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Home My WebLink About018-1087-76-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACf I TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Hen ,James Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: /~ ~!f ~ 9 / ~ n n tC.'~. ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~~ A9rEkfCIT- v~C ~ I ~CJ ~'~i~s Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic .Z / ~ r ~f J / ~ J / f` Dosing Z . / ~~ t ~~ / ~~, ~ Aeration Holding PUMP/SIPHON INFORMATION ~~ _ Manufacturer ~ Demand GPM Model Number TDH Lift Friction Loss System H ead TDH F t ~0 Forcem in Length ~ Dia. ; i Dist. to well ~ 'S 15Z Z 7 ~ SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 453401 0 State Plan ID No: Parcel Tax No: 018-1087-76-000 SectionlTown/Range/Map No: 20.29.17.696 STATION BS HI FS ELEV. Benchmark ~. G /Cj ( /off, Alt. BM Bldg. Sewer ~i~5 ~~~s SUHt Inlet I~ ~1 5~ gy . St/Ht Outlet Dt Inlet Dt Bottom I Z ~ ~ $ ~~ ~ Header/Man. z , L ~Q . Dist. Pipe ~ ,.3 b ~g 1~ Bot. System 3.0~ cf7~~~o Final Grade 3 ` 7 ~i 9 St Cover Cr ~ ~ c.3 ` a ~ ~-, '3 7 q7 • ~ 1 ~~ et BED/TRENCH DIMENSIONS Width ; Length ~ No. Of T nche ~ PIT DIMENSIONS ~ No. Of Pits ~ Inside Dia. Liq ' Depth ~ / \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: IM~a u J Ig / `~( ~ IZ~ /~~~ UNIT Model Numbe . DISTRIBUTION SYSTEM Header/Manifold ~ ~ Z Length Dia Distribution ~,LF. ~ . / ~ Pipe(s) ~~ ( ~Z ~ Length Dia Spacing x Hole Size ~/~~n/J x Hole Spacing ~T ~/ l~ Veit to Air Intake l'..''.> 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/Trench Center I , ~ ~ BedlTrench Edges ` Topsoil ~ ~' es L] No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: r~ / Z~/ b-T ~Inspection #2: / / ~~n= a CJ Location: 1653 87th Ave Unknown (SE 1/4 NE 1/4 20 T29N R17W) Hammond Oaks Lot 76 ~,~~ sx~ ~ I ~ KJ Parcel No: 20.29.17.696 1.) Alt BM Description = Se P~~ ~ ~~, J ~. 1 ,~.~~z- 2.) Bldg sewer length = I -amount of cover = ' ~ ~~ ~ 3.) Contour = ~-~+ Plan revision Required? Yes No i ~ Q ~~ ~, i ~ ~ ~ i~ 1/p_~~ 3~ ~~ Ji Use other side for additional information. ~_- `~ I__-__ _._ ~- Date Insepc s Sign ure Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County ~ ' ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~ , ~~, . - rscons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) i Department of Commerce (61x"8) 266-'s 151 L~[5-7 cl ~r Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ~ ~' ~ ~ ~ TCZ ~S • /la maybe used for secondary purposes Privacy Law, s15.04 1fm __....~__-•.---.~- _--- oject Address (if different than mailing address) I. Application Information -Please Print All Information R l6 3 , ProperT Owner's Name 1 ~ i ; ~ ~ ~ ` , arc_ ~} # t # Block # Property Owner's Mailing Address ~ op ati Z ~ J I N r T Su f ~ Zo G7 _ ~..._ - .~ y ~/ W '/ Section Z c~ ~ City, State Zip Code Phone Number ,, ,, _ ~SDt~ Sy~ ~ ~ (3~~dU • 070{ (circle one) RAE oa~ T ~ N II. Type of Bui ding (check all that apply) S ; ~ ~ Su b di v isi o n N ame CSM Number ~ , '~l.or 2 Family Dwelling -Number of Bedrooms ~f ^ Public/Commercial -Describe se j ~ ~ ~ ~ ~ ~ / ~~*"^^Q"" p'+ IBS ^ State Owned -Describe Use ~ ~ \ ^City_^Village .Township of /'~~/lti-~,•~w-•o~ , -u. ~~ t III. Type of Permit: (Check only one box on line A. C plete line pplicable}---- C) ~ ~p .