HomeMy WebLinkAbout032-1054-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St.
Safety and Building Division St. Croix
INSPECTION REPORT Sanitary Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) 605068
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: FCity Village Township Parcel Tax No:
H & J Properties Investment LLC TOWN OF SOMERSET 032-1054-50-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
21.31.19.270C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration
Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION
Type Of System: CHAMBER OR
UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
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 eded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil TT Yes No E] Yes E] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 455 210TH AVE
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes No
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
County
r J Indust Services Division St. Croix
~ 'P`}00 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
Box 7162
S %w ~~N 2 9 2018 - Madison, WI ;3707-7162 aT &65 b (A
St. Cro~,, OW i t, ~1, State Transacti lyber
Communit}~ _ tP~rmit ApplicatioiI on►,t^"'
In accordanfiih-S .21(2), Wis. Adm. Code, submission 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 second Project Address (if different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 455 210 Avenue 01
I. Application Information - P ase Print All Information
Property Owner's Name ' Parcel #
H & J Properties Investment, LLC 032-1054-50-000
Property Owner's Mailing Address Property Location
349 Rice Lake Road
Govt. Lot
City, State Zip Code Phone Number NW %4, NE 1/4, Section 21
Somerset, WI 54025 rcle one)
T31N Rl9Eo-0
II. Type of Building (check all that apply) Lot #
® 1 or 2 Family Dwelling - Number of Bedroo Subdivision Name /7/ f
NA S
F-1 Public/Commercial -Describe Use (Ct NA.e Block #
❑ City of
❑ State Owned - Describe Use E] Village of
CSM Number
10~- t _ 7+-`7 G~ r1o ® Town of Somerset
III. Type of Permit: (Chec / e A. Complete line B if applicable) ZoAi,
A. ❑ New System ® Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
® Goa.-
IV m/Com onent/Device: (Check all that apply)
Non-Pressurized ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
er Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Tr ment Area Information:
Design Flow (gp Design Soil Application Dispersal Area Require (sf) Dispersal Area P osed (sf) System Elevation
450 Rate(gpdsf) 643 700 97.86', 96.70'
0.7
VI. Tank Info Capacity in
i U
Gallons Iota] # of Manufacturer U
cC V
Gallons Units n o °3
New Tanks Existing Tanks &)yO ' _ L S0s p v z C7 Cs.
Septic or Holding Tank 1000 1000 1 Wieser ' ncrete ® ❑ ❑ ❑ ❑
Dosing Chamber 1 ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) P b 's ignature MP/MPRS Number Business Phone Number
John Schmitt ~ZT ~1l1 223760 715-760-0486
Plumber's Address (Street, City, State, Zip Code) _
616 1501h Ave. Somerset, WI 54025 14
VIII. ount /De artment Use Only.
Approved lsapprove Per~m/it Fee Dat Issu Igent Signatur
r Given Reason for Denial $ d
IX. Condi'a~ns fort Disapproval
~ I a•n• ~ a e.
nt~'_ ec
ulslyew n cell r:+ttst Al be ic?s 'r0'?
