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HomeMy WebLinkAbout020-1441-76-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600275 GENERAL INFORMATION State Plan ID No: ~ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] i' \j Permit Holder's Name: City Village Township Parcel Tax No: Mark & Sheri Croswell TOWN OF HUDSON 020-1441-76-000 CST BM Elev: Insp. BM Elev: BM Description: - Section/Town/Range/Map No: ` Usk f~ (lt t.' 36.29.19.2802 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j Benchmark Dosing Alt. BM -'i Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom,-), _.r Dosing Header/Man P7 Aeration Dist. Pipe Holding - Bot. System Final Grade PUMP/SIPHON INFORMATION q0, Manufacturer Demand St Cover GPM Model Number tit= ~t n/ TDH L4 i Friction Loss System Head t TDH Ft tt 1 Y ~ - 1 Forcemain Length Dia. Dist. to Well r' . SOIL ABSORPTION SYSTEM BED/TRENCH Width --J L ength No. Of Trenches r7i~~NS No. Of Pith Inside Dia. , J75e~. DIMENSIONS 1 1r SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: / CHAMBER OR UNIT Model Number: f DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vel to Air Intake l.' s Pipe(s) 1.~ { Length " - Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Teeded/Sodded xx Mulched Bed/Trench Center / Bed/Trench Edges-' Topsoil - - / ,....J; Yes G No L Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 663 MARY JO CT r 1.) Alt BM Description = ,`a R 2.) Bldg sewer length - amount of cover =~t Plan revision Required? Yes No t r 1~ ~ 7,1~ ,I LL- Use other side for additional information. • 1 ✓ - J, G :eLL SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. PLOT PLAN N Project Name: Croswell 4 bedroom Replacement Soil Absor tion Area Legal Description: SE1/4, NW114, S36, T29N, R19W P.I.D: 020-1441-76-000 Subdivision Name: Cottonwood Ridge 1st Addition Lot # 76 Township: Hudson Parcel Size: 4.71 Acres LL E: 1^=50' County: St. Croix System Elevation: T1= 95.20 Existing 81.25' INFIL. Standard Slope: 1% T2= 95.20 Existing 81.25' INFIL. Standard A BM1 Elevation: 95.31 To of Septic Tank cover T3= 95.20 Existin 81.25' INFIL. Standard BM2 Elevation: 91.51 Basement floor T4= 95.20 Existing 62.50' INFIL. Standard o Backhoe Pits: T5 95.20 Proposed 75.00' EZ Flow Trench T6 95.20 Proposed 75.00' EZ Flow Trench Existing Tanks WLP1200/800-MR T7 95.20 Proposed 75.00' EZ Flow Trench Existing Filter Zabel A-100 T8 95.20 Proposed 75.00' EZ Flow Trench 4 inch Sch 40 -ASTM D2665 See Plat Map for complete view of parcel 2inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 L s' { V / e 4 U i T3 T.5 ~ t_x,s~ ~a~ 0 3i~61 \v o/ boo A` ~ a N ~ Jf Z G~RAC, L 1° ~ 7 L Page 2 ? 1%- AKYA(J~N, County a `..1 RECEJ Y ED Industry Services Division St. Croix D 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co-) P.O. Box 7162 l r Nov 1 ( Madison, WI 53707-7162 , 1 110MMUNft%W'K iit Applicat State Tran((sjjaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to to ap re e I unit s. is required prior to obtaining a sanitary permit. Note: Application fortns for statre submitted to the Department of Safety and Professional Services. Personal information you provide may e used for secondary Project Address (if different than mailing address) Purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. Same 1. Application Information - Please Print All Information A l5 Property Owner's Name Parcel # Croswell, Mark & Sheri / 0020-1441-76-000 Property Owner's Mailing Address Property Location 663 Mary Jo Court Govt. Lot City, State