HomeMy WebLinkAbout020-1363-22-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
569582 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)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Graf Properties LLC, C/o Todd Graf I Hudson, Town of 020-1363-22-000
CST BM Elev: Insp.BM Elev-. IBM Description: //�� Nn Section/Town/Range/Map No:
7�- IV` " \ 6.5-r 27.29.19.2159
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER •i CAPACITY STATION �BS HI FS ELEV.
t
Septic i y,� /. -766 Benchmark �a1 t /aa 7
Dosing ` r /.O Ad;
BM
C n,�.tlb tS �
Ae�r,, T b a Bldg.Sewer 7,35 Y4 •7
Holding St/Ht Inlet
7,46 �"�• to
TANK SETBACK INFORMATION St/Ht Outlet 7. 6 44,
TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet
Septic Zb 5. 3 .7 C Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
Holding Bot.System -7 7.41j p
PUMP/SIPHON INFORMATION Final Grade -7, 3 c?Q 7
Manufacturer Demand St Cover` I DJ -3
Model Number
TDH ift Friction Loss Syste T7H Ft
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width 3 Length No.I SIONS Of Trenches PIT DIM N No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturer��
INFORMATION CHAMBER OR �/l F,•(d�-fa
Type Of System • / / UNIT Model Numbe 'q C
DISTRIBUTION SYSTEM 14T e_&4-,ll eQ5 J
Header/Manifold Distribution Ix Hole Size Ix Hole Spacing VentttoAiyl t ke
Pipe(s) �� N a 1
Length \ Dia\ Length Dia Spacing
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 Bed/Trench Edges Topsoil O Yes ED No Yes D No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 647 Brakke Drive H dson,WI 54016(NE 1/4 SW 1/4 27 T29N R19W) it 4 Business Park Lo Parce o_:j2.7.29.19.2159
1.)Alt BM Description �f�7vv v fC
2.)Bldg sewer length= 5.3 PLO
-amount of cover
Plan revision Required? ❑ Yes No Use other side for additional information. (_:7:Wft L17 _i
SBD-6710(R.3/97) Date Insepctors, nature Cert.No.
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o Safety and Buildings Division St.Croix
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201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.)
a, G Madison,WI 53707-7162
\v 0
State Transaction Number
ermit App c2tion G
In accordance with Sl£S'3 `�02�is\"Adm.Code,submission of this form to the appropriate governmental unit b 5 04
is required prior(i g a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of afety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the PriM Law,s.15.04 1 m,Slats. 647 Brakke Drive,Hudson,W154016
I. Ap lication Information-Please Print All TA&rmaticA
Property Owner's Name r+ fS Parcel#
Blue Scooter,LLC/Halverson Concrete Conce is -Tom Anderson,President 020-1363-22-000
Property Owner's Mailing Address Property Location 2-1 !51/
•
579 Schommer Drive Govt.Lot
City,State Zip Code Phone Number SW _ '/. Section 27
(circle one)
Hudson,WI 54016 (715)690-227 T 29 N; R 19 W
IL Type of Building(check all that apply) Lot#
❑1 or 2 Family Dwelling-Number of Bedrooms C22) Subdivision Name
Block# Plat of Exit four Business Park
Public/Commercial—Describe use Office&Equipment Storage Na
❑City of
❑State Owned-Describe Use CSM Number ❑Vin e of own
� C 1 I ,er-- Na of Hudson
II1.T e of Permit: (Check o ly one box online A. Complete line B if applicable)
A. KNeW System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain)
B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
1. a V`
IV.Type of POWTS System/Component/Device: (Check all that apply) r d
❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in.of suitable soil ❑Mound<24 in.of suitable soil st 0-6-0
El Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain)
V.Dispersal/Treati6ent Area Information: 19 Infiltr4tor Quick 4 Standard Plus cVarnbers&2 end ca s,PolyjLok PL525 effluent filter
Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal.6;ea Proposed(s System Elevation /
151.50 Gpd 0.4 Gpd/Sq.Ft. ij 378.75 sq.ft. 3000 sq.ft.. 97.50, ✓
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units
New Tanks Existing Tanks f Cz ° ° 9 05
D ✓ a U iii v� w C7 Ci
Septic or Holding Tank 700/300 Na 1,000 1 Wi er Concrete X
Dosing Chamber Na Na 0 0
VII.Responsibility Statement- I,the u ersigned,assn a responsibility for installed of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber' Signature MP/MPRS Number Business Phone Number
James K.Thompson -- Z MPRS 30021 715 248-7767
Plumber's Address(Street,City,State,Zip Code)
340 Pa lson Lake Lane,Osceola,WI 54020
VII .Coun /De artment Use Only
XApproved approve Permit Fee Date ssue Issuin ent Sign
$
en Reason for bmiai !�• lf�
IX.Condi 't- Reasons for Disapproval
Y tank,6tlf enhfllternnd 3)
tliapersal*must all be services/maintained
";*_f managetnentplan provided by plumber.
