ~SC~~ ~~ci~fid<try Protect Address (if different than mailing address}
,lie Department of 5afcth wad Pro:es ional Sen ices. Personal information you pro, I&c -ui%
w " in accordance c,ith the I rivacy Law s. F5.0411 fu,). 1)1.11, Same
1. Application Inforn on - Please Print All Information
P-ope.ily O,%ner's Acme Parcel
Leslie & \attcv Zell 032-2089-70-000
Property Owncf s Mailing Address Property Location
;;7 upper 215°i .lcenue 00 t j4
Ciovt. Lot
City, Statc Zip Code Phone Nunibcr NI: SA'USection 15
Somcrsct . bVl 54025 tcircle oney
T31N R19LorW
ILI Type of Building (check all that apply) f~
El f or 7 Famils 11%%elling \unibei w ficJ:o( m_, ! ? Subdivision Name /
l Northern Oaks F.statcs ✓
El 1'ublic,Cornmeretal - Describe Use ` nlock
❑ City of
❑ Stag Owned - Describe Use El vilia- of
C9b1 Number
r J A G~ r / ~b~ ❑ I'awn of Somerset
111. Type of Permit: (Check only one box on line A. Complete line B if applicable)-
A. Ii ❑ New Sysicin ❑ Rcplacc:rcnt Svstcm ❑ Treatment,[ lolling Tank Replacement Only ❑ Other Modification to Leisting System (explain)
B I ❑ Permit Renewal ~ ❑ Permit Recision ❑ Change of ❑ Permit lranstcr to Ne%% List Previous Permit Nurnber and Date L,ued
r3efi,re Expiration Phtmher (honer 430576 1112003
I
IV. Type of POWTS System'Component: Device: (Check all that apply) - -
❑ Vim-Pressurized ]n-Ground ❑ Pres,urizcc In-(iround ❑ At-Grade ❑ Mound ? ,,f in of suitable sail ❑ Mound < 24 in. of suitable soi!
❑ Iio mg' an t .cr ni,pcrs,al ('un,puncnt lc.plainl ❑ Pretreatment Device (explain;
Dis ersal/Treatin t Area Information: ( J
Design Fiosc igpd) DC11L_'11Soil ;s.pp11c:hu:1 Dispersal Area Require) Dispersal Area Prrp sed (sfi System Flevation
600 Kate(gpdsl', 957 900 C02.90,
07
%?L Tank Info Capacity in
Gallons 3
Total # of
Manufacturer
Ciallons , Units I' - g r
New lank, f•.xisiriv rank:
i I 6NIGC. V n n
Septic or Holding Tank 12 0 12;0 1 Wieser Conerelc ® ❑ ❑ ❑ . ❑
Dosing C'hamhcr -1 ❑ ❑ ❑ ❑ ❑
\ll. Responsibility Statement- I. the undersigned, assume responsibility for installation of the PON 1'S shown on the attached plans.
Plumber's Nar,e IPrint i Plumber's 'k 'i fj MP \4PRS Number nusmes Phone Number
John Schmitt - 16 223760 71;-760-0486
Plun,t±efs Address (Street, Cit}. State, Zip Code)
616 150"' A\ c Somerset. 11-'1 54025
\111 ountrrDe artment Use Only
Approved Permit Fee Dare sued Issuing n: Signature
,even Reason for Denial S $5 • 41 /3 J
I\. Condiii' fa~f~1Y Reasrl,ns for Disapproval
1. ept~ rk. e t._r; n t e I wind
uisper• , cell n:is; jl. be : ~I_ic as ` m in a~rec
as per managemen! pla-i p,o ndedbyby plumber,
2. AY aeftsc t regUtetnents must W maintsirad
w per *KN= la c*ds / ardinancu.
