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HomeMy WebLinkAbout018-1086-21-000Wisconsin DepartrlSent of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT} Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ermit Holder's Name: City Village X Township Goulette, R an Hammond Townshi ST BM Elev: Insp.. ~ Elev:_, BM Description: r-~ . ;~ ~ ~ 'ANK INFORMATION ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic // //'L ~ ~, Dosing ~' Aeration Holding TANK SETBACK INFORMATION TANK TO ~,~P~~ 1I1~ELL~ `, ~ BLDG. Vent to Air Intake ROAD Se tic p f ~ (a r h,~ l~l~c~ ' 5 ~ I { ~ i,ns ~ i ~< - L. Dosing ~': i^ "' ' '~ tom, i ~ .~ ~ ~ .' ~, r i Aeration ~ i ~ ~ / ~ ~ Holding 0 .~ - ~,ed ~•h. /le d~ ' P P/SIPHON INFORMATION I hS~~~°~ is ~" C'~.,~J Ft I I~vi~.cniaui I~Ii ~yya,. :.q/ Ivia. L...... ....~...,~ v ,/+ f ~~ ~~ i1;'"/I SYSTEM DI SIONS ~~ ~ SETBACK SYSTEM TO INFORMATION Type Of System: DISTRIBUTION SYSTEM r I No. Of Trer P/L BLDG WELL County: $t. CfOIX Sanitary Permit No: 399534 State Plan ID No: Parcel Tax No: 018-1086-21-000 STATION BS HI FS fiELEV. Benchmark '4 ' ~ u ~2 •~~ Alt. BM _ ~_ ,~ 1 ~ .~~--- ~~~ - ~t~~'--r q ~ 7 ~~ -• Bldg. Sewer ~ ' " .~ ~3 ~ ~ ~ ~, . ~~° St/Ht Inlet ~ ~ ~ Jam'.-• •`. y a ~i n. - - s St/Ht Outlet ~ • 8 Z Z -; , _, ~~' . Dt Inlet _ /~ • 7 ~ ;, o Dt Bottom ~ ~~ ~' /,3 Header/Man. jt,,,QS~ - - . ~... d 3, ~ } ;y . '1. Di t. Pipe r ,_ B t. System : ! /' ~ / ~ Final grade n ~T 2 ~. ~ i1,; ~;~ : ` E : . ~: ~ 9~ ~ ~ 3~0 --, ., .l .n ~, ` J''~ ~r r DIMENSIONS No. Of Pits ~KE/STREAM LEAC G CHA ER OR /. ,-' UNIT Dia. Number. 57((CI«~`E' r.~ ~' . r ~, rte. t 91+- z Header/Manifold j Distribution ~! x Hole ize , ;' ~ x Hole Spacing Vent to Air Intake !~ ' " , Pipe(s) ~ I ;~~~ _ ~ i ~ ~ ~ i '~ ~ ~ ,~" ri> t~ Length ~ ~ Dia ~ _ Dia_ Spacing Length l~ i % SOIL COVER x Pressure Systems Only xx Mound Or At-Grade SYStems OnIV COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: !+ / _ ~ _> / ~- =~-' Inspection #2: ~ / •~~? /G' ~- Location: g51 162nd Street Hammond, WI 54015 (SW 114 NW 1/4 20 T29N R17W) Hammond Oaks Parcel No: 20.29.17.641~~ 1 ~~t ~It yY1 > l c'{` 11. CCU ~~L_ C c, t~ ~<< 401X.1 1.) Alt BM Description = .fi ~ i; ,; (~~; ,~~y 2. Bld sewer len th = ~' ~~i'_~~- •.i,! ~f~ /~. :- ~l .i; ~.n~~./QJ~,~, -~ ~' ` f ~-- ~~rZti~ ) - amount of cover = ? \ ~ ~I ~! ~ ~~SCQ~ ~ -CJ~C~ ~~ 3.) Contour = ~~ ~v c~.Y `~ Y ~.P.P7~( ~L ~ diy~-K' tt (tiv"""~ ~'/'y~,~"_ `'YNr~!'Ty~K~ ~ Plan revision Required? ^ Yes No ~ ~ ~ ~ ~ ~ ~ ~,/ i / + (~-Cis ~ y~ ~ ~ Use other side for additional information. ~ ~ i - __- ~ --- Date Insepctor' Signature Cert. No. J SBD-6710 (R.3/97) th Over Depth Over xx Depth of xx SeededlSodded xx Mulched Be ench Center A . ~ - ~ ~ Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ~ No •r _ r~~ ,Box 1~~ x x <<~ X \6 ~f ~ 0~'~ I.V" ~ti~ ~ ~ ~ ~~~~ , .~ ~~~~~ ~, ~~~~ ~ Ito/a~f `~ ~~1~ ~~lo~li;~~.~~ ~~ ~~~~~ ~~ s~f i ~s,-~- `~ ~ ~~ 8 ~" a Se.~ .B~:;.~s -- / ~ ~- ~~r /-~~vK~- Z.,~kic5 dGG~ c1,- t s~ ~ ~~ ~~ Nrn~ ~~~ slur r~~ ~~~ /` C~~/~nu.l /4.1,~ ,ta 97.,E CA P~ = . ~p ~ a~t.~ sue. ~ Safety and Buildings Division CO11r'ty "ti P.O. Box 71 S2 ton Ave. Washin 201 W ~ , g . ~-sconsin Madison, WI 53707 - 7162 SittvAddress n~ ~~ ~ De artment of Commerce Saniary Permit Number Sanitary Permit Application ~~ 1~~, 3 c} In accord with Comm 83.21, Wis. Adm. Code, persotsal information o ~' ~,. i Check if Revision ma be used for seco ses Privac Law, s15. I. Application Information -Please Print All Information REeE>'vE0 Plan I.D. Number / ls~ Prope Owner's Name p ~ T P}.reel umber ~,0. Z,cj , l ~. , (o~. I _ 1 ~ ~n~1 '___ aS -~o~-Z t ^'bd a pro rYy Owner's Mailing Address j1,., ~~ _~ Location 1 State 'Lip Ctxfc Phut 'N~Unrtxr. City t Number _~ 131ock mbcr , -_~.