V k OqUireMents must be maintained
0 per ippNrable code/ordirtailicei
Attach to complete plans for the system and submit to the County only on paper not less than g 112 x 11 inches in size
SBD-6398(R. 11/11)
Conventional POWTSIndex & Tilte Sheet
Project Name: Blue Scooter,LLC/Halverson Concrete Concepts
Contact Name: Tom Anderson-President/Owner
Owner's adress: 579 Schommer Drive,Hudson,WI 54016
Site address: 647 Brakke Drive,Hudson,WI 54016
Project Location:
Subdivision: Lot 22 of Exit Four Business Park
Legal Description: NE1/4 SW1/4,Sec.27,T.29N.,R. 19W.,Town of Hudson,St.Croix Co.,WI.
Parcel ID#: 020-1363-22-000
Page I Index and Title Sheet
Page 2 Septic Tank Maintenance Agreement
Page 3 Waranty Deed
Attachments: State approved Design&Installation Plans
Mater PI her Restricted Service: James K.Thompson,Dept.of Safety&Pr9fossional Services Credential#30021
Signature: s Date:
Page I Of 3
Design pursuant to In-Ground Soil Absorption Component Manual for POWTS,version 2.0 SBD-10705-P(N.01/01)
JAMES K THOMPSON Page 2 6/2/2014
• The gravelless system components must be installed in accordance with the manufacturer's printed instructions,
the plan approval,and SPS 383 system sizing criteria. If there is a conflict between the manufacturer's
instructions and the plan approval,the plan approval and code requirements will take precedence.
Reminder
• The float switch shall be a type that does not contain mercury.2009 Wisconsin Act 44 prohibits the installation
of float switches or relays that contain mercury.
• The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Access to
the filter for cleaning must be provided per ss. SPS 384.25(7)and(8),Wis.Adm.Code product approval
conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of
the filter is required.The outlet filter shall be installed per product approval stipulations.
• Materials shall conform to the requirements of SPS 384. SPS 384.10.No fixture,appliance,appurtenance,
material,device or product may be sold for use in a plumbing system or may be installed in a plumbing system,
� P g Y
unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and
ch. 145,Stats.
• Surface water drainage shall be diverted away from the system area.
• Maintain well and waterline set backs per SPS 383.43(8)(i).
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 Industry Services reserves the right to require changes or additions should
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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 and the POWTS management plan to the owner and any
others who are reJ634 stallation,operation or maintenance of the POWTS.
Since Fee Required$ 250.00
Fee Received$ 250.00
Balance Due $ 0.00
Pa ' ' d
POWTS Plan ReServices WiSMART code:7633
rT15)634-7810, 0,M-F 8:00 a.m.-4:45 p.m.
pat.shandorf @wi
cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm
Note: Effective January 1,2012, all codes under the jurisdiction of the Division of Industry Services(formerly
Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with
"SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to
the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered
and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed
by SPS Chapters 360-366.
