HomeMy WebLinkAbout032-2177-05-000
I ;.:,un-y
viicc^sir =_carrr m c mne PRIVATE SEWAGE SYSTEM:. raix
,-r -anc buit7n2 Gr:'=-,^;~:~ ~ennr Nc
INSPECTION REPORT tr 7!9
Nc -
S=NERAL INFORMATION 'zate I--, / ~Ww
-,jna :nr.,rmat,or VOL rov,ae ma t.:_ eyed to, sexmaan eu.vcs_s
~rllao= X Townsnl arM 7az Nc-
I' erm;. '7~,ae s ham (~(LfJlb
r r 63z-ZI77- 05-MP.
:Secncl ovm~Kan~e Ma[ Na
I~'- 3tJ. cer li. c 3h.1 =i~: Bld Uescnoi,or.
/oz 35,n -
7.ANK INFORMATION ELEVATION DATA
Pr14 N _1-H _ T J?=r A=:A~. S TATOK H'
eons / IBsncnmarK. J t~+ albz- 14. 3 4-5
r`he~+r+e ~AI'. BV
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F; IR17 ; we,
~:,~ratlnr ~ -
1-olaln_ ~ ;SL~H: inr~:
'gi'rt '.-~utl°: ~ ~ ~
TANK SETBACK INFORMATION
IZO I 42 z
ieaaeriMar. j •7.Z4 e?5,-75
~si~c S
i
rs: pir,_ ` 5~ 1
,~.cr3[I~n 'I , I i I rr.
IBo: Syste-r '
93. S
Ir=is Gr@de ~PUMPlSIPHON INFORMATION i
I;d;anu=a:cure IDeman :W 16-164 /Q Z
ltvvla-~ Numbe•
-=D _jfi =rj-t,or, Loss >yster is -D- i
I
SOIL ABSORPTION SYSTEM
~cDTR°_N~- W f' en?tr NC J".r=ncne, i IPF DIMENSIONS Nc s Ira:ne a Lieuid Deptr
LAK~'ST? 41J L=ACHINv tJanutactur /a
476 1 , , ScT6A h: pSl'S E1J l~rL IBLDG 1^r-LL ~ -
CHAM3=R OR
IN=JRMA-ION',
J` S"ata _ I uNr- Model Nt m
t ype r w
a ¢r 07.6% Z 1
DISTRIBUTION SYSTEM cr Z.
77~ ii-:~~ to A,r mars
lease 1J O~'S /6
I enotrGr-_-en~tr ~czcacrrn_ _
Nti vr• ?
SOIL COVER z Pressure systems. only xx Mr,)unc Or A? grade Systems Only
l!ectr _w ID-r'r Jver I c Jeptr v ceeeed'Su:,n- - I 10 f 6 7-rencr Ceuta 35 I oc;:n _ i _ es Nc
.5°d ^'encr =:,neE-~ i YES Nr
:OMMENTS; ;Incurde code dscreo_naes. Dersnns ❑resa „n: In3Demtor
bar Na:
3t5c sewer ienutr = G I ~G(e,~S ~ ,J,rll (le
arr,,urr cr saver = GXt "f <<. ) d
_I rear: jar r eauirec" let X'"c
--sB otn_• sid_ t-' aciditiona' Inmrmalior ~,J - - ; er_ Nc
Dare IrseD7lor : r na:ur-_-_
County
Industry Services Division St. Croix
't ~DsPE~rrEIVED 1400 E Washington Ave
t anilary Permit Number (to he tilled in by Co. )
P.O. Box 7162
$ Madison, WI 53707-7162 C
MAY 1 2 016 ° 594 -75"t
- ~Flsppr w\~;
ST. CR~{' 6 IuPermit Application S IramactionNumber
;n acrordancew~. _q, RT1nbmission ot`thi> form -o the appropriate governmenlUl unit
required prior to obtaining a salutary pctnnt Note. Application forms for slate-o%%ned Po% FS are suhmitted to
il•e Department of Safety and Professional Services. Personal information you provide muv be used liar secondan Pro ect Address (if different than mailing address)
622 ?22 Avenue
~ aurF~uses in accordance with the Privaer f aw, s 15 114(1)(m) Slats
1. Application Infor n- lease Print All Information
Property Civsner's Name Parcel #
1'redrickson. Greg 0.2-2177-0516-000 x
Property Owner's Mailine Address Property Location
6!2 222' Avenue
Govt. Lot
('m. State Zip Code Phone Number - NN, !-S, SW Section I 1
ti,rnetset. W1 54025 (circle one)
T31N R19F.o
-
II. Type of Building (check all that apply) Lot;;
1 or 2 Fanuly Dvtcllin, - \ llmbcr of Bedrooms 5 Subdivision Name J
Iliddcn Hills ✓
❑ Public/Commercial - Describe Use Block P -
❑ C'it}' of
❑ Slate thvned - Describe F:se ❑ Village of
CSN1 Number
~O ®l oven of Somerset
z+~~ t ( 7 f
7
ill. Tv e of Permit: (Check only ne box on line_A. Complete line Rif applicable)
V ❑ \cm System Q Replacement S}:stem ❑ Treatntent'l lolding Tank Replacement Only ❑ tither Modification to Existing System (explain)
❑ Permit Renewal ❑ ;'crmit Rc%kicn ❑ Change of ❑ Permit IransCer to Ne%% ~.,~IPre ermii Number and Date Issued
Before Fxpi ition Plumber - (honer !O
