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HomeMy WebLinkAbout032-2147-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567263 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Peper, Jeffrey& Heather . Somerset, Town of 032-2147-70-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: lob Gm / C5T 15.31.19.1288 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic - r,.. L1/c : i l _ 6, 1°66 @ 1.35 /G1.35 ietn Dosing J Alt. BM Gow..ioa Po 6 8co qq Alt. . �awc.. Z'9 /65'.4 Aeration . 5'25 5 J Bldg.Sewer g, /Qa . 6 7 y C...... a labz.. Holding ?to ��` ,('rte St/Ht Inlet 77 C St/Ht Outlet �,40 `• 7..7 TANK SETBACK INFORMATION I'17 77% i p ent TANK TO P/L WELL BLDG. Air Intake ROAD Dt Inlet 1 Septic I n 1/1 f � Dt Bottom \ 39 Header/Man. /0, 'S. 5/ ferz-li OD 1 1 AA to _Aeration _ Dist. Pipe 0464 h/. 3 Holding _ Bot.System 7 /4.77 97 38' Final Grade PUMP/SIPHON INFORMATION 2.1- /Q/'/S Manufacturer Demand St ACoy/�r/�,, / C GPM t,Yli �� Lobe... 2.? /'J-� Model Number TDH • Friction Loss System Hea. TDH Ft Forcem-.• Length Di Dist.to Well C SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length ( No.Of Trenches ' PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS QA J Z -- TG tAu{ A SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:cl rzo,..) INFORMATION CHAMBER OR G TypeQ*System / 39/ A- /] UNIT Model Number <4 JO ( 0*AO 2 .��{I /e _ n DISTRIBUTION SYSTEM 9 4-- f /g ,' l� Header/Manifold /( Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) �yIS'jZW` Length 7 Dia 4 Length Dia pacing / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3 7 7 Bed/Trench Edges Topsoil yes D No Yes ] No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 527 214th Ave Somerse,WI 54025(NE 1/4 SW 1/4 15 T31N R19W) Oak Haven Lot 17 Parcel No: 15.31.19.1288 1.)Alt BM Description= in :4; *,_. cU„w,,,,,,,:t 2.)Bldg sewer length= ii -amount of cover= // ovl. /Plan revision Required? :: Yes o 17- 13 , /„V3e/ u Use other side for additional information. lv SBD-6710(R.3/97) Date Insepctor's S/ ature ,/ Cert.No. i4i` County oX 4 ' Safety and Buildings Division 5/ c- (2 / s ,, r� 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) . P$ fi� Madison,WI 53707-7162 1 5�-7z c�■ sanitary Permit Application State T Transaction In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit T/' is required prior to obtaining a sanitary permit. Note:Application forms for state-owned PO milted to Project Address(if different than mailing ess) the Department of Safety and Professional Servies. Personal information you provide may be used s rrdary 52,7 2_/L{ 1L(_ /. -e..-- purposes in accordance with the Privacy Law,s.15,04(1)(m),Stats. a/�� y " +"�`j' L Application Information-Please Print All Information ,' /� /� /7 Property Owner's Name ,/` C�1 f 'J Parcel# SE''ri- /in) k) -t Tilt=v PE-PZV aTc"?i, < Z& ©32 Z/ 417- 7O—C(20 Property Owner's Mailing Address ''� C0 Property Location .5 Z 7 2/ y%f•/ lit- Govt.Lot , /Z City,State , 'A/ Y Zip Code Phone Number N E y S W y,, Section /-- --50//,t S eL T V V 1 J vo C T 3/ N, R /4irclEe oone) II.Type of Building(check all that apply) Lot# / CO 1 or 2 Family Dwelling-Number of Bedrooms Subdivision Name 6k p o‘x›2_ BI Ott K fl 1 Al E/U ❑Public/Commercial-Describe Use 1 f I A.",,_ ❑City of CSM Number ❑Village of ❑State Owned-Describe Use //^^ Z ;04- C dX s w� 14- 9 �� Fl.6 r) ®Town of 50,/1 L'(�Sc 7 III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑Replacement