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HomeMy WebLinkAbout020-1292-30-000 Land Use Planning & Land Information Y. S T. C ROI jsco,//S~ 1 /1 Resource Management Community Development Department Thursday, September 12, 2013 c/o Christine M. Faron Colonial Savings, F.A. 681 Badlands Road Hudson, WI 54016 Regarding septic inspection for c/o Christine M. Faron Colonial Savings, F.A.. Location of Property in St. Croix County: Municipality: Hudson, Town of II Subdivision or Plat: Humbird Hills 1st Addition Certified Survey Map: Lot: 14 Address: 681 Badlands Road Dear Applicant: A septic inspection of the above reference property was conducted on September 10,2013. This property is located in the NE 1/4 NE 1/4 of Section 27, T29N R19W, Humbird Hills 1st code compliant lfor a 4 At the time of the Addition bedroom home. inspection, this septic system as found to Croix Additional Notes: Existing 1000 gal tank with a new 1000/600 Wieser tank, Polylok 525 filter to 8.5 X 118' At Grade. abandoning seepage bed (can't use valve, new pressurized system) If you have any questions regarding this, please contact our office at 715.386.4680. Sinc y arrington Zo ng Specialis cc: file Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 www sccwi.us/cdd www.facebook.com/S--tcroixcountywi cddCa -^mint-Croix.wi.us County: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sanitary Permit No: Safety and Building Division INSPECTION REPORT 567201 0 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION Personal information you provide maybe used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Parcel Tax No: Permit Holder's Name: City village X Township 020-1292-30-000 Colonial Savin S, F.A., foreclosure sale Hudson, Town of SectionlTown/Range/Map No: CST BM Elev: Insp. El BM Description: 27.28.1 8.1440 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 11 CAPACITY STATION BS HI FS ELEV. Septic Benchmark Alt. BM ONta"J Aeration Bldg. Sewer O~•b2~ Z St/Ht Inlet Joe ~t a a k• sZ St/Ht Outlet 2. W... ~ , TANK SETBACK INFOR ATION I w ROAD Di•k~ie! 3 TANK TO P/L WELL BLDG. Vent to it Intake /660 -r' :5.34 , Dt Bottom 47 i d Septic / ;3z I 77, Header/Man. Dosing 1,5Z, 74 I S-7 / - L Dist. Pipe 3 , 7, S Aeration Bot. System Holding Final Grade z PUMPISIPHON INFORMATION t J~~ 3,• 3 Manufacturer Demand St Cover- .04 ~ GPM q ~l • gv Model Number 6•,/~ Q~ 3 • l.0 C 3.74 TDH UJ .s Fricti Los System Head TDH lFt Forcemain Length Dia. Dist. to well Z SOIL ABSORPTION SYSTEM Length No. Of nch PIT DIMENSIONS No. Of Pit Inside Di~` Liquid Depth 1 31 BED /TRENCH Width / G DIMENSIONS 19.5 SETBACK SYSTEMTO p/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR INFORMATION Type S stem: /I 4~ 53 , UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold x Hole size ' x Hole Spacing ven Air In -7 Distribution I Z I •-3 3 L Pipe(s)~~ J! Length Dia Length Dia Spacing `7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched ench Center Depth Over xx Depth of xx Seeded/Sodded Depth Over (e Co Bed/Trench Edges Topsoil I F41 0 No 5rgs 0 No BedlTr ' COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / /d/ Inspection #2: / / CIS..`-s~A• /s~.J Location: 681 Badlands Road Hudson, WI 54016 (NE 1/4 NE 1/4 27 T29N RI 9W) Humbird Hills 1st Add'tion Lo 14 Parcel No: 27.29.19.1440 1.) Alt BM Description CL., lit- ~p d i'~-- 2.) Bldg sewer length = !D ~1I - amount of cover = 11 Plan revision Required? FK9 Yes No 9 3 I~ Use other side for additional information. Date In Cert. No. sepctor ignatur SBD-6710 (R.3/97) County / r . Safety and Buildings Division a/ ! ry ~ 201 W. Washington Ave., .O. Box 7162 Sanitary Permit Number (tobe filled in by Co.) p a<'' 1 1 Madison, WI 537 V 91, State Transaction Number My Permit Applications S ~e In accordanc, Wis. Adm. Code, submission of this form to the app to govental unit is required pro ing a sanitary permit. Note: Application forms for state-owned submitted to Project Address (if different than mailing address) * ndary the Department of Safety and Professional Servies. Personal information you provide may b~'u 'co purposes in accordance with the Privacy Law, s. 15.04 I m Stats. 1. Application Information - Please Print All Information Property Owner's Name Parcel # Property Owner's Mailing Address Property Location ' J Govt. Lot City, State Zip Code Phone Number &ry./,, Section A7- e) circlE eo0, TX17/. 