HomeMy WebLinkAbout018-1087-64-000WisconsinDepartmentofCommerce 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)j.
'ermit Holder's Name: City Village X Township
Doelz, Walter & Diane Hammond, Town of
;ST BM Elev: Insp. BM Elev: BM Description:
GYj ~~r-'~,1 GS
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~~
'~-
D
Dosing
CO w~a
,~
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~~/ ~~~/ / D ~
to ~~/
~--
Dosing ~ ~ i ~ .~cJ ~
•~L~ ~/ ~D / .-
Aeration
Holding
PUMP/SIPHON INFORMATION ~[`.
Manufacturer
~ errand
t
` ~ GP
M
Model Number ~ ,, /
~71
JIIJJ `
TDH Lift Friction o System Head Z5 `l Ft
TDFj
•~$ 1+ b +
// T
Forcemain Length + Dia. ~~ Dist. to Well f
Z ~ ~
SOIL ABSORPTION SYSTEM
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
463278 0
State Plan ID No:
Parcel Tax No:
018-1087-64-000
Section/Town/Range/Map No:
20.29.17.684
STATION BS HI FS ELEV.
Benchmark
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Alt. BM y,nA w
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Bldg. Sewer
SUHt Inlet • bG ~~ • ~~
SUHt Outlet \
Dt Inlet
Dt Bottom ~+ 9~+ --7
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Header/Man. ~+ ~ G ~ +
~~/
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Dist. Pipe
Bot. System ~ ~~ ~~ ~~$
Final Grade • ~,Z a ' ~
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St Cover 1~` 6,~ GG
a~
+ Z7
~ 5.9 ~~ • Z
BED/TRENCH Width Length No. Of Trenc s 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 fSystem: ~+ ~~/
U
/U~ / /-
r(Jli UNIT Model Number: ~`
D
I'IISTRIRIITIl~N SYSTEM
Header/Manifold
Length Dia rl~ Distribution I ~' /
Length ~ Dia Spacing x Hole Size x Hole Spacing Venti~nta e~
Still CnVFR ., o~e~~~~.e c..~+o..,~ n~i.. YY Mn~~nrl nr o+.f;rada Systems Only zu'~"`-
Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ' ~
• Bed/Trench Edges \ Topsoil ~ ~•
es ~] No
es ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ /~L / ~S ~ Inspection #2: / /.
Location: 860 164th Street Hammond, WI 54015 (SE 1!4 NW 1/4 20 T29N R17WI),,Ha{,mmond Oaks 1st Add Lot 64 Parcet No: 20.29.17.684
1.) Alt BM Description = '~'~ ~'~'~ ~'~'`" ~~•• n'`J ~ ~S ° i~ plel.~ 0~
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Safety and Buildings Division
201 W. Washington Ave., P.O. Box 71b2 County
S~ ~Df`o`
Madison, Wl 53707 - 7162
si
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i Sanitary Permit Number (to be filled ;n by Co.)
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(608) 266-3151 ~ 3 Z ~ ~f'
De artment of Commerce
to PIan LD. Number
Sanitary Permit ~IVE~
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In accord with Comm 83.21, Wis.
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L Application Information -Please Print All Iaf
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propegyQwner'sName ZQNINGOFFICE\ P el# Lot# Biock#
6H
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erty Owner's Mailing Address
prop ti
perty Loca
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II. Type of Building (check a
~ $ !!! >D `
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S bivssion Name CSM Number
.
~r 2 Family Dwelling -Number of Bedrooms ~ sT'
py~
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^ Arblic/Corrtutercial - Descnbe Use
.
T Dvillage ~fewnship of
'ty
be Use ~
^ State ~~ - ~~ _
III. Type of Permft: (Check only one box on line A. Complete line B if applicable) D~~ fO$} - b - O'er
~~'" New System ^ Replacement System ^ Ttrzttnent/Holding Tank Replacement Only ^ Other Modification to Existing System
B. ^ Permit Renewal . ^ Petinit Revision ^ Changc of ^ Pcrmit Transfer iA New List Previous Pemtit Number and Date Issued
13eforc Expiration PIumber Owner
IV. Check all that a 1
of POWTS stem:
/
^ Non Pressurized In-CirOUnd pC~ Mound >_ 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 ^ L.eachung Ch ^ Drip Lie ^ vel-1 Pipe ^ Other (explain)
V. D' rsaUTreatment Area Information: ~ _ • ~ ~~ ~
Design Flow (gpd) Design Soil Application Rate(gp Dispersal Area Required (s Dispersal Area Proposed (sf) System Elevation s,~
`1So . S o0 00 ~b ~?8
VI. Tank Info Capacity ;in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
Ncw Existing
Tanks Tanks
Septic or Holding Tank ~ ~~ Q(7 ( W (f .S f /~ 'L
Aerobic Treatment Unit , ~.
