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020-1395-49-000
. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division Sanitary Permit No: INSPECTION REPORT 589750 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Brian & JoAnn Wert T TOWN OF HUDSON 020-1395-49-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 5 M~ loaf. ZY U du?ZIr;~r !r; 25.29.19.2443 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ?-r-`/3 /v7.7 / zy Alt. BM Dosing 7 L ~/tea Aeration Bldg. Sewer Holding St/Ht Inlet 3. c.LZy TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. /r (py `OL V $ Aeration Holding Bot. System Final Grade PUMP/SIPHON INFORMATION /03 7Z Manufacturer Demand St Cover TAD Model umber TDH Lift Fric oss System Head TDH Ft Force Lengt Dia. Dist. to Well SOIL ABSORPTION SYS BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~laod Dr Z MBER OR Manufacturer: C - SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAEACHING / INFORMATION Type Of System: UNIT Model Number: N ("o.~~/~vr'ravi4~ ? Z~ yv ? loo z o DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent to Air Intake Header/Manifold Distribution 1Q i Pipe(s) Length ` Dia H Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only [-Depth Over Depth Over xx Depth of 7- Seeded/Sodded --T- -Mulched Bed/Trench Center .2 Bed/Trench Edges S~ Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7-1-7-16 Inspection #2: Location: 739 REGAL RIDGE CIR NNN VWV~ ft47Z lt 7, t4oW 12Er l~- fJ ~N7 1.) Alt BM Description /~G/ 2.) Bldg sewer length = , C (JIV VG yg/V - amount of cover = I/~/IrjS irv~ CN aF .uEw/ Plan revision Required? ❑ Yes No Use other side for additional information. p'/ ,a Date (~O Q y Insepctors Signature Cert. No. SBD-6710(R.3/97) 6g410A Di5e,)4416,6' FRtrvN t~(fr~~UG CRL. 0-0 G~tI~ ~J 9 r✓ 056 n OIN)1 046P 6 6~sbl-l. 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) 739 Regal Ridge Circle located at: NE/a, sW/a, Section 25 , Town 29 N, Range 19 W, Town of Hudson , 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 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1250 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser Concrete Age of Tank (if known): 12 years Permit number (if known) 453453 John Schmitt (Lie sed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS -7 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 10 PLOT PLAN N Project Name: Wert 4 Bedroom Septic System Legal Description: NE1/4, SW1/4, S25, T29N, R19W P.I.D: 020-1395-49-000 Subdivision Name: Scenic Hills Lot 49 Township: Hudson Parcel Size: 5.094 Acres SCALE: 1 County: St. Croix 60' System Elevation: T1= 97.00' Existing 87.50' Bio Diff. Trench Slope: 15% T2= 99.00' Existing 87.50' Bio Diff. Trench A BM1 Elevation: 106.96' To of Filter Manhole Cover T3= 100.80' Proposed 90.00' EZ Flow Trench BM2 Elevation: 104.24' Top of Outlet Pipe T4= 103.00' Proposed 90.00' EZ Flow Trench ■ Backhoe Pits: Tanks Wieser Concrete W1250-MR Filter Pol lok 525 See CSM or Plat for complete view of parcel 4 inch Sch 40-ASTM 02665 p 4 inch 3034 - ASTM D3034 ( f KI \t~`v>>1 ivy _ JrUl- a -IC i SoT fsi 9`Q ~toP A 1~ ,EGa L L G~CLr ~ o LL ~ 1 rV' age 2 r3 L4 County Industry Services Div' ton St. Croix ~t RECEIVED C 0 1400 E Washington Sanitary Permit Number (to be filled in by Co.) Sp P.O. Box 716" r1 S JUL ~ ~ 2Q16 Madison, WI 5370JPGVJVV h 4R4,F:c