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042-1052-60-500
n CO) 0 c d C d _1 � m I �• m y a i 0 � c ;_ I n _ 3 _ O a� Q C T. N p v O co A C • �' < < C 0 , co N C CL C 0 0� w OD cn Q • A N C5 N N (A N -� N cr cr O n w C 0) CD C� 00 _ 7 (n O � O 00 o _ _ w m o r* o � � 7 W 00 O Q O d tD Er CD a m 3 (D G :.'. (D y w Z O N N fD . a . a CL l i z 0 0 0 A o N A Z v N 3 N N --I W D O O O O' y N » N 3 (D N 'C CD (o !r F N N A v a - I� N z z O o Z D - m fll 0_ N c O 7 fD = • 3 @ N W O _ d C •p W (D n 3 ° m C �_ o N 3 -4 N T d A 2 n 0 � A � 3 o. w � O CL z 3 �. F! z A F I O N p y a S O 0 0 0 O - N O� T c7 O Z C O C O N ? N O CD y U 3 M C O o rn�om O N C) N Q ? O CD 3 3+ pl N CD U7 4 j O <. O fi N 0 - m . � m o 0 o 0 m o v o o 3 ?} A (D N EA 0 + A CD � o .O Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST. ,�`�,�" Madison, WI 53707-7162 Sanita >Y _ resin (608) 266 -3151 Department Of Permit Numbe be filled in by Co.) Co mmerce Q Sanitary Permit Application State Plan I.D. Number { In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ! may lie used for secondary purposes Privacy Law, st S.04(1)(m) Project Address L (if different than mailing address) ._ I. Application Information - Please Print All Information C � ?0 S 7yi V ED PrD v'n ty Oer's Nam I I ' N n O O 6 Paroel # Lot # Block ,1VIV , I ' Prer's Mai ling Address ST, CROIX COUNTY Property Location I Ci Start Zip Code Phone Number - �' ` "a'V '�. Section — R A 4 - o 0 A/ 1 / 06 T N / - ; R / Er j II. Type of Building (c eck all that apply) I 1 or 2 Family Dwelling - Number of Bedrooms _i Subdivision Name C /SnM Number e' j ❑ Public /Commercial •- Describe Use t✓' 9 /aJ ❑ State Owned - Describe Use _ ❑City ❑Village Township of MhTF III. Type of Permit: ( Cbeck only one box on line A. Complete line B if applicable) A. New System � ys El Replacement System ❑Treatment, Holding Tank Replacement Only ❑ Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS Sy stem: Check all that app r, it - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized hr- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating S ynthetic Media Filter ❑ Leaching Chamber ❑ Drip Line Gravel -less Pipe Other (explain) V. Dispersal/Treatment Area Information: Des Flow (gpd) I Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevati / /_ (f' C . �Q �C�C� �� /V b J! ' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fi er Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks i . Septic or Bolding Tank x Aerobic Treatment Unit Dosing Chamber E V.hI. Responsibility Statement- I, the undersigned, assume responsi lity for installation of the POWTS shown on the attached plans. Plumber's Name (Pr' t} Plumber's na MPiMPRS Number B siness Phone Number Plumber's Address (StrcfK City, State, Zi Co ) �y yS'7 , /L cc Gil S VIII. Coun /De artment Use On 11 Approved C1 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued 711suingAgent Signature (No Stamps) Surcharge Fee) 11 Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01 /03) able I L 4 0 F � �� 2 Co �� c /a q,� ion �� 6$ ra 0 � �S 'A t 1 k' TVA WEATl1ERPROJK --- LOCKING COVfiR JUNCTroN [v ,,YW c f1BE�f . Bcix QvICK arac,oawcr --� 9" 12 MfPD 7Noi,%TuRe.ED P`�L I "- 24" 2.D. J 4,. 4 0 MANUOLE vI: /4" r ; �"wric GWRDVLQ A I T >t0:t I �i f%v;_ lS4F -T 3C1NrS Sal, U. P^ � BAFFLE j 0 1.AL s � 3' O-ero ?►w E LT I o ttii w j . �. �X. ► t - l c)-tJ ON C q�-i tr.cLzstvcD. OLF I a R A co��cxE r� I BcoCK ! SEPTIC i SPCCIFI•CATIOU DOSE TnuKS MA►JUFACTURC �j' � S I.ILLMDER OF OOSCS: PER OAS TAWK SIZE: II GALLOWS DOSE VOLUME tt ALAR00% MAS1UFACTUK&R: INCLUDING 5ACK FLOW: vA��ONS MODEL LIl1M6CR: CAPACITIES: A= �� I,JC►+CS OR 9 —b —V ag waa.ew� wl�, uA vl j SWITCH TyPt: �__ ,� ^ ■_��_ P `�CZ.+v 8= a I W CHES OR �1.a U MP MAIJUFACTURCit: � C•- '�LOa•S C ■�IUCHES OR 1 faG._i- Y vA�_Ol'S MQOEL IJUMDCK:�„ f �•G� f{�� �Wt7 T'JP y - + o.�.a.v C INCHES 0R IJ_OTE' PUMP A►JO ALARM ARE To aC r11►J1MUM DISCNAR" RA TC GPM INSTALLEO OW SEPARATE CiRCc:TS ST CRO C O UNTY PLANNING & ZONING FAx MEmo DATE: TO: p-q( -E CodeAdministratio • FAX NUMBER: �S- 715 386 - 4680 r Land Informatio FROM: K. �-V / A J Plannin I FAX NUMBER: 715 - 386 -4686 715-386-4, 74 PHONE NUMBER: 3 ce e Re roperty 7 : - 386 -4677 NUMBER OF PAGES, INCLUDING COVER SHEET: R c - ng 715- 8. -4675 RE: . S 16 ti �1(�E 1 ST. CRO1X COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W1 54016 7153864686FAx PZ @COSAINT- CROIX.WWS WWW.00.SAINT- CROIX.W1.US I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479268 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: j Fouts, Dan I Warren, Town of 042 - 1052 -60 -500 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: M. , aj CST ` It 19.29.18.295E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. �� Benchmark t �•� • 1 00.0 Dosing w � � - � �r Alt. BM Aeration � Bldg. Sewer Holding St/Ht Inlet w g2 r � .