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HomeMy WebLinkAbout018-1096-18-000 Wisconsin'liD Count eoartment of Commerce PRIVATE SEWAGE SYSTEM St. Croix Aatety and BAding Division Sanitary Permit No: INSPECTION REPORT 15 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No. Personal information you PIMpe may be u for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village X Township Parcel Tax No Bank Hammond, Town of 018 - 1096 -18 -000 BM Elev: Insp. BM Elev: BM Description, KJ Section /Town /Range /Map No: 09.29.17.793 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 141 CAPACITY STATION BS HI I FS ELEV. Septic =,J., , Benchmark l � 3•7 /43-7 /m Dosing � b � Alt. BM � / 9 7 J � >4eretien Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 5d /a / / Dt Bottom Dosing / c1 Header /Man. i t / • ✓d z Aeration Dist. Pipe * /6Z - Holding Bot. System Z • I /Q/' Final Grade D (f 103 PUMP /SIPHON INFORMATION OK ; ' I Manufacturer �� Demand St Cover // 9 L" � 6/4 �b''.. GPM Fi l Ga7A., tO Model Number M _ r 6\1 p ; . Z � �u TDH Lift ,a Frictio��oss� System Hea TDH t � 6 � 1 �, 7 Forcem i Length, D Z •� Dist. to well / +C' 3` I SOIL ABSORPTION SYSTEM BEDITRENCH Width f Length 67 / No. Of rent s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Q � SETBACK SYSTEM TO 7 / P/L VVV BLDG G WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of stem: t UNIT Model Number: OJ Jam- N DISTRIBUTION SYSTEM Header /Manifoy 10 Distribution / /� / x Hole Size 1 . x Hole Spacing V�r�[ to Air Intake 7 Pipe(s) T /� 3 i P - 1 1-ength_ Dia Z Length -+ Dia Spacing / �� �" Q SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over `� Depth Over xx Depth of xx Seeded /Sodded yuPA..._ xx Mulched Bed /Trench Center ' - / Bed /Trench Edges ` Topsoil 1 C•es No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / I Inspection #2_ Location: 1081 170th Street Hammond, WI 54015 (NW 1/4 NW 1/4 9 T29N R17W) Pheasant Ridge Lot 18 Parcel No: 09.29.17.793 P &J G b k /' ff-- 1.) Alt BM Description = ' 1 K' G elJt�� G •^• L ..� l aG�S a �. C -: 1,V 2.) Bldg sewer length = Z '16 - amount of cover = > '$ of �� n n �,�,� � � � , AGE �� n � V• y� ,( l Plan revision Required? Yes No -7 2­ Use other side for additional information. Date Insepctor's Si ature Cert. No. SBD -6710 (R.3/97) , 94/22/09 TUB 09:30 FAX 715 386 4686 Q001 c eltletttlter+os t+rl.(pv Safatjr and Bwaft8s Divism 1 W. W A P.O. Banc 7162 20 aiwgtna ve., cons in 1Vdsgsw%W153707 -716 SudwyTwmkWw*w(b be fiRedisbyCa) Sanitary Permit Application Z--7 0 In aeoordsttoa %ft s. Cam= 9321(2), Vim im Mm. Cod0. submiaaial ofLeis form ta t w aWapdaw arow eNd um is respired pnw w obaknop s ssrslsy Pmak Nook Appbcafiea fafat for sawowaad POWIS ors 6111 dn submitted a the ca Oaporeawtt of Caa.aee Pereolgt ' WOW for ,L � J -7 � c7V i is sordaaee ii ti we Lm s. 1S. t a �i PropalY Own es Naae Parnel l 1 0 6 Y - Pmpwty Owner's?Mailing Addmw pfqwty acmico Of 3 sr. C. Code c 9R9e" r l E EL Type of (eb" an 60 apply) � � or2F ws Dwellftg- NumbaofBad0000 O Ja Q Pablie/Cavmw W - Dmdbe tlse ❑ Cisy of ❑Start Owned - Describe Use �_T_ CStYt Number Q Y of of IL 4A 4 SS rr 5 7 A10 a I!L Ty pe at 1'+svatik (Geek My are w Bee A. CospWe liu s if a > Neer Syras ❑ ❑ Taearnent/ttot "Tank OWY ❑ Otber Modifias+on q bcetiai SY+m (�+i") 8. Q Paak RerinreJ Pamir RaVW" Q agar of Mamba g oww Transfer to New List Previors Pentlit Nuabx sad Doe tswed tlerore Fxpirsaio — 1v. T dPOWTS alt t� ' Q NowPtesawmil brGwwwl Q Prdmarized to-Qr Q AbCnade > 24 w afxwhassbd Q MMW <24 in. ofwinble" Q H*Wm$ Tank ❑ dawrDispasai CwwVnax ❑ Pea eft Dwiea (asplair►) V. E!!! reatosrtt Ann 1 " r Dasigrr Flo-(07 7 � Area Rees (at) S ' F.iraooa� -v v f�� VL Took lafo CV604in tw � a v_ New TwAm ffxb tTWs b �' e• �; r Sy7tica twt Tank o� 3C VU. Sfadeaseet` L tie auwiae fir fssadiNia. oraie P1NV1$ rMw. a, tie sttaeied MPfINPRS Nwabex a.airrcaa Phone Ptwsber' NaN►(�fi+ty ekatbers � Z�P� /✓ =aZ J`a` J _ rlwa s (Rest City. Sow, zip code) VUL C U" only Pansit Fee Ekate Siynt�rs l3 Dtoil : D ✓ • � 7 � o� m calwali {�Tat�telYaw�t.eps Tor Diapprgral 2 1. Septic tank, effluent filter and 3� Qr/r ( /��� (bv ; �, /1Gt.✓ dispersal cell must all be servtces'1 maintains:! as per management plan provided by OKmlt er. �,p J„�„p ,`_ w . b ww,t,. , ✓►'tom r 2 All setback requirements must be mikitMd M OK code / MAMt lames. Aasdr N oawplste pbw see aaagaaa and arira M dw CoVidY a* ON ids Wr a was 11 lama babe SBD -6398 (R. 01107) Valid thrtt 0I109 p a l% PLOT PLAN PROJECT Ron Bonte ADDRESS 1654 87th Ave Hammond Wi 54015 NW 1/4 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 99.2' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none Ilk BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 2 Acre Lot Scale = 1/4" = 10' 170th St. Please note: sanitary permit was renewed prior to experiation Well O Pro 3 Grading is to be done to Bedroom divert run -off away from House system jH uffficutt B -2 99' n B.M.* 98. 97 , — g Combo Tank B -3 10% Slope Area 15' below system is Tank is to be properly to remain undisturbed bedded and provided with lockdown covers with approved warning labels 1 67C0 Py Property Line f ' PLOT PLAN PROJECT Ron Bonte ADDRESS 1654 87th Ave Hammond Wi 54015 NW 1/4 NW 1 /4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 99.2' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none Ilk BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark 2 Acre Lot Scale = 1/4" = 10' 170th St. Please note: sanitary permit was renewed prior to experiation Well O Pro 3 Grading is to be done to Bedroom divert run -off away from House system VHuflffcutt B -2 B.M.* 99 n 98. 97' g Combo Tank B -3 10% Area Slope 15' below system is Tank is to be properly to remain undisturbed bedded and provided with lockdown covers with approved warning labels Property Line No Safety and Buildings 3824 N CREEKSIDE LA COn1111 @CCe.W1.gOV HOLMEN WI 54636 ■ TDD #: (608) 264 -8777 i scons i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary June 26, 2008 CUST ID No. 226900 ATTIC• POWTSInspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192, ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/26/2010 Identification Numbers Transaction ID No. 1554401 SITE: Site ID No. 707992 .......... Ron Bonte Please refer to" both identification numbers, 170TH St above, in all corres ondence with the agency. Town of Hammond St Croix County NWIA, NWIA, S9, T29N, R17W Lot: 18, Subdivision: Pheasant Ridge FOR: Description: Three Bedroom Mound System/ New construction / 10% slope / Revision Object Type: POWTS Component Manual Regulated Object ID No.: 1054053 Maintenance required; 450 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2. 