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Home My WebLink About018-2001-16-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St, Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 633332 State Plan ID No Personal information you provide may be used for secondary purposes [Pnvacy Law. S 15 04 (1)(m)i Permit Holder's Name Brian & Anita Borgen Gty Village Township 1 Parcel Tax No TOWN OF HAMMOND 018-2001-16-000 I. -I , TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION I,.r vc <) r III A`d c TANK TO P/L WELL BLDG Vent to Au Into e OAD Septic 4 01 � � � , Dosing fs ` �t Aeration Holding PUMP/SIPHON INFORMATION Manufacturer 1 `"�� Demand 1 GPM Model Number 2� TDH Llft Fnclio L s s�_Syst m H d T ,sFl Forcemain LenQLh I Uis,to wen ,r , ELEVATION DATA OIL vn BEDlTRENCH DIMENSIONS Width �r Length _ �, 3 No Of Trenches 2 PIT DIMENSIONS NPits o Of Inside Die Liqui Depth SETBACK INFORMATION SYSTEM TO ,� P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Man urer Ty Of System , iA I I Mode m i I Kli I IUN STJ I 17A.. .)"o•. L..t�S..i... - - Header/Ma Lengthisr old 1 „ Oia t 1(y Plstents' bon p IIl��yy w I x Hale Srze� !� I Le I .Hole Spacing t Vent Vent to Au Intake gth�! ia_1Spa mg�_ • F�� O 1 JUIL CCJVEK E Pressure Svstems Only xz Mound Or At-irradu Rvetnm¢ nnh. v h enter L� Depth Over Bed/Trench Edges �a Depth f Topsoil S �` I Z rx Seeded/Sodded ,�./ 19[I Yes [ No rof Mulched ,.�/ AI Yes No COMMENTS: (Include code discrepencies persons present etc ) Location: 1944 94TH AVE 1.) Alt BM Description = rUY1nP 2 ) Bldg sewer length = 36 1 - amount of cover = > 117. " Plan revision Required? ❑ Yes No Use other side for additional rnformatl n SBD-6710 (R 3197) Date Inspection #1. Inspection #2 -�') U \l k� 4 ('1 uAu n �'y,`�� w V0 \�p,l1 . l�Jj ) G I , YIN anal - )Q9 County Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 St Croix Sanitary Permit Norther be fined Co.) rr •. -- Madison, WI 07-7162 (to inby Gl t+i•= Z� 633331 ' irk 1 Sanitaery�a ermit Application State Transaction Number In ecco� ce with SPS 383 2112), Wji , ) km. ode, submission of this form to the appropriate govern n rs regw dglo�y4taitiyY a S ote: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the De a ety and Professional Servies Personal information you provide may be used for secondary ' purposes in accordance with the Privacy Law, s 15 04(1)(m), Stats 1. Application Information - Please Print All Information T Property Owner's Name Parcel k Borgen 13 ?-I s Aj li r Olt- 018-2001-16-000 Property Owner's Mailing Address Property Location 1503 Sequoia Lane Govt Lot 16 NE SW /, Section 14 City, State Zip Code Phone Number New Richmond WI 54017 262-728-1955 (circle one) T 29 N; R 'r 'M W 11. Type of Building (check all that apply) Lot q Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms 16 Block t / Forset Ridge Estates a ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM ❑ Village of Number -�--' ® Town of Hammond 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) `� ew System y El System ❑ Treatment/Ifoldin Tank Replacement Only B P Y ❑ Other Modification to Existing System (explain) g Y D ) B. ❑ Permit Renewal ❑ Permit Res ism. ❑ Change of Plumber ❑ Pennn Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner u f IV. Type of POWTS System/Component/Device: Check all that imply — — ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade 'bra _ "" J Mound <24 in of suitable soil I ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Applieprion Riate( 0 Dispersal 5rea Requ d (sf) isperod Area Pr (sf) tern len / 450 `(/ (- z•f 2� .`8 �ti oi.so VI. Tank Info apacrty TotaL Manufacmr Gallons Gallo Pol Lock 525 y y ee 2 New Tanks Existing Tanks a — U a Septic or Holding Tank Weser 1000 1000Weser 1000/600 combo x Dosing Chamber Wieser 600 600Wieser 1000/600 c2MILp x V 11. ResponsibilihStatement- 1, the undersigned, assume responsibilih for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signs MRTIPRS Number Bmmess Phone Number Countryside Plumbing & Heating /P2 �'�� 715-246-2660 Plumber's Address (Stre4 City, State, Zip Code) 321 Wisconsin Drive New Richmond WI 54017 VIII. Coun /De artment Use Only Approved ❑ Di v Permit Fee Date ssu Issum Agent Signature T 110 w n Reason for enrol IX. Conditions o pprov asovsiorBisapprotral 3) � t�a..�l'�'^S �A•� &-%a- / �h SYSTEM OWNE - y .