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HomeMy WebLinkAbout018-2021-29-000Wisconsi~Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Hammond Hills Estates LLC, c/o Oranzo Oeve Hammond, Town of .ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION n. TYPE MANUFACTURER ~ r CAPACITY Septic 'Z+~. Aeration Holding TANK SETBACK INFORMATION TANK TO ~ PLL 6 WELL BLDG. Vent to Air Intake ROAD Septic ~ / , j /-_ / ' 7 a / Dosing Aeration Holding N PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Li Friction Loss System Head TDH Ft Forcemain Length la. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: $t. CroiX Sanitary Permit No: 515085 0 State Plan ID No: Parcel Tax No: 018-2021-29-000 SectionlTown/RangelMap No: 08.29.17.1310 STATION BS HI FS ELEV. Benchmark z . c~o /02. ~ ~>~ Alt. B ~~,,,.. I. ~S /cry . ?5 Bldg. Sewer 3 . ~ 9g r SUHt Inlet 5.~ 97. aS SUHt Outlet 5.75 ~.ss Dt Inlet ~ ~~ Dt Bottom ` ~_ Header/Man. ~ ' 9~ . Dist. Pipe g.q ~~3. 7 Bot. System ~ ~ ~ ` Final Grade 5.~ `~'' St Cove, ~' $G /~ ` 75 ~ ~ Z G5T 3.50 9'~J. ~ BED/TRENCH Width / Length ~ No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia_ Liquid Depth _ DIMENSIONS ~ ~/ ~O Z ' /„ ~ _, _ ,~ J~ ' ^' 1"-v~ -~ " ~- ~ SETBACK SYSTEM TO P/L BLDG L L W E LAKE/STREAM LEACHING Manufacturer:.~•~ .,` _~ "- ~°f J / INFORMATION CHAMBER OR -. ~ Type Of System: i C ~~ ~ 1 ~ 1 ~ UNIT Model Numberti DISTRIBUTION SYSTEM /. lotl- ~ ~I. ~. 7.~1 z Y 75 t'a~_ Pleader/Manifold ~ / ' 1 Distribution Pipe(s) ~ ~ ~ x Hole Size ~~ x Hole Spacing ~ Ve7nt to A' Inta e Length_~ Dia "j' ~ ' Length Dia Spacing ~ J ~Q d SOIL COVER a Prwssure SvsYemc Only rr Mound Or At-Grade Systems Only ~+~ Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~' ~ Bed/Trench Edges ~~ Topsoil _ ~~ ~ No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 1005 166th Street Hammond,//WI 54015 (SW 1/4 SE 1/4 8 T29N R17W) Hammond Hills Estates Lot 29 1.) Alt BM Description = ~, ,~` ~"'~`~~`- 2.) Bldg sewer length = ~~ - amount of cover = / 3 Plan revision Required? ~ Yes No ~ 2 1 I ~~ Use other side for additional information. Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 08.29.17.1310 -- ---~°~~_ Cert. No. ~,i t~ f~lG.i U Y~G1 ~e2~ commerce.wl.gov Safety and Buildings Division County 1 ' S~ ~ 201 W. Washington Ave., P.O. Box 7162 ,Lc: K • i sc o n s i n Madison, WI 53707-716 ~ ~ r (to be filled in by Co.) itary Perm Numbe Department of Commerce a 5 5 S 5 Sanitary Permit Application State Transacti o~~nNumber // - In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental rT unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information rovide may be used for se ses in accordance with the Privac Law, s. 15.04 1 m , Stats. ' I _I „`~1~ } ~ I I. A lication Information -Please Print All Informatio , VVJ ~J ~,f/ Property Owner's Name C>~vfc;~. /~~t~~s ~~ E~~ Pazcel # 018- ZoZ!