HomeMy WebLinkAbout018-1090-50-100
Wisconsin Dc•artnrorl
p of Commu~a• PRIVATE SEWAGE SYSTEM St. Croix
Safety anc Bundi-g Dfrasion
INSPECTION REPORT sandary Prn,t Na
606975
GENERAL INFORMATION (ATTACH TO PERMIIT) Sl to Plan ID No
Perso-.a: nfa-^-a:ir. you prnvice mx: ne sec for seccnAary pwposes IPrtacy i aa, s I SrSn i rimjl
Pr•n'n: l s Na^-e Cry L•il age TO+:nsh p Parcel Tax No'
Timothy Kazmierczak TOWN OF HAMMOND 018-1090-50-100
~,ST BM Ele, Insp. BM L ev. BIA Descr pBe scctic-r'-o.x'.140nge..Map NC
s %t /a~ le 16.29.17.715A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS III FS ELEV
Septic Benchmarx. 3 • 11/61
r, j 4.'. /•jCQ., 4- / o v 0 3 9 5
Dosing P r TSb Alt. Btv1 „ ` GJ
3
n Bldg Sewer v S
Holding S1, Mt inlet
Stil Dille:
TANK SETBACK INFORMATION
TANK IO P~L V:'LLL BLDG Ven: Ar Intake ROAD of Inlet
septic 9`0 &7 36 33 Or Bottom 74' O
Dosing
96 / &7 / HeadeuMan r .~p 7
V O
Aeration Dist Pipe
-7. V% x'3.7
Holding - - Bol. System
Y. c.~ IL .7
PUMPISIPHON INFORMATION Final Grace 5 7 31
7
Mani facture Demard St Cover
y
GPPA A
Model Nur•IOer
TDH L If 3 Friction Loss System Head TDH Ft
g • o. s9 A_ 8 9
Forcernam Lendth Dia Z! Cyst •kll 77
SOIL ABSORPTION SYSTEM
BED:TRENCH 'v'; Urt Lcn,f- N.,. CI Twnd%cs PIT DIMENSIONS No. Of Pis IrsrAe Ura Licuic Dcp:h
DIMENSIONS J. -Z
SETBACK SYSTEM TO PiL BLDG WELL LAKE;STREAPA LEACHING Laanu'ac:urer
INFORMATION CHAMBER OR /OLd
. e OI tiysp..., 9 UNIT
6-D 7 Imneel N~TCer. Sl -fill
~la~Lv YY 4
DISTRIBUTION SYSTEM g 9 = / faQ
leaceaM.'n (id➢~ fhsrit.•ti. t 1-e c Srtc x Hole Spac ng Ven] to Ai• InJake
P:e:s: /O L Kd
Lergtn.¢ 3 Una Lrng;r 7 Son; ng All ♦ (A- l
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only dh d or+ ill
DVpth :)VP," / Oe:)tr Over "OcpC of xx Seecec.S:mied xx WIched
Bcd^c":h Ccnla l0~ Ilanl hence Ldgss Tnpw.l "--.Y -s Vu .Yes No
COMMENTS: .;Include code discrepencles, persons present. etc ; Inspection #P Inspection 02
Location: 065 176TH ST /
1 ; Alt BW Descnplion = ~I/-.. C^0
2 ; Bldg sewer length = E~/v _ L.l
- amcunt of cover = G~ ~7iii, r wS •ii- ~V it I III'
Plan revs on Required Yes xNO it
t$
Use Witter side for add tional information III
_ -
Date Inse cto rgritwe Cerf No.
SBD-6T1C (R 3,9.'!
(hunk -tom /
Industry Services Division sl-O°"
r.
p l 1400 h Washington Ave
S IY 9 4f~5`'~ NO. BOX 7162 Sandary Pc'nnil\mnber ho he tilled in by ('o.)
