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HomeMy WebLinkAbout018-1086-49-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building vision INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary pumoses iPrivacv Law, s.15.04 (1)(m)1. Permit Holder's Name: City Village x Township Jahns, David Hammond Townshi CST BM Elev: r ~ Insp. BM Elev: J r BM Description: ~~I .a ~t7 .t, ~ly = ~Q TANK INFORMATION v v - TYPE MANUFACTURER CAPACITY Septic ~ (i ~~•~' 2~- C 2~Q Dosing ~ u ~1 ration _.,...----- -` Holding " TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~v / ~ ------~ Dosing u ~l .~, ~ !,. ~ T~ Aeration Holding i PUMP/SIPHON INFORMATION ELEVATION DATA ~ D 1 ~ l :,r~T•1 cO1n~~ St. Croix Sanitary Permit No : 399496 State Plan ID No: ~~ ~a.~s.fD~- Parcel Tax No: 018-1086-49-000 ~a,a9~~y, ~~9 STATION BS HI FS ELEV. Benchmark CA\ JJ o t. `vt ~ lJU •'D Alt. BM Bldg. Sewer ,d l 0 }~ ~ /• ~~ / S Htlnlet J~.(,b ~(.S}' SUHt Outlet , ~,}} f . Dt Inlet 1 , e l • 9 r. 3 Dt Bottom ~ S-~` g~, ~~-~ + Header/Man. 3•~$ r 99.9 Dist. Pipe 3r~~ 99-~3 Bot. System .O + • O.~ Final Grade S #~ St Cover DIMENSIONS INFORMATION '' log ~ -` 9~ ~ ~~ ~ '~ DISTRIBUTION SYSTEM ~1-~ / `f.'f'g . ~ ~P3J- ~. ~-r-t9 Header/Manifold Distribution + If r x Hole Size II x ole cing Vent to Air Intake 2 f- `' O r Pipe(s) ~ ' O 31 ~ ~ ~ '~ S i c~~ I/~ ~~ ~~ ^' Dia Length pac ng Length DS Dia SOIL COVER x Pressure Systems Only xx Mound Or At-Grade SVStems OnIY r COMMENTS: (Include code discrepencies, persons present, etc.) Inspection 1: / 0 ~" /~ Inspection #2:~/ (3 /~ Location: 883 161st Street Hammond, WI 54015 (NW 1/4 W 1/4 2 T29N R17W) m nd ~(~ f jp Parcel No: 20.29.17.669 \ 1.) Alt BM Description = ~ a ~ ,r•~ { ~ l" '"~"' '~ ~Ca~+~'" \2.) Bldg sewer length = ~ ~~ as PaJ.~Q.w~. 11 - amount of cover = r ~ 3.) ontour = fo~Cw~~svr 5'8 • l9 ~ CS~t, 98 ~'~ - ! 0 3.1 I ~ ~ -~ao Pan revision Regwred? ~ No ~ ~ ~ Use other side for addition i 3 ~ ~ --~ ate ; sepct s S' atu~ ~ Cert. No. SBD-6710 (R.3/97) Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ` Yes ~ No [] Yes [f No SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length I No. Of Trer+egss DIMENSIONS ~ ~ '~- r/ ` I ~~ ,. ~ Safety and Buildings Division City •.-. ~ 201 W. Washington Ave.. P.O. Box 7162 S~` scons~n Madison, WI 53?07 - 7162 rtment of Commerce Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal " ma be used for record ses Privac 1 ^ AllInf o I. pplication Iinf rrnatlon - P ~ t o ,~ ~ 1 Property Owner' ame ~ ECEIV S Z GEC ° property Owner's Msiiling Address _ SrT GAOL City, Zip .~ ~"_ ~1.~ l~bet. 9 ~ d ~~l "Oi Site Address ~(~ / ~ 8'x'3 /~~l ~ ST ~ Sanitary Permit Number 0 Check if Revision ' ' StaG~1a[tL,~Z ber q Parcel N6um7be7 r 2 ~ 2 T ; ~ ~'. ~ ~ / a/~'-X016-~9~ ©on Property Locado_a/ ~5i ~i.; S ~ 'TZ N, R Lot N Block Number .