HomeMy WebLinkAbout032-2157-20-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 597396
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:
DEBORAH LAMBERT TOWN OF SOMERSET 032-2157-20-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
a ~ :5 111. cn oif 12.30.19.1354
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 2. 4*5 16Z 3 166
' Ze,14. 'X. A-106 Alt. BM ~.,i~- ~e••.. Z•4 16& • O
Aeration elf _ / r Bldg. Sewer 1
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet r
TANK TO P/L WELL BLDG. vent Intake ROAD Dt Inlet
Septic Dt Bottom
~L Sy i S ~D ~ i
Dosing Header/Man. ! 9 s 9(0 • C4y
Aeration Dist. Pipe 7I'`'7 .~T/
C O~
Holding Bot. System 1% 11. L 7
PUMP/SIPHON INFORMATION Final Grade 7
3• 5 19,13
Manufacturer Demand St Cover
GPM Z !cho a
Model Number
TDH Lift Friction Loss System Head H Ft
Forcema Length Dia. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 -7d 2 Te ~
JA_0A
SETBACK SYSTEM TO v P/L BLDG,•~ WELL LAKE/STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR 62 r /G~✓`S
Type f System: r
UNIT Model Number:
dwJ ILI a 3lo Z~ 7S A w
/ Al
DISTRIBUTION SYSTEM _74-7- jlll~b~
Header/Manifold ( Distributi
cip. x Hole $Qe Ix Hole Spacing Vent to Air Intake
Pipe(s) 1 le `p C
RAJ J
Length Dia Length Dia Spacing_ I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
es No 'Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1682 89TH ST C
Go.J~
1.) Alt BM Description =
2.) Bldg sewer length = Gam; 4 ~~J V d ~1 + ~
- amount of cover = G I ~Y r MM
Plan revision Required? ❑ Yes ')~N. / 2 7
Use other side for additional information. / I _4 U _/7 SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No.
° ~a~ EC E IV County
ty
K, Industry Services Division St. Croix
P
;5C, D • S S t)U0 6 2017 1400 EDWasohington Ave
`fit ! f 1L Sanitary Permit Number (to be filled in by Co.)
n\~ST CROIX COUNTY -7162 a PM I: NT
o4--s-0-- 517,3 0)
anitary Permit Application State Transagtion Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission ofthis form to the appropriate governmental unit NN/'!
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. Sa 4.~
1. Application Informa ' n Please Print All Information ~ < ~ 9
Property Owner's Name Parcel #
Lambert, Deborah 032-2157-20-000
Property Owner's Mailing Address
Property Location /d 0' 1 I•
1682 89°i Street
Govt. Lot
City, State Zip Code Phone Number NE V<, NE 14, Section 12
New Richmond, WI 54017 (circle one)
T30N R19Eore,"
H. Type of Building (check all that apply) of #
® I or 2 Family Dwelling - Number of Bedrooms ti~ 12 Subdivision Name
The I lighlands
❑ Public/Commercial - Describe Use Block #
El City
El State Owned -Describe Use of
CSM Number ❑ Village of
A; CtAb w 7 ❑ Town of Somerset
III. Type of Permit: (Check only o e box on line A. Complete line B if applicable) 72
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 andy~ate Issued
Before Expiration Plumber Owner 430081 11/7/2003
IV. Type of POWTS System/Cornonent/Device: (Check all that apply)
® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ 1-1 tng an spersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Tre ent Area Information:
Design Flow, (gp Design Soil Applicatiot Dispersal Area Required f) Dispersal Area Prop sed (st System Elevq
450 Rate(gpdst) 643 700 95.50' V '2%
0.7
VI. Tank Info Capacity in
Gallons Total # of r,
Manufacturer U v
G73
allons Units o w
New Tanks Existing Tanks ) I U y c V P.
Septic or Holding Tank 1000 1000 1 Week's C. P. ® ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumb~gi ture t MP/MPRS Number Business Phone Number
John Schmitt lz - t//Cz- ~ 223760 715-760-0486
Plumber's Address (Street, City, State, Zip Code)
616 150 Ave. Somerset, WI 54025
VIII. C nt /De artment Use Only
Approved Permit Fee Date sued Issuit gent Signature
er Given Reason for Denial S 7
I pt IX. Con(iilReams fo Disapproval 3)
Gisper d cell must ell be ic_s I r,12 illt_ _!r e( '
>1s: per ipgnagernent plan p! c, rlael by plumber.
