HomeMy WebLinkAbout030-2085-20-000 (2)
%N:s:o'sinoevaa...e':"C...... r,.F PRIVATE SEWAGE SYSTEM Cwrty
swat., and Ddndmg D ' s or St. Croix
INSPECTION REPORT Sa`~~ w Nrme No
GENERAL INFORMATION (AI TA-N TO PP_R'o91Tj 606910
Sl~%- Pla•, ID No
Pe'FOr al r brrvat on G: vole, °Jy oc used f^r svwncary perp>ses IPr va-, :aw, s IS J< C 4ttli.
Pem, 1 •Inld=r's Nan" City' ''Jrl c;gc Tcinsn,p Pa'a.•I Tax Nn
Marshall & Kristin Zerse TOWN OF SAINT JOSEPH 030-2085-20-000
:SI IR.1 D" nsp. dt1 Elev al! Ces~npl on _ SeCUa^'"!'nNRa'~e:IaLap NV
f'1 It 32.30.19.723
TANK INFORMATION ELEVATION DATA
FDosiig PE Ie1ANUFACTUREH CAPACITY STATION us HI FS FLEV
c An Br<t
Aerat on _ _ J 9Wg. Se'ne' -
Ho r fj
, 1~ SIHt Iii
j
i525
TANK SETBACK INFORMATION suHt Ol
I ANK TO Pil. V`JELL BLDG. ':'e•uc~•r rt ke I Dl ln.el
Septic - CI Bottom
Coring Header.+I-l p
Aeralicr - Otst Pipe
0.1 O
Ho dh'g Bo! System r- -
PUMPISIPHON INFORMATION Real Grace
tdan~fad'utet Dmand St ovm _
M
X("~/! h - -
Model N61'1JCr
I [)IT Lit' F ction Coss- _ System Head Ft
- - - - -
Fo'oema r ergm Dta C'st In I
SOFL ABSORPTION SYSTEM
FIFD;TRENCH Yu1,m .en /71 No -1 CRIT IMENSIONS Vc CI P~rf'V Ins dcD3. _q;.tl Uepl^
DIMENSIONS 21
SETBACK SYSTi TC P:L BLDG VVFLL LAKF,:ST :rrt LEACHING I'l, L_ :fJ:/cLr INFORMATION CIIAMSEROR '
r ~C Y') r UNIT 1'ac.?I AU^r ovr
DISTRIBUTION SYSTEM 1
Heae[ M, t, Ielc Est FL.l On x -iCde Sze x 11JIe _~ya': ng VEnf IO ,Sr
1' PIFes,1 - x
"ev5t" ❑ a Y ,ungm_ L`. a_ Spat n9 _ to T` YT?s..
L
SOIL COVER x Pressure Systems only xx Mound Or Al Systems Only
f gfi r DeP'hdl Hx 5'eded+SciJcd 1 1 xxM_eflc7
l vr_~Ce'I-r Bed~n it G.tcs Ir•+s>A
Yes Vc Yes Nr
COMMENTS: :w-luce code dlscrepences, dersons prosent etc; Irsdec.ion itt: Irsdecbor,#2
Location: 430 RC-, ING HILLS LN
1.1 A I BW1 Desc•wlion
2 i Bldg Sevier IcnglF = ~tl V
- arcil of cove' - y
P an revision Reyu Teti Yes - No
Use olhe• side for addUOnal m`orrTation
r;R',.._r- _ a Dutc I^geFUcr's or, :r t t.;:
r _ K~ - tl ~i Industry Services Division St (',Tax
s H U j L L 1400 E Washington Ave - - -
ti muary I'em n Numbs Ito be filled in by Co)
t P.O. Box 7162
$ ,y : l MadisoA, WI 53707-7162
((oglb
' Sf~IllltlIly Permit Application t~ Slate 1, onNumher
_'f
I11 acq nJUilce with HI'S 4lf:yy+ .t( ~--Aden Code. subaii ion of the loon to We ap mental unit
reglliri3im la ohnunfng a,annoy Nnin Note Application h mts for state-o%acd P0v% I. arc suham -
the Ikpanmcnt of Safely anal I'rotissnnr,J Sere ices Personal infior cation you pros tdc may be tr cal far %ccanda Project Addre,s (if different than mailing addres,`)
t{ utyuscs in accordance with the ploac% I aw x i s rNi I irnl i. Stars 430 Rolling Hilt, lane
