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HomeMy WebLinkAbout026-1109-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572892 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: Schmidt, Henry J. &Gloria Richmond, Town of 026-1109-40-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 0::.C.) • 0 1°1. 3 60H1M 4 srv.d 6 diO4.30.18.612 TANK INFORMATION ELEVATION-BATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic IL-11001A111 � boo J j Benchmark U n ' . 3 )O' 3 Dosing Alt.BM Hufft.0 tr (p3U 06.i Sepfi•c (ow Aeratbh Bldg.Sewer FIL�e S i M �zH -- 7Jy,i H S VN� nldi�ng__ . St/Ht Inlet St/Ht Outlet O,' TANK SETBACK INFORMATION 10 . 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet r �� eao- £51 e (1'G.✓G�e j D Z J S q Septic ' 6, f )50' 7' ryll/ Dt Bottom P-1. 2 S7. 1 Dosing /0' )�/)/0/ " J V)t Gip) Header/Man. ,o 95 3 Aeratio Dist. Pipe V 6.0 9'5.5 _■-■ L— 5.0 9ta. 3 Holdin�� Bot.System <] '] (n. 9 N•3 15 3 Final Grade q� PUMP/SIPHON INFORMATION ,rp 3 •3 ll Manufacturer Demand St Cover I G�I Zb�LLI ,I� GPM b Model Number S, ` S TDH (Lift 9 Friction Loss System Head TDH Ft 0. 5 -- q.1 lJ C----- Forcemain Length Dia. 2,I Dist.to Well > 5 I\, SOIL ABSORPTION SYSTEM BED/TRENCH DIMENSIONS Width i Length / /,j No.Of Trenches i PIT DIMENSIONS No.Of Pits Inside Dia. !Liquid Depth DIMENSI 1/�,/�j�r/j -�y� SETBACK SYSTEM TO P/�1 as4.,BLDG WELL LAKE/STREAM CHAMBER BLDG OR Manufacturer: I N F loon)Q e INFORMATION Type Of System: LoNv �Nf V01- —I I 51 )5D N /A UNIT Model Number:(�/1 U/t� y 5r RU.r DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intak6,O! U// Pipe(s) 55 Length 1 Dia ( Length Dia Spacing - r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only easi- en(75 Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched IBed/Trench Center ) BedfTieneh Edges -Topsail No es No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 1187 CARROLL ST New Richmond,WI 54017(NE 1/4 SE 1/4 4 T3ON R18W) Viebrocks River Valley Additio Parcel No: 04.30.18.612 1.)Alt BM Description= Duf�T ba.tfcIS Qn Se fic arc p!�'/c_ in 1 b(J �� p St(7h c C DVS P --) C NUNS 2.)Bldg sewer length= -- w I t k Oh N S i D4 F o osc -amount of r(tt n i�✓ St fi C 1�0 � ,) S�S�Cw, a-bc..,�lo�v4I Plan revision Required? Yes o Li S 15 ild 1 '2 7 /,1�(;j 3y �, Use other side for additional informati n. y� y��sYY� Date Insepctor's Signature Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Henry Schmidt ADDRESS 1187 Carroll St. New Richmond Wi 54017 NE 1/4 SE 1/4S 4 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 94.9-94.6' 3.5 `below grade @ B-2 3/30/15 3 BEDROOM DATE CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Bottom of shed siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank, piping shall be Schedule 40. • • Carroll St. Vent Scale is 1" = 40' >6„ Quick4 Standard unless otherwise of Cover Leaching Chamber 75, noted with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long Li3 4 Grade at System Elevation We 25' Existing 3 Garage / Bedroom Old dwell is to be / House pumped and buried ✓✓✓ 20' D W 20' \•Failed 99' 50' 4% Slopeit I:-2 B-1 • 70' � i1 40'l' 1 Ii0' Vents 35' IN B-3 1p:`.M.* dd ■ 2-3' X 66' cells with>3' spacing Shed Property Line �y uc �` �.we° l County K°-, "r�� " ' ;:. ; Safety and Buildings Division rj f. ,/'0 t � 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit umber(to he filled in by Co_) S K Rf t • .DNS Madison, t7Z' .? �Z g 4a $ t t' \ Lip Ci 5 "` S�• Qt'. State Trimsaction umber ,o40An.itary Pellnit Application this form Yo the appropriate governmental unit 4 '+ � Wis.Adm.Code,submission of PProP than is required prior with bra_ing a s_), s is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Ad css(if different a mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary U��� //�� `� ��, purposes in accordance with the Privacy Law.S.15.04(1)(m),Stats. I. Application Information Fk se Print All inform ( Parcel 4 Property Owner's N c (/ or, ,, ,,,..._ i / //DP-- �4 6 in �'/'�'n Property Location Property Owner's Mailing eesss {l 7 L ct (( 0 /L I Got.Lot (, iz' City,State I Zip Code Phone Number N 1/,, �L' V, Section / 1 r Ne_,,.) Jlj ci,,,,„,„A2, V1/4 15 01 -7 T.0 N; R / islE e n II Type of Building(check all that apply) Lot# I Subdivision Name i or 2 Family Dwelling-Number of Bedroo i / /� /1 Block 01C iO/'0(,tC Rl,,- PubiiclCommercial-Describe Use Re13\44a4 ' ❑City of S CSM Number ❑Village of ❑State Owned-Describe Use Town of t �. D,* c..g >A) (0j.1� III.Type .f Permit: (Check t my one box on tine A. Complete line B if applicable) 20 mil.-, A. "IF* ew System pr • .laczment System � ❑Treatment/Holding Tank Replacement Only 1 10 Other Modification to Existing System(explain) I List Previous Permit Number and Date Issued B. DI Permit Renewal ❑Permit Revision ❑Change of Plumber 1 Permit mit Transfer to New I '� r Before Expiration I ;1 1'<.A-i L w Lll N.Type of POA"I`S S_ystem/ComponentlDevice: (Check all that apply) 5421 -)a fr 1 411.)', r ' r+lon-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil Q�.M�1�0e. ✓ ❑Holding Tank El Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treat eat Area Information: 3 r s'13e G r c� Z Jl Design Flow(gpd) Design Soil Application Rate( sf) Dispersal Area Required(sf)�' Dispersal Area Propo d(sf) System Elevation '// VL Tank Info I Capacity in Total #of Manufacturer I Gallons Gallons Units 3-e 1 v •N New Tanks Existing Tanks ;1, 1 ;u J ! :' 'O-m „If: Septic or Holding Tank /` r� �, 7 (,[ }? h LL�i/�7 Dosing Chamber U 3© _C,a.- / L[.177'6 � "'� 1 VII.Responsibility Statement-I,the undersigned,assume resp• • for installation of the PORTS shown on the attached plans. II I Plumber's Name(Print) Plumber's Sign, I MP/MgPRS Number Business Phone Number ,___C",iCe__<_,_ ;5;60C-a Plumber's Address(Street,City,State,Zip Code) �/� c VVI ountv/De,artment Use Only 4 - Permit Fee I Date Issued I issuin4 eat Signature rII Approved I r % ,approve• S CC) I 31 1 5 �� 1 I fir ,,Ia�0�� . Owner • . 'eason for Denial ! '� IX.Condittfini$,. .r 'i' 7tsons for Disapproval L 1 1' ,Septic tank,effluent filter and 3) 61.1 5' S+ - T a 0' dispersal cell must all be services I maintained as per management plan provided by plumber. parrt1 2. ..AU suck requirements must be maintained as per applicabie'code/ordinances. Attach to complete plans for the system and submit to the County only as paper not less than 5 1/2 111 inclun in size SBD-6398(R. 11/11) PLOT PLAN PROJECT Henry Schmidt ADDRESS 1187 Carroll St. New Richmond Wi 54017 NE 1/4 SE 1/4S 4 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX ELEVATION 94.9-94.6' 3.5 'below grade @ B-2 3/30/15 3 SYSTEM EL BEDROOM DATE BE CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Bottom of shed siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H,R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. A A Carroll St. Vent Scale is 1" = 40' >6„ Quick4 Standard unless otherwise of Cover Leaching Chamber 75 noted with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 5' 34" Grade at System Elevation O We Garage 25' Existing 3 / Bedroom Old drywell is to be / House pumped and buried ✓✓✓ • 20' A 20' Al% DW 9Failed 99' 50' 4% Slope :-2 B-1 70 Of- 40' • 30' Vents 35' • B-3 10:\.M.* 2-3' X 66' cells with>3' spacing Shed Property Line P Y Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/30/15 Owner: Henry Schmidt Location: NE1/4 SE1/4 S4 T30 N,R18W 1187 Carroll St. Richmond System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Section 9. Pump Curve 10.