HomeMy WebLinkAbout032-2157-10-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)],
Permit Holder's Name:
City Village Township
DANIEL & KARI RAE SIKKINK
TOWN OF SOMERSET
CST BM Elev:
Insp. BM Elev:
BM Description:
�'e • 3 �
�S
t
� �M0,v�Vlo `2 Lpqer
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
W��I�
bbo
Do�
I
.,� W�Po[�kSzs-
[fA�era
Holdin
TANK SETBACK INFORMATION
Vent to Air Intake
wo
0 WN-4 W- —a MN..—
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Mode umber
TDH
Lift
Friction Loss
System Head
TDH Ft
F emain
Length
Dist.
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651282
State Plan ID No:
Parcel Tax No:
032-2157-10-000
Section/Town/Range/Map No:
12.30.19.1353
STATION
BS
HI
FS
ELEV.
Benchmark
3.19
Alt. BM
Bldg. Sewer
St/Ht Inlet
X
do ���A
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man.
gee,
WXe-
Dist. Pipe
Bot. System
S�
MbLLI
Final Grade
St Cover
Lf
f
ILI
0 51c_ 1901K ac-Ali-t Co - 7-15 q!, zr `
BE TREN
Width
Length
No. Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS
3
-r7 !;
1 C3)
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL LAKE/STREAM
LEACHING
CHAMBER ORtp�a_Rrairylo
Manufacturer:
Type Of Systgm:
r
f
I
Model Number -
I �aa Ft-o w
I
,
I
�
� �O
DISTRIBUTION SYSTEM
Header/Manifold
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
0---
Pipes
I
Length Dia
Length
� �
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 9�2(1/2023 Inspection #2:
Location: 882 167TH AVE S . CV,
1.) Alt BM Description
� �-
2.) Bldg sewer length = ° ((-)3,r?S7
- amount of cover - n a,+ � (w) $r � �-°� ^ * c, r
+revt JAo &v\,
2.
Plan iravkision Required? ❑ Yes No ! 2
V,-�
e other side for a iti I information.
�i. aC C e_. Date Snrepcfor's ignature Cert. No.
D-6710 �R.3/97)
, , p �r z SerS� ovve "5` ST
%
RECEIVED industry Services Division
cowty SAN-2023-204
St, CMIX
S 09/05/2023 1400 E Washington Ave
Sanitary Permit Number (to be rilled in by Co,)
P P.O. Box 7162
Paid via Ascent
Madison, W1 53707-7162
# 31259
Sanitary Permit Application
State Transaction Nuinber
In accordance with SRS 383.21(2). Wis, Adm, Co(le, Sjjbrr11S1,1L III Of th s 6 k� )prnpruffle -!�ovemmcntal unit
i f ml to th 3T
is required prior to obWning a stnitary permit. Note. A pp I i cat i on forms for state-40 WAed P(Akl S, are submitted to
1-1 Fo I ec i Address 0 f d lifferent. than mai I I ng address )
the Depument of Safety and Prafesslonad Services. Perscmal in formation you provide nia% ht used t')r scoindary
.
_urp o.ws in accordance wiEh the Privacy Law, s. [5."l_Xm). ;rats
_p
882 167" Ave
1. Xppficstion Information — Please Print All Information
PrOJ)�FLV Uwner's Name
Parc L: 14
Dal lic] & Kari Rae Sikkink-
032-2157-10-000
Property Owner's Mailing Address
i Property Locaion
882 16r Ave
Govt- Lot
NE 1/4, NE 1/4, Section 12
City, state Zip Code
Phone N ki, 111ber
New Richmond,, W1 54017
rcle one)
R19Eo T30N
11. l'ype of Building) (check all that apply)
dr� i�ion Name
I or 2 F'amik, Dw01 iilij - Number ot'HWmms
l !Suh
'Fhe High1wids
f3 lock, #
Publis/Cone mcr('Fal - Describe La W
City of
Ll State o"ned 1)escrihc I use
Village of
CI Number
"rown of somerset
Y
Ul. Type
of Permit: (Cheek onh, one box on line A. Complete line B if applicable)
A-
New System
ke[ilaL:ement Svswrn
ni�D
TrcatmeTi 01 ol d I n L, Tank Re pi acernent Only
0 Other Modification to Existing System (explain)
B
F-1 Pemiit Renewal
Permit Revision
Change of
El Permit 1'ransfcr to New
List Previous Permit Number and Dale Issued
Before Expirzition
Plumber
Owner
A29gr
1Y_ TvDc afTOWTS System/Cornponent/Device: (Check all. that apply)
00,
Non-Pressu'rized la -Ground Pressurized In -Ground L] At -Grade 0 Mound > 24 in, of suitable soil E] Mound < 24 1 n. of s u itabi e so I I
Holding Tank er Dispersal Component (explain) Pretreatment Device (explain)
V. Dispersal/Treatment Area Information: V:�_ E2� �t�.r q.D5CLp-&(
Design Flow (gpdl
Design Sol] Applicc- nonDispersal Area Required (0)
Dispersal Area Proposed (sf) "4 System Elevation
750
Rate(gpdsl) 1071
1)25 -193. 93. ?7�1973- 1�
0.7
I. Tank Info
Capacity in
&W A 10b
Gallons
1) it �d
4 of
�
IM W I u fac I U fer
� �
� �
2
New Tank-s
Lxi_�Zjn
(Jallons
Units
U
LZ
SepfiL; or I loldingl'auik, 150
1000
1 1750
2
W'eiser colicret-:?Weeks
Dos mig Chamber
1 L1
1 0
11
V11. Responsibility Statement- the undersigned. assirme responsibility for Installation of the POW-I'S shown on the mliched plans.
