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HomeMy WebLinkAbout018-1086-06-000I isconsin Department of Commerce PRIV l~ SYSTEM _~fety and Building Division INS- .. I ~hORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. permit Holder's Name: City Village X Township M rlie, Jason Hammond ownshi SST BM Elev: Insp. BM Elev: BM Description: l ~ ~ B~ ~ /ao • ~ ~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ' ess-~- ~Qo~ Dosing ~ ~U C~~d Aeration , .1 W f~- `1 ~~ Holding TANK SETBACK INFORMATION ~' TANK TO ~ P/L L '{ W E LL BLDG. Vent to Air Intake ROA Septic '2 ~ I t ^ N ~H ~ ~j I ~~j I 1 Dosing 3 ~ i I~~ "''S ~G t J `~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer [) Demand ~ GPM Model Number ~~~ 1~~Z TDH Lift ~2•~I Friction Loss - 5 System Head ~ • ~ TDH Ft f~7.31 Forcemain Lent Di ~ H Dist. to Well ~ SOIL ABSORPTION SYSTEM ~ county: St. Croix Sanitary Permit No: 453257 0 State Plan ID No: Parcel Tax No: 018-1086-06-000 SectionlTown/Range/Map No: 20.29.17.626 ELEVATION DATA , I ~ ~ STATION HI FS ELEV. ~ () Benchmark Bldg. Sewer I p SG1-f ~U 3 a~ { ~ `J 3. ~ 3 SUHt Inlet !I. Z 93.z SUHt Outlet \ ~---- Dt Inlet Dt Bottom HeaderlMan. ~ QS ~~ ~ ~~ ~ G~ Dist. Pipe `` 2 , 55 ~ ~ ~ • ~U Bot. System ~~ , 92 Da S d.~ i ~ ,4 ~v~_ v Final Grade JtSI . ( ~oU~iL 1 0 3 . St Cover ~ ~ ~• ~ . ~~~ ~ t G l e ~~ ~ ar - '!~ 1~0 ,~ ~ ~ Z ~ --~ I.~- ~ ~ 45 .~P ~1~1'I BED/TRENCH DIMENSIONS Width ) Length. 7 ~i 1l No. OfTre es PIT IMENSIONS No. Pits Inside Liqui epth ~ ~ `` TT SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ INFORMATION CHAMBER OR _ Type O ystem: ~ ` _~I lD ~ ~ UNIT Model Number. 6J DISTRIBUTION SYSTEM HeaderlM Lengt ~ Di ~ Distribution Pipe(s) Length ~ ~ tr ~ j J J Dia / ~Z' Spacing Z ~ ~ x Hole Size `-' / ~ x Hole Spacing ~ . Vent o Air Intake SOUL COVEI,~' SLL61~Q{ /92 ~~e~sQre Systems Only xx Mound Or At-Grade Systems Only ~ O~ r~o n Depth Depth Over xx Depth of xx Seeded/Sodded Bedfrrench Center Bed/Trench Edges Topsoil ~ Yes I I No - Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / / / a'T Inspection #2:~-~~ /U Location: 1620 89th Ave Unknown (NW 1l4 NW 20 T29N R17W) Hammond Oaks Lot 6 ~'Ow ?J~ Parcel No: 20.29 7.6 1.) Alt BM Description = a M _ ~ "~ b15~ ~br~f~-~ ~ ~~"FF~F-- ; ~~ ~~~ 2.) Bidg sewer length = ~ 5 ~ -amount of cover = ~Z r I ~ c~ rc ~ ~' /-~ ~ . ~'%~~ ~` -- ~~ ~v [ ~~e.d ~_ e u~ k ~ ~c~a. rr"~ ~ s Plan revision Required? ~ Yes ~ryo Use other side for additional information. JI_._..~_ ! ~__ ________ __ SBD-6710 (R.3/97) ~~G/~~"'Y`-' ~ ~ Insepctors Signature Cert. No. ~} ~ n N 0 ~ ~ ~ ~ h = ID A ' ~ ~ .0 ~ ~ ~ ~ d , ~ l D 3 ~ ~ '~ ~ ~ n ;: ~ r: ~ Q A ~ N f'A O C ~ ~ I ~ NO ~ ~ ~• ? ~' (D p 3 f~D fD y N 3 tD ~ N ~ CO FBI "~ c ~ ~ p V C.. ' ~ v~ Q ~ ~ °' \ 1 O c (D ' ~ ~ p m C G ~ Q ~ ~ m I m cn z D I ~ eo m a c'o a -o 3 c~ D W 0 ~ D °~= N oo ~_ ~ o I N A A 7 a N w Q l~l• I 3 ~ o I ~ ~ ~ rn ~ ~ o ~ ~ ~ v v ~ ~ ~ , °» y O I ' ~ y a ,~ I z ° C o0 I ~ x a ~ : ° O ~ I ' p . I s ~ a m c w m m Z -~ -~ fA A ? 0 O N f 1 ~ .~ L~: p 7 ~ p j ~ p .. I A ~ ~ ~ o a ~ z ~ $ . Z ~ I I ~ y ~ Z I fD W f ~ a I I ~ o ~ DO Zn9"o D O ~v d ~ a ~ `z~-y I • o ~•~ ~? Sino fD 3 0 ~ ~ c i ~c~-'•u,•-om~a~~ 01 ~t fp-D p (D Dl N O y ~ ~ I Sov a o N ~v a .. d fD O O N O ~ N O? ~~ N y 7 N y ~ ~ ~ 7 N ] Cp j f~ O d d 3 O N f D ~ ~ (/1 N pj 7 ~ y ~C"' 7 C O C j a ~ a; v 3 c cbm ~' . N~ ~m fi oco~ aav a v, o ~ m ~~ m~ N I p~mx-nom~ ~ , N O ~ ~ ~ ~ ~ N I m DO N ~ 69 Q ti A o ~ I ~ ~ I Safety and . s Division County 201 W. Washin P.O. Box 7162 ~~- ~ a ~ ~ ' ISC~,1/tS// 1 Madison, . ~ . ~~ ~ v7 - 7162 (608) 266-3151 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce .3z 5. Sanitary Permit A licati State Pan I.D. Number pp on In accord with Comm 83.21, Wis. Adm. Code, personal information you provide C ~ t= ~ 2Ad/5 , p. may be used for secondary purposes Priva y7~' Project Address (' iff t than mailing address) ~ 1 ~ I. Application Information -Please Print All Inf t' n (~Z~ ~+ ~ ~..rvwrto:~.