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HomeMy WebLinkAbout026-1149-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556366 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: Rum za, Keith & Mind Richmond, Town of 026-1149-23-000 CST BM Elev: Insp. BM Elev: BM escription: section/Town/Range/Map No: f e .r S Fl~~"" 36.30.18.1123 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ms's CAPACITY STATION BS HI FS ELEV. Septic T,~ 3 Benchmark e~eti, Frtt„ ~'.s 1260 9 X10.:I gl~ /Df.9 /oy / Dosing Alt. BM a'Asa.- NOJ Cor.u-- 6 6~~o . o~ S; kt • (o 163-11 Aeration Bldg. Sewer ~o I6 /d • C113 17-T. 38 ro71 St/Ht Inlet ll, Z 13-11 TANK SETBACK INFORMATION St/Ht Outlet \ TANK TO P/L WELL BLDG. Veit to Air Intake ROAD Dt Inlet \ Septic Dt Bottom Dosing 33 Header/Man. Aeration Dist. Pipe Holding Bot. System C ~S D'F 31 8 S 7. PUMP/SIPHON INFORMATION Final Grade 3, / 141.2.1 Manufacturer / t Demand.,,_ St Cover -7 2d ~ t-w ~o✓~~ s 5 Model Number GPM n ~ I ~ 6 TDH Lift Friction Loss System Head TDH //Ft A) Pr Forcemain Length / Dia. / Dist. to Well 1za z 33. SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 8~ 7411 _i SETBACK SYSTEM TO O P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ~,,P' -1, Type Of System: f 5a < UNIT Model Number: DISTRIBUTION SYSTEM /0o f a+-^ S,'~ a ~o oS L 21 Z 1 4- f HeadedManifold/. Distribution x Hole Size x Hole Spacing Vent to Air I take / W Pipe(s) \ \ LJC S Length Dia Length Dia Spacin\ ~ \ 2L SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C~ Depth Over Depth Over xx Depth of Ixx Seeded/Sodded xx Mutch d Bed/Trench Center 'g Bedlrrench Edges Topsoil \ „Yes No Yes E2] No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 1258 142nd St et New Richmond, WI 54017 (SW 1/44 NW 1/4 36 T30N R18W) Torey Pines II Lot 23 Parcel No: 36.30.18.1123 1.) Alt BM Description = CO✓~ C / ~-ac O 2.) Bldg sewer length = / 3 I - amount of cover = 5 Plan revision Required? ❑ Yes No 21 ' y a~ y j Use other side for additional information. SBD-6710 (R.3/97) Date Insepct s Signatur Cert. No. CA. fib t r"%, t t~ B ~e LA ~~o !-a-J Inat l` oho Q County G Safety and Buildings Division - "r a 3G 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be film in by Co.) Madison, Wl 53707-71 S A`W'I ermit Application Stagy ra tionN°mber in accordance with SPS 38321 WIS. Adm. Code, submission of this form to the appropriate governmental unit A)A- is required prim to obtaining a sanitary permit Note: Application fors im stye-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used fior secondary Durposes in accordance with the Pfivacy Law, s. 15. 1 m , Stats. / Z f t/ 7 L Application Information - Please Print All anion / TG- Property Ownees Name / Parcel # r1H GZG - //417. -23 - 60 Property er s Mailing Address Property Location •;S8 1 !a Z ND 5 T tiovc lot l/ 2 3~ City, State / Zip Code Phone Number 5 V YS ~tv y., Section tGw e'CN O_M (54fti' p(cucle one T ~N; R 18( E m IL Type of Building (check all that apply) Lot # o pN e visi ❑ 1 or 2 Family Dwelling- -Number of Bedrooms CY Z3 Subdi T Block F1 P ❑PublidCommereial-DmmbeUse 6k ❑ City of ❑ State owned - Descxibe Use CSM Number ❑ Wi agc of -3 Ce-tt!z GJ 1 0 G"Town of~Irla >V f,~ III. Type of Permit: (Check only o e box on line A. Complete line B if iipplicable) A. WNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Ettistmg System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber T[I Permit Transfer to New List Previous Permit Number and Datc Issued Before Expiration Owner IV. Type of POWTS miCom onent/Device: Check all that a I D(Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 m. of suitable soil ❑ Mound <24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain} ent Device (explain) V. Dis ersal/Trea nt Area Information- Dispersal Area Req Area e-d System ievati Design Flow (gpd) Design Soil App&aiti 09A~i 43 S 1 !moo ! 