{ f 1 Septic tank, effluent filter and t^^'> k dispersal cell must be serviced I maintained 10 p - as per management plan provided by plumber. T / I 7V �O�. '•/ . All setback regwrernents must be moin'ained as per c'JU I'.,,J:, I,; GJ—Atlftkhlto dhmdlete plain for the system aad submi to the Coumt- only on paper not less than 8 irz s 11 iaehes in Simi 3 7 SBD-6398 (R. 1 1 / 11) t 2l0 IOrest Ck�AA � 5f�itS f1`I 'OpY � G 94, I- — a POP /00 3 gNoam do,^e- gY44 Rill � �oK�Ov • e3 �.- ' oPVG 13 f i aVt a.ndl fin,}a `�D fgR`1 la �q*cal l i� oIB-2�1-1L'o� Lot Il,. 7 2q 0 R 17W, gyp' PVC ��ofi LetL,,,L loo, �icncl, k laa,'" I- COPY April 17, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-04-17 Plan Review: PWTS-042100561-C PAUL R KOEHLER 321 Wisconsin Dr New Richmond WI 54017 SITE: Brian and Anita Bergen 1944 94th st Hammond Wi Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: Description: 450 GPD-New Residential GSF Mound Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http Udsps wi gov/programslindustry-services www wlsconsln gov Tony Evers - Governor Dawn Crim - Secretary CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE ELJEN GSF Mound Component Manual — May 2018 Version The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10). Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Items- POWTS Design Approval • This system is to be constructed and maintained in accordance with the approved plans, and the "Elgen GSF Mound Component Manual- May 2018" • Elgen requires the pressurized lateral to be sleeved in 4 inch perforated pipe with the lateral orifices installed pointed upward w ith every 5" orifice point downward to drain the lateral. • Due to the confusions related to the Soil Evaluation Report. Ked Grab nd Use and Zoning Department and this reviewer concluded that a basal loading rat f .4/.8 gpd/ft2 be used. • Fence off dispersal area prior and during construction to protect and avoid disturbance, compaction and use of the site. • With new construction, it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or of site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Verify property line location. • Verify neighboring well(s). • Provide surface water diversion around the treatment tanks and mound dispersal component. • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS) in accordance with SPS 383 and the approved management plan • The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or secured except for inspection, evaluation and maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the pOWTS. Sincerely, 114f, Mark S Finger POWTS Wastewater Specialist, Division of Industry Services (608)574-1189 mark.fineer@wi.gov GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Project Name: Borgen — Ten Mile Constrution Owners Name: Brian and Anita Boroen Owne's Address: 1503 Squia Lane New Richmond Legal Description: Ne 1/4 SW 1/4 SEC 14 T29N R 17W Township: Hammond County: ST CROIX Subdivision Name: FOREST RIDGE ESTATES Lot Number: 16 Block Number: Parcel I.D. Number: 018-2001-16-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 GSF mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 filter specs Designer: PAUL KOEHLER License Number: MP 225410 Date: 3/17/2021 Phone Number: 715-246-2660 Signature: Designed Pursuant to the GSF Mound Component Manual (N. 08/16). and SSWMP Publication 9.6 Design Pressure Distribution Networks for STSAS (01/81) GSF Mound Version 1.0 Page 1 of 8 �a �rJ GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Site Information R Residential or Commercial Design 450 Design Flow (gpd) 7.0% Site Slope (%) 100.00 Installtion Contor Line Elevation (ft) 14 Depth to Limiting Factor (in) 0.8 In -Situ Soil Appliction Rate (gpd/ft2) Distribution Cell Information MB43 Unit Used 8 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 2.0 Dispersal Cell Design Loading Rate (gpd/ftz) 2 Influent Wastewater Qualtity Distribution Information Center, End or No Manifold (Pump to Gravity) 4 Lateral Spacing ? Number of Laterals i Orrifce Diameter (in) (e.g. 0.25) Number of Bedrooms (optional) 100.00 Contour Length Available (ft) 33 = Dispersal Cell Length (ft) Are the laterals the highest point in the distribution network? Enter Y or N If N above, enter the elevation ft of the highest point. 