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HomeMy WebLinkAbout026-1087-50-130 (8) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: OSoL GENERAL INFORMATION (ATTACH TO PERMIT) S Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)j. Pe if Holder's NaLerLt-h- City Village Township rcel Tax No - TOWN OF oZtp - /~T~~ Sd_ /3a CST BM Elev: Insp. BM Elev: BM Description: Section Tow i/Range/Map No ~ rA 36 -ire). ~S TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~f Benchmark O ` ~P7 (4~ 106 Dosing Ct ( L1.1 ca ~ b~ Alt. BM 77. 7"5 Bldg. Sewer Holding St/Ht inlet TANK SETBACK INFORMATION St/Ht outlet 9 la . 73 TANK TO P/L WELL BLDG. Vent to it Intake ROAD 66*A S X10 Septic 124; Dt Bottom .0 0 O 6 Dosing 87 , 2.4 Header/Man. i 33 Aeration rt. Dist. Pipe fl. Z A.: Holding ` Bot. System PUMPISIPHON INFORMATION Final Grade , c1 Manu facturer Demand Si Co~( -!r 9 Model Number GM TDH Lift Friction Loss System Ft Forcemain L Dist to Well SOIL ABSORPTION SYSTEM EBEDITRENCH Width Length No Of Trenched PIT DIMENSIONS No. Of Pits Inside Dig Liquid Depth 3 Z_ SYSTEM TO P/L BLDG 1LL LAKE;STREAM LEACHING Manufacturer CHAMBER OR Type O System: UNIT 0 A J s M $7 ] "may Model er DISTRIBUTION SYSTEM 6, S to S 3 Header/Manifold 0 ution x Hole size x Hole Van Dia A(s) Q~ Dia Spacing SOIL COVER z Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over , B Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed I rench Center Ld Bed/ r ench Edges Topsoil II ` Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1.) All BM Description = If G 2.) Bldg sewer length = L O - amount of cover J y ~a~ Plan revision Required? [I Yes No R U Use other side for additional information a Date nsepctor' gnature Can. No. SBD-6710 (R.3197) ~.eaari~ r, - t County In St. Croix X+') S r Ij U ~,C l_2 ~C [E )3 1400 E Washington Ave ` (J Sanitary Permit Number (to be filled in by Co.) i'~' S •~w" Madison, WI 3707-7 2 `r w.~ jf l JUN O 1 201& 66662-4 u~ Sancta tiler it Application State Transaction Number In accordance with Dex~ , c fission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. Same 1. Application InformqtiQQ - Please Print All Information A; 72- 149, 11J Property Owner's Name ( Parcel # ,3 0,3 0, if, vl S Gerhardt, Dale & Debra "29-1087-50-130 4j Property Owner's Mailing Address Property Location 1372 100th Street Govt. Lot City, State Zip Code Phone Number SE V<, NE 'A, Section 30 New Richmond, Wl 54017 (circle one) T30N R18EorW II. Type of Building (check all that apply) ® 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name NA El Public/Commercial - Describe Use Block # ❑ State Owned - Describe Use ❑ City of CSM Num r D V~1AQ ❑ Village of ®Town of Richmond Z 6,.t0%T_ c 1v5 t v 4-:54- 5 EZ ~ S t1 III. Type of Permit: (Check only one box on line A. Complete line B if a pli able)) T v v zo& Lai- zllpt4 A. ❑ New System ® Replacement System ❑ TreatmentlHolding Tank Replacement Only ❑ Other Modification to Existing ~ a B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 315894, 8/21/1998 IV. Type of POWTS System/Component/Device: (Check all that apply) Non-Pressurized_ln-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 6! 7,6 V. Dis ersal/Tre tment Area Information: Design Flow (g Design Soil Application Dispersal Area Required ( Dispersal Area oposed (sf) System Elevation 450 Rate(gpdsf) 643 650 90.30', 89.60' 0.7 VI. Tank Info Capacity in Gallons °J Total # of ,a o o Manufacture ro v U New Tanks Existing Tanks Gallons Units &J W 11 OSLA t o v a. U r7 v~ w C7 LS,. so A 3,U - 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) Pl~rre s 5if-ature 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 VII ount /Department Use Onl Approved Per4j4 Date sue Issui Agent sign re iven Reason r Denial $ / IX. Condit, r tsalg; Im Disapproval 'G1SpeRr:a cel4jo ail be ti°i 1Cps ! Ir r rltc'r 8M riper mar nt plan iced by plumber. Ql t 2. Allae+b~:kr -,anstnusttt ;F::u.