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HomeMy WebLinkAbout022-1061-50-025 Wisconsin Department of t'ommc.r,;e' PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division — INSPECTION REPORT sanitary Permit No: (ATTACH TO PERMIT) 506130 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: Schmidt, John I Kinnickinnic, Town of 022 - 1061 -50 -025 CST BM Elev: Insp. BM Elev: BM Description: Q Section/Town /Range /Map No: /Od low 1 cs l 21.28.18.332A TANK INFORMATION ELEVATION DATA 12 i TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L CQ Benchmark 3 fQb, 3 L.J� esk-.— P� Dosing g � Alt. B� ` �b 5.3 9S. t Bldg. Sewer 7 , 6 �p 13. &Y Holding ec;k c St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet .� Septic / 3 $ > 5a 10 .4 Z61 Dt Bottom Dosing ! 7 5d, zd _ Header /Man. 9' 7 3 Aeration Dist. Pipe 3rZy 97. Holding Bot. System �• S� q 6 s(p Final Grade Z • w+ PUMP /SIPHON INFORMATION Sn Manufacturer Demand St Cover ,5. 36 p GPM ! Model Number $J . (5 TDH 1-ift Friction Loss System Head TDH Ft ZS ;W1 �Z Forcemain Length I Dia. Dist. to Well f /55 Z 7 � SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r„ 1 1 SETBACK SYSTEM TO A JPIL JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER Type OfAyyst� /DZ I /Sa IT OR Model Number: # i t �\ DISTRIBUTION SYSTEM Header /Manifold 84 Distribution 1 I o x Hole Size x Hole Spacing � Vent Air Intake • Pipe(s) p.. �J Length 3 Dia Z 1 1-ength . W, (0 Dia Spacing o SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over J IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center („ Bed /Trench Edges ` Topsoil ' ` es No `Yes 7 COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:60/ Zp / O �Q Inspection #2: / / Location: 204 Pine Tree Road River Falls, WI 54022 (SE 1/4 SW 1/4 21 T28N R18W) NA Lot P I& '' A& I•' Parcel No: 21.28.18.332A 1.) Alt BM Description = �� , C &cJ -,., 2.) Bldg sewer length - amount of cover = ' i t ,D1 D� E T1 6W Plan revision Required? Yes XNo Use other side for additional information. 67 �LJ Date Insepctor's S' nature Cart. No. SBD -6710 (R.3/97) / • Safety and Buildings Division County g � 201 W. Washington Ave., P ox 7162 -57 Ltoix Lconsin Madison, WI 53707 2 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 5a (V 130 Sanitary Permit Application a: Number .74 8 R In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide "3' 9 a:34 39 may be used for secondary purposes Privacy Project AddressM different than fling address) I. Application Information - Please Print All Informatio n Property Owner's Na me I Parcel # Lot # Block # (7 t ST. CROIX COU,nITv Q 9 — — S O Property Owner's M ailing Address Property Location C 33Z- \ 2 ` S " 77r _ 1 4, �C� 'k,Secdon _- 1 ✓\ City, State Zip Code Phone Number C x 61 1 _ v ao -119 (circle e) II. Type of Building (check all that apply) � , T �� N; R�E or k c+� �-/. s0b�„ 191 or 2 Family Dwelling - Number of Bedrooms 4 t4,— Subdivision Name CSM Number ❑ Public /Commercial - Describe Use �" , ❑ State Owned - Describe Use tp k /on MD _ ❑City_ ❑Village ATownship of 1l 'yjC III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ❑ Non - Pressurized In- Ground X Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding ank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) S , P _ /Z V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate f) Dispersal Area Requir (sf) Dispersal Area Propos sf) System Elevation �o yon ao 1 7 q s VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units n Concrete Constructed Glass New Existing U / k 