as per ih0r.3ement plan p!:,4dea by Plumbe. PtA. G
2. AM k rec,.LJw!nen,s writ Lie -,Ec:nL it e
a$ per PXilcM,%Gr)drr ! a.fdiill e..x,
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x II inches in size
SBD-6398 (R03/14)
SYSTEM PLOT PLAN
Design Flow: 450 gallons/day A
Project Name: H&J Properties Attach design flow calculations for I V
Project Address: 455 210th Avenue commercial plans:
BM1 Symbol: A& BM Elevation: 100.00' Pipe Materials / ASTM Standard Scale: 1" = 60'
BM Description: Top of 2"PVC Pipe Tables 384.30-3 & 384.30-5 0 60 90 120
BM2 Symbol: 0 BM Elevation: 108.38' 4" SCH 40 PVC ASTM 02665 ~ZA
BM Description: Bottom of Siding 4" 3034 PVC ASTM D3034
15z
Slope Gradient of Tested Area: (14%)
Well Symbol (if applicable)
Notes: Notes
A
R/W 210th Avenue i
- 660' - -
i
T1 3'x70' EZ Flow Trench El. = 96.70'
T2 3'x70' EZ Flow Trench El. = 97.86'
I
0
I CD
Shed
r
CD
~ m
CD \
1359.65'
r
} i
1 ,T1 T2
■B1 a
14% slope Driveway Wefi 1
I B3~
G rage y cYr
o~ e ooh
B2
■ BM2
x s r
I
\ Existing System
f I BM1 102 to be abandoned
96 98 100 L as per code i
ieser WLP1000-MR
Property Line Septic Tank w/ Poiylok 525
Page 2
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: H & J Properties 3 Bedroom Replacement Septic System
Owners Name: H & J Properties Investment, LLC
Owner's Address 349 Rice Lake Road
Somerset, WI 54025
Legal Description: NW1/4, NE1/4, S21, T31N, R19W
Township Somerset
County: St. Croix
Subdivision Name: NA
Lot Number: Block Number
Parcel I.D. Number 032-1054-50-000
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic Tank Specifications
Page 4 Effluent Filter Information
Page 5 System Sizing & Cross Section
Page 6 EZ Flow Information
Page 7 Management and contingency plan
Page 8 Septic Tank Maintenance Agreement
Page 9 Warranty Deed
Page 10 CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 6/28/2018 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: H&J Properties Design Flow: 450 gallons/day N
Attach design flow calculations for
Project Address: 455 210th Avenue commercial plans:
BM1 Symbol: & BM Elevation: 100.00' Pipe Materials / ASTM Standard
BM Description: Top of 2"PVC Pipe Tables 384.30-3 & 384.30-5 Scale: 1" = 60'
0 60 90 120
BM2 Symbol: Q BM Elevation: 108.38' 4° SCH 40 PVC ASTM 02665
BM Description: Bottom of Siding 4" 3034 PVC ASTM D3034
Slope Gradient of Tested Area: (14%) 152
Well Symbol (if applicable)
Notes: Notes
R/W 210th Avenue
660'
T1 3'x70' EZ Flow Trench El. = 96.70'
T2 3'x70' EZ Flow Trench El. = 97.86'
-n
I I o
I D
Shed
-U
m
CD
1- \ 1359.65'
W1 V2
o ' 0 B1 i
14 /o sl e ' Driveway Well
a
133J 3
I ' G rage y cy,.
J B2
BM2
I A
BM 1 \102 r ' \ Existing System
to be abandoned
96 98 100 L _I as per code
ieser WLP1000-MR
Property Line Septic Tank w/ Polylok 525
Page 2
E aged
SM-OldW :31U 99'b8-9Z2-008 O
09L*9 IM 'N001 N301VW OL AMH Sfl 9LLEM z \
:anod-lsod :31v0 00/00/00 :31V0 ivnNdW OIld3S W o
'AM
:8flOd-38d ,0-,L=a6 L :31VOS dOM :l8 NMVaO 313801100 13131M 0-00OIdim
0
LLJ
N Li J
U H Q
z
° m0
w m °
cn x w w 1=11 d z V) (n o° c=i° 0 0 a w 4.
U ° w J ll1 Q
Z d M 0 a o E- o V m o
Q\ 0m pkQ Z o iR a w~ H O o o z
-j V)
Q w`n D 0w aaU Q °w~ z ~ m~ < LL a o b
c; D
O LL M O_ O . 00 iv CO co Q a Q w ~ J F- O in Z Y ¢ a
U = UOpd to-1 N~ Mww r a0 a0 Q
0 W Na Na`t °WWJ~ F as ~ a } ~0.. ~ WO zZ Y~
V- e ~~(OJ~tO ( U ZN F =o z -o z0
V) N 00Z`~ ~v)1- OZx C) Y J O wN 1 F-
J N ..O ~0~~F ..30~ 0",Y 0°w ¢ ¢f-a w mF oo QO
z J=:MCD 0- 0(n OOF EL C, Y °d0 OaWZ0WO Z. a z~0 V O V C7 z0
LLJ
- ~m N~
Z Nam u x mZol a~0 a~., ZOa z o 20
? p ¢ w ou
Q w w Y
Z z _ OJ OU Fa- V
J
a
W
i
a
~ F-
< w W
`t F:2 0 w
U
O Da. w
D CY
_ w
a x
~t i N
Ow V
W
I w_ m \I I W i 3
LL w
~I F-
j x C) 1.1
0
LLJ
1
o
W
W
Z~ U
„Z-b w
z
a
438M3~1 Sd w
x
a
cn
Y.