- Subdivision Name CSM Number c./ II. Type of Building (check all that apply) ^City 1 or Z Family Dwelling -Number of Bedrooms ~ /~ i~-~ ~~" ^Village ^ Public/Commercial -Describe Usc Township ^ State Owned N st Road ~~ ~ III. Type of Permit: {Check only oae boa on line A (numbering scheme for internal use). Compl to line B if applicable) A For Counq use 1 ~ New ^ Replacement System 3 ^ Replacement of 6 ^ Addition to S sum Tank ON Exis ' S stem Date Issued B. Permit Number if Sanitary Permit Previously Issued IV. Type of Permit: (Check all that appl ing scheme is for internal use) ~~ ~~, , //~~ 44 ^ Non -Presswized En-Ground 2 Mound 47 ^ Sarsd Filter 50 ^ Constructed Wetland i 22 ^ Pressurized ln-Ground 41 Holding Tank 48 ^ Single Pus 51 ^ Drip Line //~~ 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other ~= K t /l V. D' ersal/Treatment Area Information: (f n~ /rv,- ~` 4~ •?~ Design Flow (gpd) Dispersal Area Dispersal Arca Soil Application Percolation Rate System Elevation Final Gnde Required Proposed Ratc(Gals./Days/Sq.Ft.) (Min./lnch) F.levadon S+~A - VI. Tartk Info Capacity in Total Number Manufacturer Prefab Coocreu Site Cottsuucted Steel Fiber Glass Plastic Gallons Gallons of Tanks Ncw Existing ^- ~ O V " ) G Tanks Tanks / c t ~ ^ ^ s r r I i VII. R risibility Statement- I, the undersigned, a responsibBity for lnstallaUon of the POWTS shown on the attached plans. Flttm r' N (Ptint~ Plttm 's Signs ~ MP/MPRS Ntunber Business Phone Number _ ~ - ~- I i Pl r s Address (Street, City, Sate, Zip Code) j 1("p ~ VIII. Count /De artment Use Oal -- d Sanitary Permit Fcc (includes Groundwater Date Issued getu Sigtnare (No Stamps) ', ^ Di sapprove pproved Surcharge Fee) ~4 (3 t' I O ~ ~ ~ I too / ~ i i l Ad ^ t ~ verse a Owner Given In t 3~s I .._ ----- Determination __ ____ Conditions of Approval/Reasorts for Disapproval f~j~s.~on~n~. ~ F(oo~;~itite '"1''~l'`-"k ~~'1'~-~Gtt ' ct ~s,b(~~~ K,.a.,r~lenwv~ cg~a~-k~w(ce.F.(~~ ~;{ier wuh,~a-eo~%~t~v f ~e p~q.>e/s-~ o~r~-tm.r'7s r~a ~ z -'~,,, t,u~el( tta.wGt ~ ~ w.: n . c1i '~ ~f ~'roti-.~`'~tiJTs tW~-G~- ~G. wJ1t , o -~'.f-~Coatiw~. 5~~9~'sor~7~xcvt_e~ . I e ~ ~7' ~ cn.ea. t:ttne,t ,~t.p.,P~ -r ar c~ l S . 3 -j1,Q 5i ~Fe Flo fx c w+.er-~-~ lt-.~. ,~ ~ d tee- ~-- ~ G ~, ~ Acsrrn wmp~ese pwiu 1w we a,wwy va,7~ w. u.c .~..~....... rr^ -~• •- -. SBD-6398 (R. OS/O1) b L~ -- ~c~Ts~-z! ~~a HOLDING TANK SERVICING CONTRACT RF~~~V Contract Date FQ MqR This contract is made between the ST 2 1 X00 Holdi Tank Owners Name(/s/)// and i Pumpers Narr(aOWERS LI(~lJl T FNC ~~~,,~ ~ ~eU ~,~17`~ i 346 GREATO FFi E y ~ i NEW RICHMOND, WI 540 ~ 715 246-5738 We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) 1. The owner agrees to file a copy of this contract with the local governmental unit that h s si ned the pumping agreement required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of ~ ~~~ ; Y 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding Tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. Iri the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) (~ynti ~~~L~~~ ~ Owners Signature(s) i ~- i~ i i I I I I ~ POWERS i_i~l)ID WASTE MGMT, ING. 346 GREATON RD. NEW RICHMOND, W154017 Pumpers Registration Number Subscribed and sworn to me on this date: Todays Date Notary Public Signature Commission Expiration Drafted by a ~ ,~~O~~I 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.wis~nsin:gov Scott McCallum Governor Philip Edw. Albert, Acting Secretary October 10, 2001 CUST ID No.224263 KIM A O'CONNELL K.O. CONSTRUCTION 504 3RD AVE OSCEOLA WI 54020 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/10/2003 SITE: RYAN J GOULETTE - GINA M BOURY RESIDENCE HWY 12 & 160TH TOWN OFHAMMOND ST CROIX COUNTY S W l /4, N W l /4, S20, T29N, R 17 W LOT: 21, SUBDIVISION: HAMMOND OAKS Identification Numbers Transaction ID No. 678943 Site ID No. 637090 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 815162 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 101.0((10), Wisconsin Statutes, is responsible for compliance with all code requirements. 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 enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance inforn~ation must be given to the owner of the tank explaining that periodic cleaning of the filter is required • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehiculaz traffic and other similar activities that impact the treatment and dispersal are prohibited. e , KIM A O'QONNELL Page 2 l0/10/Oi • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and,. maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall bd considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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 requved. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. AlI permits required by the state or the local municipality shall be obtained prior to commencement of construction instal lation/operation. [n granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 Charles L Bratz POWTS Plan reviewer [I- Integrated Services (608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM cbratz@commerce. state. wi. us WiSMART code: 7633 cc: RYAN J GOULETTE -I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE ,~' Project Name: RYAN J GOULET?' - GlNA A9 BOURY owner's Name: RYAN J GOULETTE _- GlNR M 60UR'( Owners Address: P.O. BOX 905 HUDSON VVl 5%w9~ Legal Descx'iptic?rt: Town ttip: Gaunty: Sut~division Name: Lot. l`1sar7'~ber: Parcel l.C~. Number: Plan 7ransacti.on No.: ~.'4Tll~l"t~OllRi~ APPROVED DEP~IRTMENT OF COMMEIt(~ AND !t ~:-J SEE CORRESPONDENCE SAN-NW SEG20-T29N-R97LM HAMMQFNE? ST CRGIX HAMMOND CJAKS ?~ B:x~uk i'Vumt',er: Page 1 Page 2 Page 3 Page 4 Nage Page 6 Page ? -- F°aae 8 Index and tide Data enf>~y Mo-_,nd r~ravvinc~s .Lateral and dose tank System maintenance specifications A~9anagement and contingency plan Plin'1~ CL:tVP, and °~Pt':t9C~t4!?Cl$ PLOT PLAN IAA A /'1/"~ AI 1 1 1 ~1. ~ i-••+r- ~e3iynf2r: KIM ~, ~..,OI ;vE~+-. Lice:fse •~+ams,~:. a. ,-, t~~tES:. i~(13~vi ~ ~ilOf ie ~iutTit7et': sign?trlre: RECEIVED SEP 2 ~ 2001 SAFETY& BLDGS DIV, X1!1 A'1~? `i ~ V.~ Ti 5- ~~-3'[ ~, • n ~ ~~ew rrn n nn ,n~~n!~~ n~ I~Vii3iJ~Ci i.{i1 i~t~i'i7ii~f Yt ~VS:#i iifai7 ~i)i 7'1~.3V V~IJ iitii bi.h}i L.i~ 3i~i7°~W3 i~ tiff. iii/J i)~ ufiv.7 SSWMP Publication 9.6 Design of Pressure Disiriblrtion Networks for ST-SAS !9'!!~t,- V~-sion 3.0 (03/01/01) Paye ~ Lf s Mound and Pressure Distribution Component Design Design Worksheet (r or c) (c or e) R Residential or Canmereial Design 00.00 Estimated Wastewater Flow (gpd) 1.50 Peakir>g Factor (e.g. 1.5 =15091,) 50.00 Design Flow (gpd) 6.00 Site Slope (95) 97.20 Ct>!rrlaar line Elevation (g) 27.00 Depth to Lirttiting Factor (in) _0.40 In-situ Soil Application Rate (gpolft2) Distribution Cell lnfamation 75.00 Dispersal Cell Length Along Contour (R) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Otuality (1 or 3) ure Disribut;on Information e Center or Erx1 Manifdd 3.010 Latetal Spaang (ft) 2 Number of Laterals •'~ Orifi Di eter (in) (e 0 2~' Note: Sand fill {D) calculations assume a Table t33~1-3 in-situ soil treatment for fecal coliform of <= 36 inches. 6.00 Cell Width (ft) Are the laterals the highest nt in the distritxftion Y network? Enter Y or N If N atwve, enter the elevation ft of the highest point. Ce am .g. stimated C~itice Spaang (tt) = 9.00 ft2/orifice Foncemain Diameter (in) Forcemain Length (Ft) Does the forcemain drain back? ~__~ Pump Tank Elevation (tq Enter Y or N Project: O 1 SyStGlll HCCZU (It) JC 1.J 9.78 Vertical Lifl (it) 0.97 Friction Loss (ft) 17.25 Total Dynamic Head (ft) C 1$.J I r-.__~ FvicG111Q111 Vlal`Ikicllrl~ (~GII) 87.38 5x Void Volume (gal) 83.70 M1liinimum Dose Volume (gal) 20.60 System Demand (gpm) Lateral Diameter Selection in. dia. o ions Chace 0.75 1.00 1.25 x 1.50 x X 2.00 x 3.00 x Treatm~snt Tank Information 1000.00 Se c Tank Capaaty (gal) weeks -~ Manufacturer Manifold Diameter Selection in. dia. 0 bons choice 1.25 x 1.50 2.00 X 3.00 Gallons-Inch Calculator (optional) 1000.00 Total Tank Capacty (gal) 53.00 Total Working Liquid Depth (in) 1 J.23 galfin (enter result in +cdl 649) Dose Tank Information Effluent Filter Information t~0.00 Dose Tank Capacity (gal) babel Filter Manufacturer 1S.S4 Dose flank Volume {gal,rin) A100 Filter Model Number Manufacturer Page 2 c?f $ RYAN J GaULETT - GINA M BQURY ~! Nlaund Plan ~1~~ T 1_ =l• -T T _l --~-_ ~ L Mound Component Dimensions Down slope tce extension made. A 6.00 ft E 13.32 in H 1.00 ft K 8.17 ft B 75.00 ft F 9.50 in I 9.00 ft L 91.33 ft D 9.00 in G 0.50 ft J 5.19 ft W 20.19 ft __ i {ft2) uispersai i;eii Hrea ~ 5~ ~ {ft'-j i3asai Hrea Hvaiiai~ie 6.00 {gpdfft) Linear Loading Rate 7.50 (ft) 1110 B Obs. Pipe Placement Aggregate Dispersal Area Fnisired Grede 99.7 (ft) .,: ~,., .,~ '~,~: , H ~ ~ .