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HomeMy WebLinkAbout030-1064-40-100 (2) 'tnsconsln Depacment of Commerce PRIVATE SEWAGE SYSTEM Ccunr;. St. Croix Salety and 1301 Ora s or INSPECTION REPORT Sariar;PeIrilutN0 606923 GENERAL INFORMATION (ATTACH TO PERMIT) slate r an :D N. Personal u110fma1 on yr... prof de. -ay oe used for sevDnrary purpeses (PI, acy Lam s 16 04:1~',^). Perm ( f loldei s Nana. Pt,,• Village Tewns-)e Pa" I I as No Jason & Abigail Wright TOWN OF SAINT JOSEPH 030-1064-40-100 CST BIA E ev. Insp IJ`.1 Flev SY Descant on S"k.. I cis-R:mce'?i No. p~ g G ; , 24.30.19.233A TANK INFORMATION ELEVATION DATA TYPE MANI I-ACTURER r 3 CAPACITY STATION BS III FS ELEV. Seclic ~ Z. i ~ L Qencnmaric AIGw W.eS z T isr ~zso Dosing Alt BM 6 iooo F• 41- Lo c /a~. 3 S Aeration 16 Ar- Bldg. Sewer Holding StJHt Inlet .~.$3 'i 1 7 II X TANK SETBACK INFORMATION SVHt Outlet /SIN d TANK TO PiL V.f 1. QuD3. VC A,naee ROAD /L 9~ -gL / /J L W 7 7 S •ho $ 7L Z f t O enT a~ 35 9Yi , <o D6osingil, 1p y 96 1 2~ 16 1 HeaderiMan. 17,14 13,5 Aeralien D st. Pipe ~V Holding Bot System n fill, /4 Final rail PUMPISIPHON INFORMATION; 5. Z 9S • S Manufacturer Demand St Cover ~l wee. ,6l GPM Model Nurn 0 f S X1.2 • S TDH Lfl Frt.. Sys'er TDH ri ~A 9.O 9 Z ! rv• Foreemar Length Dia. ups! :c'.vsn ~e/ q•3 y~'g SOIL ABSORPTION SYSTEM BED!TRENCII -A!.,on~x 1 .ungth No )f-e-cncs PIT DIMENSIONS No Of PIS nsde:)a '_7u d Dv_t'DIMENSIONS 3 75 1 (e SETBACK SYSTEM TO P!L BLDG VJELL LAKE:STREANI LEACHING Mandlacmrerr /O✓ INFORMATION I • , O's yslert CHAMBER OR r1 C UNIT `•locel Nunlner DISTRIBUTION SYSTEM ~ 1,46611 1 a `1 7 5 4. 7•S =LZ -'S leacer+Pdan li Disvit-slur a Help. Size x iclo SDa rp g `v eyLto Alr n +e / Pi zz_ D 6 _C,xh 1 Z Calf Lcn(71r '316 ~ - Soar'm pl/ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only (:>ptr Oder Q' hpU, 6.ci Ucpl'1 0' :r Seesceusocdc9 xx Wls lched lied)be nch Cen:c~ o ?re~Trend' Edyos Tc F'soil~ ~ L No No COMMENTS: prelude code disc'epercies, pe•sons present, etc i Inspection 101 Inspect on 102. Location: g76 '40TH AVE~ t. i All QM Description = /I 2.i Big sews, length - amount o` cover = l Plan revision Required _ I Yes > No 14 G ~3y Use other side for adddional m'ormation. - og. Uale -PC'B Cen No 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) 876 140th Avenue located at: SE V4. sE IA Section 24 Town 30 _N, Range 19 _W, Town of St. Joseph St. Croix County Wisconsin. Upon inspection, I certify that I have lbund 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 Did flow back occur from absorption system? Yes_ No_ (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Cone rete x _ Steel _ Other _ Manufacturer (if known): Age of Tank (if known): Permit number (if known) - (Liven d Plumber Signature) (Print Name) z2 (Title) (License Number) MP:/MPRS " ILI - (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 9 Industry Services Division 4;" 0 ;4\ 1400 f- Washington Ave xanlix% Penml Number (to he filled in by Co ) ?I''l ~g LI P.O. Box 7162 1;,~~ Madison. WI .53707-71621 c~I11tc1I1 PermitApplicatloll 4tatq't'ranr.cion\umhcr In aceolJanec anh SI S S?..' I!