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HomeMy WebLinkAbout020-1419-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556370 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: McCormack Classic Construction LLC, c/o Sc Hudson, Town of 020-1419-60-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: eJy 651- 20.29.19.2664 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 1 is+i, ~a Septic L~ Benchmark Dosing Alt. BM r C 7-7 1!5 Aeration Bldg. Sewer Holding SUHt Inlet TANK SETBACK INFORMATION St/Ht Outlet ` i TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic ~ Z ;"5e) / Dt Bottom 2z . 77, Z Dosing 3to Header/Man. 7.7z Aeration Dist. Pipe g.(CS 93. Z Holding Bot. System 9 • 9 Z S 9, T5 PUMP/SIPHON INFORMATION Final Grade S. g Manufacturer Demand St CoverC / L) e L-t- GPM ` I ( 3S 93 6C Model Number TDH Lift Friction Loss ISystem Hea 1TDH t .7 . g Forcemain ILengtk§e IDia.2 /f Dist. to Well SOIL ABSORPTION SYSTEM 38 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ' UNIT 7 Model Number ~e..r DISTRIBUTION SYSTEM 6"".f ;c A-j Header/Manifl / Distribution \ x Hole Size x Hole Spacin Vf~J/'~ to Ai411nt, ke AA jipe(s) Length Dia Length ` Dia \ / ✓ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over \ xx Depth of xx Seeded/Sodded xx ulched Bed/Trench Center Bed/Trench Edges \ Topsoil es No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 850 Chebek Lane Hudson,, WI 54016 (NW 1/4 SE 1/4 20 T29N R19W) The Glen Lot 70 Parcel No: 20.29.19.2664 1.) Alt BM Description = FI ~Uw e Z 2.) Bldg sewer length - amount of cover = (I tA~ 6 Plan revision Required? ❑ Yes s No Use other side for additional information. Date 4~11nsepctors Si ature Cert. No. SBD-6710 (R.3/97) County RECEIVE Safety and Buildings Division ~j 3' CitoiX a R S A 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Q 2 3 2012 Madison, wl 53707-7162 PSft J ermlt Application ' e Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governnren unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are sub mitt Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privy Law, s. 15. 1)(m , Slats.' S y~ e L _ ~j I. A llcation Information -Please Print All Information 44 3 Property Owner's Name / Parcel # G(-'0,&Y,4 G GL S G SrX.06r/On1 ( d TT G ce'e ee 02d " /I con -520 Property Owner's Mailing Address Property Location 078 e2f dE. Govt. Lot " Z" it City, State Zip Code Phone Number 41 '/4 , ? ~~w/ .SE Section O d 1 ~J yo~6 715- 7VO -,?a211 T,? 19 N, R_/? (circle II• Type of Building (check all that apply) Lot # X I or 2 Family Dwelling - Number of Bedrooms Subdivision Name OK ate. Block E GLEE ❑ Public/Commercial - Describe Use 0-t?iipof ❑ State Owned - Describe Use CSM Number B-vm8ge of 2 O w,24- 22- IM Town of uD.s o.J III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) A. )fNew System 11 Replacement System F-1 TreatmerithIoldm'g Tank Replacement Only ❑ Other Modification to Existing System (explain) List. Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner i, , IV. Type of POWTS S stem/Com nt/Device: Check all that apply) KNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable sort ❑ Holding rank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsaffrea ent Area Information: 1/ -1 Design Flow (gpd) Design Soil Application Rat sf) Dispersal Area Required (s Dispersal Area Proposed System Elevation Goo .7 8518 c9 71. G 9,7. V 9x o VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 9 o v New Taroks Existing Taroks c Y2 u u t' U rn y En w i5 c% 4 6~ y Septicor-Holden k sO - .?S4 s---w CorJGaEr-E Dosing Chamber SQ _ 7 r0 i1 it ✓ VII, Responsibility Statement- I, the undersigned, assume responsibility for installation of tie POWTS shows on the attached Plumber's Name (Print) Plumber's Si MP/19ffg9 Number Business Phone Number J o ~v EL,YE~ ,7313YG 7~S GT.?-S.?61L Plumber's Address (Street, City, State, Zip Code) AV C~ 98 r. wy ~s t©U~.+•~o 4/- Sy ~G VIII our /De rtment Use Only -XC pproved :1 Permit Fee Date ued Issuing Signature s .oo /d L5 /Z en R for Denial ~ 7~ IX. Condig"l,Reasons for Disapproval 3'/~ r /atJ : t ~-a ~d J, n r1 e 0 t ,.UF.t, t.✓ 5 4. Septic tank, et rtt filter irkif dispersal cell must all be servk*s t maintalfie l /04114 1rC~vlG~ /iL i~J' DA , as.per management plan provided by plumber, 2 All Sack req*ements must, be maintain+fQ as codr>e.iatarires'. willia" Per Attach to complete plans for the system and submit to the County only on paper not less than 8112 x 11 inches in size SBD-6398 (R. 11/11) ~ n 13 u Q ` O Z ~'1 v ~ Q 14, r ~L~ Q T, it t1 \ J ~ Y1 ~ J .sue ~ a 6- s Q Y -3 3 V `C h 6 o Y c ~ ~ a G O. O p ~ y V c Z v ~ o v a o ~ V N \ 10 N3 j e - T k x N Q~ ~ I 10 y ~ov~ i v ~ Nq -4 v ~W 1 vil Private Onsite Wastewater Treatment System Index and Title Page Project Name: .S44rr CaAV,4IX - 4X. /,J- 10A. ,10 AWrs w/a~Fr ~ rl~r~o,r Owner's Name: SCcrr /yc Co~,,vc.K ~/"Ic Co1lIY,yuc C«ss~c Co.~ST Gt~o,J) Owner's Address: s7a /,?.0 ~dE 7/S 7co - tea/ ~ - Legal Description: /V Gl~-5rgE; 34, 91V / 9 4) Municipality: 12M Verge, Ply of County: `ilo/X Subdivision Name: ;~;Pr hzle;d Lot Number. 70 Block Number. 7 Parcel I.D. Number. oao - 1y19- 4o - aao Page 1 IA;,OEX r6£ -5//X r r Page 2 ~GoT IAAW d~~itoss - .~EcT'ie.✓ ~1..lRt zlyey Page 3 SE'.~ric n4,< //-4~.0 <<YAewm Gloss- .S~c rio r Page 4 w.y►o ~E,t i'o.crvowe. er G!ug a r Page 5 ~ol~lTs OaJdEti s /YAwk~,oL rrvdAcEi~E.Nr i°LA.J Page 6 „ Page 7 X/L rr ~i0lnJTEw/Aw+LE /,df0 Page 8 66.-Ydo rVK Slrecs Page 9 I rJrX10*rlwl r = ~m~t di/ZNATio.J WE0a.c r Name of Designer: J o ,v ~fLK License Number: /1Y1 ,?3/.3344 Signature: - Date: /d /7- ?.o AR Designed. Pursuant to the Following POWTS Component Manual and Comm 81-85: In Ground Soil Absomtion Comp gppt Manual for POWTS (Ver 2 0) SBD-10705-P (N. 01/01) I ~a Q v 13 ~ 3 h O cr `Y \ 'z. v 14 let Y S ~ e b~ J s .'a1, a- ~cr 4 V e:1 h j r p y t< v s ~`Va " ante. u M i t o 2 ~ V Ile O \Q n 4 R ' p ~J ~ I W ik 00 ~ ~z 14, vi C~ Z v v° T V k X N 14 v ~n ~ t ti V ~ ~ L1 4i v K v a~ v V e M V t ~ O ~ L6 Ilk 14, Page 3 Of 8 SEPTIC TANK &*PUMP CHAMBER CROSS SECTIOW AND SPECIFICATIONS - .s Saw f'o. 4" CI. VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF /,0' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS y Bt~ow W/ PADLOCK & ~i.