Plumb-cr's Name (Print) MP/MPIRS Una her Business Phoft Number
John Schmitt 223760 715-760-0486
Plumh,tr's Add es rz f'�trcLet, City, State, 7 ip Code)
586 ,"'111c\ vic\� Frlii_ Somerset, 1 1 54025
Vill. County/ e p altmU ent se Only
-
Approved • prove Permit Fee Date Issued I Agent Signature
I =N�= m�ason for vial $ /26
IX. Conditions o Approve 3)
(�G� AA U.N. C,+ A* W
SYSTD.1 C*NER: -kLs,
h 1. Sl,l 1111, 111,1,,l 111,�, and liSperad edl
m3in1j;:f:c-Lt as per wr
plan ;.,r,-)Ynjo1 by plur,iiim-
2. A� Si�!Ljd ri-quiren-e rz rn,;st be nia'idained
-'S r'E` d[!J:hW�Je Cride .-iw1inanow
Attaeb to complete pkans for the s", tem and submit to 1ho, Crmi Pity nnty o1ra paper not Ims thnn 8 1—nay e2 I I inches in wine
45'. r,T . ....
fi) 6A_ 6:115r�a4 AA46,f:
SBO-6-108 (R(111i 14)
SYSTEM PLOT PLAN
Sikkink 5 Bedroom Septic System
Projecl,Addre�s 882 167th Ave
BN11 Symbol: A6 BIVIElevallon- 98.35,'
BIVI Descriotion: SOMr. lank manhole cover
W-12 Symbol, A BM Ellev3tlon q5 72'
blyl Description, EvJsljng septic, tank, OLIflef
Slope Grad lent of Tested Area,
Well SymbO (if Frpplirib le-'i
NV,��s: See CS-M for coiiiplelL- lot
De siq i i How- 750 GPik
Attawl design flaw ca"IaWns for
cownercial pl�kns-
Pip e Materials I AST M Standard
Tables 3:84-30-3 & 984 -10-Fi
ASTI.A-
4" SCH 3,OUPVC pipe
ASTIVI- D3034
a
p
a
CONVENTIONAL COMPONENT DESIGN
Application
INDEX AND TITLE PAGE
Project Name:
Sikkink 5 Bedroom Replacement Septic System
Owners Name,
Daniel & Karl Rae Sikkink
Owner's Address
882 176th Ave
New Richmond, 1 1 S4017
Legal Description-,
NE1/4, NE1/4, S12, T30N. R19W
Township
Somerset
County:
St. Croix
Subdivision Name-.
The Highlands
Lot Number.
11 Block Number
Parcel I.D. Number
032-2157-10-000
Plan Transaction Nc.
Page
1
Index and title
Page
2
Plot Plan
Page
3
Existing Septic Tank Specifications
Page
4
Existing Tank Certification
Page
5
Existing Effluent Filter Information
Page
6
Proposed Septic T ank Specifications
Page
7
Proposed Effluenrt Filter Information
Page
8L
System Sizing & Cross Section
Page
9
EZ Flow Information
Page
10
Management and contingency plan
Page
11
Sanitary System Ownership/Address Form
Page
12
Warranty Deed
Page
13
CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt
Date: 9/5/2023
Signature-
Licnese Number- MPRS 223760
Phone Number. 715-760-0486
Page I
SYSTEM PLOT PLAN
Sikkink 5 Bedroom Septic System
Projecl,Addre�s 882 167th Ave
BN11 Symbol: A6 BIVIElevaillon- 98.35,'
BIVI Description: SaMi,r. lank manhole cover
W-12 Symbol, A BM Ellev3tlon q5 72'
blyl Description, EvJsljng septic, tank, 01.1flet
Slope Grad lent of Tested Area,
Well Symbii:4 (if Frpplirib le-'i
NV,��s: See CS-M for coiiipleIL- lot
De siq i i How- 750 GPik
Attawl design flaw ca"IaWns for
cownercial pl�kns-
Pip e Materials I AST M Standard
Tables 3:84-30-3 & 984 -10-5
,I' H .1('� L) r,
4" SCH UPVC pipe
ASTM- D3034
I
commereemi.gov
IScof'15i1'1
Department of Commerce
February 16, 2010
WEEKS CONCRETE PRODUCTS
RAY WEEKS
1832 215TH STREET
NEW RICHMOND W1 54017
SAFETY AND BUILDINGS DIVISION
Pkimbing Produd Review
P.O. Box 2658
Madison. Wisconsin 53701-2658
TTY: Contact Through Relay
Jim Doyle, Governor,
Richard J. Leinenkugel, Secretary
He: Description-, SEWAGE TANKS, CONCRETE
Manufacturer: WEEKS CONCRETE PRODUCTS
Product Name: SEPTIC. HOLDING, OR PUMP
Model Nurnber(s): 1000
(49 IN. L.L., 21.76 GAL/I N.. 84 IN MAX, DE PTH OF BURY 5 G. P. D. WHEN USED AS A
SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL
WASTEWATER.. TANK DIMENSIONS = 84 IN. L X IN. WX491N.H)
Product File No: 201100040
The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with
chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160. Wisconsin Statutes.
