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HomeMy WebLinkAbout018-1087-71-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405007 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. o L/ 3 3 r r Permit Hold Name: city Village X Township Parcel Tax No: em es y g p Ga , Paul Hammond Township 018 - 1087 -71 -000 CST BM Elev: Insp. BM Elev: BM Description: t I )W/ I Id TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. vZ 0 Septic O � BeWhmark� .22 DZ2 M L v Z Dosing y �� Alt. B � N 5 /6D / 02 .0 - Z �• D /0/• Z� Aeration Bldg. Sewer 3 S�/ • Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L VYELL BLDG. Vent to Air Intake ROAD Dt Inlet p J/ Dt ottom Se f tf Irc. Dosing / / a 1 Header an ' / l Aeration ,! Dist. Pipe Holding ot. System g T� �3/ 97 Final Grade PUMP /SIPHON INFORMATION — F"P vr G�L44 -Z 1� Z• 99' �O 2i Manufacturer Demand St Cover y UL I) S GPM NarO� fd PBe7nJ /Itf Model Number 6o( F02) // Zg. 3 2 TDH Li Friction Loss System Head TDH x.03 .3cp .mod F orcemain Length Dia. , Dist. to Well t.� -c�' 17 . 21 > I CIO ' SOIL ABSORPTION SYSTEM BEDITRENCH Width Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / 1 — SETBACK SYSTEM TO P/ re BLDG WELL LAKE /STREAM L C G Manufacturer: � INFORMATION CHA ER OR Type Of System: U �� U Model Number: / M L 1 ' 1 DISTRIBUTION SY T M; Header /Manifold istribution x Hole Size x Hole Spacing Ven it I talfe _ Ic ! t Pipes) �JbgY/tit/ 2 ! Length ✓ Dia 7/� Length �3• J Dia •� Spacing 3 i /.-�o � 3. 5 : ! SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Tren enter , I / Bed/Trench Edges Topsoil Yes ; � No Yes ❑ No /D y COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 //J, /l Z Inspection #2: - 7 Location: 1640 87th Ave Hammond, WI 54015 (SE 1/4 NW 1/4 20 T29N R17W) Hamm Oaks Lot 71� Parcel No: 20.29.17.691 1 �� ,. a�.11- .�.�u•a� -� r�w�.+ -rid' Ito /�i�•W- a- �sr..Yta�� 1.) Alt BM Description = —?CM✓n 0.vSJD 2.) Bldg sewer length =35 - amount of cover =� f 3.) Contour 14 Yes Use other i on for information. _ -- Date Insepctor's S nature Cart. No. SBD -6710 (R.3/97) r Safety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7162 1'\ Visunnsin dison, WI 53707 - 7162 Sine Address De artment of Commerce � /l0 0 - • ©134 Sani Sanitary Permit Application Permit Number �o Soo 7- 83.21 Wis. Adm. Code, rsonal inibrmation you provide In accord with Comm Pe ❑Check if Revision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information fate Plan I.D. Number 4 Property Owner's N 1 Number Property Owner's Mailing A Property Location / -A fij l4; N, R City, State Zip Code Phone Number Ut N ber Block N ber Subdivision Name CSM -74 �Wt5l-� RE ipe of Building (check all that apply) ❑City 1 or 2 Family Dwelling - Number of Bedrooms 002 ❑village ❑ Pubudcomme Describe Use ownship ❑ State Owned C "�'" ° l6 .8p ST. CROIX COUNTY Nearest Road )C (Yk" C:Q�Q. ` ` D k ` NVG O ICE M. Type of Permit: (Check only one box on line A (numbering scheme for internal use . Complete line B if applicable) A 1 9 New 2 11 Replacement System 3 ❑ Replacement of 6 ❑Addition to For County use stem Tank Only Number Date Issued Existing stem B. ❑ Check if Sanitary Permit Previously Issued Permit V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ❑ Non - pressurized In- Ground 21$ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In-,round 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation �.� . Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing / Tanks Tanks Septic or Holding Tank Dosing Cbamber 1 VII. R Statement I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. is ) Plum 's Si MPRAPRS Number Business Phone Number Plumber's Address (street, city, State, zip Code) VIII. Count /De artment Use Only Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) P pproved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Determination 3 �' 2oO7- 17X. Conditions of Approval/Reasons D isapproval cam cod$. Attach complete plans (to the County only) for the system on paper not leas than 8112 It 11 inches in size _SBD -6398 (R. 05101) I i II i6O' 1 � �J u.