�f2 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ,. fl r `, \ 21 4 Dt Bottom • Dosing 4 3 Head � �• ` 3' �a sz / 1 Aeration Dist. ip � e Holding Bot. System 1 PUMP /SIPHON INFORMATION Final Grade Aw l w Manufacturer Demand St Cove &i 4&rt- GPM .(�/ Z•C jOZ • b �+ Model Number TDH Lift Friction Loss System Head TDH Ft t�• O•b9 Forcemain Length 1 Dia I i Dist. to Well SOIL ABSORPTION SYSTEM 2 ID �•�-. ews BED/TRENCH Width ( No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ? T" r 3) SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufact er. INFORMATION CHAMBER OR �f Type Of System: i UNIT 2-1 Model Numb / coy w. DISTRIBUTION SjkTEM Header /M ifold Distribution x Hole ize x Hole Spacing Vent to Air Intake Pipe ) Length Dia Len Dia Spacing SOIL OVER 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 Bed/Trench Edges Topsoil ' 2 n Yes L No rg Yes j No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: � ��ff_ J Inspection #2: _- 7 - ' — T` Location: 903 89th Avenue Roberts, WI 54023 (SW 1/4 NW 1/4 19 T29N R18W) rc No: 19.29.18.295E 1.) Alt BM Description = J —� 2.) Bldg sewer length = �• 9q.IZ. �• wp.'� - amount of cover = �• �r5 qp �s -- a = s 1$ .92 -- - Plan revision Required? � Y � No � I Use other side for additio ation. -- SBD 6710 (R.3/97) Datgr Insepc ignatu q Cart. No. T ' Q �► Q D , cue seta,. Safety and Buildings Division County MA 201 W. Washington Ave., P.O. Box 7162 O 1 ��►���,� Madi WI 53707 - 7162 ,, S San Permit Number (to be filled in by Co.) Department of Commerce (a ) 266- 3151''t 7q26g S Permit Applieio ,State lan I.D. Number n In accord with Comm 83.21, Wis. Adm. Code, personal informan u provide . ; = may be used for secondary purposes Privacy Law, s15.04 Allroject A ress (if different than mailing address) I. Application Information - Please Print All Information NG' 0V E Property Owner's Name arcel # Lot # Block # D" finJ3 ( 4) Property Owner's Mailing Address Property Location %., � /s, Section City, State Zip Code Phone Number d s cn, C � 3 0 - a (circl TN; RE L of W J � Type of Building (check all that apply) �--/ ' 2 Family Dwelling - Number of Bedrooms s , CSM Num er �� p �3 f�9 /2SS ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ❑City ❑Village ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p 2 - 052 - B - S"DU C. 2— A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that app! - ,i? - F dL r z , ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter ❑ Constructed Wetland �essurized hi- Ground El Holding Tank 11 Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter El Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip-Line ave] -less Pi ❑ Other a lain P ) V. Dis ersal/Treatment Area Information:o Zpp Design Flow (gpd) Design Soil Annlication Rate(gpds Dispersal Area Required (sf) D persal Area Proposed (sf) S em Elevati n VI. Tank Info Capacity in T t Number Manufacturer Prefab Sit Steel Fiber P14tic Gallons Ga s of Units W 1 r n Concrete Constructed Glass New Ex / dab e l Tanks Tanks isting Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber Q 7 VII. Responsibility Statement I, the undersigned, assu a resp for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' gn a MP/MPRS Number Business Phone Number Plumber's Address (S t, City, State, Z' o e) AA V III. Coun ty/Department UYe Onl Approved ❑ ' approv Sanitary Permit Fee includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Aw Surcharge Fee) 3C7 3 r Given Reason or Denial �� Z - IX. Conditions o prov o al �> 5�4 - C° 6L- " 31, W� SYSTEM OWNER) 1 � 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6338 (R. 01/03) . r - - Safety and Buildings Division County 81 VI- Scory-s in 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Oe artment Of Commerce (608) 266 -3151 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sI5.04(1)(m) Project Address (if different than mailing address) !. Application Information — Please Print All Information Ptnperty Qwner's Name Parcel # Lot # Block ;, Property Owner's Mailing Address Property Location I City, State TZip de Phone Number V, Section C IS 1 06 1 (circle o e) it. Type of Buildin (check all that apply) T N; pp Y) R ^ C_E or(9 ❑ I or 2 Family Dwelling — Number of Bedrooms Subdivision Name CSM Number U Public /Commercial — Describe Use ❑ State Owned — Describe Use ❑City ❑Village PdTownship of III. type of Permit: (Check only one box on line