1V. Type of PO1wTS System 'Com onent'Device: (Check all that a lv) +
Non-Pressurized In-(iround ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 to ufstutable soil ❑ Mound 2.1 in of suitable soil
}lidding Tank Other Dispersal Component (explain) ❑ Pretreatment Dcv ice (explain)
V. Dix ersal!Treatme Area Information: 4 '01
Dc,ign 1`,0%% (,pd) Dcsign Suil Application Dispersal Area Re red ot, Dispersal Area Propose fl Svslem Flevation
600 - Rate(gpdst) 857 900 90.00'
197
V1.1 ank Info Capacity in
Gallons Total n of
Rlanufacturcr
Uallons :;nits v _
New tanks ' st.t~nr l rinks
Septic or Holding lank 1260 1260 1 Week's Cvncre Products _ ® ❑ ❑ ❑
1)0s1eChantbe1 1 ❑ ❑ ! ❑ ❑ ❑
VI I. Responsibilitv Statement- I, the undersigned, assume responsibility for installation of the PONLTS shown on the attached plans.
('lumber's Name iPrintl Plumbex5 S'_n, re N1P/ IMS Number Business Phone Number
John Schmitt 223760 715-760-0386
Plumber's Address iStreet. Ca%, State, /ip Code)
(116 15O' :'we. Somerset. W[ 54025
I
VII ounty" apartment Use Only
r
Approved >appnwe. - Permit Feed Date ssnne'd f [ssuin ent ti_ ignalure
yen Iteasun fur Denial S -9 . Ob r/ /
VNE
IX. Condi o 1
n Disa royal
Ra iP e tl Rt~~t9ln pp
disper.Bi cell rust an be swvic~s ! mr n> ¢S
as per management plan provided by plumber.
2. AN *Obeck requOerw is rnW oe mairdi mid ~(a ,tea
as W Voicabls c*6? / Crdinanm. A
\ttach to a-mplete plan, fur the ,?stem and submit (n the aunt} onln on paper not le- than R 1 c 11 inches in .ice
SBD-6 , 9s i R(I i'' I i
PLOT PLAN
Project Name rredrickson 4 Bedroom 3eo, acement Drainfield
_eaa Description NW114. SW1i4, 511, T31 N, R19W _ F.I.D: 032-2177-05-000
z)u_,division Name' Hidden Hills _ Lot 5
SCALE 1"=5D'
Tr.:rshic: Somerset Parcel Sze 3.070 Acres
--anry':,St. Croix
System Elevation T1= 94.74' Existing 87.5' 11" Biodiffuser
op :114'ro T2= 94.72' Existing 87.5' 11" Biodiffuser
102.35' Top of septic tank inlet manhole cover T3= 91.00' Proposed 90.00' EZ Flow Trench
-2M", E'ieaatioc: 102.50"Top of lot corner pipe I T4= 91.00' Proposed 90.00' EZ Flow Trench
■ ?ackhoe ?its TanKS IWeek's Concrete Products 1260 gallon
FiiteriZabel A-100
See CSM or Plat for view of complete ~'hrcel
4 in:- 5_ 40 -ASTI 32663
~ la incr 3034 - A51M D3C36
1
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1 i
3 rf~
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CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Fredrickson 4 Bedroom Replacement Drainfield
Owners Name: Greg Fredrickson
Owner's Acdress 622 222nd Avenue
Sor"erset, W1 54025
Legal Description: NW1/4, SW1/4, 511, T31N, R19W
Township Somerset
County: St. Croix
Subdiv;sion Name: Hidden Hills
Lot Number: 5 Block Number
Parcel I.D. Number 032-2177-05-000
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic Tank Specifications
Page 4 Effluent Filter Information
Page 5 Valve 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 Existing Tank Certification
Page 12 Warranty Deed
Page 13 CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 5/9/2016 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 j
Pro)eot Narre. Fredrickson 4 Bedroom Replacement Drainfield
Legal Descri ption: NW114, SW1/4, S11, T31N, R19W P I r) 032-2177-05-000
Sutdivis or Name: Hidden Hills L-et # 5
I ownsnip: Somerset Parcel Size: 3.070 Acres SCALE: 1"=50'
County. St. Croix
System Elevation: T1= 94,74' Existing 87.5' 11" Biodiffuser
S npe 14°.o T2= 94.72' Existing 87.5' 11" Biodiffuser