System y p y ❑Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System(explain) B. ❑Permit Renewal El Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner CZ r/ ,(-I-) IV.Type of POWTS System/Component/Device: (Check all that apply) / 5 ec..4--e`de r—. ($Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.DispersaVPreat ent Area Information: / Design Flow(gpd)/Design Soil Application Rate( t) Dispersal Area Required(s Dispersal Area Proposed( System Elevation r 600 ✓ Oq 7 $57 9 'lc©0 97. � v/ VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units u u Y New Tanks Existing Tanks ' / r:://...4.,__ s: a� ° u `') 1 O Ly/e3/t a�.U in vi LZ 0 w Septic or Holding Tank Lz�g�^a - ZOOID / /Ef 6,e,(eeL 77 X Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' .gnature _ MP/MPRS Number Business Phone Number e•--ii / .`1 &f//0 SCinil'l I T 1 4-o( e 1" 72371 0 7/5-7 C -651g 6 Plumber's Address(Street,City,State,Zip Code) lr�/6 /507 H Avc 50,-1 c,est 7; kiki r s LAC z J VII. ounty/Department Use Only / Approved II s"W.. Penniitt Fee Date I ued Issuing nt Signature/, /--`■ O.0 en Reason o S nial ( IX.ConditINSTEMPIMIlellalgeasons for Disapproval 1 . ('GS' —// 1:`'Septic tank,effluent filter and Li) / fl4 ^^•0.'^'r & �A dispersal cell must all be services/maintained as per management plan provided by plumber, 2. *setback requirements must be maintained as per apply coda/ordinance e: Attach to complete plans for the system and submit to the County only on paper not leas than 8 1t2:11 inches in size SBD-6398(R. 11/11) PLOT PLAN N Project Name: Peper 4-Bedroom Septic System F Legal Description: NE1/4,SW1/4,S15 T31N,R19W P.I.D: 032-2147-70-000 Subdivision Name: OAK HAVEN Lot#: 17 Township: SOMERSET Parcel Size: 3 Acres SCALE 1"=40' County: ST.CROIX System Elevation: T1=97.40' Proposed 90'EZ Flow Trench Slope: 8% T2=97.40' Proposed 90'EZ Flow Trench A BM1 Elevation: 100.00' Top of 2"PVC Pipe L' BM2 Elevation: 100.12' Top of 2"PVC Pipe 4 inch Sch 40-ASTM D2665 • Backhoe Pits by Tom Schmitt 4 inch 3034 - ASTM D3034 ❑ Backhoe Pits by Gary Steele Geotextile fabrics to meet requirementsof Table 384.30-12 Zi'-/%" / )J 3i3ci 4, 1 / $11t'Z Cut. 0= 5 t DZAINAGG r4A)i) LtT/Lir% r4S.iiwel4t1 ,„ 2 31- i cir- ./\ / \ a \ t i- (,,N e t 63 p'� t 87 '`i \ I 3� (3, pRoPcsaJ " H ►3v2d©iM 1 i zt'c/i cc6 rto ur 5 N. ` \ �S� \S1� TAkIi` AGCt= / Wc;"pot dta. \ 6"-/..J.- f / / ® / / o fl trs a tz 11 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Peper 4- Bedroom Septic System Owners Name: Jeff& Heather Peper Owner's Address 527 214th Ave Somerset, WI 54025 Legal Description: NE1/4, SW1/4, S15,T31N, R19W Township Somerset County: St. Croix Subdivision Name: 3 Acre parcel Lot Number: 17 Block Number Parcel I.D. Number 032-2147-70-000 Plan Transaction No. Page 1 Index and Title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Filter Information Page 5 System Sizing & Cross Section Page 6 EZ Flow Information Page 7 &8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 11/4/2013 �,� Phone Number: 715-760-0486 Signature: / ( ,'/J��`'iL In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P(N. 01/01) , PLOT PLAN N Project Name: Peper 4-Bedroom Septic System Legal Description: NE1/4,SW1/4,S15 T31N,R19W P.I.D: 032-2147-70-000 ` Subdivision Name: OAK HAVEN Lot#: 17 Township: SOMERSET Parcel Size: 3 Acres SCALE 1"°40' County: ST.CROIX System Elevation: T1=97.40' Proposed 90'EZ Flow Trench Slope: 8% T2=97.40' Proposed 90'EZ Flow Trench A BM1 Elevation: 100.00' Top of 2"PVC Pipe O BM2 Elevation: 100.12' Top of 2"PVC Pipe 4 inch Sch 40-ASTM D2665 • Backhoe Pits by Tom Schmitt 4 inch 3034 - ASTM D3034 ❑ Backhoe Pits by Gary Steele Geotextile fabrics to meet requirementsof Table 384.30-12 Zl -/%" Av.,. 