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Home My WebLink About030-1063-70-015 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 589771 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)] Parcel Tax No: Permit Holder's Name: City Village Township Andy & Nicole Oman TOWN OF SAINT JOSEPH 030-1063-70-015 9") Section/Town/Range/Map No: CST BM Elev: Ins p. BMlev: BM Description: ~ 'i . n, 24.30.19.228A-15 q T~Ir TANK INFORMATION ELEVATION DATA TYPE MANUFACT CAPACITY STATION BS HI FS ELEV. - :::~-j Septic ~7 Benchmark C~ l D 2 JIBS G I vt D~Sir3g_ ~ _ Alt. BM Bldg. Sewer q ~3- 2 Aerafflo~r HekhrT Ht inlet IQ -I' R2.g5 St/ t Outlet ~ p, 5~ Z ~ J TANK SETBACK INFORMATION TANK TO P LL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2 I n / 1r1_ /1/ t Dt Bottom Dosing (V rJ Bader an. 92 Aeratio Dist. Pipe / - Holding ot. System I R~ .99 . D~ - _ Final Grade 91/• PUM /SIPFION MATION J Man facturer Demand St Cover 1 GPM M Idel Number DH Lift Friction Loss System_"--- TD Ft FoIcemain Length Dist. to Well A I - i,711 SOIL ABSORPTION SYSTEM Tren ches PIT DIMENSIONS No. Of Pit Inside Di~ Liquid DeptDIMENSIONS / BED/TRENCH EM SETBACK BLDG LAKE/STREAM LEACHING Manufacturer: IY1 I 711 YGtCHAMBER OR l! INFORMATION UNIT Md S1 ~ IBUTION SYSTEM ve t t r Intake x Hole Spacing He r/Manifold Distribution x Hole Size ' Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched De th Over Depth Over xx Depth of xx Seeded/Sodded p ` Bed/Trench Ed es f Topsoil Yes No Yes No Bed/Trench Center g COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspecttion #2,: *W ell fib4 1cv; 1I lC~ I f}~~ '~~it f) V l(,(~f~1 L .6 Location: 812 140TH A E 1.) Alt BM Description = 1 Ct~v- 2.) Bldg sewer length - amount of cover = Covv on ~I l ! 4~,Insepctor's Plan revision Required? I Yes NoUse other side for addltlonal mformatl Cert. Date Signature SBD-6710 (R.3/97) c , County leh tt i . St. Croix Industry Services Division { w' V 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) D i S P i P.O. Box 716 L Madison, WI e 6 J 977/ ~°Ft:sxm ~v-' S ST. ~111t Application in accordance 1( tate Transaction Number 2 Wis. Adm. Code, submission of this form to the appropriate govt. 't 4y is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are d subt.- ~t Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be use for seconu 812 1400i Avenueaww ffAA n accordance with the Privacy Law, s. 15.04(1)pn), Stats. cation Inform PPint A ll Information wner's Name Parcel # ndy & Nicole 030-1063-70-015 Property Location pt ~ ~ 1 ~3 ~~a ~ its Property Owner's Mailing Address 812 140'h Avenue Govt. Lot City, State Zip Code Phone Number SW 14, sW '/4, Section 24 cle one) New Richmond, WI 54017 CQL , T30N R19Eor~ II. Type of Building (check all that apply) ® 1 or 2 Family Dwelling - Number of Bedrooms 2 Subdivision Name bk., lock # ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number E] Village of ~ 1230- GL Of 2t, P, 44w ® Town of St. Joseph Ill. Type of Permit: (Check only one ox on line A. Complete line B -if applicable) A. ® New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Permit Renewal ❑ Permit Revision ❑ Change of El Permit Transfer to New List Previous Permit Number and Date Issued B. Before Expiration Plumber Owner how IV. Type of POWTS System/Com onent/Device: (Check all that apply) ® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd Design Soil Applicon Dispersal Area Required (st Dispersal Area Propo d (sf) ~System 95 fi0, 94 30tion 600 