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HomeMy WebLinkAbout018-1094-09-000I I I I I I ~ d a . I No-~ c ~ o ~ I c n ~ I ~ ~ ~ I ~ I v I °~ I ~ I 3 I I I I o I ~' I o• I N a I _z 0 I =R w I o. I I w I z I I y I I I I I I I I I I I I I I I I I ~ ~ cd O .- n >11 ~ O rn ~ c > > ~ O ~p c ~ ~ c cn ~ m ~ v (n Z Cn Z D d co D co D y m a n W ~ - 3 ~ ~ .. N O N ~ ~ ~ n c c c Q v d ~ m m 1 1 ~ ~ 01 01 ~ ~ O N C co m (/~ O N m A ~ ~ C A C7 W S Z1 01 D n n .. OD A N O' . 7 ~o~mc'' C.a > ~ ~? rn > ~ wm nm co p Z ~~ ~ ~ ~ ~w o -w 7 ~ D ~j O? N ~ . O ~ .C-•C~ ~ fvZv aN ~, _ Ao a~D~~' N w m Q W ~ n .C. O A ~ N C y O O ~ fD 7 ~ 'O fD con oo m~ N .+ ~ j A ' A !v . p ~ c °~n°3 mm • N ~ X ~ II W O 7 N O O °o °o ~- y Z 0 o' N 7 a z 0 o~i 0 7 w a Z 0 N O 7 ~ 3 'm o ~ p o rn > > fn Z !/~ Z D ~ D cn D y n fl. W r. 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Z ~ w A G C a A b m b N O W ~'0 ~00 , ti 0~p N Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and ~3uilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township D.S. Construction, Inc. Hammond Townshi CST BM Elev: Ins ~" Elev: BM Descrip~~~ n: / ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ % ~ ~jO d Dosing L~ ~ a ~ ~ d~ Aeration Holding T SETBACK INFORMATION TANK TO ~/L WELL ~' BLDG. Vent to Air Intake ROAD Septic l C / i ~ ~ ~ ~ ~ ~ Dosing S ~i Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand ~~!!-1_D rj GPM Model Number ~ v '3'S-~ TDH Lifter / Frict~n~~s System T~j CJ~ Ft 7 Forcemain Length ~ Di ~~ Dist. to/Well ' SOIL ABSO~FtPTION SYSTEM (~ ~~,.h (,,~~ ~,.~~~ ELEVATION DATA county: St. Croix Sanitary Permit No: 420516 0 State Plan ID No: Parcel Tax No: 018-1094-09-000 STATION BS HI FS ELEV. Benchmark ~ ,.L /~. ~ (~ ~~ ~\ Alt. BM S '~'_ ~V ~?~ 3 Bldg. Sewer ~,.s y3. SUHt Inlet ,a ., ~ ~ zp St/Ht Outlet ~- Dt Inlet ~ --~ Dt Bottom 2 'y I g ,~ S-. 3 qo = ~ e r an. ~ 0 2 ~ G!!0- V Dist. Pipe Z /~ ; .Z ~ d. a Bot. System - Z Final Gra ~.~~ .~ St Cover ~. O~ ~ ~_ 3 BED/TRENCH DIMENSIONS Width ~+' Lengtnh ~ No. Of Trenc es PIT DIMENS S No. Of Pits Inside Dia. Liquid Depth ~ /n (~r YY~ SETBACK INFORMATION SYSTEM TO P/L ~ BLDG WELL LAKE/STREAM EACHING CHAMBER O Manu tur r: ~~ I~r~Yl Typg Of Systr~ /W~. to 1 ~- ~ ~ ~E~ // Model Number: DISTRIBUTION SYSTEM Lr Header/Manifad 3 / it Length Dia Distribution P~pe(S> / ~ Il~ ~.~' ,3 ~ l Length lY Dia a x Hole Size ~~~ x Hole Spacing Vent to Air Intake ~ (( S~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~hd t~ Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center S ,~ Bed/Trench Ed es g To soil p r Yes ~ No U Yes [~ No ~~ - _ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~~ /n~ ~ Inspection #2: / / Location: 994 167th Street Hammond, WI 015 (NW 1/4 NE 1/4 12 T29N R17W) Prairie Run Lot 9 `~` Parcel :12.29.17.749 S' i ~i0 v"' '..~`-~ ~'I~-- t"Qi1/11~.2 a~p17~~ G~~/? OZ- `i - r~~-~~ `c~ l l~tL%Ih~ 1.) Alt BM Description = ~~ ,- J 1 , I ~ 2.) Bldg sewer length = 3D1 ~~~ x ~Q~laly ~~ ~ ~-0~' Ls~ ~'~"~{~~"~'~ E~ r ~w~' -amount of cover = 'vuJ G ` ~ 5~,, - I ~ `~ L _ _ - ` ~~, ~. ~ Gl „ / _ [._/J ~ 7 (~-r.