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HomeMy WebLinkAbout018-1021-70-000 (2)'Afsconsln Department of Commerce PRIVATE SEWAGE SYSTEM County St. CfOIX Safety and Building Dvasion INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION ATTACH TO PERMIT I ) SAN-2021-215 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 Jacob & Carissa Kusilek Clty Village Township Parcel Tax No TOWN OF HAMMOND 018-1021-70-000 CST BM El, Insp Bht Elegy IBM Description TANK INFORMATION Aeration TANK SETBACK INFORMATION TANK TO P'L WELL BLDG ent to Air I ntake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist to well SOIL ABSORPTION SYSTEM ELEVATION DATA Final Grade BS BEDITRENCH DIMENSIONS Width Length No IN Trenches PIT DIMENSIONS No Of Pts Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKESTREAM I LEACHING CHAMBER OR UNIT Manufacturer Type Of System Model Number DISTRIBUTION SYSTEM Header/Manifold IDistribution xHole Srze zHole Spacing Vent to Air Intake Pipe;') Length DIa Length Dia Spacing SOIL COVER _ n............_.___ Depth Over Depth Over xz Depth of ix Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No ❑ Yes No COMMENTS: (Include code discrepancies persons present, etc ) Location: 1979 110TH AVE 1 ) Alt BM Description = 2 1 Bldg sewer length = - amount of cover = Plan revision Required9 [ Yes _ No Use other side for additional information SBD-e710IR Y97i Date Inspection #1 Insepctor's Signature Inspection #2 Cert No y Sanitary Permit Application ST. CROIX COUNTY WISCONSIN qQ\��\\ Chapter 12 St. Croix County Sanitary Ordinance COMMUNITY DEVELOPMENT DEPARTMENT 7inf ST. C J' ersotion you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER nuaa [Privacy Law. S. 15.04(1)(m ' 1101 Carmichael Road 2-t' Hudson, WI 54016-7710 1 (715)386-4680 Fax (715)245-4250 e plans for the system on pb n 112 x 11 inches in size. �C y r, eanit # [I Check if revision to previous application J6t) I. Application Inf on - Please Print all Information Location: Property Owner Name 1/4 1/a, Sec, L—I&J 01 T A N, R 11 E (or W Prope Owner's Mailing Address - Lot Number Block Number I 1 `rh 1 City, State Zip Code Phone Number Sebdrdsierrfferne o S I to 5(4w 38}68 P• 13&1 II Type of Building: check one ❑City, ❑ Village R1 Town of 9 1 or 2 Family Dwelling - No. of Bedrooms L4` ❑ PubliclCommercial (describe use): 1 ❑ State-owned Neam Road 1 T II. Type of Permit: (Check only one box online A. Check box online B if applicable) Parcel Tax Number(s) A) 10 Repair Reconnection 2 30 Non -plumbing 4.❑ Rejuvenation 04' i —_�0 -000 Sanitation B) Permit Nu ber Dattp Issued State Sanitary Permit was previously issued �z %, c7 20-Z D IV. Type of POWT System: (Check all that apply) ❑ Non -pressurized In -ground ❑ Mound a 24 in. suitable soil Mound 5 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispers il/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 6. System Elevation 7. Final Grade 5rPekeel� (Min.Anch)�, Required Proposed (Gals./day/sq.ft.) Elevation VI. Tank Information Capac# m Gallons Total # of Manufacturer Prefab Site Con Steel Fiber- Plastic Gallons Tanks Concrete strutted glass New Existing Tanks Tanks 1 14 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIL Responsibility Statement I, the undersigned, assume responsibility for repair/reconnect: rejwen installation of non -plumbing for the POWTS shown on the attached plans. A license is not required for teralift repair or the installation non-plu ng sanitation system. lumber's Name (print) BsinsPhone Number. e au ass lumber's Address (Street, City, State, Code) Vill. County Use Only Disapproved DL Approved Ow mhal Adverse Sanitaryroil Fee Date I sued Issu g AgentIll.oslomps, % Determination �Z IX. Conditions p roval aeons for Disapproval: 3) ���,,,�nn SYSTE Septic tank, effluent filer and "' f `7� /Q re c.e..dispersal .. cell must besery�ed /maintained as per management plan provided by plumber. Sotnn22.All setback requirements must be maintained �G 0"1. itUf� felerNlLd1 .. Z as per applicable code/ordinances dT L la R v3/21 ►'VyQ.I lt.a-t ft2-G� �'"�- t� f• e A R'ta+� n er g S,1P LQ/ p to c 18� ` V P-q 170JL m dw Wtw P2 BMN2 -Baaan aflloure SAftS8 Comer 61ewNan - 99.32, _..I ra Page 2 of FN# 197Y 110a Am Sanitary Site Plan For: Jacob and Griva Kui><k k Parcel to the NEV4 -NF, 114 Sec 11 1'29N-R17W C5 Town o }Hammond - St- Croix County Faiv ` I l Sok 40PFCdldg vas p4w Prepo.ed N'Soi. 40PPC C.,).. P#ft Abar Ibadoa Paa9[SaaarYSyaa.e m Pw S"ULM amde @ 9.84Av � Ckm.crt , -97n' VI Propand i.r� Cmmtr I WLP7504a Dau ia,.t 93.T1' FMpa. d 1' S,*. e0 PVC Fu Mab, E6evation Data Proposed Pwnp Tank Gnuie = 93 72' Idg Sewer = — 94 20' A Top WeO Casing -Top arThreaded plug E HRP-Same ASSUAMELLV.— 10000, SM YELL BanT 130JL m A.So A PIL BON)COW F1ddSeed.d6ma G� P.M Barir 160JL w * BwrP/L P`qp ai6'j'Yowd / �CFacaeJckwaIOOtle 9711'CaWw rda ffwom Ere.. of 9t.75' 66007' 7.J% . / I I �Z / 9KJ0' 97.0D 914 9&W O�ti(<(/S.aiei ram Crum ', iC lC O p Y 66aoT Jac St. Croix County Occupancy Affidavit C0.t'i5561 M - 1Z4Ast W<' Name — (Owner) Typed or printed Jul 16 2021. ml Title CommUnrtv.De:�: He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, with their deed or document of ownership interest recorded as Document Number _1013139 St. Croix County Register of Deeds Office. This property is described as follows (include lot no. and subdivision/CSM or detailed legal description): OR: (X) See attached deed copy for legal descriptions Tx:4695707 1134784 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 07/16/2021 10:04 AM EXEMPT N: REC FEE 30.00 COPY FEE 4.00 PAGES: 3 Name and Return Address 0a.ri SSa KvtSl leV- I 1-1 e) ! Ufi Aye— O�ldt-fn Wl g41:702 018-1021-70-000 Parcel Identification Number (PIN) As owner of the above described property, I acknowledge that a Private On -site Wastewater Treatment System (POWTS) serving the primary residence is sized for _4_bedroom(s) with a design wastewater flow of 600_ gallons/day (DWF is based on 150 gpd /bedroom @ 2 persons per bedroom). A maximum of _8_ occupants are permitted; if the number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate increased wastewater flows and/or contaminant loads and may be subject to premature failure, and may require modification of the POWTS. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated di 1 �/ duy of 7� ALTHENTIC.A11ON umhcnlicnlcd Ihn da) of [ITLE. MEMBER STATE BAR OF WISCONSIN (if not. authonzed by ys 706 06, Wk Stars ) THIS INSTRUMENT WAS DRAFTED BY: Sr Criax Coumy Community Development (Stenature. maybe authenticated or acknowledged Both are not uccessa ).) ACKNOWLEDGMENT STATE OF WISCONSIN 1 )ss. St. Croix County ) �/-l�F� Personally came before me this 1t,Zday of ;It JA4 120 a"I the above named nr si e IF to me known to be the person(.) who executed the foregoing instrument and acknowledge the saint' =NANCYGEI.STEI Notary Public, State of Wisconsin ' My Comma, I is ermanent. If not. state expiration dale Date: L2ioi DocumentNumber THIS DEER, made between and State Bar of Wisconsin Form 1-2003 WARRANTY DEED DOcumem Namc " whether one or more), " whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See Exhibit A attached hereto 1013139 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 06/04/2015 10.10 AM EXEMPT#:N/A REC FEE: 30.00 TRANS FEE: 747.00 PAGES: 2 Recording Area and kvol\\ki 018-1021-70-000 Parcel Identification Number (PIN) This �.S homestead Property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: None Dated Signature(s) authenticated on TITLE: MEI/IBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Star. § 706.06) THIS INSTRUMENT DRAFTED BY: Bumet Title Scott Tranby 5151 Edina Industrial Blvd, #500 Edina MN 55439/ 15-06232 STATE OF WISCONSIN , ) ss. St. Croix COUNTY ) Personally came before me on N1ak 2�' 7,� the above -named Travis J. Jor as an lza e or , married to each other, and Nanette J. Jordahl Hammon FICA Nanette J. Jordahl and Gordon Hammon, married to each other to me known to be the person(s) who executed the foregoing instrument and acknow g d m . KELLEY A. HUTTON NOT RY PUBLIC * NSIN e ey u on , LL Notary Public, State of Wisconsin Zf 'L D� N ) My Commission (is permanent) (expires: Z (Signatures maybe authenticated or acknowledged. Both are rot necessary - NOTE: THLS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SIIouLD BE CLEARLY IDENT I NO-l-2DD3-- wARRANTY DEED 0 2003 STATE BAR OF WISCONSIN— - - ' Type name below signatures. St. Croix Coonty 1013139 Page 1 of 2 EXHIBIT "A" Legal Description File No. 15-06232 ) of Certified Survey Map in Volume Five (5) of Certified Survey Maps, EAgA 1344. as Document Number 387684, filed in St. Croix County Register of Deeds Office on September 12, 1 83, being located in the Northeast Quarter of the Northeast Quarter (NE'/4 of NE'/4) of Section Eleven (11), Township Twenty-nine (29) North, Range Seventeen (17) West, Town of Hammond, EXCEPT parcel in Quit Claim Deed in Volume 1028, Page 445, as Document No. 504062, further described below. Subject to 110" Avenue right of way. Description listed in Quit Claim Deed in Volume 1028, Page 445 as Document No. 504062: All that portion of the Certified Survey Map recorded in Volume 5 of Certified Survey Maps on Page 1344 as Document No. 387684, being a part of the Northeast Quarter of the Northeast Quarter (NE'/4 of NE 1/4) of Section Eleven (11), Township Twenty-nine (29) North, Range Seventeen (17) West, which is located West of the fence line shown of said Certified Survey Map which pproximatel 0f land 10 feet nadjacent widthtonthe is Southerly end ndCertified Survey Map measuring app Y approximately 12 feet in width on its Northerly end. _ .• .,,ini4l9QPanP.i0f2 Wa� 1;' 1011",11.1'.""' PRIVATE SEWAGE SYS m St. Croix _a , r'Itu lliln. r.r. ri INSPECTION REPO 624921 GENERAL INFORMATION IAiiar!I I0 i'L Itt,1' • Jacob & Canssa Kusllek TOWN OF HAMAIOND 018-1021-70-000 - �/Id. b5 „1.1 .29.17.161E TANK INFORMATION ELEVATION DATA* 4, 95 /OD, Sl TYPE 1,'A`IlP A':RIP I-V SePlr. — w i CAI- - iCf — �-}- -7 L- ��,•r<, W it5vc -Zr 75D Aer.IhrPl TANK SETBAGfK INFORMATION I!1 I't V.ELI H_:'G - kr1A1. FIANK rCL, Lr — AN•:a: PUMP/SIPHON INFORMATION lder u'.eJu a•r Go.,�d5 ikloar of Nuomci TDII rorccl•,., i Lv ui.l� „ SOIL ABSORPTION SYSTEM Iu *Ay f 3j. y 9 .i'I -I .%"II 71oc' ,'A-Vttl ©S HI FS E1CV Ilr.rr. hn,iti, 3 b 103.E lo-a o&p 5 j j I Y;t g1.3z Illdq Svwt-r 79 '.I:•It 11 1. I 1Z1 .{p6 '.1'1! Uu;.•• 5.98 Syr 53 a� I• Ir.l � I� -r 9 I . qo r , . r , 3� `1`1 •�f5 �l `f7•NS I,,1 ,.,.,... -7. ct I vial Grub. `,I Cuvrr BED 7Rf NCH DIMENSIONS :. 'r .- .;,✓J '.:I-..�+..r,.:r - ,1 PIT DIMENSIONS SETBACK INFORMATION L,Kp <'PEAI•r LEACHING CHAMBER OR UNIT - 1 ��Ci VrivI I 7100 -. .3c_-- UIJ I KIt5U I IUIN JTJ I tM ..F.,.•. r Gl.r 11 L.,rjrr �. . �i.'.. i � , y7 5 ` 2 - -� . „ ... . Ir iL- 1p ., ��: �•�� .t «. 4n ... 1)Q�t cr, y Z. (Ghri alllL UUVLK x PressUrc SwItems Only •• M.amd Or ALGraAn Svatnms Only iv/ V/✓n I,-- ❑aprRfMrC-- , IArt.If :1�r. `//�I��T l .r....LNan9�Cxe\n Ves r,u vM..«.imX,• Yn-..— 40 t 1 COMMENTS' Ilu uda r�rd.•i•r,r �rtxnucs persons presort cc Ir r.p.•r r"I r.f Ki1ouf B`?6 Zo Imla>rPnn N7 Location t[II9 ilU1I1 AVf 1 ; A't H.1 I>...,.',.j.,,., �7•'�I�'t sr�. iv �lh� �q Ycd �yp w� >� 'MM� %D {�J iC.