3 Estimated Orifice Spacing (ft) = 13.2 ftz/orifice ? Forcemain Diameter (in) System Head (ft) x 1.3 illTotal Vertical Lift (ft) —�� Friction Loss (ft) Dynamic Head (ft) Project: Lateral Diameter Selection in. diam. o lions choice 0.75 x 1.00 x 1.25 x 1.50 x X 2.00 x 3.00 x Se tic Tank Information 1 OR Septic Tank Capacity (gal) WIESER IManufacturer Dose Tank Information 600 Dose Tank Capacity (gal) 11.82 Dose Tank Volume (galfin) WIESER Manufacturer Borgen — Ten Mile Constrution Does the forcemain drain back? Y� (ft) a 35 Forcemain Drainback (gal) 92 5x Void Volume (gal) 27 Minimum Dose Volume (gal) 13 System Demand (gpm) Manifold Diameter Slection in. dia. options choice 1.25 1.50 2.00 X 3.00 Gallons/Inch Calculator Total Tank Capacity (Dal) Total Working Liquid Depth (in) gal/in Effluent Filter Information POLYLOCK Filter Manufacter 525 Filter Model Number Page 2 of 8 Mound Plan View rvivul iu wrnyvnrrn uuriensions A El It L D 22.00 n G 20.50 ft J 17.23 ft W 28.43 ft 264.00 (ft2) Dispersal Cell Area 699.68 (ftZ) Basal Area Available 13.64 (gpd/ft) Linear Loading Rate 3.30 (ft) 1110 B Obs. Pipe Placement Finished 103.09 ft Grade (:G JH ++:�^T��2i♦♦. ...... tN�. 102.09 (ft) F ♦+♦T'A'' Dis ersal Cell ts+i, Lateral In 101.50 ( ♦♦ n,,, : p ♦+!Iiliiiti"_ ' 1ii, Elevation Dispersal Cell i+�T;i. �: l! i t . r,. :.mf ::,.,,e;♦ Elevation �hsr�yil .,ice.,.,. ;:(� Countour Shading Key 1 Topsoil Cap 2 Subsoil Cap O/W ASTM C33 Sand Tilled Layer GSF Media 7% Site Slope �(D a o � 2 ft H/ O m m c h � st O 0.5 ft Typical Dispersal Cell See Page 5 Geotextile Fabric_ f-1 F L I L! G See details on page 4 for number, size and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Borgen — Ten Mile Constrution Page 3 of 8 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below • = Tum-up w/ball valve or cleanout plug Z '1st orifice located at Z �--X Onffices point up ex /i 5lh one points down for S `dralnaga. PAII main connection via tee or cross to manifold at any point. Laterals & force main of PVC; Sch 40 rals Identical with omfce equally spaced. (per OOMM Table 84.30-5) Numbers of Laterals Lateral Diameter Lateral Length (P) Lateral End (Z) Lateral Spacing (S) Lateral Flow Rate System Flow Rate 2 Orifice Diameter in Orifice Spacing (X) ft Orifices per Lateral ft Orifice Density ft Manifold Length gpm Manifold Diameter gpm Forcemain Velocity Pump Off Height Tank Information 1.5 31.255 0.74S 4 4.119256 8.238513 30.51 Dose Lcddng corer vBh wa in9 _ --- iabd and looking drAm, and 9ecblcal as per NEC 300 sealed wateftO and Carm 1628 VAC -. — --: 41n. mn Dsemned -y - --_ 1, Plwnat, Tank cgrpmdt is prgN Ay vented W IESER Capacity, 1 600 Volume 1 11.82 Manufacturer Gallons gal/inch Dimension Inches Gallons A 33.8410668 400.0014 B 2 23.64 C 2.92035456 34.51859 D 12 141.84 Total 50.7614213 600 V— A B r C —T Mr. r Betting under molt Alarm Manufacturer SI ROMBUS Alarm Model Number I PS PATROL Pump Manufacturer IGOULDS Pump Model Number _ _ -E=TEl"Ofiq Pump Must Delivery 8.238513 gpm at 19.35764 ft Forcenoh dfoF deNm � Aerp effdndkn (14 89.3 Dose lark deiaeorn (it) — 88.3 TDH Project: Borgen - Ten Mile Constrution Page 4 of 8 GSF Distribution Cell Media Layout ®Cell Width (ft) Sidewall to Lateral (ft) a FT WDE CE COM ON Distribution Cell Cross-section Arrangements Drag appropriate drawing to space below. 8ftWide Is11,:- > `B43�. [f 1�-' -,B43 nd ASTM C33 Sand/Mound Sand A42 43 Module Lateral Lr Turnup (contained in Turnup Enclosure) Distribtion Cell Pland View Layout - Typical 8 Cell Width - A (ft) 33.00 Cell Length - B (ft) 8 B43 Modules Required per Row 16 B43 Total Modules Required End Connection Later Layout Diagram Drag appropriate drawing from left to space below. FORCE WIN �✓. 'Y �;�f `�Lmt -X Project: Borgen — Ten Mile Constrution Page 5 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Phone POWTS Regulator's Name Phone System Flow and Load Parameters Design Flow - Peak 450gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BODS 30 mg/L Septic Tank Capacity 1000gal Maximum TSS 30 mg/L Soil Absorption Component Slze 264 W Maximum FOG 10 mg/L Maximum Fecal Coliform 10E4 cfu/1D0 mt. Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Frequency Inspect and/or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to the standards, have a watertight cap, and are secured in a as shown in the Eljen mound component manual. 2. Dispersal cell media conforms to Eljen products approved for use with the Ellen Moon Component Manual approved August 2016. Ellen media is covered with the manufacturers geotextile fabric. 