~ Subdivision Name CSM Ntunber i~~s,~...ei~i t it rJL'r r- II. Type of Building check all that apply) ^Ciry 1 or 2 Family Dwelling - Number of Bedrooms '~ O ~ ? ~~ '~S S~~'` ` " ~ ^Village ^ Public/Commereial -Describe Use ownship J~/lji~¢J~ ^ Sate Owned Nearest Road ~*- III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) For County use A' I ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition W S sum Tank Onl Ezis ~ S stem Permit Number Dau Issued B. ^ Cbeck if Sanitary Permit Previously Issued IV. Type of Permit: (Check all that apply)(ntrmbering scheme is for internal use) " '-" i 44 ^ Non -Pressurized In-Groutd - , 2t~ Moues ~ q X ~i ~ 47 ^ Sand Fitur - " SU.O Constructed Wetlard 41 ^ Holding Tank 48 ^ Single Pass it ^ Drip Line 22 ^ Pressurjzed In-Ground - 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other 45 ^ At-Grade ~ ~ fT V. D' rsal/'Iteatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Appiicadon Percolation Rau System Elevation Final Grade R fired proposed Rate(Gals./Days/Sq.FtJ (Min./Inch) flevadon .~- ,, ~~,, 3~ /.vim ..~ Or Ca i in Total Number Manufacturer Prefab Siu Steel Fiber Plastic VI. Tank Info P~ tY Concreu Constructed Glass ~' Gallons Gallons of Tanks ~ Ncw Esisdoy Tins Tanks _ Septic or Holding Tank ~ -~ ~ L(ffZ. Doaint Chamber ~ ..- •~ VII. Responsibility Statement- I, the undersigned, assume respoosib y for installation of the POWTS shown on the attached plans. Plumber's ~ nature #P/MPRS Number Business Phone Number Plumber's Name (Print) ~`^ Piumbin & Perk Testis '~'2 ~ ~~~ 7~J _~~~ p~O~ t g Plut~$~~~~~TtL~I t•~~~ State, Zip Code) " ,ILL S/- yLu ~/Ov/i VIII. Count /De artment Use Onl - " - Sanitary Permit Fee (includes Groundwater Dau Issued ~Q Approved ^ Disapproved Surcharge Fee) //`` ^ Owner Given Initial Adverse ~ ~ ZS ! Q J~ Z D ~ Deurmination IX. Conditions of Approval/Reasons for Disapproval 1 Effluent filter to be installed and maintained per manufacturer's recommendations. 2 , Any filling and grading that will affect the capacity of the HWL retention area is prohibited. Issuing Agem Signature (rvo a[amps/ oomPlde plans (to the Camp odd) ror tLe nstem ao papa' not Irss than 31l3 x r1 mcaes m sue EI SBD-6398 (R. OS/O1) ~~ ~ ~ iscons~n 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 Scott McCallum, Governor Philip Edw. Albert, Acting Secretary October 03, 2001 CUST ID No.691727 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/03/2003 ATTN.• POWTS ZONING OFFICE ST CROIX COUNTY 1101 CARMICHAEL HUDSON WI 54016 SITE: Owen Norcutt - 161 S` Street St. Croix County, Town of Hammond Part of the NW I/4, NW 1/4, 520, T29N, R17W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 812875 ~•.; T\ ~ . ~~-y,~`~ i ,. R~~~w~0 ~~.~: OCR 0 ~ 2001 ~. Sf ~Y ~ ~~ ~ r-. ~~ ,- _. Transaction ID .67648 Site [D No. 6363 Please refer to both identification numbers, above, in all correspondence with the agency. 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • 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 "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • 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. Owner Responsibilities: • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of the instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • 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. ARTHUR L WEGERER Page 2 10/3/01 • 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. 