A BM1 Jevaticn 102.35' ITop of septic tank inlet manhole cover T3= 91.00' Proposed 90.00' EZ Flow Trench
BM2 Elevation: 102.50' To of lot corner pipe T4= 91.00' Proposed 90.00' EZ Flow Trench
■ Backhoe Pits: Tanks Week's Concrete Products 1260 allon
Filter Zabel A-100
See CSM or Plat for view of complete reel
4 inch Sch 40 •ASTM D2GG5
4 inch 303 - ASTM 1)3034
I
i
sif~a
?r TL
L
Z6~ (_AL
SLdI'll C y 1
TJ4 r
DEC \ 1
Lj
Gi~~a(cC IiCUSr '
\ \ \
A ~~~NO 0 ~1~ ~.4 ~t \
SEPTIC TANK DETAIL ! SINGLE COMPARTMENT
Project Name: Greg Fredrickso^
Tank Manufacturer: Week's Concrete Prodccts
Tank Model: 1260 Construction Type: Precaste Concrete
Tank Volume: 1260 ga
Liquid Level 58 inches
Effluent Filter Manufacturer: Zabel
Effluent Filter Model: A-10C
97.58 F Inlet Eie+;atio-i Outlet Elevat on 97.30 ft
T T
I
23'' Mini nurn Manholes wilocking devices
4 < - and warning !abe!s
o Finished Grade
"I
- ~ ;
Baffle
s,acie & -
Effluent
approved piping Scum Layer
Filter ' 4" stable 8
app-rned p,pinrg
G
Clear Space %
♦ I
Sludge Layer
3' Deddmg Under Tank
PlumberlDesignerSlgnature: ~ • 1 t- Z",
License 223760 Date: 5/9/2016
Page 3
II
f'- 1i 1~'1 Tr Af%d C r
A100", A300`'t A600"-12 Series Filters
Iv ar r..l r -g r t. .I J. :-t. d . h _ t;hr lh~r d la t't r,.. A it m- :r
_ -ion on 'x-,it this imcr~„l ti^:wld b,~ :a riot t~Ay aai~(~ nuc j~ >t °V90 .D`'.<: )!c,r!~ fh1 1~1J!'I •Ifti' .1 1C
s s:' t^~, `r!•. ncv cE scr no fa the tank, s~ould tu' cle-wr . vnccr ftv^ s:.ptc U* Is r'xtrall! ^,p,ced and ptrnpi d
cur frer is virtualN ss''•clr i^ ng. I!~ ccrmn, M 3cic~' cf the tRicroto c orge-im cr^'ho label flcr cause's
:k.-s :c. dr,•Int::qrs o and f311 a-
_-r Mir- rinternec•:~, =.:rr:irt=
To service the filter.
Vr; 00% drib •-•:I'! :foie or :i C'I" L•_i .h ireltd 13'~I. L•i! ~ (Okzj"!r
STEP ti'.<< STEP STEP
':n •,c ..._~1 _cvc- -n:i ~ultl~+Fhcr
jni F'JTa :tc, Iank a -dc and sk62 the
r,- y U Frwcnl arty wt of the
Awrea.. ti•v)r-n ~ •:~.:an^y'.. Cd'ye. l
• ~ W"i^ t9• 'tlCt'S
r• n-vrd.
i.=
STEP STEP
~ _ rrLL l I
Y
Ir 3.1 c fuel cartndge back
,ti'-t F I; - _~r.rj.~ 1c t~•: i° :iii. making sure the
a: ra i sc off :-)c ca"_i~g: )t c ca-tnd9 is pcp-"
v, -1 e_k, b?ny ciTOU to rnsv aL;n ardconrpMcay
r• 3: ' jr.~ nserud it the case 1
: L:)i.ue the se* tart L_j
ccifu_
tV:-rL
• \r _ ~ `I'_.'_ ` ~:-I'I'I{ S' - 3.1j -a'.rc. ~:•~r 'hp :•.i~- .~_~tI'17 J~r.'- _:f::7"r7'~~ : I•af v
c _i1 f.Dr i free I A l l I N E- • 1-800-221-5742.Or Orcler Online: www.zabelzone.com
Page 4
American Manufacturing Company Bull Run Valve Page 1 of 3
_ dMorw
Horny About Site Ma Order Info Trainin Videos Contact Dn S stm
Treatment Controls Products Downloads Design Guidance
THE BULL RUN TM VALVE
'VMTM-TI0Hr
ACCESS CAP
RI SER CAP
AD A TFR
RI eER
TUBE
VAL VE DIRECTI ON
HANDLE
The Bull Run Valverm is designed to split flows to septic
fields or systems. In addition to the advantages of Ar OVT PORT
longer life and easier installation it is the most public C OUT PORT'
health safe alternating device available for wastewater
disposal applications. The use has absolutely no contact
with wastewater due to the valve's leak-proof and
external operating characteristics. The change over from C IN PORT
one drainage field to another can be accomplished in
less than a minute by simply turning the valve without
digging or contact with wastewater. The Bull Run Valve is available in 4" sch 40 pvc
and is suitable wherever septic disposal systems
are used - in commercial, industrial, and
residential applications.