Attach to complete plans Gar the system and submit to the (:wunh wily on paper not less than 8 11 x I I inches in size
SBD-6398 (R03 ~ 14 1
PLOT PLAN
Project Name: Zel; 4 Bedroom Replacement Soil Absorption Area
_egal Description: NE114, SWV4, S15, T31N, R19W P.I.D 032-2089-70-000
Subdivision Name Northern Oaks Estates Lot 7
Townshio:iSomerset Pamel Size 2.655 SCALE: V--50'
County: iSt. Croix
_ System Eevation:;T1= 92.25' Existing 56.25' Siodiff user
Siope:'13% to the south T2= 92.60' Existing 56.25' Biodiff user
A BVi1 E evation 96.54' 'Top of Septic Tank cover T3= 92.97' Existing 62.50' Biodiffuser
BM2 E evation: 91.69' Top of 2" PVC Pipe
I T4= 92.80' Proposed 90.00' EZ Flow Trench
■ Backnce Pits T5 92.80' Proposed 90.00' EZ Flow Trench
Ex'st:ng Tanks Wieser Concrete W1250-MR
See Plat Map for complete view of parcel Existing Fi:te• Zabel A-100
14 inch Scr 40 -AS-M 026E51
4 inch 3034 - ;-STN D.;N4
+
i
Ij
~VCtz
0
i L1 13c0,2.CCn+ ei ,
~~+y
V LV>; r41 ► ~ ti?t X250 C~t_ 5. 1
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r
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cHr~►vlu'~QS 6,*tI
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SEt H 7-
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Zell 4 Bedroom Replacement Soil Absorption Area
Owners Name: Leslie & Nancy Zell
Owner's Address 557 Upper 216th Avenue
Somerset, Wl 54025
Legal Description: NL1/4, SW 1/4, S15, T31 N, R19W
Fownship Somerset
County: St. Croix
Subdivision Name: Northern Oaks Estates
Lot Number: 7 Block Number
Parcel I.D. Number 032-2089-70-000
Plan Transaction No.
Page 1 ndex 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 Existing Tank Certification
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: 4/8/2016 Phone Number: 715-760-0486
Signature:
n-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1
PLOT PLAN N
Project Name: Zell 4 Bedroom Replacement Soil Absorption Area
'-egal Description: NE114, S_W114, S15, T31N, R19W P.I.D: 032-2089-70-000
S..bdivsion Name: Northern Oaks Estates lot 7
Township: Somerset Parcel Size: 2.655 scA~e: r'=so'
County: St. Croix
System Elevatior: T1= 92.25' Existing 56.26' Biodiff user
Slope: 13% to the south _ T2= 92.60' Existing 56.25' Biodiffuser
BM1 Elevation. 96.54' ' To of Septic Tank cover T3= 92.97' Existing 62.50' Biodiffuser
BM2 Elevation: 91,69' To of 2" PVC Pie T4= 92.80' Proposed 90.00' EZ Flow Trench
■ Backhoe Pits T5 92.80' Proposed 90.00' EZ Flow Trench
Existing Tanks Wieser Concrete W1260-MR
See Plat Map for complete view of parcel Existing Filter Zabel A-100
incn Sch 40 -ASTM D2665
4 Inch 3034 - ASTM D3034
To - _ (
a
WF(z
0
j
cj~
NC)TC
SO
T-N5TtALLL 13 pr
r ®B3
Brl I ~
C t-1 J~ Yl l 43, r2 S ` Q
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`n
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Leslie & Nancy Zell
Gravelless Leaching Unit Specifications
Manufacturer Model Laying Length EISA Rating
EZ1203H-5ft 5 0' 25.0
Inf tra:or
EZ12C3H-10f: 10 0' 500
System Sizing
EISA Rating per Foot of EZ Flow 5 ft` Soil Application Rate' 0.7 gpdfft2
F600.0 --pd Design F ow : 0.7 Sol Application Rate F5 EISA = 171.4 Feet of EZ Flow
trenches 90 feet long each
2 No. of Cells 9 Per Cell
3 ft Cell Width 18 Total No of 1203H
90 ft Cell Length 450 sq ft EISA Per Cell
3 n Cell Spacing 900 sq ft Total EISA
Typical Cross Section
Finished Grade S' ft Observation Pipe with
approved cap or vent
` J Soil Backf ill
36 inch Geoteztile Fabric
12 inch II O Slotted and Anchored VenVObservation Pipe
with Cap
92.80 ft Infiltrative Surface
F>36 inch
89.80ft
Plumber/Designer Signature:
License MPRS 223760 Date: 04/08/16
Page 3
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Page 4
• f
IVIAI!,\A 1•rtdAt~,.~~
A100", A300", A600"-12 Series Filters