~ ~~-~- Property Owner's Name ~ ~ P cel # Lot # Block # '~/~~ ~7 Pro p erty Owner's Mailing Address ZONING OFFICE Property Location ~ -^ W City, State Zip de hone N b um er ~a, Section '`~ ~d 5'~ /1(~. d (.l.Y~~ (~ ~ ~ J~ ~ //P 1 ~ J -~ 1 l.lt~5 (/ J°C~ - 1~~ ~ q circle T ~ ~ II. T ype of Building (check all that a l N; R_ E or pp y) ~1 or 2 Family Dwelling -Number of Bedrooms ~ ~ p t7 YY1, g I t Subdivision Name CSM Number ^ Public/Commercial -Describe Use =~ l ~~ ~ \ a rv~ ~af~S r ^ State Owned -Describe Use fl J t ^City ^Village~Township of~ _ _ III. Type of Permit: (Check only one box on line A. Complete Ime B if app 'cable) ©~ ^ ~ _ ~ _ , `~~ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Petmit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: ^ Non -Pressurized ht-Ground ,Mound >_ 24 in. of suitable soil t ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) ~5v Design Soil Appl' tion Rate(gpds 5 ~ Di ersal Area Re wired (sf) Dispersal Area Propos (sf) ~ System Elevation ~ . 3 .o s 1 [ S I ~ ~5, l~'9~ ~.~ VI. Tank Info Capacity in - Gallons Total Gallons Numbe of Units Manufacturer ~/~ / -^ ~-- Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Tanks Existing Tacks ~~/~ ate' n 'T Septic or Holding Tank 1 \ c ®.~ W 1 xr~t x Aerobic Treatment Unit Dosutg Chamber V , \ ~ ~, ,/ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name rint) Plumb ign a __-_-_ AMP/MPRS Number Business Phone Number Plumber's Address (5 t, City, State, Ztp Code) VIII. Coun /De artment se Onl ~pproved ^ Disapproved Sanitary Permit Fe (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Owne iven Reason for Denial Surcharge Fee) `~ ` ~~ IX. Condition Approva al 3~ ~ ~ ! ~ ~ I € tJQ,rt h~ ~~„~ SYSTEM OWNER: ~ 1 Septic tank, effluent filter and StwM. t ~~- (g~- ~,;Kp,~ .%+~ ~ dispersal cell must all be serviced /maintained S ~~ ~4e~ ~. ~~ C ~- ~~ plumber lan rovided b er m ement na y p p g . / ~ as p a All setback requirements must be maintained ~~ S~-8c,~ S 2 , . as per applicable code/ordinances. ~ 1~~~ ~ ~ ~C S Q~ / A • ..M .. •-••--- -~•~r•~•~ r...... t... •~< <-ouu.y vu~y~ iur cue system on ape aot teas tuarz x ],it inchesin size - ~~ SBD-6398 (R. 01/03) `~C ~~~~ `4° ~0~ ~ ~e~ ~~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary May 19, 2004 CUST ID No.225094 MICHAEL P ROGERS ROGERS PLUMBING E4457 HWY 12 MENOMONIE WI 54751 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/19/2006 SITE: Orlin & Judy Myrlie 85th Avenue Town of Hammond St Croix County NW1/4, NW1/4, S20, T29N, R17W Lot: 6, Subdivision: Hammond Oaks Identification Numbers Transaction ID No. 982899 Site ID No. 672257 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 948749 Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); 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, the "Mound Component Manual for POWTS -Version 2.0" SBD-10691-P(N.O1/O1). The pressure network is to be constructed in accordance with publication SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for POWTS - Version 2.0". • 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 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 per Comm 84 product approval conditions. • Comm 83.22(7) - A cow of the approved plans specifications and this letter shall be on-site durin construction and open to ins ection b authorized re resentatives of the .e artment which ma include local ,s inspectors. ~ ~ ~ ~ : ~`; ~" ~.; . ~. g"~E~` n ~ ~ 1 ~ ~,~~~ ~ q ;T,r ~ r ~~, ' Design Criteria `' ~L~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L ~.. ~ ~ ~ 3 ~~ ~ ~ ~ r-' `~ q v' cY r. .I Y 0 ! 0 >_ r~ ~' f k t _ ~ s ~' ~-~ ~ o' s ~'.~ y !'`'' ;i ¢ d~ ~'~ d Z ~ .: ~ ~ ~ / ~~ ~ ~ ~ ~' , ~ ~ \, ~~~ ~_ • ~, ~ ~ ~ ~~ ~ ~. ~ ~ ,~ ~~ -~ .+ ~, D ~~ ~ o ~ ~ ~ ~J,. 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K b _ ~N L ~ Mp '11T0 \ ~~~~/-\~ ~(z • 0 1 ~+ ( ^ _ v t ~ • X~C G ~ ~q kt v ~,~ O+~,t S ~ ~ a~ ~ ~-~- LI '1 1 z. ~~vc s~4° _ i~. _ ~~ ~ s ,\ V '~ LO.CKING~GOVfiR ^-~ tvA~t'n- i~~ ~ /18E~ . aWGK ~I•co~ytGT---~ G~ , u ~~ ~ ~~~ ~ ~~ ~4 ~~ ~~~, PIPE 3' no I~N~-sjuae~o 5o-L i~ r pW ctwtC SKl:T 3b1,R'J ~ P ~/G w+EcTIO~+S E~e~. ~~ ,~i ~~ 24u 2.