A. Complete line B if applicable) ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B- ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of PO'WTS S stem: Check all that appl ❑ Non — Pressurized In Ground ❑ Mound > 24 in. of $ uitable 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 ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing 'Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Clamber VII. Responsibility Statement - L the undersigned, assume respou ' lity for installation of the POWTS shown on the attached plans. Plu ilacesName(Print) Plumber' ig re MPIMP Business Phone Number Plumber's Address TStreet, City, State, Zip Code) VIII. Coun /De artment Us nl ❑ Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) 11 Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not le than tY Y) Y P P less an 81/2 x 11 Inches in size SBD -6398 (R. 01/03) , L dby d Y ILI �•� av��p a � Fa 3 r' � r 1 ` a q r la� 83 a y 5 f 4 9 i ' � 1 i ra L4�,_, OQO Y , �J d a � ?gyp a o f �i � ` ice` 0 1 t p .aa,..•, >t°''�s"' � ,,.. 1 1 F yYnN ' 8 iv d t N�ti N4 r Rt '°L. • [ L l ; 1 Qua $� dr.o f rr d r'•` e RECEIVED �SI MAY 10 2002 1568 Wisconsin Department of Commerce SOIL EVAL TAdmZMNG ION REPORT P age 1 of 3 ST. CROIX COUNTY Division of Safety and Buildings in accordance with Comm 85, OFFICE Gustum Septic Service Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must C oun ty St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I. D. Please print all infonnaidon, eviewed y Date Personal infomhaw you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r Property Owner Property Location Humbird Land Corporation Govt. Lot n/a SW 1/4 NW 1 A S 19 T 29 N R 18 W Property Owner's Mailing Address Lot # Block # i Subd Name or CSM# !- 332 Minnesota Street, East 1404 4 1 n/a 1 1 V SM l� City State Zip Code Phone Number J City j Village Town Nearest Road Saint Paul MN 1 55101 1 651 - 222 -5555 1 Warren I Young Road / 92ND Ave. New Construction Use: 01 Residential / Number of bedrooms 3 Code derived design flow rate 450 GIRD Replacement J Public or commercial - Describe: Parent material outwash plains Flood plain elevation, if appli le a / General comments and recommendations: Part of 2.05 acres. BM #1= 100.0'. BM #2 = 104.6'.�f L 1W �- YD F Boring # I Boring K Pit Ground Surface elev. 101.5 ft. Depth to limiting factor >80 in. Soil Application Rate I le K 1r Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -12 10y2/2 none sil 2msbk mvfr as 3f, 1m 0.5 0.8 JCS 2 12 -25 7.5yr4/4 none sil 2msbk mvfr cvv If 0.5 0.8 3 25 -38 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.9 4 38-80 10yr5/6 none s / gr. s 0 sg ml - - 0.7 1.2 Boring # Boring W1 Pit Ground Surface elev. 103.1 ft. Depth to limiting factor > in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Q PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 10y2/2 none sil 2msbk mvfr as 2f, 1m 0.5 0.8 2 11 -27 7.5yr4/4 none sil 2msbk mvfr Cw if 0.5 0.8 3 27 -35 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.9 4 35-80 10yr5/6 none s / gr. s 0 sg ml - - 0.7 1.2 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 9371h St., New Auburn, WI 54757 5/8/02 715- 658 -1344 Property Owner Humbird Land Corporation Parcel ID # pending Page 2 of 3 Boring # _j Boring 16 Pit Ground Surface elev. 101.5 ft. Depth to limiting factor >80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10y2/2 none sil 2msbk mvfr as 2f, 1m 0.5 0.8 2 12 -25 7.5yr4/4 none sil 2msbk mvfr cw if 0.5 0.8 3 25 -38 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.9 4 38-80 7.5yr5/6 none s /gr. s 0 sg ml - - 0.7 12 F Ong # A Boring J Pit Ground Surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color R,edox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I Boring # I Boring J Pit Ground Surface elev. fL Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenoe Boundary Roots i GPDNP n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 * Effluent #1 = BOD > 30 < 220 mg/Land and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg /L — _ s _ mglL and TSS < 30 /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, ulease contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. 4 � . I QD Property Viva 1 c 1 I -c m m p I pN 11 ba � I , r 01 ►; o 1 c �ci ► r i ► `% r r ` 1 ► .