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018-1086-59-000
wisaonsin ~pa+i`ment 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 Tittle, John Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: °l , g 1 ~' e 1 v~ - zed ' - 3 T,4N!( INF~RM~4T1(]N ELEVATIO DATA t ., TYPE MANUFACTURER CAPACITY Septic ! J~ ~ , \ / Dosing ~~ ~ ~~(.~-'~' U~- ~ Aeration ~ ~ ~ ~ r 0 Holding TANK SETBACK INFORMATION TANK TO P/L WELL oT BLDG. Vent to Air Intake / ROAD Septic , ~ ~ ! ~ CJ D Dosing ~ Aeration Holding -_ ~ ~ PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number / / '~~ ~y1 ~~ , It-~' TDH Lif~ ~~ Friction oKssl Systet ~!!m Head TDH Ft . , Forcemain Len th 1 Di~q- !~ Dist.t~b~ /~ f~A~~ A AAAl1l1T~A\1 nVl~TCI• vv~~ r+uwr~r ~ wn v ~ v ~ ~.m BED/TRENCH Width ~ Length No. Of Tr~ef~c~ s DIMENSIONS ~ l 2,~ ~ 1 Y L d`'1i~~ SETBACK SYSTEM TO P/L BLDG WELL INFORMATION county: St. Croix Sanitary Permit No: 399567 State Plan ID No: Parcel Tax No: 018-1086-59-000 TATION ~ ~SS ~ HI S ~E~ rt Z! r Bench ark ~ ~ / DD . l < < Alt. BM I~/CZtaF ,~ -!tom 8 (QZ ~ p p ~0 Bldg. Sewer ~ b Z St/Ht Inlet ~ ~ ~. S~9. Sf/Ht Outlet o•Sc 7 ~ /o io. ,, ~, Z Dt Inlet coq ~ v. ~~ ~,Z Dt Bottom / ~S He r/Man. /' •,~ ~ ( p /a ~~ Dist. Pipe ~ / ,3 ~ . 9 by Bot. System ~„ L ~ ~ ~ ~ . ` G Final Gra ~ / „l ~- V [/ St COV /q,S h`- ~s y a•71 ~ G~ / ~ ', e w s: / ~ ~ 7.3 ~ ~. z ?~ Type Of Sy~ i~ ~ / ~ ~~ k N~ o ~ IT Model Number. ''. DISTRIBUTION SYSTEM /l. ./a. .~I., ~.h,' ., 7 /'.~.~G~411. iSrvl.lrl~' ~~ HeaderlManifol / f ~ ~ h istribution 4 Pipe(s) ~ ~ r ~ ~ x Hole Size l 2~ 1 ~ x Hole Spacing J Ve ntake~ Lengt Dia ' Length + Dia ~' Spacing . l SOIL COVER x Pressure Systems ~nlv xx Mound Or At-Grade SVStemS OnIVTI~°~~~/~`°" Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center V%'+'" ~j~~ Bed/Trench Edges Topsoil ~~ Yes ~] No (] Yes (~ No vf?G COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~ ~ / 2 Inspection #2: ~ ~ /~ ~ Location: 1601 87th Av~e~nue Hammond, WI 54015 (SW 1/4 NW 1/4 20 T29N R17W) Hammond Oak ~ tf1~ ~ Parcel No: 20.29.17. 7~ 1JAItBMDescription=~n -~~tQ~,Lr~(R7~' `ff1/ I~-;~S-}t~.,~Il'sl~ad G>~~•t~-eJl-ev-V~'f'e,~!".~') sa'u' "' Sl~-e- 2.) Bldg sewer length = ~ Nr,t:~e. 3 ; ( ~~o-¢~S -amount of cover =~ ~ ~ 0 3.) Contour = f ~_ 1 __ , r_ Plan revision Required? ( Yes No , j Z ~ l a i l- S O .~, Use other side for additional information. ~ f~ ~" SBD-6710 (R.3/97) Date Insepctor Nature Cert. No. a Sanitary Permit Application Safety & Buildings Division In accord with Corttm 83.21, Wis. Adm. Code See reverse side for instnrctions for completing this application ~~ 201 W Washington Ave. PO Box 7302 Madiso W 153707 7302 be used for secondary purposes '~~i S~s~~.~~ ma o ti id f l i n, - , y e . on you pr v orma n Persona department of ~taamrneree [Privacy Law, s. 15..99( rz' (Submit completed form to county if not state owned. Attach com lete tans to the coon oni ,fpr,thte ern,.. of less than 8 -I/2 x ! 1 inches in size. Coon State Sanitary Permit Number q Chock if revisipn to _` ~ licxtion State Pk~D. Nurnba I. A iication Information -Please Print aft Infot•ttta eiY ;' :Cr ~! Location: Owner Name Pr~Y t l ~ ....= ..~' r1 re ~,~ tt ~--- ' C P ~~ Jr~1/ 1/4~ 1/4, S ~ T ~7 .N R~7E o W . T \'~'~~t ( property Owner's Mailing Address - I.ot Number Block.l\Jumber 130 ~ , So . ~ ~-` :. -~ Phone Num City, State Zip Cade .~, Subdivision Name or CSM Number \ ~~ QQ Nj 1~ ~ ~ : ` ~g02 ammo IBS . IL Type of Buildin (check one) ~-~ _ _ :~- ~ ~ ~k '~~ ~ f ~ `"""h ~~"`~ed ^ City ^ viuage L~ 1 or 2 Family Dwelling - No. of Bedrooms : ['Town of ^ public/Commercial (describe use):_ ~ YYl YYl n ^ State-0wned _ Nearest Road ~ .7-f~~Y ~ Paroel Tax Number(s) ~ / 8 - !O 86 - 5 9- D ~ III. T re of Permit~Check onl one box online A. Check box on line B if a licable 5 Z a - Z `~• ~• 6. ^ Addition to . q) 1. New 2. ^ Replacement 3. ^ Replacement of 4. Existin S stem S stem S stem Tank Onl Permit Number Date Issued B) ^ A Sani Permit was reviousl issued N. Type of POWT System: (Check all that apply) / ~ , S , ^ Sand Filter ~ l ~ Z ^ Constructed Wetland - x ^ Non-pressurized In-ground ound ( ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At- de ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatme Design Flow (gpd) I nt Area Information: - ~L ~ 5 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate G 6. System Elevation 7. Final Grade Elevation . Required i Proposed ~ ~ Rate (GalsJday/sq. ft.) (Minlinch ~ ~ ~~o ~ ~~o ~ yea ~ , o . 