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HomeMy WebLinkAbout004-1035-50-110Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15,04 (1)(m)], Permit Holder's Name: City Village Township DEAN & PEGGY SCHRAMM TOWN OF CADY CST BM Elev: IBM Descr�iy�tion: TANK INFORMATION TYPE MANUFACTU Ft CAPACITY Septic eLcr N . 5 0 0 0 Dosing (h & 0 0 Aeration Y v TANK SETBACK INFORMATION TANK TO P/L O 4� WELL BLDG. Vent to Air Intake ROAD Septic � log Dosing N, 1371 j Vk 7? t -7 / 7 1 Aeration Holding PUMP/SIPHON INFORMATION Manufacturer � (jC/Kr I Demand GPM Model Number TDH Ljft, Friction ev Loss System Hg3d T� LiS Ft Forcemain Len � Dial 14• Dist. to Well I ELEVATION DATA O ty: St. Croix Sanitary Permit No: 617889 State Plan ID No: Parcel Tax No: 004-1035-50-101 Section/Town/Range/Map No: 15028615.237D-01 STATION ON BS HI FS ELEV. Benchmark (� p D �UI• !bd Alt. BM Bldg. Sewer 7*4= Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. � • �� Dist. Pipe G 55 `1G.35 Bot. System •2� /5 • I6 / Final Grade r 3.9Atrv� SOIL ABSORPTION SYSTEM u � (�, 7 j BEDITRENCH Width Length 56, � � N � s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �] SETBACK SYSTEM TO / P/ VW BLDG WELL LAKE/ RE M LEAC IN n facturer: INFORMATION Type Of S stem � CHAM ER R YP f7Vi�l ( 1 NIT Model u er. DISTRIBUTION SYSTEM Header/Manifold t1 1 Distribution ' x Hole Size x Hole Spacing � t Vent to Air Intake 11 Dia 2 1 4 Dia Length Z Spacing Length l U TQ var Length SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Svstems Onlv l�/!` IT��, w,�.r Depth Over Bed/Trench Center / 'r � Depth Over Bed/Trench Edges 'Z xx Depth Topsoil of Nj % xx Seeded/Sodded xx Mulched / I 1' Yes � No �] Yes 0 No COMMENTS: (Include code discrepencies, persons ppresent, etc.) �. Location: No Address Available 1.) Alt BM Description = l � /k r (ovtt� 2.) Bldg sewer length = amount of cover = 7 1J Z Plan revision Required? � Yes Use other side for additional informatio ���sss "� Date SBD-6710 (R.3/97) Inspection #1:C�/ � • 00 1 ZD Inspection#2: a vh Insepctor's Signature Cert. No. 7.1 3.� yy.t5 �i3.5 Y5 s�U Z2 0 as 0'? N OFF Ie Industry Services Division County S�'• )4, 1400 E Washington Ave ° 4 2020 _ - Sanitary Permit Number (to be filled in by Co.) APR 1. P.O. Box 7162 s Madison, WI 53707-7152 UJ .,,,lss St. Croix Count l om it Application State Number '' acc dance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit PwrrpwS D Z ODO T83 ^t= is required prior to obtaining it sanitary permit. Note: Application forms for statempowned POWI'S are submitted to Project Address (if different that mailing address) the Department of Safety and Professional Servics. Personal information you provide may be used for secondary u oscs in accordance with the Privacy Laws s. 15104001), Stats. I. Application Information — Please Print All Information Property Owners Name l f4l, eta- , S�� ra. ttit VA Pareel H C04 W 44) a- 1!^ �Ic WOOF"" Property Owner's Mailing Addrtlts TU U Properly Location �3c 3 Ii h}E tr-- Govt. Lot _ Ct . �,_ t�� yt Section I S7 City, State Zip Code Number 11504 S 027 -'-f ti0- 7 TAN; 1'$E11. Type of Bull ng (check all that apply) Ellhone or2Family Dwelling — Number orBedrooms__ �__ I Subdivision Name y �e.p�C1„�Qlilll(Y�' S�S� 131ocktl ❑Public/Commercial —Describe lls ❑ Village ❑State Owned — Describe Use _ SM Number % I% ,,^� Vol. b 1 of otatof. ' V01,D, f 111. Type of Permit: (Che line A. Complete line B if applicabl ��_�_�� A' New Sy cm ftepInclement System Treatment/Holding Tank Replacement Only Qt thcr Modification to Existing System (explain) 13. Q permit Renewal Q Permit Revision r'�-� g t. khan e of Plumber OPennit Transfer to Now List Previous Penn it Number and Date Issued Before Expiration Utmor U_ IV, lXp2 