~r:.ved d~AAE WARNING LABEL G.C•v0e~ y - =~___4" MIN. 18" INLET it WATER TIGHT SEALS GAS- ' IDES r 77 ' A SETIGH ALT~ c 'JAPPROYEO JOINTS WITH APPROVED Fit rE2- I_ r ALM APPROVED PIPE PIPE 3' B i ON 3' ONTO ONTO SOLID C SOLID SOIL SOIL PUMP OFF ELEV. 83JIFT. OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC./ DOSE TANK MANUFACTURER: ~/iE.sER ~Onlcit6rE NUMBER DOSES PER DAY: sa (/9~) TANK SIZES: SEPTIC /~So GAL. DOSE VOLUME INCLUDING //S.,? y S.7 = DOSE 7So GAL- FLOWBACK: /.?0.9 GAL. ALARM MANUFACTURER: ST E. ~h/or►,6ys CAPACITIES: A = 30 INCHES = 5/613 G GAL. MODEL NUMBER: SWITCH TYPE: /`~E-cf/.o.~icAC B = 2 INCHES = 3a. GAL. 6,4rs. _ PUMP MANUFACTURER: ZoEU~-,c / ~N~H C = 7.25' INCHES = /ao. 9 GAL. MODEL NUMBER : SWITCH TYPE: /%ELNAN/6fL D 8.s INCHES = /370 GAL. REQUIRED DISCHARGE RATE o GPM PUMP 8 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . /O• D FEET MINIMUM NETWORK SUPPLY PRESSURE . . . . . . - FEET + 3S FEET FORCEMAIN `X lo FT/100 FT. FRICTION FACTOR . .r.. y . FEET TATAL DYNAMIC HEAD /o y r FEET .0 INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ,5". ; WIDTH 8o ; DIAMETER - LIQUID DEPTHH- yg , D~. y d~ s TOTAL DYNAMIC HEADIFLOW W PUMP PERFORMANCE CURVE PER MINUTE MODEL 151/1521153 EFFLUENT AND DEWATERING 50 14 45 153 MODEL 151 152 153 12 40 Feet Meters Gal. Liters Gal. Liters Gal. Liters _ 9 35 152 5 1.5 50 189 69 261 77 291 = t0 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 0 6 151 \ 20 6.1 29 110 44 167 52 197 F \ 25 7.6 16 61 34 129 42 159 0 6 20 30 9.1 - - 23 87 33 125 35 10.7 - - - - 22 85 15 4 40 12.2 - - - - 11 42 10 Shut-oft Head: 30 ft. (9.1m) 38 tL (11.6m) 44 iL (13.4m) 2 0145088 5 i 0 Model 151 Models 1521153 10 20 30 40 50 60 70 80 90 100 GALLONS 67132 67132 LITERS 0 40 80 120 160 200 240 280 320 360 3718 458 3718 4518 FLOW PER MINUTE 014506A CONSULT FACTORY FOR a 3~ - 37/8 ISPECI L APPLICATIONS 3716 ® ~ 3718 • Timed dosing panels available. a • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. f • Double piggyback variable level float switches are available _ j for variable level long and short cycle controls. - kill - • Sealed Qwik-Box available for outdoor installations. See 1111116 12118 FM1420. Tl • Over 130"F (54oC) special quotation required. 415n6 5318 15111521'i53 Series ( SK2444 SK2064 15111521153 MODELS Control Selection Model Volts-Ph Made Antos Simplex Duplex N151 115 1 Nat 6.0 1 2 or 3 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 "Easy assembly" N152 115 1 Non 8.5 1 2 or 3 (pump & drsdraW pipe BN152 115 1 Auto 8.5 Included 2 or 3 not lnduded.) E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Induded 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 _ 1 Auto 10.5 Included 2 a 3 _ E153 230 1 Nor 5.3 1 2 or 3 BE153 230 1 Auto 5.3 included 2 or 3 SELEC T iClti' GUIDE OFT 10,11JAL PUMPF 6-11ilND Ply; 10-2213 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. Reduces potential clogging by debris. 