-12. Soil Test / � 13. Existing Septic T�- orm Signature License numbep6900 PLOT PLAN PROJECT Henry Schmidt ADDRESS 1187 Carroll St. New Richmond Wi 54017 NE 1/4 SE 1/4S 4 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 94.9-94.6' 3.5 'below grade @ B-2 3/30/15 3 BEDROOM DATE CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Bottom of shed siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' of tank,piping shall be Schedule 40. A Carroll St. ao Vent Scale is 1" = 40' >6" Quick4 Standard Leaching Chamber 75' unless otherwise of Cover g noted with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 5, Grade at System Elevation 34" 0 We 25' Existing 3 Garage / Bedroom Old drywell is to be / House pumped and buried 20' D W 20' iFailed 99' 50' 4% Slope B-1 70' / e-2 ( A 40' 30' Vents 35' Pill B-3 10'`.M.* 2-3' X 66' cells with>3' spacing Shed Property Line • Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above rade 5.6ft^2 pair of end plates g Finish grade elevation Typical Installation 99.5' Vent Grade 411. ow Vent ■ 3' 4" 3' • 46-''30/34 Septic Tank Oft 5' Long 1" 5' 5' Long Grade at System Elevation 3 6" Grade at System Elevation Spacing 5' 2-3' X 66' ' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A_94.9' B 94.6' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ANT) UVVNEKS{||P CEKII[rlC/\T|cl.'N FORM Owner/Buyer - Mailing Address _� r __--_-_- __----� --___ > | °�-� /�~ ( rnocdyA��dzeua / � � � w, (Verification n:gn�nd6n'uPl000Jog��3vu� Dxpmhoxat/vz/ep'um�/nutioo) ------- -- ---- City/State Parcel Identification Nut '� 2^� ��r '� -'-- '-----'-------'---- --- -- " � � �� ^��/�� �� ���� elf0--___ LEGAL DESCRIPTION Property Location r."'" � , � 1/4 , Soc. . [�2 U N � / � W, Town o[ �� . v----- ----- —'-- ^-� C ---�j-- -- u� Subdivision/��� �� , LN#_�� Certified Survey Map #______________�~~~~- __ , \//J�oux ~-�---Page # ________ ____ `�» ��� ��m U�eed# ___ q3-7 m^ Vmiuu/c , Page It- Spec house yes no l»( iJoUdiub o SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pr,nriature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, 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 wasie disposal system. Owner maintenance responsibilities are specified in§Comun. VI52(l)and Lu Chapter-l2 St. ( FOIX ('o nity Sanitary Ordinance. The property owner agrees to submit to St. Cmix County Planning S.:Zon trig Department a certification term,signed by lire owner and by a master plumber, journeyman plumbei,restricted plumber or a licensed pumper WA-i Vying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2) atter inspce and pumping(if necessary), the septic tank is less than 1/3 full of sludge. I/we,the undersignedliave iead the above requirenrerits arid agree to niaio tairi the private setage disposal system with thin standards set tbith,herein,as act by the Department ofuoumicice and time L)eparureni of NamodKoxmupes, State of Wisconsin. Certification stating that your septic system has been maintained must be completetl and returned to the St. Croix County Planning& Zoning Departnrent within 30 days of the three year expiration date. I/we certify tha all stat u on this Wcbrm'`fu`y/^nzkuovv|mige. 1/we ant/are the owuel(S)of the property described above by virtue of a warr ty deed recorded a wair ty deed recoidert in Register ol Dee Is Office. Numb o �� �� "� ���/ +�c��.-/ 7'�\11TD� (] ' �p]�} X�/��`lY�� ~^^` ~ `^~~ ~~ ` , [)/\T6 *^*Aoy information that is misreptesented may result in the sanitary permit being wvoked by the Planning& Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds ' ffice and a copy ot the certitied survey map if reference is made in the wairarity deed. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page a FILE INFORMATION • SYSTEM SPECIFICATIONS Owner Tank Manufacturer iir/7,1e,,J ❑ NA Permit# 0 StS.aptic ❑ Dose ❑ Holding Volume:l (gal) Tank Manufacturer. ��j *(NA DESIGN PARAMETERS • Number of Bedrooms: ❑ NA eptic ❑ Dose ❑ Holding Volume: ‘30 (gal) Number of Public Facility Units: - 4-.NA Vertical Distance Tank Bottom(s)to Service Pad: (ft) > Horizontal Distance Tank(s)to Service Pad: /V/11 (ft) Estimated(average)Flow: or, (gal/day) PrSpecific servicing mechan ics must be provided if vertical is>15 feet or o Design (peak)Flow=(estimated x 1.5): Xj72 (gal/day) if horizontal is>150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: , (gal/dayfft2) Effluent Filter Manufacturer: /47$j• 1fC ❑NA Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model: /51--/AV Fats,Oil&Grease (FOG) 530 mg/L Pump Manufacturer: 2 eg, ❑ NA Biochemical Oxygen Demand (BODs) s220 mg/L ❑ NA - Pump Model: ,/3/L2 ,5,3 Total Suspended Solids(TSS) 5150 mg/L High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L - Manufacturer ✓�p` (BODs) >220 mg/ NA ❑Mechanical Aeration ❑Peat Filter (TSS) >150 mg/L ❑Disinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other. (BODs) 530 mg/L Soil AAbsolion System Fecal Coliform(geometric mean) s10'm A 'CXIa-Ground(gravity) ❑In-Ground(pressure) ❑ NA ❑A-Grade ❑Mound Maximum Effluent Particle Size t14 in dia. ❑ NA ❑Drip-Line ❑Other: Other: 4A Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency .Pump out contents of tank(s) en combined sludge and scum equals one-third('h)of tank volume ❑W en the high water alarm is activated At least once Inspect condition of tank(s) every: ❑month(s) (Maximum 3 years) ❑ NA s) rYyear(s) . ❑month(s) Inspect dispersal cell(s) At least once every: . jr-year(s)year(s) (Maximum 3 years) ❑ NA J art ar(s) ) ❑NA Clean effluent filter At least once every: ,` ears) amonth(s) ❑ NA Inspect pump,pump controls&alarm At least once every: ear(s) ❑month(s) NA Flush laterals and pressure test At least once every:. ❑year(s) other: At least once every: ❑month(s) NA ❑year(s) Other: ❑,NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding 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 treatment tank equals one-third() )or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper)and disposed of in accordance with chapter NR 113, Wisconsin Administrative Coder All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units. and any servicing at intervals of 55.12 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) • Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected tank(s)re ed have the contents of the tankmoved by a Septage Servicing Operator(pumper)prior to use. ;. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will bedischarged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage restoring ower to T the pump this situ act a Plumber contents of the pump tank removed by a Septage Servicing Operator(pumper)prior g P or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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. the life of the treatment Reduction or elimination of the following from the wastewater stream may improve the performance and prolong tanks and soil absorption system: acids, antibiotics, baby wipes, cigarettee'butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump)discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products, pesticides,sani ry napkins,solvents,tampons, and water softener brine discharge. 