~. t~,~uo~s A \ 4 c D ~F' 4'' ~FL.E: ,~ Fotic~ ~`'~,Q~w WEATHERPROJF ~JLNCTiOrr 20, O'I I I~III L / NC-l a~ .r-- ON - ~ o , 3 ~„ o~ PtudP q~~ CO/~/GRFTc b~oC~t 7 Iz i~i,~7r';,~ v.k k;, ~ ~~ a o v~.~- J -1~` ~~ ~~ ~c ~ s`4, 40 3' D-rT o ~wu-.o SEPr~c t _ SPECIFI~GATIOIJS TAW~.S M/~1JUFACTURCR: IJUMDCR OF DO~CS: ~ `" PEK G~~ TA-JK SIZ C : ~ ~~ ~ ~µO GALL0IJ S DOSC VOLUM C S J \.~ ~,}v IIJCLUOI1JCa 6AGKfLOW~ ~3'~ • ~~, - A~ARI'1 M/WUiACTURCR; 7 ~ v ~ti; hoocL uuvtecR: . ~ ~ ~ ~'~ `~ CAPACITIES. ~ . Zoe o IAJCHES OK ~3~' Z :.~.__ ~.: SWITCH TyP[' ~'~~` ~``l' g e Z ~ucH[s oa 33'sZ ~ - • vA.... ti PUMP /1AAIUFAGTURCR: ~oe~~l MOOEL lJUMOCR; `~ Z ~ 1St~•$~ D^ INCHES GR „~,.,.•_. SWITCH TdPC: ~~"`~~ `~' IJ~OTE: PUMP AWD ALaRi~ ARC TO DC f1I1JIMIUM DISCHARGE RATE. 2 'g G-M INSTAlLCO 0-J SEP~R~rE ciKC.. -~ VORTICAL DIiF[R[IJCC ~fTW[CIJ PUMP Oi/ AUO OWTRI~UT101J PIPE,. ~ ~ ~ ~ FECT + Mi-JIh1uM NETWORK SUPPLY PRfttURTC~~ ~ 2'~~ FEET ~,'~-S~ +~~ FCET OF FORCC MAIN X 1~_ ~/po/tFKICTI0A1 FACTOR. `'`;~ FEET ~ z~ ,~ - ~ ~ ,~~ ~ ~ '- TOTAU Oy1JAMIC Hf Ap = f EE T ~ ~ y ~. IIJTERIJAL OIMCIJ510AJi Or TAIJK~ LE:A.ICiTH I~~;WiOTH ~g .r;LIgUID DCPTH 3b toa~.~ 6 ~, a g -1 r ~. ' ~IVALUATION REPORT Wisconsin Department of Commerce Dlvlslon of Safety and Buildings in accnrrhnce+ with Cnmm RA Wis Aram Cede 2024 Page 1 of 2 Certified Soil Testing County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy t.aw, s. 15.04 (1) (m)). Property Owner Property Location _ Myrlie, Orlin & Judy Govt. Lot NW 1/4 NW 1/4 S 20 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3624 Ashbury Road 6 Hammond Oaks City State Zip Code Phone Number City Village Town Nearest Road Saint Paul ~ MN 55122 651-454-7179 Hammond 85Th Ave. New Construction Use: / Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ;; Replacement _. , Public or commercial -Describe: Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install 10' x 45' rock cell mound on 100.0 contour as upslope edge of rock w/ 0.9' sand fill; this report a supplement to previous reports Boring # t!i Boring :j Pit Ground Surface elev. 100.0 ft . Depth to limiting factor 36 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 7.5YR 2.5/1 - sit 2 12-16 10YR 3/4 - sl 3 16-26 7.5YR 4/6 - s 4 26-36 10YR 6/4 - s 5 36-44 10YR 7/3 f2f 7.5YR 4/6 s Boring # ~ Boring __; Pit Ground Surtace elev. 99.7 ft. Depth to limiting factor 36 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-8 7.5YR 2.5/1 - sit 2 f sbk mvfr cs 1f/m .6 .8 2 8-20 7.5YR 4/4 - sicl 2 m sbk mfr cs 1f .4 .6 3 20-24 7.5YR 4/6 - Is 0 sg ml cs - .7 1.6 4 24-36 7.5YR 4/6 - s 0 sg ml gs - .7 1.6 5 36-45 10YR 7/3 f2d 7.5YR 4/6,5/8 s 0 sg ml - - .7 1.6 pit to 24" then hand boring in sands Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 50 mg/L "Effluent #2 =GODS < 30 mglL and TSS < 30 mgL SST Name (Please Print) Signature: CST Number -lenry F. Grote ~ 222774 4ddress Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 5/12/2004 715-233-0398 ~' d U' cf i y ~ .. ~ . . ~ ;~ _ d s m ~ `~~ _ 0 4~ ,r i _ , ~ Q ~ ~ ~ ~ 9 C./ ~~~ ~ `~ S ~ ~ ~ ~ l :~ ~/ ~) . n ~ d ~ ~ p ~ v1 / d O ~ ~ ~ . lYI ~ _ ~ ~ ~ t~ `' 3 J `~' ~ "" ~ M d _ ~ ~ ~ d 40 (~ y 1 ~ ~+` t a ~ ~ 9 ® o ~ V i -~ ~~ -i 4 ~ ~~ '" ~ g g ~ ~ `' .~ ~ '~ ~, ~ , ~ ~ ~ j ~ r. ct 4' i p~ Q ~? ..~~t1~ u ~ b ~ N b' I;, ~ ~. o' v ~ ~ ~. .n ~ r ~ ~ ~ ~ v a, O' a, 90 v ~~ D I r1 1 ~--I' ~ ~~p- "~ .~ ~_ y gs a 0 0 d D v ~i ~' O F~ ~, ~ ~ 4 h~ ~? 4 ~ ~. 0 ~ v '~ - ~ ~ as ~ ~ ~- r n J rkT+ f V ~'~JI ~~f !~~ ~~ ~ P~D 2024 wisconsinDepartmentofCommerce SOIL EVALUATION REPORT Page t of 2 Division of Safety and Buildings ;,, ~rrnnl~nro uui4h Cnmm as ~nr~ nom r.