0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during constructionor installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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. • 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 ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleating of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy p1? of the a specifications and this letter hall e roved _P lans s p s b on-site during construction and open to inspection by authorized representatives of the Department which may include local inspector . P.O.W.T.S. Conditionally APPROVED DEPARTMENT OF COMMERCE SHAUN R BIRD Page 2 6/2612008 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.Comm 83.54(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 acceptabb 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 Safety & Buildings reserves the right to require changes or additions shoull 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 75.00 Fee Received $ 75.00 Balance Due $ 0.00 C � 2 � rdM S gz ��� POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, '7:15 am - 4:00 pm WiSMART code: 7633 jen cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. nncc Zoo Cover Page sg 9 oi N�s Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 6/ 18/08 Owner: Ron Bonte Location:NW1A NW1A S 9 T29 N,R17 W Lot 18 Pheasant Ridge Hammond System type: Mound System (revision) Plan # 1220030 Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Co i ncy plan 9 -12. Soil test Shaun Bird Signature License n er 226900 SEE CORRESPONDENCE 4 so Date Non -Woven Fater Fabric 4" Observatim Pipe Perforated Below Filter Fabric r Distribution Pape AM C-33 Shed (v " Topsoil Slope f O sod Of f = 2 %Z L Force Main i�iltwe�# Drain Rack Frans PumO Layer Crass Section Of A Mound ' fti tern Usk A Sed For The Absoret Area i A Ft- h ^_.S� - Ft. ' .. K Ft.. :......_ _.... _ _ .. ..: - t- Ft.. - L J 4Qbservation Pips -� ' a. . a_ _ C. 77 JK o Farce Moin From Pump :IDIS fribution Bed Of 7 2,_ Pipe - Drain RocK `f s A 4 Observation PiDt �CC4A4 Permanent MOrker ym or Rods PI*n view OLMOUnd Using A Bed for The Absorpsfon Area P�►CrF� F.... r 1 Pa.forated Pipe 04foo f j na vt.. Pestorates �I►. PVC P.ac eP 1YMs L"aled 04 8009106 �1ey QOeMy e�.s /laic O� 0 PV C Farce 1NoAs i• ftft�'t • uat t sis+eT is C� }+� PVC ' "W*I%W Ripe rw Tr. c s-�, _ acyos - t?issr+aee:on Piise Layout p � Ft. _rb 1�, R X ?tphes ts"" Si Role Diameter 3 1. i �. � Inch License Neer: Lateral •" Z; Inr.���s� lfattc: ftnifold w 'Z to tes ' F orcq ftin . a L kWh" # o f toles / pim Z? Invert Elev4tf4= Of tater&js?t . 3i'f� C# � '48£R CitflSS SECT' A ND SPEerf ICATr(ms S£ PTI£ �'A3i3C APPROvED no Not . itro OR lo 1�! �14Ax 6 £li to Q I�s' �3l6 I1tL _ GAS— SST• • T� SiA SEAL i • put SOIL PEPE 31 C. ; TAOM PAD ..I -;, I :z DA Dos SVMC s - DO SE Est Ci UMV ��c , j GAL - gZZ£S s •S'F�"�C � � � `' � 0 • s.3�,,.,....�.. '�!►GX DO= G ir c omac T 2 KL*," r-Avw.A=! = C �.._.... . FWW JLS .� �asce aeu rE F. � DISSS °� -s r E - rA YOMCAL DI � S£s - ' g �. + �Q*C X "' ! I� .. TEL 3�Y� I 10- 46 z. Sent By: H' LaserJet 3100; 1' 71 bWe Me ; wa -o -uc c.: wo w ..,w Izi 9EH SERIES SUMP /EFFLUENT PUMP 0 "am aaas iwwa�atasf» fmw Os eaaa 1= a�.s aIOR a i !� OaLdRl •�0 ! t[ at s 14 ou OOst Rat�q 0a a� 'BOOR WML WQ 115 as = 1Am 70 SA 05 m Rt $ d� fa7 stl3t�tl� 9EB coo am KGL 4R 000 Olt i5 1000 70 Ed 45 d 00 or vs all xilm m mumn am molt Me0 N5 all SD 1000 70 Ot S 41 !! 7!i v R Iti:n3lstft �a•� 5�to oar rya � a si 1a1n nt a.1 ss se � - o m s+am ru)w- oo Ln[Rsn+ast CORls�RtC'�OR Cased East Iroc o w soao a000 Mosoc tc isa�pelter ibtateriat _ luccuar TWO as wohtte ADS .. 73' Power Cacti Nihcilefvi&carbonand _ eo Medwmim l matt Seat aramic aim _w_. -.... Upper Mwm and Lower Dearinp Batt 8 o ao Q co so nxw, wLLOm4w ou 3W=V a1z roomems.ou*nwck&OK pbmu 4S5Mjsts - 7w6 4as:asys s...� d� ramous —aim T PLAN POWTS 4�ER'S MANUAL & MAi+�AG trt+ . StYSZ'-As SPA mom sopTsrtit C:+W�br !.� D NA lfts 3 � jo pftTar& C3 NA p si 91* .� 0 A Q KA fPtti') PJ�TERS .-3: C2 CIA � Mods � ra � az* 6'3c7 t>rr of eedtaom pump T ,acomalo WAS p�ipTatdc �� � E PUMP i PtmsP L2 S ° mo�Y avreraEg" II � Cl Past Fuer QTY n a VVeftnd �� & (� SAO rn� t7° Q Other. end (Btu St24 mQ�- o D SwWoliod -rao.b a�� bbeesa■ � p 3 d ( tam (peeseutined) � mad _XXV* - huxd* �� �� Tore! t : sits dW400mi Q �e ►Y!= ., v �yba�1b�rve MAtN TS "Cg sMg DUL E Ssrvlas t= rrgete�Y Sefvbe Event 17 rnor�e s) tMaWk= m 3 Ym -) m of At feast onoa sv+ery _ mss) tlVhet► toCtY7binad sludge and sc n 0499& of rank Mme PUMP wA conterAs of tanKS) C3 s) (&ftXkn a 3 yrs.) *) At )east once every At !asst orfCe every , r s) Covana'fteriiffiber C3 n=WW s) © MA imwm ct Pip corn & afmm Rt lest arcs every 13 nxxww s) © NA Rush wwab old At WQwt once every od,eG A beast once Wary 0 nwathis E3 your(A) O NA otlesc At least - once every is mobsths t1 y ear(p) L3 ttA MLtt TEMA WX INSTIUJCTIONS tSA� stiff be by ntt sud"bNduai ors of the ar ow af ineo P ResWoWd Sewar. POW TS try: POW TS �Aslt+er P7 of ttte mss) ep WW Q Or bj W o � Oper&W. Tank � M� ode br vb tnspea�ore and saw ow m cbm* for arty beds uP ha Y W etec or . mss tm vokmw of eombhmd a b cheCic the e etafaoe Tfie dtbipersat =912) stems be Hspacbe p and ter any of eilfuen# On 00 g= nd surface- Tft Ptii O °a ens "boo may ba aoc�n O f 1Dgeb� the )brmedkdo no of tho lore! ' �'Or _qmLmd eq �vbw the om aW � or skoge s� Swrn b WW tank �s or moe+e Oft* c voturb+e:. >he f of tsar 1c shb be rac:oovai by a S SW of � somm a �+ �'- MR i3 VVfwot$n i#,tsmk%btra" fie- - ��; and arty Tile So" afi ett + . m� °r pr�surt "cr.i i 5 oompo a oot�ied l mmmome m� elf jg of I2 ltlb)tt�ls sa' shalt be ps a or of axe of setrrve event �;W� mpo4Sh itbe WVWded to ft JOCW reguia Xy at#'to* a 1 0 d� STAW UP AND OPERATIOAt For now t. �br to uses of go Pavers dmdr.ftm trnertt tmkfs3 for btu P of am off' fi c,uerrbiCe(s eiat btW traabrtera proomss and/or darrr o do dtsponW CW1 If I*b domed tow dta wn*m of the woofs) removed by a sept2ge SwWcbg opermor pbr to USL , i Stern sort up s� not cicxur Vol "conditions are fromn at the inf Wative sudaee. wmen nu�g r imp tanks M y a above normal ticghv�rat$r levels. W h e n Aowec is to *and fire y r� ,era0rnrwill be � to the OWS) in one large dose. overtcadutg the ced(s} and may re:nNt in the To avoid this sm adon have the contents of the pcintp tw* removed by a ba�arP cry power to the effluent pump or coa1oict as Pl=lbecor fa0wr6 M rto S " restore normal levels wfthin t#ee pump tank.. amain f118rit1dt�a' - OSfEfj f� �COttlprdG„ po f wf dim or Pak WON °� �'� and � �. Do not drive of patio . the ate , t5 meet down -9" of arty mound or at -grade =1 absncpirorr area- � . }ion or- ergNnatiolt of the #oS � "e w� sis�eam may improve gm � and pcv�orlg ft ft � '�� butts condoms, eatban swabs: degrees: delaat &>ss; dapet� of file PO'IAri'� d� fat tr�wida6o dia�Ct (sue PUMP) "ter; trtut and vegetable peter $ ' tom; meant s orb � p��% � sanitary napkins: tamPons:'snd vra6ar sot6armr brine. ABANDO taken out of service the following steps shalt h* taken en to k=re th= the vltlmre the PO�WTS fads rtrtdfor is p �m compliance with ch_ Comm 83- 33.W000rsran Ad6nin9sb26ve Code: systa m is p vpexlyan+d abwv:kxwd • All piping to tanks arrd Pots shall.be drsconnected and the abandoned pipe OP~ sealed. 