Zip Code Phone Number SE Ya, NW 'A, Section 36 Hudson, Wl 54016 circle one) T29N R19Eor& IL Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms _ ZY 76 Subdivision Name ) Cottonwood Ridge Ir Addition _j r El Public/Commercial - Describe Use j t t Block # ❑ City of ❑ State Owned - Describe Use _ CSM Numb ry ~ t ❑ Village of 1 I r 1 S"" t L F,, Town of Hudson Ll~) jj_eZ l~ 11VIJ L411,11 111. Type of Permit: (Check only orie Uox on Doe A. Complete line B if applicable) A. ❑ New System ® Replacement System ❑ reaunentlHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit "transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 430329 9/11/2003 IV. Type of POWTS SystemIC o! onent/Device: (Check all that apply) Z Non-Pressurized In-Ground ❑ Pr . surized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil [D-119lding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Plow,(gpd) Design Soil Application Dispersal Are Required (so Dispersal AreaL'rtSposed (sf) System Elevation 600 Rate(gpdst) 1500 1500 95.20' L 0.4 Vl. Tank Info Capacity in y V Gallons Total # of Manufacturer ti U Gallons Units g New "ranks Existing Tanks S 1_ - U r C7 C Septic or Molding Tank 1200 1200 1 Wieser onerete ® ❑ ❑ ❑ ❑ Dosing Chamber 800 800 1 Wieser Concrete ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. e MP/PRS Number Business Phone Number Plumber's Name (Print) PI is tgnatur M John Schmitt r 77Z.C.-_/" 223760 715 760-0486 Plumber's Address (Street, City, State, Zip Code) 616 I50`1' Ave. Somerset, WI 54025 VII1. County/De artment Use Only proved El . ts, eutCd Permit Pee Date Issu d Issuing Agent Signature ~ ~ s' ark ❑ Owner Giveli Rtsan or Denial IX. Conditions of Approval/Reasons for Disapproval C`ech LC~fl~dY1 S ~ SYSTEMOWNER- 1 - ~~~~~Ptl Septic tank, effluent filter and dispersal cell must be sexy ced_/ maintained ttac y l,46 oippl j~ Wind submit to the Count,, only on paper not less than 8 1/2 x 11 inches in size 2. All setback rc un'emen s must be maintained as per applicable code/ordinances. S13D-6398 (803/14) CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Croswell 4 bedroom Replacement Soil Absorption Area Owners Name: Mark & Sheri Croswell Owner's Address 663 Mary Jo Court Hudson, WI 54016 Legal Description: SE1/4, NW1/4, S36, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Cottonwood Ridge 1st Addition Lot Number: 76 Block Number Parcel I.D. Number 020-1441-76-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic and Dose Tank Specifications Page 4 Effluent Filter Information Page 5 Dose Tank Cross Section Page 6 Pump Curve Page 7 System Sizing & Cross Section Page 8 EZ Flow Information Page 9 & 10 Management and contingency plan Page 11 Existing Tank Certification Page 12 Septic Tank Maintenance Agreement Page 13 Warranty Deed Page 14 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 11/5/2017 Phone Number: 715-760-0486 Signature:: " i7 In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Croswell 4 bedroom Replacement Soil Absorption Area Legal Description: SE1/4, NW1/4, S36, T29N, R19W P.I.D: 020-1441-76-000 Subdivision Name: Cottonwood Ridge 1st Addition Lot # 76 Township: Hudson Parcel Size: 4.71 Acres SCALE: t^=50' County: St. Croix _ System Elevation: T1= 95.20 Existing 81.25' INFIL. Standard Slope: 1% T2= 95.20 Existing 81.25' INFIL. Standard A BM1 Elevation: 95.31 Top of Septic Tank cover T3= 95.20 Existing 81.25' INFIL. Standard A BM2 Elevation: 91.51 Basement floor T4= 95.20 Existing 62.50' INFIL. Standard ® Backhoe