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018-1087-75-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Boru, Paul Hammond Townshi CST BM Elev: ~ Gj~. 3p Insp. BM Elev: s q~.3o BM Description: CsT gw-~ Z TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic C ~ ~C.r ~ ~ ~~ Dosing « Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,` ~ ~\ J Z3 t ~~ Dosing .~..a ~l- l.~ k -•- 38 ~ Aeratio Holding PUMP/SIPHON INFORMATION Manufacturer ~`~ ~ Demand ~I GPM Model Number ZS .~ ~ t~Z' ` TDH Lif v" Friction Loss, System Head • TDH ~t ~ o•~o •2S o•9S Forcemain Length t .• Dia. 2t` Dist. to Well ~~ . SOIL ABSORPTION SYSTEM E Width t Length ( No. Of~enehee. MENSIONS p • 2 Z' q SETBACK SYSTEM TO / P/L BLD~G'~ `W~`E`'L~aL INFORMATION Type Of System: ~ ~ ~ ~ / DISTRI~TION SYSTEM ELEVATION DATA County: St. CrOIX Sanitary Permit No: 429900 0 fate Plan ID o: •~r- e =TroKG. ~~ Parcel Tax No: 018-1087-75-000 SectionrrowNRangelMap No: 20.29.17.695 STATION BS HI FS ELEV. Benchmark S, 3 S '~.b ` Alt. BM 6e~~ ~i Bldg. Sewer ,~ • ~s,,,/ SUHt Inlet ~.o Z 93.3, SUHt Outlet Dt Inlet Dt Bottom 1Z• 3 `jo. 3© Header/Man. t`• Q'S' l ~ ~ / Dist. Pipe ~ 'a ~~ r , Bot. System ~ ,~ ~ • Final Grade `~Se~.~.~,Q Z / ?p{ St Cover (. ~a ~ 9(0 .ss' PIT DIMENSIONS No. Of Pits. Inside Dia. Liquid Depth CHAMBER UNIT Heedor/ anifold tl ~ Distribution ( ~/ ~ Pipe(s) ~ ` ` Z- ~' ~ x Hole Size ~ ~ 3 ~` x Hole Spacin ~ Vent to Air Intake `-' Length Dia Length~~PJ~'' is Spacing ~ Q SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil L~ Yes r] No f~l Yes L] No ~~ OM T (Inc~e co isc ~ cie persons present, etc.) Inspection #1: / D 7 ~ Inspection #2: / ~.~,~- ocation: 1654 8~ Ave Kar~~mon f 4 15 (S 114 N 4 20 9 R17W) Hamrtloi~i aks Lot 75K~~ Parcel No: 20.29.17.695 1.) Alt BM Description = 2.) Bldg sewer length = 2 - amo nt of cover = ~~~'~ • (-~~ 31 ~ ''"'~C ~ 1 Plan revision Re fired? Yes ~ No Use other side for additional information. SBD-6710 (R.3/97) C.l~l~. V Safety and Buildings Division County _ ~ 201 W. Washington Ave., P.O. Box 7162 r' ~~' ,~CO~~,~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.} Department of Commerce (608)266-3151 ~ G~G~~/~ ` K~ Sanitary Permit Application State Plan I. .Number In accord with Comm 83.21, Wis. Adm. Code, personal i orma t ~ i $ S f~ ~ ~ y / may be used for secondary purposes Privacy La ~ s15.0 L.- I V C V Project Address (if different than mailing address) ~ I. Application Information -Please Print All Information CLt~rL, f (D S N ~'? APR 0 2 200 Property Owner's Name Parcel # Lot # Block # ~~ B ST. CROIX COUNTY Property Owner's Mailing Address Property Location `/ ~ ` S i ~ ~ W ~~ ~ 1~ City, State Zip Code Phone Number ect on _ °' 0' t ~O 6 Q/ N s~i4'/~,. .$` 2 ~0 ~d ~ lD O y Circle oge) ~ n C RJZE or® 7 J ~ N T p _ II. Type of Building (check all that apply) ~ ~ ~ ; . j / ~.1 or 2 Family Dwelling - Number of Bedrooms .3 ~~~y,.t,,,~,~ ~ - Subdivision Name CSM Number / ~~ ~ ^ Public/Commercial -Describe Use ~ f~A i/!~d ~ s ~ ^ State Owned -Describe Use ~ ~ k ~ ^Ciry ^Village t(~Township of / III. Type of Permit: (Check only one box on line A. Complete line B if applicable) _ 6Od `~' (~ New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 / ~ " ^ Non -Pressurized In-Ground Mound > 24 in. of suitable soil ound < 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 ^ Leaching Chamber Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Qi4Rst_ I Design Flow (gpd) Design Soil Applicatio Rate( dsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ' y54 • ~ 1 /.o~ ~s = 90o ysD iy 5/ . ~ ~. en VI. Tank Info