^tz+r:e., / `0 s A. Soper topic" cod-/-:.rdl,vv-.r . Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x t 1 inches in size SBD-6398 (R03/14) SYSTEM PLOT PLAN Project Name Dale & Debra Gerhardt Design Flow: 450 GPD N Attach design flow calculations for Project Address: 1372 100th Street commercial plans: BM1 Symbol: A BM Elevation: 100.00' Pipe Materials / ASTM Standard BM Description: Bottom of siding on house Scale: 1" = 50' Tables 384.30-3 & 384.30-5 p 50 75 100 BM2 Symbol: A BM Elevation: 95.64 4" Sch 40 ASTM D2665 BM Description: Existing septic tank cover 4" 3034 ASTM D3034 Slope Gradient of Tested Area: 13% Standard Standard 12.52 Well Symbol (if applicable) i Notes: Notes i I I Property Line - To 100th Street Driveway Flood Elevation Garage 79.60' G 83 85 87 89 91 93 95 Well I I I I 3 Bedro m I t \ House I BM 1 I I B2 val\ B Existing Week's C. P. 1000 gallon septic tank 61 ~ I I I B6 \ ■ ■ Concrete Filter canister w/Polylok 525 effluent filter I I I I :5 10 I B3 I 2-3'x65' EZ Flow trenches Property Line t ~cp i T2-Existing 3'x56.25' Infiltrator High Capacity chamber trenches pngp CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Gerhardt 3 Bedroom Replacement Septic System Owners Name: Dale & Debra Gerhardt Owner's Address 1372 100th Street New Richmond, WI 54017 Legal Description: SE 1/4, NE 1/4, S30, T30N, R18W Township Richmond County: St. Croix Subdivision Name: NA Lot Number: 8 Block Number Parcel I.D. Number 029-1087-50-130 Wan Transaction "JG, rage S index and titie Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 i=nter Canister Specifications Page 5 Effluent Filter Information Page 6 Bull Run Valve Page 7 System Sizing & Cross Section Page 8 EZ Flow Information Page 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: 5/31/2018 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Project Name Dale & Debra Gerhardt Design Flow: 450 GPD N Attach design flow calculations for Project Address: 1372 100th Street commercial plans: BM1 Symbol: - BM Elevation: 100.00' Pipe Materials / ASTM Standard BM Description: Bottom of siding on house Scale: 1" = 50' Tables 384.30-3 & 384.30-5 0 50 75 100 BM2 Symbol: A BM Elevation: 95.64 4" Sch 40 ASTM D2665 BM Description: Existing septic tank cover 4" 3034 ASTM D3034 ZZA Slope Gradient of Tested Area: 13% Standard Standard 12.52 Well Symbol (if applicable) Notes: Notes Property Line - To 100th Street -IV Driveway Flood Elevation Garage 79.60' ~ 83 85 87 89 91 93 95 3 Bedro m Well I I I I I House I I BM 1 I ;2 valvX1 B xisting Week's C. P. 1000 gallon septic tank I I I 1 , B1 I I I I ■ B6 ~ ■ Concrete Filter canister w/Polylok 525 effluent filter I I I I ■ :5 I B3 2-3'x65' EZ Flow trenches Property Line 2-Existing 3'x56.25' Infiltrator High Capacity chamber trenches Page SAFETY AND BUILDINGS DIVISION Plumbing Product Review commerce.wi.gov P.O. Box 2658 Madison, Wisconsin 53701-2658 i sco n s i n nY: Contact Through Relay Department of Commerce Jim Doyle, Governor 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 plans for this plumbing product have been reviewed and determined to be in compliance with 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 with a maximum monthly average value for BOD5 of greater than 30 mg/L and less than or equal to 220 mg/L TSS, or 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 Page 3 £1133HS:3314 9518-5Z~-008 0102 'Nbr 'n32~ O \ aflOd-1SOd 31V0 OIOZ ,1 jvnNVf :31N0 OSLtiS IM 'NOON N301VW 04 I.MH Sfl 9LL£M ~vnNVN 011d3S Z L'i :aInOd-38d ,0-j = „ti £:31VOS 1MS -.1.8 NMVNO 31303003 13531M = II`d13O 831SINd0 2131113 V ~ J J Z J Q Q Q J _ bi W O p cn J to Q W J ~ j V) O W Z F- 71 Q:~ W Q C)O(J') p U N J W (Y W M J N i QW ~ F z LL ~ a - J U N r( Q ~ U w N o Y O W `Y N 2 C O Z I~i ~ . J d Q J I 'NIW ,,2L W p Z o Q~ =Q U J J d I W LLJ z „Z Z cn F: 119 V) N Ja' z U~ J2'(D O Z J W N J Q LLJ (n H J Q Z W Q Q Q ~ LLJ Of IW o u a~ a Page 4 M ^4wiOAA .