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HomeMy WebLinkAbout040-1280-10-000 rtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ig Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 317 0 .� ORMATION State Plan ID No: .,ormation you provide n-ay be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. -rmit Holder's Name: City Village X Township Parcel Tax No: Bodin, Kim Troy, Town of 040 - 1280 -10 -000 CST BM Elev: Insp. BM Elev: BM Descrip on: Section/Town /Range/Map No: I du 0 " . o /v u 17.28.19.1573 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ;;; � � . % Z B ark oD �, L -/- cr.+ivC � s Dosing AD o 4 Alt. BM Aeration Bldg. Sewer ' t ��• Y t Holding Opt Inlet 9.3 e. TANK SETBACK INFORMATION S utlet -[ • p5- TANK TO e/L WELL BLDG. Vent to Air Intake AD Dt Inlet A 1' Septic -� ✓ ` / Dt Bottom Dosing � Z Bader an.� v us Aeration Dist. Pip S r e ! 0 9 4 Holding Bot. Syst F Gra tom" PUMP /SIPH INFORMATION Manufacturer Demand St Cover P-z GPM J Model Number TDH Lift Friction Loss S Head TDH Ft Forcemain Length A Dia. Dist. to We SOIL ABSORP ION SYSTEM 2 BED/TRENCH Width ► Len .- ; No. Of Trends PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG W L LAKE /STREAM LEAC G Manuf INFORMATION CHAMB R OR Typ f System: �� `36 j UNIT Model Number. I IBUTION qySJE Head anifoP istribution / x Hole Size x Hole Spacing V ke /� Pipe(s) �. ength Dia Length t 'Dia Spacing I SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center t Bed/Trench Edges Topsoil Yes No 7 3. /� � Yes No COMMENTS (Include co s epencies, persons present, etc.) Inspection #1:/ 0 / " Inspection #2: Location: 473 Omaha Road Huds n WI 54016 NW 1/4 NE 1/4 17 T29N R19W Eagle Bluff Lot 41 ! Parcel No: 17.28.19.1573 1.) Alt BM Description = 0p Br mom h 1e aG� ) 2.) Bldg sewer length = �/ - 6v _ - amount of cover = / "e Plan revision Required? Yes I IN / Use other side for additional information. _ —_1_�_ Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County N Viscon S, 201 W. Washington Ave., P.O. Box 7162 n Madison, W1 53707 — 7162 nitary Permit Number (to be filled in b Co ) Department of Commerce ( , VE / Sanitary Permit Applica ion n to Plan I.D. Nu mber In accord with Comm 83.21, Wis. Adm. Code, personal inforrAtition yo �.\ p, '_l_il 1� W-A may be used for secondary purposes Privacy Law, s1504(1)(ni P t Address (if 4ifferent than mailing address) I. Application Information — Please Print All Information 1, GR 73 7 z D f� ZONING F Property Owner's Name Parcel # Lot # Block # Property Owner's Mailing A dress Property Location � 1 D L10114, / � /x; Section City , State Zip Code Phone Number S S Q / circle e) �S'� 5o T N; R &E o(D II. Type of Building (check all that apply) Aki c K 1 or 2 Family Dwelling — Number of Bedrooms Subdivision Na a CSM Number ❑ Public/Commercial — Describe Use IE ❑ State Owned — Describe Use ❑City_ ilia ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. (� New System ❑Replace rut System g p Y g Y ❑ Treatment/Holdin Tank Replacement Only Other M itication to Existing System B. Permit Renewal ermit Revision ❑ Change of El Permit Transfer to New List Previous Pennit Number and Date Issued ❑ Before Expirati6n Plumber Owner - 3 ' 6 IV. Type of POWTS System: Check all that apply) , r , : , < + 2 W — Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ching Chamber QDriq Line ❑ Gravel -1 pe ❑ Other (e x p 19 n V. Dis ersallfreatment Area Inf ormation: Design Flow (gpd) Design Soil Application e(gpdstT , ispersal Area Required (s Dispersal Area Prop o Sys em Elevatiolt D� 93 VI. Tank Info Capacity in er Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank s �_7'� Aerobic Treatment Unit /ICJ Ot Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for i allation of the POWTS shown on the attached plans. Plumber's Name (PrinW Plumb 's Signature M /MPRS Number Business Phone Number ,R 17/5 - go?6a- & 5 � Plumber's Address (Street, City, State, Zip C e VIII ount /De artment Use Onl Approved El Disapproved Sanitary Permit Fee includes Groun water Date Issued Iss 'ng Agent Sig ;,6 o - Surcharge Fee) (j - � g bD ❑Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disappro al r 7 �e Q Q7Z 3 . ' Attach com p pia � (to the C only) )f for the system on paper nj less than 81/2 x 1 i ;h m size S� At r I - SBD -6398 (R. 01/03) Gt/ U �o et ly r f^ yam_ q y I� N �1 0 � r I ys� 4 y 4�f S � 6_• 13 p o - L,1-� . SY 93' • I 2 POWTS OWNER MANUAL &MANAGEMENT PLAN Pag of 9 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Q ga l ❑ NA 16 Permit # 3 Septic Tank Manufacturer ' ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model a� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) 4 160 gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) b gal /day Pump Manufacturer ❑ NA Soil Application Rate gal /da /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L K in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <_10' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA C2 Jtr year(g) Clean effluent filter At least once every: ❑ month(s) ❑ NA A& - year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ' ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: 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 identify 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 (Y 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. 2, - Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: 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: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. rI T alua ' a o ing ank 80441 Py rr&T' , �i2 /�/�L✓ GflNS`TKVC' DrV ❑ 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 «,( Name Phone �� _ _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name ST. l 6V N 2DIl�l Phone Phone '7 /S— This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Wisconsin Department of C Teroe SC IL EVALUATION REPORT Page of Division of Safety and Buildi s ;;� � A U (, in lack�rdait h m s. Adm. Code 4 County Attach complete site plan pa n 11 i es in m st ro include, but not limited to: rticace 2 (BM), n Parcel I.D. percent slope, scale or di rid distance d. Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). roperty Owner Property Location ;.� Govt. Lot ,`� 1 /4,e/' 1/4 S T N R E (or Property Owner's ailing Address Lot # Block # Subd. Name or CSM# city State Zip Code Phone Number ❑ City ❑ Village Wown Nearest Road [ New Construction Use: 12 Residential / Number of bedrooms 3 Code derived design flow rate O O GPD ❑ Replacement ❑ Public or commercial - Describe: _ Parent material () U-� C� Flood Plain elevation if applicable General conwrients and recommendations: a Ong # ❑Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. 7*E Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#2 O a Boring # Q Boring pit Ground surface elev. z O ft. Depth to limiting factor 0 in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 ' -3 C Ivy S . K 11P 4 o �/ 1 / S, - -fir of i3 — M S 1.6 Effluent #1 = BOD > 30 < < 220 mg/L and TSS >30 150 mgA- ' Effluent #2 = BOD < 30 mg1L and TSS < 30 mg/L CST Name (Please Print) — — ignature CST Number T333a 9' Address Date Evaluation Conducted Telephone Number 5' -7- - Q -I 7 /S' ' o, q / � � Property Owner Parcel ID # Page of Boring # ❑ Boring Ground surface elev. W1 6 ft. Depth to limiting factor in. Soil Application Rate Pit don Texture Structure Consistence Boundary Roots GPDM