~ -,- Plan revision Re ulred . es ~, No ~ T ~ - J ' ~ ~ ;~;r ~ I I q ~- Use other side for additional ~ ~~ ~~ ~ ~"' information. I~ 1_~ ~~ II I - - - ~ - --- -- - -. ~i~-- J ~_ _ ~ _ y _~ J Date Insepctor's Signat re Cert. No. SBD-6710 (R.3/97) r i Safety and Bulldings Division ~" ~ ~ ~ ~ 201 W. Washington Ave., P.D. Box 7162 I ~~'j '~~~~'°,~ ~ Madison, WI 53707 - 7162 Qe artmerlt of Cpmmerce (~$) 266-3151 unitary Permit. Application In accord with Comm 83.21, Wis. Adm. Code, personal informaticn you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) I. Application Information -Please Print Atl Informs Property Owner's Na me City, 'on ~~~ ZOt~;ti CAF-FILL= Zip Code ~ Phone Number Id. Type of Building (check all chat apply) ~n~,~k~.A"°~e--~ TF.ff;~- 1 or 2 Family Dwelling -Number of Bedrooms ~'4-tit a,rv~a~~Z~iLv~>f' ^ Public/Commercial -Describe Use ~ --- I ^ State Owned -Describe Use _ County S"~t'Y~ i' rSanitary Permit Number (to be filled in by i - State Project Address (if different than tnailing ParceE # Lot iY Block ~ f Prnprrty Location ~ .-- tµ,~l4,Section / j F i (circle o ) T~~N; R~B~ Subdivision Name CSM Number ~GCity^uVillage~ownship of-~~`'"I" III. `T'ype of Permit: (Check only one }sox an litre A. Complete lime B if applicable) A' New System ^ Replacement System ^ Treat:xt;;ntiHoidutg Tank Replacement Oily ^ Qther Modification to kxisting System i c I ~ i ~ ~ List Previuas Permit Number and Date Issued B. ^ Permit Rsnewal ^ Permit Revision ^ Change of ^ Permit Transfer to New j Before Expiration ~ • Plumber i Owner ~ f / ~ 0 ~ / ~ ' O/ ~g/D ~v IV. T e of FOWT6 System: (Check all that a 1v) ~ ? Non -Pressurized In-Crround ^ Mound > 24 in, of suitable soil ^ Ivlound < 24 in. of suitable soil ^ At-Csrade J Single Pass .Sarxt Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ~) Aeroisic Treatment Unit ^ Recircuiau~~ F'Iter ~- ~`~ ,~- ors ~ ^ Recirculating Synthetic Media Filter.~,~Leaching Chamber ^ Drip Lina ~ Gravel-less Pipe i C?ther (explain) -~7°' ~' V. Dis rsal/Treatment Area Inforrtiatian: Destgn Flaw (gpd) Design Soil Applicarion Rate(gpclsf) Dispersal Area Required (sf, Dispersat Area Proposed (sf) System Elevation II VI. Tank Info Capacity in I Total Number Manufacturer Prefab Site ~ Steel Fiber Plastic I Ga llons I Gallons ~ of Units ~ Conerere ~ Constructed i Glass Ncw Tan4s Existir rans~. $ ~ 1 ~ ~ i ~cpnr. or rtoiamg t 3nr< I X ~ E r~_ ~fif ~ ~ !~/t ~P.~t f/ ! iC ` ~ i uasmg t;namoer t ~I..VII, Itespattsibtlity Statement- I, the'undersigtted, assume responsibility for iststallation of ikte POWTS shown on the attached plans. i Plumber's Na the (Print} i Plumber's Si gnahsre J 1PRS Number ! Husinoss Phone Number ~~ ' ~: f+fa rx SCI, ~ a i't'~r ~ ~ ~ ~- ,- 3 e• 2 ~ Plumber's Addre ss (Street, City, State, Zip Code) Saratary Permit 7udes rou Date Issued i Issuing Agent Signature (No Stamps} Approved ^ Disapproved 5u:clvirge Fee ~ ~ ~ ^ Owner Given Reason for Denial IX. Conditions of ApprovaUReasans for Disappro~'al - - ,GL~~ ~`~~-- `~'~- SyS.~P~Y~• .~-Cam- ~v, ~~?~~.~o`n. -~0.~~ ~//~o~~. iLJ Attach cornpiete plants {to flit: County only]-for the system on paper sot less than 811 x 11 inches in size SEPTIC '.~`AN1C € 'r'UMP C1-'.~:M?Er"c ~k;;SS ~~;CTIOIyT h1;i ~ ~CiFwCAi.~.CNS_ . 4" CI VENT i~IPE 12" MIN. ABOVE GRADE ~ WEATHERPROOF ? 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR xNTAKE ---- WITH CONDUIT MANHt~LE COVER W ! PADLOCK ~ FINISHED GRADE ',~~ARNING LABEL 4" CI RISER - ;,~-,...~. 