525 Tanks Tanks , � 1 Septic or Holding Tank L � ' h C +/ Aerobic Treatment Unit ✓ Dosing Chamber 7s, VII. Responsibility Statement- I , the undersigned, assume responsibility for installation of the POWTS shown on the at tached plans. Plumber's Na me (Print) PI u be ' s Si gnature MP /MPRS Number Business Phone Number ,� a G SS y 4�s-- �G o Plumber's Addre ss (Street, City, State, Zip Code) VIII. ount Department Use Onl Approved tsapp Sanitary Permit Fee (includes Groundwater Dat Issu Issuin ent Signa e ( Stamp Surcharge Fee) r Given Reason for 'al 7 IX. Conditions of Approval /Reasons for Disapproval _ SYSTEM OWNER: J t 1. Septic tank, effluent filter and ca P e � ,^.. • �'' dispersal cell must all be services / maintained t as per management plan provided by plumber. pp__ II t 2. All setback requirements must be maintained �(r)5 !aye C o to l 4 w s 9 1 as per applic" code I ordilwrAs. (� -ter � a Co L�J owe, o w -�- Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) P PC6T PL _ 9 - -:o S CALE 37tACRE PARCEL ��C /y , 4'w /y, 2C� 4e' k?kl I (� t, nom, 0 0 ac W dC H j t3C Li.! F- 125 D 47 - 5 o__W _iEsER Capc W T,aNK PILYIQK .52 Fi1TERaDU�T COMIIO 4 % pyC. W E(L t7D� 2" PORCE MAIN v s s i Sl - - p - - O F 7 - - - PCOT S ► "_ ��, 37±ACRE PARCEL �- 20 4b' + go 0 0 ac W 0� L U,,,� 4Y F— _► 2so /- 750_ - _W _I E SE R g .52 Fi1TFR C poLrL aK OMi3p Gt_ A R o 4 +prc 4 ?FVOSEP will. - --170' 2 fORCE MAIW o Dr►vt v y i i i ' St i W isconsin Department of Commerce S IL ALUATION REPORT Page of Division of Safety and Buildings In 85, Wis. Adm. Code County Attach complete site plan on paper not less 81/2 x 11 e. Plan must S% r Include, but not limited to: vertical and horizontal_ j{ polnt (BM), direction and Panel I.D. percent slope, scale or dimensions, north arroran d loc a tion ` and dicta to nearest road. Please prl tall Review b Date Personal Information you provide may be u (Privacy La d for secondary purposes (Pr s. 15.04 (1) (m)). I Z1 6 �o Property Owner P P ® _ �ovt. roperty Location 2 �p �} Lot 1/4 /4 S T N R E Property Owners Mailing Address ST t # Block Subd Name or CSM# 426 S. Fork - en$ih City State ZIp Code , Phone Number / (3 City [j Village_ ®T wn Nearest Road J50 59 �4 !S G w e re I p1h Tre g New Construction Use; ❑ Residential / Number of bedrooms 3 Code derived design flow rate GPO ❑ Replacement ❑ Public or commercial - Describe: _ Paront material TJ Flood Plain elevation if applicable (11 1t 1 _ ,, aand�recommendadws: 7 s7� � ✓'7101 -01 Ott (' o h t V— c1 _ 9 5 0 5 LO t *^ �r M Ih'? o V-/ San � Boring # ❑Boring ✓ a C] 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 I 'Eff#2 0,7 '2 Boring # C] Boring ❑ Pit Ground surface elev. qq ft. Depth to limiting factor in. So A 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 Y l SI 6�X m I C s 1 v' 4 0,? �Fsk I cs t L, D a -04 t o s y I 1-4k - t C a 1 Ora 411 Effluent #1 = BOO > 30 220 mg/L and TSS >30 150 mgA. ' Effluent #2 = BOD < 30 mg/L and TSS <— 30 mg1L CST Wme (Please nn)t I a tU CST Number Uewl P lk.%- a Address Date Evaluatio Conducted Telephone Number property Owner GfYI s d� parcei ID it _ Pago a _ of F37 Sorkv # ❑ Boring ! `� — .