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. All permits required by the state or the local municipalityshall be obtained prior to commencement of construction/installation/operation. ' In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state slats 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, Gerard M. Swim POWTS Plan Reviewer -Integrated Services 608-789-7892 Mon -Fri 7:15 AM to 4:30 PM j swim@commerce. state. w i. us FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 W~SMART code: 7633 cc: Owen Norcutt Fogerty Plumbing & Perk Testing, Inc. TITLE SI-i.EET ROUND SYSTEi~1 FOR A y BEDROOrI RESIDENCE Page 1 of ~ This plan has been prepared in accordance with the Mound Component Manual SBD-10691-P and the Pressure Distribution P•Ianual SBD-10706-P (N.O1/O1) (N.O1/O1) LOCATED ICI THE NW 1 /4 OF THE f`1W 1 /4 OF SECTION Z~ , T Z-q N, R 1~ W, TOWi1 OF ~~y~py~~ ~ S~-•, ~GZO~X COUNTY, WISCOPdSIid. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEr•I IIAi~AGEi~1ENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIE[7-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUI.IPING CHAP~IBER CROSS SECTION PAGE 7 of 7 PUrIP PERFORI.IANCE CURVE PREPARED FOR _- ~~ o s e~-~-c.~.~B~zcz.~ ~ P~itional~y - -- __vvo~D Bv~zY , >~ ~, s s l z R __ _ oV~Q ENT Of COMMERCE DEPpR7 ~ gUtlDtN~ VtSIQN'~F PREPARED BY ~pES~{CE, WEGEI~ER S~3 I L . TEST ~ SIG ~RRES AND . DES S G~i S~RV S CE P.O. Box 74 421 id.c~Iain St. ~~~aa~~soo~o River Falls, [dI 54022 ~,~° ~~~ti~~~J ~~ Phone 715-425-0165 a ~~~,,,...••:..,~9 ' Fax 715-425-6864 „~~` ~~";:' ••~'~ m 'b ~ ~ AitT!^M-!4 ~ WEuEF<t~ j ~•v+s P ,~ EuswoarN wr,;. - ~ DECEIVED ~°~#~~~~~ r~~h~ .;Q ~.~ ~~~~ ~ SEP 1 7 2001 q_ 1 S _~ ~ SAFETY& BLDGS DIV. JOB N0. UI- ZZ~ Mound System Management Plan Page Z of Pursuant to Comm 83.54, Wis. Adm. Code SeoticTank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank; If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps.shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual {~8n-~ ns~~-o ~o ~~~~11 arid local or state rules pertaining to system maintenance and maintenance reporting. S~j_lDbg(_pClvollol~ No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected far water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Cantinaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump,. pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. ~uc~~loiis aoou[ Lne operation or maintenance of this system should be directed to: The County Zoning Office at BLS- ~'~, L~ 681 S~". ~°.~ 1X The system installer at _ ~ 1S _ G3 S - °Z6 09 w GC~r-y The tank manufacturer at -1 LS - Z~ ~j _ 5. Z $ S W ~"~, tZ. S The effluent filter manufacturer at _ SDO-- ZZ,~ - 5'1~{Z, Zp~-,gLsZ, The pump manufacturer at - X30- ~ZQ_~I$l(.$ GOULL~.S DT !'1T D7 TAT ,~ Scale 1 "= 50' 6~^'- N-Z. =_ _tst , l lib .-?8'-- - __ k ~ _ _ __ ~b wpT c0~"IPA~'r O tZ D ~STu~'z.L3 'f~{-1. S ~TZ~rA ~~ Page 3 of ~ ~~ 2 s y 2 ~~ ~' • Z ~ D $,+', fir) . ~L °~S. q 1~~ ~~~ r 07 NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be lZ o p gallon capacity manufactured by W ~~S COIN CP-C.