97-- VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanis Esting Tanis w = o ° o it m lok~ 5z5 a. d w ~ Septic or Holding Tank 960 rz Dosing Chamber VII. Responsibility statement- L the undersigned, assume responsibility for installation of the POVM shown on the attached plans. Plumber's Name (Print) 's S Business Phone Number -7ss z Y 61 zZ 2y2 -76 ,JE FP AA4 Plumber's Address (Street City, State, zip Code) P -8oX 5 is b?92S ` U) add VJIL Conn /De rtment Use Only Permit Fee Date Asued/ issuin t Sign r APPS ❑ er~iv lZeason o etial $ 1411-1112- %0- IZ/ A i M Cond%iWLOpftWReRMeasons for Disapproval (~.,~(tJ 1. Septic tank, effluent fiRerand dispersal cell must all be services I maintained A 0 r . as. per management plan provided by "plumber, U tJ 2 JA# setback requirements must be maintaindd 1 ♦ T r r ~as pet hPP code i ordirwicW, h- I M -a r 0, Attach to compere plans for the system and mit to the County only on per not less than 8 lax 11 ' es m sizg SBD- 398 (R. 11/11) Q -IT ea cz, N ~ CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: }1 FU An P ZA Owners Name: S Owners Address: ZsC~ `1 Z J00 ~6"1 turn &V SI0Z7 T 3~ . /g Legal Description: SIN / ~ vj Y"/ !S3(, Township: K 1 ChA /M► O 10 County. - S'T li R,OI i Subdivision Name: 70RY -V> Lot Number. 23 Parcel 1D Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber F License Number. Date: Phone Number ICJ' Ss' 214b Signature DwWwd Wmuarrt to ties in-t'arward Sol Absorption componad rrfanuW for Powrs version 2-0 S8a10705-P (N.01ro1). Page 1 V1 a C R) ,i AJ n n j QN Q O ~ -Tt LA cd ~ p -t J to ~ `Y' ~1 m n! a . ~ F m Id 4 ~ s 3 0 V X71 - ~ ' - * • • ' - Jon. o _ k 0.x1 " o 11 n ~ - • _ -fl 0 f F pOL YA.K'I~~ INSTALLATION INSTRUCTIONS 8, Wastewater Precast Drainage Zabel' PL-525/PL-625 FILTER & Wastewatter Products ® A Division of Palybk I= PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: • Rated for 10,000 GPD e PL-525 = 525 Linear Feet of 1/18" Filtration T' PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 .Accepts 4" and 6" SCHD. 40 pipe The PL-5251625 Effluent Filter should operate efficiently • Built in Gas Deflector for several years under normal conditions before ,Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every .Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the .Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a 1ertified septic tank pumper or installer. RECOMMENDED PRODUCTS r Polylok PVC Filter j Extension Handle Risers & Riser Covers Extend & Lok- Riser Safety Screens Filter Alarm Panel and Polylok risers bring your Polylok Extend & Lok" Polylok safety screens SmartFilterTm Control septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual nd time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of ating digging to find tank installation a snap. impending filter and tank entrance. Fits 3" and 4° pipe. servicing. For a full list of Polylok products please visit our web site at: www.polylok.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner septic Tank Capacity /7© al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer L6 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model Z`7<' ❑ NA Number of Public Facility Units ^NA Pump Tank Capacity al ❑ NA Estimated flow (average) 7L)0 gal/day Pump Tank Manufacturer VV l~ 13 NA Design flow (Peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate ss al/da ./ft2 Pump Model ~N ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ~)A Fats, Oil & Grease (FOG) 530 mall- ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD,,) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other; Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (GODS) 