nosing ember ~ 6 p p - a C
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POW'I'S shown oa the attached plans.
Plumber's Name t) Plum 's S' ature
~~
~ MP/MPRS Number Business Phogne Number
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P bet's Address (Street, City, State, Zip C e)
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VIII. Coon /De artment Use Onl
Approved ^ ~~ Sanitary Permit F includes Groundwater Date Issued uin gent Sign o Stamps)
, Surcharge Fee) ~~ ._.- O 3
^ Own ven Reason for .
IX. Conditions of rov 3) ~~ ~ _ ~ t ~q,
SYSTEM OWNER: ,~~~,,~,,~ ~ ,(.Q,Q ~~~j
1 Septic tank, effluent filter and ~ ' ~ ~""'`~ '~`~7"""' - ' ~',
dispersal cell must all be serviced /maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances.
Aitactt complete plans (to mt i.ounty omy) rot we ayscem vu Y°I+« „~. •~° ~° °~~ ^ -~ ."--•-- - _--.
SBD-6398 {R. 01/031
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commerce.wi.gov
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Department of Commerce
Safety and Buildings
1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
TDD #: (608) 264-8777
www.commerce.wi.gov/sb/
www.wisconsin.gov
Jim Doyle, Governor
Cory L. Nettles, Secretary
November 29, 2404
CUST ID No.227618
THOMAS GUSTUM
GUSTUM SEPTIC SERVICE
N 13450 937TH ST
NEW AUBURN WI 54757
ATTN.• POWTS Inspector
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 11/29/2006
SITE:
Jim Henry
160TH St Lot 64
Town of Hammond
St Croix County
SE1/4, NWl/4, S20, T29N, R17W
Lot: 64, Subdivision: Hammond Oaks
Identification Numbers
Transaction ID No. 1086593
Site ID No. 692798
Please refer to both identification numbers,
above, in all corres ondence with the a enc .
FOR:
Description: Mound System for Jim Henry
Object Type: POWTS Component Manual, Regulated Object ID No.: 994447
Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD-10691-P
(N.OI/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 owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to
occupancy or use:
• This system is to be constructed and located in accordance with the approved plans,
and the "Mound Component Manual for Private Onsite Wastewater Systems Version
2.0" SBD-10691-P (N.O1/O1).
• The pressure network is to be constructed in accordance with publications SBD-10706-
P (NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater
Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP
Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)".
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 iuchide local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
~ ~ - '` THOMAS GUSTUM Paget 11/29/2004
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,
A- ~lX~r~~''~.
Keith A Wilkinson
POWTS Plan Reviewer ,Integrated Services
.(715) 524-3630, Fax: (715) 524-3633 , M-f 6:00 am - 2:45 pm
kwi Ikinson@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
.~ ,
pI~CEftlEp
Na v ~ 7 zooa.
Mound System
Project Name:
Owner's Name
Owners Address
Cover Page
pg 1 of 6
Henry 450 GPD Mound
Jim Henry
2217 Vine Street Suite 200
Hudson, WI. 54016
715-381-4904
Legal Description I'E I ~ I %4, I'~w~ %< Sec 20 T 29 N, R 17 w ~
Township Hammond
County Saint Croix ~
Subdivision Hammond Oaks 1st Addition .. •
w ... ,,
Lot# 64 `
„ . __.,
ParcellD# '
is
~~ ~
- ~' Table of Content -- ~- ~ ~
Q';' ••;~ ~' 1 Cover page -
~;~ THOMAS D. ;N'; 2 Mound Sizing Calculations `'~
GUSTt~v1 Z 3 Pressure Distribution Layout and Dynamics / 3
'~ 1201 4 Dose Tank /Pump Curve (~ ~ rv ~~
'~ : ' ~ 5 Management and Contingency Plan pJ~
O~~i• •N~~• 6 Plot Map ~ ~ ~ 1
~""'_
total # of pages: 6
Designer Name:
License #:
Date:
Ph. #:
Signature:
Tom Gustum
D1201
11 /15/2004
715-658-
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01)
per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01/01)
3bAdvisement N12486 220th St, Boviceville, WI 54725 Ph: 715-643-6068 email:
Mound .System
Page 2 of 6
Mound Sizing Calculations
Project Name: Henry 450 GPD Mound
Site Conditions
Project Type: 1 or 2 Family Dwelling ; ~
Slope: 11
# of Bedrooms: 3
Depth to limiting factor: 29 in.