Pits: T5 95.20 Proposed 75.00' EZ Flow Trench T6 95.20 Proposed 75.00' EZ Flow Trench Existing Tanks WLP1200/800-MR T7 95.20 Proposed 75.00' EZ Flow Trench Existing FilterlZabel A-100 T8 95.20 Proposed 75.00' EZ Flow Trench 4 inch Sch 40 -ASTM D2665 See Plat Map for complete view of parcel 2inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 t' L. r~ ~1laL ~k '5 T(I zoo/ ~(Ie' ~cryi is Jt)~s~ I ~-f ~~Ok~cry O VJ ` 6~6~f9t ~i~' 2 G~RF16~ ~a J l d / G Page 2 an-oos/ooalaw~3ni~ 9Sb8-5Z~-008 ° z\ OSLbS IM 'NOOa N301VN OL .,MH Sn 9LLCM :dnOd-1SOd -31V0 00 00 00 31VU 1dnNVn Olid3S w O VOS 313dDI~DD 13531M anod-3bd 3~vOS dOM J8 NMVao ~W-008/OOZLd 1M n w m z > a o co O m ce w l/1 CL LLJ Li 0 (n V) CL O ~p a~ p F Q . °w U w J wp W m L D C/O Z H V) XO lLO . d D xm Q I Q o o z fY Q J"i °m Zia zz mL` z 3 LL 0 W pm OQ QJU U tiJ O Q CL Cl I~ w D OO 0Lj WF~-W U° z OQ Q a C) Q m o mti ~LAC) (o J cod vwio U) Y a s J z p U o0 eo a¢ w N° V' M: Q 00 d-re) M w l ¢ w Ln Q Cj 00! 0 mwW ~ \r-r\\ d'0H J~j~ I <H- < r}}7N 00 Lj zz z ~..J ~ Q ° NM Co x W ~00 J<U ,wJZ~ F- Z (/JU ~(n Ho O JmU QCO zzx v w Uw owo o~ N CO !n ..O C O0 -L: - 'SOS 0 LLI OOUS W o ma_(n XX NU Ile, °¢o oQwLz Z4caa a° ° z no ~m o0 n- Z z~m uM3:-1 `mJ F- p O ~Y Q J J J a z 0 Q U Z W Z J J F- U F- U) I < --i D F- Q U W > W D ~ ~7 W II 0 1 II• I I I, w II ` I II III L II IP I ° 11 I~ I I I N 11 - II o ~I _ ~ N w II I~ > I I a •II ` ~ 11 ~ I I I o 0 I I o f JI W ~a I►• I I. w Q ~II ~ II ~ w II Q I~ i• I I a 1 I I III I ° U Q D r w Z w QO~a ry Q „96 Sd ~5 Y z a Page 3 A10Q A300"r A600`-12 Series Fibers he int :r, A b; st t; arc 4 a ccdi "hrou_hout ht i lnited `t'tt th :re tr~>~r tf 3 •_nc c~ oar-icn on ,a•-at thi in'cn,31 uld be -_ut most rr~~~wlat a-_r:nc,>, sugg: A c) years he label .iltc~r. vv" C ~ r, rev: in r~ c t `rc,s r1c;r cr t , ~ictn~ t_r the tan1:. ~ould C~, clcar~ r~hc~ th=:pt t is vtrrall f :ed and pu n~~ I Ic,~F .:r _-ur fiecr t 'artualt'y ck 7 ng. Ire n'in d 4c'ia c he Ors r'reb orQa r1` h lab= I fzr: cau~es :~zgcd p;~ .tdt.,s .o disint :gra;c and f_,il cl L-:: _-•_r.cm J t 'an -;_-..r iltor t U n,. u ~m ri: t : al m, wcr- Mll be ncttf an at~~ n ~.hcn t "o `Gltcr nerw:, in; To service the titter. ~.`e {'r ~ai~J uil~r~::.; 4~~'~ r 3i' f it ~L~Uit7 :7'ii~r l~'t~' !1l~tii ~ ~+:r' !:4`'rit+'~4`i7 $t"S~•iil: iuiir GUI~;L~i f (if ti`}C%; ii4 ~ STEP STEP STEP L ~~iir`i tt u~'~ ,'iY t'.IC• ~ ~ r J pj- i t rk if _ {tt c',{ 4.' jh~ to r i.,c1t ary ~ge wt of thc ~,'srrt ZDi-rc`c cVy r..r-a4vt~. STEP STEP Irr;, t u ;i r cartrdie v nakir- >r rs t:_K ,~'"i. F s t C r L, rtrc 1; l~.., i f :try 4 is f c P'2 r j r I r~_r ~~~~~o ~7ttt;• _ I ~ 0!f ivtC t 6 nL ca •fu to rn sc rc~ tr t7e casE j :`e se -t c :nrk 'A:CE•{'IEer. t*- sJ•c 3!1J T.Cc'I C--ar'te _.J:-.`. Cc-'rl'g t~-rr,t3ai}lt'L`,Q( Call for a free ZABEL ZONE' - 1-8001-221-5742 -Or Order Onlirie: www.zabelzotio.coni Page 4 SEPTIC / PUMP TANK SPECIFICATIONS 4"0 Vent Pipe (No Scale) >10 ft from Building Electrical must comply with 12" Min. or 2.0 ft above SPS 316 and NEC 300 Established Flood Elevation Extend manhole riser as necessary. Weatherproof (typical) Approved Junction Box Approved Locking Manhole IMPORTANT: Vent Cap with Warning Label Attached ~ (typical) Anchor tank(s) as necessary Conduit pursuant to SPS 383.43(8)(g) 4" Min. or 2.0 ft above Established Flood Elevation (typical) Airtight Seal Finished Grade Quick Disconnect 18" Min. CAPACITIES @ 22.24 gal/in a (typical) 1 Depth (in) Volume (gal) ' - A 18.0 400.32 * I Weep Approved Joints with Hole