✓Q S'Y�_ - /x.13 X 8� 83 s� a a ' _ _ - _ _ _ _ - -_.. -- ...___: -- ism• // � _ _ loot _ 3 - i13 _ t - Safety and Buildings w 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 N visconsin www.wisconsin.gov i n.gov iscon in.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary April 03, 2002 CUST ID No.224263 ATTN.- POWTS Inspector KIM A O'CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/03/2004 Identification Numbers Transaction ID No. 721335 SITE• Site ID No. 642784 Paul Gary Please refer to both identification numbers, 87TH St above, in all correspondence with the agency. Town of Hammond St Croix County SE 1/4, NW 1/4, S20, T29N, R 1 7W FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 835277 p.O •V'' The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes CO31 i$ and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in L• 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: EN" General Approval Conditions: 0 • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD -10 - SEE GOBS ( N.01 /01) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic T nk- Soil Absorption Systems." • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. Slats. • 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. • The maintenance plan for this system must be given to the owner of the POWTS. Key Item(s) • The actual gallons per inch for the specified pump tank is 21.76 and the liquid level is 37" per product approval. The proposed pump settings provide a dose volume that is greater than 5 times the void volume and less than 20% of the design wastewater flow plus drain back. The extra 3" included in the proposed settings was taken out of the "A" dimension. KIM A O'CONNELL Page 2 4/3/02 Note • The designer proposes to install a state approve outlet fiber to achieve the requirement cf wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • The management plan / users manual must contain the telephone numbers of persons to contact in case of any component failure (generally the installer of the system and the county agency). Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Anchor tank as necessary to negate buoyant forces per COMM 83.43(8)(g). • Provide frost protection per COMM 83.43(8)(c). 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 construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state 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 copy of this letter to the owner and any others who are responsible for the installation, operation or ntenance of e POWTS. Sincere l Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 G N Patricia L Shandorf POWTS Plan Reviewer, Int ' ated rvices W.iSMART code; 7633 (715) 634 -7810, Fax: (715) 634- 50, M -F 7:4 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 1 1 J MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: PAUL GARY Owner's Name: PAUL GARY Owner's Address: 1613 PINEWOOD LANE 7 HUDSON WI 54016 Legal Description: SE- NW- SEC20- T29N -R17W Township: HAMMOND County: ST CROIX Subdivision Name: HAMMOND OAKS Lot Number: 71 Block Number:l�y Parcel I. D. Number: NVE COMME 1 ✓��`.�� Plan Transaction No.: Pagel Index and title PONDENCE Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank l Page 5 Pump specifications Page 6 Management plan Page 7 System and maintenance specifications Page 8 PLOT PLAN Designer: KIM A OCONNELL License Number: 224263 Date: �S Ph e Number: 1- 715 - 755 -3145 Signatur I t Mound and Pressure Distribution Component Design Maximum Design Flow 900 gpd Site Information R Residential or Commercial Design (R or C) Orifice 300.00 Estimated Wastewater Flow (gpd) Diameters = 1.50 Peaking Factor (e.g. 1.5 = 150 %) 1!8 0.125 5/3 = 450.00 Design Flow (gpd) 3/16 = 0.188 6.00 Site Slope ( %) 7/32 = 0.219 96.80 Contour Line Elevation (ft) 1/4 = 0.250 0.281 = 30.00 Depth to Limiting Factor (in) 9/32 9/32 = 0.313 0.50 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 1.00 Dispersal Cell Design Loading Rate (gpd/ft 75.00 Dispersal Cell Length Along Contour (ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the hi hest point in the distribution Y Pressure Disribution Information network? Enter Y or N E Center or End Manifold (C or E) 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals /32 of the highest point. .1 Orifice Diameter in ) (e.g. 0.25) 3.50 Estimated Orifice Spacing (ft) 10.23 ft /orifice Orifice Density 00 Forcemain Diameter (in) 110. Forcemain Length (ft) Does the forcemain drain back? I! J 50 Pump Tank Elevation (ft) Enter Y or N 6.50 Operational Head (ft) 17.94 Forcemain Drainback (gal) 9.80 Vertical Lift (ft) 67.44 5x Void Volume (gal) 1.92 Friction Loss (ft) 85.38 Minimum Dose Volume (gal) 18.22 Total Dynamic Head (ft) 28.32 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 1.00 1.00 1.25 x 1.25 x 1.50 x X 1.50 x 2.00 x 2.00 x X 3.00 x 1 3.00 x Treatment Tank Information Gallonsfinch Calculator (optional) 1000.001 ST/ATU Capacity (gal) 800.001 Total Tank Capacity (gal) WEEKS Manufacturer 41.00 Total Working Liquid Depth (in) gal/in enter result in cell B48 9 ( ) Dose Tank Information 800.001 Dose Tank Capacity (gal) Effluent Filter Information 19.641 Dose Tank Volume (gal /in) IZABEL I Filter Manufacturer WEEKS IManufacturer A -100 Filter Model Number Mound Plan View T 1 / 66 J 1 / 613 y ' ' ' Observation Pipe — 1 T ... A W " — I: I ..:.,. .................... B I L Mound Component Dimensions A 6.00 ft E 10.32 in H 1.00 ft K Eilft ft B 75.00 ft F 9.50 in r 7.87 ft L ft D 6.00 in G 0.50 ft J 4.56 ft W 450.00 (ft Dispersal Cell Area 1040.40 (ft Basal Area 6.00 (gpd/ft) Linear Loading Rate 12.50 (ft) 1/66 Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.09 (ft) ► G ♦ H F Dispersal Celt 97.80 (ft) Lateral 9 7.30 (ft)—► — Invert � � II EL Dispersal Ce E D 96.80 (ft) Contour Elevation 6.0 % Site Slope Shading Key d �, Dispersal Cell Topsoil Cap c See lateral details Subsoil Cap 0 77 page 4 for number of ASTM C33 Sand v 2 T F laterals, size, and Tilled Layer d 0.5 ft Typical Lateral spacing. Laterals are Aggregate centered in the AxB } A Distribution cell. Lateral Layout Diagram Laterals centered over the A & B dimension O - Turn-up vd ball valve or clean out pl u g rForoe P dentical IE X Hol es drilled on the bottom of the lateral S equally spaced onnection via tee or cross to manifold at any point. Laterals & force main of PVC Sch 40 (per CONW Table 84.30 -5) Number of Laterals 2 ✓ Orifice Diameter .1 Lateral Diameter 1.50 in Orifice Spacing (X) 3.50 ft Lateral Length (P) 73.50 ft Orifices per Lateral 22 Lateral Spacing (S) 3.00 ft Orifice Density 1Q.2 3 ft /orifice Lateral Flow Rate 14.16 gpm Manifold Length 3.00 System Flow Rate 8. gpm Manifold Diameter 2.00 in Total Dynamic Head 18.22 Ift Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and —► _T Comm 16.28 WAC 4 in. min. Disconnect �� Tank component is properly vented : >? Altemate outlet location Forcemain diameter WEEKS Manufacturer �_ 2 in. Cap acity , 800.00 Gallons Volume 19.640 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 53(p B 2.00 y3 . a- P� um p off e levation (ft) C 4.35 qj y 88.00 D 6.00 I Total Do� elevation (ft) 87.50 Alarm Manuafacturer JSJ ELETRO Alarm Model Number I HW 100 Pump Manufacturer lGoulds Pump Model Number IWE031 1 L Pump Must Deliver 28.32 pm at 1 18.22 VDH j .r • Nr 151- �Qa 101 � ■ ON "��■�� \EN■ E EMO NON■ m iam m m a-m ffill m " R.- ■■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ R onammmal m- ma ■■ ■ ■ �mmm 1►�ME ME M WE1. I ME MEMO MEN t \MEME EM EM■ME�UM■MM MEN ■ \ �ENE MODEL 3885 MEN EEEEEE So I '■M ■ ■ ■ ME NEM NONE ME mm` M ■E I MEM E NEEN ME .. ■ ■■ MEN NEON EE■■■■m''u■■NMEEEME ■ ■NE MEMEMEE► \MME■■■ ■N■ NONE ■NMEMMENN�ENNE NONE NEEMEE MR6 . , mmmmim Nm mmmm I N NE ■N M`��EE� ■ �N MN NONE INNINEENEMENIMMEMMONEM N ■� ■NEEN���E�,NEEE ■EE ■ ME MEMO mMEMEMNMMEN■ENNEM Mound System Management Plan Pursuant to Comm 83.54, Wis, Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shah be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. if the filter is equipped with an alarm, the fitter shah