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HomeMy WebLinkAbout018-1083-39-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division r '= , • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Hawkins, Matt Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ Z ~-y~ Dosing I G r k `7 ! ~~ Aeration 3 w ~ l U~ Holding (',t TANK SETBACK INFORMATION TANK TO P/L WELL I BLDG. `~ Vent t Air Intake ROAD Septic >~ / /~ Zd~ ~~ ~ "~. Dosing .~ ~~ ' 30~ 6„•, Y Aeration Holding PUMP/SIPHON INFORMATION ~ K._,_ 7 Manufacturer errand GPM Model Nu r ~} TDH Lift Friction Los System T~ / ~ - S Forcemain Len i Dia. ~ / Dist. to W II SOIL ABSORPTION SYSTEM ' BED/TRENCH Width ' Length fZ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `~ /~ ` ~~ TQM.+ \ ~ ~~- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ~ Manufacturer: ~ , \ INFORMATION R OR CHA ~ Type O f Syste t ~ ~~ ~ ~ ~~ UNI Model Number: J; ~ D Gh I~ ` DISTRIBUTION SYSTEM Gln's'll..'r G / - =' / 7 ioa g m r ELEVATION DATA County: St. CroiX Sanitary Permit No: 463429 0 State Plan ID No: Parcel Tax No 018-1083-39-000 vlap No: 16.29.17.611 STATI ` 7iy BS HI FS E EV. Bench^ mark 2.g /6Z•g /~ Alt. Sfi , ? , / Y~ 3 Bldg. Sewer ' ~~ SUH~ let 3. Y•t St/Ht Outlet /y , 1°~ . ~.. ~ /- Dt Inlet ~ J `~ -Q Header/Man. 7. ~$ 95- ~z Dist. Pipe 7~g /, O ~~ . ~ 7 C. Bot. System \\ aw Final Grade (o.to 96 - Z St Cover Q ~~„~ o ~ J ' ~ / 7 ~I ~ , ~ ~7~• '~ 'Z. 8 ~ Z ~ i Header/Manifold i/ ~ Distribution ~ ~ x Hole Size x Hole Spacing Vent t Ai In ak ~ Pipe(s) . i L h ~ Di S Dia Lenghh pac ng engt a S(~II COVER v Drocc~~rn Sv~4cm~ Anly a J xx Mound Or At-Grade Systems Only Cgil Q:(' ~( I((JICt~.T Depth Over r Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ) s Bed/Trench Edges \ > Topsoil \ Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~,JZ~/QQ Location: 984 172nd Street Hammond, WI 54015 (NW 1!4 NW 1/4 16 T29N R17W) Pheasant Hills Lot 39,~ 1.) Alt BM Description = ,~jT.G(N~~ ~~ 2.) Bldg sewer length = ~ b -amount of cover = ~ ~ ~ a L / -S~~ Inspection #2:~ Z~'_S' Parcel No: 16.29.17.61~Q Plan revision Required? ~ '_', Yes No ~ ' ' 2__65' ', ~ ~~~~~~ ' Use other side for additional information. --- - -- --~ - -- ~- --- - __ -- - -- Date _ Insepc or' nature ~ ~3~~5 SBD-6710 (R.3/97) G . ~ ' ` P.O. Box 7162 W ~ -A 201 W , . ~~~~~ Mttdtson, 537 7162 ~~/ Sanitary Permit Number (to be filled in by Co.) ~ ^ (608) 3151 Department of Commerce - ~ ~ ~ State Plan I.D. Number Sanitary Permit Application , ~ Z ``~ ~ In accord with Comm 83.21, Wis. Adm. Code, ptxs be used for scconda<y purposes Privac Law. ma project Address (if different than mailing address) y I. Application Information - Please Print An Ltfortnati APR 2 ~ X005 /~Z -ST ~~o~v property-Owner's Na me GR~IX CO~1N~Y E 1 ~ Lot y Block H ~- ~YT y~ S zON1NG OFFrC ~ D~3~ ~ 9 ddres s A Property Owner's M ailing rty Location pe P ro .,~ ~ ~ -~ ,, / ,ice =~ .~ / /[~ ` ~ ~ J ,f/4J Y`~S(`,Searon l~ City, State Zip Code Pho~ Number ` Gtj.,'t f ~ / _ ~ / Jam'- d " ctrcle o _ T ~ N; g~E o II. Type of Building (check aII that apply) Q /C ~ pe1' he Jae. ~ ~. ~ Sumvision Name CSM Number or 2 Family Dwelling -Number of Bedrooms I ^ Public/Commercial -Describe Use - - - - ^City ^Village ~ownship of ^ State Owned -Describe Use III. Type of Permit: (Check only ante box an lime A. Caanplete line B if applicable) A' I~tew System ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ir tion Bef E ^ Permit Revision ^ Chaage of Plumber ^ Permit Transfer to New Owner List Prevmns Permit Number and Nate Issued ~/ ~ ~ r a ore xp ~ ~ G.. IV. Type of POWTS System: (Check all that a ) ~'Fton -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grime ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressuinal Itt-tiround ^ Holding Tank ^ Peat Fillet ^ Aerobic Treatment Unit ^ Recira-lating Sand Filter ^ Recirculating