�'1:i yZ r i `/ Icc �ioi� �...,.• - _..r ,�,> '��, w� y - _F�ll+c a lgr,,,t inr�A/C,tC SEC.-- .... _� .. - :-a•--^ -. •i.. P' FNd 19791101h.4m Fawa�e�.L I V NANMH 170J1 m dw wan P2 AMd1-Bus. of How Sldbye.Cd. Gaeaerl \ filnvdoo a 99.12' \11 Prw,*d I' ScA 40 PVC Cae. P"V Propoeed W(ocr Cbwr m 50,07' W1-750-JRDl 7'a4 �pJ 71 Page 2 of 7 Sanitary Site Plan For: Jacob and Cariaaa Kulsick Parcel in the NiEI/41 -NPF. 1/4 %ec. 11 T29Ni-RITW Torn of llammood - SL Croix County d'Sdk 40 PVCAW rear. Aye WMw Caaerm W P11J(MLRSeydc Tad AafyLot PM2J F%w Now Abada PdOW SAY &At— Pw SM lv.M (b� ® 9.81 Ao C4io.ow , -9L71' P1opawd l'SA. eO PVC Faroe mate Ek�ation Data Prcrposed Pump i Ilk (imdc - 93 72' Fi Mg Smer - - 9.i 20' / *M- Top Well ('sane - rap o(Threaded Mar. )E HRP-Same ASSUMIMELEV.- ioniw kLELL Bom r-130Jt w Ae Sor4 P2 Iku"'A" ao ores FAL Room �S , 1—_ 160Jt a At PmrP/L Ceres • Prtpaeed C. /k0.am / Diipo,a/ C'di raer aa loes the 97 e1' Cawev ,rd Sir / El". of 94 77 2J% 40 • %J(l �7W 9711' 9&W Judd s«ddaro tan=, 4 C`ICO 66007' 66m, 231 SaYv a^c 3,1 c: res D',s,s cn $f C A o Z x - --- .p\_ •' 11 : I.:as^i-g!_n A_e PG 8:;. Fr•—r \. Hrr l ..<I ___..r ,__-__-_ vp Sanitan Permit App] icatio 1 \ppht ahem Inlnrelalion flea,, 1'.Int \Il lntrt tabnll NEl1 `L _ SJA �.II„IP 3 •]p_.a..h 1179 llo`A RvE c•Inxlin^ A! 17 /YIr1 QAI D w — AIC ,fry I t yet( is T j4002 79-oYbl 19 Q II i,pr of IIY IAIr01 nAnk all that pp ad i - � - � f x PI A'r epe ul 387 b a `113 � %41„n,•I /•I &V DD III I %pr of Ver"In I( heck nnl, une I... nn I nr I,( nntplrle her I111 appllrahl<I -(-- --- � ^ - ` I<m (nmlrnnrnl Ilr,ur J heck Al [hal apple r __.... \ Ih,prrul I rralmenl \era Infarmalum 0� 1�r�— /1 r •- If 11 .,r r lir.l n.w.i/l vl ^„uepr^Iln..nn \I lank hlln r � I i, •e„, _.--_ , III .II. In Inr - G_TLt Est —�Lp125 LOZ--- E �(J�5 AR 9So 1 +�LEy€Q ✓ \ 1runr,.,s•rl uuwmr .rq.n unbn her , tub n.a l rnr r 1 , -�---� .h•+n m t!r anaa►ed plau. HENRY NECt+yri-t.IL, -2118 715-749-33-J2 9b� Hw 65 of3jCAT5 LJ; 5-yo-l3 \ 111 (uunla,ll_ ly rinunl I ,e (hd, - 1PI'.••:1 U..q._ro d __ 14irul l,r Ire l•r .:--u At ru•Aru,.Ynf\r_�//J�� ,pf/�.�� ZOZO I\ (nndtllnn, ru \ rma - SvS-Elf ^:"".ER 13)E�Ci5��5a�}12� lu+.�i`K i S@:;:'ln+@w.@.ra... a+A 6.7 j�,r` •E1Gfi 5TI;LL ' 7]4 �!'@')! �f -.5' :t' SE- ::: ^'? •"' . \ �➢.r Cgwi..0 I..J � ,T 1 2 @S l 1•..�\/.°r(.�-L-11 - w t'TL. `ut S�7 (Y! VItl t_r, nlx llt II II. i(�^`�Lx4. �(RviiO�Ar,_S�d w. Ka�x Y-�tIaHGQ eA� rMI prlja-� �D PS DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS Pl. GREEN BAY WI 54304-5211 Contact Through Relay httpl/daps w gov/pogrertwllnOustry-servicea www wecoraiin.gw Tony Evan - 0ow oa•rrt CrIm - Bw.tary May 29, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES. 2022-05-28 Plan Review: PW7S-052000954-C KEITH F SIONLR 23220 Woodcreck Rd Siren W1 54872 SITE: Kusilek Jacob Replacement Mound System Town of Hammond Saint Croix County Total Amount: $250 (R) Pressure Dtstnbuuon Component Manual Ver 2 0, SBD-10706-p (N 01101, R 10/12) Mound Component Manual -- Ver. 2 0. SBD-10691-P IN 01101, R 10112) Descefndon. 600 6PD M Bedrooms — Replacement) Maintenance Required The submittal descnbed above has been r cwcd for conformance with applicable Wisconsin Administrative Codes and Wisconsm Statutes The submittal has been CONDITIONALLY APPROVED. This svocm is to be constructed and located in accordance with the enclosed approved plans and with any component manuel(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 cunstntction or untallation and pnor to occupancy or use • Preserve dispersal area pnor and during construction to avoid disturbance, compaction and use of the site. • Any tall grasses, leaves and shrubs shall be cut shun and removed poor to tilling the surface for installation to prevcri matting under the dispersal area All loose organic material to be removed from PONM Dlsperul Area It cn_e ifi too wit tosrgwre If n crumbks site Oreoarouan can orocecd If the sue is too wet to preparedo not proceed until it efrtes. • Abandon Existing System per SPS 383 33 • Pump t_Iscat♦ in_br u_I _led rrl dill M I .ionrur 1•,I PL1 n. %Itl r11413ur' ma) u1 PUMP rraline lu meet I I111 4nJ 41'Vt ti )rulicalmn. • Divert surface water fium POWTS Area. • All piping shall conform to SPS Table 384 30.3 and SPS Tabic 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382 30 (11)(c) • Tank Installation to follow all manufacture's recommendations • Verify property line(s) prior to Installation • Well setbacks to meet chs Nil 811 & 812 • ILC.11 ibat are I CC1.111ed t 1 7 . I' _ 1� 1,..:. I w ll i Id, rn'„II . 1, ov,•mi o: od . .nl.Ihb i •1 ice'. 11. -'r, .,1 r ❑ 1: m�.,y .n 41._I`'T. I ,. 11 : 1, b,'A uCJ P1 IN I s I)Ilpcn.d 1,..., , ..... ._ d i'1,i' 1 „ i 1.,, ,.u, ,11', 1 m. IL. -..I �,.i v.•1,:1u,n,. .ui II .�._lit t Ili` 71,111 .