z
a
F-
Zabel'
A Division of Nlyfok Inc. v
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
5251inear 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.
Rated for 10,000 GPD (gallons per day). Alan„ switch
10,000 GPD (Optional)
525 linear feet of 1/16" filtration.
Accepts 4" and 6" SCHD 40 pipe. G~ Accepts 1" PVC
Extension Handle
Built in gas deflector.
Automatic shut-off ball when filter is removed.
Alarm accessibility. j Rated for
ta_
Accepts PVC extension handle. 10,000 GPD
Ideal for residential and commercial waste flows up to 525 Linear Ft.
10,000 gallons per day (GPD). of 1/16"
Filtration Slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.
Accepts 4" & 6"
3. Glue the filter housing to the 4" or 6" outlet pipe. If sCHD 40 pipe
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing.
5. Replace and secure the septic tank cover. Certified c
NSFIANSI Statnclard 1-
The PL-525 Effluent Filters will operate efficiently for - -
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
Gas Deflector
needs servicing. Servicing should be done by a certified <
septic tank pumper or installer. Automatic
1. Locate the outlet of the septic tank. Shut-off Ball
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL-525 cartridge out of the housing. k
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 SmartFitterfl switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.76.5.9565 Fax: 203.284.8514 www.polylok.coni
P1ei15
a12 CD o$
C7 N U O
c
L~ N C g N ~ 'i
m m a~ ~°t
wc Q u' E~ v c -O
~ E
v i- c O
CO N ~ O C
E c a
c Z o a` o c Vi N
N M U
n ¢ •m II _ v C)
O `off m~ Q
c
E2 3 a a y N I :a i GZ
0. co m U U aa°~ ~--~-~j N
S Co
'
w ` Ul N U) m ~fpz O V U) _Co
} ,w N -7 C
1JJ c
a I I N E M O
CL- N
J co = L!J ~ I 11 I o
G( Q. > I I E a tl
M v m c co W
H H
CN CD U)
L- -1 0
U) N vuWyz° ~a^
W c [L - C I II I ~ a~
~ ~ t- N ~ .19 a l 11 I O H
as d
0 .2
V co
z
Q m ► ii I
O o o~ I 1 W
~ Z3 N = o
I
~(1)~ -C 16-
0
I
~ J . Q I I O' M M O o F-
I C9
I
$ II 11 II II x
W o - W Q
o c v ro I I
O t` ° o" I I w w a
'it 21:~
Q I rn o a „ a
N w
Z w
Z I- I I w
v ~v a
c.c= ~ I ~ C c O
m
„
o r ` °
W CL
~U ~ ~ I 11 I ~ ~ .fl 11
.f « II
CC> I„ I d d L6
E V s
_ rn = I I
W II Z ~ 11 ~ ti o
a w w (D I z
I li I -
QQ o I Ii I +
I-
W U~-J
a Z
Page 5
Installation Instructions for 44E O? 'm
• EZ#o .Systems .in Wisconsin isconsin flbyFILTRATOR
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- dies 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 positioned 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 tines. Be trenches as may be necessary to avoid trees, boulders, or
careful to set correct tank, invert pipe, header line or dis- other obstacles,
tribution box and trench bottom elevations before instal-
lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might
be expected that natural buoyancy forces would tend to
2. Remove plastic EZflow shipping bags prior to placing : cause EZflow assemblies to float out of ground when
bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however,
trench before system is covered. that this is not a problem when systems have a minimum
of 6" of soil cover as recommended by manufacturer.