Synthetic Media Filter bing Chamber ^ Drip Line ^ Gravel-less Pipe Other (ex n) V. Dis reatment Area Information: G / - X o z~ 2 - 0 ~ `` , Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Proposed f) System Elevation C ~ 9y ~ C- , d S 0 /SOJ 9 c- 3 .9 VI. Tank Info Capacity in Total Number Matntfacturer Prefab Site Steel Fiber Plastic ete Cotasuttetad Goss C oncr GaUoac Galbrts of Units Wew Eitstmg G ~ - f~'G Tanks Tanks Septic or iielAing-Tan1c LSO - 2 jJ / jam/ -'` V O Dosing Chamber LS6 ~ 6/~ V VII.. Responsibility Statement- I, the"undersigned, assume resp~bi>ity for installation of the POW7s s6ovm on the attadced phos. pl~untter•s Na me (Print) Pl 's Si gna -1t~/MPRS Number Business Phone Number Fogerty Pium~ing ~2 ~ 7J~- 3s- 9Lo Phmtitrr~~e~ .~it~~tate, Zip C ) "a 7/S-li3S = s 1 ~'~ FAX \ l V ds'i- or- vd c WI 5480). ~~ Spooner , V - Out -4'70 - 7 L Sanitary Permit Fee (includes Groinwater Datd Issu' Si to (No tamps) Approved Disapprov ~, ~ Surcharge Fee) ~ ~ '"'t ~1 s~ 3 00 26 6 Owner en Reason IX. Conditions of ApprnvaUReasons for Disapproval ~ ~~ ~ ~I ~ ~6~ ~cc-`~ a~S /1~1t)5~ SYSTEM OWNER: 1 Septic tan , e uent filter and [~ ~ l o~ I, c b~ Sa-, Gfa ~ ?r ~o~~- c. _ , ispe~sa c ~ must all be service maintained 6 as r mono ement plan provided by lumber. ~ ~ ~ /~ ~~ ~ Aa „` ~ t%rvfe~v2, ~ ~ 2. All setback requiremen s mus a maintained / I t1 /Ylw~of~~ as per applicable code/ordinances. (_ Law ~~ I n.~l~k~ls~->~ P G ~I ~~ r not than 1/Z x 11 inches is size `~ Attach complete places (lo the County only) for the system on page \~ i l~ N o ~ v J ° \ d ~ ~ o. a ~' ~' S ~o oa.. 4 1~ ~" ~ \ ~ ~ o ~, ~ a ~ I it ~ ~ ~ ~ ~ \ ~ ~ ~ ~) ~ v v ~ 3 ~ ~ ~ 3 ,~ ~~ ~ ~ ,~ u d ,~ k. • ~ i ~~ , ~" a 0 v ti '/~ _ ~. V `i ,\ i ~~ ti ~ ~~ ~ t ~ \' l~~ ~ ~ ~ h I ~ I '` ~ ~\~ I I ~ I S I ~\ O V- ,N V ~ i~ h q o ~ ~ v 3 o ~ 0. a ` a ~ ~ °° ~ a o ~ ~ "o o ~ O ~- ~ o I h ~ h ~ ~ ~ ~ ~~ -~ °~, a ~ \ ~ ~ ~ 3 N `' ~ v ~o ,~ ~ ~ ~ 3 v ~ ~ d ~i u ~~ b~ Sc ~ ~~ ~ H N ~„ M \S Do M X d ~ x ~~ M ~ C7 ~~ vl vI a w~scorrsin Department of commerce SUIL tVALUA I IUN KtF'UK 1 D1vi~ion of Safety and Buildings in accordance with Comm 85, Vlfis. Adm. Cade County . Attach corrrptete site phan on paper not less tlran 81@ x 11 Nrdres m size. Plan must include, but not limited to: vertipl and horizontal reference pant (BMj, direction and Parcel I.D. percent slope. scale a dimensions. north arrow. and lo~twn and distance to nearest road. - p Please print all information. Rev~Med ~ Personal eirorruation Y~ Probe ~1/ be used rcr seaordary PurP~ IP~Y I.aw, s. 15.04 (1l (m)l. Property Owner Property Location Govt Lot ~~,~ f 1/4 1/4 "S T Property Owner's Mai "ng Address Lot ~ Block 8 Subd. Narr~ ~ CSI~f ~,$~ Q ~ s'/ ~ --- City State Tp Code Phone Number ^ City ^ V~age ^ Town Page ~_ of Z s'! -Gd0 Date i ~9 N R ~~ E (o~ ~.L.S ~_ Nearest /7o y rT. [[New Construction Use: (~'Itesidential ! luumber ~ bedrooms ~ Code derived design Bow rate ~~ GPD ^ Replaoem~lt ^ Putllic or comrnerwl - Oesal'be: _ Parent material TrG G - Flood Plain elevatiarl if apptir.~We .y/~ ~. © # ^ ~ ~ ^ Pit Ground surface elev. S t< Depth to Smiting facto' ~- in. Sod Application Rate Horizon Oepth Dominant Color Redox Description Texture Stnxxure Corlsisterrce Boundary Roots GPD/ft= in. Munseq flu. Sz. Conl Color Gr. Sz. Sh_ •Eff87 'Eff#2 - / ~ ". L ~,$'- 3 S 2 S'L Z S • S - E?S~ O 6 _ - ._ .~ ,~ lr' in - Bing ~ ^ eoring ~y -' 3®7e ~,e , ,~ ^ Pit Grornrd surface elev. R Depth to tailor ~- Say Apptigtion Rate Horizon Oepth Dominant Color Redox Description Texture Stru-ctrue Corlsisterlce Boundary Roots " GPD/ft2 Yl. Munse9 QL. Sz. Cons Color Gr. Sz. Sh. 'Eft~'1 •Eff~2 ~ T L ~ ~.. ® N ~ ~ L.r ~ v~ tt ~ T • Etlhrer> t ~l =Boo, > ~ < 22o mgA. and TSS >30 _< 1 50 mgll. ~ =Bobs < 3o mgfl and TSS < 30 mgll-- SST (Please Pent) ^ `! ~. ~r "A R . .~!~ ti--~. CST Numtrer .