� 0 pit Ground surface elev. _ R. Depth to IintiUng factor Soil ApOl icaticin rRate Horizon C firth Dominant Col Redox Description Texture Stn,chre Consistencs F nry Roots GPCff! In. Munsell Cu. Sz. Cont. Color Gr. Sz Sh. - MI *Eft#2 _B a " (w v 8-I o a 71 s af s�K r�. v ©. ' �Jr a 2 ---- sb/ C ❑ Boring # r Bodn4 pit Ground surface alay. tJ _ R. Depth to flmitMg factor I^ Soil Application Rate Horizon Gepth Domirtartt WI Redox Desc^otton Texture Structure Consistence Boundary Roots GPDNF gin. Munssti Cu. Sz. Cont. Color Gr. Sz. Sh. *Eft 'Eff#2 I f j i ❑ gyrin a Scnng Ground surface elev. _. _, ____` R. Depth to limiting factor in. ❑ pit Soil Rate Horizon Depth Dominant Colod Redox Description Texture Structure Consistence Boundary Roots QPCW M. Munsed Cu. Sz. Cont. Color Gr. SL Sh. �E!t#� 'Eff#2 i y. f Effluent #1 s BOO, > 30 < 220 n91 and TSS >30 _< 150 mgfL ' Effluent #2 = BOD, S 30 mgfL and TSS 5 30 mgfL 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. S8C•i330(R.6�W1 i � r - PLDT P LA H �� 3OF_ T _ J V4N 5 CHMIDT' 39, 9 C PAoecFL- - 5CAtt ��vzr Rd N a N N� .Q 92 FL. •6 � _ 5 a x l 6 00. rPg� wj5�cv P057 G�nwa em Z � p-�t� .�M"� sake �� p6s* EZ,loo,0 y F2.1oa ao 6 f a Safety and Buildings + 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 s c O n s' n www.commerce. n sin.gov www.wisconsin.gov D of Commerce Jim Doyle, Governor Mary P. Burke, Secretary March 28, 2007 CUST ID No. 220554 ATTN. POWTS Inspector CARL P HEISE ZONING OFFICE BETTENDORF EXCAVATING ST CROIX COUNTY SPIA 285 CTY RD SS 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/28/2009 Identification Numbers Transaction ID No. 1382689 SITE: Site ID No. 723638 John Schmidt Please refer to both identification numbers, Pine Tree Road above, in all correspondence with the agency. Town of Kinnickinnic St Croix County SE1 /4, SW1 /4, S21, T28N, R18W FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1124022 Maintenance required; 600 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System: EZ -Flow Mound Component Manual, (N.6/03), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. C • The observation pipes must be located at a junction point between two EZ -Flow products so as not to create P"p? separation of the bundles within a product. Of EtC • The void at the manifold is to be filled with aggregate. • The changes made in red to this plan on 3/28/07 by this reviewer were acknowledged and approved by the SEE coRE system designer. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. CARL P HEISE Page 2 3/28/2007 • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 11 , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. . t . 285 COUNTY ROAD SS EXCAVATING � RIVER FAL 500- 828 -3723 '"'°� 715- 425 -6200 715 - 425 -8466 FAX TITLE SHEET MOUND SYSTEM FOR BEDROOM RESIDENCE LOCATED IN THE N S Y. OF THE N W %. OF SECTION, , T_-2B N, R W; TOWN OF k',ry ro +e ST Cra' ,c COUNTY, WISCONSIN. INDEX PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 SYSTEM MANAGEMENT PLAN PAGE 3 OF 7 PLOT PLAN PAGE 4 OF 7 PLAN VIEW -CROSS SECTION PAGE 5 OF 7 DISTRIBUTION PIPE LAYOUT PAGE 6 OF 7 PUMPING CHAMBER CROSS SECTION PAGE 7 OF 7 PUMP PERFORMANCE CURVE PREPARED FOR RECEIVED -4 26 s FOR DR . HU950N , W,� . 5101c MAR 2 6 2007 SAFETY &BUILDINGS wMrrlly PREPARED BY � VED OF COMMERCE cESPONDENCE CARL P. HEISE CST/MPRS 220554 This plan has been prepared in accordance with the Mound Component Manual SBD- 10691 -P and the Pressure Distribution Manual SBD - 10706 -P. a. !P 2 ol r:} Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tan use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. ' Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. ...�.- -- mil"iiLL®rmi SO y -.. ' • .... .. •••rr _. .. • ^ �,��y��,.,�t.�. •... ,J fro � ,reJ.. «...�.. ,sTT�...�y.TM .. 7. .:.r -_.•. *t- • Co ��N LylaL�rlJdj •�: .��� ' V iYft+/�.iYM/4YVa� �_ ., '� .'