-• Z7-zxsb Propert y(Owner's Mailing ddress / Property Location '~/~ ~ 3 ~ ~ ' v~' ' ' E ~ ~ ! ~ ~ S L Govt. Lot C City, State Zip Code P Qfi1CE G ~ ~ 8 SW /., SE /., Section f ~E w ~ ~ " (cycle one) rJ lG /y/~ d !tom " 0 / 7 T Z 9 N; R ~~ E or W II. Type of Building (check a I that apply) p~ Lo ~1 or 2 Family Dwelling - Number of Bedrooms ~ L 9 Subdivision Name / f / ~' ~ Bl S LS7 1 ~ls / oc R ! A..r„~yn J~•c1 7 / ^ Public/Commercial -Describe Use ^ City of ^ State caned -Describe Use CSM Number ^ Village of x ~ ~~ ~ Town of R .~+-+n+~ 0 ~- III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) `~' ew S stem y ^ Replacement System ^ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POWTS S stem/Corn onent/Device: Check all that a 1 ~on-Pryycnri~ed in-(ir ~ and ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component ^ Pretreatment Device x lain V. Dis ersal/Treat nt Area Informatio :~ -L' c~ S 3 ' A Design Flow (gpd) Design Soil Application rea equtred ~' Dispersal Ar oposed (s ~ System Elevation y ysn ~S 90~ , qi8~ 3 9 VI. Tank Info Capacity in Total # of Manufacturer o Gallons Gallons Units .o ° ~ New Tanks Exi ti T k ~ c ~ ~ ~ `~ `~ s ng an s ~ Septic Holding Tatilc /~JUO / sls~~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS s n the attached plans. tuber's Name ( nt) Plumber's Signature Number Business Phone Number k~ ~rcw ~/~,tiS f' ~L~Fj7l- `~7Z- ZSIZ ~ Plumber's Address (Street, City, State, Zip Code) Zc~S9 ~~ a ~'' S~. ~-I.t-c_h- ~ X853 VIII. Conn /De artment Use Onl pproved ^ ~ Permit Fee $ ~~~ dG Date ssue~d O~ ~ ~ Issuing ant Signature en Reason nial ^ 1 IX. Conditions of ApprovaUReasons for Disapproval e ~ ,~...~ iNEN 7- a NU a 1. ,P / Septic tank;_efflUt3nt finer and dispersal celi must all be servlcesJ maintained ~ ~/ a ~ Z • ~ SD 6 ^ / o G~ `~ / - ply . ~ ~/ ~ J 2. / as per management plan provided by plumtier. AN selbeclc fettet4lenle muss be :nreihtainad o r a ~s b / ~ laflt •s pef ppiioa i~ codR / . Attach to complete plans for the system and submit to the County only on paper not less than 81/2 a 11 inches in size 3~ ,Q~,t~.~, f ~,,x.lo~. ~ Gov tt~ nek, ~,Ma~.t~ wf'~. d~-~4,~ ~ ~,.'-~.s i~(' o~. , ~foo~l ~ A o f SBD-6398 (R. 02/09) V id thru /11 ~ ( ~ o _ i o~ \ -~ o -~- h ~, ~ `~ ~~ ~ a ~ ~' ., ~. W ~~T ~e ~ o ~ ~ ~ ~J V ~ ~ ~~ cl~ h ~.- ~' 5--.. ~ v ~ ~ ~ ~ 3 a o ~ ~ ~ Z ;~ 3 ~ . h `: ~~ ~ ~. o ~ _~ v ~'""~ ~~ ~ a 1, ~~ ~ 3 ~----- ~. ~- ~ -,. ,~ O -~. oa v~ e-, M ~- a a b h -~. h ~ h ° \ r` _ Z ~ \~ V 2 ~ ~ ~' ~ N ~ ~ ~ a ~ N ~ D o~ -.~ a ~ ~Cpp~, z ;~ h ~, ~ `~ a ~~ ~, ,_ ~ . o a~ ,~ y ~ a w .a U ~° °~ e~ M '~ i J h h w Z 'o Jam'" ~ I~ ' s ~' aC ~ ,. t, ~ O ~ ~ 3 `~ O o .!~ ~ T 3 ~ '~` ~ ? h `~ ~ - ~' ~ ~ v h ~ f~.T vp h 3 0 ~ _~ h ~ ~ ? r a ~ ~ 7'` ~ ,h V V ~~ ~Y a ~ ~~ 3 cs~ N ~ ~~ N 0~ ~ ., I~ v~ ~,~ M 4 O ti ~I a a a ~ }' w o ~ ~ o. f'~ C~ N h -~ r- .; , y ~~:. ~ Wiseartsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings ~~ . Attach vomplete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ~~~ `' ~ include, but not fimiled to: vertical and horizontal reference point (BM}, direction-and p~ i.p. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie by 'Date Personal information (yl !m you provide may tx used (or secondary purposes /~ ~~/d Property Owner PropeAy Lo 'on ~~-' t.,~ ~ C' li ,Z ~. p ~., 1/4 1/4 S ~ T Z ~ N R ~ E ( W P Owners Ma' Address ~ Lot # BI # S .Name or CSM# ,~~. o~ ~ ~„. r t s City fate p Code Phone N ST. City Village Town Nearest Road New Constntcbon Use~f Residential / Number of bedrooms ~ Code derived design flow rate ~ GPD (] Replacement ^ Pu is or commeraal - gibe: _,_ __! _ Parent material 4_ Flood Plain eleve ' 'cable ..~~/r~ ft. General oDrnrrterrts ~ ~,~-- 5 y5~'C v~l , il. lal`n.4.~C , .~ e 0~~~ ~~;~ and recorrtrrtendations: ~ J G ` ~~ L L System Type ~O /Z/t/ ~ r T~ System Elevation ~ ' ' r- Boring G„~ v/ - - ..1 ~~ # Ground surface elev. C~~ ft. pepth to limiting factor _~in. Pit Sal Rate Ebrizort Depth Dorninartt Redox Description Texture Structure Consistence Boundary Roofs GP D/fB in. Murtsed Qu. Sz. Cont. Caor Gr. Sz. Sh. •Efi#! 'Eff#2 ~ ~~-> ~ 3 ~_~- /y/ J f > C~ r ~ .r s , ,-s' ~, ~~ ~ i t n µ ~~ Boring # ~ ~~ Pit Ground surface elev. ~ ~~ ft. Depth to limiting factor / ~ in. Sal ication Rate Horizon Depth Dominant Cd Redox Description Texture Stnxture Consistence Boundary Roots GP D/tF in. Mansell Qu. Sz. Cortt. Color Gr. Sz. Sh. `Eff#1 'Efl#2 °I Z r 3 z - I r s~-, FY c s Z rrt t!P 2 2-~ r ~~ ~" c I a, m Fr w ~ ~ yy~z yi ~- S ~S r ~ ~ ~ . 5 ,L, Il ,, 62 • Eftluertt #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg1~:' • EtAuent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Na~rrle (Please PrirtU Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted ~• Telephone Number 1008 192nd Ave, New Richmond, Wt 5 ~ ~^ o -7 715-246-4516 Page of Q Pit Ground ~~ elev. ~ ' ft. Depth to limiting factor ~ ~. ~ ication Rate ®~~ # U ~~ Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDIff f#2 in.. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 'Ef I ' ~ r, ~-- ~ C_S Q c U ~ ~ 5 .- C~ b ~--~ w Y F ~t -~ ~p a ~~ ~ ^ Bonng ^ Pit Ground surface elev. Horiza~ Depth Dominant Col Redox Description in. Munsell Qu. Sz. Cont Cdor tt. Depth to limiting fac3a~ in. SoU Rate Texture Structure Consistence Boundary Roots GPD/fP Gr. Sz. Sh. 'Eff#1 'Etf#2 I Rn.inn if ~ ~~ U v ~ Pit oroura sonata el6V. IL ue~,al W IU~NYI.y ~....H ~• SoU ~ tion Rate Horizon ')e th Dominant Redox Description- Texture Strx~ure Consistence. Boundary Roots GP D/fi= p in. MurtseU Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `E1f#2 ~- ' Etlluent #1 =BODE > 30 < 220 mgll_ and TSS >30 < 150 mglL 'Effluent #2 =BODE < 30 mglt. andTSS _< 30 mgll The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need. material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-s~otR.snoo- . ' ~ ~ w ~ Soil Test Plot Plan Project Name Oevering Homes LLC Sha ' d Address P.O. Box 179 ~;. New Richmond Wi 54017 ~ ~~ M #226900 Lot 