77�e c o errs of all tanks and pft shat be removed and properly d"cspos®d of by 8 SCE@ Senrian9 • Af l P-Pbg. aft tanks and pits shall be excavated and removed or Mafr ovvem ren-ovra and 9'm void sp aUe laded whit soli. QMve,'or art~ klert solid rnatefiaL C f t PLAt�i am fdkyw reg measures have been. or must be taken. to provide a code repairad I f the PDWTS tWS and cannot be compliant replacement sysbwx a A sine INPlaCOMOnt-area has been evaluated and may be uMized for the location of a replacement son ate - r m di ment area should be protected frosturbance anti compaction and should rent had be iafringed upon by' Smo fi cks m emslrng and proposed structure, lot Tunes and wraps. Failure to protect the replacement araa WM rirsult in the need for a new soil and site evaluation w establish a suifabte jWfacernent arias pjptaownent systems must comply with the rules in efFed at that lime - D A scalable nepiaeement area is not avwtable'due to setback and/or soil Cmirtatrons_ �9 advances in POWT S technology a holding tank nay be ktssaTfed as a last resort to r3epiace the far7ed PO1AtTS. e sibs has not bem . evakuaftd to identify a suitable replacement area. Upon tailurre of the POWTS a s+od.and site evaluation must be perforrne�l.10 locate a suitable replacement area. If no r4Warc8"m t area is availalte a tank may be iced as a last resort to replace the faiiled POWI'S- rierreovaF o€ the biortcrad at and at -grade soli aabsorpfton s may be reconstrructed in place foacmmbB tha irr tivaa sacrrti a ReconstrrsdiOns of such systems must corruply with the naes in efiecx nt that Ome. <¢vtlArt SEP , PUU TIC, PC714IP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR tNS't1fFECtENT DXYGEId. Do NOT 13crM A sl mc PUMP QR OTHER TRFATMEN - 1 TANK UNDER ANY CIR UMSTANCES. DEATH litAY RESULT . RESCUE OF A PERSON FROM THE R4TERfOK OF A TANK MAY BE ptl'piCi)LT OR IMPOSSIBLE. ADDITIONAL COaI7 W-WS Powfs,NsTALLER Powrs MAINF'AEMER Name t Name ff,401-W ez Phone Phone —� 5EPTAGE SERVtC1NCs QPt tATOR LOCAL REGULATORY AUTHOWY Agency Nara j C Phone . p2 Phone / r,r s aazer«a tuns dcacfteri by, no st.* of ins C�cesrr Lake. � acrd Waashara Coaruty 2oruirrg aid ImbbM aneneft Thk dma cn00s ads n*&nM � d ch. Coals X IXdA% =,d 1D-1(l?. C) b (3), Wswrain A6� Code. Ejsw of Brio daema Wl doh 00t gc>'are4w Ore potiu arse of the PWM. MAW 0011 Wisconsin Deparbllent of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code //�� count 4 %_C C 1 ' Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must . inc ide, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 11 — (y I COD Please print all infonnatlon. Reviewed by Date PwsonN information you provide rimy be used for se0WAM Purposes (Privacy law. s. 15.04 (1) (m)). Property owner Property Location Govt. Lot ^/1,1j) 1/4 A; /4 S T N R r E( W Property Owners Mailimg Address Lot # Block # Subd. Name or C" b 4- et rate Zip Code Phone Number ❑ City O Village X1 Town 'Nearest w s ) l"?O .� New Construction Use: Residential / Number of bedrooms Code derived design flow rate `S' GPD O Replacement PuWic or ekxnrnerniai - Describe• -- _— - r Parent material _Srs �'Y�sy.St� Flood Plain elevation if applicable /Yf �9�- R General comments and recommendations: System Type Dil- System Elevation ? 9 ' F 71 � # Boring Pit Ground surface elev. — f f ' L '% Depth to limiting factor in. Raft hbrtim Depth Dominard Color Redox Description Texture Stnxttrre Consistence Boundary Roots GPD/fF in. Munsell Qu. SZ. Cont color Gr. Sz. Sh. 'Eff#t I 'Eff#2 i. z:- 3D �o s ---- 51/ u soft ® _k Pit Ground surface Depth to rNniting factor in. Sou Noicatim Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDW in. Marsala Qu. SZ. Cont. Color Gr. Sz. Sh 'Eff#1 'Eff#2 2.- Z4 , t7 • Efa mtt #1 = 800 30 5 220 wq& and TSS >30 _< 15o ' Effluent #2 = SOD _< 30 nV& and TSS 530 myL CST Nerne (Please Prim CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 D 715 -246 -4516 lag= IWARAW mm NSA ®� . • Soil Test Plot Pla Project Name Ron Bonte Sh k d Address 1654 87th Ave Hammond Wi 54015 /#226900 Lot 18 Subdivision Pheasant Ridge Date 6/16/08 N W 1/4 N W 1/4S 9 T 29 N /R 7 W Township Hammond F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. B ottom of Siding System Elevation 99.2' *HRPSam 2 Acre Lot Scale = 1/4" = 10' 170th St. Pro 3 Bedroom House B -1 B -2 99, n n B.M.* 98. 97' 9 B -3 10% Slope Property Line Wasconsin Department ofComme SOIL EVALUATION REPORT Page of Division of Safety and Buil ' n V i accordance with Comm 85, Wis. Adm. Code County r. Attach mple plan on paper not les than 8 1/2 x 11 inches in size. Plan must include, ut not limited to: ve d horiz ntal reference point (BM irection and Parcel I.D. percent ope, sca le pr �c�1 north a w, and location dis to nearest road. b I - q �j- 1 6 - Imp P y If7f a/ m Revi by Date Personal i rmatio o f � ors ry purposes (Pri s. 15.04 (1) (m)). 1 V� Property Ownek lu Property Location Govt. Lot AN) 1/4 n/ j1 /4 S k T N R ] E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1 8 1 -- /- e city Wgm4�� I u; 1 1 -fllol S I wat t--� State Zip Code Phone Number ❑ City ❑ Village X1 Town Nearest R X ilid New Construction Use: Residential / Number of bedrooms Code derived design flow rate ^ (] GPD ❑ Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable w� ft. General comments and recommerxiations: System Type M ' q a- "CX- n System Elevation �9 Boring # ; Boring 2 I pit Ground surface elev. �' ' Z ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color ! Gr. Sz. Sh. "Eff#1 1 •E02 -1 7— U r 3'1- r-- ,-� yr� ` p2,.— • D ®Bor'ng # kPit Boring Ground surface elev " — ft. Depth to limiting factor �CJ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z - ,a Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008192nd Ave, New Richmond, WI 54017 / 0 Z 715- 246 -4516 S' Property Owner _ Parcel ID # / Page of [ Ong # ❑ Boring , 1, � ✓/ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structtin`e Co_ lfsistence Boundary Roots GPDO in. Munsell Qu. Sz. Cont. Color Gr-S4. Sh. 'Eff#1 `Eff#2 �t7 S ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. - 9o�i[Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ' Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. C1 Pit Soil Application Rate Horizon 'depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ` Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mgA- ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SB0.8330 (R.W00) t Soil Test Plot PI Proiiect Name Ron Bonte S n rd Address 1654 87th Ave Hammond Wi 54015 M #/226900 Lot 18 Subdivision Pheasant Ridge Dat 6116108 NW 1/4 NW 1/4S 9 T 29 N /R W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding System Elevation 99.2' *HRpSame as Benchmark 2 Acre Lot Scale = 1/4" = 10' 170th St. Pro 3 Bedroom House B -1 B -2 99, n 98. 97' 9 B -3 10% Slope Property Line I ST. CROI K COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHD? CERTIFICATION FORM Owner/Buyer Y� C �E' ✓ �'� {� Mailing Address v�-- no o n 5� � �� � _ ,m u.� -517 I Property Address b / -? b 4ti s (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION / Property Location 1 /0 , &jA' /a , Sec. , T �N R l W, Town of u �' Subdivision Lot # Lc � Certified Survey Map # — , Volume Page # 'Warranty Deed # ��� o / , Volume , Page # Spec hous6 no Lot lines identifiable (�Io 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 fimcdon of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comma. 