~7E- ~/ (~ -1800 Z~3~Z- 1/1 L`7~2 P~ P T~+~d-~ `1U ~B~ ~(X) C RZ. W~~~1z.S _ 4. $ench marker : S~_ ~OU~ 5. Divert surface water around system to prevent ponding at the uphill side. P_pproved Synthetic Covering AST~i C33 Distribution Fipe ~/. 1:_._ P __ J ZS' --hzo t~ ~'P~vkS ; _ ___ _ -_ ~~y'r1P P~1Z-FO~Z.~"~1~YyCE CUizUE uouias ~~-la%- r 3885 .r •,~ APPLICATIONS Specifically designed far the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: 3/a° maximum. • Discharge size: 2"NPT. • Capacities: up to 128 GPM. • Total heads: up to 123 feet TDH. • Mechanical seal: silicon carbide-rotary seat/silicon carbide-stationary seat, 300 series stainless steel metal parts, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor Single phase: •'/s HP,115 V, 200 V, 230 V, 60 Hz, 1750 RPM; %z HP, 115 V, 60 Hz, 3500 RPM; '/~ HP -1'/2 HP, 230 V, 60 Hz, 3500 RPM. • Built-in overload with automatic reset. ~o • Class B insulation. Three~phase: ' •''/z HP -1'/z HP 200/230 460 V, 60 Hz, 3500 RP • Class B insulation. ©1995 Goulds Pumps, Inc. • Overload protection must be provided in starter unit. • Shaft: threaded, 400 series stainless steel. • Bearings: ball bearings upper and lower. • Power cord: 20 foot standard length (optional lengths available). Single phase: •'/3 and'/z HP -16/3 SJTO with 115 V or 230 V three prong plug. • 3/4-1'/z HP -14/3 STO with bare leads. Three phase: •'h-1'/i HP -14/4 STO with bare leads. On CSA listed models - 20 foot length SJTW and STW are standard. FEATURES ^ Impeller: Cast iron, semi- open, non-clog with pump- out vanes for mechanical seal protection. Balanced for METERS FEET 25 20 0 a W 2 U a 15 Z } ~o io ~~ ~ 5 smooth operation. Silicon bronze impeller available as an option. ^ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge adaptable for slide rail systems. ^ Mechanical Seal: SILICON CARBIDE US. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. ^ Shaft: Corrosion-resistant stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. ^ Motor: Fully submerged in high-grade turbine oil for lubrication and efficient heat transfer. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage. ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. ^ 0-ring: Assures positive sealing against contaminants and ail leakage. AGENCY LISTINGS SP Canadian Standards Association ~~ Underwriters Laboratories 10 20 30 40 50 60 70 80 90 100 110 120 130GPM 10 CAPACITY 20 30 m3/h Effective May, 1995 / ~Lo 1 C~~/ Latwr and Human Relations -~' ~ <~ - rayo Wis 09 -1L`HR 83 -it . h ~. Division of Safety and Buildings in accordance . \~ ,,. . , `' ~ (`j ,,} 1, r Attach complete site plan on paper not less than 8 1/2 x 1 f inches in s'ze? plan must :: i,~_: ~!T ~ d ~ County , S~'; ~'~Q/ J` , `" i Ldirection an include, but not limited to: vertical and horizontal reference point (BM t percent slope, scale ons, north arrow, and lion and dis nce to n~ar~st r9ad; ~ ~~, '' • parcel I.Q. # O ~' • s • • ' ~~ . -`~, s-r ~.faolx 1V0'CZC. V T ~- a SO !