Madisor} WI 5 ~7-7162
Sdni#am, Period Apphcalion 11 State 1'tansacuon Number
In a....enfanec swth sl'z-~Xi?I; `A ls. ;\Jm Cudc.>uk.mi..i rn ut this Iium to the appropriate govarnmC11t9ttrmt-
N4
u o3hatcd prior to obtaining a,muuuy permit Note Application looms fir state-owned )'O&lS are suhmmed to - ` - -
u:c IXparmlcnt ofSafcly mid Prctss>ional Sen t.es. Personal intomtahon .ou provide may he used for second project Addres, (it different than mailing address)
purNaes in acennlancc with the Pncacs Lay, . I; (N; I qnl), Stan - - 965 I'r. Street
1. Application Inform i n - Please Print ,111 Information
I'topcny Ownu's Namc Parocl a /DO
Kymiactak. 'I'unothy OIK-IINII)-Sfr-yYtfT
1.1-7. It S A,
Propcrtp Owner's Mailing Addle,, Property I ,cation
965 156"' Street
_ trot Lnl
("Is' State - /lp ( ode Phone Number SW l,, NI. section 16
I)amnumd, WI 54015 le onc)
_ 'I 29\ R 17 P. ore
I I. Type of Building (check all that apply) te,l t!
Q lur ''!anvil. I)acll;rte Numbr;d Rcdo.oms Sts Subdinsion Name
Pheasant l tills I' 1Jdition
11 LQ.
E] Public! Commercial - Describe I.se Block p
❑ col\ of
❑slate Osencd IkscribeUse
SAI E] Village of
q /9 f Nuuthcr
2 Ql~ E4 (~/ow~j ❑ Town of Hammond
111. Tvpc of Permit: (Check Ly-une~oa(~aline A. Complete line B if applicable( -
;
A. ❑ Ncw System ❑ Replaeemcnl S"wUl ❑ I rcaunarVl lolling Tank Replacenem ONy ❑ Oder Modification to Ixic6ng System (explain)
1 1"min Renewal ❑ Pcnum Revision ❑ Change of ❑ Pcmnit Transter to Ncw' I osl Prevlnn, Permit Number and Date 1 sucd
liaore l \poruln i Plumber Owner aJ ~IC~ .3 Z
IV 1ype of L'O TS Systu»'ComponendDevice: (Check all that apply _ 'T _ - _
® Nun Prusunzcd In Ground' ] . resvtnrd In-Oruund ❑ AI-Grade ❑ Mound - 24 in. of suitable sod ❑ Mound 24 in. of suitable soil
k- -l Mhe: l~; vp realm p.rucnl ic\pluiu) ❑ Pretreatment l),cv;ce(explain)
_ /V _ ow l (explain)-
V. Dis crsal/Treatment Area Information:
Design Row (gpd IV s n Sod Apph.:anon Ui,penal .1r<a 14yd 'J h11 Dispersal Area I'm i,,cd 1st) Sysic.. I Iev nn -
9tat 91'(1'
6rNt Ralu„pd,l) ✓ 857
_ 0.7
VI. Tank Info C q uny m _ r -
V C 9
Ilnns final d of ~ L ~ d _
11:mu1'aclurer
Gallons I not,
huafi;p I:mk> IJ ~ - 3.
Septic or l told ing'I ank 1-'511 I2SO 1 Hu11'cull( ln)c etc Inc ❑ ❑ ❑ ❑
Iksnv~('humtxr sit 'SII I Ilulliult Concrete Inc d (X'-- ❑ _ n
VII. Responsibility Statement- 1, the undersigned, assume resp;msibilih for installation of the PON"IS shown on the attached plate.