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 phimber, 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 full of sludge. Uwe, the undersigwd 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. Uwe amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 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. 08105 State Bar of Wisconsin Form 6 -2003 * 8 6 6 9 7 5 1 SPECIAL WARRANTY DEED 866975 KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CD., WI RECEIVED FOR RECORD THIS DEED, made between Bank Cherokee 01 /09/2008 02 :50PM WARRANTY DEED EXEMPT i ( "Grantor," whether one or more), and Ronald Bonte a/k/a Ronald C. Bonte REC FEE: 11.00 TRANS FEE: 150.00 PAGES: 1 ( "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 Recording Area St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): Estreen & Ogland Lot 18, Pheasant Ridge, St. Croix County Wisconsin 304 Locust St. Hudson, WI 54016 iL300L 018- 1096 - 18-000 Parcel Identification Number (PIN) This IS 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 arising by, through, or under Grantor, except: Easements, restrictions and rights -of -way of record, if any. Dated December 31, 200 (SEAL) (SEAL) * B J Boldt Seni redit Officer (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF Wisconsin ) ) ss. authenticated on St. Croix COUNTY) Personally came befn*P me on December 31, 2007 * the above -name, Bxy anBoldtSenior Credit Officer Bank TITLE: MEMBER STATE BAR OF WISCONSIN Cherokee (If not, to me known to be the persons) who exeautdd Qtd authorized by Wis. Stat. § 706.06) ins and arkj)wledged the same. , %d' THIS INSTRUMENT DRAFTED BY: * f e vg r H - r v Attorney David J. Estreen Notary Public, State of W ; S c o ti S ":• A 01 304 Locust St., Hudson, W154016 My commissions Perl ellt) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) - f r `rn NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY ik VTIFIE SPECIAL WARRANTY DEED ®2003 STATE BAR OR WISCONSIN d�t1'. 6 2003 *Type narne below signatures. INFO- PRO- Legal Forms • (800)6_ • Waproforma.com 1 of 1 1 g , • , :j . x co s , M �o ' o, ro S� r n, J ... r -+ .. a r o y y r e Cr) Id o co y co J• I r W �p ip M �,• V^ N N M N N - / Q1 to N x ti Oo� L L. • o CI to J N N ", co � ZZ O � 7 N3 „s0 ,01 o �{ , "' � x x O r r s 1 0 ON a0 M T tO �i X �r ^ �� ~ M O N �' ................ 0.:4 ° —. ° ....... .... h ..J ........ ...... 0 o CIO ?� _ x 222. 74' I o f x LINE OF THE IN 1i4 N co r TI ►0 n r ► . c1 c l\ urV c T r ► NF e)r T14F AlW I id o N83 T j 34, w � \ C DRAINAGE :............ 76' rft _ pR4 /N4G NT3'S EASEIIENT: F E4 0 1 { _ n 2 — 30' .3 LOT 19 30.00' ®' ' C h '� I. 60 ACRES L OT 20 -- - __ 76• ____; N 388 4 SI E f;W 1. ✓�, , 20 f 69, 800 SO. FT. 79 ACRES N OR /yEN,A HWE: 1070' W 78, 051 SO. FT. I O J LFE : 1072' HOE 1070' ' � O LFE 1072' Iy N S89500� 48 :W M I N N ° a C O e,. {"' "' 161. 08' 252.21' ' LA 2 13. 01 ' TOP OF I • i 200.28 a v , " 413.29' ioai .73PE- 2 17 I N85 0 25 34 E 94, 413 LOT 21 1K 10 I 'p L OT 18 M 1.93 ACRES Cal L FE 1a m ; 1.60 ACRES N 83,HWE2/070'FT. 2 I :y iN 72, 187 SO. FT. LFE 1072' i • WE: 1070' I � V LFE: 1072' I.p ' N85 ° 26' 12 "E O 498.46 - - - -- i - - - - -- 244.33' - - - - - -- - - - - -- 25 13' a� EASED M o I ro GOLF COURSE $ 28, � 233. 859. { ° 244. 10 920-740 SSO 02 6� 0 1 " W I 133. 45' 246.29' I ------------ _— _�-------- _- - - - - -- UNPWTU LA I WEST LINE OF THE NW 1,14 W li4 C ORNER OF iv SECTION 9, T29N, 100 0 1( m R 17W. ( SET P. K. NA IL 1. GRAPHIC SCALE - FEET 200115OF THIS INSTRUWNT DRAFTED BY JIM WEBER commerce.wLgov Safety and Build gs Division County 201 W. Washington P.O. Box 7162 e l co Madison, WI 07- 62 Sanitary Permit Number (to be filled in by Co.) o �f 5 8 5 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approp gover AMA 0- V unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owne OWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you 'de may, be used for condary p urposes in accordance with the Privacy Law, s. 15. 1 (m), Stats. y, ) h D ; 1. Application Information -Please Print All Informado lVJ Property Owner's Na Pa el # 419 �J Oh4 Property Owne ailing Address {� Pr rry Locatiop,.,' ST. CR ELF 7-57 G ot: City, State Zip Code Phone Numll®NING OFFICE y.' /., Section nl� n circle o "T N R� E r W II ype of Building (che all that apply A _ Lot # Subdivision Nam ;� I ' or 2 Family Dwelling- Nu rof Bedroom o tr'' O C i j Block # e'' ❑ Public /Commercial - Describe Use r � ❑City of bey'' El State Owned - Describe Use t / CSM Num + 1, LJ Village of wn of GG g k OJ /tee III. ype Permit: (Check only one box on ' e A. Complete line B ',Vapplicable) A. iv System ❑ Replacement System Treatment/Ho)di Tank Replacement Only ❑ Other Mo ification to Existing Systept (explain) Or 9 B. Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Cha Plumber Permit Transfer to New Be fore Expirati O er `'--� IV. Type of POWTS System/Component/Device: Ch all th 1 ❑ Non - Pressurized In Ground ❑ Pressurized In Ground Jht At - Grade ound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil All ❑ Holding Tank ❑ Other Dispersal Component (explai ❑ Pretreatment Device (explain) V. Dis ersal/rreatment Area Information: Des' n Flow (-pd } Design Soil Applica ' to sf) Dispe sal Area Requi (s Dispersal Area Propo System Elevation �,._�, t om, ,z � 5� 9', p Vt. Tank Info C itJfn Total # of Manufacturer Gall s Gallons Units ° U New Tanks Existing Tanks ! • : U in to to w Z5 A. Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- Ae undersigned, assum sibility for installation of the POWTS shown o e attached plans. Plum s N me (Print) I lumbe ' re I MP /MPRS Nbq&r Business Phone Number Plumber's A dress (Street, City, ffate, Zip Code ) l VIII. Coun /Department Use Onl Approved p Permit Fee Date Is ued issuing t Signature Owner � n Reason for vial � 14 IX. Condit P�veasons for Disapproval I 3 J` 4-0 ` e 1. Septic tank, effluent filter and dispersal cell must all be servtces / maintained kil 6w", -a. as per management plan provided by plumber. 2. All setback requirements must be maintained J � Its 6 " O he Attach to complete plans for the system and submit to the County only onrp n less than 81 x 11 :l in size i G�'t'c -cam•' Gv� SBD -6398 (R. 01/07) Valid thru 01/09 1 3 KATHLEEN H. WALSH SHERIFF'S DEED ST. CROIX CO., WI ON FORECLOSURE RECEIVED FOR RECORD Document Number Document Title 11/28/2006 01:00P?1 SHERIFFS DEED EXEMPT M 14 REC FEE: 13.00 TRANS FEE: WHEREAS, pursuant to a judgment of foreclosure COPY FEE: rendered in the Circuit Court of St. Croix County, Wisconsin, CC FEE: in an action between: PAGES: 2 BankCherokee Recording Area Plaintiff, Name and Return Address: Drafted by : Ralph Moore V. Case No. 06 CV 406 STEIN & MOORE, P.A. Attorneys at Law Advanced Homes, Inc., et al., 332 Minnesota St., Suite W -1650 St. Paul, MN 55101 Defendants, 018- 1096 -18 -000 Parcel Identification Number after due advertisement, the mortgaged premises hereinafter described were sold on November 7, 2006, to Plaintiff BankCherokee, the best bidder, for the sum of One Hundred Ninety -three Thousand One Hundred Twenty -seven and 00 /100 Dollars ($193,127.00); AND WHEREAS, Plaintiff is now entitled to a conveyance according to law; NOW, THEREFORE, the