- y 1 .. _ ... 98.45 (ft) Lateral ~ ~ ~ ~~~ ceu Invert Dim Dell 5~ ~] D 3 ! °" t Elevation E D ~` -: ,,~/ ~ ~ ~. _ 9 .20 {ft) Contour Elevet~on 5_Cr yf, ritP ainrw '"':'~~ ~; ~l- ~ ~~-. ~ ~ ~- I ~ Geatextilc Fabnc Cover Shading Key ~ ~ rsal Cell See lateral details on 0 t ~ ~ -a Topsoil Cap ~ ~ ~ c 1.5 ft o s ~ Page 4 for number, f d i i © Subsoil Cap ~ ~ ~ ze, an spac ng o s l L t l © ASTM C33 Sand ~ F s are s. a era latera ®~ Tilled Layer ~ ~ ~ ~ T i ~acerai 0.5 ft ;~ ~ ~ ~ ~ y ~ uall s ced from the distribution cell's >~: Aggregate 0 .r ~ A centerline in the ri~etiilvrtjnr} roll {~vR~ ^:oect: RYAN J r=nJLETT -- GI1~!A M BD~Ry Pace 3 cf 8 1 .-,4 _ `nf~ ~'~o~e~ie~.-.-±j~; s 1 ~~e°.r_~.s>a `u~ v~.a~ viu~i cm '~ °~ '^'~`"'~' • s Turnip wltball valve or ~atoanoutplug P aAN lat+rrals ahr i~de~tical If X -->~ hFD1~F5 dhNN 8n the t>,ott~om 4f tMre IxfK•1 $ ~~ saP~ -~ Faroe mare ~onrri+oti~on via tr+2 at droe'~ td mxvlhold x x-~ point. lat+e+••Is a r,at.:r m•m of I~v'c ~ ~1 (per coiww TaW~ arE.3o-5] IV1A111i,JG1 Vf LcitCId1J ~L VIIIII.G VIQIIIGtGI Lateral Diameter 1.50 in Grifice Spacing (Xj Lateral Length (P) 73.44 ft Orifces per Lateral Cetera! Spaang (S) 3.00 ft Orifice Density Lateral Fia~v Rate 10.30 gpm Manifold Length System Fiow Rate 20.60 gpm Manifold Diameter Total Dynamic Head -'"17 25 ft; Forcemain lleiocity - vvv~°. T~nV iiifvi ~~iiuuwii i-~ f ! EEectrical as par NEC 300 and ---~ `-' ~ Lamm 16.E 1 NAC pisconnect ~-._ V.1L.7 III 3.f}6 rt 2s 9.00 ft`/onfice 3.00 ft 2.fk7 in 2.10 ft%sec Lock!ng co~~er ~rth ~rarning label antl locklna device and 5@31Et1 W3iBri1}"~i1t 4 n. min. -~~ i arV{ti GjNilFx7flefit iS PfOpfir {y verlie~ I,.R~eeks Capacity 800.00 Voiurne 18.64 PAarZUfacturer Gallons gailnch A B C D Dimensio Inches Gallons A 25.98 510.34 B 2.00 39.28 C x.75 93.26 D 8,00 157.12 Total 40.73 800.00 3„ urxier tank Alarm Manuafacturer S.J. ECECTt7 SYSTEMS Alarm Mode! Number HW 101 Pump Manufacturer GOUCDS Pump Model Number WE0311C Pi.iliip ivlii5t uGii"vvr ~ L^v.o~lglnil ut j i7.~~~ii i un ofternate o4:IR Location Fercemain diameter ~ 2 tn. Weep hole or anti- siphon device ump off elevation (ft) 88.6'7 lklse tank elevatron tttl ~ t38.~ ..-^: vjeCt: RYAPJ J Gt3UL1=T?' - G9NA M °^uRY 1.-~'agc -~s 3` 3 11A.~...+iJ C w1~e.r~ 11A.~:r.4er~.a.~i.~ ~a.~-rl /l er~i:i..+ C.-~t.w:i:n~f:.-..nc. IC+L: wii 3Ri G.ii.Z itri i+ :iiA:: +iGiiQifirv Gil iS.: C.: :.iGi Giii:S:i Virl~~' ~Qii~ Service Provider's Name ~ KIM. A OCONNELL Phone X15-755-~1d5 POWTS Regulator's Name r ST CROIX COUNTY BONING Phone 71586-dG80 e....a...... C+~.... ., + a 11.-........... a.. _.. .zvai~:ci r:vw aliu `vSas rma+Ilcic+a ^--'-- LJCJI}~I 1 Fluvli - Pt7~1R) Estimated i=row-Averages Septic Tank Capacity Soil At~sorption Component Size Type of Wastewater ~ " ---' '_ n°__I 4~l! I~FJU WIdX11111J111 II IIIUCI Il Ir'dl llt.:IG OILCI 3a(} gpd Maxirnum csODS' 1000 gar Maximr~m TSS' 45Q ftz Maximum FQG', C3amastic Maximum Fecat Cotiform' I%O III 220 mg/L 150 mg/L 3Q mg/L >10E4 cfu(itZ(3 mL Canlira FraYr+lanri~ Septic and Pump TanN Effluent Filter Pump and Control Alarrr Pressure Sysien- Other Inspect andlor service once every 3 years Should inspect and clean at least once every 3 years Test once eve 3 ears Should test monthly Laterals should tie flushed and pressure tested every 1.5 years In for and a once ev 3 ears AA: .. I1.... .. .. /~..r...a......a' ~J AA..a..~'..Iw Ca.....J..~.aw iii"' Qii.T~ i'T~."' - J:%::3 is C:L ii~". Ai:G iY+Qiv:IAi3 •7LRIItAAti :: I 1 !1~ a: l..ss .~ ~..J a_ "..I~ ..G a.. T..i.4.. lam.. O / ~]A .~ 4.... ... •...a:._i.a ... .. .~u.avr':auvii rs:~ .,.a 3i:..i$i: a:....is~i..::a..~......:vr:si i:, : ;c/ic .....::i:i: ..~...... ., :servo ~ i:'va:csisa::...r:, ~nt1 ara ec~~ srcui in ~c c,_,~niwrn in the mn~ iru~j rnmpCnanf man~ial. 11 ._ ..av ..t.. .. 3.. /~.. OI 7n IC\/:\ \Af... A.J.Q. /~~.~.- ~1 r1:,.......~..1 .... v ~r~ti .... ...... vv..v L. v. :r..i .+~.ii tiCii a~ v~:.i vv. ..... ......... vv.... ~: :3=:..:.3 \"~\'l, a:.... . w.... `2 411 gr~yity ~nf~' 1Yy"aCCllrc I{1iirv_ng matcrialc rnntnr'm to the rcuri iiramantc in r,;nmm Rd_ 1A/ic prlm_ rrde. ........ ....... ...i..... ........ ..`. ;. T:IEua~ ~` tl iv t'•'rs"' isi Sr=s is ..,.,, Ti~sii$.~::d :~ u a :: sv r' c+.-.~iar \"'J z;r %ii:&at pl 'vr: F Tho m~i_;nr1 etn ir•ti,irn tinri nthar riie}i irhn~'1 araac will ha csanria{'1 anri mYi(~hari in nrcvant cnil arncinn '- r• •-- ~"~ i" ~ "' rad:ice f ra3: }lcna i allot: .. ..:'r% Mara! ~I~rr3_~in 17atail Finished ..~~+~ Grade ` / 6-8" Diameter Lawn Sprinkler Valve Box Distritx~tion Lateral n~..: ,...a• AV AI 1 r~/~I 11 CTT /~IiIA •A olYi IA\/ .::j.-.vi. n i J'1iv wi :7vvLL i i - \9iiv/1 ivi Uvvn i e.t~~~r Threaded Cleanout Plug or Batt Valve Long Sweep 90 or Two 45 Denree Bends Same i_')iam~tar ac 1 afarai n~.... c s o r aac v vi L ,~~, . e~eea~s~ieZe~.--. C~ ~~~:rii R~r~ss ie~.ee~~°wie°.iit+. ~~ar~ i`iiiifoiiai'i[ ~ tFaFi"iUi'ii vv.3+°r~ ifiS. ~aiiii. v~a"~ General i ilia Sjr3:3tit aiSii ucGj+ctwctir ii1 SGCGiumIGBY~il1 vGliuit uLv4'vVi$. /iGli1. viri~i:, eii~i SilSii ITiuiiliSiilci~ iii uw+viuiiilGS Y'r"liii n~ GGtiljwilc~7t . nm wmo ~`vCsiJ~ 1 a/vJi -ij ii v.v i iv i j 8i w vvVVrrii i UGii~uiilin 'ci.v wi iv i ~j 8iiu iin:ai Gi aaCo ruiw ~.aai wiiii ly iv oywc . i i .SiTi~ tai ICo 8i lu n;nin~onr:w Ttarv.r--nn -- t.} .e.le,a- vv GI io aiviii6 8Y6i oTitot 8 So"'f7iiC Gf NUiTi~ iei In oii IG8 uetiyaTGuo y85vo t'7'i8 ji i/6 NiooolT ii Ins wuiG GBu~ uoa~f i. Septic and Dumo tank abandonment shall be In accordance wth Comm tl:3.:ii; Wls. Adm. (rode when the tanks are no longer used as Dn\nrre n~M~ .,..~.. cor.+:n e,, ne....n ionL r.ennhniu .:~~ on.w~~ .:~o.~ on.i nne.o.r ~he...Li }.n :nonn..+wi fe.i ;.,ofwr +:Vl;inoc.o o..a ~r.::n:1•;~-~ n....~ ....o..;n..~ iiac . iGi 8ot'viGS 8nG SS82"oi31Tii'aiti StiBii uo ."aii8jou Y awtiiy ti ujiGt i iito wITlNiaiGi a GT ovi'viio. rii ey Gpag;gy Gwg:f;:.::i wugG, Gu.wu'vo, Gi B::Djv:.a to tatlure must be replaced. txoosed access ooerilnds Greater than ti-Inches In diameter shall be secured by an ettel~l\,ie lackinG device to f rn. u...i uL-Giaj~aZl yr ,'n„ •hnr:+.+rl nrd S :..Mn + i..nL n nmm~nnn~ ... ., ..._, .. . u...s+.eu ,~•e e-v~ ex eu :e:e_ v ees:en yr _-~•eeeF _••••- . Ce.diC T~r.L • ••~• • •- v. s v i .iv, vii:::5. . nv w: iilo: ii:i vi i.ge '.ii' idi iiC . ew .av}X:G Uif IK cliiSli l..'C' fiiii:::iol::Fa'.3 liji aii IiiGi JlClli6ii L'Ei i:Ilv:.i iJ ~F3i'rivE :iGjiiiv ic:i ii.:i ui:uSi }+l'" shall hA dirnna~i of in arrnrdanca w~h NR 11 S, Wic Adm (',nrfe? ThFI nnP.ratinn cnndtion of ihP cP.rNic tank and nltli# fittP.r shall tx1 a~e~c[-xl of In<.,~ .. o Z ..Dore h.e :nonc..}:..n Th` 7uk1~ ArM~ :a~ii li te~i C< ui+~ u~ ..iG:.'rt' }i ....__e T n..~~;n TM~ NMn. ~A.:.J nh` `Iv n~ h.. ... n.~ ,,nln.. vr. _~.~.... u.t .^ ...., _.. .."'.. °. ;T~ 'lvsuie. ~i uio i~~ia +s .. in, iiis iiii';li ,.,,.,.~ .~ Ieaesiii :::.rawer Iii igeiaai:uiiiS giay ~iuuyii oii uie iiiiai 'rliib:i i~ii~ s~'•Ytte tt~ ~ ~iw•rf~ •rug Qii aiai shall t>P cP.nAeixl it the alarm is arli\mteael e:nrltinunucly Intexrrlttnnt fiGar alarms may indicates clirna flaws nr an imnP.ndinn rnntinllolla alarm Thn ~o.d:n jBrL Rheuii ei°se° Ae nn.An..Fo .ae.e~e~ `e'r'}'.°." }lie r..l:' .e_ ni ~1.i~3o n.~ c n }hw ~.T~L a .•m.+~ 1~J4 }tin Ily..7:~ :".r~.:,.,,., of jlio }o.:L li , ... . ... .. ... iM;. nnr..F~~n `i N~` }ywL G~..iy. wIJ r....+n..vl ..} ihn ti.r.n nF w },.innn:sl w_~_ __....n..w, .ll~..!•_.._ _ _. _. _.,"nl .-I...II n.d.. ~ +L... t T}e 1e nF .. L.*.. }hi n.A _ . _..e~.rt-.. t:t t..v ... ...^`.^nt... ...t .. ...nnnn n _. _ _.. ... .. u ' i::Fii;::}Sig iebi :LSwn wn: 'av "" "iiCi ai:uylc iSCGUfiii:"diiU;i i" if i:: """" ~:'rii:(: iiE.E°.±E.: i:i i76 ~'i i:Si:iibv LU "ioi: """""" wtn w - . .. .w,,,.. The? addtinn nt hinlnniCal nr rhamical additives to i>nhanca septic. tank ne~fnrmanr.P is ne~l}arally not rpnuirPtf HnuvPw.r, if such nrndur7s ara .~-a,i +tinee ~tio.j tin onnrn.orl i T ro.,i~n }nnL .,ten }...+tin ner.wrtm~± r;f r~mm~..o D. «.... T~r.L e ki aUR:~ 1GG61it~j iBitiC widil i3a iii3~a 3G 8i ii:~bi GiIGG orot y J jic:wiu. Ril J'rrllCii>s~, SiBiTio, Bite NuiTiF7:a 3(ioii CiG if:aitiG CG v~;ifTy F'irGPGi ooerahon. If an ettluent htter Is Installetl wthln the tank t shall be InsoelYed and serviced as necessary. lAr. r..i o...i Owe~..