Capacity in Gallons Total Gallons Number of Units ~~M~an~ufaQcturer ~/L~~~`~ ~`/bO Prefab Concrete Site Constructed Steel Fiber Glass plastic New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit - / Ie< Dosing Chamber ~- VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Si MP/MPRS Number Business Phone Number Plumber's Address (S t, City, State, Zip Code) ~~ ~ ,3~ D p VI Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surchazge Fee) ~~~ ~ ~ Dat Issued ~ Is rng Agent ignature ps) ^ Owner Given Reasott for Denial • / 7 ` . C nditions of A~prov~n~ r DisX~ `^ "'ova~~ ~~~~~ `~ni'Ly'~p (.~//~`~II~~E~ L ° ~~~ 0 f `1'tccG.~ ~- !~'i~f ~/i2 ~/~ !L ~2~~!~''~ / ~ ~ / aiJ ,[,~ Via' Z~tt~S , /~'t[,6o ~~ .~ i al,i ~'~ n • /~..a on.p.~e .ans ~w ~ne~'~ ~ my omyl~r rne~n - n/pan~r~ ! ~n~a'n nl/~7[,11 inches iri ylu /' ///' ~..,_ t A ~~ ~t /(•,~, _,"_~~7.v/~ ~p y (//' )/~ i civ v~~~j• ~Zi Gt~Q/,'{''[j ~%s~t... !/~G~ (/L'V , uvC/ ~~~.. , G _ ~'~ 3 ,/ /1 - __ ~9 ^O 1I - 3 n Q Y~~~ J ~+' ', I I ,~ ~ ._ ~~ 9 -' i r + r ._ ~V\ o, __. f _. 2 r N _- m w -, . v v w l/1 s , ~ ,. Y J W ~ r 4 w Z ~ ,., ~,., > z J Y ~ W 4> 4. l.. 0 Q ~ ~ O Z ~ ^/ s ~- ° o ~ N `~ ~ ~ N ~r, ¢ ~ c, f z o ~ o ~ ~ O r,. D w W ~ ~ rn O zoN C~ W J > O ~ a ~ ~..+ d- ~ O J O J J Q ~ w w ~ II = d I~ ® II ~ II ~ w U N V1 ~ ~ Q7 Cn aui~ ~(iaadoad `'~ ~ ~ ~ ~ S 9°~~ X ~ ~ J ~n ~ ~~ J ~ u O ~ ~' S J ~ ,. 3 , ~' Conio 94.9' O \ \ Jt f J J ~...~/ 7 f ~.~_~~ ~ ~ s J K~ ~~ f aui~ Ai~ado~d m ` a --T.- --- ~ ~` _~• i - ~ ~ ` ~. 1 ,~ r N N r W N pp 5~~°~~ ~ 1...{. ~ vines 5 t: . ~1„ ~ r ~ ~ ~ `O p i. ~a~\ a 2c~ninruWi ~, ~!' j U N a -U' !n___---- -- / O 3 r S ~~. ; .~ j ~`~ J -.. -1 ;~ .d 1 J C: :_) _~ ..' ~• I ... ~ ~ ~ a` ~_, i m ~ ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. comme rce. state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary March 20, 2003 CUST ID No.225094 MICHAEL P ROGERS ROGERS PLUMBING N4563 320TH ST MENOMONIE WI 54751 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI Olb ~i~~ ~d~'~o v CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03!20/2005 SITE: Paul Boru 87th Avenue Town of Hammond St Croix County SE1/4, NW1/4, S20, T29N, R17W Subdivision: Hammond Oaks -lot 75 Identification Numbers Transaction ID No. 850084 Site ID No. 656771 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 895622 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 alt code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the approved plans. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - 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. Owner Responsibilities: • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. ~Qp °:~ rs. A w ~ ~I~I®lZty17,. MICHAEL P ROGERS Page 2 3/20/03 Owner Responsibilities Continued: ~ The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The 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 i Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: -7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing RECEIVED MAR 1 8 zw~ Paul Boru -Mound Transaction # 3AF~y & BLDGS Dl V. Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (01 i01) Pressure Distribution, SBD-10706-P (01 /01) Location: Lot 75, Hammond Oaks SE 1/4, NW 1/4, Sec. 20, T 29 N, R 17 W Town: Hammond County: St. Croix Date: March 19, 2003 Owner: Paul Boru Address: 4237 46th Ave., N. Robbinsdale, MN 55442 Plumber: Mike Rogers / ..._ ,'/ ../ Signature: License # MP 225094 Attachments: 6748-Plan Approval Application SBD-8330 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management ~/ ~ DiV1Si0N OF SAFETY QND L UI DINGS SEE CORRESPONDENCE page 1 of 8 Design Criteria ~~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 galJbedroom/day x 1.5 ~~ gallons/day hydraulic load Design Calculations In situ designed loadin rte uf,1r¢ o •3 t gallons/sq. ft. per day ~ s'T~ Soi l s -~ ~ Depth to estimated high roun~ water . 