be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shah be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil conpaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/LTSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is peformed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. G eneral This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintence and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shah be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintence of this system should be directed to your designer, county zoning or health inspector. Page 6 of Mound System Specifications Owner's Namel PAUL GARY Designer's Name I KIM A OCONNELL Sanitary Permit Number Design Flow - Peak (gpd) 450 Estimated Flow - Average (gpd) 300 Septic Tank Capacity (gal) 1000 Soil Absorption Component Size (ft 2 ) 450 Type of Wastewater Domestic Infftuent Limits Septic Tank Pump Tank Dispersal Design Flow - Peak (gpd) 1000 450 450 Maximum Influent Particle Size (in) NA NA 1/8 Maximum BOD5 (mg /L) NA NA 220 Maximum TSS (mg/L) NA NA 150 Maximum FOG (mg /L) NA NA 30 Service Frequenc Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals flushed and pressure tested once every 1.5 years Mound Ins ect once every 3 years Other Lateral Tum -up Detail a 6 "Diameter Lawn Finished Grade Sprinkler Valve Box Threaded Cleanout Plug or Ball Valve Distribution Lateral ��• �� Long Sweep 90 or Two 45 Bends Same Diameter as Lateral �7 1 /V` 0 9z All zoo oz I _. BCisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference partt(BI1Pl), direction and St. Croix percent slope, scale or dimensions, imesions, north arrow, and to 'd distant eto nearest road. Parcel I.D.# APPLICANT INFORMATION - Pleasp`ptji# all i Reviewed By Date Personal information you provide may be used for seomia}y pur�os es yjr4 Law, s. 15.(t4 (1) (m)). ` I Property Owner Property Location Humb Land Corpor Govt. ot n/ SE 1/4 NW 1/4 S 20 T 29 N,R 17 W Property Owner's Mailing Address Lot.# Block # Subd. Name or CSM# 33 Minnesota Street, East 1 404 o n/a ❑ Hammond Oaks ,, )W Addition City State Zip Cede Phone�4,r,r Q ty ❑Village MTown Nearest Road Saint Paul MN 5510 . =651 222 -5555 Hammond 160Th Street New Construction Use: ❑ Residentia'ms 3 [—]Addition to existing building _df to ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd/ft .6 trench, gpd/ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate .5 bed, gpd/ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) along 96.8' contour ft (as referred to site plan benchmark) Additional design / site considerations B M 2 = 97.2' Parent material ground moraines Flood plai n elevation, if applicable n/a It S for system Conventional Mound In- Ground Pressure AT -Grade System in Fill i Holding Tank U= Unsuitable f o r system ❑ S ® U N S ❑ U ❑ S ® U ❑ S ® U E I S ®U ❑ S ® U SOIL DESCRIPTION REPORT ' ?Aw Depth Dominant Color Mottles Structure GPD/ft Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench F 1 1 0 -8 1Oyr2/2 n one sil 2msbk mvfr as 2f,1m 0.5 0.6 • f 2 8 -24 1 0yr3/3 n one sil 2msbk mvfr cw if 0.5 0,6 •S Ground 3 24 -30 10yr4 /4 none sil 2msbk mvfr cw - 0.5 0.6 . S' etev — 97.2' ft 4 30 -34 10 yr4/6 none sil 2msbk mfr cw - 0.5 0.6 Depth to 5 34- 0 7.5 4/4 c2 -3d 10 7/2 De - - _ p yt' 7.Syr5 S sit 2msbk mfi 0.5 0.6 limiting factor 34" Remarks: 2 1 0 - 9 10yr2/2 none sil 2msbk mvfr as 2f,lm 0.5 0.6 2 9 -21 10yr3/3 none sil 2msbk mvfr cw if 0.5 0.6 .5 Ground 3 21 -30 10yr4 /4 non sil 2msbk mvfr cw - 0.5 0.6 5' elev _ 95.9' ft 4 30 -36 10yr4/6 c2 7510I'8 sil 2msbk mfi - - 0.5 0.6 Depth to limiting -- factor 30" Remarks: CST Name (Please Print) Signature: Telephone No. Tom Gustum _ 715 -658 -1344 Address Gustum Septic Service Date CST Number Ref# N13450 937th St., New Auburn, W1 54757 3/1/00 227618 1192 PROPERTY OWNER. Humbird Land Corporation SOIL DESCRIPTION REPORT tts 0 Page ---2-- of 3 . PARCELI.D.