2. A K Wrr lento muut w mF nt irE l
S DPW !p11crbls 006t badnanan ,
Attach to complete plans for the system and submit to the County only on paper not less than 8 I/2 x 11 inches in size
S13D-6398 (803/14)
PLOT PLAN N
Project Name: Lambert 3 Bedroom Replacement Septic S stem
Lega} Description: KIM-, NE $12, T30K, R19W P.f..D: ITI -2 X57-2Q-QQQ
Subdivision (Marne- The Ri hFands Lot' Township: Somerset Parcel Size: SCALE: t^=so'
County: St. Croix
System Elevation: 96.32 Existin 68.00' Biodiffuser
Slope0 96.27 Existing 62.00' Biodiffuser
A BM1 Elevation: 100.00' Bottom of siding T3= 95.50' Proposed 70.00' EZ Flow
BM2 Elevation: 103.28' NW lot corner pipe T4= 95.50' Proposed 70.00' EZ Flow
Backhoe Pits: Existing Tanks Weeks CP 1000
Existing Fitter Zabel A-100
fee PliatMap, sear:complete view-of parcel
14 inch Sch 40 -AS_TM D2665
4 inch 3034 - ASTM D30341 I
BI
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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) 1682 89th Street located
at: NE '/4, NE 1/4, Section 12 , Town 30 N, Range 19 W)
Town of Somerset , 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 X
(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): Weeks Concrete Products
Age of Tank (if known): 14 years
Permit number (if known) 430081
John Schmitt
(Li used Plumber Signature) (Print Name)
MPPS 223760
(Title) (License Number) MP/MPRS
7,17" /7
(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
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Lambert 3 Bedroom Replacement Septic System
Owners Name: Deborah Lambert
Owner's Address 1682 89th Street
New Richmond, WI 54025
Legal Description: NE1/4, NE1/4, S12, T30N, R19W
Township Somerset
County: St. Croix
Subdivision Name: The Highlands
Lot Number: 12 Block Number
Parcel I.D. Number 032-2157-20-000
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: Lambert 3 Bedroom Replacement Septic S stem
Legal pescription: NF1/4~ NE /4, S12, DON, R19W P.1.0: 032-2157-20-Q00
T
Subdivision Name: The Ri htands Lot 1'z
Township: Somerset Parcel Size: 3 SCALE: 1"=so'
County: St. Croix
System Elevation: T1= 96.32 Existing 68.00' Biodiffuser
Slope: 8°1o T2= 96.27 Existing 62.00' Biodiffuser
A BM1 Elevation: 100.00' Bottom of siding T3= 95.50' Proposed 70.00' EZ Flow
0 BM2 Elevation: 103.28' NW lot corner i e T4= 95.50' Proposed 70.00' EZ Flow
■ Backhoe Pits: Existing Tanks Weeks CP 1000
Existing Filter Zabel A-100
See Plat Wlap for complete view of p arceF
4 inch Sch 40-AS 02665
14 inch 3034 - ASTM D30341 I
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SAFETY AND BUILDINGS DIVISION
Plumbing Product Review
P.O. Box 2658
commerce.wi.gov Madison, Wisconsin 53701-2658
TTY: Contact Through Relay
i seon s i n Jim Doyle, Governor
Department of Commerce
Richard J. Leinenkugel, Secretary
February 16, 2010
WEEKS CONCRETE PRODUCTS
RAY WEEKS
1832 215TH STREET
NEW RICHMOND WI 54017
Re: Description: SEWAGE TANKS, CONCRETE
Manufacturer: WEEKS CONCRETE PRODUCTS
Product Name: SEPTIC, HOLDING, OR PUMP
Model Number(s): 1000
(49 IN. L.L., 21.76 GAL/IN., 84 IN MAX. DEPTH OF BURY 511 G.P.D. WHEN USED AS A
SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL
WASTEWATER;. TANK DIMENSIONS = 84 IN. L X IN. W X 49 IN. H)
Product File No: 20100040
The specifications and/or tans for this plumbing product have been reviewed and determined to be in compliance with
plans
chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes.
The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of JUNE 2015.
This approval is contingent upon compliance with the following stipulation(s):
This tank must be designed to withstand the pressures to which it will be subjected.
• The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's
stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the
department.
When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent quality
or
with a maximum monthly average value for BOD5 of greater than 30 mg/L and less than or equal to 220 mg/L TSS, o
greater than 30 mg/L or less than or equal to 150 mg/L TSS, and F.O.G. of less than 30 mg/L.
