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HomeMy WebLinkAbout040-1016-80-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 592259 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 KRISTOPHER THOMPSON TOWN OF TROY 040-1016-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: i 1 OV-7 loo. 15 ~ 04.28.19.61 C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic je mark i(L rw . 1-7 _ 7 All. BM Q su* L Nw~ Co t n Bldg. Sewer n,la 1~.3 Holdin St/Ht Inlet ~a3a qt. 4'~ 'St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD n et Septic ;70 1 Header/Man. Dist. Pipe g Bot. System PUMP/SIPHON INFORMATION Final Grade 3. C~ ~3 . y3 Manufacturer Demand St Cover Mod umber H Lift Friction Loss System TDH Ft FO main Dia. Dist. to Well ~J 1• SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trepches PIT DIMENSI S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ``~~'1!// O/~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR V...) Ty e Of S : / h Aj UNIT Model Numbe~~ j ll DISTRIBUTION SYSTEM q. 25 ~ • Header/Manifold DistributioJ^ Ix Hol e Ix Hole Spacing Vent to Air Intake Pipe(s) fit S 1Length ~ Dia Length Pacing ✓ ~DM~hC{ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over p of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench llffes soi Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 582 TOWER R~D',,.~~ ' l 1.) Alt BM Description 2.) Bldg sewer length =5`f ra 4x -j - amount of cover = 1 / Plan revision Required? ❑ Yes IvO ' Use other side for additional information. _ ( 11 I /~A 10~ SBD-6710 (R.3197) Date Insepctor's ignature Cert. No. ~cvnx4arE;v~ County G" J I)EI IEV Industry Services Division St. Croix xj i d S r 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) F P.O. Box 7162 S~l ~ ~ 7 Madison, WI "2 2_7 " _~P ST. CROIX COUNTY J 1 ,OMMUN rmlL 1~ppl1Cat1011 State Transaction umber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govemme tafvnit 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 Preject Address (if different than mailing address) urposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 582 Tower Road L Application Inform s - Please Print All Information Property Owner's Name Parcel # Thompson, Kristopher 040-1016-80-000 Property Owner's Mailing Address Property Location 582 Tower Road Govt. Lot City, State Zip Code Phone Number NE'/. SE'/n, Section 4 Hudson, WI 54016 (circle one) T28N ; R19Eor© II. Type of Building (check all that apply) Lot # ® I or 2 Family Dwelling - Number of Bedroot CD Subdivision Name ❑ Public/Commercial - Describe Use '~.►t.Q. Block # ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 7 n, ~ GA5 ( . * . 7 6O c ® Town of Troy III. T pe of Permit: (Check o ly one box on line A. Complete line B if applicable) A. ❑ New System ❑ Replacement System ❑ Treatntent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal ❑ Permit Revision E1 Change of F-1 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System/Component/Dev ice: (Check all that apply) O ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Ho ding an Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatme Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Propo d (sf) System Elevation 300 Rate(gpdst) 429 450 80.00', 78.30' 0.7 AA 64,p, VI. Tank Info Capacity in C 0 U Gallons total # of Manufacturer New Tanks Existing Tanks Gallons Units , ` P la k- y o °3 2 D ~J Septic or Holding Tank 320 1000 1320 2 UnknoJ , Wieser ® ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ V11. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWI'S shown on the attached plans. Plumber's Name (Print) Plumbs Sigt tore MP/MPRS Number Business Phone Number r~~ t ✓G%i O Z 223760 7715-760-0486 John Schmitt Pltmber's Address (Street, City, State, Zip Code) 616 150°i Ave. Somerset, WI 54025 VIII. ount /De artment Use Only Approved Disapprov Permit Fee Dat Issu Issuin ens Signatur © en Reason ? o enial s ~ ' ab 0117 IX. Condit Yl teasons for Disapproval n + 1. "-%i*ydr tank, *AtXrttiitW ofti utvpar:::,i ceN rr►vat III ¢e I ! rm inta,'. q~ r f I J lts - t~q~5:ryltttent plan pYvrided by plurnbe;. 1 2. 'AI Alc nl mush, tw rrar.ti7 ir.i u w0crbe •R cn&/,R1itltUtt:m 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: Thompson 2 Bedroom Replacement Septic System Legal Description: NE114, SE114, S4, T28N, R1 9W P.I.D: 040-1016-80-000 Subdivision Name: NA _ Lot NA Township: Troy Parcel Size: 3.2 SCALE: 1"=40' County: St. Croix System Elevation: T1= 80.00 Proposed 45.00' EZ Flow Trench Slope: 17% T2= 78.30 Proposed 45.00' EZ Flow Trench BM1 Elevation: 100.00' Top of Septic Tank cover 0 BM2 Elevation: 100.35' Bottom of Siding SE garage corner Backhoe Pits: Existing Tanks Unknown Existing system to be abandoned New Tank Wieser Concrete W320-MR Effluent Filter POLYLOK 525 4 inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 W c L GaaacE ' Z pu -CCO\ 1.}E~ist / 51,A2 o ~ C, n1 I ~ .5cfnc 17 O ~ ~ 1 ~At, t k kP \ Page 2 CONVENTIONAL COMPONENT DESIGN F; r :-t,~s icirraia 1 ,`;p p- i,cc-,,i;c r INDEX AND TITLE PAGE Project Name: Thompson 2 Bedroom Replacement Septic System Owners Name: Kristopher Thompson Owner's Address 582 Tower Road Hudson, WI 54016 Legal Description: NE1/4, SE1/4, S4, T28N, R19W Township Troy County: St. Croix Subdivision Name: NA Lot Number: NA Block Number Parcel I.D. Number 040-1016-80-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 System Sizing & Cross Section Page 6 EZ Flow Information Page 7 & 8 Management and contingency plan Page 9 Existing Tank Certification Page 10 Septic Tank Maintenance Agreement Page 11 Warranty Deed Page 12 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 3/27/2017 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: Thompson 2 Bedroom Replacement Septic System Legal Description: NE1/4, SE1/4, S4, T28N, R19W P. 1. D: 040-1016-80-000 Subdivision Name: NA Lot NA Township: Tro Parcel Size: 3.2 SCALE: I"=40' County: St. Croix System Elevation: T1= 80.00 Proposed 45.00' EZ Flow Trench Slope: 17% T2= 78.30 Proposed 45.00' EZ Flow Trench BM1 Elevation: 100.00' To of Septic Tank cover BM2 Elevation: 100.35' Bottom of Sidin SE arage corner Backhoe Pits: Existing Tanks Unknown Existing system to be abandoned New Tank Wieser Concrete W320-MR Effluent Filter POLYLOK 525 4 inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 w~L Ga~ai,t Z gr0~2.cciti jUT"i C 62 QO L`1 tc f- \ Page 2 an-oast 411d g5b8-8Z~-008 \ 0 af10d-1SOd bI-ZZ-Zt -31b0 00/00/00 31 d0 OSL4S IM 'HOOa N301HW Ol lMH S(1 9lL£M Z oN Oa 313HOODO 13531M it/f1NdW OI1d3S w :?Jf10d-3ald :31VOS dOM :,18 NMVaO ?Jw-oa2M 0 w V) ~ J m HQ z > ~w O J Z 00 ~0 0- < } v m CL, z O X Q- w W a m Q) ° IAJ m N W F- J l W Ln Q o F- Li0~ 0 0 Q z m w o O W O pm Q = Ckf F- Z Q C M w~ ¢ H LL O j o z n Q U Z) M I- 3 o a ry < ix C14 mV) WHW J Z lid ZO Q d ce G CC J I t-i O m ¢ D \ O U c ¢ a 0 G D CO m <C ¢ L~ O 6i Z Z (n 0 q a I ¢ w to Q ¢ w o o Y © U C14. c O~JO°o I-~Q mLL) Q m 00 O J ° Q N W , co o _ w oo w ¢ c> LLI m = Z zkt vi ~ V) Z C) r1r) a_ 0 ..O d~,. 0~~ ..~OF O¢Y OOW ¢ w m woW < C/) U) pJ~ >j Z: M: ZUZp0Z:)O Z0¢ ZNo Q O Z W Xx p0 Z Z m °mm-j mM ¢~t? ¢ia Q Z C¢) N mo LLI F- o o Q w W D Y cw OW -j -j Q O Z Z O QZ ? Z V) F- O U J w cn I ¢ I ~ Z ¢ W U Li W W- r} C1 W H w W N I o I „917 ~gY M f II II w w w II I > I ~S > U I I 1 I I O I I ..