of POWTS S Stem/Com orient/Device: Check all IM O Non•Pressurized In -Ground OPressurizedInpGround OA Grado Mound >_ 24 in. of suitable soil ound < 24 in, of suitable soil []Hold ing Frank Other Dispersal Component (o Sin _ t trentme vice (explain) ,__ __ — t V. Disyemal/Treatm nt Area Information: _ ' Design I'Iow (gpd) Design Soil Appli do RaWgp st) Dispersal Area Requir d (so Dispersal Area Proposal (sf) System Elevation` `-f �p, 11 4Sc� S 1 Sd 9 , VI. Tank Info Capacity in Gallons Total Gallons 0,14of Units Manufacturer W t'e�ll�C e is Tanks New Tanks Existing d 0, a. U in ti, w t7 septic or Holding'rsnk l ) Dosing Chamtwr r Q ► s 1, k VI1. Respasiblllty Statement^ 1, the undersigned, us r instal lion of the POINTS shown on tite attached plans, _ Plumber's Name (Print) Plwnber'e Sioyfur MP/MPRS Number Business Phone Number Lewis BJork 253976 715-2314375 Plumber's Address (Street, City, State, Zip Code) E7818 County E , Menomonie WI 54751 _ VIII. County/Department Ilse Only_ _ Approved ❑ Disapproved permit Pee 5 Dalf Issued �`�9Job I sill g Agent Signalu ❑ Owner Given Reason for Denial �/��.� ZPZD �pprovaVReasons for Disapproval 3� 5 S ad P ` Ir �,v� 1, Septic tank, effluent filter and �L D dispersal be / `� P Q' ,gyp �A f\ - �� W t e9 cell must serviced maintained eK as per management plan provided by plumber. q,�� Gl vlt_�2- is ^ 2, All setback requirements must be maintained 49 Ad C*Ak��yyt�_�410 '�"' r"" "'NN""`•""" """GNYtpN1'rd'ebf++tlitte plats for ute system pw iuomn o the 4o y o uy on paper n�t�ugnnts a irz x t t mcnen to a,ae S13f)-6398 (R0313) c2pM �r OHIOCK BOX AS APPLWOWLl3. SOIL_ EVALUATION SITE MAP WRCMEC ` NAME; PI2C)JBGT ADDRESS; n SM 3ymw: * BM Elevtllon::i /�p - F, I SM D06011 tlon: .,... AQP ..1L.,....aLl�IJ-'�•.` Sloppe Gradient (56) (� Wolff SyntCd (Ir applicable); of 7ealedAres: A5 let ales 1" 11 Zu so GHEQK UOX AS APPMABLS. �• PAGE � C7� (; s�rsT M 4's �6H - "� PLOT PLAN t)ps)GN FLOW: , GPb Attach design flow calculagtms for commercial plans. Pipe Matodal I A$7M Standard ('tables 384.3" & 384MoS) °.....�....._ r,_ �6 -� N Sanitary sewer,, ForrA / - 6Ch 40 r _. Inq ih ty d mry en N how rot d elev lion nntpu at sulfa teals. ont ep�vop Nnv, $ 0�. .K' r (` .� �1tr, ry /FoMO DS , April ] 0, 2020 CONDITIONAL APPROVAL PLAN APPROVAL I✓�PIRhS: 2022-04-10 Plan Review: PWTS-042000483-C LEWIS G 13JORK E7818 County Rd E Menomonie WI 54751 srr1J: Larry Wiegand 322 310th street Town of Cady Saint Croix County 'I'ot1>.I Amount; 5250.00 Descriptiart: 450�PD t3 Berlroones _ Reyulce»ierrt) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http:!/dsps.wi.gov/programs/industry-services www.wisconsin.gov Tony Evers • Governor Dawn Crim . Secretary Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-p (N.01/01, R 10/12) Mound Component Manual —Vet•. 2.0, SBD-10691,P (N.O1/01, R 10/12) 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 tnanual(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: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site, • Any tall grasses, leaves and sltrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Prior to construction of the dispersal area, check the moisture_content of the soil to a depth of 8 inches, Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles,_sitc_pieparaton_canrgceed. If the site is too wet to prepare, do not roceed until it dries. • Abandon Existing System per SPS 383.33 • Pump Floats to be set and verified per approved plan Any changes may result in pump resizing to meet TDH. and GPM Specifications. • Divert surface water from POWTS AI'ea. • All piping shall conform to SPS Table 384.30-3 and SPS Table MUM • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • 'Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the POWTS Dispersal Area must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • 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. 