~... ~ ~ ~irPd ~~ Fogerty Plumbing b Perk T sting ~/Dmte E'~ti0" Corrdrirxed Te1BphOne Nurreer7@~ 9R9RR MrKnn~:n D~ //~O~ ~ /_~!L L~%~ Z'/rS Zl~p Isconsln Department of Commerce ND SITE EVALUATION e Division of Safety and Buildings ~ i with (~~ Comm 83.05, Wis. Adm. Code Page 1 of 3 Certified Soil Testine wniN,c~c puc N~aii vn paNci iioc-rCSS uran oTx n mt:rtes In s¢e. Nian must include, but not limited to: vertical and horizontal reference point (BM) direction and Count y , percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. St. Croix _.___ Parcel I.D.# APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (~~ (m)). Reviewed By Date Property Owner Bonte Ron Property Location N , W 1/4 NW 1/4 S 16 T 29 Govt. Lot N R l7 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 101 1 170th St. 39 Pheasant Hills City State Zip Code PhoneNumber Hammond WI 54015 715-796-5240 ^ City [~ Village ®Town Nearest Road F1- ammond 170Th St. .-- New Construction ~ Residential / Number of bedrooms 3 ^Addition to existing building U se: __; Replacement ^ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ftZ •4 trench, gpd/ftZ Absorption area required 1500 bed, ftZ 1125 tr ,DcH; ft~ ~` xlmum design loading rate •5 bed, gpd/ftZ •6 trench, gpolftZ Recommended infiltration surface elevations ~ 24" belowntours () ft (as referred to site plan benchmar Additional design I site considerations install 2 - 5' x 1 tow trenches on contours for 3 br Parent material till Flood lain elevation, if a licable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ® O U ®S ^ U ®S O U ®S O U O S~ U ~ S g. U Boring# i 38 Ground elev 97.5 ft Depth to limiting factor > 72" 2 Ground elev 97.5 ft Depth to limiting factor > 67" ons a ow Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPDIftz in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, Bed ~ Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-13 7.SYR 2.5/1 - sl 2 f sbk mvfr ~cs lm .5 .6 3 13-20 l OYR 4/3 - sl 2 m sbk ds gs 1 f .5 .6 4 20-57 7.SYR 4/4 - sl 2 m sbk mvfr gs 1f .5 .6 5 57-72 l OYR 4/4 - sl 1 m sbk mvfr - - ,4 e _ __ _ nrracin nal Ic ~."~L.~: b 1 40° ~.~~~~p~~J. 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if/m .5 .6 2 4-I1 7.SYR2.5/1 - sl 2 f-m sbk mvfr gs if .5 .b 3 11-22 7.SYR 3/2 - sl 2 m sbk mvfr gw if .5 .6 4 22-45 lOYR 4/4 - sl 2 m sbk mvfr gw lm .5 .6 5 45-63 7.SYR 4/4 - sl 1 m abk mvfr cs - .4 .5 6 63-67 5YR 4/4 - sl 0 m mfr - - .3 ,4 n_~__i._ . h~ri~nn 5 hac inrh~cinnc in vn 4/6 f 0 s (, sg, dl) & occasional SYR 4/4 sl mcluslons (2 f sbk, mvfr) ~ST Name (Please Print) Signature: Telephone No. Henry F. Grote 715-665-2681 address ertl le of esUng D to CST Number Ref # P.O Box 57, Knapp, WI 54749 413/2000 222774 1049 ~'~ l/ d p ,PR~PER?Y OWNER: Bonte, Ron. PARCEL I.D.# SOIL DESCRIPTION REPORT Page 2 of 3 Certified Snil eT~sflnQ Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft2 Bed Trench 3 1 0-5 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 5-12 7.SYR 2.5/1 - sl 2 f-m sbk mvfr gs if .5 .6 Ground elev 3 12-18 l OYR 4/3 - sl 2 m sbk mvfr gs 1 f .5 .6 96.4 ft 4 18-35 lOYR 4/4 - sl 2 m sbk mvfr cs lm ~ 6 . Depth to limiting 5 35-63 7.SYR 4/4 - sl 1 m sbk mvfr - - .4 .S factor > 63" _ Rnm~r4e • Or1ZOn as occasron s , sQ, m e usrons: no w reoo a ere: sou wa as - s s~. Ground elev 96.5 ft Depth to limiting factor > 69" S Ground elev 96.5 ft Depth to limiting factor > 64" 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-14 7.SYR 2.5/1 - sl 2 f-m sbk mvfr cw if .5 .6 3 14-29 7.SYR 4/4 - sl 2 m sbk mvfr cw if .5 .6 4 29-69 7.SYR 4/4 - sl /0 m mfr - - .3 .4 L,z~~ RCIIIQI RJ. ____ - ____ ____________ _ _ _ __ .. _ ~ ..- _._ ., ,, ., ~,,, .,b, ,..~ ,,,,,,,,,,,,,,,,,,,, ,,, ~.~ ~....