~~p Certified Soil Testing County Attach complete site plan on paper not less than 8Y: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . Please tint ~ fn ~+~, ~ ewed B.y D Personal information you provide _ y be used for secondary purposes (Privacy , s.15.04 (1) (m)). ~~ p Property Owner MAY 17 2004 ~ Property Location Myrlie, Orlin & Judy Govt. Lot NW 1/4 NW 1/4 S 20 T 29 N R 17 W Property Owner's Mailing Address . -„ ~; c,n~i~.UOu~'~; Lot # Block # Subd. Name or CSM# 3624 Ashbury Road Z~ NI 6 Hammond Oaks City State Zip o e one City Village ,{ Town Nearest Road Saint Paul ~ MN 55122 651-454-7179 Hammond 85Th Ave. V New Construction Use: y Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD ~4 Replacement __, Public or commercial -Describe: Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install 10' x 45' rock cell mound on 100.0 contour as upslope edge of rock w/ 0.9' sand fill; this report a supplement to previous reports Boring # !!! Boring ~" Pit Ground Surface elev. 100.0 ft . Depth to limiting factor 36 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence oundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 7.5YR 2.5/1 - sil 2 12-16 10YR 3/4 - sl 3 ~ 16-26 7.5YR 4/6 - s 4 26-36 10YR 6/4 - s 5 1 36-44 10YR 7/3 f2f 7.5YR 4/6 s Boring # /~ Boring _~ Pit Ground Surface elev. 99.7 ft. Depth to limiting factor 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 7.5YR 2.5/1 - sil 2 f sbk mvfr cs 1f/m .6 .8 2 8-20 7.5YR 4/4 - sic! 2 m sbk mfr cs 1f .4 .6 3 20-24 7.5YR 4/6 - Is 0 sg ml cs - .7 1.6 4 24-36 7.5YR 4/6 - s 0 sg ml gs - .7 1.6 5 -45 10YR 7/3 f2d 7.5YR 4/6,5!8 s 0 sg ml - - .7 1.6 pit to 24" then hand boring in sands ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 50 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mgL CST Name (Please Print) Signature: CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 5/12/2004 715-233-0398 .. ,.. (~ ~~ ~ - d ~/ 1 A,. J •.~ , Uj ~ J c,-, .,~ ~ ~ s, ~ Rio ~1 V _ ,~ ,r c b o~ v ~ S'~ ~ d i 4o s i o ~~~C~ r ~~ n s ~ ~ ...+ ~ ~. ~ P ~ ~-~ ~, 9 ~ 'se ~ o :.3' .v $ ~ ~ ..~ d' ~ ~ v `~ at v ~ ~ g g o a ^f~ r a <<~ ~, ~ ~f n ,_~ ~ o ~~' ~' ~~~ ~ ~ .. f a '' ~ ~ ~- , o ~ v o, i ar' c 9° ~ ~ ~ ~.~ v ti .. ~, • ~ 4 ~ aq-, ~ ~ ~ !~' n 0~ .9 O' lv7' d i ~ v ,~ ~ '[I ~ J Q ~ ~ V '~ 4 ^n J' ~ CAS ~ ~ .d• 1' - f s ct ~ s } o ,~ ~+ s ~ t .~ s ~ ~; 1 .(~ d ~ _~ ~ 3 ~ 3' ~ ~~ 9 ~f y ~, ~ ~ "'sO f ~ ; Q ~ J _ ...r. 1w ' 1. A Wisconsin Department of Commerce Division of Safety and Buildings ~' ' 2005 SOIL EVALUATION REPORT Page 1 of 2 in acrnrrlanrs~ with Cnmm A9 Wia lt~~,,t~de`- -••~, ._._ Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan ust St. Croix include, but not limited to: vertical and horizontal reference point (BM), directi nand percent slope scale or dimemslons north arrow and location and distance t nearesllirr!~~d~? t , parcel I. , , , ~ ~ Please print all information. Review By Date Personal information you provide may be used for secondary purposes (Privacy L s. i5.04~t~(m)) Property Owner Property Lo Myrlie, Orlin & Judy Govt. Lot NW 1 NW 1/4 S 20 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3624 Ashbury Road 6 Hmmond Oaks City State Zip Code Phone Number ~ City ~ Village Town Nearest Road F ~ ° _, ' " ~ MN 55122 651-454-7179 Hammond 85Th Ave. New Construction Use: Residential /Number of bedrooms 3 Code derived design flow rate Replacement _, Public or commercial -Describe: Parent material IoeSS over till Flood plain elevation, if applicable General comments and recommendations: install 10' x 45' rock cell mound on 99.0 - 99.7 design line w! 1.6-0.9' sand fill 450 GPD NA a Boring # -Boring /! Pit Ground Surface elev. 98.7 ft . Depth to limiting factor 52 in . Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-7 10YR 3/2 - sil 2 m gr mvfr gs 1f/m .6 .8 2 7-14 10YR 3/2 - sil 2 f sbk mvfr cs 1 m .6 .8 3 14-27 10YR 4/4 - sil 2 m sbk mfr gs 1f .6 .8 4 27-33 10YR 4/4 - sil 1 m sbk dsh cs 1f .4 .6 5 33-52 10YR 4/6 - s 0 sg dl cs - .7 1.6 6 52-56 10YR 4/6 - fs 0 m dh cs - 0 0 7 56-64 10YR 5/4 c2p 7.5YR 5/3, 4/6 scl 0 m mvfr - - 0 ~ 0 ~ a Boring # J Boring ~!~ Pit Ground Surface elev. 98.7 ft. Depth to limiting factor 52 in• Soil Application Rate Horizon Depth ~ Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 I horizon 6 is weakly cemented, resistant to penetrtion " Effluent #1 = BODS> 30 _< 220 mg/L and TSS >3 < 1 0 mg/ 'Effluent # - D5 < 30 mg/L and TS5 < 30 mgL CST Name (Please Print) Signat re: CST Number Henry F. Grote .