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 s. Comm 83.33,Wisconsin Administrative Code: • All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator(pumper). • 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 the rules in need a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at the time of their permit issuance. A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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. . ❑ Mo��aRa-srtdcw abs� a th N following -oval of the biomat at the infiltrative �� its such systems systems comply reconstructed the rules in effect at that time. WARNI NG TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK RESULT. OXYGEN TO OR RESCUE SUSTAIN ROM THENNTERIOR OFRA ANY TANKAMAYIN STANCE. DEATH MAY NOT BE PO SIBLE� ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Ar — - Name 1 ` Name,5L ,2/ ,r7 �/�c>'„„,,5n-9 l Phone 7) �, -- j�S /6i Phone J ,,. SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY Name --B U / Name f (co k ,1ll2 ._ Phone Phone -7)J r 3�x Q This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. 1 1 ` 1 ; 1 El . .____ . - 1 ! 1 I T 1 i I 1 1 , rr"--- 011100.1M2 1 ! 1 1 I ii I 1 i ■i 1 1 ;, .....tio 1 i II 1 i i I 1:)- 1 { 8 ' , ir 1 , 1 , 1 !I I II I ! : I I 1 i 11 1 ! 1 , -In 1 7„.i I L. ..... , , / \\ . ! n 1 L i A ' L , , , . r i I I il ' 1 ..., i .-i------------ - h ' 1 I ' 1 ll i i II t i! ' FLfJ 1 1 : 1 ! I 1 II 1 1 '1 1111 --------- -: 1 I --,.....- i - I . . i 1 1 ..„...---* .-...... ---.- ---.,-....-....7.7-.,,..-- . „‘..,T r_....p, A 171 7 -M i T TH 0 h\- ' / ' _. . ' %,.) , , L___ 0E98 HORTON GAY NORTH RD . , BOYNE CITY, Mi 4g71 : .• 1-889-999-3290 FAX 1-291-532-7324 . . . 1 SIM/TECH EILTEI:.' A7.'Y DFIIII PATFN I 568,5 „. ..,.... r___ ,_ 1 J HOWERY 1 Errir-loo i ___ . ; 1 --• --, 1 il GARY KOT .ESEY [ANEk ,-.. i_____. .--•-•,,- -----,v"----*----- SO/NI 39Vd 03 dWnd G38d3A3ad 898LbaSIL LV:OT ITOZ/90/L0 Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer i-L-C-euizt Minimum Pump Performance Required Tank Model Number ,ty0 2 0 GPM @ /p, '7 Ft TDH Total Tank Capacity C 3 0 Max.Bury Depth 9 Total Dynamic Head(TDH) -Feet Pump Manufacturer -2P lleit/ ` Elevation Head /0 Pump Model Number S 3 ,/ Distal Pressure , -c-- Alarm Manufacturer v Lc -o-r-55 Network Pressure Loss . Alarm Model Number )) t,-.V Force Main Pressure Loss • 7 Switch Type Jr P-Cli z.,cL*2 Total H Z T , c. F, 1.ij-✓ Manhole Min.4"Above Grade I I With Locking Device Vent Min. 12" Weather-proof Above Grade --► , 'iv+) With Cap Junction Box P .- . -- - - Finished Grade — — -1— — •. — Depth of Cover 1 Ft js'N.,Disconnect NEI Means ! 1 rn ,4C 4 ,t i i . 4 4 4 4 t 4 4 4 4 4 4 i < t 4 4 4 4 4 4 4 4 4 1 4 4 t 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 t t,i ? ,4 44 t,4 Outlet 4 4 > r Switch Settings and Reserve Capacity II , Inlet '>;r --*---- ------ 4 <'< t y Tank Volume= ( j GPI , C 4 4 >4, Dimension Inches Volume Gal. A Cy4 ;4; (reserve)A a .� 3 6-2, r Weep 4 f- 4 < Wee ( ) 3o ' ;�, alarm B 2 B -� 4'4 Hole ,iy ,ty _ (dose) C G, �J`1, 3 Off Elev. ` �'< >s r (dead) D q / 3 s �S>?' Ft ► <:< >.; Total �/a-, 6 3 p ---h >; yiy D Cy4 Bottom of Tank Elev. TT S, t > • t 2 4 rir SJ t}4 rir �y iy ite< . .y., 4r 4'4'4y 4y 4y 4y 4y 4 4'4'4'4'4y4 4'1 4'4'1 4y 4y 4y 4y 4y 4'Cy 4'4'4'4'4y 4y 4'4y 4 1'1 4y4y Cy4'4'4y 4 4y4 4 ,y4}4y Cy 4y 4r 4y Cy iy4 GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis.Adm. Code. 03/05 lgj Page of D8i's 4,M1C HIA[L;c48-LAciT, C:s '1(^.Tv DFLE,'. ',.111'iL,TE ,:,,,17fIL 8/:5-1./rp'3 ,-_-L-1-HEN[ A:',ir_; ILEWA7-1?NO 25 , . , I i V c c e., i 5975/57/59 —.-- . : ,, _t . ,;!‘„),,,-,, -...,, .,, i ,-- i I r--— ----- _ , 4-- I L. _ ■ >- •,..,.., C.: K ' - - , ___ r ; — _ ;9-- ' ' --- 2— , — -:: 'Irt,------,-..- :T..".52---, C --I . 1 /i"— /2 I ----r--/ U.S. GALLONS 15 23 30 40 SO . ,L____1,,,, , , ■ 7- - ,, o---L'LL. I ITER:, ,,/2- '- ,\ 11--L 1 6C 8C, 1 (1,/,', "---.. 8-:-- .' , ',4,: ,-'s--,-„„' •-,_-,,i(___-- is.