~.aumvi"~ w, aay uw~ 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-13 7.SYR 2.5/1 - sl 2 f-m sbk mvfr cs If .5 .6 3 13-33 7.SYR 4/4 - sl 2 m sbk mvfr gs 1 f .5 .6 4 33-48 7.SYR 4/4 - is 0 sg ml cs - .7 .8 5 48-64 l OYR 4/6 - s 0 sg dl - - .7 .8 1\CIIIQII~J~ Ground elev Depth to limiting factor Remarks: ~. ~~~ ~.a h1~ N ,~ = 3 ~ rt _~ .~+~ ~ a ~ ; ~ ~ ~ ~~ ~ ~ -~ ~ 3 -- ^o~ ~ Z ~ ~~ ~ 3 ~ J" o~ ~ z s f~ o y ' 7 ~ ~~. ~ ~~ ~~~ 3~ d ~ ~ d t ~ d ~ ~ ~-~ ~ ~` end 9 --~, S ^^'0 ~.e ~~ ,C t r' C ~r Op b N n . ~~~ .~ 1 ~~ o~~ v '~ T o d ~ ,~~~ c~? ~ ~$ N ~n i 0 -~ t ~o 4~ `~1 ~. Wisconsin Department of Commerce • OR'•/~~~ ND SITE EVALUATION Division of Safely and Buildings `~ti'`~ith Comm 83.05, Wis. Adm. Code Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and d St. Croix . percent slope, scale or dimemsions, north arrow,_~ndJocatlQn and distance to nearest roa -- - Parcel LD # t ~ , ~ APPLICANT INFORMATION - P l~ ~~pr~nt ail ih#b ation . , ~ . Personal information you provide may be us§~foitiseCOndary proses (PiivaBy L w, s. t s.oa (~) (m>). Reviewed By Date ~ s <, Z6 Property Owner 1' _ `~ Property Location Bonte, Ron _ Govt. Lot NW 1/4 NW 1/4 S 1 T 29 N,R 17 W Property Owner's Mailing Address ~ °~ `~ r` ~ ~:~ f.~ Lot # Block # Subd. Name or CSM# 1011 170th St. `i ~,. ; ~ 39 Pheasant Hills ur~er ,;' City Statte. Zi Code p ~~ ~ City n(~ Village ®Town Nearest Road 170Th St - ; 6~5240 015 `T~ Hammond WI 54 . aammond I3 ~ ~ residential / Numbecof"bedrooms 3 ^Addition to existing building >':~ New Construction Use: Replacement ~ Public o`r comrrle"rcial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpolftZ •4 trench, gpd/ftZ Absorption area required 1500 bed, ftZ 1125 trench, ftz Maximum design loading rate •5 bed, gpolftZ •6 trench, gpolftZ Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar Install 2 - 5' x 112.5' shallow trenches on contours for 3 br Additional design /site considerations Parent material rift Flood lain elevation, if a licable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ® ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ~ U ^ S X U w~~ v~~~.R[r [ wig t`~rvr~ ~ Boring# 38 Ground elev 97.5 ft Depth to limiting factor > 72" 2 Ground elev 97,5 ft Depth to limiting factor > 67" Depth Dominant Color Mottles Structure nsist n C Bounda Roots GPDIftZ Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. o e t ry Bed ~ Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-13 7.SYR 2.5/1 - sl 2 f sbk mvfr cs lm .5 .6 3 13-20 l OYR 4/3 - sl 2 m sbk ds gs 1 f .5 .6 4 20-57 7.SYR 4/4 - sl 2 m sbk mvfr gs if .5 .6 5 57-72 l OYR 4/4 - sl 1 m sbk mvfr - - .4 .5 Ramarkc• occasional Is inc-usions below 4u" 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if/m .5 .6 2 4-11 7.SYR 2.5/1 - sl 2 f-m sbk mvfr gs if .5 ~ .6 3 11-22 7.SYR 3/2 - sl 2 m sbk mvfr gw if .5 .6 4 22-45 lOYR 4/4 - sl 2 m sbk mvfr gw lm .5 .6 5 45-63 7.SYR 4/4 - sl 1 m abk mvfr cs - .4 .5 6 63-67 SYR 4/4 - sl 0 m mfr - - .3 .4 Remarks: Horizon ~ Has mciusions iu r x 4io rs ~u, sg, at) ac occasional ~ r tc vi4 si inclusions << [sox, mvir~ CST Name (Please Print) Signature: elephone No. Henry F. Grote ` 715-665-2681 Address em ie of esting Datg CST Number Ref # P.0 Box 57, Knapp, WI 54749 4/13/2000 222774 1049 PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT PARCEL I.D.# 3 Ground elev 96.4 ft Depth to limiting factor > 63" 4 Ground elev 96.5 ft Depth to limiting factor > 69" 5 Ground elev 96.5 ft Depth to limiting factor > 64" Page 2 of 3 Certified Soil e7' sting Horizon Depth Dominant Color in. Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPDIft2 - Bed Trench 1 0-5 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 5-12 7.SYR 2.5/1 - sl 2 f-m sbk mvfr gs if .5 .6 3 12-18 l OYR 4/3 - sl 2 m sbk mvfr gs 1 f .5 .6 4 18-35 lOYR 4/4 - sl 2 m sbk mvfr cs Im .5 .6 5 35-63 7.SYR 4/4 - sl 1 m sbk mvfr - - .4 ,5 Remarks: orizon as occasrona s , sg, me ustons; no wa repo a ere; sou wa as s , sg, Remarks: orizon as me us~ons s , sg, o Iona s me ustons , m, m r 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-14 7.SYR 2.5/1 - sl 2 f-m sbk mvfr cw if .5 .6 3 14-29 7.SYR 4/4 - sl 2 m sbk mvfr cw if .5 .6 4 29-69 7.SYR 4/4 - sl 0 m mfr - - .3 .4 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-13 7.SYR2.5/1 - sl 2 f-m sbk mvfr cs if .5 .6 3 13-33 7.SYR 4/4 - sl 2 m sbk mvfr gs 1 f .5 .6 4 33-48 7.SYR 4/4 - is 0 sg ml cs - .7 .8 5 48-64 IOYR 4!6 - s 0 sg dl - - .7 .8 r~ai i iai na. Ground elev Depth to limiting factor Remarks: Q I r ~' 3 ~ ~~ ~+- ~ a ~ 1 3 ~ 9~ 1 ,~ 3 -- ,~ Z ~ ~Y ~ (~ ~z s d ~~ .,r- 9 -~- l.. S ,,..~~//0 ~.O ~~~ 4~~ ~v ~ ~ o~ s ~o~{ Q y .- ~ ? i ~ ~ ~ss ~ ~' 9 ~ ~ 3`~~ ~ ~~ d pA ~ .~ nr~tl h N I'~-'/1 ~O -~ 9 r '__ 0 d ~' a J ~..~J 0 'N 0" _ ~~ c* .;J a ,,, N ~ n '~ ~ d' J ~~, ~ ~~ d v ~ ~ { t ~~ a~~ V d ~? ~ .$ tY ~ 'po d ~ or 1+~.~.~ . ~n i 0 ~+ t a ~ o ~ ~ o ~ -® ~ ~ ~ ~ c ~ ~ o ~, ~ y ~' ~ II Il II 1 '~ ~--~ _ __ I ~ ~ ~ c~ .~... a~ - II y is -~, : ~ -..., ~ i ~ __.._.____. _. I ~._..,_. _. I ~ ~. ~ , ~„ . . o '•~~ ~ ~ ~~ ~ ~~ I ~ ~~ ~~ ~~ ~ti y •.. .. ,~. , ..~.~~ \ .. .• . ~.. s \ _ AA'' ® ~ w '~~CjD r-+ ~y ~. .. .. .~ ... a , -:.. ~, ...:. ~ ~ ~ M ~° ~ ~~:. ~ ~ ~ ~, - >n ~w tx~:...:.~y ~ ~ II ~:~ M ,4 - . ~ ~ ~ ~ ~` I ~ a ~ .e..~.:- ~ + h~ i ~, ... ~- '~:~~_i_'i~s.~ ~-~ V O ~! ~ N { OQ v ~ N~ ~, ~ ~ ~ ~ W~X~-~ a. ~ "' - ~ c ~. ~ o0 C~7 '7 '"'' ~ ~' t0 UI N O 3 s II ~ it W ~ r+ p, ~ II II IV ~ I~ ~sible Pump "~ far wnstruction pwiwses.) \ II` ~~~ ;~' l.z.z~ 1.6 -+ ~~z" NPT DISCHARGE 3.1 ~.6 linimum Mazdmum Shipp'mg Basin Sotids weight iameter Size Ibs/lra 18" 1 .5' l 31 / 14.1 Motor. •EP04 Single phase: 0.4 HI; 115 or 230 V, 60 Hz,1550 RPM, buih in overload with auromatic reset. • EP05 Single phase: 0.5 H? 115 V ~230V, 60 Hz, 1550 RPM, built in overload with automatic reset • Power cord:l0 foot standard lengtfl,16/3 S1TW with three prong grounding plug. Optional 20 foot length,l5/3 S1TW with three Prong grounding Plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and effident heat tlansfec Available for automatic and rnamnal operation. Auomatic modek include Mechanical Moat Switdt assembled and preset at the factory. FEATURES ^ EP041mpefler. Thermo- plasticsemi-open design wafl pump out vary for medianical seal protection. METERS ,FEET a °a 7 x u 6 z s n a 4 O zo? _ _ ; z t 0 Submersible Effluent Pump ^ EP05 Impeller: Thermo- plastic endosed design for irrglroved performance. ^ Casing and Base: Rugged thermoplastic design provides wperior strength and wrrosion resistance. ^ Marton Housing: Cast iron for efficient heat transfe` strength, and durability. ^ Motor Cover. Thermoplastic cover with integral handle and float switch attachment paints. ^ Power Cable: Severe duty rated oii and water resistant. _..__-- o z Goulds Pumps ITT Industries '` ,~ ~,,: EP04 & EP05 Series APPLKATHN~IS Spenificalty designed for the foNowing uses: • Elfluerlt systems • Homes • Farms .d~~ • Dewaterin9 SPECIFICATIONS • Solids handling mpability: • Capaati~: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'h° NPT. • Medhanical seal: tarbon- rorary/cerarnic-stationary, BUNArN elastomers. •Temperature: 104°F (40°n corrtinuous 140°F (60°C) irrtem~ttent • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. 4 6 8 utPnclrr ^ Bearings: Upper and h>wer heavy duty ball bearing coo- strunrion. AGENCY LISTING canadan standartk 0.sced~ai "Fae~tn3BS4v EPOS 70 12 m'fi Goulds Pumps ITT Industries Fogerty Plumbing & Perk Testing Spooner, WI 54801 Combination Tank Component Cross Section Approved Manhole Covers With Warning Labels and Locking Device / 4" Min. Above Final Grade 4" Sch. 40 Vent > or = to 12" Above Final Grade o Weather Proof Junction Box Electric per NEC 300 & COIvHvI. 