�03 t sun �►° N ; ' r A r i i i i a r � ► i i i i I ' � i i ► s Z I w � � ► I c ' 1 m W m _. W � LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1052 -60 -500 Parcel Number 19.29.18.295E OWNER NAME: First Last NIELSEN ENTERPRISES INC PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 19 TOWN 29N RANGE 18W %160 NW 1 /440 SW Line do Line Description TOTAL ACREAGE 3.290 P T CSM 16/4376 042/02 LOT04 BLK 019 29N 18 SW NW 15 02 LOT 4 C 16/4376 16 03 EZ -RD -0 90/589 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit .uw 691 255 APPROVED , nyy �Q�'Z Gv �o �¢� VOL 16 PAGE 4376 ST. cfzolx COUNTY �, r Pl an nina Zoninn and Parks Committee 0 yL oZ GU -00 KATHLEEN H. MIALSH $EP 1 7 ZOOZ vy�-- /O A Go -040 ST. ST. CROIXOCO., WI If not MCO(d RECEIVED FOR RECORD ppp rova daEN� FI ED SURVEY MAP 09 -20 -2002 11:00 A nu Y:ddkrED IN PART OF THE SWI /4 OF THE NW1 /4 CERTIFIED SURVEY MAP OF SECTION 19, T29N, RI 8W, TOWN OF WARREN, REC FEE: 15.00 ST. CROIX COUNTY, WISCONSIN. COPY FEE: 4.00 SURVEYOR P S & N LAND SURVEYING NW CORNER OWNER DOUGLAS J. ZAHLER SECTION 19 WOODHILL LAND, LLC 2920 ENLOE STREET E1404 FIRST NATIONAL BANK BUILDING HUDSON, WI 54016 ,?SECTION Z 332 MINNESOTA STREET W o ST. PAUL, MN 55101 '.a 4 UNPLATTED___ ° NDS NORTH LINE OF THE N89 1'55"E 487.38 SW1 / OF THE NW1 /4 271.80' 215.58' ' N Z ;p i� ;� C CO) ; o 0- o - o W gg ' LOT 2 N I� W W CO ° i A 2.39 ACRES w O ►.� �, �, 104,200 S O FT m ;o W o LOT 1 m 4h; co W 2 Sz 1371606 SO FT V Z 1 � W Q! b AZ ` N S ?e o22,� ,��°s 3a31 m 5 '66 "E A \ /rAll it SECTION: 3.20.014 �Us1L /TY PUMPS 0403 L Product information �. ® 0 Supersedes presented here reflects w a ° 1202 conditions at time of publication. Consult factory regarding discrepancies or MAIL TO: P.O. BOX 16347 • Louisville, KY 40256 -0347 visit our web site: inconsistencies. SHIP TO: 3649 Cane Run Road • Louisville, KY 40211 -1961 http / /Www.zoeller.com (502) 778 -2731 • 1 (800) 928 -PUMP • FAX (502) 774 -3624 ZOE1616ER ON -SITS WASTEWATER PRODUCTS IN W8,00=0 SO M" Ow -SrrZ "DOSK -mr1 , Pumps col"jii',AR t Siar:>a FEATURES Durable cast iron construction. 151/152/153 EFFLUENT SERIES Model 151 comes standard with a glass - filled polypropylene base. (For Pump Prefix Identification see News & Views 0052) Corrosion resistant powder coated epoxy finish. �-. L," N I Stainless steel lifting handle. TE� - Assembled with stainless steel bolts. Non- clogging engineered thermoplastic vortex FOR SEPTIC TANK - LOW PRESSURE PIPE (LPP) impeller design. AND ENHANCED FLOW STEP SYSTEMS • Model 151 - 1/3 HP passes 1 /2" solids. SSPMA EFFLUENT - MEMBER • Model 152 - .4 HP passes 3 /4" solids. SUBMERSIBLE • SUMP Model 153 -1/2 HP passes 3 /4 PUMP PMFRS. ASS SN. " solids. A 1 NPT DISCHARGE MFRS. G CRA�� • Motor - 60 Hz, 3450 RPM, oil- filled, hermetically sealed, automatic reset thermal overload protected. a fvtade11U15JJtJ153 Carbon /Ceramic seals. CC us Hig . Head Tested to UL Standard UL778 Effluent 4 Upper sleeve bearing and lower ball bearing running and Certified toCSA in bath of Oil. standard cSA22.2 No. 108 iV UDLE...S AJA L.A3Lc 20 ft. UL Listed power cord with molded 3 -wire plug. - N151/N152/N153 & E151/E152053 nonautomatic a 1 NPT vertical .discharge. • BN151/BN152/BN153 & BE151/BE152/BE153 packaged with Piggyback Variable Level Float Switch BN and BE standard models include a 20 ft. variable • 1/3_4 & 1/2 HP, 1 Ph 115V or 230V level float switch. Operates at temperatures to 130° F (54° C) in _ - —_ -- effluent applications. All models include a 1 x 2" PVC adapter fitting. Note: The sizing of effluent systems normally requires variable level float(s) controls and properly sized basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. POWDER COATED TOUGH - Model BN162/8N75'_ Manufacturers of... High Head Effluent O ` QUALITY PUMPS FINCE lg, „ © Copyright 2003 Zoeller Co. All rights reserved. w PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD /FLOW 50 MODEL 151/152/153 PER MINUTE 14 45 153 EFFLUENT AND DEWATERING 1z ao MODEL 151 152 153 0 35 10 152 Feel Meters Gal. Liters Gal. Liters Gal. Liters v 30 5 1.5 50 189 69 261 77 291 z 10 3.0 45 170 61 231 70 265 0 5 25 151 15 4.6 38 144 53 201 61 231 0 20 6.1 29 110 44 167 52 197 6 20- 25 7.6 16 61 34 129 42 159 � 30 9.1 -- -- 23 87 33 125 15 35 10.7 4 — — -- — 22 85 10 40 12.2 — — I -- 11 42 2 Shut -off Head: 30 ft. (9.1m) 38 ft. (11.6m) 44 ft. (13.4m) 5 0145088 0 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 20 0 240 280 320 360 FLOW PER MINUTE 014508A Model 151 Models 152 / 153 CONSULT FACTORY FOR 5 7/32 ZOPEOIAL APPLICATIONS 3 7/8 4 5/8 3 27/32 4 5/8 • Timed dosing panels available. 3 716 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling o 3� single phase systems. / e z /3 • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik•Box available for outdoor installations. See FM1420. T--Ehl. • Over 130 °F. (54 °C.) special quotation required. 