IApplication Inform u - Please Print All Information
- -
I opens t by let , Na:ne 1 - - - Parcel 0
Lux, Marshall r. Krislnl WO-208°?0-fast
3c .1,1. j, >
Property Owners Mailing Address Propcrh Location
4101tollme (tills Lathe
I Govt I of
lit., Slate Zip Cale Phone Number NIA , SW Section 32
Iludsun. l4'I 54016 (circlc one)
_ 1 30 N R 19 1' into
11 I s•pe of Building (check all that apply) Lal
Itr'i~umdv Jwclhne-Numhcr of Hcdlool s L MIMbvls:on Same
1 _ Johnw t Parkway
❑fuhliuConuueteial-Ikz:ribc Use _ IQG~ _ DkKkU
❑ City of
❑ State (honed - f k scribe 1. se
CSA1 Number ❑ \tillay!e al'
Z' 6",5 Mown Of St. Joseph -
Ill. 'T'ype of Permit: (I Iheck o v c A. Complet(e~lioe B if applicable) - . x-- - -
A t I Systnnl Replacement Sy<InUtlolding Pail, Replacement Onl)
OIIIa Mtalihcation m 6xtst:/7ng~System lexplain)
It. ❑ Permit Renewal ❑ Pemut Recision ❑ Parnit I rnsler to Ncw U.11 Preu umhS/0, ,`sued
Hcfiwc Ispiration mber (Nner E / 5e D r,5
IV stem,•'Componendl)evice: (Check all that apply)
Von-I'resunzal In-Grouli~ Pre,,un/cal In-Gnouod ❑ At-(iradc ❑ Mound 24 to M unable wil ❑ Mound 24 in. of ct ilahle sail
Tank - ❑ T)Olcr Dsncoal / ~•mponcnt (cxplaml ❑ 1'relraalmem lxy ice (cxplain)
Dispersal/ 'I'rea_tm nt Ana Into rmation -
I )c,l_n I low iq
r.1, c U t n 1 nl Apphca6on Ihsper>al Awn Reguirc 110 TI)ispersal Area P poscvl (,I) System f.Ic%ation
1 : t2•t0.(ep4,f) (4a ' 650 191.811' - -
it _ I JJJ
VI. Tank Info - - Capaeny in
j _ (altars,` '('taut of y $
l Manafaclnrer
Gulloas units 0(//~ R a
I,cw TanAx Lncnnl;'ranks ,-r ~ ~ t L ` a
Scptic or l folding 'Rutk IMO _ 1000 I ack'. R ❑ ❑ ❑ ❑
Dosing Chambcr.~ - I i ❑ ❑ ❑ ❑ Ll
11. Responsibility Statement- F, the undersigned, assume responsibility for installation of the POWIS shown on (he attached plans.
Plumber's Narnu I Print) flan s igt- ore J&14 - \it'M PRS Number Ifu,mos Phone\unlber
john lchmill ''P _'7760 ?IS-?604036
Number s Addre,s (Street City. Slate, /ip Goad / - -
616 150" Ase. Somerset- q'1 54025
Vltl. 'vunty/De arhnent l!sc Only - - '
:1ppr;wed - Permit I cc (late s,u Isti Agenl Siena to 1
Jy- ~5
~IlwICT C :vul Rcacnn far Ikmal _ ~
I\. ('ondi ~~~~,~JIYQQ,, €~~j{YRea ns fo Dtsa rural
)»pF!r•Ct t+llun tea rn3 Pp 3)
u'sF rr cell u l all beis s tnr ec l
is p"r nar ayemen. pie) ? ,oel by plunge rip, uc~ eXjS L s h` 7-.ti +~G--1 ((11
2. AU aeftsgck rect.itAoens muatwra'~r.L if.[',
!u pm ~ppiier.We ox'~r ; ad~cawt;t. '\ttaeh In eun9.lrlr plan. fur the,r,lem surf ,nhmit to the( ..anonly nn paiwr not Icss Than a :1 r 11 awhes in sir
S I M-6198 1101 "i 11)
SYSTEM PLOT PLAN
Project Name: Zerse °esgnFlox: 45opa"°nm4ay E~
- - AltacIn design flow calcelaUOns for
PfCJCCl AdCfCSS: 43J Roifino Il...g commercial plans.