3. This product must have geotextile fabric that meets re- '
quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extending 1203H-GEO
down along the sides of the product to a point at least six
inches from the bottom of product. - - - Geotextile
Barrier Material
4. When installed in a trench, the trench should be dug to 1i I -
a width of 36 inches. This not only saves labor in excava- 12 ll - °
tion, but also provides better load-bearing capacity after
backfilling is complete.
h- 36"
Page6
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 S 150 mgL"; FOG 5 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 (113) 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 filter(s) 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:
John Schmitt Phone: 715-760-0486
Name of individual or company:
Local government unit: St.Croix County Community Developmer Phone: 715-386-4680
Local government unit address: 1101 Carmichael Rd., Hudson 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 7
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer H & J Property Investments, LLC
Mailing Addre s 349 Rice Lake Rd
Property Addy 455 210th Ave. .
(Verification required from Planning & Zoning Department for new construction.)
City/State Somerset, W1 Parcel Identification Number 032-1954-59-000
LEGAL DESCRIPTION
Property Location NW t/4 , NE t/4 , Sec. 21 , T 31 N R 19 W, Town of Somerset
Subdivision Plat: NA~^ Lot # NA
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume Page
Spec house 1]yesno Lot lines identifiable Elyes[]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 statements on thi 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 a wat my deed recorded in Register of Deeds Office.
Number o b drown-A ,
6 26 / 18
/ 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 8
4
. r
i
a-
.fit.
s~ z
E
41 Ar
i~
a s
r
m4rr
4c,
R
A».: s4c~*nhh~aM=.,#'~' .rte^_
r r
u. x w, 16
O ~
A yaw p C '~fk e" r 2" E~ [
1-4 m
z .r
ry
ri
owl
Aor
5 t9
Ff t`r, }^S ",fin ~ v
-
Department of
D,,~3OIL EVALUATION , ~ #1938
SP Safety anq,, 9 2 in accordance with Comm 85, Wis. Adm. Code Page _ 1 of 4_
Professional Services Schmitt Soil Testing, inc.
~ ou`slt`/ County
~t
Attach complete site plan te paper ho Iess,tharFnches in size. Plan must St. Croix
include, but not limited to: g fzonfidf reference point (BM), direction and - -
percent slope, scale or di ns, north arrow, and location and distance to nearest road. Parcel l
_ 0 _ -1 54-5_0-0_0_0__ _
_ _
Please print all information. Revi ed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /a
Property Owner Property Location
H & J Property Investments, LLC Govt. Lot W 1 / , N 1 /4, S21, T31 N, R19W -
Property Owner's Mailing Address Lot # Block # Subd. Nan or CSM#
349 Rice Lake Rd NA _ N Available 20.0 Acres
City State Zip Code Phone Number City Village Town Nearest Road
Somerset WI 54025 651-964-9612 Somerset 210Th Ave.
New Construction Use: ! Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash (Plainfield loamy sand) - - Flood plain elevation, if applicable NA_.-____ ft•
General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation is 97.86' (high trench), 96.70' (low
and recommendations: trench). Greatest slope of area is 14% next to B1.