3 9~~ ~ V"II. Tank Capacity in Total # of Manufacturer Prefab Con- Site Stee! Fiber- Con- glass Plastir, i j Information Gallons Gallons Tanks New Existing ~ub~l ~~ I / Crete structed '~Q-°~- I Tanks Tanks /d0O ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersi ed, assume its onsibili for installation of the POWTS shown on the attached laps. Business Phone Number Plumbers Name (print) Plumbers Signature (no stamps): ivlP/IvIPRS No. 5 3 2 ' ~ 5--(~8y - 33'1 ~' 2 b . ~ a\e, E Nv~dsa. ~t ~ Plumber's Address (Street, City, State, Zip Code) o ~ s b 18 5 ~-oa 2 IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Surcharge Fee) l Ad i i Iss ~ A~ignature (No stamps) ~ (~ ~ ~ p / verse t a Approved ^ Owner Given In ~ 3 Z ~ ~ Determination - X. Conditions of Approval /Reasons for Disapproval: ~ ' /~k.e,--e:e- ,Cl6~~e. ~ ~ rw,.na 6~~w5 Stu%•ki~.~ims i r Sca/e: _yd, ^ So,% Ada/cca~a,-~ p,~ ~ E/~ dccza'o~ sw~w,s. Zo r.~. ~ `~ ~~. S.Tir/ 303 5/ ~°de, bu;/d;rn Proposed ;G~/GOD a//.~ eo~nb:na~~,.., ~/~ ewer ~/ S,T. /Rc. wiL'~'~ a6.~ /.4-i~tJ e,~'/c~c,~~ c~,o-,~2 B ~ ProPC cJc F~/'~i~s-Ea// a~STou.~i/e~. ~~e. ~~ 460~~ \ ~'' .Z sit. s/o,o , v. c P~cpos.ed Fo*c~ hcc~rn . P~oposcd driveway , 3 b.cd~ov„~ n _ 1"GS~de~CC, v i -~ 9S.S6' ' ! 3v' ~ al~a.tii~a/ i e. 1 9io~, ~ ~ / 5 1 ~ s '83 ~~ 3.s~ / D q~ • is is ' ~g'~ 97.oy' / QroPOSed t~-totc,,2~ a-~.Z6,/7x /19.A1 ~ ~~ ~ .ts ~' y X //?. S' ac,'S crsa / ce //. fo C ~ 1 /a~c~a./s of !ry sSSS'w/Y~~ , 1 ~ ~+ cri~iGES Spaced n.LL .Z.0,2,., ._/' ~ 1 97.E ' 1 l~ ~ 82 ' ~~ 3 e" : T~ooF'/off 3. She. ~ss4r+-c c/ e%~ . i~.~' ~~~~ l ~ ~ ~~ ~ ~ w 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 Phtiip Edw. Albert, Acting Secretary September 28, 2001 CUST ID No.220853 DALE E HUDSON 820 MAIN ST BALDWTN WI 54002 A7TN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/28/2003 SITE: JOHN TITTLE / HAMMOND OAKS LOT 59 160 AVE TOWN OF HAMMOND ST CROIX COUNTY S W 1 /4, N W 114, S20, T29N, R 17 W LOT: 59, SUBDI.VISION: HAMMOND OAKS Identification Numbers Transaction ID No. 676379 Site ID No. 636341 Please refer to both identification numbers, above, in all cones ondence with the a enc . FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 812780 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: • 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/Ol) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VII[ of the Mound manual, and the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any PO WTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the o~~mer of the tank explaining that periodic cleaning of the filter is required • Limited activities are allowed in the azea l 5 feet down slope of the component azea. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal aze prohibited. f ~ ~ .,- ~ . DALE E HUDSON Page 2 9/28/01, • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shalt be submitted at intervals appropriate for the component(s) utilized in the POWTS. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. . • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the PO WTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the cjesignated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • An overpayment of $175.00 was paid. As of today's date, our records indicate that a refund in the amount listed in the FEE portion of this letter is due. The refund will be sent to you under separate cover. Please expect a 6-8 week time for fiscal processing. Refunds will be made to the payer. 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 municipality shall be obtained prior to commencement of construct ioNinstal lation/operation. [n granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review sha[i 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, ! ;~? Charles L Bratz POWTS Plan reviewer II- Integrated Services (608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM cbratz@commerce.state.wi. us FEE REQUIRED $ 175.00 FEE RECEIVED $ 350.00 REFUND AMT $ 175.00 WiSMART code: 7633 cc: JOHN TITTLE R ~ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: John Tittle 3 bedn7om residential mound Owner's Name: John Tittle Owner's Address: 1303 Cleveland Ave. So. Legal Description: Township: County: Subdivision Name: St. Paul, MN 55116 Site Address: 1601 87th Avenue SW1/4NW1/4, Sec. 20, T.29N., R.17W. Hammond St. Croix Hammond Oaks Lot Number: 59 Block Number. NA Parse! I.D. Number: 018-1086-59-000 Plan Transacfion No.: ~~~ APPROVED i~'°°Y"~'"s~ar- SEIi~CORRESPONDENCE Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report RECE1vED SEP 14 2001 SAFETY & BLDGS Div.' Designer: Dale Hudson License Number: 220853 Date: 09/11/01 Phone Number: 715-684-3378 Signature: ~ r Designed Pursuarrt to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01!01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) Version 3.0 (03/01/01) Page 1 of 9 ^~. r R Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table83-04-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) `~~~" ~ ~- ~ ~~ 450.00 Design Flow (gpd) 3.50 Site Slope (%) 97.16 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.20 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 112.50 Dispersal Cell Length Along Contour (ft) = 4.