4 " MIN . r ~,~" IN. 6" MAX, ~~ ~'~ i ~ e ° 't +~ f z ~LE.4 ./'' L ~ 1~ ~r~'~,/ ~ ~ ~ ~~ WWATER TIGsiT SEALS ~ ~A5• ~ i ', IGHT ~ e , ~ ~IAPPROVEO A S~'L ~ JaINTS WITH tPPROVED ~ --~- ~ ALM APPROVED RIPE DNPO St~LID "~"` ~ ~ SON SO~.IDrSOII T 'OIL PUMP OFF ELEV . FT . --~-- ~ ~ ~OFp '~'~ RISER EXIT D PERMITTED OTiLY ~ F TANK MANUFAC'T'URER HAS APPROVAL 3" AP?ROVED BEDDING UNDER TANK CONCRETE PAD ~p£CIFICA'I'iGNS 5EPT?C 1 DOSE TANK MANUFACTURER: ~J~~ Ir'°t.~MBER DOSES PER DAY': TANK S_ Z"~ES: SEPTIC ~ GAL, DOSE VOLUME I~'CLUDTNG DOSE 8ya GAL. FT,O4v$ACK: 1,5~/ GAL. ALARM MANUFACTURER: ....~-.~:L._a. ~'s~'% CAPACITIES: A = ~,~ INCHES = ~~_.GAL. _`_w~___. MODEL NUMBER : ,U~ ....~ SWITCH TYPE: ,yy~~,-c F~ - 2 INCHES -GAL. PUMP MANUFACT',JRER: ~'~,~~~./~s~` C = ~ INCHES = 1~8 CAL. MODEL NUMBER : ,C' ~ SWITCH TYPE: .~~ ~ 35~- D = _..~._ REC,~vIRED DISCY~.ARGE RATE GPM-N PUMP ~ ALARM 4~'IRING A VERfiICAL DTFF£RENCE SET6JEEN PUMP OFF AND DIBTRiBUTION PIPE + MTNIMU NETLJORK SUPPLY PRESSURE . + FEET FORCEMAIN X x•64 FTI100 FT. FRICTION FAC'~OR /~~. / TOTAL DYNAMIC HEAD 3 F£R I LHR 16~ ~'AC . ,~1~ FEET FEET /. 7 FEET _ r,~~ FEET Z•~~ ihTERNAL DIMENSIONS OF PliMP TANK: LENGTH ---° ; WIDTH ~--' DIAMETER `'~"' SIGNED: ~,~~,~~~~~.,~~'~ LICENSE N'JM$ER: ~'~~',~~'- DATE: .~ J~'>' ~3 _ 11$8 ~Oi~~~~ PR~~~ C~ ~aF ~ ,~'. r~ r.,. ~ APPf~90JlTlfli~ Speatical~ des)gned for the foliawittg uses: Efftuent systems . Names • FarR~ + Heady duty Sump •'~atertransfer • l)~atering iIPEGlFtGAt'ltlif~6 Pump: EP04 • SpNds handling capability: 3/~' n'1~drtUR1. Capachles: up to 55 GPM. • Total hers: up tD 24 feet, • ®is~args size: ~,~?~ f~IPT, Meoharrmal seal: cartmn- rotarylceramk-statlanary, suf~-f~ elastomers. • Temperature: i1~4°F (40°C) rontlnuous 14t1°F 60°Cr intermittent. • Fasteners; 3t1Q serer stainless steal. • le (~ Nnning dry without ti8f i1ag8 to p,CtlrnpaneittS. 1`Y~: ~5 • Stflld$ handling capability: ~a' maximum. " Ca~citiss: up to 60 GPM. • Total heads: up to 31 feet. DI;~CI#arge 5128: ~ ~f3` H1PT. • l~fecfianical seat: carbon- rotary~ceramlc~stationary, AUlwh'f~t 6fAStt3rnerS. • ~ 04°F (4t1°C~ CgtftltlUOtlS 140'F ~Q°C} irlt~mittent. Ql of 1~.7f71~1i ~. • Fasteners: 300 series stemless steel. • Capable of running dry without damage to campoaents. MRtot': • EPp4 Single base: 0.4 HP, 115 or ~3Q V, 6tD Hz, 1550 RPM, built In overload with automatic reset. • i:PQS Single ph2se: 0.5 HP, 1 i 5 V, 60 Hx,1550 RPM, built in overload with automatic reset. • Power cord:l0 foot standard length,l Sf3 5,#TO with three prang grounding plug. i~ptlonal 2~ faot fength,1613 SJTW with three prang grounding plug ;standard on EP05). ua~RS FEET ,o~- 6 5 n 7 p~ 4 F Submersible y Effluent Pump ~~~~~ 3871 EP05 r Fully submarBed In high grade turbine oil far iubr+cation and efficient heat tr8netar. Available far automatic and manual aperatien. Asttomatls madeta U~Utde t~aal Fiaat $wttch aaaacnbled and preset at the faattut-. FfEAT11t~E8 sf EP04 impeller: Thermo- plastic Semi-open design with pump out vanes far mechanir~i seal protection, ^ EP05 impeller: Thermo- plastic eaalt-seddesignfor improved performance. • fasiitg and Base: Rugged thermoplastic design provides superior strength and cuROSIOn. rQSistanca. • Ailator lfttttRlnQ: Cast iron for effldent ht~et transfer, strength, at'Kxl durability. ^ ~otOt firer: Themropias- ticcoverwith integral handle attd f~ SWltclt atbu~ment points. ^ Powsr Ga61e: Severe duty rated aW anti water rosistant ^ 13eaaf~tg;: Upper and lower heavy duty baf! bearing construction. 