3l3p/ra �$rtl'Z- CUE- Dec satic/ peAlf0AGE two UT/L,r'! tAS€/4 /Jr /!----; %„ '' B1 ▪ $3 C ec 9 2 r' A [ 1 t- c‘P 6�� t 63 1 A % t 01 ® 87 sLc�i T/ 1 a�2 i V r at \ '3�' C PRoksci) I - i_ 14 3-viao©>M f 1 /zc'c/ 'cC6l; r/ou 5 r_ 13 Cb / \5'r T) ' pECr \ SLS \ r N. .-• / I, / / / ® ' / 00 , in n a J 1 I 31109/00tlem :31L 9518-5Z2-009 oLOZ 'Ndf a3SIA321 a\ w OSL4S IM 'mood N3OIdw at AMH Sn 9tL£M z :21110d-lsod Siva otoa AavnNVr alva ldnNYW 3ILd3S w o anOd-3ad ,0-,t=,4Jt •31VOS MIS A8 NMdaa 313111®1 IISIIIII aw_�iooZ1d N r-\ I- z L Z cr W 0 H -J 0 6 i- J rx U Q W Q U.. 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N I N ■ ■ U Int —/ ex J 1%. 8 Ul 0 ¢ a'W W•(W/) W m Eti a SVa «4 2 :-.t «a4 do o ' L \r a C _�LiN. 6 aZ a M j ZI _ a abJa ce «96 SV «£S Y POLY_OK.Inc INSTALLATION INSTRUCTIONS Innovations in&Wastewater Product Drainage ,sil Mason of P Inc, PL-525/PL-625 F 1 LT E R INSTALLATION INSTRUCTIONS Center filter i 1 ,i 1 1 i ' ., i ,i , 1 1 ,t with opening .1 1 1 i e 1=t NM ', El t K- II.= ,;— 2 LL= S f" ., Additional pipe or Al Polylok Extend&LWIC" e Glue .' for centering. b.A' $" .7 Step 1: Step 2: Step 3: (A)Locate the outlet of the septic tank. (A)Before installation, place the (A)Glue the filter housing on the (B)Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B)Make sure that the housing (B)Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS 1 , 1 ,1 , t ,1 i 1 ,1 i 1 i 1 ,1 !i ,. ,1 r 1 i 1 ,, I ,1 1 r -, 74'.isr .fit. 4, €^_'V4`,..,,.'t'. .... . ur ,„ z s • ' I -'� .- 'm°.,wP4 —:4'..%. a Step 1: Step Step 2: Ste 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A)Insert the filter cartridge back if necessary. in. DO NOT USE PLUMBING to the the housing making sure WHEN FILTER IS REMOVED (B)Pull the filter out of the housing. the filter is properly alighed (C)Hose off the filter over the septic tank and completely inserted. USE RUBBER Make sure all solids fall back into the (B)Replace septic tank cover WHEN CLEANING FILTER septic tank. SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Project Name: Jeff& Heather Peper 2 No. of Cells 9 Per Cell 3 ft Cell Width 18 Total No of 1203H 90 ft Cell Length 450 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: to Infiltator Gravelless Leaching Unit Model: 1203H Typical Cross Section Finished Grade 100 ft Observation Pipe with approved cap or vent �.........■..•n .:: • Soil Backfill 36 in • • • • Geotextile Fabric • • A T 97.40'ft Infiltrative Surface 12 in O ___v � 1 I , 92.75ft Limiting Factor A >36 in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License#: 223760 Date: November 4, 2013 Wisconsin Wisconsin Department of Commerce,Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow(GPD) and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84,Wisconsin Admin.Code,and Chapters 145 and 160,Wisconsin sizing can be used in Wisconsin, resulting in a 40%smaller Statutes. All sites must meet the Site&Soil Conditions&Locations 1%Isolation distances as noted in local regulations. drainfield. The approved products are 1203H(3-12"bundles with pipe in cen- 6. Place EZflow bundle(s)in the EZflow configuration approved ter bundle in 5'or 10'lengths)and 