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c ~r e, Center or End Manifold 2.00 Lateral Spacing (ft) If N above, enter the elevation (ft) Number of Laterals of the highest point. 0.15 Orifice Diameter (in) (e.g. 0.25) 00 Estimated Orifice Spacing (ft) = 4.02 ftZ/orifice 2.00 Forcemain Diameter (in) .1;it0.00~Forcemain Length (ft) Does the forcemain drain back? Y 85.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 "y, y5"-24:47 Forcemain Drainback (gal) 12.66 Vertical Lift (ft) II. ~ 7$~~ 5x Void Volume (gal) 6.45 Friction Loss (ft) ys S ~ "956 Minimum Dose Volume (gal) 25.61 Total Dynamic Head (ft) 46.14 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. o tions choice in, dia. o tions choice 0.75 1.25 x 1.00 1.50 x 1.25 x ~ x~ 2.00 x 1.50 x ./ 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional} Treatment Tank Information 602.82 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 51.00 Total Working Liquid Depth (in) Wieser Combination Manufacturer 11.82 gal/in (enter result in cell 649) Dose Tank Information 600.00 Dose Tank Capacity (gal) 11.82 Dose Tank Volume (gal/in) Wieser W1000/600-M Manufacturer Effluent Filter Information Zabel Filter Manufacturer A100 Filter Model Number Project: John Tittle 3 bedroom residential mound Page 2 of 9 y ~ Mound Plan View t . .•. 1/1 0 B . . ~.~.•.•.•.•.•.•. ~gU' J . .j _ ~. 'Observation Pipe K TAO ^ A W f•. . ~. 6 - '~• I • .•~. ..... .................. ............... ! L Mound Component Dimensions Down slope toe extension made. A 4.00 ft E 13.68 in H 1.00 ft K 8.52 ft B 112.50 ft F 9.25 in z 16.00 ft L 129.55 ft D 12.OOin G 0.50ft J 6.17ft W 26.17ft 450.00 (ftz) Dispersal Cell Area 2250.00 (ftz) Basal Area Available 4.00 (gpd/ft) Linear Loading Rate 11.25 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.93 (ft) ---- ~. ~. , ~.a ~.- :; ~ ~ ~ H atera I F ::: ; : ' Disperser ceu 98.66 (ft) L I 98.16 (ft)-~ Invert Dispersal Cell J.~ :~ ~ ~ ~ •' ~ ~ ~ ~ ~ Elevation E ~ ~ D ' : ~3 : ~ ~, . ~, -~ ; ~~ ,, , ~~,® a , : - ~~; ~- 9 .16 (ft) Contour Elevation 3.5 % Site Slope Geotextile Fabric Cover Shading Key m ~. ~ Dispersal Celt See lateral details on 1[] ~~ Topsoil Cap c ~ 1.5 ft - ''. -~•- Page 4 for number, ///// Subsoil Cap ~ ~ ~ ~ I size, and spacing of ©~ ASTM C33 Sand :~ ~ ~ ~~" ~ ~ F laterals. Laterals are T icall.aterai ® ~] Tilled Layer ~ m 0.5 ft YP ~ equally spaced from Q C~ Aggregate ~ o ~ 0`: ~ the distribution cell's ~--- A -----~ centerline in the distribution ce!! (Ax6). Project: John Tittle 3 bedroom residential mound Page 3 of 9 HOLDTS PLBG & HTG Fax :715-684-3144 Nov 06 '01 14:53 P02 '`- s ~' IJ`~I~ IMf.f __ ' G ~'`~ PUMP CHAMP~i:R CR~55 ~~C`tO:J AhJC,_SPECIF IC/-'f'10~!5 s i; ttl~ a c D Iz'Mlu. VEI-17 CAP MAWMOI E COVE f•: 4° lyI1J. 18' /"IIAI, I ll~ ___ I I I V I II I ~ ~ ~ APPICOVED ~OfuTs III I I ~ ALARM EXTEld01-IG 3' I ONTO SOLID SOIL I I I I orv • it J 1 CfFF 4"C.z. ~E".!'i PIPC 1 ~'~~ ~~0."1 DOOR, WIWpOW UR FR1=5H AIR IAITAKE le"MIN. IIULET APPROVED JOfAI`( ELEk S`'~FT. 4EATNERPROOF_ JUAICTIOIJ BOX I GRADE ~ I GOUOUIT ~-- V ~'Ea P Rgvl D!; AIRTIGHT 5[AL ,7o~8Z~~.~w~ PUMP --~ Coa1CRETE el.ocK RISER EXIT PCR1~11?rED OIJI`J IF TA-IK MAIJUFI-CTUREI[ HA5 StICN APPROVAL sEpTlc ~ _ sPECIF1~Gl~T1AtJ5 005~~ f~ TI~,,,it,~ hARlUFAGTU0.E1~: ~"`~~% LS~ r~-,~-~ AIUMgER OF POSES: ~ PER DAB TA1JK SIZE : ~~ r-. ALE'OIJS D'OSC VOLUME ~ LARM l~'IAYUFACTUKC~~~ ~ ..- 111iCLV01~16 fAGI(FLO~J: ~~ ~~ GA~LOluS ~- ' !'~OOCL IJUM~CR: C-PACITIES: A=I r~ItvCgES OR~~.~J GAlEOA1s SWITGM ~'yP[' T GILT g z ~•+ 11JCNE5 ORS GALLOWS PUMP MAIJUFAGTURER:~sOl~ I ~ C ~ g,~'~ IUtNES OR~d GALI.o1J5 ~` MOOEL AlUMgtR: ~ ~~~ ~ ~ D+1Z IucHES oR~lJL~'GAILOi.15 SWITGM TkIPC' /' /GY'G ~T~ PU/tP A-JO AL.A0.M ARf TO 6E MII-IIMUM OISCNAR6E RATE ~ ~ M INSTALLtD OIJ SEPARATE CIRCUITS VERTICAL pIFFEKfiA1CE B>`TWCCI~I PUMP OFF D DI+JTRISUT10A1 pIPC../z.66 FEET • MIAIINIUM AIETMIORK SUPPI.y PREiSLJRTf,~/, SO F[CT • ~ FCET OF PORC[ 11AlIJ X ~~F/oarT.FK1CTlo-i fAC~OR. 6~ S FEET _ TOTAL Oy1JAMIC NEAP = r~-'S~~°~ FEET i ~~ (~"4 IUTERwIAI.. OIP1E1lS10Ali OF TA1.JK: LEa~GTH ~ ;WIDTH ~;LIQLIID DEPTH ,5,~._,.,,_ 31Gi~1f;D;11~ `'r" ~ ~tCEtJSE All]I1BER: Z~~~`~~ DATE: ~ -~ ~~ ,, _ Center Connection Lateral Layout Daigram Force main oonnection via tee or cross to manifold at ang point. ~E P •=Turn-up~m'ballvatveor ~FX cl®anoutplug Hotes drilled on the bottom of the lateral. Laterals are identical Laterals ak force main of PVC Soh 40 per CQMMI Table f14.30-5 S .]k.. Number of Laterals 4 Lateral Diameter 1.25 in Lateral Length (P) 