_ %k,, Urn Code, iuhnusion of this torm In the appri prlale esisernmcii unit !a requited prior b: ohtaioui a sanitary pemlil. Notr' r\pphcati+m I'ornJS Rx slatewwned POwfs arc 3ubmilleJ to Pro!ccl address of different than nettling address) the U p;ulmcm et Salil) and Po s t!ual Sen I v Personal information p!u proeiJe map he used for second 8?6 140" .Avenue - pulfo t' in accordance with the I macs I,aw I flat 1 Nun, Stan, 1. Application Infornlis~1t~ak~n~ Please Print All Information _ - Pruptm lhxllalt\ame v arccld Jason ,Y :lhicail N'nnhl 030-tuft)-ire 1011 X30 ►d3 19opsns USnur+Mailing Address - IropcnI l meat..... x.r IIC Awnuc < wt Lot I'r City. Slala Zip('side Phone Number I tit SI( i• Section 24 \csx Ri:iunon;l, 1y1 153017 ~~jrdc or+rl Ir T3UN K14 Lsi~(w I IL'I'ype of Building (cheek all that apply) I_o1 a - J ? Sukfdins+ou Smile. ©I or 2 I :nnih Uwclhnp - Nuw6cr of Ralnnm+ NA ❑ Pnhlic+( nnonercial- Ilesaibc I'zc Block a ❑CNof r~3~ ate fTsncd - Ilexnh I'~p¢ 7/L►07ZCo ❑ \'illauc of ('SM Nundx•r T OO G10 ~ll ~ t,~ 756Z PaheJ~ ✓al P 2 ~liswn of St. Joseph 111. '1 ypc of Permit: (Cher A. Complete line B if applies ) ,Z - •••Repluxntan System Treatmenvl loldine Tank Rcpl:+ccnrenl Oniv ❑ other Moditrahon to Lxiam • Systen! (explain) _ ❑ Perron Renewal C3 Permit Rcs icnm ❑ ('hm+ee of ❑ Pemlil Transfer In New List 14ey inus Perms Number and Ilene Issued B Bctere I \poa ion Phmthcr lAsuct - 7 - IV. Tv c of POW`TS Svsle11) Component Deice: (Check all that apply) _ _~L•-/ _ O,f~. . Q \un-PresmieaJ In-Ground ❑ I"c,,rrned In-Ground ❑ At-Grade ❑ Mound 1 !n. ulsunablc soil ❑ Niound 24 in ol'stdtable aril I loldinr an n no hspcrsa! C•. mponenl (explain) ❑ Pletrcatmem Uc, ice (explains DisLrsalrTrc Went Area Information: j,w Ikmu! Flnw !ep I) moil :'yr, Im:auc.n Ilispcreal Aica Rc(porcd If) Drsp"'il Arcs Pngwscd!cl'I Viiv FJcs anon 4150'. - Rnslgpd;q IQ?I I~ \'l. Wank Info l spank in (;s)))ons TI - Tidal rt of 61:mufaclulcr 1y w laa.: si.unc lank. W ~d IG.. •K~ ~ ✓ ~ i :7 ^ 1 Scptu or I WlJine'I ask 5p. I Post I -11 2 Cnknow'nJ 'icscr Concrete C1 El Dosing Ch:,n+hcr Q ❑ ❑ lr.~~l❑l VII. Responsibility Statement- I, the ondrrsi0ned, assume re pon li or in.tall!rlion of the LONV IS shown on the alluchecl plans. l11o" yrs \amc: Print) I'1 i' i/•' 'awe ~ ~ ~J~/''~ Nil -NiPRS \umb„ Rumness Phone Number JnhO Schmitt J1. X17 / 't'/L J/L~ `'~21➢i60 _ 'IS-?6u-0486_. Plumber s Addreu IStrcet. (its: Stale. Z!p Cock) 6161517' \%c. Somerset. WI 53025 N'Ill . Coun[yfUe arlment Cse Only - - - - - - ApptuecJ mggrtn I'cmtilQFer~r Dal I xucd I Issuit Agent Sieu or 'J (h men ):cram I:rt IXnia1 S ~rZ ~ ' 16C CunAi 11~6rK i 1104 Uisappru. al j+ ~a~ r vv : , crll oust aN j~t-,. "-j s -@L j fP. ?s per .oar ayemer~'. pl: n c'i rI Irv ylumUe:. f t ~ eMl~t v 2. AA aeroeck rect.ir~' -an,y mu;l (.u i`•f•.fttr If t? 4-6 as per apgi!crlbl a c+Jr',I f : rd's 7A,y3r t. Anach m emnplcu plan, for the tynem and submit to the ( ouno only nn Itnper nor le- dun a . I V I I inch.. m sne NBD-6398 IILO:'1 t) SYSTEM PLOT PLAN CCs@n frow' T5C pa. onsNa. Project Name: Wright N - - AUa~b dCSign flrnv ca:culatinns fnr "!ner. Addross. 