HomeMy WebLinkAbout032-2045-30-005
!
ECEI V E County
Safety and Buildings Division St. Croix
201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
JUN ZQ 1 dis , W"37 -7162
ROIX COUNTY
,^,OMMUNITY ermit Applicat><oII State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Na
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stets.
L Application Information - Please Print All Information
Property Owner's Name Parcel #
Stetson & Laura Baker p4rf of 0~,
Property Owner's Mailing Address Property I.-atiou
721 26a Ave. Govt. Lot
City, State Zip Code Phone Number NE /4, SE Section 12
(circle one)
Cumberland, W1 54829 (715) 651-9210 T 30 N; R 19 W
I1pe of Building (check all that apply) Lot #
1 or 2 Family Dwelling - Number of Bedrooms V 1X9 `t Subdivision Name
nUU w/ Block # ~ CSC
❑ Public/Commercial - Describe Use t/ L nQ r s vbm I /1 . Na
t, an l [I City of
❑ State Owned - Describe Use OV CSM Number `/L , yf/ Villa e of
DISTV-1 61 I DA/ W1 W 1-W 4- 20 dt1MyW&r own of Somerset
Ill. Type of Permit: (Check only one ox on line A. Complete line B if applicable)
ew System
❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. List Previous Permit Number and Date Issued
❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. Type of PO m/Component/Device: (Check all that apply)
Non-Pressurized In-Ground ❑ Pressurized [n-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitab
❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information: 4 Infiltrator Quick 4 Standard Plus chambers & 3 pair end caps, PolyLok P1.,-525 effluent filter
Design Flow (gpd) Design Soil Application Rat pdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) yytem Elevation
614-
600.0 Gp 0.7 Gpd/Sq. 857.15 sq. ft. 1,215.60 sq. ft. 95.0', 94.0' & 93.0
VI. Tank Info Cap ity in Total # of Manufacturer
Gallons Gallons Units
New Tanks Existing Tanks
0
a. U ~ v~ is U a
septic or Holding Tank 1,340 1,340 1 Wieser Concrete X
Dosing Chamber
VII. Responsibility Statement- I, the on rsigned, assuane responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumbe' Signature " MP/MPRS Number Business Phone Number
James K. Thompson MPRS 30021 (715) 248-7767
Plumber's Address (Street, City, State, Zip Code..-'
340 Paulson Lake Lane, Osceola, WI 54020
VII1. County/ ear ent Use Only
~7 Issuing Agent Sig ature
ed Disapproved Permit Fee Date Issued
en Reason for Dema $ IV ~ /QC 61 -7
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNED; (,UI~~/TTIGYIS' r/1 lan~ USt %Crm- in c"rt'(~
1, Septic tank, @Mu@nt filter mnd
dlspereal cell must be s.erM.0 / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
F app Ica e @ ji {W t,&ns for the system and submit to the County only on paper not less than 8 1/2 x 1 I inches in size
SBD-6398 (R. I1/11)
Conventional POWTS Index & Title Sheet
Project Name: Baker 4 bedroom Rep] Conventional Dispersal Cell
Owners Name: Stetson & Laura Baker
Owner's address: 721 26% Ave., Cumberland, WI 54829
Site address: 5165th Ave.
Project Location:
Subdivision: Na
Legal Description: NEI/4 SWA, Sec. 12, T.30N., R. 19W., Tn. Of Somerset, St. Croix Co., Wl.
Parcel ID 032-2045-03-005
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing Calculations
Page 4 Dispersal Cell Cross Section
Page 5 Infiltrator "Q-4" Chamber Specifications
Page 6 Wieser Septic Tank Cross Section
Page 7 PolyLok PL-525 Effluent Filter Cross Section
Page 8 System Management Plan
Page 9 Septic Tank Maintenance Agreement
Page 10 Warranty Deed
C 5ru\
Attachments: Soil Evaluation Rcport
Mater PP rnbcr Restricted Service: James K. Thompson, DSPS Credential #30021
t
Signature: Date: CtC ~2C3
Page I Of 10
Dcsign pursuant to In-Ground Soil Absorption Component Manual for POWTS; version 10.1)'13D-10705-1) (N.01/01)
xxX 1',' 5 Ade .