2. See FMO712 for correct model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. 3. Variable level control switch 10-0743 used as a control activator, specify duplex Made of durable, noncorrosive ABS. Raises pump 2" off bottom of basin. (3) or (4) float system. Provides the ability to raise intake by adding sections of 1%" or 2" PVC piping. A CAUTION Attaches securely to pump. lk,l ti °tcor,r , ectu 1911 devises o"d" ir'rn h 'l1 d1," quaffi-i • Accommodates sump dewatering and effluent applications. u~eii5eu edLtiielaii, Ai! l eleiilC aGU az y ocdo5 h L~ to!G cd ;il,.! q ,!-,L most recent Nationai Eiectrical Oude (NEC) and the Occupaiiwa; Safety aj J naalih NOTE: Make sure float is free from obstruction. Act (OSHA). For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2008 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page .5 of 8 FILE INFORMATION SYSTEM SPECIFICATIONS Owner ,.9 • //G O!( AG SSG COnJ ST'RNcr/o.J Septic Tank Capacity 1175'0 a! ❑ NA Permit # Septic Tank Manufacturer ❑ NA ~✓/Esex o.JC~srE' DESIGN PARAMETERS Effluent Filter Manufacturer 49ES0 NA Number of Bedrooms •y ❑ NA Effluent Filter Model Z7 -/O ❑ NA Number of Public Facility Units _ ❑ NA Pump Tank Capacity 75'0 gal ❑ NA Estimated flow (average) Y00 gal/day Pump Tank Manufacturer L✓lE.SER 61Oi1JCR~'F ❑ NA Design flow (peak), (Estimated x 1:5) 600 al/day Pump Manufacturer Za s-./ Z ❑ NA ex Soil Application Rate 7 gal/da /ft2 Pump Model /1-71 0 NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L llln-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100mi ❑ Drip-Line 0 Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: ❑ month(s) 3 ear(s) (Maximum 3 years) 13 NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) 3 0 year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 13 E month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA 3 )9 Year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: ❑ month(s) At least once every: NA ❑ year(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,. measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page 6 of STARTUP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surf ace. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will-be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; ' medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name fo n/ EiKE /~'073/3`/G Name /V ~EZ E ELKF LaM6i.~t Phone 3.?~L Phone 7.?- S.?LG 7S G / -71 4 SEPTAGE SERVICING OPERATOR (PUMPER) - LOCAL REGULATORY AUTHORITY - Name Name c ac Q-10 r. T ~i10/X Z .~i Phone Phone ~S ~8C - S/680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. H t LU rn rn LL. O O1 ~ 1 m y E y d A ~ ~ ~ i y m a a V 41 L Z CL u w V J + c c cu ~ Q 0 . ~ N ^I = N .a N N C N w E W G r 2 w 3 W .cA,; o ~ mo Y C C x O;i y ~n V I- C r Y 41 :og 4- 0 > LC 3..a~~ Y m~ J- W W 4; i.1 R 3 .Q W 0 M LA, 2Z A'S 3" N C r` M d w wt w'N u~.CP O N ~ C Y W v Y V N N~~ ~ v R M. V C d C VA-. v= y ~ _ N A C w y 4+ V w N W > o 4- D M i LL c 4~ N m CL u O ay+ a m A O a wc Ew E w a! r ai w ° www a. M, c 0 ZEE wt0a a V~-rI a~mc L w m K E m y fV w „~3w ._~c3 CL~o CL :3 yco,Rm M %n o Q T u N m O.