1~E11CY U8TfNG Nita 8fat~da ~ {CSAi1li}~mopde~numbers In yr Vr NA~'.) 1 3 ~~_ f ' R ~_~_ t i I i 1 ~:~ t 0 ~ ~ ~.. j ` I .~ s i 5 ~ f '~ ~ 4 ~ ~ t J I I s f I On ~ n 9 0 9 fi b fl 2 OPM tt 2 ~ $ 8. ,t tz msfi ~ ~I. ~YP~ Safety and Buildings Divtston ~°-_, ~ ~~ ~~ ~ ?Al W. Washington Ave., P.D. Box 7162 Site Addroaa ` ~SCO~~~~ Madison, WI 53747 - 7162 ~ 9 ~ ~b ~~ ~~ Da artment of Commerce 5aaitary PermitNutnber S~~y permit Application ~~D s16 td with Comm 83.21. Wis. Adm. Code. petsoml informtuioa you provide ^ Checfc if Re ion Ia atxo ~ ~ used tot s Priv Lsw, s15. 1 m 5ata Phm 1.D. Number T~~ I. Appllcstion Yatormstioa -Please Print AII Information ~~ •.~ 4~'~ r rr~ p Nuatber Property I,ocuton . ~~g rty owner's MaiUng A SO / fGr ~, ~" • ~GrJ!4 ~ i4: S/? T -~Y N, R /? ~i~a ,~/.'l/e'r e sT S~ umber Lot Number 9 Block Number City Stste Zip Code Subdivision Name C Number ~.~, O~ ~., ~ ~ ~ ~a-.mil/ ~ /~l.~f~ ~ ~ ~ S. Dcuy II. Type of Buildln8 (check all that apply} ..s P" s,,,~`~ ~1 or 2 Fatas~y DweUirrg -Number of Bedrooms ~ ^Village ~fo filss sye ni o/J~ ^ pttblWCommerciai - Deacriba Use Naat+est Road ^ sa-te owned /G T `~ onl one bmt tm line A (numbet'ln~ scheme for internal use}. t^,~tpiete line B it appgcsble} III. Type of Permit: (Chxk y For County use A• 1 New 2 ^ Replaceaoent System 3 ^ Replacemcat of b ^ Addition m S stern Taak Oni stem Permit Number Dace Issued B. ^ Check if Sanitary Permit Praviousty leaned IY. Type of Permit: (t'r'heck ail that apply)(ntunbering scheme is for internal use),~~.~~ Constructed wetiand 44 ~ Noa -Pressurized In-Ground 21^ Mound 4a ^ S~ ~d~r 41 ^ Holding Tank 48 ^ Single Pass SL ^ Drip Line 22 ^ Pressurized Ia-Ground 3p [} Other 4S ^ at-Grade 46 ^ Aerobic Treamneat unit 49 ^ Recircula ' ~ ~ ~ b ~r V. D tmeat Ares Information; ~~ s7"-`,~ a r' Dm~n glow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Race stem Flevttioa Final Grade prop~d Itata(Gals.lDays/Sq.Ft.) (Mirr./Inch) ~~, ,~ d Elevation ~ 9~',lD ~/~'~ ~' ~~~ z~'~ ~ T ~ Prefab Site Steel Fiber Plastic 'VI._TGSLk Info Capacity in Total Number Manufacturer Coxt~ete Conattueted Glass rt~ttrnu GaUoas of Tanks sepfle ~ xow:n Phaabar's Na plumber's Ad ~d2Av !t" I, the tld~ assume rn oAnuu Plumber's Si;nature , ~k.~G State, Zip Coda) for to~an°.r~. of the POW'iS shown on the 9'~'!J ~~-S~~ -.31' z / ` ~~~ :____~ VIII. C !De artment Use ON - ent Si nature too Sanitary Permit Fee (includes Groundwater Date Issued lean Ag 8 ~( Approvod ^ Disapproved Sutcbar8e ) / ~ ^ t?wner Ciivea Initisi Adverse 2~~- ,~ Deoermh~ioa YX. t^,ortditfioaa of ApprnvsUReasoas fo ~-Pprov~ 1 IMA~'`-~°~'"""'~'. rill u~a-~- ~a.~c- ~2 - ~ `~~ aO ~ --~~s . ,1t t°t°-ping{ (to~C ooly)~or the is ~ A~aPa~831i x 11~'"'"~x~~~ ' SBD-6398 .05101) ~"- Sramps) ~r s~i ~ o.JS ~' .C~i ~ ~ .~~' ~ r!` c. ~G~--A/ T G~.tJ dG`~ ~i ~ ,r~ cf,~-~i ~~ f l% p~G- /DD- a ~- ~~~~ l`a ,dyG 9~,~d .-- / ~~ - ~~ l~/~ll© ~~~~~ " )1e Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of 3 County ~ / C - Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 7 ~ include, 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. Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). .2q Property Owner Property Location ~( 5 Govt. Lot yW 1/4 ~E 1/4 S / ~- T Z N R / ~ E (or~$ Property Owner's Mailing Address f ~ Lot # Block # Subd. Name or CSM# ~ . s ~~ ~ ~ q Gf i City State Zip Code Phone Number ^ City ^ V illage [~ Town Nearest Road l~vHpy2.