Horizon Depth Dominant Color Redox Description in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Z Z _ 1 ,m D ✓ �-- s F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor i "• Soli lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM - in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring # ❑ Bonng Ground surface elev. ft. Depth to limiting factor in. ❑ Pit FSoihApoication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ` Effluent #1 = BOD > 30 <_ 220 mg1L and TSS >30 1150 mglL ` Effluent #2 = BOD 1 30 mg& and TSS 130 mg(L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 2648777. SM4330 OL6=) PAGE —Z-0 F NAME /�Q�� \ LOT# 1 LEGAL DESCRIPTION /ayE'/a,%;Z TZ ,N ZZE(OR / SCALE: I" Ile BM 1 ELEVATION /,/JO BM 1 DESCRIPTION 1/1B! ••/� ge C—,t -fre -e BM 2 ELEVATION .J BM 2 DESCRIPTION SYSTEM ELEVATION C� SYSTEM TYPE -3 SIGNATURE Z, D TE � SYSTEM OWNER= 6 ��7 # vt,.. 4,f, v� pere tic tank, effluent filter and �� ssal cell m 0 ust all be serviced d / maintained �Q/ as per manage lumber. QQ 2. se ask requirements must be maintained as per applicable code /ordinances. bo n 0� 35'� 3 , l� f" Safety and Buildings Division Coung NVi sconsin 201 W. Washington Ave., P.O. Box 7082 Madison, WI 53707 7,N82 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 261 6 Q 41 -� Sanita Permit Application State Plan LD. Number In accord with Comm 83 , Wis. Adm. Code, personal information you provi f 'Trn,-nS. -TP, may be used for adary purposes Privacy w .040)(m) Project Address if different than J ( mailing address) I. Application Information - Please P n All Informatio w o Property Owner's Name , O Parcel S Lot M Block S Owner's Mailing Address U IT U T Property Location ZONING _ FICE ���OCJ°f`Q -6 C7 City, State Code Phone N ber `—`-'y, .l___!../ Section �Z ,5 . ) • IL Type of Building (check all that apply) TISN; R_Eo N/ /. 91 or 2 Family Dw -Hing - Number of Bedrooms N Subdivision Name CSM bet ❑ PublidCommercial - Describe 'use E ❑ State Owned - Describe Use ❑City illage kownship of ILL Type of Permit: (Check only one box on line A. Comple line Y If applicable) New ❑ Replacement System ❑ Treatmen 1 g Tank Replacement Only th qafisr4on t is g S B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List J MvJJ :p R Munilber and Date Issued Before Expiration Plumber Owner r IV. Type of POWTS System. Check all that app ly) , ❑ Non - Pressurized In -Ground M Mound > 24 in. of suitable soil Mound < 4 in. oCsuile s 11 taboil At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter C1 Leachin Chamber ❑ Dri Line ❑ Grav less Pi El Other (explain) V. Dis ersaVrreatment Area Information: Design Flow (gpd) Des' So licat Rate( I) Disp real Area Re red (s Dispersal Area Pro ed (so System Elevatio OD �� 0, lz oa O a( o 0 VI. Tank Info Cap ac' in • Total Number I Manufacturer Pliefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Sepuc or Fioktutg Tank — / G4:2� / Aerobic Treatment Unit w Closing Chamber 00 — 00 VII. Responsibility Statement I, the undersigned assume responsibility for In Ilation of the POWTS shown on the attached plans. Plumbzw�m Plumber's na a IMPRS Number Business Phone Number 1 71 - 5 - - Plumber's Address (Street, City, State, Zip Code) VIII oun /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater : 2a Issued Iss i Surchar a Fes �f �^-- Cl Owner Given Reason for Denial g ) ff �J IX onditions of Approval/Reasons for Disapproval If YL� �'� �- ,do n�,u a �,4.v� Sau f i'l2 W,77d ep r PLOT PLAIT Page 3 of3 r• Scale I'= 40' Q:) r LV? O � DoT y � p ►., o - r cow, P 0TZ CDLSTUe.p a / a cowTav� �. `LSo.o' Sot'7on Or- c.k.z L-L S �,» 5 -2A CN a ab zq o UTL-),:)T ' a sh - - M►ri a� i L_oS' �ti IS 715- 425 -0165 220254 