3. All gravity and pressure piping materials conform the requirements in the state code. 4. Tillage of the basal area is accomplised with a mold board or chisel plow. S. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail 6 - 8" DIAMETER LAWN SPRINKLER FINISHED GRADE LATERAL ENDS AT LAST 4' PERFORATED PIPE ORIFICE WHERE VARIABLE 4^ ENE LENGTH CLEANOUT BEGINS CAF DISTRIBUTION LATERAL LATERAL CLEANOUT PLUG J—'l TWOLONG45 DEEP 90GREE OR BE ///`_TWO 45 DEGREE BENDS SAME DIAMETER AS LATERAL Project Bergen -- Ten Mile Constrution Page 6 of 8 Mound System Management Plan General This system shall be operated in accordance with SPS 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals Eljen Mound Component manual August 2016 and SSWMP Publication 9.6 (01/81)] 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 SPS 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. 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 113 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 tank use by the Department of Commerce. 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 Svstem 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 as protection from freezing. 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. 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(s) 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 absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project Page 7 of 8 IPb=,1 fool 71"IVW' -vw;s t LI � 0b7J. irl"SMS ."T3m -�r-r�z-spa►bcl I pa Wb i 1140 a VAPOIpg _ b� �YSS , fd6 c�j L 33.02 [ 83.9 cm 7 _ 20.71 [52.6cm1 _ _ 4" (10.16 cm) BALL HOUSING TRAVEL FILTER CARTRIDGE MATERIAL -POLYPROPYLENE A — 5.78114.7cm1' MATERIAL -FILLED POLYPROPYLENE -- — JL - -- O `� 9 gr - -''pnt I (i 19) N(�1,��tl�{11i�94'I. Mu6�ASi3:aNFP'i 6 9,14n,i?sidll4��-1 ll� 1�111lVYIIIII'IIIIIIIIdf1�11Pi�lii11119VdlIIG 11111i1111K,H 111111HIIIII��I�dlll�l�i'IIIV1Gl?IIIIIII�IIIIII +, 9� 4 o� �i�1� ®1' MIi1o1 ®m 1a11i�1u1i�1ou0i1111oe11o1o111oo11iu; VV 1 ,r nr + " � ri / � � .)�� ;�„; '��Wl�tl:ll,LUG'��u9ltlW�dtdPC!pIIM�1;d}JI9'ddn � l+t 1llltldlY 9lfll t f i + BALL PUSH ROD ' n FACTORY INSTALLED SECTION A -A — A MATERIAL -FILLED POLYPROPYLENE 6.5"(16.51cm) SEALED BALL 4"AND 6" FACTORY MATERIAL -HOPE NTALLED PIPE OUTLET OPTIONAL BUSHING MATERIAL - PVC (FOR 4" THIN WALL PIPE) PART NO.30142-R POLYLOK PL— 525 - 625 CUTAWAY (FOR OPTIONAL FLOAT SWITCH 110 MM. PIPE) PART NO.30142-EUR R GOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '/<' maximum. • Capacities: up to 60 GPM. �1 • Total heads: up to 31 feet. • Discharge size: 1 yr• NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 1041(40'C) cordinuous 1401F (600C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor. • EP04 Single phase: 0.4 HP, 115 or 230 V. 60 Hz, 1550 RPM, built in ovedoad with automatic reset. • EP05 Single phase: 0.5 HP, 115 V or 23 V,, 60 Hz. 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 STTW with three prong grounding plug. Optional 20 foot length, 1613 SITW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ■ EP04 Impeller: Thermoplas- tic semi -open design with Pump out vanes for mechanical seal protection. MMTRc "c n Submersible Effluent Pump EP04 & EP05 Series ■ EPOS Impeller. Thermoplas. tic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ■ Motor Cover. Thermoplastic cover with integral handle and float switch attachment points. ■ Power Cable: Severe duty rated oil and water resistant. CAPAaTY ■ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING Cenaft standards Assadn5on . Fie i UWs49 Goulds flaps Is ISO 9I101 Reylst,,f 10 12 IWA Goulds Pumps ® 2003 Goulds Pumps e fecmive July, 2003 B3871 ITT Industries 4" CAST -A W1000/600-MR TANK SPECIFICATIONS DIMENSIONS: CAST -A -SEAL WALL° 2 1/2" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 69 1 /2" LENGTH: 9'-6 7/8" WIDTH: 7'_9• BELOW INLET: 57" LIQUID LEVEL: 51" WEIGHT: 12,380 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 19.61 GAL/IN (SEPTIC) 11.82 GALAN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL 0 TANK CAN BE USED AS: a o 4" VENT SEPTIC/SEPTIC, SEPTIC/PUMP, OR SEPTIC/SIPHON { -.