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epartment of Commerce PRIVATE SEWAGE SYSTEM Building Division INSPECTION REPORT ~`' (ATTACH TO PERMIT) Gt.,ERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Henr ,James Hammond Townshi CST BM Elev: Insp. BM Elev. BM Description: ~ /~ a yv- ~ ~ ~~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic /OUo Dosing ~~~lf'y~t,~ ~~.,, b d U Aeration ---- h'C~ , Holding TANK SETBACK INFORMATION ~~.:~G~a~~{~a1~ TANK TO ~~ jj /L +v0+~ WELL BLDG. Vent to Air Intake ROAD Septic ~ / 20 vy~YLt 0 Dosing ~ f1 ~ Aeration ~ ___ ~. Holding PUMP/SIPHON INFORMATION n IL Manufacturer / , Demand ~ _ ~~ /.e.- GPM ' Model Number ~ ~~ 2S• TDH Lift ~ Friction Lgss '! System~ea„d~ TD~ ~~ Ft ' O O ~ [~ + Forcel~nain Length Dia. ~ N Dist. j Well .:f Sell ~RSORPTIt7N SYSTEM county: St. Croix Sanitary Permit No: 430629 0 State Plan ID No: Parcel Tax No: 018-1086-58-000 Section/TownlRangelMap No. 20.29.17.678 STATION BS 7 ~ HI ~7• FS ELEV. • b Benchmark ~3m~ t .~~ 1~yt ~D~.o Alt. BM Bldg. Sewer ~ r/ b ~ Z SUHt Inlet ~ 35~ 3 ~i9- ~ SUHt Outlet ~- Dt Inlet ~ ~ Dt Bottom ~- ~ 1 ~.~ 9 ~ • a Header/Man --~-- -P-~ 3•?~ ~ d 3 . g Dist. Pipe ~, ~o ' ~• l 'l ~ ~ S 3, I .J 103 •~ Bot. System Final Grade ' I .~ ~.~_ ~ ~ / oS,° St Cover / ~ h.~s-ems 2:3 / ~~/• ~O -~vt11~ ~. U ~I Z ~ 1 rI BED/TRENCH Width Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~r ~(.,+ / ~~ ~ ,~ A „ ~ / '.` /~ SETBACK SYST EM TO P/L BLDG WELL LAKE/STREAM LEACHI anufacturer: INFORMATION C ER OR Type-Of System: ~~) 7 ~h y ~O / ~ UNIT Model Number DISTRIBUTION SYSTEM .DIJ.~ . nl. ~~ l G~•GC'lGa-(I C67~u/Zd GtSd 0 Header/~~a~- Distribution x ole Siz x Hole Spacing Veneto Air In ke ' N i Z ~ Pipe(s) ! ti t ~, .t' i h S ~1' Di ~ ~ S 3 3 / / ~ Length D a pac ng Lengt a ' ~ (~ SOIL COVER Y Prassura Svctams Only rr Mnund Or At-Grade Systems Only -I~Si„~, ~ Oyir ,. / Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes i No ;Yes ! ij No >i :.~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: `, / ~ / lL7 /t inspection #2: y / °~ °~'/ Location: 870 161st Street Hammond, WI 54015 (SW 1/4 NW 114 20 T29N R17W) Hammor'~i/IOak~~8 T b,~( / Par 0.29.17.678 1.) Alt BM Description = 5' ~ ~~~~ IV/V~{ ok' 2.) Bldg sewer length = Z (o ~ - amount of cover = ~ - _, _._ ''Ian revision Re wired? Yes i~ _ No I--, ( ~ K J` _ - _ _ _ - < - ~ ~i q ~I v7 I +her side for additional information. Date Insepctor's gnature Cert. Nc (R.3/97) Safety and Buildings Division County ~ _ 201 W. Washington Ave., P.O. Box 71162 ~~ ~scans~n Madison, WI 53707 - 7162 ' Permit Number (to be filled in by Co.) (608) 26 -3151~~C~'VE Department of Commerce ~ Sanitary Permit Applicatio pp y ' 2 personal information y u proviJ~ll 1 2 In accord with Comm 83 21 Wis. Adm. Code State lan LD. Number bsl5~ , , . maybe used for secondary purposes Privacy Law, s15.04(1)( ) Project ddress (if different than mat ad~ess COU Y Ib ~'f I. Application Information -Please Print All Information ZONING OFFIC n ld Pro ert Owner's Name ~ Parc 1 # Lot # oc ~r~ ~ +~.,~ ss t.~ ~c o ~~ S8 C . ~ Property Owner's Mailing Address Property Location // Z C. ~~ ~~i"L ~ Sv/(Z ,200 N wy< Sw '/< Section Zo City , ~~ate Zip Code Phone Number , , ` /_,C v J~~ w ~ ' s D/ c~ circle one) T z / N; R~E or~ Type of Building (check all that apply) II. CSM N b di i i N or 2 Family Dwelling -Number of Bedrooms ~ ~ ?~ l um er v ame Sub s on t I ^ Public/Commercial -Describe Use ~, ~-~~1-'~?wto Y" ^ State O - De tribe Use t ~ ~ ~ «. ~.OI ~ ~ Z -µ' Kt ~Mnti ^City_^Village~Township of~ III. Type o Permit: (Check only one Lea .......,. A. Complete line B if appli able) `4' ew System ^ Replacement System ^ TreatmendHoldin Tank Re ]acement On] g p y ^ Other Modification to Existin S stem g y B• ^ Permit Renewal Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number nd Date Issued Before Expiration Plumber Owner L1 •~ ©~~ ~^ ^ ~ ~ ~O ~(J ~( IV. T e of POWTS S stem: Check all that a 1 ^ Non -Pressurized In-Ground ~'~Gt6und > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ 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 ^ beaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfj Dispersal Area Proposed (sf) System Elevation ~-fs`D ~ Z ~s~ yso o s~ VI. Taltk Info Capacity in Gallons Total Gallons Number of Units ' Manufacturer ~ ~ __ 1 _ ~ Q IQ ._ J (~ (~ ~ ' "° Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Existing E ! ~- /1rTli~~„ -~ ~-`r,1~(JG~ T~ Tanks Tanks Septic or Holding Tank / .b~ ~ ! l/ ~ ~ ~•C~ /Z Aerobic Treatment Unit Dosing Chamber V~ / VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumble/'s Name (Print)/ '~ ~ ' ~ Plumb 's Si ature MP/MPRS Number Business Phone Number /S ~r ' 7 a L / y ~ ~S'7 ' S'/SS' i Plumbe 's Address (Street, City, State, Zip o ) l~ ~~ ~~ ~~ ~~,~ o Co V III. Coun /De artment Use Onl ,,// ip, Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater S h Date Issued sui Agent Si at a (No Stamps) ^ Owner Given Reason for Denial urc arge Fee) 2 ~ 7 t IX. Conditions Approva easons for Disapproval 31 ~~ ~ ~ SYSTEM 0 ~ J 1 Septic tank, effluent filter and ~i~ ~~q .