11 11/16 12 1/6 151/152/153 Series 151/152/153 MODELS Control Selection At Model Volts -Ph Mode Amps Simplex Duplex 4 3/8 5 1/8 N151 115 1 Non 6.0 1 2 or 3 L BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 151 SK2064 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 El 52 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. A CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256-0347 Manufacturers of. . SHIP TO. 3649 Cane Run Road ��!! p ® ® Louisville, KY 40211.1961 : !VA /TY/—UMPE �F1,YCE IS,7 http✓Avww.zooller com PUMP L O (502) 778 - (5 2) 774- 928-PUMP FAX (502) 774 -3624 © Copyright 2003 Zoeller Co. All rights reserved. Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: FC) Project Name and System Type: 4 pY,n Location: � L�+ �- Street Address L4-) V4 S 1 9 T2 9 N R 13 vi Legal Description Township /County Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey Map Page 11: Copy of House Plans Attachments: Plumber/Designer: Mike Rogers Signe Credential Number: 225094 Date: (� Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems DAN FOUTS lOwnees Name 6/21/05 Review Date N Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 Ezflow EZ1203HP & EZ102H 600 jgpd Estimated Daily Peak Flow 0.60 gpd /ft In -situ Wastewater Infiltration Rate 1000.00 ft Chamber /Unit Area 50.00 EISA ft / Unit 20 # of Chambers /Units �ft Proposed SAS Elevation 26.50 Bottom Area ft / Unit Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 1 101.50 80 97.83 100.50 No Fill required 2 1 102.70 80 99.03 101.70 No Fill required 3 101.50 80 97.83 100.50 No Fill required 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 04/03 I TDH Calculations TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems DAN FOUTS Owner's Name 6/21/05 Review Date X X Gravity Dosed, or gpd Design Wastewater Flow X Pressure Dosed ft Total Combined Lateral Length Y or N Forcemain Drainback in Lateral Diameter Must select drainback y/n Must use 4 in. pipe with gravity dosed 9 25 ft Forcemain Length in Forcemain Diameter gpm System Flow Rate T 1.11 ft Minimum Design Head ft Vertical Lift ft Forcemain Friction Loss 16.11 ft Total Dynamic Head 2.55 ft/sec Forcemain Effluent Velocity Choose Pump That Discharges At Least: 25.00 Igpm at 16.11 Ifeet TDH Egal 0.0 gal Maximum Dose Volume 13.1 gal Maximum Dose 0.0 gal 5x Lateral Void Volume 13.06 gal Forcemain Drainback 13.06 gal Forcemain Drainback 13.06 Minimum Dose Volume Version 4.1 ( 07/03) ' wilconrleoavrrtntentafCcrnlrtlrts SOIL EVALUATION REPORT 1688 PaOe x oa OMWO of LS*lyr and Buildings In aomdanoe vAIh Comm Bs Wis, Adm. Cafe G uatt inl Sepk S alvia, eoa+p1e91 qb DMA on paper not iluin J3K r f 1 irriae m a1r>! Plan moot co+nb $!. Crobt It IRM tau mat M t Iw JIM haft lel point Ill, dVww Md Wtant time, Nab wdmeAwlat4„ nortl IMM, need dk ew ID maw old, 1>eroet (.Q. polRtlnp Ptewtrr 13 U! Reviewed By Data PafllnMhlttmrlonYeupiorld�ANr1a WPNOP+N YLMI.at&H(i)(MX PMWW o vnar fPmpeny Laedon kiumbird tend gampr ttort Oovt. I& nit SW 114 NW 1!i S 19 T 29 NR t9 W Property CK*WsMrltlnaAdit" Loth ttlooc a Subd, Hatneor 0800I0 332 Minnazatr Street, aget 1404 4 n1e Pencong CSM ott r 814th 210 Cady Phew Number c Qty rJ Village A Town Naareat tpond Saint Paut --- LNMj 55101 661 - 22Z - 6585 Warren Young Road ! 92ND Ave jd New Coeetntetion deal � Ratdandai / Number of bedroan4 3 000 darned design W w t** 450 GPO ,,;,1 Replacement ;j PUbIIC Or Oonunerd - DeeQtoe: PamMmeteaei outwachplains flood plain elevatlon.)}aPplleable n1a Ga,"fat cormments — and fSOWO arrWWw; Part of 2.05 acres, OM 741 =100.0'. w4 g2 a 104.6'. 11 awl ik7 Pit Ground Sur1at* alev. 1 1,5 tL baotn to Gml#nptfacbw __>A0 q In. Jo11 Rala I 0+t� nent P4100 sectue Caietlbna Bounaery Naohr In. ltueew Cu, t IOt Gl. St, Sh fItR1 1i 0 -12 1(iy?�2 ttoae eU 2rnatlk Mor as 3f, tm t7.t5 �:6 2 12 -25 7.5yr414 none 61) 2triabk ravfr cw 1f 0.6 0.t3 3 2648 7.6yr44 none pr, sl 2msbk rtivfr 6w - 05 0.9 4 30-M 1Cytrs/8 none a! gir, r 002 mi - 0.7 1.2 t,-- -1 id Pit GnwridStxPawekv. t03.1 'z Depthtottmllingjs tat >_ B0 ► n. g ;ate NatenA eat Redo¢ Oa o Town Strunun CaAehtenae ndey Rorie tA. la uatau -- 00 - - ft Cont. Cabr Gr, Sz. 5n. 1 7 0 11 t012 none ail 2mabk mvft a4 7,f, 1rn 2 11-v 7.byr4/4 none 4l1 2rmbk mvlr cw 1f 0.5 0.8 3 27.35 7, fiyr4d9 none 8r. st 2mrbk crw - 0.5 0.9 4 �i5.60 1 Qt+' 8 none tt 1 gr. r 0 eQ rnl _ 0.7 1.2 61tJuan3 rqt a HOD > 30 a 2M �{, and T88 730 s 150 M94 • BMkant *2 SOD IL30 "v& anc TS9 <30 mglt. CST hlrme (Pierre tl - siprroe�Ah: - CST Toth Gusturn Number 7276th Addraea► Guettan sepia Srrvkh DOW ts Conducted Telephone Number N1 Auburn W 54TV 715.658.1344 POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity gal E3 RA Permit # Septic Tank