~l /d . APPLICANT 1 MATION -Please pant al forma [oit:\ couNTY ', ZONI~~r,UFFICE 5 R .views by Date %~. ~ S ~ :04, (t) (m)). Personal information you provide may a or secondary purposes (Privacy Law;: 1 L / ~ Property Owner ~ ~ rH G3 ~ eo L~Ai~ D ~ b C~O PFQp~~i tfotatio~ ~~ ~' Q Z 0 T Z / ,N,R r 7 E (or) W S 1 /4 N~(I1 /4 (~ ~ ~ t", N•/l~ X774 1 I IO ~ _ G , . Property Owner's Mailing Address 33Z. h i UN~SoTA ST: E~1S T l yo ~ Lot # Block# Subd. Name or CSM# .. ~4~t,HOwD ` oi9`,~s' City State Zip Code Phone Number L N , s O ~ ((o.s/ )222.555,5 ST• Pnu I M 15 I i Nearest Road , w ~ Z- ^ City ^ Village l.~ Town q~Q I (.v d ~tesidentiat / Number of bedroom ~ ~ "'~ ' ~ddi~(on to ezisti building []'New Construction Use: ~ t-=---~~- `~ ^ Replacement ^ Public or commercial - Describ . ~ rs`• ~ u~ ~~ gPd .~,e~commended e~jgnri'ig rate bed, gpd/fit ' ~ trench, gpd/fit Code derived daily flow ~ 2 ::~ Absorption area required _~_bed; ft2 3~S trench, ft2 • ,'.j M~i~it3um e~;toading rate '• bed, gpd/ft2 trench, gpd/ft2 Su . 3 ~~ ~ tyT` ft~@s referred to site plan benchmark) Recommended infiltration surface elevation(s) f`~ ~~, Additional design/site considerations NJ ~ ft Parent material ~oECS DlJ~ Q~NSF T/~/S FI od•pl ' elevation, if applicable t S = Suitable for system Convent~io~n/al Mo~u In-Grou re AT-Grad~e,~ System inn Full Holding Tank U = Unsuitable for system ^ S L~ u u° ^ U ^ S U ^ S L~l U ^ S L7 U ^ S U .r..... r,~nno-r Boring # ri q ,~:: Ground elev. ~ ]~ft. Depth to limiting factor ~_n in. .7VIL v~avnrr r rv~. ~ -• Structure GPD/ft2 Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench ~ o•~ i~YR ~/3 .` t i~she s ~ w i f . ~l ~ . s ~p ~I •F Mots S/~L /7~56~ ern vl~i • -- - . t ; . 3 ,o ye 4~L Rnm~r4e• Boring # 2 Ground elev. ~it. Deplh to limiting i /0 2 ~ ~ ~ ~ ~~ cs - . S . 4 /o~~ /6yR~tz s~~ l ash ~v~• .i :3 . . ~- ~•s~~ie y~~ Remarks: CST Name (Please Print) Rpl3~{zT 7iI~t~R1Ck-1' Signature I elepnone rvo. ~~s• 3$G • ~I ~ s Address Ulbrlcht & Associates Pr vale swage ons 655 O'Neil Rd. Hudson, Wis. 54016 Date c;s I rvumoer DGT. Z~1. ~fS4 x4375 a .cY a s~ Wisconsin Department of Industry, Labor and Human Relations Division of Safety and Buildings SOIL AND SIT~~~kt.l1~ATION LL, ,~ ' , in accordance ItT,t ~.=1LHR 83.09, Wis; r,s ~~. Attach complete site plan on paper not less than 8 1/2 x 11 inches in s' include, but not limited to: vertical and horizontal reference point (BM , di percent slope, scale or dimensions, north arrow, and location and dis t1G °. APPLICANT INFORMATION -Please print all inform Personal information you provide may be used for secondary purposes (Privacy Properly Owner ~ (~ M Q l Qp L>All9 ~ G d . . ~u I '-~. S'e~ti~/J ~~ li l ~O~ _ Property Owners nnanmg Naaress 332- h i UN~5oTA sT City State Zip Code ST• Pnu~ ~ 1~N.~_SS~o I ~~~r, e- County ~ i7/ v ~lan mu t ~~'c~~ ; Jr . G/P /~ action and 1 to r>~r~st rgad, )~~ parcel l: . # O •~ -; i :;WC~X d~ ' ~d ~~ COUNTY Re~iBW by ;~QNINGOFFICE ;~...... ~ .. A O Lot # E~15T t4o~l Phone Number I (~oS/ )222. •SSS,s ^ city ['New Construction Use: Q'~esidential ! Number of bedrooms '3 [] ercial - Describe• Page / of Z •yv•vv • S.