~ w( SKa/S (7/S) 79G- Z-~!3 /~a /oUf_; /~r~, [~ New Construction Use: [~' Residential /Number of bedrooms 3 _ `~ Code derived design flow rate °/.SG /(® oG GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~i~~/ Flood Plain elevation if applicable ~ ft. General comments .SYS~t ~"'1 -P/-~ ~ . To~ ~y~ G Go w ~'' q ~ /G ,. and recommendations: r a Boring # ^ Boring ~ ~o y n ~•:TrCf~f?( ~, eG ,.V .. ® Pit Ground surface elev. 9~•.~U ft. Depth to limiting factor ' ~ licatlon to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun ry ^' Roots GP pNt2 ~' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ',~ • 1 *Eff#q ' ;~ ~ '`Eff#2 1 -/Z ip Si Zmab ~ S 1 ~~ ~:`~~ . 8 Z ~~ r y e ~ si / Zrr~r b --~ c - . 5 8 - 10 ~~t m5 D ml - - •7 /•2 ^ Boring Boring # ® Pit Ground surface elev. 9~ S~ ft. Depth to limiting factor / / in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z 0 y/ --- s; I Zrrab ~ c - . 5 . 8 3 0-99 10 c~ m OS m 1 - ~ 1. ~~f b~ 9 . /~ ru ms's • 8 ~. ~~ * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ~ Signat~ CST Number }dam ~~hurrlctl~er' ~~5 ----.~~~ 253 3D9 Address Date Evaluation Conducted Telephone Number 2113 8~~3 S~. Same,~5~e-E, c,~J t SyoZs //-2g-p~ ~~~5)Zy7-~UUg Slill-253311 (KU7/l)U) Property Owner 7~7r~Lt~fCJ/^2 S Parcel ID # Page ~ of ,, Boring # ^ Boring Pit Ground surface elev. ~ ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ O-I~{ 10 31 - Si! 2rrtiibk m~r ~S (v~ .5 . 8 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = GODS < 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. SBD-8330 (R.07/00) .. ~ PAGE ~ OF~ NAMl~ ~ ~ k ~'~- ~ LOT# cl L GAL DESCRIPTION il/w ~ NF ~ ,~ ~ ~- T Z `t ,N, R, 1 ~ E(o~ 0; 0. a (3-~ M 5 SIGNATURE ~~;E~~ ,r-~ DATE, S7C CIrOI[~C COIJNI"Y ~ SI?PTIC TANK MAINTENANCL~ AGRL~EMLNT ,~ ~. 5 '. • AND ~~ ~~"'_ OWNrRSI-IIP CRRTIFICATION rOILM awiier(Buyer L ~ n - ~' , ~'/lam ~~ s?~ S ~ // o - tvlailing Address ~9~ ~ / Property Address U"1" (Vcrifcation required from Planning Department for new construct//ion) Parcel Idelatif cation Number (~I$' ~og~~ ~-~7----- City/State CT ~__(~~ I.,TGAL DT;SCRIP'x'ION ~ '/,, Sec. T~N-R_~.w, Town o~~ ? o~z property Location ~/~ . /,, ~ ,~---~ ~ l~ v !~ Lot #~ .~__~___. Subdivision --~-. ~'.'_`-` ~-- ,Volume ~"- ,.Page # -- Certilied Setrvcy 11~a1~ # _ VVarrattty Deed # ~~ ~/Stio _7 , ~Tolurne o?~ / y .Page Spec house jz~ yes D no I-,ot lines idetltirable (~ yes ~ no SYSTEM IVIAI.IVTENANCIG Improper use and maintenanceof your septic s astcor soouerc if,needed bYmu licensed pu nperndtWltai you P tpvlt ~~tb7'~m consists of pumping out the septic tatrk every tlxree ye rs can af'Feat 4ha function of the septic tank as u lreatnient stage in the waste disposal systcni. The ro erty owner agrees to submit to St. Croix Zoning Department a certification foct~n sitenwast waterdlsposal system p p drat 1 the mastt;rplumber,jonrneyman plumber, restricted plumber or a licensed pumper verifying ( ) is improper operating condition and/or (2) alter inspection and putnpirtg (if necessary), the septic tank is less than 1/3 full of studgc. Uwc, the undersigned have read the above rc;quirccneaits and agree to maintain the private sewage dSspoeaof wis onsui- Certt~~ a set forilr, lterc'tn, as set by the Dcpartincnt of Commerce and the Drpartu~ent of Natural Resoorees, stating