~4 1'1'.-+~:_L.. d:.... C.....io e.....se..: .ae..r a e....~.. v ~.., s~lxev.t vr-e. _ ~In ir.....+ nr ..hn.L... nwt.n. ,Irf hn n1...J.nj Can ihw w.n„n.i Dlwri}inn...v..... hn r.....In ..rn sn..l ihn ~.nn ~~u'~ ~ , _m.,in. nn.l +L.n .w~i na .•hi 11 ve!~a..~vr :+..1 vt_•u fvJev ~•eueee•,± teems-e:.VS.ee e•..e. •-• -•••'- eee~% . =• e!rs..._. .. ... ••• •.._ _ _ _ _ . .. .- iit SE.~;::.w t:iiG iii4iVlttrnj a~: ::w'v::abtiiy i:J iJI Cr{li ii Cfi U.'tiiL::i tiiiG iv jii'vViU6 :3:7i iib iii Jicviivi: iiviii iiiia Nviio.:'ai:UiL .:ii1;iG ;C:.::o7 iieoii iii: VISyEnwi:'r"..i ma1n1P51anC.E11 nn the. mnlIRC1 IC rift rernmmAnliPlt GnCP. R(111 C.tlmnaCllrfrl mAV hlndFx aAfatlnn of the. IntllfrafNP. CtlrfaC:P. wthln the mnllrld and Cr1(1W .v.mnor}:nn:n+hn•.:n}.,,r.+wl n.n,Tr.+o frn~..or.cire}:n.. r`nl.i...en}I.o.'nc+ollo+:....c/lly j~ne.o.CoL..,i~...\~:rlo+o+l~..++ho ,m_:~~w.o Li~..I~m::ev:i`.'{+i .. _.~._.e pee v..~ e...e .•.l} •• ... }-tee.+_..._.... __... .. •~-v._.. _. 1, .~+....~_._.._ ~_ __. _..._. „ _ _ _ _._..._ ... n.~n~iun WCwi f tti wn y r nueumn ytiwiii.ji ii iiV Ui8 iii'vJ;iU ojiadiii iaay :i:.". @nvc'ca c~J iiiiy"L uvv~, .w nnyL :vv, w;iv .7..i ::iyiL i G.i'v iVi ao}euv iwi:n 'c';iiuo: is G '.]!1 ..;VA pllrlV it1 ..i~ ~.~T44 ~~1 .nyA C`1/`_ onii 1`\F nf„MM ...I ~... I.:nL.l.. +.ootn.i nifll ~on+ t~fll.o..+ Fl..... .no., nr.} o..ym.i ...o _...y,m .ice-:Jf; fl.i~: M:F:~ :n M.n ...+r.,,.ii ~r i'i eeS i'ru"i'•ui~ua'Cli y '~'Thn e ' lTP ~~i lki: ~:•• oe.eAio.n ~ :e~oa .•~l. o Fl, .a>~h:.. :~ o} +I.o or.a of ooyl. lo+~ol C.~ :F :-s ...n , .. .w.l~i +I.o+ uonh io}n.ol L..° f1.1wL.~ Ji BvwutTiiii&'iu""7 iaGiiuB qa ia"'8a vi w2 i.rut r i v I I IGI IN 10. Y YI IG 1 B'II FT~i%1 G C\A7L 10'!GI I VI I I Ia/ It JI IGYN vo a.GTiNBi cu iG ii to ii uTiBi icot VrTta 1 ii lu SVSTP.m W85 1i15i811ed LQd~ermine n Onnce ClodOlnO 1185 oCCUrfetl 8r1tl If Onnce sleeping 15 fedUlred [O melritaln BflU81 tllstnbUt10r1 Wlihln the d'n..`..c-nl WWII yl- /'1hro~to+:'nn n:..oc-....Fh:n }l,o .i:cnor~ol ndl choll hn nlioe•4~ fn. niflTinn} nnne+inn Dnna:n.. Io,.do ~i.oll L.o ion..r+~l +n +L.n n...no. oi..i on.. Ini ~c BTiv'rc v ii IGitlq"'o wiTBiua w Bo 8itt iTi~t"iuli ly iiYuiBU~iG ~aiiui c i oyuiTii ty BGuiiGi ISi, Tivi c i i cyucl n IT'iGi uZGi ii ly. Cc>~tirx'ru~y.PtaR If+hn cn.Jie• 4onL nr one. ~ni :Fc ne.m......n..b hne•e..no eir+F....+n,n }hn +onL n. e.n...nn..o..+ .-{....11 ho r..n<.:..,.i ~, r lono.i +s, rex.n u{.o .-. _. r .......... ., ~,... ... F.T. .. ,........r .. ...e:e~••: .:p ..~v:.e.,}.._.::_-e.e...-....~,.,__<.._t:-•x:e_-_ee•-..w:ae:•: s••r,.:}•_.., _-:e.=-:.e:, u._. _, ... _.. .. <-j~,~.<. __._ _ r ._ ~~5~. ~,. n.n."•.. nnvwi:nn nn ~ii:wr. ..~.,'...~ .:xigy iagx, I.iuiiip, r~t.tr „e;i;;icis, aiaiig v: i~.w.~.: rr:ii:y ie~;;:sig~ c~~"r,~:li:2l~:e dziecilv,z Gc;;ij,3Gi;egi~`.i~ :~;iai+ i%d ~igsiii:c:ia:i y ranairPri nr rarNar.Prl with a cmm~GnPnt of thA camp nr l~.nual nPlfnrnlancP. If++.ne..ne,nei r.,.m..r.nm..}fo:lo }n one~.d ~~ dwe..o+nr nr hd.:ne}...i:....}.o...n ...oo}n,.eo±o<}.. +i.n .. _,.*'r: ~,.rioe:o :+, :II L.n .o ~rwa ..~ n..lor.u~:,. linr nrnnn..i ~nn.ri:nn h.. :..wr.... ~iww h..r...l ....... If t~ I.~.. L..nn .. . h..•r n hinln +11.. nln nn~ nhnnr..iin _ _n.l .Ji.-.,n. ~..1 ...n.J:n nu r`:Lina n,.. ......^... •r_w.,.~.: yr t: r_....vt .,~ tees-=1e ue _• ,. _ • ••=+,._e _ • • : =w n. • _ _ _e _ _. _ _ Y" _ """'i i ' dgU 1 IdGiii Shctj i:U(1i t Idl ilia d5 UL'Cf Ilb:; : ~ 'C,,.R;,iailf y lG i:i ii iy ii i6 Jy:a6g::i :iG yi Gj,i@I C~I dlii iLJ' "viii iCSiiiUi i. MAY' y, ~ ~ ~ ~ ~~ SPP. Pang ~ of this plan fnr il1P. name and talP.nhnnP numhP.r of vnur Inral PnWT S rP.nulatnr and cervire3 nrnviriar ,.~ i v ~.: u :':vjcC~: 4YA~{ J GCvLETT - Gi~`Jr^~.1v1 °uvvR~i nMa~ c .;F o ^ Vi /`M/1 i 111.1 •~/~ ~~ . ~~Curves ~Ui11 S `~7~~~ ~' . .' MEnRa/ BEET PO ?5 ~ ~o 7 ~, P -. ~ t5 .o IC ~ 5 to 0 0 f r ~~ ~~- ~~ - " ~ - - - -- j - j SIZE i~ So~~as - r\_ I----~; j- -r- ~-~---; Wt0.7 M f~ ~ ~ ~.-., - ~ _ ' T ~ ~ o w zo 00 w so cro ~ o ~ sa tw ~ t o t :o it ~ M p IJ :'0~ ;~ m~,T CAPACIri I~ ` 'ri; .f ~'i~. ~i.fr %~';'~1.1!'1r ~"'T. 'r~'A; 'I~ rimer ~ (~ '?