Approved Pipe 3 ft onto B 2.0 44.48 A Solid Ground (typical) [C] 7.0 155.68 -Alarm D 9.0 200.16 B b-on [C] PUMP-OFF Pump Tank Liquid Level = 36 in Pump -oft ELEVATION = 888.211 ft D _ Concrete INSIDE BOTTOM Force Main Diameter = ~~~in ` Bloc< ELEVATION = 87 46 ft 2355 ft 3" Approved Bedding Material Beneath Tank Farce Main Length = Vertical Head = ~~ft Force Main Void Volume = 38.31 gal + Min. Supply Head = 0 ft mommoomm~ [C] Total Dose Volume (TDV) = 194 gal/dose 14 + FM Friction Loss ft (5X total lateral void volume < TDV < 0.2X design flow) + (force main drainback volume) + Fitting Loss* = ft *(min. supply head x 0.3) IN. PUMP DISCHARGE RATE = 20 gpm = TOTAL DYNAMIC HEAD = 2_3.3 ft M F_ ONMENSWA~ PUMP TANK: SEPTIC TANK(S): Volume = 800 gal Total Volume = 1200 gal Manufacturer: Wieser Concrete Manufacturer(s): _ Wieser Concrete Pump Manufacturer: Gould Install approved effluent filter at the septic tank outlet woommomom~ EP0511 (See attached pump curve.) immediately upstream of the pump tank inlet. Pump Model Controls/Alarm Manufacturer: Filter Manufacturer: Zabel Controls/Alarm Model: Filter Model: A-100 Float switches containing mercury are prohibited. Page 5 Wastewater METERS FEET 10 q 30 -►~~l-5GPM 8 2.5 FT i 25 0 7 I w 2 U 20 B Z 5 0 15 4 EPO S' 0 ~ 3 10 3 i EP04 2 Y 5 1 0 00 10 2b 30 40 50 GPM i i 0 2 4 6 8 10 12 m3/h CAPACITY MODEL INFORIMATION Order Minimum Float Cord Discharge Minimum Minimum Minimum Maximum Shipping Number HP Volts Amps Circuit Phase Switch Length Connection On Level Off Level Basin Solids Weight Breaker Style Diameter Size Ibs.kg EP041 1 Plug / 10' Manual Manual 20 / 9.1 No Switch 10' 12" 6" 21 / 9.5 EP041 1 A WPiggyback / ide-Angle 115 12 20 EP0411 F Plug / 20' Manual Manual 20 / 9.1 No Switch .4 EP0411AC Wde-Angle 20 12 b 21/9.5 EP0412 1 No lug 10' 1 Manual Manual 15" %1" 20 / 9.1 230 6 10 EP0412F No lug 20 Manual Manual 20 / 9.1 EP0511 F Plug / 20' Manual Manual 22 / 10 No Switch 115 13 20 EPOS11AC .5 Piggyback / 20' 12" 6" 23 / 10.4 Wide-Angle EP0512F 230 6.5 10 Plug / 20' Manual Manual 22 / 10 No Switch PAGE 3 Pai:e6 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Croswell 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 07gpd/ft` 600.0 gpd Design Flow + 0.4 Soil Application Rate _ F-5-1 EISA = 300.0 Feet of EZ Flow F4 trenches 75 feet long each 4 No. of Cells 7.5 Per Cell 3 ft Cell Width 30 Total No of 1203H 75 ft Cell Length 375 sq ft EISA Per Cell 3 ft Cell Spacing 1500 sq ft Total EISA Typical Cross Section Finished Grade 97 ft Observation Pipe with approved cap or vent Soil Backfil! 36 inch Geotextile Fabric O O O Vol 12 inch Slotted and Anchored ~I b:- Vent/Observation Pipe with Cap 10 - >36 inch >3 Feet 95.20 ft .Infiltrative Surface Plumber/Designer Signature: License MPRS 223760 Date: November S, 2017 Paee 7 Installation Instructions for 4AE ~WTM EZfloy) Systems in Wisconsin Z flbyFIITRATOR 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. rninistrative 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). Remave 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 HVVVV''vo V, `a"o 4etlepo ga~rier tMatenal inches from the bottom of product. 4. When installed in a trench, the trench should be dug to 19 !~jill~u~ a width of 36 inches. This not only saves labor in excava- I tion, but also provides better load-bearing capacity after ° backfilling is complete. . 