Oo - S- y CST Signature Date Telephone No. CST No. Job NO. ot t c,-t z'/ r� r wt F -sWJL - 12cal6c° sr/ pr — s®� 3s ?c 3s y B r-op" �, A PLOT PLAN Page 3 of �• Scale V= 4p' 0� LoT i � O ►J 0 T CAr'1, P OTL pIST��p Hol of ekn-L LrL Is a ab 2, \ \ o U JZT J � / t � 7 715 - 425 -0165 220254 00 -3► S- y CST Signature Date Telephone No. CST No. Job No. V k -s II ti Safety and Buildings commerce.wi. OV 10541 N RANCH ROAD g HAYWARD WI 54843 TDD #: (608) 264 -8777 i sco n s i n w�vw•commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 06, 2005 CUST ID No. 220357 ATTN: POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA 110 KELLER AVE N APT 112 1101 CARMICHAEL RD AMERY WI 54001 -1034 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/06/2007 Identification Numbers Transaction ID No. 1151614 SITE: Quality Homes Site ID No. 701080 Town of Troy, St Croix County Please refer to both identificatiw numbers, NW 1/4, NE 1/4, S 17, T2 8N, R 19 W above, in all corresp ondence, with the agency. . FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1026936 Maintenance required; 600 GPD Flow Rate System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.0 1 /0 1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Dept. per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.O1 /01). • The pressure network is to be constructed in accordance with publications SBD - 10706- P(NO1 /O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)". 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. BRADY J UTGARD Page 2 7/6/2005 The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Leroyy G. Jk►nsky, Wastewater S e alist Integrated Services Bureau WiSMART coder 7633 (715)726 -2544 Voice Ijansky@commerce.state.wi.us I ` MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: QUALITY HOMES Owner's Name: QU Owners Address: I q (0o . Legal Description: NW1 /4 NE1 /4 S17 T28 NR19 W Township: TROY County: ST. CROIX Subdivision Name: EAGLE BLUFF Lot Number. 41 Block Number WA Panel I.D. Number: PENDING Plan Transaction No.: 11 -0 161 i. Page 1 Index and title P.O.W.T.S. Page 2 Data entry Conditionally Page 3 Mound drawings Page 4 Lateral and dose tank A P 1 R U V E D Page 5 System maintenance specifications DEPARTMENT OF COMMERCE Page 6 Management and contingency plan DIVISAON Of SAFETY AND BUILDINGS page 7 Pump curve and specifications Page 8 PLOT PLAN EEG RESP DENC age 9 soil test Designer: BRADY UTGARD License Number 220357 Date: 5 Phone Number. 715 - 268 -6995 Signature: Y��l Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.11 (R. 06101) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83-44-3 kvsku soa beatmet for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) cditm of - 36 k ches. 600.00 Design Flow (gpd) 14.00 Site Slope ( %) 950.00 Contour Line Elevation (ft) 31.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gWfe) Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gp w) 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 10.00 fe /orifice 2.00 Forcemain Diameter (in) 85.00 Forcemain Length (ft) Does the forcemain drain back? Y 940.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 13.86 Forcemain Drainback (gal) 10.25 Vertical Lift (ft) 46.75 5x Void Volume (gal) 2.72 Friction Loss (ft) 60.61 Minimum Dose Volume (gal). 