3 m. LL~2 - ~Sa-fit Z = ~~ ~~ Depth to bedrock Cross slope at system Force main length Manifold/header length Drain-back Lateral length ~ @ Lateral elevation Lateral hole size 3~i V in. @ ~ ~ holes/lateral >, 3 to in. ,~ ~% ym.~ 2~ ft. of Z in. Z •~ ft. of Z in. 3•~~ gallons 90.o ft. of ~`~L in. ~~•~ ft. @ bottom of lateral Vm~° in. ( S: ° ft.) Spacing ~~ h 1 1 Lateral volume 1 b•s b Total lateral discharge rate ~~~nK Network pressure compensation losses ~•~'~ Elevation difference (°'~ S~ Friction loss n'2'~ "Dotal dynamic head ~ ~•~'~ Pump/sipjaon Z`t gpm @ ~ Z Manufacturer ~a y,~ o~,...` ~,`-~. Dose volume ~~'~~~ Lift/siphon tank ~ ~ ~°~+~ ~ ~'~'~ - V~ ~ •^~ ., Septic tank ,, ,, Effluent filter ~w~ ~ '~~ Measurement pump on and off ~' Z- Height alarm from tank bottom ~ 3' 2- Reserve capacity ~ 8 L • 1 spccs.calcs.res o es tota gallons gallons/minute @ ~' ~ ft. head ft. ft. ft. @ ZS~ gallons/minute ft. ft. of head Model # ~ ~ ~ ~ gallons ~ ~ gallons ~ ~~ gallons tn. m. gallons Page Z of ~ M • l~ I U I~~i Y _ / .. W i ~ ~-__-_._ (~/7 U w J - Y w r N ~ a W z 3 o w _ ~ ~., ~ J ~ w `'' G .,~' m O Z - ~ r__ 9 = o ~- \' ~ ~ i ~r, ~ c' z o f ~ - ;,,-~ CC O f Z O O ~ W C~ C7 _ n W ~ > ? O 1 w w / n n ii ii w ~ ® ~_ ~ N (/7 • ~/ ~ ~ ~ m O] ry ~i ~~~~ ~ h y - o- ~I ~ ~ ~ s' f o° 9 t~ X ~ •~ J "~ ~~ ~,, -~ ~ U I - -~ ~ °~ j ~. + r ~~ ~ J ~~ d O/ -- ', s i / 3 ~ N ~ ~ ~ c-' m w v ?', z 0 O N x o 0 ~ w Z ~ O p ~ d ~ O 4 ~ 2 a aui~ ,(~~ado~d Q ~ ~ ~r"_-__1' ' '~ ~ ~ ~~ ~I ~ z ~ i;' lb~ '. in ~ I ri W V~ N . ~ I ~ O L.{~ ~ ~ ~.. U N h c~ ~; ~ u7 g p ;: ,I I ~ ii °c o z E ~ r- -i= `~ d ~ ~ E c Z I i-~ 5~po I; 1 N 1= - mac ' Y ~, 2 M fA F V~ C -- - ~a ~ (n u J ~! S ~• ~ ~• J y. 3 ~' Conlour 94.9' ~ I \ ~ j J J ~~ J V ~~ J ~- S ~ -~ ~~`i K~ ~~ aui~ ~(~~ado~d 3 80 J \ 1 d ~~- J ~, ~J i q V I a. i _~ ~~ ,~ ~- I -~-~ J ~ ! t } J ',, ~ ~ - s ,~ ', ~~ ~ ~ I < i <_~ ~ ~~ __., • ~ S S ~4-a. +M C.. w v s S J ~. Q- i- ~ cv~ .. 0. Vt L~t, ~~~ ~ilOw Z'I ~ 3 ,~ o~~ ~ ~ ~'h ~' ~.. 3 ~ ~ ~ o .. ~~,3 /- ~ 1 ~a~l \ ~o i..bto:1 1 a... S ~,1~3 ` 1~~L tw`e-~..~a~t.~ :.cU~-~q~ 1 1 0.h ~• ~ o. r.~ ~ " ,~ I~ \S ,l ~I 5•~, ~_~ ~ ~ ~.' Q,~' I.Z.' ~ ~t.l' , ~ nR ,~4 p '. ~ ` ` ~ V ~ 1 ~ - a.e7~- (f~ ~ O~ 14~v~ v - ~ , ~ ~ y ~.. a l 1 ~ '[b b e ~ o ~., + t . ~~ `~ ~1 ~~1 0 +Q.; , v4 ~.Q.v....1~..~ ~~0 tv..\S 4~ow o.+y-t o 1. ~-ec.~ bo 1 ~ r(II (~ 1 S.o' I 5'.0' ` t' K V 1h K S ~'/ /ll\/ Y . t Q. t N PVL SL ~ O~t~ r.A~.~ ""'~ . 3/fib u ~ p\ t~ o -•. l 4~ R~+ ~ ~.,.'S ~ ~ o~ o .., `; .. e..i ~.. ~ O -0 N Abp e-'--~ l S~• c7 ~ ~ ~ a~ ~ /~ ~ r ~`li~ Pvc s~, 40 ! q~•~' I w ~ aX .._~ L./ Q_ 1 N ~ i .~ s ~~ B .~ 2t.$'r -LOCKING~GOVSR '~ G</A/t'N /NG ~( ABED . Q~IcK ol•ca,utcT--~ G~ 4 ~ ~ ~i// )~S PID6 3" no kNolsTuae~D \ Sol /oW ct.DVLD SY,ET ~N'T'J L P l1'G _ w+ E C.T I o r+S ~e~ gt.~.~ ~~~ `t o . SCPTiC f DGSC A'~ARI'1 ~,.MP L At.~ T-- ON - s Z,. ou ~„ - ~~ Faa~~; I`~a,w wEATHERPRO~F (~ JLNCT~c~ J ~ &~ ~~ I T r.//~//~i~7 o~ ~`~ 40 ~_ -~-~ a ~~ -----~. - -. ~:, 3 " ow' c 3 ~„ i ; II ~ ; PuXP Co^/UPErc ~ b~oCK ~ 1 L, k ~'(' ,~ ~~ 'C ~ t t< ~~ IL,~b. ~~;,~ _ SPEG~FI"CATIOLJ$ 0 T^-UK SIZ C ; ~ ~~ ~ ~"~° _ GALt_01JS ~oocL uu~ecR. ~ ° ~ ~~" `~ SWITCH TyP[; ~~`~" "l~ /1AIJUFACTURCR: ~~` C ""` ~~ MODEL -JUMDCR; S1--t:C- 3~ L '' UJMBCF. OF OOSCS. _. P ~ ~ ,;~- DOSC VOLUME ~~ I ~~ IIJCLU01lJG 6AGKFLON~ ;,..,;,ti, CAPACITIES ^= 22'~ wCNCS cK "3~2'I :~__~,: 0^ ~ INCHES GR ~~sc~,S(a _ v~` ... ~wITCN TbP[, _ IJOTE' PUMP A-JD ALARM ARC TJ f;C MI-JI1'1UP'~ DISCHARGE RATC Zr'~ G-N INSTALLEp Ou SEP~R~rC C~hc.. ~:, VERTICAL DIiFERi1JCf OCTWCCU PUMP OFI AUO OISTRIDUT101J PIPE.. ~•~~ FEET t MIuIMUM -JCTWORK SUPPLY PRCis;uRT,E/. ~'~ FECT'~~'~''~ + 20 FCET OF FOftCC MAIIJ X ,'39 F/ O'Lg ~J 2.5~ i00/tFRICTlO-J FACTOR.