undersigned, in consideration of the payment of $193,127.00, receipt of which is hereby acknowledged, conveys to BankCherokee the following tract of land situated in St. Croix County, Wisconsin: Lot 18, Pheasant Ridge, St. Croix County, Wisconsin. Dated: November, 2006 Dennis Hillstead Sheriff of St. Croix County By: Deputy Sheriff 1 of 2 i STATE OF WISCONSIN ) )ss. COUNTY OF ST. CROIX ) On the 7- day of November, 2006, before me came &/lnjS Q 1h) , known to be the individual and officer described in, and who executed the above conveyance, and acknowledged that he /s+tcexecuted the same as such Sheriff, for the uses and purposes therein set forth. Notary PWi ark �i c My Commission Expires: Q6 -/3 ", -6 1 0 onsin M J. Mals11 public Federal I.D. Number of BankCherokee: 675 - Notary K. f W PubH stat" 2 2 of 2 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix SAfety and Building Division INSPECTION REPORT Sanitary Permit No: • 488040 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: Running, Bill I Hammond, Town of 018 - 1096 -18 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Elev: 7 09.29.17.793 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding rcp Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer De and St Cover Model Number TDH Lift Friction Loss System Head DH Ft Forcemain Length Dia. Dist. to well _T SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. ranches PIT DIMENSIONS Of its Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LE I Manufacturer. INFORMATION CHAM R OR Type Of System: UN Model Number. DISTRIBUTION SYSTEM Ll I I \ Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(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 Mulched Bed/Trench Center Bed/Trench Edges Topsoil o Yes N Yes ! f _ No I COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1081 170th Street Hammond, WI 54015 (NW 1/4 NW 1/4 9 T29N R17W) Pheasant Ridge Lot 18 Parcel No: 09.29.17.793 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = information. Plan revision Required? Yes No Use other side for additional Date Insepctor's Signature Cart. No. SBD -6710 (R.3197) Safety and B rags isi County = 201 W. Washington Ave., B 71 j is'cvnsin Madison, 707 --- 7 Sanitary Permit Number (to be filled D!Lpartment of Commerce (608)266 Sanitary Permit Applic atidNECEIVE ® State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal inf rmation you provide maybe used for secondary purposes Privacy Law, 15.04(?(!u) y 20 q Project Address (if different than mailing address) tQ i I. Application Information - Please Print All Infor lion ! T. CROIX COUNTY A ` I Property Owner's Name Parcel # 01 # Block # dais Y1,0 -' I " Property Owner's Mailing Address � Pr ,} opertty Loccat City, ! "rX V4,1 V4, Section t). Zip Cod-e{� Phone Number V �E W �� 7? 3 H ype of Building (check all t apply) C k cz aa. -6o6o : ' n Subdivision Name CSM N bet Family Dwelling - Number of B ms — t i o u -- r — f 4 JCV1 El Public/Commereial - Describe Use G ❑ State Owned - Describe Use �S 7 ❑City ❑Village of tL . III. Type f Permit: (Check only one box on line A. omplete line B if applicable) $( . �� A. New stem ❑ Replacement System ❑ T enUHolding Tank Replacement Only ❑ Other Modification to Existing System B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑Permit Revision ❑Change N101 r iY Transfer to New Before Expiration Plumber ner IV. Type of POWTS System: (C *k all that appl ❑ Non - Pressurized In -Ground > 24 in. of suitable soil ❑ Mound < 24 t of suitable soil 11 At-Grade El Single Pass Sand Filter El Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank F1 PeXt ❑ bic Treatment Unit El Recirculati g Sand Filter ❑ �� Recirculating Synthetic Media Filter 11 Leaching Chamber ❑Drip Li ❑ Gravel -less Pi ❑ Other (explain) V. Dis ersaVI'matmeat Area Information: Design Plow (gpd) Design Soil Application Rate(gpdsf) Dispers Area (s f) Dispe jVa Proposed System Elevation VI. Tank Info Capacity in Total Number Manufacturer b Site Steel Fiber Plastic Gallons Gallons ofUni G Concr Constructed Glass New Erosting Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber D VII. Responsibility Statement- 1, the undersi ne ume responsibility for installation of the Povhs shown on the attached plans. Plumber's Name (Print) Plumber afore MP/MPRS Number Business Phone Numb a�>ti) Plumber's Address (Street, City, S e, Zip e) oz, / � i o� VIII. Coun /De artment Use Onl Approved ial J ❑ San ate ary Permit Fee (includes Groundwater D iss Issuin gent Si S wne n Reas Surcharge Fee) , CC ,2 d5 g7 O IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3, J r r ✓v L6� - Sv i Q Q W MCci CSL 1. Septic tank, en wit t few nd a� +/ dispersal CON must ON ackc i ' �b � �.es��✓ �` . as psr mv%q ment plan provided by per. 11 _� 2. AN setback � must be nobftilled 5 CA. . as per applicable cods, ardhWloas Li I ,� . Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) PLOT PLAN PROJECT Advanced Homes ADDRESS 1654 87th Ave Hammond Wi 54015 NW 1/4 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 97.0' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK i j MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 100° Fil ter 7�- -- ❑BOREHOLE WELL *H.R.P. Same as Benchmark i i I Scale = 1/4" = 10' f: i Well is o Mee `o setbac found in Pro Comm. 3 B ' ouse f at B.M. #1 M. #2 Tank is to be properly Bedded and provided with lockdown covers with I approved warning labels / ❑ Huffcutt Combo Tank B -2 Grading is to be Area 15' below j done to divert system is to remain run -off away B-3 undisturbed from system � 6% Slope Scale = 1/4" = 10' No % Delfection on the B -1 mound contour Pr er 97' 96' 95' COPY 1 PLOT PLAN PROJECT Advanced Homes ADDRESS 1654 87th Ave Hammond Wi 54015 NW 1/4 NW 1 /4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 97.0' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none IL BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 100 Filter Xa��.�,.:L4 rrn ❑BOREHOLE O WELL *H.R.P. Same as Benchmark 170th St. lJ� Scale = 1/4" = 10' Well is to meet all ` w, ro 3 setbacks found in B oom Comm. 83 Hous B.M. #1 B.M. #2 (� T is to be properly L� Bed d and provided with lockdown covers with approved warning labels ❑ Huffcutt Combo Tank B -2 Grading is to be Area 15' below done to divert system is to remain run -off away ❑ B-3 undisturbed from system 6% slope Scale = 1/4" = 10' No % Delfection on the �I 6 -1 mound contour Property Line 97' 96' 95' i Safety and Buildings 4003 N KINNEY COULEE RD lt commerce .Wl.gov LA CROSSE WI 54601 -1831 �l lscons TDD #: (608) 264 -8777 i n �,.c ommerce.v i.gov /sb/ www.wisconsin.gov epartment of Commerce Jim Doyle, Govemor Mary P. Burke, Secretary December 02, 2005' CUST ID No. 226900 ATTIC• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/02/2007 Id CAD on Numbers Transaction ED No. 1220030 SITE: Site ID No. 707992 Advanced Homes Please refer to both identii batl,on tim S, 170th Street above, in all oftop w000w4i the a o Town of Hammond St Croix County NW1 /4, NWl /4, S9, T29N R17W Lot: 18, Subdivision: Pheasant Ridge FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1054053 Maintenance required; 450 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0 SBD- 10691 -P (N,01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (14.01 /01);' Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite,Wastewater Systems Version 2.0" SBD - 10691- 1`(N:01 /01). • The pressure network is to be constructed in accordance with publications SBD - 10706- P(NO1 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks, for ST -SAS (O1 /81) • 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.' • Inspection of the POWTS 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited: • 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 ppr Comm 84 product approval conditions. • Comm 83.22 - A co of the a roved plans, s ecifications and this lettanshtli kg Qa-Aite durin construction and open to ins ection by authorized re resentatives of th a include local ins ecp tors. 1Zlr 17 APPROVED SHAUN R BIRD Page 2 12/2/2005 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. • Comm 83.52(1)(a) - 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. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee. Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608) -789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 11/28/05 Owner:Advanced Homes Location:NW1 /4 NW1 /4 S9 T29 N,R17 W Lot 18 Pheasant Ridge Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil 4te Shaun Bir Signature License n00 DI ViSIQN 0 SAF TY AND BUILDINGS RECEIVED SEE CORRE ONDENCE DEC - 1 2005 SAFETY & I ', S BUILDINGS Designer_ No Date Non- -Woven Filter Fabric 4" Observation Pipe Perforated , Distribution. Pipe Below Filter Fabric ASTK C -33 G �Lll Tapsoft .� a �4 7. Slope Bed Of !/ Main \Flowed (� Z from Pump Layer Drain Rack trtound System Using F Cress Section Of A lion Area l Bed For The Absorp G A Ft . - A t'� t; ! - g. Ft- S - �� Ft. Y.` aS L Ft. r e Ft. L 470bservation Pipe- _.__ K A i Force Main ____--- - -___- --------- From Pump ------- C • • �f o Distribution Bed f3! /Z - 2 o Pipe Drain Rock I � 4 Observation Pipe " OC LA" Permanent Marker P i pe or Rods � r lion Area Plan View Of Mound Using A Bed For The Absa D PAGE_,._ SF_- PtforattG OiCe Detail / End View �Pertarotta ,,,j Y� Pv( Pape Kos Equated 4:* $otsom. A d �eti rR EqunnY $pocea r X } t Pv C'=orceMain I FIRST Aou t4rwr t e CartAtC }'at PVC Manifold Pipe D /f', Cisr.;avtaa Pipe / L�rn � '! Distribution F 6pt l.oyav P Ft. 41 - X C2Y Inches l <,� . Y 9r Inches Signed: Hole Diameter �I� Inch Lateral Inch(es) Li cense Number: Mani fold -- Inches Gate: Force Main " Inches # of holes /pipe 2 Invert Flevdtion of Lateralsl/, 5 Ft. PUMP CHAMBER CROSS SECTION AND SPECIF ICATIOKS SEPTIC zAN�C � wEA�RPRWf APPROVED 1 212 STN, ABODE GRADE; ,JU}�CTIfli� BOX GI � ENT PIPE � i�d� NI3aW flR � ITS C�31�t3U I T MANHOLE COv ER > Q` rRom DOOR. w/ PADLDCX & FRESH -: "IIt INTAKE 1. .__..-- --SING IABE:. 4" SIR. PIlt, GRAD ,. IN- INLET � GAS + fD LiAT£R TIGHT SEALS TIGHT' joI� %lITH A SEAL { _ PIPE ALm l� 8 I flN 3 omm SOLI IL I PE 3 C FF 090 SOLID. J FT . "' — SOIL po"r orF ELEV - m T �N� v� �. CONCRETE: PAS 3s* AppRCV EC BECK C A Z5 f ,CIFICATIO sP NS -� I)xY = �.._... I DOS Q E _ DOSES PER SEPTIC FAC URER: 11. �'G ! / 5 GAL. - t BflSE �tt3i:JME Ii�tCL�CIbMs , — ,"y, MAN�J GAS— F LtSAC K s �---- SEPTIC � CAI, . : �� -pAmE SIZES = flflSE %T�-3 IrAcurS ...--- --�– CAPACITS'ES- A. ---- 3 ,. Aj,Ait?'t MAWJFACWRER; � MODEL OMB t S Il�iC1ES s �.,..�, fiAL SWITCH TYPE: C — > � — PUMP SI3R 16- 23 WA llutlB#a : P ER M P ;TCt3 T3f PE = 4,5 � or P ALAR" �IIRZ i�G - M FEET ( f PIPE. FEET CaE I CffAR T S 8U R£t3vIRE� �3I 3 -�--- FE£T CE BEEN p�3�4P OFF #4.�dB DI STi= I _ - . /• VERTICAL DIFFE'REH FRIN FACFCHt FEET MiNllt`�3M "M( $K SUPPLY PRESSURE CTIO T/100 FT- s IC Mr i T gORCEl - -- TOTA €?YNA _ DIAM ETER FEE r ;At4 + _. r - TANK: LF-NGTH I NTER14AL DIME14SI014S of -DATE = LICENSE SIGNED! _I _ :.1�8 ' w TOTAL DY PAA P A M HEAD/CAPACITY HEAD CAPACITY CURVE EFFLUENT AND DEWATERING MODEL 152/153 MODEL 152 153 Feet Meters Got. Liters Gal. Liters 50 5 t _5 E9 261 77 291 153 10 3.1 E1 231 70 1 265 12 40 152 15 4.6 1 53 201 1 61 231 0 20 6.1 I 44 167 52 197 s 25 7.6 34 129 42 159 30 30 9.1 23 87 33 1 125 8 _ a a5 1 10.7 — 22 I 85 a 20 tip 1 12.2 I I 11 I 42 0 Lock Valve: 38.0 Ft. (i1.6m)144.0 Ft. (13.4m) otasm 4 10 1 I I D 20 p 60 80 100 GALLONS i 6 t / ..�� LITERS 80 160 240 320 - 3 a 5f8 v /32- �+ ---"� 0 FLOW PER MINUTE , 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • variable level control switches are available for controlling single phase systems. •Double piggyback variable level float switches are available for variable t level long and short cycle controls. • Sealed (Qwik4a0x available for outdoor installations. See FM1420. I f • Over 130 °F. (54 °CJ special Quotation required. ! 12 1/8 rs 152MS3'Series 1521153 M can of Selecdon t/9 Am Sim lax I D !ex Madel Volts Ph 8.5 1 2 or 3 V � SK2W 1152 115 1 Non n 8.5 Incuded 2 or 3 t BN152 115 1 Auto 4.3 1 2 or 3 E152 230 1 Non 4.3 included 2 or 3 BE152 230 1 Auto 10.5 1 20r3 SELECTION GUIDE N1 115 1 01 10.5 Included 2 or 3 bade variable level float BN153 115 1 au 5 3 1 2 or 3 1. Single pi99Yback variable level float switch Or double P i99Y E153 230 1 Non 5.3 included 2 or 3 switch. Refer to FM0477. =BF-153 236 1 Auto 2. See FPd0712 for correct model of Electrical Alternator E-Pak al d 3 CAUTION 3. Variable level control switch 10 -0225 used as a control activator, seedy P All ���0n of Controls, electrical t�� should t most licensed electr{ctan• d sd* codes be followed - or (4) float system. recent National ElectricCode (ttEC}andthe Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN r Zoeller um . --, For unusual conditions a reserve safety factor Is engineered into the design of eve p ump. MAIL ro. P.O. BOX 16347 Louisville, KY 40256 -0347 Manufachrersof.. SHIP T0: 3649 Cane Run Road Louisville, KY 40211.1961 &fl - Y PWAY 51,16a 1939 (502) 778-2731 - 1 (80Qj 928 -PUMP / ler turn PUMP IO FAX (502) 774.3524 © ights reserved. Copyright 2000 Zoeller Co. All r w Page 01.,.„,. G E MEµT PLAN II MANUAL & MANA pOWTS 0-WNER 'S sYSTem SPEC[FIrA'IOHs SePdc r.* capacity o al ❑ NA n t+t Manufacwrer FORMA - Tatrtk N c = t.B INFO �P'c r d�lJe � E3 NA tJe Effluent Titer Manuta o Na Petmfl Model d Efilueni pilfer �. Q NA I l i - DESIGN PA ►M Pump -Tank Cspadtf tier of 8edf00ms Number Of Comtner ial U nits al/da PumF Tank M ar► �r ❑ NA Mariufacef ,� 1'umP E avara9e .