- ~ _ ~ • A' flew S tem ys ^ R lacement S tem dP ys ^ TreatmentlHolding Tank Replacement Only they 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 ` lv. T e of POWTS S stem: heck all that a I ^ Non -Pressurized In-Ground ound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Crrade Single Pass Sand Filter . ^ Constructed Wetland ^ Pressurized In-('hound ^ 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: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required sf) ~ Dispersal Area posed (s System Elevation 600 Q ~ Cl~ o sa I -Zov ~~ ~Z ~ v 6 a° 8 ~ 9 < ~. . VI. Tank Info Capacity in Gallons Total Gallons Number of Units Manufacturer ~ 3[ e., lv ~ S ; "~ )10 Pr b Concrete Site Constructed Steel Fiber Glass plastic New Existing , ~yh . _~ / E?T"~.tu 'tti ~• Tanks Tanks Septic or Holding Tank ~ / tr0 ( I j f C.D~ Aerobic Treatment Unit Dosing Chamber ~ v I~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Si tore S MP/MPRS Number Business Phone Number /~t,~ ~- l~ ~l / ~~a~ ~ 7i-~" 962 -~/ss- r Plumber's Address (Street, City, State, Zip Code) ~ 1P0 . ~3c... ! c~ C'o ~F~ w s .S o VIII. Coon /De artment Use Onl Approved ^ Disa roved Sanitary Permit Fee " ncludes Groundwater Date Issued I suin gent Signature Stamps) ^ t• iven Rea for Denial Surcharge Fee) ~ ~ ~-- J IX. Conditions of ApprovaUReasons for Disapproval 3 ` ~~ SYSTEM OWNER; 1~,~~ pQ ~ ~~~ S 1 S eptic tank, e~luvnt filter and ~q,(,p I ~Q}~~---1 dispersal cell must all be servic~fl / ma intained C~~ b~-. °~ ____ ( as per management plan provided by plumber. ~$w~t L~ . ~~~_ ot i~~u~•-e 2. All setback r i ~ equ rements must be maintained ~ ~ as per applicable code/ordinarlr,~;s, ~ _ ` ti*c~+~9 0. 4~w r~cracn compete plans tto the county only) for tde system on paper not IBS than Sl/Z x 11 inches in size SBD-6398 (R. 01/03) ~~ ~ `~ ~0~-'~T'~- `~ ;• ~: r.. , ~ ~ .~ ~~, -~ " ~ ,. - 1 l/d ~" ~ ^m ~ m ~ ~ m ~ ~ m --,." .- _- ~ _ V ~ ~ o -,-'~ m ~ pj ?~ - ~ t C_~ 7 ~ ~ O ~ ~ i Q ~ ~ V i i ~ ~ ti i O) i i C ~ CQ) Y ~ C i i n ~~ i ~ C $ O ~~ o a ; ca ~ ~~ a `~ ~~ ~ ~ q ~~ o yr 'V .bz~ vd ~~ m a `o a U oa o~ ~~ ~ L Q~ a~ GpP'~ Q 8 zg~~~~ _~ ~~_~ ~~s `~~) ~~r~ ~Z ~c~=tip N F M a a ~'o e~ cp O a+ ~ ~ ~ ~ II m ~ e- ~ ~' t, 8 4A J m ~ N ~ Q W g ~ rr t ~ ~ U rr m rr • ~o ,. -'~ ~ ~ ' ~ommerce.wi.gov ~~ a ^ ~scons~n Department of Commerce Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 14, 2004 CUST ID .No.227618 THOMAS GUSTUM GUSTUM SEPTIC SERVICE N134S0 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: 07/14/2006 SITE: James Henry Hammond Oaks 1ST Addition Town of Hammond St Croix County SE1/4, NW1/4, S20, T29N, R17W Lot: 76, Identification Numbers Transaction ID No.1017283 Site ID No. 686060 Please refer to both identification numbers, above, in all correspondence with the agency...: FOR: Description: Mound System for James Henry Object Type: POWTS Component Manual, Regulated Object ID No.: 967588 Maintenance required; Replacement system; 600 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The 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.14S.