Htf.T~ ANFHR7E 'ransaction N-umber coMMU fflmclJ1tit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWT 'are submitt~to rtment of Safety and Professional Services. Personal information you provide may be used for seconroject Address (if different than mailing address) the Depa pu oses in accordance with the Privac y Law, s. 15.04(l)(m), Stats. am/ 1. Application Information - Please Print All Information Property Owner's Name Parcel # Wert, Brian & Joann 020-1395-49-000 Prop rty Owner's Mailing Address Property Location 739 gal Ridge Circle Govt. Lot City, State Zip Code Phone Number NE 14, SW 1/4, Section 25 Hudson. WI 54016 rcle one) T 29 N R 19 E of I'll II. Type of Building (check all that apply) Lot # ® I or 2 Family Dwelling - Number of Bedrooms YZ - L{ Subdivision Name Scenic Hills F-1 Public/Commercial - Describe Use Block # ❑ City of ❑ State Owned - Describe Use [I Village of CSM Number ®Town Hudson 'It -~7 L^~ / e -Qf D5rr1fJUttbry l .tIcs IV 0/03 III. Type of Permit: (Chec Complete line B if applicable) 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 ermit Number and Date Issued Before Expiration Plumber Owner 453453 / 8/10/2004 IV em/Component/Device: (Check all that apply) Non-Pressurized In Ground ❑ ssurized In-Ground E] At-Grade ❑ Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil ❑ Holding an er ispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: V Design F w (gpd) Design Soil pplication Dispersal rea Required (st) Dispersal ea Proposed (st) System Elevation 600 Rate(gpd 857 900 103.00, 100.80" 0.7 ✓ VI. Tank Info Capacity in o b Gallons Total # of Manufacturer Gallons Units o New Tanks Existing Tanks ~ U ~;n 17; C7 4 Septic or Holding Tank 1250 1250 l Wieser oncrete ® ❑ ❑ El F-1 Dosing Chamber ❑ ❑ ❑ ❑ ❑ V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl:mlAigirature MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 616 150`" Ave. Somerset, WI 54025 VIII. Count /De ent Use Only Approved DisapprPermit 1Fee Date Issue Issuing Agent Sig eas on for eriial S `I 1 liI 2b1u IX. Conditions of Avvroval/Reasons for Disapproval 5hoa1A 0 Irloty nn J/1S-kic aTpl its, ITSO(T Z a SYSTEM OWNER! . I 'A use rim . - iv &iS1Vr1Danct 71,O1)bft2 1. Septic tank, effluent filter and rtgQk(S 10.0 o dispersal cell must be serviced / maintained l9 Cv/ , (~,vf~tn+ Qrp4aS L ' ~ dtslw as per management plan provided by plumber.16N O?0 17, 2. All setback requirements must be maintained V as per appli ilt9 "&6r&F~Oeet.e system and sub o t oun only aper not le s t an 8 12 x I I inc es in size AA- %m,?eL~-i 00 , Cpvev bve~ d~5~sa1 Ce\1.S P~ SBD-6398 (803/14) 15) Iww%V 1vhvt ">W 6~ CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Wert 4 Bedroom Septic System Owners Name: Brian Wert Owner's Address 739 Regal Ridge Circle Hudson, WI 54016 Legal Description: NE1/4, SW1/4, S25, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Scenic Hills Lot Number: 49 Block Number Parcel I.D. Number 020-1395-49-000 Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 System Sizing & Cross Section Page 6 EZ Flow Information Page 7 & 8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Existing Tank Certification Page 11 Warranty Deed Page 12 CSM or Plat Attachment 1 Soil Evaluation Report Attachment 2 Previous Permit Designer: John Schmitt Licnese Number: MPRS 223760 Date: 7/12/2016 Phone Number: 715-760-0486 Signature: L 1( C ,~/LC.