Boring # - Boring -
Pit Ground surface elev. 100.86 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 0-6 10yr3/3 none sl 2fgr mvfr as 2f,2vf 0.6 1.0
2 6-28 10yr4/6 none Is Osg ml gw 2m,2vf 0.7 1.6
3 28-44 7.5yr5/6 none grls icsbk mvfr gw 1vf 0.7 1.6
4 44-96 10yr5/6 none s Osg ml as 1vf 0.7 1.6
,c
2] Bonng # Boring - - ,
Pit Ground surface lev. 100.86 ft. Depth to limiting factor 98+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ft2_
in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. *Eff#1 *Eff#2
1 0-4 _ 10yr3/3 none- sl - 2fgr _mvfr as 2f,2vf 0.6 1.0
2 4-21 10yr4/6 none Is icsbk mvfr gw 2f,2vf 0.7 1.6
3 21-36 7.5yr5/6 none Is icsbk mvfr gw 1f,ivf 0.7 1.6
4 36-98 10yr6/4 none s Osg ml as 1vf 0.7 1.6
r
%
T
Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
h 227429 _
Thomas J. Schmitt
Address Schmitt Soil Testing, Inc. f Date Evaluation Conducted Telephone Number
1595 72nd St. New Richmond, WI 54017 6121/2018 715-760-1978
SBD-8330 (R.07/00)
J
Property Owner H & J Property Investments, LLC _ Parcel ID # - 032-1054-50-000_ Page 2 of 4
Boring
3
F I Boring # 11,
Pit Ground surface elev. 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 0-6 10yr3/3 none Is lfsbk mvfr as 2f,2vf 0.6 1.0
2 6-17 10yr4/4 none Is icsbk mvfr gw 2f,2vf 0.7 1.6
3 17-37 7.5yr5/6 none Is Osg ml gw 1f,1vf, 0.7 1.6
4 37-96 10yr6/4 none s Osg ml 0.7 1.6
Boring -
4 Boring #
, Pit Ground surface elev. XX•XX ft. Depth to limiting factor 32 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 10yr3/3 none sl 2fgr mvfr as 2f,2vf 0.6 1.0
2 10-23 10yr5/2 none sl 2fsbk mfr gw 2m,2vf 0.6 1.0
3 23-32 7.5yr4/6 none scl 2msbk mfr gw lvf 0.4 0.6
4 32-44 10yr5/6 c2d 10yr6/6 grls lcsbk mvfr as lvf 0.7 1.6
10yr6/3
5 44-68 7.5yr4/6 m2d 7.5yr6/8 vfsl Om mfr 0.2 0.5
7.5 r6 2
Boring
Boring # 1 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#1 'Eff#2
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: H & J Property Investments, LLC
Thomas J. Schmitt, CST 227429 Address: 349 Rice Lake Rd
586 Valley View Trail City, State, Zip: Somerset, WI 54025
Somerset, W l 54025 , _ . .
Phone: 715-769-1978 , PID: 032-1054-50-000
Signature ~ Lot No. NA
- Date Legal Description: NWI/4 NE1/4 S21 T31N R19W - T - -
o Backhoe Pit Township, County: Somerset, St. Croix County
A Bench Mark 1 El. 100.00' Top of 2" PVC pipe
a
- ® Bench Mark 2 El. 108.38' Bootom of siding, top of foundation on house
Slope=
Scale 1"= 60'
i
;
t
t
1 NOTE: For full view of Lot see Aerial Photo (Page 4 of 4)
/Vase-~~ ~oiEk-ty L/rub' -
104-a~~= _
I
I
I
t I
1
1
d
I
Q ,
~ ISq, p ~ ° yr,
43 70
25
~2UPr~SL D ~ Z
C-->r 15Ttkflr
s E P-t l L
l D R,Atir. Pi ew
D~ UWc14e'1nl ~l2~
'£'lii4 e a ads.. !~-i i8A' 2 ' °'Ayy,'. HY 1
,z-
e.
PEI A,
"Zi
V'l
fir. '~`'A~F? - - ~`A<,•';~~~..
mss.' %fi+~.`#Y'• ~r r4x °:ffi r x ' M A~.
ay & : #
e,v s:: r * +^d , ;a'te' T ° IS
r,
~ i
i R Y 9 M AJ -
t -
464,
1~ o a i ass.' z_ 5, ~ ~I r
"VI
it 1
&5. lX}
3. i`." rft" Li{,~ s Alt
'v
} s d
,v
wx N: NAtam-:: .F' s°"- ry~~ t` f ~ s/,,•~f•~'- ,s~#• .Jt ~ k
.~`t `'o'a ~+4n ~'"k'~.. ~''a Jt• S ~'i7'~ 110.
• 1p
I'A
M M
to I,-
VV,
',wF'
~x',.~~-e~ ~ tea „~'"S~'~~ t~ e~ i ~ ' ~ ~ d ~ ,q~.
r' dt~ "L' a ip o-4• .