57E '10'h avenue :ommerdal plain BM' owilool. 3h•1 Plevaunn. 1(1(. .10 pipe Materials i .457Ia1 S;andarU Scale: 7'• = 6C 910 7esmphnn 9otloll o' Sd!rrc -abies 384.30-3 S 384.30-0' o G 60 L 120 3b1 SymbaP jf\ 91A Elevat,oll 99.C', 4' S-E 4C PVC 4,Tll . ?n _ _ _.v_ - BAd -)P%Criphon. q ,2f, of eXmlllp Senu_ rant manhole cover I r,• 3JQ4 P %1z: :,STN 03C:W - I Stow 3t)Ienl of Tested Area. ji3ivi i~. t4ell Symbol (V apphcab4l \o1C5. nolcs i I Property Lline I Existing Drain Field , j Existing 1000 gallon yO; Septic tank r 'I \ \ \ Valve Shed II • I i B1\ . BM2 Deck BM1 5 Bedroom House Gar ge B\3 13% \ ; `,,yt B2 Driveway', \ Well T2\T2 1•, \ a 0 New 750 gallon Septic a_ tank w!Polylok 525 96 \ 94 r T1 3'x75' EZ Flow trench El. = 92.50' n T2 3'x75' EZ Flow trench El. = ~9~1.~5,0~'^ \ a_ T3 3'x75' Ez Flow trench EI. O F' . Centerline 140th Avenue Page I CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Wright 5 Bedroon Replacement Septic System Owners Name: Jason & Abigail Wright Owner's Address 876 140th Avenue New Richmond, WI 54017 Legal Description: SE7/4, SE1/4, S24, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: NA Lot Number: 2 Block Number Parcel I.D. Number 030-1064-40-100 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 Lxisting Tank Certification Page 10 Warranty Deed Page 11 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 10/8/2018 Phone Number: 715-760-0486 72 Signature. i'7/ % '/i'/7LCZ'/ In round Soil Absorption Component Manual Version 2.0 SBD-10705 P IN. 01/01) Page 1 SYSTEM PLOT PLAN Project Name: Wright Design Flow. - 'cC 9atcnsday N - - A!W)) design flow calculations for Project Address. s I, • 6Ct Avenue commercial plans- Bht/ Symbol- A Bld Lievation. IJO. CO' Pipe Matenals t AS] M Standard Scale: I" = 60' Bf.4 Description. 6nt.,M of So.nJ Tables 384.303 & 386.30 5 0 60 90 120 BM2 Symbol: Q Bfd Llevabon. 90.08 4' SCr 40 PVC :.STN .)2e6S BM Description: 'op of ex,sara Septic nor, ion.hdl . aver 4' 3034 PVC ASTM D:A:fd - - Slope 3rament of Tested Area j1Ts 15 Well Symbol (,f applicable) Notes. Vaes Property Lline Existing Drain Field Existing 1000 gallon _ 98 Septic tank r - } I ~ I B, \ rValve Shed BM2 _Deck BM1 5 Bedroom House Gar.ge \ B3 \ 13% c ~ J B~ Driveway > Well \ T T T1\ a l 0 New 750 gallon Septic a- \ tank w/Polylok 525 96 94 a~ c J T1 3'x75' EZ Flow trench EI. = 92.50' c T2 3'x75' EZ Flow trench El. = 91.50' a T3 3'x75' Ez Flow trench El. = 9d Centerline 140th Avenue Da e 7 en,xtan 3TId gr~bk-SLZ-OI_', d\ 'eilOd .L3d -L4U E JC OC OC 7Ltl0 Oti: r, W, 'aSJN NKitlti 0. A.11- Sil 5l_' M 313HOUBB 13331M lVf1NVW OIld3S o :y°Od -38d -.I=„4 '{1W:J5 d~N, 'A9 NNtlyO c- \ arv-osLdw w w J K