that your septic systeiu lras beta maintained must be completed and rctuxzted to the 5i_ Croix County Zoning Off cc wtQun 30 days tlrc three year expiration date. ~~ / 7/ 6 ~ - _ - llAT1; GNATU : O ~ PPLICAN`I' a~WNrR CI;RTITICA'X'lON y ( ) g aul arc the owneds) of I (wc) certify chat all statcrnents on this fo t ~l~leed recorded its Register of Deeds Officce, I (we) ( ) the properly describccl above, by vtrhte of a wawa y / /~ t DATL~ SI A'1'URI? r APPLICANT **x*~« **+**• Any infonnatiou that is finis-cepresentcd may result in the sanitary parnut being revoked by the Zoning Departaucnt. *« Include wittx this application: a stamped wan~anty decd from ilia Register of Deeds office n copy of Ilse ccriiGcd survey arial~ if reference is made in the warranty deed Private Qnsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment Sys#em (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Desian Sneclfications Sanitary Permit Number Z;oS'i Number of Bedrooms 3 Desi n Flow -Peak pd) 'b Estimated Fiow - Avera e { d) w Se tic Tank Capaci (al} ~,p Soil Absor tion Component Size ( ) 3 T e of Wastewater mestic Table 2: Soi! Absor tion Com onent -Limits of Reliable Operation Septic Tank Component Soii Absor tion Com one t Desi n Fiow -Peak { pd) ,Z, Maximum influent Particle Size (in) 1i8 Maximum BODs {m /L 220 Maximum TSS (m /L) 154 Table 3: Maintenance Schedule Se tic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once eve 3 years Soil Absor Lion Component ins ect once eve 3 ears Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease -' Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se is tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet flit shall be cleaned as necessary to ensure nronT~.._-ra~iera. The filter cartridges ou d not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ~. Mana~em~ent Pier, fcr a Septic Ta^~ era aoi. Aasarption Com~ar~e~t _..~,. filter ie equipped with sn alarm, the fUter aha(1 be sarvloed i! the alarm i~ activated cantlr~~ausly. Intermittent 111#~~ Harms n3ay Indicate surd flows or an impandlny continuous alarm. The sep~cr tank:pal! hpve its oantente romovad when the voiums ai scum and alud~e In the tank sxcoeds '113 the liquid volume at the tank, ii the aor+tontlt of the tank an not n3n~oved et the til~ne Ot an assea>sm8nt, rnal#n#enancs peraOAne! ahaii advice the owner of when the next service needa to oe performed to maintain less than maximum scorn and slud~s sca~mulatlon In the #~rnk, >~lanhoie risers, aocess risero and covers should be Inspected far water tlphtnoss and soundness. ~coess openlrl9a used far service and assr-serr~t split be sealed wat~trtlght uacn the ~mplatlon of se~tvlcg. any opentn~ deemed ;~nsaund, defecilv~, ar tsub{ect to i~ c~-ust be replaced. ,Exposed ecaeas openlnas groater than ~•Inches kn diameter shall be aeoured ~y an sffic!!ye lockJnq dwJce to prsvsn# acddsntal or unauthorized entry into the tarfic. !Va one arhoald enter a sepfls or otiar tnabnerit or holdMq tank ivr~ any nraan wlthawt betr~ !n lu11 canpllanas- with ilRQt~1 att~nahrrda tar on~rlr~~ a a~lliNalapave. the ~tmon within the as or odrer t~l~ttir-r~t o~ 11a1~a11n~ Ifenk ~ oonbtln hh'u1 peee~ +tnd naeu~r of a per~ewt l~i» In~rlOt ot~te bnik rya. mutt orJ~potelts~ .