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Baker 4 Bedroom Dispersal Cell Sizinjj Calculations
1. (4 bedrooms)(] 00 gallons estimated flow)(1.5 design factor) = 600.00 Gpd design flow
2. Infiltrative capacity of native soil = 0.7 gpd/s_q. ft.
(a
3. Absorption area required: 857.15 sq. It
~
5.2
4. Absorption area as proposed: 1,215.60 sq. ft. (based on 0.5 gpd/sq ft 60 chambers + 3 pair end caps)
pro post d'r
Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber. Infiltrator "Quick 4" end caps = 5.20 sq.ft, EISA/pair
857.15 sq. ft. (3 pair endcaps)(5.20) = 841.55 sq. ft. J20.00 = 42.08 chambers required
Number of trenches: 3 a 20 chambers per trench (60 chambers total)
Trench width: 2.83'
Trench length: 83.00'
Trench spacing: 9.0' on center
Total system area w/ 6' trench spacing: 18'x 83'
Pg. 3 of 10
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6. Vo(IO
INFILTRATOR' The s
Standard Chamber
The nick
Q 4 Plus Standard Chamber
offers maximum strength through
its two center structural columns.
This chamber can be installed in _
a 36-inch-wide trench. Like the
original line of Quick4 chambers,
it offers advanced contouring
capability with its Contour Swivel
Connection TM which permits turns
Lip to 15-degrees, right or left. It is
also available in four-foot lengths to
provide optimal installation flexibility.
The Quick4 Plus All-in-One 12 uick4 Plus Standard Chamber Benefits:
Endcap, and the Quick4 Periscope • Two center structural columns offer increased stability and superior strength
are available with this chamber, • Advanced contouring connections
providing increased flexibility in
system configurations. • Latching mechanism allows for quick installation
• Four-foot chamber lengths are easy to handle and install
• Supports wheel loads of 16,000 lbs/axle with 12" of cover
Maximum Strength
size uick4 Plus Ail-in-One 1 Endcap Quick4 Plus All-in-One Periscope
34"W x 53"L x 12"H Benefits: Benefits:
(864 mm x 1346 mm x 305 mm)
• May be used at the end of chamber • Allows for raised invert installations
Effective Length ( row for an inlet/outlet or can be < 180° directional inletting
48" (1219 mm) installed mid-trench
• Mid-trench connection feature allows ' 12" raised invert is ideal for serial
Louver Height construction of chamber rows with applications
8" (203 mm) center feed, as an alternative to
inletting at the ends of chamber rows
Storage Capacity • Center-feed connection allows for
47 gal (178 Q easy installation of serial distribution 11
Invert Height systems
0.6" (15 min), 5.3 (135 mm), • Pipe connection options include I Certified by the International
I Association of Plumbing
1 8.0" (203 mm), 12.7" (323 mm) sides, ends or top and Mechanical
Officials (IAPMO)
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\ = W840/500-MR 'USER CCt1CAETE
° SEPTIC MANUAL REV.
\ z W3716 US HWY 1C MAIDEN ROCK, WI 54750 DATE: 00/00/00 DATE: POST-POUR:
0 800-325-8456 FILE: N10D0/600-4R
Inc,
XNiT .aria, Preeast6 Vic- J Lanes' PL-525 -fluent Filter
lion of Polylor.Inc.
PL-525 Kilter
I lie P1.,-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 PoI lok PL-122,
y 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 wont leave the tank.
Features; 1/16" Filtration Slots
• bated for 10,000 GPD (gallons per day). Alarm 13titch
110 000 (optional)
525 linear feet of 1/16" filtration. r
Accctit5 I" PV( -
• Accepts 4" and 6" SO ID 40 pipe, Lxtension lcandle
• Built in gas deflector.
• Automatic shut-off ball when filter is removed.
• Alarm accessibility. xatet] for
70,000 ct'l~
• Accepts PVC extension handle.
PI.-525 Installation.
Ideal for residential and commercial waste flows up to 525 Linear f't.
10,000 gallons per day (GPD). ofl/th"
Yiltration Slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.
\CCepts'
3. Glue the filter housing to the 4" or 6" outlet pipe. If "tl tt) 40 pipe
the filter is not centered under the access opening use a
Polylok Extend & I ok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing.
5. Replace and secure the septic tank cover. 'L Certified to
NS rANSI Standard 46
PL-525 Maintenance.
f'lie P1,525 Effluent Filters will operate efficiently for s
several years under normal conditions before requiring
(-leaning. 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 i
needs servicing. Servicing should be done by a certified Gas 1)eftecfor
septic tank pumper or installer. tlutonratu
1. Locate the outlet of the septic tank. Shut-Off Uall
2. Remove tank cover and pump tank if necessary.
1 Do not use plumbing when filter is removed.
4. Pull PL. 525 cartridge out of the housing.
k
5. Hose off filter over the septic tank. Flake sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
Ctctcl<7or sa a B i4terlaran I:xtc niI & Lok' "
sure the filter is properly aligned and completely inserted
1'olylok Label & I cst tilter~ accept Fasily instaus
7. Replace and secure septic tank cover, the SmrrtVi1tc01, switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll F'rec: 877.765.9565 flax: 203.284.8514 wtivtiv.poly] okcom
PJ. 74/0
Conventional Septic System Ma Bement Plan
Pursuant to SPS 383.54, Wis dm. Code
General
The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system
should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at
(715) 386-4680.