~.v. ,~-- ~ p,,~~ t/, J dispersal cell must all be serviced /maintained _ ~_ _ (~~~Q (~.~ ~ C ~ a,~e~.~. as per management plan provided by plumber. ~ "`-~"" p _.p. ~ ~ n 2. All setback requirements must be maintained lSl~: -~-o SN~+~-~ e~x.xS ~ ~~~ G~Q.Q ~ ~ S as per applicable code/ordinances. ~ i ~ --_----- ~. Attach complete plans (to the County only) for the system on paper not less than S1l2 x 11 incheB11r51~-'~- ~•i SBD-6398 (R. 01/03) .:. - ~ _ .-., ,._ ,.ryv __'=.r.~ ~ ,, • ^ Z+C.+G+3~?S[iT sY 1~"'~i'.3t.....,,..._ ~.-ist•.:. r. t.. . gM ~p~w: ~~.0. wv~ ~~ ~4 b1 C 1 ~o . o) "~- .l~K ~ ~ ~gg.8`~T• • ~~,~,ib (r` __~~-~..."''-..' .-(-,too. ~ 4.09 C tit b~~ S~ i ~ - ..-r-~......~„,o,,e) o~ r, c,,~Q Letita..e <<oz~ 4.s~- ~~ oS.sS 9. `ao. 4S ~ ~~ 0 3 0 4" SG.~~<< - " 1 o i.Z ~,~.w ~vw - _-- - --~r. a x, ~ ~ ~,. M,. i~l t q,~..,~; a, 3 t,.,, ,; /~ / ~ : tea,,, ~ ~*u[--6up tt3l .~o ~-y,,~~ i ~ ~,~ S ~, ' ..__.._ ~~~ / 3~o,t~t' N o Z~ ~.~, t . ~.~ ~14t 'LZS4 ~4 t-ll b,, : ~,S}~,~- ~ e.Y.B..~ ~ utn~.,.~1.~- ~,~ ~u~ 1 o ~+.t 2 1 O Cw~ i:.0 M ~o .~ c-AM iv ~s ir4,. dCD.<c~:je is v a 3 0 ~- ~ .~ 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 January 30, 2004 CUST ID No.224199 KENT HOKE H & H PLUMBING LLC PO BOX 10 COLFAX WI 54730 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01130!2006 SITE: James Henry 161st Street Town of Hammond St Croix County SW1/4, NW1/4, S20, T29N, R17W Subdivision: Hammond Oaks; lot 58 Identification Numbers Transaction ID No. 965150 Site ID No. 669311 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Proposed Three Bedroom Mound System; Revision (One cell design revised to two cell design) Object Type: POWTS Component Manual Regulated Object ID No.: 935362 Revision; Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade Systems: 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) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans that were previously approved on December 12, 2003 under TI No. 950572. All other portions of the plans shall remain the same. 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 plumbinf? in the state unless licensed to do so by the Department der 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 and with the "Mound Component Manual for POWTS -Version 2", SBD-10691-P(N.O1I01) and the "Pressure Distribution Component Manual for POWTS -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. • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal area are 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 coQy of the approved plans specifications and this letter shall be on-site during construction and omen to inspection by authorized representatives of the Department which may include local inspectors. ~ ~, ~~,~a ~. ~., Clll1l~'d~gQy~~ ~`, KENT HOKE Owner Responsibilities: Page 2 1130/04 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -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). • 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 be considered a human health hazard. 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 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. 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 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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce. state.wi.us Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ~.~.. } James Henry -Mound Revision to Trans # 950572, Site # 669311 Construction Materials and Techniques ~~~ ,y/,Q ~~~ ~'' 1 ~~r~ a~~ ~soi All materials must comply with Comm 84 and be installed in accordance with manufacturers 1; specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (01 /01) Location: Lot 58, Hammond Oaks SW 1/4, NW 114, Sec. 20, T 29 N, R 17 W Town: Hammond County: St. Croix Date: January 9, 2004 Owner: -James Henry Address: ReMax, Team One, Hudson 2217 Vine St., Suite 200 Hudson, WI 54016 Plumber: Kent Hoke Signature: ®' License # MP 224199 Attachments: 6748-Plan Approval Application SBD-8330 Note: mound site must be defined, located, and fenced off prior to construction to avoid compaction during building process. page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management W~ ~~ ~' Dki'ARTMENT OF COtJI},gERCE DIViS-QN ~F ETY AND BUiLDiNGS SEE CORRESPONDENCE page 1 of 8 t~ ~ , Design Criteria ~~'S Residential Wastewater Contaminant Load: 30 mglL < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 ~~~ gallons/day hydraulic load In situ designed loading rate Depth to estimated high ground water Depth to bedrock Cross slope at system Force main length Manifold/header length Drain-back Lateral length ~ @ Lateral elevation Lateral hole size ~~1 b in. @ 1 ~ holes/lateral Lateral volume Total lateral discharge rate Network pressure compensation losses Design CaL O,Z ~, i4 ?4-g culations gallons/sq. ft. per day in. in. o~ ~,,, 3 ~ 1 q ,~ g,ll s4~•o ~ ~ 3,~ 3b•o ~ ~ ~.~131~ ~~~o~ ~ .