The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code, This
approval is valid until the end of JUKE 2015.
This approval is contingent upon compliance with the following stipulation(s):
This tank must be designed to withstand the pressures to which it will be subjected.
The manufacturer must keep at the nianufacturing plant a set of plans and specifications bearing the department's
stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the
department.
When this product receives wastewater from dwell'ings and is used as a septic tank, it will produce an effluent quality
with a maximum monthly average value for BOD5 of greater than 30 mg/L. and less than or equal to 220 mg/L TSS3 or
greater than 30 mg/L or less than or equal to 150 mg/L TSS. and F.O.G. of less than 30 mg/L.
Approval is issued for this product as being equivalent to a floor outlet water closet when the fixture drain is installed
in the vertical position. The design meets the intent of s. Comm 82.32 (5) (c) and 84.20 (5) (n), Wis. Adm. Code, which
requires water closets to discharge through a minimui-n diameter 3" drain pipe or fitting and the bowl to conform to ANSI
Standard Al 12.19.2M. The intent of the code is met since this product provides the same functional performance as water
closets that meet ANSI Standard Al 12.19.2M.
BEDDING; Bedding material shall be used to provide a uniform meeting surface. A iinin. of 4-inch base of
sand or granular bed on top of a form and uniform base is recommended, The lank should not bear on rocks. Sites
with high ground water tables should have specially designed bedding. Solis should be compacted under the tank.
This approval supersedes the approval issued on 4/21/2005 under product file number 20050106, This approval letter shall
be incorporated with your previously approved plans and/or specifications approved under oroduct 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 POS holding or treatment
lank in Wisconsin.
The department is in no way endorsing this product or any advertising, and is not responsibile for any situation which iiiay
result from its use.
Sincerely,
Jean M. MacCubbin, CST
Engineering Consultant -Plumbing Product Revi*ewer
Commerce; Safety & Buildings Dfv, PO Box 2658; 201 W Washington Ave.; Madison W1 53703-2658
Phone; 608-266-0955; Fax: 608-283-74,56; E-mail: Jean,Mac.Cubbin @wIscons1n,gov
SBO-10564-E (N-101`97) File Ref: 19"JI,Doc
PAGE 2, of 2
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.
Igo wever, our filter is virtually self-cleaning - The c�ontinued action of the anaerobic organisms on the Zabel filter causes lodged
particies to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter@ alarm, you will be notified by an
alarm when the filter needs servicing,
Ni
Step 1:
Locate the outlet of "the septic tank
and remove the tank cover.
Step 4:
While holding the cartridge over the
access opening, rinse off the cartridge
with fresh water, being careful to rinse
all septage rater -al back into the tank.
Step 2:
Remove the tank cover and pump the
tank if necessary to prevent any solids
from escaping to the the drain field
when the filter is removed.
Step 5:
Insert the filter cartridge back in the
case, making sure the filter cartridge
is properly aligned and completely
inserted in the case. Replace the sepbc
tank cover-
F4"
Step 2:
Firmly pull the filter handle and slide
the cartridge out of the case.
ResidentialApplications
Certified to AN S I/N S F
Standard 46
CCPYHPhf PD�y-'O-- AP i�ghts teserved
Productfs) red by one or more U S, andlor Intems."f(ina? palents. Other U. S, oind Intarnadonal patents may be per7ding
1-877-765-9565 / www.polylok.com Page 4
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
1"his is to certify that I li,ave inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address)882 167th Ave located
at. NE V4, NE
1/4, Section 12 Tow,, 30 N., Range 19 Wdk
Town of Somerset St. Croix COLintv Wisconsin.
Upon inspection, I certify that I have 1"ound the tanks}, to the best of my
knowledge, will conform, to the requirements of'SPS. 394..,�,5. and it (they}
%�z
appear(s) to be ffinctioning properly.
i
Most recent date of inspection - nspection or service
Did flow back occur from absorption systern?
Vol
(If no, skip next line.)
Approximate volume or letigth of time,
Tank Capacity: __ 1000
Construction: Prefab Concrete X Steel,
Manufacturer (if known): Weeks
Age of Tank, (if known).- 5/20/2003
Permit number (if kno\vn } 4299195
(Licensed PILIMber Signature)
A I a oil R,
(Date)
Yes No
,John Schmitt
roll,= L
(Print Name)
0*10TO
minutes
(Licerise Mlniber) MP/'MPR.S
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter- -3Q5 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2 011
Page 5
m
r
x IP
M
0 40L Inc.
, I kM14111hoM 41,
MROVAM iTI PrSWA WiRage ZaW.1'
& Wastawalor ho4ers
04 A vlsori of ter lytok I u.
PL-525 Effluent Filter
PL-525 Filter
The PL-525 Filter is rated for 10,000,GPD (gallons per day) maldng it one of the larg(.,st filters in its class. It lias
525 Linea r feet of 1`1 " filtration slots. Like the Po lylok PL-1 22, the Po I \.1-)k PL-525 has an au lorn a tic sh u t-off ball
insta Iled with every filter. When the fj [ter is reinovt2d for cleaning, tile ball will f [oat up and temporarily shut off
the systeni so the effluent won't lea,�,,e the tank.
Features:
* Rated for 10,000 GPD (gallons per day).
9 525 linear feet of 1 / 16" f I It ra t Ion,
* Accepts 4" and 6" SK1-1 1) 40 pi pe.
Built in gas deflector.
Automatic shut-off hall when f it ter is removed.