341 Symbol. BM Elevation- IOC.00' Pipe Materials +HSTId SlandarC r
34 Description Top of 1"S:ecl Pipe behind oa mok ° Seale: 1" = 60
1 abler 364.30-3 R 364 yt-,, 0 GO 90 120
86:2 Symbol. A BM Elevation: 96.67' 4' S''r 4C wC A.SIM :2665
BM Desc iption: Top of exwsenee Mawx;lo yJ G, 3A P'✓C rti I M J30U
Slope Gradient of Tested Area. ;85e) 15'
t4'ell Symbol (if applicable)
Notes. Voles
I
I
Property Line
I
I
1
1
I
1
I
m
C I
J
- Existing Week's
o Well _ 1000 Gal. Septic
a Tank. Polylok 520
Shed -l- ~Bedroo}n to be installed
Paragel~ouse 11
c
J
I D
Drive Valve egg I o
I ~ABM1 _ a
Existing 94-,
SBA-
L------_ 12'x54' T
T2
Drain t 92,
R/ Field B` 8% 1115
/j, j T1-3'x65' EZ Flow Trench El. = 92.50'
G117
9T2-3'x65' EZ Flow Trench El. = 91.80.1
a,,e
Page 2
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Zerse 3 Bedroon Replacement Septic System
Owners Name: Marshall & Kristin Zerse
Owner's Address 430 Rolling Hills Lane
Hudson, WI 54016
Legal Description: NWl/4, Sw1/4, 532, T30N, R19W
Township St Joseph
County: St. Croix
Subdivision Name: NA
Lot Number: 2 Block Number
Parcel I.D. Number 030-2085-20-000
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic Tank Specifications
Page 4 Effluent Filter Information
Page 5 System Sizing & Cross Section
Page 6 FZ Flow Information
Page 7 Management and contingency plan
Page 8 Existing Tank Certification
Page 9 Septic Tank Maintenance Agreement
Page 10 Warranty Deed
Page 11 CSM or Plat
Attachment 1 Soil Lvaluation Report
Designer: John Schmitt Licnese Number: MFRS 223760
Date: 9/15/2018 Phone Number: 715-760-0486
Signature: Z I >I L, 't/
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page. 1
SYSTEM PLOT PLAN
Project Name: Zerse Design Flow. 450 (lato•smar
Attach design flow calculations for
Rrotect Address N
a3J Rolling Hills Lase - commercial plans:
RM: Symbol+ - RM Elevation. 100.0C' Pipe eMaterials rcial plans. / s. ASTNI Standard Scale : V=60'
BM Uescriplion. Too of t"S1eel Pipe De~iM JiD pock Tables 384.30-3 & 384.30-5
C 60 W 120
3'.12 SymbnC AM Elevation. 08.87 4' SCr 40 P'VC FSTN D1d6S
E0.1 Cescripbuo- top r.' excting Manoole wuer I 4' S03a INf. ;:STN D3C;47 -
Slope Gradient of Tested Area: (a 15-
bVell Symbol (if applicable)
Notes Nc:es
i
Property Line
J 1
T I
~ I
a Existing Week's
o Well 1000 Gal. Septic
a Tank. Polylok 52
Shed Bedroofn to be installed
aragItiouse c
Drive o
Valve-_
g BM1 - a`
91
Existing -
12'x54' \ T
Drain gg,
R^ Field - ` iB8% EB51
T1-3'x65' EZ Flow Trench El. = 92.50
T2-3'x65' EZ Flow Trench El. = 91.80',111
Page 2
PAGE 3 OF 5
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Page 5
SAF_l Y AN:: B-11 DINS ,I'ASION
f I,imb:ng Product Revie&
commerce.wi.gov P.O. Box 2658
Mad sog, Wisconsin 53701 2658
TTY: Contact Through Relay
tsconsin
epartment of Commerce Jim Doyle. Governor
Richard J. Leinenkugel, Secretary
February 16. 2010
WEEKS CONCRETE PRODUCTS
RAY WEEKS
1832 215TH STREET
NEW RICHMOND WI 54017
Ra Description: SEWAGE TANKS. CONCRETE
Manufacturer: WEEKS CONCRETE PRODUCTS
Product Name: SEPTIC, HOLDING, OR PUMP
Model Number(s): 1000
(49 IN. L.L., 21.76 GAL11N., 84 IN.MAX. DEPTH OF BURY 511 G.P.D. WHEN USED AS A
SEPTIC TANK BASED ON A 3 YR. SERVICE IN I LHVAL FOP, RESIDENTIAL
WASTEWATER;. TANK DIMENSIONS - 84 IN. I. X IN. W X 49 IN. H )
Product File No 20100040
The specifications andlor 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(si:
• This tank must be designed to withstand tie 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 roust be open to inspection by an authorized oPresentative 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;t and less than or equal to 220 mgrL TSS, or
greater than 30 mgrL or less than or equal to 150 mg'L TSS, and F.O.G. of less than 30 mgrL.
• 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. Con1m 82.32 (5) (c) and 84.20 (5) (n). Wis. Adm. Code, which
requires water closets to discharge through a minimurn diameter 3" drain pipe o• fitting and the bowl to conform to ANSI
Standard At 12.19.2M. 1 he intent of the code is met since this product provides the same functional performance as water
closets that meet ANSI Standard Ai 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 ssued on .121 20C5 under product `ile number 2005C106. 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 rray
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@wiscolisin.gov
SBD-10 ;644; ;N.1 W971 Fds Ref. 1000,1003 :)O,;
Page 3
~.0X
'^~w9unsm Rrrxr. J~:-„ ,~j Zal>Lf
l4a#rvnrer ProawY. I 5 on_~ ~ =dy .