55.55 ft Lateral Spacing (S) 2.00 ft Lateral Flow Rate 11.53 gpm System Flow Rate 46.14 gpm Total Dynamic Head 25.61 ft Orifice Diameter 0.125 in Orifice Spacing (X) 2.02 ft Orifices per Lateral 28 Orifice Density 4.02 ft~/orifice Manifold Length 2.00 ft Manifold Diameter 1.25 in Forcemain Velocity 4.71 ft/sec Dose Tank Information Electrical as per NEC 3fl0 and -~ Comm 16.28 WAC Disconnect ~- lank component is properly vented Wieser Combination Ca ci 600.00 Volume 11.82 Manufacturer Gallons galJinch A Dimension Inches Gallons A a~~ 28.73 339.63 B 2.00 23.64 C D Total , i 8..03 12.00 50.76 •-94:89 141.84 600.00 3" Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds Pump Model Number 3885 WEO5H tank. Pump Must Deliver 46.14 gpm at 25.61 ft TDH Project: John Tittfe 3 bedroom residential mound B YS=7' D Locking cover with warning label and locking device and sealed watertight i 4 in. min. --~..~ E---- ARemate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P• ump off .elevation (ft) 86.00 Dose tank elevation (ft) ~- 85.00 Page 4 of 9 - r Mound System Maintenance and 4peraflon St~eciflcationa Service Providers Name Boldt's Plumbing -Dale Hudson Phone 715.6843378 POWTS Regulators Name St. Croix County Zoning Phone 715-386-4680 $vst~M Flow and Load Parameters Design Flaw -Peak 450 gpd Maximum Influent Partide Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 rrtglL Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cful100 mL $„ervl ~rggusncv Septic and Pump T Effluerrt Fil Pump and Contra Alarm Pressure Sys#em Mourul 1 and/or service once ev 3 Should i and dean at least once ev 3 Test arx~e ev 3 Should test month Laterals should be flushed and tested ev 1.5 Inspect for poring and seepage once e++erY 3 Years Miscellaneous Construction and Mate„fials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound c manual. 2. Dispersal colt aggregate conforms to Comm 84.30 (6)(i), W+s. Adm. Code. 3. All gravity and pressure piping materials conform to the requirerner>ts in Comm 84, ws. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound stnuture and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetrartion. Lateral Tum-up Ostatll Finished • .............. ~ ................ Grade 6-~' Diameter Lawn _,_.~ Threaded Cteenout Sprinkler Valve Box Plug or t3aN Valve Distribution Lateral ``~.~ Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: John Tittle 3 bedroom residential mound Page 5 of 8 4 , Mound System Management Pian Pursuant to Comm 83.54, Wis. Adm. Cade This system shall be operated in acxardar-ce with Cantu 82-84 Wa. Adm. Code. and strati rnakrtaeted in atoordarroe wflh ds' component marrtrels (SBD-10891-P (N.01/01) and SSVVMR Potion 9.6 (01/81)] and kxal «stabe odes pertairbr~g to system rrreir-berrarrce and marriertarroe rePating. Noone should ever enter a septic «pump tarn since dangerous gases may be preserrt that c~uuld cause death. Septic and pump tartlc absndonmerrt shag be in aocor~darxre vuith Comm 83.33. Wis. Adm. Code when the tarns are no kXtger used 8s POWTS rArr>ponerrts. - Septic «pt><np tonic rrtar>hole risers, access risers grid corers should be irrspecbed f« water tigMnees and soundness. Arxegs operwrgs used f« service and assessment still be Beaded waDsrtigtrt upon the oanPletiorr d servkse. Any apenin9 deemed unsound, defective, «subject to failure must be repiat~d. E>g~oeed access aperurrgs greater than 8-inches in diarrreber shaft be secured by an efiectivia device to prever>t accidardal «ur>gulhorized entry into a tank «component. Sarltic Tank The septic tar>Ic shah be maidairtect by an individual certified to service septic tardcs under s. 281.48. Stets. The corrberrts d the septic taNk shad be disposed d in acxordarrce with F1R 113, Wa. Adm. Coda. The operating condition d the septic tonic and outlet filer' shall be assessed at least orate ever 3 years by inspection. The cadet fifler shall be cleaned as necessary to ensure proper Operetion. The filter carKidge sftoukl trot be renwred unkilss provisions are made to retain solids in the tank that rrmy siougti off the fdber when removed tram its enclosure. tf the fiker is equ~ped vviflr an alarm, the fAter shall be serviced if the alarm is activaAed kroritinuousy. Irderrridtent filter alarms may iridk~te surge fka+rs «an kriper~rg continkiotis alarm. The septic tank shall have its cxxrtertts rerrioMed when the vdume d sk,dge and scrim in the tank exceeds 113 the dquid vdtxrie d the tank. ff the c~r>bmts d the tank are not renewed at the tkrie d a triennial assessment, mairdenanoe persamel shad advise the ovvrier d when the next service needs to be perfarried to medntain less than maodmum saar- and sledge ~ ~ the tank. The addition d bidogical «cFiemical addi/iwes to eriharice