Plumhcr, \arue (Print) u ct ,t plure \111 MITI, Numher Iiuanc'as Phone Number
John Schlnlll _ ~✓L~//Lt-'L/ ~17bn 15.76o1Nx6
Plumber's Address :I nec( C'm. State, /ip( cider
616 150"Ave. Somcraot. WI 54025
VIII. ount_v!_Deparlrnenl Ise Only
Approscd p Permit Ice Dal•Issued Issuing A Signature
_ s ~g$• ! 2L /8
U"A W t lsur Ration for Denial ~
_ I
IX. Condi{iot%(got~C12jRge. Disapproval 5 .L~ ( fln.~ P~✓i f
41s,per.:a cell - oat all be XVV (~~f~n ""~1II G
ss per;yw 3yenlenl o4n pt. I net - o - ak- $ 7e',r+, d'n >n ~r4:.t v
2. AN ntl * fact ker^ !ntAfmr
as per PWAG Ith uait / crd ,.3 : I _ 1
Ca.A.e.,..n2
- wach m camping plan% for the %vetem and submit to the ( ounty only on paper not lees than a n: x I I inches m site
SI10-6393(RO" I41
SYSTEM PLOT PLAN
GcsiSn Flrnv. 6on,inllu^::'any
Project Name: Kazmierczak F!; =N+,
Ana Oh desnn floe: GdcalaliUns for
~ralcet Addfes5. _SE_lEV Sveee canuneu::al plans
S.11 SyinWI A 310 L:evanon Pipe Mateaals AST!:
BV Dcscnplav. sonom of S'a-Q - •ies 384.303 E 384.305 6CaIB- 1" = 60
C 00 90 120 'i
30.52 Symbol 91v1 Llevalion. 9750 4 S(;kl 45-V- AS Itd D28F.5
80.1 Descopnon. Top of exisnne Seo w ank manhoe caoe ASTrv C30}4
Slope Gradient o' Tested Area. r< 15'
SVell Symbo iif applicabel
O
Notes' N-tes Drainage
~ Drainage
_Easement F
r
98 Sip,
% 94
I / i I
I 1r~T(~3^2 TS
'•Y /
n2ji 11 I
i +1 II
I II II II II I
IIII I II
j l ~ l ~I I I B3 I .
1 I I I~iI
III ~ I
jIII i~
I X11
--xisting iluffcuC
. ' 25C.75') SepGcOose T. anK
Q
' ~„~C3M2
cy'
4
T' 3'x8' S' Infltra;or Trench EL=92.'IC' louBedroom se ~ e+~j
T2 3'x87 5' Inrihrator Trench El =92. V \ o°/
T3 3'x90 EZ Flow Trench E.=92.70' - \1 Q%
T4 3'x90 EZ Flow Trench E..=9270
4Vel ! ' Garage f
/
Driveway
m t'
m
m II `-'ne.
III t„ooen,
n
I I
Rage 2
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Ka7mierc7ak 4 Bedroon Replacement Drain Field
Owners Name: Timothy Kazmierczak
Owner's Address 965 176th Street
Hammond, WI 54015
Legal Description: SW1/4, NF1/4, 516, 129N, R17W
Township Hammond
County: St. Croix
Subdivision Name: Pheasant Hills 1st Addition
Lot Number: 50 Block Number
Parcel I.D. Number 018-1090-50-000
Plan Iransaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic & Dose Tank Specifications
Page 4 Septic & Dose Tank Cross Section
Page 5 Effluent Filter Information
Page 6 Pump Curve & Specifications
Page 7 System Sizing & Cross Section
Page 8 E1 Flow Information
Page 9 Management and contingency plan
Page 10 Lxisting 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: 11/18/2018 Phone Number: 715760-0486
Signature: L kll~ 21C./%Le
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1
SYSTEM PLOT PLAN
Project Name: Kazmierczak Design Flaw `°a yanc Sddy N
Allach design flow calculalwns for
Project Address. 955175%Strout commercial plans
-
FId1 Symbol - BNa Llevation. Pipe 64alenxs+A'Tf4 '
Scale: 1" = 60'
BN1 Descliplior. Boll.- of Sidirc T les 384 30-33 R 384.30-.5
0 60 90 120
R0.42 Symbol Q BM Elevation 97 50' SCH 40 P': C AS"41 D26ti5
80.4 Description. "op Of exal10 sem c l aoh manbaa Mn f 4" 30..4 PVC ASTM D3U34
Slope Gradient of Tested Area. 14w.: 15
'Nell Symbol (if applicable)
Notes* Niles A
'O
Drainage p07y
Easement
i`
98 96 9 1 4
I
I 4 T2 T1 I
r B2 I
I I I
I I I I
I III
I I B3
I Bi
I 1l
c I l5
v 1
Gtr existing Huffadt
o`~ t 1250f750 Septic/Dose Tan<
Q BPd2
c
T1 3'x87.5' Inbltrato' Trench Fl=9210' 4 Bedroom C
House m
T2 3'x87 5' Infiltrator Trench E1.=92.10' o
T3 3'x90 EZ Flow Trench E:.=92.70' - Q`
T4 3'x9C C=Z Flow Trench E .-9270' -
Well Garage
o _
Driveway
s
N
m
m
n
C IaPF
p
V