Rate(gpdst) 1200 0.5 VI. Tank Info Capacity in 4? n Gallons °5 Total # of n Man facturer o Gallons Units New Tanks Existing Tanks 50Z r ` U rn C/~ L" C7 0. Septic or Holding Tank 1250LP 1250 1 Wieser C Crete ® ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ' n 're MP/MPRS Number Business Phone Number John Schmitt /C(/G'A 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 616 150`h Ave. Somerset, WI 54025 V11I bunt /Department Use Only Approved tsapprove PermittFFeeee Date ssued Issuin ent Signa re ner Given Reason for Denial $ 0 F. l IX.Condi ott~c' ~~5 Disapproval 'Q~ w°'^. 4 dispemai cell must all be seivlces I maintairec' d ss Ir►ent last provided by plumber. {tar ntaneglf plan O f.- 2.1liNiiKi+t+st)exr l+girsad as per oppi 1, it h colt I tftiw. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R03/14) PLOT PLAN N Project Name: Oman 4 Bedroom Septic System Legal Description: SWIM, SW1/4, S24, T30N, R19W P.I.D: 030-1063-70-015 Subdivision Name: Lot 2 Township: St. Joseph Parcel Size: 9.796 Acres SCALE: 1" = 50' County: St. Croix Mao System Elevation: T1= 95.60' Proposed 120.00' EZ Flow Trench Slope: T2= 94.30' Proposed 120.00' EZ Flow Trench 8M1 Elevation: 00' Top of 3/4" PVC Pipe BM2 Elevation: 99.90' Top of 3/4" 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 3 peaasSZO PRCPos, b WELt or )_:~V cAL St=_P'trC TAk'K i W1 jkLY1-0K ~5 Z>' ii "ICE ~r ABAI Q i qV T" Page 2 CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Oman 4 Bedroom Septic System Owners Name: Andy & Nicole Oman Owner's Address 812 140th Ave New Richmond, WI 54017 Legal Description: SW1/4, SW1/4, S24, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: Lot Number: 2 Block Number Parcel I.D. Number 030-1063-70-015 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: 7/25/2016 / Phone Number: 715-760-0486 Signature: 'l t ~/L'f Zt In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Oman 4 Bedroom Septic System Legal Description: SW114, SW1/4, S24, T30N, R19W P.I.D: 030-1063-70-015 Subdivision Name: Lot 2 Township: St. Joseph Parcel Size: 9.796 Acres SCALE: V= 50' County: St. Croix System Elevation: T1= 95.60' Proposed 120.00' EZ Flow Trench Slope: 15% T2= 94.30' Proposed 120.001 EZ Flow Trench A BM1 Elevation: 100.00' Top of 3/4" PVC Pipe BM2 Elevation: 99.90' Top of 3/4" 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 I i ~~ai~sk.+3 PRQ~csK~ or 1)51c c;,AL s;FPr,c rAA)K na~sc _ P,L _ _ _ B► _ A B M, T R(u% N~ i A oa„o an-091dW :3 13 9519-=-009 0 \ o :8 nod-1SOd :31V0 00/00/00 :31VO 09L49 IM `}1006 N301VW OL ,IMH sn 9LL2M ,dnNdw Ol1d3S w A321 31383 11~~ 13531M W \ :8nod-38d „0-,L=„4 L :3-lVOS dOM :,19 NMV21O 8N-05ztdIM w w L'i J H Q JQ z co O LLI ° o o W a z d. v Q a m W z 0° o o N ~ w V) Q ° Lij (n c) w o a s a m° Z~ a u, ~o~ o r- O ~ c~ o Z z Q °o m o ~Q z L a in HL.L > Ln O c> r- _j Z J= \ CV Q M m F- 3 > G ry q 0 O w w< Q mLd Z EL W~ 00 ¢ a o CL O p m to J w LLJ c7 ca O I- O Li : F o\\o LN muwwiLI - CL a 'ooo Q J a LO C14 a N'- O° F- J F- I Q F- Q J a. ~ O Z V) H U \w NCV: WW00 WQC) WZ- OQ cn2 C~Z x7 W NtocjLO -rozwao ANN Y=° 0 o\ ~n~ Qo LLJ (n Q' V) fnNO~°~~ ..3 C) °VY °OW Q QWQ W mF ~0 z 00 052 o V) a. x Y 0 3mo~=w m~3 <'t0 a ° V ZOOQ Z UN O z r F o a ow z w J 5 J Q Q p Z Z _ Z Z OJ F 0IQ- U J Q W co 1 Q I v w =I „6~ o Z w Li w a_ o r 1 I I. \ 0OJ I N W WQ I I b a m I ~ w _w o I a f > I „9c > Q N I v ( ~o I I o w w Ir a p N r 1 I Li ~g / i W of -ji N a z z ab32~ _ ~ b8 Sd «JZ5 a Ln z Q Page 3 P I INSTALLATION INSTRUCTIONS Inc, 40L MYAOX-.