~ '~ Date I~ is 1 ' I, 1/4 NW1/4,S.20 T L~1 ,N.R ~7 E (or) W Block# Subd. Name or CSM# . ~-~t,HOwD o~",~, f' ~~~ Nearest Road w ~ ~-• ^ Village _ ~„~LJ I own I ~ ~ ~ d Addition to existing building ^ Replacement Pubic or comm ysv Recommended design loading rate ' bed, gpd/fi2 • ~ trench, gpd/ft2 Code derived daily flow 9Pd 2 trench, ft2 Maximum design loading rate bed, gpd/fiz trench, gpd/ft2 Absorption area required ~-bed, ft 31S Recommended infiltration surface elevation(s) su ~ ft (as referred to site plan benchmark) Additional design/site considerations ~/~/~„ ft Parent material ~D E'sS D ~~ O~NSL~' T/ ~~f' Flood plain elevation, if applicable Conventional Mouryd In-Ground Press re AT-Grade System in Fili Holding T+ g = ~ Suitable for system ~,/ ,-,/ ^ U ^ S ~ ^ S ~ ^ S U ^ S U = Unsuitable for system ^ S l~ ~ L!7 5 SOIL DESCRIPTION REPORT Boring # I tionzon I uel it 1.._... ~ O•+ y d. Ground 3 elev. yg, ~ft. Depth to limiting factor ~fL_in. ~} Remarks: Boring # , O ~..... Z Z d z Ground q /~ elev. ~S •~n. Depth to limiting UI h~ CST Name (Please Print) RpQ~R1'- Z~~t~R~G~T Signature ~~s• 3$~ • ~~ ~ S Date ~°' '"~"f""'°' ww 77/~Z /~ Remarks: _~_..., wr.. r:-_ ~. UH $ ~ ~Q L ~~~ SOIL DESCRIPTION REPORT PROPERTY OWNER • - ~ 6j4 ~ S s t'' g ~ • Page ~ of ~.or y9 ANho~ tie PARCEL I.D.# 2 CqC Mottles Texture Structure Consistence Boundary Roots Horizon De th Dominant Color Gr. Sz. Sh. - Bed ,Trench Boring # p Qu. Sz. Cont. Color in. Munsell ~~ / ~ (,~ , s ~ ____ Sig 2 ~- ~' rs ,s Ground 3 'Z 0 ~ ~ '~ elev. - ~,, ~, ~.,~}~ S/GL _ , 1-~-~7~ / D ~/Q ~l /Z- Depth to S~ limiting factor 2~m. Boring # Ground elev. n. Depth to limiting factor ----in. k . Boring # Ground elev. ft. " Depth to . limiting factor in. Boring # Ground elev. ft. Depth to limiting .__.... Remar s. GPD Mottles Structure Consistence Boundary Roots Bed , Ti Horizon Oepth Dominant Color Texture Gr. Sz. Sh. , in. Munsell Qu. Sz. Cont. Color ~" ~ 30 3- ~~, Ulbricht li< Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 CS~224375 „ _ 2 (~ , SC,¢LE % / O V N ~U ~vl (~,u SAN p I ~• Zg /~~' t33 S~ ' • (~ 2 D ~~ ~. T ~ ~ . ~ G- _. ~~' ~ ~ ~ j3 M # ~ = s uRu~ ~/olE'S ~~,~~~ o,v LoT Liw.c. ~l~d,= /pd~0 /. i ~G r y/ zo, (7C,T-"+:1$-2i:)C~ M~1N 0~ ~u AM FF(7M,NC)kCU~T HO?v[L~ :'?~_ .iAX;(,„i 4~8 uu11 PAGE: 1 iei®82061 ~8~23 FRAM Fa94rtq ~1q9~ 'r, e,. 7Q 151.4588811 P.~2 S~k'3"iG '~'A3~IIC M~iii~'~s4;~ANCB AC~R~' AI+TD ot~ q~z~c~-~ax Fo> ~g A~ ~ ~~ ~,r f -+ ~ (~~{Ciatl4n LL1I'Od frC-i~ Planning +~AC ' 31G4V rr~neM,f~'Q~() ~~ Yom" ~' lr ~flStat~ ~'Aitel Idt~1t~C~tic~II TTt1In1~r 1~, f ~rt~-.~to~-t~an _,~~, ~~, sue.,.., ~`~~ ~~w, ~ of T.ot # , ~ Surve~- p # ~ ,~ ~°^-" ^ - .. Volume '~- ,per ~ '~~ ~i-ain~~y bead # , .