HomeMy WebLinkAbout026-1061-95-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 592120
GENERAL INFORMATION 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:
Travis Rassett TOWN OF RICHMOND 026-1061-95-000
CST BM Elev: Insp. BM Elev: BM Descriptiiy~ Section/Town/Range/Map No:
20.30.18.305E
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER : All-!S CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
~:•t /4r~0 I$ 102.2 c~ /d/•oT
LA po" to%C. 25 Alt. BM rt vl~it,. • / 3!
Aeration Bldg. Sewer 1-73 217-5
Holding St/HtInlet ,j► /4` ~d7o '5 7p 96,
TANK SETBACK INFORMATION St/Ht Outlet w 7/
TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet
o fem.
Septic , (o q 2-4 7 CJ Dt Bottom \
Dosing 1 Header/Man.
Aerati Dist. Pipe
L •~a C, S• 5q
Holding Bot. System 5
t
PUMP/SIPHON INFORMATION Final Grade ~l 7 (o
Manufacturer Demand St Cover
GPM -,O 7
Model Numbe
TDH Li Friction Loss System Head T Ft
Forcemain Lengt a. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: / V I UNIT Model Number: 16-5 DISTRIBUTION SYSTEM -7
.
Header/Manifold#/ 1 Distri(bution x Hole Size x Hole Spacing Vent to Air take
Pipes)
Length Dia L• Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only G ti
Depth Over Depth Over xx Depth ots xx Seeded/Sodded 1xx Mulched
Bed/Trench Center G Bed/Trench Edges Topsoil
/ ~ Yes ~ No Yes L] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1432 CTY RDA CJ✓r S b h
1.) Alt BM Description =
2.) Bldg sewer length =
-amount of cover = I ~ No
8
Plan revision Required? ❑ Yes No q 24 all
Use other side for additional informati
SBD-6710 (R.3/97) Date Inse tor's Sign re Cert. No.
r ~`cr"arA~t~> Count
ECEIVED St. Croix
Industry Services Division
1400 E Washington Ave
Sanitary Permit Number (to be filled in by Co.)
PS 20 16 P.O. Box 7162
~
` COUNTY Madison, WI 53 71
Rr~sxS umav-~~'`
VG9
Rmf4ff If ('YMit Applicatio.. 25~PZ State Transactio her
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriat A
e
W P4 jE
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PO TS are subm~,,__
the Department of Safety and Professional Services. Personal information you provide may be used for seconda Project Address (if different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. ' Avenueame
r 40 2 C`7 '-(j ~
1. Application Information - Plginse Print All Information
Property Owner's Name Parcel #
Rassett, Travis & Turner Jessie 026-1061-95-000 1 e os L
Property Owner's Mailing Address Property Location
1432 County Road A
Govt. Lot
City, State Zip Code Phone Number NW 1/4, SW 1/4. Section 20
New Richmond, WI 54017 (circle one)
T30N R18EorW
II. Type of Building (check all that apply) Lot #
® I or 2 Family Dwelling - Number of Bedroo Subdivision Name
❑ Public/Commercial - Describe Use I Block # 0~6
❑ City of
❑ State Owned - Describe Use
CSM Number ❑ Village of
5 EZ s ® Town of Richmond
-5 W
111. Type of Permit: (Check on one box on line A. Complete line B if applicable) Zem, x,
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 Permit Number and Date Issued
Before Expiration Plumber Owner
~d
II-d
V. Tye of POWTS System/Component/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 Application Dispersal Area Requi d (sf) is rsal Area Proposed (sf) System Elevation
450 Rate(gpdst) 643 94.75'
0.7
Vl. Tank Info Capacity in
Gallons Total # of Manufacturer U ~ N U
Gallons Units o L
New'Ianks Existing Tanks V_) Pd 1O1 _ Z U N a
Septic or Holding Tank 1000LP 1000 1 Wieser Con rote ~Jri ® ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' , r atu , MP/MPRS Number Business Phone Number
John Schmitt l~1/Cc 223760 715-760-0486
Plumber's Address (Street, City, State, Zip Code)
616 150`h Ave. Somerset, WI 54025
14 Od
VIII. County/ eartment Use Only i
Approved Permit Fee Dat Issue II Issuin gent Signatur
tven Reason for nial $ OS .CD 9 (O V
IX. Condi Q~t Re as ns for Disapproval
'talnk t end 3) OU
dispersal ceH must all be selvlc's;/ mainI A,; _,g.r 6 i /
as-per manapment plan provided by plumber.
2. All >Retbeck requivertents must be mainti fined
as per applicable code / ordinances.