-r,~ In-Ground Soil Absorption Compo nt Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Wert 4 Bedroom Septic System Legal Description: NE1/4, SW1/4, S25, T29N, R19W P.I.D: 020-1395-49-000 Subdivision Name: Scenic Hills_ Lot 49 Township. Hudson Parcel Size: 5.094 Acres SCALE: V= County: St. Croix 60' System Elevation: T1= 97.00' Existing 87.50' Bio Diff. Trench Slope: 15% T2= 99.00' Existing 87.50' Bio Diff. Trench BM1 Elevation: 106.96' To of Filter Manhole Cover T3= 100.80' Proposed 90.00' EZ Flow Trench BM2 Elevation: 104.24' Top of Outlet Pipe T4= 103.00' Proposed 90.00' EZ Flow Trench Backhoe Pits: Tanks Wieser Concrete W1250-MR Filter Pol lok 525 See CSM or Plat for complete view of parcel 4 inch Sch 40 -ASTM D2665 4 inch 3034 -ASTM D3034 U~Lt SO $cD~~ ~d 6,T o~ / S 70 $ L o P E U / r ~ REGA, L G /LL W LAKf~ - - - age 2 an-MA 3114 95 9-9Z2-009 0 \ 09Z-V9 IM 'N006 N301VN OL I,MH Sn 9LLCM Z :HnOd-LSOd :31Va 3373373773-1 Va ibnNVN ~Ild3S 2lnOd-3214 .31V0S dOM 7 NMV?10 313401100 V3131M aw-oSZW N W w H Q Z > co 0 m W C J Z 00 00 Z < ~ Z O CL w W N a m m V) :2 O W H O 0 V) m W V/ Q ° z o F- W O Li 0 Imo- C) ¢ O J m F o O Q Q om 0~Q z 0 D CL W m U H Q ° o z F W O Q QJU J O r~ Q O m P H O Q V) C) Of 8 u Q s In 0 O m En J w W d G9 ~ Z CL O W O a- 0 _U 11) O a m JQ ~O(n j s 0 O~ U a a~ IL U0 O MrJ Q ¢ W ~ ~ -z,) 0 Z Zip V) a a s ~0 s\ 0 N~ mW tD W U a 0 000_ Z U IWO N-~oWJN WQQ w Q N Ja 0 0 ~ H N W vJ=~F I o~ z j= ~Z Y~ a- J.. OOZ J 1= ~ Y C7 \ 0 N O ~0H 0~ O O j QY 0 0Ow ¢ Zz < w m F po w FQ- Z(n Y M<o oawwowo~ ad-0 <NO 0 c~Dv c~ Q vwi x° N z Z3m UM=J~m-i o ZO< Z U ~g Nm W w w o ~o Q -J _I O Jo Q Z Y OO W O z z J 2 < z CC) F- U J Q W N I Q I ~ Q z w U LLI O "og Or W N N a i ~1 I Q m _w I° w w I~ II > > U o x of 0 (Y U F- F N O J_ W I W N U Q I LL J Z z W Q "98 m6incl2j Sd Y z a Page 3 ~ ~~r I r 1>>>~r rs f C J Al A300", A600"-12 Series Filters 'ho in ri-4+I °g -er (ic'vn=.. b tat vr)i:. cod, `hrcoLr:hout'h • 11nb?d tat+: th to , a w.x af(:-~ --nc ::r -Aion on ;a°„at this, in t'rti v! ~.~otaldth. 'ui rx-z;t R7 -tat aZ ~~:nc 4"", UQ~ : •r, f:, , c t . fo year . 'tt lab l' `tlt r ti~~ie a s trc r nc;,` c c .7crnQ fu the tank. ~ 'ou1di too clear) d `who ifw. ::pt tacks frralfy spa ed and pu I loewv=,'f ,ur frcr is virtualfy c.ct' cks^<ng. Ine Lcr" m ,d ac x c4 t? aw rot,,_ org.~- ms c-- ;hc' labd ftr•' cauS'?s : ~w _ick •c~ di int :gr -c anif f"Al -u t tt r' ' :rK.. _ _r ~~!tcr c:-t:, n, ~ S wcc ~ ill be not~f-••:: v a, _ f'1~R# 1,1:-' _ al.~'n To service the fitter k f~ tar? il+ 'i ::i 1;1`+' it t OLIU Ill LWi b' Licinf 6,ij r r-if. v stv.t,r zjnt puf.' pcr Lirir!$u,';t f STEP ci °c STEP STEP .,t c tack _~__~n :.:n rti J~K wve' .,r r-~•; ~L I tt',~ f l:c~ M-~ w ar d pJfr3 .tr_ tank d h l le a C 5i62 the r to i c vent any ivq;' c~Jt of the .y d" rn # ....gin; tc cay~. f ~;nuvcd. ~ p' i rn STEP STEP a . ~ lmel e i}cr amdge back .t•s:arrdgc cvc' nakirg SLre 0C co_ t ty •i-se off hL tarn g.: t N- c::-tr1L' is prcpcdy w N -"l +iLA,, tang carcfLt to rnsc JI rr~~ and comp tc'y € _ t a«• r _ tick rsc i._ :are n,cRed it LIE casa , :~ca+aci the septc tank € tu4 tK: t•: s • ' J C1•V? 3 "I' Ce+. i i'` tc, el !it'er. t- s,•? a-i S;.rci ar ?he :U cc-:f i-)j >arr a eCt~:7 t :1? 't'.. f :~/~'-;'t - t ,:a:.•i• .