1203HP(3-12"bundles with pipe by system design permit specified for the particular site.The in each bundle in 5'or 10'lengths. top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler.Any additional aggregate ed by EPS aggregate and is held together with polyehtylene net- only bundles that may be required,should be butted against ting.A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filter fabric pre-manu- • EZflow®Bundles factured in between the netting and aggregate. The fabric • EZflow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZflow Internal Pipe Couplers sure the the GEO is positiioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation Instructions 8. The EZflow Drainfield Systems should be installed in a level The instructions for installation of EZf low it,products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom)and should follow the contour of the ground surface defined in chapters Comm 82 through 84,Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code,and Chapters 145 and 160,Wisconsin Statutes,as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing,con- figuration,and layout for the EZflow systems,stake or mark 9.The trench top shall be graded such that water will not pond. with paint the location of trenches and lines.Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe,header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10.EZflow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZflow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30(6) (g), Wis. Adm. Code, installed EZflow assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown,however,that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6"of soil cover as bottom of product. recommended by manufacturer. 4. When installed in a trench, the trench should be dug to a 1203H-GEO width of 36 inches.This not only saves labor in excavation, Geotextile but also provides better load-bearing capacity after backfill- Barrier Material ing is complete. Lalitlifi- 1 9 P it EM •u,,, giggiff w f- 38' Tap r VHF EZflow Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. QQ DOES IT F: 1-866-279-9203 Oakland,TN 38060 s Ringlndustrial.com 1044101008 0 2006 Ring Industrial Group,LP POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Jeff&Heather Peper Tank Manufacturer: Wieser Concrete r NA Permit# 1 Septic Lr Dose rflHolding Volume: 1200 gal DESIGN PARAMETERS Tank Manufacturer: r NA Number of Bedrooms: 4 EVA rE Septic E Dose EHolding Volume: 800 gal NA Number of Public Facility Units: 0 PA Vertical Distance Tank Bottom(s)to Service Pad: ft Estimated(average)Flow: 400 gal/day Horizontal Distance Tank(s)to Serivce Pad: ft Design(peak)Flow=estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/day/ft2 horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok / r NA Fats,Oils&Grease(FOG) s30 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand(BODO) 5220mg/L r NA Pump Manufacturer. P NA Total Suspended Solids(TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 5530 mg/L Manufacturer: Biochemical Oxygen Demand(BODO) 5220mg/L r NA r Mechanical Aeration r Peat Filter P NA Total Suspended Solids(TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Fitter r Other: Biochemical Oxygen Demand(BODO) 530mg/L Soil Absorption System Total Suspended Solids(TSS) 5.30mg/L r NA r✓In-Ground(gravity) r In-Ground(pressure) r- 1 NA Fecal Coliform(geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: Y.in dia. ENA r Drip-Line r Other: Other: r N Other: r NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third(Y3)of tank volume Pump out contents of tank(s) When the high water alarm is activated ✓ months) Inspect condition of tank(s) At least once every: 3 r7 Parts) (Maximum 3 years) r NA ✓ monlh(s) Inspect dispersal cell(s) At least once every: 1.5 r✓ rear(s) (Maximum 3 years) r NA r month(s) Clean effluent filter At least once every: 3 r✓ year(s) r NA ✓ momh(s) Inspect pump,pump controls&alarm At least once every: r Mr(S) r NA ✓ month(s) Flush laterals and pressure test At least once every: r years) P NA ✓ month(s) Other: At least once every: r year(s) r NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:Master Plumber;Master Plumber Restricted Sewer;POWTS Insepector;POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface.The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third(1h)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,Wisconsin Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page of START UP AND OPERATION For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels.When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells.Do not drive or park over,or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics;baby wipes;cigarette butts;condoms;cotton swabs;degreasers;dental floss;diapers;disinfectants;fat;foundation drain (sump pump)discharge;fruit and vegetable peelings;gasoline;grease;herbicides;meat scraps;medications;oil;painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: •All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. •The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. •After pumping,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been,or must be taken,to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ID A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations.If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name:St Croix County Zoning Phone: Phone:715-386-4680 This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev.2/05) • 111111111111111111111111\111111 8 5 Tx:4038780 WARRANTY DEED 952778 BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI THIS DEED, made between Mark W Kelley and Debra K Kelley, husband 03/20/2012 12:46 PM wife ("Grantor," whether one or more), and Jeff Peper and Heather Peper, EXEMPT#. NA husband and wife survivorship marital property ("Grantee," whether one or REC FEE: 30.00 more). TRANS FEE: 75.00 PAGES: 1 Grantor,for a valuable consideration, conveys to Grantee the following described ireal estate, together with the rents,profits,fixtures and other appurtenant interests, in St Croix County,State of Wisconsin("Property"): Lot 17,Plat of Oak Haven in the Town of Somerset,St.Croix County, Wisconsin. Name and Return Address St.Croix County Abstract&Title 219 S.Knowles Ave New Richmond,WI 54017 129870 032-2147-70-000 Parcel Identification Number(PIN) This is not homestead property. Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services,recorded building and use restrictions and covenants,general taxes levied in the year of closing and Dated this 16th day of March,2012. aAaA7: I ,� or k W Kelley 4 ,,, : J- i - :Ka Kelley AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on • ST.CROIX COUNTY ) * Personally came before me on this 16th day of March,2012,the TITLE:MEMBER STATE BAR OF WISCONSIN above-named Mark W Kelley and Debra K Kelley to me known (If not, to be the person(s) who executed the foregoing instrument and authorized by Wis.Stat. §706.06) ac•, o !edged the same. THIS INSTRUMENT DRAFTED BY: * • , -- { �( Z� is U `H'`��rr ' ' Robert L.Loberg Notary Public,Stake of Wisconsin i �E iJ ) Loberg Law Office al ri My Commission(is permanent)(expires r.