Attach to complete plans for the system and su mit to the Co ty only on paper not es han 8 1/2 x I I inches in size
P /4-W ti
SBD-6398 (R03/14)
PLOT PLAN N
Project Name: Rassett 3 Bedroom Septic System
Legal Description: NW1/4, SW1/4, S20, T30N, R18W P.I.D: 026-1061-95-000
Subdivision Name: Lot NA
Township: Richmond Parcel Size: 3.5 Acres SCALE: V=
County: St. Croix 40'
System Elevation: T1= 94.74' Proposed 70.00' EZ Flow Trench
Slope: 5% T2= 94.75' Proposed 70.00' EZ Flow Trench
BM1 Elevation: 101.09' To of 2" PVC Pipe
.~BM2 Elevation: 104.98 Bottom of siding on house Tanks Wieser Concrete WLP1000-MR
■ Backhoe Pits: Filter Pol lok 525
14 inch Sch 40-ASTM D2665
See CSM or Plat for complete view of parcel 4 inch 3034 - ASTM D3034
Existing system to be abandoned as per code
& ~ Al - 5
f / i
V Page 2
i
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE:
Project Name: Rassett 3 Bedroom Conventional Septic System
Owners Name: Travis Rassett/ Jessica Turner
Owner's Address 1432 County road A
New richmond, WI 54017
Legal Description: NW1/4, SW1/4, S20, T30N, R18W
Township Richmond
County: St. Croix
Subdivision Name: NA
Lot Number: NA Block Number
Parcel I.D. Number 026-1061-95-000
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page3 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: 9/14/2016 Phone Number: 715-760-0486
Signature:
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1
i
PLOT PLAN N
Project Name: Rassett 3 Bedroom Septic System
Legal Description: NW1/4, SWIM, S20, T30N, R18W P.LD: 026-1061-95-000
Subdivision Name: Lot NA
Township: Richmond Parcel Size: 3.5 Acres SCALE: 1" _
ao'
County: St. Croix
System Elevation: T1= 94.74' Proposed 70.00' EZ Flow Trench
Slope: 6% T2= 94.75' Proposed 70.00' EZ Flow Trench
A BM1 Elevation: 101.09' To of 2" PVC Pipe
BM2 Elevation: 104.98 Bottom of siding on house Tanks Wieser Concrete WLP1000-MR
■ Backhoe Pits: Filter Pol lok 525
4 inch Sch 40 -ASTM D2665
See CSM or Plat for complete view of parcel 4 inch 3034 - ASTM D3034
Existing system to be abandoned as per code /
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Page 3
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ovations in Precast, Drai+. y Zabel' - - - -
Nastewater Products I A Division of Polylok inc.
5'15 1 A O
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tank.
Alarm Switch
Rated for 10,000 GPD (gallons per day). 1~,~0~ GPD (Optional)
525 linear feet of 1/16" filtration.
Accts 1" PVC
Accepts 4" and 6" SCHD 40 pipe. Exten ion Handle
Built in gas deflector.
Automatic shut-off ball when filter is removed.
Alarm accessibility. Rated for
10,000 GPD
Accepts PVC extension handle.
Ideal for residential and commercial waste flows up to 525 Linear Ft.
of 1/16"
10,000 gallons per day (GPD). - ' F
iltration slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.
Accepts 4" & 6"
3. Glue the filter housing to the 4" or 6 outlet pipe. If SCHD 40 pipe
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing.
5. Replace and secure the septic tank cover. NSF/ANSI CertifiedStandard 46
0 0
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring _
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
Gas Deflector
needs servicing. Servicing should be done by a certified
septic tank pumper or installer. Automatic
-
1. Locate the outlet of the septic tank. Shut Off Ball
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL-525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank. t, g
6. Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserted. asil i `ll
Polylok, Zabel & Best filters accept Easily installs
7. Replace and secure septic tank cover. the SmartFilter@ switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford., CT 06492 '1611 Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com
Page 4
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Travis Rassett/ Jessica Turner
Gravelless Leaching Unit Specifications
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ1203H-5ft 5.0' 25.0
EZ1203H-10ft 10.0' 50.0
System Sizing
EISA Rating per Foot of EZ Flow 5 ftZ Soil Application Rate 0.7 gpd/ftZ
450.q gpd Design Flow _ HE Soil Application Rate _ F s I EISA = 128.6 Feet of EZ Flow
F trenches 65 feet long each
2 No. of Cells 6.5 Per Cell
3 ft Cell Width 13 Total No of 1203H
65 ft Cell Length 325 sq ft EISA Per Cell
3 ft Cell Spacing 650 sq ft Total EISA
Typical Cross Section
Finished Grade 99 ft Observation Pipe with
approved cap or vent
Soil Backfill
■ e ■ I
36 inch
■ . Geotextile Fabric
■
■
12 inch II O Slotted and Anchored Vent/Observation Pipe
with Cap
94.75 ft Infiltrative Surface
>36 inch
92.40 ft Limiting Factor
a■..:,
Plumber/Designer Signature:
License MPRS 223760 Date: September 14, 2016
Page 5
Installation Instructions for E~ ZUTM
EZflow Systems in Wisconsin
by INFILTRATOR
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- dies and do not require any r
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 ~~t z ii(' f~~-hr r e-
only and is held together with polyethylene netting. manufactured in between the netting and aggregate, -1
• fabric is inserted to prevent soil intrusion. The instal
Materials and Equipment Needed shall make sure the the GEO is positiioned upward anc;
• EZflow Bundles in contact with the fabric contained in the adjacent cy
• EZflow Geotextile Fabric der before backfilling.