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-14691-P (N.O1/Ol). • The pressure network is to be constructed in accordance with publications SBD-10706- P (NOl/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)". • The sand fill depth (D) is measured from the highest existing grade elevation in the area defined by the mound distribution cell. The sand fill depth along the length of the remainder of the distribution cell shall be increased so that the bottom of the distribution cell is level. THOMAS GUSTUM Page 2 7/14/04 The "I", "J", "K", "L" and "W" dimensions shall be increased to coincide with the increased sand fill depths. Additionally, all side slopes may not be steeper than 3:1. 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 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, r Keith Wilkinson POWTS Plan Reviewer ,Integrated Services (715) 524-3630, Fax: (715) 524-3633 , M-f 7 am - 3:45 pm kilkinson@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 - " ~ i S r , i~ECENED I Moun Cover Page pg 1 of 6 SIYG l i Ct C~.~ ,t~l l;/l~l I ~wLiJ' It ~ ~ ~~~ V :.4 CIA AL.vi ~JiVLi s.~Y i Project Name: Henry 450 GPD Mound Owner's Name James Henrv Owners Address 2217 Vine Street Suite 200 Hudson, WI 54016 715-760-0704 Legal Description SE ~ '/4, Nw ~ ~ %4 Sec 20 T 29 N, R 17 iw Township Hammond County Saint Croix ', j Subdivision Hammond Oaks 1st Addition C(~Ill~lt`LOldl~~r~y Lot# 76 Parcel I D# L1Fs'ARTh"FONT GF COh1P~ERCE DI`11SsON OF SAFETY AN Ei~IILD{NGS SCE CORRESPONDENCE Table of Contents 1 Cover page ' 2 Mound Sizing Calculations D, ;~~ 3 Pressure Distribution Layout and Dynamics ~~ :Z 4 Dose Tank /Pump Curve 1201 ~ 5 Management and Contingency Plan ,f 6 Plot Map ~~G NEB total # of pages: 6 Designer Name: License #: Date: Ph. #: Tom Gustum D1201 7/1 /2004 715-658-1344 Signature: -'--ems--~ ~J 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) DtV. Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: 3ba@3badvisement.com I • iVlound System Mound Sizing Calculations Project Name: Henry 450 GPD Mound Site Conditions __ 5 ~~~~ Design of Entire Fill Project Type: l or z Family Dweuing •~, ,~11 depth at upslope edge (D): Slope: 1 % ~~it ~(i depth at downslope edge (E): # of Bedrooms: 4 Distribution cell depth (F): Depth to limiting factor: 29 in. Cover thickness over edge (G): Absorbtion rate of fill material: 1 gal/ftz/day Cover thickness over center (H): Absorbtion rate of in-situ soil: 0.5 gal/ft2/day End slope width (K): -, Effluent quality Eff#i ._) Fill length (L): Max BOD effluent value: 220 mg/I Upslope width (J): Max TSS effluent value: 150 mg/I Downslope width (Toe) (I): Fill Width (W): 7.0 in. 7.8 in. 9.5 in. 6 in. 12 in. 7.3 ft. 114.6 ft. 5.5 ft. 6.1 ft. 17.6 ft. Distribution Cell Basal Area 600.0 gal/day Basal area required: 1200 ftz 6.00 ft Basal area available: 1210 ft2 100.0 ft ~ ~ ; ~{ 600.0 ft ~. t}4 ~ Observation Pipes ~, 97.30 ft Location from end of cell (Z): 16.67 ft System Elevation of Mound: 97.88 ft Final Grade of Mound: 99.68 ft Mound Plan View Design of the System Design Flow: Distribution cell width (A): Distribution cell length (B) Area of Distribution Cell: Page 2 of 6 /Observation Pipes z----~ _ - ~ - - - W ~,. K ~ ~istributiort C~1! ,4 _~ _ _ _ _ _~B _.. _- __ __ - K ~ Tilled Area/Fill Material L Mound Cross Section Final Grade-- Synthetic Fabric--~, Distribution Cell-~_ `'~ System Elevatian ~ ,~' ; _cs .