~ S~ Elevation difference ~ ~ ~ Z Friction loss O.42.. Total dynamic head i4' ~ `~~ Pump/sip~on ~~ gpm @ 1 S Manufacturer L-.'~~~ ~ ~ 4w~ Dose volume Lift/si~ion tank ~'' ~~ t, ,` ~1 Septic tank Effluent filter ~a~.. ~' ~ `~' /~Qirt.~ Measurement pump on and off S~ ~ Height alarm from tank bottom 1 to • o Reserve capacity ~~ S -~ specs.calcs.res 8 3, g t ~ - b vo Ca ~a p 1 u ft. of ~ in. ft. of Z in. gallons ft. of ~~lz in. ft. @ bottom of lateral in. ( 3 • ~ ft.) Spacing holes total gallons gallons/minute @ ~'•~ ft. head ft. ft. i ft. @ z S gallons/minute ft. ft. of head Model # ~ ~ gallons ~ `r'O gallons ~ `~'`}~ gallons in. m. gallons Page Z of ~ i 1, ' .--. S~ - ~S W , ~.O.2.gt -1 ~ ..~. C ~ sv . o ~ -~+'K L ~4g•8~T' ~f ----.~~ t e a. ~ ~ t~ oS.sS + ~`e3o, 4'S' w. Ll ~ ~~ o.,, 7A by S~ ~t ,;, ~ ~.~ 3~' _ ~., PSG ~°,,.-fin ~~-- \~ _._~.__ ~'~ ,~ ` f;. s I (~ ~ i.c, S t-, ~ `~ ~~. ,; . >> 3~o,Vt' N S .~~ ~`~ o z~ 4.0 . ~~ ~r~+ zzz~ ~4 t Q~,o e~ ~ N ~ 10 ~ ~-e• J-~a,. r p 1~ ~K ~ Lq g.~~~ ~vta~'t~,~ , ~Q ~ ~. yZ~, S~ ~ 1r~ O •+-1. Q~ , O C.d 1:.0 N ~i v ~-AM i~v w-a ~rd~ ~.~L G+~D i~~c3 ~. ~ ~ C7 3 ~,,~ ~;;~ J ~ ~ Q. ~M Vf• ~ t S ` ~ s.L'Ft oy . , .--~- ,f t .aC, ... ~ w~ W a~ t co v w ~}C ~"`i ~~ ~ w~ a ~~ ~r ~ 1 ~11 ~ ~~Nr. l ~ ~.~ -_` t ~ w ~y / w. ¢. 5, n .,.. \ ~Iw. ~ o2.Z 4-~ . ~, ~~ ~ ~ ~ o c $ i _ L,~~ ... -. ._.~...... ~.. a.. _. ~ .. ... ....._.... .. i i i ~ M l ~ 4ti t ~-a -- S ~, a z.o, i.o~ ~ o p z.d~ .o~ O ~,~.~ 4.0' i ~ s ~~4' ~"~=~ ~-. o' lS~~-~t~ S~ ~ o _T--- t i t. ~,, ~' . , ~~-~ 1 t 1 0."4- P~r• a.l i ? fL. v w. i ~n ~, Y ~ ? `r n w. ~ w \ ~~ 2', - 1 C 1~ O ~ ~~ n N(~f+v ~":oM. wt~~S ~i u 1vo~OM- • 4 y ec.,~. ~ •O,wcJ~,e.~ q. p v e. c .. S 1o a Ac, o _ _ .. .. _~.T_. _ 1 L (~ I ~ N ``~z PvC s~ 40 3.o I 3.0~ I 13.0 I 3~0~ l ~~I ~' 4~Ih4~1 rye T~YL~~ 1L~r~ '1"O Yi K~1/' -y-MQL(Z Q2( ~~~ Q ~}~ w~ V w` v t b e X i. (, O y ~.~,/v\V 0. ~ O.w t\ ( ~ J \1 C `\ 3~Ib ~ ` ~~ 1 /1 ~ ~ ~ ~..S~ ~ ~ ~ ~ a~ ~ ~ ~ ~ ~~ ~- I' l.a.CKING~COV6R ^-~ [vA~N ~,uc ~ ABED . avlcK D~~COU~tcT--1 ~~°" ~ J. DIP6 3` no NoISTua~D Soles 24'' I.D. tticwuo>~ .... i~,t r QW ROVr<D A Z ~ . p `: SKET ~KT'J _~ ~' F L E, 1 L Ptli- 0 1 ALO.W~I ` 1K `` `` '~ Cl.ev. C ~\T2~v :h Owt1.a.~ S,O`~ qz.s' ocF ~~ D q,~ r ~ ~ ~~~ `~1,~ SEPTIC E DOSE } C r _ SPEGIFI~GATIOIJ$ N ~oRcE ~`~Q~w WEATNE0.PQOJF (`~ JU N CT 10 ti l ~ 6Fa ~~wc.v N U;.L 3 ~" PwlP COn/+CR~Tc I . b~oGK ~1e.~-b ~(;~.. I~' j / /777,,7 P.,~ k:. ~~~ 40 Y G ,ti" -~ ~ ~~ - - -~. -_ --, ~~{ r. ~ 4`.. 3' ow-c T~u..S MAVUFI-CTURCR: ~ `~~~ ~' (JUM9ER OF pOSCS: ~ PEk D~~ T^1JK SIZE ; I ~n ~ l,~o GhLL01J5 DOSE VOLUME ALAFr1 h1/WUiACTURCR; S `~ `~` ~'~-~"~~ IWCLUOIAIG 6AGKfLON~ ~ ~~ g ;,~,,;,ti, AODCL 1JUN~CR: • ~ ° 1 ~~ ``~ CAPACITIES: A= ~~ b IuCHCS OK 33~~Z ; :, ; SWITCH TyP[: ~4.1...~r w~~ , -_ ,,. 33.,52 , PUMP /1AIJUFACTURCR: l"~~~' G-~f~r~li ~~ MODEL 1JUMDCR: 9 15'n•$¢ 0~ INCHES GR ;,^,-;,'-- ~~+'iTCH TdDC: ~MQ.V.~+•.v ~•. 1JOTE: PUMP A1JD ALARM ARC TO pC MIWIM\Uf'~ DISCNARGC RATE. S~1 (,//~ INSTALLS j 0-J SCP~RATC CiKC.. `:, VERTICAL DIiFCRCIJCC CCTWCCIJ PU!'4P Off AUO OISTRI~UTI OFJ PIPE.. 11`Z F'ECT + MI-JIMUM -JCTWORK SUPPLY PRCtLURE ~ 2'~ ~-0'~"~ FLCT TT/, + ~`~ FEET OF FORCE MAIIJ X \-- ~~- f moo itFRIGTIOU , FACTOR. ~ ~4Z FEET ~ ~'~ „~ __~ -- TOTAL OyUAMIC HEAD = ~ `g} FEET ' • 14-4" IIJTER-JAL DIMEIUSIOIJi Of TAIJK: LE1.1G7H ~- 8 '' 3 ~' ;WROTH ~ ~ Liqu~o pC P'r H ~ 6 a 8 A~.` ~ _1 ' . t t t ~ E ~ ~~ I~_t..~~~~, '~ ,, ~. ~ ~~ ~~ ~ µ. ~# ~ i _ , g ~ 9 E SERIES SUMP/EFFLUENT PUMP Specifications - - ----- MODEL ITEM SOLIDS SIZE RUNNING PERFORMANCE (GPM @ HEAD) SHUTOFF PWR. CRD. WEIGHT DIMENSIONS N0. N0. LISTING HP DOLTS (Dia. In.) AMPS/WATTS 5' 10' 15' 20' (Ft.) P.S.I. (Ft.) (Lbs.) (H x L x W in.) 9E-CIM 509200 UUCSA 4/10 115 3/4 12.3/1000 57 53 40 15 23 10 15 26 9.15 x 9.6 x 6.8 9E-CIA-RFS 509300 UUCSA 4/10 115 3/4 12.3/1000 57 53 40 15 23 10 15 27 9.15 x 9.6 x 6.8 9E-CIM 509250 - 4/10 230 3/4 6.2/1000 57 53 40 15 23 10 15' 26 9.15 x 9.6 x 6.8 9E-CIA-RFS 509320 UUCSA 4/10 115 3/4 12.3/1000 57 53 40 15 23 10 20 28 9.15 x 9.6 x 6.8 9E-CIM 509225 UUCSA 4110 115 3/4 12.3/1000 57 53 40 15 27 10 25 26 9.15 x 9.6 x 6.8 row- ureRS/yu+ure w a IO s< ~ .e ~o e 0 ~ ~~ ~ ~~ • w/out plug 9 s 6 y~ 3 s 3 = a Construction Cover Nylon Motor Housing Epoxy Coated Cast Iron Impeller Material Nylon Im eller T e _ Vortex Volute __ E ox Coated Cast Iron Power Cord SJTW-A ! Mechanical Shaft Seal ___ Nitrite with carbon and ceramic faces Fasteners Stainless Steel Shaft Steel Bearings Upper Sleeve and Lower Ball Bearings r1YJ!`1 3,.u, 4tr s .5 a a w~. . xs~ r ISO 9001 CERTIFIED Little Giant Pump Co. PO Box 12010 ` Phone: 405.947.2511 Okla. City, OK 73157 `~ Fax: 405.228.1550 www. LittleGiantPump. com ~? Form No. 994341 - 11/99 9E Series 115/230V 60112 v s~ System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, H & H Plumbing, 715-962-4155, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 1 1. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. . 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. I I .Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. , Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.~~ (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 !~ ,~"~ ~~ ~^y ~~ r , .~ _.~_ , ~ r r. u.__., e.., o- _. a .Rx.~ ~~~ ,_~~.,M-., ~ , ~.. ~ ~ ; ~`" ~~~~~~ Wisconsin Department 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)]. Permit Holder's Name: City Village X Township Hen ,James Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 430629 0 State Plan ID No: Parcel Tax No: 018-1086-58-000 Section/Town/Range/Map No: 20.29.17.678 STATION I BS I HI I FS I ELEV. Alt. BM jBldg. Sewer 'SUHt Inlet SUHt Outlet ',Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ~ Yes No '~~, Yes [~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 870 161st Street Hammond, WI 54015 (SW 1/4 NW 1/4 20 T29N R17W) Hammond Oaks Lot 58 Parcel No: 20.29.17.678 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Re uired . ~-~ ~ -- -- -- - - q ~ i- . Use other side for additional in Yes No formation. ' _____ - - ___ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and B ilding~n~ ~` ,~ D ~/ `` nty5 ~ ~ ~ ~ 201 W. Washingto Ave., BB ~ ~scons~n 'Madison, 53707 - 7162 Sa nary Permit Number (to be filled in by Co.) Department of Commerce (608) 66-3}~~C 2 2 2003 u `~` a ~ ~ Sanitar Permit A licati n Y PP ST. CROIX COUNTY" st a Plan I.D. Number ~5Q 5~~-J In accord with Comm 83.21, Wis. Adm. Code, personal informati you p1~IfNG OFFICE maybe used for secondary purposes Privacy Law, s 15.04 ject Address (if diff t than mailing address) J Sr• Sr I. Application Information -Please Print All Information . ~ ~ ~'-~ C~ .~ )6l JJ Property Owner's Name ~~ ~ (yam,, Parcel # Lot # ~B3eslF#-' ~~M~s -~ >v~~ ~ 3 ~ ~~~ ~ ~ ~8 erty Owner's Mailing Addres Pro Prope cation p C.2-1~ Sic ST, svt~ Zf~ %, y Nl~/ '/ Sectio a~ City, State Zip Code Phone Number ,, <, n F„ / -U_d~,3 ~_ ~"I-~' (D ~` (circle one) R /~ E or~ T ~ N II. Type of Building (chec 1 that apply) ~j J ~' ; _ ~i or 2 Family Dwelling -Numb f Bedrooms ~ ~g ~ ~~ Subdivision Name CSM Number ^ PubliclCommercial -Describe Use. LL /1- ~~ FS i ^ State Owned -Describe Use DIs~ • y.jJ ~ J 2 ,~ ~ (',~y~,-(-~~chJ /. / ~ ^City ^Village Township of N ,..i,., o~ III. Type of Permit: (Check only one bo n line A. Complete line B if applicab ~ g ^ pg' . 5g_Q~p , (o A. New System ^ Re}ilacement Syste r ^ Treatment/Holding Tank R acement Only ^ Other Modification to Existing Syste ~----' F B• ^ Permit Renewal ^ Permit Revision Change of "` i revious it Number and D ssueA ^ P it Transfer t ew Before Expiration Plu er O ' er ~ IV. T e of POWTS S stem: Check all that a 1 ^ Non -Pressurized In-Ground ound >_ 24 in. of suitable soil nd < 24 in. of suitable soi ^ At-Grade gle P Sand Filt ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank t Filter ^ AerobictTreatmen it ^ i ulattn and Fil ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ lhi ine Gravel-less Pipe .. ^ Ot (e ) V. Dis ersaUTreatment Area Information: Flow Design (gpd) Design Soil Application te ds Di ersal Area R i s Dispersal po to le ~ .+~ ~ ~ ~ ~ /' d ~ 2 ~ Iez' ~ ~ V LJ l Z SA.v VI. Tank Info Capacity,in Total Nu Manufacture Pre a el ib Gallons Gallons of nits Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ,/ /~ O ~ WIC~Sa~ Aerobic Treatment Unit Dosing Chamber . J X - ~ ~r VII. Responsibility Sta te ment- I, the and igned, assume responsibility for installation of the POWTS shown o e attached plans. Plumber's Name (Print) Plu et' Si ~ afore MP/MPRS Number usiness Phone Number ~;~~ ~ ~z ~ ~ _9~z_ys- ~-- L . i Plumber's Address (Street, City, State, Zi od VIII oun /De artment Use 1 - Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssuing Ag t Signature s) ^ Owner Giv Reason for Denial Surcharge Fee) dD ~~' a. / oc (o j~ lX. Conditions of Approv easons for Disapproval S 3 la,.- ,s~.2lCc- effl t filter and yl, ~3, ~Z tic tank S 3 , ep 1 ~ ~~ ~, GU'~~ ~"""-- ~ I `7 ~ 2~6 d l s ii dispersal cell ent . ded by plumber rov an as per managem p p ~ ~/~~~ ~~ hl,~~ ~~~~ ~,` 2. All setback requirements must be maintained _ '~' V `~-'r--~~aZ-., `(~~ licable codelordinances. ~p-vIS=f7t,( G~~ l~ .cc~ r a , . ~ ~ pp as pe ~ d n ~w /nod ~ C•~,~,,,Y. , ~ 3• 'f3'I ~ ~+uucu compere puns m me ~oun[y niyy for tae system on paper not Tess than 8112 x 1 inches in size SBD-6398 (R. 01/03) ~~ ~~~, ~~•tZ~-~ ~5-~- h~ 'lv ~-bz t~~ n~~~~~ ~ ~1~-~-~ ~a~~ ~e ~~ _ ~3t r -~~t L I . L48.S~T'. ~~ o z. 6~ +-~3 ~~ oz.sS + ~ $r;, 4s ~` altt.S~ ~. vc y~ ~~k}~.~ti ~, t ..~.,~ ~ S'~U ~ ~~~ ~`~~~ ~. os p.,. , ~-~~ k° ~ ~.t,,, ~ oVq - b crp ~ h~ ~~ S~ l ~,t'~ S ~. Lioe,l~ d°`SS ~(-~ Qi_i~ `1.~,~ ~ l~ Z • Ls ~4, ~'', ~< 2t SF:, 3 l ,!e ' ILIJ ~ ~ \ a l ~,t..~.L ~,. -~~ x4.~Q"~ d~ . ~ry ~ ~ 'U ~~T~ O Z~ t c111i 'L2Z~ ~~ ~ ttb~: ~~a..~ ~Qb """~, pa:K,~~ ~~L. 2 ~1~ 10 ~ L,,.6.. 1J,.a,h ~ `~ a r 3 ` s Cs~. o ~ o ~~ ~~~~ ~ `*-i Q" d Cs ~ O N CA:~'J ~ cJ ~. 3 0 ~ ~3 1 ~ ~~S ~ ~^v' ~ Al i x `\ / V \` j~\J V ~~~~ ~C~ C~ ~C~ -~Piv~-cj ~~.rr~ r~ ~,~ d -,.