Manufacturer t 6 ❑ NA DESIGN PARAMETERS" Effluent Filter Manufacturer ❑ NA Number d Bedrooms I00gpd/bedroom ❑ NA Effluent Filter Model - a ❑ NA Number of Commercial Units NA Pump Tank Capacity ?7f gal ❑ NA Estimated flow (average)* gal/day Pump Tank Manufacturer 1 :1 NA Design flow (peak), estimated x 1.5* t bD gal/day Pump Manufacturer ❑ NA Soil Application Rate gal/da y fe Pump Model ❑ NA Pretreatment Unit ❑ NA Influent/Effluent Quality (NA❑) Monthly Average ** ❑ Sand/Gravel Filter ❑Peat Filter Fats, Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) [3 Disinfection [I Other: Total Suspended Solids (TSS) < 220 mg/L 5 250 mg/L Manufacturer: Model: Pretreated Effluent Quality ❑ Monthly Average * ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) < 30 m c3 In-ground (gravity) ground (pressurized) Total Suspended Solids (TSS) �' [3 At -grade ound 5 30 mg/L ❑Drip -line c3 Other: Fecal Colifonu (geometric mean) <l0 ❑ Leaching Chamber Manufacturer Maximum Effluent Particle Size 1/8 inch diameter Model Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate Area Req. - V-(Other than bedroom based) Absorption Area Credit per unit ft Minimum Number of Chambers ❑ Aggregate Design Flow/Loading Rate= min * * Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ***Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 - "Design of Pressure Distribution Networks for Septic Tank -.Soil Absorption Systems" Publications 9.6 0n "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — site Wastewater Treatment and Disposal Systems ", EPA 625/1 -80 -012 October 1980 ❑ SBD - 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD 10567—P (8.6/99) "In Ground Absorption Component Manual" El SBD 10705 -P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 [3 SBD - 10628 —P (N.6/99) "Recirculating Sand Filter System Component Manual" p SBD 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" p SBD 10572 -P (86/99) "Mound Component Manual" SBD - 10691 —P (N.01 /01) "Mound Component Manual" Version 2.0 p SBD - 10595 -P (&6/99) "Single Pass Saud Filter Component Manual" ❑ SBD - 10657 P (8.6/99) "Drip -line Effluent Disposal Component Manual" El SBD - 10573. -P (R 6/99) "Pressure Distribution Component Manual" [3 SBD - 10706 —P (N.01101) "Pressure Distribution Component Manual" Version 2.0 Cl Drip -line Effluent Dispersal Component Manual for Multi flo Onsite Wastewater Treatment Units D MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Freq ency Inspect condition of tank(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one - ird (1/3) of tank volume Inspect dispersal cell(s) At least once every El months year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months years) Inspect pump, pump controls & alarm At least once every E3 months ear(s) E3 NA Flush laterals and pressure test At least once every ❑ months ear(s) p NA Valves At least once every .❑ months earls) [3 NA Other: At least once every ❑months T3 year(s) NA Page of START UP - For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that de a treatment process and/or damage the dispersal cell(s). If hi concentrations are detected have the contents of the may i the p g p P� y r 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water to the ed softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged gr ound surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. `Valves alves shall be operated in the following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS,, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. 1NPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. A Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. E3 In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of ' At- Grade, ln- Ground Pressure // The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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 other 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 from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result is 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. p 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. p The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 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 CONTIAN 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 ';fj5 Z3S'7. ( (S7— Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency T C - " t Zf)n1 iN Phone Phone Kp\WPDATMEWOWTS OWNER'S MANUAL.doe Page of Jun 21 05 11:20a BrightKEYS 715-426-6758 P.1 ST CROIX COUNTY SEPTIC TANK MAINTF-NANCF AGP%E2MENT All-,n OWNERSHIP CERTIF(CATION FORM Mailing Address J1jj S4, SLR 5`i bA Vrope'fty (Vecirication required from