Alarm accessibility.
Accepts PVC extension handle.
PL-525 Installatil)rl.*
Ideal for residential and commercial waste flows up to
10,000 gallons per day (GPD).
1. Locate, the ou Net of the septic, tank.
2. Remove the tank- cover and pu.mp tank if necessary.
3. G1 Lie the filterhousinn g to the 4" or 6--' outlet pipe. If
1. h e fj I ter is n o t centered under the access o p en i n g use a
Polylok Extend & Lok or piece of pipe to center titter.
4. Insert fie PL-525 filter into its hour ina
0,
5. Replace and secure the septic tank cover,
PL-52.1; Mainteiiance:
The PL- 525 Effluent Filters w T- I o pera to efficiently for
several years under normal coni 6 o n s bvetore requiring
cleaning. It is recomm�-,?Ided that the filter be cleaned
every time the tarLk is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
needs servicing. Servicing should be done by a certified
septic tan k p u ni per or installer.
1. Locate the outlet of the septic tank,
.remove taiik cciver an(l puniji tan,1, 11- recessarN?,
3. Do not use plu m bi ng Mien f i I ter is ru,ni ov ed.
4. PuU PL-525 cartridge out of the housing,
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank,.
6. Insert the filter cattridge back into the housing making
sure the filter is properly aliped and completely ftiserted.
7. Replace and secure septic tank cover.
1/16" Filtration Slots
-rmay. yI tch
(P-rOOO GPD) (Optional)
Acccpts 4"' & 6"
SCHD 40 pipe
Arrpnts 1" PVC
t-un�,wn Handle
Rcited for
101000 GFD
525 Linear Ft.
of 1/160,F
Filtration Slots
Certified to
INISFIANS1 Standard 46
7 Gas Deflector
: Automatic
Shut -Off Ball
Mari 1'xterid& )kl%i
Polvlok, Zabel & Best filters accept Easily installs
tht, 5martFitter(M switch and alarm. into exi.5,ting tanks,
Polylot jnc. 3Fair fieldBlvd. Wallingford,CT 06492 Toll Free- 877.765.9565 FaIca 203.284.8514 www.poiylok.com
Page 7
I
A A'
Ift-GROUND GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with EZ1203HP Bundle-
3-ft Trench (down -sizing credit) I
MAO d a - -. * P lI us!!
kLyPK_;U1j .W
TYPICAL TRENCH
t.0mu5Z SECTION 1UP VltVV
(No Scale)
Septic Tank(s) Manufacturer:
Weeks/Wieser Concrete
Septic Tar*(s) Voium(s)
1000 . gal 750 . gal I gal gal
Effluent Rher Manufactuw.
label/Polylok
Effluent Filter Model #- AJU 525
Hi hest Trench I
System Elevations= 93.55 ft; 96.37 ft; 93. 19 ft:i
Lowest Trench (as applicable)
TYPICAL TRENCH (Show loc-ation of inlet I Gititlet pipe connection on [)Ian view.)
PLAN VIEW 4 F? 0 Observation piape shall be instal"
a] j
(No Scale) Perforated Lateral uridt'ofi between two unds.
(typical)
B= 75
qp� ft
(typicat)
INSTALL PER TRENCH:
7 10-ft bundles @ 50 ff EISAiunit = 350 W
1 ff 2
+ r-;-ff hi inci1pe: ia 9r-; ff P: iqA ii in't = 2 5
tt .
Provide m in i m um 3 ft
separation between trenches.
OBSERVATION PIPE DETAIL
4t Screw -Type of
Finishat: G rade
Slip Cap (loose)
(muLheri & seeded)
4"0 PVC P've
Too so F! cover
Top o 1' fxpe to te r rrm i ate
(alln, 1 fool)
al or above firn it h rd g nade
(4)1j4"-V2`X6"Sb1s
@ 90 21 part
Ancriciring Davice
Irifiltrot,
S u rface
A — 3.0 ft
(typical)
EZ1203H Bundle
�typical)
(mfd by Infiltrator Systems, Inc-)
Install pursuant to manufacturers instruct -ions.
Proposed E I SA per trench = 375 ft 2 Required Infiltration Area = 1071 ftZ
x 3
trenches = Pro p o sed Total E IA 112 5 w
E5E
Distribution Method:
distribution box
E
Installation I nstructions for
A&L
E TM
Zflo
())),- Systems in Wisconsin
W
,., IN
by INFILTRATOR
Wisconsin Department of Commerce, Safety and Buildings
5. The Absorption area (SF) necessary for a given 51te shall
Division, has reviewed the specifications and/or plans for this
be sized based on irraximum daily sewage flow (GPD) and
product and determined it to be in compliance with chapters
the Permeability for the site. If certain crIteria is met, the
Con-im 82 through 84, Wisconsin Adtynin. Code, and Chapters
BSA sizing can be used in Wisconsin, resulting in a 40%
145 and 160, Wisconsin Statutes, All sites must meet the Site
smaller drainfield.
