HomeMy WebLinkAbout020-1178-60-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 597400
GENERAL INFORMATION State Plan ID No: /a ~
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Y\1J~
Permit Holder's Name: City Village Township Parcel Tax No
Allen & Susan Kramer TOWN OF HUDSON 020-1178-60-000
CST BM Elev: Insp. BM Elev: BM D scription: Section/Town/Range/Map No:
28.29.19.1125
TANK INFORMATION L VATION DATA
TYPE MANUFACTURER ' CAPACITY STATION BS HI FS ELEV.
`.5
Septic Benchmark
')Z .Sly 03,
I V a 0 d0 5Z Alt. BM
Aal;jj in ~ Bldg. Sewer
I~etdinrT t Inlet
O 97.
TANK SETBACK INFORMATION ll~ St/ t Outlet
TANK TO P/~ WELL BLDG. Vent to Air Intake ROAD Dt Inlet /
OV
Septic 25- Dt Bottom
Dosing 7 Iv Header/Man. 7(1
Aerati Dist. Pipe
r
Holding Bot. System
- lo. q, 9.09 7
Final Grade q7.7
PUMP/SIPHON INFORMATION ~1~?.$~•`7 Manufacturer Demand St Cover +~n IWO. 6
M del Number
TD Lift Friction Loss System TDH Ft
Forcemai Length Dist. to Well
SOIL ABSORPTION SYSTEM Inff f' (00 11 1
U'
BED/TRENCH Width Leng No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG ELL LAKE/STREA LEACHING Manufacturer: Z PrL
INFORMATION CHAMBER OR
Tce Of S stem: f f ✓ UNIT Model Number:
TRIBUTION SYSTEM
.nifold 11 Distribution x Hole Size x Hole Spacing Vent to Air Intake `p
Length Dia Length Dia Spacing all <AIn V`J
SOIL CO ER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over 1XX Depth of xx Seeded/Sodded xx -Inherl
Bed/Trench Center / Bed/Trench Edges Topsoil
❑ Yes [I No ❑ Yes ❑ No
COMMENTS: (Inclu code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 552 DRU DR .ry) tJ U' ' ` ct;rli `r
3 N~ ~UUU
1.) Alt BM Description = oup- COO-
~1 3~Lo 5CA~
2.) Bldg sewer length = ,J
- amount of cover -
V' X5,1
Plan revision Required? Yes No
Use other side for additional nformati6n.
SBD-6710 (R.3/97) Date I s ctcr's Signature Cert. No.
PLOT PLAN N
Project Name: Kramer 4 Bedroom Replacement Septic System
Legal Description: SW1/4, NE1/4, S28, T29N, R19W P.I.D: 020-1178-60-000
Subdivision Name: Cedar Hills Estates Lot 25
Township: Hudson Parcel Size: 2.003 SCALE: 1°=50'
County: St. Croix
System Elevation: T1= 94.50 Proposed 60.00' EZ Flow Trench
Slope: 10% T2= 93.70 Proposed 60.00' EZ Flow Trench
A BM1 Elevation: 100.00' Top of existing bed drainfield ventpipe T3= 92.90 Proposed 60.00' EZ Flow Trench
A BM2 Elevation: 100.90' Top of inspection pipe on 1000 al tank T4= 92.90 Proposed 60.00' EZ Flow Trench
■ Backhoe Pits: T5= Existing 68.00' Hi Cap Infiltrator
T6= Existing 68.00' Hi Cap Infiltrator
Bed Existing 18'x52'
See Plat Map for complete view of parcel Existing Tanks Wieser Concrete 1000 51
New Tank Wieser Concrete W320-MR 5 z-
ExiSti'" Ciit°r ooi-1-6 525
y r.~
4 inch Sch 40 -ASTM D2665
4 inch 3034 -ASTM D3034
tN K44
\
EL ALL D; AiN ',=i 105
Q
F7 r
-f o
Page 2
RECEIVE D County:
Industry Services Division St. Croix ao 6
d 1400 E Washington Ave
$ `i 'Sanitary Permit Number (to be filled in by Co.)