16.28 WAC ,--, Alternate Outlet Location W/Approved 4" Sleeve _ Inlet Approved Efrluent Filter Baffl~ < or = to 1/8" Particle Size p Force Main Diam. _ " eep Hole or Anti Siphon Device B Pump Off Elev. C Tank Mfr. fv,~~~ D Dose Tank Elev. Vertical Difference Between Pump Off and Distribution Pipe =1~ Minimum Required Supply Pressure ...................................... _ ~ ~~ FT. of Force Main x L S yFriction Factor/100FT.... _ . 92- , ~~ Total Dynamic Head .................... _ ~Z Number of Doses ... _ ~ Per Day Gal. Per Day/ #of Doses = ~[~ Gal. Volume of Backflow .................................................................... _ ~~Gal. Total Dose Volume ..................................................................... = ts9 r~Gal. Pump Tank Capacity ~ Gallons Pump Tank Vouune ~~ Gal/Inch Pump Mfr. G D Pump Model ^ Minimum Discharge Rate = _~ GPM Alarm Mfr. r' p Alarm Model _. m Dimensions Inches Gallons A ~ 7, 7 ,~~d B Z ~3 C // 3 ~~ D 1~ /L P d' Total= ;~'3 7~1 y. 99' Z Bed Tank per COMM. 83.45(5) Anchor Tank as necessary to negate buoyant forces per COMM. 83.43(8)(g). ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~,~~~ .~ ~.~ ~; s Mailing Address //s/ //D!~ S ~ ~ ~ ~i ~ /i ~ ~ r( w~ sy~~ 7 Property Address / 72 ~ (Verification required from Planning Department for new construction.) City/State , 1 ~ _ ~" Parcel Identification Number ~/~- J6'J~~39- ~ LEGAL DESCRIPTION Properly Location ~/c~'/a , ~ 1/a ,Sec. /G ' T ~N RAW, Town of f,~ita~ar~syJ~ Subdivision /1'i,~,F ~~~ r~'~zLs' ,Lot # _„~. Certified Survey Map # `~ Volume - ,Page # Warranty Deed # ~~' ym/ ,Volume ~,~_, Page # // 3 Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE 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 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 conditionand/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds set forth, herein, as set by the Depaztment 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 Zoning Department within 30 days of the three year expiration date. ~~_,.1~ SIGNATURE OF APPLICANT N / 7 /05 DATE r OWNER CERTIFICATION Uwe certify that all statements on this form aze true to the best of my/our knowledge. Uwe amaze the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office _/_/_ SIGNATURE OF APPLICANT DATE ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. ****** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. ALE tti11FORMATION Owner Permit ~ - - utarun rrv^.ianc.._...^ Number of Bedrooms O NA Number of Public Facip<Y Units : ~~ Estimated flow !average! ~ gaUd Design flow !peak!. !Estimated x 7.51 ay Soil Application Rate aUdayfft2 Standard InfluenilEfNuent Quality Monthly averse` Fats, Oi{ & Grease iFOG1 X30 m9/L Biochemic~ Oxygen Demand lBODSi ~0 m9~- ^ NA Total Suspended Solids ITSSI <_150 mg/L treated Effluent Quality Pre Mornhly average _ Biochemical Oxygen Demarxl IBODsI Si0 rng/L Total Suspended Solids ITSSI X30 m9fl- O NA -- Feral Co6fam lgeanetric mean) 5t0• cfu/700rn1 Maximum Effluent Particle Size Ya iR dia. O NA Other; O NA "'Values typical for M-astewater and t~ eta. MAINTENANCE _SCH~l1 Service Event Inspect condition of tank(s) Pump out contents of tanklsl Inspect dispersal cellis) ~., Ctean effluent filter Inspect pump, PAP controls & alarm Rusfr laterals and pressure test SYSfB~ SCE ~ ~ Septic Tank Capadty _ al ^ NA Septic Tank Manufacwrer .. ^ NA Effkrent eta Manufacturer ^ NA Effluent f~rx Model _ .p ~` O NA PtxnP Tank Capacity g~ ~ NA Pump Tank Manufacduer ~ ~` Pump Manwfacturer - ~ ~ Pump Model ~" y ~1 NA Pretreatrnent Unit C] NA ^ Sid/G~~ ~~ O Peat Filter - ^ Mechanrcai Aeration ^ Wend O D'rsinf O Otherc Dispersal Ceplsl ^ NA ln-Grormd l~avitt-) ^ In-Grownd l~essurizedl O At-Grade O Mound, ^ Dry-Erne O Other: Off: O NA Odrer: ^ NA O~ O NA Servitoe Fr+egrrencl/ ^d monthlsl laa~r,r,„„ 3 „ears! a NA At leas[ awe eery: ~i ~yearlS) When c age and scwrt eQuals one-Uurd (X~1 of tank vohsne O NA O monthlsl ~ S y~l 3 O NA At least once eery: ~ yearisi O momhlsl O NA At least once every: J . ( year(s) O mondrlsl -R,J~IA At least once every: O yes) O monthisl C1 NA At least once eery: O yearisl ^ monthlsl _ ~[ NA At feast once every O year(s) ANA MAINl.'