OPERATING THE VALVE
The direction control handle should be rotated
Field Fuld VFP periodically to direct effluent to one or the other
No.i No.2 of two septic fields. After removing the screw
cap at the top of the riser tube, the valve handle
valve Valve can be turned with the valve key furnished.
Positioned ed BULL RUN VALVE
on No. 1 . Z
dig
Complete Valve Kit
during
Odd Years Septic Septic Even Years Contains
Tank Tank 1. Bull Run Valve body
2. 28" Valve Key
3. Riser Cap Adapter
ITEM DESCRIPTION 4. Watertight Access Cap
BRV4 BULL RUN VALVE 4"
Page 5
file:%;iC:iUscrs,John%-?OSchmitt''DesktopiJolln'American°.,O?ONIanufacturing~,a2OCompany`,'-1020--%10Bull°, 2... 5'1012016
SOIL ABSORPTION SYSTEM DETAIL ! GRAVELLESS LEACHING UNIT
Project Name: Greg rrecrickson
Gravelless Leaching Unit Specifications
Manufacturer Model Laying Length EISA Rating
Infil:ratcr EZ120.?H-Eft E 0 250
EZ1203H-'Oft 100' :i_ 500
System Sizing
EISA Rating per Foot of EZ Flow F_5 ft` Soil Application Rate 0.7 gpdrft`
600.D gpd Design Flow Soil Appl cation Rate + ~ EISA = 171.4 Feet of EZ Flow
trenches 90 feet long each
2 No, of Cells 9 Per Cell
3 rt Cell Width 18 Total No of 1203H
90 f: Cell Length 450 sq ft EISA Per Cell
3 Cell Spacing 9c3 sq ft Total EISA
Typical Cross Section
Finished Grade 95 =t Observation Pipe wwi
-i rap1
Soli
36 inch '
Geotextile Fabric
12 Inch O II O Slotted and Anchored Vent/Observation Pipe
with Cap
91.00 ft Infiltrative Surface
'36 inch
Plumber/Designer Signature:
License M PRS 223760 Date: May 9, 2016
Page 6
Installation Instructions for A E ZTM
EZf0)r Systems in Wisconsin
FILTRATOR
'isconsin Deoa-tment of Ccmrrerce, 5atety and Bui'dinics E. The AlLsnrptior area (SF) necessary fcr a give-i site shall
Division, has reviewed the specrficat.ons and;'or olans for 1h is ; be sized oased en maximum daily sewage f ow ',',PD) and
product and cetermirec it to be in comp lance with chapters : the Permeabil ty for the site. If certain criteria is met, the
Comm 82 through 84, Wisconsin Adm n. Code, and Chapters EiSA sizing can be used in W sconsir, resin-irg in a 40".
',15 and 160. Wisconsin Statutes. All sites must meet the Site smaller drainfield.
& Soil Conditions & Locations & Isolaticn distances as noted in ;
Ir;c:al regulatiors. 6. Place EZflow bundle(s) in the EZf ow ccn-icuratior ap-
proved by system design permit specified for the particu-
I ne approved products arc 1203H (3-12" bund es wilt pipe in lar site. Tie toD or center-most bundles contain,ng pipe
;:enter trundle in 5' or 10' lencths) and 1203HP (3-12" bundles are oiled end to end with an internal pipe coupler. Any
w:itn ppe in each bundle in 5' or 10' lengths. additional aggregate only bundles that rray be required,
should be butted against the other aggregate-only bun-
A single pipe bund e contains a four inch perorated pipe sun- dies and do not require any type of connectior.
rounded by EPS aggregate and is held togetner with pcdy-
chtylere ne tirg, A single aggregate bundle costa ns aggreca-e 7. The top of each GEO cylinder con;a ns a filter fabric pre-
nnly and is neld tcget,re, with polyethylene netting. manufactured in between the netting and aggregate. The
`abric is nscrted to prevent soil intrusion. The installer
Materials and Equipment Needed shall make sure the the EEO is oos,tiioned upward anc is
• EZflow Bindies it contact with the fabric contained in the adjacent cyiin-
• EZf''ow Gectextile Fabric der before back'dling.
