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HomeMy WebLinkAbout032-2019-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574327 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Higgins, Thomas P. .& Shirley Somerset, Town of 032-2019-70-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: A5,07 / c���� 05.30.19.542A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV. Septic —z:-_ 3 Benchmark Dosing Alt. BM rI I I) /D 5 • � Aeration Bldg.Sewer 13Sr3 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO (/� WELL BLDG. Vent to it Intake ROAD Dt Inlet \ \ Septic -7 S a Dt Bottom {I`7 'B' 1 --� Dosing SQ I /6 Header/Man. 3 d� 3 . Aeration Dist. Pipe 3 .3 /D�• Holding - Bot. System 3.9 . PUMP/SIPHON INFORMATION Final Grade d z.3 i y Manufacturer I Demand St Cover GPM k ; `7 6'% /a Jr' Model Number `P 17. 3 TDH Lift Friction Los System H ad TDH t /1- 71 /. KP Z3. t4 Le0-4� B Forcemain Len th Diaz I Dist.to Well 1 11-71 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No.CXTrench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS /0 C� �f� `�- -- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Ty f System: UNIT Model Number: o?,�to� I� 33 /Z3 DISTRIBUTIO SYSTEM J Header/Manifold Z. Distribution Ix Hole Size /� Ix Hole Spacing Ve4jo Air Intake 1� Pipe(s) 1.5 3� Length 3 w Dia� Length (3, ��Dia Spacing "`� 3'3 : V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only e, Depth Over Depth Over xx Depth of xx Seeded/Sodded U xx Mulched Bed/Trench Center / Bed/Trench Edges Topsoil es No No COMMENTS: (Include code discrepencies,.persons present,etc.) Insp ,00nW'#�1:�/2 / Inspection#2: / ! Location: 447 CTH V V(-fka Hwy 35/64)SOMERSET,WI 54025(NE 1/4 SW 1/4ON R19W) metes&ho, ds Lot Parcel No: 05.30.19.542A 1.)Alt BM Description= qtr �J�- (- t�`� "' ,AXE° -d 2.)Bldg sewer length= s I� �. -amount of cover D// kA Plan revision Required? (. Yes X'' No Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Si lure Cart.No. ol-3/s}�3 X04 _ Ao 13 lax, r 8- r A Ys /GS County Uxcra?atFS',. Industry Services Division 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) �Q1 P.O. Box 7162 Madison, %70170 -3J--7 State Transaction Number ,ot tix itary Permit Applic tier-- / In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit Z i Y L F is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) Ute Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15.0 1 xm,Slats. L Application Information—Please Print All Information Property Owner's Name Parcel# !;::::4 Q 37 .20 t 1- %p -66b Property Owner's Mailing Ad ss Property Location /. ZW 7 Govt.Lot City,State Zip Code Phone Number A/f' iia, $W '/a, Section cite c o S TOLN R t EW II.Type of Building(check all that apply) Lot# 1 or 2 Family Dwelling-Number of Bedrooms � Subdivision �e ❑Public/Commercial-Describe Use_ Q Block# y]� U ❑City of ❑State Owned-Describe Use F-1 Village of eQ CSM Number Town of III.Type of Permit: (Ch n y one box tin line A. Com lete line B if applicable) A. ❑ New System Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B ❑ Permit Renewal ❑ Permit evision ❑Change of ❑Permit Transfer to New List Previous Permit Nugibeyand Date Issued / / Before Expiration Plumber Owner /Y 7-, 7 E / IV.Type of POWTS System/Component/Device: (Check all that a ❑ 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) ❑Pre r �- V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Dispersal Area Required(sf) Disp sal Area Proposed(sf) tEleval Rate(gpdsf) �� ) VL Tank Info Capacity in l Gallons Total #of Manufacturer Gallons Units y p= "S New Tanks Existing Tanks C� w Septic or Holding Tank - ❑ ❑ Dosing Chamber ❑ ❑ 1 ❑ ❑ ❑ VII.Respghsiblility Statement-I,the undersigned,assume res ibiIIty for' lion of the POWTS shown on the attached plans. Plum Nam Plumber' tat MP/MPRS Number Business Phone Number Plumber's Address(Streetle .State,Zip Code) V oun /De artmont Use Onl Pe it Fee Dat Issue 1ng Agent 1 atroved ❑ Disapproved ��� G� ❑ Owner Given Reason for Denial IX.Conditions of Approval/Reasons for Disapproval ,� 4V t`va f��n / SYSTEM OWNER: \. /f1C1 (.