I L:1j II'. r-ht - I IWAA 1 A :r' Il (1C
:r lOn On 'rti'".at thi, I(T1=fi ~I-` "OUh t,i' '.d rx l rF~; Jit=r j oyn:flC ~l?a } .i 0 v f'~e: ~f'~( Ik:' ! ~bf . it or ''N-IC
C x •i~~. }~rlCy cf sc•-> IcinQ fcf to tank. s mfd be dearw-A nhc'n the ~a pCc l3 k is rormaliy -,p tted and ptrnG►
t10~'i►-"+':Y CUr fl:i'r I- viriualty Ck' ^alg. The ccinnn M aCUCr. Y '.hl' anwrottc orgy-~,m4 C'?'hC: lab-1 fXcf Cau~('S !Aged
I) dlL-mt- gr,: r jnd f;,+ll':- C 'Y _Com J re 'arx. f `Ilter tc -l.j n,~ a Smarl v • ,1dm. y: Mll be notif; :.y an
To service the lifter. _ '-I
1t r•+,~'~4.i'`.r . fstou,dtr~i t J,:inf'CiJct, rl`kvSff'o id'lKOLIf'Y!YLlfIn<041Y
C :'1C
ST`P cf tic STEP STEP
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rp:ma yto ~•cverilany :a-rg C'jlofit
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Off !ti ~df~: I~l~i f t l.- :Vl~Q' :i ;(Opp-' ,~"17
V+•^ ('i- til rL~IE'. t:•'r1: Ca cfU to frl5r 3i cor±Q~:1C{1f ?
r _ : t r ?rt ( n;::red Ir L'1E case.
Pr n acc, the septc tank
cover.
• r. I'~r ~ .y'•;~~' I'~f z._ :~j ~rc'r 'rir 'fc ._j'_ rr:{l?; ~i.~. ,n...-.a•
I X111 for free /APSE 1 I'.;N • 1-800-221-5742.Or Order Online: www.zabelzone con
Page 5
Installation Instructions for AEZ TM
EZ//(,,,, Systems in Wisconsin
flby,FILTRATOR
VVsconsin Depar.-lien-. of Co-rrmer :e, Sa:ety and Bu ldings ; 5. The Absorp_ien area (SF) necessa y for a given site ,hull
Division, has rcvicwcd the speci=ications ardier plans for this : be sued based on maximum Gaily sewage f:ovv (GPD) and
procuct and detcrmired it to oe i- compliarce vJth chapter., the Permeability for the site. I- certain criteria is met, the
Comm 82 through 84, Wisconsin Admin. Cade, and Chap-e-s EISA sizing can be used in Wiscorsin, resultirg it a 40%
145 and 160, Wisconsin Statues. All sites -us- -nee- the Sre s_rraller drainfield.
& Soil Conditions & L_oca_:_ir_.,ns _8.1_s_olat on 6s-arces as rotec in
oral regulations. 8 Place EZf oNv bundle(s) n the FZflow con'icuration ap-
provec by system resign permit specified for the paricL.-
I-he approvec prcducts are "203H (3-12" burd es with pipe in lar site. The top or center-most bundles conta ning pipe
center bundle in b' or 10' lengths) aro 1203HP (3-12" b-roles arc joinee end to enc with an internal p pe coupler. Any
with pipe in each bundle it 5' or 10' lerg.hs, add tional aggregate oily bundles that may be required,
• snculd be butted against the other agg-egate-only bur-
single pipe bundle co-tains a four inch pe- foraled p pe sun- files and do not require any type of connection.
ourded by EPS aggrecate anc is he d together with poh;- :
ehtylene rotting. A s rgle aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre-
only acid is I,elc togethe, with polyell-ylen~ netting. rnan-fac_wed in between the netting and aggregate. The
fabric s riserted to prevent soil intrusion. The installer
Materials and Equipment Needed shall rrake sure the the GEC is positiiored upward and is
• `Zf ow Bundles in contact with the fabric contained in '.he adjacent cyiin-
• LZfow Ceote.cile Fabric : der before back-filling,
• FZflow Internal Pipe Couplers
• Pipe for Header and Inlet 8 [he FZflow Drai-field Svstems should be installed in a
• Uac.<hce,'Lxcavater e.^el trench in all directions (both across and along the
trench bottom) and shot ld follow the contour of the ground
Installation Instructions sirfacc elevation (uniform depth). w th a[ continuous
The instructiors for irstalla.on of EZflo^r, prcducts a-c: giver adjoining 10-? cot cylincrical bundles placer end -c end,
below. This oroduc- m-st be installed it accorcance Faith state wi-h central bundle d stribut on pipe interconnected,
Iles defined in cl CUlrlm 82 inroUgh 34.'NiscOrsm Ad- wichoui any cams, stepdowns or othe-water s`.ops.