• FZf ow Internal Pipe Couolers
• P;pe -cr Header and Inlet 8. The EZflow Drainfield Systems should be -nstalled in a
• Bac~.h:~%Fxavatar level trench n at directions (both across and along the
trench bottom) and should follow the contour of the ground
Installation Instructions surface elevaticn (uniform depth}, with all continuous
The instructions *cr installaticn c= EZflcvv products are given ad cirirg 10-foot cyl'ncrical bund es placed end to end,
below. This product must be irstallec it accordance with state ; wits central bundle d stribution pipe intercornected,
,ales defined in chapters Comm 82 tnreugh 84, Wisconsin Ad- w thout ary dams, stepdewns or other water stops.
ministrative Ccde, and Chapters 145 and 160. Wisconsin Stat- ;
utes, as well as the local healt-r department's current design ; 9. The trench -ep shall be graded such that water will not
manual. pond. Backfill should be seeded or sodded immediately
after completion to reduce erosion.
After the local health department has determined sizing, '
config_raticn, arc] layout to, the FZfow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved
or mark wrh paint the location of trenches and ;fines. Be trenches as may be necessary to avoid trees, boulders, or
careful to set correct tank, invert pipe, header line or dis- other obstacles.
trioution box and trench bottom elevations before instal-
laticn of pipe Lundles. 1. LPS aggregate is I gnter than water, therefore, it might
be expected that natural buoyancy forces would tend :o
Remove plastic EZflow shiop tic bags pr )r to p acme cause EZflow assemblies to loat out o' grcund when
Lundles in -he trench(es). Remove any plastic bags in the pending occurs. Field experience has shown, however,
trench before system is covered. that this is rot a problem when systems nave a minimum
• of 6' of soil cover as recommended by manufacturer.
3. this product must have geotextile fabric that mews re-
qui-emen-s of s. Coma 84.30 (6) (g), Ws. Adm. Code,
installed directly on top cf -he product and extend ng 1243H-GEO
down along the sides of -hc p-od-ct to a point ad east x:
i-iches 'rcrr' the bci'cnn (if p[ci:!w:t. - - - - (;ewextile
Barrier Material
4, 'A"hen in,lta;lcd in a -rcnc-, tnc fie i l sh:nr c e ;lad to a vJdtn of 36 inches. ~h s net uniy saves labor n excava-
tion. nut also provides better bad-hearing capacity after
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..Page 7......
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Greg Fredncksu~i Tank Marufacturcr. Week's C. P. ❑ NA
Pem1i' # -7 Sept c ❑ Dcse ❑Holding Volume. 126C gal
DESIGN PARAMETERS Tank Manufacturer Wieser Concrete NA
Number of Bedrooms: 4 ❑ NA septic [ Dose Molding Volume: gal
Number of PuDlic Facility Units: NA Vertical Distance Tank Botlont(s) to Service Pad. ft
Fstimated (average) Flew: 400 gallday Horizontal Distance Iank(s; to Serivice Pad. ft
Design Flow = estimated x 1.5: 600 gal day R_-wstc servlcJng mecrtarocs most be crr; de l verbs-ai is>15 feet cr a
In Situ Soil Application Rate galtoayM2 o,izcnta1 a > 150 feet $aeofc rns:vcuons to ce provideo or pack.