4 / w ` / T N; R ~ H. Type of Building (check all that apply) Lot # ❑ I or 2 Family Dwelling- Number of Bedrooms r / ~ Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State owned - Describe Use / CSM Number❑ Village of L7Town of ~ ~3dti III. Type of Permit: (Check on one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explau)} List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner opt, 4) 1 IV. Type of POWTS S stem/Com onent/Device: Check 11 that al I ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTre ment Area Information: Design Flow (gpd) Design Soil Application Rate(g f) Dispersal Area Required (s Dispersal Area Proposed (s System Elevation t~ . G ~~t~ X03 en . o VI. Tank Info Capacity in Total # of Manuf er Gallons Gallons Units ; 2 0 b New Tanks Existing Tanks d o :2 2 2 p~ a 40 ' w U rn b;v~ i~. 5 Septic or Holding Tank 10 to Q`TJ Dosing Chamber po VII. Responsibility Statement- I, the undersigned, assume responsibility or insta on of the POWTS shown on the attached plans. Plumber's Name (Print) Plu s Signa MP/MPRS Number Business Phone Number Plumber's Address (Street, City, Stye, Zip Code) - & ~.e 9"g -,7 IL-5g W V Coun /De artment Use On Permit Fee Date Ised Issuin gent Signature Approved $ C7,ve. Reason for Denial IX. Condit(p"1J.XAt1 Wteasons for Disapproval 3 Q J ~gi'o prou. hem 1 Septic tank, effluent fitter and IJispersal cell must all be services I maintained 1LCrMA-o~JwffQ-A-. as per management plan provided by plumber. 2. Aft sMl*k regtleements must be maintaitiO , ss per ap~ tie Tor*W;lces: / c7 (bv L l4c than 8 in 111 incpesize Attach to complete plans for the system and sub 't to the County only on paper no C,re, SBD-6398 (R. 11/11) Page 9 of 9 Badlands Road FFWAr# 681 Sanitary Site Plan For: Colonial Savings Lot 14 of the Humbird Hills Sub. See. 27 T29N R19W Town of Hudson - St. Croix County 0 20 40 Greptue Seeps {Feet) 1 Inch m 40 tG 95.00' l~ proposed 8.5'x 119'At--Grade Mound Cell w/a System Elev. of 96.90 2.44 Acres 960' 3% #2 96.90' A BM = Top of Spike Large Box Elder 0 0 Tree Flagged. Elev. = 99.44' 97.00 D #2 Proposed 2" Sch. 40 F. M. Proposed Wileter Concrete #1 10001600 Combination Tank with BM a Poly-L k PL-525 Filter P/L #2 o P2 C*BM ,7 Proposed 4" / Existing Drain Field Conveyance Pipe Existing 1000 Gal. Existing 4" bldg. Sewer Septic Tank Four Bedroom Home Garage Note: Abandon failed system per SPS 383.33 #1 /ELL A BM = Top of Spike in Large Box elder Tree HRP=Same r+~PY ASSUMED ELEV. = 100.00' V ARTM DIVISION OF INDUSTRY SERVICES x ' - 0~~~~vEpFNTOs 3824 N CREEKSIDE LA HOLMEN WI 54636 0 Contact Through Relay 3 i S P www.dsps.wi.gov/sb/ S www.wisconsin.gov Scott Walker, Governor A~USSIONP~ 5~4 Dave Ross, Secretary August 27, 2013 CUST ID No. 648443 ATTN.• POWTS Inspector ZONING OFFICE KEITH E KNUDTSON ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMICHAEL RD ROBERTS WI 54023 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/27/2015 SITE: Identification Numbers Colonial Bank Transaction ID No. 2296467 681 Badlands Rd Site ID No. 794460 Town of Hudson Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NEIA, NE1/4, S27, T29N, R19W Lot: 14, Subdivision: Humbird Hills FOR: Description: Four Bedroom At-grade System / 3% slope / concaved w/4.29% deflection Object Type: POWTS Component Manual Regulated Object IDNo.: 1444787 Maintenance required; Replacement system; 600 GPD Flow rate; 42 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. C014DI The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code APP requirements. DEPT OF S No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06,pRQFE$S'Q~1J stats. DIVISION OF AND The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CO E • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. KEITH E KNUDTSON Page 2 8/27/2013 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. erard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jeny.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Page 2 8/27/2013 KEITH E KNUDTSON Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Fee Required $ 250.00 Sincerely, This Amount Will Be Invoiced. When You Receive That Invoice, erard M Swim Please Include a Copy With Your POWTS Plan Reviewer, Integrated Services ubmittal. (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm W Payment ment S S code: 7633 jerry.swim@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Services (formerly Note: Effective January 1, 2012, all codes under the jurisdiction of the Division n o"du have 'been replaced with Safety & Buildings) will be modified. Code references with prefixes starting "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. RECEIVED AUG 1 2 2013 INDUSTRY SERVICES RESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping site INDEX AND TITLE SHEET Project Colonial Savings Lot 14 Humbird Hills Owner Colonial