• 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
Barrier Material
4. When, installed in a trench, the trench should be dug to
a width of 36 inches. This not only saves labor in excava- 12"
tion, but also provides better load-bearing capacity after
backfilling is complete. -
36"
...............................................................................Page 6......
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: Travis Rassett/ Jessica Turner Tank Manufacturer: Wieser Concrete ❑ NA
Permit # Z Septic E] Dose ❑Holding Volume: 1000 gal
DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA
Number of Bedrooms: 3 ❑ NA ❑ Septic ❑ Dose [-folding Volume: gal
Number of Public Facility Units: 21 NA Vertical Distance Tank Bottom(s) to Service Pad: ft
Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft
Design Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if
In Situ Soil Application Rate: 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) 5530 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 (BODs) 5220mg/L Q 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) 530mg/L of Sortlon System
Total Suspended Solids (TSS) 530mg/L ED NA LJ In-Ground (gravity) ❑ In-Ground (pressure)
Fecal Coliform (geometric mean) 5104Cfu/100m1 ❑ At-Grade ❑ Mound
Maximum Effluent Particle Size: Y. in dia. LINA ❑ 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
Inspect condition of tank(s) At least once every: 3 month(s) (Maximun 3 Years) ❑ NA
year(s)
Inspect dispersal cell(s) st once every: 1.5 ✓ month(s) (Maximun 3 Years) ❑ NA
ear s
At least once every 1.5 month(s) E] NA
Clean effluent filter
~ ear s
Inspect pump, pump controls & alarm At least once every: month(s) Q NA
year(s)
month(s)
ears ❑ NA
month(s) ❑ NA
year(s)
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Ma- i-_
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
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:
❑ 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.
POW B05)
i
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer Travis Rassett or Jessica Turner
Mailing Address 1432 County Road A
Property Address 1432 County Road A
(Verification required from Planning & Zoning Department for new construction.)
City/state New Richmond, WI
Parcel Identification Number
LEGAL DESCRIPTION
Property Location S VU Sec. 20 , T 30 N R 18 W, Town of Richmond
Subdivision Plat:
Lot #
Certified Survey Map # , Volume
Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house OyesEho Lot lines identifiable ByesOno
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), 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 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 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 warranty deed recorded in Register of Deeds Office.
Number f bedr s 3
09/02/ 16
SI AA TURE 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)
Page 9
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Department of
asp P Safety and SOIL EVALUATION REPORT #1830
in accordance with Comm 85, Wis. Adm. Code Page --1 -of
Professional Services
Schmitt Soil Testing, Inc.
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel i
026- 06 95-000
Please print all information. - - - -
Rev By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /
Property Owner Property Location
Murry, Thomas(Seller)/Rassett, Travis Govt. Lot W1/4, W S20, T30N, R18W
Property Owner's Mailing Address Lot # Block # ~Subd. Nam or CSM#
1701 Industrial #3
City State Zip Code Phone Number City Village Town Nearest Road
Hudson WI 54016 i 612-562-1876 Richmond C Rd A
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Outwash Sand (Burkhardt-Sattre Series) Flood plain elevation, if applicable 93015 j ft.