( ti, Pr Or ,44% ,a O •f (Signatures y be authenticated or acknowledged. Both are not necessary.) 7. •„ � f�[:��`c / �� h 6 *Type name below signatures �� { it . ..t. Z%.1.t" J _ kit'` FORM NO.1-2003 W ORRANTY DEED 80' RADIUS TEMPORARY CUL—1 EASEMENT TO BE EXTINGU/SHE EXTENSION OF THE ROADWAY. ----------NOO'11 '50' W 2666.27'- NEST LINE OF THE NE 1/4 Of THE SW 1/4 dth .,." "". 417.55' -.5't` 66.01.-4' 6.01 '\ ---- - �- ! 1 I I ;---------- 1 1 io / I u \ `' / 0%..�— �`z I c _1 I v I ■ fii ~�' I N 1 -"' ' NOQ'11,50» 1 • • N--- 417,55' ,_ . _ °i I °' i u - - N I I r."i4i f 1 r 1 33' I w ~ '•""`i w 1 I --56'-- I I I l L. CROIX COL NT\ st,PTIC 1-12.\ANCE iRL M 1 AND )\VNRSHiP (*ERTIFI(:A lioN12()R\I Jeff & Heather Peper 527 214th Ave Somerset, WI 54025 Same rLuit,-,j:tom &2.t-Ar.: t ty, •)tatc.. Somerset' WI Ritcei \ 1,- r 032-2147-70-000 LEGALE1P TION I NE SW 15 _ 31 19 r Somerset li\Pro:•;,:rtv r-,c,:t:(111 1 oi _ _ • v-a, Oak Haven '17 - ertiiik,c1Survey _ — WarranO, 1)eed 11)07;VOiUnit 11:1:7C: _ . SYSIVM &INTF.NA,NCE C.)\\NEI1 CERTIFICATION ;0,,r1,tLil I11 ;.t . I Arc: :::, r.t.. can a:ic -lc tur,c:,. 143, 171 I.: ;t:-;:;.: - i t 7.1,c pr'Jpert■. 07,11v t, Si ? Zfl.1' 1).1": 1tint-1, 11 1fl1L Jo: ho• n1r 1) :r(rat flcflJt wIr tre 1.1J:1 I tre „r, ! tatik I II I :1-1c , sysit_sir,ii dip' 'H • H !\:',:.PAT;41 T1 ' IflIfl s;;;:,`,.c.: 71:o;,1:.; ,..ortkr,,:d flfl1d 1, thc St 1,:ro'f,t; ev.7,4741: rd, C11‘... ;ure ■:;;•VIC.12,,,!. %VC 0;11 1;1, It d'clo\c, : 4 NunIber of bcdrooms,•- ---"-- 11 01 13 Of' AI'PIXA:\:TI DATF . I I I II j, :nap r in rn, (RE\ 414'121 Department of #1728 ;'1 l SOIL EVALUATION REPORT } tP a Safety and in accordance with bmmm 85,Wis.Adm.Code Page 1 of 4 '1, _ Professional Services -I Schmitt Soil Testing,Inc. Attach complete site plan on paper n less than 8%x 11 inches in Plan mt7 F County St.Croix include,but not limited to:verti rizontal reference point( rr ion and ® Parcel 1. percent slope,scale or 'm 's' '7%• arrow,and location and distande�tS r� rest road. 1. p a ri t information. �� y"" p ;�j,. Revi By Nib Date Personal informati • prov ay be used for secondary purposes(Privacy LaN,Qj1)5N0)4(1)(m)). � I /l �3 Property Owner Property Location Peper,Jeff&Heather Govt.Lot NE1/4, :W1 4, S15,T31 N,R19W Property Owner's Mailing Address Lot# Block# Subd.Nam 'or CSM# 527 214th Ave. 17 Oak Haven City State Zip Code Phone Number f City El Village P Town Nearest Road Somerset 1 WI 1 54025 1 651-269-9674 Somerset I 214Th Ave. New Construction Use: g Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Outwash(PmC Plainfield loamy sand) Flood plain elevation,if applicable NA ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sqft rate. Possible system elevation for primary area is 97.40'. Slope of and recommendations: area is 8%. See attached Soil Evaluation Report by Gary Steel(6-1-2013)for B1-B4 Information. 