- Y,J Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions misting to proper use and maintenance of the system Owners shall reserve a copy of the appropriate operation and maintenance manual and/or uwnces manual for the POWTS described in this approval SPS 393.54(I) • In the event this soil absorption system or any of Its component parts malfuncuons so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans A copy of the approved plans, specifications and this letter shall he on -site during construction and open to inspection by authomed representatives of the Department, which may include local inspectors All permits required by the state or the h)cal municipality shall be obtained pnor to commencement of ctmstruct 1oo4nstal lationi operation In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions anse making them necessary for colt 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 K) WTS manegemcnt plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS Th7/anks�. t/-IA r/IA4'!4 ICl/d� POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of -Industry Services Cell 608-516-6134 Page I of" Index and I itle Sheet Project Name Jacob and Carissa Kusitck Mound S.tmtar} System Propert% Owner Jacob and Canssa Kusilek Address 1979 1 10`h Ave Baldwin WI 54002 Phone 608-879 0461 LegalDscription PartoftheNEI14 NFIA Section 11 T29N-R17W Township Hammond County: tit. Croix Count} Suhd»iswn Name. Na Comp a Parcel ID. 018-1021-70-000 Ct)NI'INIS Page 1 Indc\ and Title Sheet Page- 2 Sanitan Site Plan Para t Mound Cross Section with Plan Blew Drawing Page 4 Lateral layout Drawing Page 5 Dose dank Cross Section Page 6 Pump Curve Specifications Page. 7 Management and Contingency Plan UtachnwniN Soil and Site Fsaltuuon 'tifound Component Manual Cxd VCr11on ? u SBD-I0691-11 (N.OI:OI R. 10'12) Pressure Dntrihution Component Manual for I'matc Onstic Wastewater Treatment S%%tems Version 2.0 Jan. 30, 200i tRes 10 12) Designer Keith li Stor0l:''I`..,., Sirnaturc .1 „1,41 License i1 Ilesigner 157-007 Rafe- May 16th, 2020 Phone 4 (715) 653-2324 r o re » Gr�pWo LY (M) � bicA M M1 170/t b At WmrP2 Page 2 of 7 Flw 1979 Had Arc Sanitary Site Plan For: Jacob nod Cariaxa Kablek Parcel in the NE114 -NV, 114 Sec. II T29N-R17W Torn of Hammond - St. Croix County Faso, Bdrooae liuwe Phpnradl'Sok 10PFCB14. ww POe Peopond WkW Camcnir WLPIZ504 H Sgdc Tate �rab Poy PL522 PtYn 02 a14I Cfet►Qt� Not: AQsodoer FAOW SM"W 7 Sjod. m I per �SlgJ.ii_ 9.84 Aare G1adr Clao►ar -972T BMN2 -Boom of House Sing SB (ono ( \ 1 ElrwNell' ae - 99. \JI Pmpared 4-SrA 10 PVC Ce. Wyumm POLL FrGpard Wismar Corrode WLP .10-1& D. Tm�t 93 72- Prcpar.d 2- Sc*- 10 PVC Fa Mess Ration Data Propoxd Purnp Tank Gradc 93 72' ldg Sewer - - 94 20' lop Nell Casing -Top of l-breaded Rag 1110-lame ASSUMZDZLZV.- iotion' -- IPropawd C. I00'MmaeI / 1liepreeol Csf1 lane* ,, ah 97 O' (A& 75' bJa Shbne FLr of 9R 73' 7 � •�vYVELL /// l.1 � 230ft. v Ad Sodl PA OWN"Id gam, 970W 9712' 9800' FLYSerddLdo G:at F-M- Bar (Here Field Sndd bra Ce® 260A b At Br P/L 2% =1 4,111 Mound Plan View Page ] of 7 Observation Pipe Mound component huncokions gk' F Et 9__s 1_ I -1(CMr 1 II sU I Ibxpaul l ell Ma S 4 7 IfL•1 It" 4m Mad" FIlt GI) 4W&ftl laer mI'mdmg Rao 1 Oo llln 1106, I%pt Poaccmatl Finished GrnKfc 100 55'� i Cellal u —j ce FlcvaLon u Mound Cross Section View \ggregatc Uinpcnal Ana 27. t 97.42' (R) Contour Flcvauon 11 a ra ';subsoll Cap F,pical a q .-.....-.:.-.:............... Aggivgate amm ;zinc Fabric C'ovw Page 4 of 7 E'nd Connection Lateral Layout Diagram IS [ 25'4E P J 125' II Laleral> and iiru Mal. of rVC>+ 40 � SP3 I ON, 194 16-1 turn w.Tsll valve m ckan J( cwl pi AP Laterals contend over the ARn dimension *lumber of Laterals 2 Orfice Diameter 1 5 Lateral Diameter in Orifice Spacing (X) 97 50' Lateral I en p 8� () ft Orifices per Lateral 30 Latem) Spicing (S) IL Orifice Density 1674 Lateral 1-low Rate gpm Slanilold Lcngth Cell Flow Rate 3348 gpm Manifold Diameter System Flow Rate 33 U gpm Total Dynamic Head Finished Grade 6" to 8" diameter Lawn Sprinkler Box Aggregate --CT--U- 0 000000 00C) 0U 000000 000000 Aggregate Media 156/5l32" 3.25 31 9.68 3.0' 2.0 19.52 Lateral Turn -up Detail Threaded Cleanout Plug or Ball -valve 1 ong Sweep 90 or Two 450 Bcnds Same Diameter as lateral in ft. Disinbutiun Lateral Note - lateral ends at last orifice where variable length to cleanout begins Dose Tank Component Cross Section Approved Manhole ('oven With Warning Label, and Locking fhvicc 4' Min Mine Final (inrk \ -I" Sch. 40 Vent . or - to 12" R , Above Final Gunk I I'✓ Inlet `:ote- Pump %%tich and alarm it, be w ucd to ,cparatc circuit, I ank Mir ),%'mver Concrete 75O g.,I NUn Dose 8970 gal Max Dow 120 gal A Pg. 5 u(7 Weather Proof Junction Box / 10per NEC 300 & SPS. 3612 r \/, 1012 WAC Alternate Outlp Location WiApproved 4" Sleeve force Main Diam. - '- Hole or Anti Siphon Device -- - = R CK I Pump Off Elev Cru� lose Tank Elev Vertical Ddlercncc Iletvveen Pump Utrarwi Distnbunon Pipe 10.33 Minimum Requunf Supply PresSurc .. .. 4 55 180 _ FT. of 1 one Main v 2 58 FnCtjon factor. 100FT 4 h4 Total Dvnamtc I lead .... - 19.52' Number of Dove, 5 Per DUN VOltune of lladilow I utal Dose `'Plume ... Pump I ank Capacit} 750 36 (Gallon.~ Pump rank Volune 20.28 Gal Inch Pump Mfr. Goulds Pump Model WIi0511 Minimum Diwharge Rate 33 48GP`I Alarm Mfr S I Rhurnbus Alarm Model Tank Al it I (ia) Per Day:+ 4of Dowc 92 34 Gal 29 34 U. .. .. 121 68Gal. Dimensions Inches Gallons X A 20 (R) 405.60 A C 2 600 40 56 i 121 �L D 9 5252 IR2I` ✓,%j Total- 37 750.36 c Float Model S)I RI-mbus Louhlc I l al Matter Pump Sous h Redd Tank per SPS 181 4S(5) Anchor Tank as neces,ary to negate boovain Iiwrc . per SPIN' 383 43(8xg). M I PERFORMANCE RATINGS ;Vo .. „. order ws wc- wc. nJ- �iee- aRa Mrs we- OJt � 03M O9H ni91 tOH 13H OaMN . 1JM1 30H i tt RPM i750 1750 Xw. 3SW 13YX 1500 j 35W 3500 3500 5 86 _ i F10 t 70 E3 78 94 -- — -� 58 95 - 1S SZ `2 1.70 90"a3i 1281 53 93 138 20 2T 35 60 H3 48 123 49 90 136 2 5 48 76 94 11_7 45 87 133 • 3D 1 � 35 67 1 8A 110 40 81 130 3s - - 22 II 57 67 103 35 H0__ 126 a ' 40 ; 45 f4 9` �3Q 77 '21 49 - - — 36 6A+A6 25 74 116 50 - - 25 53 71 - 70 110 ' ec 67 - 66 103 I 12 60 3c 56 - 63 96 20 45 - 58 89 1 3 � 55 81 r 2 51 14 LBO- - - - - _ 47 1 66. 190 37 49 _.� 100 ; - - - —_ -28 1 30 DIMENSIONS AI: ;tlmemm�rs ��e i7 n,.