29 Subdivision Hammond Hills Estates Date 6/2/07 S W 1/4 SE 114S $ T 29 NIR17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 94.3/94.2 *HRpSame as Benchmark Scale is 1" = 40' unless otherwise noted 208' Property Line /_~ I \B.M. 330' Property Line 166th St. 99' 150' B-1 45' 100' 50' B-3 2% Slope p~ . a~ Please note: survey was not \ complete at the time of testing, installer must check all setbacks prior to installation. B-2 ~~~~l~~l~~~t~l~ COUNTY PLAT OF. s es'~o'sa' w 44a.oo' -tliyi6l lrfiS;7I Ste. ' 150.OC' i !59.rf' !44.GJ' S'tA,]i1U"..ui I ~ 6.I9'J 259. N ~~Y ' u/,? J?9 ~ 1'~ HA~~IOND KILLS i i I Ag Z01 w5j6.6g' ~aP~A~ECUV_es ~~~r~s7MA LOT Z LOT Z ~ Z ~ s e9zo'1o' w 2n.s2' 'Ic.Lr~PIL ~I~TATES ~ 755". y~ o ~~ ~~ LaurEOwarararvE~'tlNOfn~sEw.nESwv4ofrNESE ! s=bco~c j F6wc5rr ~ LOT-16 ~ ~ ^ NY 55.E A :51 A<. 0 ~1:. C r/~ ry IN, rHE NE iN OF iVESN IN IlA7 rNE SE IN OF iNE $W IN dSEC11ON 1 '-~'AC ~ LOT II ,. ~~ ~y ~ ~'~ T~10, 6,77Wl,R17W, 10WN OF HANMONp. Si. CAOtC COIR:rY, W,~ONSW. j fi:`i 1. ! ri Y:/r eu "n 9,+~ E_- 568 J. f I f I I ; ; 4i x;. I ~ rn.wau "6 n ~~ . . I ' j' r ~' ~ i '~. GRAINAGEIASEMENTNOTE; I °o I a <r;l~j c~ ;~ I~ ~~`~la 4>/o tEC LOT`21 J~)J 6v~ ~~ I ~r _ _ - - I` "Y - 0 5 NOOWNER ORRRSIOEII SHLLLOON9YfWNGIWf01 WQIILD INTERFERE WAX ~ ~ " ~ :,:. 1 _R .' OR ONNCE THECPEMIpNOF iNEAPPRd"ID COMPREHENSIVE I 'rl _~ ,13".I;m I ~ /• / / ~"~.. S10ACWIAIERANNAPEAENI PUN, Sf-AFM ANDEROSNNl COIAR0. PLAN ( IA AE j i, \a7~ / ,~:: Z ig11X5FU1, lw5 eNAlAES BUr5N0TLMITED iO,BUtDWGUWN sc ' ~ Q ~Ei~i3} ~ j r` \N' ~ ' ~. t OBSTAIICENS, krERING.FAtAlC,EI(CAVATpG, ORPVUIrINGNANY 0AAINAGE ~~ I' ..,-~ b - , I - - I z/ LOT 20 \ - U J-11°' F1iSF9JFHfS, SrdtlAS'AIEItDON05, WA1ERORANItGEDRCNES,WAIER ,u~a Y: t PoAAVAYe,WATERCOLVERT$OR BERMS , ~ I .. N, nJ j~~ R Sd ®_ _ I 0 / N;`=: \ ' ~ . .. "Pj++a GENERAL NOTICE STATEMENT; I a \ ' N e9~o sJ' F J9I9a ~. ," ~~`r ®. ,~~ £ V --- s -~-- - -- - - -- LOT 2 .. EAOI PA7tCELSNOWNON MB MAyp'IAIIRSLBIECr rosrAlE, to ~~ ~. ~ ',A 2' ' ';@ 5 ES'I05J' W J97 0 COlW1Y,AM191pANUWSAULEBNgAEGlUTA1NSllF. 7a[` ti- 75.k - 5290 h`\ ~ 9rg 85 \ n~sr. - ~. 0p w- MERRAEAA7, AWPAAA1 LOrSPE ACCESBTORARLEt,ETG1e6fORE ~-~~.`• / I 2 4 ~0. PLacNASPtca+PEVELaPINCwYLma~wo,coxrAClrl~sr. ,~, ~' i i I I~ ~ ®._ ~~ LOT 19 ~P ~ ~ amaauwtY'nAUSxcalauNCPEPAmuENrA7mnl6raxM „ T-,u I ~' 4 _ I- _. /02 %~ OFHAIWOIIO~FORADVICE. F A It I O ~sJ.- Nd . ,. + y. JJ. e° •C~~ vrrc uru ~`~ ` UTILITY EASEMENT NOTE: rs r r Icw ~ QO 76 S ~ ~ - - N mknA~, I ' ' B,. q~N~ ePSY 9 ~ ~ ~ LOT 23 t,~ NoraEaaeuwEOC~sLESrREro~aACEOSU~+nuTnf ~ : I z v '>' "SC ~"'~W. 7. elsruurlowwouoolsnlAeeANYaIAW:YSrANE,atoesrRlA;r i LOT ,; LOT oI LOT Il sc5\. c". ~„ /'t, s aso , ,,,- umonuaecuWLOru~a~a>r~LU,~.nEO~sn i 13 °I~I 12 u.~ s„~~ ~n Ist,7,~, asst a.o ,0 0' S,, - OFASURNEYeTNfBYM`IOIE6A'AOUSNMlCFSECiXMi t16.S7 0. rriN. ~ fib. he .. ,?.r ~ J'r. / . r~. PASCOHSM S1ANfE5. UItItY FASEYENRISHEAIENSEI FONFFI "- n '"'Z i` o i ie ~_ ~ I < © 6 B ` ~ Nr ~.. ~. ~ O} AAEf0A1YE VSE Of PUBLEB001~AAUPfMA1FNUB.IG ' ': s:, ~ 7 ~ r ; 0 tti. 