-- _ ---I- :LOW DER 1'!IN : 009897 ,‘,.... / ' ''----.;:.i„-7,---:„1,-- •-•••:-..,,,,I,,,,,,,.),, 1 1 - Variable level float switches available. Variable level long cycle systems available. I- - T15_7, ,,,----------- Available with special cord lengths of 15, 25, 35 and 50. Alarm systems available. o , Duplex systems available. _i_ , I 111,-77---r-,!;„7-7-,,,,T__ , SK8b8 Single Seal [1-1-4. Control Selection Listings 1 I Model , Volts 1, Phase , Mode ' Amps 7-Simplex . Duplex CSA UL 1. Integral float operated mechanical switch,no external control mguired. - - M53/55 8,M57/59 tt 115 t 1 Auto ' 9.7 1 Y Y 2. Single piggyback variable level float switch or double piggyback variable level -N5a55&N57/59 ' 115 1 I Non - 9.7 2 3 or 4&5 Y V - r float switch.Refer to FM0477. '-:--EiN53 115 I 1 —Auto I 97 ' 11 V EN57 1 1 ---- --- -1 ' 3 Mechanical alternator"M-Pak"10-0072 or 10-0075. ' * 15 : ' Auto , 9.7 ; N Y i I--- y v-1 4. See FM0712 for correct model of Electrical Alternator. : *BE53t57 -1.- 230 ' 1 T Auto 1 4.8 * ' . ....._, r-- - D53/55&D57159 I-I-230 1 .,, Auto , 4.8 1 y y 5. Variable level control switch 10-0225 used as a control activato-,with Electrical E53/55&E57/59 1 230 1 I Non 4.8 , 2 IL 3 or 4&5 1'; Y Alternator(3)or(4)float system. l'Single piggyback switch included. For information information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches,FM0477: - ' - Electrical Alternator,FM0486;Mechanical Alternator,FM0495;Sump/Sewage Basins,FM0487;and Single Phase ' - - -- ' - 4:--", --- -,, 'r- -- Simplex Pump Control/Alarm Systems,FM0732. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 1A.217 '',... Louisville,KY 40250--;.::-;. ,,,,,-..>-thi.75;&-. Manufacturers of.. I. ill/g• , ,, ... iF SHIP TO:3649 Cane Run Road ... „„.,,, , 4 :,,Gr. ® Louisville,KY 40211-1961 ,a/ALITY PL/AIPS,5NCE /gm (502)778-2731•1(800)928-PUMP http://www.zoeller.com "6fr"whip cif. FAX(502)774-3624 CO Copyright 2002 Zoeller Co.All rights reserved. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I ha e inspected the septic tank presently �erving the residen e located at.: - ' ' "'� _ Section TS-� N, id W 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: _,0c (�/L/ 1' cl flow back occur fr m absorption system? __ Yes ___ No (If no, skip next line) Approximate volume or length of time: ' gallons m.i.nutn.; iapacity: C.2 Construction: Prefab Concrete -K____ Steel Other Mwufacturer: (If known) :cLi / - Ace of Ta If known i' . /•nature} (Name) Please 1/1/2 -- print (Title) ? (License Number) }_) i t ____ e /�� l'urm to be completed by licensed plumber (s. 145. 06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: 1:1 accepting the above statement regarding e ,/'s ing septic tank condition, 1 certify that the tank to the best conform to the requirements of ILHR 83, Wis. , . . C ode (except wfor Inspection o ping ov utlet baffle). ' Code for. ■ Name 4/d1'' Signature_ de/ •/MFRS , . . : Lf l u ' 0 a . c .... 4 a a 0.` 0 joy o q . . c" 7 M ..... . . . :. .... .. .. .... . �. . ,. 32.50' itttt ;;;u;;.::.: ..r .::::.....tri F 0 15 to . r- • 14 tr; . ..-"c: r-. 0 13 6 = I I o a r ' o IFS . `: COUNTY TREAsuREF TAT F WISCONSIN ) , IIUIIUI1IIII UIUIIUiii ii I TRANSFER ON DEATH DEED 8 07x:4021671 937867 This deed shall constitute a non-probate transfer on death, made BETH PABST by Henry J. Schmidt and Gloria Jean L. Schmidt, husband and wife REGISTER OF DEEDS ("Grantors"), to Brian P. Schmidt and Michael S. Schmidt, ST. CROIX CO., WI ("Beneficiaries"), for the purpose of creating a payable on death provision RECEIVED FOR RECORD affecting the following described real estate in St. Croix County, State of 06/21/2011 11:50 AM Wisconsin: EXEMPT #: REC FEE: 30.00 Lot 13, Viebrock's River Valley