-iinistrative Code, and Chapters 145 and 160, bhrisconsir Stat-
utes, as well as the local health cepart nent'c curre-t design 9. The -rerch :op shall oe graded such that water will not
-Manual. pond. Backfill shoulc oe seeded or socked immediately
after completion to reduce e,osior.
I . After the local health cepartr-ent las delermired sizing.
cc~rfigjraJon, and layou' for the EZflow systems, stake 10. EZfioo•, EPS bundles are flexible and car fit in curved
^iark with paint the location of ;rend ,es and lines. Be :rencl-es as may be necessary tc avoid trees, boulders, or
ca•cful to set correct tank, inve,t p ,pc, heaeer line or d :s- other obs ao'es.
t, L-tior box anJ -.refch bottc,n elevalior•s before insta -
ati r c= ~Iipe bundles. 1 EPS aggrecate is lighter than water, therefore, it might
be expected that natural buoyancy forces would tend to
Re nir, I: Hstic E74ow s-ipoing hags prio• -o placing cause EZflow assemblies tc float out of Ground when
:n,ndles e trench(es). Remove any clastic hags it tre cording occurs. Fie d experience has shown, however,
t,en-h he=rre ~:v, ..em is covered. that this is not a problem %vher systems ''aye a minimum
of 6' of =oil Gwen as rec.a nmerde:j by ma"u'act~ colt
3 h's proc_ t rno_=t have ce_ctemCle fabric ,hat meets c
q-irements of s. Coma 84.30 (6; (g), 'Alis. Adm. Code,
r~talled eirect'y on top of the procuct and exteroirg 1203H-GEO
down along the sides of -he procuct to a pelr- at least six
irches from the bottom of product. - Geotextile
harrier Material
4. Vv'hen irstalled in a t-encl-, the trench should be dug to
a w dth of 36 nches. This not only saves labor in excava-
t,c-, but also provides better load-bearing capac ty alter
backfill'nc is comolctc. -
Page 6
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Ovvrter. Leslie & Nancy Zell Tank Mani factu•ec Wieser Concrete ❑ NA
Permit # r-- Septic ~7 Duse ❑Hofdiny Vclume: 1250 gal
DESIGN PARAMETERS Tark Manufacturer: Wieser Concrete ❑ NA
Number of Bedrooms 4 NA Septic ❑ Dose [-Holding VOlume gal
Number of Public Facility Jnits NA Veiticaf Distance Tank Bottom(s) to Service Pad. ft
Estimated (average) Flow- 400 yaliday Horizontal Distance Tank(s) to Seiivice Pad. ft
Des,gn Flow = estimated x 1 5 600 caliday Spec^c se^ncrg mec-anics must oe provde f vertica s,i5 feet or if
In Situ Soil Applicat en Rate- yalidayP12 ro•zorta' is > 15u feet Specific instr,ctors to to provroeo en tack
Standard Domestic InfluentlEffluent Monthly average Effluent Filter Manufacturer: Zabel NA
=ats, Oils & Crease !FOG) s_'D irwL Effluent Filter Model. A-10U
Gicchemical Oxygen De•nard (6005; s220mg L NA limp v anu adorer
Total Suspended Soi,,us i rss; 515orcrt Pump Model-
High Strength InfluentlEffluont Monthly average Petreatrnent Unit NA
Fats Oils &G•ease FCGi s3C mg~L Manufacturer:
Biochemical Oxygen Ditti ;13,005) s220n)91 El NA L~ M!. nemc•.ni Arrar.rn ❑ Peat FJter
Total Suspended Soi (1 SS; <_'5Dmg4 ❑ Disrdii ❑ Weta-ri
Petreated Effluent Monthly average ❑ Sard!Graeel rimer ❑ other:
Biochemical Oxygen Cemard ;BODs; `30i of Absorption System
Total Suspendec Solids (TSS) s3Cmg,_ [ NA U n rn nn gravity) ❑ Ir-Gro.md
l Co fo-m (georretncmean) _t:.acfirlnOml E:
.-G•aoe C r^o.:nc
Maximum Effluent Particle Size % in dia NA cnp-Lie .finer
Other: Other NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
When combined with sludge and scum equals one-tnird of tank volume
Pump out contents of tank(s) When the high vdater alarm is activated
Or tr''i
Inspect condition of tank(s) At least once every 3 erUi (Maximun 3 Years) C NA
st once every 1 5 mnr r' (Maximun 3 Years) ❑ NA
Inspect dispersal cell(s) ea si
At least once every: 1 5 month+c) NA
Clean effluent filer ear s1
At least Once every monrhisl ~ NA
,
inspect pimp pump CiD is & warm year 51
m,orth',S) 7 NA
earl;i
rDrty s1 [ NA
early
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cel 5 snal b8 (name by an individua rarrying one of the follow fig licenses or ceViications blaster