- t`waterPre`a5f. °'a'°age Zabel' d Wastewater Pwducfs ~ A A Division or Polylok Inc. & Was PL-525/PL-625 FILTER INSTALLATION I Center filter with opening /f t; 91~1 ® N y W J :3 E0 S Additional pipe or Polylok Extend & Lok'" 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. MAINTENANCE INSTRUCTIONS a 1 v ' zW; t 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 ism III (B) Pull the filter out of the housing. the filter is properly alighed (C) Hose off the filter over the septic tank. and completely inserted. 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: Oman 4 Bedroom Septic System Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ12031-1-10ft 10.0' 50.0 System Sizing EISA Rating per Foot of EZ Flow 5 ft2 Soil Application Rate 0.5 gpd/ft2 600.0 gpd Design Flow = 0.5 Soil Application Rate ~ EISA = 240.0 Feet of EZ Flow F 72trenches 120 feet long each 2 No. of Cells 12 Per Cell 3 ft Cell Width 24 Total No of 1203H 120 ft Cell Length 600 sq ft EISA Per Cell 3 ft Cell Spacing 1200 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 B CD,-,~- Slotted and Anchored Vent/Observation Pipe with Cap 95.60 ft X 94.30 ft Infiltrative Surface >36 inch Plumber/Designer Signature: License MPRS 223760 Date: July 25, 2016 Page 5 Installation Instructions for 41&EZ ow- EZflow Systems in Wisconsin fllyiNFILTRATOR Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters : the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in ; local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dles and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positioned upward and is • EZflow Bundles in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric der before backfllling. • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- ; without any dams, stepdowns or other water stops, ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design ; 9. The trench top shall be graded such that water will not manual. pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 1 1. EPS aggregate is lighter than water, therefore, it might • be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered. that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 1203H-GEO down along the sides of the product to a point at least six inches from the bottom of product. - - Geotextile fL Barrier Material o°o 4. When installed in a trench, the trench should be dug to VJ1 a width of 36 inches. This not only saves labor in excava- tion, but also provides better load-bearing capacity after ! backfilling is complete. - 36" Paiga 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Andy & Nicole Oman Tank Manufacturer: Wieser Concrete ❑ NA Permit # Septic ❑ Dose []Holding Volume: 1250 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA Number of Bedrooms: 4 0 NA ❑ Septic ❑ Dose ❑dolding Volume: gal Number of Public Facility Units: 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: 0.50 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: POLYLOK ❑ NA Fats, Oils & Grease (FOG) s30 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand (BOD5) :5220mg/L NA Pump Manufacturer: Total Suspended Solids (TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit L /J Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 1-220mg/L E3 NA ❑ Mechanical Aeration ❑ Peat Filter Total Suspended Solids (TSS) !5150mg/L ❑ Disinfection ❑ Wetland Petreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other. Biochemical Oxygen Demand (BOD5) 530ni