~ Cover Material /~ I Late"ral Fill Materie.l~---~--~. E In~`~ert ~- ~ k. .~~:.~--~` ~ S I e p e ~`~--_ Observation Pipe ~ ~~~ G filled Area ~~-- Fa rce m ai n ~Syste m 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 a`n ~ ~F Page 3 of 6 Mound System Pump tank manufacturer: Pump tank size/model: Pump tank gal/inch: Tank bottom elevation (inside): Septic tank manufacturer: Septic tank size/model: Septic, Pump and Dose Tank Project: Henry 450 GPD Mound Tank Information Skaw Precast 750 16.05 92 f Skaw Precast 1254 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 Watertight Locking Cover 4 InchWith Warning Label Minimum Finished Grade Alternate ~ Outlet Location Elect. per Comm 16.28 and cemain NEC 300 Weep Hole A orAnti- Siphon B Deice C D Page 4 of 6 Dosage Volume Does forcemain drain back to tank? Lateral void volume: 20.9 gal Dosage to absorbtion Cell: 104.6 gal Forcemain volume: 13.1 gal Total dosage: 117.7 gal Total Dynamic Head Are laterals highest point? if not, enter highest elevation: 0 ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 5.97 ft Friction loss in forcemain: 1.73 ft Pressure loss from filter: ~ft Total dynamic head (TDH): 14.20 ft '3 ~5 1 Dose Tank Levels In. Gal A Reserve ~ ~ • 7 :.~-~~ 519.9 B Pump off to Alarm 2.0 32.1 C Total Dosage 7.3 117.7 D Effluent depth for pump 5.0 80.3 Total Capacity: -4~"1" 750.0 ~' 7 30 Pump must be capable of: and head pressure of: W ~ 20 33.0 GPM A a 14.2 Feet = 10 10 N 7.5 W H W E s a 2.s 0 Pump Curve: 9EH FLOW- L[TERS/HOUR 0 ]000 2000 3000 0 Little Giant FLOW- GALLONS/MINUTE 9EM PUMP PERFORMANCE CURVE IISV 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. . . O U m Q ~ " ~ lld (O - c~ 3 ••- ~ '~ i ~ ~ ~ ~ _ - -~~ ~ ~l - ~ ~ ~ __- - -- _ 0 ~i ~ ~ o " ~ --- ~ ---~ m m~A~ °z - m -'~ I _- ~~r,~w_ ~ ~p ,- ... ~ ~ , ~ ~. r ~ '~ ~ ~ ~ ~ m ~ i ` o---- ~ ~--__~ o a ~ ~ o U i+~ ~ . ~ ~ '1 ~ i ' C UUUQ Y ~ i ~ e $ O i i i ~ 8 0 0, C i i i i NU ~ ~ f i i i i ~ ~ d ~.i ~ i ~ d ' C G ~ ~ n `o U ~ ~ ~ > ~ Q `r°~ a ' ~ _ ~ rn v o 1' ~ ~ ~ i ~ Ch ~ ~ U ~ ~ ~ I ~ Q ~ ~ 1 I 1 ~ ,n V ' ' ~ a x ~ ~ ~ ~ c v= fl ~ is ~ ~ O ' ~, ~ ~ ~ ~ II U `O m ~ ~ i ~ O i 0 ~ S W Z W ~ ~ `' J ~ ~ Q ~ ~ W ii to o ~ m W ~ U - ~~ ~ ~ ~ „ m ~~ ^ ~ ~tiZ L l/d O ~ i i pp - - v Wiseonsin,.DepartmentofCommerce SOIL AND SITE EVALUATION -fiivi~ion Uf Safety and Buildings in accord with Comm 83.05, Wis. 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 County include, tart not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and lo~cat_iQn_and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Pl e~lrl -t alll info r» n ~ti i r , e~ o . ~ Personal information you provide maybe used fo ry purposes (Privacy Law;a. 15.04 (1) (m)). e 'wed ey Dat z / Property Owner fi" ~ ~ roperty Location Humbird Land Corporation < ' ~ vt. Lot n/a SE 1/4 NW 1/4 S 20 T 29 N,R 17 W Property Owner's Mailing Address ~ ; ;-~ ,. 