— COVER: MIX DESIGN #8 (NO FIBER) --- ---- TANK: MIX DESIGN #10 (STRUCTURAL FIBER) INLET - CUSTOMIZED TANKS: -0 T FOR CUSTOM TANKS CONTACT WIESER CONCRETE 2 .. REVIEWED BY h PUMP PAD REVIEW DATE DRAWINGS SUBMITTED SIDE VIEW FOR APPROVAL APPROVED BY: APPROVAL DATE: RE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REDIIIRFMFNTS PRODUCTS NEEDED BY: k' 0 11 �IOF V w nwr Oaprcrrrrt Of CarvrreCe SOIL EVALUATION REPORT Pwa..l_ol 3 Dnw,<, ar S•Nly,ne eVY4fIQ1 1+aomnanu wM Comm 4 Wk. Aem. Coe. APaQr wmylar ane OVn m PaPr nol lqa l M B 112 a 11 a.clraa N atta. plan m.uf C LAry Sri CA IA hlcerda, Oul rolHmeaG b: rW W YW Me+or41 nhnnp pdn (BMJeMdM W p ago 1D. ►� pwCantfropa. ataM ordmMtbra, rlorlh crow, anebgOonaft dlatanwmrwrMlnao, � �66�1 Pdsau print oil lnlem"110n. n/ Deal 1'v.o.M.M•.e•• rww.r.•ww...dr..mnew owns... fRm+.r t..... Isalyyu_ 1pMM f�-'fj,-/� raPMytar+ AR Jr��//�N"/U A !1 A)ii 1/4 spl IN S 1Y T A N R i� OfF1'A' ws 1 5'102211115) 42 .- v..:Pq n.raan.wrwr+rraua6o0.n __ - Coda OaA..d oealon Mo. rw (COU _GPD I O RaQ paC~ P10w or aelrrrm" - Dawtb.: Panwmalww— TIl-LII OL'ruA%j Wwtomd"o�. General odnnmo, R7.a1-I3 z—•Lb ..A rM nmrnnrrraatlenr MDl�A1D SN ST6M �' , / — /Y1 IBC 5r7R 1.O' SAAfi) c ILL .- IN O.S L AbIA14 R11T6 th Si SOI'I 4112` - •� �� f�i7 1 7 J' Pn c+ama Iona wr. ----- — a own 10 bmft factor y52 m .-. 1�-Ls6k ` lforfzon DePDr Dommanl Room Di in. Munyt If o- Z ' 4 2u _ cF. Tomas Snare Cmahlena Saawry Row I��IIIII IrM 40d2m OaPO. In._ Oor•Yr.aM Cal Munaak Red" Teeters sow" Q .S2. ConL Gr. Se: Sh. Roots I GPW 'E&I 1'EMIt ' 11 as m y _toinyI m as s 3 -t L - 3.1 Y S — s 1 Cs b 7.5 V _ in5 Oys Z 5:6 b sct t- Elggn 1I • D . ]D_ mVL ww T8S s7o < 150 nrplL • Eftent M2 • BOO _ 00 mprL arE TSS 130 CSf Name Pippa PNq} &gnmkn CST 0 H t �1STE K 2Z mV`L "*w '9°aa Dar aAlNm CenORyd TAphrr Nunbat W9175 690�'`quE,I�yERPALLS wT 54022 0$--07—OZ 01Siy26-1.11 PLAKMD : 1 f-oZ esr�vt s t. o�• e Brhz2�ry._ 4 ulu (LOT 16) pmwnyo..,.r MACLK S4LAott tr m110111 (P&m)wc, Paoa Z of 3 ®0 o •ems®e�^��e*�.. �� ■ii .:: t..�iai�iiii o ...no ("1:111 Ir Pit a LQW sweeps.w.I01_? _ n Dam to tarowy aedt _ rI.3 _ w tw Nedmn Depth in. DaNtum cob &%~I Redo Denta"m f3u. &. Cam. Ca, Tnpn Slrudura 0r. Sz Sa. Cdubuttea fhandary (!Wa OrQR TO'E!q 1 0-S to z — L 3 -C6 D Z II- It z/t — L s% 0.b - to 3 -20 o OL ' St IU-mCbK,,to s Iff-co Q.5 D. 4 f R sl s31. --jj -1. s Wt4tq S OSj fl S-m 1 N 6 "Aftil 11011, ❑ Dodng S ❑ SOMA ❑ pit • t:lTt nm n . 800, a 70 < 7b M /lK•C-n G(O fT'%`'c'� '. `- 30 mg& ud TSS _< 30 myL z.�. e. The Department of Commeru it or nerd w{rtancc to uws aryl W M need material In .n alterrute fotm.4 pleaac contact the depenmem at ova-aro-j t) I or TTY 608.2644777. o"Int..cn / , / N.B. A 897881 S.F. I i ( i lI P I I /I i f N.f�. 3.90lAc. I I I I i -----LAW � — ,'� , f / �� ,� I 1 / 121423 SFr' y.B: i21423,sF.�- 7 2.fT Ac. fJyAp • \ / , 2.A cc. EL60 is / r .'L I I x 1215.e N.B. 155732 co 58 1204.6 ��/ , , r/ .8. 3:58-A��— — / // rr / t ' P- I 5 210.2 r cy / a Y\_ 66455 /,S.F` ,. vzsl~L- r N.B. K455 S.F`.,�z_ob— _ ';' /` < � - { X \� ~�,,NB 1.53%��/2�4_ ', ' a.-7.`iAC. i L s 1'2409'_JI� 47 `Zq. / 4 - - - N.B. 1.64- _ r�`g/-�•p _ �� -Ar/ 80• RADIUS qqY-` � � N.B. fi$948 S.F. � r ot'iFwa p�i,glC.A� � I cp ~/ / 11 1 --'4 fo N.B. 1 cp ^ �— N.B. 71946 $fir '� q1r —= --� ✓--' — I� N. 1191.2 lip - Q- R 1' lJ 11,1'J O 1 1 N' l 1J u L) LOCATED IN NORTHEAST 1/4 OF THE NORTHWEST 1/4 AND IN THE SOUTHEAST INTERFERE WITH 1/4 OF THE NORTHWEST 1/4 AND IN THE NORTHEAST 1/4 OF THE SOUTHWEST TINT WATER 1/4 OF SECTION 14, TOWNSHIP 29 NORTH, RANGE 17 WEST, TOWN OF IVE S BUT IS HAMMOND, ST. CROIX COUNTY, WISCONSIN. SETBACKS: gown8�i 25D' (UNLESS OTNERWISE NOTED) ■ w � REAR - 25' 1 EACH PARCE TO STATE, E REGULATIONS TO PARCEL, ANY PARCEL ZONING OFF ADVICE. .UNELAIIED-LMCa NORTH -SOUTH 1/4 SECTION UNE ___ __—___ 656.11'-- i — — _ _ — _ _ S 0971b3' E E42.w 1 1 � _ 1 ` J 1 V Parcel 018-2001-16-000 12M/20% 17.63 PM PAGE 1OF1 Aft. Parcel s: 14.29.17.880 018 - TOWN OF HAMMOND Current IX ST. CROIX COUNTY, WISCONSIN Creation Data Historical Date Map Y Sales Area Application # Parmlt It Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner ' MEOENCIY, CAROL CAROL MEDENCIY 674 CTY RD K7 OLPE KS 66865 Districts: SC = School SP = Special Property Address(es): ' Pr" Type Dist p Description • 1944 94TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres; 1.560 Plot: 1961-FOREST RIDGE EST V30 018/03 SEC 14 T29N R17W PT NE SW FOREST RIDGE BlooJeondo Bldg: LOT 16 ESTATES LOT 16 (1.560AC) Tract(s): (Sac-Tvn-Rng 40114 1601/4) 14-29N-17W NE SW Notes: Parcel HNtory: Date Doc d Voupage TWO D&07/2003 734312 2352J286 QC 08107/2003 734309 236MS3 WD 01114/2003 705829 9/46 PLAT 2004 SUMMARY SRI M Fair Market Value: Assessed with: 271,200 Valuations: Description Class RESIDENTIAL G1 Totals for 2004: General Property Woodland Last Changed: 07/162004 Acres Land improve Total Stets Reason 1.560 35.000 0 35,000 NO 1.560 36.000 0 35,000 0.000 0 0 Lottery Credit: Claim Count: o CertiOcation Date: Batches: Specials: User Special Coda Category Amount Total Special Aasessm Special Charges Delinquent Charges 0.00 00 0.00 L . HOLLISTER'S SOIL TESTING MAR 0 4 Mary Jo Hollister 2��4 W9875 690m Avenue River falls, WI 54022 L_TCj2)ON- (715) 426-1775 20N0 OFFICE St. Croix County Zoning Pam Quinn. Zoning Specialist 1101 Carmichael Road Hudson, WI 54016-7710 RE: Soil Evaluation Reports for forest Ridge Estates. Town of Hammond Dear Ms. Quinn, After our meeting on February 131^ and further review of the reports that were submitted here ore the findings and facts: 1.) Loh 4, 5, 6 and 28 will need to be extended to allow for the 0.2 loading rate for longer mound systems. We have agreed to do this with hand borings that will be completed as soon as possible. The position of the driveway for Lot 30 can be worked around. A Fcensed plumber has reviewed and stated that lots 11, 13, 14, 17 and 18 have enough area for a system. 2.) As per our discussion, driveway locations were not an issue at the time the tests were completed as it was requested by the Comfy to complete these tests before approval. These wit have to be addressed at the fime the driveways are located. ALL mound areas were staked and taped as requested previously. 3.) Bevations were corrected on lotoJ i 16 and 18 and have been resubmitted. For many years now, my reports hove had the ccurate readings for BM #2 based on infamation*om your office. Now I will report them a different way. A new report for lot 15 was submitted on 11-25-03 due to location of lot One. The elevations for lots 20 tit 21 are not the same due to different reading locations of the boring (Le. upsfope vs. downslope side) due to site clearance. 4.) The notations for the Structures were corrected in the office. The "L" for "large" structure instead of "CO" has been reported on my reports for years. Thank you for clarifying that for me. If you have any further questions or corriments, pkose call. Thank you for your time and attention to this matter. Page 2 - Forest Ridge Estates Sincerely, —17/eu5 May Jo Hollister CST #224832 Cc: Mark Syllo, property owner Leroy Jansky, State of Wisconsin Wastewater Specialist POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION Owner Brian and Anita Borgen Permit R DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Number of Public Facility Units ID NA Estimated flow leverage) 300 gal/day Design flow (peak), (Estimated x 1.5) 450 al/day Sail Application Rate .8 al/da /ft' Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (SOD&) :=0 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODe) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Coiiform (geometric mean) 15104 cfu/1 DOm[ Maximum Effluent Particle Size Ye in dia. 0 NA Other. 0 NA -Values typical for domestic wastewater and septic tank effluent. MAINTMANCF CCHFnNI F SYSTEM Septic Tank Capacity 1000 gal 0 NA Septic Tank Manufacturer WIESER ❑ NA Effluent Filter Manufacturer POLYLOCK ❑ NA Effluent Filter Model 525 ❑ NA Pump Tank Capacity 600 al D NA Pump Tank Manufacturer WIESER 0 NA Pump Manufacturer GOULDS❑ NA Pump Model EP04 ❑ NA Pretreatment Unit ❑ SandlGravel Filter ❑ Mechanical Aeration 0 Disinfection ❑ Peat Filter ❑ Wetland 1I Other: elgen,s ❑ NA Dispersal Cells) ❑ In -Ground (gravity) 0 At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) 0 Mound ❑ Other: Other: ❑ NA Other. 0 NA Other. ❑ NA Service Event Service Frequency Inspect condition of tankis) At least once every; 3 11 meaan(s (Maximum 3 years) ❑ NA Pump out contents of tankis) When combined sludge and scum equals one-third %) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 0 monthls) Q yeans) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 1 ❑ months) qr yearlr0 NA Inspect pump, pump controls & alarm At least once every: 3 ❑ monthls) KI year(s) 0 NA Flush laterals and pressure test At least once every: Q year s11s1 AS NEEDED ❑ NA Other' At least once every: El monthts) 0 year(s) 0 NA Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or eartthcations; Master Plumber•, Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identity any missing or 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 cell(s) 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 tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 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 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 START UP AND OPERATION Page Z of 2 For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cells). 