HomeMy WebLinkAbout032-1082-50-200
7- &-/t, 6-~ IZ .'cci
wiseorsin Department of Commerce PRIVATE SEWAGE SYSTEM ounw: Si_. CpOIX l
Saien anc Buirdinc Division
INSPECTION REPORT Sanitary Permit No
sg9~Z $
GENERAL INFORMATION (ATTACH TO PERK-) State Plan ID Nc.
Persona information you provide may be used for seconaary ourposes [Privacy Lawr s.1 E.D4 (1)(m);.
Permit Holders Name
City Village dwnataP Parcel Tax No
Pc--~*k :
~E(~SC ( d32 - (082-SZ) -Zud
CST BM Elev Insp. BM Dev: BM Description Section,'Town/Range/Map No
5 rvi L2 U F U%r 010, -o csF L " P116 PIPE cu) 9.0.. / 3 ~ 74 46)
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAP,AC17Y STATION BS HI FS ELEV.
I
;Septic Benchmark
(Dosing Sz Alt BM
lr~
'Aaration Bldg. Sewer
to;.a9 ~~9 gY,~lo
(Holding St/Ht inlet
ra~.vg ~p.~b Yi•!~3
TANK SETBACK INFORMATION 'St/Ht Outlet !a;•o9
TANK TO PJL WELL BLDG, vent to Ai in,akc ROAD Dt inlet
Sepik r /(0~ ( /or > l eJd ~ D Bottom
Dosing f Header/t✓ran.
lAeration Dist. Pipe ik / Z3 Ala
I *z X03 -of
o f .79
(Holding Bot. System {f I 12 -10. 47
G
# Z /03.04 I L's 1??- 741
Final Grade 50"TA ZA o
PUMP/SIPHON INFORMATION TIIA CAi ~S /D3.elf, Manutacturer Demand St oovar
3
f Moda n I
N oer . -
TDr, ILift, - riction Loss System Head TDH i Ft
I /
Forcemain Length Dia. his tc Wel!
SOIL ABSORPTION SYSTEM
ZF6
BED,TRENCH Width Length No. Of Trenches PIT DIMENSIONS No O Pits Inside Dia Liauia Depth
f DIMENSIONS 70 Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture-:
INFORMATION CHAMBER OR
_ ~Z" F1.0lt~
ype Of System
UNIT Magel Number.
Lp.tJ(/GaNPrL V/ 04
lZb 3
DISTRIBUTION SYSTEM
Header/Manifoic Distribution jp7q{. x Hove Size x Hove Spacing Vent to Air Intake
µ Pipe(s) I /9v`
'LenatDia Length fa / Dia Sdacinc
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xz Depth of xx Seeded 5odgee r Mulched
~Bedrrench Center _ Bed, i rench Edges Topsoil Y_s Nc Yes No
- - -
COMMENTS: (Include code discrepancies, persons present. etc., inspection #1: 7 /(p inspection #2:
Location: q;; ' /?Z -4A A✓L Parcel No:
13/VI~Z U.S~D R7- /~)Sy~LTr~
1.) Al, SM Description = f1-DV !77p,tl St ~PPOStf~LY
Z1914 /n/S aGl~ S ~JIL ~3C
2.) Bido sewer length = ps 41 1,V& OFF WOT -5/.P6
- amount o` cover = (o~-~ ld~ /T~✓12~1 !J -?~d Cd js~ 6F kUlisSC 2 '=LdjC~
Plan revision Reouirea Yes No ! J _
Use otner side for addltiona', information. 7 l0 `/ten 6
Date insepctor s Signature CerL Nc.
SBD-6710 (8.3157)
s~cna ntF L RECEIVED County
` St. Croix
Industry Services Di Ion
1400 E WashingtC ~ve Mary Permit Number (to be filled in by Co.)
jUN 2 4 Z016 P.O. Box 71(K
gFSNN8`.