~ Tank abandanmsnt shall bet In ac~rdancs with Cornet Is8.33- Wls, Adm. Cads wrhen tns tank Is r~o longer used as a POW1'8 component. '?'i1e sell absorption oamponer+t gNinp thla struaturo fa deslyned to accept domestic wastewater from a resldentlai fac3flty. The limits of opsratton of t»ia compQnertt are spawn in Table ~, TI1e ior~~evity oI° s eel! absorption component depends pres#Iy an proper and timely maintenarres, and syst,wm use within or bsiaw the limits of reliable opera#lon, Qaod water oanasrvatk~n practices by cif oocupantt and the Instat}atlart ai water cor~servinp piumbin~ fixtt~rss ars Itey factors In extendlns the useful life at?tttls comparwnt. TI~- rsoolt at»orptlon camporsent's operation must be assessed by lns~atfon at b®st once every three yeera. The Inspection shall Include necording the leveia of pandlnQ- if any, in the abservsdan pipes, end a vfs~ssi Inspection for any evidence of sunc~e sespape or d~schsrgs from the cafmponsr~t. Un steeply:Icpirsq sltes- areas cf erosion ahnuld bs id®ntLi~ed and reported ~ t#te owner for Npelr. The eurfaoe dl$CharQe of dornesttc wastewater or sewspp from the systerpt is prohibited and considered a human health hazard, TratflC srout~d nr aver the sell absarptlon component should be avoided parttcular~ly durln~ winter months, The campactlon or rernovai a# sneer cover over the component may lead to hy~drauilc hiiure by freezlrtp, This type of failure is usualSy #emDorarY, but is dliilcult or Irr:p+osetble t0 repair unlit weather aondltions Impravs. In general, soar. cornpsctlon aver this o~arnponettt will reduce d>ttuston of oxyyet+ into the Boll and dispersal calf, which may load to mare lnt$nse~ and earner, or~artio cloQgln~ a! the nail. Management pion for a Septic Tank and Soi6 Absorption Component Plantings o! deep-rooted trees and shrubs directly over of within ten leaf of the component should be avoided since root intrusion into the component may obstfvc;t wastewater flow. Contingency Pian In the event of system failure, a new system could be initslied in an alternate area. With the instaifation of a diverter valve, the existing system could also be reused after a period of three to four years. (t is the property owners resporZsibility to mafntsin the alternate area free from any planting of trees, shrubs, etc, in case of (allure of the original system, the sitemste area wilt be needed. ff arty trues, shrubs, etc. have beers planted on the atternete eras, they will haw to be renwwci at property owners expense. !f altsmete area is destroyed, there are other altemativa systems that can be used, in which, could result in added expense to the property owner, Any tank abandonment shall bs done in atcotdance with Wisc. Code 83.35, Any questions regarding this code, please contact your kxxl Zoning t?ffloe or contact the Installing plumber. Zo.~ ~ ~., o~ 'mss-;s ~c,~„ '~ ~ S, 3 g t~ - y b 8 0 ~~,~~ak~~ ?~w~,~~N~ t,ts~ 3a~,31 a L U DOCUMENT NUMBER 1vARRANTY assn 201yP 228 Midwest Equities, LLC, Grantor, conveys and warrants to D. S_ Conat~ ction and Associates, Inc., Grantee, the following described real estate in St. Croix County, State of Wisconsin: Lot Nine (9 Prairie Run, Town of Hammond. _~ 69t*568 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIx CO. , MI RECEIVED FOR RECORD 10-17-2002 11:20 AM YARRiWTY DEED EXEF~T # REC FEE: 11.00 TRANS FEE: 128.70 COPY FEE: CERT COPY FEE: PAGES: 1 NAME AND RETURN ADDRESS ~~~w ~v~/l~~ s ~a~ -Z'~. 