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 cellls) 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 was within 15 feat 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: antibiotics; 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: a All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. a The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e 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. M ❑ 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 time. < < 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. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLG AND HEATING Name PAUL R KOEHLER Phone I 715 246 2660 Phone 715 246 2660 SEPTAGE SERVICING OPERATOR (PUMPER) Name DARRLES SEPTIC . Phone I 716 426 1025 LOCAL REGULATORY AUTHORITY Name fj L' {(DuLhy 20rLil (% Phone %/S- .3F(0- {Opp D This document was drafted in compliance with chapter Comm 83.2201b)(1)(d)&M and 83.54(11, (2) & (31, Wisconsin Administrative Code. ST. CRo TY SANITARY SYSTEM File #: ce nly OWNERSHIP/ADDRESS FORM Created120 1 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. � ; OWNER/BUYER INFORMATION Owner/Buyer Brian & Anita Borgen Mailing Address 1503 Sequoia Lane City/State/Zip New Richmond WI 54017 Phone Number (required) 262-728-1955 Email Address (required) aborgen5384@yahoo.com Parcel Identification Number 018-2001-16-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NE 1�, SW 1/4 Sec. 14 T 29 N R 1 w, Town of Hammond Subdivision Plat: Forest Ridge Estates Lot* 16 Certified Survey Map # Volume . Page # Warranty Deed # lOJ f .J '05 (before 2006)Volume Page # Number of bedrooms 3 Spec house O yes ■ no Lot lines identifiable ■ yes 0 no pFf(a M ONLY New Property Address 14 4 `4 c 'f Ave (verifica on of ne address required from Community Development Department for new construction.) !N24 4.ffl,$) (Dat This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Once and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department- Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd(lsccwi.gov 1101 Carmichael Road, Hudson, WI 54016 WwwsCCWi.ao FRONT F ATION RE- F WAT oN Kim Bft INO p�a4 CROBE SECTION A - A �o-wvm a.w rrc /j WALL SECTION B_B 1Ej1�{J{. ROTE wGWE WI.LLb PAE oveewrw e. i 5• wR -- rwrmaTioR wan q y! _ OCREEN v .+r Yy,: •F ."T Rn eEDRn •) - s 4 a �e a i •i n V c r ! GAR4GE nam moors aaR t v v 52 w •�•�. �•.��• Hsu Rmmece vast I iI`° i a � war n.ie. rcu.marox THE '°fie°B1° ��3. 1, �` 4 a 'Nlsconsln Department of Commerce SOIL EVALUATION REPORT Page_y—ol 5 DldsJon of Safety and Bulldinge In accordanco wllh Canm 85. W ,,. Ad, Code Coun, AdUn aoomDlote Site plan on paper net lass Irian 8 1/2 x 1 t Inches inel2ty, _Te. Plan mustCR � Include, but not limited lo. venncal ano horfxonUl reference point (BM), olfaction and Pamel I D � J OD1 i �— &5b percent slope. sole or dlmanslons. north arrow and location and distance to nearest road Plaaaa print all /nlorrrlaflon. evlew, Date nenonu mlonvibn you wo.Me cosy De uses rw ucwla < ' ProPeM PmpeM Loralbn Ak LL A.)� 1/a 114 5 lY T 2�( N R 17 W Property Owners Mailing Address Lot ou a SWd Name a CSW Ill-{ W, Old ISI DN ST, _ — 0KJ56-r RI DCE E-51-ATE GN State Lp Cade Friona NumDv ❑ Gry ❑ Ullage gJ Town Nearest Road AW12-12 FALLS I wr IS4oZ (115 ` Z10-48o HA M nw I sr,µ E" New Conseunlon Use' m Residents! l Number of bedroos Code derived design now rate_ (OO GPO Q Replacement ❑ Pubtic a commercial - Describe Parent material _ TILL o aT e+evatlon d eppsQ la General comments Ci7•G I �} 2— anerecommendaorxls: MDU)i SYSTEM l �-N'1 y) I S Si'2-Q LOr $fiAiD F tLl — ; 0'5 rah°loco RATE ih Saito Soil }v j2" uYl ) I Boring a 0 Boring qq.4 r - --- -- — V Pit Ground surface elav h De th!o hmlo f 1 Jr2 I �-Lsb - C-Fsaa ��-- ___--- D rig aC orm. -- _ Sal Rate Hcdzon Depth Dominant Color Rados Description Tuxlura SIn1pIVm Consistence Boundary Roots GPO ,n Munsell ou, Sz Cont Color Gr Sz Sh 'Eft, "eRe2 / 12- 5b Gtb 0.5 s 4(eo 0.5 0. & s 5 z a34 — i- s v- 0,-7Z v - LE Or la 2- 7. 