-~?S Iillor
The PL-525 Filler is rated for 10,00II GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of I/ Io" filtration sluts. Like the Polylok PI. --122, the Polylok P1.-525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ball will float up anti temporarily shut off
the system so the effluent wont leave tl1e tank.
C, J
Paled for 10,000 GI'D (gallons per day). Alarm Switch
'10,000 BPD, ~ (Optional)
7
525 linear feet of I; In" filtration. , Accept, t•' PVC
Accepts 4" and ti" SCHD 40 pipe. Pxten ien Handle
Built in gas deflector.
Automatic shut-off ball when filter is removed.
c=~ - -a
;Alarm accessibility. Rated for
10,000 GPO
Accepts PVC extension handle. I
t
Ideal for residential and commercial waste flows up to 575 Linear Fl.
i "
QAIRI gallons per day (GI'D). uf I l n
Fdtranon slut.
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.
3. Glue the filter housing to the 4" or o" pullet pipe. U
the filter is not centered under die access opening use a
Polvlok Fxfend Lok or piece of Pipe to center filter.
4. Insert the PL-_,2_5 filler into its housing. - -
Grr Standard to
i. Replace end secure the septic tank cover. ® NSF!AN5I Standard
the PI.-525 Fftluent Filters will operate efficiently for
several years under normal conditions before retluiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. It the installed filler contains an optional alarm,
the Owner will be notified by an alarm when the hltci
needs servicing. Servicing should be done by a certified
septic tank pumper or installer. Auturnalic
I. Locate the outlet of the septic tank. .hut-0 lit Ball
2. Remove lank cover and pump tank if necessary.
Du not use Plumbing when filter is removed.
4.Pull P1...525cartridge out of [lie housing. 5. I lose off filter over the septic tank. Make sure all
solids fall back into septic tank.
b. Insert the filter cartridge hack into the housing making
sure the filter is prolx•rly alilmtd and completely inserted. nd
Polylok, %alrl K 1A"t hllrrs mvpl Easily install
1 . Replace and secure Septic lank rover. the Sman Filler-' ,v li and a::arm. into meting, tanks.
Polvlok. Inc. i Fairfield Blvd. Wallingford, CT 116492 Toil Free: 877.765.9%5 Fax: 211? 284.9514 v vAu.polylok.COu1
Page 4
Installation Instructions for #*EZf Own
EZ/6,t' Systems in Wisconsin ,J by INFILTRATOR
Wisconsin Department cf Commerce, Safety and Buildings 5. `nc Abrorphon area lS- ne:i `or a given rile shs'I
Division, has reviewed t''^.e specifications and;'or plans for this be ;red based on maximum daily sewage flora (GPD) and
product and determined it :o be n cornpliance with chapter; the Permeability for the sate. If certain criteria is met, the
Comm 89 t•vough 84, Wisconsin Acmin. Code. and Chapters EISA sizing can be used in Wisconsin, resulting in a 40
145 and 160. Wisconsin Stalwes. All <.itcs must rreet The Site smaller drain`cld.
& So 'I C n i-,ons & Locations R IsokitQ distances as noted in
local regulations. 6. Place EZflow: bundle(s) in ,he F71low configuration ap-
proved by system design permit specified for the partc,
he approved products are 120311 (3-12' bundles with pipe in lar site. The top or ceder-most bundles containing 6pe
center bundle .n 5' a• '10 lengths) and ' 23311P,3-12' bundles a•c joined end to end with an internal pipe coupler. An.,
•,•rth pipe in each hurdle in 5' or 10' lengths. acditional aggregate only bundles that may be ri i•ed.
should be butted against the other aggregate-only nun-
A sincle• pipe bundle contains a four inch perforated pipe sun- dles and do not require any type of connection.
tourdcd by FPS aggregate and s held together with poly-
e,,lylenc rotting. A s note aggregate oundle oancain _c aggregate 7. The lop of each GEO cylinder contains a filter fabnc o,c
onl. u,a is `r_Ic tugcther p^'yetf ,I~u, rt itnq. -eanufaclunt in between the netting and aggregate. Tns
fabnc is inserted to prevent soil inbusior. The inslale
Materials and Equipment Needed shall make sure the the GFO is pcsiii cned unwvar : a•wd ie
• CZflcw Bundles in contact with the fabric conlainue n the adjacent q;Iin-
• FZllcw Guolcxtil~ Fair c der before backfilling.