& Soil Conditions & Locations & lusolation distances as noted in
6, Place EZflow huridle(s) in the EZfloc configuration ap-
proved by systern design permit specified for the particu-
The approved products are 1 203H (3-12" bui ir."Nes wit]-i pipe in
lar site, The top or center -most bundles containing pipe
center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles
are joined end to end with an internal pipe coupler. Any
w 'Ith pipe in each bundle in 5' or 10' lengths. ■
additional aggregate only bundles that may be required,
should be butted against the other ag-g-negate-only bun -
17�
7
A s i n g rpipe bundle, contains a four inch perforated pipe Sur-
dies and do not require any type of conne,,-+-r^ n.
rounued by EPS aggregate and is help together w4h poly-
ehtylene netlin)g, A single aggregate buinc�e- �,ontains aggregate 0 11
7. The top of �each E. cylinder contains a filtef fabric pre -
only and is held together with polyethvlen:,� netting. 0
manufactured in between the neftingand aggregate. 'The
fabric is inserted to prevent soil intrusion. The installer
Materials and Equipment Needed
shall make sure the thc, G.E70 is -csitijoned upward and is
w B
Ems; oand lei
in contact with the fabric contained in the adjacent cylin-
_tZflow Geotextile ri-abric
dcr elore backfilling.
FZfiow internal Pipe Couplers
Pipe for Header and Inlet
8. The E,Zflow Drainfield Systems shoi..iild be installed in a
Backhoe /Excavator
level trench in all directions (both a. -rocs and along the,
trench bottom) and should f ollow the contour of the ground
Installation Instructions
surface elevation (uniform depth). with all continuous
The instructions for installation of EZflow products are given
adjoining 10-foot cylindrical bandies placed end to end,
I)r-.-low. This product must be installed in accordance with state
with central bundle distriibution pipe interconnected,
ill I e. c; d efi n ed i n chapters Com m. oh 84, Wi_
�,ons, . r), Ad-
without any dams, stepdowns or othei water stops.
minislYative Code, and Chapters 145 and 160, Wisconsin Stat-
utes, as well as the local health department's current design
9. The trench top shall be graded such thar, water will not
maF1 Lial.
pond. Backfifil should be seeded or sod 'ee. ,mmediately
RIter completion to reduce erosion.
1. After the ,local health department has determined sizing,
C'311,11guration, aria layout for the ELZ_flo,�,v systems, stake
10, EZflow L'.PS bundles are flexible and can fit in curved
or mark with paint i.he location of trenches and lines. Be
trenches as may be necessary to avoid, trees, boulders, or
careful to set correct tank, inveil pipe, header line or dis-
other obstacles,
fi-lbution box and trench bottom elevation.<, hefore instal-
ia"Jon of pipe bundles.
11 EPS aggregate is lighter than water, therefore, it might
be expecte J h -wrd to ' that natural buoyaj is fofces ould te
2. Remove plastic EZT'low shipping bags prior to piacmg
cause EZfiow assemolies ..o float out of ground when
bundles in the trench(es). Remove any plastic bags In the
ponding occurs. Field expedience has shown, however,
trench before system is covered,
that this is not a proNern when systems have a minimum
of 6" Jr soil cover as recommended by manufacturer,
L13) - TIC is product must have geotextile fabric that meets re-
quirements of s. Comm 84,30 (5) fig), 'vVis, Adm. Code,
■
installed directly on top of the product and extending
1203H-GEO
down along the sides of the product to a point at least six
inches firor-1 1h.e. boftom of product,
(3, cot ext Ic
F%1 V it 10 V 0 * V I Fm
0 M
T -9 T V Barrier ateral
4. When in6f'alled in a trench, the trench ihould be dug io
m lb gr 1
a width of 36 inches. This not only saves labor in
1 2i
V -F
tion, but also provides better load -bearing capacity after
lac c
I
backfilling is complete.
*1 +00 V Oiw 6 *loop@ slope 49064se useve a go s
41006a Ed 0 006*00#4006M ffiesdoom M400MOSS • 0
Page 9
A
in P!A—MK4
a n
AM W W -ground Gravity �TJ. IWL I
aq
, I 1'j 1:101'Loal fil kI, 11 a
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SFAS 382-384, Wisc. AdminL 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 �
.1,
gpd; 130135:5 220 mgL' , TSS 05 150 mgL-'; FOG 5 30 mgL'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
C age of system
o nulsane factors (i.e. odors, user complaInts, etc,)
0 mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
0 materiall fatigue leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) arid any distribution appurtenance(s) (1,e,, distribution drop boxes)
a neglect or improper use 0'.e., exceeding design capacit'ies, prohibited activities, etc.)
0 extent of panding 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, connect -ions, switches, controls, timers, alarms. etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification)
c surface d1scharge of effluent or sewage back-up into structure served
Maintenance Checklist
MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tan I shall be pumped by a certified septage servicing operator licensed under S. 281,48 Wis-
Stats. when the volu me of sollids in the tan k(s) exceeds one-third (1 /3) the liq uld volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Aid ran in, Code.
o Effluent fill shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to roan Ufa Cturer's specifications. A servicing period will always be greater than 12
months,
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company- Schmitt & Sons Excavating, Inc. Phone. 715-760-0486
Local government unit. 'St. Croix County Community Developement Phone. 715-386-4680
Local government unit address. 1101 Carmichael -Road, Hudson ZIP, 54016
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin-
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Ad Min, 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.
ContingencV 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 Aban_dOment
If use of this POWTS is discontinued, it shalt be abandoned in accordance with SPS 383.33, Wisc. Admin Code
SANITARY SYSTEM File #-
5-1. i,..i,,)UNTY Office Use Only
=00
0- OWNERSHIP/ADDRESS FORM crmted2l2o2,
Comn-iunity Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new -or replacement sanitary system' This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property 'valUes, and county resources. Once approved, this completed form and educational
information will be sent to you by eniall, If you would like to view your Issued sanitary permit online, you can
do so by using the Prol2erty Files Scanned weblink.
