HomeMy WebLinkAbout032-2060-10-010
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 597324
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:
JOHN COOK TOWN OF SOMERSET 032-2060-10-010
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
17.30.19.739A-01
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
/Z:56 9.71
Alt. BM
Aeration Bldg. Sewer
fo•Z 167.4
Holding St/Ht Inlet 7r a0
.7, Zq
TANK SETBACK INFORMATION St/Ht Outlet
/ d r
TANK TO P/L WELL BLDG. Vent Air Intake ROAD 07
Septic j 137, 27 57 Dt Bo m Qj~- Cot 7• 1~ .
Dosing HeadegMa 7. TAt -06.1%
Aeration Dist. Pipe q. Lfo ~9•
Holding - Bot. System
e ~
.
PUMP/SIPHON INFORMATION Final Grad~
~;t ~a (p."7 /OZ •a(
Manufacturer Demand St Cover
GPM ~ Z•~ 5~
Model Numb„e-•a~7
$ .5 166. A,
T Lift Friction Loss System Head TDH Ft TZ 9 • ~7 xL
Length---TW&.---- I Dist. to Well
Force ~ftatm
SOIL ABSORPTION SYSTEM / LOIJ /fir 19 9 . SL
BED/TRENCH Width Length No. Of Trenches PIT DIM NSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 / 6
SETBACK SYSTEM TO P/L BLDG WELL / LAKE/STREAM LEACHING Manufacturer: r
INFORMATION CHAMBER OR z- r/o c.~
Type Of System / JA- UNIT
GC AJ j 'O ~ (O A/ Model Number
DISTRIBUTION SYSTEM ' A 1 51-56/s
Header/Manifold II Distribution x Hole Size x Hole Spacing Vent to it IIntak,~
Q Pipe(s~_ 5 P-0-1-.6 Kn•
Length / y Dia T Length Dia Spacing
0 i
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only e
Depth Over _ I Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bedlrrench Center Gi r Bed/Trench Edges Topsoil
/ I s El No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1525 47TH ST
1, Gamic.`, Y Tr.M.- Lady rc'
1.) Alt BM Description=
2.) Bldg sewer length = 3S
- amount of cover
ow AN
n J s
~I I
Plan revision Required? Yes o I _ '7
Use other side for additional informat n. L _ lJi ~(J
Date Insepctor's S ature Cert. No.
SBD-6710 (R.3/97)
1
-S 4 al Q,)
/fit Rr+,r,
County
.Cro
41
RECEIVED
Y, Industry Services Division St. Croix
U S 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
P MAY 12 2017 P.O. Box 7162
S Madison, WI 53707-71.62
E ~J
ST. CROIX COUNTY
and al"y it App1icatG7EQQ87FRQNA4 State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if differegt than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 1525 47t' Street
1. Application Info a ' n - Please Print All Information
Property Owner's Name I Parcel #
Cook, John 032-2060-10-010
Property Owner's Mailing Address Property Location
1525 47`' Street
Govt. Lot
City, State Zip Code Phone Number SE 1A, SE 114, Section 17
Somerset, WI 54025 (circle one)
T30N R19EorW
II. Type of Building (check all that apply) ~J Lot #
® 1 or 2 Family Dwelling - Number of Bedrooms 7` Subdivision Name
❑ Public/Commercial - Describe Use ~4 u, Block 4
❑ City of
❑ State Owned - Describe Use
CSM Number ❑ Village of
Town of Somerset
III. Type of Permit: (Check only one bo on line A. Complete line B if applicable) 00"__
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 FLCL.o 5
IV. Type of POWTS System/Component/Device: (Check all that apply) A
® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding an ter Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treat nt Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Required sf) Dispersal Area P74 ed (sf) System Elevation
600 Rate(gpdsf) 1200 1200 100.60, 99.60', 98.60', 97.60"
0.5
VI. Tank Info Capacity in
Gallons c
Total # of ~
Manufacturer U o
New Tanks Existing Tanks Gallons Units ° a ~
0.U ~ N CA " ~ a
IAJ ~ D
Septic or Holding Tank 1250 1250 1 Wieser Con ete ® ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum Si ature MP/MPRS Number Business Phone Number
John Schmitt 223760 715-760-0486
Plumber's Address (Street, City, State, Zip Code)
616 1501h Ave. Somerset, WI 54025
VIII. ount /De artment Use Only
Approved ed Permit Fee Dat Issue Issuing nt Signatur
ner Given Reason r Denial $ ~66 /
;
