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HomeMy WebLinkAbout026-1109-70-000 VVisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 538801 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: Volkert, Richard I Richmond, Town of 026- 1109 -70 -000 CST BM Elev, S � t Insp. � El I BM Description: �; /' �^ I9q Section /Town /Range /Map No: I CU/ 1/1�J(�' - �y(fy,r� 04.30.18.615 TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR R� I VO 5 STATION BS HI FS ELEV Septic � � /;•' � ( /_ _ / � � n Benchmark � �� l►� Dosin Sll �t /`f Alt. BM Aeration (/V BI Se�e1r (� / I \ 200 Holding S H nl ! �S � IJ I­It Outle TANK SETBACK INFORMATION :20' Pj -f� hfUI R sr c u -12 _ TANK TO P/L WELL BLD Veneto Air Intake ROAD I Dt Inl EF(1571 ` _ ,3 . 5 - 7 Septic 7 > > S t B I J O iL >�g , ` �� ( / /'� Header /Man. 1C1G1 (� Aeration m Dist. Pipe Holding Bot. System / Final Grade PUMP /S4449N INFORMATION /J'0 Cf d-n Manufacturer U Demand over GPM p.T DL C 2 • Z Model Number V - 0 (� / rh _(_ fFj all TDH Lift Friction Loss System Head TDH Ft r Forcemain Length Dia. Dist. to well -� t SOIL ABSORPTION SYSTEM 5 t`v� • • , BED /TRENCH Width Length No. re ch s PIT DIMENSIONS No. Of Pits Inside Dia. L d iq i epth DIMENSIONS SETBACK SYSTEM TO P/L jBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR TM Of System: UNIT Model Number: J DISTRIBUTION SYSTEM (Y Walk Header /Manifold Distribution x Hole Size Hole Spacing Vent to Air intake Pipe(s) — L Length Dia Spacing J SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes Efl No E-11 Yes ' No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 7 / Inspection #2: Location: 1179 Carroll Street New Richmond, WI 54017 (NE 1/4 NE 1/4 4 T30N R1 8W) Viebroc]�Rjp�� ya11eA d iti - t N': 0 1 iq 'j 1.) Alt BM Description =D•� C�II , �I,,,,� ��- � ^` ,may, / Cd_V �y���[ 2.) Bldg sewer length GV""" - �" -1`" C�v�ned ln,tis Pdu."s c�. -f , , , - ►s���/// (j ��f - amount of cover = b�►Z� -C/CY ` � 5� � }�/h� � / �' + '"'�"�"�S 1 Plan revision Required? R Yes No Use other side for additional information. Date I sepctor's Signature Cert. No � A_ � . SBD- 6710(R.3/97) An n , Cr /S /l f„, 1 /7 L„ &Ut, Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 538801 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Volkert, Richard I Richmond, Town of 026- 1109 -70 -000 CST BM Elev: T77 BM Description: Section/Town /Range /Map No: CST BM Elev: 04.30.18.615 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold IDistribution Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes ❑ No El Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: I / Location: 1179 Carroll Street New Richmond, WI 54017 (NE 1/4 NE 1/4 4 T30N R18W) Viebrocks River Valley Addition Parcel No: 04.30.18.615 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes FRI No Use other side for additional information. Date Insepctor's Signature Cert . No. SBD -6710 (R.3/97) It commerce.wi.gov Safety and Buildings Division County EC IVED ashington Ave., P.O. Box 7162 r, C /l.C?-'L��4, 's c O adison, WI 53707 -7162 Sanitary Permit Num (to be filled in by Co.) Department of C merce 5 3 0 8 Sa tar"e1r 1Ap ication Transactionber -- In accordance with s. Comm. 83.2 (2), Wi TA B# 0 ' � ission this form to the appropnate al IV unit is required prior to obtaini p e. A li anon forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of n you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats.. 1 - 7 9 S I. Application Information — Please Print All Informatio Property Owner's Name Parcel # Orb 9k Property Owner's Mailing Address Property Location (n / Govt. Lot City, State Zip Code Phone Number N� �/, � 1 /;, Section (circle on - ° © T R II. Type of Building (check all that apply) Lot # J / v4dj'vi n N am e l or 2 Family Dwelling — Number of Bedrooms / (� u Block # 11 Public /Commercial — Describe Use •^^ El City of CSM Number El Village of El State Owned — Describe Use A Town of y