16.22 Total Dynamic Head (ft) 39.32 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1 .911 1.50 x 1.25 x X 2.00 x X x 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) 35.97 Total Working liquid Depth (in) WIESER Manufacturer 22.24 gal/in (eater result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) lZabel Filter Manufacturer 22.241 Dose Tank Volume (gal/in) A100 Filter Model Number WIESER Manufacturer Project: QUALITY HOMES Page 2 of 9 Mound Plan View T 1/106••• . � .Q. J1 B _ _ _ _ _ - � • �; I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i L Mound Component Dimensions A 8.00 ft E 19.44 in H 1.00 ft K 8.49 ft B 75.00 ft F 9.25 in I 14.95 ft L 91.99 ft D 6.00 in G 0.50 ft J 3.74 ft w 26.69 ft 600.00 (fl Dispersal Cell Area 1721.44 (fe) Basal Area Available 12at 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grp 952.27 (ft) —� ..f.�.... G H .s.�. }.�.. 2 ��r...�.,. F D Cel 951.00 (ft) Lateral 950.50 (ft) _ Invert Dispersal Cell : •D Elevation E = {- t } �, �4 950.00 (ft) Contour Elevation 14.0 % Site Slope Geotextile Fabric Cover Shading Key a Dispersal Cell See lateral details on Q _ Topsoil Cap c 1.5 ft .... ,..... Page 4 for number, size, © Subsoil Cap m o :;':';• and spacing of laterals. © ASTM C33 Sand .—' �•�•:�:�' •' _ =ti: F Laterals are equally :. ®� Tilled Layer p • 0.5 ft Typical Lateral . • spaced from the 0 rtir:'r:' p •ti r:r: :'r;. distribution ce Aggregate v -- ii-- �_ A °� centerline in the distribution cell W13). Project: QUALITY HOMES Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical P 5 �L •= Turn -up vWball valve or If X- -4IEaf2 I W241 Laterals & force main of PVC Sch 40 of ea n out plug per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 36.69 ft Orifices per Lateral 15 Lateral Spacing (S) 4.00 ft Orifice Density 10.00 ft /orifice Lateral Flow Rate 9.83 gpm Manifold Length 4.00 ft System Flow Rate 39.32 gpm Manifold Diameter 2.00 in Total Dynamic Head 16.22 ft Forcemain Velocity 4.02 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC . 4 in min. Disconnect _ Tank component is properly vented iz Alternate outlet location Forcemain diameter WIESER Manufacturer 2 in. cap acityl 800.00 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 22.25 494.75 C B 2.00 44.48 P, ump off e levation (ft) C 2.73 60.61 �---- 940.75 D 9.00 200.16 D Total 1 35.97 800.00 Dose tank elevation (ft) 3' Bedding uncler tank. — 940.00 Alarm Manuafacturer I LEVEL Alarm Model Number LDLV Pump Manufacturer GOULDS Pump Model Number EP05 Pump Must Deliver 39.32 gpm at 16.22 ft TDH Project: QUALITY HOMES Page 4 of 9 Mound System Maintenance , __ y and Operation Specifications Service Provider's Name UTGARD PLUMBING Phone 715 - 268 -6995 POWTS Regulator's Name ST. CROIX COUNTY ZONING Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once eve 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code, 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. 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 Finished ................ Grade 6 -8" Diameter Lawn �_� Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: QUALITY HOMES Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ewer enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. 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 finer shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic 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 fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not reconmer ied since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Colo weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg& FOG for septic tank effluent or 30 mg/L BOD 30 mgtL TSS, 10 mg/L FOG, and 10 cfu/100 ml- for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continuency 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: QUALITY HOMES Page 6 of 9 , gpt elA- ot ha Logy- -f 1�1O 410 r wt1�5iEA- C/ ` IZao�P,00 .r- PUMPS [(b] GOULDS ' Submersible Effluent Pump MODEL 3871 EPO4 & EP05 Series APPLICATIONS • Fully submer in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. heat transfer. ■ Casing