'l.1 URIiN:SHAWNGAPofAA 10SEFh4 fIEAAEA. ; ~ E f) ~ lAT lO / `:-'. :" ~ LOT 2\~ 11 oB.T`A AJ lL 6 I s i Q ~ ~ . NOTES ~ y i I '"~- cI _ ~„ `'. )e. ' / c, <`,I - w a*+m of c w 11 a J t'~ 5.1 , f~NTSETBAIX,EP(UF$ESSOINEAWISE NOrFOI 07 I I ~.h_:i_ 2 W Y A smESErAwt.+7sps'caAer~ ° I -~,- ( ~ ~ •~~ LOT 25 'rN ~ 5 REAR~reAac=a ~ m ~ " LOT 9 ~'~ 4 ~~ -- NEIIANDSETWX=IP Iy 0 ~`P9 I '-I~ A ~. ~ , 'FRONfSE1eK1tMFASLAffOFROMA{1W b ~ I ~~ t`.:Ec ~ r n ha NfiN'k. ~' y , s s " Y • 1'1 N',~// ie~las>y. III AlleIM.DNOSIOBEGQSfAUC1EDwPAOXAMIYW11H0R4N4CF Ii ml 1,5.00 ~ V`~17500' 175. 7y ~A, e.t to r1 9. EASEME+ASSwuIUUEAtaA~srauEaNCaPENwcoawemav bW ~` LOT B rya,' a ~ ",, "'o/' y" WFllEiEYA1NINNPTIf551NWN1WOFEET/epAE7ME Wpl 4n 0~. ...N 69205J'IC 125.57'... :..~ / A ~3a. s~. >,, q biN ~ WAER9F1A1gN ~( ~ I ` ~' J6 a ; Z ~. h ® " ~ ~; z,YA_u ,~ -t:,, " z >';'"; LOT 26 .~ e w t j mmUr n, eN:,I ~ z .i sine , A IIDOAIIMII LOCATION MAP: : r=t41~x ~ o Is, a° ' ~ sc. s ~ w MgIBt PlOTTOSCAIE) , I, ~_ LOT 6 P 460 0 'n,. .ya~~%, `N'}' .~~-~- '' •~,a. ~ 1 ~ ± _ __ - - RmSJ SY. 5''} ~Ig, j i ~y h 4 ~ ?/{ 1 pO(pACE SECTION 6, TI9N,RI1W, I . _- ~',t\ tes e~ a r /~~• Ry~ rtrr / 1[ ~ Sir 0 ° ~• o° 14 ! E P` / ~ IIOTN AWN.F k+. wt a~ ~'j S'+lo , y'=-~--~f I I~ >~a, i es i LOT 27 ~ Yy ~I ++ ~ I 0 g ~ u II 's<, ~ < I:, LOT 7 60 ® 1 2`w ,,~y-;i~ ~y , a- V I ~ I'- ~ rA S 1 U ~l fl.~/ el - (1' I -. '~ /g5. I ~. / .~ I J W <ae ~. • f nn Y ~~ ~ ~ ~h°, I > ~ C4(~' ~ I _ 6_B9'J4!& .736 tE c ~7' g LOT 2B ;'1 a w :~ KO ~+ i/ 4 , •$.. y.. + .., a sr. ts; Imo. ALLeEAAeWSAREAEFEAENCFJI TO I ~ u F u `+ _ _~ , , - 39 `. '~ " ~. F,r ~': " nesolANLnEOFn~sE.waF ~ I ~ 101ST AVENUE ~- ~ , iA , y ' s `•,s,. r. 997116 W IOc,9' ~ c . ~y ''s. sECraNe,r>wI,R1rw,ASSUMEO IW,XreAf A / '. ~ r '; TOBFAtNfe9f17'EISI.CAOIX ~ `v~fl ~ ~II6.61 - 79.SI ~ ~" f j cwxnaPRwulE srsrEM1 auttocnnoN I "-' LOT 5 ® ~ \ ~ N B9 n IE' E Inr 7 ® ._. ... . - .. ... ~ 06.49 h. ____ zwR ,r. 6 . ._ ~ s `~"u. I 7j7J'S5 i o LEGEND: I A?v.~c.JC I t'A`a zl '' O+~}m?°sP a ~" o . SP(NADSE7BAOtteE B9 = 4'Y : i w A F019gl UI'ptONPN ~ `, A"~ET~ n I ~~ ~/~ °P - _ .. IrurEnYEASElFAA ' ~ n"'` ~;.I '~ ° ~ LOT 29 ~ ~•" ryaESSarxorAUE!urEOl , sEr1w•erle•froNwewr.A.m M ' ' LOT 2 j' LOT I '• ~' Ir ` LBBkT. ~ LOT 4 ~~ lOT 3 fl .:, s :. _...__._._DPAWACf FA9EMENiIY[ :a~+E i'. 0 sµr,sr. 's';$'~' £ v:. c~. ~,~ i n 0 11 , 1 SFi YI'BY ICKN7N PIN Wr.lEO Iii H. Iry ty A:_ u~ N ,h. - iENCE LINE 1, lBS.fT. Al HlCiMER LOi a ..~, h IZ V °I 3I I Y 1 WGII WATEAELEVRipN ~ IZ 1 \~ a~ Z ~ t ® PRCWOSED OANEWAYLOCA1gN ~ ~ x 63~ :^ f `•~ l (1'N A - v..'' ~ I 9 1 cV i17N :". IOSW:51 eU0.01NGOPENNNG ® I I T e7 '', I e:, ,[ PROPoSC-0JgNI PRJVEWAYlOCA71PV I... .. - .. ,.. . .. _ .I . _. .. _ I y. I c. -f ~ ~1 j FpiA'D .;r!r --'.p'-_ WFTIAND _I \ F ~ - ~ t'-.c~ I Tt ;.. ..... COUNTY MONUMENT ~. d6i.:6'. .. .. _-~ISC.x. .. L-: 116.6 .... :R I'i-: .