°'.'f:.; .:air: Call for a free ZABFL ZONE' • 1-800-221-5742 .Or Order Online: www.zabelzone.com Page 4 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT :jy-ia(\ A oAmw. WQr Project Name: men Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating EZ1203H-5ft 5.0' 25.0 Infiltrator EZ1203H-10ft 10.0' 50. System Sizing EISA Rating per Foot of EZ Flow F-5 ft2 Soil Application Rate 0.7 gpd/ftZ 600.0 gpd Design Flow, 0.7 Soil Application Rate - 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 ft Cell Spacing 900 sq ft Total EISA Typical Cross Section Finished Grade 104 ft Observation Pipe with approved cap or vent Soil Backfill 36 inch ~ Geotextile Fabric 12 Inch II Slotted and Anchored Vent/Observation Pipe with Cap --703.00 ft 100.8ft Infiltrative Surface >36 inch Plumber/Designer Signature: License MPRS 223760 Date: July 12, 2016 Page 5 Wisconsin Department of Commerce, Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow (GPD) and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84, Wisconsin Admin. Code, and Chapters 145 and 160, Wisconsin sizing can be used in Wisconsin, resulting in a 40% smaller Statutes. All sites must meet the Site & Soil Conditions & Locations & Isolation distances as noted in local regulations. drainfield. The approved products are 1203H (3-12" bundles with pipe in cen- 6. Place EZJIow bundle(s) in the EZJIow configuration approved ter bundle in 5' or 10' lengths) and 1203HP (3-12" bundles with pipe by system design permit specified for the particular site. The in each bundle in 5' or 10' lengths. top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler. Any additional aggregate ed by EPS aggregate and is held together with polyehtylene net- only bundles that may be required, should be butted against ting. A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filter fabric pre-manu- • EZJlowO Bundles factured in between the netting and aggregate. The fabric • EZJIow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZJIow: Internal Pipe Couplers sure the the GEO is positiioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation Instructions 8. The EZJIow Drainfield Systems should be installed in a level The instructions for installation of EZJIow® products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom) and should follow the contour of the ground surface defined in chapters Comm 82 through 84, Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code, and Chapters 145 and 160, Wisconsin Statutes, as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing, con figuration, and layout for the EZJIow systems, stake or mark 9. The trench top shall be graded such that water will not pond. with paint the location of trenches and lines. Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe, header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10. EZJIow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZJIow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed EZJIow assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown, however, that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6" of soil cover as bottom of product. recommended by manufactu er. 4. When installed in a trench, the trench should be dug to a 120 -GEO width of 36 inches. This not only saves labor in excavation, Geotextiie oooo but also provides better load-bearing capacity after backfill- Barrier Material il ing is complete. 