• FZ`ow Internal Pioe Couplers
• - pr. to, Header and Inlet 8. The EZflow Drainlield Systems should be installed n a
• 3ackhoe;'Exca.~ah,t level trench n all directions (both across anc alorq t•-e.
lronch bottom) and should follow the contour of the ground
Installation Instructions surface elevation. (uni'crm depth), with all conbnuo.s
-I ,c irstnrc cns for installation of EZflow produ;xs are gwen adjoiring 10-foot cylindrical bundles placed end to end,
below;. Ths piod.st trust be installed in accordance with state with central bundle dis:nbution pipe interconnected,
•w.le dcf4roc i cnaptors Comm 82 h-rough 84, Wisconsin Ad- ; w,tho-11 any dams, stepdow•ns or other water stows.
minist-atve Cooe, and Chapters 145 one 160, Wisccnsin Stat
ales. as well as the local healt, department's current desgn P. Ifie :rear, top shall be graded such that water will not
manual. pund. Backfill shoud oe seeded or sodi immediatey
after completion to reduce e-osion.
After the local nealth department has defeunined swr
conbeuration, and Ii for fne EZflow sy:°.fems, sli : 10. EZflow EPS bundles are flexible and car) fit in curved
or mark wath paint the location of trenches and lines. Be trenches as may be. necessary, to avoid trees, boulders, or
careful to set correct tank, :nveri pipe, •ieader line or dis- other obstacles.
trib-lion pox and trench bottom elevations before instal-
latlcr of pipe bundles. 1. CPS aggregate is lighter than water, therefore, it might
be expected that natural buoyancy tortes would tend to
remove plastc EZlluv, snppng bag: prior to ulacng cause CZflow assemblies to float cut of ground when
bundles in the trench(es). Remove any plastic nags in tf e pending occurs. Field experience h-as shown, however,
itc^cr before system is coi that this is not a problem when systems have a minimum
of 6" of se I cover ar; •ecemmonded by manufacturer.
i. his o'oduct must have geotexiilo fabric that meets re-
::ui emonts of s. Comm 84.30 (6) (g), Wis. Adm. Code,
r,iealled directly on top of the p oduct and extencinrl 1203H-GEO
dowvn along the siocc of the product to a point at least six ;
irchos from the bottom of product.
,ii~ oar 'a1e'Bfi91
a non installed n a trench, the tench should be. dug Ic OY
1 rialh of 36 inc^o -his rut c nf•; saves labor in rxcava ^ n . -
tion but also oresid;.~ I-o tter Iced Leminp F,+cP after
b37,diling s ccrrple:c.
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. Cede 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:5 150 mgL'; FOG 30 mgL"
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
age of system
nuisance factors It a odors, user complaints, etc )
o mechanical malfunction (ie.. pumps. valves, switches, floats. etc.)
material fatigue (i e., leaks breaks. corrosion. etc.)
solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e distribution / drop boxes)
neglect or improper use (te . exceeding design capacities, prohibited activities, etc.)
extent of ponding in distribution cell prior to dosing
dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings. etc.)
electrical components - if applicable (i e., wiring, connections, switches controls, timers. alarms, etc )
distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
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 seplage 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.
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
SIPS 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 maybe
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 ZONING OFFICE
CERTIFICATION STATEMEN'T'
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
1 his is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 430 Rolling Hills Lane located
at: NW Sw Section 32 Town 30 N, Range 19 W.
fown of 8t. Joseph . St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will confirm to the requirements of'SPS. 384.25. and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service L,' -
-
yid flow back occur front absorption system? Yes- No x
(if no, skip next line.) -
Approximate volwne or length of tirne: gallons minutes
Tank Capacity: 1000
Construction: Prefab Concrete x Steel Other
Manufacturer (if known): weeks Concrete Products
1ge of Tank (if known): 21 years
Permit number (if knowwn) 2134292 -
(11 ~17C' John Schmitt
(Li eased Plwnber Signature) (Print Name)
MPRS 223760
(Title) (License Number) NIRA-IPRS
(Date) -
Form to be completed by licensed plumber (Dept of Safety and Prolcssional
Services Chapter 305 and s. 145.06. Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin ;Administrative Code)
Rev. 2/20 t 2
Page 8
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer --Marshall & Kristin Zerse
Mailing Address 430 Rolling Hills Lane
PropcrtyAddress 430 Rolling Hills Lane
(Verification required from Planning & Zoning Department for new construction.)