septic tank performance is generelty not regtared. fkavsuer, ii such proc~cts are used they strati be appravad for septic tank tree by the Deparb~nerrt d Commerce. Pklfnq Tank The pump (dosing) tank shad be inspected at least orrice every 3 years. AN svvitcties, alarms, and pampa strati be tasted to verity proper aperatiori. If an effhierit Oder ~ installed within the tank it shad be inspected and servked as rieoassary. Mound and Prerreure Distribution t3vstern tdo trees «shrubs stiokYd be planted on the mound. Plardirigs may be made aramd the mound's perimeter, and the mound shad be seeded and nxik;tted as necessary ~ preuera erosion and to provide sane protection from frost penetration. Traffic (other' than f« vegetative rnairr6enarioe) onthe miokind is not recarr>rrierrded since soil compaction may hinder aeration d the irrflitrative surface vvdhin the mound and snow conipactdiori in the vviraer void prkxriote frost perietraition. Cold wwtlter ketsilatiarrs (OCtober-Februa-y) dkdate that the mound be tieenrdy rriidctied as protection Fran freezing. Inflt~eM gustily iMO the mound system may nil emceed 220 mglL BODa,150 rngll.. TSS, and 30 mgA_ FOG f« septic fordo effluent « 30 n>,gll. BODY, 30 mglt. TSS, 40 mglL FOG, and 10' du/100 mL f« highly treated effluent. linfluerit flaw may trot exceed rrisoarritm design fk>rv specfled in the permit for this iris~tatiori. Thor pressure distribution system ~ provided with a fltetiing point at the end d each lateral. and it is recarrirrierdedfhateach lateral be fkashed d aoaxrw~ted sodds at ki~ast once every 18 martl'is. When a pressure best is performed it shook! be ~mpared to tl-e initial test when the system was ir-stalted to deterrrieie if orifice dogging has acairred and if orifke dearting is required to maintadn equal datribkttion vwlhai fhe a ~. Otxiervatiori pipes vvittiin the cad shad be checked f« effkier>R poriding. Pondirrg levels shad be reported to the owner, and arty ksveis above 6 irtcftes corisideted as en inpending hydra<ilic fadtx+s rrs~riring adddional, rriore frequent monitoring. Canlirtaranev ~ ff the septic tank «arty d its componerr~ became defective the tonic «comporierit shad be repaired «replaoed to keep the system in proper operating cx>rdition. M the dosing fordo. Pump, pump , alarm «r~eiated wiring becorries defective the defective corriporierrt(s) shag tae krrrrectiataly repaired «replaced with a cornporient d the same «equal peAomvance. ff the mound component fads to aa~ept wastewater «begins to discharge virasberNater to the ground surface, t void be repaired « replaced in its' present kication ~ fricreasirig basal area if tae leakage ocairs «by rerrwving ~9>~I+ ~g9~ ~ dispersal ~ and related p~irrg, and replacng said carnporients as deemed rieceisary to bring the system arto proper operating coriditior-. See Paged d this pNan f« the Halms and telephone number d your kx~t POINTS regulatctt and service provider. ~~ Pt~ect: Jahn Tittle 3 bedroom residential mound Page 6 of 9 • `~ ~ _~ ~t 7 J J Y": METERS FEET ~ 1~ u 12a 110 C w 100 W 90 U 2B CO ~o z~ ~ 80 N rB S ~ 40 10 30 20 s m o t o v +~ a.'-, `~ Yn k ' ~ i ` 1~, ,.$a Effluent Pum0 , x 3r~" '' MDDEL 3885 ,yy : 1 //p k Np ~H ~M ' ylk 1_._ 1 10 20 30 a0 ~ _ 50 60 l0 BO 90 100 110 120 130 40 U.S.G _ ,,. ~. ~,r„ 20 3o m m, Pump Specifications '/~ through 1'/2 HP Up to 130 GPM Maximum head to 123' Discharge size 2"NPT Solids:'/." maximum Motor All motors feature ball bearing construction. Available in Single and Three Phase 115, 200, 230, 460, and 575V. All single phase models have capacitor start motors. Materials of Construction Cast iron Stainless steel 'M Features and Benefits •All models feature silicon carbide mechanical seal faces for superior abrasive resistance and extra long life. • Cast iron semi-open non-clog impeller with pump-out vanes for mechanical seal protection. • Rugged cast iron volute type casing adaptable for slide rail systems. • Corrosion resistant threaded stainless steel shaft. • Motor is fully submerged in high quality oil for lubrication and efficient heat transfer. • Optional silicon bronze impeller available. •CSA listed models available. METEfl8 FEET 8 7 20 O B = 5 15 V G 4 Z 1a O 3 J 2 ~ 5 0 00 t F'.Y i.Nf ~ _ MODEL: 3872 so 0 2 9 6 B 10 12 td 16 myAr CAPACITY Pump Specifications '/2 HP Up to 75 GPM Maximum head to 18' Discharge size 2" NPT Solids: 2" maximum Motor All motors feature bait bearing construction. Single phase: 115V Materials of Construction Cast iron Thermoplastic Stainless steel Features and Benefits • Glass filled, thermoplastic vortex impeller with stainless steel insert and pump out vanes for mechanical seal protection. • Rugged glass-filled thermoplastic casing and base design provides superior strength and corrosion resistance. •Cast iron motor housing for efficient heat transfer, strength and durability. •Corrosion resistantthreatled stainless steel shaft. • Available in automatic and manual models. •CSA listed models available. u~ Underwriters Laboratories I All Models are designed for continuous operation and feature stainless stee/ hardware. (~~. 