page 7
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
I
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address)_ 965 176th Street located
at: sw , NE V;, Section 16 Town 29 N. Range 17 W,
Town of Hammond . 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 111912018
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: 12501750
Construction: Prefab Concrete x Steel _ Other
Manufacturer(il•known): Huffcutt Concrete Inc
Age of Tank (ifknown):_ 15 Years
Permit number (if kno/wvn) 420593
j1 ~1L //L~ John Schmitt
(Li nsed Plumber Signature) (Print Name)
MPRS 223760 _
(Title) _ (License Number) MP/MPRS
11118/2018
(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
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Page 3
PAGE 5OF6
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
A? 7 1NT
Boildirg Pre:rn,al muu mmpy -All
1 M or 2 0 It atovc SPS 316 and NEC 300
i eLn Ji:hed FIOW Ele•,11ion :4' Fxlend -ar ,ato ^~av a>: ^ecnssa^y.
Ily Pical} ~ eatherprcol
AnPfe02d -Jun ul,or n°x
ApproeW Lo:7,m9 4.9arrnle
INAPORI AN C vml (a{, vith Vdan-ing Label Aaacha7
I (ypicel;
Anchor tank(s) as necessary ---Corduit
pursuant to SPS 383.43(8)(g) a" nan. or 2.0 ft abwo
Eslalished FloW Elovalon
~Anbilln Seal - \1/
F isl•ad Grade I I Buick DISWr'1C1:(
n. 1 R' Min.
CAPACITIES @ 16.85 gal.in . , hnwl7
C 1
Depth (in) Volume (gal) -
*T
A 24 404.40 'Aeeo `Appruvud Joints im
Hde Approved P P. 3 11 000
B 2.0 33.70 Selld JNU'N
[C] 7 117.95 `
Alum,
D 12 202.20 B 0-On
I h[-I PUMP-OFF
njmp "o oil ELEVATION = 87.40 ft
*Pump Tank Liquid Level = 45 in I
INSIDE BOTTOM
Force Main Diameter = 2 in c° mete
I Bbx:k ELEVATION = 86.40 It
Force Main Length = 70 ft 3" AuP'o"ed Bedd rg Mate^al Boncal, T:nrk
Vertical Head = 5.97 ft
Force Main Void Volurne = 11.41 gal
+ Min. Supply Head = 0 It
[C] Total Dose Volume TDV) = 131.41 galidose
+ FM Friction Loss = 2.31 ft
- (5X total lateral void volume < l DV < 0.2X design now)
+ (force main drainback volume) + Fitting Loss' = 0 ft
- - ~irnin, supply head x 0.3;
MIN. PUMP DISCHARGE RATE = 20 gpm - TOTAL DYNAMIC HEAD= 8.28 It
PUMP TANK: SEPTIC TANK(S):
Volume = 758 gal Total Volume = 1263 gal
Manufacturer: HLIffcUtt Concrete Inc. Manufacturer(s): Huffcutt Concrete Inc. lWlllllllllllllll Pump Manufacturer: Hydromatic
Install approved effluent filler at the septic tank outlet
Pump Model: SHEF30 r;9nTgChEj pa^ n immediately upstream of thepump tank inlet.
aa ' JJ N9.1 I
Controls?Alarm Manufacturer: Existing Filter Manufacturer: Zabel
Controls/Alarm Model: Existing
Filter Model: A-100
Float switches containing mercury are prohibited. Page 4
USA
INSTRUCTIONS MAINTENANCE ZABEL FILTERS: A10013001600
AGE 2of2
The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of
opinion on what this interval should be. but most regulatory agencies suggest two to five years. The Zabel filter, which does not
increase the frequency of servicing for the tank. should be cleaned when the septic tank is normally inspected and pumped,
However our filler is virtually self-cleaning- The continued action of the anaerobic organisms on the Zabel filter causes lodged
particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFllterO alarm, you will be notified by an
alarm when the filter needs servicing
I
Step 1: Step 2: Step 2:
Locate the outlet of the septic tank Remove the tank cover and pump the Firmly pull the filter handle and slide
and remove the lank cover. tank if necessary to prevent any solids the cartridge out of the case.
from escaping to the the drain field
when the filter is removed.