4 Madison, W 53 C GJgZZ2 5q
ST. CRON CO N7643 /
Ntrfl 1 ary &rnit Application State Transaction Number
IFI
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project ddress (if different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 454 192'd Avenue
1. Application Information - Please Print I Information
Property Owner's Name ' Parcel #
Pederson, John & Nanette/ Eichten, Zac & Sara 032-1082-50-200 p
Property Owner's Mailing Address Property Location d $ 19-10
454 192nd Avenue
Govt. Lot
City, State Zip Code Phone Number NW 1/4, SE ''/4, Section 28
Somerset, WI 54025 (circle one)
T31N R19EorW
II. Type of Building (check all that apply)
® I or 2 Family Dwelling - Number of Bedrooms 1 Subdivision Name
❑ Public/Commercial - Describe Use Block #
❑ City of
❑ State Owned - Describe Use ❑ Village of
n n L CSM Nu ber 2 ~p
Z p1 Li { ` GZ H'~Ofw~ 5 bJ ®rown of Somerset
1 L4
III. Type of Permit: (Check only one box online A. Complete line B if applicable)
A. ❑ New System ® Replacement System ❑ Treatment/Hol ding 'rank Replacement Only ❑ Other Modification to Existing System (explain)
B ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System/Component/Device: (Check all that apply) Zirm
® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil
❑ Holing Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treatm nt Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Requir d (sf) Dispersal Area Prop sed (sf) System Elevation
600 Rate(gpdsf) 857 900 91.03', 89.33'
0.7
VI. Tank Info Capacity in
o
Gallons Total # of anufacturer
Gallons Units M v y
o n ? b
New Tanks Existing Tanks P6 o U i a v G~
tb~ Septic or Holding Tank 1250 1250 1 W ser Con rete ® ❑ ❑ ❑ ❑
Dosing Chamber I ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' na e j~OLJ MP/MPRS Number Business Phone Number
John Schmitt 223760 715-760-0486
Plumber's Address (Street, City, State, Zip Code)
616 150th Ave. Somerset, WI 54025
VIII.-County /De artment Use Only
Approved ❑ Permit Fee Date ss d lssuin ent Signat e
m,~
Reason for Denial $
Llf<
_r 0 %0001
IX. Condi
fw, Q , e s ns for,Disapproval AS
P4-k-
dispemrAl cell must all WiL F
,*a -per mnagement plan provded
2. W *40Q1n ft rn*,,.be 1,f„A c 66 /
as per ~ cc* I wdi.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size
SBD-6398 (R03/14)
PLOT PLAN N
Project Name: Eichten 4 Bedroom Septic System
Legal Description: NW1/4, SE1/4, S28, T31N, R19W P.I.D: 032-1082-50-200
Subdivision Name: Lot 1
Township: Somerset Parcel Size: 3.249 Acres SCALE: 1" = 50'
County: St. Croix
System Elevation: T1= 91.03' Proposed 90.00' EZ Flow Trench
Slope: 15% T2= 89.33' Proposed 90.00' EZ Flow Trench
BM1 Elevation: 100.00' Top of 2" PVC Pipe
BM2 Elevation: 97.26 Top of 2" PVC Pipe
■ Backhoe Pits: Tanks S1 Wieser Concrete WLP1250-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
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Page 2
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CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Pederson 4 Bedroom Septic System
Owners Name: John & Nanette Pederson
Owner's Address 454 192nd Avenue
Somerset, WI 54025
Legal Description: NW1/4, SE1/4, S28, T31N, R19W
Township Somerset
County: St. Croix
Subdivision Name:
Lot Number: 1 Block Number
Parcel I.D. Number 032-1082-50-200
Plan Transaction No.
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 Warranty Deed
Page 11 CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 6/15/2016 Phone Number: 715-760-0486
Signature:
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1
PLOT PLAN N
Project Name: Eichten 4 Bedroom Septic System
Legal Description: NW1/4, SEIM, S28, T31N, R19W P.I.D: 032-1082-50-200
Subdivision Name: Lot 1
Township: Somerset Parcel Size: 3.249 Acres SCALE: V = 50'
County: St. Croix
System Elevation: T1= 91.03' Proposed 90.00' EZ Flow Trench
Slope: 15% T2= 89.33' Proposed 90.00' EZ Flow Trench
BM1 Elevation: 100.00' Top of 2" PVC Pipe
A BM2 Elevation: 97.26' To of 2" PVC Pipe
■ Backhoe Pits: Tanks S1 Wieser Concrete WLP1250-MR
Filter Pol lok 525
See CSM or Plat for complete view of parcel
14 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
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Page 3
POLYAVCVa,DX INSTALLATION INSTRUCTIONS
i1, C,
fr. 'ovations in Zabel
& Was PL-525/PL-625 FILTER
Wastewater Prodefs ADivsionorPOlyickInc.
INSTALLATION INSTRUCTIONS
Center filter
i with opening
f 4M A k is e
z!
I~ ~Z
wN
J ~
LL =
Additional pipe or
Polylok Extend & Loki" Glue
for centering.