Q Z ~ ; k d J Z O coo w w M a Z 0~ N o a m w LA a 0 o W~ o 05 w to Q 0 J J w J HOp WO IiOH Q o V- a w = U at o Om oaa z V a w~ a H O y oa, ~J ZJm < m m~ Q ~'(''y 0 O w Q< U Q ~pw N 1. n z 3 LL aam0 min WWw U ^O z O~ V Q - t.C) C) Gj J I ?N p n m In d' W Q I <WN N ~J O IN Z Y a ° i n Vw017 N~ mw 0 -oaf Q p OD ° < -i U) N NQ~HyJy~~0 I Q ~NQ N aJ W a O Z N~ ~M1t wp J>'O ~1 V F2 ?N Uo Z N 2 O~ Zo Y N"aJ W?J 10 OZ, U YJ U w~ ~O Z N O~O~p30~ >aY OOW < <a~ W m p: a on L) 0. L( x wu mm- C) u)0 OF p z Q oaoo<w5waN <ao <~o u za~ z ca.{ 0 25 ~o F_ Z3 CD V~x Om J3 O ow w w 6 0 a Z ~'i N C] ? Z J m F U< 7 J J t N z u „Lb a O N a ~ > I a 1,1 y c w t - x O W W N O ZI W ..Lb ~ U III ~ _bi3 ❑~i•II"l~~A SV ..tti a 3 w K 6 N zZ Q F Page 3 w;ions r P[era ! ! r Zabel It skwer F i l ~h'. I 'WAOF ILL-S2~ I'lllll File PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 325 linear feel of I 116" filtration slots. Like the Pulvlok PL-122, the Polvlok P1.-525 has an automatic shut-off hall installed with every filter. When the filter is removed for cleaning, the ball will float up and lemporarily shut off the system su the effluent won't leave the lank. Rated for 10,000 GI'L)/ allons per day). c. - Alarn! SH;na, 1~i 1 ! (Optional) ,25linear feet of 1%1G' filtration. 110'000 GPI) < Acceplc 1" PY(. Accepts 4" and 6" SCI 11) 40 pipe. extension I Iandle Built in gas deflector. Automatic shut-off ball when filter is removed. Alarm accessibility. Fated for uf,INNI GPD Accepts I'%( extemfon handle Ideal for residential and commercial waste flows up to 525 Linear FI 10,000 gallons per day GIV . 1- Locate the outlet of the septic tank. 2. Remote the tank cover and pump tank if necessary. _ • 3. Glue the filter housing to the 4" or 6" outlet pip, 11 s I ill 40 the filter is not centered under the access opening use a Polylok Fxtend Lok or piece of pipe to center filter 4. Insert the PL-9',, filter into its housing. - GertiTied to 5. Replace and se\ ure the septic tank cover. ® HSF!ANSt Standard e.6 The PL-525 F(fluent Filters will operate efficiently for several Years under normal conditions before raluiring cleaning. It is recommended thal the I iller be cleaned evert' time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, Ihe owner will be notified by an alarm when the filter _ needs servicing. Servicing should Ix- done by a certified [;a, l`,•rl,cwr septic tank pumper or installer Automatic shuWn Kau 1 Locate the outlet of the septic tank. 2. Remove lank cover and pump tank if necessary. 3. Igo not use plumbing when filler is removed. 4. Pull P1,525 cartridge out of the housing. 5- Hose oft filter over the septic lank. Make sure all ~SIP solids fall back into septic lank, 6. Insert file filter cartridge back into the housing making sure tte filter is properly aligned and completely inserted. roltaok, ialMa c I a liner, accept Fa.,ih' inst:dl, fhr SmartFdlcr7 switch and alarm. into existing lank,. i'. Replace and Sl'cnra' septic tank cover. Polylok, Inc. 3 Fairfield Blvd. WShcinllard• CI' 06492 Toll Free: K".76>.956? Fax: 203.2S4,8~14 Aixiv.pohlok.coin Page 4 v_ PAGE 3 OF 5 a~ R^ `c_m L u c 1 Gt (D L Q 1 E - M C O O C E a) ~'a x d E .C Zen • 7 N e- O z T Z) N L Q v.