~~~ INSTiiUCT10tNS are of the fopowing ~ certificates' Inspections of tanks and disperses cells shop be .made by an uidividual ~'~ O ator. Tank Master Plumber; Master Plumber Restricted Sewn; POWTS lnspect~; l'OWTS Maeitainer% Septa9e Serv~g mks ~ teaks, of the tanklsl to ideritifi/ any prig or ixoken hardwat'e, id~Y any inspections must 6ickide a visual inspection for any back ~ ~ of effluent on the ground surface. measure the vo~me of comliiced sludge and scum attd to check and to check for any Pced~9 to check the effluent levels in the obsen-ation pipes aces the The dispersal cep(s) shall be vY inspected ~ effMrent on the ground sinface may indicate a fairing caiditiai and req of effluent on the ground surface- The Pig immediate notification of the local regulatory authority. When the combined accumulation of sludge and scu 8ervi~ciyng O~~ ~d a~~~)ofr~ o~~~e ~ chapt NRe contents of the tank shall be removed by a Septag Wisconsin Administrative Code. ~~~ pretreatm~t All other services, including but not lanited to the servicing of effluent filters, mectian~~S Mfe~ ~a~ompon units, and any servicing at intervals of <_12 months, shall be performed by a certified A service report shall be provided to the local regulatory authority within~l0 days of completion of any service event. . iartT UP AND OPERATION For new construction; prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals that may impede the treatment Process and/or dam~8e the dispersal ceQlsl• ff high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soa conditions are frozen at the infiltrative surface. During power outages pump tanks may fGl above nomnal higliwater levels. When power is restored the excess wastewater wilt be di~harged to the dispersal ceU(sl in one large dose, overloading the cell(si ~ may result in the backup or surface discharge of effluent. To avoid this srtuatrai have the contents of the pump tank removed by a Septage Servicing Operator prig to restoring power to the effluent pump or contact a Plumber or POWTS Wlaintainer to assist :in manria0y operating the pump controls to restore normal levels within the pump tank. Oo not drive or park vehicles over tanks and diispersal ce~l~. 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 arrprove the performance and Prolong the Gfe of the POWTS: antibiotics: baby wipes; cigarette butts: condoms; cotton swabs; degreaser's: dental fkus; drapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; 9r~e% herbrcrdes; ~~ 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 sortable replacement area has been evaktated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance mid come and should trot be uifringed upon by structure, lot fines and wells. FaGiire to protect the replacement area will required setbacks from existing and proposed a ~ replaceitient area. Replant systems must result in the need for a new soil and site ev~uation to establish comply with the rules in effect at that time. ^_ A suitable replacement area is not available due to setback and/or soli 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 srte 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 CONTAp~I LETHAL- GASSES ~D/O~~U~YUi~ ~C~OF A =BITTER A SEPTIC, PUMP OR OTHBL TL~ATMBGT TANK UNDBi ANY CIRCUMST PERSON FROM THE INTERIOR OF A TANK MAY BE DlFFlCULT OR IMPOSSIBLE. . #221180 __ ~ c en goner WI 59ffi1 (715) 635-9609 ~ POWTS INSTALLER POWTS ~ _ ~` -v -Name Name l Phone p~ Phone f'r- ~ - °7is- ~3 LOCAL g~.ATORY AUTHORITY SB>TAGE SERVICING OPERATOR (PUNPBi) ~~ ~ Name N~ ~1 ~.~~-}~~p~C~/wJ{~,~~ Phone Phone ~s pV au _ This document was drafted in compliance with chapter Conan 83.221211W11 lldl&ff) and f33.5M11, 121 & 131. 