~, , s ~ ~ 4 Y ~ T ~~ ~ '` ~ - .~ ~ ;1 -- ...rte ~~}~~~ ~' `\ O Z , l~ 1+11 -~_ 4,s~~ C\ oS,S~ } X40, 4S ' ` ~~ Yl~t.1~ ~ac1C~ u~.~, ti a.l ~'" ~i ~ s~e~ l+~~oa.t ~ oi.l -+-~1.aa . ~1 i\;~ l OL.~-~ ~ 2. J ~C~ S~ ~ ~L~.-r+0~"i~ 0r-~S Sw-~W •~,o •Z,Qt -l~ w O r-w ; ~~ 0. w ~ ~~ c ~, ~¢. S ~ l e~ sb S ~, ~; °~+ I1 ~ 1.1 ~ 2l ee`. 4~, ~ o ~ ., / S a,,,; ~~. 3 ~ o .1.L~ `'~ ; ass w ~ svcs _ ~ ~-o S ~~ ~,. ~,~~ tA.-loo I-.,,(- Se~ ~ ~~Q w~..:M ~ ~~~ /~ ~~ ~ 7 t~ ~o(~Lt. ~ ,.~ S i-, r ;~ o,. ~ . ~..:~, ~.,r. ~ou., ~ ~~~ t ed,:`a N ~s~-~ - ~~ ~ L a7 ~` ~'~ 13'{`1 Jfl .~~ ~o~M~ ~ pa`.K~-~ ~~~ 2~ Q,v o r t ~~o e~ ~ N.~ 10 ~ c.6...,,~o~.. fg1 \3K .ti L9 g,sc~~ e~,yto+~'b•?~ , s~G a+ ~, `li' S~' ~[ ~;r1'~ ~ t,~tbw~~ ~.4 ~,....~? ~. `~-y~ `s"~'+.c` 1 .t~k~ S~o~t ~ 12, 41o s(~~ Cs.~.o~ ~o~~ ` O cA i:ON to .. ~~AM ~ •~~ dG~CJk~1 ~~i3a. 3 a~. ~ U r L~ f S"~S 5 ,.~ P I~ r I~U N^ .~^ ~ .1 d1 ~s ~~,.~ ~.a a/` ~~. roc s4; ~- isconsin Department of Commerce Safety and Buildings 4003 N KtNNEY 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 December 12, 2003 CUST ID No.224199 KENT HOKE H & H PLUMBING LLC PO BOX IO COLFAX WI 54730 CON IONAL APPROVAL PLAN A OVAL EXPIRES: 12/12/2005 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: James Henry 1615` Street Town of Hammond St Croix County SW1/4, NW1/4, 520, T29 17W Subdivision: Hammond Oaks; t 58 FOR: Description: Proposed Three Bedro Mound System Object Type: POWTS Component M al Regulated Object ID Maintenance required; 450 GPD Flow r 24 in Soil minimum Systems: Mound Component Manual - Ver n 2.0, SBD-10691 Manual -Version 2.0, SBD-10706-P (N.O1/0 , Identifi tion Numbers Transaction ID o. 950572 Site ID No. 66 11 Please refe o both identification numbers, above, in correspondence with the agency. 935362 pth to limiting factor from i (N.O1/01,), Pressure Distribution \~ The submittal described above has been reviewed for co rma e with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDIT LLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for co Hance with all code requirements. The following conditions shall be met during construct~n or il~tallation and prior to occupancy or use: • This system is to be constructed and located in acco ante with t enclosed approved plans and with the "Mound Component Manual for Private Onsite W tewater System VERSION 2.0" SBD-10691-P (N.O1J01) and the "Pressure Distribution Component Man for Private Onsite astewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • Limited activities are allowed in the area 15 eet down slope of the compone rea. Soil compaction, excavation, vehicular traffic and other si ' ar activities that impact the treatme nd dispersal are prohibited. • A state approved effluent filter is requ' d. Maintenance in ation must be give to the owner of the tank ex lainin that eriodic cleaning o he filter is re wired. Access to the - er o g mus e provided per Comm 84 product approval co itions. • A Sanitary Permit must be obta' ed from the county where this project is located in accordant ith the requirements of Sec. 145.135 d 145.19, Wis. Stats. • Inspection of the private swage system installation is required. Arrangements for inspection shall be ri1~e with the designated county o cial in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. ~ construction and o en to ins ection b authorized re resentatives f he De artment which ma include local inspectors. ~ ~' a ~`; ~. ~' ~.~ KENT HOKE Page 2 12/12/03 Owner Responsibilities: • Comm 83.52(1)(a) -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). • 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 be considered a human health hazard. 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 is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 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, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing ~' ~ ~ ~ ~ ~ ~~CEI OFD s oE~ z o ~ao3 James Henry -Mound AFE~y & D Construction Materials and Techniques L~GS DIV. All materials must comply with Comm 84 and be installed in accordance with manufacturer s specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (O1/O1) Location: Lot 58, Hammond Oaks S W 1 /4, NW 1 /4, Sec. 20, T 29 N, R 17 W Town: Hammond County: St. Croix Date: December 11, 2003 Owner: es Henry Address: ReMa , eam One, Hudson 2217 Vine t., Suite 200 Hudson, WI 016 Plumber: Kent Hoke Signature: License # MP 2241 Attachments: 6748-Plan Approval A SBD-8330 Note: mound site must be defined, located, and compaction during building process. page l: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve / 8: system management off prior to constr~tion to avoid ~, ~ ~ ~:~ p~;~ARTMENT Of COMf~dFRCE plV151QN Of SAFETY AND BUlldl CGS 5EE GORRES ONDENCF_ page 1 of 8 Design Criteria ~~'S Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 ~'b gallons/day hydraulic In situ de 'gned loading rate Depth to est ated high ground water Depth to bedroc Cross slope at syste Force main length