36" Page 8 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 PObVTS 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; anc 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 soi 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 shad 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 repairec 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 e suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is riot 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 4; 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 minim im 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 quarantee the performance of the POWTS. Paee 9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Mark & Sheri Croswell Tank Manufacturer: Wieser Concrete ❑ NA Permit ] [Z Septic ❑Dose LJ-lolding Volume: 1200 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA Number of Bedrooms: 4 21 NA ❑ Septic E]Dose ❑}iolding Volume: 800 gal Number of Public Facility Units: 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: 0.40 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 Effluent Filter Model: Biochemical Oxygen Demand (BODa) s220ni ❑ NA Pump Manufacturer: ou 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) s150mg/L ❑ Disinfection ❑ Wetland Petreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other Biochemical Oxygen Demand (BODe) 530mg/L o1 so, rr tion System Total Suspended Solids (TSS) 530mg/L El NA ~i In-Ground (gravity) ❑ In-Ground (pressure) Fecal Coliform (geometric mean) :5104cfu/100m1 ❑ At-Grade ❑ Mound Maximum Effluent Particle Size: X. in dia. A ❑ Drip-Line ❑ Other Other: ❑ N Other: ❑ IN MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume At least once every: 3 month(s) Inspect condition of tank(s) ear 5 (Maximun 3 Years) El NA At least once every: 1.5 month(s) (Maximun 3 Years) ❑ NA Inspect dispersal cell(s) ears At least once every: 1.5 H month(s) ❑ NA Clean effluent filter ryear(s) Inspect pump, pump controls & alarm At least once every 15 nth(s) ❑ NA H meaor s For at least 5 month(s) ❑ NA Dry existing drain field ear(s 1 mo Alternate between new and old nth(s) E] NA ear(s) drain fields 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 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) Paee 10 S"1 CROIX COUNT"Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM _ Mark & Sheri Croswell V NN (IW ( LU.Y lrt Mailing Address 663 Mary Jo Court PropettyAdd r,9 663 Mary Jo Court (Verification required from Plannint= & Zoning Department for new construction.) City/State Hudson, VVl Parcel Identification Number 020-1441-76-000 LEGAL DESCRIPTION ` C 3" -r 29 >\t 19 Hudson Prnp-r-tk= T n-?~i SC NW Subdivision Plat. Cottonwood Ridge 1 st Addition Lot # 76 J Certified Survey Map # Volume Page # `N'arranty Deed # -1 9 15 (before 2007)Volume Page # Spec house 1-1yesEbo Lot lines identifiable 0yesE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the svstenl call 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 ovv-nc i mill b a Gidszci- "'i uiiiocf, "ouri-,C' aiaii "ii unip Ci " •uuwi. of a iiccilscii ual ci- tiCi"i 1' a that' [ t lc oil-siic wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full ofsludge. 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 true to the best of Illy/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office_ Number f b' root>IS 4 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. include with this application a recorded warranty deed from the Register of Deeds office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Pale 12 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) 663 Mary Jo Court located at: SE '/4, NW '/a, Section 36 , 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 t l` 2 9-/7 Did flow back occur from absorption system'? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1200/800 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser Concrete Age of Tank (if known): 9/11/2003 Permit number if known) 430329 l John Schmitt (Li nsed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS -z 17 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Set-vices Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 11 W Lt+ 31WO ohm ON84 Q h I I Kuwnwm~amisnaix~rx~ou W C:2 cv 0 O ( p ea; P. ®I W v g g; i t = szso~ 3N1NtNUXK Hl11CM! .iseea w 9 LL ~ sK~y OJB5 m ~ by $ J O ww a~ \ Q! m ri `1'~ ~ ` by ro f3 ~"tiuw Z O O m OU. w Z ,a ♦ ozo OqR Ow w IL cc 4 LL e.yy GO- Z Z 4;~ psi !~-xg 3 to W O -J 0 = R ~ co LL a O = k~~9; , l fc -v IL 31. co z F- 1- F- 9 a O 1 7 h'~8 LL O? . ,Ng 1 I ~1S Ory~ { ra {V Z '=I l 3 : ~3~2pca~,y LL~ } 00 uii 1 a , ~C WWA43N130 WQS 3N1 C0 3M MM M.1O01.00N W313 O1 mYY1fL3Y'K NCU."T353O 3w tlt K9)OS WI)ON 3N1 Q1037N3N333tl3W S9~FW3B ~ ~ ~j 4 ~ ~ 3 VihYJL1LSlYl~J1Q~ z w~ O m W 0 0 0 I I f -1 a ~p Qw I' W Q0 rc w 6 3 s i q: , Z L (o fla Ctl Ur 3 a x d ffi qw 1k=) Page 14 Wi:consinQepartmentofCommerce PRIVATE SEWAGE SYSTEM County. St. Croix Sataty arn#Building Division _ ` INSPECTION REPORT Sanitary Permit No. 430329 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 Bast, Kernon Hudson Township CST BM Elev: Insp. BM Elev: BM Descripti ection/Town/R le/Map No ~ 36.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2- 36 1 a 9S• ~'G Dosing n' Alt. BM "Wo~ft 6 P- o. Aeration Bldg. Sewer Holding St/Ht Inlet 3a-3 V , °I X0,3 TANK SETBACK INFORMATION SUHt Outlet --TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom Dosing Header/Man. -7( Aeration Dist. I OF ' cGt b-~ y s Cv~ Holding Bot. stem 7-75- '91'1-51 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM J }rl" S / IO / 3 Model Number r~a 3 ~ /y TDH Lift Friction Los L SystemiH add TDFj Ft v ~t~ 9 f ~ (i I Force n in L _r th Dia. st. to Well SOIL ABSORPTION SYSTEM ('5-{-(`3+ 0 t O 7z:~ 14,q BED/TRENCH Width Length No. Of Trenct s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ SETBACK SYSTEM TO P/L , BLDG WELL LAKE/STREAM EACHING Manufa INFORMATION J7`/iC -16 -r4i Typ f System: CHAMBER OR V y w/r UNIT M at umber: DISTRIBUTION SYSTEM / Header/M ' older Distribution x o P. Size x Hole Spacing Ven n 1i"~ Pipe(s) r ~Air lrrt~ke -y~ ! Length~V 't Dia ti Length pia f Spacing i' `j~7 v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~f TDh Over xx Depth of Seeded/Sodded xx Mulched Bed/Trench Center rench Edges Topsoil Yes ! ! No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:Z ~7 0 Inspection #2: -YU Location: 663 Mary Jo Court Hudson, WI 54016 (SE 1/4 NW 1/4 36 T29N R19W Cottonwood Ride 1 t Ad Lot 76 Parcel No: 36.29.19. 1.) Alt BM Description Wl (1(6m, 2.) Bldg sewer length = /,tj y p f, "w.e/I / A - amount of cover 3 ~Qoet C~ c-4 Plan revision Required? Yes I>] No -T----r ~_I 4re~Use other side for additiona nformation. SBD-6710 (R.3/97) Date Insepctor's SigCert. No. f />v y . 3 De"v.,oop eFPvoN /395 r 3 .0o,v1V t VE&R 13145 r-" Wisconsin Department of Commerce SOIL EVALUATION REPORT page of 3 Dtvhbn of Safety and Bt>itdtngs In accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not loss than 8 1/2 x 11 Inches In size. Plan must s r G`` 0n1~~ Include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. 