1lr~nsin q~niitisvative Code• ,~.t a °° ~,;~ ~.5J3PAG~113 ~~ ' STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number This Deed, made between Ronald C . Borate and Dine M. Borate Grantor, and Matt ew T. Haw ins an isa aw ns; husband and wife as survivorship marital property - Grantee. Grantor, for a valuable consideration. conveys to Grantee the following described real estate in St Cr01X County, State of Wisconsin (the 'Property'): Part of the NW ~ of the NW ~ of Section 16, Township 29 North, Range 17 West, in the Township of Hammond, St. Croix County, Wisconsin, described as follows: Lot 39 of Pheasant Hills filed May 5th, 2000 in Volume 7, Page 86, Document #622544 Together with all appurtenant rights. title and Interests. Dine M. Borate Grantor warrants that the title to the Property is good, Indefeasible In fee simple and free and clear of encumbrances except Easements, licenses, zoning ordinances, and restrictions of record Dated this 1 6th r >day-of February 1 6 2001 , ~~ ~ - C~T~ +V~ (SEAL) ~~Y ~ "` ~ - l ~"' ~'~-- (SEAL} Ronald C. Borate AUTHENTICATION Signature(s) (SEAL) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by §706.06. Wls. Stats.) THIS INSTRUMENT WAS DRAFTED BY Ronald C, Borate 1011 170th St, Hammond, WI 54015 63'94 1 Y.ATHL.EEhi H. WALSH kEGr_STEk OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD 02-28-P001 f1:~5 RM NARRIiIiTY DEER EY.EMP? M CERT COPY FEE: COPY FEE: TRANSFER FEE: 82.50 REEGRDING FEE: 10.00 PRGES: 1 Recording Area Name and Return Address Eu51 e V :. ! le~ L3a,,,,k~ !v. ~ . 130! Glee ~1_~ Sfe. ~ Z ~f-IT,t ~i b ~~,.. w ! ~~! ar 6 018-1083-39-000 Parcel Identilicatian Number (PIN) This 15 riothomestead property. (is) (is not) ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. Croix County. Personally came before me this 'L.61-h day of _FP ruarV 2001 ,the above named Ronald C. Borate Dine M. Borate to me known to be the person R who executed the foregoing instrument an/d~ acknowledge the same. ~~ Cu .l~-~ .-n i-~ n jct r- ~•e.,~ ~~ L ;,~ ~ Notary Public, State of Wisconsin My commission Is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ~~ifi~~LY~ ! ') necessary.) ' Nam's of persons signing In any capacity must lx typed or printed bebw tixir signature. STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 1 - 1998 WiaCOnatn legal (31ank Co.. kw. Mihwauk«. Wis.- " St-Croix County Map Output Page Page 2 of 3 44 ~2 ~ ' ~' ~ 597 w 41 ~, 614 613 ~ ~ ~, ~,' 25 ~~ ~ , i ` ~'~ `~ W '~ 40 ~ ~ '~~, ., rn 612 ~~ a~ ~~'s ~~ ----__ ~- ~~ ~ 4~t4.'t9 319:68 ~,N ~~ ' I _ ~ ._ . _.~~ _ _..___..._m__...~____. __. 8 ~~ _1 '~ , - `~ ~ ' ~ 6U9 ~-----~~ ', ~ -'~" ~~ LoT1 w N _ . --~"~"~ f ~~ ~ ~~ :. ~ !/ http://69.5 8.147.26/servlet/com. esri. esrimap.Esrimap?ServiceName=StCroixOV &ClientV e... 7/ 16/2004 Parcel #: 018-1083-39-~~~ 04/25/2005 04:43 PM . * PAGE 1 OF 1 Alt. Parcel #: 16.29.17.611 018 -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): " =Current Owner *HAWKINS, MATTHEW T & LISA M MATTHEW T & LISA M HAWKINS 1151 110TH ST NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 984 172ND ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.100 Plat: 2297-PHEASANT HILLS '00 SEC 16 T29N R17W PT NW NW PHEASANT HILLS LOT 39 3 100AC Block/Condo Bldg: LOT 39 . Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-17W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 02/28/2001 639401 1593/113 W D 05/05/2000 622544 7/86 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 56724 33,200 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.100 27,800 0 27,800 NO Totals for 2004: General Property 3.100 27,800 0 27,800 Woodland 0.000 0 0 Totals for 2003: General Property 3.100 27,800 0 27,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSM ENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00