-. .Itg,c6,.. o L,: ._ -. .. If0UN0ASN01EOE 5 E3 i476' E 66J6f N S .: ~ ".1T% J!.td 5 'U<'". s 4~ AENCWJNtN n ~ Y t 6'_C_ ^A.OC' ~ ~ ..._ T IYE107 I "~ ~ 5 6954'26' E 653.66' 100TH AVENUE N 8PD41T E 711.74' o1+rflEOer:;EFFUazx .. _. -r -- HEET10, 2 St AXr J .. fiC.1X l/=C.A TR _.. _ ~ ;. I, ESE. L0.5 6 SCC d e9r R'iW SC r W Gf 9c UArUf'CO IANOS _ E~ ~ r J\ 6 '___ 56 AS ~OarB _________ v.C e i;?`l, RI7P ___ _ 4"~I i fFCU 1C ~ C" r1Y (FkNA7'~ C!Alittt R7L71 '" '.~Jd~7r q;R~E. N}N) 4'N4;1 NARl F l b. *. f.~al F A 1 I A I t 3''J 4 !T' _________ __ "~T4 ________________ _... KN Soil Absorption Svstem Cross Section ~~ ° ft 4" Schedule 40 Final Grade PVC Vent Pipe ~~' With Vent Cap ~ ft Leaching ~~ \\ •- Chamber U 9~f, 3 ft -~~ ~ System Elevation ~ ft S ft Soil Absorption Svstem Plan View 9t~ ft 3 ft J ft Trench 2 4" Dia. Header Leaching C~ h/am/ber Specifications Manufacturer And Model !-/ ~l L a ~ c, "~ - ~ '~ N~~ ------- EISA Rating / 9 / sq ft per chamber Soil Application Rate • .~ gpd/s ~ ft ~/ q ~`~~ gpd Design Flow T S Soil Application Rate •t; 1 g. / EISA = '~ ~ Chambers 2 rows of ~ ~ chambers ea~ Page of l~ /'~P'~s. ZLZ~7v ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer (~~ V ~,~ ; ," Mailing Address ~`/ ~ j ~~~,~- /~ vu ~~ ,(~. /(,~,,., /'~eh.rH o~d~ w,~ ~S'~!S/ 7 Property Address 0~ `~ - (Verification required from Planning & Zoning Department for new construction.) City/State LEGAL DESCRIPTION Property Location St''~' '/~ , S£ Subdivision Plat: lea Certified Survey Map # Warranty Deed # Parcel Identification Number '/4 , Sec. 8 , T ~4 N R ! 7 W, Town of ~~~,~, o~-J Volume ,Page # Spec house ' yes ~o Lot # Z 9 (before 2007)Volume ,Page # Lot lines identifiable yes ' no SYSTEM 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 in §Comm. 83.52(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 I!3 full of sludge. 1/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 Commerce 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ,3 SI A U OF APPLICANT(S) G / ~ Z/~ 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. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __ of FILE INFORMATION Owner ~~. vf",G., •ti / /`' r ~rvr f S Permit /t DESIGN PARAMETERS Number of Bedrooms ,3 ^ NA Number of Public Facility Units .ANA Estimated flow (average) S~J~ al/day Design flow Ipeakl, (Estimated x 1.5) ~ 7~ al/day Soil Application Rate ~ al/da /ft2 Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (GODS) <_220 mg/L ~A Total Suspended Solids lTSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) S30 mg/L S'IVq Fecal Coliform (geometric mean) <_10° cfu/100 m1 Maximum Effluent Particle Size Ya in die. NA Other: B-NA 'Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity f O 0 D al ^ NA Septic Tank Manufacturer S/~~ w ^ NA Effluent Filter Manufacturer ~~5 f ^ Nq Effluent Filter Model -df'~- ~- ~=~ 0 ^ Nq Pump Tank Capacity al ,g'Nq Pump Tank Manufacturer ,1].Nq Pump Manufacturer ,g-Nq