of A sor~-tlon System Total Suspended Solids (TSS) 530mg/L 0 NA L In-Ground (gravity) ❑ In-Ground (pressure) Fecal Coliform (geometric mean) 5_104cfu/100m1 ❑ At-Grade ❑ Mound Maximum Effluent Particle Size: % in dia. LJNA ❑ 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 At least once every 3 month(s) (Maximun 3 Years) El NA Inspect condition of tank(s) year(s) At least once every; 1.5 month(s) Inspect dispersal cell(s) ry(Maximun 3 Years) ❑ NA ear s Clean effluent filter At least once every: 1.5 month(s) ❑ NA ear s Inspect pump, pump controls & alarm At least once every: ears month(s) E] NA month(s) ❑ NA year(s) month(s) ❑ NA ear s MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks. measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of .-rt 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 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units, and any servicing at intervals of 5512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. Page 7 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 accode compliant replacement system: Ed 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 f 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. Paige. B05) ST. CROIX COUNT SIRTIC TAfi~i KALN LWCE AGR= TT A'N-, D OWN-ERSA CERTIFICATION FORM c A7ner: 3-uver Awk-A21LI-e- C)MkAd lvi '~-r r,!v7'w tt I l1 ~ : V ~ ~-t~ 1 L l/f V t veriticaaon required from Planning & Zoning Department for new conswiction.) ciiy/State, f'Gr/ Ch 22~ Parcel Identification Number LEGAL DESCRIPTI P o-oe- lY ? rcaat~n ~ I/c . Skk-~ Sec. ~ T -3 U N Rff'y?;% OZ Subdhdsion Plat: . 1)-0 B(2- DES S Lot # Certified Survey -Map # --Uc S bS~?Volume , Page j 'Warranty Dee ®r (before 2007)Vo ume , Page Spec house 2 yes 0 no Lot Hnes iden€tifi* Oyes 4 no SY STE_IM IIAO TTENANCE AT,%TD 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. Wisat you put into :pie system can affect the function of the septic iaak as a treatment stye in the waste disposal system. Owner maintenance e,-Donsbil ies are soecu ed in §SPS. -,83-52(1) and in Chapter I? - St Croce County Sanitary ordinance. The propem owner agrees to submft to St: Crom County Mmming & Zoning Department a certification form signed by the owner and by a master plumber joumeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping Ctf necessary), the septic tank is less than I13 full of sludge. 1/we, the underfed have read the above requirements and agree to maintain the private sewage disposal system with the stm ciards set fmtb her ein, as set by the Department of Sam And'-Professional Seavices and the Departnent State of W-isco Cat6ca tl your seatic system of Im-ne Resources, m=g his been . mam=aed be caxsxpi and ret~¢.d to the St Croix County Planning & Zoning Department wnbin 30 days of the three year e)TkMaou date. Uwe a-riify that all statements on A form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above; by %ttaee oz alfirranlY deed recorded in Register of Deeds Once. Nu e of bedro SIGH. t✓ flF A' LIC_ \ s') DATE "Any Any information that is misrepresented may resuh in the sanitary permit being revoked by the Planning & Zoning Degarmient_ include w m this application a recorded warranty deed fi om the Register of Deeds Office and a copy of the t ed survey map if reference is mace in the wa-'nuts, deed. (REV. 04112) Page 9 ` •3 ' ap = 4 LIOV9 IM `dWOWWDRI MAN `a^V 440VL Zt8 co i2wv ~woob 6uIMn.Ja s'uInl zfoa a-Vaav'sj s sg r. o >3 m I; I i n ! omo kl E ( 1 a } ~ I n3 i u E I k Z J ! 