332 Minnesota Stre e t East 14 4-`. ,~,,, r , ~ -L t # • Block # Subd. Name or CSM# SST n/a Hammond Oaks~FiB Addition -:: ~~' 1 _ _ State e.,.~•i~ de Ph~ne~l}lglber <`' City _ City ^ Village ~7own Nearest Road Saint Paul MN ~1.~1 ~~5 ~'~~~ Hammond ~ 160Th Street ~ R ~'de till / Nu ~f ms 3 ^Addition to existing building ^ New Construction U se: ^ Replacement ^ Public o ~ al=d scribe Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd/ftz .6 trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ftz Maximum design loading rate .5 bed, gpdfftz .6 trench, gpolft2 Recommended infiltration surface elevation(s) 97.3' ft (as referred to site plan benchmark) Additional design /site considerations BM 2 = 97.5' Parent material ..ground moraines Fkxxi lain elevation, if a livable 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 501E DESCRIPTION REPORT Boring# 1 Ground elev n~n~u Depth to limiting factor 34" ~~ 2 Ground elev 97.7' ft Depth to limiting factor 29" Horizon Depth Dominant Color Mottles T t Structure Consts in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. Trench 1 0-9 10yr3/2 none sil 2msbk mvfr as lf,lm 0.5 0.6 2 9-16 10yr4/4 none sil 2msbk mvfr cw if 0.5 ~ 0.6 3 16-22 7.Syr4/4 none gr. sil 2msbk mfr cw - 0.5 0.6 4 22-34 7.Syr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.6 5 34-40 7.Syr4/6 c2 ~S 10yr7/2 gr.. scl 2msbk mfi - - 0.4 0.5 Remarks: 1 0-10 10yr3/2 none sil 2msbk mvfr as lf,lm 0.5 0.6 2 10-17 10yr4/4 none sil 2msbk mvfr cw If 0.5 0.6 3 17-21 7.Syr4/4 none gr. sil 2msbk mfr cw - 0.5 ~ 0.6 4 21-29 7.Syr4/6 none gr. sl 2msbk mfr cw - 0.5 0.6 5 29-36 7.5 4/6 yr c2-3d 10yr7/2 7.Syr5/8 gr. sl 2msbk mfi - - 0.5 0.6 Remarks: SST Name (Please Print) Signature: Telephone No. Tom Gustum ~~~ -,fs!~'~% 715-658-1344 4ddress Gustum Septic Service Date CST Number Ref # N13450 937th St., New Auburn, WI 54757 3/1/00 227618 1176 ten Boundary Roots GPD/ft~ Bed 1 ,~ • (E . (~ (C ,~ • r i_ • ~- r PROPERTY OWNER: Humbird Land Corporation SOIL DESCRIPTION REPORT PARCEL LD.# 3 Ground elev 97.3' ft Depth to limiting factor 31' 1178 Page 2 of _ 3 C,ustum S~ticS~v~ce Horizon Depth Dominant Color Mottles Texhue ~ Structure sistence Boundary Roots GPDIf~ in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ~ Trench 1 0-10 10yr3/2 none sit 2msbk mvfr as lf,lm 0.5 ~ 0.6 2 10-16 10yr4/4 none sit 2msbk mvfr cw if 0.5 0.6 3 16-21 7.Syr4/4 none gr. sit 2msbk mfr cw - 0.5 0.6 4 21-31 7.Syr4/6 none gr. sit 2msbk mfr cw - 0.5 ; 0.6 5 31-40 7.Syr4/6 c2-3d IOyr7/2 7.Syr5/8 gr. sit 2msbk mfi - - 0.5 0.6 . ~. .~ 1, Remarks: Remartcs: ~~ 5 ~ ~ ~. s z ^ ~ ~ ~ O ~ A ~ ~ ~y~ ~ ^. ~ U' ~ ~ J /, ~-~ ~ ~R h 0 `fi 0 ~~ 0 "O ,. Q-~ A e, ~m 3 ~ B ~ N an ~~'i i ~{~ ~d o O ~ a ~_ A~ r ~ ~. `h ~. ~ ° r~r ~ 8 1 ~o -~ - \ ~\ ST. CROIX COUNTY SEPTIC TANK MAINTEI~JANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer .~ ArwlE-S t~l e,~ Mailing Address Property Address ~ ~ ~~3 ~~'~~ f~~~ . (Verification required from Planning Department for new construction.) City/State Parcel Identification Number D l ~- ~ 0 $~ ^ ~o - b15D ~ ~ q~ LEGAL DESCRIPTION Property Location s~ '/4 , N ~'/4 ,Sec. ~ , T z ~ N R ~~ Town of ~t~l, V~(.