III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, ❑ New System ❑ Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ;SOO L 1 1 q IV. T e of POWTS S stem /Com onent/Device: Check all that appl ❑ 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) ❑ Pretreatm nt Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) tspeT1,4ea Proposed (sf) System El H;C ;-4t 6. GO 7 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units g Tanks p � j New Tanks Existin -/'' �t / / a. U v� V Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility fo installation of the POWTS hown on the attached plans. Plumber's Name (Print) Plu s Signatu MP RS Number Business Phone Number / - 0 9 Plumb is Address Street, City, State, Zip Code) _ V II. Coun apartment Use Onl Permit Fee Date Issued Issuin ent Signatur Approved ❑ D G� $ ❑ 0.Reason for Denial IX. Conditions of Approval/Reasons for Disapproval QQ f n tan)(j if luer>Ffifter and 16 Gw� dispersal Celt must all be services ! maintained Ez Y as per management plan provided by plumber. e ,� 2, Alt se0wk regw(ferttents must be. ma nlalned r + - AA aC a comp e e t the system and submit to the County only on paper not less than 8 1/2 a I I inches in size QA et V l ✓ SBD -6398 (R. 02/09) - STC - 104 AS BUILT SANITARY SYSTEM REPORT J OWNER � J ADDRESS } 1101 SUBDIVISION / CSM SECTION T N - W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING - WITHIN 100 FEET OF SYSTEM `1.0 rte' aa6 v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 2 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS � r SUBDIVISION / CSM SECTION__ W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING - WITHIN 100 FEET OF SYSTEM 0 i - r�� w , 6� r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. U:IC(_:H HLJ NLW /NK0DUCIS /1ANK /S burial re uirements.DWG c) cn A W N Z C - n C) O m °O� mfn mDm rnm N N Q a x � zm 0 — -- J Ozm O - n. c m a V) Z — Z m� fVT 7 cn N O O N .� a �' z O O u1K`<0 S =m pF CZ -Z m o m m , 7 T m z -g CD S D Z C D N i ID 61 Z a N $ Z p a `_. N c d IT m J 0 0 p_ g m a m m O x n _' _a m a m 5 - AA o ° F, a n I o o m o (D m o p C CD < C1 7 3 m p_ . 1: C D CO „ c . 1:1:1:1 :1:1: �l m 6 Q N O < (D < 1D 3 .-T: C (D :1:1:1:1:1:1 J N CD 3 O a m Q R CD Q ? X V L (D 7 a 7 v n a y < m v tD d m O mmpr r p N Z N T m N 7 N C, O 0 O �.:'.. .I. .I' N O (D A p m IT1 = ''r',:'•<'•� 1:1= Z a) I m m 9 0 (n X00= X D D =xI: n 7 0 N U , �' m ' m m I:IG �O1 rI: p3j (/(Di N O d N m m r N P: 1 0 00 3 v o' 7 t .: •'. �. 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) y / � ✓�/ S Parcel Identification Number o4X - I Jb C / - �a (iC Cit /State LEGAL DESCRIPTION Property Location '/4 , ' /4 , Sec. T N R W, Town of Subdivision Plat: i- z (/1L0- t.tl , Lot #. Certified Survey Map# , Volume , Page # Warranty Deed # `r+ � w y (before 2007)Volume � , Page # Spec house I yesxno Lot lines identifiable Ayes : no 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, 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 §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 form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) 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. l /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 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, u er f bedroo s T - SIGNATURE OF APPLICANT(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. (REV. 08/05) 9 c° A East 17 5.23 �;�* `/ EI ♦�,9 ', P4 s. Q Zg6 M argaret O r , o �O� pis -as' ,�� 'a East 154-?5 E a° �ar° / "0 � ` C��� .t .,64.73, 91}.00` 0 50.70 d 50" X �o 94.00" 94.0 a � ♦i.Q� o ♦.a 47 0 .q 6. B4 0 O O O O t (� �` O o ��2 ♦ CO r O I V a L O �./ a O 0 fr h a� 0182 �N �oert18°52'w 0 ° 9 z'a° N ° 94.00' 94.0t '6.17' 0 0 `o -D a o ioB °s2 190.26' o °j 95.00' 90.00 o n 87. 50 � . , a yTa°aa / o East 375.26' West $ ° a _ _ I a 8 7.50 "'0 ' o �} 1122 3T ` / ,� E .,• � � West C,[?