Standard Domestic InfluenVEftluent Monthly average Effluent Filter Manufacturer: Zabel ❑ NA
Fats, Oils & Grease (=oG) <30 rr_),_ Effluent Filter Model: A-100
Biocfemica! Oxygen Demand (BOD,) s22C-ig,_ ❑ NA ump .,anu ac urer
Total Suspended Solids (TSS; <_'50m@1 Pump Model:
High Strength Influent/Effluent Monthly average Petreatment Unit NA
-ats Oils & Grease (FOG) 53? mg~L Varufacturer:
Biochemical Oxygen Demand (BOD%) s220mgrL 'L= j I~J m.,& r),,o A,,,w n
NA ❑ ree•. F„ter
Total Susoended Sol,cs (TSS, 5-50mg+L ] Disinfection ❑ we:an,c
Petreated Effluent Monthly average ❑ Sar,y(; avel ~ tte• ❑ Omer
Biochemical Oxygen Demand (BODs; 530m1t1_ of H sor tlon ystem M
Total Suspendec So ds (TSS) s3Cmgn_ ❑ NA n-nn-i-nc gravity) ❑ Ir•Gro,no presswe;
Fecal Ccli`crrt igeomet-ic mean) slCacfu!100m1 ❑ ?t-3 ace ❑ Mounc
Maximum Effluent Particle Size: Ya in dia A ❑ Dnp-Lne ❑ vtner
Other: Other
7777A
MAINTENANCE SCHEDULE
Service Event Service Frequency
Nihe.n combined with sludge and scum equals one-third (Y,) of tank volume
Pump out contents of tank(s) When the high water alarm is activated
At least once ever 3 monrhi,.l
Inspect condition of tank(s) Y• (Maximun 3 Years) ❑ NA
yea s'
Inspect Dispersal cell(s) Al least once every: monthisi (Maximun 3 Years) ❑ NA
1 5
•ear s'
1 5 n,onthlsy
Clean effluent filter At least once everY L] NA
••ear s
Inspect pump, pump controls & aterm At least once every' mont`(s;
L NA
•ear s' ❑
Use new drainfield for 5 years Once every 5 nonthlsi ❑ NA
_ ear s
Aitemate between old & new Orre every I 1 monmr(s' ❑ NA
' C`a S
dramfields annually or as indicated by
inspection
MAINTENANCE INSTRUCTIONS
nspectioes of tanks and dispersal cells shall be made by an incividual cam ng one of the following licenses or cecificat ons: Waste,
Plumber Master Plumber Restr,med Sewer. POIXTS Insepecto'; PCVVTS Maintainer Septage Servicing Operator (pumper) I ank
inspections must include a visual inspeciton of the tark(s) to identify any missing or broken hareware, identfy ary cracks c' leak,
measure the volume of combined sludge and scum and a cneck fo, ary back up cr ponding of effluent on ground surface. The
o spersal cellts) shall be visual y inspected tc check the effluent levels in the observat on pipes and to check for any ponding c` ef'I ue't
on the ground surface The Dondirg of effluent on the gmurd surface may ind sated a failing condition and reeuires the rnmea te
notification of the local -egulatory authority
When the combined accumualtion of sludge and scum n any treatment tank equals one-third i%s) or more of the tank volume t a e °t e
contents of the lank shall be erroved by a Septage Se'v arg Operator and disposed of in accordance with chapter NR 113, Wiscc
Admininistrative Code.
All other services, irduding but not limited to the servicing of effluent filters, mechan cal or pressurized : omponents, petreatment r.
and any serv cirg at intervals of s12 months. shall be performed by a certified PCINTS tdairta ner
A. service report shall be provided r. IFr. c-r! rcq L. atorp author ty Aitrin 30 days of cc-nple:icr, o` any service e,enl
Page 8
l_
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting procucts, solvents or other
chemicals or sediment that may impece the treatment process andro, damage the soil dispersal cell(s). If high concentrations are
cetected 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 oy 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
,.v thin the pump tank.
Dc not drive or park vehicles over tanks and cispersal cells. Do not drive or nark 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 mprove the performance and prolong the life of the POWTS.
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs: degreasers; dental foss d,apers; disinfectants; fat: fourdat on drain
(sump oump) discharge; fruit and vegetable pee'ings; 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 follow rg 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 py 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 compacticn and should not be infringed upon by required
setbacks from existing and proposed structure, lot Ines 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
pe-mit issuance
❑ A suitable replacement area is rot available due to setback and!or soi' 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 instailed 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 Jchn Schritt Name Johr Schm a
Phone 715-760-C486 Phone 715-750-3486
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Ovners Choice Nare: St Croix County Zoning
Phone Pnore:?15-386-46e0
This document is intended to meet minimum requirements of Ch Comm 83 22(2)(bi0',(a)&(f) and 83 54(1;, (2) & ~;3), Wisconsin Administrative Code
Use of this document does not guarantee the perormance of the POWTS.
PcIgQ. gas)
ST. CROIY COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner'13uver Greg Fredrickson
Mailing Address 622 222nd Avenue
Property Address 622 222nd Avenue
(Verification required from Planning & Zoning Department for new construction.)
City/State Somerset, V V l Parcel Identification Number 032-2177-65-000
LEGAL DESCRIPTION
Property Location NW SW ',4 , Sec. 11 T 31 N R 9 W, Town of `Somerset
Subdivision Plat. Hidden Hills , Lot # 5
Certified Survey Flap # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house Dyesano Lot lines identifiable Elyes0no
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 puntpmg 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
responsihilities 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.
Uwe, 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.
Llwe certify that all statements on thi 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 wa my deed recorded in Register of Deeds Office.