~xln Zabel' k' 11 Effluent IaiIi 'I A Division of Polylok In, The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Alarm Switch for 10,000 GPD (gallons per day). p 10 000 GPD (Optional) 525 linear feet of 1/16" filtration. Accepts 4" and 6" SCHD 40 Accepts nvle pipe. Extension Handle Built in gas deflector. Automatic shut-off ball when filter is removed. Alarm accessibility. Rated for 10,000 GPD Accepts PVC extension handle. Ideal for residential and commercial waste flows up to 525 Linear Ft. -Z of 1/16" 10,000 gallons per day (GPD). - Filtration slots 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. Accepts 4" & 6" ~j 3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. - - - Certified to 5. Replace and secure the septic tank cover. NSFIANSI standard 46 The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified C~ Gas Deflector septic tank pumper or installer. Automatic Shut-Off Ball 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. i~ 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all► solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Polylok, Zabel & Best filters accept Easily installs 7. Replace and secure septic tank cover. the SmartFilter® switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 5 PF1 F _F Home About Site Map Order Info l Training Videos Contact Drip Systems I Treatment Controls Products Downloads Design Guidance rid` I y I 'VVATER-TIGHT - ACCESS CAP RI SE R CAP ADAPTER RISER x TUBE VALVE DIRECTI ON HANDLE The Bull Run Valve TM is designed to split flows to septic fields or systems. In addition to the advantages of longer 4" OUT PORT life and easier installation it is the most public health safe 4" OUT PORT alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak-proof and external operating characteristics. The change over from one drainage field to another can be accomplished in less than 4" IN PORT a minute by simply turning the valve without digging or contact with wastewater. The Bull Run Valve is available in 4" sch 40 pvc and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated Field Field Field Field periodically to direct effluent to one or the other No. 1 No.2 No. 1 No.2 of two septic fields. After removing the screw cap at the top of the riser tube, the valve handle can Valve Valve be turned with the valve key furnished. Positioned ~J Positioned on No. 1 on No. BULL RUN VALVE during during Complete Valve Kit Odd Years Septic Septic Even Years Contains Tank Tank 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter ITEM DESCRIPTION 4. Watertight Access Cap BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE & KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVKEY28 BULL RUN VALVE KEY 28" BRVCIRISER - 4" BRVKEY36 BULL RUN VALVE KEY 36" ADJUSTABLE TO 28" HIGH BRVKEY48 BULL RUN VALVE KEY 48" Page6 PAGE 3OF4 C7 y 0 3 t/J and a~~ O N J v H E M -C U Q iz E N c ~ W L) E 3 c W O C Cc: E CL Z Co U > Co c E o , N 70 a) Y o c O Z C/) L C` m ii I C) Q H m U a m c N > p `oy m2 u C v N a Q) N W a_°o Q .c ° v c (0 U) CL U) 4k ~7 -0 Cl fn C/) U w m (1) O aU > ow o 2 o X m Q c N a o m Ua' c I- -I E Cl) O O O m y O _ .Q a M O a w $ I ii 1 Ny c E (D CD _ ° II II = w a ~ I I w ~ m a`°i Q C) Co U) Wz" I I Q c w ai O F- F= ( 1 1.; o U Cf) a) I II I ~ 'o Q) I I Q ° CL II I I ~ w (n o o o Cr w o Q z ^m+ ~O J m 1 I~ I a` nou~j a T ~ ~ $ c a~ Nv I " ( II y U o o°~ I to Q L.J M Q V T= c I I I v e O O 1= 0 0 N ~ c a I I ~ N w N -N Q CL w I I °O ►n N $ I I M N Co N - O 1• c I 1 11 I 11 X U)_0 1 I i~ g y y II a s 5u 1 O ~cT Tm cn cn Q c v o m'D I I ""L1 00 3 = w CL 0 N 1 (ll a i 1 ~c, 3: w CL UJ -2 U) Z o M L I a Q C: C: O ~o ro n ~ I 1 U y a U) O> E~ Co = 1 1 w o U " d O I I w o') z II I I ~ w Z-0 W ~W 1 ~i 1 N > c 1- > v o g (on 11 11 w _ (01 -1 J J000 1 II 1 Z ° W vaz I I + U) I II 1 - Page 7 Installation Instructions for EZ TM EZflow Systems in Wisconsin by1NFILTRATOR Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this ; be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in ; lar site. The top or center-most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles ; are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, • should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dles and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate : 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positiioned upward and is • EZflow Bundles : in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric der before backfilling. • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the • trench bottom) and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given ; adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops, ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 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 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 2 - a width of 36 inches. This not only saves labor in excava- tion, but also provides better load-bearing capacity after ; backfilling is complete. 36" Page 8 PAGE 4OF4 In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow= 450 gpd; BODE 220 mgL"'; TSS 150 mgL"'; FOG 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filters shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: John Schmitt Phone: 715-760-0486 Local government unit: St. Croix County Community Developement Phone: 715-386-4680 Local government unit address: 1101 Carmichael Road, Hudson, WI ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Page 9 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) 1372100th Street located at: SE 1/4, NE 1/4, Section 30 , Town 30 N, Range 18 W, Town of Richmond , 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 5/16/2018 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): Week's Concrete Products Age of Tank (if known): 20 years Permit number (if known) 315894 "4A / f& John Schmitt (Licensed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 5/31/2018 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 10 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Dale& Debra Gerhardt Mailing Address 1372 100th Street Property Address 1372 100th Street (Verification required from Planning & Zoning Department for new construction.) City/State New Richmond, WI Parcel Identification Number 026-1 087-50-130 LEGAL DESCRIPTION Property Location SE 1/4 , NE '/4 Sec. 30 , T 30 N R 18 W, Town of Richmond Subdivision Plat. NA , Lot # 8 Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yesElno Lot lines identifiable Dyes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, 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 statement/aarranty s form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of deed recorded in Register of Deeds Office. Number of be rooms 3 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) Page 11 Department of SOIL EVALUATION REPORT #193- S P $ Safety and in accordance with Comm 85, Wis. Adm. Code Page 1 of _3 f Professional Services Schmitt Soil Testing. inc. Jaunty ,,aach 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 - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 02,6-1087-50-130 Please print all information. - - - Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 4 / g Property Owner Property Location if I Gerhardt, Dale & Debra _ Govt. Lot SE1/4, NE1/4, S30, T30N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1372 100th St g ~ CSM 8/2315 City State Zip Code Phone Number 1 City 1 Village Town Nearest Road New Richmond WI 54017 715-246-7803 Richmond 