City/State Hudson, WI Parcel Identification Number 030-2085-20-000
LEGAL DESCRIPTION
Property Location NW , sw Y. , Sec. 32 T 30 N R 19 W, Town of St. Joseph
SubdivisionPlatJohnson Parkway ,Lot# 2
Certified Survey Map # Volume Page # _
Warranty Deed # - - (before 2007)Volume Page
Spec house 0yes0no Lot lines identiliable D,vesQo„
SN'STENI MAINTENANCE AND OWNER CERTIFICATION
hnproper use and maintenance of your septic system could result in its premature failure to hmidle wastes. Proper
maiirenance consists of ptunping out the septic tank every three: years or scxmer, if needed, by a licensed Pumper. What you pill into
,he ystcni can affect the function of the septic tank as a treatment stage in the waste disposal system. t )weer moinlcuance
responsibilities are specified in pSPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary O rdinaocc.
Ibe property owner agrees to submit to tit. Croix Comity Planning & Zoning Department a certification dorm, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on sitc
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (it necessary). the septic tank is
less than 1/3 fill of sludge.
owe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
,lantiards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources.
Suve of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Plarming & Zoning Department within 30 days of the three year expiration dale.
Uwe certify that all statements on s form arc true to dtc best of my%uur knucvlcd)~e. hwc am'are the owner(s) of the
property described above, by virtue ofa wa only decd recorded in Ref-islet-of Decds 011-ice.
Number of bedrooms 3
SI NATU . OF APPLICANT(S) DATF.
*-Any inlbrntalion that is misrepresented may result in the sanitary perniil being, revoked by the Planning & Zoning Department.
Include with this application a recoree' warranty deed from the Register of Deccis Office and a copy of i6e certified survey map if
reference is made in the waaaniv (Iced.
(REV. 114/12)
Qeprnl l J $ IL EVALUATION REPORT #1944
P= Safety and in widance with Comm 85, Wis. Adm. Code Page _ 1 of _ 5
PrfIfessiong[ Servt4 7018 Schmitt Soil Testing, Inc.
? County
Attach complete sitelplan on paper, npt tets than 8% x it inches io size Plan must - St. Croix
include. but not hmrtgd to- vertical 2nc(honz nt cadre ce point BM). direction and -Pare - - -
percent slope, scale br i~sM.o t all lnf~rmation. 1~ation ai is 13Z ~ IT6-f1e3MStroad. Parcel I
'p 03 08,1 0-000
~ - - -
Rev I I Date
Personal Wonnahon you provide may be used for secondary purposes (Privacy Law s 15.04 (1) (m)).
Property Owner Property Location
Zerse, Marshall & Kristin Govt. Lot W1/rr WIM. S32. T30N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Nai CSM#
430 Rolling Hills Lane 2 Johnson Parkway
City State Zip Code Phone Number City Village Town Nearest Road
Hudson WI 54016 StJoseph Rollin Hills Lane
New Construction Use. Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe.
Parent material Flood plain elevation. if applicable _ NA If
General comments Area is suitah P. !or a oamrentiorlal system with a 0.7 gpdtsqft rate, Possible system elevation for replacement area is 92 5- High
and recommendations: french, 91,8' Low irecch. Slope of area is 8%.
7 Boring # Boring -
Pit Ground surface elev. 96.50__ ft. Depth to limiting factor 96+ in. (Soil Application Rate
Horizon Depth Dommanl Color Redox Description Texture Structure Consistence Boundary Roots GPDffl'
-
in Munsell Qa Sz Cont. Color Gr. Sz. Sh. •E##1 -En#2
1 0-13 I 10yr3/3 none sl 2mgr mfr as 2vf 0.6 1.0
2113-20 10yr5/3 none sl 2msbk mfr gw 1vf ti 0.6 1.0
3 20-31 10yr4/6 none Is lcsbk mvfr gw 0.7 1.6
4 31-96 10yr5/6 none s Osg ml 0.7 1.6
B] Boring # Boring
Pit Ground surface elev. 94.15 N. Depth to limiting factor 96+ in. !Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture I Structure Consistencq Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •E"I •Ert#2
1 0-12 10yr3/3 none sl 2fsbk mfr as 2vf 0.6 1.0
12-71 10yr5/3 none sl 2msbk mfr I gvv I 1vf 1 0.6 1.0
3 21-46 10yr5/6 none vgrls ! 0sg ml as 0.7 1.6
4 46-96 10yr5/6 none grs Osg / ml 0.7 1.6
-'-fit I Z
' Effluent #1 = BOD" 30 < 220 mg1L and TSS >30 < 150 mgiL ' Effluent #2 = BOD. <-30 mgri and TSS < 30 mg&
CST Name (Please Print) Signature~ / CST Number
Thomas J. Schmitt ~Zc . 227429
Address Schmitt Soil Testing. Inc Date Evaluation Conducled Telephone Number
1595 72nd St. New Richmond. WI 54017 8/20/2018 715-760-1978
tHI1:U U~ IIi:OIXq
Prai;erty Darer Zerse, Marshall & Kristin Par-el r; # 0.K-2085-20-000 Page 2 o' _ 5_
Boring
5 Bo
] nng # I'll Ground surface elev. 93.05 (t. Depth to limning factor 7g+ :n ISoil Application Rate
Horzon Depth Dom nant Color Redox Description Texture Structure Consistence Boundary Roots GPD71=-
in Mansell Ou Sz. Cont. Color Gr Sz. Sh. '111 1 - •E!ra:
1 0-10 10yr3/3 acne sl 21 mfr as 2vf 0.6 1.0
2 10-15 10yr5/3 none sl 2msbk mfr gw lvf 0.6 1.0
3 15-29 10yr5/6 none vgrls Osg ml as 0.7 1.6
q 29-78 1Cyr5/6 none grs Osg ml 0.7 1.6
Boring Completed - • .