Number of bedrooms 4
SIGNXTU ~F 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 10
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATE`IENT
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) 622 222nd Avenue located
at: NW 14, SW Section 11 , Town 31 N, Range 19 W,
Town of Somerset St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service 4,22,'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: 1260
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): Week's Concrete Products
Age of Tank (if known): _1 1 years -
Permit number (if known) 479393
John Schm tt
(Uccnsccl Plut1ihcr SIL'~ti;wIl-) ('Print Nari121
Pv1PRS 223760
(Titlc) 5 10!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
(Nit 113 Wisconsin Administrative Code)
Rev. 2%2012
Page 11
H I L L--6 CURVE TABLE
' PLA C [JRVE 5 DrLi A ARC ORD IO BEARD:, TANG NT BEARINGS
ttwt 0%►tN part of 64 Normeast Quarter of 167M 1 6653-Jr -
ttr of 00 Sovthwsst Ouortsr eN h Sectlan ~
A G St owx ConntX mscons,h. C2 194 W 3~N24-42103 L4 _
I7
2p oz zmm, -'A'
LCT 1 LOT CERTIFIE SURVEY MAP
115ti.20 VC!. 11 PAcE 3241 La-
_
-1125.t8~_ I
LFIw~ fnAtnNlYf - I-
wt Ar LahrY0 !o I
~'~•S9"E 827.10' I
I
~I
209.5fTsq.q. Ft. h LOT v
®t C" s 281,105 sq. ft.
6.84 acres ''I
I
u' N89'29'ID"W 960.00' j
i I
1
I - -see't4~t'E 4ea,r ~ ,
137.4J' N88 24 .W I
~r>v>rtTF 260 20' I
won
I C S_M_. Q_ _ C.S.M.. VOL 17
PaGE 84; %'''tws
LOT~ a PACL 45oa
CSa = DCJ.a' T84 735 sq. ft. - - - J - -
YI J.78 acres
z
ONO&
S87"2'to"E
650.57'
UDY 597.10
120.14
LOT 5'D~
1 f„
15AS58 eq. n.
.107 acres
LOT 6 CBO - M5'
176 757 sq, ft. p
P
r- ® tBO - 9663'
-jIih
S6e•24'11'E 815.58' 57. kF>Ie,~ y \jYv.~,GR.
R]CI11 4nOµlt
Lor7 Zoo=
®f4.T,698 sq. ft-."
Leo - S&P. a'." w ■
T4E PARCELS SMONN ON THIS MAF ARE
~,,i ' ~ ® WaJECT TO STATE. COUNTY AND TOWNSHIP
' ~7N .Gy LAWS RULES AND REOUTATiONS (Iw.
X"1403. MINIMUM LOT SIZE ACU-n TO
815 .U PDE OLF.N£G ANYBEFDRE.PUR CONTACT THE ORST. "k
CROOK COUNTY ZONIHO o"XE AHO THE
3ff r J~ ! • QUARTER LINE APPROPRIATE TO%% BOARD FOR ADVICE.
%D /6 % t • t t
m TO W-,R Us'
crow WOULD ~ ~
a
APPROVED ?ry r = ` ftoM
AM=
MGM KM FOR - 1NQ OR PCANTINO IN ALAN IN VD Y Q J 2004 VC"TYMAP
WO ~V~ qn ry SEA 51. T. 31 N.. R.19 N.
EDIN06A~ _ TOWN OF SOMERSET. ST. CRDIX CMUMTY. IM
ii.l it ilril UUIV, r Nor ID OGtL
Page 13
'.N consin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix
Safety and 2uilding Divis on
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plar ID No 479393 0
Person8l
infortrt8tion you provide maybe used for secondary purposes `Pmvaey Law, s 15 Q4 (1 kmll
Pemil Holcer's Name: City Village X Township Parrxel Tax No
Crotty, Jason Somerset, Town of 032-2177-05-000
CST BM Elev: ! Insp B61 Elev: BM Description: Section/TowniRangetMap No:
In). fD M • 0t ?v C 1 11.31.19.1509
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ,
tc~sr✓--~ 12-42 ~•3o UT 0
Dosing Alt, UM
Aeration \ I Bldg. Sewe
Holding StrHt Inlet
_ . ' JP2
TANK SETBACK INFORMATION SVHt Outret I Z •OOr 3o r
TANK TO P)L WELL BLDG. Vent to Air Intake ROA- i Dt Inlet
Septic ! > +~r S Dt Bottom
Dosing Header/Klan w 71) 13 j- i 6 3 r
Aeration = Dist. PPI e 13 b3
`t !3•~~ `
Holding - 6o1. Systerril) IT-ST- S'8 9`I" : 2-r
Final Grade I I
PUMP/SIPHON INFORMATION t~
Manufacturer _ Demand St Cover r q
GPM l~wl~ D • 35
Model Number -
i
TDH Litt ion Loss ISystem Head TDH Ft
i
Forcernain ength Dist to I F
SOI ORPTION SYSTEM Zg
/TRENCH D/Vidth r Length t
l 1 No- Of TrenchEs PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM 3 - - Z
SETBACK SYSTEM TO PIL BLDG WELL LAKEISTREAM LEACHING D•lan aiture
INFORMATION T l CHAMBER OR
Ype Of S,stem I i UNIT Model Ku c
Cov%V. Z `d Sc +
DISTRIBUTION SYSTEM
f
3 HeaderMlanifold Disiributio-i x Hole Size x He a Spacing Vent to Air Intake
L~ Ppe(s;.