Pump Model -~A Pretreatment Unit p'FjA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cellls) ^ NA n-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) -~J year(s) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY,) of tank volume ^ NA Inspect dispersal celllsl At least once every; ^ month(s) (Maximum 3 ears) -B-yearls) y ^ NA Clean effluent filter At least once every; / C.o -~"~onth(s) ^ year(s) ^ NA Inspect pump, pump controls & alarm At least once every; l ~D .,®'month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: 1 ^ month(s) -year(s) ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ NA 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 IY,) 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 cal regulatory authority within 10 days of completion of any service event. d'~/~'~ GMW (4/01) P1L S- Z L Z ~ 7x- of the tanKlsl removeo oy a septage serviang operator pnor to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. ,; During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal ce(lls) in one large dose, overloading the ce(lls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive. or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 INS~'gLLER Name ~ k W f1 ~~ ~, 5 Phone ~~L.~ Zu/Z/ SEPTAGE SERVICING OPERATOR (PUMPER) Name ~,~ ~ G,. Phone POWTS MAINTAIN R Name ~ G G L ~~,., c~, A.s Phone ~l7 L .. Z~ Z J LOCAL REGULATORY AUTHORITY Name ~j'`-, ~.c..v,•~~ pt~ ,. Phone ~~g - ~~~I U This document was drafted in compliance with chapter Co 3.2212-(b1111(d)&(f) a Sc r12) & (31, Wisconsin Administrative Code. ~i~,GS ZzL~7y State Bar of Wisconsin Form 1-2003 WARRANTX DEED Document Number ~~ Document Name THIS DEED, made between D&B Equipment, LLC A Wisconsin Limited Liability Company ("Grantor," whether one or more), and Hammond Hills Estates Development LLC ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See Attached PINS: part of the following parcels 018-1016-50-000; 018-1017-00-000; 018-1017-30-000; 018-1017-40-000; 018-1017-50-000; 018-1017-50-001 i~~iil i~i~~ «~i~ «<ll i«ir «~f~ i~il ri~~~~ i«~ iii * 8 5 0 4 1 8 2 850418 KATHLEEN H. WAtSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 05/11/2007 03:15PM WARRANTY DEED EXEgPT 1 REC FEE: 13,00 TRANS FEE: 1333.20 PAGES: 2 Recording Area Name and Return Address Asstued Title, LLC 1810 Crest View Drive, #1B Hudson, WI 54016 Parcel Identification Number (PIN) This 1S NOT homestead property. (is) (is not} Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements, Restrictions, and Rights of Way of Record Dated ~ ~ b ~~ - - * Ronald C. Bonte, Member ~e~t>-"`- ~. ~~~,/„~n (SEAL) * Steven M. Dalton, Member (SEALZ (SEAL) * ~~ * RUTH `~ Cj~ ACKNOWLEDGMENT Signature(s) ~ 0 STATE OF WISCONSIN ) * ) ss. authenticated on •~ St. Croix COUNTY ) * pU~LIC z * Personally came before me on u ~~ ~ ~ ( ' TITLE: MEMBER STA the above-named Ronald C. Bonte and Steven .Dalton as the Members of D ui m L (If not, t me ow be a per (s) wh executed the foregoing authorized by Wis. Stat. § 706.06) in trument ac noWledt: d the me. THIS INSTRUMENT DRAFTED BY: Richard K.Y. Lau - Redmon Law Chartered Notary Public, State o tsconstn , 2217 Vine St., Ste. 204 -- Hudson, WI 54016 My Commission (is perm~(expires: (Si natures ma be authenticated or acknowl ~ S Y edged. Both are not necessary.