12" A, VV11 - T I' I(G\1LRI3 IDLII V.'I IH 36" Top Vi- EZflow Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. Ez DOES IT., F: 1-866-279-9203 Oakland, TN 38060 Ring Industrial. com 1044-101008 © 2006 Ring IrRagrelfEroup, LP POWTS OWNER'S MANUAL & MANAGEMENT PLA y FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Brian Wert Tank Manufacturer: Wieser Concrete ❑ NA Permit # 2 Septic ❑ Dose ❑Holding Volume: 1250 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete Q NA Number of Bedrooms: 4 ❑ NA ❑ Septic ❑ Dose []Holding Volume: gal Number of Public Facility Units: E NA Vertical Distance Tank Bottom(s) to Service Pad: ft Estimated (average) Flow: 400 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft Design Flow = estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Zabel ❑ NA Fats, Oils & Grease (FOG) 5530 mg/L Effluent Filter Model: A-100 Biochemical Oxygen Demand (BOD5) 5220ni ❑ NA Pump anu acturer: Total Suspended Solids (TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit NA Fats, Oils & Grease (FOG) :530 mg/L Manufacturer: Biochemical Oxygen Demand (BODs) 5220mg/L 0 NA ❑ Mechanical Aeration ❑ Peat Filter Total Suspended Solids (TSS) <150mg/L ❑ Disinfection ❑ Wetland Petreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other. Biochemical Oxygen Demand (BOD5) 530mg/L of sorption System In-Ground (gravity) ❑ In-Ground (pressure) Total Suspended Solids (TSS) 5_30mg/L ❑ NA Fecal Coliform (geometric mean) 5104cfu/100m1 ❑ At-Grade ❑ Mound Maximum Effluent Particle Size: /a in dia. A ❑ Drip-Line ❑ Other. Other: Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third ('/3) of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Maximun 3 Years) ❑ NA Inspect condition of tank(s) At least once every: 3 ear s month(s) Maximun 3 Years) Inspect dispersal cell(s) At least once every: 1.5 El NA ear s ❑ At least once every: 1 5 H month(s) 0 NA Clean effluent filter ear(s) At least once every: month(s) E] NA Inspect pump, pump controls & alarm ear s 5 month(s) ❑ NA Turn off T1 &T2 ear s 1 month(s) ❑ NA ~ ear s Alternate between Old & New drain fields annually 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 (%3) 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 5_12 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 7 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: [If 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 1 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. Pa(ge. 905) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND p~,a OWNERSHIP CERTIFICATION FORM ~I Owner/Buyer _ 2trf ~~~UT Mailing Address _ qZ3 6"ar,2 L-F t c°~2ccs ,osc-~~ (,,Jz 9q0,((. Property Address 3 5 12E 6,h,.- s6/l~.t F (Verification required from Planning Department for new construction.) City/State ,os i,.,. 6j'_ Parcel Identification Number 6 2 o - 13 9 $ ' ~ " D ~ ~ LEGAL DESCRIPTION Property Location A)L %4 , 5LJ V4 , Sec. S , T ~2~_N Rj° _W, Town of ` S Yg . Subdivision S z w l-24iLc s , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # -7!Y Volume d , Page # 6~7 Spec house yes no Lot lines identifiable (2) no SYSTEM MAINTENANCE 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 § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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 Commerce 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 