Note: Servicing any Zabel filter
should only be done by a certified
sepbe tank pumper or Installer
Note: ff you have a
before Case model ffiter, be sure and
spray clean the outlet opening
replacing
Step 4: Step 5: Residental Applications
While holding the cartridge over the Insert the fitter cartrage back in the Cerlified to ANSI/NSF
access opening. rinse off the cartridge case, making sure the filter cartridge standard 46
with fresh water, being careful to rinse is properly aligned and completely
all septage material back into the tank inserted in the case. Replace the septic
tank cover
COVInghl ^O 14. Pa,',k;N, Inc dfl rights reserved
PfoduCL'SI CO':DfDtl Dy v^e of t.Die L. and/or mfemanonag patents other U.$. dAtl lRfema96^3o:Ce,,.'S ^4yhn (x!rping
.j_,-.- - 7 a , ":.:,I};h -,r. I' Pages
HYDROMATIC" ilk
S H E F3 0 Wholesale Products Page: 6350-1
Dated: January 2001
SUBMERSIBLE HIGH HEAD EFFLUENT RPM: 1550 Discharge:1 Yz' Solids: 3/4
.I
~r.t(
12 - 40
9 w 30
w
w z - -
6 a 20
r V,J
0
= a SHEF30
3 o 10 -
0 0
Capacity-U.S. G.P.M. 0 10 20 30 40 50
Liters/Second 0 1 2 3
The curves reflect maxirnurr performance character sties without exceeding full load (Nameplate) horsepower. At, pumps
have a ser-vue factor of 1.2. Operat-on is recomrnended in the hounded area with oprraticna~ point vlithin the curre I. not.
Per for mdncr ::u "de:> ar c based on .rst:rdl m:>t> with uedr water at :/0° I . and 128U loot cite elevuaan.
Condit ons of SPrvicr:
PENTAIR GPM: TDH:
Page 6
PAGE 3 OF 5
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Page 7
Installation Instructions for af1EZflOwn
EZ110n Systems in Wisconsin by INFILTRATOR
`ddsconsin Den irnent of Commerce, Salety and Buildings : 5. The Absorption a:ea ;SI j necessary for a giver site shall
lit sicn, has rcviovicd tic specificalions ai&or plans for this be sized based on maxirnjm daily sewage flow (GAD) and
product and determined is to be in compliance with chapters : the Permeability for the site. If certain criteria is met, the
Comm 82 :hrough 84, Wsconsir Admin. Code, and Chapters EISA sizing can be used in Wscons IT, resulting in a 4345
145 and 11130, Wisconsin Statutes. All silos rn.ist meet the Site smaller drainficld.
& So I Conditions & I oc:ations & I<_elation distances as noted in
Irral egulators. 6. Place EZflow bundle(s) IT,, the EZflow configuration ap-
proved by system design permit specified for the particu-
The apprpvee 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' Iengtns) and 1203HP (3-12' bundles :are joined end to and with an internal pipe coupler. Any
with pipe 'n each bundle in of 10' lergths. ; aacit.onal aggregate only bundles that may be required,
should be butted against the other aggregate-only bun-
A s rgle pipe bundle cor.tars a four rich perforated pipe 'I,,,- dlc:: and do riot require any type of connection.
ounded dy =PS aggregate and is held together wit,) pmly-
chtylere netting. A _ingle aggregate bcu~dle c ;stains aggregato The top of each GEO cylinder conta ns a filter fabric pre-
crly add rs held togot'ncr w If pid"etf-yl-re retng. manufactured a: between the nelling and aggregate. llie
fabric is inserted to prevent soil Intrusion. The, installer
Materials and Equipment Needed stall make sure tine the GEO is posiliioned upward and is
• Plow Handles In ccntact with the fabric contained in the adjacent cy4:r.-
• EZt1ow Gcotcxtile Faonc der before back' fling.