•res Go rot cse lo, construct on purpwes 1 Ir tlh-� H Svy kCT/',T_ ON j r _nr_a 1E" 1' NPT KICK -BACK yS1. xylem t M's Solve Water PW 6of7 m sller Casp _ f M.chan. al Seal 3 S Mow Shaft Maw 6 Ball Beann I 8 1 C inu0 Rmo 5--in 1[� 6 ��- 4 6� a i 3 I!Y n :t Xylem, Inc 9A81Easl8ayard St,uvt6.1 SUIteA Srnrca Falls, NY 13148 Phone ;866)325 4210 Fa< 5886) 322 5677 www.xyremmc corn/bfands/youldswateftechnology ... .,Id•. �s a .,vend o-atlavk cl G�u.m rLmp.- Mc and • us•e pnOH ecru 03985 R. P".' ).]1f Wastewater APPLICATIONS ' I-,-, ih, .dlydoigno,I Lu Lfn. hill. R,Inrl uses • I L,nu •,. Earn;, T•eib- (,ri M,ot, l._ .,, hcols. !nfi I of I Illi.rni , SPECIFICATIONS Pump •i- ,. 1ur ie %PT • ( el,.lr itn,� L.p to 14C _ .1" • I,dnl head` uo to 178 I", I I it I • r�l if ltDLllUt L' 1041 fl.�•L; conb n,lr :,r . 14ft r [GD C) intu-rm rtr•nt • <,r ,. ardor nurr'6cls .........r.. !I-- Ir 1 c H� .rJ!-.P. Eli,.=c .:•.,!pp%, L,t1,� MOTORS • (LI.•. iS nr.ulatar, cot 1'. I lip ..„;r,. , • ( Lv- i utSule',or. toot 7 11f' Single phase (60 Hz): • ( al.,, It s;ar; IRttpr, Ir.I I, anrlrn C rq lor,:u, • I1( )'o.Vor x•v,-n Ihry roil .md Water resi5l,mt 1 u,;yi t Iorc-; • 1 1IP rnudel, h,w, Nl MA Ihn•,• hung groundmq . 1 H:' rd larcor ..tor I t„n,• I�-..d curp ends Three phase (60 Hz): •'� iPi I:...., fn,.-I-� 111, r.r. I, r.. 1..,,.! cord cno, •ffor Canhnr.,.u�f;I n•t.l•nm Pump ratings eh •'wAhm the rnutU, its. mr.ii it it, I,*-. re LOrtimprided w<,I k nq Iimrt , can h,• nl tr,.ltrri , mil muuusly with , 11n ,tam lq(, when fully •.t.I wwiq,-d • Pot ...... UVpe, n• d L,.v, 1,n •<rvy .1.1; brill heer-I q , Ghpn .. •u'c Co•• �.. r. ... �'r "t :,>m lgr dot.: �prr-,rnt o.l ,aic:.in t rr, 1.0 l r, .,i iy 20' d low pnS Ile I.-A:H- • f )ring A,,sureS pout ar •,Iln<1 iq, inao contarri n,n 1" rind u)I leatage AGENCY LISTINGS L1F"1 pS F"T 40- iJ0 WEtSHM SERIES WE 10 L - ;SILL '/." SOLID .RPM 3500 & I1S0 t10 ._ WE20H ►I 1, GPM 30 100 _. ., R u 90 - WE15H �0 07- rt WEO iS 50 -EOSH_- O 40 .. 1G I 301 WE03M _. �_. .. 1' .:C SJ 6� 1q •,5 90 t00 113 120 7 1" 140 150 160 GPM 0 10 1ti ]:, 25 in 35 m'/hr A PAC Iry ;3 � Page 7 (1 of 3) Private Onsite Wastewater Treatment System Mound Management Plan Pursuant to SPS 383.54 Wis. Adm Code each Private Onsite Wastewater Treatment System (POW1S) Shall Include information and procedures for maintaining the system within the parameters of SPS 383 and 384, and the conditions of approval by the department, agent, or governmental unit The approved plans and permits for the system will be filed with the county zoning or health department. This management plan complies with SPS 383 54, Wis Adm. Code, the Mound Component Manual for Private Onsite Wastewater Treatment Systems (Version 2.0) SBD-10691-P (N 01/01R. 10/12) and the Pressure Distribution Component Manual (Version 2 0) SBD-10706-P (N 01-01 R. 10/12) Table 1: System Iesign Specifications Sanitary Permit Number Number of Bedrooms Design Flow iCil'D) Soil Absorption Component Size (sq_ fl } SepticTank Capacity Gal Pump Chamber Opacity Gal Lj L of Wastewater - — 4 600 600 1250 750 Domesuc Table 2: Soil Absorption Component — Limits of Reliable Operation Desi m Flow -Peak Max Influent Particle size_ Maximum BOD 5 (MT,1) Maximum TSS (mo) Maximum FOG 1 Scptic Tank _i 600 4NA 'NA 600 1 /8 Inch Table 3- Maintenance Schedule Septic] ank Inspect andlor service once every three years _ Outicl Filter Should_ inspect at the time of tank servicing 1'um_pCham►mer _ _ Ins tat every se tp is tank servicing. Soil absorption Component Flush laterals every 18 months. Page 7 (1 of 3) Septic_ I anti The septic tank shall be maintained by an individual certified It, smice septic tanks under sec 281 48, Stats. lice content, of the septic tank shall he disposed of to accordance with NR 113, A is .Adm C ode (Servicing Septic or Iioldmg I anks, Pumping Chamber. Cirrase Intcrcepton, Seepage Beds, Seepage Pits, Seepage I renches, Pnv des, or Portable Rostrums) The operating condition of the septic tank and outlet filter shall he assessed by inspection per T able 3 of the nwmtenaacc schedule I he outlet filter shall be cleaned as nocessan" to ensure proper operation 'Ihe filter cartridge should not he removal unless provisions are made to retain solids in the tank that may slough oil the filter when removed from its enclosure If the filter is equipped with an alarm, the filter shall be sari iced ifthe alarm is activated continuoush Intermittent filter alarms may indicate surge flows or an impending continuous alarm 1 he septic tank shall have its contents removed when the solumc of scum and sludge in the tank exceeds 1/1 the liquid volunic of the lack. If the contents (it the tank are not removal at the time of an as,c,sment, maintenance p:rsomncl ,dial I ads tic the owner of when the nett service needs to be Performed to maintain Ies, than maximum scum and sludge accumulation in the tank P tT!p C'humber The pump chamber also requires nunnonng and should be inspected when the septic tank rcenses inspection or the time of pruhicm, complaint or failure Inspection should include checking the duw rate, vohune and frequency Warning: "I he dose clmamber may fill due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have prblcros In this sduation, the pump chamber should he pumped by a licensed pumper before pump csclutg begins or other measures shall be used to dose the uiinp orient with onh the proper amount of influent This tray include manual operation of the pump controls until such time the pump chamber has reached its normal level Septic tank and Pump chamber risers, access risers and covm should be Inspected for water tightness and soundness Access openings used for wrvice and assessnxnt shall he sealed watertight upon