14 LTI :1 Ifi 4 ISIA I Z 1 ;[0111 I'll F.-A 1 [01 Z
Owner/Buyer Daniel Sikkink
Mailing Address $$2 167th Ave
City/State/Zip New Richmond, W1 54Q1 7
Phone Number (re q u I red) 701-793-7741
Email Address (required) dandksikkink@gmaii.com
Parcel Identification Number 032-21 57-1 Q-0D0
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property LocationN E i/4 NE .1V?4 , Sec. 12 - T 30-N R 19 W, Town of Somerset
Subdivision Plat: NA
Certified Survey Map #, 682294
Warranty Deed # 1146025
Number of bedrooms 5
I New Property Address
(Staff Initials)
kFe ma#
(before 2006)Volume
Spec house 0 yes N no
OFFICE USE ONLY
Page # 19
Lot lines identifiable E yes 13 no
(Verification of new address required from Cornmun,ity Development Department for new construction.)
This form must be submitted with oil Private Onsite Water Treatment System (POWTS) applications.,
New System: Include with this for o recorded waffotity deed from V)e Register of Deeds Offlce and o copy of the certified
surve map if reference is made in the warraqy deed.
y
Community Development Department - Lard Use Dvisjor.
715-386-4680 St. Croix County Government Center 715-245-4R5O Fax
cdd Ccosccwi.gov 1101 Carmichael Road, Hudson, W1 54016 1A, 1141' LIV, �.' ( ( ( I (,') V
Page I I
State Bar of Wisconsin Form. 1-2003
WARRANTY DEED
Document Number Document Name
THIS DEED, made between Begiamin M. Hai,es, a siLngle person
("Grantor,"' whether one or niore),
and Daniel Stuart SikMnk and Karl Rae Ne uist n!i,.,husband and wife
(:`- ranteev IN whether one or mon-,)_
Grantor, for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in St.
n
Croix Counr�,�, State of Wisconsin ("Property") (ifinore space I's needed, please attach
addendum):
Lot 11, The Highlands, a County Plat m the Town of Soinerset.
1146025
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., W1
RECEIVED FOR RECORD
12/29/202.1 09.03 AM
EXEMPT*.
RE C FEE 30.00
TRANS FEE 1,36650
PAGES: 1
**The above recording information
verifies that this document has
been electronir-aliv recorded
& returned to the submitter
R:ordGnLy Aj�ea
Name a!id Retum Addrt!-q.,,
PartFicc5 T01c
1380 Cxpo(-ate Center Ciii-re. Suite 3-407
Eagan, MN 55121
Parcel Idnfification Nwnbc-r (PIN-0
This is hc)inestea d property,
0s) is not)
Grantor warrants that the title to the Property is good, indefeaslble it) fee simple, and free
and ClCa.r Of enC'Llirbrances except- easements, restriefiGns and reservations, if any, of record.
Dated
SFAI)
*Betijanin M. Hayes 7/
AUTHENTICATIO-N
Signature(s) Be apLmirl M. 14aves
_ I
autbenticated on
*Kristina 0,gland
-'ONS[N
TITLE- MEN4BER ST�kN%71 TE BAR OF S(..
(If not,
authonized by �Vis. Stat. § -106,06)
THIS INSTRUMENT DRAFTED B)r - -
SEAL)
X
ACKNOWLEDGMENT
S1 ATIE OF WISCONSIN
SS.
T. CROIX COUNTY
MIME
Personally came before me on
the above -named
to me Idiown to be the person(s) who executed the foregoing
instrument and acknowledged the same.
Kristina Oelamd, Estreen & Oglaiod
304 Locust Street., Hudson,., W1 54-016 Notary Public, State of
My Commission (is permanem) (expires:
(Signatures may be Aut1henmess ed or acknowledged. Both are not netessaly.)
NOTE: THIS IS A STANDARD FORK ANYMODIFICATIONS TO THIS FORM SHOULD RE'CLEARLY IDENTIFIED.
NNARPLINTY DEED C 02003 STAIT BAR OF WISCONSIN FORM N04 1400.1
Type name below 918ft3lures, INFO-PROT" Wom Forms wo--e6b.2o2i www,in1ovrcAjrmscom
'iswmin Deparimenl of Commerce PRIVATE SEWAGE SYSTEM
Safety and B01ding Division
4 INSPECTION REPORT
GENES INFORMATION (ATTACH TO PERMIT)
Persona I informaticKi you provi de may be u sed for pond a ry p u rrposes J.Privy Law., s.15. G4 (1)(m ) 1
lermit Holders game: city Village X Township
Grand Properties L. P, Somerset To w ns.hi
O T SM Eiev Imp, BM BM DeScIrliption,
rU(— 064U CS-r g Pik
4 -1
A ■ILF 1Ltrw*d" Mbb #T■P%■I ^0 bwlk y s �•.0%.IL f sue. in -a
P417I r% 11117 WF%IN 1 1 rl
TYPE
MANUFACTURER CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
AIL
WELL
BLDG.