~~1 S'~' ~ Subdivision ~~~~N~ ~.~'-S -" ~' ~pD ~ N ,Lot # ~ . Certified Survey Map # ,Volume ,Page # Warranty Deed # ~ ~~ ~~ ~ ,Volume z<o 0 / ,Page # Spec house yes no Lot lines identifiable yes no ~S5- 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. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning ~`\ Department with' days ofr1the three year expiration date. /C~ ? l~l~ ~% SIGNATURE OF APPLIC DATE ~--- OWNER CERTIFICATION Uwe cert' that all statements on this form are true to the best of my/our knowledge. property de d above, by virtue of a warranty deed recorded in Register of Deeds Office SIGNATURE OF APPLIC ~/z/z DATE ~---. ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. ****** Uwe am/are the owner(s) of the Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. U 2601P 555 STATE BAR OF WISCONSIN FORM 2 ; 1999 Document Number WARRANTY DEED This Deed, made between Andrew D. Beaudet. Grantor, - _ Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin space is needed, please attach addendum): Lot 7 ,Pat Qf Hammond Oaks 1~` Subdivision in the Town of Hammond, roix County, Wisconsin. * drew D. Beaudet Recording Area Name and Return Address V`~~ l~~ 018-1087-76-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated thi day of June , 2004 * -- --- #-_--- Signature(s) AUTHENTICATION --- -- rac authenticated this _ __ day ofnl~$CV Pub~iC State of Wisconsin * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ ___ _ authorized by § 706.06, Wis. Stats.) THI5 INSTRUMENT WAS DRAFTED BY Attorney Krishna Ogland_ Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not t~cessary.) KNOWLEDGMENT STATE OF ) ss. County ) Personally came before me th' of June _ , 2 the above named Andrew D. Beaudet, to ~]f known to be the person(s) who executed the foregoing instti~kttent and acklto~ie~gd the same. 7E.6725 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., YI RECEIVED FOR RECORD 06/23/2004 10:00AM ItARRAHTY DEED EXEMPT t REC FEE: 11.00 TRANS FEE: 110.70 CUPY FEE: CC FEE: PAGES: 1 My Commis4[ot}„is permanent. (If not, state expiration date: * Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 -1999 Information Professionals Co., Fond du Lac, WI 800.655-2021 ~~ • • J~ ~ O I ~~ 0 .-. ~ Q~~ v ~ ~ N ~ I ~ ~oW Z W W~a I O ~ X F- UO W \ 287.36' ,9L~lZ~I \ ~~ ~, ~ Q ~ O I ~ M J ~~ ` b \ v ' ' ' 21 E 287.28 SO'23 V ~' Nw 8 ~ ~ V ~ ~ Q F-- ~ O ~ M t D ~~ ~ SO'23'2t'E 287.20' U. Il 1-J r W V W G ~i.~ G I m N G ~ ~ H ~ ~ W Z p W ~ ~ C ~ I Q O ~ ~ I Q -~ C WI m~7 ~' J~U zl arc 100 ~ \ 216.64 ,~ ~ I `` 1 I •~~~. ti~ I 1 ~ 6' i L I '~ N ~ ~ ~ i~ of I m I i ~I ; I ~ 1 h °~ ' O rn iN n ~ cp I^ ~ irk n I i I ' I ^y~ ~-h -r°. I I ~ ~ / UNPL EAST, LINE OF THE SI 1V Q~•2~ /e 136.97' w h N ^ / v „ / ,~' 'y / ~. O ,y1~/ -~+` / /~ ~ n ~ y y-~ / -% ~g '`~f 1ti / ~~ ~`'~' /~ 3° /,mob W / .-h ~ w/ ~-1 Z Z Q W 51~ '~~i ~ o ` ,~ o Q ~ w ' vs I ~~ . ~ r7 W . ~ N I ~~ ~I a fir'`.' N ~'''~ Q ~I 33' 33' r° .tt'4~,1 ~ ~ ,n ~' t~ .., 5~ ~ H O,n ~ ~,. ~O ~ ~ ~ ~ ~ ~ ' m ,f<Z'6ZS 3 "9S,OZ.Sc I ~'r- N SO'23'21'E 287.13' - .~ ~ ~ (~ ~ .. 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