Manifold/header length Drain-back Lateral length ~ @ Lateral elevation Lateral hole size 3 fl b in. @ ~ 9 holesllateral Lateral volume Total lateral discharge rate Network pressure compensation losses Elevation difference Friction loss Total dynamic head Pump/si~Jaon 4' 3 gpm @ Manufacturer L ; ~~ ~ ~' Dose volume Lift/sij~ron tank Lu ; d- ~- l wren - ~ Septic tank ~ • '' Effluent filter ~~- '~~ Measurement pump on and off Height alarm from tank botto Reserve capacity specs.calcs.res Design Calculations ~ • Z- gallons/sq. ft. per day ~ ~ /~. < <f -5~ ~'~~~~" ~ erg in. w... r S ~ ft. of Z in. ~'~ ft. of in. ~ • 3 gallons S S.S' ft. of ~ Z- in. ~ ° ? • b ft. ottom of lateral '36•o in. 3 • ~ ft.) Spacing 3 g les total ~ °• ~-- gallons Z S''D gallons/minute @ Z •; ft. head °,~~ Ia.b o~ ~ 4 4~ 1~ ~Y 3•'g Co .•.`ro ,, ft. ft. @ 5~ gallons/minute ft. ft. of head Model # `t gallons ~o'° gallons ~ "'~~ gallons ~'~ o in. { b • 1° in. 33J t gallons Page ~ of t 1 S~v . 0) r ~ rho, - ~~'~'l l.. "' g - ~~~rl(o .aa . t~f ~, T ~ {` -. t so, i.,} ~ ~ , o ~~c. -•, tit-¢.. S .~c ~loz,~~ ~-1'l 4.s~„ C~ 03.5 + ~ ~o, 45 ' ' ~~ : ~~t.s ~ ~ d~~ «x.52 ~, ~., l-~~.,~ ti s\o~ O s.~co~, to{,l ~~ Sc~ 'SV }O-oQ S, A ~~. ~. ~ ~~~ ~~ 1(~~L~,~~~~, ..~ S~, ~' ~ ~~ ~~ir i.~' I 30 ~.~ S <..~ ~ ~ 4,., ~ vvp.buo ~-~ L-...~-- N ~~~ 01.1 i~ ~^ y e,a:~, r~~ ~ ~ ~ ~ 3l o ,~,t~ N . , ` O 2~ l ~~ ~}{ t2t~ Ala. ~'~ 13 4`{~1 J~O . ~~ ~-o w,,.~ ~ p a'.w~a~ ~ a~ ~ 2.\ 2u o r. t Qt4 ex ~ N •~ t o ~ ce.. ~ Q ulb~..-~Sl.~ ~~n~ou~ ~ ~~ ~r~.eZ .,t)t~.. S~wZt ~ ~z, 41os, Cv~.o~ In o ~..+t 2 ~ O c.~ l; o M to `, ~-61~N ~ •-a ~ c'~Lfi.~ C~v.,h is eS ~. . 3 a ~. ~ :.P:' ' ~~ S - z~-~~ -doss S ~~. ~-,o~ ' ., . '~Z i z ... ~.s4~.Q ; ~, ..~Sl 3 ~ee.~ ~a~ a..~.hrt a~t (^i~' ~os~ow1 Z~~ RR ~p 0.v ` ~r a..~.~.TV~, ~.~C a.v ~ a ~ , b / ~ ~ 1 l 1 ,. cv . ~o + o t ~'~ , l o ~ , 4 ~ I tltir.ti \ '~ b s..l,co;1 ~.~~ ~ ~,ew. G~ ~ ~w o.v ~.._ ,~ O 1. ~ G o way, 'k~' ,` \ . 1y o~e.~, Y ee.~ `~ k~~ ~0~~ 0.~ 3~ I L ~ e..a~~-~.~a s.~ a c9 .}9~ J O~ i~ ~ •, ~ 12 P ~ c s..S~. 4c~ i'KV N \ ~~ ~~ ~r o~.,Qs s P~~ s~ 1`t " ~ 1 _(_ C1 3/11., Yl OI t~ O\ \...~QJ~ CtLy,VW ~~ O~ ~ • wY- Ch w7V~~M ~ ~ ~O+ \ 4~e~ ~~ ~ s ~ $ ~- _ ° 3 p ~, 4 1 l~ v c. ~ ti n~ t~ c~ S Q,,, v .~. ~ o•, .... Q 1 V \ , ~ , 9r --~ i ~3. ~~ O~ O t Y O~.It y i ~f u ~. IL ~o +~-.il a ,t { ~ r-~-c ~ 1 ~., I ° 2.4` ~'+ Ptic ,.~,~ ~° PIP6 3" f10 I~ND-STUR2,ED \ SDI 1,. inc. r ~ oW aovtO 51(ET ~~J ~ P4-t 1WELTIONS Ct.e~, q2.o t - 1 G l.FV, ~t L k ~T 1S L>~r ~a ~~ L4,CKI-JG~GOVfiR --~ !t/i4/t~N ~,UG ~ ABE~C . G1vIeK G~•co~vtcT-~-~ 6'~ > 4'' 24" Z.~. r~ta~+uo~ A b D FLE, fir: \ T : h O w t 1. a. 2 ~o2cE 1`~f3~w WEATNERPRO~F JUNCTION &7ic a' ,O~O Z H Ua 1 1 ~ ON I s. o" 3 ~ • " oc~ PwlP q,. COMCRFrc • b~oGK it" i~i~ r,,~ P G" 4 O ~~.~, Q li 'r - - -'r. - - - --~ A _ I ~ ti ... ~ 4C 3' ow- c I `d i:.; v ~.. C 9~.0 i~,~-~ . Q 1 SEPTIC E SPED FICA IOIJ ~ ,~,. Tn-J~.S MAUUFACTUiICR: (JUMOER OF D 5.~ ~~~ PCK ;,~~ ' TNIJK SIZ C ; I ~~ ~ ~~'o GALLO S _ • .005E VOLUME . ALARh1 I'1MJUFACTViLCR: `` S J ~7~ ~c•i'YS IIJCLUOIAJG OAGKfLO ~ ~ g .,~..;,r.,; nooCL -JUNpCR: • ~ ° I ~~ ``' CAPACITIES A= ~O"O IuCH K 3~5~ 2. ; SWITCH TyPC: ~~~'` wl~O ,~, _v`_ Z 33.52 . G MP / ~~~` ~` ~ . IucNcs o ;.~_,.... 8= u 1AIJUFACTURCR: ~ ` C^=~„iUCNES OH ~''~ ;,~..~~,: MODEL -JUMpCR; 9 r D^ 9 INCHES GR 1~•$¢ ;,~,_,,.__ SWITCH TyP[; ~~"~ IJOTE' PUMP A1JD ALARM ARC TO DC M11.11M1UM DISCNI~RG~ RATE ~' '~ (,//.~ INSTALLED OAl SEP~dATC CIKC.. '~ VCRTtCAI. DIFFEIltA1CC ~CTWCCU PUMP 0 AUO DISTRIDUTIOAJ PIPE.. ~O'b FELT + Mi-.11h1UM uCTWORK SUPPLY Pit iLURC .. ~ ~ ~•~ FCCT ~'~•~i~ ~ + S~ FEET OF FORCE f'1AlIJ X ~~ ~ F/porxFRICT1o1J FACTOR. , ~'~~ FEET ~ Zvi .~ _ - ~~ _ TO TAI. OyAJAMIC NEAP ~4 t~~ FEET IuTER-SAt_ DIMC1Jb10Alti; •Of TAIJK: LE-JC,7N ~ ;WIDTH ~, ~, ~-g ~ LIQUID DEPTH 3 --1 `. , ~.__d.~~.. ~ ..~,...~ ~~ ~~...+..r~~~ ~,~ ..sue,-~..~t ~~~ 9E SERIES SUMP/EFFLUENT PUMP ;~ • w/out plug specifications ~- ~ ~~ ~ '-"~- "~-' MODEL ITEM SOLIDS SIZE RUNNING PERFORMANCE (GPM @ HEAD) SHUTOFF PWR. CRD. WEIGHT DIMENSIONS N0. N0. LISTING HP VOLTS (Dia. In.) AMPS/WATTS 5' 10' 15' 20' (Ft.) P.S.I. (Ft.) (Lbs.) (H x L x W in.) 9E-CIM 509200 UUCSA 4/10 115 3/4 12.3/1000 57 53 40 15 23 10 15 26 9.15 x 9.6 x 6.8 9E-CIA-RFS 509300 UUCSA 4/10 115 314 12.3/1000 57 53 40 15 23 10 15 27 9.15 x 9.6 x 6.8 9E-CIM 509250 - 4110 230 314 6.2/1000 57 53 40 15 23 10 15* 26 9.15 x 9.6 x 6.8 9E-CIA-RFS 509320 UUCSA 4/10 115 3/4 12.3/1000 57 53 40 15 23 10 20 28 9.1b x 9.6 x 6.8 9E-CIM 509225 UUCSA 4/10 115 3/4 12.3/1000 57 53 40 15 27 10 25 26 9.15 x 9.6 x 6.8 FIOMI- LITERS/MINUTE ~ ~~ ~ • e .~ e , .