Savings Address P.O. Box 2988 Fort Worth Texas 76113 ZONALLY n J r% Legal Description NE1/4-NE114 Sec.27 T29N-R19W %FETY AND SERVICES Township Hudson County St. Croix STRY SERVICES Subdivision Name Humbird Hills Lot No. 14 Parcel ID Number 020-1292-30 NDENC~ Plan Transaction Number Index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 Pump curve & specifications Page 7 Modified At-Grade Plan View Page 8 Plot Plan Page 9 Designer Keith Kn dtson License Number MPRS# 648443 Signature Phone Number 651-470-1737 Date 08/03113 Designed pursuant to: At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (03/12) Page 1 of 9 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping site Flows and Site Data Entry. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow (gpd) 600.0 Design wastewater flow (gpd) 3.00 % Site slope 96.90 Contour elev. below lateral (ft) 42.00 Depth to limiting factor (in) 0.60 in-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 6.00 Linear loading rate gpd/ft 8.50 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 118.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) c Center or end lateral connection 2 Number of laterals 0.156 Orifice diameter (in) e.g. 0.25 Not a final calculation 1.75 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 3.74 Forcemain flow velocity (ft/sec) 35.00 Forcemain length (ft) y or n Does forcemain drain back? 87.00 Pump tank elevation (ft) y or n Are laterals at highest point? 4.55 System head (ft) x 1.3 NA 9.90 Vertical lift (ft) 5.7 Forcemain drainback (gal) X 0.98 Friction loss (ft) 53.5 5x Lateral void volume (gal) 0.00 In-line Filter Loss (ft) 59.2 Minimum dose volume (gal) I 15`43 Total dynamic head (ft) 36.6 System demand (gpm) 3 5 Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Design options Design choice Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in Gal/in (enter result in cell G46) one lateral 1.5 in x x diameter 2 in x Treatment Tank Information 3 in x ]Septic tank capacity (gal) Wieser concrete Manufacturer Effluent Filter Information Dose Tank Information Pol -Lok Filter manufacturer 603.4 Dose tank capacity (gal) PL-525 _ s Filter model number 16.8 Dose tank volume (gal/in) Wieser Concrete Manufacturer Project: Colonial Savings Lot 14 Humbird Hills Transaction Number: Page 2 of 9 See page 8 of 9 for modifications AT-GRADE PLAN VIEW to this chart due to the concave slope deflection. D _t 116 B Observation pipes (2 typical) A 8.50 ft p B 118.00 ft 1/6 B 19.67 ft C 10.50 ft C W D 5.00 ft E 2.00 ft L 128.00 ft D B W 20.50 ft A x B 1000.00 ft"2 L Cap obs. = Total aggregate cell A x B Typical pipe. Slotted in n the lower 6", and = Plowed area L x W anchored securely. 6" AT-GRADE CROSS SECTION Svnthetic fabric cover 98.69 ft Finished grade Lateral elevation invert elev. 97.40 ft Observation pipe at aggregate toe E 3 % Slope Surface contour 96.90 ft C A and system _l elevation D -T ® = 12 in. topsoil and subsoil over aggregate and tapered to toes. Plowed layer below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. s Project: Colonial Savings Lot 14 Humbird Hills Transaction Number. Page 3 of 9- i PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection P ~ IE- X JE xn + W41 Laterals & force main of PVC Sch 40 Last hole drilled next to end cap per SPS Table 384.306 Holes drilled on the bottom of the lateral, equally spaced • =Turn-upYObsll valve or clesnout plug Lateral Specifications 0.156 Orifice diameter (in) Center Lateral connection point x 1.73 Orifice spacing (ft) 2 Number laterals 34 Orificestlateral P 57.96 Lateral length (ft) 18.3 Lat. discharge rate (gpm) 1.50 Lateral diameter (in) 2.00 Forcemain diameter (in) 36,6 Sys. discharge rate (gpm) 35.00 Forcemain Length (ft) 15.43 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device junction box Final grade 4" disconnect `s Tank component is Alternate properly vented outlet I /location 18" min. Electrical as per NEC 300 and I~ Approved SPS 316.300 WAC outlet Tank full joint c Inches Gallons :LA Provide 1IN' .0 A 24.4 409.8 Alarm on weep hole or = B 2.0 33.6 antisiphon E C 3.5 59.2 Pump on B device. ® D 6.0 100.8 87.50 ft C Totals 35.9 603.4 -100 Pump off D 3" Bed ing under tank 87.00 ft Goulds Pump manufacturer SJE. Rhombus Alarm manufacturer EP05 Pump model number Tank Alert Alarm model number Project: Colonial Savings Lot 14 Humbird Hills Transaction Number: Page 4 of 9 At-grade System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4fi80 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 ZD,,Pd gal Maximum TSS 150 mg/L Soil Absorption Component Size 1000.0 fe 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 ears Effluent Filter Inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Ins ect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished .•••.•Z35 . Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Sweep 90 or Two 97.40 ft 45 Degree Bends Same Diameter as Lateral Project: Colonial Savings Lot 14 Humbird Hills Transaction Number: Page 5 of 9 At-grade System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10854-P (N. 03/07), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N. 01101)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, 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 shali be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittentfilter 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. At-made and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade 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 at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade system may not exceed 220 mgA BOD5 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring, Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at-grade 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 renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other 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: Colonial Savings Lot 14 Humbird Transaction Number: Page 6 of 9 Page 7 of g ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Total Head Gallons Per Minute No Description (ft. of water) EP04 EPOS 1 Impeller 5 53 - 2 Base 6 10 46 62 3 Pump Casing 15 36 55 4 Mechanical seal 20 21 46 7 5 Ball Bearings 6 25 0 33 6 0-Rings - 1 l e 30 7 Power Cord 5 8 Oil Filled Motor 4 9 Motor Housing/ ; Stator Assembly 10 Motor Cover 2 METERS FEET 10 j 9 30 i S GVM . i i , 8 2.5 FT 25 _ 7 u I ' 6 20; 5 0 15. J 4 EP05 0 3 - j EP04 2 i 5,. _ 1 0 Oa. to..--.. 20 3`0_ 40 5 i 0 GPM 0 2 4 6 8 10 12 ml/h CAPACITY 3 a~rrt~t~c~wbdyc~ ~ II N II II II t:~ ~ p ~ tzi N II II N v► II oo d ~ O 00 ~O ~ ~ O ~ tip ~ a A n ~ it ti A m o' o b b C~ a a n co CD 6-. z S~ oo O ~ h h 00 k II O A II ~ ~ ~ ~ p N ti ;A O" O cep b n + DQ n p0 II ~ n m 00 - o a ~ b w ~ 0 Badlands Road Page 9 of 9 FN# 681 Sanitary Site Plan For: Colonial Savings Lot 14 of the Humbird Hills Sub. Sec. 27 T29N-R19W Town of Hudson - St. Croix County 0 20 40 6raphls Seals (last) 1 loch R 40 }t 95.00' Proposed 8.5'x 119'At-Grade Mound Cell w/a System Elev, of 96.90 2.44 Acres 96.00' #2 3% - BM = Top of Spike Large Bas Elder 96.90' Tree Flagged. Elev. 99.44' O 0 97.00 posed 2" ID #2 Sch. 40 F. Proposed Wieser Concrete #1 10001600 Combination Tank with P2 CA BM a Poly-LokPl-525 Filter #2 O P2 OA BM Proposed 4" Conveyance Pipe Existing Drain Field Existing 1000 Gal. Existing 4" bldg. Sewer Septic Tank Four Bedroom Home Garage Note: Abandon jailed system per SPS 383.33 #1 • WELL A BM = Top of Spike in Large Box elder Tree ARP = Same ASSUMED ELEV. - 100.00' Filters W X25 EFFLUENT FILTER PL-525 Filter is rated for 10,000 GPD (gallons per day) 1116' Filtration Slots it one of the largest filters AWM is class. It has 525 linear feet ! f + t,. 1.16" filtration slots. Like the' ACC" PK Exto"im o k PL-122, the Polylok -525 has an automatic shut hall installed with every filter. men the filter is removed for Wining, the ball will float up and porarily shut off the system so .r effluent won't leave the tank. sur h.ot,nr other filter on the market can Mrafiawn Rowd RK over ice that claim. ,oooocPO t' Accepts 4" & G i PL.-525 Maintenance: SMo.40 Pip* nib) The PL-525 Effluent Filter should operate efficiently for several years render normal conditions before R- r.. . g requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or ~-=mom at least every three years. If the 4['l - 1,500 CPD, installed filter contains an optional alarm, the owner will be notified flovsandcan NF by an alarm when the filter needs servicing. Servicing should be NScbrtifi~d for done by a certified septic tank GnDet pumper or installer. Bag Whm is 1. Locate the outlet of the U.S. Patent No# 6,015,488 Fdter 5,971,640 h septic tank. 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 3. Glue the filter housing to 3. Do not use plumbing when the 4" or 6" outlet pipe. If filter is removed. Ideal for residential and com- the filter is not centered 4. Pull PL-525 out of the housing. mercial waste flows up to under the access opening 10,000 Gallons Per Day (GPD). use a Polylok Extend & 5. Hose off filter over the septic Lok or piece of pipe to tank. Make sure all solids fall 1. Locate the outlet of the center filter. See page f' back into septic tank. septic tank. 19-21 for Extend & Lok 6. Insert the filter cartridge back 2. Remove the tank cover and information. into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter the filter is properly aligned into its housing. and completely inserted. 