IX. Condi Y8
fon~Ce D41+ p►siS)psQ5 Disapproval 4.6
U1;"P .:S i c44- rum all tc~s
es Wt. nt : de i by plwnbee. PA-
All LAdLQ~
Z f #f f'i Ct M tot tRl.r w,1*i 1614
10 W c v: titQiil#110fi.
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: Cook 4 Bedroom Replacement Septic System
Legal Description: SE1/4, SE1/4, S17, T30N, R19W P. 1. D: 032-2060-10-010
Subdivision Name: NA Lot NA
Township: Somerset Parcel Size: SCALE: V=40'
County: St. Croix
System Elevation: T1= 100.60 Proposed 60.00' EZ Flow Trench
Slope: 13% T2= 99.60 Proposed 60.00' EZ Flow Trench
BM1 Elevation: 100.00' Top of 1" PVC Pipe T3= 98.60 Proposed 60.00' EZ Flow Trench
IL BM2 Elevation: 109.06' Top step SW corner of house T4= 97.60 Proposed 60.00' EZ Flow Trench
■ Backhoe Pits:
Existing Tanks Wieser Concrete WLP1250-MR
See Plat Map for complete view of parcel Existing Filter Pol lok 525
Existing System to be abandoned as per code
14 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
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Page 2
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Cook 4 Bedroom Replacement Septic System
Owners Name: John Cook
Owner's Address 1525 47th Street
Somerset, WI 54025
Legal Description: SE1/4, SE1/4, S17, T30N, R19W
~I
Township Somerset
County: St. Croix
Subdivision Name: NA
Lot Number: NA Block Number
Parcel I.D. Number 032-2060-10-010
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 & 11 Warranty Deed
Page 12 Aerial Photo
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 5/8/2017 Phone Number: 715-760-0486
Signature: 1 L
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1
PLOT PLAN N
Project Name: Cook 4 Bedroom Replacement Septic System
Legal Description: SE1/4, SE1/4, S17, T30N, R19W P.I.D: 032-2060-10-010
Subdivision Name: NA Lot NA
Township: Somerset Parcel Size: SCALE: V=40'
County: St. Croix
System Elevation: T1= 100.60 Proposed 60.00' EZ Flow Trench
Slope: 13% _ T2= 99.60 Proposed 60.00' EZ Flow Trench
A BM1 Elevation: 100.00' To of 1" PVC Pipe T3= 98.60 Proposed 60.00' EZ Flow Trench
BM2 Elevation: 109.06' Top step SW corner of house T4= 97.60 Proposed 60.00' EZ Flow Trench
■ Backhoe Pits:
Existing Tanks Wieser Concrete WLP1250-MR
See Plat Map for complete view of parcel Existing Filter Pol lok 525
Existing System to be abandoned as per code
4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
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Page 2
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Page 3
#,7 t:IlltE'l"tT 4'IIIL.'1
. Zabel'
q ~ A Division of Polylok loc.
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.
1
Rated for 10,000 GPD (gallons per day). Alarm switch
~ (Optional)
10,000 GPD
J
525 linear feet of 1/16" filtration.
Accepts
Accepts 4" and 6" SCHD 40 1" PVC
pipe. Extension Handle
Built in gas deflector.
Automatic shut-off ball when filter is removed.
Alarm accessibility. i hated for
10,000 GPD
Accepts PVC extension handle.`
525 Linear Ft.
Ideal for residential and commercial waste flows up to of 1/16"
10,000 gallons per day (GPD).
