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HomeMy WebLinkAbout032-2169-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 579020 0 GENERAL INFORMATION 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: Quist, Blake & Crystal Somerset, Town of 032-2169-05-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: X1'9 .7 13 m 1 18.30.19.1431 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t Z Benchmark (~..~►e.5,u~_ Ft ~ , p /OZ T'S, 7 3.5 ZO6 Dosing 3I Alt. BM T66 3 r eratton D c Bldg. Sewer c~ J 7, (7 Holding St/Ht Inlet 7-G7 '75- ICN3 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent t it intake ROAD Dt Inlet Septic -75 ~ t/►- Z ? ~ Dt Bottom f f, 3 9 Dosing 7 5 / A)+ Z7 ~J Header/Man. Z .4 ( /zd. Z9 Aeration Dist. Pipe z • 45 /116 . Z 5 Holding Bot. System '3.1 cl-I a" PUMP/SIPHON INFORMATION Final Grade 161. Z Manufacturer J Demand St Cover l GPM V C, -3.7 9 Model Number G L72. 31 G J r TDH Lift Friction Loss System Heal/ L~ TDH~ Ft • 7 ~Cr Forcemain Length Dia., S Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length NoTren a P IT DIMENSIONS No. Of Pits Inside Dia. liquid Depth DIMENSIONS O 75 e SETBACK SYSTETO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION e CHAMBER OR Typ ystem: 1-7 J~r6 ~l/ /'-J j~ UNIT Model Number: t cy 1 DISTRIBUTION SYSTEM 46J I44,, ahf Header/Manifold) t Distribution Z x Hole Size Ix Hole Spacing` / lVen~~Air In ke i J Pipe(s) . 3Z Z J3 Length Dia Length 7~ • v 1 Dia / Spacing 1 _l _~L 1 6~ f SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx M ed Bed/Trench Center / Bed/Trench Edges Topsoil Vc 5 ` . --s-) es ~ No 0 ]No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: IT ~ 6 Inspection #2: Location: 1507 34th Street SOMERSET, WI 54025 (SE 1/4 SW 1/4 18 T30N R19W) Quail Ri ge L%ot Parcel No: 18.30.19.1431 J 1.) Alt BM Description = C~.q,i ~S P/6 2.) Bldg sewer length = 3(a - amount of cover = ~ ~i pr6Lj oL 7 yrz o~- _ Plan revision Required? 0 Yes No 1 C Use other side for additional information. ~ t Lf ~ ~J ' SBD-6710 (R.3/97) Date nsepctor s Sign ture Cert. No. &ML &v 67- t, S 19 -56 71 h,- 19 vJ <E'1U SJ Lb- 5 OuAk~- t~~t r- ` rO W A; OF -S:L3 W\.E7RS0r ST C W d ~4 CT--/ 61A RA6C S i eEL Onto NGNM AkIC ~2 L- IV TG~ o F ~ 1 l y w 5 r ,ESL lZt5t7 s ~t~~SE 4 St~tL ~~1~~5~ SCALC r -tit l i + t~ f 'a Jj, S. 1,!t Shl Z l ~eearaegtr A ! Industry Services Di County n 5 4400 E Washington ti P.O. BOX 7162 Permit Number {to be filled in by Co.} " S. ST. C~tdIX OOUNTY ~ G -OMMUNCTYDEVELOPM NT Madison, WI 53707 y5 5 ~/1 Sanitary Permit Application State Transaction Number ~J In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Z J~ 9.5 / ✓ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department in accordance Safety and Professional Services. Personal information you provide may be used for secondary Project Addres purposes in s (if different than mailing address) rdance with the Privacy Law s. 15.04(1 in)- Stats. L Application Information - Please Print All Information l 5b~ Property Owner's Name Parcel # 5 0 r $ e -r-- SLa - Q u1s-r r S U i s-~ 03Z- z 161 - 6~- ~6 Property Owner's Mailing Address Property Location / ST RZ 35 Govt. Lot X31 City, State Zip Code Phone Number 8 Section O LR W1 z 0 (circle 011e) Type of Buildin T 3Q N R17 g o g (check all that apply) Lot # tal or 2 Family D wvfling - Number of Bedroo Subdivision Name ❑ Pubho/Commereial-Describe Use 1/bM1 k# 6JA L- R1 D6 ❑ State Owned - Describe Use h oU SC J A n.S ❑ City of ` 7`J CSM Number ❑ Village of ~D1~~17L L -Town of s1Sgl~PRG~~ erm` • eck l one boa on line A. Complete tine B if a licable ZD AA- of New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner L J hL IV. T~Tie of POWTS S stem/Co nent/Device: Check all ❑ Non-Pressurized hr-Ground ❑ Pressurized 1n-Ground ❑ At e V Mound > 24 in. of suitable soil Mound < 24 in, of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ent Device -~7i V. Dis rsaUTrea ent Area Information: Design Fiow {gpd) RDesl gp o Application Dispersal Area Requ ed (s fl Dispersal Area osed (sf} System Elevation t/. .o G . l50~ 156 C/, 60 VI. Tank Info Capac' Gall Total # of ° Gallons Units Manufacturer Q cs' p" New Tanks Existing Tanks W ~O/y/p, 325 t / bi { 1.114 Septic or Holding Tank Q 1 0 Dosing Chamber -r1 5~ O VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print um Mnatq4, 4P VnD ; er Business P e Number Plumber's Address (Street, City, State, Zip Code) - V - i s t115 D'\~2]~~ 'v~ CJCJ VIIL oun /De artment Use Only Pl~pprovad Lpermit Date n Issuing Agent Signature 7 5 MC~ ~ xaUReasona for Disapprove! 