� 1.Septic tank,effluent filter and / dispersal cell must be serviced/maintained �. 6t '�CL�tC7 as per management plan provided by plumber. ans for the syste and submit to the County only on paper not less than 8 112 t inches i ze as per applicable @ '/�fr84H'�4i'fc '. S f s 3Y3. 33, V f �"� o���TUr DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD V 9 HAYWARD WI 54843 3 s Contact Through Relay f" www.dsps.wi.gov/sb/ 92 p s www.wisconsin.gov G sfit hG Q" A�OsstoN� Scott Walker,Governor Dave Ross,Secretary July 08,2014 CUST ID No. 224263 ATTN.•POWTS Inspector KIM A OCONNELL ZONING OFFICE KO CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 07/08/2016 Transaction ID No.2414418 SITE: Site ID No. 803203 Tom&Shirley Higgins Please refer to both identification numbers, 447 Co Rd Vv above,in all correspondence with the agency. Town of Somerset St Croix County NE1/4, SW1/4, S5,T30N,R19W FOR: Description:Mound,3 br res Object Type:POWTS Component Manual Regulated Object ID No.: 1490030 Maintenance required; Replacement system; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01 101,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12), SSWMP Pub.9.6; Effluent Filter CONDITI The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes APPR and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed DEPT OF S and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. PROFESSION The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code DIVISION requirements. _ No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: CORK Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. • The mound must conform to the shape of the contour. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it 1 KIM A OCONNELL Page 2 7/8/2014 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis.Adm. Code. • Insulate building sewer per SPS 382.30(11)(c). • Provide frost protection per SPS 383.43(8)(c). A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Patricia L andorf POWTS Plan Revi wer Integrated Services WiSMART code:7633 (715)634-7810, Fax.(715)634-5150,M-F 8:00 a.m.-4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012,all codes under the jurisdiction of the Division of Industry Services(formerly Y Safety;&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "S PS" recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Tom &Shirley Higgins Owner's Name: Tom&Shirley Higgins Owner's Address: 447 CTY RD W Somerset WI 54025 Legal Description: NE--SW--sec5--T30N--R19W Township: Somerset County: St. Croix Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 032-2019-60-300 NpLLY Plan Transaction No.: WED ,FE'CY AND Page 1 Index and title L SERVICES Page 2 Data entry 1STRY SERVICES Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications SPONDF Page 8 Plot Plan Page 9 Soil Evaluation Designer: Kim Oconnell License Number: 224263 Date: 06/13/14 ` Phone Number: 715-381-7917 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N.01/01, R. 11/12),and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01,R. 10/12) Version 7.0(R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5= 150%) fecal coliform of-36 inches. 450.00 Design Flow(gpd) 2.00 Site Slope(%) 106.50 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate(gpd/fl?) Distribution Cell Information 45.001 Dispersal Cell Length Along Contour(ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/fl?) 1 I Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution I � Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter(in) 3.19 Estimated Orifice Spacing (ft)= 10.71 ftz/orifice 1.50 Forcemain Diameter(in) 55.00 Forcemain Length(ft) Does the forcemain drain back? Y 93.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft)x 1.3 5.05 Forcemain Drainback(gal) 14.33 Vertical Lift(ft) 59.94 5x Void Volume(gal) 1.56 Friction Loss(ft) 64.98 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 17.30 System Demand (gpm) 22.39 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information 1000.00 Total Tank Capacity(gal) 1000.001 Septic Tank Capacity(gal) 1 36.001 Total Working Liquid Depth (in) Wieser I Manufacturer 1 27.78 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity(gal) Plo lock Filter Manufacturer 16.761 Dose Tank Volume(gal/in) PL 525 Filter Model Number Weiser Manufacturer Project: Tom&Shirley Higgins Page 2 of 9 Mound Plan and Cross Section Views T 1/10 B ;:;:;:;:::::::::::::::::::::::::::;. . . . . . . . . . . . .;.:.;.:.:.;.: . J Observation Pipe _ I K a TA W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L Mound Component Dimensions A 10.00 ft E 20.40 in H 1.00 ft K 10.18 ft B 45.00 ft F 9.50 in 1 9.55 ft L 65.35 ft D 18.00 in G 0.50 ft J 7.90 ft W 27.45 ft 450.00 (fe) Dispersal Cell Area 1 879.65 (fl?) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 1 4.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 109.79 (ft) --� ,.,.,, .,,..,. ♦ H ................._... F Dispersal Cell 108.50 (ft) Lateral 108.00 (ft)—♦ — Invert Dispersal Cell ( . Elevation D . `. 106.50 (ft)Contour Elevation 2.0 %Site Slope Geotextile Fabric Cover Shading Key $'. T Dispersal Cell See lateral details on 1�® Topsoil Cap �� 1.5 ft Page 4 for number,size, Q ,,..,... Subsoil Cap c and spacing of laterals. ASTM C33 Sand e° '�° Laterals are equally Q Tilled Layer Z F spaced from the m 0 ft Typical Lateral © � distribution cell's Aggregate o - centerline in the A distribution cell(AxB). Project: Tom&Shirley Higgins Page 3 of 9 End Connection Lateral Layout Diagram Center the laterals over the A&B dimension •:Turn-up vrfball valve or oleanoutplug P _I All laterals are identical IE X l Holes drilled on the bottom of the lateral s equally spaced Laterals&forcemain Sch 40 PVC per SPS Table 384.30-6 S Force main connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.35 ft Lateral Length (P) 43.55 ft Orifices per Lateral 14 Lateral Spacing (S) 3.33 ft Orifice Density 10.71 fe/orifice Lateral Flow Rate 5.77 gpm Manifold Length 6.67 ft System Flow Rate 17.30 gpm Manifold Diameter 1.50 in Total Dynamic Head 22.39 ft Forcemain Velocity 3.14 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► 1� SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented E-- Alternate outlet location Forcemain diameter Weiser Manufacturer _� 1.5 in. Ca aci 600.00 Gallons Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 21.92 367.42 B 2.00 33.52 C Pump off elevation(ft)_t C 3.88 64.98 94.17 D 8.00 134.08 D Total 1 35.801 600.00 Dose se tank elevation(ft) ,,T---37'—Bedding uncler tank. 1 93.50 Alarm Manuafacturer JSJ Electro Note: Switches Alarm Model Number 1101 HW containing mercury may not be used in Pump Manufacturer JGoulds this system. Pump Model Number I PE 51 Pump Must Deliver I 17.30 gpm at 22.39 ft TDH Project: Tom &Shirley Higgins Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Kim Oconnell Phone 715-381-7917 POWTS Regulator's Name ST. Croix CTY Zoning Phone 715-386=4686 System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished •..••......... ............... Grade vl 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution �.� Lon .gg Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Tom &Shirley Higgins Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[SBD-10691-P(N.01/01,R. 11/12),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD- 10706-P(N.01/01,R.10/12)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. if an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS,30 mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. ST. CROIX COUNTY SEPTIC TAI\'K-MAIINFTENANCE AGREEMENT AND OV,rNERSHIP CERTIFICATION FORM Owner/Buyer / Mailing Address7/Y►-� Property Address � e from planning&Zo nin g Department for new construction.)'erificad n reqd City/State 1 �.__11 �-ate Parcel Identification Number �- 2- 1 f- lL ) -'7 OC�O LEGAL DESCRIPTION Property Location 1/� ;�S 1/4 , Sec. , T- C N R_W, Town of &LAdf � L( Subdivision Plat: Certified Sae 'VIap # , Volume ,Page# 0,3 (before 2007)Volume ,Page# 1 _ Spec house-0 yes)(no Lot lines identifiabiejS�'es❑no SYSTEM MAINTENANCE AIND OWNER CERTIFICATION 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 years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the a aste disposal system. Owner maintenance responsibilities are specified in§SPS.383. 2(1)and in Chapter 12-St Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department 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 it full of sludge. Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein, as set by the Department of Safety And Professional Services and the Department ofNamral Resources, State of'Wisconsim Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department witbin 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Resister of Deeds Office. Number of bedrooms r Zi!��SIGNTAARE�OF LICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed- (ELEV.04/12) 7 J [jGOULDS PUMPS Submersible Effluent Pump PE 4"Off PUMP SPEaRCATIONS MOTOR FEATURES Pump—General: General: ■Corrosion resistant • Discharge:1 W NPT ■Cast iron body. • maximum,continuous F(s when . 115 vohs ■Thermoplastic impeller and maximum,continuous when fully submerged. • Bui � Nn ml overload pro- cover. • Solids handling:'h" tectlon with automatic reset a Upper sleeve and lower • heavy d ball bearing here. Class B insulation. vy �Y .� maximum sp • Automatic models include a ° Oil-filled design. construction. • High h strength th carbon steel ■Motor is permanently APPLICATIONS float sw i tch shaft. lubricated for extended • Manual models available. life. designed for the - service Specially l 9 • Pumping range:see PE31 Motor. following uses: `performance chart or curve. • .33 HP,3000 RPM a Powered for continuous ' • Mound Systems • 12.0 Maximum amps operation. • Effluent/Dosing Systems PE31 Pump: m All ratings are within the working limits of the motor. • Low Pressure Pipe Systems • Maximum head:25'TDH PE41 Motor: • Basement Draining .40 HP,3400 RPM N Quick disconnect power • • Heavy Duty Sump/ PE41 Pump: cord,20 standard length, Dewvatering • Maximum capacity:60 GPM • 7.5 Maximum amps heavy duty 1613 SJTW with • Maximum head:29'TDH • PSC design NEMA 5-15P,three prong, PE51 Pump: PE51 Motor: 115 volt grounding plug. • Maximum capacity:70 GPM • .50 HP,3400 RPM ■Complete unit is heavy duty, • Maximum head:37'TDH • 9.5 Maximum amps portable and compact • PSC design m Mechanical seal is carbon, METERS FEET J..__.-..__.__._._.._ ceramic,BUNA and stainless 40 —._ MODELS:PF31.PE41,PE51) steel. P 5 ■Stainless steel fasteners. i W_33_40_50 { 35 10 t a► —z GPM AGENCY LIS(1NGS 30 E41 , 1 FT 25 i _:. - _ - i .� C�p US .. E _ .: .._ L -._ ,. Tested m UL 778 and a 20 _ �_ , ice_____. Z _ # CSA 22.2108 Standards o #..; { By canxian Sund Fie AF08549 1 O 9 Goulds Ptvrvs 61509001 RegisliffikI. w , 10 r — _ ..; 5 ' - - 0 10 20 30._ _40 50 bow_ 70 GPM 80 5 10 15 m3/h GOI.l�S Pumps CAPACITY all( v 9-01, � ins AS _ 9S _ /cc lee;? .f�8 toll/0 dil F 0 Property Owner S Parcel ID# e-5.?