~ 4 N 4-6 r Q w F Y t aq ~ V O c22o.ass o-- m W CL-Cc: w w` i t2 Y=Vy i v m rn~ Q c 16 3 a 0- R am w wo aA+ w ~ ~ v7 j `Z y ~ • I +I v z Y azy w~~u~ - Lcwrn~ 0w0 rw0 i 3A,5 :E o f 40 0- c Y> 6., >ri~ v► a N c O O 0= =s 0/a N. CL E ~ c w c -13 T • C LL. Y C A Q rw ( } ° mar v A E o ~~yJ A Y y 0 m CL V 'v Y N a o E E v ~i~~r _u xdw v ; 3E co 4-6 w V N A V w a a dv O u= E u Em 4 N u w A(D Y w L ~ ° c rn E ~~j v► a=.. ~ 0 (D = w E O .Y I- _I Y N G' N ' O 'a V O / y Gi M N y ~~yy a.. Ac ~ 7 a C aw+ ~ ~ ~ ri . rl 4-A rin s" d .,w. O # a0i T; w YS 0 a 0 IA9 -5 U - I - N a+ r. M6 on am M9 s ~ °L 'd Hn__OGc aSZtj mm ksvnwr 9stv8-SZ£-oo9 Boaz -NHr -A32! MiS IS ' MM N3MM1 mum sn gum ° o i""s xe 3131,®9 Q ~[1PtVN1 ~ud3s W ova -ON A321 d a */tSri-ML ()9z LM ~ m w F J Z Z W w W M- W w O O or w O J t,~'~ Z U bi w O F- > o o! Z jW 0 U) LLI 0 Lai 11, ir ra O F__ U W N O O C LM O O U w~ J vwiO w O Z 3 1 F- U W o ti O p ..vim < O H U Q a- OM C1qks( Z z H > Ix P Z 0- Q W w oo< a~U J\ Q O> O Z Q w d N OW W< F- LLI 0 QQ Z I- a O a ¢ o vi m 1 t,w w U o w 3 \ z U o 0 LC) U_ pQO MCOm <<L w c' ON O NZ OS W W rf~ C 0 U) -Mw Z> ¢ p a N X V CV Ne to O 1-- _J 000 1- 1 Q H N Q N GO p Q W O\ O W V) 0 LO N OJ.. ODZJ~ ON~ OZ~' U O Q J =\Q D 1- N vs ..00===l=- 30= OVY pow a W = m P W W mo~c a- O¢O O Qil OWC3W Ze Q ZNO U U. Y-~ Z Z W m ~m 3: Z3m07 -wi mD3 ¢d c9 ¢3.. o Z Z¢ ¢ c U) 0 ZQ O Q _j -i _Q °a z o O Z Z J OJ H Y W NZ O ~ ¢ W O O Z w U ¢ O Z Q L7 l5 n z t- I I - 1 1 I > I1 IL v-d J it Imn U U IN N w J .9B Z .FS .99 8 ~O ~ 7 .oo t4 r c S"l'. C ROIX COUNTY SEPTIC TANK MIN f: ~ "CE ACS R", < Nil _':4 T OWNERSHIP C'i R r ! IFI ' ATION FORM Owner/Buyer Mailing Address Property Address C) Q (Verification rewired from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESC;`RII' ION Property Location 1/4 , 1/4 „Sep T N R 6 , Town of SLJbd1V1Si0!1 Lot Certified. Survey Map # , Volume , Page # Warranty Deed ~ Volume a , Pagt~ _ ~ Spec Douse yes no Lot lines identifiable y=es no SYSTEM MAINTENANCE AND 01N,' ERCERTIFICATION Improper- ' rnaintenance of your septic system ceu2:cult in its pre atw ia:lirr. a handle wastes. Proper ainterra,~ c 1,umptn- out the septic tank every three ye.,, t ~ aoner, ifueedcd, by a licensed pumper. What you put into the sys:er n - c t , c_.~~r tl.e scpt o tank a a txeatute~lt; th_ -vastc diskosa1 system. fawner maintenance respori4i`t s a sl,: ;a ` l _omrn. 83.52~1) and in C:'h aptcr 3 Ct :ix tuoucX,y 4 nit<rry ( r<1i.~:+nce. 'the property owner agrees to - t{~ t, f t` , rt Plamin & Zoning Depa 'Li t a ce tification form, signed by the owner and by a master plumber, ourn:,°-~ -Au; ; nLiaiber or a l c;es.sed pu p,: v(: nc that (1) the on-site waste. . ter dispo. ai terr: is in proper op -Icing co 3inori aml or (2'~ aver inspection and puml ng (if necessary), the septic tank is le- ; t' t b"_ full of SL,4d 0. I/we, the nd _rsign d have read the at ve requirements aj i ni..:. ,3in the p i Vote sewage disposal system with the standards set forth, her. i I, asset by the D ir~ i at of C"o