3 e on dl I 1 ms iA 1. Septic tank, effluent filter and 7(eC ~A/s I ~ dispersal cell must.?e Sery~ced I .Maintained CT / s+ ~e, as per management plan provided by plumber. ` 2. All setback requirements must be maintained Y V e 1, -h N(j,4-~' NP-80, Wb V e i)I Yrm1 as per app ICs @! as for the system a submit to the County o* on paper not less than8 to z 11 inches in size ' SBD-6398 (R.03/14) oernx7.r DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD D s HAYWARD WI 54843 Contact Through Relay p http://dsps.wi.gov/programs/industry-services www.wisconsin.gov °FFss101S Scott Walker, Governor Dave Ross, Secretary June 24, 2015 CUST ID No. 223242 ATTN: POWTS Inspector JEFFERY V FOX ZONING OFFICE JEFF FOX CONTRACTING & SEPTIC INC ST CROIX COUNTY SPIA PO BOX 565 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/24/2017 Identification Numbers Transaction ID No. 2561957 SITE: Site ID No. 814010 Blake Quist Please refer to both identification numbers, 34TH St above, in all correspondence with the agency. Town of Somerset St Croix County SE1/4, SWIA, S18, T30N, R19W FOR: Object Type: POWTS Component Manual Regul d Object ID No.: 1541815 Maintenance required; 600 GPD Flow rate; 2 ' Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, 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 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code 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: Insulate as per SPS 82.30 (11) W.A.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. JEFFERY V FOX Page 2 6/24/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035 M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm i MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Blake Quist Owner's Name: Blake Quist Owner's Address: 534 ST HWY 35 Osceola WI 54020 Legal Description: SE-SW-sec 18 T30N-R19W Township: Somerset County: ST Croix Subdivision Name: Quail Ridge Lot Number: 5 Block Number: CC4~'~IT"ihl,~.LL~f Parcel I.D. Number: 032-2169-05-000 Plan Transaction No.: DEPT OF SAFF-V ND 10NEAL PROFESS SERVICES Page 1 Index and title DIVISION OF INDUSTRY Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifcati NDENCE Page 6 Management and con gency gWE COP~R E Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evaluation Designer: Jeff Fox License Number. 223242 Date: 06/08/15 Phone Number: 715-755-2461 Signature: ` 7r P 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. 01101, 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 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for i 1.50 Peaking Factor (e.g. 1.5 =150%) fecal coliform of 36 inches. 600.00 Design Flow (gpd) 2.00 Site Slope 99. 00 Contour Line Elevation (ft) I 26.001 Depth to Limiting Factor (in) OAO, In-situ Soil Application Rate (gpd/fe) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fe) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution l Y Pressure Disribution Information network? Enter Y or N (C or E) I E Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation (ft), m 2 Number of Laterals of the highest point. ~ p0.166 Orifice Diameter (in) - 2. - i .50 Estimated Orifice Spacing ft O - 10.00 fly/orifice i 2.00 Forcemain Diameter (in) _ 60.