the completion of service. Any opening dared unsound, defective. ur suh3eci to failure must he replaced Fsposed access openings greater than 8anches in diameter shall be secured by an cltcctise locking dcsicc to pxevent accidental or unauthorved entn to the tank Warning: No one should enter a septic or other treatment or holding tank for any reason without being In full compliance with OSHA standards for entering a confined space The atmosphere within the septic or other treatment i,r holding tank mas contain lethal gases, and rescue of per%on from the interior ni the tank niay he difficult or impossible Tank abandonment shall he accordance with SPS 18333. W is Adm Code when the tank is no longer used a, a POAYT'S component Page 7(1 of3) Soil Ahs.h tirP on Component 'llic sxl absorption component serving this structure is designed Ito accept domestic wastewater from a residential facility The dorms of operation of this component are shown in Table 2 I he longevity of a s iI absorption component dap cmi% greatly on proper and timely maintenance, hind system use within or below the limns of reliahfc operation (o«xl water conservation practices in all occupants and the installation of water consrn mg plumbing fixtures are key factors in evtending the useful lite of this axnpo.nent- Ilhe soil absorption component's operation must be assessed by inspection at least once every 3 sous lateral rum ups are pros ided at the ends of the laterals for the purptxc of flushing the lines of any solids f lushmg these lines should tic done eycty I g months llte inspection shall include recording levels of pondmg, if any, in the observation pipes, and visual inspection for any cv tdence of surfacedixharge from the compxncnt On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health haiard Trafbc around or over the soil aMorption component should be avoided particularly dunng winter m.nthn The compaction or rrmoval of snow cover over the component maylead to hydraulic failure by frcrnng This type of failure is usually temporary, but is difficult or impossible to repair until weather condiltouv improve In geneml, soil compaction over this component will reduce diffusion o(oxygcn into the ..al and dispersal cell, which may lead to more intense, and earlier, clogging of the snl Planting of deep nxdcd trees and shrubs dorcctly over tr within 10 feet of the component should It avoided since root intrusion alto the congxnent ma} obstruct wxstewater flow Cgntingcncy Ilan In the case of septic or close tank vompionent damage, measures shall be taken to repair tr replace the tanks to there original operating condition. Upon lahlure of the disinbuliart cell component, the system shall be inspected to determine the cause of failure Steps taken to repair or replace the mound may involve the rcmoval of a bn.rnat, which would require cleaning or replacement (if the distribution network as well as replacing the rock and clogged portmxhs of the sand fill \oxhvillc Fxcavaung St _Croix ('ou�tN, %Amid Wieser Cori rote Products Sc Lc Purnfwr Component (Tuners Contact l.iat Walter Kcchyillc Maiden Rock WI Ron's Sewer Service #(715) 220-6053 (715)386-4680 (800)325-8456 (.715) 749-0153 wlafYW NOVIment of S*ty and Prdesvonal Serf a""C4k4S"serw " SOIL EVALUATION REPORT `3509 Page 1 ol 3 n accnMwcc v SPS M!, We Adm Cafe Kean Sloner CST A114M to Me 1hul M r=1mplO { Paper riot Ims 01an fl:5 a 1 I InChey N s1[n Ptan rant County 51 Croix Cednal Imd b wl poiniITMI, ilw and — — pCril slopedwrow akcseoi and to nMarBel rna0 Patel I U O 18-1021 70-000 Please pNnl all information. - RetlewW Br Dale Wwaru r+vmatK. "I V w rney Os anod b vcadarr peoosea IF nv law. a 15 04 (1) tmi) Propwq Owner Properly Loca"m r 1 n l Jacob 6 Canssa Kusrlek C. Lot NE 1/4, NE1/4. SI 1. T29N, RI7W Proper Oil Us," Address l d a DW* a Sled Name a CSW 1979 1IOm Am 1 CSM Vol 56 log 1344 City Slate /4s Code IMvnin Numb, n C ty ] Ylaage Town Nearest ROM Baldwin WI; b4002 608 879-0461 Hammond i Same 1 `wrr Cona!•vyari I15o ` ' 01e. dw hg# Mrrvrr Lit OMnrnz 4 Cgde derived desgn rW rap 600 GPD • ] Ilepeeernmt f•�elc w COnvrwrav Oosata- Paera material Sandy Loam lilt __-_ Flood plain elevation, it applicable NA a Ownwal eomrr+enta {trxioae a 6 s 100' r rd dispLn it =4 located along C1e 97 47 opnlour with a s�trn rilra0n = 98 75' Upslope mn0olr st4hed rwmrrener�6at and or a I Haug 6nnngl �: I'd f Y.KMd surlace okry 9681 It Deem to hrraon9 factor 27 in - S.; AMka l- F"7 Hommn Depth Uonenam Cdw Hedo[ Urnrnryron Talws StruCaae Coruula+u BnrnOary !loots GP" rn AQY.SN Ou SL C.arA. Co" Gt Sr. Sh _ I 0-9 IOYR3/2 - nil 2mst* rrlvfr a 3f-m 0.6 0.0 7 9-16 I13YR4/3 5l j 2msbk mvfr 95 11-rt1 0.6 I 08 3 16-23 IOYR4/4 yd 2msbk mfr 95 2f 0.4 0.6 4 123-27. SYR4/4 _ sJ 2rtlsbk mvfr 9s If 0.6 10 I S 27-15 5YR4/4 c2d5YR5/H sl If-msbk Mfr I - - 0.4 1 0.7 I Fiatlg a r I Ilwkrg ;.] Pa CrrKad surtaco dev %.73 n UOPm to Iwraeng IaC'10r 20 n Sd AOOkoaon Hotel Hatton bepm Uannant Color Hados DcwPom Terarw SVL,Moo COrerssence PM,4 ry Roob GPO.'M rn khrrinM CAr Sz, CCaW we Cr Sz Sri _ rtaat ri ea2 10YR3/2 I - sil 2msbk I ITsvfr a 3f-m 0.6 0.8 2 B-17 I0YR4/3 - yl 2msbk mvff 9s 12f-m 0.6 0.8 3 17-20 JOYR4/4 - sod 2msbk mfr 9s 2f 04 0.6 4 20-25, 10YR4/4 c2d5YR5/8 j Ski 2msbk Mfr qs ]f 0.4 0.6 5 2540 5YR4/4 I c7.5YR 518 5I - T.SY1ur1 I � if-msbk Mvfr - - 0.4 0.7 ra>.Jo<rou mqs � 'E r r 82. 8001s 30 myt and TSS i 30 mg/L CST Nano !Pie,," Pnnn Sgnaue _ r•� CST Ni.,m er Kenn Stonerr.V _ 224059 Addrwas Koren SbrK CST Ode Tvaluaaon r onAt1M Talephwre Nwnber 23220 Waj Croat Rd yren WI 54872 5/12J2020 115566-0900 SaDilw a vnry Property 011rler Jamb$ Cartier KUSlfek_ parrnl K)! 