• .. ' • Fill Matmial Finish Grade C33, fine aggregate) i� TMed Ara Slope`- Force Main .Crass- section of a me and system • :. _ __ . « Using EZ Flow product # 1203H -- - 0 f= J • 3(0 C E ress Section Of A Mound Sy stem Using F �� A Bed For The Absorption Area G O A 6 Ft. 5 10D Ft. 1 _lam Ft.- Y. 10 Ft. Alternate Pcsiticn L 12p Ft. cf u 2— Ft. • Force Main L 40bstrvction Pipe -•� e — ` ' —K-� A Wi'n t o - - - -- -------- - - - - -- ------------------ - - --�1 Fo �`' 3 - - -- - - ---� From P p Oistribvtion Bed of Y 2 Pipe Orcin Rock • _ I �M 4 Observation Pipe Permanent. Market • _ - Pipe or Rods * 4 pioft v ;trr ot. i,lound Us a "B e "Fof Ttse a x--: bsorptlon . � I a - ;t7rYp!Y+f•iRL.: :F� - ..K:.`$Si.: -Y7.r - A ?� 4 a+. • a ... .. •, tinf�r. � � _ ��� . raj: �•... a 4r,r "•�t_DERS INC. 713 42 • Dtatribution Pipe Layout Pag 5 of Place the holes at the bottom of the distribution pipes at equal spacing, Remove all burrs from tae pipe and holes. F.xtcnd the end of each Late, - up with the use of long twin or 45° fittizg to a Foiat within si- inches of the Seal made, Te•'zinate the e - of the Iatera?s with a valy¢ threaded plug. Provide ace:ss fora f aI e for the v i ' 'wed cap o. &' a. , e, tlzseaded cap or tarcadcd p 1CR, t_ Pi k: 714 C. pvC lateral Msrifol� 1ZV C tatarnl r Y i x x!Z xa x z 31 14 tncth _ _ lrttrlll.tncth - P Oisl:iburton 'ne PI. rJ V\ O—_•_ I I DRILL 9 HOLES AT 12 00 0 CLO d- / AT 6 a'CLOCK + RFPEAT PMTFRk Hole Diameter inch S- -i -- - Ft . e -; Lateral _ inch(es) X--16 Inc' Manifold " Z inches Force Main " inches #of holes /pipe - Invert Elevation of Laterals _J 7 , 0 Ft. G.P.M. Page /o Of-�— SEPTIC TANK &•PUMP CHAM CROSS SECTION AND SPECIFICATIONS 4" VENT PIPE 12" MIN. ABOVE GRADE & WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE T WITH CONDUIT MANHOLE COVER FINISHED GRADE W/ PADLOCK & WARNING LABEL y + _� -4" MIN. 18 " I N . 6 " MAX. INLET WATER TIGHT SEALS GAS - Fj TIGHT i �1 \/APPROVED A SEAL , JOINTS WITH APPROVED --L- ALM APPROVED PIPE PIPE — ON 3' ONTO C ` SOLID SOIL PUMP OFF ELEV . e �'LFT. v.r � OFF '''' RISER EXIT D PERMITTED ONL IF TANK MANUFACTURER ?" �5'Q_ HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS S EPTI 1C DO / SE TANK MANUFACTURER: W f EF EK CQID NUMBER DOSES PER DAY: TANK SIZES SEPTIC /250 GAL. DOSE VOLUME INCLUDINGt��.� DOSE GAL. FLOWBACK: ��7, 71 GAL. 1 7. `TQ ALARM MANUFACTURER: S ST I LFC7 CAPACITIES: A = i ) INCHES = q 3 _ GAL. MODEL NUMBER: 101140 yrq, c/g SWITCH TYPE: , B = 2 INCHES = GAL. q - 7 PUMP MANUFACTURER: G 05)_LF (o .wi C =,} INCHES = GAL. MODEL NUMBER: _ SWITCH TYPE: ���Y 7.37D = _ INCHES = 121,5?- REQUIRED DISCHARGE RATE 44 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . )0 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . . 7� FEET + 170 FEET FORCEMAIN X L pij FT /100 FT. FRICTION FACTOR �HL FEET EET 15 T.OTAL DYNAMIC HEAD = T INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DTTT .!!7 3 • n i PUMP c Y t PERF M EFFLUENT S i OR r-- Model 185/41 uld not be subjected to less than ELM M et TDH. 1 ■� ■ ■A ■MEN ■■■■■ �\ ME MENNEN ■■ NOMEMEN ■� \► \11 ■ ■■■■■■■■ III MENEM 0 ME ■■■N ■► �► 11. ■■■■■ ■n ■��11► ■■■■■■■■ \ MOMMON ►. 1111\ . ■ ■ ■■■■ \. 11111 ■ \�� ■■■■■ ►. W I ki111■■ ONE WE S ■ ■■ 1i11 \■ \ \■ ■ ■■ ►. �1►11100 ■■\\N ■■■ ►S` \� 0 1 ,1 1 011 \MENNEN 010111 MO B■■ 1 10 ENEWIME No ■ ■■IR 1110, W O■■■ n ♦ . 12 i _ Apr 12 07 12:30p John & Melinda Schmidt 17153817176 p.l nkW: ur►: iY b YA 715 386 4686 0 001 ST. CR OIX COUNTY SEPTIC, TANK MA 4TENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Own �fh. • ✓Cam+ -+wc �� Mailing Address �p s U ^ t� k y ✓� 44 L5 6, Property Address 0� Q 't_ J .