• EZ'ow Interral Pipe Cm.plers :
• F pe `or Header and Inlet : 8. The EZflow Drainfield Systems should be installed it a
• Backnae,'Excavator : level trench in all di•ectiors (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 rstrectoi lo, irslall;ator of EZ-..ow, erodaa, are giver: ad dining 10-toot cylindrical bundles placed end to end,
below. This product mast be mslalled in accordai will stale with central bundle dislributron pipe interconnected,
rules defined in chapters Cer•-m 82 (hrough 84. Wisconsin Ac- vothout any darns, stepdowns or other water stops.
minstae!ive Cede. and C-apteis 145 and 1f Wisceii:iT,
Stat-
ute-:, as well as ,ne kcal FeAl celd~rtrtert's cUr-ert design 9. '7c trench lop shall be g-aded such that water will not
manual. :rind. Backfll should be seeded o, sodded immediately
after completion to reduce e•osion.
1. Afte• IF-c oe al hest n Jepa,t-tent has detr 'ranee ling,
ccmr liyurat or, and la~Cir. irr the FZII:w• Inns. stake 1;:. =Zflow EPS bundles are flexible and can fit in curved
or mark with pain] :he I :eat on of trenches and lines. Fie :ienches as may be necessary to avoid trees, boulders, or
careful to set correct tark, river. pipe, header line or dis other obstacles.
lributon box and trench bottom elevations before instal-
lalon cf pipe bundles. 1.i PS aggregate Is lighter than water, therefore, it might
be expected that natural buoyancy forces would tend to
2. Remove plastc EZflow: shipping bags prior to planing cause EZflow assemblies to float out of ground when
bundles n the :ren bliss). Remove any plastic bags in he nonding occurs. Field experience has shoaan. however,
trench before system if: covered. that this is not problerr when systems nave a minimum
of 6" of r;o,I cove- as recommended by rranr ae:urer,
3. This product must have geotextile fabric that meets re-
quirements of s. Cornet 84.30 (6) (g), Ws. Adm. Coce,
installed directly on top of :he product and extending 1203H-GEO
cover along the sides of the product to a point at least six
inches from the bottom of product.
barrier Male[ al
4. When installed in a trench, the trcrch should be dug to
a width of 36 inches. This not only saves labor in excava-
tor, but also provides better bad-bea.rnc capacity aster ;
backflliing is c::nplete.
.aage8
PAGE 4OF4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-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= 600 gpd; BOD5 220 mgL"'; TSS :5150 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 (re, pumps, valves, switches, floats, etc)
o material fatigue (i.e.. leaks, breaks, corrosion, eta)
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 (1l3) 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.
c Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturers 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 Development Phone, 715-386-4680
Local government unit address 1101 Carmichael Road. Hudson, WI ZIP 54025
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. Wises 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
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
VA ?,.A IEQC i?
OwnerBuyer T C., it. J. a.1 lc H ~ ~ u ^ L'
Mailing Address
Property Address Clips i 76ik 57. t-a 5o
(Verification required from Planning Department for new construction)
City/State N A h,....d / WT, Parcel Identification Number o 16 - 1011s -90 - 000 (~I S
EGAL DESCRIPTION
Property Location Sw 'h, W f- Sec. 11. , T Z4 N_R l 2W own of k AHK c nJ
11 Add So
$nbdIVISIOII P / G S 4 n} µ i Its isF Lot #
-
Certified Survey Map # Qs Volume _ Page # q_•
Warranty Deed # Volume _ I Qz Page # CU
Spec house ❑ yes~no Lot lines identifiable yes ❑ no
SYSTEM MAINTENANCE
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 yeas or sooner, if needed by a licensed pumper. What you put into the system
an affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St Croix Zoning Departmeat 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 113 full of sludge.