and Base: Rugged •Effluent systems 9 99 • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion manual operation. Auto- Canadian Standards Association • Heavy duty sump matic models include resistance. s,' File # LR38549 • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer Goulds Pumps is ISO 9001 Registered. factory, strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic • Solids handling capabili FEATURES cover with integral handle and g p ty float switch attachment points. ' /a" maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1' 12" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA -N elastomers. • Temperature: 104 °F (40°C) continuous 140'F (60°C) intermittent, METERS FEET -- _ -- __ -_ • Fasteners: 300 series 10 stainless steel •Capable of running 30 I dry without damage to - � -- - components. $ z.s Pr Q _ _ Motor: _ • EPO4 Single phase: 0.4 HP, v 6 zo -_ - -__ �.___— ___ -.__ __._______ 9 P � f- - -.__ , 115 or 230 V, 60 Hz, 1550 f a - __ _ RPM, built in overload with o 5 t s 1 — r — w'; aoZ automatic reset, - -_ _--- ---- -- • EP05 Single phase: 0.5 HP, 4 _ . ___ _ f..... 1 EPOS 115 V or 230V, 60 Hz, 1550 3 10 37 5 RPM, built in overload with automatic reset. 2 EPO4 • Power cord: 10 foot 5 i - -/— +-- - -- - _ standard length, 16/3 1 __ —_ - -- SJTW with three prong grounding plug. Optional 20 ° c i 10 zo 3o ao so GPM foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). ° 2 4 6 8 10 12 rr1'/h CAPACITY Goulds Pumps © 2003 Goulds Pumps nw v q O ` Effective July, 2003 83871 ! / vfJ S ITT Industries / r Wisconsin Department of Commerce SOIL EV ,�1t1t�' REPORT Page of 3 £ I #ision of Safety and Buildings 1 �, , l •, } in accordance with Co � County Attach complete site plamon paper not less than S 1/2 x 11 1 size. , g include, but not limited to: vertical and horizontal reference iftf M), dirf+�ri:�ti p rcel I.D. E]V percent slope, scale or dimensions, north arrow, and locati and distance to nearest road. Please print all infortnatim NOV 0 7 20CD A e ' Date Personal information you provide may be used for secondary purpo�g44F ivacy LavT' S. " (m)). Property Owner C-0 0 �Ek3 ELGIP � CD _eA_ 1/4 1/4 S T Z$ N R E (or Property Owner's Mailing Address pi 43 bp # Subd. Name orR6W 118 ` z N SU"nE ) o ti 1FPYG 13 L,uF - f City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road MN 1 5514t1 � --ttol� 0MPr\4 R Rop © New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate q -S 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable N l ft. General comments and recommendations: MOU h,b W� 9 ' X- S v ` D t 3TiZ- . Bu 72 O k1 C-ELL , 1) 1"Q" r OF 5 A7,4 fi t.(_ . Boring # ❑ Boring L� pit Ground surface elev. Depth to limiting factor 3 ) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft� in. Munseli Qu. Sz Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ti►,'�i Z g 3 lo i — St 3 ` hk s1, cw - •5 :4� 3 1 - 3 10 - 1 a - 3!` �` 1- S-1rZs -/b S't 1 p 113 -trZ s! . . Li 1'F S O ti"t S - .0 spfx-ot> F Boring # . ❑ Boring ® pit . Ground surface elev. - ft. Depth to limiting factor > in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 o- l o�r� 3 1 z _ std Z`Fsb m`fi c�,, 1 � ,5 _ $ -gip to — sil Z�tsbr� rQ sV1 ew - . s _ 3 Vlo -S 1s wt \j V. Z Y S3 -1Z tio`1rZVA _ S U : S9 M 1 _ - -. z- • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) s CST Number Arthur L. Wegerer o b' 31S ' �I 220254 Address W e g e r e r Soil Testing & . Design Service Date Telephone Number 421 ITT. Hain St. River Falls, WI 54022 1l_S O 715 -425 -0165 l 1 Property Owner QY��I�l_ �� , (�`i2 �, Parcel ID # 1::OL1VD1N(:; Page Z of F3-1 � Boring # ❑ Boring ® Pit Ground surface elev. 9 SZ. S ft. Depth to limiting factor y S In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 I •Eff#2 L � -2q lo S1 � - Si I Z k art. Ck, - • S -g 3 �-9 -qs WIR. 6q lrw- vz_Sl6 l-F rtiIz 51t� 1`Fs o ►v<v - •o .O L I I'JS W c °La ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ❑ Boring # ❑ Boring El Pit Ground surface elev. (t. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L • Effluent #2 = BOD, 130 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. ssD- 9330tR610ol PLOT PLAN Page 3 of 3 Scale 1'= gip' LOT QU? LoT q I � p 1.10 T C.t�►"1, P PS 73i2S fr1Z.�i °` ca t ' o uTl zT i qs� M Z a., '� YLft��f, 3[Y'DIA:: PvC: P1 PE` :lljL -L-AM. pp 715- 425 -0165 220254 00 -3L S- y CST Signature Date Telephone No. CST No. Job NO. i Jul 14 05 02:15p Chad Bleeker 715 381 8296 P.1 ! 1 4. 2005 2: 02PM Chad lilceker 7jr ,,, ,,,,!o. 4009 P. S CROIX - ot:..vr. MAi3V'FL.NA4C2- AGR8BMENT 0 %NEI - 6) lip C." V Ow;-gr/B I Ajdm=4f.► t 41 )Q4P W : LO A — .I- —PJ—M- 9 N !'ZOPerty Locstion JVLA �i, 12- T-26-4 -Zf\V, Town of A4 -SUMMstoa 07 Ctruned Survevvap 1' tic "' Dred Veit— paw - SP= ho:w it Yes Lot fincs 1 per M—Nepul affect : touv to hawk '"SIM - rommliaw=wc cams�sft U!.0 eve:Y d 34ow. !f 4. a em 06A by if o.—j A raMpen Wha t PM Unt iMt* the S,'f =i= r =* as a *3t:jtM--V. q'Vc in nor F"Pert34 3-1 is JM 'Y :hlj Own-of aad by ta PrUxeoPenUm%Cb".-;,, vj d" ly ! :b&AI fi O f :ti tat1z, h iWam vic or, i:'M as =r by D*mt am w. rA=,,,., " W-'V"F dilp"ni S.'stem W42; dm amm y r 1 1 "it qW-v- �j 9 be i re. mt be Ca .i;c wL Vg 30 D e, ATE I N- C cerfify do a =* Malsom are tic u p =1 to :1b, Sex of try ( -0 Lmwic� ( ii * in jar*'- tim aw.-. APPLCANT - AZY kqm-Ar;Qv :hat 11 %ciuda with skis *Ana" ci-we rfoc. th � g j sftr .. of r c "fied 3 "ryr.y n-P if !ifcmr.-:z i =; 4-e3 7999�4- U 2 8 `I O P 5 2 1 KATHLEEN H. W ALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 07/11/2005 01:50PK WARRANTY DEED EXERT # REC FEE: 11.00 THIS DEED, made between Michael H. Latuff and Kathleen F. Latuff, husband and TRANS FEE: 372.00 wife COPY FEE: ( "Grantor." whether one or more), CC FEE: and Kim Jeannine Bodin, a married person _ PAGES: 1 ("Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is ?� �li f 1 needed, please attach addendum): Lot 41, Plat of Eagle Bluff, Town of Troy, St. Croix County, Wisconsin. kilt 17 040 - 1280 -10 -000 Parcel Identification Number (PIN) This is not homestead property. (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated July 7, 2005 (SEAL) �f C (SEAL) * *Michael Latuff (SEAL) (SEAL) * *Ka Teen Latuff AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF WISCONSTN ) ) ss. ST. (ROTX COUNTY ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on July 7, 2005 (If not, - the above -named Michael H. Latuff and Kathleen F. Latuff, authorized by Wis. Stat. § 706.06) husband and wife to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instrume t and acknowledged the same. Attorney Kristina Ogland Hudson, WI 54016 * Virginig R Gartman Notary Public, State of Wisconsin PV My Commission (is- p�nt) (expires: January 20. 20A8 ( may be ted or acknowledged. Both are not necessary.) NOTE: THIS IS AS ORM. A O ICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED VIRGINU�i�. 