P.o. ~
,<< P JUL: 0 0 20 0
E. Madison,] 0a
4+
$T. CROIX COUNTY
anitary Permit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governntentaf 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 different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. Sameti _ y
1. Application Information - Please Print All Information
Property Owner's Name Parcel #
Kramer, Allen & Susan 020-1 178-60-000 ,
Property Owner's Mailing Address Property Location oC ' • • 1 r
552 Dru Drive
Govt. Lot
City, State Zip Code Phone Number SW NE Section 28
Hudson , WI 54016 (circle one)
T29N R19EorW
II. Type of Building (check all that apply) Lot 4
® I or 2 Family Dwelling- Number of Bedrooms 25 Subdivision Name
Cedar Hills Estates ,
Public/Commercial - Describe Use A AP Block 4
❑ City of
❑ State Owned - Describe Ilse El village of
CSM Number ,
d` SM 77 r ru__5 ; r 01y I 175 ® Town of Hudson
11
111. Type of Permit: (Check only one bdx on line A. Complete line B if a licable)
A. ❑ New System ❑ Replacement System ❑ Treatment/Holding "tank Replacement Only E] 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 119432-19", 399411-10/30/2001
1V. Type of POWTS System/Component/Device: (Check all that apply) y
Non-Pressurized In-Ground ❑ Pressurized Iii-Ground ❑ At-Grade ❑ mound > 24 in. of suitable soil ❑ Mound < 24 in. f su al4e.io,1 )
❑ Holding `tank ❑ Other Dispersal Component explain) ❑ Pretreatment Device (explain) ez_ A
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil ication Dispersal t x1i Required (so Dispersal a Proposed (sf) System Elevation D
Rate(gpdA 857 1200 % 94.50', 93.70', 92.90',
0.7
V1. Tank Info Capacity in
Gallons Fotal N of Manufacturer v
Gallons Units 2 5 ~ f6
New Tanks Existing Tanks . U ti s C7
Septic or Holding Tank 320 1000 1320 2 Wieser Concrete ® ❑ ❑ ❑ ❑
r ❑ F-1 F-1 El 1:1
Dosing Chamber
a"- V 7V V-1 WV
VII. Responsibility Statement- t, the undersigned, ass me responsibility for installation of the POWTS shown on the attached plans.
Pltunber's Name (Print) .Plumber XatUre _f MP/MFRS Number Business Phone Number
John Schmitt ??3760 715-760-(kl8fi
Plumber's Address (Street, City, State, Zip Code)
616 150`1' Ave. Somerset, W1 54025
VIII. County/ eartment Use Only
y proved ts. tevcui hermit Fee Date Issue Issuing Agent 'gnatur
❑-Onmtr Given Reason o ial , 7
°dl n ?.4, ~j) ,-4,
It. Conditions of A pproval/Reasons for DisapprovTrt
OWNER: a ' >1~1k ~c,
SYSTEM effluent filter and n;,d ~pl c1 e 0Iq ~3
1. Septic tank,
ersal cell must be serviced I maint~lu -r.