- ,�. t. ��wDst 9 a so 1 87.8 6 - 0 90° 105.00 105.00 105.00' 105.00' 105.00 g� �o,° 32.S 0 9 ?3 di 34 ' LO P7 B6 O _ - N O O 17 O O t 6onote! O r _ O �� I3 C 19 0 18 17 16 15 14 u ' 9 0.00' q 105 -CO' 105. 105.00 105.00' o° °+° 100.00' West 10t6.00' Un2latted lands COUNTY TREASURER'S STATE OF WISCONSIN) SS View Addition to the Town of Richmond, County of Si Croix and ST CROIX COUNTY ) aret Viebrock Ronald J. and Betty Lou K. Fischer, and I, Carl Da t being the duly r ssE g � y tax sales and no unpaid taxes or special assr: g at a point which is 34.24' \ -Vest and 1569.00' North of the 255.00`.. thence West 1016.00; thence N14 226.80', , henceN81 °02 E.241.30,thenceN37 0 42 'E 201.40, thence Nl3 °06 E 198.00, East 53 2.90', a the water's South er's CE RTIFICATE e point of beginning, OF TOWS between the .meander line and the water's edge.'' ?yed and the subdivision thereof made. °— l� , bein and the subdivision regulations of the Town of Richmond and office, there are no unpaid taxes or special as coward R. Kruse Surveyor Reg -No. S - 518 COMMON COUNCIL RESOLUT Resolved that the plat of Viebro I, divided, mapped and dedicated as represented on this plat. David R. and Marguerite C. 8oeddeker, own 1:.., t -11 1... ems. _ _�___a _ .�.. ... ..• . a .. . � RV a.: rr _. ... �" THIS SPADE RESEED FOR Hu"-ono NG DATA _f�.OFUMEMT' GTA'IE BA R OE WISCONSIN CORM 3- 19821 _ - f3c — ___ . :..........:..�:'.F -- a.tvt t vsr+aaw- - ✓rrr— TL - _ _ .. 6. __ - ._ - !� REGISTERS QFF_, I 2..1x14- 1J1 �...� {a.n Baarbara A Mye s, i Formerly Barloara_ ,� + gecrd rrr e - -__ _`. -- - - APr 3 -k - 987 ` _ z 1� } do -- iv �_ 8 30 _ -- � y of zazasS 9taitreistcfn_ Cr t -­- -------------- ------- ....... :_ the IIoving describedrreal estate in St – Cs_01X County, - I RETURN TO -- ... .. ,_ . _..- _ .__ ,. __ . . -_ ... - , .., TSY P8YCeI'•NO .._. _ -. �. ��- .;;; yo`��rS (15 i =�' ^t•` cl�:° s ..R� -veY �Ta�.? ey fir;' ew - Ac�cl.� � on to tYie_ lawn Qf_ j= - M U'-' r - S i .: � �- �•-- �ri�.H cle�� is= exe=cu-�eel -gizr= spa -t�. to- thy= == endings ard== orde -r- enteredFor�_ =�he �reccsrd icy tkie Ste. Croix Circuit Court,- Branch I a� divorce hearing held arms 1 W - — �• ` '� { ' S 1 S homestead property °, f� � x. Thi3 i 4� (SEAL) Barbara A_ Myers, fo ';m err ly Barbara Vol °lie t _ _ r - ,.� ._(SEAL) _`` .... i 4r - t .,. (SEA: r° . S r AZJ'THENTICA :TION ACKNOWLEDGMENT T ! Signature(sj STATE OF WISCONSIN , as. !L - - - -- -- -- - Croix : _ County. ._ St — _.. }� thenticated this day of - - - -- 19 - _ • - ,_ Personally came before me this ___a fith__day of au - : Apra ____, 19 7 the above named i 1} _ kV - - -- - - - ---- " --- --- --- = --- - °° Barb 4 A _ MY - ��� a X53�t�LLL��1g._.. - -->- - - Barbara �ol; ... ............. - -------- ' - -- - ------- - ------ - I TIT LE .MEMI ER STATE BAlR. OF WISCONSIN --------------------------------- ----° - • (If not -- -• _- .... -- --- --- --- - - -- --- _ ti .i b R ?OC 1R, W a. at¢.l �a the , _ ____ w.. 'a!•as� f - .i�!i� ' ... � _--_ _ -' CY iV lI443 kilo W T. w as < y a _ - - -- ;` forc instrument an , ac n ledge the ytr+ re iC,� If r THIS INSTRUMENT WAS DRAFTED BY Renstra, Van Dyk & Needham, S.C. , Tan L. Maser l__`_r�._F_ Attarncys a� av� ------ -- ---- - - - - -- New R1.chmond, Wiscorisin . _ .. 54017 -0127 Notary Public __.. St -_ „Croix -- .. .. __Coun'.y,sWas” (Signatures rn:.y o4 authenticated or acknowledged. Both My Commission is permanent - l If not, state expiration •ire not necessary) date: 19...