~ 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 3/26/2004 715-233-0398 ~- ~ J d w !~' s ~ o ~.. ~.1 eil ~~ s~ a ~ ~ ~ ~ Q' ~. n ~d' r C~ ~•, ~ J .9 ` a ~~ t 1 s ra.n d' i~ r~ `~ ~ r __ ~ 1 ~.~+~- 9 ~. 0 J ~~~ ~~ -i ~ N I ,~ ~ -' ~ 7 ~ ~ ~ pro ~- `~ m , m " s ~,~~ 3 ~. ~ ~( ~ n \ g ~ o ~~ ~ ~ ~ e ~ ~ ~ ~. ~ 3 ~,t ~ ~~~ ~~~~ 3 l ~ r~ :~~ ~ v ~ ~ ~ ~ ~~ .~ o « s ~ ~~ ~ ~ y " .~' ,~ d ~ ~ P ~" ~ ~ f o ~ :~ Y s ~- f ~ ~ ~ r ~ ~ ~ ~ o f~ ~ ~ ° ~ -t ~ ~ ~ w ~ ~ ~ _ ~ i ~ ~ ~ o j ~ ~ ~ 9 _. ~J 3 ~ ~~ ~~ ~,~, a ~~~.~ ~~-~~ 3 ~ ~ ~ 9~ 9 fj ~ -~ Z -~ 9 ~~ ,~- a~ NI ~' ~ ~~ ;~ ~ ., a . •,a . Wisconsr department of Industry, SOIL AND SITE EVALUATION / Z Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, WIS. c> '~ ~. s i Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. PI mp3t„`•- - - r, ~~'-~• ~~~/ include but not limited to: vertical and horizontal reference oint (BM) dire i n nil , p , , Q percent slope, scale or dimensions, north arrow, and location and distanc tFt?t~arest rc~tt ~., -;, J . - ,arc k31. O te ' • • , . •..' ;.r ) //''~ APPLICANT INFORMATION -Please print all informat~ ~ 4. ~ ~ ,,, ~~ ~ view®d-b Date Personal information you provide may be used for secondary purposes (Privacy Lavl, .15.04 (1) (m)) Z Property Owner ~ ~ M Gi ~ ep LAN p c a C/o _ ~ ' ~ ~ Propp~,ts ~- obn "~ S ZD T 2 v~~ ~•/A'~ 1/4 L t G t R ~ E (or~ N S ~ H,~ ~~ 1 ~ ~O ~ V , ov o . / , , Property Owner's Mailing Address 332_ h i UN~SoTAI S T. E~1S T ~ yo ~ Lot #.' (p° .: Blockf~ '~ ~~ __`.~s- ~ .Name or CSM# ~~ttiowD o~9-,~s' City State Zip Code Phone Number ST~ ~- 222. •S55 • Pnu ~l IyN.'~ SS~oI I (eSl) S Nearest Road w ~ Z, ^ City ^ Village L"J Town ~t..,-.,~.~,~r~ i ~ C.v +^'~lew Construction Use: ~iesidential /Number of bedrooms 3 Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow y~0 gpd Recommended design loading rate gibed, gpd/ft2 ' ~ trench, gpd/fl2 Absorption area required 3?~ bed, ft2 ~ 7f trench, ft2 Maximum design loading rate _' bed, gpd/fl2~trench, gpolft2 Recommended infiltration surface elevation(s) Su 'PQ • 3 ft (as referred to site plan benchmark) Additional design/site considerations Parent material ~oECS ~G~ OL~'NSL~' T/~~f Flood plain elevation, if applicable N~T~_ft S = Suitable for system Conventi~on/al M~o/uJJ~~d In-Ground Pre ure AT-Grade System,i~n,Fill/ Holding T~ U = Unsuitable for system ^ S L~ U ~ ' ^ U ^ S ~ ^ S ~1 ^ S L.~ ^ S C SOIL DESCRIPTION REPORT Boring # I ,m Ground ~el v. .~n. Depth to limiting factor ~'~in. Boring # ~ ... Horizon Depth Dominant Color Mottles Structure i t C B d R ts GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons s ence oun ary oo Bed ,Trench •~ ioy~ 3/3 - Sig /fshk ~ ~ c - .Z ; •3 G 2 Ho ,s ; ~•s +r Remarks: /b L ~• s y~ y/G Ground tev. ~y,~ft. Depth to limiting to for ~in. Remarks: t~ 91 CST Name (Please Print) Rot3~RT' ~IL~R1G~'T" Signature ~/S• T~~ ne~N~ •~ Address ~/~ Date CST Number I Ilhrlehf R Accnelata~ ' `7/ ~ ~ /' ! f ~~ ~ ?`4 3 7 5 ~ Private Sewage Consultants 655 O'Neil Rd. u..r~~~ u~t_ e~n.e ``'' r;l VH $ ~ r2O l ~a,~~ SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.M ~AH~'~O.vv ~~ ~-s S d g Boring # 3 Ground elev. ~G~ft. Depth to limiting factor ~in. Boring # Ground elev. n. Depth to limiting factor in. Boring # Ground elev. ft. ,, Page ~ ~ of Horizon Depth Dominant Color Mottles T Structure C i t B d R t 2 in. Munsell Qu. Sz. Cont. Color exture Gr. Sz. Sh. ence ons s oun ary oo s Bed ,Trench i . > >o y2 3~3 - t shy ~+~R . K ~ , s .2 0 ~ ~f: ~ ~ s- . - • S • , s Uf5 /vf ~1~fi ~ ~~ w CGS L , G Remarks: Remarks: Horizon Depth Dominant Color Mottles Structure i t C B d R ts GPD/ftz in. Munsell Qu. 8z. -Cont. Color Texture Gr. Sz. Sh. ence ons s oun ary oo Bed ,Trench Depth to limiting factor in. Boring # Ground elev. n. Remarks: Depth to limiting factor 'n' Remarks: SBDW-8330 (R. 08/95) ~_ . •3 ~~`, I 1 ,f v I M i .. _cr __._..__-i (Y ~. ,~ ~u ~. v~ a ~\~ C h~ 4 I ~ N ~- w f ` O ~ v~ ~ v~ 'O ~ ~p~o ~ ~, o ~ ~ ~ ~ ~ o ~ ~~ f ~ ~U 0 f M ~, V v ~-- a ~-- a ~ ~ a~ _~ a c~ "V ~_ ,,~ ~ V ) Vl Q o o 7' 1 v7 -L s~ 3 X a~~/ ~ ~X ~~ ~~ ~ ~ J, /^J "/) /\~~ A~ "1 M M .pm. a m ~U (~ o ~ 'O a a ~; ~ ~~'~3 ~,~o~ v ~o,,wz M 4 ~. ~ \ .~ C~ ~ O / ~ ~ a v ~ ~ ~ a r; . ~. r Private On-Site Wastewater Treatment System (POWYS) Index and Title Sheet ,~- - ~. Project Name and System Type: ~ ~.~ ~., r yo ~ m a ~h Lt Location: ~~ ~' ~ ~Xl tl e__ I,D + ~ ~~ cP~~n w~ a ry~ ~a.Q2 S Street Address Legal Description L Township/County //~~~ Contents: Page 1: S(~. ~ ~ ~~ ~~,v vv~ I `~ 1'"1 p ~ ~ ~ L' ~-~ ~ ~ Page 2: C' ~ ~ (kw~M - ~ ~ ~ Page 3: i~ Page 4: Page 5: ~ e. p t ~i C. ~ [,~.y~~ ~~~e~ YY1 P~v~- Page 6: l,J~"_.Y ~.. Page 7: (~ J1n, Page 8: ~ o~ ~ '~ ~~5~ . Page 9: C~~ ~ ~~'~~ ~i ~`/~n~.S Attachments: Plumber/Designer: ~i ke '=~ a P ~ Si e Credential Number ~, a 5 0 ~ ~- Date• Vl(~ a.~,- ~.C7~' ~ DU ~-~- ,~c POWTS OWNER'S MANU.a,L MANAGEMENT PLAN FILE INFORMATION Owner 0.5 o h ~ i ~. Permit # S DESIGN PARAMETERS Number of Bedrooms 100gpd/bedroom ^ NA Number of Commercial Units NA Estimated flow (average)* ppgaUday Design flow (peak), estimated x 1.5* gaUday Soil Application Rate . 3 gaUday InfluentlEffluent Quality (NA^) Monthly Average** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (BODs) Total Suspended Solids (TS5) ~ 220 mg/L 5 250 mg/L Pretreated Effluent Quality ^ Monthly Average* Biochemical Oxygen Demand (BODs) < 30 mg/L Total Suspended Solids (TSS) Fecal Colifonn (geometric meant ~ 30 mg/L <10+cfu/100m1 Maximum Effluent Particle Size 1/8 inch diameter * Wastewater Flow Verification on and calculations: (Other than bedroom based) ** Values typical for domestic (non-commercial wastewater and septic tank effluent. * * * Values typical for pretreated wastewater. SYSTEM SPECIFICATIONS Septic Tank Capacity Q gaI ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ~:Qpe ^ NA Effluent Filter Model - ipf7 ^ NA Pump Tank Capacity p gal ^ NA Pump Tank Manufacturer ~ ,~ ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ NA O Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: ~ Model: Dispersal Cell(s) ^ In-ground (gravity) ^ ~ und (pressurized) ^ At-grade ~ ~ ~iu,,,,,~' ^ Drip-line ^ Other: ^ Leachin Chamber Manufacturer Model Appro tipulation Soil Application Rate Area Req. Absorp ' Area Credit r unit fl Minimum be Chambers ^ Aggregate D Flow/Loa ' te= min Materials: all materi us omply with WI Adm. Code COMM84 and be ins manufacturers specifications and approval letters DESIGN CRITERIA / ^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ^ -"Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Beds". RJ. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 ^ SBD -10570-P (8.6/49) "At-Grade Component Manual Using Pressure Distribution" ^SBD -10567 P (8.6/99) "In Ground Absorption Component Manual" ^SBD -10705-P (N.Ol/Ol) "In Ground Soil Absorption Component Manual" Version 2.0 ^ .SBD -10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" ^ SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ^ SBD -10572 P (8.6/99) "Mound Component Manual" SBD -10691 P (N.O1/Ol) "Mound Component Manual" Version 2.0 ^ SBD - 10595-P (R6/99) "Single-Pass Saud Filter Component Manual" ^ SBD -10657 P (8.6/99) "Drip-line Effluent Disposal Component Manual" ^ SBD -10573 P (R 6/99) "Pressure Distribution Component Manual" ^ SBD - 10706-P (N.O1/O1) "Pressure Distribution Component Manual" Version 2.0 ^-Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ^ months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (1/3) of tank volume Inspect dispersal cell(s) At least once every ^ months year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ^ months year(s) Inspect pump, pump controls & alarm At least once every ^ months ear(s) ^ NA Flush laterals and pressure test At least once every ^ months year(s) ^ NA Valves At least once every p months ^ year(s) NA Other: At least once every ^ months ~:^ year(s) NA Pagei~,of_Z START UP For new construction, prior to use of the POWTS check treatmennt tanlc(sy for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a seetage servicing operator prior to use. System start up shall not occur when soil conditions aze frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. 1vlaintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over a1I system components. Compaction of snow over the dispersal unit may cause it to freeze up. p Valves Valves shall be operated in the following manner: Lx4,,AlarmS // Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regulaz operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual cazrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). ~eptic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardwaze, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking deviceto prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NRl 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices. and other hazdwaze and the condition of the filter. Any service needs or repans shall be promptly taken caze of. D In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. ~q-~ Page ~f Mound, At-Grade, In-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or dischazge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failur necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) yeazs. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. e REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned incompliance with Ch. 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 other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank maybe installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank maybe 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 CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR Il~'IPOSSIBLE. ADDITIONAL CONIl1'~NTS POWTSINSTALLER Name ~,l~C-E- ['-OCt `~-S 'Phone ~'fS. 23S /l3 ~- SEPTAGE SERVICING OPERATOR (Pumper) Name: Phone K:\WPDATAIEH\POWTS OWNER'S MANUAL.doc POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Agency i . J Phone Page ~ of? May 07 2004 3:08PM HOM4ME, INC 651-423-6286 p.2 ~~ , ST CRnT1; COUNTY SEPTIC TAM{ MAINTPNA,MC$ ACrR.~IrINEN'T / OWNERSI~iII' CERTi~F[CATION FORM ~tP2o ~~ ~ ~G- Mailing Address Pro~,arty Address • . -........~., •,.yu..s,., ••~~+- riamutg turemncM t"ar new eoa,t:vcNan) CitylStatt Parcel Idt:ntification Number ~~~_t'd~O -06_~ ~ X26) ~i~G~AL DF,SCRi'pTrnN Fropa:ty rACattioD ,~ 'i:, i~ 'J., Sec. ~(~ , T~~N-R~~Towr~ of _~.~~'Yl(M.o SubdiYision ~ QOM 1M yt1 Gt ~~s I.ot # Cet~tillt:d Survey )<i8p # ~- 'Volume Psge >Y Warranty Deed # DOZ. ~ ~ Volume Z~2 .Page i1 _~ Spec Kruse O yes C1 ao i.ot Lines identifiable !~ yes D no 5`i'ST..~EM MrAj~T~NANC~' Improper urs and moiat•nanco of your septic system could result iss its premature tailuse ro handle waatos. Proper mniutcnencc consists of puusping out the aaptic trait ovary three yearn ar sooner, if xseedad by a licensed pue~per. What you put iota tine mysrem can af[ect thrflseceioa of the eeptio tank to a treatrt~at tsars in riia wsstt disposer system, 'i3e propetrty oWaer agret;s to submit to St. Goix Zoning Depatymcat a ct,ttificatioa farm, signod by the garner and by a masctr plumber, )otuaeytYSast p lumber, rt;strticted pi uwbcr or a f icetued pumper verifying flint (i) the on-site ~asteweterdisgas ril system it is prover opt:retiog condition aadloc (Z) after inspection and pum~tiag (if ntecssaryj, rise septic tonic is Irma than 3J3 full of sludge. 1'Jrve, the uodorsigoad hava reed the above roquiremenu nrcd cares to tsYeintsiss We ptiva[e :swage disposal eyatetn vrit6 t'he standards set fartb. hrreia„ ar let by the t3epartssseat oC Oommcrae and the Deparmnoat of Nansrs! Rraauuces, State of Wircoasio. Cenit-icstioc, sts ' t your septic syst•ra has bean troaitstsined muse hs carnpleted and t"eturasd to the St. Croix County 2'ASiur Office within 30 s of ~ year exptrrriao date, sit;N o~ ArisY,YC~xr awls we) certify that al! statauuuts oo this form era true to the best Gf my (aur} Satawledge, i (we) em (are) the owner(s) of c grape rii;ed above, by virase of a warranty deod recordad ie1 Register of Deeds OE'iloe. SI0 UAS OP APp[,(CANT' ` r t D~-TE "" 'Any iatormerioa that is mis-rrpresented tray rest,lt to 113e sanitary pesrtsit being revoked by fist Zoning Dapattmeot. "'•"''• •• Include wish thlr apptieatlon; a stampod warranty dead frets the Register of Dt~eds of~co a copy of the cordficd survey autg if reference is code in fist wstttnty deed z® ~~~ ~t ~~Iewma sa~~a c~aessa Ie:rl vaazi~eise I F __ ~ ~' -- ~ ~ _~~ -- < < ,. -- - - - ~ -y J j I '~ i-,~\ ~ s j ~ L~ ,~ ----_ - ------~ I I ~ 4n i~ ~ ~~ ~~ ~ --- ----^----- ~ r ~_ u ~~ II ~ ' - _ _ r, ~ L -------- '~ --- I ~ ~ f c"\ -~ -------- ~1-- ~'~ ~ f~-- I ~ ~ - ~----- ~a ~~ i ~~ 1 ~ ~ I ~ ~;`y ~ ~ I~w ~ ~, ,'~ ~ ~ ~ _ ~~ ~ ~ l ,~ ' ` ! ~ ` Jbl ~ ~ ~ U ~ _~_,__.L_.