Plr.moer. Master Plumber Restricted Sewer; nObNTS Insepector. ~OS4?S Maintaine•; Septage, Servic ng Operator (oumperi. 'ark
rspectiens must include a V,sl.al inspecitor of the tank(s) to identify any mss nc e, aroker hardware identify any cracks or leaks,
measure the volume of combined sludge acrd scum and a check `or any bacK up or pond fig of eff cent on ground surface. The
c spersa cel'(s) shall be visua iy inspected to chei t')e effluent evels in the obse•vahor p pes and to check for any pording of effluent
C9 the growid surface The oonding of effluent on the ground surface may indicated a failirg Condition and requires the immediate
notification of the local egulatory authority
sNnen the combined Zi.;CUmualtion of sludge and scum n any treatment tank equals ore-third (X) or more of the tank volume the entire
contents of the tank shall be removed by a Septage Sew,arg Operate and disaosed of ❑i accc;dance with Chapter NR ' 13• Wisconsin
Acmininistrative Code.
iJl other services including but not limited to the servicing of effluent f ters, mechar cal or pressurized oomponems. petreatment units,
and any servicing at irte-vais of s2 moitis shall be performed by a cerified PCWTS Mawtainer
A service -eport s•i al be prov Jed tc the local •eaulatory authority within 30 days of cemaieticn of any service event.
Page 7
Pane cf _
START UP AND OPERATION
=or new const,uction, prio' to use of the POWTS check treatmert tank(s) for -he presence of painting products.. solvents or other
chemicals or sediment that may impede the treatment process and!or damage the soi dispersal cell(s). If high concentratiors are
detected nave 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 infi:trative surface
wring extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will
be discharged to the dispersal cells) in one large dose and may overload them resulting in the backup or surace discharge of eff!uent
To avoid this situation have the contents of the dump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Mainta,ner to assist in marually 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 o, compact. Me area within
15 feet down slope of any round or at-grade so,l adsorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS.
aotib otics; baby wipes; cigarette butts; condoms; cottor swabs; degreasers; dental floss; diapers disinfectants; fat; foundation drain
(surrp 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 taker 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 Se vicing Operator.
• After pumping. all tanks and pits shall be excavated and removed or ther covers removed and the void space filled with soil,
gravel or another inert sol d mater al.
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 replacerent area has been evaluated and may be u[,lized for the location of a replacement soi, absorption system
The replacement area shou d be protected from disturbance and compactior 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 eva'uat or to establisn a suitable replacement area Replacement systems must comply with the rules in effect at the time of their
dernit issuance.
A suitable replacement area s not available due to se-back andor soil iimitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS techrology, a holding tank may be installed as a last resort
C 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 ca reconst ucted in place followrlg removal of the biomat at the infiltrative
s,rface. Reconstructions o` 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
ti CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT.
ADDITIONAL INFORMATION:
POWTS INSTALLER POWTS MAINTAINER
Na-re: John Scimitt Name. Joh-i S::hrnitt
Pnore 715-760-)485 Phone: 715-76C-0456
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name: Owners Choice Name St. Croy County Zor ng
P-iore Phcie 715-365-4630
f his bocumem is i•itended tc meet rrininlurr iequirernents of Ch Comm 33 22i2)(b;(1);d)&(f) and 53.54") (21 & 13} Wisconsin Administrative Code.