- •---•) -14—e. of Derso ns aignin{f in any capaci *y should !7-- typed or Printed belo th.e }r ai8nacu rts. r++eze. cTATF. BAR OF e Ga..k N 130'2 - �ss<�> 0 . as -- H.GM }IWrCorryanYl Ml FORM No. .1 — l�n:. SAFETY AND BUILDINGS DIVISION Plumbing Product Review commerce.wl.gov P.O. Box 2658 Madison, Wisconsin 53701 -2658 i sco n s i n TTY: Contact Through Relay Department of Commerce Scott Walker, Governor Paul F. Jadin, Secretary January 4, 2011 INFILTRATOR SYSTEMS INC. GOVERNMENT AFFAIRS DEPARTMENT 6 BUSINESS PARK RD PO BOX 768 OLD SAYBROOK CT 06475 Re: Description: SEWAGE TANKS, THERMOPLASTIC Manufacturer: INFILTRATOR SYSTEMS INC. Product Name: SEPTIC, SEPTIC /SEPTIC, SEPTIC /PUMP, PUMP OR HOLDING Model Number(s): IM -1060 (1060 GAL. ONE- OR 2- COMPARTMENT THERMOPLASTIC SEWAGE TANK; 1247 GAL. ACTUAL CAPACITY WHEN USED AS A HOLDING TANK; 713.3/356.7 GALS.; INJECTION MOLDED POLYETHYLENE OR POLYPROPYLENE RESIN, 2- SECTION TANK WITH MID -LEVEL SEAM) [44.0 IN. L.L., 6 IN. MIN. AND 48 IN. MAX. DEPTH OF 1311 507.6 G.P.D. WHEN USED AS A SEPTIC G.P.D. WHEN USED AS SEPTIC /PUMP TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; SEE TABLE 1 FOR TANK CAPACITY IN ONE -INCH INCREMENTS; TANK DIMENSIONS (OD) = 127 IN. L X 62.2 IN. W X 54.7 IN. H] Product File No: 20100475 The specifications and /or plans for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of January 2016. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of the manufacturer's installation and servicing instructions must be given to the owner of the system. • When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent quality with a maximum monthly average value for BOD5 of greater than 30 mg /L and less than or equal to 220 mg /L TSS, or greater than 30 mg /L or less than or equal to 150 mg /L TSS, and F.O.G. of less than 30 mg /L. • Before this product is installed a warning label meeting the requirement of Comm s. 84.25(8)(b), Wis. Admin. Code must be securely attached to the manhole cover. SBD- 10564 -E (N.10/97) File Ref: 10047505.DOC INFILTRATOR SYSTEMS INC. Page 2 January 4, 2011 PRODUCT FILE NO. 2010475 • BEDDING: Tank bedding consisting of native soil (without rocks or protrusions) or 4 -inch depth of granular material —pea stone, sand or gravel. Anti - buoyancy control measures may be required if the IM -1060 tank is to be installed with less than 16 inches of soil backfill cover and the seasonal high groundwater table has the potential to rise above the elevation of the tank bottom. Otherwise, no control measures are required. If the seasonal high groundwater is higher than the elevation of the tank bottom at the time of installation, coverage with at least 16 inches of soil backfill cover will eliminate the need for anti - buoyancy control measures. For backfill depths of less than 16 inches, the need for anti - buoyancy control measures must be determined based on backfill cover depth and height of groundwater above the tank bottom. If the groundwater table has the potential to rise above the elevation of the tank bottom, see the attached document(s) for information on the types of controls and applicable backfill and groundwater conditions. • This tank is approved to use the following: . The tank is provided with 3 ports on each end (one from each side, one for the tank end) used for inlet and outlet piping, depending on site configuration(s); Four -inch diameter inlet and outlet piping, Schedule 40 or SDR 35. Department- approved effluent filter installed in accordance with the product approval for the filter including a properly sized and located access opening for service and maintenance. . Inlet/outlet pipe water tightness is provided though the use of a rubber gasket, Serco Septic -Tite gasket. See tank wall penetration detail in attached document(s). . Mechanisms for pump electrical connections from riser lid or other locations in. riser must be completed in conformance with the riser manufacturer's instillation instructions. . Compatible risers include 24- inch - diameter riser products — Infiltrator TW Riser, E2set by Infiltrator, Polylok0, Inc., and Tuf -Tite@ Corporation; other state - approved risers recommended by Infiltrator. Maximum riser height is as per the state - approval and riser manufacturer's installation instructions. • BACKFILL: Backfill with suitable native soil. If native soil is unsuitable, replace unsuitable fraction with suitable soil. Suitable soil includes soil textural classes defined in the United States Department of Agriculture soil triangle. Suitable soil textural classes are based on the tank installation depth, as measured from finished grade to the top of tank. See detailed information on backfill suitability in the attached document(s). • Additional information is included as attachment(s) to this letter; see attachment A; B AND C.. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Jean M. MacCubbin, CST Engineering Consultant -- Plumbing Products Review Commerce; Safety & Buildings Div. PO Box 2658 201 W Washington Ave. Madison WI 53703 -2658 Phone: 608 - 266 -0955; Fax: 608 - 283 -7456 E -mail: Jean.MacCubbinC WI.GOV L O y O s d 0 d c _1 �7 M n c a� n Cs N O� N O O W O A ° a N <� • C : D " ? W 9 H N j v C C3 ? CD 00 O M O N 7 O OR 1 CD O 0 � N� y N � N O � O C'7 3 a! a F o 3 vr =3 O O CA O m m 14 o D O m o ` u '" m N a n ni o c�, rn rn CD O O CL µ . O Z (D O W - T U CD ) o Z y O C CD 2C .. 6 "*A • z O O O 0 o co `L 3 o n c N y (A m CD _ � v o c a e� 0 o m w a O .d. .. to A �'. Zl N O N CL z N Zco z o 0 D C o O ? D CL 0 CD m m a • CD m m N c m m w m CL z m E6 O 10 ;' z n n A z O v a C 7 o. O Z co - M W 0 zt zt Z °o z N D A W N N 7 a 3 N CL CD ? 4 c N — O z a co 0 m, m cn a. I � � I � y A CD A O N N X O V i.` r 0 O o b N ''.. O cn m to O D DO o : �' a Parcel #: 026- 1109 -70 -000 05/25/2005 07:59 AM PAGE 1 OF 1 Alt. Parcel #: 4.30.18.615 026 - TOWN OF RICHMOND 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 RICHARD A VOLKERT * VOLKERT, RICHARD A 1179 CARROLL ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1179 CARROLL ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.420 Plat: 2573- VIEBROCK'S RIVER VALLEY VIEW SEC 4 T30N R18W LOT 16 VIE- BROCK'S Block/Condo Bldg: LOT 16 RIVER VALLEY VIEW ADDITION Tract(s): (Sec- Twn -Rng 401/4 1601/4) 04- 30N -18W Notes: Parcel History: Date Doc # Vol /Page �Tyne 07/23/1997 776/127 1 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.420 24,800 125,400 150,200 NO Totals for 2005: General Property 0.420 24,800 125,400 150,200 Woodland 0.000 0 0 Totals for 2004: General Property 0.420 24,800 125,400 150,200 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 � w ' . Ln V ` � V f 44 i ;f w i � r r -' ce i IC + I � ! i� I i X - - -- ------- - - - - -- f i f i - - -- -------------------- ON I� :02 y STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS_ // /� ��' 06 " f SUBDIVISION let" SECTION_ T W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING'WITHIN 100 FEET OF SYSTEM oL � 6 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Wisconsin Human Relations a entofIndustry Labor and Hu PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT $T. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: VOLKERT, RiCHA%cu El El Village E] Town of: State Plan o.: CST BM Elev.: Insp. BM Elev.: BM Description: - Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t I'& Benchmark Dosing/� ' U/ efo D a (� Aeration Bldg. Sewer Holding St/ Ht Inlet t �- TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. vent to Dt Inlet n n Air Intake ROAD / n � �( Septic ,�� ' > 1 <' NA Dt Bottom 0,0 Dosing 7 J g 4 0 ' YO' NA Header / Man. Aeration NA Dist. Pipe 1 Holding Bot. System � y , � �• � PUMP/ SIPHON INFORMATION Final Grade Gov- 7 a -3 :::� Manufacturer / , �) Demand 4 • l 93.3' Model Number �' a5 GPM TDH Lift �,'( Friction I �JI ! Syesteem TDH 1,,0 Ft Forcemain Length 3p' Dia. ` Dist. To Well3 �{ r SOIL ABSORPTION SYSTEM DIMEN Width Length L No- Of PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER System: `� - ���� �S' > �p - ,�J `� OR UNIT Model Number. DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only D Over �,' L xx Depth Of xx Seeded / Sodded xx Mulched ed /Trench Edges . ' J To soil P ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND, HE, SE, LOT 16, CARROLL ST Plan revision required? E] Yes No Use other side for additional information. +' ix ' f� , SBD -6710 (R 05/91)' ` Date Jlm� 4tor'sSignature Cert No i Safet SANITARY PERMIT APPLICATION yand Idi nggWaterstems lS Bureau of Buildin y 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. r , 1 • See reverse side for instructions for completing this application State Sanita Permit Number The information you provide may be used by other government agency programs �� (Privacy Law, s. 15.04 (1) (m)]. ❑ Check if revision to previous application State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner N V perty ation /4 5 1/4 T , N, R E (or Property Owner's Mail gAddress Lot Number ,, Block Number City, State Zi Code Phone Number Subdivision Name o CSM N ber ( II. TYPE OF TUI DI G: (check one) El State Owned ff wage yy Ne Cad ublic or 2 Family Dwelling - No. of bedrooms n OF Ill BUILD( G USE (If building type is public, check all that apply) Parcel Tax Number (s) 1 ❑ Apartment /Condo o-,," 2 [ Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. E] New 2 <Feplacement 3. ❑ Replacement of 4_ E] Reconnection of 5 E] Repair of an ------ System -- - - - - -- System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 110Seepage Bed 21 ❑ Mound 30 E] Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (s q. ft.) (Gals/da /sq. ft.) (Min. /inch) Elevation 0 Feet 16V. t/> e e t VII. TANK Capacity in gallonAik Total # of Prefab. site Fiber- Ex er. INFORMATION, Gallons Tanks Manufacturers Name Concrete Con- T Tanks Steel Plastic p New Exi strutted glass App. Septi c Tank or Holding Tank Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu r' ignature: (No amps ),MP /MPRSW No Business Phone Number: J PI be ' ress Street, City, State, Z ocl 00 6 IX. COUNTY / DEPARTMENT USE ONLY j ❑ Disapproved S apitary Permit Fee (includes Groundwater Date issued Issuing Agent Signature (No Stamps) W Q Surcharge Fee) pp roved ❑ Owner Given Initial f V Adverse Determination 0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber PLOT PLAN PROJECT Richard Volkert ADDRESS 1179 Carrol St. New Richmond Wi 54017 1/4 1 /4 S 4 /T 30 N/R 16 W TOWN Richmond COUNTY ST. CROIX MPRS BYRON BIRD JR. 3318 rr DATE6 /7/96 BEDROOM 3 CONVENTIONAL IN- OUND PRESSURE CONVENTIONAL LIFT )00( HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 800 Gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12' X 54' I L BENCHMARK V.R.P. Base of Garagae ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark VENr SYSTEM ELEVATION 12" GRADE "12' VERING 1 " i K Property Line IL O, 23' 67' n T hed 0 Existing 3 18 T 12 M , Bedroom 20' '" House 60' o 18' 2 , 20, ' -1 r 3' 14' OWell a ` 2% 4' Slope 75' B -3 Vent ' ' ` 15' 12 X 54 Bed B -2 AL 18' Property Line • Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to; vertical and horizontal reference point (BM), direction and G �„d percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ❑ Govt. Lot E11/4 ❑ 1 /4,S T JQ7,N,R FEE (o Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City -/- S to Zip Code Phone Number Nearest Ro r J/C e V4,, ❑ City ❑ villa Town c° ❑ New Construction Use: gk'Fiesidential / Number of bedrooms Addition to existing building WN "Replacement ❑ Public or commercial - Describe: v Code derived daily flow Ogpd Recommended design loading rate ' 17 bed, gpd/ft 1 O trench, gpd/ft Absorption area required _ bed, ft 2 5 4 . /, 3 trench, ft�2 Maximum design loading rate -_ bed, gpd/ft gpd /ft Recommended infiltration surface elevation(s) C/ ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill HoldingTak S U = Unsuitable for system JZ S ❑ U � S ❑ U �S ❑ U ❑ U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles r Structue GPD /ft2 Texture Consistence Boundary Roots �# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench ail �4 51 z_ Ground J Depth to limitin 3 Remarks: Boring # / I Ground Depth to limiting � g�_ d Remarks: CST Name (Please Print) a re Telephone No. Address Date CST Number �/ a e ✓ b` 15-- Soil Test Plot Plan Project Name R V ByEqa Jr. S