9 W a _ {R~Q> \ ;;~r Z Q - u- m^^...^ 'i Z ~I U @7 g E ZOz e~ a L j U J s m W u=i W U C rn { 3 f `IOU 6F'c~ °odT `"m in _jLL 2 R~ I >M E; °i°0~mnan~ ~d- mQn 9100 LUoo-(~ &U!mejC s,u+el~ vu~~u~s~cma a uzaesca~ o !2 + "I?" 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Revi ed by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ Andy An #~lticole Oman Property Location Go of na sw 1/4 sw 1/4 24 T 30 19 ■ pPropertyOwner ner 's Mailing AddressN R E (or) W 881 161st L # Block # Subd. Name or CSM# 2 na CSM State Zip Code Phone Number ond Wl 54015 ( 715-41 7-4508 Ity Village ■ Town Nearest Road St. Jose h 140th Ave F New Construction Used Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: na ent material Pitted Outwash Flood Plain elevation if applicable na~✓lc ft eral comments Conventional system, system elevation 95.60ft 3.33ft below grade. Trenches spaced and depth to code. and recommendations: ❑ Boring # 11 Boring f Pit Ground surface elev. 91.40 ft Depth to limiting factor 120 in. Horizon Depth Dominant Color Redox Description Soil A licafF Rate Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color 1 0-25 Gr. Sz. Sh. 'Eff#1 'Eff#2 10yr 3-1 none A 2msbk mfr es lc 2 25-29 .6 1.0 l Oyr 4/4 none scl 2msbk mfr cs I c 3 29-48 .4 .6 7.5yr 4/4 none ms osg ml 4 cs na .7 1.6 48-72 7.5yr4/6 none fs osg ml cs na 5 1.0 5 72-120 7.5yr 4/6 none I's/ms osg ml na na .5 1.0 Boring # ❑ Boring 91.40 120 Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A GPD~Lf n Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-6 1 Oy r3/2 none sl 2msbk mfr cs 1 c .6 1.0 2 6-15 l Oyr 4/4 none scl 2msbk mfr cs if .4 .6 3 15-20 7.5yr 4/4 one sl 2msbk mfr cs 1 f .6 1.0 4 20-38 7.5yr 4/4 none ms osg ml cs na .7 1.6 5 38-50 7.5yr 4/4 none fs osg tnl sc na .5 1.0 6 50-72 7.5yr 4/6 none fs/ms osg ml cs na .5 1.0 7 72-120 7.5yr 4/6 none cos osg ml na rI .7 1.6 Effluent #1 = BODS > 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) _ David J Steel Signature., CST Number Address 248056 1 F99 1 S(lrh zr New R irhmnnrt WI 54017 a e Evaluation Conducted Telephone Number 0 10 1n I 1Z 71 '~-7oVI-MA7 Property Owner Andy And Nicole Oman Parcel ID # Page 2 of 3 3 Boring # Boring 98.90 Pit Ground surface elev. 120 ft- Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application n Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-6 1 0yr 3/2 none `Eff#1 'Eff#2 sl 2msbk mfr cs I c 2 6-10 10yr 4/4 6 1 none scl 2msbk mfr 3 10-72 7.5yr4/6 none cs l c •4 .6 6 ms osg ml cs na .7 1.6 4 72-120 7.5yr4/6 none cos osg ml na na .7 1.6 r F-I Boring # 11 Boring Pit Ground surface elev. Depth to limiting factor in. Horizon Depth Domin to Redox Description Texture Structure Consistence Boundary Roots Soil GPD/fg Application Rate in. M Qu- Sz. Cont. Color ~ p Gr. Sz. Sh. 'Eff#1 'Eff#2 V Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application GPD ft? Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-8330 (R07/I3) a STEEL'S SOIL SERVICE 3 of 3 David J. Steel Andy and Nicole Oman CST-POWTSM SW1/4,SW1/4,S24,T30N,R19W 1699 150th St. Lic. #248956 Township of St Joseph, St Croix Co, New Richmond, WI 54017 Direct 715-760-0347 9.796 Acres Fax 715-246-0318 Legend N 1"=40' A = Benchmark Ele. 100.00 ft F Top of 3/4" white pvc pipe J / G - ( ti-~'j • = Alt Benchmark El 99.90 ft Top of 3/4" White pvc pipe 0 = Borings f l _ Boring Elevations B1= 91.40 ft B2 = 91.40 ft B3 = 98.90 ft B4 = 0.00 ft ~r fist; .7 '1 1C7`~ , J- 410 1113' V - - i1 G ,-A r'V~.