5. Replace and secure the septic tank cover. 7. Replace septic tank cover. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/3uyer Colonial Savings Mailing Address P.O. Box 2988 Fort Worth Texas Property Address 681 Badlands Rd. (Verification required from Planning & Zoning Department for new construction.) City/State Hudson WI. Parcel Identification Number ~2~ 292-3a LEGAL DESCRIPTION Property Location NE '/s , NE '/4 , Sec. 27 T 29 N R 19 W, Town of Hudson Subdivision Plat. Humbird Hills Lot # Cer0ed Survey Map # , Volume , Page # Warranty Deed # 9,-) (before 2007)Volume , Page # Spec house C}yesOno Lot lines identifiable Oyesono SYSTBM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified an §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fall of sludge. /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St_ Croix County Planning & Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are a to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed corded in Register of Deeds Office. Number of bedr SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) I This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 681 Badlands R. located at: NE 1/a, NE 1/a, Section 27 , Town 29 N, Range 19 W, Town of Hudson , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 7-24-2013 Did flow back occur from absorption system? Yes X No (if no, skip next line.) Approximate volume or length of time: System Failed gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Age of Tank (if known): i^ Permit er (if known) D 71 zji~ Zee Licensed lumber Signature) (Print Name) (Title) (License Number) MP/MPRS T /Xt~ (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 SHERIFF'S DEED 8 1 4 3 8 6 3 Tx: 4116560 DOCUMENT NO. 975887 STATE OF WISCONSIN CIRCUIT COURT ST CROIX COUNTY BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI COLONIAL SAVINGS, F.A. 04/01/2013 2.08 PM EXEMPT#: 14 Plaintiff, REC FEE: 30.00 vs. Case No. 12-CV-407 PAGES: 1 Hon. Edward F. Vlack Br. 2 CHARLES H. MULLAN DENISE R. MULLAN ASSOCIATED BANK, N.A. RETURN TO: Defendants. Mallery & Zimmerman, S.C. 500 Third Street, Suite 800 P.O. Box 479 Wausau, WI 54402-0479 PIN # 020-1292-30-000 WHEREAS, pursuant to a Judgment of Foreclosure entered in this matter on July 17, 2012, the property described below was sold at public auction, at the Entrance of the Government Center, 1101 Carmichael Road, Hudson, WI 54016 on January 22, 2013 to Colonial Savin>;s, FA for the sum of One hundred seventy-six thousand nine hundred forty-one and 49/100 Dollars ($176,941.49) being the highest and best bid, therefore; Now, therefore, the Sheriff, by virtue of said Judgment and pursuant to Wisconsin Statutes §846.16, hereby transfers, sells and conveys to Colonial Savings, FA the following described land situated in the County of St Croix, in the State of Wisconsin, to-wit: Lot 14, Humbird Hills First Addition in the Town of Hudson, St. Croix County, Wisconsin. Dated: dC . Sh rif ohn A. Shilts or Designee (please print or type name) St Croix County, Wisconsin ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. BROWN COUNTY ) Personally came before me on the above named John A. Shifts or Sheriff s designee, , to me known (please print or type name) _ to be the person who executed the foregoing instrument and THIS INSTRUMENT DRAFTED BY: acknowledged the same. John A. Cravens Mallery & Zimmerman, S.C. 500 Third Street Suite 800 * NpG// P.O. Box 479 Notary Public, State of Wisconsin ,r `State of,,.,, bljo Wausau, WI 54402-0479 My commission expires: Q~ Q H IoW 1 of 1 OUTLOPT 3 E3 • Wb44 Sq. n- o. 198 Ac. [ N 00* 4a' 19"W) 3l7-70'.. . S 00 `0 2 ' 22' E 403-03* t 9' LOT 14 13 - 106.3-91 Sq. Ft. 2.442 Ac. l5 34 .~i in n 0 n E N M 0' NOTE: >c W of i a ! t DRAINAGE "ALE N ~ N • js \ M o~ ~f a NOTE: Outlat 2 Tavern of Had LOT 13 right-of-way 1A'ti 130.434 SO FT. ' 40.37' 2 994 AC. a T •RR•.R* [witNtuiT 4p ' w 933.010 s W 00' Ww 486.'.14' $ ^ 1406000'tj t 8".38' a J9? 70' Q ! 50r-i 8 160' $ 0' ( 1 1 DRATM PIPE 1 " W~ 40 ! i r. I --T nf.ooa ti cd SOIL EVAUMTM REPORT l7irilion afS~fiN~►aad 8a tnaamdsMaewftC+aiaat#B.Wk. ndftMode Ida ! ototieeewaaYlxllttdsesiaafaa.PLaat - a~todawdbodta~twAwnoapit~.dirtioaaad - - se nio~ m &a■o^ him -Y aaetL 2 Plloame print Srbn~sYOa~ M Deb Faun tws.era.,,wea~r.t+~►~ i is itcnM~ ,X ~oUN - /3 - fo et ~na ~i t~ort'd lM Ut S _ T.2 N R EM Propeolt0 lslt~lYiA~as lu" SdINIL aAINGFCOW a!r 13vftv MUM fleas MIMI r1~ we h4~liv / Q t~.oTaaotaUt~uerafta~6a~s . Codadriraddwlgovi11 is ~o0 6PD BUIVINooment D Plummer FJoind ~eelwatml[ap~e~la .y/t~ t 131 aoauseats ~-J?.r t ~^ct®rr♦af.rr~a✓~c~ ~ fa'te~~~ loir{it~i'' ~l'1! ~ 0 Bodes T Q~~# II pE 6~adsafoosiw ~t pgA~tii~igiboloc~bL Sot Aare Ho1~ Oeplh E1oai■~t R rewonfla e• Tiae- ~nrolnus Om~dd~nas Roost- OWN iar WAMt Q•SL CMaLCator ~SL911 'fit '9t2 . 