44D ~di !IC res~. ~a l~Q4, ~ ri cv-rS~a2- 018-1036-80-000 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this / day of October, 2002. (SEAL) J. Wel a anagi g ember of idweat Equities, LLC AUTHENTICATION (SEAL1 Signature(s) authenticated this day of 2002 (Signature) (Name Printed or 1Yoed) TITLS: MEMBER STATS BAR OF WISCONSIN (If not, authorized by 6706.06, Wis. Stata.) THI9 INSTRU![SNT WA9 DRAFTED BYs Leo A. Beskar, Attorney at Law Rodli, Beskar, Bolen & Krueger, S.C. P.O. Box 138 River Falls, WI 54022 ACRNOWLBDCiMSNT (SEAL) (SEAL) STATE OF WISCONSIN ) `.:' sa. _.y .-''~ ',,. covNTY ) = ',1~t fi n~ Personally came before me this ~ day o~.Octebe@,-002 _ the above named Larry J. Wellena to me known to be the persona (s) who exe¢i~ed His ~~ ( ai forego'- g inst t and acknowledge thus~~~~,e. •~ :- ~ • i ature L I-~e .f * Name Frint2d oz ~ ed Notary Public ~~' VCS County, Wis. My comMmi~ssion is p/ermanent. (If not,. expiration date:) U 201yP 22? DOCUMENT NUMBER 6 9 4 5 6 7 KATHLEEN H. MALSH WARRANTY assn REGISTER OF DEEDS ST. CROIX CO. , NI RECEIVED FOR RECORD William E. Hawkins, Grantor, conveys and warrants to Midwest E itie~ 10-17'2002 11:20 Arl LLC, Grantee, the following described real estate is St. Cro~County, ~~ ~ State of Wisconsin: EXEMPT ~ 17 Lot Nino, Prairie Run, Town of Hammond. REC FEE: 11.00 `'-'-"' TRANS FEE: COPX FEE: GERT COPY FEE: PAGES: 1 Thin Warranty Deed is given in partial satisfaction of that original Land Contract between the parties dated June 12, 2001, recorded Jun 15, 2001, in Volume 1660, pages 445-447, as Document Number 648396. NAME AND RETURN J~DDRESS L ct.NN~ k~G/ ~R ,5 18-1036-80-000 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this ~ 7 ~ day of October, 2002. !!~ ~~~ (SEAL) ~lliam E. Hawkins ADTH$NTICATION Signature(s) (SEAL) authenticated this day of 2002 (Signature) (Name Printed or 1YOed) TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 5706.06, Wis. Stats.) THIS INSTRDNSNT WAS DRA8T8D HY: Leo A. Beskar, Attorney at Law Rodli, Beskar, Boles & Krueger, S.C. P.O. Sox 138 River Falls, WI 54022 ACRDIOWLSDO~NT (SEAL) (SEAL) STATE OF WISCONSIN ) s~~~ ) Sa. CovNTY ) 1 ~j -7 ~ Personally came before me this ! / day af:'Oc~d~i~~.O02 the above named William E. Hawkins ~ _ to me known to be the persona(s) who execute~Che~( ~_`~ foreg ' ng inat ment and acknowledge t~e~ame . t~~ y ! ~,• , ~f e •. Si 'i3 ~ ~ v ? ~'J•,1 * Name PtlAeed~or ed Notary Public ~~ County, Wis. My commission is permane t. (If not, expiration date:) o~l-aa ^ n ~~ 1 f1t IV VY t ~ '-t vl AND PART OF ~ W 1 ~4V ~ OF THE TOWN OF 1 1 IL 1VL_ ~ ~ ~ ~ ~~ vv ~ r~~ ~ ~ v~ THE SE 1 i4 OF THE NE 1 i4 NE 1 i4, ALL 1 N SECT i ON 1 HAMNIOND, S T. CR 01 X COON T UNPLATTED LANDS ......... ................................. ~~`. ~ ~' <~ °~` ' ~ ~ 2602.28' (TO NORTHEAST CORNER OF SECTION) ~- - NORTH f.INE OF THE NE 1/ - - N89° 04' 14u E I9 16. 68' (TO NE COR. 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N C N X N' y 7 '~ N C N m w N s ~ N w n _ I a ' 3 ~; w ° °° OZ 7 ?, Q~ ~ -I N A Z N ~ Ao ~j m N ~ ~ ~ M n a~Qo a A Z O w y ~ O ~ I ~ ~ n ~ n w fD ~ _ Z N V (p N ~ W ~ w G G O I +a o, ~ z I °~ Z A 3 3~ I y v ~1 ~ m~ Z I ~ ~ ~ ~ I I W~ n I ~ °' _o- ~ .. y ~ I , C~. m 7 a ~ I w ~ _ ° t o c a w O O y d I 7 ~ I I ° ~ ~ i ~~ a ~o a ^' I w ~ ~ w I v°, 3 c N o I o~ °w I W ° A w ~ ~ I ~ I m oro w c ~ I O e °o ~- v'