Length Dia 1 Len ra
s Spacing
SOIL COVER x Pressure Systems Only xx Pdound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seede(PSodded xx Mulched
BedlTrenah Center BedrTre.nch Edges Topsoil
Yes No Yes --1 No
COMN T {Ir i e code discrepencies, persons present, etc.} Inspection #1:0N • L<i X~ Inspection #2: ---f
z"~'r :11.31.19
,t1
Location: 522 222nd Avenue Somerse~t,QWI W25 (NNW 1,4 S"r 114 11 T3' V R19W) Hidden Hills L Io`t 5 Par el 1599
1.) Alt BM Description = -');T. ~~r^ le "5 ` ~te'~ 1t 16.E ~y~q,~t( ~C+
2.) Bldg sewer length = - L4S+
mount of cover =
Plan revision Required? Yes No
Use other side for additional irformado ,I t
Dale Insepctor's Signature Cert. N0.
SOD-6710 ,R 3,W)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings po E
w I~!
Ell ~ - i 85, Wis. Adm. Code
County L r ;
Attach complete site plan on pa r not less than 8 1,2 x 11 inch sin size. Plan must r
include, but not limited to: verb and trp=nt*I fe pointuBM), direction and Parcel I.D.
percent slope, scale or dimens n a d on a distance to nearest road. Q 3 - 1 -7- - Q~~U
Plea a pr9V 01t(,~ Kg0Wpn. ZReiiewed by Date
Personal Udorination you provide nvacy Law, s 15 04 (1) (m)).
Pr 7 Owner r~ Property Location
/ C / - /O Lr r'~l'e Govt. Lot W 114 -S /"-1/4 S f~ T3/ N R /
/y y ! (or &
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
6 V- 22o c u e S 141,We, h: its
City State Zip Code Phone Number ❑ City ❑ Village [a Town Nearest Road
SpM c:'ff GfL 151410 2.5- (7iS ) z17SOrnP-fe f 224- avc
New Construction User Residential 1 Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 0 Le 4-4--- .f .L Flood Plain elevation if applicable fl.
General comments ✓ 5 YS~ C ^L• / D ~lr ~?tc~ G «4 - ; -
and recommendations: $ Zy
Boring # ❑ Boring
1 pit Ground surface elev. ft. Death to limiting factor
~G in.
Soil AppFption Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EM 'Eff#2
0-7 101
L -zr z- c~~ .74 A&
Y- -/101 AN 1/j
56 Y /q2,
2 Boris # Boring Q
pit Ground surface elev. O , 7 ft. Depth to limiting (actor 7/ z-0 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft'
in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
A~~~
e /o
i
32 . c{ 6P
Effluent #1 = BODS > 30 < 220 mgil- and TSS >30 < 150 mg1L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) nature CST Number
k3tl ,,I e
Address Date Evaluation Conducted Telephone Number
7/s- z yT 3Zo
SBD-8330 (R07/00)
1
Lois
Property Owner ~,L 4e Parcel ID # Page Z of
F --?I Boring # I❑,~ Boring
Pit Ground surface elev. 7 y O ft Depth to limiting factor A6o in.
SoH Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft2
in. M//++uruell Qu.. Szr.~Cont. Color / Gr. Sz. Sh. •Eff#1 'Eff#2
I /W- G ii'''t S,3& /4 1141 4 s 11'2
i~-3 7,s7~ ~y iA LS
)3-IO 01 ~1r~¢ ~ vS ry , 7` A
it
F Boring # ❑ Boring
E] Pit Ground surface elev. ft. Depth to I i 'ng factor in.
Sal Application Rata
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW
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 = GODS > 30 < 220 mg/L and TSS >30 < 1 SO n,9& ' Effluent #2 = 90135 < 30 mg1L and TSS < 30 mgll
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 608-266-31 5 1 or TTY 608-264-8777.
5804330 (R.07/00)
OWNER Page 3 of 3
Name C k Brian Parnell
Addressr , & 2 O cu CST 231314
4-;;r Date
Benchmark 1 .2 ~fL~C ,'iPe j~5`. jDGs. &
- Benchmark 2
❑ Sol[ Boring
Suitable Area
1" = 40' Scale
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