709 .: 1 i~ ~ SCa/e. =ytl ~ So,% C Jll~ita.-b~n-~ P, • E/t dccz~; on ~~/-de -saL ~.e~Sq ~/a~of~..,n,dndC:~ Sc.~nw,S.1D Tit. o~ 1~mA~OrK/ ~$~.C/OiX ~~ ~~ ~ ~~. S.TM. 303 ~ Proposer! 1, a~/60o a//ass eo•n 6~'na~~-- ~d.C. buJ/d~nq JG~ ems'/kcn~ ~'i'J~'Gr%/JSfd--~~ aL~S'TOw'tle~• 8 ~ P~oPCS4r ,,~¢1/~ ~~e. 909 e • ,2'sc~.~loRd.C. E`~c~-.cAth . ProPos-e.d ~ P~oposc.d.d~i~~~..>ay 3 bcdror~w, ~ J ~i ~'LSide,ce e, ~ ,,,_ ~ L~. ~ ToPof'1'~„ • 1 8- galdQni~cd pi,oe. 9S.S6' ~ J V~kt~ = 9~ 87.' 1 97.oy, ~~ Jf ~9°~ ~I 9,7.oy. ~roPos~d rn.ou-rtd a,E .t6•/7z /29.A~ ~ ~ la ~t~a/S QE J!'y X Ssss'~/Y8 ,• I1 o~if'i[e1 S~oac2d a~ ,Z.o.2.. ' ` + 9~K' sz 1 ~ l -.. ¢ n TAO o F /off ~ ,sue. ~ssarnc~/ elev` = iCYI.~ 3. ~Co 0 ~St r.e ~Z~ ~. -~ P 8 0~9 ,~ ' ~ ~ __ Z Wisconsin Department of Industry, SOIL AND Si.TE'EVALUATION Page / _- of Labor and Human Relations Division of Safety and Buildings in accordance~wit~ s. I~.HR 83.09, Wis. :. ~ County sT G. p~~ /~• Attach complete site plan on paper not less than 8 1/2 x 11 inches in stze. Plan must /~ include, but not limited to: vertical and horizontal reference point (BMj, directiop.and + • percent slope, scale or dimensions, north arrow, and location and dist 'rice,to nearest road. Parcel I.D,: # O ., ,. ',•;r,;r, 7r~ICt. Date APPLICANT INFORMATION -Please print all information: Reviewed by ' ~~ Id- l6 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m))., Property Owner ~ (~N (3 l (7p L•~ll~ ~ ~ b •- C~~ Properly Location`' Govt. Lot Sw 1/4~/W1/4,S ZD T Zy ,N,R /7 ~ (or) W Property Owner's Mailing Address ` Lot # Block# Subd. Narne or CSM# 33Z ,H ~ IuN~SoTA sT: E~15T ~ yo ~ ~4MMOND o,q-,~s" ~~~ Nearest Road W r ~- City State Zip Code 'Phone Number [] Village L"J I own e-, .Q ((p (~ ST• PnuL 11`•l ~. 15Slo I _ c~o5/ ~z32.5555 ^ ~i~ ""'~ - _ [v~'1'~esidential I Number of bedrooms ~ Addition to existing building - [~'fJew Construction Use: ^ Replacement ^ Public or commercial -Describe: X' ~t, "~ bed, d/ft2 J trench, gpd/fiz Q 2 ~~~ 2 Recommended design loading rate 9P Code derived daily flow ~_ 9Pd d/ft2--~-_ trench, ft Maximum design loading rate bed, gp trench, gpd/fit Absorption area required ~_bed, ft • Recommended infiltration surface elevation(s) Su ~ ft (as referred to site plan benchmark) T12 E,cJ T ~(ID E ~IOU~vl~ /~~C+'v~'/E'ED Additional design/site considerations '~' D (!~ Q~.eNS'Lc- T~ //f' Flood plain elevation, if applicable ~~ n Parent material /~ F6•s Conventional Moun In•Ground Pressure AT-Grade System inL7U Holding Tank S = Suitable for system ~_,/ ~^ U ^ S l5d't~ ^ S U ^ S ^ S `-' - U = Unsuitable for system ^ S L7 U LL77 55 SOIL DESCRIPTION REPORT Boring # i Ground elev. t ~ Depth to limiting factor m. Boring # F . Ground elev. Depth to limiting Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture ~ o.~ ioY~ z( - L ~ ~•~ /0 3 - SiL • a io y ----- SQL • /6 G ~. ~ Mod s C L /b I/~ 4<2 .s ~ Remarks: o•/o /ot/iP 3f3 - ~. •/ /o yid / •s c 2a2 t /byiC~l!!Z y. S/ 1. Remarks: Structure Gr. Sz. Sh. Consistence Boundary Roots '" - Bed ,Trench I s h,~ ,~.f cs - ~ ~••w• ~~i2 ~ s - . s . ~ if hk ~~~~' - - N G / S ~ 5k cS if .~ .S s/~ ~ s h~ h c s -. Z• 3 SL SGC CST Name (Please Print) RpQ~RT' ?.IGI~R-GI~T• Signature Telephone No. ~~s•3g~,•g-~s Date ~~~ ~~~~~~~~~ ,~ N ~,,, 6 i ,gyp ~ ~'~~ SOIL DESCRIPTION REPORT iOPERTY OWNER ~'~ K S' S D ~j 4RCEL I.D.q L~ ~ ~ ~AM~10~~ oring # 3 ro~~nd r elev. ~~,~© Depth to iirniting (arlOr in. ~- f? - Borng # C;round elev. ft Depth to lirniti~g factor in Boring # Ground glee. ft. Depth to Ilmiting factor in. Boring Ground ~~~ tt Remarks Page ~ _ of -~ Depth to , limiting • w ~ j~M ~ / SlJ /'r U E %D/~ S % ~ _ , /.S', ~ -~4> L o T Limit/-e. w Q '~~ ~I 1 i o~ S -~ a ----- -----__._..._.~ } } ~ -~ w 1 P - ~ l v \~ O ' ,~ ~ ~ " ' ~ N n ~ -~ ~ ~ . y ~ ~ ~ ~ ~ ~ \c ~ ~ c ~~ ~ ~ ~ ~ . O _~ U'1 • W (~ n~ v T ~, r , \ ~~ i~ N 0 ~ _ ~~~ a ~ /t Y ~ ~~~ Y L "' +~ Z Wisconsin Department of Industry, SOIL AND ~ ~~`,jALUATION Page ~ of Labor and Human Relations \ . ' Division of Safety and Buildings in accordanc .vbi~q s. I~HR-X3.09, Wis. ~. r--.,; _ ,; ~, t , .. - . County `~ ~; c/PO/ ~- Attach complete site plan on paper not less than 8 1/2 x 11 inches in flan, must ~ ~~ include, but not limited to: vertical and horizontal reference point (BM , drr~ctiol~ ~ ,-r,.