5e Ikk Lv IE percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please grin( all'A RV E D Reviewed by Date Peraondi h+rormadon you pmAde may be us for .acondary pur"" (Privacy t.aw, - 15.04 (1) (m)1. 'l) \ Property Owner ropertyL.ocallon IVE of W z IV51,1 X11/LGp p,s~ JAN 0 9 2003 ;OL Lot S£ tfe,Uttllra S3& Y 2Q N R/~ ~(orJW PM ~ Owner's MalthgAddress _ t ST C20,x000f.TY of if Block tf Subd.Name orCSW.• Pl,,V6- dJ 4' Cry. /ZONING OFFICE late Zip Code Mone MAW" ❑ City village Town Neared R IVA blad 11 14 ~i`UpSo.v w/. 5,/0/4 (7i5J3b'G ~izq ffv~So.✓ /fw r N C ortsfructlon Use: 00 Residential J Number of bedrooms 3 Code ded ed design flow rate Y_S© ~o O"U GPD ❑ Replacement ❑ Public or commerdal - Describe: parent matedaf /0 55 !W &?e s~ 40J 25V J-, , Fbod Plain elevation H applicable ! R m vn to: TEST ~9Rt~4 sue, a~ l/ CD,t1 U~ 7`iON~¢ L ~ D• Gam, % • S . C/3/D l,~i' FFV S ~~5~ 16 ' Boring N ng b F ® pit Ground surface elev. R. Depth to Arr>H{rrg factor' in. • Appfla" sd Rate Horizon Depth Domkrant Color Redou Description Texture Shicture Consistence Boundary %ON kt Mtnsel Ou. Sz. Cord. Color Gr. Sz- Sh. •Eflttt •EtFA2 l o-1Z loy/'c3/ L ~v1f<' 041 y (P Ob z 11 a2- S/ Z- /-/S&e 41-6k C1~0 /7 Z 3 3' Y 7-5,V SL ~~sh~ "ko w c .2 2- eoring zCv > 5 Pit Ground surface elev. R. Depth to limning factor in. Sol Applicatort Rata Horizon Depth Dot inant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Mtmsell Ou. Sz. Cont Color Gr. SL Sh. 'EfNlt 'Ett112 o G' /o t 3 G /~s6 orfiQ lfJ 3 f ~,rh 2 /b ~.S - 5L atshll,'~ 4v1 fie S s 9 3 z / 7. S s / c - -7 /a S S Effluent p1 a o > 3D < 220 mg/L and TSS >30 1150 WgrL. • Effluent x2 • BOD < 30 m4l" and TSS < 30 rnWL CST Name N"bar Ko I3ER 711h ?/',-h T- Signature .2 G S Address Data Evaluation Conducted Telephone Numbet Ulbricht & Arsoclntes 71S• 3 ~G • ~~~5 C55 O'Nali nd. I+udson, wla.:~rote ~iiVS s~ o~Nl~ ago- ~/op . ~d • ~ Property Owner /t ~r L GUt (C So,~ Parcel tG a 0-10 - 1161 • o o Page Z of Sog# F3-1 M-pl~j Gm and surface elev. J! ' Z fl. oeptl, to rtmttr,g factor fo in. -Appkatm Sod Rate Ho+fnon Depth DorrrlnaM Color Redox Description Textre Structure Consistence Boundary Roots GPIW kr. Mtnse# qu. Sz. Cant Cola Gr. Sz Sh. EMI 'ER#2 / o•~/ /~y~3 shc, of 2 /d S~~- / S k rg C4i >G Z 0' S 5~ 2-)" S 3q. q6 /D /-f i ' Borl # Boring Pit Grp W surfa4 Iv Depth to llmitktg factor in. Sod Appkation Rate th Dom(nanl Color R x pfion Texture Stricture Consistence Boundary Roots GPDN W in. Murrell Ou. Sz- CoM Cola Gr. Sz. Sh. 'Eff#1 'Eif#2 E Bo ft # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to W &V factor in. Sod Aoplicat Rate Hon mn Depth Dominant Coin Redox Description. Texture Stnuctm Consistence Boundary Roots GPOtlf In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 Efft12 D BO&V # ❑ Boring ❑ pit Ground surface elev. 11. Depth to *niting factor in. Sod Application Rafe Horizon Depth Dominant Color Redo Description. Texture Structure Consistence Boundary Roots GPDM In. Munsed Qu. Sz. Cont Color Gr. Sz. Sh. 'FJf#1 '002 ' Effluent #1 = BOD, > 30 < 220 mg4- and TSS >30 < 150 "V& • Effluent #2 = BODr c 30 mgt, and TSS 130 mWI The Department of Commerce is an equal opportunity service provider and employer. of you need assistance to access services or need materiel in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. i soars»ra.smr 01- 5 r~ ' OVA r o Q (3 Zo r ~ Aix • i = ~o • r 2., b 16 ;fir 9y.35 ~f ,7U r of Va. S For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater oonsubM and ptumbM 655 O'Neil Road Hudson, WI 54016 715.386.8185 or 715.772.3442