~ 0 Construction Cover Nylon Motor Housing Epoxy Coated Cast Iron Impeller Material Nylon Im eller T e Vortex Volute E ox Coated Cast Iron Power Cord SJTW-A . Mechanical Shaft Seal _ Nitrile with carbon and ceramic faces Fasteners Stainless Steel Shaft Steel ~~ Bearings Upper Sleeve and Lower Ball Bearings I' ~ s~'"N~pR Little C><iant Pump Co. ^'°• a ~ PO Box 12010 `Phone: 405.947.2511 ® ~~. rf Okla. City, OK 73157 Fax: 405.228.1550 ISO 9001 CERTIFIED WWW.L1ttleGiantPLimp.com Form No. 994341 - 11/99 9E Series 115/230V 60HZ ` ~ System Management ~- YOUr1~ /~ ' ~~~ Mena ement of this s stem is critical. As a condition of a royal of these laps this s stem manant section must be g Y PP P Y reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, H & H Plumbing, 715-962-4155, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . [f the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 1 1. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. ;. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system. itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.4 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner JG~~~jy Permit #~ 3 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units -Q~:~ Estimated flow (average) .3b a al/da Design flow (peak), (Estimated x 1.5) ~~ al/da Soil Application Rate ~ , Z al/da /ft~ Standard Influent/Effluent Quality Monthly average• Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS! 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (RODS) 530 mg/L Total Suspended Solids (TSSI 530 mg/L NA Fecal Coliform (geometric mean) 510` cfu/100 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. ueu~xuww~ne cnuenru e SYSTEM SPECIFICATIONS Septic Tank Capacity ~Q al ^ NA Septic Tank Manufacturer ^ NA Effluent Fllter Manufacturer ~ ^ NA Effluent Filter Model ~(?(~ ^ NA Pump Tank Capacity (pQ(~ al ^ NA Pump Tank Manufacturer ~ ^ NA Pump Manufacturer ~~L' ~ ~~ ^ NA Pump Model ~ ~^ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: A Dispersal Cell(s) ^ NA ^ In-Ground 19ravity) ^ In-Ground (pressurized) ^ At-Grade ,Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA ..,r..... c...-...vim vv^.~......... Service Event Service Frequency ~-'-_ Inspect condition of tank(s) At least once every: ') (Maximum 3 years) Z - 3 ,$ ear(s) ^ A Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3 r31 a - ~^ NA Inspect dispersal cell(s) At least once every: ) (Maximum 3 years) Z, ?j -isvaaris- NA Clean effluent fiker i~~ ~ At least once every: ~ ' ~ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ year) 1(sl ^ NA Flush laterals and pressure test At least once every: ' ^ month(s) ^ yearls) ^ NA Off' At least once every: ^ monthlsl ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cert~cations: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanklsl to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,1 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 NR 113, Wisconsin Administrative Code. AN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ~ of Z START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls-. If high concentrations are detected have the contents of the tankls) removed by a Septage servicing operator prior to use. System start up shalt not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ^ A 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 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 may be installed as a last resort to replace the failed POWTS. T a o in ank aluat' g ~~ e ai ~RD4-118TTF~ ~Oi2 /~/~/ C~NS"T~Rtl~TtO~ Mound a d at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the i ve surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN 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 lNTERlOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS Name ~ Z Z ~ Phone 7 ~ S -~ 2 ., S~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S ~ ( ZD~l~ Phone ~'] / S- 3 0 (p - (p This document was drafted in compliance with chapter Comm 83.22(211b11111d1&Ifl and 83.54111. i2) & (31, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM OwnerBuyer G~ w~c- s ~2v( /' Mailing Address a~ l `7 ~/. %~ S f- ~ ~<'.~ ~ a o /yidJ°.~ ~-~`~ .S~,~o( ~ Proporty Address ~ ~ U St' (Verification required from Planning Department for new City/State ~ ,. ~~ Parcel Identification Nurriber~~ ~ ~ ~ - ~0~~--s~ ° ° o LEGAL DESCRIPTION • ~~ Location ~ %., ~ '/., Sec. ~~ T~N-R~ Town of ~- M. p'~P~Y Subdivision ~~ ^~ Lot # ~. Certified Survey Map # .Volume ..Page # Warranty Deed # ~ ~~ !0 3- ~ ,Volume ~ 7 -Page # ~ y `~ . Spec house yes ^ no Lot lines identifiable yes ^ no STEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system csa affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of three year expiration date. SI TURE OF APPLI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. SI ATURE OF APPLI DATE *«***s Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped wacraaty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed .: . ~,* . Page / of - Wisconsin Department of Industry, SOIL AND SITE EVALUATION Z Labor and Human Relations Division of Safety and Buildings in accordance with s. ;ILHR 83.D9, Wis. - '~. '~ ~ ,, ` County Attach complete site plan on paper not less than 8 1/2 x 11 inches in a~ie "Plan rrly~t ' ~ ~, S~ C~PO/ include, but not limited to: vertical and horizontal reference point (B~il~ dltectfon attd , ; ; t y ~ -'" percent slope, scale or dimensions, north arrow, and location and dtsiance to nearest road. Parcel .D. # O Date APPLICANT' INpOpMATION -.Please print all inforri~attnn. rvoix Revievred by ~ LI f ~ I ~ Personal intormation you provide may be used for secondary purposes (Pnvacy~ar-; s. 15:fYt~~1),(~~ Property Owner ~ (~ H Q (ep ~.