Use of this dnn.iment does not q.ia,an-ee the performance of t'1e PQb'VTS
Pdge &5,
ST. CROW COUNTA' ZONING OFFICE
CERT[FICATION 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) 557 Upper 216th Avenue located
at: NE SW Section 15 31 N, Mange 19 W,
Town of Somerset St. Croix County Wisconsin.
Upon inspection, I certify that 1 have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 354.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service April 8, 2016
Did floe- back occur- from absorption system? Yes No X
(if no, skip next line. )
Approximate volume or length of time: gallons minutes
Tank Capacity: 1250
Construction: Prefab Concrete X Steel Other
Manufacturer (if knoNN,'n): Wieser Concrete
Age of Tank (if knoNvn): 12 Years
Permit number (if known) 430576
1f rir L~ John Schmott
2 ~Z4 7 rl/h
(Lie sed Plumber Signature) (Print Name)
MPRS 223760
(Title) (License Number) MP-N,IPRS
418i2016
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, NVIsconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/201 2
Page 9
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGRFF,VENT
AND
OWNERSHIP CERTIFICATION FORM
O«,ner,Buver Leslie & Nancy Zell
Mailing Address 557 Upper 216th Avenue
Property Address 557 Upper 216th Avenue
(Verification required from Planning & Zoning Department for ne•a • nstruction.)
Somerset. WI 032-2089-70-000
CityState Parcel Identification Dumber
LEGAL DESCRIPTION
Property Location NE ,,,a SW 1 Sec. 15 , T 31 N K 19 W, Town of Somerset
Subdivision Plat: Northern Oaks Estates Lot 4' 7
Certified Survey-Map # , Volume Page #
Warranty Deed # 'before 200? )Volume , Page
Spec house ❑yesElio Lot lines identifiable ❑yesOno
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Imprope- use and maintenance of your septic system could result in its pretuztu: e fai ure to handle a:astea. Proper
maintenance consists of pumping out the septic tank eveiy tluee years or sooner, if needed, by a licensed pumper. What you put into
the svstern can affect the function of ate septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 3113.52(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 concition anc nr (2) after inspection and pumping (if necessary), the septic tank is
less than 1l3 all of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with :lie
standards set forth, herein, as set by the Department of Safety And Professiona: Services and the Department of Natural Resources,
State of Wisconsin. Certification slating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I?we certify that all statements on this torte re true to the best of my'our knowledge. irwe am.'at e the owneri s I of *.he
property described above, by virtue of a warranty d ed recorded in Register of Deeds OfficL:.
Number bedrooms _
SIGNATU F APPLICANT(S) DATE
***Any information that is misrepresented may result iu 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 sunray map if
reference is made in the warranty deed.
(REV. 04112)
Page 10
T
IV
775 ACRES Apati%~ n~o
O M
kn OD
V ~ Q
P b31 ACRES o
385 -66
LA . /VE ;
5. gs r 4r s m
N 89 38 55'_ E 480 89' - - 1 -
- - _ o
8.9- - _ 51974
.268 6 ;36 t
52057
co
),E4 - V.i ^d 139" 38, 55" E 4 81. 72' - -
v
w `r MPORARY CUL- DE -SAC TO BE °z
AUTOMATICALLY `VACATED UPON ar
EXTENSION OF ROAD TO THE EAST J1
N rD
O
O M
6 7 W
x.711 ACRES 2.655 ACRES Q0
J1
a.
's.
510.00 344.16r
OUTN LINE - NW 1/4
-iIS INSTRUMENT WAS DRAFTED BY SCOTT B LOHMAN SHEET I OF 2 SHEETS
County. Wisconsin Departmert of Commerce PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Uvision . INSPECTION REPORT Sanitary Pemvt No:
430576 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you piovide may be used for secondary purposes (Privacy Law. s. 15.04 (1)(m)i.