Septic Tank
Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 28 1.48, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 113 scurn and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. 'the addition of biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weznh.°r tllomh~. Cold X;e:jthor i,n f~dkj .-m"
(October-March) dictate that the system be heavily mulched for frost protection
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L T',~ l i ( k, lin m, lot
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contineency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Pg. 8 of 10
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Stetson & Laura Baker
Mailing Address 721 26 3/4 Ave Cumberland WI 54829
Property Addre 8 3 65th Ave.
40
(Verification required from Planning & Zoning Department for new construction.)
City/State Somerset WI Parcel Identification Number 032-2045-03-005
LEGAL DESCRIPTION
Property Location NE '/4 SW Sec. 12 T 30 N R 19 W, Town of Somerset
Subdivision Plat: Na , Lot # Na
Certified Survey Map # N a 'Volume N a Page # N a
Warranty Deed # 1043973
tY (before 2007)Volume Na Page # Na
Spec house ❑yes[Dno Lot lines identifiable ElyesE]no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), 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,
S= of Wi =ons Certification stating that your septle systern has been rnan:ta.ne~ must he completed and ret'_,.rnod to the St Crnot_
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on thi orm 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 ranty deed recorded in Register of Deeds Office.
Number of bedrooms 4
G~.05 12/17
SIGNAT RE OF APPLICA T(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)
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Wis.`Dept. of Safety and Professional Services : SOIL EVALUATION REPOR 1
Page 1 of 2
Division of Safety and Buildings i C7~ l 1 _r
in accoi"r,vith SPS 385, Wis. Adm. Code
County St. Croix
Attach complete site plan ea t,JtQl'1 .ih~ff-f)..i12*i1)h1'bhes in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 032-2045-30-001
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q
Please print all information. Revie by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1
Property Owner Property Location ■
BRENT MASON Govt. Lot NE 1/4 1/4 S T 30N R 19E (or) Wa
Property Owner's Mailing Address Lot # Block # Subd. Name or M#
2334 KINGSTON AVE NA NA NA
City State Zip Code Phone Number FICity Village ■ own Nearest Road
MAPLEWOOD MN 55109 ( 65)1-307-5082 Somerset 165th ave
0 New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
n Replacement Q Public or commercial - Describe:
Parent material Outwash Flood Plain elevation if applicable NA ft.
General comments GOOD FORCONVENTIONAL SYSTOM WILL NEED TO SIZED AND LAYED WITH THE CONTURES OF
and recommendations: S PE.
rG.41
IBC le
1
Boring # 11 Boring
❑
Q Pit Ground surface elev. 100 ft. Depth to limiting factor 89 + in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ` ff#2
1 0-10 10 YR3/2 SIL 2msbk mvfr cW 3m .6 .8
2 10-24 7.5YR4/4 L 2msbk mfr ci 2m .6 .8
3 24-89 10YR5/6 S -m- ml .7 1.6
2 Boring # F]Boring 97 94+
Q Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 *Ifff#2
1 0-12 10YR3/2 SIL 2msbk mvfr cW 3m .6 .8
2 12-27 7.5YR4/4 L 2msbk mfr ci 2m .6 .8
3 27-94 10YR5/6 S -m- ml .7 1.6
t
Effluent #1 = BOD > 3C < 22 g/L and TSS >30 < 150 mg/L ' Efflu nt 42 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
PETER ERICKSON 1293207
Address Date Evaluation Conducted Telephone Number
1291 170TH STREET ST. CROIX FALLS WI 2/25/2017 952-261-1100
SBD-8330 (RI 1/11)
BRENT MASON 032-2045-30-001 2 2
Property Owner Parcel ID # Page of
❑ Boring # Boring 93.5 88+
Q Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2
1 0-18 10YR3/2 SIL 2msbk mvfr cw 3m .6 .8
2 18-34 7.5YR4/3
L 2msbk mfr ci 2m .6 .8
3 34-88 70YR 5/6 S -m- ml
Boring # 4~_ _I Boring 97.5 I O 1+
(_l Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence oundary Roots GPD/ft z
in. Munsell Qu. Sz. Cant. Color ff#1 ff#2
Gr. Sz. Sh.
1 0-12 10YR3/2 SIL 2msbk
mvfr cw 3m .6 .8
2 12-28 7.5YR4/4 L 2msbk mfr ci 2m ,6 ,g
3 28-101 10YR5/6 S -m- ml ci .7 1.6
Boring
❑ Boring #
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L
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