�L b e- (Verification required from Planning Sc Zot Lig Dcpurtmcnt for new construction.) City /State P l & )l IAZZ Parcel Identification Number U0 0 T,EG, L DESCRT.TL'TION Prop trty Location '' /4 , S � % , Sec - �W, Town of � � L Subdivision , Lot n _^ Certified Survey Map # � T , Volume , Page rt Wsrra>gty Deed ikf voIullae _ . Pa�c Spec house ycS no Lot lines identifiable yea 110 SYSTEM MAINTENANCE AND OWNER CERTIFICATION in use and mainteinancv of your septic syslum, Could result in its pr-etna failure to handle wastes. Proper trlaintcnance consists ofpurriping out the septic tank every three years or sooner, ifneeded, by a licensed pumper. What you put into dic system can affect the function of the septic tank i a treatment stage in the waste disposal system. Owncr maintenance rc;pon.5ibilities arc specified in }Comm. $3. Arid in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner allrce5 to submit to St. Croix County Planning &: Zoning Dcpatffmcut a cCttiticarion forriL signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a. JJcensud pumper verifying that (1) tike on -site wastewater disposal system is in proper operating; condition and/or (2) after inspection and puaTlping (if neccrsary), the septic table is less than 1/3 frill of''sludge. Uwe, the undersigned have react the above requirements and agree to maintain the private scwaae disposal syslenl with rue standards set - forth, Mersin, as Set by the Department of Commerce and the I)epartmesit of'Natural Resources. State of Wisconsin. Certification stating that your sesptic system has been niaintained must be eurnpleted etnd returaed to the St. Croix County Planning cC 7..oning '.15cpartcnent within 30 days of the three year expiration date. Uwe ccrtifv that till -'tatcme:lrs ou this form are true to thin best of illy /our knowledge, t /wo aw/are the owmcr(s) of the propetry dcs e aboby virni f at t d recorded in Register of Deeds Officc. _ /e / *�7 IGNATURE OF AP L,T(JANT DATE Any ill1orniation that is tl)isrepresentnd resUlt in t1}c sanitary permit being revoked by the Planning & Zoning 0cpartalenr."�" Iaclildc with this application a recorded warraaity dwd frorn the fit gister of Deeds Office and a copy uCthc certified survey map if reference is mado in the Warr: -urty deed - (RCV. 08 105) 844D 03Es KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST. CROIX CO., WI WAPIUNTY DEED RECEIVED FOR RECORD Document Number Document Name 12/05/2006 01:00PH WARRANTY DEED EXEMPT # THIS DEED, made between Maralee M. Anderson, a single person and Michael E. McLaughlin, a single person TRANS FEE: 1 TRA FEE: 81010..00 0 ("Grantor," whether one or more), COPY FEE: and John D. Schmidt and Melinda A. Schmidt, husband and wife; CC FEE: as Survivorship Marital Property PAGES: 2 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more Name and Return Address space is needed, please attach addendum): scenic T i t le and Abstract In 220 Locust Street Hudson, WI 54016 See Attached 022 - 1061 - 50-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Restrictions, Covenants, Easements, and rights -of -way of record. Dated November 29, 2006 �Q3GSX.Qf (SEAL) (SEAL) Maralee M. Anderson Ichael E. McLaughlin (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. ST. CROIX COUNTY ) Personally came before me on November 29, 2006 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Maralee M. Anderson, a single person and Michael E. McLaughlin a single person (If not, nown to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.0 - «++""'" """' ent and acknowledged the same. Brian Scott Eckh6 THIS INSTRUMENT DRAFTED BY Notary Public Robert A. Wertheimer Attorney at La State of WisCOMM Scott Eckholm 522 2" Street, Hudson, WI 54016 otary Public, State of California My Commission (is permanent) (expires: 9 -11 -07 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2 * Type name below signatures. 