Zoning Department within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTMCATION Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the prop scribbov y virtue of a warranty deed recorded in Register of Deeds Office ' SIGNATURE OF APPLICANT DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey reap if reference is made in the warranty deed. r - 0~ 1 20 Y , l _ 95," 4 ~ ~ ~ ~5 ANT tt H. ~Q ~ \-4 77> r - HIGH WATER LINE WATEP. LINE DINAP~l, Hi~1 }C RECEIVED C Department of Safet 14 SOIL EVALUATION REPORT #1829 1 of 4 . ^ P v 4 2016 in accordance' Comm 85, Wis. Adm. Code Page Professional Services Schmitt Soil Testing, Inc. ST CROIX COU Attach complete sit*+gMMWWW 1 inche F$ County St. Croix include, but not limited to: vertical and honzol~nce point 9 - - percent slope, scale or dimensions, north arrow, and location and distai,_~6q 1 4 Parcel I.D. ~4/~P 020-1395-49-000 Please print all information. - Reviewed Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ! /1//& Property Owner Property Location / Zy Wert, Brian & Jo_A_nn_ Govt. Lot NE1/4, SW1/4, S25, T29N, R19W ( J) Property Owner's Mailing Address wt # Block # Subd Name or CSM# 739 Regal Ridge Circle 49 -Scenic Hills City State Zip Code Phone Number City Village Town Nearest Road Hudson WI 54016 Hudson Regal Ridge Circle New Construction Use: j ; Residential / Number of bedrooms _ 4 Code derived design flow race _ 600 GPD j Replacement Public or commercial - Describe: Parent material Outwash (Burkhardt-Sattre Series) Flood plain elevation, if applicable 930 ft. General comments Replacement area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for replacement area is and recommendations: (High trench 103.0' low trench 100.80') Slope of area is 15%. Boring F Q Boring # I Pit Ground surface elev. 105.74 _ ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-7 10yr3/2 none Is lfsbk mvfr as 2f,1vf 0.7 1.6 2 7-51 10yr5/6 none Is Osg ml gw 1vf 0.7 1.6 3 51-70 10yr4/6 none Is Osg ml gw 7 1.6 4 70-96 10yr5/6 none Is Osg ml 0.7 1.6 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 6/23/2016 715-760-1978 SBD-8330 (R.07/00) Property Owner Wert, Brian & JoAnn _ Parcel ID # 020-1395-49-000 _ Page 2 of 4 57 Boring Boring # J Pit Ground surface elev. _ 105.14__ , ft. Depth to limiting factor - 94+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/2 none sl 2mgr mvfr as 2vf 0.6 1.0 2 6-18 10yr4/6 none grsl 2msbk mvfr I gw 1vf 0.6 1.0 3 18-60 10yr5/6 none is Osg ml gw 0.7 1.6 4 60-94 10yr6/4 none s Osg ml 0.7 1.6 _ I Boring F3 ]Boring # pit Ground surface elev. _ 102.3 ft. Depth to limiting factor >78 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 7.5yr3/2 - Is 1 f sbk ds cs if/m .7 1.6 2 5-58 7.5yr4/4 - s 0 sg ml cs 1. 1.6 3 58-78 7.5yr5/3 s 0 sg ml - - 7 1.6 Lm roots to 44" This boring was describe by Henry Grote on 8/5/2004, it was added to this report for convience in referencing it T 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 I. Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format. please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Paoe 3 Conducted bv: Conducted re: Schmitt & Sons Excavating. Inc.. Name: Brian & JoAnn Wert Thomas J. Schmitt, CST 227429 Address: 739 Regal Ridge Circie 586 Valley View Trail City, State, Zip: Hudson, WI 54016 Somerset, W 154025 Phone: 715-760-1978 PID: part of: 020-1395-49-000 Signature _ Lot No. 49 Scenic Hills Date Legal Description: NE1/4 SWI/4 S25 T29N R19W ■ Backhoe Pit by X" Township, County: Hudson, St. Croix County ® Bench Mark 1 El. 106.96' Top of 2' Filter manhole cover. ® Bench Mark 2 El. 104.24" top 4" outlet pipe filter is glued to. Slope= 15% Scale 1"= 60' NOTE: For full view of Lot tee Aerial Photo off y liter r 01) ' ~ /s~" QcA~~B az \Aj A~ f any' .237 G 1 W€cL ' ~!s' L ~i9G-G5 y o t c~pps cn = ; 0 0 m j MAR. jl Z 8 o s. 00 o' N 3 0 AV a ~ ~ `~V: ~ ~ zsr~ ~ fit' ~ 60 G L' ~ '~'~-~y' O ,.mow q .'~•:xp:' - 00 ir-po k'• All qF bYl, k°YT. 9 ybe rt4 m R°. a h n t A` as .•k h -4 tr r r~ a Sanitary Permit No. 453453 0 tsatety and Liuming uivision INSPECTION REPORT State plan to No: (ATTACH TO PERMIT) GENERAL INFORMATION rivacy Law, x.15.04 (1)(m)1. parcel Tax No: Personal information you provide may be used for secondary Purposes City Village X Township 023-1395-49-03d Permit Holdets Name: Hudson, Town of SectionlTownlRangelMap No: Wert, Brian 25.29.19.2443 CST BM Elev In BM Elev: BM Description: CST,. Qvx*- tic) -0 t J ELEVATION DATA BS HI FS ELEV. TANK INFORMATION CAPACITY STATION TYPE MANUFACTURER,n ~~~•Q ~"'f0D Benchmark °I,21 ~OR,21 ~~I Septic tS~ , 2~ Alt. BM Dosing l Bldg. Sewer 3.92- 05.2-9 Aeration , !0~-S St/Ht Inlet 4(o-+ Holding r St/Ht Outlet TANK SETBACK INFORMATION vent to Air Intake ROAD DtInlet TANK TO PIL WELL BLDG. Dt Bottom Septic , r 2 3 ~ , 7 >(v0 Header/Man. 01 • Z~ 99 •9 2 Dosing L} 1j .9'f 1 Dist. Pipe 11,Z~ Aeration Bot. System IZ.zi . co Holding Final Grade a ' PUMPISIPHON INFORMATION Demand St cover 2.25 0619 Manuf cturer Model Nu er TDH Lift Frictio oss System Head TDH Ft Forcemain Le h SOIL ABSORPTION SYSTEM IT DIMENSIONS 0. Of Pits Inside Dla. Liquid Depth E C Width Length cStI NO.OfT rich s DIM s 3 9a ' 2 LEACHING Manu urer: p/L BLDG WELL LAKEISTREAM CHAMBER OR -u SETBACK SYSTEM TO INFORMATION f 1 1 UNIT Model Number: tr /J_ n 6D I Type Of System: 10D DISTRIBUTION SYSTEM x Hote ize x Hole Spacing Vent to Air Intake Headermanifotd Distribution > tP~ Pi (s) Lengt Dia II Le i Spacing ngTn_ xX Mound Or At-Grade Systems Only SOIL COVER X Pressure Systems Only SeededlSodded ~ Mulched Depth Over xx Depth of Depth Over Topsotl YeS (J No Yes [ No BedlTrench Genter Bedfrrench Edges Inspection #1 S 6,1g- j Inspection #2: ' COMMENTS: (include code discrepancies, persons present, etc.) arcel No:, 25 29. 9.2443 Location: 739 Regal Ridge Circle Hudson, WI 54016 (NE 1! SW 114 25 T29N R19W) q ) nANl Hills Lot 4 / ~7/ 1.) Alt BM Description = 2.) Bldg sewer length - amontofcover= Z~~ + • (ll 3S~s 4- 3) Plan revision Required? Yes No Use other side for additional information. Cert. No. Date -I Insepctors Signature SBD-6710 (R.3197) - Safety and Buildings utvrston 201 W. Washington Ave., P.O. Box 7162 S?- Q'0 /Y 11*is~onstn w Madison, WI 53707 - 7162 SanNuy Permit Number (ta be filled en by CoJ (649) 266-315! 5 De artment of Commerce state Plan i,)3rNu~ Sanitary Permit Application NN In accord with Comm 83.21, Wis. Adm. Code„ persortai information you provide may be used for se onduy purposes Privacy Law, sl 5.04(1)(m) Project Add re p It (if different thumm u ilia W- 90) 1. Application Information - Plew Print All Information 7 9 R,Q &A-L, 21®(of L( ' Parcel p Lot M Block N property Owner's Name , y `i3 Cj e zo ^ 1 t ^ C 0 Property l oes ran Owner's Mailing Address S section .2 4 nU w city, state Zip Code Phone Number tt gfcircle aSt)~+ 5yai6 Is-- 76,o- -00 7 T,a N. Rr C EorYV II, Type of Bu lding (check all that apply) Subdivision Name / CSM Number JKl or 2 Family Dwelling -Number of Bedroom SC,'! c G 1T I a S ❑ Publitcommer clal - Describe Use ❑City Qvitlsge (kowmhip of _ jLji..