4R3 _ — 0,0 ® Boring a ❑ Damp lil6'z.axvs "t Pit Ground auAe elev )� Depth to Ymltlnp IeCo _ 5f[,n SoY you Rate Monzon ph DOminanl GDlar Redox piton tainur0 Saucture Conslsien undary, Roofs GPDrtP In Munsell Du Sz Coil ola _ Sz Sh_ 'EMI: 'E@Vi OLs .5 of rx 3 10-z Z _- at -mob r CS D, 0 0.6 7,S 4 E.5 Elouenl e1 - 130 < p myL and TSS -30 150 mgrL • EMVeni #2 • 1300 < 00 mg& and TSS < 00 mg/L Nam CST e (Please Print) 5i nature CST Number A)A 0 H LLLSTE. � � Atlases Dale Evalua0w Conducted Telephone Number W9fl75 b9o"AVE,o�vE�FALLSYWT S402Z 0g-0-?--02- (71S,�I26-117s F' ftEwsco Ig-0Z 1?M2 F' ftEwsco Ig-0Z 1?M2 (LQ�v i�') �r � property chvner �2K S4 LLc--ft I ID p _Nn �.5�--.- page Z. of -3 eod q x ®9o^ng 7.3L pit Ground surface elev. _ Depth to Ilm{Ihp factor _ �-$ n K.11 Rate1 Q S ssa p ❑ eo*v 3 twr 1w Pit Ground suAaoe r.v.j01-- — ^ Doom to Ianu g t.m _ yG3 — in Sam Rw fiodzun Depth in. Dominant Color Murues Redox Description CIu. Sz Cont. Color Tealure Structure Gr. Sz. Sh ConYslanoe Smn/ary Aoae GPW 'E"I •E"2 Z Wfe Z/z — Z;- ,3 -z0 10 R SO 1 L-i- 61611K m e S zff- .5 . 0, 4 1 svK v sl < S 3• Ry� — S 0 1 S Iv4_rn I Z ON lµ R RA S 90LIu ft J— ICIO ❑ pit Boring a Bodng Ground slu ---- I- ._� factor U Z load" A'e��vvr� w D j,: i33 3� ' Effluent #1 - BOD, > 30 � 221 n/1 . .1 [, (� 'r _` 30 � and TSS < 30 mgtL. lI (G�tX�tl/(.'L,C.(il . L77,. `�'�L The Department of Commerce is at Lneed assistance to access services or need maternal in an alternate (ortmR, please contact the department at or TfY 608-264-8777. seo-root. wm _o10EST V4 nr-Z 1 1� SEC. 14 T29d1 KI1,.1 i N x P BiS�y 8Idl*4 Ul6C �- ilallo EoRIr�G / / / .B. p 69788 /S.F. I I I P-@6 / / I I ( i / / o N / / i Il - - - - - -' / N.O. 3.90 Ac. A �00 II i /� /�j �, a/ II ,/_121423 SFy�:iz1423�F �- 2.7 / YT 600.91' Lo /1-5573� �T. 3 N.B. 155732 S.F. ---_ 1204.E 51 -7 r�3'42 58� E JL 1 / / / I J 5'/ CO 10 N.B. b6455 S.� �z� ! �o 1.7� AC. 1 r / N.B. 1.53 Ac%� /104 _ i / N.B. �30 \ x I L \� _ - ' ��./ 4� ,---r N.B. 1.64 c - / \ S 86'20_0YA 347.22' /702 Q�� 80' RADIUS TEMPORARY --- MIA )'� Im CUL-BP=� EASEMENT (TQ ' W I' -REMOVED .EASTERLY L o N.B;fi8948 v EXTENSI ROAa ` I \ CA cP P- - 121.8 \\� 1 -6--= 4' - --� N.B. 71946 FFr \\0.41-''_--L+'' N \\ \ jBit.65 A�•�55. _ J hI' W I N - �A297. 211jl ♦ Y1 .� i' 1r% ` 1 t ` 1 I I j1 L L _ LL66 1 U 00 �1 co Ln 00 008 2 4_,r E 0. � 9' m � - -3�6 79 87 18 0 �7 ,11 � . z swnOpr °� 1% F U48 1041 - rvkt 2 �j�, S r3 -I"1J Zo-�l-Or ;a�tln� aYrn S � �,,�-✓��-sue ��'�t "v "" y/ � -Z. Yfl 1 �I Zo•bl-bo : castt\ab U' � 53rn �l Ijy � i'�LI TI�R42� •any �o gcttbo'a ac+vFf=p � X r Qti„1 1 N •1 f�,(��,S7$�� A� ' - I l`' c I 1 1'24 �� _ S3L1d1S3 3= Parcel #: 018-2001-16-000 12/03/2004 12:53 PM PAGE 1 OF 1 Alt. Parcel #: 14.29.17,880 018 - TOWN OF HAMMOND Current 1X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner ` MEDENCIY, CAROL CAROL MEDENCIY 674 CTY RD K7 OLPE KS 66865 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 1944 94TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1,560 Plat: 1961-FOREST RIDGE EST 1/30 018/03 SEC 14 T29N R17W PT NE SW FOREST RIDGE Block/Condo Bldg: LOT 16 ESTATES LOT 16 (1.560AC) Tract(s): (Sec-Twn-Rng 401/4 160114) 14-29N-17W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 08/07/2003 734312 2352/286 QC 08/07/2003 734309 2352/283 WD 01/14/2003 705829 9/46 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 271,200 Valuations: Description Class RESIDENTIAL G1 Totals for 2004: General Property Woodland Last Changed: 07/16/2004 Acres Land Improve Total State Reason 1.560 35,000 0 35,000 NO 1.560 35,000 0 35,000 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 000 0.00 0.00 • WQX COUNTY STATIzI rQ!SANIT R !lyq I 1SAVo OXWASF ��,L PREVIO OWNER PLUMBER TOWN OF_A SEC-&,T /OR LOT LIC.# 22TI to N, R_ 1 t EV tsLOCK �M' NO. 633332 PERMIT CHAPTER 145.135 (2) WISCUNSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: if you wish to renew the permit, or transfer ownership of SUBDIVISIONthe permit, please contact the county out hority. U RIZ ISSUING OFFICER -DATE mot( PERMIT EXPIRES NLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20) LOT 19 f 155732 S.F. / 3.58 Ac. S X4z'56" E 754.46' 266. LOT 18-- 66455 S.F. 1 �y 1.53 Ac. W I $ LOT 15 U" OF . - T I 76257 S.F. 1 FlN EtEY. ` l.it' I s as'zo'o5=w4�•?z' --. 6$048 S.F. I I 1.75 Ac. N ao' RAoius TEMPORARY !� 1.56 Ac. I , CUL- DE- SAC EASEMENT (TO BE NREMOVEO UPON EASTERLY LO T 17 I ! I EXTENSION OF ROAD) 4 J L� 71946 S.F. 1.65 Ac. '57" E 1 ts 6- 3 f r Na7'S6'05"1Af 5��1