Approval is issued for this product as being equivalent to a floor outlet water closet when the fixture drain is installed
in the vertical position. The design meets the intent of s. Comm 82.32 (5) (c) and 84.20 (5) (n), Wis. Adm. Code, which
requires water closets to discharge through a minimum diameter 3" drain pipe or fitting and the bowl to conform to ANSI
Standard Al 12.19.2M. The intent of the code is met since this product provides the same functional performance as water
closets that meet ANSI Standard Al 12.19.2M.
• BEDDING: Bedding material shall be used to provide a uniform bearing surface. A min. of 4-inch base of
sand or granular bed on top of a form and uniform base is recommended. The tank should not bear on rocks. Sites
with high ground water tables should have specially designed bedding. Soils should be compacted under the tank.
This approval supersedes the approval issued on 4/21/2005 under product file number 20050106. This approval letter shall
be incorporated with your previously approved plans and/or specifications approved under product file number 20050106.
As of May 15, 2008, a copy of a successful water tightness test report for this product must be AVAILABLE FOR
INSPECTION AT THE MANUFACTURER'S PLANT prior to this product being used as a POWTS holding or treatment
tank in Wisconsin.
The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may
result from its use.
Sincerely,
Jean M. MacCubbin, CST
Engineering Consultant--Plumbing Product Reviewer
Commerce; Safety & Buildings Div.; PO Box 2658; 201 W Washington Ave.; Madison WI 53703-2658
Phone: 608-266-0955; Fax: 608-283-7456; E-mail: Jean.MacCubbin@wisconsin.gov
SBD-10564-E (N.10/97) File Ref: 10004003.DOC
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SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Lambert 3 Bedroom Replacement Septic System
Gravelless Leaching Unit Specifications
Manufacturer Model Laying Length EISA Rating
EZ1203H-5ft 5.0' 25.0
Infiltrator
EZ1203H-10ft 10.0' 50.0
System Sizing
EISA Rating per Foot of EZ Flow 5 ft2 Soil Application Rate 0.7 9pd/ftz
450.0 9pd Design Flow - 0.7 Soil Application Rate = F-5 ] EISA = 138.5 Feet of EZ Flow
F trenches 70 feet long each
2 No. of Cells 7 Per Cell
3 ft Cell Width 14 Total No of 1203H
70 ft Cell Length 350 sq ft EISA Per Cell
3 ft Cell Spacing 700 sq ft Total EISA
Typical Cross Section
Finished Grade 99 ft Observation Pipe with
--approved cap or vent
Soil Backfill
36 Inch ~ Geotextile Fabric
O Slotted and Anchored Vent/Observation Pipe
12 inch with Cap
95.50 ft. Infiltrative Surface
>36 inch
Plumber/Designer Signature:
License MPRS 223760 Date: 06/29/17
Installation Instructions for E ZTM
EZflow Systems in F
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 intercorncr-,e ,
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
Barrier Material
4. When installed in a trench, the trench should be dug to
. uR n
a width of 36 inches. This not only saves labor in excava- 12 o~~rEt_111 _j l {
tion, but also provides better load-bearing capacity after _ cad
backfilling is complete.
a- 36"
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: Deb Lambert Tank Manufacturer: Weeks CP ❑ NA
Permit# Septic ❑Dose ❑-Iolding Volume: 1000
DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete [f NA
Number of Bedrooms: 3 E] NA ❑ Septic ❑Dose ❑iolding Volume: gal
Number of Public Facility Units: 2 NA Vertical Distance Tank Bottom(s) to Service Pad: ft
Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft
Design Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if
In Situ Soil Application Rate: 0.65 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back.
Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Zabel ❑ NA
Fats, Oils & Grease (FOG) s30 mg/L uen I ter Model:
Biochemical Oxygen Demand (BODS) s220mg/L ❑ NA ump anu acturer:
Total Suspended Solids (TSS) 5150mg/L Pump Model:
High Strength Influent/Effluent Monthly average Petreatment Unit NA
Fats, Oils & Grease (FOG) <_30 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) 530mg/L of sorEUon system
Total Suspended Solids (TSS) 530mg/L ❑ NA EJ In-Ground (gravity) ❑ In-Ground (pressure)
Fecal Coliform (geometric mean) s104cfu/100m1 ❑ At-Grade ❑ Mound
Maximum Effluent Particle Size: 'A 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
month(s) Maximun 3 Years) ❑ NA
Inspect condition of tank(s) At least once every: 3 years
month(s) Maximun 3 Years) ❑ NA
Inspect dispersal cell(s) At least once every: 1.5 year(s)
H month(s) ❑ NA
Clean effluent filter At least once every: 1.5 ear s)
month(s) NA
Inspect pump, pump controls & alarm At least once every: ear s)
month(s) NA
ear s)
month(s) 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 sl2 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)
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
r 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. 2105)
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Deborah Lambert
Mailing Address 1682 89th Street
Property Address 1682 89th Street
(Verification required from Planning & Zoning Department for new construction.)
City/State New Richmond, WI Parcel Identification Number 032-21 57-20-000
LEGAL DESCRIPTION
Property Location NE '/a , NE 1/ ,Sec. 12 , T 30 N R 19 W, Town of Somerset
Subdivision Plat. The Highlands Lot # 12
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house ElyesElto Lot lines identifiable ElyesOno
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that yo septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 0 days of the three year expiration date.
I/we certify that all statements on thi form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property de ibed above, by virtue of a warr my deed recorded in Register of Deeds Office.
Numb r of a rooms
3
SIGNATURE OF ; LICANT(S) DATE
***Any information that is misrepres nted 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)
Wisconsin Department of ComMerce PRIVATE SEWAGE SYSTEM County. St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 430081 0
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 Holder's Name: City Village X Township Parcel Tax No:
Grand Properties L.P. L Somerset Township 032-2157-20-000
CST BM Elev: Ins BM Elev: BM Description: l / Section/Town/Range/Map No:
C~ : C 7604 O yYti2f'~t W ed k cf e Wcls 12.30.19.1354
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / Benchmark
v~U G lliD
Dosing Alt. BM
Aeration
Bldg. Sewer
Holding St/Ht Inlet
• .she 1 % $.l3 9~~ 3c~
TANK SETBACK INFORMATION St/Ht Outlet 19,35
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic f Dt Bottom /
Dosing Header/Man. . I -7, 2
Aeration Dist. hips r o,' CN~F,►f ;R- N~ 1 / 7
Holding Bot. System
i • r 'L
PUMP/SIPHON INFORMATION Final Grade ,3U /GG./3
Manufacturer Demand St Cover
GPM /UD,(oU
u,
Model Numh'hc
L-~ 1~ ► I ~,Q Y10 S .
TDH Lift Fn Loss System Head TDH Ft
For afnain Length Dia. Well
SOIL ABSORPTION SYSTEM
jBED/TRENCH Width Length jNo.OfTren has PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 r, jr is ; ~t5
SETBACK SYSTEM TO 7^14 F\ P/L BLDG ELL LAKE/STREAM LEACHING Manufacturer. 0 !
INFORMATION CHAMBER OR n/ l^'
Type Of System: v\J
UNIT Model Number.
7' DISTRIBUTION SYSTEM J
Header/Manifold Distribution x Hole Size x Hole Spacing Vant to Air Intake
s / / t / Pipes
Length~~'v Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Scdded xx Mulched
BedIT ch Center Bed/Trench Edges Topsoil
A U Yes No
-4 COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 0-1 / 0 Inspection _
~ I : o Oryrrt
Location: 1682 89th St New Richmond, WI 54017 (NE 1/4 NE 1/4 1122 T30N R19W) The Highlands Lot 12 Parcel No: 12.30.19.1354
1.) Alt BM Description = 6v"yL- 4 Q~r,n Q a
2.) Bldg sewer length ' ~J 1
- amount of cover - 1 sly ( t .5 tirl r `~'h~1r4 ~o~ i~(
f/
Plan revision Required? Yes No I U~ ~r ► ` ~A~ 1
Use other side for additional information. _ J -
SBD-6710 (R.3197) Date Insepctors Signatu- re Cert. No.
l
• ,/~~(Jr St ow,
` Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7082
seonsin Madison, WI 53707 - 7082 terry permit Number (to be filled in Co.)