~ Cl) 5 C o c o m w d 41 nv~ s ~ I -4 (0 d m i l'' 3, i ~ C y m ^U)^` O V 3 X m = Q W N ri a V CO N 6 U Lli 04 Q m a I II N o cli f I _ LU N W n r r Q U> I II II E ~ II zz I v Q W n i g to C) _p co U w W ~ N N J U C/) S I m d U Qul p v g o U) II Q Z d p53 I v W C EL- U) ~~.N ~ ^ tRs I II ~ r?' I > = r G ~ o 0 CL U fc I a 3 M v I ii II ~ ~ p J ' o o' I a~'i I c c W H C o - CO c~ v g I CD 1 u) I Q O~ • a • 5 N I ^ Lo N I r- col I a Jay co Q >c; s 1 -7 .•1 II II II II X Zw a a a ~ I o I W w ~ ~ ,f o s c Q I I x a I .N U) I II v Z 1~ v n I; Z n n C W 2 v 'c a F F- -"r E - = O LU C II o ui m I II I = rn = I I I w u I II II y U) ti c 0 af > M I II z J _j zcn I I + W < J 0 L_ J E 4 a m W T Page 5 Installation Instructions for 4*EZfOw" EZNryty, Systems in Wisconsin Cy INFILTRATOR 'vVia:;:onsin Deparlmen'. of Commerce- Safety and Buildings 5. The Absorotion area (SFi necessrry for if given rile shall Division, has revie•o:ed the specilications and 'or plans for Ihis be s, ,ed based on maximum daily sewage tow (GPD) and oroduct and determined it to be in compliance with -hap-.crI- rc Pcrmeablty for the site. If certain criteria is met, the Comm 82 frrough 84, ''Wisconsin Admin. Code, and Chapte••: LISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160: Wisconsin Statutes. All sues must meet the Sie smaller drainfield. & Soil Co°dilions & Localicns & Isolation distances as notes in ; local regulations. Plsce Inflow bundle(s) in the EZflow• configuration ap- proved by syslerr design permit specified for the particu- The approved prcd-cts are ' 2031- (3-12" bundles with pipe m ; lar site. The top or center-most bundles containing pipe -enter bundle in 5' cr 10' lengths:) and 1203HP (3-12" bundle: a•e joined end to end with an internal Pipe coupler. Any with pipe it each bundle in 5' or 10' lei addilioral aggregate only bundles that may be required. • should be bulled against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe su•- dles and do not require any type of connection. rounded by LIPS aggregate and is held together with fxilp- ehtylene netting. A single aggregate bundle contair accregato Y. 1 no top of each GCO cyii^.der contains a filter fabric pre- u^ly an is held togethc: v:ith. ppd.ir:thy'.rnr, nctti°e. manufactured in between the noFing and aggregate. The fabrig is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure fine the GEO is Positioned upward and is • =Zllov: Ui -,dles in contact with the fabric contained in the adjacon: cyl n- • -./llov: 6ectcv le ;1l:1i:. der bc'oro badddling. • =Zflcrx Internal Pine C~_plers • Pine for -leader and Ifilet 8. `re =Zflow Drainfield Systems should be installed n a • iiack--owBcadalcr levul trench 'n all directions (both across and afore tic he.nch boltcm) and should