~ _ percent slope, scale or dimensions, north arrow, and location and gist 'c~to nearest road Parcel-I . # O 1 ~ °~ =vf~-iC1_ Revte .ed by Date APPLICANT INFORMATION -Please print all informatibl fr~, ~ . ~ l~ ,~ Personal intorrnaYwn you provide may be used for secondary purposes (Privacy Law, si~S.oR (n ~(~1~. -- ,. % P ~f Property Owner ~ (~ H iR ij ep' L~~ D C d . ~~) fJ ~ ~~ 1 ~ ~D Ira Govt. Lot 5 w 1/4 ~~1l4,S ~D T Zy ,N,R ~ / E (or) W FJ ~d ~ 'Lot # Block# Subd. Name or CSM# Property Owner's Mailing Address" ~ d~f': 332. =h i uN~SoTAc ST: E~13T ~ y0 ~~ S ~F~t.~towD ~~~ Nearest Road ' w ~ ~- City State Zip Code 'Phone Number ~ City ~ Village IJ ~ o`m~ ~ (~j a ST'• Pnu~-- I N N. i SSI o I t ~oS/ ~zZZ •555.5 [residential / Number of bedrooms 3 Addition to existing building []'New Construction Use: ^ Replacement ^ Public or commercial -Describe: ~r• '"` bed, d/fl2 ~ trench, gpolfi2 Code derived daily flow y~o 9Pd ~~S Recommended design loading rate 9P bed, tt2 trench, tt 2 Maximum design loading rate _,~-beds 9P~~ • ' trench, gpd/ft2 Absorption area required ~ . tt (as referred to site plan benchmark) Recommended infiltration surface elevation(s) •~~ T1 / ~ ~OV~~ /~~Qv~, ~~-D Additional design/site considerations ~ '~' Y " /~° ~ f~~ D ~~ ~~NSF T~ ~~f Flood plain elevation, if applicable tt Parent material ~DE'cS In-Ground Pressure AT-Grade System in Fill _ Holding T Conventional _ Mou ^ / ,l.-~,,,~/ ~ S S Suitable for system ~L~,/" S ~ U ~ S L~'~ [] S U ^ S U Unsuitable for system ^ S U Boring # Horizon Depth Dominant Color ~ in. Munsell ~ ~ - o•~ iDY~ i~ Ground • a /~ elev. g~. ~tt. r ~6 Depth to limiting factor m. ~~ T `Y Boring # Ground elev. 4~. ~ft. I Depth to limiting Remarks: .~c ~s factor ~in. Remarks: p© Signature ~ Telephon~; .~ CST Name (Please Print) R®(~ERT ~Ll7F1G~~ 1 •~~' 38G SOIL DESCRIPTION REPORT i Mottles Cont. Color Sz Qu Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz ged ,Trench . . ~ /fsh~ ~f~ c ~ f .~~. s ~. sic. ifs h,~ .~~' ~s - • 2 -- S/L, zw. ~~i2 ~s _ . S ', • to ~,,~. ko~s ~~ ~f hk ~~~~' - N s'b I/~ 4<2 , .S/ 1 Date ~ ~' """ ""°' - .. -~ .-~ ,~ y p`-,: ~~ .. ~, • ~(~ L ~a!] SOIL DESCRIPTION REPORT Page ~' of ~u~+$t PROPERTY OWNER ~ ~ ~i ~ ~ S' s C~ g ' ~ ~•- s~AM~'1 o~t7 PARCEL I.D.# LD l p Structure Consistence Boundary Roots Bed ,Trench Mottles Texture Boring # Horizon Depth Dominant Color Gr. Sz. Sh. ' Z in. Munsell Qu. Sz. Cont. Color !.~ • Z,. • 3 ~3 ~o~~, ~! sip ifs /~ ~-f' ~~ _ •5,.~ ,~ 3 ~ ~ sti ~~ Ground ~ ~ ~ ~ ~ ~ ~~ ~ 5 ~~ • elev. • Q. ' _„ ~ S Depth to f ' HST , ', limiting ~D,Jtl S~ factor 7,` ~in. Boring # Ground elev. ft. Depth to limiting factor in -- --- Remarks: GPDlft2 Structure Consistence Boundary Roots Bed ,Trench Mottles Texture Horizon Depth Dominant Color Gr: Sz. Sh. , Munsell Qu. Sz. Cont. Color in. Boring # ~ ' Ground -- , elev. ft. Depth to "limiting ` iactor ---~-'n~ Remarks: , Boring # - ' Ground ' elev. n. I -- Depth to , limitina ^. ~ ~,~ ~ W cv ~s r ~ o r ,~ . /~~ ' _..~ _~ ~, .~ a --- c~ ~, o~ a - _- ~ - ' ~ .N w a -. 1 y 1 O ~ N n ~ ,,~ ~ ~ ~ r ~ •• ~ ~\` v o II ~3 ~` I (~~ T'~~ v j _ ~ ~ ~ oa ~ c ~ ~ \~\I V \IL`1- O _I s ~~ i~ O -~ ~ _~,~~ ~ .,,-Q y ~~ y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer S oh v~ ~ ~~ ~~ ~ ~- Mailing Address X303 G~ev e\cx~n ~V' . SO ~. PnI~MNi ~J `1ls Property Address ~ l9~ ~ O~~ t"\\CE ~ ,T a m rno n ~ ~J ~ ~ y015 (Verification required from Planning Department for new construction) City/State ~ Q rnr~ a n Ci LU~ Parcel Identification Number ~ ~ p ~-' ~ ©~ ~o- ~~ V ~G~ LEGAL DESCRIPTION Property Location 5 Vy '/4, ~'/4, Sec. z~ , T 2~ N-R1~ W, Town of ~('~11'Y~ Subdivision S~b.~mm0'~C~ ~ Q~S ,Lot # ~_. Certified Survey Map # Volume ,Page # Warranty Deed # l'~~D~~ ,Volume _L~l .Page # ~ ~ _. Spec house @7 yes ^ no Lot lines identifiable [J" yes ^ no SYSTEM 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 can 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 masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 t your septic system has been maintained must be completed and returned to the St. Croix County Zoning OfI•ice within 30 days of e e xpiration date. ~~ / f / d/ SIG TURF OF APPLICANT 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 prq~ep~ desc~ed above, by virtue of a warranty deed recorded in Register of Deeds Office. APPLICANT /o / S / o~ DATE ** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed V!!~..