# _ _ _ Gustum 4eptrc Service Horizon Depth Dominant Color toes Texture Structure sistence Boundary Roots -- GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -10 10yr /2 none sil 2msbk mv fr as 2f,lm 0.5 0.6 .S 2 10 -19 10y r3 /3 none sil 2ms bk mvfr cw 1 f 0.5 0.6 S� Ground -- - - - -- - -- - - -- - -- - -. — . - - . - -- - - - -- - -- elev 3 19 -23 1 /4 none A 2msbk mvfr cw - 0.5 0.6 97.2' ft 4 23 -30 7.5yr4/6 none sil 2msbk mfr cw - 0.5 0.6 •S� Depth to c2 - 3d 10yr7/2 limiting 5 30 - 36 7.5yr4/4 7.5yr5 /8 A 2msbk mfi - - 0.5 0.6 factor 30' Remarks: Ground — -- - -- — - -- — -- -- -- - elev Depth to limiting factor Remarks: Ground — — - elev Depth to limiting factor Remarks: Ground elev Depth to - -- limiting factor Remarks: i � c Property Line a � r Q Q CD Z7 O Q d Aw N W -10 co C-71 N L 6� Proposed Road c 0 0 0 0 c OD CD (9 CD CO C/') N o n C-) N W ➢ m II II II II m m ci) O < < r T ' G7 77 ➢ v O Z O O CJ w m o i o i 0 0 � ➢ _u CD ° z C/J C /� Z O CID UJ '^ O S ➢ V fTl O n rF .y r X A C � ➢ m � z 3 0 F7 o CD ➢ N a 10 N ca z m .Zca ' _ 3 c j T NT ➢ N CL N C N O }77 � N z C A r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address + roperty Address (Verification required from Planning Department for new construction) � City /State 24Lvz Ct� z� Parcel Identification Number - - 7/- M- L E GAL DESCRIPTION Property Location S� 'G_ /,, /,, Sec. , T,, -2!N -R W, Town of Subdivision Sr , Lot #,. Certified Survey Map # , Volume , Page # Warranty Deed # , Volume Page # Spec house O yes K no Lot lines identifiable `g yes O 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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. 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 &IGNA TURE epti system has been maintained trust be completed and returned to the St. Croix County Zoning Office within 30 ye r expiration date. APPL AN / Z DATE OWNER C ERTIFICATION 1 (we certi y that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro scr' ed above, by virtue of a warranty deed recorded in Register of Deeds Office. NATURE OF APP ANT 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 n_-1864P 605 r 6 7596 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST CROIX CO. MI This Deed, made between Merlin Land, LLC, a Minnesota Limited RECEIVED FOR RECORD Liability Company 04 - 01 -2002 1:30 PH WARRANTY DEED EXEMPT # Grantor, and Paul Gary and Rita Gary REC FEE: 11.00 TRANS FEE: 80.70 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Return Address LAND TITLE, INQ Lot 71 Hammond Oaks 1st Addition Subdivision mm ,Town of Hammond, St. SUITE 200 Croix County, Wisconsin 1900 VI VER LAKE ROAD NEW SRIGHHtgON, AN 50 12 FILE NO. 018- 1087 -71 -000 Parcel 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 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 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 $26,900.00. Dated this 22nd day of March 2002 Merlin Land,LLC ■ « by G5f�iG(.dtis'� -- President - . Austin J Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. Signature(s) Ramsey C ) Personally came before m(- this 22nd day of authenticated this ` day of March 1 2002 _ the above named Austin J. B aillon TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing f r REGISTER'S OFFICE ST" CROIX CO. WIS. ,s to this plat with respect to Received for Record this 3 der' 236.20 and 236.21 (1) and (2), of A.D. st &.4L cl M. Rwor&d ans 233 of the Wis. Admin. Vol uu�e ,ec. 236.12 (6), Wis. Stats. AV ku R jo!!� . c 5 20� Register of Doo* .lawwarr) kd inistration UNPLATTED LAND =TAIL A NORTH LINE SE1 /4 —NW -1 /4 LINE OF SEC. 20 S 89'43'29" W 1312.89' 1 60.00' 1 52.00' 152 c 288.34' 169.48' 66 00 -- 622.58 -- I LOT 69 o LOT 71' I 7 2 N LOT 70 a w �OT 0 1.00 Acres w 0 .00 Acres w 43769 sq. ft t, 1.06 Acres 0 45918 sq. ft LOT 7� M 3 45957 sq. ft w �; r'+ 4 638 sq. ft 1.00 A 43650 L4 m ` 14 v n> p si oo I ' N I 8i Own N (A res q. ft I 33' 33' i - I 15• 56 - ' _ _1 _J � 152 0 S89'45'08 "W 216.13' 87TH AVE. S89'45'0 " W 216.29' 19 54. - 162.00' F 27.38' 7 T V) j ', 0 A � — _ E MENT ere ft L N I ATER 0 I `t ION 1079.00 s LOT 65 N LOT 6 N v' 1.01 Acres m 1.03 Acre LOT 66 43918 sq. ft 45017 sq. ft H8$ 23'i 1.00 Acres 43672 sq, ft ,, Q �;