follow the contour of the grcu•.d Installation Instructions ...race elevation (unifo•m depth), with all continuous the instructions for in-;t.i -tiorr cf CZIIov, product aru .yver•l adelning 1C loo: cylindrical oundles placed end to enc, below. -his pred..cl mull be installed in •rc:-nrdance v;ilh stale central bundle distribution pipe inteiconneeuc, rules defined if, chapters Comm 82 throc,gh 84. ,Wisconsin Ad vo-.,out any dams, stepdow^s or other water stops. mini strative Code, and Chanters 145 and) 60. Wisconsin Sial- utes, as well as the local health department's current desigr 9. -l•c trench top shall be oraded such that water ill not manual. - ocnrd. Backfill should he seeded or soused immediately after completion to reduce erosion. 1. After the local health departmen: has determined s¢ioj, r:ont gu abon, and 11- A for the FZflow systems, stake : 10. L/flow ENS bundles are flexible and can fit in C-r.~ or mark wrath paint the location of trenches and lines. Re trenches as may ue necessary to avoid trees, boulder,„ o: c: reful to set correct tank. ,raver-, pipe, header line or di;. ith^r obstai trim tion box anc trench bottom eievatons before instal- Pt.tior of pipe bundles. I EPS aggregate is lighter P•an water, therefore, it night re expected that natural ouoyancy forces wood tend to R:,r,iC,ve plastic FY°ow shipping nags prior to placing ::ause czflow assemblies to foal out of ground when rcndlas in the bench(es). 3ernove any plastic bags in the pondng occurs. Field experience has shcwn, however; tasnrh befcre sys'em is sevei that Ihis is riot a problem w"n systems have a rnin:rrn_m it 6' of soil cover as rccommc~ded b,,~ manufacture•. product must have gcotcxtilc fabric that meets to a,_i anents of s. Corp-1 84.30 (6) (g).'vbis. Adm. Code. Bled directly on top of the orodur. and extending 1203H-GEO dov:n along the sines of the predict to a point at leas' six nc:hes Porn the bottom of product. ' ' ~ -r er Iv1=L.r 4 %Vnen installed in a trench, the trench should be dreg in a w.din of 36 inches. This not only save- labor n oxcava : ,ij. Ton, but also provides octtcr leas-bcarin_l capacity aftur ` backfilling is cornplele. Page6 PAGE 4 OF 4 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= 650 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 (i e, odors. user complaints. etc ) mechanical malfunction (i u, 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) o neglect or improper use (i. e., exceeding design capacities prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing dosing irregularities - if applicable (i a 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) 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. n 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 pe iod 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 7 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ONN7N1?ItSI-111' CERTIFICATION FORM Owner/Buyer Jason & Abigail Wright Mailing Address 876 140th Avenue Property Address 