Vwe, the undersigned have read the above requireratuts and agree to maintain the private sewage disposal system with the standards
s set by the Department of Commerce and the Deparmrnt of Natural Resources, State of Wisconsin. Certification
set forth,
p c em has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
djprty s o e expiration date.
ICANT DATE
CAT O
hat Ili statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
bove, by virtue of a warranty dad recorded i n Register oC Deeds Office.
LICANT DATE
4•90" Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.
" Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
I
Wiarram Depatsnern of Commerce PRIVATE SEWAGE SYSTEM Cauny; SL Croix
S.--1 an olliidin9Oivison
INSPECTION REPORT SanAary Ferrol No 420593 0
GENERAL INFORMATION (ATTACH TO PERMIT) Sol Plan'D No
Plrumal mla,net{ n y:m ptovioe nw be cseu fn, rec:un.1»y lartglam (hinw-y Lax. r. 15 OJ (t )Knit
Permit 14 wes Nam. City votage Township Parcel Tax No
Kazmierczak, Tirr Hammond Township 018.1090.50-000
CST BM E'uv: an tnsp BM Eler, BM D~owa~p( coon` ~
al 00.a' Z" Sli( 4A.
TANK INFORMATION ELEVATION DATA
TYPE tv1ANUFAC7URER CAPACITY STATION BS HI FS ELEV.
Septic L-~ Benchmark c( C4, 4z I
Dosing Lr Alt. OM
Ae.mton Bldg Sewer r
~.54 r T
Holding SLtillnlel r
l3.roo 5b.&0
TANK SETBACK INFORMATION So?it Outlet
TANK TO ML WELL ULDG. Font to Air Inake ROAD Dl Inlet
Septic y S, 3~I _ DHIrMem /9,C pr JD'
Dosing IWdeh?Aan. I(~ 93• 5 r
Aeration Dist Pipe f ('3O 3• /o /
Holding dol. System - o
Q2•ra
rz. 30
-
PUMP/SIPHON INFORMATION Final Guide
Manufacturer Demand f (-over (e
IhrkTl C_ GPM50
Model Num r
- Stt~F - 30
TDH Li" 0 Frcnnn Loss system Head TOE Ft
It p.51-SI
Forcemain Length 1 Dia p OW 10'.VeI
5~
p ti 1~ OIL ABSORPTION SYSTEM
BED/TRENCH 4,111 r Lenpt' I No 01 Tr.,.. a PIT DIMENSIONS IN. Of PBS l°SCe Ca .or,xi Ce;m
DIMENSIONS g}.~ eA.
SETBACK SYSTEM TO E PA BLDG WELL I AKEISTREAM LEACHING IAnnule - A 1
INFORMATION ty;.nrnSkaten, sr Q I r CHA ROR
UNIT t.lodel h'unhori-+1. ^ D
DISTRIBUTION SYSTEM oc
HoadoeN.nv'oiG Di3ldhWcn n14•le Sae 1.11. - ° - Ir Vrtnl to>W Intake I 4,
Pipe(
LBngtn___ D'a ,.erpth__ Die SpeUnq 7
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Do" Over xx Dept- of u Scededl'Soccac xx Mule
8edrrrench Cenlor BeddTronch Edges Topsoil vas ■l No I1w Yes No
I
`)COM NT 140clud~ea disrrepe es. persons present, etc.) Inspection #1' yy1.Lr_LZ903 Inspection #2'.
to LM
LdCBRdn: 965 176th Street imniond,Wl n `54Q11_5 (SW 114 NE 11416 T29k R17W) Pheasant Hills Lot 50 Parcel No: 16.29.11.715
1.) All BM Description= LArtjC $T. taf.~.
2.) Bldg sewer length = -1~T2
amount of cover = 4
3) 06S4,rif J PL~{a t ^ Z 140 Tv. 4 142AA 'N AA1A t~i✓ fw~~~N.
Plan revision Reauwed? o Yes No
Use outer skid for additional infonnalifb. - "`_"'lll_ I .1 L -
SOD-6710 in 3~?71 C,i9p Dar - - ^ . lnaepl%°fa Slpn Olure CaM1 N°.