View Addition to the Township of PAGES: 1 Richmond. This directive is not a conveyance. The Grantors intend by this deed to take advantage of sec. 705.15 and 77.25 (10m) Wis. Stats. and Name and Return Address: related statutes, which collectively permit transfer of real estate upon the death of Grantors in a non-testamentary and non-probate fashion. The Leah E. Meyer Grantors intend this deed to be deemed a"transfer on death"and"payable Remington Law Offices,LLC 126 S. Knowles Ave. on death" conveyance such that Grantors retain full management and New Richmond, WI 54017 control in fee simple during the rest of Grantors' lives and during the life of the surviving Grantor. This includes the right to sell and convey said real property in any manner or rescind this transfer on death designation. PIN:026-1109-40-000 This deed is revocable and may be changed by the Grantors at any time. Upon the death of one Grantor, the survivor may alter or revoke the This is homestead property. transfer on death designation. Upon the death of the last Grantor, this real (is or is not) estate shall immediately pass and vest in the named Beneficiaries. If any of the named Beneficiaries shall not be living the interest of said Beneficiary shall pass and vest in the Beneficiary's then living descendants, per stirpes. If any of the named Beneficiaries shall not be living and shall not have living descendants, such interest shall pass and vest in Grantors other named Beneficiaries. Beneficiaries will receive title subject to all encumbrances or liens or record on the death of the last Grantor to die. Nothing contained in this document shall prevent Grantors from conveying or encumbering this real estate for any purpose and in any manner permitted by applicable law or from exercising any right allowed by applicable law regarding this real estate. This instrument shall not be an encumbrance upon this real estate or prevent Grantors from conveying clear title to this real estate. If this instrument is in conflict with any instrument signed by Grantors prior to the date hereof, then such prior instrument shall be considered null and void and the provisions of this instrument shall control the disposition of Grantors' interest, if any, in this real estate upon the death of Grantors or the survivor of them. This document is exempt from fee and return under secs. 77.21(1) and 77.25(10m) Wis. Stats. because it is a transfer on death deed under sec. 705.15 and at death of Grantors will be exempt under sec. 77.25(11m)Wis. Stats. Dated this 16'h day of June,201 1. * *Henry . chmidt 6,3 k1 J ¢a n (29ab frLt * *Gloria Jean L. Schmidt AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated this 10 day of June,2011. )ss. ST.CROIX COUNTY Personally came before me this 16"day of June, 2011, the T▪ITLE:MEMBER STATE BAR OF WISCONSIN above named Henry J. Schmidt and Gloria Jean L. Schmidt, husband and wife, to me known to be the persons who executed THIS INSTRUMENT Meyer,#1081407 DRAFTED BY: the foregoing instrument and acknowledge the��pi>tll it is%,_ Leah E.REMINGTON LAW OFFICES,LLC !'� �, / %r7V^� �� N}'. MEW'', 126 S.Knowles Avenue * Leah F.Meyer .= oT A,9 ' New Richmond,WI 54017 Notary Public,State of Wisconsin. _ t ' Telephone(715)246-3422 My Commission is Permanent. =* • Attorney for Grantors (If not,state expiration date: (P., .OUEs`\CJ 2 S (Signatures may be authenticated or acknowledged. i S •O�?`� Both are not necessary.) � rFOFtW$G` ,��� "Names of persons signing in any capacity should be typed or printed below their signatures 1 of 1 Property Owner_ Parcel ID# Page of 3 Boring# [� ,.V.1.