876 140th Avenue \ eI:fi(at i on :egnuOki f} on; Planning & Zunmg Department fin t ew cons I, ucr,,:,u.1 0tvlStatc New Richmond, WI Parcel Identification Number 030-1064-40-100 LEGAL DESCRIPTION SE SE 24 30 19 St. Joseph 3roperty Location „ ; , Sec 1 N R-- _Nt1, Town of 2 subdivision Plat: Lot # -ertitied Survey Map # Volume Page # Varranh, Deed # (before 2007)Volume l'a~c eniiiiab! cs❑nn Spec house Ely" Elo Lot hiwe YSTEM MAINTENANCE AND OWNER CERTIFICATION l;npIopet use and maintenance o: your septic S1'Stem could result in its premature tatlure to handle .vaacs. i'i:.,_. aintc ian, c consist, of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. n..~ p-t c system, can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner mamtcnane sponsibtlines are specified in §SPS. 383,52(1) and to Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed '0 lit tier and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1 1 the oit-sv;e tsresvater disposal system is in proper operating condition and or (2) after inspection and pumping (if neccss:u'~ 1, the septic rink is ,s than 1i3 fill ol'sludge. Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal systein with the ndards set forth, herein, as set by the Department of Safety And Professional Services :md the Departmeni of Natural Rcson:ccs. to of Wisconsin. Certification stating that your septic system has been maintained must be somplctrd and rctnrncd to the Si C rois unty Planning & Zoning Department within 30 days of the three year expiration date 1!we certify that all statements on tht form arc true to the best of my tour know IcdRc. I~ tN e am ore the osvnc:i,s? of t : pcrty described above, by virtue of a war anly decd rcconicd in Itc@iSler of Deeds t_)ffice. mber of bedrooms 10 SIGNA RE F APPL WANT(S) DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. ude with this application a recorded warranty decd from the Register of Deeds Off ice and a copy of the ccrtitic(l survc) limp it rence is made in the warranty deed. ay7 u=n 1„ i~ f~~il :)RT SOIL EVAI_lJATON PE lf Iesun •nc. .J{ cocfon paper r.ot Less tnan d : x 11 j4e -LAS CO: si ar,cai and horrole en''€'t+^r Ope ,re n<ipnc not', aid L-. r:: i'.': Pfease print aft information. E r , coc:u' e ; fu. yes IPr +ac; Laa c, I '"1f ral m ;rmat -T 'i ~u prOEG^_ maY 7e u.~ F< rent' Owrer tnperty Lo:a!,o-, - . , SE -Or 1 _r Jason R Abigail -,party ^wner's Ma,t,no Address ! # Blnrk # S SN v a r r, 140th Ave 1 G CtA c C y State' Zr-, Code Phone Nerlber ir Vi 'dill 54017 651575-9412 St Joseph 140Th Ave 'J ,,v Richmond Code `!ew C oristwo-on Use ReS zent•ai NU19 rill( Gr betl'OO.",c deflvPC O25ign (1dw rate 450 GPC Replacement DUb'J9 or comr I'Vai - Describe a ^i;•. ft I „arena material Outwash (Chetek-Onamia Series[ Flood pia n eleed' c ' =neral comments hfFA K .unable 1 r , ^ven4pna srsteP sit ? C; t ypd cp;: ra!v. r h'e srs.