-.7 Page of _ E) Boring Boring# rrpp�� ,l Pit Ground surface elev. /D/y. 9_ft. Depth to limiting factor ?in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 * ff#2 ¢ e ❑ Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 ❑ Boring F-I Boring# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Donsistence oundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 102 *Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(R11/11) Wis.Dept.of Safety and Profegi ga�eW►�e� SOIL EVALUATION REPORT Page f of- Division of Safety and Buildings JT CP,QIX Ca'N�gTWwith SPS 385,Wis. Adm. Code County P.lT1` DE b Attach complete sit6plA wpaper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. Q3 Z ' 0/4f''7 � percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 4 _ Please print all information. Reviewed by Dat 4,�I� Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location Govt.Lot A& 114 - 1/4 S T N R E(or)&/' ,f, , / e Zl�/J!5' _g_)Property Owner's Mailin ddress Lot# 1!2# 1 Subd.N`a Y`{mn/,e SM# -f���/ ! ^. City tate Zip Code Phone Number ❑City ❑Village ®Town Nearest Road ❑ New Construction Use:0 Residential/Number of bedrooms Code derived design flow rate GPD Replacement ❑ Public or commercial-Describe: Flood Plain elevation if applicable Parent material ft General comments and recommendations: / Boring# Boring ® Pit Ground surface elev. 10,2 ft. Depth to limiting factor -3;2 in. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. C nt.Color Gr.Sz.Sh. ff#1 -$ff#2 _ t IJI 01.1) r Boring#- � Boring Ej Pit Ground surface elev. 1_ft. Depth to limiting factor in. =Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 402 *Efflu nt#1 =BOD >30<220 mg/L and TSS>30 <150 mg Effluent#2=BOD <30 mg/L and TSS <30 mg/L CST Name P ase P'nt i S, a CST Number Address ✓ Date Evaluation Conducted Telephone Number 1C — eJ — FO— SBD-8330(RI 1/11) I � I �_ � _ ! � _. �_._ � ! � � � i � I � i 1 .. -- - n i E � � 1 � - _ - _--,_ � - -� � � �� _r . i i __ _w .��T - .ii �_ �, '_ I I f I _ I I � I I � � I � .. 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Parcel M 05.30.19.542A 032-TOWN OF SOMERSET Current )(I ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 07/25/2012 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-HIGGINS,THOMAS P&SHIRLEY THOMAS P&SHIRLEY HIGGINS 447CTYRDVV SOMERSET WI 54025 Property Address(es): '=Primary *447CTYRDVV Special SC=School SP=S Districts: p Type Dist# Description SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Notes: Legal Description: Acres: 0.000 SEC 5 T30N R19W 1.00A IN NE SW COM INT N LN NE SW&SE LN HWY 35,TH E 150'S Parcel History: 130'W 250'TO HWY R/W NELY ON R/W TO Date Doc# Vol/Page Type POB 471/155 ALSO TRI> PARCEL IN VOL 07/25/2012 960503 QC 615/332 ASSM'T INC (541G) 07/23/1997 800/150 032-2019-60-300 ALSO INC PARCEL DESC IN 07/23/1997 471/155 DOC 960503 Plat: *=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: *N/A-NOT AVAILABLE 05-30N-19W NE SW 2014 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/17/2013 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.888 24,400 75,600 100,000 NO Totals for 2014: General Property 2.888 24,400 75,600 100,000 Woodland 0.000 0 0 Totals for 2013: General Property 2.888 24,400 75,600 100,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 08/23/2013 Batch M 13-07 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 EXHIBIT "A" The amended southeasterly right-of-way of County Trunk Highway "W" (formerly known as State Trunk Highway "35/64"); lying within the SW1/4 of the SW1/4, NW1/4 of the SW1/4, NE1/4 of the SW1/4, SE1/4 of the NW1/4, SW1/4 of the NE1/4, and SE1/4 of the NE1/4, all in Section 5, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin; further described as follows: Commencing at the SW corner of said Section 5; thence N00°41'30"E, along the west line of the SW1/4 of said section, 932.79 feet to the beginning of said