~J19 ~ ~ d ~y/O , Properly Locatieri -," '`' {~ ~~ ,Gp _:"tfof,"y 1/4 /ViVi/4,S ~ T Z.q ,N.R I7 E (or) W V ~ ~~ ~'~ v~ t l (~ ~" ~ Lo k# Subd. Name or CSM# Property Owner's Mailing Address ~~.~.f' 332.. l~tiluN~SoTAI ST: EAST lyo~ $~ ~~t;HOND Nearest Road w ~ Z City State Zip Code Phone Number ~ City ~ Village Town ~ (~ d ST• PnuL- I !~~• 155ia { t~o5/ ~~2Z. •S5S5 - []'~sidential / Number of bedrooms 3 Addition to existing building (]'Flew Construction Use: ^ Replacement ^ Public or commercial -Describe: Recommended design loading rate • ?' bed, gpd/{~ • ~ trench, gpdfft2 Code derived daily flow y~o 9Pd 2 ~ ~ ~ 2 ~_bed, ft trench, ft Maximum design loading rate ~ bed, gpd/ft~ r trench, gpolft2 Absorption area required Recommended infiltration surface elevation(s) S~ ~ ft (as referred to site plan benchmark) 7'/~E~ t~L~ TYPE' /-t 0 iJ ~ 1~'~- a y i ~ ~',t~ . Additional design/site considerations ~/~ ft Parent material ~~ Fts ~ ~~ 0 ~'S~ ~ Flood plain elevation, if applicable Conventional Mound In-Ground Press AT-Grade System in Fill i Holding T S Suitable for system ~ / ,~/ ^ S ^ S ~ ~ S ~ U Unsuitable for system ^ S LlYt1 ~ ~ ~ U ~ S BOfing # Horizon Depth Dominant Color in. Munsell i / •~ /oyIIP 3t3 Ground Q • 2 /0 7/C Y1 elegy. Depth to limiting factor m. Boring # _.. a. Ground elev. TDevpth to limiting Remarks: d •/p /D L • / /~ ? . >L Remarks: /0 /D 3 SOIL DESCRIPTION REPORT Mottles Color Cont Sz Qu Texture Structure Gr. Sz. Sh. Consistence Boundary GPD/ft2 Roots ged ,Trench . . . - SL ~ sti ~s ~ .~{ ,, S - sL 2,~ b ~~ - - . s ; . ~ ~" ~ L ~ shy al ll ~~ •~' s/L z ,~ f ,.~ _ .5 , .~ Xo~' S ~ c ~ EGG i-~n .l ~ • - n • ~7 Y„ ~f~'}i ~o y~ ~!Z CST Name (Please Print) RpQ(eRT" ZlI.~R~C,tiT' s~9nature ~~ t efepnone rvo. ~~s• 3SG • ~~ ~ s Date ~~' """""°' --. ~-~~- *. ~ ~,~ B ~ ~p ~ ~aJ SOIL DESCRIPTION REPORT PROPERTY OWNER ~i ~ ~- S' s O g PARCEL LD.M 4~ Boring # rtonzon ~~Y"' in. 3 •~ •~G Ground ~ • Z~ elev. j nA ~~ Depth to limiting factor ~~In. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. -- Remarks: Horizon D~ Boring # Ground elev. ft. Depth to 'limiting factor - 'n~ Remarks: Boring # Ground elev. ft. Depth to Iimitin0 Page Z of r c~ ' .~ N N w. ,~ 1 0 o o°'^~ H ~ N ~ - c ® ~ ~ zC • 74'96c9 ~ ~ ~ ' ~ IN koEtM 2 9 cdNS STATE BAR~t9~ w KATHLEEN H. MALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO. , MI Document Number RECEIVED FOR RECORD This Deed, made between Hammond Land, LLC, a Minnesota Limited Liability Company 12/19/2003 10:30A?I MARRANTY DEED EXEMPT # Grantor, and James D. Henry and Barbara J. Henry, husband and wife REC FEE: 11.00 TRANS FEE: 92.70 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recordin Area Name and Return Address ~~. Lot 5 ammond Oaks Subdivision,Town of Hammond, St. Croix County, isconsm 1 ~~ I ~Ci~- 018-1086-58-000 Pazcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements,restrictions,covenants and rights of way of record, if arty, including but not limited to those for drainage,water retention,ponding,and or utilities as may be shown on the plat of Hammond Oaks Subdivision recorded in Vol. 8 of Plats, page 2, St. Croix County, Wisconsin.The warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to an amount not to exceed the consideration expressed herein, that being the sum of $30,900.00. Dated this 15th day of December , 2003 Hammond Land, LLC * by ~cQ~.rL. ~_ President AUTHENTICATION Signature(s) authenticated this day of ~ Austin J. Baillon ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. Ramsey County. ) Personally came before me this 15th day of December , 2003 the above named Austin J. Baillon Dec 26 03 10:17a James Krueger 715-455-1752 p.5 Dec 26 03 10:16a James Krueger 715-455-1752 p.4 ~_ r~ Dec'26 03 10:16a James Krueger _ r------ 715-455-1752 p.3 < x a ~ ~ ~ e C~ ~ o z d ~ ~ y ~ - ~ L t ~ d - ~ ~~ Dec 26 03 10:16a James Krueger ~ c ~ ~ ~ ~ ~ ~ x a e ~ . > i ~ < a z ~ L=J z ~~ ~ " z p ~ ~~ ~ ~ ~ ~ ~ ~ x~ 715-455-1752 P-~ `.~ ~ ~ • o ~~ O F w O ~ ' O \/1 O I ~ • . _ ~ 0 N .~' ~ ~ ~ w~ ~ N _ ~ .~-_ _ ~l v (r w ~ m i C I 28 75' ~ o "'- p r*i ~ I ~ ~?~ ~ ~-~ 8 INT 6' ~ Z= ~ m~ 4e'oF~e'aw~ s ~ Vim{ 282.89 ~ Cn z ~ ,.~ ~ N w o I ~ ~ O Or ~ N \ ~ is N _ o ~~~~ Z / a w - ~ x r rTt o cn ,~ 1 p ~ 0 ~ ~ ~ N O ~ ~ ~ 0 ~ ~ I ~ ~~ (n ~ N v ~ ~ ~ t~ v 1 Y ~ ~ 106 S~ v ~ ~`8•~ ~' s- O `~~ 4 ~ ~ ~ v ~ ~ ~ O ~ D ~ r D Y ~. ~ D ~ ~ ~ Z ~ ~ Q / / ~ ~ ~ ~ N ~ Z z ~ ~ ~ ~ ~ _ ~ G7 ~ ~ ~0 ~I v ~ -I Z ~~ N ~v O N W~ ~ ~= r~ Z a ~ ~ I / ~ ~ _ ~ z ~ C ~ ~ ~ O (r \ =O ~o o ~ - :17 ~ Z ~ ~ Z Zl I ' - - /~- ~ ~ - ' - - ~ ~ Z ~ -~ ~ 124.92 24.0 85 ~ ~ -O ~ 10 . 2 0' 153.93' 1 3.9.. 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