• e~IQ4L
w a~
SOIL EVALUATION REPORT
i.w»ri owl a cann«c.
DMefOna96dMY End " In* y wOh COmm 65, VAS. Adm. Cod* Carts
ANSO Nnq"w aft pion an pWw• na W.6~ 6 M ■ 11 kdvm in bn ~ Ped M _
6a not tn6kd be vertld Ond WWnId minwm6 Pa" (W
pmOpwmme.wdn or mw sww nosh w~, .4 beMY6n WA ekwwrA n6ro4 mW. Daft
by A
P16t66 pf" ON &Wnwdon' Tiw6 Oy
pynpeilMbnMOn yw N6 'af r ~ d W weom" pia- (pllGY U+• 16M M kNx
•
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M Z. ' e (C- z l.a 0 SWk 6 Swd. Noms Or CSW
Addlem owwrawes p1GC a vv~ o n ❑ c6T O ~w RTOM
~ Nr.a Rake GPD
(9 awdam Cod* dnkmddWQnftf0W d6
CWWWucdon UMEB Rm@WmW )I Num* r
❑ PvW0Fcowmwdd-DsvAW _a-
R6plocemsnl Flood PWn OWS$on 0 ryp6u~ 'lower
°andm SySfem, elelr. R CEIVED
~spYp1 1__I ammo i In._.., Doom 10 O>tim-~--In' SW Role
® P6~ R.OOIo
Cow BO XWWY -Em 'EM2
Howmn 06p6~ D-Wnam COW Rwdm O Gr. SL Sh.
Munkd Ou. SL COnL COW
0-is r Cw IS
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Pk Gmod WAWD dov. Cagy,, BuundwY Root GPOW
Halmn Doplh ppwin~tCdoc Roeoc T6ndtow Gr. Sz. w •Efet 'EA2
In. Mugo6 ou. SL caw. COW G. Sz Sf. Mf, ! CS 1 U~ S
I o- Z L yn c c S v • S'
Halo _ -
•tlk.m 02.• 30 myl rd Tys<3o myL
emmmh-sm 30t 22o mplLad TM>30<_760 mpfL CST Nntw
CST Nero lPk~eoe N4 a Q
c..luJG-,,,~„-Cgducbd. T61epIV~s MknOs
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❑ Barra ® q5 ao a o~ a r~"o um, In.
pit nd wbw ROD" GPDW BoLwdwy p.dmc Tocb" Sratraa Canilws •E02
Haman Daplr oa am COI Or. Sc Sr. I vi
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0-8 jo, 31Z
Z q-30 0-115 a
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0 Ono to NWOV Irrrx In. Sod Rtla
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❑ BorYp ❑ PM ~prgard_aalaaaaMN Daardarr Roots (pDA! Dw*wd Taraua SYnaba ~ •EN7 'EW2 ompa"an Hamm Daplr Color Ad.
h MOW" aa Cow. $ OWL Gr. St Sr
Gbbr
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pear
Haman Dagr POW*Wd oow Rasa DSOC*4 ar Ta1pY1a BOW*" ~ e~or,erY •glrt 'dM2 Gr. SL Sh..
in. WAVAI Do. Ss Cart C40W
J--- TSS I3D na0.
a4TSS a30 <19a rrglL 'C draggpr:3a rrDfL ad
FJirra M • DGDr a 3D <240 myt
Tre DqW mrnt of COr m r" is as oqw opp&rmlr a 6W266lf you .3 sl a X2644'n-sm;~• w
wed maoaial ~ r aYeroaae fonoat. Piaaae
ro.o>.R~aarr
PAGE,LOF,
NAME: 7~V>T#jC_LEGAL DESCRIPI7GN~I/yy,~..V4,SjfpT~,N,,fLQ 00
SCALE: 1^=___~U
1
gmkELEVATION:-_j00.0
BM I DESCRIPTION: _1,, n n-i 11i
BM 2 EL EvATFON:
BM 21)MRIPTION:,_p.j.' - t-
SYSTEM ELEVATION: p 9 o-Lo~ iz,6c
SYSTEM TYPE:_ cane, 4 -
qS
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1
4
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SIG A __,DA'