018-1021-70.000 Papa 2 d _3 n Dodrp ! M P4 Coowrd surface Mek 97,82 n. Depth It fift' p latter- - Horl2dn Devm Don+rrarn C01a SOW. Desc+peon te.tue Strutters Covalence amr daryy % to C." 19 Mansell Ou 57 Cant Coiw Ci Sz Sh -Ew+ -Earl 1 - J 0-9 10YR3/2 - vl 2msbk mvfr I cs 3f-m 06 0.8 2 91S IDYR4/3 - sd _ 2msbk - mvfr 95 2f•m 0.6 0.8 3_ 1522 i0YR4/4 - vd 2msbk mfr gs 2f DA i 0.6 4 - _- I" _ 4 22-27 IDYR4/4 51 2msbk mvfr gs If 0.6 1.0 6 i 2296 SYR4/4 C2d5YR5/8 57 It-msbk mfr - 0.4 0.7 i 15 - wen md� 4 0s9Is 4 Finrvp t L Ro ing ... [*1 G, x nd w Il olev - _ 94. W -_ h. [)Mer 1. br.brv41xlor 0 _ n, -- -- -- So+ apw-abn a Nonron Dryer Dcnunem Ccim Redo. r e "%Tron lo<]Urc Suwure (:ansrsterrce aotrdary Roots GPD17P - ' In Mim50X Qu 87 Cont C:olq i (:r _>t, $h I 'F"I I -HW2 I 0-7 16YR3/2 �- q1 lmsbk mvfr CS 3f 0.6 0.8 2 7-10 10YR4/3 f2d5YR5/6 - - I sal 2msbk mvfr 96 - - 3f i 0.6 0.8 _3 - 1018 ID4/ YR4 _ _ i c2d5YR5/8 sd 2msbk mvfr- gs -----0.4 2f -- 06 � 0 8 4 18-29 IDYR4/4 m2d5YRS/8 :ad 2msbk mfr qs 0 6 5 29-35 ! 5YR4/4 c2d5YRWB 7 5YR617 - I t-msbk — mvfr - - -- - - 0.4 0.7 t 'rw CiIvu, d surface uhry h. [aevm to krjwv lacier -- In SroX Ap(llkebpn R Hwizon 1 Deper Dominam C,obr i Hodo. Doxry[ion I lo.luro ' Structure -- Canzrstergn Fkaarrdary Rrwtt GPD4P In kWnsak r]a Sz. [:amt (:der � Gr 51 Sh, _ --Emir I ----Ow Cllla tt.HCX/..30a 220 mg1 and fSS.30c_ 1]4 rtpl E tXuent !:. E±W� c 30 mp't and TSS t 30 mp'L �H�F1 ARrn�k l:•I �� 4�N Sifw CST I I /70Jt b Ar NwAl Pape 3 of 3 FW19nIUa4Am. Soil Test Site Plan For:•lacnd) and Carim Kuixlek Parcel in the NEI/4-NE t/4 Sec. 11 T29N-R17W 'I own of Hammond - St. Croix County For Fnioa. Jlaer M2 BM � C1m..Aa �� CLara�ie -97.SY I y 1 Ele.atjya Ihta 6=1 9687 731, 843 - 97.82' Prapose6Uons Tani 66007" W4 44 70' 0172' I'rop.xcd Ih:mp Innl. Grsdc '�� ";=' Bldg Scwcr -'/4 '(r sM -Top Weil Caning -Top or Threaded Plop -)OF RRP-lame ASSUMED ELEV. - 100.or `- FacAhoe Pit �- iB111F1 �_ -J VEL'_ �t L2J0Jt b oM Sa A P/L Fsrepvd -/� Ll tilff Nlar 12th, 2020 �'d!A"& Stoad CSTk 224099� "w -Fond. emimmme slit SA Cu,w Akmd m - 9932' 9.61 Ads PLtiSsinf ab G1.e 3L Rase c.ma 1 96—w 9700' 9742' 96 0& Fdd Sam" ado c.® 260¢ m Ar m P/L Gfili)li 1 . CROLT COI TY OTN',,ERq-"', CER "Fi 'IC . - CtN FORM _. _ . j Ito I'rof)c:tvAddr.s:s /Ifj Ile' 11h, .t%�,,,_ w2- .: � cIi:,a:tor. rc¢urcd _ os P;a:uu: il• .� '.o�i >rr.'uv:mat for a^ac:,rstra.-.toc w; sya� :_-�.:a--_ _,: _ ors-10)1-70-(500 LFCAL DESCRIPTION / .." ,�::rc• ?:,�:, ' ; N f �.:. N F ��= ! r . � 9 '� �' ! �� ,-'ou':+ �'1 �`' o.vr..n+l.c->.� Cc•ri fled Surwev ,\tap % u� NN a: rants Deed - I L .121 2_ 1',STT�q MAitiTE:1AA7CF ANI) OWNER C'f:RTIFICATION m Pap -- — ., .... _ :._�"_ - - .......,... _,.i. :=u_ zsus E'r.,:,a wr- •i.L L' $$f• i F _. _ S, ,he p mpcny owne: ay ecs :o :a:ha.II it, St Q: (',,.e:nv P:�ttu:g :: TanmC Depar=snt a mrtibc=on fora, squicd by the a Taco {' ::u.^x, r�ane�•na:, ni=ibcr, rcr.-i, tr.: rdlnbc D.d !s cu. rc p:a:nper 1'=:fpt::F t3ar TJ .he as-snr _..�_,-,. ". L.a :Yj�_,i I:: ice' ..._C__ _c g.i :.: C:LJ. •s ;:ue, t�:.:•i.ir. :;:,rc hzc:.._.'. _r aF,: _. _ ..:.c._ .r,c z;-r:........:....... _. ..._ Age dis- JS L, r. Zcm *_:)e •aan r. r:_i sct fora, h:':n�, s se: 6� 9,c :'rp:u-s�rst �`: ztrty I.::d F-: fey:;r: ra: Sc�a:rs a�'_ the Grp'=Tent of Nat:c i] Rcso=es, S t:dr of CS roast:, i crr._5canoe xanag di :: yotr s2:pj: se'te:n hi S a:; trt;une_ mea ne cos pricd and temn^_d t(.']r.. it :retr 3,r _fee N'ear:rp�.:�.,r..iat~ \ut�her o bedrooms Ll_-____ 2G ZoZo -,L w L fec-t tams:, 3,:a c r•"'optesrn:rd rzc rs:_::n lt,r '..Haut. =M:' ra:e :rv:Ca_ t_ie ! :;cin:r.g & Za:a:{, -'epartment ••• I't:!a.ir u7fi apyl:;a :oc a rocora:d •.c;t.::_:+ dccd .`r: -r :i,c is-4-�.r ;`i,ec_s +E_: and a :•,y)' ni tl.c cer'ft: runic sap -- — - -, f ST- 2020 - aq � Wrxtnsrl Chgtrtmn�pl BBWtY erN7RKc3biaMl.�iiiyt�t! ,1:r3gnrnlnduVh :x!�Ylrr!5 SOIL EYAt LLyyllii'„UUREPORT ORIGIN4 23509 " tIT '1-,r+.- �'h jrj _i_ Ws Ad'^ l u•}• Kam Shxxe (.S7 Attd.11 UYnYe LiC pi Y, fRt �j]et MJ11 , cun:, CiS C'd� n 11 JM3.P s..'C '�d9 matt $i (-.rplfi 'Ixhl(kn !N,l ljM llnp(oQ 70 YUr'_ne-AndM^•^-"j dM1 jxttPnl tklix�iL` C Tgn$NinS north 111(hv .,,-I b,aLon and dKlancv to nea•eSt roar) Vat, el I b C 16-1021 70 000 Please print all information I•m �,,,� miolnwuori .. , Hy r• .u_Y , [ i'.•1 �, Y / I hcgxnlyfkylxv F'rnrymdy Lec.YUnn - _ I ., 1 Jacob R Canssa Ktmlck GOA I'll NI 114 NEIM. Sl l T29N RI IW i'my,•dy (WIL-1's Madmg Address lot # Hkx'.k r ':Idxl Name or CSMa 11) 1101h Ave t CSM Vol 56 Pq 1344 l.nY $INIe J p Lrx1r• P,iurv• !iUTDCI (.sty Vdl.ly.• , • I n r• Nearest ROdd Rakfwln W 54CU: ;]4161 Harrrnund Same N,w (rNlSn urtgr` •Jse �. ur..up-;.• d `. a• t., ' b-��xm5 . . 4tiM Ih'n. n1 (Fw�n ItoLY •ate 6C)rJ ' .0[ i'a•,vY rgalCnal Sandy . Gam T' r trxxi jxy.n „Ir,a1Np1 'r apoircapc NA tl (}f`n„Lll uxnnN•nt•. %'TDP Se:d .v,;VJ 41:, t'te 4i 'x'Ir .r witi ISyS,eryn rier.i: n-�,p'E JD%-K'r';ntiv, q.MIM a Ix11,x,xnnwndawns onsle i3ounq IGNIIN] # —1 F9687 .. F'.t (iuwnd •.lill.lr„ auw tl UeVtrt to hntNnq Lx]or 2f m Sol Appl�;ilml H4Ie I lrxrpm IMq,th 1lominant Colo( 14., J. .ugIDna Iequfe StruCfWo L,r,,%tencc tloundary Flws GPIIAI eI Munscil Uu `,: L G• ,. St- •Fnr 1 G-9 10YR3.'2 Sit 2mSbk nrvt! CS 3f-m 06 0.8 ? q 16 10YR4 3 yi )m..bk mvir g: 2t-m 06 0 N _1 16-23 lOYR4 4 S&i 27isbk mfr gs 2f 04 0 4 23-27 5YR4/4 •J 2MSbk Invtr gs It 06 1 U ti 27-45 5YR4/4 JJSYk',/H sl 11-msbk ndr - OA 0.7 'Nu r...Nlnd •.u•e.l,,•.n..., ')b 73 I)eohtn nrnrtinq la�nN ,'20 1 u, 'Sat A{lixiraf+nn d.