i
Department of Commerce (608 rV 3 '13 co
Sanitary Permit Applica n sta Plan I.D. Number,
in accord with Comm 83.21, Wis. Adm. Code, personal informal on you tr#vrlle 2 "U03 All `
may be used for secondary purposes Privacy Law, s 15. (1 xm) Pro erA Address (if different then mailing address)
1. Application Information - Please Print All Information
94 8
Property Owner's Name Parcel # Lot M Block #
O
Property Owner's Mailing Address Property Location.. u / 3
t 7
Ci state r ,[LE. 'a%ti section
ty. Zip Code Phone Number
e
Q (circle
II. ofBulldin TLN; R,J~Eo
Type g (check all that apply)
1 or 2 Family Dwelling - Number of Bedrooms ~L 6'4 t G~lm~-~ AZ Subdivision Name CSM Number
__3 r
❑ Public/Commercial - Describe U
❑ State Owned - Describe Use 7D 1ST' t^_ ff- (itJ lo Fscitp ❑City ❑ Village f Township of O/)J EA S&7'
IIL Type of Permit: (Check only one box on line A. Complete line B If applicable) -
A. t New System ❑ Replacement System ❑ Tteatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal 9 Permit Revision Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber ,er 3
S m0 y34o8/ ~3 0
IV. T of POWTS S rem: Check all that a 1
Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter hing Chamber ❑ Drip Line ❑ Gravel-1 Pi ❑ Other (explain
V. Dis ersaUTreatment Area In ormation:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
"2 4.Y3 rcS3, i F46-11
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units G/JJ Concrete Constructed Glass
New E fisting
Tanks Tanks
Septic or Holding Tank
AMa
Aerobic Treatment Unit
Dosing Cbaa*a
VII. Responsibility Statement- 1, the undersigned, assume responsibility for instal4 f the POWTS shown on the attached plans.
Plumber's Name (Print) PI 's Signature M PRS ber _S-a, Business Phone Number
3
Plumbers Address (Street, City, State, Zip We)
I 2
VIII oun /De artment se Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date; Issued IssuWAgcn ;=P:)
Surcharge Fee) d Z' td Z 3 3 `
❑ Owner Given Reason for Denial Q
IX. Conditions of Approval/Reasons for DisaRproval
~~cU rzu a,~~cr ►i -'t °,~J r~/~~r 4iu/TS
S STEM OWNER:
-
1 Septic tank, effluent filter and 3, S-v is
dispersal cell must all be so / m i In
as per management plan provided by plumber. e p-4ej~ aA"--, .4.~-~/ `j
All setback requirements must be maintained _§_C~ /
as per applicable code/ordinances. nu e". 313.
pAllach complete plans s (to rise County only) for the rystao on paper not less than 8117 :11 lmcb" to sla
SBD-6398 (R. 08/
~ ENS~~Z~t J'c"L~
-A P--fih
.
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9, 1, 11110
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3
03
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o ,
-04_'.._---..-..-------
1173
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt
County
Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel i D
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3 2 _ ~~r~ cy CSL~
Please print all information. Re y Date
Personal information you provide may be used for secondary purposes (Privacy iav, s. 15.04 (1) (m)).
Property Owner Property Location
Grand Properties, LP Govt. Lot NE 1/4 NE 19 S 12 T 30 N R 19 W
Property Owner's Mailing Address Lot # 81ock # Subd. Name or CSM#
712 Rivard Streeet, Suite 300 12 The Highlands
City State Zip Code Phone Number J City _j Village 601 Town Nearest Road
Somerset WI 54025 715-247-5900 Somerset 89Th St.
V1 New Construction Use: so Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
I Replacement _j Public or commercial - Describe:
Parent material Outwash Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sqft rating. Possible system elevation for Area I
is96.90'
Boring # J Boring
601 Pit Ground Surface elev. 100.39 ft. Depth to limiting factor 100+ in. Soii Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 fit,
1 0-7 1Oyr3/4 none sl 2msbk mfr Cs 2m,2f .5 .9
2 7-100 1Oyr5/6 none ms Osg ml - .7 1.2
It
-7 -7~
I
T Boring # J Boring &01 Pit Ground Surface elev. 101.39 ft. Depth to limiting factor 101+ in. Sal na tionRate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1~/ft,E
1 0-10 1Oyr3/3 none I 2msbk mfr cs 2m,2f .5 .8
2 10-17 1Oyr5/3 none st 2msbk mfr 9W 2m .5 .9
3 17-31 10yr5/4 none ~Is 1 msbk mvfr 9w .7 1.2
1
4 31-101 10yr5/6 none ms Os9 ml 7 1.2
I
" Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD <_30 mg/L and TSS <__30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt w> 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 8/16/03 715-247-2941
Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
7 Boring # J Boring
Pit Ground Surface elev. 98.09 ft. Depth to limiting factor 100+ in.
Soil Application Rate
Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots CPD/ft2
`Eff#1 •Eff#2
1 0-13 1Oyr3/4 none sl 2msbk mfr CS 2m,2f .5 .9
2 13-100 1Oyr5/6 none ms Osg ml - .7 1.2
r~
• b
4k
❑ Boring # ~ 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
•Eff#1 GMT
❑ Boring # Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
`Eff#1 •Eff#2
I
Effluent #1 = BOD ? 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.
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