0 TE BAR OF WISCONSIN FORM NO. 2-2003 � Type name below si- natures. l G1�T iNFO- PRO' Legal forms 800 -655 -2021 www.infoproforms.com 4t11 1 I � 9T eo h 111,, F a W` Wisconsin Department of Commerce SOIL EV REPORT pivssion of Safety and Buildings ! Page of 3 4 in accordance with Co 9? dm. '6 Attach complete siteplan on paper of ss than 8 1/2 x 111 ize� ,!:; County S_ include, but not limited to: vertical a ntal reference M , d percent slope, scale or dimensions, nor>lw, and locati distance to nearest road. }` rcel I.D. Please print a4Format /o j W 0 7 2000 a iewed by Date Personal information you provide may be used for secondary purpo a 'vary La'N T. I ) (m)). Property Owner Z OI ftI&pca 1/4k 1/4 S T Z$ N R E( Property Owners Mailing Address 0 U # Subd. Name or Ram# l 18 �O `Zp ?v SST N E , S U t 1 u ti t="p I_E )8 w City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road "N I 55� Y 9 1 ( -) 63) Z S'1- o I Q M pr'4 R R.o � © New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate so GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ►� n. General comments and recommendations: w'1bu),_p t~.I/ 9 'X S tJ ` D t S1�Z C bu T? 0)-1 CLzLC- �'l llV lMU><I (o Up S A .4 PwL , 1 I Goring # ❑ Boring Pit Ground surface elev. 9 S 6 . o ft. Depth to limiting factor_ in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 t 0 -% tiolVz- 7L L I rL, a _ 5 A c�) — 0 p _ '�► s k3 .0 Boring # Boring ® Pit Ground surface elev. Q ft. Depth to limiting factor Z L Z 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 1pots GPD /ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o_ %-f TL s 1 z s z�FS b ►z m `f1 cf�, 1 f s , 8 3 yo - , s�rz31 — 1.S 1 O_Sb1- wt 'Aftuent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 m CST Name jPI , Print) s _ 9/L and TSS < 30 mg/L Si CST Number Arthur L:. egerer ,�1 �b -31 S - �{� 220254 Address lleg+�rer oil Testing & .Design Service Date 421 N. Main. St. River Falls, WI 54022 Telephone Number t1 -S .00 715 -425 -0165 Property Owner Q�l`� Nit- �� . t-,(� 2 Parcel ID # pOuOl A J 6 Page Z or 3 .. F3 -1 Boring # ❑ Boring ❑ Pit Ground surface elev. ' Cl SZ. S ft. Depth to limiting factor In. Soil ApplicatIo n Rate Horizon Depth Dominant Color Redox Description. • Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -8 io r7- z 1 Z S l 1 Z`fsbk �vi'�- �.�' • S - 8 S I Z k y,t. CLU - •S g 6q tw- tki - 1-3 - Li 5�� ��'$ o ►v< tJ�� _ . o . kj S w c.. F -1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application !late Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 T77 Boring # ❑ Boring ❑ Pit Ground surface elev. ff. Depth to Ilmlling factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -1))0 (P-M) v i LV� v , i ♦ v rr , vr►i v v� 1 �V I .J Vi �V i♦ VVVI V I 1 , v I JVVI V.J 1 OF THE CERTIFIED SURVEY MAP RECORDED IN VOLUME 9, P D LAND UNPL� I -- — — N 88 °37' 26" E 1 2648.40' NORTH LINE OF THE S 1/2 C 2 OF THE SW 1 /4 OF THE SE 1 /4 618.24' 1 258.57 ' i 50' I I o OUTLOT 2 5.469 ACRES I I ul 238,241 S.F. 'EX /STING I l HOUSE I w / LO 1 I i o f N 82 000' 00 E 14.242 ACRES / 1 n 134.6_ N 82 °00' 0( C . S — 620,368 S.F. I o ► p�,;� �� �tn 147 7. PA_GE_2_613 I 50 I �, 1 .027 ACRES ° E / , o•` 44,736 S.F. cp0n ' °0_ N DO y 4983851 I , o ° '\ W VOL. 9 .� 20 8 — / l 1 65.64' 10 4.04' p q A 0 0., / 'E 2613, DOC. h° I S 8205110.3t, E 1.013 ACRES 169.68 44,108 S.F. (R —N ✓9$.$:�9•, l 'gip 2 I � �\ R =80' 89 E 349.08' M 1 - 2 o, .168 ACRES 3 . / 89 W 349.08' 150,874 S.F. ' , � � (R -S 89 °38'59" E) 3 - -S = ° o(b 1.210 ACRES �° U) <v 52,729 S.F. /N 88 0 36' 10 _ ° 2647.02' S 8 0 00' 0 _�4 IV 42 615 ACRES 3 6 � _. W 1. p o , �� '75 6 8.26 \, i M �, 0 70,358 S.F. OUTLOT o�ry r, N (o v; / 1.000 ACRE OUTLOT ;., �\ 7.292 ACRES \ \ \�� _ ° M LO - /N `� 43,563 S.F. /� °N 91 , ` \ 317,625 S.F. %E 156 N o N * co °° I � / � ` 2 263• 134.69' 4' \ \ 2 247.69 129. 3 / N :. 4 04222 N o 117.15r1 /2" 130.54' 631.07 3/4" a . 119.4 N 81 57 12 I o � ` t°° �o I / I 0 wy -' °o �°- -�- - ____ -- I 1 I 1 11 ( l ww��i!>> ° o °• � I I ✓ I I � - I I I o „ 0 �j TOWNSVALLEY ROAD I , I N 1 p TO BE DEDICATED TO THE PUBLIC) I Q '(1 I - 194;31' \ \ C x Qv °5 - 81 ' 29 116.75' \ I mo �__- - I 40 1.087 ACRES\ \^