� NA t�tirnab"d lbw ( --� atld 1 rrt fiA ode! % .5) .0 DgWn t'low (PeB ' �> t� aVd P fe rment Unit - r3 Peat Filter Sod APPW �` Monthly average' p SandfGrB� t-i r 1no n ❑ Wetland � Eftlupnt Quality G) Sao mgn p Mechanic-! Aetst?a Other. Ical Wen Grease a ( 5 22o mgt ❑ Disinfbc ter Bi ochO m or"'On ed 9011,691 (TSS) 9115 n - .. t]�pe 6191 t cett(s} Q !n-groun (Pn3ssuri¢ed) Monthly average Q At-g�d (gravRY) pt went -,,;3 ``und � Demand (130Ds) S30 mB� D Other. Biochemical Suspen Saiids (TSS) E3 �1'" °"ri°0` Ana Total Sus rperim (9eQmetnc mean }Q dull oOml varues typt� for domest� t~eCai Colifo y, inch diameter Septe ta ,k effluent. � Mraste rater• Maucnnum Effluent particle Size .. values rives, for pmv" Seryiee Frequency MNN7ENp►NCE SCNEO`ULE ©months 61(91) (Maximum 3 yrs.) $ervfoe Event of tank volume At least once every a and scorn equals one -third (K) inspect c ondition of tank(s) When opmbined sludge r(s) (Maximurt 3 Ym•) tank(s) p month Pump out contents of At least once every r(s) ❑ mon lnsped dtspeiSal cell(s) At Least once every /V/ s) ❑ NA Z. ❑ months s) ❑ NA Clean effluent filter A t least once every � � months tnsped Purtp. pip Controls & alarm ❑ NA At isast once every � m onths Ks) a ysa Flush laterals and pressure test At least once every E3 months II '�'K s) ❑ NA y 01 At least once every osror 081 licenses or UC7IONS one of the following twiner, SOP MM �NCE 114STR rsat carts shah be made tyy an individual t?OWTS ►nsP@�4r. POWrsa� o r bro"n 1 p�6ons of tanks and dlspe Mater Plumber R rictsd s to ie mrss� on of the tank() dntify f or any i UP Master Plumber: visual 11 i om and scum and c eck t e ffl uen t is °gyp tor. Tank inspe�ns must include volume of combined sludg to check the efft O ore the v isu ally inspe� �� of effluent on the hardwgu , any crac or leaks. �S f dispersal 1(91) steal! be entttotity round surface nding of effluent on fate ground surface. The po tng of e fflue nt on the g for any {ion of the local regulatory vo l u me, the Pfd pipes and rio che+* wires the immediate notitrca Q1, more Of gte tank NR in the observation cond'tfton and once ground surface may indicate a failing a and scum in any tank equals one�i►ird sad of in accord acc of stud$ a Septage Servicing Opero�r and dispo yin the combined ac k shall t)e removed by nents•, and anY entire contents of the � Code. °Hants. pretreatf'r'e t�Po Maintainer chanical or pressurized . 113 Wi OXWn a certified pOWTS me POWTS imp tfo�ed ay semce evens The setv9 effluent at intervals 12 months or less. shalt be p? of � of any other maintenance or monitoring regulatory authority t�vithin 1 Q days A serer WN't shati.be provided to the local rag rodud�s or other treatiTt tank(S) far the p�,sent� of painting P � STARTUP AND OPERAT use of the POw fS check . e the disp ersal cell(s). if high c�oncen "W For new ponstivcixon. a the treatment process andyor darnaeg servicing opef3tOf prior to use chemicals that may imped removed by a sap g _ dewed have the Contents of th tank( w � - Page vt when soil - conditions are frozen at the infiltrative su rface - povm is restored the eX'om t occur en start up s no anal ttighwater levels. V�fh P m result in th S Bove no s Mild m ay e S's a Mel' tanks rimy 'dose. the ( ) urrn a dos . es pu one During ter outage d"ts oell(S) u3 � W of the pump tank removed by a 9 e Pence w�wiU be disdiar9e of To avoid this situation have the ate MaIntam to or or surface dnsd�9e _, effluent to the effluent pump or contact a plumber backup 0 or prior.tD �n$ JeT normal Ievels within the Pump te restore e in W pump ass ist OPeiBff con tr ols t0 fk Oyer, Dr Othemi-`e disturb Or Compact, . � In n7anUaltj not drtVB Of X33 assn and dispersal Cells. Do Do not dibre or park vehideS over tanks feet down sbPe of any mound Or at soil absarptrQn area a rfarmance and Prolong the fife within t5 i mp ro ve ffi pe area may im � fr the wastewater wastewater stream Y P ro Reduction or- eamtnation of the tOtlowing - rt buds condoms; meat co tton swabs; degn�sem: dental moss; diapers; POWTS: anti- lilo64s ; .baby wipes; dg n r fruit and vegetable peelings; gasoline; greaser herbicides; Of lire fouridafion diain (sump pisrnP) Ovate softener brine. dL medx o ns; cat'; gainfing products; pe tades. saner' napkins; tampons: and v+rater scraps ASANDONWENT mmlly.taken out of service the fotiowiny steps shall Ile taken to Insure that the When the POWTS fat's andlor is perm oompGance with ch_ Comm 83 - 33, Wisconsin Adm'nistrative Code system is properly and safety abandoned in i ! s sealed - to tanks and pits All piping shall to disconnected and the aband � a P�� Servicing Operator_ It .. The contents of an tanks and s shall be removed and prope After pumping, all tanks and pits shall be excavated and removed or their covers reanoved and th void space filled with soil, grate o another inert solid Material - CY PLAN y ores have been, ar must be taken• 1D provide a code COHITII+IGEN the following meal if the POWTS fans and cannot be repa compliant repiaoernent system: and may be utilized for the location of a reptac�ern sod has been nce and compaction and should not t3 a sin � Th evaluated cement area should be protected from disturbs be infringed upon by required setbacks from existing and Proposed structure, tot lines and welts. Failure to eslab protect the replacement area will result in the need for a with �e {motes site n effect at that time - a suitable replacement area. Replacement systems must comply !cement area is not available due to setback and/or sOil l failed POWTS technology' ng advances in POWTS O A suitable reps led as a last resort to repiace techy a holding tank may be instal n falure of the POWTS a sorl.and e site has not been evaluated to identify a suitable reply ernent area Upon n Z ite evaluation must be performed to locate a' suitable replacement area if no replacement area is available a Icing tank may be mstailed as a last resort to replace the faired POINTS. the biomat at and at - grade Soil absor'P�n systems maybe reconstructed in place following removal of ns of such systems must comply with the rotes in effect at that time_ the infiltrative surface. R� «VVARNINIG>y ES ANDfOR INSUFFICIENT OXYGEN- TREATMENT TANKS MAY CONTAIN LEfHAf. CI RCUMSTANCES- DEATH MAY C PUMP AMC) OTHER TANK UNDER ANY SEPTI ()(3 NOT ENTER A SEPT [G, PUMP OR OTHER TREATMENT RESULT.. RESCUE OF A PERSOtd FROM THE INTERIOR 01= A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADOMONAL COMMENTS POWTS MAINTAINER POWTS INSTAt1ER / Name _Q'�/✓ Name �fn Phone Z 1J =' 1` ­ Phone �J J i✓a ` I LOCAL REGULATORY AUTHORITY n SEPTAGE SERVICING OPERATOR PUMPER r /I � Agency Name / as-a- _ Phone 2JJ b Phone f ,J �' Thy dacvmeM m - the Green take, Mamuette and Wmshara County Zoning and San?latim ager>des nt does not rtes d o ramie ai was chaired b�! the stafTs of Cede Use of this daaame the anu+im�an n�qu+rentlents of at1. Caamt 83-22CZpXjXd)&(* and 83.,5x(7 ). (2) & (3), Wisconsin AdMMWrz '"e C (Mi) guara'w ft performance of the Powl"S. II - isi'n,department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � (_ Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must �T include, but not limited to: vertical and horizontal reference point (BM); direction and Parcel I.O. / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. QOO Please print all information. by Date Personal inromwtion you provide may be used for ) (m))° • 3f (p Q - 3 Property Owne P Location Govt. I- t (V 1/4 NW1 /4 S 9 T 29 N R ( '7 E (or W Property Owner's Mailing rid s t # Block # Subd. Name or CSM# 1 - � n� rd P - City State Zip Code Ph a Number N I N G 0 F F I ❑ Ci ❑village Town Nearelf Road (_115) 4amm l 76 S� . G - N ew Construction Use: I$ Residential / Number of bedrooms Code derived design flow rate 60 ;GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material T/ � Flood Plain ele tion if applicable . General comments ��/�f 2y1�) 21-2 U • y S Q 1 CTK ` f and recommendations: � ('o n-[vu � t? It i, 9' `�. o d !