- ❑ State Owned - Describe Use a A w 'I"ll "I I'll " UI. Type of Permit: (Check only one box on line A. Compete line B if applicable) t On 0 Other Modirwation to Existing System A. ~,@Iew System 0 Repiacen"t System 0 TreaurmtMotding Tank Repiacernen Only List Previous Permit Number and Date Issued Chillof O Pemit Transfer to New B. 0 permit penewitt 0 Permit Revision owner Before Expinitftat Plumber 1 11 IV. T of POWTS S em: Check all that apply) Non ..Prrsst>on_ and 0 Mound ? 24 ia. of suitable soil ❑ Motmd < 24 in. of suitable soil ❑ At-0ratk ❑ Single Pass Sand Fiber ❑ ❑ / Constructed Wetland 0 Press d nd 0 holding Tank ❑ Pmt Filter 0 Aerobic Treauntnt Unit ❑ RecircuWing Sand Filter ss pipe ❑ Other lain) G Red Synthetic Media Fitter Chamber 0 Dri Line 0 Gravel-le V. rsaVrreatment Area 010 tion: f I l Area Propoacd (so systsen Elevatron Design Flow (gpd) Design Soil Applirrt'on Rato(gpdaf) Dispersal Area Required Of> UaP / rL f -l v . 7 > g 5~, t S 7v r 8 Manufacturer Prefab site stool Fiber Plastic Vl. Teak Info Capacity in TtKad Number Concrete Constructed Glass Gallons cations of Units New Exist* Tanks Tins Septic or Homing Teak Aerobic Treanaent Unit Dines CAa'nba Res asibili Statement- 14 the andersilIl ascame+esPo Busi+ for iustaUatioa of the POWTS shows 4113 the amts hod phflaus. one VII. Plumber's Signature MP/MPRSNumbs ness Numbs Plum s Name (Print) 7~ 7 Z- 3 Z 1 _ 2 Z to Z Plumber's ddress (Stroet City, state, Zip ) r "U 3 f2 h t w f VIII oun /De artment Use Only dssuin It Si tamps) Sanitary Permit Foe Cncludrs Groundwater Da Approved 0 Disapproved Sul ~ Fee) 7 ~ ~b Q ❑ Owner Given Reason for Denial w IX. Con tions of ApP%v~ for Disapproval n S ~g SYSTE OWNER:DD dGUy~ I<,u~a of plc('c c OwC ` 1 Septic tank, effluent filter and dispersal cell must all b service / m0inttalned ®S S>1 G~ ) , /,tJrYt On , as per management plan provided b lure r. . 2. setback re uiremen s mu as era licable code! r in swauUcbm .tae /it p Athe6«taMe+et+(t.ar< +•~Ter!'° .e< 3 !o +141n S S/Yh ! , /,,J/n~,, 3 SBD-6398 (R-01/03) Gliucl Gt t~~y'"` ZGc' s omm &^%#nwn s sn%x SHEET NO. OF c/ Route 1 BOX 192 WILSON, WISCONSIN 54 7 CALCULATED BY_._yLL~ (715) 772.3214 CHECKED BY J DATE MPRS #3224 WI SCALE ' .......,..I ...............................:......................I........... ..........I..................... 1..........1.........:' ..1.. .........1 ..................~...........1........... L......_. ;...........i i I . ....T.........; i I t f { 1. 1 i I ...L i 1 I . j.. { I 1 .L:... t..... _ . ......i....... ! , i I t b r J Y~ ! L.. t.......... 7 ' 'Q F'rwJ,t y i ! r t : i i ! v « t { . I I ! I j I i , 4. , ~ A~eyar I r... ..j...IVp~ T.I vF : .....1 i s o-. i : I 3 j 4 { i...... i......... + i ; : ~ S. ' f i ' ± - . : . ...r. 1 1 i~ S . ' i ..r..........7........ : i + + . r i l I . r { . : w : h ,T u..L - ~ ..1.7 i t .A I. - - a. :.........i . 1 , ...1........ . ....f . F y . I i A PROWCT 2051 4~lm 0lotw, Miff 01471.10 0idm PHONE TOLL FREE 1-000-1 RA)