rnerce and f:: D.: i tmc»t of N itur.t4 Resources, State of Wisconsin. Cmification stating that your septic systet , ? ;i2rttaincd must be ccarupieted air l rctwrtc;d to the St. Croix County Planning & Z ,ring Department within 30 days of the three year expiration date. Fwe certify that all st rtz r -1 this for i _ t ..e tl b Df my/our knt ,h 'ae. I/we antlare the owner(s) of the property described above, by vi-t,,, i , s rl -~d : : led in F _a .a c of Dee<!- l~ ttxrtiter ml~TTJRE `APPLICANT(S) BATE ***A.ny infoz: h::t cs m._.repr.si- _ iay result in the sanitary pertnit being revoked by the Planning & Zoning Department.' Include with-ked from the Register of D and a copy of the certified survey rats if (REV. Uhid5) 111111 8 0 Tx94077243 STATE BAR OF WISCONSIN FORM 1 - 2000 966041 WARRANTY DEED BETH PABST Document Number REGISTER OF DEEDS O. , WI THIS DEED, made between Michael D'Jock, a single person Grantor, ST. CROIX C PM and McCormack Classic Construction LLC, a Wisconsin limited liability 1ST. CR IX O. EXEMPT2 :45 company, Grantee. REC FEE: 30.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 276.00 described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lot 70, Block 7, The Glen, Town of Hudson, St. Croix County, Wisconsin. - Recording Area Name and Return Address: Land Title Inc. File No. 388589 2200 W. County Road C. Ste 2205 Roseville, MN 551 13 Together with all appurtenant rights, title and interests. 020-1419-60-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements, Restrictions, Reservations, Roadways and Rights of Way, if any, of Record. Dated this 10th day of October, 2012. * Michael 'Jock v I 4d AP!, SE IJ - AUTHENTICATIO ACKNOWLEDGMENT Signature(s) NOTARY STATE OF WISCONSIN ) P©LK COUNTY. ) ss- authenticated this 10th day of October, ?N PUBLIC Z- jl Personally came before me this 10th day of October, 2012 U'thie above named Michael D'Jock, a single person to me * tj~known to be the person(s) who executed the foregoing ' CG I- mst iient and acknowle h ne. TITLE: MEMBER STATE BAR OF WISCON rte? (if not, authorized by § 706.06, Wis. Stats.) *Nler ee J Bune THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wi consin My commission is permanent. (117not, state expiration date: Larry S. Mountain, Attorney at Law 10/27/2013 ) (Signalurcy may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature 1 of 1 WARRANTY DEED STATE 13AR OF WISCONSIN HARM No. 1-2111111 I ,.q1 .awgFj` ®1H'J1LAd00'S39yWtl0 NOi WIV1J tl O1 nOA ll3[9 n5 AVW ONy 031IHIHONd Si NOLJnNLSNOJ ]I55tllJ XJVWNOJ~W 9!065 IM'uazpnH O i0 N 31 No N3d N3111NM 3H1 H1IM N L 03 USNOJ any 4IM Us N S1dJNOJ ONy 59NtMtlN0,SI 353HL 103s5n 11 ' N OI1JfI1LL5NOJ szaippy U014Jnj),SuQ'J F I l- --D MJVWNOJ>W i035113AI5111JX33X1 NOi F N IIWI auoia~ a'NOIllnN15NOJ JISStlV XJVWtlO- AOA HUONd aweN 4U21lD JISSe~~ ~JewJO~J NJ a = ONy 1]n00Nd XNOM ANV13INdMd 3H13HV SONIMVNO 353H1 31y0 A0 NOII MSM 'ON NOL NJS301DRM AS O30.