- --'E` Filtration 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. Re lace and secure the septic tank cover. Certified
P NSF/ANSI Standard 46
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
needs servicing. Servicing should be done by a certified Gas Deflector
septic tank pumper or installer. r7Amatic
Shut-Off Ball
1. Locate the outlet of the septic tank.
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 1
solids fall back into septic tank. 1
6. Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserted. 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 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com
Page 4
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Cook 4 Bedroom Replacement 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 ft2 Soil Application Rate 0.5 gpd/ft2
600.0 gpd Design Flow _ 0.5 Soil Application Rate = ETI EISA = 240.0 Feet of EZ Flow
F4 trenches 60 feet long each
4 No. of Cells 6 Per Cell
3 ft Cell Width 24 Total No of 1203H
60 ft Cell Length 300 sq ft EISA Per Cell
3 ft Cell Spacing 1200 sq ft Total EISA
Typical Cross Section
Finished Grade 97 ft
ft Observation Pipe with
approved cap or vent
36 Inch , Soil Backfill
12 inch II • Geotextile Fabric
O
100.60 ft. +I O • Slotted and Anchored
99.60 ft. II O Vent/Observation Pipe with Cap
\tt I - I t
>36 inch
98.60 ft.
> 3 ft 97.60 ft Infiltrative Surface
Plumber/Designer Signature:
License MRS 223760 Date: May 8, 2017
Page 5
Installation Instructions for EZ 'M
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- dles and do not require any typ
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 1G nc rr"-
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 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 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
;o 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"
Page6
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: John Cook Tank Manufacturer: Wieser Concrete ❑ NA
Permit# 2 Septic ❑Dose ❑-folding Volume: 1250LP
DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete 0 NA
Number of Bedrooms: 4 0 NA ❑ Septic ❑ Dose ❑iolding Volume: gal
Number of Public Facility Units: E NA Vertical Distance Tank Bottom(s) to Service Pad: ft
Estimated (average) Flow: 400 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft
Design Flow = estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if
In Situ Soil Application Rate: 0.50 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back.
Standard Domestic InfluentlEffluent Monthly average Effluent Filter Manufacturer: POLYLOK ❑ NA
Fats, Oils & Grease (FOG) 530 mg/L Effluent Filter Model:
Biochemical Oxygen Demand (BOD5) 5220mg/L ❑ NA Pump Manufacturer:
Total Suspended Solids (TSS) 5150mg/L Pump o e
High Strength Influent/Effluent Monthly average Petreatment Unit d NA
Fats, Oils & Grease (FOG) 530 mg/L Manufacturer:
Biochemical Oxygen Demand (BOD5) 5220mg/L ❑ NA ❑ Mechanical Aeration ❑ Peat Filter
Total Suspended Solids (TSS) 5150mg/L ❑ Disinfection ❑ Wetland
❑ Sand/Gravel Filter ❑ Other:
Petreated Effluent Monthly average
Biochemical Oxygen Demand (BOD5) :530mg/L of sore tion ystem
Total Suspended Solids (TSS) 5_30mg/L 21 NA LJ 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: NJ Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
When combined with sludge and scum equals one-third (1A) 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) ❑ NA
Inspect condition of tank(s) ~ year(s)
Inspect dispersal cell(s) At least once every: 1.5 month(s) 0 ears (Maximun 3 Years) El NA
month(s) NA
Clean effluent filter At least once every: 1.5 ears ❑
At least once every: month(s) E] NA
Inspect pump, pump controls & alarm ears)
month(s) NA
year(s)
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: 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 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.
(Rev.2/05)
Page 7
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are
detected have the contents of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will
be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely
abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for
a code compliant replacement system:
❑ 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. 2/05)
Page 8
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer J o h n Cook
Mailing Address 1525 47th Street
Property Address 1525 47th Street
(Verification required from Planning & Zoning Department for new construction.)
City/State Somerset, W1 Parcel Identification Number 032_2060-10-010
LEGAL DESCRIPTION
Property Location SE 1/4 SE , 17 T 30 N R 19 WTown of Somerset
/4 , Sec.
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house 13yes[Dno Lot lines identifiable Elyes❑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(l) 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 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 arranty deed recorded in Register of Deeds Office.
Number of bedrooms 4
aZ_ C"L) 614-- 7
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 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 10 AA
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Departmenl aECEIV091 EVALUATION REPORT #1877
S P Safety and in accordance with Comm 85, Wis. Adm. Code Page 1 of _4
_ Professional Servi fty 12 Z 017 Schmitt Soil Testing, Inc.