• ....... iAKrth 00MAantC. ( :>.LIIe St-oc"v r.x,vvlPrN r't TAWS (WO11 1 --- 0-8 10YR312 -- -- st 2mcbk nrAr ci 3f-nl 06 it H 1 8-17 IOYR4!3 al 2m:bk mvlr gs 2f-m 06 08 3 I7-70 10YR4/4 sld 2msbk mfr qs 2f 0A 0.6 4 7025 10YR4/4 (hl Wlt',/H sid )msbk full gs If 04 11.6 5 2)-44 5YR44 rm'.ra'7H / I',YR,,•'; 51 if-msbk rnvfr 04 U I 'f m..entn FiCG,o 33•:;0'n:l -rx1" .r.. ?H...•.. r: H"{).,,lu,J. aM TSS t 30 myl �'i f Name i i,,, PI r[ -]'• CST Number Kegh Sloner 224059 Add ....... Yevm L'A w, CST l0. 1 .,duct"' L.xbucied Tglcoxnne Nuv,tx •� :'.1220 W(xxl Oeek Rd SNen W i •.w r. 6 1:, :,n70 715-566 0900 Fboparty ownm Jacob & (anssa Kusilek Parcel ID a 018-1021-70-000 Page 2 oI 3 3 (ionrg ► �fbnng •,1 /�\ Pe Ground surface ew, 91 82 11 (kfxh to hnxtxg factor / 22 n Sal npprcawn Hate Fla t:on (hpAh DOmmant C;ckm Redo. De .ptgn Teo,,e Sirut7we Consatcnce Boundary floods GPD1P m 114,nsdt Ou. Sz. Cont. Coin, GA S: Sh 'Ewn 'Ean 1 0-9 IOYR3./2 - stl 2msbk mvfr cs 3f-m 0.6 0.8 2 9-15 1OYR4/3 - vl 2msbk mvfr gs 2f-m 0.6 0.8 3 15-22 1OYR4/4 - s,d 2msbk mfr gs 2f 0.4 0.6 4 22-21 r IOYR4/4 - sl 2msbk mvfr gs If 06 1.0 S ( 27A6 � 5YR4/4 C2d5YR5/8 sl It-nlsbk mfr - 04 0.7 i I as with'"Jin,an of(Kq Is �Honnq F &nrtg a • • Prt rd Grpusurface elev 94 /() Depth to itrgct limmfaor / Q i �Sorl Apptratxxr Hale', tirmum Ucpth Donnnvn Cob, Hedoa Des, qx - Teowe Structure Confence Boundary Roots GPD4P n ivtu,el OU Sz Conl. Cob' (u S: .'J, -1 "a, •raf: 1 0-1 IOYR3/2 - vl 2msbk mvfr cs 3f 06 0.8 1 7-10 1OYR4/3 f2d5YR5/6 sil 2msbk rrtvfr gs 3f 0.6 0.8 3 IO-18 IOYR4/4 C2dSYR5/8 sit 2msbk mvfr gs 2f 0.6 0.8 4 18-29 I0YR4/4 m2dSYRS/8 Sid 2msbk mfr gs - 04 0.6 5 29-35 SYR4/4 cId5YR5/6 sl If-bk ms mvfr - - 0.4 0 7 7 5YR6f 1 , 1 I Boono lkxug a Pd Gtound SUrfdCC dev n Depth to lim,brg IdCton rn ,Sal Application Flair Honzoo Depm Ou,,nAm ( at, Hello. UanCnrdwn L•,iwr Smxturr, Couusler Bo ndary Hods GPD1P m lkunf Cu Ou Sz Cont. Cda (r St :,n •Ertr 'fenIf ' f Mmnt 01 - WX), > 30 <_ 220 mg 1- and TSS >50 < t su mgI ' f fftoont 82 = BOD, < 30 m9l and TSS � 30 mgt -,I ..e. sab.. c,. i i a 25 w � corer srr ir..r+ i +uze- so n 170 fr to the West P/L I Fx>r rv>v r rnet �,�. Soil Test Site Plan For..lacob and Cari«a Kulslek Parcel in the NFI/4 -NE V4 ,sec. Il T29N-R17%1 ToN n of Ilammond -tit. Croix Counh Fa Bednwen Hans k2� BM Clem , Grade � �._ Ckanoul -9712' Page 3 of 3 Bkrk1 -Botmm oJHw Siding SE Caner F.kwatwn - 99 32' 9N4An i F.laralion Ila1a 660 07' B= 1 `! t '1 I' 93 71' K `� Field Seeded orto Gene 660, 07' Propowd Pump lank Gmdc 9, 72' \\I� Bldg \c�rrr '7 L_iP I . nM + Inn \\ .11 a-n I..n of I Arwv.re.1 Vluo r HRP-\amr ASSUMP.D ELEV.- IMAM'- ' - Awkhoe Pit l I; BM Ail AWEIl 150f1. to the Soeah IA Ba.n3md 260 ft to the E4W P2 Gnaw---- l,� � f } E / 1 /73% 96,30' 9700' 9742' 9800, r_✓r e='r �,j. MaN 12th, 21120 Frhr Seeded Gmu ` [ __!G tlt F Stoner` CS7Yl 224059 660.07' Warranty Deed # I O 13 V39 (before 2006)Volume Number of bedrooms 1-/_ Spec house E3 yes 18 no SANITARY SYSTEM KFile#:ST. C RO �' IVTY. Only OWNERSHIPIADDRESS FORM1 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. If you would like to view your issued sanitary permit online, you can do so by using the Pro eeM Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer (W L ASM 0.0 _ Mailing Address /0-�!� &Y.2 City/State/Zip Phone Numbe Email Address (required) 01`/ j6(�G Qyld )O(r)19 G nk,2.dI Parcel Identification Number 04 - /62 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location KE 1A , NF. 1A , Sec. ) J . T -,N RAW, Town of k�,- M jrj1 b Subdivision Plat: Lot # �. Certified Survey Map # s%itsI�/ Volume . Page Page #—a-. Lot lines identifiable Dyes 13 no OFFICE USE ONLY New Property Address �/4 (verification of ne4 address required from Community Development Department for new construction.) (stiff Initials) / (Data) / 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 Office 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@sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwLgov - T D D r -+ mp �z T�i VI KUSILEK, JAGOB <CARISSA - 1979 IIOT�LMI , Wl V BALDWIN, WI Nz n k v$ KUSILEK, JAGOB s CAR 1919 tlOTH AVE. BALDWIN, WI - ---L- �-- �_ E. PREUMNARY DRAWN&A— NOT FOR CONSTRUCTfON4 o KUSILEK, JACOB 6 CARISSA -- 2 Dj EI9G,K iSl9 IIOTN AVE. �. ,.� ST, CRO1X COUNTY No. S-rc-!549,r28 1,21r SANITARYPERMIT OWNER PLUMBER w 46K9 LIC. 22 REPAIR ❑J RECbNNEGTION/� NON -PLUMBING ❑ SANITATION REJUVENATION ❑ (a) The purpose of the sanitary permit Is to allow repair, reconnection, rejuvenation, or Installation of non -plumbing sanitation as described In the application for permit. The approval of the sanitary permit Is based on regulations In force on date of Issue. (o) The sanitary permlt Is valid for 2 years from original date of Issuance ar may be renewed for similar periods thereafter. Application for renewal shall b TOWN OF LOCATED made through the county and shall comply with regulatlons In effect at the time. N E I ((' N !� c C ' 1 I'� (d) Changed regulations will not Impair the validity of a sanitary permit until /LIB M / SEC ` T N ; R the time of renewal. (a) Renewal of the sanitary permit will be based on regulations In force at AND/OR LOT BLOCK the time renewal Is sought. Changed regulations may Impede renewal. (f) The sanitary permlt Is transferable. A sanitary permit transfer shall be • Avp, ` obtained from the St. Croix County Zoning Department. If you wish to renew the permit, or transfer ownership of the permit, SUBDIVISION please contact the St. Croix Countv Zonlna Dsnartmanr AUTHORIZED ISSUING OFFICER- DATE IIS PERMIT EXPIRES 7V�2023 UNLESS RENEWED BEFORE THAT DATE TWO YE RS FROM RIGINAL DATE OF ISSUANCE POST I-N-PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION