HomeMy WebLinkAbout040-1279-00-000 (3)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 597490
GENERAL INFORMATION State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holder's Name: City Village Township Parcel Tax No.
JOHN & GAYLE ZABEL TOWN OF TROY 040-1279-00-000
CST BM Elev. Insp. BM Elev. BM Description: Section/Town/Range/Map No:
10n c5C 4i'c. Ca 16.28.19.1562
TANK INFORMATION ELEVA ION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark .I Z 50
64/6
~
za'Le-C ' oo Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. en Air Intake ROAD Dt Inlet
Septic 2, t Dt Bottom
Dosing Header/Man. 00, 8.49 9t.sS
Aeration Dist. Pipe If. of air j -S
. liq
Holding Bot. System q,y 9aj• ->C
a, t • 1"
Final GracfA
PUMP/SIPHON INFORMATION i
Z 97• $'`f C;lt
AL
Manufacturer Demand St Cover
GPM 7
JAS .b4 ln6
Model Number
TDH Lift Friction Loss System H Ft
Force a. e Dist to Well
Z
SOIL ABSORPTION SYSTEM Cp a v~'f
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Li id Depth
DIMENSIONS Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: n UNIT Model Number:
aA%J"'a11 1 L Z I 40 90
DISTRIBUTION SYSTEM cr r- Ct g
Header/ManifV Distribution x Hole Size Ix Hole Spacing Vent to Air Qe /►~a
Pipe(s) I~
Length Dia 'T Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed Trench Center Bed Trench Edges Topsoil "Ls No,` es ]:Nd
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 388 CEDAR CT dG 4-6
a , J G Cd J ~~a-:
1.) Alt BM Description =♦"~f
2.) Bldg sewer length
- amount of cover =
Plan revision Required? ] Yes X -11, No ~i
Use other side for additional information. L_ I
Date Insepctor' Signature
Cert. Nc.
SBD-6710 (R.3/97)
oo"
I'v
~~:p xr.CiFV~, County
~I-Industry Services Division St Croix
D ARECEIVED 1400 E Washington Ave
P I"I P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
l'1 t .S i
~ 1 9 201 Madison, WI 53707-7162 -7ZZ ~F~
ST: CP 12111 AppI1C State Transacti n umber
In accordance wrt i . 2 ls. m. submission of this form to appropr" governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms fors muted to
Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information y u provide may be t sed for second~y 19
~
purposes in accordance with the Privacy Law, s. t 5.04(1)(m), Stats. ~ ~ Same 01 1 -1 1 1. Application Inform Please Print All Information
Property Owner's Name Parcel #
Zabel, John &Gayle 040-1279-00-000
1✓, dK.l 1SE
Property Owner's Mailing Address Property Location
388 Cedar Court
Govt. Lot
City, State Zip Code Phone Number NW NW 'A, Section 16
Hudson, WI 54016 (circle one)
T28N R 19Eorv
II. Type of Building (check all that apply) Lot #
® I or 2 Family Dwelling - Number of Bedrooms 30 Subdivision Name
Eagle Bluff
❑ Public/Commercial - Describe Use V.DkeLcleA-4-c~ Block #
11- ll ❑ City of
❑ State Owned - Describe Use
CSM Number ❑ Village of
Z D;**- ct& o~ ® Town of Troy
Ill. Type of Permit: (Check only one ox on line A. Complete line B if applicable)
A. ❑ New System ❑ Replacement System ❑ Treatment/I folding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B ❑ Permit Renewal ❑ Permit Revision i ❑ Change of :LR Permit Transfer to Ncw List Previous Permit Number and Date Issued
Before Expiration Plumber n er 399435, 10/8/2001
IV. Type of POWTS System/Cornponent/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
Folding Tank Other ispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treatme Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Req 'red (so Dispersal Area Prop ed (so System Elevation
600 Rate(gpdsf) 857 900 94.00', 94.70'
0.7
VI. Tank Info Capacity in
v c
Gallons Total # of
Manufacturer
Gallons Units o L s
Ncw'ra rks Existing Tanks „p oy T v V
Septic or Holding Tank 1250 1250 1 Wieser Cot )rete KE ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum is . igi dire MP/MPRS Number Business Phone Number
John Schmitt 223760 715-760-0486
Plumber's Address (Street. City, State, Zip Code)
616 1501h Ave. Somerset, WI 54025
VIII. nt /De artment Use Only
Approved I r-1 Permit Fee Date sue Issuin nt Signature
• 6
en Reason for Denial $ T
IX. Condit b Y+ l~f ,A%Aw' l~r,IDisapproval
ep u r4
utspet tusfaA s
, , etas! r 'n?_ . ee
as per gertNn+ plan pro iideii by plumbe .
2. -'AD setback regLA41*1 4"Illotbe, t-QW1.:C
as p!f 9XItc as colt 1 amrul "S.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I t inches in size
SBD-6398 (R03/14)
PLOT PLAN N
Project Name: Zabel 4 bedroom Replacement Soil Absorption Area
Legal Description: NW1/4, NW1/4, S16, T28N, R19W P.I.D: 040-1279-00-000
Subdivision Name: Eagle Bluff Lot 30
Parcel Size: 1.228 Acres SCALE: 1"=50'
Township: Troy _
County: St. Croix
System Elevation: T1= 95.26 Existing 93.75' Biodiffuser
Slope: 7% T2= 95.26 Existing 93.75' Biodiff user
BM1 Elevation: 100.00' Top of Septic Tank cover T3= 94.70 Proposed 90.00' EZ Flow Trench
0 BM2 Elevation: 99.79 Bottom of siding on the house T4= 94.@0 Proposed 90.00' EZ Flow Trench
■ Backhoe Pits:
Existing Tanks Wieser Concrete W1250-MR
See Plat Map for complete view of parcel Existing Filter Zabel A-100
4 inch Sch 40 -ASTM D2115
4 Inch 3034 - ASTM D3034
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CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Zabel 4 bedroom Replacement Soil Absorption Area
Owners Name: John & Gayle Zabel
Owner's Address 388 Cedar Court
Hudson, WI 54016
Legal Description: NW1/4, NW1/4, S16, T28N, R19W
Township Troy
County: St. Croix
Subdivision Name: Eagle Bluff
Lot Number: 30 Block Number
Parcel I.D. Number 040-1279-00-000
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic Tank Specifications
Page 4 Effluent Filter Information
Page 5 Valve Information
Page 6 System Sizing & Cross Section
Page 7 EZ Flow Information
Page 8 & 9 Management and contingency plan
Page 10 Existing Tank Certification
Page 11 Septic Tank Maintenance Agreement
Page 12 Warranty Deed
Page 13 CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 9/14/2017 Phone Number: 715-760-0486
Signature:
In- round Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
PLOT PLAN N
Project Name: 1 4 bedroom Replacement Soil Absorption Area
Legal Description: NW114, NW1/4, S16, T28N, R19W P.I.D: 040-1279-00-000
Subdivision Name: Eagle Bluff Lot 30
Parcel Size: 1.228 Acres SCALE: 1"=50'
Township: Troy _
County: St. Croix
System Elevation: T1= 95.26 Existing 93.75' Biodiffuser
Slope: 7% T2= 95.26 Existing 93.75' Biodiffuser
BM1 Elevation: 100.00' Top of Septic Tank cover T3= 94.70 Proposed 90.00' EZ Flow Trench
BM2 Elevation: 99.79' Bottom of siding on the house T4= 94.90 Proposed 90.00' EZ Flow Trench
■ Backhoe Pits:
Existing Tanks Wieser Concrete W1250-MR
See Plat Map for complete view of parcel Existing Filter Zabel A-100
4 inch Sch 40 -ASTM D2665
4 inch 3034 - ASTM D3034
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Cell for I-j free ZABEL ZONP • 1-800-221-5742 . Or Or(ier Online: www.zat)elzone.coni
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Zabel 4 bedroom Replacement Soil Absorption Area
Gravelless Leaching Unit Specifications
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ1203H-5ft 5.0' 25.0
EZ1203H-10ft 10.0' 50.0
System Sizing
EISA Rating per Foot of EZ Flow 5 ft2 Soil Application Rate 0.7 gpd/ft2
600.0 gpd Design Flow _ 0.7 Soil Application Rate = ~ EISA = 171.4 Feet of EZ Flow
trenches 90 feet long each
2 No. of Cells 9 Per Cell
3 ft Cell Width 18 Total No of 1203H
90 ft Cell Length 450 sq ft EISA Per Cell
3 ft Cell Spacing 900 sq ft Total EISA
Typical Cross Section
Finished Grade 97.5 ft Observation Pipe with
approved cap or vent
Soil Backfill
36 Inch Geotextile Fabric
12 inch II >3ft Slotted and Anchored Vent/Observation Pipe
1( ~ i with Cap
94.00 ft. Infiltrative Surface
>36 inch 94.70 ft.
Plumber/Designer Signature:
License MPRS 223760 Date: September 14, 2017
Installation Instructions for 4wiIEZ Ow-
JlQ2,p Systems in Wisconsin flbyINFILTRATOR
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- files 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, 1 1. 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 pending 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
f; Barrier Material
4. When installed in a trench, the trench should be dug to
12 ~ ~~FiII31~Ik~ l~T~~~i ~IIt
a width of 36 inches. This not only saves labor in excava- Il'1l,,T i ~-l F
tion, but also provides better load-bearing capacity after o_o
backfilling is complete.
36' -r
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Tank Manufacturer: Wieser Concrete ❑ NA
Owner: John & Gayle Zabel
Permit # 0 Septic ❑ Dose E jHolding Volume: 1250ga1
DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA
Number of Bedrooms: 4 ❑ NA ❑ Septic ❑ Dose ❑-lolding Volume: gal
Number of Public Facility Units: 0 NA Vertical Distance Tank Bottom(s) to Service Pad: fftl
t
Estimated (average) Flow: 400 gal/day Horizontal Distance Tank(s) to Serivice Pad:
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: Zabel ❑ NA
Fats, Oils & Grease (FOG) :530 mg/L uent i ter o e : -
Biochemical Oxygen Demand (BODs) s220mg/L ❑ NA Pump anu acturer:
Total Suspended Solids (TSS) 5150mg/L Pump o e : NA
High Strength Influent/Effluent Monthly average Petreatment Unit
Fats, Oils & Grease (FOG) s30 mg/L Manufacturer:
❑
Biochemical Oxygen Demand (BODs) _220mg/L ~ NA Mechanical Aeration El Peat Filter
❑ Weiland
Total Suspended Solids (TSS) 5150mg/L ❑ Disinfection
Petreated Effluent Monthly average ❑ SandlGravel Filter ❑ Other
Biochemical Oxygen Demand (BOD5) 530mg/L oI sor ton ystem
Total Suspended Solids (TSS) 530mg/L 0 NA L In-Ground (gravity) ❑ In-Ground (pressure)
Fecal Coliform (geometric mean) 5104cful100m1 ❑ At-Grade ❑ Mound
Maximum Effluent Particle Size: in dia. A ❑ Drip-Line ❑ other.
❑ N Other: ❑ NA
Other:
MAINTENANCE SCHEDULE
Service Event Service Frequency
When combined with sludge and scum equals one-third ('/a) of tank volume
Pump out contents of tank(s) When the high water alarm is activated
month(s) Maximun 3 Years) ❑ NA
At least once every: 3 ear(s)
Inspect condition of tank(s)
At least once every: 1.5 month(s) (Maximun 3 Years) I]NN Inspec
t dispersal cell(s) ear s)
month(s) Clean effluent ffter At least once every: 1.5 year(s)
At least once every: year(s)
Inspect pump, pump controls & alarm
month(s) ❑ NA
5 ear(s)
Use T3 & T4 for 5 years
month(s) ❑ NA
Alternate betwwen old & new soil 1 carts
absorption areas annually or as
indicated by inspection after 5 years
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank
inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The
dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Admininistrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
(Rev.2/05)
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 or
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 POW-TS 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
POWTS.
replace the failed
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT
OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY
CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT.
:sue
ADDITIONAL INFORMATION:
POWTS INSTALLER POWTS MAINTAINER
t e: John Schmitt Name: John Schmitt
ne: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. o ^r
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) 388 Cedar Court located
at: NW '/4, NW 1/4, Section 16 , Town 28 N, Range 19 W,
Town of Troy , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service 9/8/2017
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: 1250
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): Wieser Concrete
Age of Tank (if known): 15 years
Permit number (if known) 399435
John Schmitt
(L]' eased Plumber Signatlzre) (Print Name)
MPRS 223760
(Title) (License Number) MP/MPRS
(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
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer John & Gayle Zabel
Mailing Address 388 Cedar Court
Property Address 8 V Cedar Court
'(Verification required from Planning & Zoning D ment for new construction.)
City/State Hudson, WI Parcel Identification umber 040-1279-00-000
LEGAL DESCRIPTION
Property Location NW NW 16 ,T 28 N R 19 W, Town of Troy
'/a , '/a , Sec.
Subdivision Plat: Eagle Bluff , Lot # 30
Certified Survey Map # , Volume Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house l]yesl-lno Lot lines identifiable pyesRno
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper, What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin, Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this rm 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 warm ty deed recorded in Register of Deeds Office.
Number of bedrooms 4
~d 44 I / /17
IGNATURE OF P ICANT(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)
,.Y.....~,
Department of l 7 #1907
S PS SQIL VALUATION REPORT
PS clifu in accord ce with Comm 85, Wis. Adm. Code Page 1_- of 4
Professional Services C~> - Zoi _ Schmitt Soil Testing, Inc.
County
Attach complete site plan on paper not less than 8'% x 11 inches in siz~tonearest St. Croix
include, but not limited to: vertical and horizontal reference opoin - - -
percent slope, scale or dimensions, north arrow, and locatt road Parcel I.
_ 040-127 27 0-000_ - -
Please print all information.' ` Revie d By Date
Personal information you provide may be used for secondary purposes (P1-1, s. 15. ~(m)). at /
Property Owner JG n
S16, T28N, R1
Zabel, John & Gayle s~' o of 1/4fM#
- Property Owner's Mailing Address Lot # Block # Subd. Name 388 Cedar Court 30
City State Zip Code Phone Number City Village Town Nearest Road
Hudson WI 54016 i Troy Eagle Bluff
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Outwash Sand _(Burkhardt-Sattre Series) - Flood plain elevation, if applicable - NA ft,
General comments Replacement area is suitable for a conventional system. Install system S deep on the contour. (High Trench) 947, (Low Trench)
and recommendations: 94.0'. Slope of area is 7%.
Boring # Boring - -
Pit Ground surface elev. 98.16 ft. Depth to limiting factor 92+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture i Structure Consistence Boundary Roots GP_D/ftz _
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 10Yr3/3 none sl 2m9r mvfr as 2m,2f 0.6 1.0
2 10-21 10yr4/4 none sl 2msbk mvfr gw 2vf 0.6 1.0
3 21-36 10yr5/6 none Is Osg ml cs 0.7 1.6
4 36-92 10yr6/4 none s Osg ml 0.7 1.6
Boring
2 Boring # i
Pit Ground surface elev. _ 97.66 ft. Depth to limiting factor 94+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _G_PD_ /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-6 10yr3/3 none sl 2mgr mvfr as 2m,2f 0.6 1.0
2 6-14 10yr4/4 none sl 2msbk mfr gw 2vf 0.6 1.0
3 14-26 7.5yr4/6 none grsl 2msbk ml gw
0.6 1.0
4 26-33 7.5yr5/6 none Is Osg ml cs 0.7 1.6
5 33-94 10yr6/4 none s Osg ml .7 1.6
t -1
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = 5 < 3 mg/L and TSS - 30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt y 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd St. New Richmond, WI 54017 9/8/2017 715-760-1978
SBD-8330 (R.07/00)
Property Owner Zabel, John & Gayle Parcel ID # - 040_1279-00-000 Page 2 _of 4_-
I Boring
3 ]Boring # pit Ground surface elev. _______97.36 ft. Depth to limiting factor 96+ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots i G_PD_/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r*Eff#1 *Eff#2
1 0-7 10yr3/3 none sl 2mgr mvfr as 2m,2f 0.6 1.0
2 _ -7-15_ _-10yr4/4 none _ sl 2msbk mfr gw 2m,2f 0_6 1.0
3 15-24 7.5yr4/6 none sl 2msbk ml gw 1vf 0.6 1.0
4 24-37 7.5yr5/6 } none Is - Osg---_.-- I ml--._-- -cs 0.7 1.6
5 37-96 10yr6/4 none s Osg ml 0.7 1.6
Boring
F Boring # Pit Ground surface elev. 98.46 ft. Deptlt(~o lim ting factor 84+_- in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ! Eff#1 *Eff#2
1 0-10 10yr3/4 FILL sl 2fsbk mfr as 2vf 0.6 1.0
- - - - - - - - - - - - - - - -
2 10-19 10yr4/3 none sil j 2msbk mfr gw lvf 0.6 0.8
3 19-46 10yr4/4 none sicl 2msbk mfr as i 0.4 0.6
4 46-54 10yr5/6 none fs Osg ml as 0.5 1.0
5 54-55 10yr4/6 none fsl Om mfi as 0.2 0.5
6 55-64 10yr5/6 none fs Osg ml as 0.5 1.0
7 64-84 10yr4/4 none fsl Om mfr 0.2 0.5
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 GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#l *Eff#2
i
- - - -
Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00) Schmitt Soil Testing, Inc.
i
Page 3 of 4
Conducted by: Conducted For:
Schmitt & Sons Excavating, Inc.. Name: John & Gayle Zabel
Thomas J. Schmitt, CST 27429 } Address: 388 Cedar Court
586 Valley View Trail City, State, Zip: Hudson, Wl 54016
Somerset,Wl 54025
Phone: 715- 6 -1978 PID: 040-1279-00-000
Signature Lot No. 30 Eagle Bluff
Date '7- ~'o/ 7 Legal Description: NW1/4 NWI/4 S16 T28N R19W
N Backhoe Pit Township, County: Troy, St. Croix County
e Bench Mark 1 El. 100.00' Top of septic tank manhole cover
A Bench Mark 2 El. 99.79 Bottom of siding on house
3
"
Slope= 10% `
Scale 1"= 50'
NOTE: For full view of Lot see Aerial Photo (Page 4 of 4)
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