~~L~ ~ I __~____ , _f ~ _ _______ -~ _ ~_-- _ ~~ ~ i `;` ~ ~ -- ~,--~-~- - ~ r .~ ! < ~ ! _: 4 i J ;~ 3 _~, s 1 ~ -__~~ ~ ~ - ~~~ ~ 1 s ~~, ~ a ~ ~ ------,------------ ~ ~ ;,, _~ i ~ s; ~ ' -- -~!- ~ -_ __ - -- - - --- - Y-- - -_ - -- - ---i_- _ ~---- --- _. _ -- - `~ --- ---------=yam -- ------__-- ., --- -.~__-_- -- --a _J ,~ i J ~9 ~ J ~ - ------- --- __~_.__`.___ _.._ _ - - ,~1.... .. ___ ______.__.__._.__ , ~ ~ ~} ~ ~ _. _ _ ,~ o i .. _.~ _ __ _ ~ -__-_ v -- Q --- ~ '- 1 --- ~- - F--- - -- ---- ~~ '1 ~" ; ' t n !i ~ ( j ' y I 4 i J ~~ ~'~ ~ ! .~ x ~ ~~ ~ 3 ~ ~~ ;I ~ ~~ -~ i ,~;j ,; ~ 3 i i '~ ,~ ~ ry ~ ~ ~ ` I ~ ~ f J ~ ' ~ ~i I d ~ ~ ~ ~ ~ 3 ~~ ~ ~ -~ I ~ $ '_-_ --- ~ v ~ I C3' M 1 ,Q ~ ~ ~- i J : 'D ~ ~ j ~~ _--._.__._- i ` ,j`'i ~~ ~ ~ ~ ~' , ~I;. ~ i ri i ~~ ~ ,, , ~, ~ i ~ - Z ! I o i ~ I i~. ; 0 1 ~ _ ~ ~ ~~ ' i ~ __ -~--~--~--~.-' -----' -- _ ~ I I ~~ - ~_-' ~I~;I Ii ~-~ '' i 0 0 ~~ ------ __J1 ~ - c„ i° ~ I i ~ j ~ ___~ __ ~ ~ ~ ~ '' ~ ~~ ;~ i ~ ~ _ o i ~, , i f `~ o .._. 3 ~ ~ I~ - • + I i ~ i -_ -~_ --' -- `~ I ~ 'j 1111 I i = ~, 1 ~~ ;{ I, ~\ U_.2572P~' Sy6 ~6~~m~ DOCUMENT NO. I STATE BAR OF WISCONSIN FORM 1-1982 WARRANTY DEED THIS DEED made Wife ("Grantor"~ Jason Myrlie and Judith A. Myrlie, Husband and WITNESSETH, that the said Grantor, for valuable consideration conveys to Grantee the following described real estate in ST. CROIX County, State of Wisconsin: Lot Plat of HaTTUnond Oaks Subdivision in the Town of Hammond, St. Croix ounty, wisconsin. ' 1 *Orlin D My/r/lie /~,.~ ~ f ~ l --"(SEAL) *J i h A. rli l,~ay SSv~k Tax Parcel No: 1g-1086-OG-400 This is not homestead property. (isxis not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Orlin D. Myrlie and Judith A. Myrlie warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Easements, restrictions, and encroachments of record. and will warrant and defend the same. Dated this _~ day of ~ ~V- .2004. * * Signature(s) AUTHENTICATION (SEAL) (SEAL) authenticated this day of .2004 s TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY KATHLEEN H. IfALSH REGISTER OF DEEDS ST. CROIX CO. , iII RECEIVED FOR RECORD 05/17/2004 10s00AN WARRANTY DEED EXEiPT # REC FEE: 11.00 TRAILS FEfi: 92.70 COPY FEE: CC FEE: PACaES : 1 Sc~So~ ,ry,yfrl~ j518'S Cur/'dtJSY-) ~# ~ v i nos~v'-~ovnt, 1J1/V ACKNOWLEDGMENT STATE OF WISCONSIN J(7 ss. ST. CROIX County 2 Personally came before me this' 3t day of ~ 2004 the above named Orlin D. Myrlie and Judith A. yriie to me Irnown to be the persons who a ecuted the foregoing instrument and a l1e-dge tho same.( Rick L. Pendereast • V \f! f ~.t~d f 'Le Gl /~ C~-li~~ e Y Notary Public 1= w ~ r'~ County, Wis. Attorney-At-Lg_w My Commission is permanent. (If not, state expir~j~py~#jp~* Si stores ma be authenticated or aclrnowled ed. Both are not ) lUfa K~~ar°~ Tp.TE O°'`co necessary.) d rr•'~~~~1 ...... ~/ij+.• Names of persons signing in any capacity should be typed or prinud below their signatures. ~ .2 -' ts~ ~`O~y •~^: Q WARRAN'T'Y DEED File # 0045 'Q' y~~ = tz teas won Form sooostna Re•.. ovta~as Vg L ~n~j°°° B'I f-, ~ NORTH 1/4 CORNER ~ N SEC. 20, T29N, R17W `t ~ 1" BERNSTEIN STEEL M ~ SURVEY MARKER I~ ~I `~- 33.00' UNPLATTED LANDS I _ ~" S00'23'21" E ------------ ' 47 76' 219.35' 133 I33 ,_ ~ °' ,~ ( I ~ ~' I .~. ~ I I ss~, I ~ v °s. LOT 8 ~,~ ' o I I °o. 49639 SQ. FT. ~" 5 1 I ~ ~ ~ 1.14 ACRES w I I LOT 7 ~~s I ~ ~ 163373 SQ. FT. ~• 1 I ~ ~ ~ ~~, 1.45 ACRES '~ I y~4 I f ~ ~ ~ ~ I~ ~ ~ 1 ~- I I A- ~ ,-_ 1 ~ ; I ~ W,45205 SQ. 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