~~ ~~ ~(r~,~'_~, VoZut~te 1~c~,~ gage # ~`° ~__~, ~~~~ IAt IinCa id~tt0 ~ yea fl ao ~ aeo and malntof yaiu aaptla ~ystclm cauld:rsult i~ ita ptes~uatutrs f~t3luro tv die- maindde>ssnue of Ixt~apiug out the tasYk ' t~reo ye$rs or awoss,eac, tf aeeda~. ~' a Wised pusupet. t~mt yv<t ri~ mto Z>so ayp9tom t~ man vt1 @se a tame as a txeatmeut stage m tlbe waste diapvaat 'I~t prag~asty aa~ a to shit to 5fi. ~~ T.onisj~ ~~ tt cartificatlon farm„ siguad bg tb~c ow~ac aad #~- sj s phtmber,~atnzmoyasass pt~xber, cfed.pltssnbes or a itcerued 'vorif?ying t~sL (~) t1~o on~i#~r was(~oardisliasat ayalnoda is xa propeor vpe~g condition agd/az (Z) filer insgadvtias: and. purcapis~g (if s>geea+pasy), tea task la l~s than 113 ~9ili of sts~Se. ~ ~ bavc read tea abeva ,[egtds~ats e#ad agroc to m~aiata£a the pti~rate rRewaga tl~spoaal ~ tl~ .4 sa! fia[ds, hvt~a. ~ a4t by the ~xr~net-t cf ~ amp thv Dct ag Natural. Ra:vurees, Stato cf W~sapasiu. ~~ g that yottt s~ hsa bees maiwtaiszed's~st tae cotmpleted a1~d xntszracd to t1~e St. Cro9x Ctamtity 7.ou~g Cltl~oa vtt 30 days o1C dxa tiuva yn*r c ~ elate. ~~ .~ o ~ a ATU>ZE 1* 1-~lLIC~NT ]7AT8 ~~ ~~~~ Y (tiva) ' tbei aII stascmeata ou tb3s fcssa ero true to the beat of mY {out) kpnw3edga. i (Rra) ara (at~c) tbRs vwnar(s) °~ one ~Y dcscss`bCd abova bX wttse of s warsasity dacd seoorded is ~ vt" Y}aods tCa. ~t~ZE4T QF ~PLIT~-^ /` ,~ ~/ D *~rww per infatsn~-tivss ihat is mis-rcpresanceef. ~xy r+tsu4t ire tlbe saa~ta~ garmit beiq,@~ x'e° .,:~ by tlbo 2~r i~ Iiep$r~t• ***'~sw ww ~tsc}ade r-lttl tb#s applicativs~: a alsmped we~aaty 4pod from Hse Ra~istr" of I)oads offiEae a copy of t~ oart'sScd r<ttwoy snap fP mt~: r ~~ is nsad N tat the rvasrpeaty stood ~ ' r r-`28 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED This Deed, made between Fiumbird Land Corporation, a _ _ Minnesota Corporation Grantor, and David L. Johns and Lisa A. Johns, husband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: 64903Es KATHLEEN H. WALSH RF.G'I.STER C7F DEF..DS ST. C.kGTX CO., WI kECEIVED FOk kECORD 06-21-2001 9:45 AM YARkRNTY DEED E?fENPT N CEkT CDPY FEE: COPY FEE: 7kANSFER FEE: 77.70 kECOROIND FEE: 10.00 PRGES: 1 Nra-m~e~an{d Return dress Lot 49 Hammond Oaks Subdivision ,Town of Hammond, St. Croix County, ~~(/i-~~ ~- Wisconsin /a 20.29.17.669 /~~~_/~•y/ Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Subject to easements,restrietions,covenants and rights of way of record, if any. The warramies of this deed, either expressed or implied are limited by the grantor to the grantee, or atryone in the chain of title, to the consideration expressed l~rein, that being the sum of 525,900.00. Dated this 14th day of June _ 2001 Humbird Land Corporation ^ by President _- AUTHENTICATION Signature(s) authenticated this ~_ day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS~~ RUMEN WAS DR TED BY ~%~i'C~f~J /r SJ ~~ J~ ~~ (Signatures may be uthenticated or acknowledged. Both aze not necessary.) + Austin J. Bail-on ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. Ramsey _ Cotmty. ) Personally came before me this 14th day of June _ , 2001 __ the above namzd Austin J. Baillon to me known to be the person(s) who executed the I,~,~,An ms ment and ackn wled 'tA^r'4a ne. ~, A , ~ /~, -~`.