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)1 nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. lnquiries 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. Thanks, POWTS Plan Reviewer —Wastewater Specialist Department of Safety &Professional Services � Division of Industry Services email: tim.vanderleest&wisconsin.gov Cell: 608-516P6134 El OF 6 Mound Flan �ndtex & Cover Sheet Component Manual Desf n References: Version 2.Q, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01/01, R. 10/12) Pg 1 of 6 Pg2of6 Pg3of6 Pg4of6 Pg 6of6 Pg6of6 #ndex & Cover Page Plot Plan Mound Cross -Section & plan View Distribution Network Specifications PumTank Specificati p ons Management Plan cements:If tnci u_r�es, _ Pump Curve POWTS Application for Review _ tank s) information Soil Evaluation Report & Site Map Effluent filter information Appliction for sanitary permit Materials to load list ^ Owner Name(s): , Owner Address: Project Address. Govt. Lot: Township: Project Parcel ID #: Project Na me Description Ai,(�j W PCgF,rtcl � Phone: i j 14 1•, �re,�, i— jk U fe Zip: .2 LIOy2DZ 1 /4, Section T N-R E or W County: ,vtS�2. L),�..�..,. - pesigner Information Designer Neme: I_ew'rs Bjork �___��__� Designer Address: E781 i3 County E Menomonie WI E-mall: lewi oa.com License Number: DSPS 2a3976 WDNR 82247 Remarks: Signature: anginal signature requires on seen suAmiaaa copy. Phone: ZIP* 54751 Date: � �� �"'--?Q � r ll v IQ t � fJA,i_l�_ CHUCK BOX AS A"k.l<7AQLf . SOIL. EVALUATION �` SITS MAID 1 WROJE T NAME% PI20JE.'C1' ADDRE99; am mam Elevation: FT BM t7esarlptbn: , Sloe Grndlent(%) l� Well 8y,"bol ill applicable): O of Tested Area; - CHLQK UOX AS AppUCABL6. Scale: V �4 M, OSYSTE:M PAGE 45 (1U 2 (11 .-� 30 b,x.� �"""'4 �. SLOT PLAN bI:SIGN FLCM: - QPD K !7HAttach design now calwistions for commercial plans, on (:3� 2 1 Iomg �3� a n Ai Pipe Motodal / ASTM Standard (Tables 384.343 A 3tkt.345) 5Ci1 :6 SanKnry Sewar, A . ._..... Force Main, w2 - Bch 40 .__. u25 ,3 9 76 IF r, J,N �a 4 �I M T r I w � p Ilktwo ;• r e a PAGE 4 OF 6 u w z z o 0 Ilk ujz l.t.l z �J404114,ok 1. Womb ... ' tJ X m -Y ss`7 !l7 SEPTIC / PUMP TANK SPECIFICATIONS 4"p Vent Pipe (No Scale) >10 ft from Building 12" Min. or 2.0 it above Established Flood Elevation (typical) IMPOR7AN'1': Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grads CAPACITIES @ gal/in Depth (in) Volume (yal) A B 3t1 C� jjttz��.a ?, { LC] �J� also 1 Z, D I 5" 19 x. 4 Pump Tank Liquid Level Force Main Diameter = in Force Main Leng#h w ^� ft Approved it cop a Forcr� Main Void Volume w , ��}' gal SAG 6 OF 6 Electrical must comply with SPS 316 and NEC 300 Weatherproof Extend manhole riser as necessary. Junction Box Approved Locking Manhole — with Warning Label Attached (typical) Conduit 4" Min, or 2.0 it above Established Flood Elevation _ ,e (typical) r- Alrlighl $eal] • 9 Quick Disconnect � � 18"Min. t a (typical) 1 Woop Approved Joints with Hole Approved Pipe 3 it onto A Solid Ground (typical) Alann + I, S ._._ on Tir IT Pump PUMP -OFF ? ott ELEVATION =>'� ft Concrete INSIDE BOTTOM Block ELEVATION = : ft 3" Approved Sodding [C] 'Total, Dose Volume (�� saw • '�� gal/dose L(5X total lateral void volume < TDV 50.2X design flow) + (force main dralrlback volume)0000 MIN. PUMP DISCHARGE RATE PUMP TANK: Ass Pump Manufacturer: Zoeller ..: • •SJ.ERombus • • ModelsAB sl Beneath Tank C� 7Was � • ft Vertical Head * Min. Supply Head = ft + FM Friction Loss = ft + Fitting Loss* = ft "(min, supply head x 0.3) TOTAL DYNAMIQ HEAD = >. I; ft SEPTIC TANK S Total Volume = I{�,� gal Manufacturer(s): I