-- FELT __~ ~ ~,,,_., TOrAL Oy1JAMIC NCI~p +O.O~ FEEr ,~ ~, IIJTER1JAl, DIMLIJb101JC •OF TAIJK: LEAlC.7H I~~ ;WIDTH ~-g ;LIQUID pCPTH 3~ _~ 6„ -~- s 4'' ~ i ~~ ~'' • y ~ • Pumas Characteristics ~A~e1M Utlr SYbti1K3E~le Aetewatlr IAod.h SMEi30A1 Iktsepewer .30 F.II food Aote/s 1.0 AAeta Sladsd 1'e4s {4 ) R.IJd. 1 SSO Morse 0 1 VeN 11S Hert: 60 lorsrponfwe 140'F AFN11ont NEMA petit. A Molstios Gies A Disslar Sh. 1-I /2' MIT ISi~J Sorids Hssiieq 3/4' i19~w) Usit Wotg~t 30 6s. borer Cord 16/3, SJTW,10' std. ParfnrrnehCA E?ate T~ >o 6 -C ~ ~ fi~ to i t ~ to to ~ cwknus,u.w t ~.... ,.._~ ~.._._.__ .....~. ~..,..,.._..__. _ t ZS'~. , ucn~S.eor o t iot~l Mo4s~ }~~t + i 12 1 ~ ZO 4~1 a~M cu.s.~ ~u 's4~ ~~ ss 1: o Dimonsiohal Data i. AEsF~ Ira ~ ~e~ ~. t (aepaMett Mwdo« ~ Ry: In ~~ •.+n 3. Mai la tcnp~nian putrae 'x~ wLa crt-ia wr 4 pYn•oon onl raipM arc ~canoc ~~ S. On/OH brei o{anoflc b, M4 rurra fV r~M A moke iNcbr b ou prfltct e>d tlw 1VY'p ceflaVr M}kt l~ rl. `. ~ ,,.,,~ tom„ =_~~ ~M~ t,~~ s'~ ~vpe ~ U61 i~li drr I ~~ HYDRQMATIC°' a a ~ ~ 840 Brney Rwd AsNand, Ohb 44105 lei: 419.2P9.3041 hx: 41191.4011 Web Site: waw,penldrpunp.rom SALES OFFICIS IN Af l NUJOA CRIES ANO COUM7AIES ilem u: W.li4.8350 t204 5Ad ~: 19V9 Hydrorndit' Purnpc, Ashlgrni, Qh~o AI! Ri~n Reei~ed. -You. Authonzed Lord Diuribvro~ - n~ ~- ~ ~ I 1 ~.. _. 7 . _... I ro ~ Materials of Construction ~.~ . ~ /~~tK.f/ S stem Mana ement ~G~T y~~• Management of this system is critical. Asa ondition of approval of these plans t~ syst~agement section must e reviewed with the owner, and the owner must be rovided with a com lete set of plans including this management section. if problems develop with the adsorption system or any other system components, the installing p um er, ogers umbing, 715-23~-1 132, or e Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . [f the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. ~. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. I I . if construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheetingand heavy mulching may be required to maintain a functional system at start-up. ~~ ~ ~~~/~~ L ~~d Maintenance ~ ~~o~ ~ ~ / I . The septic tank must be inspected every three years by a properly licensed person--~ ~~' 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. ~. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. ~. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9 Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. I I . Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.E-f (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing. and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 Wisconsin ©epartmentofCommerce SOIL AND SITE EVALUATION Division of Safety a~d Buil~i~gs in accord with Comm 83.05, Wis. Adm. Code Page 1 of 3 Gustum Septic Service Attach complete site plan on paper nd less than 8Y: x 11 inches in size. Plan must County inGude, but not limited to: vertical and horizontal reference point (BM), direction and St. CroiX percent slope, scale or dimernsions, north arrow, and location and distance to nearest road. parcel I # APPLICANT INFORMATION - P/ ~ t ~~d ~» . . s ease l r Personal information you provide maybe