disp ndcement plan prov;deu t / ,
n us, be. mawta,11~u
as per ma s iret-~ents
-u~-
licaMa~ iriV ans for the system and submit to the County oily on paper not less than 8 uz z I1 inches in size
2. All r _s as per app
SBD-6398 (R03/14)
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Kramer 4 Bedroom Replacement Septic System
Owners Name: Allen & Susan Kramer
Owner's Address 552 Dru Drive
Hudson, WI 54016
Legal Description: SW1/4, NE1/4, S28, T29N, R19W
Township Hudson
County: St. Croix
Subdivision Name: Cedar Hills Estates
Lot Number: 25 Block Number
Parcel I.D. Number 020-1178-60-000
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: 6/29/2017 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: Kramer 4 Bedroom Replacement Septic System
Legal Description: SW1/4, NE1/4, S28, T29N, R19W P. 1. D: 020-1178-60-000
Subdivision Name: Cedar Hills Estates Lot 25
Township: Hudson Parcel Size: 2.003 SCALE: V=50'
County: St. Croix
System Elevation: T1= 94.50 Proposed 60.00' EZ Flow Trench
Slope: 10% T2= 93.70 Proposed 60.00' EZ Flow Trench
BM1 Elevation: 100.00' Top of existing bed drainfield ventpipe T3= 92.90 Proposed 60.00' EZ Flow Trench
BM2 Elevation: 100.90' Top of inspection pipe on 1000 al tank T4= 92.90 Proposed 60.00' EZ Flow Trench
■ Backhoe Pits: T5= Existing 68.00' Hi Cap Infiltrator
T6= Existing 68.00' Hi Cap Infiltrator
Bed Existing 18'x52'
See Plat Map for complete view of parcel Existing Tanks Wieser Concrete 1000 .51
New Tank Wieser Concrete W320-MR 5 Z.
Existing Filter Pol lok 525
4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
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Page 2
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° -m+ SEPTIC MANUAL DATE 00/00/00 DATE: 12-22-14 POST-POUR:
~ z W3716 US HWY 10 MAIDEN ROCK, WI 54750
O 800-325-8456 FILE: W320-MR
Page 3
P
tnoovationsinPrecast, Dfx"age Zabel` PL-52 Effluent Filter
Wastevtater Products A Division of Polylok Inc.
The ~L-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.
&~ZFJ 1 34 $b Lt it 4J$k Jit1L:Y
Alarm Switch
Rated for 10,000 GPD (gallons per day). (Optional)
525 linear feet of 1/16" filtration. GP's
Accepts 7" PVC
s Accepts 4" and 6" SCHD 40 pipe. Extension Handle
Built in gas deflector.
® Automatic shut-off ball when filter is removed.
' Rated for
Alarm accessibility. s~ 1o,00OGPD
rs a- is
Accepts PVC extension handle.
• V . w
f t.-525 Instz111atinn: Or
i
1 17, 1
Ideal for residential and commercial waste flows up to t`. k 525 Linear Ft.
10,000 gallons per day (G PD). ~ of 1/16„
'F:_ ' Filtration Slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.
Accents 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.erYifiea~ to
gt~~('~~'S9 st~radnrct {.r i
PL-:s25Maintcnauce: I'i~~` ~ ~y~~,:;``
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 r
septic tank pumper or installer. t Automatic
Shut-Off Ball
1. Locate the outlet of the septic tank.
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.
5. Hose off filter over the septic tank. Make sure all i+
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making Outdou, sure the filter is properly aligned and completely inserted.
Poylok lylok, Zabel 8c Best l Bestt filters Ata accept Extend
lEasily
installs
7. Replace and secure septic tank cover. the SmartFilter@ switch and alarm. into existing tanks.
Polylok, Inc. 3 Faifeld Blvd. Wallingford, CT 06492 Toll Free: 877.7659565 Fax: 203.284.8514 www.polylok.eom
Page 4
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Kramer 4 Bedroom Replacement Septic System
Gravelless Leaching Unit Specifications
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ12031-1-5ft 25.0
EZ1203H-10ft 10.0' 50.0
System Sizing
D
EISA Rating per Foot of EZ Flow ft2 Soil Application Rate 0.7 gpd/ft2
750.0 gpd Design Flow Soil Application Rate EISA = 214.3 Feet of EZ Flow
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 98 ft
j~ Observation Pipe wit
approved cap or ven
36 inch Soil Backfill
12 Inch Geotextile Fabric
MO.~ 011 Slotted an
VenVObservation Pil
>36 inch 93.70 ft. - - - i - O
92 90 ft. ~ ~r~ ~ 4
- > 3 ft ft Infiltrative
- . h
Plumber/Designer Signature:
License MPRS 223760 Date: June 29, 2017
Page 5
Installation Instructions for &EZ r,
EZfow 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 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. FPS 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 (5) (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
12IILt IE { _ I-
a width of 36 inches. This not only saves labor in excava- r n ,zE 1
tion, but also provides better load-bearing capacity after
,...aoo9ooo
backfilling is complete.