7 ' / T .M-- L . 6 klde e ,r r ♦ ~ w r< eS ♦ 'o n x ZL w Fl5-4#p t~t D aof D 7' s ~/y N~'e ®yfi~r 1n Ms i rv~ i'r~ i wt e~otaatraaeatar..,,•_ /io~td~gieaor Gmr`s• F 410AM DoOl Dodnilt twootow wos Tere Smock" amdoey 1i~ IL 1Mneet aLSL CwLaft S LOLOL IM L s 1 AIIE c- - - CBrMrir llddnera - _ noAe l+W/C cwt 71s~ -moo BAD /LID~ P?l 0 p 6I. UM" Q1681L CkvLcdor :OcBLUL ~t o= s m ~ ~s ~ o -L cLv .L l e- L 4~' c ' ot rs ' di/``~~'ff { e c 7IrC r i-I f' Q # El P!t ~ a"&%-M0 5loor ft tieii~a O~pb Oa~iie~t Aet■ctfaoa~i. 7t~s 8t~e 6aiwd~y Roams bPOAF tyea~elt ~.ac t1~Edolor +ews~.~ 'ae~ 'E~2 El ftfts ❑ moo t>~bwro ❑ 1011 -0 p 11. 0o' ftEl" t flriscOdeaOM Timis amain peals ere.aatt taLW- cao*r ft t ft •>~~=ooa~=~:a..a:>ws~s~~~as~aat. •ti.~ac~rt= ~s ~ ~.owl.arsss:~swu. _ ~is~!a.at.~c~.mos~aa~..t.~o~■~►seNtosps~3/~ra.ta~ir~ Its.a..i..~w..eat.aeoe.saerjoe~sar _ aoet atraY iaa ~Uet~tre~.ttK,lie~r+o aie *Pom st dmwu g wTff inqui4m.. . • I 0 r r ~ N~ ~ ~ I N b o w~ 0 wy x' I~N i c ~ ~ e e~ ~ n v I Lv o e `u ,a J h M1 e ~ ~ p 4 P R STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S, M AI L L 4 4 ADDRESS g0 X * 2g 2- SUBDIVISION / CSM# yU~Y1 d /Q J> 4 / L S LOT # y SECTION Z 7 TAN-R~ Town of }~iJ.ISc~ lY ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM M. 0- e of 1 E~ =/oo.aa" i We ~!tIS A i i btu>L, h ~}pUSE elf, i GARAE E i W E ! L INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 4. BENCHMARK: %D o~ Q• f~•fi /efi /'Na = /00,'00 ALTERNATE BM:_ 76 ©h G Qu j}a0 l 1. 71 SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:',so►~ Liquid Capacity: /ooo Setback from: Well S House 3'/-- Other. 1a C~ f f /of h~ Pump: Manufacturer Model# ~--maize Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM / Width: r Length Number of trenches - --Distance--&--Direction to-;nearest pro p ,-3-i-ne - Setback from: well: / 15' ' House 6 5 Other ELEVATIONS Building Sewer _ ST Inlet; S . 5 ST outlet 5 - ~o PC inlet PC bottom Pump Off Header/Manifold -T,v~ m-T Bottom of system Y~ Existing Grade (,0 Final grade Cc , y DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: ~I INSPECTOR: 3/93:jt 1'~vC' r~slTfe'Part r n ~tTndilsl 29, gW AYE SE AGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitar r it GENERAL INFORMATION Permit Holder's Name: El City ❑ Village Q Town of: State Plan o.: ILLER SAN E. lHudson CST BM Elev.: Insp BM Elev.: r BM Description. Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400075 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -P-- - Benchmark Dos' I' ' ~ ~ ~ ~o. X51 Aeration Bldg. Sewer Holdin StlFWnlet ANK SETBACK INFORMATION St/fOutlet ~d'~ / Verit TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic) C 1 / 14 NA Dt Bottom Dosing NA Header CAian 57 Aeration Dist. Pipe'" / a Hold Bot. System Fro PUMP/ SIPHON INFORMATION Final Grade C Manufacturer Demander Model Number GPM TDH Lift I Friction H Ft Loss ea Forcemain Le Dia. Dist. To Well SOIL Al SORPTION SYSTEM BED/TRENCH Width Length/ i No. Of Tre ches PIT No Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM Manufacturer: INFORMATION Type Of CHAMBER um er: System: 11EALC( DISTRIBUTION SYSTEM Header/Manifold / Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 11 Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Depth Over Depth Over y ' xx Depth Of xx-Seeded /Sodded xx Mulched Bed/T Center, Bed/Tr,,*Edges,:;),/ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.27.29,19W, NE, NE, Lot 14 / -1-r Plan revision required? ❑ Yes N/No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No SANITARY PERMIT APPLICATION CO' In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than aQ 0,7015 2~ 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S~X fj'f 1W / LL 116 % t,- %,S z7 TZ ,N,R/ E(orkff~ PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, ST TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 0 CITY VILLAGE NEAREST ROAD 11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ U So L 3 ~D ❑ Public ~ 1 or 2 Fam. Dwelling-#~ of bedrooms Z PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) Q Z - L Z f L " 3 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 220 In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE SO REQUIRED (sq. ft.) PROPOSED (s q. ft.) (Gals/day/sq. ft.) (Mindinch) G ELEVATION 7ZO 0.7 7 K TO- Feet O Z. O Feet VII. TANK CAPACITY Site in alions Total # of Pref b. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Conc%te Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank D~(7 / Wes, i S Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on 11 he attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MP W No.: Business Phone Number: ~L 3 Dtuc_ STR0 M Q E,ENI Z.1/07 Plumber's Address (Street, City, State, Zip Code): ,0,BOx-1t !ZZ-N.C.- k1tN aND wZl-- T9'0 7 IX. LINTY/DEPARTMENT USE ONLY ❑ ' Disapproved Sarypary Permit Fee (Includes Groundwater Date- s ue Issuing A ent Signatu o Sta ps) ~~Yf / XApproved El Owner Given Initial Surcharge Fee) oe~ Adverse Determination /Z MIIIW[jl X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS w 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renev)ed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. Il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) $AM AAXltA R BADLANDS /poA D IYA L0TaWC, 77719' L~6END + B.M,Tof a4 PIp oIVCAsT 5l. _ / DO, oo S e4 y 5 y s`fd 641. A ¢J8" Sr0 fS; /O L OT 19 ~p ~R !l •V ~ m V/ r 1 ~ rn s Z v B.M tkbK ~/PE' ON. k-OT LINE El. /moo" w v 7- ALrEInV,4r rE-yo~ A 3f' A OR '1 o f S SD" A//J izo" ~,~42A 6E 3s• W~tL Sow-f1W TL/NE 2772 f NT U U t Z W ~ 0 CL W LLI 0 co x > x 0 ~ o o°~ F= rn T ~o ~[r x ~j Rd. z LLI rf.~ 4 I v, CL "Mrn z T o wI Q~ ~ =d I w Z I I I I a 1 I I 1 4 I o I I M -j I I I 0 I a I Lu _O U I I z a. i w U CL I W m I I I ~ I J Ra ' I cD I M ' I I I I W ~ I I I I I U9 I I o I w o w I I W 0 CL o- ~ I I I ` 10 ~ I I I > = I o I• w W I J P) -N to ~5 ~I- ~lVpLATTEO_LANDS 2603.02'. _z S 89' 44' 13"E 617.13' 5.33' s 89° 44' 13"E O ~9 '339.1$7- S89-26'42"W 617.161 277.29' O 00 c- P a, H r" `W 5 10 0 000 - Z . to 0 W ' c, `r / O In O o` s N O ~ Z ' 1 ' n rn D tD ' ~ - Iffl w O p N Off` r 0 1 A 0~ m O 41 N O to Imo, D 'T1 C 4 W 0 n w a` cn N `o H N Im N r z .4 LI T D N J rn O IO O 9 4~ m = 0.(n IN x 0 Ln Im (A r. 90 A M % J * g3 o O q m f D ID ~0 Z K o a c a M p o ~ a c { r• O M R O 340.05' 277.29' N S 89'26'42'N 817.34' o O O c A C~ r m C UNPLATT ED_ _ LANDS rn ~ w ~I O O z T O O0 m .Y O 0 x~ a O O 0 lP W D Oo n w a, 0 H - w oo oM o U m m .P n~ o c t Qt k... ~p R, O' N O Z to a N CT a N N N I N N N I N N M r• fl cc Q O D O N I N N W I L.) Q W I! p O m A b O O -4 d+ t„ ~,•ti m m 0 0 o rn .P o 4-" 00 .o -1 W04 O v.o w e O tr .P O O O N W` tl~ O o C> co w OD ZE -e 'w `d ►~t m p p p O co vs•ti.. 4%J N{, o 1V 1.2 1 _ C+ to Q OL 006 00 W A~, 00 co to , d0 OD 00 0 O rn w .0 ao 00 00 00 O OD W ►'l J W N O O O O O O W :.1± O O G _ O O O O o O . I•j G O O Cl O O o O O O O. O -O O O O 0 o WIsconsk-Department of Industry, SOIL AND SITE EVALUATION REPORT O Page I of 3 Labor and Human Relations Division of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ~rC+~olx not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. A PLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE P ERTY OWNER: PROPERTY LOCATION 1 GOVT. LOT N E' 1/4 N C 1/4,S Z~ T 779 N ,R /7 (or) W 5J~1iM > Q E L r:t~2 PROPERTY OWNER':S,AAILING AD ESS LOT BLOCK# SU D. NAME OR CS CITY AT ZIP CODE PHONE NUMBER [:]CITY ❑VIL GE OWN NEg/~-EST ROAD U ~Sa-0 tA)l ( ) v~sar [S~aD L#4v&S New Construction Use. Residential / Number of bedrooms [ J Addition to existing building [ J Replacement [ J Public or commercial describe f„ Code derived daily flow gpd Recommended design loading rate gibed, gpd/ft2 0.6 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate O bed, gpd/ft20,g trench, gpolft2 Recommended infiltration surface elevation(s) ON PAILt 3 0¢3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MO ND IN- QS PRESSURE &T _GRADE SLY 5s IN FILL HOLDING T K U =Unsuitable fors stem S ❑ U S ❑ U KS [3 U S ❑ U S [I U ❑ S KU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 67 j O- ~q 1611A 3 ! sw 0,4 jLz- 0-4f 16w -*4 Si c z AbK - a s 0.6 ` Ground 14S-SK 16\1 k- S M 1• M / 0:7 O.% lev. Depth to limiting factor SY 4 S c ~7 r ~i^ 4 / OS 0.6 > 7.0% Remarks: Boring # -b ,s 16A Q 13 ~eh.Ttg JL' 61; 6,4 Ground 136-1/4 I &P, 4/4 S A r Al j O.-I 0 elev. /dZ •'19 ft Depth to limiting f for > .67 Remarks: CST Name:-Please Print d J~N~lSO~v Phone: Address: 140-240)'4 Lj1 S-4074 Signature: Date: / 94 CST Number:.3484 PROPERTYGMER ~!d LLC?