Permit Holder's Name. City village X Township Parcel Tax No:
Thomas, Edward Somerset Township 032-2089-70-000
CST SM Elev: Insp. BM Elev: BM DesAcriplion~ Sect on/TownlRangelMap No
IM "6 /M ~ / Uc4X 4h -s S 15.31. , 9.884
TANK INFORMATION ELEVAT N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ~ vl Benchmark D ~ ~ J / Der J
p1 J l
Dosing Alt. BM
Aeration Bldg. S wer b
s ~
Holding SUH1 Inlet
93 z-
TANK SETBACK INFORMATION strHt outlet
TANK TO P/L WELL BLDG. Vent tc Air Intake ROAD Dt Inlet r,
Septic I , 1 3S Dt Bottom
Dosing Header/Mar. Mtlp~ C'~
Aeratio
n DD~pe Holding PUMPISIPHON INFORMATION Final Gy*de y~-
Manufacturer Demand St Cover ,
'64 6"AJ
3- X16.
Model Number
I
TDH Lift Friction LEDia System TDH Ft ,1n Pr 12'-at-
Forcemai n gth Dist to We l
SOIL ABSORPTION SYSTEM, - / U Z
i
BED/TRENCH 'Alidth Length No. Of Trenches PIT DIMENSIONS No. Of Pits ia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO JP/L'S BLDG WELL LAKE'STREAM ACHING Man4r", re':
INFORMATION HAMBER OR p 11O r-
Ty f System: `20 >
!Irz ` t1NIT Model Number.
DISTRIBUTION SYSTEM 0 ce l~r1e 1__S p~ '%~e~
Headeo'Marifo',Distribution x Hole Size x Hole Spacing Vent to Air 1•rlake
Pipe(s) !
Length Dia _ enylh _ _ _ Dia Spacing
SOIL COVER x r sure Systems Onl z ou r`-Grade Systems Only
Depth Cver epth Ova xx Depth of xx Seedcd5odded xx Iched
Bed`Trenun Center ecrrrench Edges To scd J Yes ~ No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 7-1' Inspection #2: 1
Location: 557 Upper 216th Avenue Somerset, WI 54025 (NE 1/4 SW 114 15 T31 IN R1 9W) Northern Oaks tates Lot 7 Parcel No: 15.31./19.884
1.) Alt BM Description
2.) Bldg sewer length =4D
- amount of cover =`,ylrJ
V G{,c~~~ - -~~v. VU E114 2-
Plan revision Required? Yes /No
17 j lI y ; _ _Glt~l~laiy,__ - Gr
Use ot:ner site for additional information. Cert. No.
0ate InsepctorsSg ature
SBD-6710 (R.1-191)
Wisconsin Department of industry. SOIL AND SITE EVALUATION REPORT Page I of _
LAW, arC Human Relations
Owiwn of safety 6 8uildngs in accord with ILHR 83.05, Wis. Adm. Code
~ COUNTY
Attach compute site plan on papw not leas than 8 1/2 nches in size. Plan must include, but ST` Ckoi X
nW limilad to vertical and horizontal reference (PM), d ip-ig;rp, red % of slops, scale or PARCEL !.D. a
dimensioned, north arrow, and location and 'qc fo-naaiest (oad: z _ 70 -000
DATE
L
APPLICANT INFORMATION-PLEA ` *14T tk~l *FORMATfb~1 EvtEWE BY
PROPERTY OWNER: PROPERTY LOCATION
~t~bq(~Q A i ~jB%q.60T 1/4 - vi,S T 3 1 ,N,R 11 W W
PROPERTY OWNER'S MAILING ADDRE c t"Ijtl
LOT r ~VILLAGE SU80. NAME OR CSM r
t%)(3~ ' c r r] N ot¢rHacK
t,) QAK S a✓5'i T>r
VTY,STATE ZIP f?rt ztHIQAljr lJ C2K St OWN NEARESTAOAR
LA I .SPS 5 NO 5 E Y iA PPEl2 -24 5T_
New Construction Use bQ Residential Ided~~r mrn~ 3 ( 1 Addition to existing building
i J Replaosment 1 Public a Cornmaroal describe
Cade derived dairy NOW U 5 gpd Recommended design Wing rate 0.7 bed, gpdfi2 0.4 trench, 9Dd 9
Absorption area required 43 bed, A2 trench, n2 Maxt~urn d ' n loading rate 0,1 bed, 9pdrft2 O.S trench, gpd/ft2
Recommended iMiltlatian surface alevatian(5) 2 J ` ►w " I ft (as referred to site plan berwhmark)
Additional design l site oonsiderations -
Pa►entmaters _Sgl?D °rto~o~ Flood p6n elevation, d appiicable V.A.