right-of-way and a point on the southeasterly line of that Warranty Deed to the State of Wisconsin, Department of Transportation, recorded in Volume 1491, Page 539 at the St. Croix County Register of Deeds office and being a point on a 1083.060 foot radius curve, concave southeasterly, whose central angle measures 4°05'28", whose chord bears N53'1 0'36"E and measures 77.32 feet; thence northeasterly, along the southeasterly line of said Warranty Deed and the arc of said curve, 77.33 feet to the point tangency; thence N55°13'20"E, along the southeasterly line of said Warranty Deed, 218.08 feet; thence N34°46'30"W, along the northeasterly line of said Warranty Deed, 14.51 feet; thence N55°26'05"E, being 50 feet distant southeasterly from and parallel with the centerline of the highway, 2652.89 feet to the east-west 1/4 line of said section; thence S89 046'17"E, along said east-west 1/4 line, 57.83 feet; thence N55 026'05"E, being 83 feet distant southeasterly from and parallel with the centerline of the highway, 393.60 feet to the point of curvature of a 2781.789 foot radius curve, concave southeasterly, whose central angle measures 15 045'52", whose chord bears N63°19'01"E and measures 762.97 feet; thence northeasterly, along the arc of said curve, being 83 feet distant southeasterly from and parallel with the centerline of the highway, 765.39 feet to the point tangency; thence N71°11'57"E, being 83 feet distant southeasterly from and parallel with the centerline of the highway, 377.84 feet to the west line of Lot 3 of that Certified Survey Map filed in Volume 5, Page 1373 at said office; thence N00°10'00"E, along said west line, 34.90 feet; thence N71 011'57"E, being 50 feet distant southeasterly from and parallel with the centerline of the highway, 415.17 feet; thence S18°48'03"E, 25.00 feet; thence N7101 1'57"E, being 75 feet distant southeasterly from and parallel with the centerline of the highway, 1046.65 feet to the west line of the east 8 Rods of the SE1/4 of the NE1 14 of said section; thence N00°24'25"E, along said east line, 26.47 feet; thence N71 011'57"E, being 50 feet distant southeasterly from and parallel with the centerline of the highway, 139.78 feet to the east line of the NE1/4 of said section and there terminating said right-of-way, being N00 024'25"E, 1253.08 feet from the E1/4 corner of said section. 2 of 2 i i►►r i►ii iii►ii�i►i i►i►i i►►�iii ► 8070228 QUIT CLAIM DEED Tx:4051764 Exempt from fee: s.77.25(2)Wis. Stats. 960503 SCCHD QCD BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI St.Croix County Highway Department, GRANTOR quit-claims to 07/25/2012 4:22 PM Thomas P. Hiqqins and Shirley L. Higgins,GRANTEE, any interest EXEMPT#: 2 in that real estate and releasing any subject highway right-of-way within REC FEE: 30.00 the following described property: PAGES• 2 That part of the NE1/4 of the SW1 14, lying north of Lot 1 of Certified Surrey Map filed in Volume 3, Page 688, Document Number 351887 at the St. Croix County Register of Deeds office, and that part of the SE1/4 of the NW1/4, all in Section 5, T30N, R19W,Town of Somerset, St. Croix County, Wisconsin; lying southeasterly of the amended right-of-way of County Trunk Highway"W"as described on Exhibit"A" This space reserved for recording data of this document. Return to a Quit claimed right-of-way contains 0.648 Acres more or less. St. Croix County Highway Department 920 Third Street P.O. Box 108 Hammond,WI 54015 Parcel Identification Number/Tax Key Number 032-2019-70-000 and 032-2019-60-300 This is not homestead property Tim Ramberg William E. Peavey St.'Croix County Highway Commissioner St. Croix County Transportation Committee Chair (Date) State of Wisconsin ) )SS. County of St. Croix County ) s0 the above date, this instrument was le ge ,before y