Page6
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: Allen & Susan Kramer Tank Manufacturer: Wieser Concrete ❑ NA
Permit# E Septic ❑Dose ❑-folding Volume: 320
DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA
Number of Bedrooms: 4 [Z 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: 0.70 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) 530 mg/L Effluent Filter Model:
Biochemical Oxygen Demand (BOD5) 5220mg/L ❑ NA Pump Manufacturer:
Total Suspended Solids (TSS) s150mg/L Pump Model:
High Strength Influent/Effluent Monthly average Petreatment Unit L 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
Petreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other:
Biochemical Oxygen Demand (BODs) <30mg/L of sort tion ystem
Total Suspended Solids (TSS) 530mg/L ❑ NA LJ In-Ground (gravity) ❑ In-Ground (pressure)
Fecal Collform (geometric mean) 5104cfu1100m1 ❑ At-Grade ❑ Mound
Maximum Effluent Particle Size: %e 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 of tank volume
Pump out contents of tank(s) When the high water alarm is activated
month(s)
Inspect condition of tank(s) At least once every: 3 ear s) (Maximus 3 Years) ❑ NA
month(s)
Inspect dispersal cell(s) At least once every: 1.5 ears (Maximun 3 Years) ❑ NA
month(s) NA
Clean effluent filter At least once every: 1.5 year(s) ❑
month(s) NA
Inspect pump, pump controls & alarm At least once every: ear(s) ❑
month(s) Q NA
year(s)
month(s) Q NA
ear s)
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer, POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank
inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The
dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of 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 (Y,) 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 s12 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
1 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)&(0 and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Use of this document does not guarantee the performance of the POWTS.
Page 8 (Rev. 2/05)
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) 552 Dru Drive located
at: SW '/4, NE 1/4, Section 28 , Town 29 N, Range 19 W,
Town of Hudson , 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: 1000
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): Wieser Concrete
Age of Tank (if known): 27 years
Permit number (if known) 119432
John Schmitt
(Licensed Plumber Signature) (Print Name)
MPRS 223760
(Title) (License Number) MP/MPRS
4
m
(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
Page 9
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EDAR HILLS ESTATES
LOCATED IN THE 10191/4 OF THE NEI/4; TNt NW 1/4 Of TNt MNI/4. TNt SWI/4
rill =t 1/4 OF THE NEI/4 OF SECTION SO. TION. NISW. TOWN OF NUMON.
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Page 12
CT i-DATV r(1TINT'TV
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Allen Susan Kramer
Mailing Address 552 Dru Drive
552 Dru Drive
Property Address
(Verification required from Planning & Zoning Department for new construction.) City/State Hudson, Wl Parcel Identification Number 020-1178-60-000
LEGAL DESCRIPTION
Property Location SW NE r/ Sec. 28 , T 29 N R 19 W, Town of Hudson
_ /4 ,
Subdivision Plat: Cedar Hills , Lot # 25
Certified Survey Map # , Volume , Page #
11 1
(before 2007)Volume 98 , Page # 6$
Warranty Deed # 548862
Spec house DyesElio Lot lines identifiable E] yesnno
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 Ordirnaiiee.
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.
Uwe certify that all statements on this form are hue to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty decd reu0iucu In OL DC;.,u~ Officc•
Number of bedrooms 4
IOF APPLICANTS)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
S Safety and V SOIL EVALUATION REPORT #1878
I'P in accordance with Comm 85, Wis. Adm. Code Page 1 of _4
ProfessM# Sgrtk@o I f Schmitt Soil Testing, Inc.
Attach complete site County F~Tti e(a-d4t~r OSflId00'l~n 8Y2 x 11 inches in size. Plan must St. Croix
include, but not~ r rence point (BM), direction and Parcel I.D.
percent slope, stale r ensions, no location and distance to nearest road.