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 10.67 Vertical Lift (ft) 67.32 5x Void Volume (gal) 1.33 Friction Loss (ft) 77.11 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 32.31 System Demand (gpm) 16.55 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 3 - 1.25 x 1.00 1.50 x x 1.252.001 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information a 1250.001 Total Tank Capacity (gal) 1250.00 Se tip c Tank Capacity (gal) _ 48.00 Total Working Liquid Depth (in) ~ieser f Manufacturer 26.04 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750 40 Dose Tank Capacity (gal) Plo lock Filter Manufacturer 16.12 Dose Tank Volume (gaUin) PL 525 b Filter Model Number Weiser _=Manufacturerm Project: Blake Quist Page 2 of 9 Mound Plan and Cross Section Views T B J 1/10 Observation Pipe : :K Q A I L Mound Component Dimensions Down sio a toe extension made. A 8.00 ft E 11.92 in H 1.00 ft K 8.12 ft B 75.00 ft F 9.50 in z ft L ft D 00 in G 0.50 ft J W 600.00 (fe) Dispersal Cell Area 1500.00 (if) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft)1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.63 (ft) .fi/{!f//I!!{/N!f ff!{l1llf{!f!!1. I F Dispersal Cell 100.33 (ft) Lateral 99.83 (ft)-► Invert Dispersal Cell D'- Elevation 99.00 (ft) Contour Elevation 2.0 % Site Slope Geotextile Fabric Cover Shading Key 'a a T Dispersal Cell See lateral details on 0 Topsoil Cap 1.5 it Page 4 for number, size, Q f!!!,{f{ Subsoil Cap a 0 © ) and spacing of laterals. ASTM C33 Sand j Laterals are equally Typical Lateral spaced from the Tilled Layer F c 0. ft distribution cell's © Aggregate o © I centerline in the A distribution cell (AxB). Project: Blake Quist Page 3 of 9 End Connection Lateral Layout Diagram Laterals centere overt imension •=Turn-up w1ball valve or ofeanoutplug 1 ,411 laterfareidentical It' X ---y~ Holes drilled on the bottom of the lateral equally spaced Force main connection via tee or cross to manifold At 41111 Doint. Laterals Morcemain Sch 40 PVC, per SPS Table 384.30-5 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral 30 Lateral Spacing (S) 4.00 ft Orifice Density 10.00 fig/orifice Lateral Flow Rate 16.16 gpm Manifold Length 4.00 ft System Flow Rate r_32,31 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.55 ft Forcemain Velocity 3.30 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented E- Altemate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 750.00 Gallons Volume 16.12 gal/inch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 31.74 511.69 B 2.00 32.24 C Pump off elevation (ft) C 4.78 77.11 _t 89.67 D 8.00 128.96 D Total 46.53 750.00 tank elevation (ft) Bedding under tank. 89.00 Alarm Manuafacturer SJ Electro~_. Note: Switches Alarm Model Number x101 HW containing mercury m _ may not be used in Pump Manufacturer Zoeller this system. Pump Model Number BN152ry Pump Must Deliver 32.31 gpm at 16.55 ft TDH Project: Blake Quist Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Jeff Fox Phone 717-755-2461 POWTS Regulator's Name. ST Croix Phoned 15- System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 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 eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound _ Ind forppondinc and seems once every 3 rs 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 Tum-up Detail Finished Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution 45nt3eeggSwee ree Bends Same Diameter as Lateral Project: Blake Quist 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, orsubject 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, Slats. 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 finer is equipped with an alarm, the filer 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 advice 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 fitter 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 BOD5, 30 mg& 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 dogging 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 TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer I57 Mailing Address S5-- /Rb 3S t~Gecouq W( 5-qw~ Property Address _ 6-1 3yf4-{ a-/- (Verification required from Planning & Zoning Department for new construction.) City/State Mu yD cel Identification Number -05-0001 LEGAL DESCRIPTION Property Location S C- '/a , 5V//4, Sec. f $ T 30 N R Il W. Town of SD 1'\E' " Subdivision Plat:_ ( ~l K 1 r%',C Lot # _ Certified Survey Map # . Volume Page # Warranty Deed # (before 2003)Volume , Page # Spec house yes :0 Lot lines identif abl SYSTEM MAINTENANCE AND 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, b a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(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 fora, 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 1/3 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 sex by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St:. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms L "4C.- A SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. 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Adm. Code County Attach complete site plan on paper riot less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~J 3 2 I (o Do 3ty OS ~a f ase a (f a sed for secon ary purposas~rnracy w, s. 15.04 (1) (m)). Re G~~~✓~ Property Location . I roperty Owner t ~ 2 7 Z0~2 Govt. Lot v 1/4 W11 14 S ~T R E (or Property es Mailing Address Lot # Block # Subd. Name or CSM# I ST. CROIX COUNTY 0616L" CRY State Zip C_ Pffi Ill ❑ City ❑ Village NbTown Nearest Road A New Construction Use: Residential / Number of bedrooms -3-7-Y--- Code derived design fknv rate _-_~Sa Q GPD ❑ Replacement ❑ Public or commercial - Describe: - - Parent material Flood Plain elevation if applicable _!r/_------ ft General comments sys~y~ e~V , me ' O a and recommendations: p( e l t]. 9; 0 ('ah~evr F Boring # F1 Boring ® pit Ground surface elev. ft. Depth to limiting factor 2lo in. Sod A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. +*Eff#1 'Effif2 7- '5 ' C_ Z r c Z 3 c C'2 k - ?44 Co F?--] Boring # Boring ~}Q ® pit Ground surface elev. ft. Depth to limiting factor -in. Soil ication 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 D-( ~p )3 - t r C-Iv • S _8 Z 12- l0 3 to C 5c.t_ 2 - - ' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Please Print) ignature CST Number 6clam Sch er b Address Date Evaluation Conducted Telephone Number 2 113 ?n_'22 SL ~0/ 4/02 iz -Z - o z Z4 7- Yov s Property Owner Parcel ID # Page of Boring # Boring Fc-1 Pit Ground surface elev99_-W- ft. Depth to limiting factor- in. Sol 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 - t - c I 5 2 .4. ❑ Boring # ❑ Boring ❑ pit Ground surface elev. it. Depth to limiting factor in. Sotl Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Boring # ❑ Boring ❑ pit Ground surface elev. it. Depth to limiting factor in. F-1 Sol 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/- and TSS >30:5 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg1L 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. sao-8330 tR.mroo> Property Owner Parcel ID # Page of Boring # Fj Boring a ~ pit Ground surface elev. 10, Depth to limiting factor in. Sol Ap flcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 lyl 5 '3 c l I ! Z - ' sl 2 b `f 3 _ c.l 2 rr P - - .44 ❑ 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/flF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # 11 Ground surface elev. ft. Depth to limiting factor _ in. Pit Sod piication 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 = BOD5 > 30 < 220 mg/- and TSS >30:S 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 608-2648777. SBU4330 (8.07100) S0a Cam. yo ~ .S.~c . ~ ~ j~ 3 r 8iri Z 99 00 2 3.sr~.s 2 e~ I 4 lr`aY~a~toe- aG , ao^ cc 61e -b Ike Se4ICA X4.1 V 1,516Ile- vs~ 1 1-70 perv,x . Zoo/ V~ Qa Parcel 032-2169-05-000 03/04/2005 11:10 AM ` PAGE 1 OF 1 Alt. Parcel M 18.30.19.1431 032 - TOWN OF SOMERSET Current 'X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner GERALDINE MEYERS " MEYERS, GERALDINE 1475 24TH ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1507 34TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.005 Plat: 2358-QUAIL RIDGE LOTS 5/11 032/03 SEC 18 T30N R19W PT SE SW QUAIL RIDGE Block/Condo Bldg: LOT 05 LOT 5 (3.005AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) L6) 3 18-30N-19W SE SW 0 C I, Notes: Parcel History: Date Doc # Vol/Page Type 05/12/2004 762410 2570/422 WD 12/11/2003 748867 9/96 PLAT 2004 SUMMARY Bill Fair Market Value: Assessed with: 11823 56,600 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.005 48,000 0 48,000 NO Totals for 2004: General Property 3.005 48,000 0 48,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00