used for • ry purposes (Privacy Law, s~~t5.04 (1) (m)). ~T~~ • «\ evie By ~ Date Ih D Property Owner 4~ sue, ~.,~ ~• ~°~~ I /~ Properly Location .. ~ ~ ""' . Humbird Land Co ration " ' Govr.' of n!a SE l/4 NW 114 S 20 T 29 N,R 17 W Property Owners Mailing Address ~ ~ r, ;_ ~ ~ ~, ~ Lot # ` 5 Block # Subd. Name or CSM# 15~- ^ ^ 332 M inne s ota Street, East 1404 ~ } ~7. Hammond Oaks ~ Addition n/a _ _ _ City State Z `Code PhonelVt~ ` ' ~ ~ ^ ty ^ Village Town Nearest Road Saint Paul MN 5 1,`., 651,; , `' #~ ~ Hammond ~ 160Th Street ... ~ Resl~1 /'Nurftb~er' °f bedroo ' 3 ^Addition to existing building ^ New Construction Use: ^ Replacement ^ Public orZb ~r 'al'd '~~ Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/f{~ .6 trench, gpolftz Absorotion area required 900 bed, ftz 750 trench~_8~--- Maximorrrd ign loading rate .5 bed, gpdi'ftZ .6 trench, gpd/itz Recommended infiltration surface elevation(s) ~ along 96.8' contour ft (as referred to site plan benchmark) Additional design /site considerations BM 2 = 97.3' Parent material Sand stone Flood lain elevation, rf a liable 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 DESGRIPTIUN REPUR I Boring# 1 Ground elev 97.3' ft Depth to liming factor ~~• 2 Ground elev 94.9' ft Depth to limiting factor A5" Horizon Depth Dominant Color Mottles T t Structure Consisten Bounda Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed Trench 1 0-9 10yr3/2 none sil 2msbk mvfr as 2f,lm 0.5 0.6 2 9-18 10yr3/3 none sil 2msbk mvfr cw if 0.5 ~ 0.6 3 18-26 10yr4l4 none sil Zmsbk mfr cw - 0.5 0.6 4 26-32 7.Syr4/4 none gr. sil Zmsbk mfr cw - 0.5 0.6 5 32-41 7.5 4/6 yr 2-3d 10 /2 7.5 /g gr.ls 2msbk mvfr cw - 0.7 0.8 6 41-48 10yr6/8 ~' 7S 1y~%g /2 WB m mvfi - - n.p. ~ n.p. Remarks: 1 0-13 10yr3/2 none sil 2msbk mvfr as lf,lm 0.5 0.6 2 13-19 10yr3/3 none sil 2msbk mvfr cw if 0.5 0.6 3 19-29 10yr4/4 none sil 2msbk mfr cw - 0.5 0.6 4 29-35 7.Syr4/4 none gr. sil 2msbk mfr cw - 0.5 0.6 5 35-42 1 r5/4 Oy /2 ~,5yr /g sil 2msbk mfi - - ' 0.5 0.6 Remarks: CST Name (Please Print) Signature: Telephone No. Tom Gustum cL~^ 715-658-1344 Address Gustum Septic Service Date CST Number Ref# N13450 937th St., New Auburn, WI 54757 2129/00 227618 1175 owraat: xwon~a i.~,a cones SOIL DESCRIPTION REPORT PARCEL. LDS P i '3 Ground elev 97.3' tl I~. 1. . 4 »~s p~ 2 xpf 3 . rte........ e-...:,, e-...:,.- Honzon ~~ ~ Mu~ l~ Tex~e Boundary Roofs - - nsel Qu. Color ~, Bed ~ Trench 1 0.11 10yr3/2 none sil 2msbk mvft as lflm 0.5 0.6 2 11-17 10yr4/4 none sil ' '2msbk mvfr cw if O.S 0.6 3 4/6 none sil 2msbk mfr cw - 0.5 0.6 4 31-36 7.5 4/6 yr c2-3d 10y~7/2 ~,S /g gr. sl 2msbk mfr cw - 0.5 0.6 5 36-45 10yr6/8 @7.Syr~/8/1 WB m mvfi - - n.p. a.~. ,, ..l1_~_J___ .. .. • F Remarks: . Ground ~~ limiting ~a5u, ...... .n. :~,:.. , Remarks: Ground elan m limiting factor ...,. rrom~rrc•._ :, ..,, r 1 .. i t r D ~ .l „ I I .. ,, N i iuNci iy J I ~ ~'_ ~I ~ ~ v w c,a J~ O co a7 ~o v ~ ~ ~ W ~ N ~~ ~ ~ ,~ L6 ono}uo~~ g 96 ono}uo~ ,6 tr6 ono}uo ~ __i ~ C 0 m ~~ C~J G t n L N n ~ fp-I C,nw2 Tg NC ~ 3 c o o i °~_=-=a Z N N N 3 ~ ~ e ~ d 7 ~ ~ ~ _ ~ N ~'O C1 N O 1T1 ~ N . .. ~ _ p C C Nroperty Line ~ ~ ~ ~ N n ~ I I II II r., II ~, ~ ~ ~ ~ ~- T o o ~ ~ rT, , , - r ~ ~ O C C r fTl ~ O W ~ _ rTl ~ ~ O O z O C~ O Z7 ~ O O Z r O - ~ ~ ~ ~ I ' ~ ~ ZJ ~ -I Vf~ 1 O C ~ S vl V ~ - D z 0 ~ QJ ~ ~ ~ ITI ~ n ~ O ~ ~ _ z < ~ r,-i O Z m D ~„ -G T ~ D f l m 0 C/7 D m m n ~ POWTS OWNER'S MANUAL MANAGEMENT PLAN Cop~/Ta (~'u~~'~ FILE INFORMATION Owner / Permit # a aD DESIGN PARAMETE]ttS Number of Bedrooms 100gpd/bedroomi ^ NA Number of Commercial Units ~-- NA Estimated