~ Il!1PAGE2~4 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRAI~ITY DEED This Deed, made between 13umbird Land Corporation, a_ Minnesota Corporation _, Grantor, arRl Home In Minnesota Inc. __ Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix ^____ County, State of Wisconsin: E',S4G14S r:HiHLEEN H. WALSH iiLG1STEk OF DEEDS ;;T. CRDi;t CQ. , WI kECEIVEU FOR RECORD Od-lo-2041 F0:15 AM UARkRFITY DEED Ef(EMPT N CERT COpY fEE: COPY FEE: ikAHSFER FEE: 62.70 kECDRDIMG FEE: 10.00 r'AGES: 1 Q /~ Lot 59 Hammond Oaks Subdivision,Town of Hammotld, St. Croie County, Wisconsin \ame and Reluln Address ~~9~5 D/ O 1 & 1086-59-000 _ Parcel Identification Number (P!N) This ~ not _ homestead progeny. (is) (is not) Exceptions to warranties: Subject to notes, easements,restriclions,covenants and rights of way of record, if any, 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 the consideration expressed herein, that being the sum of $20,900.00. Dated this Ist day of August `, 2001 » AUTHENTICATION Signature(s) authenticated this ~ day of , » TITLE. MEMBER STATE BAR OP WISCONSIN Qf not, ___ authorized by § 706.06, Wis. Stals.) THIS INSTRUMENT WAS DRAPTEI) IIY Paul A. Baillon, Atiotney at Law (Signatures may be authenticated or acknowledged. Both are not necessary.) Humbird Land Corporation » by ~ President s Austin J. Baillon -- ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. Ramsey Comfy. ) Personally came before me this 1st day of August , 2001 - the above named Austin J. Baillon __ __ to me known to be th 8 instrument and aekn he st>apd1L A. BAILLON ~~ NOTARY PUBUFuINNE50rA ~, MY~Qb1Ml$$B~N EItPI' ' Paul A. Baillon ~ _____ -~_ Notary Public, State of Wisconsin My Commission is permanent. (IC not, state exptration date: January 31 ~_, 2005 ~.) •Namea of penom signing in any capacity should be typed or printed bolow their signatures SrA7E BAR OP W l$CONSIN WARRAIYrv DrCD FORM 1'ro.2 • 1998 1NFORMAiION PROFESSIONALS COMPANY FOND Dli LAC, WI BW-655.2n21 N N N ti 1~.., ~... _ __ - I... -- Z -~ -- -- '~ _~ - - - - - - - ~ = - - - T64;5i' - --164.84'- - - - - -- --164?ii'---- -- ` -155:00'- - - --168:28=------ -- t51-08 u - - ---161:56 -- " , 50'2321 E 1753.30' Fr CROCUS HILL_ROAD_ u_ _______ ___ _ __- -- --- -- - - -- - ------- - w ~ - N031. - _ _ NO'23'21 "W 1753.13 FT 21' - -150.2' - - - - - - 130:21= - - a 50 - - - - - - - - - -290. - . . d.21'_ - - - - - -150.-2t- - - - - - 4-150~t- - - 20.00' -- --- ---- _ 20' DRAT AGE -- -- ------ -I-- --- - -- 18 g g 8 g ^ I d oc LOT 33 g H N I~ H 44,500 S0. F N ry LOT 39 L~~T 38 T 40 ; s LOT 37 ; ~ ; LOT 35 ; LOT 34 LOT 36 ~ M 49,361 SQ.FT. 561 SOFT 43 I; 1/^ 1.02 ACRES ~ 43,`61 SOFT. r 43,561 SOFT. N S1 SQ.FT:~ 43,561 SOFT. , 43,561 SO.fT. ~ . ~ 1 13 acres I ~ a1 n 1.00 acres 1.C0 acres n n 0 ocres .. 1.00 acres ~ ~ 1.00 acres 1.00 acres „ ~, i ~, ~ m ~ vao, ~ I N LOT ; N N N I 44,777 ' I 1.03 A Y23'21'E 150.21' S00'23'21'E 150.21' 21' Sd 00'23'2t'E 150 ' ' SOO'23'21'E 150.21' S00'23'21'E 170.21E ,°. S00'23'21'E 150.21' ' . - E 150.21 5 21 7] 05' ' 153 2,51 -_N 239.46' ~ - - - - - - - - - - - 50'23'21' . 153.05 256.55' ~ ~-2O' DRAINAGE EASEMENT ' ~ h ° ~ / ~o• / LOT 54 a L " ~ % LOT 50 ~ LOT St N lOT 52 ~ ^' / 53751 SOFT. LOT 53 ,3• / 1.23 ACRES 96R' ' ~ ~ 44,E 1 1 ~,,~ 43926 SOFT. ; 43,584. SOFT. ; 43,987 SOFT. ; 1 43812 SOFT. hn, .y ^, 01 ACRES 1 ~ ri n ~ . ~ 1.01 ACRES ~ 1,00 ACRES n 1.01 ACRES $ ~~ . ~ 20.00' ~"~' ~ ~r •^ ~ m / ~''~ n ~ - ~ ~ ~ ~ 43561 SQ.FT. 00 ACRES ~ 1 m „ '^ °' 44,640 ~- ~~ _ ~ -- - a -- . / ~ ~ ~ 1.02 ~ ~ ~ ~ 156.24' ' ~ - -t~:'••~9- - - - - - - \ 505'42'42"E 299.98 ® ~ ~ ~ 500'32'23"E 291.63' a 9 ~ ~'~ I m ~ I H 50'23'21 ! ~, - - - - - - - ©SAN'`PIPER LANE u ® ! LOT 56 Qi / ' 43,603 SQ.FT. 3 LO ' ' ~ - - - \ © ---i ~ SO'32'23'E 500'32'23"E I \ 1.00 ACRES / ~ 44,27 I ~ / 90.43 ~ 135.20 ~ \ - ~ / ~ m 1.0: ' ~ ~I ~ ~ , I ~N o I w ~_i n JS~ ~, O H I N c ~ ~ ~ r lOT 58 ~' 12.10' N ~ ; l0T 47 .~ LOT 46 ; 817 SOFT. "' 54,373 SQ.FT. I nl X I ~ 101' S9 5 .v* 47500 SQ.FT. ; 443561 SOFT. *. 09 ACRES 1 -~I - , 3 I ~ ~0 51 .30 ACRES 1.25 ACRES ~ t,_ , ~ ,794 SQ.FT. L - . N 1.00 ACRES ~ -- - - -~ - ; n - 449f ~ ~o _ o~~ 1CCRES O ~ 1. -- - - - ~ - ~i ~ ~/o . YN Y n, 1.C l ~. h e $ 10„ ~ Z i 100. N~ r I , ~ ' I 162.35' ' 290.0 218.16' I 66 1 183.40' . 0' 280.45 NO'24'S9"E 2535.04 FT M M -- ~ WEST LINE OF NW 1/4 OF SEC. 20 NO'24'59"E 2518.68 FT '`~ - M - - - 160TFi_STREET - ~-------- ---------- -- UNPLATTED LANDS DtvISION D NOTES: - ALL gUIIDINCS TO BE CONS,'RUCTED IN PROXIMITY w1TH RICH WATER EASEMENTS SHALL HAVE A FINISHED FLOOR OR MANDOW WELL ELEVATION NOT LESS 'f' THAN TMlO(2) FEET ABOVE T:IE HIGH WATER ELEV. SHOMfN !~i ~ BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE -; i NORTHWEST 1/4 Of SECTION 20, TOWNSHIP 29 NORTH, i RANGE 17 WEST, MfHICH IS ASSUMED BEAR N89'41'48" E. li GENERAL NOTICE STATEMENT EACH PARCEL SHOWN ON THIS MAP (PLAT)IS SUBJECT TO STATE, COUNTY ANO TOWNSHIP LAWS, RULES ANO REGULATIONS (I.E. WETLANDS, MINt1AUM LOT SIZE, ACCESS TO PARCEL. ETC.) BEFORE PURCHASING OR DEVELOPING ANY PARCEL OF LAND. CONTACT THE ST. CROIX COUNTY ZOINC OFFICE AND THE APPROPRIATE TOMfN BOARD FOR ADVICE.