Miming Department for now con.w ic "J�ieaj_ 3 LEGAL DESCRIPTION Nopeny Locatiou Z1, - 1 a Town C r i" Lot Map 9 L-ftgc iH cordiled su"ey 7 Warranty Deed 0 t Volume page 'dcr -1 Spoe bouie; C yes k ilo ui 1111es I -,,ifiablc 0 yes '� tlu Improper we and m aincomance or your so pt i c system could result w its i3ronlaturc failure to handle wastes, ?roPCTM3iL)tC1%Ance consists of pumping ou t th septic unk every three years or soccer, if needed by a i pumper. What you put iatO dit SYSM txelt �n T. waste disnpossl system. "� affect the furetion Of LIM septic Mr- 2 : 2 D e- The property ON%Mel agrccs to submit to St. Croix zoning Deparuncnt a certification font, signed by the owner and by a mzstGrplurcber, jourueyrnazipluriber, restrictedplumberoi a li-,ensecipumper vcr1fY1A9 that(i) the ""'t evanewaterd ' s p osal s is in Proper operating corlditiou and/or (2) after inspection and Pumping (if necessary) the septic tank is loss Jon 113 full of sludge. U-m-, the ion&rftned hav-, r•zid dit reT%iiroalents and a—cir u3m=�tajr, ie private i�c%vagr disposal s yst."m with the s—lards v* set ibrLb, here as set by the Departnient of Commerce and the Deparunent of Natural Resources State Or Wi Certification 5 that your septic System his bun maintained must be CQV'P and returned tO the St. Croix COUDtY Zoning 0fr 30 S1014ATLIRE OF APPLICANT DATL' QWNF,R CERTIFICATION i (we) certify q all stAtomerts on diis form are L-u c to t h e b o f r r y ( knawlcdge. I ( am (are) die 0-10s) Of the pr dq n describe DATE of a warranty deed reeordad in Register Of Deed! Ofrice Si UKL A Any , qni�)rnlaklonxhak is result Un the i'QjL448 Dopar'"icnt. Include with this s ppti ca tio n a stomped warrea d from the Register of Dctds Office g copy of the certified survey nup if reference is made in the warranty deed 10 39Vd ONI '9NiaW7cl $8390d U 2739P 217 �� - 7 86JZ)S9 JZ) STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. WI Document Number RECEIVED FOR RECORD This Deed, made between Nielsen Enterprises. Inc.. a Corporation 01/28/2005 12:40PM Grantor, and Daniel A. Fouts and Amber L. Fouts. Husband and Wife Grantee. WARRANTY DEED Grantor, for a valuable consideration conveys to Grantee the following EXEWT II described real estate in St. Croix County State of REC FEE: 11.08 Wisconsin (the "Property "): TRANS FEE: 285.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address The Fi -y National Bank PO Box 9 New R h ..d. W1 54017 Pu 7_ l "Lu 55 v 3 042 1052 60 500 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) p rt Cert ified Survey Map filed September 20, 2002 in Vol. 16, Page 4376, as Document No. 691255. Located in f the SW '/4 of the NW % of Section 19, T 29N, R 101414, Town o f Warren, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this O day of January 2005 (SEAL) (SEAL) Thomas K. Nielsen, President Nielsen Enterprises, Inc. (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, St. Croix County authenticated th6 I day o1 ( - 13 L I C S T AIE7 7 SC O N S f N Personally came before me this ``' day of January 2005 the above named Thomas K. Nielsen as President f Nielsen Ent ri es Inc.. a Corporation to me known to be the person TITLE: MEMBER STATE BAR OF WISCONSIN who executed the foregoing inst K: (if not, s me. authorized by §706.06, Wis. Stats) / + ( L1 THIS INSTRUMENT WAS DRAFTED BY (lp a j <- '1 -, cr (�>J Coldwell Banker Burnet Notary Public, St4te of Wisconsin 1301 Coulee Road Hudson, WI 54016 My commission is permanent. (If not, state expiration date: 4 -55602 (Signatures may be authenticated or acknowledged. ) Both are not necessary.) Names of` p2rsons s!2ning in any ca aci must be typed or printed below their signature. • + APPROVED 6 9 1 c 5 S 6T. CROIX COUNTY VOL 16 _PAGE 43 76 Plannlna Zoninn And Parks Committee KATHLEEN H. 1ttALSH 5�P 1 7 2002 REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD #ppro 11 not w% � FI FI ED SURVEY MAP 09 - - 2002 11:00 A �l d "Wb% &ED IN PART OF THE SW-1/4 OF THE NWI /4 CERTIFIED SURVEY HAP OF SECTION 19, T29N, R1 8W. TOWN OF WARREN, REC FEE: 15.00 ST. CROIX COUNTY, WISCONSIN. COPY FEE: 4.00 SURVEYOR P 3 S & N LAND SURVEYING OWNER DOUGLAS J. ZAHLER NW CORNER WOODHILL LAND, LLC IQ 2920 ENLOE STREET SECTION 19 `I � Z E1404 FIRST NATIONAL BANK BUILDING HUDSON, WI 54016 332 MINNESOTA STREET W - o ST. PAUL, MN 55101 ' N� L ATTED LL.AIr�DS W w�$ UN P -- - - ---- -- ---- ------ ---- -- -- - -- NORTH LINE OF THE N89 1'55"E 487.38 SW1 /40FTHENWI /4 271.80' 215.158' m N w Z O iG o C3 LL �0 I� N :� Z Z `�_ °0 �, LOT 2 �°, W W A A 104,200 SO FT m o ;o CD LOT 1 m �z� A 3.16 ACRES Gll � CA 2:3 137.608 SO FT V 1 � U ;1 ZO Rcn 