flow (average)* o p gal/day Design flow. (peak), estimated x 1.5* ~p gal/day Soil Application Rate h S/ ~ • 31 gaUday Influent/Effluent Quality (NA^) Monthly Average** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (BODs) 5 220 mg/L Total Suspended Solids (TSS) 5 250 mg/L Pretreated Effluen Quality ^ onthly Average*** Biochemical Oxyge mand s < 30 mg/L Total Suspended TSS) 5 30 mg/L Fecal Coliform ometric me _10 cfu/100m1 Maximum Effluent Particle Size 1/8 inch diameter *Wastewater Flow Verification on and calculations: (Other than bedroom based) * * Values typical for domestic (non-commercial wastewater and septic tank effluent. * * * Values typical for pretreated wastewater. SYSTEM SPECIFICATIONS Septic Tank Capacity p0 gal ^ NA Septic Tank Manufacturer. w ~ r s~v,.- ^ NA Effluent Filter Manufacturer / ^ NA Effluent Filter Model ~ o ^ NA Pump Tank Capacity o gal ^ NA Pump Tank Manufacturer ~ ~„ ^ NA Pump Manufacturer ~ ^ NA Pump Model ^ NA Pretreatment U 't ~ ^ NA ^ Sand/Gravel F' to eat Filter ^ Mechanical Aeration Wetland ^ Disinfection ^ O e . Manufactur Model: Dispersa Cell(s) ^ ln-ground (gravity) ^ In-ground (pressurized) ^ At-grade Mound ^ Drip-line ^ Other: ^ Leaching Ch ber Manufacturer Model Appr Stipulation ~_ Soil Application Rate fl Area Req. Absorption Area Cre ' 't ftZ Minimum Numb of Chamb ^ Aggregate Design Flow/Loading Rate= min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIA ^ "Wisconsin Mound. Soil Absorptoon System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ^ _"Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Beds". RJ. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 ^ SBD -10570-P (8.6/99) "At-Grade Component Manual Using Pressure Distribution" ^SBD -10567 P (8.6/99) "in Ground Absorption Component Manual" ^SBD -10705-P (N.O1I01) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD -10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" ^ SBD. -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ^ SBD -10572 P (8.6/99) "Mound Component Manual" QG7-SBD =10691-P (N.O1/O1) "Mound Component Manual" Version 2.0 ^ SBD -10595-P (8.6/99) "Single Pass SaudFilter Component Manual" ^ SBD -10657 P (8.6/99) "Drip-line Effluent Disposal Component Manual" ^ SBD -10573 P (R 6/99) "Pressure Distribution Component Manual" ^ SBD -10706-P (N.O1/O1) "Pressure Distribution Component Manual" Version 2.0 ^ Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE MONITORING SCHEDU LE Service Event Service Frequency Inspect condition of tank(s) At least once every ^ months [@' year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (1/3) of tank vohune Inspect dispersal cell(s) At least once every ^ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ^ months year(s) inspect Bump, pump controls & alarm At least once every ^ months 1~ year(s) ^ NA Flush laterals and pressure test At least once every ^ months t~year(s) ^ NA Valves At least once every ^ months ^ year(s) NA Other: At least once every ^ months ~ ^ year(s) NA rage_Loi,Z_ aTART UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System startup shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treahnent devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, eta This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a gazbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. o valves Valves shall be operated in the following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made. by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardwaze, identify any cracks or leak, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed andfor locked upon completion of service. Any defects shall be promptly corrected. Facposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter I>IR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specification's. Provisions are to be made to retain solids in the tank. Filter cleaning maybe necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the 51ter. Any service needs or repairs shall be promptly taken care of. p ln-Ground Gravity Component Dispersal Cells The inspection shall inchuie recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or dischazge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page Z of~ <~ ~ 'Mound, At-Grade, In-Ground Pressure Th8 inspection mall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or dischazge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure disin`bution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) yeazs. Pressure checks of systems with multiple-laterals should be done to ensure. that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated aad removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ' ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement azea should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement azea will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement azea, Replacement systems must comply with the rules in effect at that time. A ~ s ' ble re aceme is not le due an r ~mita . B v V ho m e installe as a last res o replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil andsite evaluation must be performed to locate a suitable replacement azea. If no replacement area is available a holding tank maybe installed as a last resort to replace the failed POWTS. Mound and at grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT. ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR ]IMEOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER I Name /f~//~G ,E'~,9.1+ S Phone o~ 3 S - / 3~ SEPTAGE SERVICING OPERATOR (Pumper) Name Phone K:IWPDATA~EH~POWTS OWNER'S MANUAL.doc POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Agency Phone Page 3 of 3 FROM :PAUL BORU CONSTRUCTION FA?C NO. : 7632Q89339 Mdr. 31 20Q3 0S: OEM P1 ~T CROI~ COUNTY SEPTIC TAI~*K MAINTENANCE AGRBEM~N7 AND OWN'ERS~I.1P CERTFFICA7'iU1~C pORM OwnerlBuyer ~r~.~ r.~~~c-- ~ _r-~'~~a-i.tx ~a r~.~ twts~lu~~ Address ~~37 SirS~-~ ~~_...~~~c,. ..~~~„ ~9~ property Address ~°~' C,i ~ ~ ~ -~ ..~ ~.~.' ~„ ~,~ (Verification required from Flatuiing i7epa~Krrtznt for new eonsxructioa) CitylState ~,~~~~ ~'"r~-. Parcel Ytlenti#ication Ntunber . ~~O•~~ DF,~CRY~''l.'1~1V property Loastion ~'~, '/+, ~ '/,, Sec. „~~ T~' „N-R1,~„'~?V, Town of ~/~;,,,.,,,.,~. Sulxtivisian Y.ot # .K" . Certified Survey Map l~ '~'arraat~- Deed # 7~ Voltune .Page # ~, r ~ 0 3 Volume . Pogo # ~c,a~sca~~..LdR~ Spec house C] yes,~'1 no Lot lines identiifiable es O no S~'~M MA~IVT~N'A,~CE Ympmper use and rtutiiutenaneeof your septic system could resul.r iu its premature failure to haadlevrastes. Propermainteaance aoossats of ptttYtgirlg out tote stptie talc every three years or sooner, it' needed by a Ucensed pumper. 'Vvlzat you put into the system Cart +r$'oct the fuuotioa of the septic tank as a treatment stage in the wash disgasal systoui. The groperiy owner agrees fp submit iq St. CrolX Zoning [3eparzment a certification forth, signed by the owner and by a ma.