Z Please print all information. 020-1178-60-000
Revie By Date
01 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /7
Property Owner Property Location t
Kramer, Allen & Susan_ Govt. Lot SW1/4, NE1/4, S28, T29N, R19W
t Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
a~ 552 Dru Drive 25 Cedar Hills 25
City State Zip Code Phone Number City Village ! Town Nearest Road
Hudson WI 54016 Hudson Dru Drive
New Construction Use Residential / Number of bedrooms 4 Code derived design flow rate _600 GPD
Replacement Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable __NA
General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible syste elevation, High to low, 945, 937, 92.9', 92.1',
and recommendations: Slope of area is 10%. 1 ~►p cr 9 /
l
Boring
❑ Boring #
Pit Ground surface elev. -97.76 ft. Depth to limiting factor _100+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots _ GPD/ft2 _
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
1 0-17 10yr3/3 none sil 2mgr mvfr gw 2f,2vf 0.6 0.8
2 17-30 10yr4/4 none sicl 2msbk mfr gw 2m,2f 0.4 0.6
3 30-41 10yr4/4 none sil rt 2msbk mfr gw 2vf 0.6 0.8
4 41-47 10yr5/4 none Is Osg ml gw ivf 0.7 1.6
5 47_100 10yr6/4 nose' s Osg ml - 0.7 ~71.6
Bor' C
F2 Boring #
Pit -Ground surface elev. 97.36 ft. Depth to limiting factor 102+ in.
_ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2
1 0-10 10yr3/2 none A 2mgr mvfr gw 2vf 0.6 0.8
2 10-31 10yr3/1 none sil 2msbk mfr gw ivf 0.6 0.8
3 31-44 10yr4/4 none sil 2msbk mfr gw ivf 0.6 0.8
4 44-56 10yr5/6 none Is Osg ml gw 0.7 1.6
5 56-102 10yr6/4 none 44 s Osg ml 0.7 1.6
r~
Effluent #1 = BO 5 ' 2 /L nd TSS >30 <,150 mg/L Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print' Signature: _ CST Number
Thomas J. Schmitt / 227429
Address Schmitt Soil Testing, Date Evaluation Conducted Telephone Number
1595 72nd St. New Richmond, WI 54017 4/17/2017 715-760-1978
SBD-8330 (R.07/00)
L
Property Owner Kramer, Allen & Susan Parcel ID # 020-1178-60-000 Page -2-of 4
3] - -Boring - ~
Boring #
;L 1; Pit Ground surface elev.._-_95.46 -ft. Depth to limiting factor 99+ in.
- Soil Application Rate ~
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 *Eff#2
1 0-12 10yr3/3 - none I 2mgr mvfr -gw 2vf 0.6 0.8
2 12-18 10yr3/2 none sl 2fsbk mvfr gw 2vf 0.6 1.0
i
3 18-29 10yr3/4 none sil 2msbk mfr gw lvf 0.6 0.8
4 29-36 10yr4/4 none sil 2msbk mfr gw 1vf 0.6 0.8
5 36-42 10yr4/4 none sl 2msbk mfr gw 0.6 1 1.0
6 42-49 10yr5/6 none Is Osg ml gw 0.7 1.6
7 49-99 10yr6/4 none s Osg ml 0.7 1.6
Boring
F4 Boring # Pit Ground surface elev. _99.21_ ft. Depth to limiting factor 106+ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#i *Eff#2
1 0-11 10yr3/3 none sl 2mgr mvfr gw 2vf 0.6 1.0
-
2 11-21 10yr3/2 none sl 2fsbk mfr gw 1vf 0.6 1.0
3 21-36 10yr4/4 none sl 2msbk mfr gw 1vf 0.6 1.0
4 36-49 10yr5/6 none Is Osg ml gw 0.7 6'
5 49-106 10yr6/4 none sg ml 0. 1.6
Boring
/
Bon9 # Pit Ground surfafce elev.97.56 ft. Depth to limiting factor _ 58 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz _
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-18 10yr3/3 none sil 2mgr mvfr cw 3f 0.6 0.8
2 18-37 10yr3/1 none A 2fsbk mvfr gw 2f 0.6 0.8
3 37-58 10yr4/4 r1o'rte- sil 2msbk mfr gw if 0.6 0.8
4 58-68 10yr5/ 'r c2d 7.5yr6/6 )sil lmsbk mfr gw 0.4 0.6
7.5yr6/2 _
5 68-72 10yr5/6 Tlorie Is Osg - ml gw 0.7 1.6
6 72-110 10yr6/4 none s Osg ml 0.7 1.6
Does not meet criteria for 1 foot or 2 foot rule.