- SONIMWO O VI f I I I i O o Q w m u6 N I Hill I I o II o C UI ~''~7 u N O O D O 0 0 o c a 0 0 0 0 0 O O O O O O e e o v I I I ~ I i o a ' ~ ~s 111H9111100'S39VWV0 HOi WIV1OV OL OOA lJ3I905 9SObS~IM~uospnH J~N_~WM N0UI9IHOUd SI NOmni Wn OI ID JIOVWMOJIW N0SSIWH3d N31 --InOH11M NI393H103NIV1N00 ,CSLd3JNOJ ONV SONIM-3S3H1 AO 3S0NOll nUSNOJ ss»ppV uo i~nJlsuO~ 31 SVIO NJVWOJIW 30 350 3AISm0X3 381 03d0I3A30'NOLJ-NOD OISSVI0 N0VWHW W30 ALN -d 2UJ2N ;U21l~OISS21D )fDeWJOZ)JW ¢ ONV 1J000Nd NWM AHV13IHdOHd 3H13HV S9NIMVtla 35381 31V0 As! 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O 'IU~e'n_ C1 Please print all infonnation Personal information you provide may be used for sewn ary purps~es (P~iy Liv1 s; t5 (1) (m)) R Date Property Owner Property L , ion J Sienna Corporation f s Lot % NW 1/4 SE 1/4 S 20 T 29 N R 19 W SEP 2 6 r Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# ~l 4940 Vilk®ing Dr. Suite 608 70 1 p~ The Glen City Fa(•hq State Zip Code P one Nuptger i Crt Village Town Nearest Road i MN 55435 952 835-2808 Hudson Dorwin Rd. i✓! New Construction Use: V Residential / Number of bedrooms 4 Code derived design flow rate 60 GPD Replacement Public or commercial - Describe: Parent material Pitted outwash Flood plain elevation, if applicable na General comments ✓ p and recommendations: System elevation 93.1 Oft, trenches spaced and depth to code 3.50ft below grade 4~7 V,141 tom' Boring # Boring Pit Ground Surface elev. 96.60 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0-10 10yr3/4 none sil 2msbk mfr cs 1f .5 .8 2 10-13 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 13-23 5yr.4/4 none Is osg mvfr gw na .7 1.2 4 23-102 7.5yr4/4 none cos osg mvfr na na .7 1.6 Boring # _ Boring f✓ Pit Ground Surface elev. 96.60 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-9 10yi3/3 none sil 2msbk mfr cs 1f .5 .8 2 9-20 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 20-33 5yr.4/4 none Is osg mvfr gw na .7 1.2 4 33-102 7.5yr4/4 none cos osg mvfr na na .7 1.6 cc~- q3.& * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si nature: CST Number David J. Steel 248956 Address steel soil service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/13/2002 715-246-5085 Property Owner Sienna Corporation Parcel ID # Pending Page 2 of 3 3 ] Boring # Boring ✓ Pit Ground Surface elev. 94 ft. Depth to limiting factor 96 in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-12 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 12-21 10yr4/4 none sicl 2msbk mfr cs 1 of .4 .6 (p~ 3 21-36 5yr.4/4 none Is osg mvfr gw na .7 1.2 4 36-102 7.5yr4/4 none cos osg mvfr na na .7 1.6 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. FSoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 i ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <_30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 NWl/4,SE1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot 70 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the soil test was conducted Legend 1" = 40' t Benchmark El. 10Q.OOFt Top of 1" steel pipe Alt Benchmark EL99.60Ft op of 1/2" pvc pipe o = Borings Boring Elevations B1=96,60Ft B2 =96.60Ft B3 =94.QOFt B4 =00:OOFt .6~ He 0 2, 60 Leo 0