£ti £ o LL_ -:~j w (n O tJi ~ w w ¢ w m O J 0 J ~ d CK Z p cn og 9tr ¢ 0 I U n a~?3N 8S D Sb' ¢ m w V) Y Z F- Page 3 Filters Y, PL-525 EFFLUENT FILTER ( WWERU' ) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD '0 Alarm t ' (gallons per day) making it one of accessibility Accepts PVC extension handle the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok P1=122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots K Rated for over float up and temporarily shut off ti 10,000 GPD the system so the effluent won't leave the tank. No other filter on J/ the market can make that claim! Accepts 4" & 6" SCHD. 40 Pipe'^ 'OLI-E3,25 The PL-525 Effluent Filter should - operate efficiently for several years` under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or g at least every three years. If the PA V A, NY! filter contains an optional alarm, the owner will be notified by an alarm when the filter needs Gas deflector servicing. Servicing should be done by a certified septic tank Automatic shut-off pumper or installer. ball when filter 1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed septic tank. 5871640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4' or 6 outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. Pale 4 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Thompson 2 Bedroom Replacement Septic System 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 ft2 Soil Application Rate 0.7 gpd/ft2 300.0 gpd Design Flow - 0.7 Soil Application Rate _ EISA = 85.7 Feet of EZ Flow F 27 trenches 45 feet long each 2 -No. of Cells 4.5 Per Cell 3 - ft Cell Width 9 Total No of 1203H 45 _ ft Cell Length 225 sq ft EISA Per Cell 3 _ ft Cell Spacing 450 sq ft Total EISA Typical Cross Section Finished Grade 82 ft Observation Pipe with approved cap or vent Soil Backfill m 36 inch Geotextile Fabric 12 inch >3 ft Slotted and Anchored Vent/Observation Pipe u d - ry with Cap 78.30 ft. Infiltrative Surface >36 inch 80.00 ft. 76.38 ft Limiting Factor -73.98 ft Limiting Factor Plumber/Designer Signature: License MPRS 223760 Date: March 27, 2017 Paee 5 Installation Instructions for ZtITM EZflow Systems in Wisconsin 49EZ O flby I ....L......... 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 positiioned upward and is • EZflow Bundles : in contact with the fabric contained in the adjacent cylin- • 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. 11. 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 gieotextile 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- tion, but also provides better load-bearing capacity after : backfilling is complete. Paee6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Kristopher Thompson Tank Manufacturer: Unknown ❑ NA Permit # Septic []Dose ❑ Holding Volume: 750 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete ❑ NA Number of Bedrooms: 2 NA El Septic []Dose ❑iolding Volume: 320 gal Number of Public Facility Units: NA Vertical Distance Tank Bottom(s) to Service Pad: ft Estimated (average) Flow: 200 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft Design Flow = estimated x 1.5: 300 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 030 gal/day/t2 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) <_30 mg/L Eff uluent-FTit-e-r-M-o-del: 525 Biochemical Oxygen Demand (BOD5) <_220mg/L ❑ NA Pump Manufacturer: I otal Suspended Dojos (155) 51bOmg/L ump model: High Strength Influent/Effluent Monthly average Petreatment Unit NA Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L NA ❑ Mechanical Aeration ❑ Peat Filter Total Suspended Solids (TSS) <_150mg/L ❑ Disinfection ❑ wetland Petreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ other: Biochemical Oxygen Demand (BODs) 530mg/L of sor~tlon System Total Suspended Solids (TSS) 530mg/L NA I ~J In-Ground (gravity) ❑ In-Ground (pressure) Fecal Coliform (geometric mean) 5104cfu/100m1 ❑ At-Grade ❑ Mound Maximum Effluent Particle Size: X. in dia. A ❑ Drip-Line ❑ Other: Other: N 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 J month(s) (Maximun 3 Years) El NA ear(s) Inspect dispersal cell(s) At least once every month(s) 1.5 (Maximun 3 Years) ❑ NA ear s} ry: 1.5 month(s) E] NA Clean effluent filter At least once eve 5 ear s) ❑ Inspect pump, pump controls & alarm At least once every: H month(s) NA Year(s) H month(s) NA ear(s) month(s) year(s) NA 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 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 512 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. (Rev.2/05) Paee 7 START UP AND OPERATION Page of 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 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. (Rev. 2/OS) PajQe 8 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Kristopher Thompson Mailing Address 582 Tower Road Property Address 582 Tower Road (Verification required from Planning & Zoning Department for new construction.) City/State Hudson, W1 Parcel Identification Number 040-1016-80-000 LEGAL DESCRIPTION Property Location NE `'E '/4 , Sec. 04 , T 28 N R 19 W, Town of Trey Subdivision Plat: , Lot # NA Certified Survey Map Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yesEho Lot lines identifiable ❑yesE] 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 (I ) 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 main-ain 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 is form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a -anty deed recorded in Register of Deeds Office. Number ` of bedrooms 2 SIGNATURE 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 fi-om the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Page 10 Department o r Yw SP Safety and ~C9 VALUATION REPORT-- v '14C7 #1869 Professional Services i with Comm 85, Wis. Adm. Code Page 1 of 4 Schmitt Soil Testing, Inc. County Attach complete site plan on paper not less than 8'% 0 1 inches in size. Plan must include, but not limited to: vertical a T}~► oint St. Croix 2H~ (BM), direction and - percent slope, scale or dimen~i~~ripy)~~ !th and distance to nearest road. Pj ENT 80 Please print all information. 040-1 16- -000 Personal information you provide may be used for secondsry purposes (Privacy RDate Law, s. 15.04 (1) (m)). 117 Property Owner Property Location Thompson, Kristopher Govt. Lot NE1/4 SE1/4, S4, T28N, R19W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 582 Tower Rd. NA _3.2 Acre Parcel city State Zip Code Phone Number City 'Village Town Nearest Road Hudson WI 54016 608-345-8280 Troy Tower Road New Construction Use: Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD - - Replacement Public or commercial -Describe: Parent material Cutwash Sand (Emmert Loamy Sand) Flood plain elevation, if applicable _ NA ft. General comments Replacement area is suitable for a conventuional system with a 0.7 gpd/sgft rate. Possible system elevation is, Stepped Trenches, and recommendations: (High) 80.0' (Low) 783. Slope of area is 17%u. Boring # Boring Pit Ground surface elev. 83.55 ft. Depth to limiting factor 84+ in. Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots - GPD/ft'---- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I*Eff#1 *Eff#2 1 0-12 10yr3/2 FILL si 2msbk mfr as ~27, lf NA NA 2 12-17 10yr7/8 Crushed Limestone as if NA NA 3 17-30 7.5yr5/6 none grs Osg ml 2vf 0.7 1.6 I - CS-i-_ I -----L_ / 4 30-50 - 10yr6/4 - none grs Osg - ml cs iVf 0.7 1.6 5 50-86 10 r6 4 - Y / none ~grcos Osg ml 0.7 1.6 t Boring # Boring I Pit Ground surface elev. 83.55 ft. Depth to limiting factor _96_+ in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - 1 0-8 10yr3/3 none - sl 2msbk - mfr as 2f 0.6 1.0 2 8-19 -10yr4/4 none grsl 2msbk mfr gw 2vf 0.6 1.0 3 19-32 10yr4/6 none grls Osg ml gw I im,lvf 0.7 1.6 4 32-58 10yr5/6 none grs OSg ml cs ivf 0.7 1.6 5 58-96 10yr6/4 none s Osg ml 0.7 1.6 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 150 mg/L * Efflu nt #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 2/10/2017 715-760-1978 SBD-8330 (R.07/00) Property Owner Thompson, Kristopher Parcel ID # 040-1016-80-000 - - Page 2 of 4 Boring # Boring Pit Ground surface elev, -,.--79.-10----- ft. Depth to limiting factor 96+ in. - Soil Application Rate Horizon Depth Dominant Color Redox Descron Texture I Structure Consistence Boundary I RGPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t "Eff#2 1 0-9 10yr3/2 none sl 2fsbk mfr cs 2m,2f 0.6 1.0 2 9-16 10yr3/4 none sl ! 2msbk mfr cs I im,ivf 0.6 1.0 - 3 16-21 10yr4/6 none sl 2msbk mfr gw im,ivf 0.6 1.0 - - - 4 21-35 10yr5/6 none girls Osg ml gw if 0.7 1.6 5 5-56 10yr6J4 none grs Osg - M1 cs 0.7 1.6 - 6 56-96 10yr6/4 none s Osg ml C - E-- - --f- - - - - 4 Boring Boring # Pit Ground surface elev. 90.15- ft. Depth to limiting factor _ in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD_/ftZ_ in. Munsell Qu. Sz. Cont in. Color Gr. Sz. Sh. *Eff#1 *Eff#2 SEE NOTE AT BOTTOM At this pit location a drainfield of undetermined size was discovered. he aggregate was clean and dry. The pipe was flexible draintile that appeared to open and did not appear to be crushed. Boring Boring # ;Pit Ground surface elev. Depth to limiting factor - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundaryl Roots _GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - *Eff#1 *Eff#2 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 SBA8330 (R.07/00) need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Schmitt Soil Testing, Inc. Conducted by: Page 3 Of 4 Conducted For: Schmitt & Sons Excavating, Inc.. Name: Kristopher Thompson Thomas J. Schmitt, CST 227429 Address: 582 Tower Rd. 586 Valley View Trail City, State, Zip: Hudson, W154016 Somerset, WI 54025 Phone: 715_- 1978 PID: 040-1016-80-000 Signatur _ Lot No. NA Date - v / Legal Description: NE1/4 SE1/4 S4 T28N R19W ■ Backhoe Pit Township, County: Troy, St.Croix County ® Bench Mark 1 El. 100.00' Top of 2' manhole cover on septic tank Bench Mark 2 El. 100.35' bottom of siding on the SE corner of the garage Slope= 17% Septic Tank Outlet El. 91.5' Scale I"= 40' r I 1 NO E: For full view of Lot see Aerial Photo (Page 4 of 4) -3 v ' C t'a i - - -i- Q~1 I 1 ~Y tS7/N !r~ U~ /N~/C L O 0~ /VD~7t IV L:-t) s~26 At? : i i ~ d i r / , 1 + - 0 3 am L a 0 C:) O m 0 O O (o m y z' ~ U U ~ nn ~ ` E a m in o m E c N V T 'S o o n O m O n U a. fn 7, m y _ ~ N C p V O O N ` U O V a m L Orn '6 N O U C m F m C C O a~£ y 4~\ d o m .U U_ s `m 2 d n o Q > O O a O E ~m = •O F F- U > to y O J 2 f4 U J Q' Q: 2 O -MEIN 2 N H N 3 V J r U 3 3 h m v+ LU o a O m.~ 5== U~c O ic. 00 ~mot{ ®R Al 13 CO ~E 12 ti. s _Ao z'.: y x J 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) 582 Tower Road located at: NE I/4, SE I/4, Section 4 , Town 28 N, Range 19 W, Town of Troy , 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: Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): Permit number (if known) (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP/MFRS (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 PaEe 9