County
Attach complete site plan on pap6Tio0WMft'cfWnches in size. Plan must St. Croix
include, but not limited to: v ~~~4 ~~q~t (BM), direction and -
percent slope, scale or dimensions, north arrow,'tt7~c~6+~'~1d distance to nearest road. Parcel I,
032- 0 0-010
I Please print all information.
<s: Z Revi d By - D~
0y ersonal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
ws' ~ roperty Owner Property Location
oo_k, John _W._ Govt. Lot SE1/ , SE1/4, S17, T30N, R19W
00 roperty Owner's Mailing Address Lot # Block # Subd. Name or CSM#
d 525 47th St. NA~ -
My State Zip Code Phone Number
W 1 City !Village _ Town Nearest Road
iomerset I WI 54025 715-760-1006 Somerset 47Th St
1 New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate _ 600 GPD
]Replacement Public or commercial - Describe:
Parent material Outwash Sand (Chetek-Onamia Series) Flood plain elevation, if applicable NA
General comments Area is suitable for a conventional system with a 0.5 gpd/sgft rate. Possible system elevation, High to Low, 100.6'99.6', 98.6', 97.6'.
and recommendations: Slope of area is 13%.
Boring
1 Boring # F-1
Pit Ground surface elev. 102.78 ft. Depth to limiting factor 96+ - in. Soil Application Rate
Horizon I Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots G_PD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 10yr3/3 none sl 2mgr mvfr as 2f,2vf 0.6 1.0
2 9-35 7.5yr4/6 none Is icsbk mvfr as 2vf 0.7 1.6
3 35-53 10yr5/6 none grls Osg ml cs ivf 0.7 1.6
4 53-96 10yr6/4 none grs Osg ml 0.7 1.6
-7 or
~l - g , Z. too
Boring
# -
F2i-
I Pit Ground surface elev. 102.28 ft. Depth to limiting factor 97+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 10yr3/3 none sl 2mgr mvfr as 2f,2vf 0.6 1.0
2 10-30 10yr4/3 none grsl 2msbk mvfr gw 2m,2f 0.6 1.0
3 30-47 7.4yr4/4 none grlfs icsbk mfr gw if 0.5 1.0
4 47-59 7.5yr5/6 none grls lcsbk mvfr gw 0.7 1.6
5 59-97 7.5yr5/6 none grs Osg ml 0.7 1.6
-
i
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS -s-30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 4v, 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd St. New Richmond, WI 54017 4/21/2017 715-760-1978
SBD-8330 (R-07/00)
Property Owner Cook,_John W. Parcel ID # 032-2060-10-010 Page 2 of 4
Boring
a Boring # Pit Ground surface elev. 101.18 Depth to limiting factor 96+ in.
- - Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2
1 0-9 10yr3/3 none sl 2mgr mvfr as 2f,ivf 0.6 1.0
2 9-30 10yr4/4 none Is lcsbk mvfr gw 2f,2vf 0.7 1.6
3 30-68 10yr5/6 none Ifs Osg ml gw 2vf 0.5 1.0
4 68-96 10yr6/4 none grfs Osg ml 0.5 1.0
- Boring
F-1 ~i Boring # i ,7
pit Ground surface elev. ft. Depth . De th to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -Eff#2
Boring
F-1 I Boring # Pit Ground surface elev. _
ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP_D_/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#i `Eff#2
--i
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00) Schmitt Soil Testing, Inc.
Page 3 of 4
Conducted by: - Conducted For:
Schmitt & Sons Excavating, Inc.. _ Name: John W. Cook fi- t
Thomas J. Schmitt, CST 227429 Address: 1525 47th St.
,
586 Valley View Trail City, State, Zip: Somerset, W154025
Somerset, W l 54025 - - 1
Phone: 715-7 0-1978 PID: 032-2060-10-010
Signature Lot No. NA
f Date ~-•2 / 7 Legal Description: SE1/4 SE1/4 S17 T30N R19W
E Backhoe Pit Township, County: Somerset, St. Croix County
A Bench Mark 1 El. 100.00' Top of 1" pvc pipe
D Bench Mark 2 El. 109.06' Top of 1st step on south west corner of house
f
Slope= 13%
Scale 1"= 40' Approximate elevation of building sewer at house = 101.50' r
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NOTE: For full view of Lot see Aerial Photo (Page 4 of 4)
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