General comments This goring was completed to move the system closer to the house to avoid a lift pump. This is an addition to Dave Steel's Soil
and recommendations: Evaluation dated 5-2-2016. System elevation is 94.75'.
a Boring # Boring
Pit Ground surface elev. 98.0--- ft. Depth to limiting factor 95 in. Soil Application Rate
Horizon I Depth Dominant Color i Redox Description Texture Structure f Consisten Boundary Roots GPD/ftZ_
I in. ! Munsell Qu. Sz. Cont. Color j Gr. Sz. Sh. I ! •Eff#1 ~Eff#2
1 0-15 10yr3/2 i none sil 2mgr mvfr as 2m,lf 1 0.6 0.8
2 15-27 , 10yr4/4 none scl 2msbk mfr cs if,2vf 0.4 0.6
- - -
3 27-37 10yr4/3 I none gris ; lcsbk I ml gw lvf 0.7 1.6
- - i - - -
4 37-80 10yr5/6 none rcos
I g Osg ml gW i 0.7 i 1.6
-
5 80-95 f 10yr6/4 - - none s - t - - r- -
0s9 ml - 0.7 1.6
i
Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 <-150 mg/L en #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
T homas J. Schmitt 27429
Address Schmitt Soil Testing Inc. ate Evaluaf onducted Telephone Number
1595 72nd St. New Richmond, WI 54017 6/23/2016 715-760-1978
tiBC).8710 1 R il'I; IN i ~
It By
Wisconsin Department of S15t llrvices C. S~ 16 C>')
Division of Industry Service VV
SOIL EVALUATION REPORT ° 1 of 3
MAY I u i~glordance with Comm 85, Wis. Adm. Code
County St Croix
Attach complete site plarr`7i145: 1/2 x 11 inches in size. Plan must
include, but not limilDOM rgl:h nce point (BM), direction and Parcel I.D. 026-1061-95-000
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location ❑
Thomas Murry Govt. Lot NW 1/4 SW 1/4 S 20 T 30 N R 18 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1701 Industrial #3 NA Na CSM
City State Zip Code Phone Number [-]City R Village Town Nearest Road
Hudson WI 54016 612-562-1876 IGl3Z Cty Rd A
( ) Richmond
n New Construction Usefil Residential / Number of bedrooms 4 Code derived design flow rate 450 GPD
El Replacement F]Public or commercial - Describe: na
Parent material outwash Flood Plain elevation if applicable ft.
General comments Conventional system, system elevation 96.6 ft. Trenches spaced and depth to code 3.75ft below grade.
and recommendations: TO F1-WPPG~1A1*0
' I S i IA1 j S S"fA APF"f-S 7b gC (5,011-14147, 1 cal !A1 F4WLAAJ.
1 Boring # D Boring 100.40 110
Q 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/fl?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-7 10yr3/1 none sil 2msbk mfr cs 2c .6 .8
2 7-17 10yr4/4 none scl 2msbk mfr gw lc .4 .6
3 17-34 7.5yr4/4 none sl 2msbk mfr gw if .6 1.0
4 34-110 7.5yr4/6 none ms cos ml na na .7 1.6
lit. IZ7 1%
1
goring # Boring 100.40 96
■ 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 10yr3/1 none sil 2msbk mfr cs 2c .6 .8
2 9-17 10yr4/4 none scl 2msbk mfr gw 2c .4 .,6
3 17-36 7.5yr4/4 none cos osg ml gw if .7 1.6
4 36-110 7.5yr4/6 none ms osg ml na na .7 1.6
y~.7 ►t
* Effluent #1 = BOD > 30:< 220 mg/L d TS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signatur CST Number
David J. Steel IJ 248956
Address Date Evaluation Conducted Telephone Number
yj_?_ ~ 71 S_7F.(1_(12d7
1609 1 58th Ct Naw Riohmnnd W1 'SAO 17
Property Owner Thomas Murry Parcel ID # 026-1061-95-000 Page 2 of 3
M Boring # ~ Boring 98.40 98
• 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/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-7 10yr3/1 none sil 2msbk mfr cs 2c .6 .8
2 7-14 10yr4/4 none scl 2msbk mfr gw 2c .4 .6
3 14-51 7.5yr4/4 none cos ml ml gw na .7 1.6
4 51-98 7.5yr4/6 none ms ml ml na na .7 1.6
i~
❑ Boring # ElBoring
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/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
F-1 Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
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 (R07/13)
L
STEEL'S SOIL SERVICE 3 of 3
David J. Steel Thomas Murry 1699 150th St
CST-POWTSM NW1/4SW1/4,S20,T30N,R18W New Richmond. WI 54017
Lic. #248956 Town of Richmond, St. Croix Co Direct 715- 760-0347
CSM Fax 715-246-0318
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N
a
1"=40'
♦ = Benchmark Ele. 100.00 ft
G Top of 1" pvc pipe
• = Alt Benchmark El, 99.70 ft
Top of 1 " pvc pipe
= Borings
Boring Elevations
BI = 100.40 ft
B2 = 100.40 ft
B3 = 98.40 ft
B4 = 0.00 ft
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