Cal) . Install approvedenk filter at the septic tank outlet j i t re rLt..of the putrtp,tank inlet, Filter Manufacturer: Orenco Filter Model: FT,=•�a 2� 2-1 4 Flog# switches cantsining me.,cu re rohibit d. Pump Tank Liquid Level Force Main Diameter = in Force Main Leng#h w ^� ft Approved it cop a Forcr� Main Void Volume w , ��}' gal SAG 6 OF 6 Electrical must comply with SPS 316 and NEC 300 Weatherproof Extend manhole riser as necessary. Junction Box Approved Locking Manhole — with Warning Label Attached (typical) Conduit 4" Min, or 2.0 it above Established Flood Elevation _ ,e (typical) r- Alrlighl $eal] • 9 Quick Disconnect � � 18"Min. t a (typical) 1 Woop Approved Joints with Hole Approved Pipe 3 it onto A Solid Ground (typical) Alann + I, S ._._ on Tir IT Pump PUMP -OFF ? ott ELEVATION =>'� ft Concrete INSIDE BOTTOM Block ELEVATION = : ft 3" Approved Sodding [C] 'Total, Dose Volume (�� saw • '�� gal/dose L(5X total lateral void volume < TDV 50.2X design flow) + (force main dralrlback volume)0000 MIN. PUMP DISCHARGE RATE PUMP TANK: Ass Pump Manufacturer: Zoeller ..: • •SJ.ERombus • • ModelsAB sl Beneath Tank C� 7Was � • ft Vertical Head * Min. Supply Head = ft + FM Friction Loss = ft + Fitting Loss* = ft "(min, supply head x 0.3) TOTAL DYNAMIQ HEAD = >. I; ft SEPTIC TANK S Total Volume = I{�,� gal Manufacturer(s): I Cal) . Install approvedenk filter at the septic tank outlet j i t re rLt..of the putrtp,tank inlet, Filter Manufacturer: Orenco Filter Model: FT,=•�a 2� 2-1 4 Flog# switches cantsining me.,cu re rohibit d. 3E60F6 IMPORTANT. The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382"384, Wise, Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maxirrlum Ispersai Area Aperatin�i Limits: rj Li Design Plow gpd; BODs 5 220 mgL''; TSS S 160 mgL''; FAG <_ 30 mgL'' Ina ectlon Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e,, pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenence(s) (i.e., distribution / drop boxes) o neglect or Improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (Le., pump re"cyciing, float switch settings, etc.) a electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEAF7S (or when necessary) o S tic n d e t s shall be pumped by a certified septage servicing operator licensed under s. 7.81,48 Wis. Slats. when the volume of solids in the tanks) exceeds one-third (113) the liquid volume of the tanks} or as required by local ordinance. Disposal of contents shall be pursuant to NR 1131 Wisc. Admin. Code. o MUgnilliter s shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications, A servicing period will always be greater than 12 months. III rill System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 363.�i5 Wisc. Admin. Code. R®port any component failure ar malfunctidn to: Lewis Name of individual or company: Local government unit: ,�,�.�;,: Local government unit address: Bjork Family peptic Service _Phone: � 5-231-7�75 fttiv--'_`"`�'' Phone:M, I 1�1�14 911:a Aa T zip: 9`1744 1 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Cade. Repair or replacement of failed or malfunctioning components shall comply with SPS 3$3, Wisc. Admin. Cods. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS :384, Wisc. Admin, Code. Contingency Pian In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. System bandonmerrt If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc, Admin. Code. Customer name LAC( Site .Address Close wIC Pumper truelz needed for old system �rcA Tank is W i L �t, Manhole &,k,n re Pump Pad 2) .� 6"x6"x4"3034tee 7) (4) $) _2" G 10)-- 12) 13) 14)�" 1 b) _ ~� 17) 18)- 19) 20) 21) _ Am 22) 23) 24) 25). 