Neat to Air Intake
ROAD
Septic
Q Lof
TO
Dosing
Aeradon
Holding
1-
PUMPISIPHON INFORMATION
DISTRIBUTION SYSTEM
AN ATI1 ® IPK ■ V'1s# ff., 1
C�Ounty- St. Croix
aNtary hermit No- 429995
State Plan ID No:
Parcel Tax No:
032-2157-10-000
ectriawTowvn/Range/M pNo-
12.30.19.135,
SVHt Inlet
mom=
=ffM=
PIT DIMENSIONS
No- Of Pity
Inside Die Uquoid De h
LAKE/STREAM
LEACHING
Manutaotur .
CHAMBER OR
01)1FFLtS6AC
UNIT
Model Number:
Header"anifold Dislfibutiori _.
X Hole Size x Hole Spacing VenI to Air Intake
Pipe's
Length C)ia Lerrgth ®. LDia Spacing
I COVER 33
x Pressure terns Only x M o u nd Or At -Grade Systems 0 n ly
De th Ovor Depth Over xx Deplh of xx SeededlSodded Kx Mulched
B i/Trenct) Center ffmnch Edges Topsoi I
y'ee w No Yes No
COMMENT(Include cue cis i persons present, eta, Inspection pt r� � Inspection .
ce:
Location: 682 167th Ave per t, W154 25 (CIE 1 /4 NE 1 /4 12 T ON R 19W) Highlands Lot 11 Parcel Nqv 0. .1353
16
1 , ) Alt BM Description
.) Bldg sewer I ngffi _
t
- amount of der
Plan revision Required? Yes � �-- ��
W_
I
Use other d for ads 1bonal information.
Waite ilnsepctoeis Qnsrure Can. - o,
G
A ->Ew
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County
include. but not limited to.+ verbcal and harizorital referenoe point (SM), direction and Par
percent slope, scale or dimensions, north anew, and location and distance to nearest road.
Please print all Info nnaLion. i ewe d Cate
Personal Inf&rnation ym pmvide may be Qs,ed for secondary purposes �PrivaLaw, !s 11;04�1�(W)
Property Owner PrDpe rty L oca tjor�,
Govt. Lot Aj 114 114 S T N R E
Property Owner's Mailing Address Lot # I Block 9 ubd. Name or CSM#
I i ssA A Tr. I / - �7he ttl' qh ia ncis
City State Zi ne Number L) City L) Village N TowtT*J Nearest Road
76
MOW
New Constructon Use. 9; Residential I Number of bedrooms Code derived design flow rate q GILD
F-1 Replacement El Public or wrnmercial - Describe:
Parent material 'e-) I A'�' ft. Flood Plain elevation if applicable
General comments -5,
and recommendations:
14. 1�e
Boring # Boring F1
pit Gro u nd Su rf ace ele V. Q*7- (vi) ft. Depth to 11mifing factor in.
Sol I Ap pli coo);Aate
Horizon
Depth
Dominant Color
Redox Description
Texture
Structure
Consistence
Boundary
:GP�O
5ff*2
in.
Munsell
Qu. Sz. Con,IL Color
Gr_ Sz%
Prn
31U,
I
Ur&j /to
-5
3S9
rn I
. __
��dr+� #
❑ Boring Ground sufaceeiev. q 7_0pit
Depth to limiting factor in.
Soil Applicabon Rate
HoOzon
Depth
Dominant Color
Redox Description
Texture
S-tructure
Consistence
Boundary
Roots
GPD/W
in_
munsell
Ou. Sz. Cont, Color
Gr.. S
*Eff#1
20#2
I 312�
2- dl
nor,:
ou r
2j! ffiL
43
�Jy r
161F �,Iu
/nn��
no-)
F1
X _07
0,;t 93. 95
--------
LLL
Effluent 41 = BODI > 30 < 220 MQ/L and TSS >30 ez 1 0 rng/L
CST Name (Please PrInt) Signature
Sc..h�nna�ker-own,,�:
Address
ZI 13 9Y6 54,11 ta -5qeSZS-
Effluent #2 � B005 < 30 rnp/L and TSS < 30 mg/L
CST Number
253 U I
Data Evaluaflon Conaucted Telephone Number
16 j Ot V/7 Vow J'
RR111)43:10 (R107/001
Fj
Property Owner S4t�i 4 Parcel U #
Bodng # [] Boring
Ig pit Ground surface elev. qlzF ft.
Depth to limiting tactor 117 in.
Page 2W of 3
I Rnil Annfir-atinn RqtA I
8
Dominant orl
Munsell
Redox Description
Qu. Sz. Cont. Coior
StrucUre
I Gr. Sz. Sh.
Consistence
ElBoring iBoring
pit Ground surface elev, ft, Depth to limifing factor in, i - RNI Annfimfin'n RatA
Redox Description
Qu. Sz. Cont, Color
Structure
Gr. Sz. Sh .
mom=,
Boring
Boring # 17 Ground surfvft ace e4e. . Depth to limiting factor in.
0 pit
Gd I Soil Aodicati - on-Ratel
Dominant Collor:
Munsell
Redox Description
Qu. Sz. Cant. Color
Structure
Gr. Sz. Sh.
Consistenc
Eftent #1 = BODE > 30 < 220 mg1L and TSS >30 < 150 mg1L Effluent #2 = BOD < 30 mg/L and TSS < 30 m9JL
- 5 - -
The Depar-tment of Commme is an equal oppoMnity service provider and employer. If you need assistance to access services or
need material in an altercate format, please contact the departimt at 608-266-3151 or rrY 608-264-8777.