~ PAULA' BAILLON /.v ::..,:~ :. '. '. rs-'mar";7.2005 Paul A, Balllon _ :~ - • • Notary Public, State Df Wisconsin My Comtnission is permanent. (If not, state expiration date: January 31 2005 ) 'Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF W 19CONSIN WARRANTY DELD FORM No.2 - 1998 INFORMATfON PROFESSIONALS COMPANY FOND DU LAC, WI 800.655-2027 / ~ ~ i I I ~t a / / ~ o 0 / ~ N I N N N ~ I ~ W~ LOT 42 3 LOT 41 3 LOT 40 3 LO O © ~ ~~s• ~ °;I 96027 SQ.FT. N 43,561 SQ.FT. N 43,561 SQ.FT.N 43,51 1 0 ~? 'A, ~I 2.20 acres ~ 1.00 acres ~ 1.00 acres ~ . I ~ 6~~ i 72.5 ~ N10433s"~, ~ \ 415.57' I I \ 251. 1j8.9A' ~i~ \ 53 ~ I \ 4, ~ `rA~9~ 164.04 S00'23'21"E 150.21' S00'23'21"E 150.21' S00'; . \ ' I I ` ~ \ ~ . Tt ~~ 183.06 256.55' I I . ~ ~ c+ ? ~' ' I ~ ~, ~ ~ ~3 33 I °~ I LO ` 3 ~~ " ~ ~ •~, ~, T 43 ws 1 '~ ~" \ LOT 49 95078 SQ.FT. 's. `~~.' LO 43926 T 5( SQ. ~ a 9 ,554 SQ.FT. ~~ ~ ~ ~, ~ ~ 2.18 ACRES ~ ~~ 1.01 ACF I .19 acres ~- ~ s. `°~~ ~ I s. n ~ I I ~1 ~. ~ ~ , OZ9*' ~ ry. ~, ~ ~, ~ I I I ~ ~~ 282 74, / ~. v ~ i 2a2•°r~ ~~5 ~1~ ~~ ~ S13 32,17"w".`'` / / I I ~~ °a W ~` w ~ JJS.44- n ~ N I i -~ N~g ~: o~ ~ .' ~ ~ ~ ~ LOT 48 I I 80.0 z I LUT 44 ~ ~ ' ~; II 3"° 85916 SQ.FT. i ~ I I 65,530 SQ.FT ~'~ ~;~;, ~ : w ~ ~~~~~., -• 1 ~ 1.97 ACRES ~ I I 1 1.50 acres l~° `~,I ~ ~ I IA6 ~9. ~ - ~ \ ~ r ~ \ Y _ J I 3pp.6~ • 3~"12~ ~ ~ ~' O '1 ~ I I I W 21 ~$ °' °`~~ 0 ~ = N19 N~1 1 ti ~ ~ 56,8 17 SQ.FT. ~ I ~ LOT 45 ~ ^ - 53 172 SQ. FTC 4 ~ 06 ryb 1.30 ACRES 3 ~ I . - - - ~ - - - - - - - 1.22 acres ~ I N r J ~ ~ ~ vr'y ,~a`L' ~'C N 2 j T ~~ 6&. 0' I 328.00' ` ~ .00' 128.37 390.55' - - - - ~ - - - - 36.21 - - - ~ ----- -- UNPLATTEC --.~.x- OVERHEAD ELECTRIC - - UNDERGROUND TELEPHONE HAMMOND OAKS SUBDIVISION (NOT TO SCALE) LOCATION MAP NOTES: ALL BU WITH HI ~ ~~ FROM :~ ~ ~ ~ I ~ PHONE N0. ~ Sep. 18 2001 04:00PM P3 ~-Y~uT ~a~: H~T~: r Ht~11~ES ~N~, ~oRNER SETS ARE STAKED FQR EACH HOUSE FINISHED FLOOR ELEVATION SHOULD BE A MINIMUM OF 1050.00' :..x.----- ~-_.._ .T L_- ---- .I i --- 150.21 ' ~QS 150. ~ 1 ' 15Q. 21 3.06' cos 256.55' ~` \ 0 'IN ~ ~ LOT ~0 SOT 49 '~, 43926 SQ. FT, ,:.1 ~ O / C.a ~ ~ . ~ ~. EL. ~ 1048.824 \ 1.a1 ACRES 2. ~ 8 ACRES EL. = 1045,97' X07 EL. = 1049.09 ~~....-- 3p~ - "~` /r X07 BM TOP -- ..- - _~ `' ~- _ ELEC. BOX, ./~ ~~~, 7~ SE CORNER 1049.24' ~I 3~~~~-~ 80.00 RAD. ~ - LQT 4S ' --- ~~ ~ ~~ ~t HOUSE LAYOUT FOR: sheet Snslnaera NQRCUTT HOMES INC. s9~ rwna sur+~eyore TOWN OF HA#JIAOND, WI 711 419Y9 conilruenoa Maayon w4v Fe:; 716-9993141 SITE LAYC3UT „~ 1 ORMe~ ir. ,pp s.: ~, ova ~+ m-aot ,>r-~~ FRI]M PHCINE N0. Sep. 18 2001 04:00PM P2 NQ7ES: ELEVATIONS ARE SHOWN FOR SPIKES SET A1` EACH HOUSE CORNER. BENCM MARK EL£VAT1ON IS SHOWN ON EAST LOT CORNER ANb ELECTRICA[. SOX CORNER. ~~~~~ NaRGl~7 `~-~ ~ DRAINA ~~~~~`" ~'" ~ E ~c ~ ~, 1 ~ 4 04 , ~-~- UTILITY x - ~,~ ASEMENT ~~ ~ _._. -~ ~ ~'~,~ \ ~' ~ ~'o. ~, THIGH WATER ~ \ BENCHM~4RK ~ ELEVATIOf~ ~= ~ TOF' OF IRON ~' ~~ 104.90' ~ \ ~ ~ c~ ~ ELEV. 1043.2 ~ ~, ~ ~_ ~'~, ~ ASSUMED I.FT. ~ ~ ~ \ ~~ ~ ~~~_ \ ~' zoo ~~. ~Q ~~ ~ 5 ~` ~& ~ ~ ~ W ~r NnanONTA~ a .A c• ~i AS PER GRAPhtIC ~^'~' 001 .PP A9-79- o fa x qEV: NAME: GATE: RENSIOM DESCY21P71QN; ISS Y P.O. H wOOdr! Bus; ?