* 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
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 Sal Testing, Inc.
Page 3 of 4
Canducted by: Conducted For:
Schmitt & Sons Excavating, Inc.. Name: Allen & Susan Kramer
Thomas J. Schmitt, CST 227429 Address: 552 Dru Drive
586 Valley View Trail City, State, Zip: Hudson, W1 54016
Somerset,Wl 54025
Phone: 715-7 0-1978 PID: 020-1178-60-000
Signat • - Lot No. 25 Cedar Hills
Date Legal Description: SW1/4 NE1/4 S28 T29N R19W
® Backhoe Pit Township, County: Hudson, St. Croix County
A Bench Mark 1 El. 100.00' Top of vent pipe on exisitng 12'X 52' bed drainfield -t -
Bench Mark 2 El. 100.90' top of inspection pipe on existing septic tank
Slope= 10%
Scale 1"= 50' Inlet pipe in Filter Basin El. 97.15' - -
I
I
NOTE: For full view of Lot see Aerial Photo (Page 4 of 4)
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 399411
GENERAL INFORMATION (ATTACH TO PERMIT)
State Plan ID No:
Personal Information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holders Name: City Village X Township Parcel Tax No:
Kramer Allen Hudson Township 020-1178-60-000
CST BM Elev: Insp. BM Elev: IBM Description:
cn.C too. A' ter; - t; -cs't`ewr l
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 5-q 6 q~•~8 f
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ~5 , u r ~f Dt Bottom
Dosing T, Header/Man.
Aeration Dist. Pipe rJb S•
L-I~rs )IL .ss 93.V
Holding Bot. System •
)D"j )0,g z.(. '
Final Grade
PUMP/SIPHON INFORMATION wL
Manufacture Demand St Cover aS.J 1
PM
Model Number ~L i, + to-z Q r
TDH Lift fiction ste TDH Ft "/(j V 91.0.
Forcemain Length Dia. Dist. to Well
e ~3e qb l(pt
SOIL ORPTION SYSTEM l Q~ C"
RE C idth f Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquld Depth
DIM NS -3 01) 1
SETBACK SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING Map[~f cturer:
INFORMATION CHAMBER OR ~11~s '
Type Of System: r
> t , r UNIT M I Number.
t
00 I
Cab If aG~
DISTRIBUTION SYSTEM
Header/Ma if aL. t Size x Hole Spacing Vent to Air Inta! e
Lengthsr • Dia th Dia Spacing J~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of T Seeded/Sodded rChad
Bed/Trench Center Bed/Trench Edges Topsoil Ail Yes On No *Yes ®No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:10 /_'30/01_ Inspection #2:
Location: 552 Dru Drive Hudson, WI 54016 (SW 1/4 NE 1/4 28 T29N R19W) Cedar Hills Estates Lot Parcel No: 28.29.19.1125
1.) Alt BM Description =
2.) Bldg sewer length = ^ 1410,
- amount of cover -km" A-4)
Z'J"'t q_~r, dues ~4l
Plan revision Required? Fail Yes No
3
ther si a for dditional i~tformation.
CS 1Z •.{s~~c' Date InsepctorsSignature Cert. No.
SBD 6710 (R. 97
~tathgaD. QAfjrJr~.wovn.v swrJL.
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) BL-59 DrL& Driy- located
at: S(-) 1/4, k)C 1/4, Section , Town a9N, Range 1 `1 W,
Town of Rukon , 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)
-17 A
(Lic Ased 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