1 4
4L
Fe
4F
PAGE,_,,30F.,3
1,64 fill 3 1 1�00 j j 1 0 1110 h2li sm
SCALE: V=
BM I ELEVATION 160,6
BM I DES(.-,RlPTIONAeAf A�a�
11 IF
BM 2 ELEVATION �Te 76)
BM 2 DESCRIPTION
AI.TERNATIC- ELEVATION f Z. kO
CONTOUR E LEVn.TlnN SC �- ��, �'o I
Rom
z1vo
SIGNATURE
z; � DATE,
17:W 2 91 IPJIIW� !i�(m I
#4h AG COM
of L - Ti f
V". r-Ft
c;
CaK.T4 co, 4w PAC"
rEmPCAAWCUUtlCtm0r-
'Awhwkffmm
i 7, YEmApffn UPUN
moau,rvooN
COUNTY PLAT OF. THE HIGHLANDS
(n 8 2- 2 LOCATED 114 THE NlE 114 0 F THE NEI 14 AND IN PART OF TH E SEI /4
AIQWMI ORA-4 OF THE N E 114 OF SECTION 12. T30N. R I OW. TOWN 00 SOMERSET,
Mimm m ST. CROIX COUN7Y. W1 SC 0 NS I N.
!w it 61
170TH AVENUE
ftootftil Um CW Tim Pim11141 6 m1-1211 a riA
LEGM0
*—"NL*w Coupm vwTKp*
PQvND 1, OUTPPC rmmurrq Fco4 PK
met 8 w Wim ouvwcm 5t IV Lom W04
"Fb. Wmmmm
Ila* "m Pm LPA&Q ftall
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AU I c"*E" Uvr comm"N vaAAAAlporm
WM 1'0wrM DAm~ s4mr "x4o maw
ffm woolm%lft I 11 op. PM;*~ obour
A" dA%c*7m:*d 4M M"qp4W
r1D rOd 4J.0 02 QATLW Or 4,M
SCALE 41N FEW
1 109
7 Cl
fP'kN IF;J-F' q --T 4'IPDX oMprN
3t? L/rL-'Y (AAtPAKW
GXAMfM MMM
Jw
14 16 AM WATM UP4 LAYA'noN
,�vvr" �� a wram "vfm
TME!"040FTMA1141A
LOCAMN SKETCH
rowN or sommsrr
I r®, u.
SECTION 12. 1 30N. 111111 OW
NEME 11640-1 NAFICT� MHOWN M q46 &W -I.
6u&*L:- — -Arp cm,4— ANDfuw4w-w
LAWS aIULUAAC Pklk&AIXY9 ki r
rtia I LAW -04PALP.1 LOT `SIZE. + 48 10
rl-':'Ft FT-- EPPRAV FEJEK34J hr OR
Wr ef � tWv4q N, r7% rHE ffT
_�'r7ti*.,XU47- ZC"NG K-* " TM
NK—W ps% NWW4,Rm P, w" - B"LU I-Loce I
Ilk IrvAT4DP%l TM
C14 LOYFC' tA, w-, PF,a7
AWDOW QR 0000 Q SrWA �- J
WrIE No G%mKdo OF FWAM4, JO m"
VW*40m
VVKXPD FOU9 E PIE WWM Ok C
OcWRAvO344 OF THE AFVftZNff n
0CWANQkHW44r4% WATWORANAM AMJ L.A-A
EFEEK74 R-M MW "*9 MAT t'PW WdM. LIOM
ILff 19 F%=r L QrMb t1J 9LM—rWW L04314,
Dutr4jumdo. AL TW*dCk RUPO 011
DICAVAM4 OP OLVi"43 IN AW FONQ
PAP*-WW9 W-klfiffl LS0~93k M�,144mj
WATM ALWWAYS. WATM DUAWITM. ACV&
'IF aPA44 SCCC@L44
F- 941 fb
%divra PER -13T DY04VW4
F&BpC*q&Wr.*5 F403AP04110 *WoffEf&NkLCE
OF 0*APWZ LAMEMEN11% APW WAItp
PWrE"TM ARFAII ;*:AilkD OR FP*-M LOT
ME CCNE%A�*n FCA L&V OVO4TM
KKft RC$0Qr4MLrV% my PREvENrP4 ow*qlwq ON
BURVEYOR:
0*vcAL" J. X^miim
"N LAND JbLIKWWnP#G qh#C. ve
20 IENLLM OTHEWr
GUITIE 101 R^
HUDDON. VA 64016
(71
6)'MW9607
1ENGMIRER.
1M
UT14 00MOUL1ING MW1CW"1'=
k920
EN"M WTRIWT
sums
101,
Imehil A46 cc o"CAR -
NU01501141
vwi 84016
1=11. 12 (110)
0111111 -M"7
10 wfs
PRRPAMD 110LOAl
10CMAND
0. d"cin
0^8
N-PANWT
I
P. STOUT
JWS AWWWKiW I%ML
mv9poom
wo "4111t
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IP N"490
"06"
my, OWN
a op
Page 13
..... . ... . . ....
... .. .. ..... . . ............
...........
MAI
NO
V -I qojf& U N-P 0
r'n Rj-r_, -1 7
Z-D r')6 )(
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval..
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: 1f you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
•
... . . .. . .. .... .
-B-VA -I- 'W T Am % -'-%Av-m -1r,
rm"-V-�j i ' Now- r-, . "' " " RE THAI,
"IRIES �11' NLESS REN" Wm
N rriRM1,11, EXr An �'! V U
9
..... .....
SBD-06499 (RI 1/20)