Step 1: Step 2: Step 3:
(A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the
(B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe.
if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the
is positioned so the filter can be housing, making sure the filter
removed from the tank for cartridge is properly aligned and
maintenance and service. completely inserted in the housing.
Step 1: Step 2: Step 3:
Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back
if necessary. into the the housing making sure
~~ff Me (B) Pull the filter out of the housing. the filter is properly alighed
and completely inserted.
g (C) Hose off the filter over the septic tank.
USE RUBBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover
WHEN CLEANING FILTER septic tank. Page 4
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Pederson 4 Bedroom Septic System
Gravelless Leaching Unit Specifications
Manufacturer Model Laying Length EISA Rating
EZ1203H-5ft 5.0' 25.0
Infiltrator
EZ1203H-10ft 10.0' 50.0
System Sizing
EISA Rating per Foot of EZ Flow 5 ftz Soil Application Rate 0.7 gpd/ft2
600.0 gpd Design Flow Soil Application Rate - F 5 ] 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 93 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
91.03 ft
89.33 ft Infiltrative Surface
>36 inch
87.53ft
'---85.75ft
Plumber/Designer SignatL.,
License MPRS 223760 Date: June 15, 2016
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer John & Nanette Pederson/Zac & Sara Eichten
Mailing Address 454 192nd Avenue
Property Address 454 192nd Avenue
(Verification required from Planning & Zoning Department for new construction.)
City/State Somerset, W1 Parcel Identification Number 032-1 082-50-200
LEGAL DESCRIPTION
Property Location NW '/4 , SE '/4 , Sec. 28 , T 31 N R 9 W Town of Somerset
Subdivision Plat: NA , Lot # 1
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house ❑yes[ao Lot lines identifiable Dyes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary ili ,~Enic _;wjk
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this for are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty eed recorded in Register of Deeds Office.
Number edrooms 4
ATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
RECEIVED
Tfei:my en,A J*.r, Lar , T #182:
i4UN jQ kLUATION REPOR P an QJ PTH 1 VQ41 KSg with Comm 85. Wis. Adm. Code Page 1 of -
ST, ti 1+1C onal
Schmitt Soil Testing. in:.
_OMMUNITY DEVELOPMENT County
;attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and - -
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.
032-10 -5 200
- -
Please print all information. Revie By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Pederson, John & Nanette Govt. Lot NW1/4, SE /4, 8, T31N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Name or M#
316 S Grove St. 1 CSM 15/4036
-
City State Zip Code Phone Number City Village' ` Town -
Nearest Road
Stillwater ; MN 55082 651-214-5464 Somerset 192Nd Ave
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Flood plain elevation, if applicable NA____ ft.
General comments The replacement area is suitable for a conventional system with a 0.7 gpd/sgft rate. System to be installed on the contour at a depth
and recommendations: of 25. Approximately (High trench 91.03) (Low trench 89.33').
Boring
i Boring #
Pit Ground surface elev. ---93.53 ft. Depth to limiting factor -97+- in. Soil Application Rate
Horizon i Depth Dominant Color Redox Description 1 Texture Structure i Consisten Boundary Roots GPD/ftZ
I in. ! Munsell
Qu. Sz. Cont. Color Gr. Sz. Sh. `Effftt 'EfF#2
1 0-10 10yr3/2 none SE 2mgr mfr 1 as 2m,2f 0.6 1.0
- - -rt - - - - rt -
2 10-21 ! 7.5yr4/4 none grls ! Osg ! ml gw lvf 0.7 1.6
3 21-38 7.5yr4/6 none grlcos Osg ml CS ; 0.7 1.6
4 38-97 7.5yr5J6 none grcos ; Osg ml - I 0.7 1.6
T-
1
These soils appear to be have a large volume of gravels. I d+4M a sieved the grcos sands and'` the highest volume of gravel to be at 32%.