~m all iecommendanons ,fCO- SInFf (,rFa ~ j~ Boring 0 Born; u Pi; Greonn sortace elev. 06.60 h. Deolh to •,mrIng IaGOr -,b, = FPphcahan Rate Strur:lure consistence Boundary Roots GPD;fl' Horizon Depth Dommant Color Redox Descnpnon Texture m tdunselt ou Sz. Con! Color Gr Sz Sr 1 0-9 10y6+3 none first 2fsbk rnfr as 2vf 0.6 1.0 ml gw lvf 0.7 1.6 2 9-17 7.3vr516 none yrcos Osg t 3 17-36 iPyrE0 none s 0s; nil CS 0.7 1.6 r1r,.r,: Or,u 111 cs CJ 1.6 4 36-46 10yr5,+4 none 5 46-96. 10yr6,i4 nuns. 'J sq r ilk 6ornxl -_M1~1~ a 6ofi'1a # ,_"1 _i~ _Fr PPl~cat,on Rare, Pd liio W*] so-face rzv 96.60 k, 5'SIl t -.q i;Jry Roots, ,PO,f•: R.e00x ,JestnpUdn rex•u:< of Honzon Cepti- Dominant Color n r sell Q'; cz Conl.Codr 21 mfr as 2vf 0.6 C 1 C-15 liiyr:,r3 none 9r5 - none vgr;s nsg ml rs 1vf 0.7 1.6 2 1534 7.5yr,16 3 34-42 7.5y'r4i6 none grsi 2msbk XJ `9 ' Effluent 01 = 60D30 220 ,ng+L and rSS >3C ^5T Number C~ Name ~,P!ease Piel1 227429 Thomas j Schmitt Te,ephc,e rlurnber Address Schmill Sol' eshng nc r-rpe,t, 4',Jrig~,;, Jason & 4.higail Parcel ID# 030-1064-40-100 Page 2 of 4 Fonnq - Boring # 95.60 If . Depth :0 5rnilin9 factor Pit Ground suds:,e elev. 96+ n'. `Soil Fpplicanor Rate'. zon DOPW Dominant Color Redox Description Texture Stru@ure Consistence Boundary Roots GPGft' ir. 69unsell Qu. Sz Con:. Color Gr Sz Sh. 'rftr 'Effa2 0-20 IOyr34 none grs! 2msbk mvfr as 3c,2m 0.6 1,0 20-30 7.5yr4•:6 none grls lcsbk mvfr gw 2f,2vf 0.7 1.6 q5 2vf 0.7 1.6 30-38 7.5yrSr6 none grcos Osg mI 1 4 38-46 10yr6/4 none IS Osg n l 0.7 1.6 o61 It Bonr',9 L Baring # P9 G•ou~id surface etev. Ceptr 111 hln~tirg facto• In Soil Application Rate H. rzon Deptn Commarl Cofer Redox Descriptor 'ex:are St,udore Car sistence Bounday Roots GPDr1t' in. ldunsell Qu Sz Conl Cclo• Gr Sz. Sh •==f`kl 'En><2 3cr rg _ 3onrg # o,t G•ou rd surface elev _ f' Depth to Iimdmg facto: In [Sol! Application Rate Hcvzon Depth Ccmmart Color Redox Descriptor Texture Strucit-re Cchslsience Boundary Roots GP04t' in. Mw,sell Cu. Sz. Ccrl Celo' Gr Sz. Sh •Elmi -I - -Effs2 Lffloent 01 = P,OD,> 30 < 220 mo!L and TSS 1?0 < 1 bi mg L Jf4rern tt2 = BO0 c 301rg1. ar.c TSS <30 n:gl The Den:;rtnurt of Ct+mntcrce k an equal oppummin crr ice pros ider md cmpk,.% •T 11 Wu nceJ assistant. to aacs..er, ic_:. I,.oil:rU I'. t'. i~s.~-II UI m_Il rm,It Irl_a~c ~,vrt:.,l rh o dr r`rtIII ..nt •r9 h!--',I j 1 ..1r 1 1) ' nr,l8-?h,.8---. homas J Schm,u CST 227425 cdress 14-6 140111 ~k c. =B Valley View Trail City State Zip \ci. Richmond. R 1 5401 _ omerset.W1 54025 II111-11161-40-11111 Phone' 715,76 , at:re / , D1 No. ' ( ti41 9 1461 3.257 Acrd Lrga' Description SEI 4 I.F. 1!4 S2413ON R19'*%' e ;~ackhoe Pt Tomnsh;p. County Saint Joseph. 5t. ( roi% ( ounI% A Bench Mark 1 El. 100.00' Bottom of siding on west end of house A Bench Mark 2 El. 99.08' top of existing septic tank manhole cover Slope= NOTE: For full view of Lot see Aerial Photo (Page 4 of 4) i i P 1 l Irk, 3 ~i ~\\''yIJfGk ~ It ,'"1 ,.~•Ir~'1I I ~ Lou3 r' ge.e sstj ~ r 443. elGU I I n -Joo 1,'~ ~ ~i tlill•1+V r''~~7 I z ? ~ •",L s4 y -'CIF rlw D w O ~ ~ '~R._ +W r ~ r