- SOIL DESCRIPTION REPORT Page? of 3 ,'PARCEL I.D. # L6 7 14 A) fh 8) k b Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends 3 $ 17-/9 OY r- S V r f~ / l 0.4 O,S r2 3 C / O ? TS Ground $ -1Z3 6YK 4' S rh r M/ elev. fgz.66ft. I / Depth to Lt-SC- A"A S .4 *,IF Q a0446crr T 6F 1 N O~ f 2-Z- . limiting factor Remarks: Boring # Q 0 1674 3/~ c r r C , 4 0 ,S t~ $ 9-29 /6YA3 4- - SC Q m c 1 .4 o. w Ground 9-/Z /OyA 414- 5 r Ai .7 elev. fD7. ft. W6 !J k4 44 0U7 9z -91 GA) Depth to lirtaiting BZ -O Z ' /ayje _ 5 Q r /`►-~r' C~ O.S 1:0,6 factor a --j > 0.05 Remarks: Boring # A a- ,z /aye 3 0.4 o.~ 4 - SC. w, r e l 0.4 Ground tg 4-~I s d M 1 O.7 056 elev. f t)S.S~ft. Depth to limiting $2. . 01 le 3 r ~i~r 4 S U. 6 > .ton '7s, Remarks: Boring # ti t~~ L Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PAZ,11- 36-F-? N - M 1 ® +Q CD 1 r c q ~ 1 , t Q ~ J ~ Q 1 J c4 J r Map M 1 Qa ~ ~ ~ a a ` DYV ~aJ l ¢ ~ N 11 ~ ~ ~ m Lis 1c 4 w a 4 M Q STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER lrjl4Z4!C~ ADDRESS 2..- ~04(40r 4<,;-Z r r4 ` MAILING If, PROPERTY ADDRESS (o S ) ~o L N ~i 5 --O to 0 . (location of septic system) Please obtain from the Planning Dept. CITY/STATE P U d S e e\ WTI PROPERTY LOCATION NOEL 1/4, ,Vz5 1/4, Section Z 7 , T a 9' N-R ~ TOWN OF 9 j2d So rj ST. CROIX COUNTY, WI SUBDIVISION HOAX Rl R,4) f i/GG 5 LOT NUMBER CERTIFIED SURVEY MAP , VOLUME IOU, PAGE Z YZ , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: / DATE: ' `7 ^ - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property _5,41!n i0/1- LE.-Location of property,~1/4X/E 1/4, Section Z 7 T Z9 N-R 9 C Township PUDSo/Y Mailing address l3o~P' ~ Address of site Cod/ 'f'0 7.x,4&4 5 'e'o Subdivision name #6),0 19,P t!/LGS Lot no. Other homes on property? Yes No Previous owner of property Total size of property 2,,1412- Total size of parcel Date parcel was created - / 2 - 3 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? 1r, Yes No Volume 1021 and Page Number Z8'2- as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 5-O z za y , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. So zzo9 Signature of plicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACC RESERVED FOR RECORDING DATA WARRANTY DEED ' 502209 YOl PAGE 292 REGISTER'S OFFICE ST. Ci~OIX CO., W1 This Deed, made between . Humb> rd Land Corporation, Fl::c'd for record A Minnesota Corporation authorized to do business i ...W> Wisconsin J U L 1 2 1993 Grantor, at 4:20 P. ~A and San) E. Miller y^ ` Register of Deeds Grantee, - Witnesseth, That the said Grantor, for a valuable consideration...... - - RCTURN TO conveys to Grantee the following descrlhed real estate in $.t a riroix _ County, State of Wisconsin. _ 7 o y ~,lcta/l Lots 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 1! and 12 in the Plat of Humbird Hills, Town of Hudson as filed Tae Parcel No: and recorded in the office of the Register of Deeds for `',St. Croix County on April 7, 1993 in Vol. 5 of Plats, Page --,,..99, Document No. 497107. Lots 13,114 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 and 25 in the Plat of Hum i bird Hills 1st Addition as filed and recorded in the Office of the register of Deeds for St..Croix County on April 7, 1993, in Vol 5, Page 100, Document No. 497,108 i 1 This ii..nQt......... homestead property. (,isJ (is not). Together wi'h all and singular the hereditaments and appurtenances thereunto belonging; And...Ht3Dibi rd..kacast..~^.FpQI t~L.} on warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except .easements shown on the above mentioned plats. and will warrant and defend the same. 19..93:.. Dated this 12th...... day of ...Julg.......................................................... Humbird Land Corporation, a Minnesota Corporation authorized to do business in Wisconsin .............(SEAL) By... (SEAL) Austin J. Baillon, President ......(SEAL) (SEAL) I AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. j / V,~.bW..County. j authenticated this ........day of 19 Personally came before me this of July .......................1 19.11. tha abase `nggled % t......--------~ lnp o`f ''•~;~c , ALl ill4 Preside >.[l_.~,...B...a•----- .n............... ;..y TITLE: MEMBER STATE BAR OF WISCONSIN Buagbi.rd .k~nSl._~Qrporatio~_ ~_;___~•j_]•~_o•_ (If not, In authorized by § 706.06, Wis. Stats.) I "e to me !mown to be the person Xvl~e~cecuted the foregoing ' strument and acknowledgAh sain4 Q H •t CJ ' THIS INSTRUMENT WAS DRAFTED BY LIMN V . f/ ID'Q,k,•,..••. f .Kueppe rs r..Hacke l..&..KueplRe-a - - 1350..Capita1..Centre, ..St...Pau1,..IM.15102. Notary I c ....S.T.....C .6.1.1X.......... County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (Tf not, state expiration are not necessary.) date: *Names of persons siEnina in any capacity should be typed or printed below their sirnaturea. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1-1982 billwaukee. Wis. I