Address 1179 Carroll St. New Richmond Wi 54017 M #3479 Lot 1 6 Subdivision Viebrock Date 6/7/96 1/4 1/4S4 T 30 N /R W Township Richmond rl Boring O Well PL Property Line County ST. CROIX IL BM or VRP Assume Elevation 100 ft o f Garage System Elevation 9 ? , 0 * H R P Same as Benchmark Prope Line L ,01 23' 67' She Existing 3 1 d T 8 ' 12' �� � 10 Bedroom 20 05 n House 18' -1 20 , 42' r 3 14' OWell 2% cu 0' Slope 4' 75' B -3 2 B -2 5 , 18' Property Line • PUMP CHAMBER CROSS. .SECTION. AND SPECIFICATIONS s4" ,Vent Pipe vent cap approved locking 10 ",from door, weather proof manhole cover & junction box warning label window or fresh t air intake 12" min grad t 4" min conduit 18" min 18" min inlet provide _•_ _ airtight - seal II _ _ _ _ i i 0keep approved . joint A II hole extending 3' t approved onto solid soil -' • B It ALA , .joints � ' P � t ON extending 3' C I onto solid __I k P oil p OFF concrete b oc 3 Approved Bedding Under Tank , SPECIFICATIONS Septic and - Dose' Tanks Manufacturer ': .._ -_-._.. . ,Number of Doses:' Tank day - Tank Size':' ;Gallons Min Dose volume gallons - Alarm Manufacture's':' � _ �� Capacities:A= inches' ' gallons Model Numbe - B= inches : allons Switch .Type:' Csinches' gallons Pump Manufacturer: _inches' allons Model Number-. '3 NOTE: PUMP AND ALARM ARE TO BE Switbh Type: INSTALLED ON CIRCUITS Pump Discharge GPM Vertical Difference Between Pump Off and Distribution Pipe p . ..f eet capacity + Minimum Network SulPly Pressure ..........................✓p /, et gai /in + F.ee.k Of. For.cd Main �ft,/10.0, ft Fzi.c.tion Fac.tor . •Total Dynamic Head = / feet Internal Dimensions of Tank: Length-2 _Liquid Depth' Signed �� %� .. No. �Q Date ■■ TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE OEM om 1 OEM 1: ■ m i x ru rwn OMEN= C3M Imm • • �■ ■ ■® :. `�\ \1111 ►�� ■ ■ ■ ■ ■ ■ ■■ \o\. 103, 1■■\ \ ■■■■■■■ -W m►\ 1111 SIN ■0 00 0 0 0 0 0 0 . ■aqW",1111 EN, ■0 \� NONE ■ ■■ •�10M IE ►■ \■■■■■ • , MEN 0 k `V1 1\■► ■■\ \INE■ i . a \\■■■■®N �R, am b2 N ►`IL,\■■■K \■■ 0 X 9 % 1 1 26 w IS MEN mm■mm■■■■■■ slj�01 70 80 1 90 100 1110 120 ST. CROIX COUNTY ZONING..OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify tha I hav inspected the septic tank presently serving the T V 0 residence located at: 1/4, 1/4 Sec. , T3N, R,�LW, Town of Upon inspection, I certify that I have found the tank and baffles. to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes NoX (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity:` //V Construction: Prefab Concrete Steel Other Manufacurer (if known) : /O'4'� Age of Tank (if known):a i (Signa Y e) (Nam Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR - 83, Wis. Adm. Code (except foi inspection ope ina P ver outlet baffle). Nam lam`" ^ $ignatur MP /MPRS` 5/88 STC -105 SEPTIC TANK MAINTENANCE AGREEMENT }; St. Croix County OWNER/BUYER i U MAWNG ADDRESS, I ZE nj8_e0_ PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY /STATE +�'�• PROPERTY LOCATION 1/4, 1 /4, Section T N -R _W 5' TOWN OF zM. y ST. CROIX COUNTY, WI SUBDIVISION , T NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER 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 licensed septic tank pumper.' What you put into the system can affect the function of the septic tank as a treatment stage is the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost. of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program° in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St..Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plunrjj�rrrestricted,plumber or a licensed pumper verifying. that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. �F I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with ' the standards set forth, herein, as set by the Wisconsin DNR. Certification statin that:your septic has been maintai must be completed and returned to the St. Croix County Zoning Ocer within 30 days of the three expiration da c 1W i C k SIGNED: f DATE: l� St. Croix County Zoning Office Government Center; =' ' 1101 Carmichael Road 11/93 Hudson, WI 540164'11 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and su bmitted to this office with the appropriate deed recording. ------------------------- - - - - -- ----------------------------------- Owner of property L , 1111 Location of property 1/4 1 /4,Section ,T v N -R W Township Z't Mailing address s Address of site S Ay Subdivision name,/' o. Other homes on property? Yes No Previous owner of property u �.� , >�2 ,^ 5 Total size of property ,. Total size of parcel �x Date parcel was created �,` 7 l Are'all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _No Volume and Page Number, Z as recorded with the Register of Deeds. --------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owners) of the property described in. this information form, by virtue of 'a warranty deed recorded in the of ice of the County Register of Deeds as Doc4oent No. '2 �, and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run-the above described property, for the construction of said system, and the same has been duly recorded in the office Qf the County Register of Deeds as Document No. ature a pplicant ' Co- Applicant Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3 -1982 TNIS SPACE RESERVED FOR RECORDING DATA (.lU1T CLAIM DEED 77fi '7 �� vaf>f 12 - _ REGISTERS OFFICE Barbara A. Myers, formerly Barbara Volkert S. CO. WIS. T CROIX CO. t Recd. for Record this 24rh ................... .................... -- .... ..................... ........ ............................ ... day of April A.D. 1981 .............. ............................ -------------- - - ----------- - - - - -- - •- •---- •------- -' - - -- .. _ .. quit- claims to .... . Richard_ . . . .. A.... YQikex. t ............ ...........---- •- ............. . at 8:30 A 1, ........ .... . ....---• ............ ............................... c ................................... I .......... - ......... ..... ............. b .............................. .............. ................. .............. the following described real estate in St. Croi X - ................. ....................... County, State of Wisconsin: RETURN TO Tax Parcel No . .............................. Lot Sixteen (16) Viebrock's River Valley View Addition to the Town of Richmond. This deed is executed pursuant to the findings and order entered on the record by the St. Croix Circuit Court, Branch I at divorce hearing held April 6, 1987. c. This i-S ...... ...... ... homestead property. (is) (is not) Dated this ...... ................. 6th_..... ....... .. day of .......... .... April ... ......-- ---- -- -..__ -., 19..$.7.. i ,J).dA. c../ /- . -(!.� . -- ..(SEAL) . ... . .. .......................... . .... .. .... ..... . . ..... ......(SEAL) Barbara._ A-.. .r?Yers,� ................... formerly Barbara Volkert ---------•---- -- -------------- ---- ---- - -- --- ------------ ------ - (SEAL) ------------------------------------------ (SEAL) • AUTHENTICATION ACKNOWLEDGMENT Signature(s) ----------------------------- ------------- --------- --- - - - - -- STATE OF WISCONSIN ss. St. Croix ........ .............................. County. authenticated this ........ day of ........................... 19 ------ Personally came before me this - ...16th._day of _.___ •April------------------------ 19 ... 8.7 the above named ------------- - ----------------------------------------------------------- - - - - -- ar Barb - -- aA�-- M . - - --ar&ara A. M ------ _ Y_er_s�.._fOxiue'rly........... • Barbara Volkert__ ...... ...._ TITLE: MEMBER STATE BAR OF WISCONSIN ---------•---------------- ---- ---- ---•---•--- -- -- -- ------ - --- (If not, ............................ --------- �....�.: - e authorized by § 706.06, Wis. Scats.) 't y to me known to be the person ._......____ who �x9tute e foregoing instrument an ar. nS�ledge the sa+rie. U I