Boring
a Boring #
Pit Ground surface elev. _93.53- _ ft. Depth to limiting factor 72 in. Soil Application Rate
Horizon I Depth Dominant Color Redox Description Texture Structure Consisten Boundary I Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color , Gr. Sz. Sh. I `Eff#1 *Eff#2
1 0-9 10yr3/3 none grst 2mgr mfr as 2m,2f i 0.6 1.0
2 ! 9-23 7.5yr4/6 none grls Osg ml gw 1vf 0.7 1.6
3 23-70 10yr5/4 none grcos Osg ml Cs ; 0.7 1.6
j 4 ( 70-72 7.5yr5J8 none vfsl j imsbk mfr 1 0.2 0.6
5 72+ 10yr6/6 Fractured
Limestone ~ i 0.0 0.0
' ~ li a I
t- 1 - - - / -.~A - -
I ~
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 _ 50 g/L ' Effluent F2 = BO s < 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 Ev lu Conducted Telephone Number
1595 72nd St. New Richmond, WI 54017 /31I 6atio 715-760-1978
SBD-93 1 01R 6'+i+?t
Property Owner Pederson, John & Nanette Parcel ID # _032-1082-50-200 Page 2 of 4
Boring
F3] Boring # Pit Ground surface elev. ft. Depth to limiting factor 73 in. Soil Application Rate
Horizon j Depth j Dominant Color Redox Description Texture f Structure !Consistence~ Boundary j Roots GPDtft2
in. Munsell ; Qu. Sz. Cont. Color ( j Gr. Sz. Sh. `Eff#1 `Eff#2
1 0-12 10yr3/3 none sl 2mgr mfr as 2m,2f ; 0.6 1.0
2 12-18 10yr4/3 none grsi 2msbk mi gw lvf 0.6 1.0
3 18-29 --5yr4/6-- none -+--grmis icsbk - mvfr -9W --0.7-- --1.6
4 29-70 7.5yr5/ 8 none ; grcos Osg mfr ! gw 0.7 I 1.6
5 70-73 7.5yr5/8 none vfsl imsbk mfr I as I 0.2 06
I t
Fractured
6 73+ 1 r6/8--- - limestone --1- - -0.0 0.0
$33 ti (ju
Boring
4
F Boring # Depth to limiting fact
89.73 ft. 9 9 in.
Pit Ground surface elev. Soil A Pph..atton Rate
-
Horizon Depth Dominant Color 1 Redox Description Texture structure Consistence Boundary Roots _ GPD/ft2
in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-12 10yr3/3 none si 2mgr mfr as 2m,2f 0.6 1.0
2 12-22 7 5yr4/6 none ? grsl 2fsbk ml gw ivf 0.6 1.0
4
- 3 +-22-31-} 7.5yr5/$ - -none sd 2msbk ml gw 0.4 0.6
4 31-39 7.5yr5/8 none j vfsl imsbk mfr j as 1 0.2 0.6
Fractured 0.0 0.0
I
5 39+ 10yr6/6 li
- I -mestone--
Boring
F-s Boring # 93 53 ft. Depth to limiting factor pit Ground surface elev. _ g -63 tn. Soil Application Rate
Horizon Depth Dominant Color I Redox Description Texture { Structure ConsistenceBoundary Roots i , GPD1ft2 _
in. Munsell I Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#t •Eff#2
1 0-12 10yr3/3 none sl 2msbk mfr as 2vf 0.6 1.0
--t-__ . t - - - - - t - - - -
2 i 12-29 7.5yr4/4 i none grsl 2msbk ml gw lvf I 0.6 1.0
3 1 29-44 7 5yr4/6 i none 1 grcos! 2msbk ml gw 0.6 i 1.0
4 44-58 1 10yr5/4 1 none j grcos Osg mfr I gw 0.7 1.6
-
- - _ - - { i - -
5 58-63 10yr5/8 1 none vfsl j lmsbk j mfr as i 0.2 0.6
_ ? _ - - - A
- - 1- --t--- - - - -
6 63+ 10yr6/8 i - - 0.0 ; 0.0
limestone -
Effluent #1 = BOD_> 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 opportuoit' se" iec prov idcr and cmploycr. I 1'.\ ou need ssistancc to acccss sere icc~ or
need material in an alternate format, please contact the department at 608-266-3151 or 'I'VY 608-264-8777.
sBD-3,,; (R.±??0i ) Schmitt Sat Testing, Inc.
Page 3 of 4
Conducted by: Conducted For:
Schmitt & Sons Excavating, Inc.. Name: John & Nanette Pederson
Thomas J. Schmitt, CST 227429 Address: 316 S. Grove St
586 Valley View Trail City, State, Zip: Stillwater, MN 55082
Somerset,Wl 54025
Phone: 71 60-197 PID: 032-1082-50-200
S;g~, Lot No.
D > - Legal Description: NWl/4 SE1/4 S28 T31N R19W
® Backhoe Pit Township, County: Somerset Township, St. Croix County
Bench Mark 1 El. 100.00' Top of 2" PVC Pipe.
Bench Mark 2 El. 97.26' top of 2" PVC Pipe
Slope= 15%
Scale 1"= 40'
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t
NOTE: For full view of Lot see Aerial Photo (Page 4 of
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