~k.rglumbar, jout>aeyraaa plumber, res~ictcd pI-rxnbor o: a licensed pumper verifying that (1) the oa-site wastewater dlspasal system Js to prnper operating condition aadJor (2) after inspection and pumping (if accessary), tke septic task is less thou lf3 full of sludge. Jlwe, the tmdaraigrted have read the above sequitiemcats and agree to maintain the pri~atc scwsgc disposal system with the standards set faetb, herela, ss set by tlx Deparnnent of Commerce and the 1)epamaent of Natural Resotn~ces, State of ''V4risconsirt. Certificatiot, stating that gout septic system has btoa enaintaiwed must 60 oouiplete.d and retura~ad to the St. Croix Cattnty 7..oning QfIrce withi i 30 yea; /tgtrs ' n date. f ,~ /~ J O ;> SIt31•IA Ol7 l.,P CA.N"C DA'r'li OWNER ~$ . ~ ' j.CATIQ~ I (we) certify tbtst all statements on this form are trot to the best of ray (our) laaowledge. T (wo) axe (are} the o~vnar(s) of ~ sa ~ by virtue of a warranty deed recorded is Register of Deeds Ot7ioe. ~T~ o I.ICI-N'r ~ ~ ~~i~3 ~~~ •"•""' Arty iafCt~ratiou that is aus•rcptesentcd may result 1a the sanitary peratit being revolted by the Zoning Deparmieat. ••"'«"* *• Include with thts appltcatioa: a stamped watianty deed from ibe Register of Deeds of£icc a Copy of the certiIIad susvcy rriap if reference is au.dC i~ the warraAty deed • ~1 2208P 315 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number This Deed, made between Merlin Land, LLC, a Minnesota Limited Liability Company Grantor, and Paul Boru and Efimia Boru, 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: ~i~s~a KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 04/16/2003 11:15A>y MARRAHTY DfiED EXEIPT It REC FEE : 11.00 TRANS FEE: 101.70 COPY FEE: CC FEE: PAGES: 1 Name and Retum Address Lot 75 Hammond Oaks 1st Addition Subdivision,Town of Hammond, St. Croix County, Wisconsin 018-1087-75-000 Parcel Ident~cation Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements,restrictions,covenants and rights of way of record, if arty, including but rat 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 $33,900.00. Dated this 21st day of March , 2003 Merlin Land,LLC Signature(s) AUTHENTICATION authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN * b~ ~, President . Austin J. Baillon ACIflVOW LEDGMENT STATE OF WISCONSIN ) ss. Ramsey County.) ' Personally came before me this 21st day of Trlsrch , 2003 the above named Austin J. Baillon to me known to be the person(s) who executed the foregoing ~~-::. .. ~ F; Y Private On-Site Wastewater Treatment System (POWYS) Indez and Title Sheet Owner: ~~4-rte. l ~Ue t ~ ' Project Name and System Type: /l~ou N Location: ~7 ~,~E- Street Address Legal Description ~,~ ~m ~ Township/County Contents: Page 1: ~ C Page 2: Page 3: Page 4: Page 5: Page 6: ~~ Page 7: ~~ctS~ ~~,~i2 S Page 8: Page 9: Attachments: ~e. S „~! R~ f r~ .Credential. Number: o?~ S-n 9~ Date: y- ~ - d ~ ~ ~. 6 3sz I ~ GISTER'S OFFICE '~ CROIX CO. WIS. .,.p °ived for Record this~~_~ K. da~1- 7 A.D.,~~i2 ?' /e o'clock M. Record m ~~ NORTH 1 /4 CDR. ~ SECTION 20 T29N, R17W iv STEEL MARKER ~ 0 Z ~D NE OF SEC. 20 N 2.89' 152.00' 168.31' ~ ~ 152.00' 152.00' -- 624.31' -- .OT 72 H N ~ LOT 75 .00 Acres w LOT 73 u LOT 74 w 5638 sq. ft N N 1.00 Acres ~; 1.00 Acres 1.11 Acres ^, "' 43650 sq. ft N 43661 sq. ft N 48339 sq. ft (°; N ~ ~ Of V N ~ w O - L-- --- - - ,68,7' 152.00' 152.00' _ 152.00' _ _ _ ~ _ _ --- -- - -- 8 7TH A VE . W ss9'4s'o8'w 624.17' 1 .,~~" - - u - - ~! ~ e~ ~ ~' S89'45'08'W 624.14' 9 ~~ - -- - - - 227.38' - - -~ ~~ - - - - 378.22' _ ~ ~ - 396.76' DRq ,e.s.~~' ~a - - -SOT 7$~ ~~ f- JL~1.,4G~€A~ - - ~ g ~ I MEN T N ~"~ ~ s, 1.5~ Acres NIGH WATER ~: ,syn. 6819. sq. ft ,~ ELE VATI ON 1079.00 N ~ ~ ~s~~'°~ ~ ;y, -- - 13R nom. ~ . ~ HAMf 80' RAD. TEMPORARY GRAVEL CUL-DE-SAC (REMOVED UPON EASTERLY EXTENSION OF ROAD) r*i