_ z0/Sr2018 ~r
Boring _
Boring # pry Ground surface elev K Depth to mroung factor in. $oll Application Ratel
Horizon Depth Dominant Color Redox Desciption Texture Structure Consistence Boundary Roots GPDM'
it Munseil Ou. Sz Cont. Color Gr. Sz. Sh. - •E'ra' -Efle2
i
J
Boring
6onng It Pd Ground surface elev 11. Depth Io loltmg factor ~Soil Rppiiralron Rate
Horizon Depth Dominant Color Redox Descripton Texture Siructwe Consistence Boundary Roots GPD:ft'
in. Munsel! Ou. Sz Cont. Color Gr Sz. Sn. eax1 •FC,na
• Effluent #1 = BCD,. 30 < 220 mgI and TSS>3:1 < 150 ng)L ' Effluent #2 = OOD_ 30 q'L arc TSS • _30 mg 'L
the U«urlment of Cotnmarcu i, an equal Opponunit. A9T ite pro%ids and empin;.cr If \,:r iac.l 10 :r cc:.., rn icr.:•r
.
need material in an nhemate Gmnm. olcase contact the Jepartnwrn a: 60-26t+-:I a l .ar 1 1 l hiiS.'t,.IA,---
Pirorkay Owner Terse, Marshall & Kristin Parcel ID # 030-2085-20-000 Page 2 or 5
Boring
]Boring # Pit -
Ground surface elev. 93.05 ft. Depth to limiting factor in. `Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure ConsistenceBoundary Roots GPD_!_R'
in. Munsell Qu. Sz. Cont. Color Gr Sz. Sh. •E##f - 'E-U2
SEE PAGE;_?
Kim O'Connell's Report
See Kim O'Corme.11 s Sal Report from 6-3-92 (Attached)
F-I Boring
Boring # Pit Grouna surface elev. ft. Depth to limiting factor in. _
- - Soil Application Rate
te
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD.KI'
in. Munsell Qu Sz. Cont Color Gr. Sz. Sh. •Eff9l •Erro2
i
Boring
❑ Boring # Pit Ground surface elev ft Depth to limiting factor in
- - Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Struct u,e Consistence Boundary Roots GPDrft'
in. Munsell Qu. Sz. Cont. Color Gr, Sz Sh. i Tot 'Etfd2
-7 4:
Effluent #1 = BOD,,> 30 220 mg+l. and TSS >30 750 mgiL • Effluent #2 = BOD- 30 mgI and TSS -j-30 mgiL.
The Department of Commerce is an equal opporumity sere ice prow ider and emplornr. If you need assisumec to access sin ices or
need nrnlcndl in an ahernnte lirtm:n. pleas eor.t:ed the department at 6118-26h-~ I i I ur l"fY Mi8-'6d-R^" _
V 6)x:wµ ::'J~II - -
....F el 11 . 1
-rnq, In[.