the n reed person(s). \ ig Notary Public) (P ' t or pe Name, Notary Public) ate Commission Expires) CTH VV R/W This instrument was drafted by the Francis W. Bleskacek QCD No. 4 1 of 2 n ■ , @ /� :k A 0 ( [ i / o t J I 7 ■ E g er g(30 a — � E , , w C & _� � 31 & \§, § 0 / � t E § o E w : 2 E co 0 e 0 4 \, � ® § § z = c < n r ■ ° d d < ■ o c ƒ � Z 2 T 'a "a I ■ �. � 7 00 k ' 7 2 1-3 CA ch ca 2 i / n - E00 % 3 o e [ § # § ' \ \ I 0 " a ' \ \ 0 { \ \ / 7 ƒ� 2 . m ) § 6 = CD m L § § z CD 2 ■ ° ° _ § ;a _ \ G) R g w M / / a CL 2 z \ � U) { : $ CA) : \2 ± �c § � \ / f X ƒ # ) _ � . % C 2 CD CD § N ' S kj i \ \ . a ■ g / CD q _ 0 k S E Wisconsin Department of Health and Social Services 'Plb. #67 370 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. OWNER OF PROPERTY Name Address (Street, City, Zip Co ) Be LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY G Check One: TOWNSHIP C. VILLAGE LEGAL DESCRIPTION 3a IV C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO 7 /,11 PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: So TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial Other Specify Umber of Persons to be Accommodated _ Number of Bedrooms _ F. APPLIANCES, ETC: Food Waste Grinder YES X NO Automatic Clothes Washer _e,YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLUMBER MAKING ST ILLATION Name: Address: License Number: IiP Signature of Applioant: MP RSW js 6 3 Address: / H. (To be Completed by Issuing Agent) Date of Application ? Fee Paid Permit Issued (data)--T— ,� / Permit Number - Agent (Name) _'` f ! i f ,� ^�1s� ,< ��,,�/ Fors Town, Village, City,.-County, etc. (Specify) Note The application cannot be considered for filing until all of the above questions are answered and the foe paid. Agents will forward application, the fee of $1.00 for each septic tanic and the third copy of the permit (canary) to the Division of Health. Checks and s,aney orders should be shade payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED �' 1 ^1I ACCEPTED. BY RETURNED (Initials) (Date) S e res.) FEE RECEIVED ✓ VALID. No. pia ?C�6 PERMIT We es or NO) REVIEWED BY APPROVED DATY (Initials) Yes or No) COMPLETE OTHER SIDE SEPTIC TANK PERMIT NO. R Z P O R T O N S O I L P E R C O L A T I O N T E S 'T AND SOIL BORINGS TO DIVISION OF HEALTH PLLMING SECTI6N P.O.Box $09, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code • P E R C .0 L A T I 0 H T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall lst Wetted Overnight in Minutes Last Period Last Period period Oner Inch Example P - 0 36+1 Top Soil 10" Cla 26" 25 Yes or No 30 1A 2/2 1 2 60 Jo ,3 3k RECORD ATA FROM MXND1UM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S 0 I L B O R I N G S - Minimum 36" Below Pro osed Abso tion S stem Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observedl Estimated Character of Soil with Thickness in Inches Example B - 0 7221 721t Black T02 Soil J2"j C 18111 Sand L8"j Gravel 2411 �z /z RECORD DATA FROM MINIM OF 3 BORE HOLES PE OF OCCUPANCYs RESIDENCES Number of Bedrooms _ OTHER: (Specify) Number of Persons rOOD WASTE GRINDER: Yes No Dishwashers Yes NoAutomatia Clothes Washers Yes No FFIIJENT DISPOSAL SYSTEM: NEW ZXTENS ION ADDITION w� REPLACEMENT Tile Size No.Lin.Feat - Trench Width Depth Number of Lines Seepage Beds Lengttr,f t Width:;-/0 Depth --?6 Tile Size 1 No. Lines Seepage Pits Inside Diameter Liquid Depth Is the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the prooedures and method specified in Chapter H 62.20 (13), Wisconsin Adalsistrative Code, and that the da recorded and loca on of test holes- 4 correct to the best of may knowledge and belief. NAME . TITLE - Type or Print)// REGISTRATION NO. or MASTER PLUMBER LICENSE NO. ADDRESS DATE S�` l 21 SIGNATURE L6'cn EL o CO I N w .CII) o L9'tpL L 0 I .p cs� co