} NOTE: THIS [S A STANDARD FORM. ANY MODIFICATIONS TO THiS FORM SHOULD SE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO. I-2003 * Type name below signatures. 1 of 2 Property Description: A parcel of land located in part of the Northwest Quarter of the Southeast Quarter (NW'/ of SE'/), the Southwest Quarter of the Southeast Quarter (SW'/4 of SE'/4), the Northeast Quarter of the Southwest Quarter (NE'/4 of SW'/4 and the Southeast Quarter of the Southwest Quarter (SE'/4 of SWl/4), Section 8, Township 29 North, Range 17 West, all in the Town of Hammond, St. Croix County, Wisconsin, and more particularly described as follows: Commencing at the Southeast corner of said Section 8; thence on an assumed bearing of 5.89°04' 17"W., along the South line of the SE'/a of said Section, a distance of 1830.54 feet to the point of beginning of the land to be described; thence N.O1°42'49"E., a distance of 572.10 feet; thence N.29°05'43 "E., a distance of 549.73 feet; thence N.68°22'03"E., a distance of 144.43 feet; thence N.21°37'57"W., a distance of 510.00 feet; thence 5.68°22'03"W., a distance of 100.55 feet; thence Southwesterly, a distance of 200.76 feet, along a tangential curve, concave to the Southeast, having a delta of 18°10'20", a radius of 633.00 feet and a chord bearing of S.59°16'53"W.; thence N.49°49'36"W., not tangent to said curve, a distance of 333.73 feet; thence 5.89°20'10"W., a distance of 217.62 feet; thence N.73° 12'01 "W., a distance of 516.69 feet; thence N.89°20'53"W., a distance of 444.00 feet; thence 5.00°39'07"E., a distance of 180$.96 feet to the South line of said SE'/ of S W'/4; thence S.89°54'26"E., along said South line, a distance of 653.68 feet to the South'/a corner of said section; thence N.89°04' 17"E., along said South line of the SE'/4, a distance of 771.74 feet to the point of beginning. 2of2 D •~E~+ ~ b,~~ ~~~ ~~ ~ ~~ W~zA~~ 3~s~~ ~~~~<-~p ~~~~~a ~~o ~~~ m As~~ F~~- ~~~ z n n 2~~ r-0 ~~ ~~ N b A p~ F ' N (A N z d x 6'-10#" 81-0K" IR.G.H.) 0 ~~ 0 im ~~ 4'-4k" 5'-3° •1.3Y"EA 8R18.~Zf P -1 L A ; x 0 ~$ ~z Z D • a 0 ~~ N 8'-pb" ~ IR.G.H 6'-10#" I w IR.C.H.) 1 "~' lU ~ '~ 1 1 II II 1~ 1 N '0 A m(~~ ~1 11 ~ ~ j 1 ~ m 1 UI ~ 1 1 ~ ~ 3 ~ I ; ' z ~ I; N " ~; Au r I n ~ O w ~ i ~ „ ~ m „ _ r 11 Z I I ~ ii II 11 m II j 1 i O 1 l 1 II N 1 1 II II II 11 11 1 ~ 5 r i~ z ~~ H ^QZ~ N 3 Q ;i~ a J ~ ~ r gg ~ ~a as z I- ~ ~~ ~s` .G-,II ,qr,e ,qF,r 1 .KC-s ~ ~ g~ .Y,YL Z ~, `'~~ k` ~- r ~ t o-; ~~ i. ~ x 4 wtiN}~r :;~~" ~ i "~'r„r'4 .N ~ , it~~ 1-10TH ~` ~_ L f1UE `". _. _ __ ~ •. , .. 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