530 mg/L 1a-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grads ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Ulna ❑ Other: Maximum Effluent Particle Size Ya in dia. O NA Other: ❑ NA Other: ❑ NA Other: 13 NA "Values typical for domastle wastewater and septic tank effluent. Othen ❑ NA MAINTENANCE SCHEDULE Service Event SerVIce Frequency Inspect condition of tank(s) At least once every: p m ar(s}(s) (Maximum 3 years) El NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3} of tank volume ❑ NA ❑ ~ Inspect dispersal cell(s) At least once every: month(s) ear(s) (Maximum 3 years) 13 NA Clean effluent filter At least once every: month(s) ❑ NA ear(s) - Inspect pump, pump controls & alarm At leas( once every: 11 month(s) Z- rear(s) NA test At least once eve : ❑ month(s) .~1A Flash laterals and pressure tot every: Years ❑ month(s) ~r Other: At least once every: ❑ year(s) A Other: [~lA' MAINTE=NANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificationsi operator. Tank • POWTS Maintainer; Sepiage Servicing Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector; inspections must include a visual inspection of the tank(s) to identify any missing of broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface, The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondinf of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y a) or more of the tank volume, the en e Servicing Operator and disposed of in accordance with chaPto tlfE contents of the tank shall be removed by a P r NR 113 b Se to 9 Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmen units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. . A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (410.1) Page of START UP AND OPERATION For now construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal call(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the exce s wastewater will be discharged to-the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to. restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb: or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antiblotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil, drain (sump pump) painting products, pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall tie taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: + All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. * After pumping, all tanks and pits shall be excavated and removed or their covers removed and the:void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: -A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area, Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption. systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that tirpa. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDRIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ZEFF FF)Y-- Name Phone 2 f (pl Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTO ORi•)Y NamO Name _ Phone Phone This document was shafted in compliance. whit chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page of START UP AND OPERATION For now construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal call(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to. restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb: or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotic.; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: + All piping to tanks-and pits shall be disconnected and the abandoned pipe openings seated. + The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing: Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and thevoid space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: -A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect thereplacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POINTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POINTS a soil and site evaluation must be performed to locate a: suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption. systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that tlr* < < WARNING> > SEPT(C, PUMP AND OTHER TREATMENT TANKS'MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POINTS INSTALLER POWTS MAINTAINER X - Name Name 5e fi) Phone C - 7 - zq & j Phone SI_PTAGE SERVICING OPERATOR (PUMPERf LOCAL REGULATORY AUTHORITY Name Name _ Phone Phone This document was drafted in oornpliance. with ohPpter Comm 83.22(2)(b)(1l(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 08/16/02 07:56 FAX 651 701 9767 JMK SALES COMPANY a PREFERRED EAU C W-002/U03 TOTAL DYNAMIC HEAD/FLOW Y PER MINUTE Pump PERFORMANCE CURVE EFFLUENT AND DEWATERING ' moDELS 151/152/153 MODEL 151 152 153 50 153 Fact Maters Got. liters GoL LUters CoL UWS -212 40 5 1.5 45 261 69 261 77 291 t0 3.1 12 231 61 231 70 265 30 152 15 4.6 30 201 53 201 61 231 6 20 6.1 29 167 44 167 52 197 ~ 20 t51 25 7.6 20 129 23 129 42 159 87 33 t25 30 9.1 - _ 22 0 4 35 10.7 11 42 10 4U 12.2 Shut-off H6a1: 30-0 IL 4.1m 38 n. 11.6m) 44 fl. 13.4m 0 m+<uaa aA 20 40 60 f3D 100 GALLONS ul[n o so 160 240 320 MOdelS1521153 nDW PER MINUTE etua+lo~ Model151 CONSULTFACTORYFOR r. 7/32 6 1/4 SPECIALAPPLICATIONS 15`a ' 21 sro 3 7/e 3 v/3z ,TkTed osingpanelsavalla6te .Eleclrirela9ematols.fordupteuYstems~areava~ahlrand - i - suPPGedwahanalarm. ® 1 12 ® 3 ua •Vaiabielev>doonttoi~~0tr0~ I slhg{ephases~ 1 .pot bl*NYbackva Wel8vekl0alswilchese~eav2dab{e I (avariahleleveNongandshortcydecar►w1s. ~ I I _ •~Q~1c8oxavaUabtedafnlrtdo0ril>s~llaibns.See FM1420. .0ver130-F.(54-C.)3peoalyuotaUon Wiled. 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FAK5g774,ZN mopoght2D022oeHowCo/1JlrfghtsmsefvOd. x LZOSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MTN. ABOVE GRADE E WGTHER PROOF 2S, FRoH DOOR, winoM OR JUNCTION Box APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE t FINISHED GRADE Y• CI RISER W/ PADLOC 7 6" Mtn. WARNING 1 ABOVE G ADE_r Mi? 18" IN. 6" MAX. INLET Olt t ; WATER TIGHT SEALS GAS- ; • TIGHT 4R ~ SEAL ~ 41 PIPE BAFFLE APPROVED 36 ONTO H • LM JOINTS W/ C SOLID -T- ' ON PIPE 3' 0 SOIL C SOLID SOI PUMP OFF ELrv. . T. 'f" OFF 66 RISER D PERMITTED IF TANK HANUFAC'TU! 3" APPROVED BEDDING UNDER TANK HAS APPRO. CONCRETE PAD SPECIFICATIONS ^ EPTIC I DOSE - - - - i TItI`1K MANUFACTURER: INI't2 NUMBER DOSES PER DAY: Tmw SZZLSs SEPTIC ~Z51Z) GAL. DOSE VOLUME INCLUDING DOSE Pe)n GAL. FLOWBACK: GAL. AUIRK MANUFACTURER: SE S CAPACITZES: : - t TQOIyt(~ MODEL NUMBER: A INCHES = Do• 3~c L SWITCH TYPE: Y INCHES =G t'UriP MANUFACTURER: (z C INCHES = H1.5 7 r- MODEL NUMBER : ITT- SWITCH TYPE: D = CINCHES = `o~II.aS C REOUIRED DISCHARGE RATE '~T) GPM PUMP 6 ALARM WIRING AS PER ILHR-16.23 VORTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • murnUH NETWORK SUPPLY PRESSURE FEET • - _ " FEET FORCEMAIN X FT/ip0 FT. FRICTION FACTOR FEET TOTAL DYNAMIC Hip FEET ~ EET INTERNAL DIKENSIONS OF PUMP TANK: LENGTH WIDTH ; DIAMETER LIQUID DEPTH IGNED : U ~1( l u LSCEN3E.NUMBER: r , Wisconsin bepartment of Commerce SOIL EVALUATION REPORT Page / of DivWon 61 Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must include, ut not limited W. vertical and horizontal reference point (BM), direction and Parcel I.D. v 2 percent tope, scale or dimensions, north arrow, and location and distance to nearest road. 2 3-co d Please print all information. R awed by Date Personal inbnnation you provide may be used for secondary purposes (Privacy taw. s. 15.04 (1) (m))• C4'h GC l~ 2~ j Property Owner . _.pY Location N)YS ve ~C GovL Lot 3(J 1/4~jU)1/4 Sap T36 N R I 0 E (oQ t Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# e h t S 1.. Z3 . wr A ne3 City State Zip Code Phone Number - ❑ city ❑ VGlage Town /`l t Road 1~- e~~ N 5~ i t ( I ~ p I tZc.J 0-New Construction User-Residential / Number of bedrooms Code derived design flow to a C~ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applica d b ; l~ alt n n ff. General comments (I/~✓, 9q:0O 7 .1 and recommendations: YS 7 © Boring # Boring ® Pit Ground surface.elev. ft. Depth to limiting factor I Ob In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft= In. Munsefl Ou. Sz. Cont. Color Gr. Si. Sh. 'Eff#1 'Eff#2 5 g -12 10 3[2-. I C :S 2 12- Li y _ Si I SbK rn~c c5 - - 8 Z(Q-►bp ► ml Z. Boring #❑1 Boring / t~ pit Ground surface elev. VU ft. Depth to limiting factor ~v in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 . 5 8 -1 Z I~ X12 - 314 Zm c rrljvr C5 I v-C 2 12 -2-t.0 y y 511 Z m~'~ ~5 5 $ 3 1 5 - s L 2m5blc -m- r 5 9 (Pg - 3 - 3 <i Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOOS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CSTNumber nature Z-5 a309 Address Date Evaluation Conducted Telephone Number Lkt3_$9-mer51~_ S~Zq 7 -yo0~ Property tuner &Q= lnye3h=Q6 C Parcel ID# Page of 3 Boring # ❑ Boring ! Pit Ground surface elev. /O a fSd ft, Depth to limiting factor in Soil Application Rate Horizon Depth , Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDt tz in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 J _ 0-12 I Z, I 2rroa C5 )v-C Z i2 G~ 4r M1 Boring # ❑ Boring ❑ pit Ground surface elev. it Depth to limiting factor in. Soil Application Rate Horizon Depth - Dominant Color Redox DescriPlion..... ..Texture _Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring - ❑ Pif • Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD/ftt In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/6 and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD43" PLW/W) Property Owner 5 ~111rni71Pi?~l LLC Parcel ID # Page of ;fit ❑ Boring # Boring ~ Pit Ground surface elev. /0 ft Depth to limiting factor ~ in. Soil Application Rate Horizon Depth. Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 c5 1v-C . 5 c5 3 - - -7 Z 7] 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 a 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/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •01#2 - • Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODS < 30 mg/t4 and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-3330 OL071Ml PAGE?OF~ NAME 7T ~ S LOT# ~ 3 LEGAL DESCRIPTION -5~ X ~ 14 ,S 3 k T 30 N ,R. Id- E(o~ SCALE: 1" ~G BM 1 ELEVATION X00, U BM 1 DESCRIPTION -1a p Q~ ~l r_c_e BM 2 ELEVATION 9j X O ec. 3 BM 2 DESCRIPTION 16,p o-c ~ ~ eoc: pe SYSTEM ELEVATION a ° ALTERNATE ELEVATION CONTOUR ELEVATION loo. c) If 40 4 ~ 1, gM~ ~.Z rmi'av I i II ' I ~ 1pJ.o° 1 100 L i SIGNATURE ~~L% DATE ;;;--/Z ' C~ 00 00 ® \ ' 0 . 2 y 46 -77, cy 7'69 ~ 428 ~ r~ co 22y, ~ U~ k3 01? 46,, ~ cy o~4tj, CO ® ~ DOO (.0 0 o w co Lu \ CO 0 w o rr to Q (Y) c~:f 0 0 co ! 00 a~ T- T- N . O ~t T j LO T C) Q w _ o O C\j co 0 - CV T CO a rn 21 O co 31 256.82 z T- . T L J • L J 0 w LOT 26 \N (2.3 ACR S) 89.4r3lE 330.00_' - - olp r-•- ~I LOT 25 2.3 ACRES a n ~OT j l\~ (2.3 ACRES) ?~2 A¢RE~ U CRE 1 297' I I LOT 24 ACRES / • - y ./MIN FFE i = 1011.00 \ l (2.0 ACRFS~ / 418, f -2ACMS.4 ACRES) \ Vol _ w r / \ N-N 7\ 2.p ACES --/STORM WATER RETENTION AREA ~2.0 ACRS) H.W.L. ----1009.0 X 317 10I N, I L I J f / X1005.81 340' 66A 12A,.' MIN FFE 1008.00., Q'~' / 1.4 ACRES) - ~,do7.Q x I /2;p Rlk i iooo.94 % / ( /340' i 4~- 1 (1.1 ACAES)l ST. CROM COUNTY SE MC TANK MAINTItINlitNCE ACRUMENT AND OWNi EDW CigRTMCATE FOAM ownertBuyer,~~$j„ f i4l lid ~I /~/~N P~ Malting Ste" Property Address 126W I Y 2 s _ NetN /jcerr'yt leMC1, w ~ S'YGt►7 (VeridmEim:ee~tram 1 D~mmt ~ae~r omsE~cesm) CityMste~ N!