5 Boring# ❑Boring E Pit Ground surface elev. 101.92 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-13 10yr4/3 none Is lcsbk mvfr cs 2vf 0.7 1.6 2 13-21 10yr3/3 none sl 2msbk mvfr gw 0.6 1.0 3 21-44 10yr6/4 none s Osg ml gw 0.7 1.6 4 44-61 7.5yr5/6 none s Osg ml cs 0.7 1.6 5 61-110 10yr6/4 none grs Osg ml ---- 0.7 1.6 / 11 �V 6 Boring# ❑Boring �j / ❑Pit Ground surface e1 v. 00.37 ft. Depth to limiting factor 111+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-11 10yr3/3 none sl 2fsbk mvfr as 2vf,1v 0.6 1.0 2 11-35 10yr4/4 none Is lcsbk mvfr cs 1vf 0.7 1.6 3 35-67 10yr6/3 none s Osg ml cs 0.7 1.6 4 67-111 10yr6/4 none grs Osg ml ---- ----- 0.7 1.6 9-7,4 tt *Effluent#1=BOD5>30<220 mg/L and TSS>30<150 rig/L *Effluent#2=BODS<_30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature: //�J CST Number Thomas J. Schmitt � ,../4 227429 Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond,WI 54017 10/31/2013 715-760-1978 SBD-8330(R.07100) Property Owner Peper,Jeff&Heather Parcel ID# Page 2 of 4 ❑Boring 7 Boring# Z Pit Ground surface elev. 99.14 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-16 10yr3/3 none Is lcsbk mvfr as 2vf,lv 0.7 1.6 2 16-51 7.5yr5/6 none s Osg ml cs lvf 0.7 1.6 3 51-110 10yr6/4 none grs Osg ml 0.7 1.6 El Boring 8 Boring# []Pit Ground surface elev. 100.37 ft. Depth to limiting factor 58 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-20 10yr3/3 none Is lcsbk mvfr as 2f,1vf 0.7 1.6 2 20-36 10yr5/3 none sI lmsbk mfr gw 2f,1vf 0.4 0.7 3 36-58 10yr6/3 none Ifs lcsbk mfr gw ------ 0.5 1.0 m2p 7.5yr6/8 4 58-96 10yr5/3 10yr6/2 sl lmsbk mfr 0.4 0.7 Boring is on the edge of the drainage way. ❑Boring Boring# El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS<_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.07/00) Schmitt Soil Testing,Inc. Page 3 of 3 Conducted by;__ Conducted For" Schmitt;Soil Testing, inc. .._.Name:_ J eff.44'Heather-Pepper____-. Thomas J. Schmitt, CST 227429 Address: 527 214th Ave. - - 1-595-72nd-St. City,State,Zip: Somerset,WI54025'___ NeW_Richmond,WI 54017 ---- Phone:715-760-1978 PID: 032-2147-70-000 Signature Lot No. : 17 Oak Haven Date- /O-JL- 20/3 .Legal Description: -NE1/4-SW1-/4-S15-T'31N-Rt19W • Backhoe Pit Township, County: Somerset,St Croix County 0 Baakhoe Pits described by Gary Steel 6-2-2001 (See attached report) _ - _ik-Bench-Mark-_1€1,400:430'Top of PVC pipe._-- --------- 0 Bench Mark 2 El. 100.12'Top of NW Lot corner rod. Slope= 8% > — -- � cckt..de Sa� tam a .3i.� �� _ ARw.rrys.-4-F e_a7/L/ & se '.T4 + • e �' \ N. — -g3 • 4 PRoPcsen li , A ij°4456' 1 i`- f — -- f -- - M K Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1_of 3 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must St. Cro i X include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. 6 2.— j q7 percent slope,scale or dimensions,north arrow,and location and distance to nearest road. . .- . . / / / —70—W6 Please print all information. /� Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). ` I �Q// (/i 1 Property Owner Property Location era h Govt.Lot NE 1/4 SW 1/4 S 1 5 T 31 N R 1 9 X (or)W Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# 1 1 1 6 0 190th. Ave. 17 na Oak Haven #5---1-7 :2/ City State Zip Code Phone Number ❑City ❑Village fc]Town Nearest Road Elk River, 1 MN 1 55339( 61 2) 4 41 -8888 Somerset 1 21 0th. Ave. rrldi [a New Construction Use:Ea Residential/Number of bedrooms 4 Code derived design flow rate 6 0 0...._..._ GPD ❑Replacement ❑ Public or commercial-Describe: outwash Flood Plain elevation if applicable;:.' ft Parent material -el.'?- General comments ") and recommendations: f 1 ` ' 't I-r 1 ,` trenches @ el. 99.92' ! 