26) 27) clay x 4" PVC fernco coupler �4" pvc x 4Allpvc 1" PVC; LB Box 01 fernco coupling 1 r stick of 1" sch 40 conduit " conduit clamps sheet rock screws ..at stuff (I) jef,6-44 24" x 6" plastic riser 24" safety pan 24 adapter , to plastic risers rind; 24" x 12" plastic manhole risers Dome aid �5/16" X 1" SCREWS FOR COVERS Rolls of thick tar Roll of Butyl 'Thin Tar 5" hose clamps Stainless screws for manhole , µSTF -100 Simect Crravity , FT-822 or 525 effluent filter ADS Diverter Valve _10' 1 " sch $0 pvc handle �► 4" �034 pvc pipe _cans of PVC primer � Cans of PVC glue 4" h 40 wyee and a45 28) 29) 30) 31) 32) 33) 34) 35) 36) 37) 38) 39) 40) 41) 42) 43) 44) 45) 46) 47) 48) 49) 50) 51) 52) 53) 54) 55) 56) 57) 58) 59) 60) 61) 62) 4" sch 40 slip cap Li 4" sch. 40 pvc 20'ers with hub 3" sch 40 pvc 20'ers with hub H2" sch 40 pvc 20'ers with hub -' _1.5" sch 40 pvc 20'ers with hub -�- ~�4" perforated pipe / ASDR 35 4►► 3034 90 4" 3034 C.O. _4" 3034 Cap _4" 3034 coupling 4" 3034 wyee & st 45 Hub SCH40 x Hub 3034 Adaptor .L IPS Hub x Sewer spikot adaptor i Zj5 12/2UF WG & 12p2-UF WG Iq z. _ 8" X 8" PVC electrical box Y� 2" PVC GREY PIPE " PVC GREY MALE adapter with lout _ -- OUT DOOR ALARM / r � INDOOR Alarm _110 volt cord. end v 4 PVC WHITE SEPTIC VENT CAP single float AMPMASTER SWITCH _151 115V EFFL PUMP 20' cord 152 115V EFFL PUMP 20' cord 153 115V EFFL PUMP 20' cord -p- 140 115V EFFL PUMP 20' cord 1- 211 PVC Male Adaptor �.____2►, PVC DEEP SOCKET SCH 40 90S 2"x 1.5 DEEP SOCKET BUSHING 2" PVC DEEP SOCKET SCH 40 TEE C 2" PVC DEEP SOCKET SCH 40 45 T _ 211 PVC DEEP SOCKET SCH 40 22 2" PVC DEEP SOCKET SCH 40 CAPS 2" PVC DEEP S SCH 40 COUPLING � 2" PVC DEEP S SCH 40 F EML ADPT 63) _ -- 2" PVC DEEPS k'CH 40 'THR.D.PLOU 64) r� _ 1.5" PVC DEP S SCH 40 FEML ADPT 65)� 1.5" PVC DEEP S SCH 40 THRD.PLUG 66) PVC DEEP SOCKETSCH 40 90 4,�IvY' i 6" PVC DEED SOCKET 7) .S ET SCH 40 TEE I{ 68)_1.5" PVC DEEP SOCKET SCH 40 Cpl 69)'; .5" PVC DEEP SOCKET SCH 40 45 70) 72)J4" x 2" Fernco coupling 73) T__ ySheets of polystyrene 2" thick 74) �- OPMEZ 2/PK , INSPECTION WELLS 75) Chamber inspector kit / two pack 76) Bag of Bentonite 77) 2" PVC SWEEPS 78) _1.5" PVC SWEEPS 79) .LAWN BOXES 80) FABRIC PAPER 8' 81) FABRIC PAPER 4' 82) BAGS OF OATS 83) !_BAGS OF GRASS SEED 84) -- ELCRIAL TAPE 85) _ Quick 4 chambers 86) Chamber End caps 87) 1 �6" 3034 frost sleeve ( 5' of pipe ) 88) _6" 3034 female adaptor w threaded plug 89) 90) 91) 92) 93) iou genes rciuucm rumps i immi rump t uiupany Hops:,/v�rv,zoeuerpumps.com/en-nrvproaucts/sump-err iuent-pumpsier.. Lu Lu Lli �W �u. 50 14 45 153 12 40 35 1p 152 � 30 Q 8 25 151 20 15 4 10 2 5 0 GALLONS LITERS 0 PUMP PERFORMANCE CURVE MODEL 151/152/153 10 20 30 40 80 1 gr 50 60 70 80 90 100 160 200 240 280 320 360 FLOW PER MINUTE I of 5 3/612018, 8:36 AM Maintenance Instructions 3 r s t t t, Effluent Filter To ensure your effluent filter is functioning properly, it should be inspected every year. Under normal conditions, your effluent filter will function for several years before cleaning is necessary. The filter should be cleaned when it becomes clogged enough to restrict normal flows out of the septic tank. At a minimum, the filter should be cleaned whenever the tank is pumped. Mast people prefer to have a septic tank service provider take care of filter maintenance and cleaning, You can find a septic tank service provider in the Yellow Pages, under 'Septic Tanks & Systems.' Or you can contact your county health department for a list. If you wish to inspect and/or clean your effluent filter yourself, be sure to dress properly. Wear full-length pants and shirt, shoes, gloves, and goggles or glasses. Then follow these instructions: 1. Remove the acpess lid to your septic tanit by unscrew- ing the stainless steel lid bolts with hex head wrench provided, If your lid is above ground, it will be easy to find. If it is buried below ground, find the marker that indicates its location. 