( Parcel Identification Numbs LEGAL 4t$aU ION Pcopelty LocatiaS , 0 u/. R=3 l 06I-ft Iv W, Tows err t om` o N Subdivision ,.~~/UPS Loth CecdSed Survey ivlspu , Vohrme Page Wares itty Dead# % Valwna Page Spec home Yes --Yno Lot haes ideutitiable_,V" no SYSTrA MAi', TNANCZ bVf*pec use and:maiutmwe dyourseptic system could result its premature hilure to heed le wastes. Proper mdntemmoe consists ofpumpiag out the septic tank every titres years or sooner, if needed by a licensed pumper. Wtiatyonput into, thesystew can Meet the function of the, septic tank as a treatment stage in the waste disposal system. The property owner ragrees to-submit to St. Croix Zoning Department a em acation form, dgeed by the ovmw and by a mastaplumber, joumayman plumber, restricted plumber or a licensed pumper va&j"9t>t (1) the o>t sitewastmderdiVasalgyd misinpmperopendingamditionsoftr(2)aftinspediimandpumpiaa(ifrree UWA the septic tank is less than 1/3 lull of sludge.- lh oa, the underdsud:haus r~rsd tbea6ovoerequ ves=ts and agree to maintain the private sewage disposal system with the standards set forth, herein. as set by tit Department of Commerce, and use the Department of Naftd Resources, Same of Wiseonsin.Cacti cntiono statingthat your septic systembas bees a oaintainedmastbtcompleted and returned to the St. Croix Comfy Zonin 'thin 10 days of the three year expiration date, !4 Z Stott of AppucANF DATE #of proposed b dtooms owl~~ CEA' AXIOrt I (we) cedify that an stn ents on, this form are true to the best of my (our) I (we) ern (are) tho owrm(s) of the propetty described above, by virtue of a warranty deed recorded m P.*s er of Deeds Mica. (o t4 (L SIONA OIr A"UCAW DATE Anyi~dammtfaadutis~mayre~altinz~ssoivaypennltbdograval~adt►ytlaZimB"~ w Iacbamwith~v~4P~+~t"Ydeedtlmne~sRgcdilasd~a@Sos ~aafi~eiaeairrradaipa4sw l l l l l l l l l l l l l l l l l l l l l l III III 8054594 State Bar of Wisconsin Form 1-2003 Tx:4040633 WARRANTY DEED 954685 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 04/18/2012 3:12 PM THIS DEED, made between DONALD C. WALKER and KATHLEEN A. EXEMPT*: NA WALKER, husband and wife REC FEE: 30.00 TRANS FEE: 93.00 ("Grantor," whether one or more), and KEITH R. RUMPZA AND MINDY M. PAGES: 1 RUMPZA, husband and wife as survivorship marital property ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in Name and Return Address ST. CROIX County, State of Wisconsin ("Property") (if more space is KEITH R. RUMPZA needed, please attach addendum): 343 SOUTH DAKOTA AVENUE NEW RICHMOND, WI 54017 LOT 23, PLAT OF TOREY PINES 11, IN THE TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN. 026-1149-23-000 Parcel Identification Number(PIN) This is not homestead property. (is) (is not Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants and general taxes levied in the year of closing. Dated APRIL 13 2012 (SEAL) 456a~ ~~..r (SEAL) * * Donald C. Walker (SEAL z (SEAL) * * athleen A. Walker AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on BERcC -COUNTY) Personally came before me on April , 2012 " the above-named Donald C. Walker and Kat WI l~.,es TITLE: MEMBER STATE BAR OF WISCONSIN Walker a i (If not, to me n to a the person(s) whotitxec thet.~oregoutg authorized by Wis. Stat. § 706.06) instr -and owledged the same. 9 _j cn THIS INSTRUMENT DRAFTED BY: STUART J. KRUEGER Notary Public, State of RIVER FALLS. WI 54022 My commission (is permanent) (ex{;a~: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 1-2003 *Type name below signatures. INFO-PRO'" Legal Forms - (800)855-2021 - inloprolorms.com 1 of 1