orarv•~tonrouury, ) J'I UC OLnIY 1 IV., I1I.I VIU
o nvmtn Af llbonl r.lfo~tOn,
(Attach Soil Profile locatio Map • To Scale • On A Separate. Si ned Sheet)
-w - 20
,f.~~yv i fIA I.M 'I tUAntM.e ♦Yrvq fP'M a.`W W,Kt n000 at
- v a 1 7/ /
t tort Y fNIM1 - Ntf \lrNO O.Drf
r 'H
1 tOC.~P afW IO.MWNVIte4 rY IMCIIYYVI
C%w'
Su B DIMS IOM ~ttw _tlh.C1
J COT BLOCK
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in MumNl onl 501 2, It, we G' I. n nvftem a Iloott a n tr omm roan e.a
cv T /i l r
"e^IOn C.OIn 00~^'nmtColor 4rot6tl Svv(:uH n.n•e F.t'f.r leno^e GO0w ~
11'--. ~ MvnNn v t ont C r 4f1 r G,. SI Sn. Conv Itnt Rows lovnou Cw n t,rocn 7.a
[Irv
1114 -A
13!Non llrnn:nD Fau,r \ao,D CVC.M~-
ten coot- 00m~l Color Mo'. !.t tvvav~t nUf Ow.. n.an ao
In MyRfll t o^ Cc o' 1111 Gr. St. Sh. n.ll , t kooks
ca
~""Qn o.olh Do".neM Color MOIpfI Sum W.t Ur+unt Fyuerr lNO^D Onc•~
L, In M n .II St o^t. Colo, T HV'e Gr L Sh ontlllen f Root, eoun0t O.em l,fan l.a
r.tv a - 1 1 _ J
L S.rvtlWf Lt~M # fu4•r \ao+t pcc ~o➢
or•ton 0101, Com,n.nl Color Motutl owls Ina, Me
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Page 3 of 4
Conducted hy: Conducted For:
Schmitt & Sons Excavating. Inc.. Name: Marshall ti Kristin Zerse
Thomas J. Schmitt, CST 227429 Address: 4311 Rohing hills Lane
586 Valley View Trail City, State, Zip: Iludson, w154016
Somerset, W 154025
Phone: 715-760-1978 PID 030-21185-20-000
5 Lot NO.: Johnson Parkway
uale - k^? Legal Description. NNN V4 SW' Ir; S32 1311V It 19R'
■ Backhoe Pit Township, County: St-Joseph, St. Croix counh
♦ Bench Mark 1 El. 100.00' Top of 1" steel pipe behind big landscaping rock
0 Bench Mark 2 El. 98.67' top of existing septic tank manhole cover
Slope= 8°6
Scale 1"= 50'
NOTE: For full view of Lot see Aerial Photo (Page 4 of 4)
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aWisconsin boiahc1Depaoffndusvy,
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labor and liumenilelaom PRIVATE INSPECTION SEWAGE REPORT SYSTEM County: ST. CROIX
" Safety and Buildings Division
:
(ATTACH TO PERMIT) Sanitary Permit No
GENERAL INFORMATION 284292
Permit Holder's Name: City ❑ Village Town o : State Plan ID No.:
VANDUSARTZ, PETER JR. & PATRIC AST. JOSEPH
T BM E ev.: Insp. BM E ev.: BM Description: Parcel Tax No.:
,op , 1 111, I _ ,/`z., 030-2085-20-000
TANK INFORMATION EL L&ATION DATA A9700061
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic d.v
u ~1A ~ Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht inlet 5
TANK SETBACK INFORMATION St/Ht Outlet 78 i
TANK TO P/L WELL BLDG. Alerinake ROAD DtInlet
Septic NA Dt Bottom
Dosing NA Header/Man. / •d /09.9.
//.D adr e.
Aeration NA Dist. Pipe /0.2.78 2 3 Holding Bot. System i u " /O/ 92 '
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand a"U- /-I- A,
Model Number GPM
TDH Lift LFri6 9 ' n S rem TDH Ft
Forcemain Len Dia. Dist.Towell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width length No Of Trencher PIT No Of Prts Inside Dia. Liquid Depth
'5 i
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Fonu ac turer:
SETBACK
INfORMATION ype CHAMBER a Num er:
5 stem ' S(1' 311 >5o r A OR UNIT
DISTRIBUTION SYSTEM
Hea er/Manio Distribution Pipes xHole Size xHOeSpacing Vent TO Air Intake
I ength _ Dia Length _ Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded I Sodded xx Mulched
Bed /Trench Center " Bedrlrench Edges topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: ST. JOSEPH.32.30.19(,NW,SW `ROLLING HILLS LN LOT 2
IL4fir.- )6,
~.c! Qu~v.~f4.,,j 77 L4 .P~ Cie 2 e,
Plan revision required? ❑ Yes B-No
Use other side for additional information. L L I~ZJLJ
SOD 6710(k 05M) Date inspe rsSignature Can No.
JOHNSON PARKWAY
LOCATED IN THE NWI/4 OF THE SWIM AND IN PART OF THE NE I/4 OF THE SWI/4, ALL IN SECTION 32, T30N, R191A
TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN.
F: T
-La; 1: F S:F(VEY ltAP a' `.0_CL1E 6, PAGE 179 COC. NO. 4;9093
' LC' 3 1 -0- 2 c CT I
1 I
LOT 3 f LOT 2 LOT o S~
I
o's no. aez ,a. n. fi' ui,~TE'1~. R!2 o
O
2600
w I
s ~ ~ iZN(LLS - -L_ pry,} 7 ~ d~ +,~,\v~
LANE-
LOT 13~.
oil
LOT 12 ti
t
LOT II
1t LOT 10
\ N90.00.00'E li0.~1'
\ \ 3 L__ F l' J °VM:EY 511E
Page 12