100Th St. New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash (Burkhardt-Sattre Series) Flood plain elevation, if applicable 79.65 ft. General comments Replacement area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for replacement area is and recommendations: 90.3' (High trench) 89.6' (low trench). Slope of area is 13%. Boring # - !Boring - - Y/ VI i- ` Pit Ground surface elev. 93.35 ft. Depth to limiting factor 96_+ 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 0-9 10yr3/3 none sl 2mgr mvfr gw 1vf 0.6 1.0 2 9-25 19yr4/4 none sl 2fsbk mfr gw lvf 0.6 1.0 3 25-31 10yr5/6 none Is Osg ml gw 0.7 1.6 4 31-96 10yr6/4 none grs Osg ml 0.7 1.6 * Effluent #1 = BODS> 30 < 220 mg/L and TSS > 0 < 150 mg/L * Efflu nt #2 = BOD5 < 30 mg/L and TSS <-30 mg/L CST Name (Please Print) Signature: Prt CST Number Thomas J. Schmitt l- cry .~:_Y!`, 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 5/24/2018 715-760-1978 SBD-8330 (R.07/00) ' Page 2 of 3 Conducted by: Conducted For: .Schmitt & Sons Excavating, Inc.. Name: Dale & Debra Gerhardt T Thomas J. Schmitt, CST 227429 Address: 1372 100th Street 586 Valley View Trail City, State, Zip: New Richmond, WI 54017 Somerset, W 154025 Phone: 715-760-197 PID: 026-1087-50-130 Signature_ Lot No. 8 CSM /02 1 y~o Date Legal Description: SE1/4 NE1/4 S30 T30N R18W ■ Backhoe Pit Township, County: Richmond, St. Croix County ® Bench Mark 1 El. 100.00' Bottom of siding on house A Bench Mark 2 El. 95.84' top of existing septic tank cover - t Slope= 13% Scale 1"= 50` 180 r es / - S" cc7Mp/QT gd by k, UC,~.tQ /1 O•Z I j _ a i ~w Gee ~~•2G~ 1 ELL 09 r QQO4G~~N~\ ~ 10 O'~) / 4 F L. \ i b I l 93 1 1 ~ 1 i , v>n Department of Commerce SOIL AND SITE EVALUA N DM?on of Safety and Buildings Page of 'Bureau of Integrated services in acxorda 19. S 83.09, Wis. Adm. Code CS p, a~ County Attach complete site plan on paper not Was than B 12 x t i in RI Vn include. but not limited to: vertical and horizontal ret (BM) percent slope, scale or dimensions, north arrow. and and distance Parcel I.D. # :Reviewed by Data APPLICANT INFORMATION -Please print 1f~tformMlo[gp;,r Personal infomiation you provide may be used for secondary pu 4 (1) (rn) 1-2 7' 9 g Property Owner ;l. tion PovE:,Lpt' 114,S T N.R ( Property Owner's Mailing Address _ # Block# Subd. Name or CSM# 12 g C,Sinn ,,12 3~"3a State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road / f _ f~ &J 1( New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Reoornmended design loading rate __,-Z_becl, gpd4?-,,2 trench, gpdffil Absorption area required - 2-~ bed. ft2 ' trench, it 2 Maximum design loading rate -Z-bed, gpdAlQ~ -trench. gl Recommended infiltration surface elevation(s) T- it (as referred to site plan benchmark) Additional design/sit considerations Parent material AX Rood plain elevation, if applicable ft S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in RII Holding !Tank U Unsuitable for system S ❑ U . Ps ❑ U ®S ❑ U ®S ❑ U El 5 ~ U ❑ S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench j3 "IS- 1Z Ground s c , elev. / Al '14 Depth to limiting factor &in. ~I Remarks: Boring # ciry ~ II 13 3 - Ground 93 m5y'5 elev. Depth to limiting fa pin. Remarks: - Name ( ease 'rn) rture j Telephone No. CST P Si Date CST Number Address ~p C c J Ildt ~~~da ~,~,~~'9,~or s.~dy-~~y -sXG.~©->'.~a~►'-~8w I~K.~O~'3 n Sam,/ Nis ~ST~ ~..5 yy l6 1 a~ / s ~D i ~i ~Q. d 0 L pD O N o O W E 'I moc w E i. m p o o_ ~ Q ; ~ w ~ ..r NY m w o n " h o f U m 3 rn v m ° Z~~1~"__ U o H E o c c 2 U 0I 3 rn o m t .3 2 T- 0 C w a x c E E a U Q c ° e i6 = m o 1 E °m ° m N L d 3 ~O o o E o m o m o"- d L m > U) o °o m o m `m Ftm L (3'1 m LL. m O O w m H V J ( O o v gs~ _ ) U~° m U~o ~ U v g t r Ulm wy Y b Y A4 A qiL r 4 6- -W v F 40 + v ' LLJ .~o € 4 ioe a d` FS ,,s $i 5t y k a ~tw c2 ) & Y it ~ ~ ~.e ?v I et 1-4 P v