Absorbtion rate of fill material: 1 gal/ft2/day
Absorbtion rate of in-situ soil: 0.5 gal/ftz/day
Effluent quality Eff#1 •
Max BOD effluent value: 220 mg/I
Max TSS effluent value: 150 mg/I
Design of Entire Fill
Cell depth at upslope edge (D):
Cell depth at downslope edge (E)
Distribution cell depth (F):
Cover thickness over edge (G):
Cover thickness over center (H):
End slope width (K):
Fill length (L):
Upslope width (J):
Downslope width (Toe) (I):
Fill Width (W):
7.0 in.
15.0 in.
9.5 in.
6 in.
12 in.
8.2 ft.
91.4 ft.
4.3 ft.
11.4 ft.
21.7 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 450.0 gal/day Basal area required: 900 ftz
Distribution cell width (A): 6.00 ft Basal area available: 1305 ft2
Distribution cell length (B): 75.0 ft
Area of Distribution Cell: 450.0 {~ Observation Pipes
Contour Elevation of Mound: 96.20 ft Location from end of cell (Z): 12.5 ft
System Elevation of Mound: 96.78 ft
Final Grade of Mound: 98.58 ft
Mound Plan View
/Observation Pipes z~
- -
W K~ <." Distribution Cell ~~,
LL_ - --
Tilled Area/Filf Material
L
Mound Cross Section
Final !Grade ~ =-+
5yn#hetic Fabric ~
Distrih~utian Cell ~
5~stem Elevatian , ~~. ,d,
d
Caver Material-~~_~~'` ~ Lateral
Fill Material ;' E Invert
seruatian Pipe
---..rG
led Area
Slape
~Farcemain~"SYs#em
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(8)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System Page 3 of s
Pressure Distribution Calculations
Project Name: Henry 450 GPD Mound
Lateral Layout Lateral/Manifold Design
Lateral elevation: 97.3 ft Lateral diameter: 1'1z ~ In.
Rows of Laterals: z ~ Lateral spacing (S): C]ft
Manifold type: Center • Lateral to cell edge: 1 ft
Orifice diameter: o.iss ~ In. Lateral discharge rate: 12.52 gpm
# of Laterals: 4 System discharge rate: 50.07 gpm
Distal Pressure: 2.5 ft Manifold diameter: z ~ In.
Lateral Length: 37 ft Manifold length: 4 ft
Orifice Spacing/Distribution Forcemain Friction Loss
Orifice spacing (X): 24.00 Inches Forcemain length: 28 ft
Orifices per lateral: 19 Forcemain diameter: 2 ~ In.
Avg. ft2/Orifice: ftZ Friction loss in forcemain: 1.401 ft
~ ~ c Lateral Side View
M anifald
Lateral Lateral
~ x x x x x x x x x x x
`2 2
Lateral Leng#h Lateral Length
Lateral Plan View
Lateral Lan th
Turn-up w/ball valve or daanout plug
PVC Manifold
O o
Orifices on bottom of
lateral equally spaced PVC laterals, forcemain and manifold to comply with
spedfications per Comm 84.30[2]
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Glean-out plug
Final Grade or ball valve
water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Nate: Closet Collar
6" Mlnlmum may be used in
Long Sweep 90 place aF 3~8" bar
^rtuvo 45's ,L 3jell Bar
Lateral
Mound System
Septic, Pump and Dose Tank
Project: Henry 450 GPD Mound
Tank Information
Pump tank manufacturer:
Pump tank size/model:
Pump tank gal/inch:
Tank bottom elevation (inside):
Septic tank manufacturer:
Septic tank size/model:
Skaw Precast
642
~~.y~
92
Skaw Precast
1000
Pump and Filter
Pump Manufacturer: Little Giant
Pump Model: 9EH
Effluent Filter: simtec STF 110
Note: Access opening of sufficient size to be provided to allow
removal of filter Opening to terminate at or above grade.
Pump Tank Diagram
WateAigM Locldng Cover
4 inch ~Wfth Warning Label Finishi
Minimum , Grade
Allemate J
ONlet ~
Location
Elect. per Comm
16.28 and
remain NEC 300
Weep Hole
orAMi• B
Siphon
Device
Pump must be capable of:
and head pressure of:
z.s
0
10
Vl
7.S W
H
W
Y
50.1 GPM /p s
9.0 Feet
Page 4 of 6
Dosage Volume
Does forcemain drain
back to tank?
Lateral void volume: 15.6 gal
ft Dosage to absorbtion Cell: 78.2 gal
Forcemain volume: 4.9 gal
Total dosage: 83.1 gal
Total Dynamic Head
Are laterals highest point?
if not, enter highest elevation: 0 ft
System head (distal x 1.3) 3.25 ft
Vertical Lift ("D" to lateral) 4.28 ft
Friction loss in forcemain: 1.40 ft
Pressure loss from filter: ~p ft
Total dynamic head (TDH): 8.93 ft
Dose Tank Levels
In. Gal
A Reserve ~~- ° -~~- ~~
B Pump off to Alarm 2.0 32.5
C Total Dosage S• O ~ .~.
D Effluent depth for pump 12.0 194.8
Total Capacity: ~-0- 642.0
3'.d
Pump Curve: 9EH
FLAW- LITERS/HOUR
3 L9.'f
a'2.3s
Little Giant FLOW- GALLONS/MINUTE
9EH PUMP PERF^RMANCE CURVE
115V 60HZ
Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and/or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce,
Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep
solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied
by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be
emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved
individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified
of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely
inspected to be watertight and of good repair.
Pump/Dose Tank
If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pump/dose tank should be routinely inspected to be watertight and of good repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4
inches or more water level is detected in the observation pipes, the owner must be notified of possible
problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the installation or at the time
of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc)
become defective, the defective tank or component must be replaced immediately to ensure that the system
can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the
surface, the component must be repaired or replaced in it's current location by either: extending basal toe to
provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in order to return system to proper working order as
required.
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
Page 1 of 3
Gustum Septic Service
Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must Coun
~
inGude, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimemsions, north arrow, and~tioi'a7xt~tance to nearest road.
1 parcel I.D
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APPLICANT INFORMATION - Pl~se print all nfor~na
~~.
' 'ew~d By Date
s~. 15.04 (1) (m)). ~(~
Personal information you provide maybe used~sc~ondary purprf~es (Privacy 1:arV,
,a •0 3 ~,.e,
c.c~J
Property Owner `~ ~ ~ " ~° , .,roperty Location
Humbird Land Co oration
• vt. Lot n/a SE 1/4 NW 1/4 S 20 T 29 N,R 17 W
Property Owner's Mailing Address ~ ~~
East 14b4 ~'; ' ~•~'x •
332 Minnesota Street - t # Block # Subd. Name or CSM# Sr
Hammond Oaks kl~ Addition
~ ~`r ~nl~
,
City State ZIp Code P ~~ ' `
'
~~
9•``
~~
~ _
_
City Village Town Nearest Road
160Th Stmt
d
1
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S
•
Saint Paul MN SS.1:0 ~ , ~
Hammon
~ rooms ^Addition to existing building
New Construction ~ Resl~ie 'tial 1 Nur~t~i' 3
Use:
^ Replacement [] Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpolfCz .6 trench, gpolftz
Absorption area required 900 bed, ftz 750 trench, ftz Maximum design loading rate .5 bed, gpolft2 .6 trench, gpolft2
Recommended infiltration surface elevation(s) along 96.2' contour ft (as referred to site plan benchmark)
Additional design I site considerations BM 2 = 97.0'
Parent material sand stone Flood lain elevation, 'rf a I'ICable n~a ft
S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U=Unsuitable for system ^ S ®u ®S ^ u ^ S ®u ^ S ®u ^ S ®u ^ s ® u
SOIL DESCRIPTION REPORT '~3 • -~
Depth Dominant Color Mottles Structure
i
t
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nda
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Roots GPDlftz
Honzon Texture en
ons
s ry
ou
Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ Trench
1 1 0-7 10yr3/2 none sil 2msbk mvfr as 2flm 0.5 i 0.6
2 7-12 10yr4/4 none sil 2msbk mvfr cw if 0.5 0.6
Ground
elev 3 12-16 7.Syr4/4 none gr. sl 2msbk
--- mvfr cw - 0.5 0.6
97.0' ft 4 16-29 7.Syr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.6
Depth to
5
29-36
7.Syr4/6 1. c2-3d 10 7/2
7•g~
gr. sl
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mfr
-
-
0.5 0.6
limiting ------"
factor
- -- -
Remarks: 1 Few bands of 7 Syr4/4 sl
Ground
elev
94.2' ft
Depth to
limiting
factor
Remarks:
1 0-8 10yr3/2 none sil 2msbk mvfr as 2f,lm 0.5 ~; 0.6
2 8-14 10yr4/4 none sil 2msbk mvfr cw if 0.5 0.6
3 14-19 7.Syr4/4 none gr. sil 2msbk mfr cw - 0.5 0.6
4 19-29 7.Syr4/6 none sl 2msbk mfr cw - 0.5 0.6
5 29-36 7.Syr4/6 none WB m mvfi - - n.p. ~ n.p.
~_
CST Name (Please Print) Signature: CG~~ -/(~ --~_ - Telephone No.
Tom Gustum LG~ 715-658-1344
Address Gustum Septic Service Date CST Number Ref#
N13450 937th St., New Auburn, WI 54757 3/1/00 227618 1186
. rr~o
Y
PROPERTY OWNER: Humbird Land Corporation SOIL DESCRIPTION REPORT
PARCEL I.D.#
3
Ground
elev
97.0' ft
Depth fp
limiting
factor
30'
~~~ Page 2 of 3
C:udum Ce!-tic Cervic2
Hon
o Depth Dominant Color Mottles
Terre Structure
sistence
Bounda
Roots GPDI(tz
z
n in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ry Bed ~ Trench
1 0-11 10yr3/2 none sil 2msbk mvfr as 2f,lm 0.5 ~ 0.6
2
3 11-14
14-19 7.Syr4/4
7.Syr4/6 none
none. sil
gr. sil 2msbk
2msbk mvfr
mfr cw
cw if
- 0.5 ~ 0.6
0.5 0.6
4 19-30 7.Syr4/6 none gr. sl 2msbk mvfr cw - 0.5 ~ 0.6
5
30-36
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7.Syr5/8
gr. sl
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-
-
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.__.--
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Depth to
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Ground
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Ground
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Remarks:
Remarks:
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06/11ltt4 FRI 47:37 FAlC 715 385 4686 ST CRg GO ZONING
ST. CRUI7~ COUNTSC
SEI~TZC TANK MAINTENANCE AGREEMENT
AND
OWNI~RSHIp CERTIFICATION FORM
Owner/Buyer l~ ti
Mailing Address
Property Address
City/State
LEGAL bESCF.~PT'It~N
Parcel Identification Number Oll~~l ~-(o t{ UZTa (! 6 ~'`T
Pragerty Location _-Sf '!4 , ~/W , %4 ,Sec. 2~ ~ T Z°1 1V R.
-1Ibwn of ~re.~o.~-~
Subdivision
- ~sT_~DJ
Lot # ~.
Certified Survey zVlap # Volume ~ page # _
Warranty bead # ~o I ~ Volume _ 2. ! 13 ,Page # _ Z 9~ .
Spec pause yes na Lot lines identifiable yes nt,
SYS'T'EM MAINTENANCE
Improper use and maintenastcc of your septic system could result irs its premature failure to handle wad, prap¢r
maintenance consists of pumping nut the septic tank every three years ar sooner, if needed by a licensed pumper. What you put into
the system can a€t'ect the function of the septic tank as a treatment stage in the waste disposal system. OWner ttsaintenance
responsibilities are specified in § Camm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinannce.
The FreperiY owner agrees to submit to St. Cmix Cauuty Zanissg D~egartttserst a certification f
by a master plumber, journeyman plumber, restricted plumber ar a licensed veri ~, signed by the owner and
system is in proper Ql~a~ condition and/or 2 a8er ' p ~g that f 1) Ilse an~ite wastewater disposal
(} sssspection and Bumping (ifnecrssary), the sep4c tank is Iess thars 1/3 full of
sludge,
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal systems with the
standards set forth, herein, as set by the Department of Coststnarce and the Department of Natural Resources, State of VV'isconsia
Certification stating that your septic system Izss been maintained must be cosupleted and returned to tltc St. Croix County Zoning
Deparment,-~vithin 3Q days o the three year expiration date.
r,
~~ ~~~ ~ 6
SIGNATURE OF CANT DATE
OWNER C~R'I'IFICATION
Uwe certify that statements this form are true to the best of my/our knowledge. uwe amisre the owsrer(s} of the
pro 'bed above, virtue a decd recorded in Register of Deeds Office
NA OF LICAIV'T l~ l a ~ f D C~
DATE
"`**~`~« Any infarsn'atian that is ruisrepresentedmayresult inthe sanitary permit being rEVOked by the Zoning Department. **~~~*
Include wills this application $ stamped. warranty decd from the Register of heeds 085ce and a copy ai~the c¢rtified survey map if
reference is made in the wamsnty deed_
t...
~ CtQ1
Z rd
~~~
(Verification required from Plannirsg ]7epartrnent far new construction-)
STATE BAR OF WISCONSIN FORM 2 - 1996
WARRANTY DEED
This Deed, made between Merlin Land, LLC, a Minnesota Limited
Liability Company _
Grantor, and Walter E, Doelz_and Diane L_Doelzi_ _
husband and wife
Grantee.
Grantor, for a valuable consideration, conveys and warrants to
Grantee the following described real estate in St. Croix _ ___
County, State of Wisconsin:
of Hammond Oaks 1st Addition Subdivision,Town of Hammond, St. Croix
unty, Wisconsin
HATHLEEH H. NALSH
REGISTER OF DEEDS
ST. CROIJt CO.. WI
RECEIVED FOR RECORD
01/17/20@3 08:30A19
EXEIPT ~
I2EC FEE- 1 i. @0
TRANS FEE: 83.7@
CDPY FEE:
CERT COPY FEE:
PAGES: !
Name and Return Address
-~~
0_15-1057-64-000 _
Parcel Identification Number (PiN)
This ~ not homestead property.
(is) (is not)
Exceptions to warranties: Subject to notes, easetnents,restrictions,covenants and rights of way of record, if any,
including but not limited to those for drainage,water retention,ponding,and orutilities as may be shown on the plat of
Hammond Oaks 1st Addition Subdivision recorded in Vol. 8 of Plats, page 25, 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 527,900.00.
Dated this 31st day of December 2002
Merlin Land,LLC
» ----
AUTHENTICATION
Signature(s) __
authenticated this day of________ ___,.______
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 70b.Ob, Wis. Stats.)
TIiIS INSTRliMENT WAS DRAF'CED BY
Paul A. Baillon, Attorney at Law
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
» by ~==~~ua~- ;/- /'•~'~~d7LPresident
» Austin J. Baillon
ACKNOWLEDGMENT
STATE OF WISCONSIN )
ss.
Ramsey County. )
Personally came before me this 3lst day of
December , 2002 the above named
Austin J. Baillon
to me known to be the person(s) who executed the foregoing
instru/m/e/n~~t an/Jd/ask/,n~~ojwy~le~d/1¢9/J,e the same.
J/ MhJ~/v. /-+' ~fr~_' ~./~/,MMM/\..n.'.I,i`.n'.An.~:~.1 \: ~/..M.A/~10
» Paul A, Baillon ,'•,~ '^"` =`~~,
Notary Public, State of ~7,Visbbhsin
My Commission is permarieift"(17riof; state expiiatioli'defe:
January 31 __."_"__ ZOOS )
*Namex of persons signing in any capacity should be typed or printed bolow their signawres
WARRANTY DF.F.D STATE liAR OF W I9CONSIN
PORM No. 1 - 199a
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800.655-2021
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