❑ Boring � Pit Ground surface elev. L ft. Depth to limiting factor /0 g in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 l 01 0 0 <1-2- ( . Cam' 0 Z-- /o-34, //Ts/y e/ „i l: 1n " /44.2 (4 - 4/ ,... Gl;-2 Ml 4/14 W).4 • 7 /7,-.1‘ ply )1\6‘P-4 i 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/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 ❑ Boring Boring# ❑ Pit Ground surface elev. ft. Depth to limiting factor in. ' Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff t2 •Effluent#1 =BOD5>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. 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. SB0.8330(8.6/00) T.7)I CFNED 1 Nth Wisconsin Department of Commerce SOIL EVALUATION REPOR ' Page of Division of Safety and Buildings ,. ('( z?�G O tJ t QTY in accordance with Comm 85,Wis. Adm. Code i- ,,..R�,/D'' e F_' Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must P�I-� include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. / / percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Oa-b— //CO '`7,J Please print all information. Revie by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). r 15 C.// Property Owner Property Location /ie A r `5 CIA -- Govt.Lot/Jr 1/4 1/4 / T 30N R 1g E("�. Property Owner's Mailing dress Lot# Block# Subd. Name > M# 1/ 7 Ccir(oft 5f• 13 —. v 164iacf( 2:,,e.k,y vtc�c,J/fcM City tate Zip Code Phone Number ❑City ❑Village Town Nearest d Next) ;C1Iitt , 10) I J/Oi'7I (7)1)22-2-'036. iz,i a� I arroll r¢ ❑ New Construction Useyl' esidential/Number of bedrooms c3 Code derived design flow rate 762> GPD replacement ❑ Public�or commercial-Describe: ____ ________.__ _- Parent material (fir t �r r_i c LJ� Flood Plain elevation if applicable /l// � ft. General and recommendations: 3•5''-3d-4,w?,...,12,✓ rxt Z-2- System Type ea'V J4 . System Elevation 7 T,/ 7} 6 + ° Boring I Boring# ,— .Pit Ground surface elev. � S ft. Depth to limiting factor //0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 •Eff#2 I 0v/t, I Os,,3/1._ S/ j — m, ,4 C'S' - ' 6 40/ 2- /0-3Z /Q r>// C / ,9,.._,1,1c. ,r- , `'-" I-e- / ' !4 3 32-t/v 4 0 ..--- 5 cis„ c?/ /,/h¢ 4'l,Q • 7 1 A l cZ. Boring# ° Boring q4 /.0j—in. 7�Pit Ground surface elev. r r ft. Depth to limiting factor l Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 I 10 /Ul, 3/Z ----- 5( 0. ., o?� - < 6 /v z f -3o_4 7 G/ -- , ' P l( /`/ , b 3 io/or 4 /. v Ds� / N j Wig ' �? 1 r 1 cz - 149 It 1 Effluent#1 =BOO.>30<220 mg/L and TSS>30<150 mg/L. / •Ef fluent#2=BOD,<30 mg/L and TSS<30 mg/L CST Name(Please Print) Sign- : CST Number Bird Plumbing, Inc. Shaun Bird . 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 —?---7 /- 715-246-4516 J I Soil Test Plot Plan Project Name Henry Schmidt Shaun Biro Address 1187 Carroll St. / New Richmond Wi 54017 CSTM 16900 Lot 13 Subdivision Viebrocks River Date 3/30/15 NE 1/4 SE 1/4S 4 T 30 N/R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of shed siding System Elevation 94.9/94.6' *HRpSame as Benchmark A Carroll St. Scale is 1" = 40' unless otherwise noted 75' 5' 0 Well 5, Existing 3 Garage Bedroom House • 20' D W 20' c ailed 99' 50' 4% Slope B-2 B-1 • �❑ 30' 35' B-3 10'\.M.* V Shed Property Line V • Property Owner Parcel ID # Page of 3 ❑ Boring Boring# pit Ground surface elev. /1l--3 ft. Depth to limiting factor /a in. I Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2 z o-3 O e a7 i � 7'7 4 - `/ _;4 � � Sri - l 3 3K i4ii 4, V4 csc _rill /✓1. k'4 > ^7 /.,,,‘ ii Lk 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/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 •Eff#2 0 Boring Boring# El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 *Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The q Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or P need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-B330(8.6/00) •