/� e s s ti- �'�ro•m Y Srr/ [] Boring a CflYt' . Boring # rte' l,y� rit Ground surface elev. `� n 7.66 ff. Depth to limiting factor &— in. Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 i �� 2 5' Zrr� mk' C5 3 2- -- s c 5 y ea ° T Boring # ❑rn Boring 97 2 \ 6 �t pit Ground surface elev. . ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Q -1 ( � - Z Sr" ( 2 i e I 5 - Z I -2 `0 Si cl Z msb c -- - �. Effluent #1 = BOD > 30 < 220 mg/L and TSS- >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) gn ture CST Number ? s3 09 Address Date Evaluation Conducted Telephone Number � — .Sr� �'z 71 J 2517 - yam � 1 T Property Owner ET `t i Parcel 1D # / (� Page Z, of Boring # ❑ Boring Q Pit Ground surface elev. GO ft. Depth to Fmiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2 1a `( 1 S ~C� 2 k r C S y (o �Jc 2 '° S ( mS c c 5 — LI I - L a 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 GPDJ t In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. SBD -3330 (R07/00) Property Owner t,. nk Parcel ID # / ! paw 'of F-31 Boring # ❑ Boring Q Pit Ground surface elev. l '4• too _ ft Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R In. Munsefl Ou. Sz. ConL Color. , Gr. Sz. Sh. 'Efl#1 •EffU 1) -12 3�2 2 cs Ivy . t> I- �� r L s 3 r U 2 C5 y 1 5-4r (P 1 a Boring # ❑ Boring Ground surface eiev. ft. Depth factor in. [] Pit Dth to limiting [ E Application Rate Horizon Depth Dominant Color Redox Description Texture _Structure Consistence Boundary Roots GPD/1`1 in. Munseli Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F—I Boring # ❑ Pit Boring ❑ Ground surface elev. R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD/f1 in. Munseli Ou. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. SBD4330 (R07/00) PAGE OF NAME ME �o TOT# I � LEGAL DESCRIPTION Nw Y ,y t4 S q T Z I .N.R, / 7 E(orX�/ ivy ia. SCALE: I"= "M I BM I ELEVATION IQ's BM I DESCRIPTION :bo p,'n - 2 ELEVATION q9.S- BM ESCRIPTION SYSTE ELEVATION q S6 i� SYSTEM .\ E M o o rt cl S S t VN CONTOUR`ELEVATION J7. O U 1 � o 0 0 0 a g.i SIGNATURE ��� � __ �-.-�� DATE c ` SAFETY AND BUILDINGS DIVISION Field Operations Bur 13 East S eau INSPECTION REPORT Chippewa Falls, Street N visconsin www.commerce.state.wi.us Department of Commerce Scott McCallum, Governor Philip Edw. Albert Secretary Date of Inspection: July 18, 2002 Plumber Name and Address: Project Name: Pheasant Ridge Use: New - Residential Legal Description: NE, NW, 9,29,17W Lot Number: Lots 25 -26 Subdivision: Pheasant Ridge Certified Soil Tester Name and Address: Municipality: Town of Hammond Henry Grote CST 222774 County: St. Croix E 4366 353` Ave Plan Transaction Number: Menomonie WI 54751 —�_ Sanitary Permit Number: Owner Name and Address: REC EIVED Wastewater Flow: 450 -600 Ron Boste gpd 1011 170' St JUL Z 4 2002 Persons Present: Jon Sonnetag Hammond, WI 54015 Rod Eslinger ST. CROIX COUNTY ZONING OFFICE This onsite investigation was conducted because of conflicting soil and site evaluation reports by Henry Grote and Adam Schumaker. CST Schumaker felt that the contrasting soil colors of the substratum might be indicative of seasonal soil saturation. Two soil pits were reviewed p Of coutca"i"A i" here ate a nt co 0 et ttte do rather-than contem Recommendations for these lots include keeping the dispersal areas as shallow as possible and no load the fin t t o . ne sand over 0.4 gpd/ft 2 Sizing example: 3 bedroom home 1125 ft ^2 or a 4 bedroom home 15 bout 37 chambers 00 ft "2 or about 49 chambers If there are any questions regarding this report, please feel free to contact me. Le y G. J sky, ast ater Speci ' Ljansky(M mmerce.state.wi.us E- it 715/726 -2549 Fax 715/726 -2544 Voice cc: ounty ❑ Plumber CST ❑ ❑ Owner ❑ Other ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerMuyer c�vae, Mailing ` 1'' ` �) M g Address LA J Property Address 1Q y (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location '/4 , 1 /a , Sec. �, T �N R '�) W, Town of 4 ✓j � Subdivision Q / , Lot #. Su rvey Ma -- , Volume , Page # Certified Su y p # Warranty Deed # e d , Volum ©) , Page #1 Spec hous yes no Lot lines identifiabl 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 1/3 full of sludge. I/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 gwner(s) of the property described above, by virt u f a warranty deed recorded in Register of Deeds Office. SIGNATUME OF APP ANT(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. 08/05) .�.r .....�...�. �� 1 :4 I� I �� ;1! � �, - � � I I Ii �s�l� _ • � -� � •�•.���� �� ��If�i1 � r r rr�rr�rr � � � �Ll O C©7'I�I I -- `� � - i i l r_-�: f i ��� = - I - � ' . ,�r . - . I� � i r r r � �1 --� a -.1 Mfl a N Q S.tl Si ga M r ed � ^ �► rt r r r r a� • � • 6PJ6322 U. 2901P 177 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 7 - 1999 REGISTER OF DEEDS Document Number TRUSTEE'S DEED ST. CROIX Go., WI RECEIVED FOR RECORD Dine M. Bonte as Trustee of 10103/2005 01: 45PH Karl M. Ulferts and Katharina G. Ulferts Fames Trust for valuable consideration conveys without warranty TRUSTEES DEED to A yancnPr9 Hrxmc Trg: EXEWjl # REC FEE: 11.00 Grantee, the following described real estate in St. Croix County, State of TRANS FEE: 222.00 Wisconsin (if more space is needed, please attach addendum): COPY FEE: CC FEE: Lot 18, Pheasant Ridge. St. Croix County, PAGES: 1 Wisconsin Recording Area Name and Return Address David J. Estreen 304 Locust Street Hudson, WI 54016 �' J _ J ` 018- 1096 -18 -000 Parcel Identification Number (PIN) Dated this ___ day of September 2005 * * Din M. Bonte Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) Dine M. B onte, Tr of Kar M U lferts _ STATE OF and Katharina G. Ulferts Family Trust ) ss. County ) authe this day of September —2005 --------- - - - - -- Personally came before me this _ day of the above named *4661 istinttt -9 td i J t.S ?'c'e.*, - -- -- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Opland Hudson, WI 54026 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Profeuionats Co., Fad du Lac, Wt STATE BAR OF WISCONSIN 800-655 -2021 TRUSTEE'S DEED FORM No. 7 -1999 r . Parcel #:. 018- 1096 -18 -000 12/22/2005 08:50 AM PAGE 1 OF 1 Alt. Parcel #: 09.29.17.793 018 - TOWN OF HAMMOND Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - ADVANCED HOMES INC ADVANCED HOMES INC 7518 NEWBURY RD WOODBURY MN 55125 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description " 1081 170TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC i Legal Description: Acres: 1.660 Plat: 2299 - PHEASANT RIDGE 1/32 018/02 SEC 09 T29N R17W PT NW NW PHEASANT RIDGE Block/Condo Bldg: LOT 18 LOT 18 1.660AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 09- 29N -17W NW NW Notes: Parcel History: Date Doc # Vol /Page Type 10/03/2005 808322 2901/177 TD 08/06/2002 686239 9/26 PLAT I 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 91041 65,200 Valuations: Last Changed: 06/30/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.660 53,900 0 53,900 NO Totals for 2005: General Property 1.660 53,900 0 53,900 Woodland 0.000 0 0 Totals for 2004: General Property 1.660 53,900 0 53,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00