2. Remove the filter cartridge by grasping the tee handle and lifting it out of its housing (see photo 1). 3. Spray the cartridge tubes with a hose to remove any material sticking to them (see photo 2), Ensure the three orifices in the optional flow modulation plate inside the filter are clear of any debris. Make sure the rinse water runs back into the tank, but do not allow solids material to fall into the open filter housing. 4. Firmly place the cartridge back into the housing. 5. Some effluent filters come with an alarm that activates when the filter needs cleaning. If you have an alarm, check to make sure it is working by lilting the float with a stick. An audible horn should sound. The alarm panel is normally mounted on the side of the house or in the garage. Nato: If your effluent filter doesn't have an alarm system and you would like one, call your local septic system installer. 6. Record the date that you inspected and/or cleaned your fitter on the form that follows. if you checked the alarm or made any other observations about the tank or system, include that information under "Notes." ?. Attach access lid by placing it on the riser, matching the openings in the lid with the bolt catches. Insert lid bons into catches and tighten with hex head wrench provided. f'horq 1. Remove the filter cartridge by liking it out of its hausJng. Photo 2. Spray tha cartridge tubes with a hose. NIN-f3•Fr-1 Rev.1.2.7/04 Page 3 of / Date installed: Model of filter: Date I Cleaned? inspected yes I no System service provider; System installer: Septic tank pumper; Electrician: Designer: NIN-FT FT 1 Rev. 22, 7N4 Pege 4 of 4 Modal tank: Single/double compartment: Notes: Phone: Phone: Phone: Phone: Phone. Size: to of t1 < 1 •. 1 1 ' • LLJ �Q W a a IW o a z p Q a (n CL U IOOOm zz �t m H O Oa a1'• �0 — V l� 4 w UO m n L00 CL o v� O U¢ 00 aro �4 aC© It n fm Ld t'` (00h+ W V)N o-a 00 M^ U Nit OLVLJ �� un !*if) t-cc Z N d LLJ m a 08 Zxw�UQ ZwwN Ia W at -gi aOat+�Q�UQ nOp a Z NU w IiII iIII ' _•", IV LIDs a On MA V) c Q ` � - 8 V w 4 0 J } a 0 APR 13 2020 St. Croix County Comm, ty. Deve o ,,,,,,n Mailing; A�dress r,i[ IVI-nA Address ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM e J « (Verificati on required from Planning & Zoning Department for new coustructioa) City/State / D/J W = / Parcel Identification Number 00000M ,,SCIi�iPT_IOIN Properly Location �LIJ 1/4, S� r/4 , Sec. S , T 2g N R) � W, Town of GAD Lot Subdivision Plat; # Certified Survey Map # 23 , Volume , Page # Warranty Deed Or (before 2007)Volume , Page it Spec house 171yes[ito Lot lines identiliablc 0ycs(]110 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 waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383,52(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 form, signed by the owner turd 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 16 full of sludge. I/we, 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 Iepartment of Safety And Professional Services 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. Vwc certify that all statements on this form arc true to the best of my/our knowledge, 1/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 3 SIGNATURE OF DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning &Zoning Dcpattrnent. «** Inelude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certitied survey map if reference is made in the warranty deed. i f St l 10l� coe�op mer WARRANTY DEED THIS DEED, made between Lawrence P. Wiegand and Sheila M. Wie6and f/k/a Sheila M. McNamara husband and wife, as ioint tenants ("Grantor," whether one or more), and Dean A. Schramm and Pey J. Schramm