~.1•.~1N P, ~.~ it 1• ~ ~.~1vOULD`~ PUI i~ METEg9 FEET t i~ t to ,~ coo 2~ ao g TO - y~ ?0 7 ~o O ~ ,A is . ,~ '0 ~ 5 to p p .i. ..~r.~ .--, ~ D r- ---T ---,--~--; E S 3~~ 5 ~ - W E 15 n H -~ -- ---r- -t-- ~ , - j~-~ --- ~ - ~ -- ~ -- -t--,-- ~ -; -', - ~ S I Z ~ ~;`~ S v ~ I C~ S --r _ (-i-'~_-- ~.r -i - _~._.~ ~ ~ ', - WE OSti N - - -. ~.. . ~ _ .. .._._ .. __- I --• - - T i--I - -- . --~ ~ . _,- I- ~ ~-1 1 -1 - ~r~ . ~ ~I -. ' . ..__~_.. ._...~ ~_IT~._._ I ` ~ ..-- --~ -i --~~--.-1-~---~ -~-~-~-.~------ -;--- _ ~ ~ , _ ~ _ , _ 0 10 70 p0 10 SO C4 10 ~. IA tW I10 t:'0 GPM t_ --------- ._._ 0 t 0 N 50 m'ni CAP~C~'r'r • ~ vo0 Ow~01 P~mpl. Ind. EMCYf~ rvq ~ n; C;1~ __ __ _ __ __ ~° C~ g 6~ ~ __ .. ~G? for ~~"". .SiJ~Y ~}/iv/f -~s<c~C - ~~1~ ~C/76 v ~/~. _ __. __ 7/,$s~ ~ 1 1 _, , _ --- ,~-. /~~ /~J~s ~C '~r /~-~/',i~- 2,~I k icy BGt~ c~.~ .~ / ,~k~- sue} - __ _._ - -- . __.. _ __ _ I ~~~dfsso ___ ~~~~~ - _ /7OU5,~ ~ c1A> d ._ _ ~ ~ _ _ _ _ G,o~c. ~~ i ~`` ~ ~ ~cF . _ '~ ~~ _~a ---.~, ~ 9~- ` ~_ ~ _. _. ~ ~~a,/~W,~~,~ ~_~_ ,E,c 9y.,~ ~ - _ - -. ~~ __ ~ _ __....._ _ .. ~.C/d6 ' 87 ~ /ft~7 ~ 7/ I ~~' Wisconsin Department of Industry, SOIL AND SIT~~A Labor and Human Relations .-~ L Division of Safety and Buildings in accordance g. ~ R 83.09, ' ~, .~,;. Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz131an must ° _ '+-,~~ include, but not limited to: vertical and horizontal reference point (BM), coon and percent slope, scale or dimensions, north arrow, and location and distatp ne~r~stao$d. tt , .. APPLICANT INFORMATION -Please print all informatiq~n ~, -'' Y`~' )~~ P<:;~ ;F~ICE Personal information you provide may be used for secondary purposes (Privacy Law ~ i 8:04 (1) (m)). Property Owner ~ V H Q ij [gyp ~•.~J19 0 ~ b ~O G 0P~( LoCatiob f~ t V ~ Sd N'll~ v~ t I'O ~ Lot # Block# Property Owner's Mailing Address 332- hiUN~5oT~4 ST'. E~15T lyo~ ~-I City State Zip Code Phone Number ^ City ^ ST• Pnu~ , /yam. i SSIo I c~5/ )zaz •S5S5 ON ~' Page / of unry '~~, ~ pv~ I~ rcell.D.lf O /~ .. • i d / • /d '~ S4 ' O~ view Date '~ ~~ I /~ /ii \ X1/4 NIVI/4.S Z~ ~• I .N.R ~ / i~Cor) W Subd. Name or CSM# ' ~MMOND Oi4'~f ~~~ Nearest Road w J ~- Village ~ nL"J I own I q,~ I (~ (~ (residential / Number of bedrooms 3 Addition to existing building [~'1`!ew Construction Use: ^ Replacement ^ Public or commercial -Describe: ~ Recommended design loading rate • Z bed, gpd/ft2 ' ~ trench, gpd/fi2 Code derived daily flow ~_ 9Pd Absorption area required ~,_bed, ft2 ~ 7s trench, ft2 Maximum design loading rate bed, gpd/fl2~trench, gpd/fit Recommended infiltration surface elevation(s) s~ ~ ft (as referred to site plan benchmark) Additional desigNsite considerations Parent material ~DEfis OV+~ ~~N`s~ 7'~~~f Flood plain elevation, if applicable %/I ~"' ft S = Suitable for system Conventional ,Mou~ In-Ground Pre~s re AT-Grad~e,~ System,in Fill Holds g TanU m S ~,/U tJ5 ^U ^S L7U ^S LJU ^S L7~ U = Unsuitable for syste ^ LIa OIL DESCRIPTI0IV REPORT Boring # i Ground ft. 97 ~ii~- Depth to limiting factor Z C in. Horizon Depth in. Dominant Color Munsell ~ •/l ~ aY~2 3( ~ • ~I o 3 .3 v s S Mottles Structure GPD/ft2 Texture Consistence Boundary Roots Bed ,Trench Qu. Sz. Cont. Color Gr. Sz. Sh. L / S! S~• C t ~ ' . S SAC. z ~~ ~~~ c - •s ~ •~ ~--- S ~- I ~ ~ cw - . ~f :. s. -F pro s S1cC l Shy i-+~-j - - ' Z. '' ' j ~s~l~e y`G ' l56l80 'd) OEEB-M08S ~R ~ v.H 8 ~ X20 ~ ~a~ SOIL DESCRIPTION REPORT page ~' of 3 PROPERTY OWNER ~aT~.l - ~fAMho~~ 6,~~s S~gfl PARCEL LD.M l C i Mottles Structure R t 2 Horizon De th P in. or o Dom nant Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary oo s Bed ,Trench D s/ f Korn /LL l ~S ,,~,~i' ~ -- - i ... ~O~/R ! L Remarks: Boring # Ground elev. ft Depth to limiting factor in: Boring # Ground elev. ft. Depth to limiting factor Remarks: ttl s M Structure R t GPD/ft2 Horizon De th p in. Dominant Color Munsell e o Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary s oo Bed ,Trench Remarks: UIb~IcM ~ AsgOCConsulta~ts P~Ivao,Neil Rae 855 Wls.5Ap18 Nudson~ C GST~~3~ 7 S~~ L~ ; ~ „ . ~-y Movtil~ s~ST. E/.~~. ~.vi~ L OT L .