4;� --------- - - - - -- — �N $� e oZ g't °31' 4 r 6 6.00 d AVENUE -tips a °E 238:6 i lf 6.47' - - 3.157' O N88 °29'6 "E 30.14 N CO W Zr" C I� cn m q W � © t LOT 4 w, goy LOAC ES m o 2.05 ACRES , m 143,174 SO FT ; up. `va W 89.366 SO FT Z al ; �° EACH PARCEL SHOWN ON THIS = MAP 1S BOTH WITHIN AND m ADJACENT TO SPECIAL DEEP CASING PIPE DEPTH REQUIREMENT AREAS ESTABLISHED BY THE 250.04' 260.04' WISCONSIN DEPARTMENT OF NATURAL RESOURCES ("DNR7. GROUNDWATER IN THIS AREA w L 888 "W 510.08' HAS BEEN AFFECTED BY N MIn�_J_PL�A5�_ ND L�AU`�{!D6 LEGEND VOLATILE ORGANIC pl COMPOUNDS. OWNERS AND w ALUMINUM COUNTY SECTION CORNER is OCCUPANTS OF EACH PARCEL MONUMENT FOUND SHOULD CONTACT THE DNR FOR 0 1 5/1e' OUTSIDE DIAMETER IRON PIPE FOUND INSTRUCTIONS REGARDING WELL 1 DIAMETER X 18' IRON PIPE SET INSTALLATION AND W7 /4 CORNER O MAINTENANCE, AND WATER SECTION 19 WEIGHING 1.13 LOS. PER LINEAR FOOT ---- -- - --- 100' ROADWAY SETBACK LINE SAMPLING. ---------- 2 3/8" OUTSIDE DIAMETER IRON PIPE FOUND SCALE IN FEET I " = 1 50' X CENTER OF ea RADIUS CUL -DE -SAC (XXXXXXXXX)N PREVIOUSLY RECORDED MEASUREMENTS 1 50 O 1 300 PROPOSED DRIVE LOCATION - - - - - - - SHEET 1 OF 3 12' UTILITY EASEMENT Vol. 16 Page 4376 �� �� 4 ��. W4sco►sln Department of Industry SOIL AND LUATION Labor and Human Relations I Page of Division of Safe and Build in accord Wis. Safety 9 e Attach complete site plan on paper not less than 8 1/2 x 11 inch �n ze. Pla IL, ' unty Include, but not limited to: vertical and horizontal reference poi (8M), directions ' % • C percent slope, scale or dimensions, north arrow, and location a d� tanc lipmea�pst road. pal el I.D. # d s T r gc j O 2, A — .l APPLICANT INFORMATION - Please print all in f � tio L nn L �VNry owed by Date Personal information you provide may be used for secondary purposes (P ykagr�s. I QWE `J Property Owner ;;^^11 (/ (. / 614. d i ;Property Loca " I j rTV/�f /,/Z!J L�ND w/'- (1'otrt. d E 1/4/V�1/4,S !7 T .c/ ,N,R M E(or Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 332- Mimwtso -- Sf• - /yv y O� v�a G- Cs y C�T• rQ.�tJL. S tate ,,A10 • Z ip Code Phone S�� J� � ) tuber C 9 � N e /C � L • S s ❑ El Villa a Town New Construction Use: 2IQidentiall / Number of bedrooms Addition to existing building ❑ Replacement U ❑ Public or commercial - Describe: Code derived daily fl y, �o�Ora gpd Recommended design loading rate • ? bed, gpdffi 0 trench, gpd 1it Absorption area required _ _ bed, it 2 trench, ft 2 Maximum design loading rate • -7 bed, gpd/ft • Q D trench, gpd /11 Recommended infiltration surface elevation(s) S- 3 It (as referred to site plan benchmark) Additional design /site considerations LGAJ /QOW 7%044 644 w / - PR &Y6 .9 - 8 - 7 — . Parent material ! be ss 'OVER sEIJ O K 4 �'�-� Flood plain elevation, if applicable N ft S = Suitable for system I Conventional Mound In-Ground Pressure S AT- G rade System in Fill Holding Tank U = Unsuitable for system Q S ❑ U 9 0 U 2 ❑ U 19 / ❑ U I ❑ S &V ❑ S E SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench C •8 / Y/? 34Z — 51L z 0 7 - 3 s z . zg io S14 Zf S ,& dk C.S' 1 1 4 G round 7.S GS / - ? ; •g Win. Depth to kmitigg fast Remarks: Boring # Ito) IOVR �, y �o ye SQL a.w. ,� �� CS — y .2 MCA Ground la4 2- 162 , 1 0 YR S. A S4 d ? ' Q elev. 5t- Depth to limiting factor Cj Remarks: CST Name (Please Print) ^ OneX r / h�� nature 71 5 - 3,?6 N o . • � /t5 Date CST Number Address /i � /J L . t 7 • �I 2.2-6e 3 - 7 S Uibricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 I ORIGINAL i PROPERTY OWNER 'I v�i� / SOIL DESCRIPTION REPORT 2 3 ��// Page of J + PARCEL I.D.# LO y eS/� © /os /�s (� Boring # Horizon Depth Dominant Color Mottles ure Struct 2 Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 o' /D /0YR 3 — S//L 2 fSk ds k Cs / f . S ; �• • z ,ay — s� zf x d �. �� — . s • � Ground 3 2. 7•S S S'. Q . '] , . g Aev. Depth to limiting factor y ln. 7G Remarks: Boring # T V- 3 o 0 -- Siff z sad k .s s s. A s .7; g Ground elev. / ft Depth to limiting factor [0 ,! /! OO Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. �Sh. Bed , Trench Boring # p•� 10VA 3/3 51L, 2. -FS& dSA1 CS /7r- . S • lv v 5 3 .s Ground elev. Depth to limiting factor In. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) , • i +S p. 4 � � r 3 `f.3 �x o 0 _ l3� i J„ f o v'`� / 0 0 .0 e 3 I I Ulbrlcht S Associates O y { Private Sewage Consultants • I' °, 655 O'Neil Rd. . Hudson, Wis. 54016 fps 60 , Aht �8 ... 58 - • ai 0 �) f k; TS svSSEs' r� 77p c� syS � • � /t�vrt-�-r�vs / �i�, T, I y o acv 1 3. 0 I rr 1 O Ln O Ln LOT 4 \,.0 0 M l ') i So i L CD rEs Ln Ln LLJ i L / \ Co f 2,210 ACES co X6,264 Q. FT Ln � o O 1 80,00'