husband and wife, as survivorship marital property ("Grantee," whether one or more), Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in ST. CROIX County, State of Wisconsin ("Property"): f See attached EXHIBIT A. IiiVllYl�llll'VIIIII�III� 1095106 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 01/06/2020 02:48 PM REC FEE TRANS FEE Recorciine Area EXEMPT#: 30.00 795. )0 PAGES: 2 Name and Return Address DEAN & PEGGY SCHRAMM 311 STATE HIGHWAY 128 WILSON, WI 54027 004-1035-50-100 (PART) Parcel Identification Nu mber (PIN) This [S (is) (is not) homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, covenants and restrictions of record. Dated: (SEAL) (SEAL) * AUTHENTICATION Signatures) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT DRAFTED BY: Adam B. Rasmussen State Bar No. 1036896 [19-653701 t i St. Croix County 1095106 Page 1 of 2 Sheila M. STATE OF WI5CONSIN ) COUNTY ) (SEAL) (SEAL) A � ��•, Personally came before me this 0grq C,, \' GBLIG gal20�, the above named Lawrence P. Wieg � �iIB� M. W e and to me known to be the person(s) who executed the f re ing instrumey ayd'a' knowledged the same. * NNon L. Flrtc� Notary Public, State of Wisconsin My Commission (is permanent)(expires Legal Description: Lot 1 of Certified Survey Map recorded in Volume 30 of Certified Survey Maps, Page 6728, as Document No. 1092341; being part of Lot 1 of Certified Survey Map Volume 27, Page 6286 as Document No. 1039497; being part of the SW 1/4 of the SW 1/4 of Section 15, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin. St. Croix County 1095106 Page 2 of 2 ����ov�D a t t A�'R 2 2 2020 St� Croix County Commwnity Deveio���t� IFIED SURVEY MAP PART OF THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 15, TOWNSHIP 28 NORTH, RANGE 15 WEST, TOWN OF CADY, ST. CROIX COUNTY, WISCONSIN. INCLUDING PART OF LOT 1 OF CERTIFIED SURVEY MAP, VOLUME 27, PAGE 6286, DOCUMENT NUMBER 1039497. West 1/4 Corner Section 15-28-15 � 1" Iron Pipe �� LOT 1. CSM_ �I � Vo1.17, Pg_4574 U 1092341 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 11/13/2019 11:55 AM CERTIFIED SURVEY MAP VOLUME:30 PAGE:6728 REC FEE: 30.00 PAGES: 2 PREPARED FOR= Lawrence P. Wiegand 322 310th Street Wilson. WI 54027 UNPL_ATT_EQ of � _ of rn LANDS _ � �I o S89'S9'52"E I r- I N I'/ 56.61' _ _ _ _ y � � I_ � S89'59'S2"E _No_rth Line_ �., � I!il � 355.00 of SW/SW I I v o ,N NI I Ilo � of �TI I lj z w LOT tuCSM `� 3 1 1 I v N Vo1.27, Pg_6286 v,l I �I , � --- -- =I I II � M LOT � UNPLATTED ; � ivarieE;N o _ z LANDS � I I �I SeQi`` v, I I �I � 297,116 sq.ft. I `I � 6.821 acres 1 J house Permit #{ 100219107 � 90' 450 0 approved shared I I`I 0� b access foCotion. U, a. IvOrie� L2 C1 175.30' I w l N89'20'0; i o �o I a Im LOT 2, C_SM Southwest Corner �� Section 15-28-15 � 1" Steel Survey Nail SCALE: 1" = 250' 0' 250' S00' w ' ,N o Oi � no S00'28'31 "E � 104.87' DRAFTED BY: Joel A. Brandt JB SURVEYING LLC �SG•ONs� ' JOEL A. 3-2AW . OLEMW000 CRY,; (�� s �\ti��g \� Line Data L1 N75'13'47"W 121.60' LZ S89'42'45"W 60.57' L3 NO6'O6'47"W 95.61' Each parcel on this map is subject to State and County laws, rules and regulations(i.e. wetlands, minimum lot size, access to parcels, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and Town Board for advice. CURVE DATA TABLE CURVE RADIUS ARC LENGTH CHORD LENGTH CHORD BEARING CENTRAL ANGLE TANGENT IN BEARING TANGENT OUT BEARING Curve 1 22968.00' 350.66' 350.65' N00'S8'10"W O'52'28" NOl'24'24"W N00'31'56"W North is referenced to West Line of the Southwest Quarter of Section 15-28-15, which bears S00°19'03"E (St. Croix County Grid Systeml LEGEND ...._.._.Found Government Corner (Ties Verified) o.....,....Set 3/4" x 18" Iron Rebar weighing 1.502 lbs./lineal foot ..........Found 3/4" Iron Rebar ...._.....Found 1/2" Iron Rebar o........ Found 1" Iron Pipe Completion Date November, 2019 Sheet 1 of 2 Sheets fin- ��a8 St. Croix County 1092341 Page 1 of 2 P----A APR 2 2 2020 tom✓ st. (:rolx County SOIL EVALUATION REPORT LO64RI�1� 1�lapaf4tieet400nlbe vistorrtst an u ngs in accordanoe with Comn185, Wis. Adm. Code County Attach complete Bite plan on papor not less than 81/2 x 11 Inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (OM), direction and Parcel percent slope, scale or dimensions, north arrow, and location and distance to nearest road, Please print all Information. v Personal Information you provide may be used for secondary purposes (Privacy Law, e. W04 (1) (m))a operty owner ' 1 Property Locatl n L A r� r q w r!i : , 1 GovtLot 1t /a J.J �S7 �av _C,('03 of 3 C L'%�) - 103Ica -� I by t 1!4Slljr7Z,8N R�7� aroperty Owner's Mailing Andress _ •-�• " -"' teto^� p e Pone um�G�er-Ity Village r Town Nearest Road v CIE _ n flow rate = �- - (3PD ��-NevrGnnsMtletian, Use[] Residential I Number of bedrooms Code derived design Replacement Q Public or commercial o Describe: Flood Plain elevation If applicable 4 ft Parent material General comments comments and recommendations: ���\\ � C I✓'- 1 Y �tR� Ct✓�+ (1,✓� t3oring # g 1 •1- PI Horizon Depth Dominant C3round surface elev. color Redox Description ou. 5z, Cont. Color �� t3orinq # � gorUlg �L.���.._J•J LJ Pit Horizon Depth Dominant In, Munse ►�r �N..�u f t7�i ` ti liV.a i I I OEM.' " effluent #f a Narnd (Pea P �t) Ground surface elev,� fl color Ftedox Description Qu. Sz, Cont. Color > 3p < 220 mglL and 7SS >30 Depth to Ilmtting To Structure Gr, Sz. Sh, t �Zr�SbU m� ,; � •r�ybk YvUI r, Depth to limiting tacto� Texture Structure Consistence Cir, Sz. Sh. _ Q t3oundary� Roola. c5 LF.. in. Soli A Ilcaticr,�F ndary Roots OPDNF�„• "Eff#1 •4zffh 30 mglL and 7St3 � 30 >✓7818 County f:: Menomonie WI S47S1 I � r2� --�`�' 715.231�737� Property OWner ® Boring # iecl6(U Parcel 1D # (X)17 abdob 1 'Ickj Boring pit Ground surface elev, q6 ft. Depth to limiting factor in. Page ? of 3 Snll Annlicatlon Rate Horizon Depth In. Dominant Color Munsell Redox Description qua Sz, Cont. Color Texture Structure Gr, Sz, Sh. Consistence Boundary Roots GPD/fF "Eff#1 'l ff#2 �43 zF .r of it/` i — -- Iftown j Vic. Boring # � Boring Pit Ground surface elev, ft, Depth to limiting factor in. Soil Aaolicatlon Rate Horizon Depth In. Dominant Color Munsell Redox Description Qua Sz, Cont. Color Texture Structure Gr. Sz, Sh. Consistence Boundary Roots. GPD/fP "Eff#1 "Eff#2 Boring # Boring Pit Ground surface elev. fl, Depth to Ilmiting farxar ___�___,_ in. Solir Anollcatlon F2atc►� Horizon Depth i�. Dominant or Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr, Sz, Sh, Consistence Boundary Roots GPD/fF "Eff#t "Eff#2 Opal ' Effluent #1 = GODS > 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, [f you need assistance to nccess services or need material in an alternate format, please contact the deparnnent at GO8.266-3151 or T'1'Y 608-264.8777, SDU•83I01'est (R07/W) CHECK BOX AS APPLICABLE. SOIL EVALUATION SITE MAP PPfb) lPf`T KIAKAG• PROJECT ADDR@SS: ot C CHECK BOX AS APPMABLE, S �crale: 1 = 30 Yc [ PAGE ?t. 0� 0 30 45 80 �S STE_Mvt,` PLOT PLAN 5' DESIGN FLOW: _« .iv ..., GPD Attach design flow calculations for commercial plans BM Symbol: * BM Elavallon::� �q ,. FT BM Poscriptlon: O) Q _ (AJ �;�� - Slope Gradient (%) Well Symbol (If applicable): 0 of Tested Area: N� HMg on Y± Pipe Material / ASTM Standard (Tables 384.3M & 381.3M) G Santtary Sewer, 4' sch 35 Force Maln: 211 sch 40 ^^ vW.v 0 I rorwa fJ y 1�r I rtti�_ i!a Del Pao' rj- eLueL a� = I how .imo , 9 3 9 S' % 8t P \P Ot.lti "A. is . ��fls , - 25.3 9 T j5 A'� 1''`i"'i �� i � l lrt! `✓► �i` V