2001 1 1 ST CROLX _/4 El Boring V, COlth`Yk. ,/ 1 Boring# 'sin.. ZONING OFFKC E /�`'s / pit Ground surface elev. 102_80 ft. Depth to limiting factor +1 0Q;" I Si p lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Botlis at2/12`" ) D/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `�L_� 1 `Eff#2 1 0-17 10yr3/3 none sl 2mgr • mvfr gw 2f .5 .9 2 17-1C0 7. 5yr4/6 none ms osg mvfr na na .7 1 .2 / �7r El Boring# Boring 102,50 +100 2 ® Pit Ground surface elev. ft. Depth to limiting factor In Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10yr3/3 none sl 2mgr mvfr gw 2f . 5 .9 2 12-100 7. 5yr4/6 none ms osq mvfr na na .7 1 .2 •Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L iffl ent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature �/ •CST Number Gar L. Steel �'''� �p 02298 Address Date Evaluation Conducted Telephone Number 1554 200th. Ave. , New Richmond, WI. 54017 6-2-2001 715-246-6200 Property Owner Gerald J. Smith Parcel ID# pending Page 2 of__,I__ Boring# ❑ Boring 3 ® pit Ground surface elev. 102.30 ft. Depth to limiting factor 75 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence, Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-15 10yr4/3 none sl 2mgr mvfr gw 2f . 5 . 9 2 15-657.5yr4/6 none ms osg ml gw na .7 1 .2 3 65-757.5yr4/6 none fs M na - gw na . 4 .6 4 75-9O7_ 5yr4/6 c2p7. 5yr5/8 fs M _na_ na na _ 4 6 Boring# ❑ Boring 102.30 ft.® pit Ground surface elev. ft. Depth to limiting factor +96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 1 0-8 1Ovr4/3 none ls. osg mvfr gw if _7 1 .2 2 R-96 7.5yr4/6 none ms osg -. l na na .7 1 .2 I - "t / l it 16 "Jf Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.6/00) L Pro a rtY .— Owner Gerald J. Smith Parcel ID pending Page 2-of-_3 P Boring# ❑ Boring 3 ® Pit Ground surface elev. 102,30 ft Depth to limiting factor 75 in. I Sail Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. ' 'Eff#1 'Eiff#2 1 0-15 1Oyr4/3 none sl 2mgr mvfr gw 2f .5 .9 2 15-657.5yr4/6 none ms osg ml gw na .7 1 .2 3 65-757.5yr4/6 none fs M na gw na .4 .6 4 75-907. 5yr4/6 r2p7_SyrS/R fs M na na na 4 t; 4 Boring# ❑ Boring Ground surface elev. 102.30# Depth Ilimiting factor +96 in. ® l Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsei Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2 1 0-8 1 Oyr4/3 Done 15- osg mvfr,. gw 1 f _7 1 _2 I B ❑ Boring Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Structure Consistence Boundary Roots GPD/ff Horizon Depth Dominant Color Redox Description Tom" `Elf#1 'Eff#2 in. Munsel Qu.Sz. Cont.Color Gr.Sz.Sh •Effluent#1 =SOD,>30<220 mglL and TSS>30<150 mg1L •Effluent#2=BODS<30 mg/L.and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SHD-8330(R.6fi0) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Gerald J. Smith New Richmond, WI 54017 MPRSW-3254 S15-T31N-R19W (715) 246-6200 254 3 town of Somerset- i lot #17-Oak Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1"=40' BM.= top of 1" pvc pipe @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 101 .20' A _id V27 ktly 41/IZEJ Gary L. Steel 6-2-2001 906.3 amp or ismai9.49 40094 . w 907.3 ' i FP Witi a 07 ftas illiF1 Ui � � t g7. x1QQ.E x1090 4 xfo7.4 x9091 4900.4 /1:::93.1 idoo/ I ,S'' i *1004.62 4 \ _4 0 907.Q - x 900,0 /f x999 f fiOA * !j / \ i ,490111.1 slii.a 007.7 Melt x IIIM ts , 1 It .7 s ► ...- ""1 x012.3 .0 QE 64 n iR 41404 sat 'Wow- to ' -r, . . c ar ,.—"""...•.. 4111. k o990•40.1.04 909. -....... .. to 911..0 9991 0722 x915.0 :, x OS+1 S {7 to.. x914.5 xY�13.7 f11.2 x912.9 S a LOT 17 ( 3.0 s ) x911.5 STBApc