~ P~ iaf3 - s ~i t w ~ 0 ~ O 0 ~ ~-~ ~ ~ o w. ~ ~ ~ ~ __ ~ ,~ 09!26/2000 OwntrBuyer Mailing Address Property Address ST CROiX COUNTY SGPTft' TANK MAINTENANCE AGRLGMCNT AND OwNfRSNit' CERT1FtC TlON FORM ~~ ~~x (verifiication required from Manning Department for new construction CitylState 1~._ PArCC( tdcntificetion Numbef ~(:a1. DESCRtPT10N Fropcrty Location ~~ `/., ,~. '/., Sec, ~, T~N-R~W, Town of Q~`~'`~ Suhdivicion Certined Survey Mzwp # Lot # ___L- Volume ,Page # WArranty Dced # , Volume , Pagc ~ Spec house D yes ~no Lot lines identiftable j~es C~ na L~ - SYSTFM MAINTF,NANCF Emproper use and ntainttnance of your septic system could result in its premature failure to handle wasrts. Proper matnrenancc consists of pumping out the septic tank e.•cry three years or sooner, if Herded by a licensed pumper WAat you put intro the system can affec+ the function of ttte sepnc tank as a treatment stagy in the waste disposal ayatem, The property owner esrees to submu to St. Croix Zoning Department • centftcetion form, sigrud tsy tht owner and by a master plumper,}aurncyman pluntbcr, restrictrdpturtlrcr or a licensed pttmpcr verifying that (I) the on-site wasrtwatcrdisposat systcrrs tc in proper operating condition antllor {2) after tnspc~+ton and pumping (if necessary), the septic rank is Less than tf3 full of sludge. IJwe, the undersigixd have rand the above rcQuhemettts and agree to maintain the pnvste stwage dispastt sysiem with the standards set forth, herein, as set by the Ucpanment of Cammcrte and the Department of taatural Resources, State of Wiscons,n. Centficat~or, stating that your scptit: syctcrri has been msittta~tic~1 must be cnmplclyd and rctumcd to the St. Croix County Zoning Off-ce with:n 30 days of the three year expiration dart, ~~ DA.~ SS G-~~'ttRE OF APPLICANT OWNFR CERTIFICATION t (we) cenify that ail statetitents ~~n this form arc retie to the txst of my four) knowledge 1 (we) am fare) the owrscr(s? of the property descrihed above~,_by ~-inur of a ~.,rtaniy deed retarded in Register of Deeds Otftce. S~I(~~~RE OF APPLICANT. DATE ...... •••••• Any information that is m+s-represented msy result m the sanstary permit bung revoked by the Zoning Department •' Include with this application: a stanipcd warranty dctd from the Registry of Deeds of(~ce o copy of the centficd survey map if reference is made in the warranty decd ' ~tl'~~• .~i1U0pnSE J 1 V • STATE HAR OF WISCONSIN FORM 2 • 1998 WARRANTY DEED Document Number This Deed, made between Humbird Land Corporation, a Nlinrresota Corporation Grantor, and Rvan J. Goulette and Gina M. Buurv Gnintee._--~_ _ _ Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix _ __ County, State of Wisconsin: /~ 651221 KRT'rII.EEN H. WRLSH kEGISTEk OF DEEDS :T. CkOIX CD.. WI RECEIVED FOP, RECORD 07-16-2001 10:30 AM WAkkANTY DEED EXEMPT A CEkT CDPY FEE: DOPY FEE: ikRNSFEk FEE: 7M.70 kECOkDING FEE: 10.00 F'RGES: 1 Na~me/and Return Ad es Lo[ 21 Hammond Oaks Subdivision, Town of Hammond, St. Croix County, ~„~~ - ` Wisconsin. 20.29.17.641 Q lg ~ ~~(~ ~J ^cX~ Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to easements,restrictions,covenants and rights of way of record, if any. The warranties of this deed, either expressed or implied are litttited by the grantor to the grantee, or anyone in the chain of title, to-the consideration expressed herein, that being the sum of $ 24,900.00. Dated this Gth day of Ju AUTHENTICATION Signature(s) authenticated this day of , I'11'LE:: ;v[F.IviBER S'PA'TE BAR OF WISCONSIN ([ f no t, __ authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS llRAFTED HY Paul A. Baillon, Attorney at Law (Signatures may he authenticated or ackrww'ledged. Both are not necessary. ) 2001 Humbird Land Corporation + by ~-[~~~ President . Austin J. Baillnn ACKNOWLEDGMENT STATF. OP WISCONSIN ) ss. Ramsey _ County. ) Personally carne before me this 6th day of July , 200_1__ ___ the above named Austin J. Buillon to me known to be the person(s) who executed the foregoing instrument and acknowle ~ ~; = PAULA. BAIILON '4'~A ! wrKS9FA- MY COMMISSNJDr EX%RES 1.71.2005 Paul A. Baillon Notary Public, State of Wisconsin My Commission is pemtatrent. 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