1 of 2 L Rpr 12 07 12:30p, John & Melinda Schmidt 17153817176 p.3 A Parcel, of lazed located in the SEA of I the SW� /. of Section 21, T28N, Rx8W, Town Of aZinnickinnic, St . Croix County, Wisconsin described - as follows: Commencing at the Silt corner of said Section 21; Thence N 88 °38'06" W (Bearing referenced to the South line of said Sw V, of Section 21, assumed to bear N 88 'W) 33.02 feet along said South Line of the SW % to the point of beginning; thence N 88 °38'06" W 1265.16 feet along said South line of the SW 3 /; thence N 00 °12'15" W 1319 feet; thence S 88 0 34'15" E 1251.30 feet along the North line of said SE '/. of the SW thence S 00 ° 48' 28" ,E 1318 feet along the West tight -of - war line of Pine Tree Road to the point of Begi i our Hw Awl um al*w 90 / 0 / Zt « sTMK 901tLl £� � -/� 1aIWH78 daNIl3W 9 NHor tu N91S393 I 9NlAJVSCl 309aNYS Lolsoito 9oi0titt i � :gyp ��o! 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II ° LU If s §ht Y x M g W I I I x * I .PA .PAI — � b a 1 a , iz .PZ A I I gu f I JA--� m Lk 1 I IC a s I n k .PAL 4At A:Yt O.OL fv II I I ¢ b x • .n I > r . 1-At in I I b w II q II II h � . d�kY Parcel #: 022 - 1061 -50 -025 04/13/2007 08:27 AM PAGE 1 OF 1 Alt. Parcel #: 21.28.18.332A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/16/2006 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner O - SCHMIDT, JOHN D & MELINDA A JOHN D & MELINDA A SCHMIDT 426 S FORK DR HUDSON WI 54016 -8042 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 21 T28N R18W PT SE SW COM S1/4 COR Block/Condo Bldg: SEC 21; TH N 88'W 33.02 FT TO POB; TH N 88'W 1265.16 FT; TH N 00'W 1319 FT; TH Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) S 88'E 1251.30 FT; TH S 00' E 1318 FT 21- 28N -18W TO POB Notes: Parcel History: Date Doc # Vol /Page Type 12/05/2006 840036 WD 07/23/1997 1092/440 PR 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 12/18/2006 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 EROSION & SEDIMENT CONTROL PLAN Parcel ID #21.28.18.332A Address: 204 Pine Tree Road., (Kinnickinnic Twp.) Owner(s) John Schmidt Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and /or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be excavation for the driveway and house foundation, as well as any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on any exposed soils will prevent erosion. Schedule application of seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement off site. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. Do not allow diverted runoff to be directed onto neighboring properties. (Refer to specification sheet for temporary diversions provided by county). 4. If sediment cannot be contained on owner's property with temporary diversions and vegetative buffers, then installation of approved sediment control products (straw wattles, silt fence, etc.) will be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and /or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & sediment control installation. Prepared by: Ryan Yarrington POWTS Inspector #683475 Owner acknowledgement of ESC Plan requirements: _/_/2007