S - SuimNe lof syst C0NVENT04AL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM W Flli HOLDwG TAN(
O F Ullsuilable for s s m S❑ U S O U S❑ U 'R S0 U ❑ S V ❑ S M I
SOIL DESCRIPTION REPORT
BoringN Horizon Depth Dominant Color Mottles Texture Structure ConslStence Barbary Roots GPD/11
in. Munsell Ou. Sz. ConL Color Gr. Sz, Sh. ! Bed Thench
I. 1 G-6 10 '4g z 6eit
C `
2 !0-I1, 10 "1 3l4 S 0,-7 0.1
Ground 3 16-}2d 7.5 %4 31y 5 s ' 1 - l 0,7 0.9
elev.
96,g It ~ ~Depth to
limiting ` i
factor
12
t
Remarks'
Boring 0
1 0- 1r3 R 2-17 ~S 1 - fl l I
Z ' 1 }oyrz Sj S 7 0.
Ground 3 1 1201 -7.5 yv_14 b 5 0 > .7 . Q
elev.
It.
Depo b
~ ~
GrIpG n9
IaCtDf U
E
Remarks:
7
MAF~ N r.-Pleas Prnt Prone (tit S (42- b -.1-7
7
ass'
Qa-"N AVF--rf ~ PZ FA 115, u)T- S14 2z
Sipnat / Data: CST Number
PwPERTYowNER r=DWAAD 1"OA 3 SOIL DESCRIPTION REPORT Page?ol 3
PAPCR I.D. 032- Zoo- 70 -17o~
Boring # Honzon Depth Dominant Color Mottles Texture Structure Corisistence Borct3ry Roots GPDHt
in. Munseil flu. Sz. Cont Color Or. Sz. Sh. Bed Trench
' 0-5, 0 2 - 15 r'\1 C s O.l 0.4
3•
2 5,12 5 Q S~ m M QS .-1 0.8
Ground 3 12- o rt 3 S D C 0,
it. -IL 7.StiK-4 J s 0 n.l 01.Y
Depot to
limiting
Remarks:
Boring
y 2 u I 0~ J 5 0 n,1 C 0'
3 I _35 10 V - S Q rn1 -
Ground
ete+r. -120 a - 5 D 1 r o.?
155, Depth 10 -
limiting ~i 0 S i7 r! Z ii
tact r
Z_
Remarks-
Baring p
a- o rz 2l) - l s 0 S - ' 0.8
S 2 0~L 3 - S m CS - 0.
0.hr
3
Ground 11-22 1 0,4 re 3 _ S Os 0. U.
elev. 7.5 V rZ 4 - S D
m It m ( cs 18
5 _ l 4 s 4 r►.~ J 0"1 ' 04
Depth to
limiting
lack r
Remarks: icv, j,4 3 ' t5 IVI
Boring ~Zr 7
sx' 1Z I~
-1z -
a
Ground
elev.
tt
De9th to -
Gmiting
lector -
Remarks:
SBD•4990(R.05142)
PROPl;ititY 0►M~~; ~brat2n -rNaM~S LE~Nb: ~!4 ~
LC)T 41 M-
ar- T icX
StrT Ka. C u -m c G p+ PG: - 10 2
50L XMNG W/ 113AM OE
NO COMM &3 5efDA K RODLEM5 Cam` I
2,105 ACA V5
C
i
rAtPfkok. LoeAltak
Y ,3 pm
~F.DQ ~ I w1
IvLla~
L~ y
01,81
EL 94.1.j BM _mw)or fj o
L-JCb 17'ED ~ C3~-{
~P gL 44.115
d
L Rrp~pc ~✓~~A
nas Dal
lC- 'l.l(e'--~ j AOQ2nr. ~,oca-,~~v of PRDP~a~y LaatE past owAlcOR,
T(Soo-1H rzetXt- UNE - NOT Pla_)
~JOZ c." ! ' 1~4.rtM 551
ham- ad~ Q
511E LOCnnON w• s~-eQ r~ ~f Sa G , ~n
l
* x SiGNEn CS' r
M03~01