AR TNT DIVISION OF INDUSTRY SERVICES
10541 N RANCH ROAD
° HAYWARD WI 54843
Contact Through Relay
9 P N www.dsps.wi.gov/sb/
S
a��� � c, www.wisconsin.gov
�A
° ssloNAyS�` Scott Walker,Governor
Dave Ross,Secretary
June 02,2014
CUST ID No. 30021 ATTN.•POWTS Inspector
JAMES K THOMPSON ZONING OFFICE
ACE SOIL&SITE EVALUATIONS ST CROIX COUNTY SPIA
340 PAULSON LAKE IN 1101 CARMICHAEL RD
OSCEOLA WI 54020 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/02/2016 Identification Numbers
Transaction ID No.2406504
SITE: Site ID No. 801517
Halverson Concrete Concepts Please refer to both identification numbers,
647 Brakke Dr above,in all corres ondence with the agency.
Town of Hudson
St Croix County
NE1/4,SWIA, S27,T29N,R19W
FOR:
Description:Non pressurized in ground,2 employees,3 floor drains
Object Type:POWTS Component Manual Regulated Object ID No.: 1485883
Maintenance required; 102 GPD Flow rate; 93 in Soil minimum depth to limiting factor from original grade; System(s):
In-ground POWTS Component-Ver.2.0, SBD-10705-P(N.01 101,R. 10/12); Commercial System,Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes COND11
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed APPS'
and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. DEPT OF
The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code PROFES$IQ
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
DtV1S1014 OF
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
OF
Key item(s) SEE C
• 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 the "In-Ground
Soil Absorption Manual System"are complied with.A copy of this information must be given to the owner
upon completion of the project.
• This approval does not include plans for the general plumbing systems or sewer piping leading to the
septic/holding tank that may be required for this project. See section SPS 382.20,Wis.Adm. Code,to
determine if plan submittal and approval is required.
• SPS 383.02. This approval covers only the domestic wastewater directed into the POWTS. The Department of
Natural Resources must be contacted regarding the treatment and disposal of non-domestic wastewater,
including those mixed with domestic wastewater. Please refer to the following website for more information:
h=://www.dnr.state.wi.us/orWcaer/cea/conliance/auto/wastewater htm#septic.
• The floor drains receive wastewater from toilet room or utility room.
Conventional POWTS - Index & Tilte Sheet
Project Name: Blue Scooter,LLC/Halverson Concrete Concepts
Contact Name: Tom Anderson-President/Owner
Owner's adress: 579 Schommer Drive,Hudson,WI 54016
Site address: 647 Brakke Drive,Hudson, WI 54016
Project Location:
i
Subdivision: Lot 22 of Exit Four Business Park
Legal Description: NE 1/4 SW 1/4,Sec.27,T.29N.,R. 19W.,Town of Hudson,St.Croix Co.,WI.
Parcel ID#: 020-1363-22-000
Page I Index and Title Sheet
Page 2 Site Plan VED
Page 3 Daily Flow, SepticTank&Dispersal Cell Sizing Calc�xvs-vY
Page 4 System Cross Section Lev VICE"
Page 5 System Management Plan Du SERV
Page 6 Filter Specifications
Page 7 Septic Tank Specifications
Page 8 Parcel map
Page 9 Septic Tank Maintenance Agreement
Page 10 Waranty Deed
Attachments: Soil Evaluation Reports by Thompson&Nelson
Mater PI 2es te d Service: James K.Thompson,Dep't. of Safety&Professional Services Credential#30021
Signatur • 5�._, Date:
Page 1 Of 10
Design pursuant to]n-Ground Soil Absorption Component Manual for POWTS,version 2.0 SBD-10705-P(N.01/01)
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Halverson Concrete Concepts, Inc.
DISPERSAL CELL & SEPTIC TANK SIZING CALCULATIONS
i
JOB DESCRIPTION:
Property is under the ownership of Blue Scooter, LLC and will be occupied by Halverson Concrete Concepts, Inc.,
Tom Anderson, President/Owner. Septic system to serve proposed office & equipment storage facility, 647 Brakke
Dr., Hudson, WI. Proposal includes installation of new Wieser Concrete septic tank and one(1)subsurface dispersal
trench. Sizing based on owner statements of two(2)full time employees all shifts,3 floor drains,no food preparation
and no retail space. Design assumes domestic strength waste.
DESIGN FLOW CALCULATIONS-Office facility:
Design Wastewater Flow: (101.00 Gp�I daily flow2(1.5 conversion factor)= 151.50 Gpd
(2 employees)(13gal.per employee)= 26.00 Gpd
(3floor drain)(25 gal./drain)= 75.00 Gpd
Daily wastewater flow= 101.00 Gpd
DISPERSAL CELL SIZING CALCULATIONS:
1. Design flow= 151.50 Gpd design flow
2. Infiltrative surface elevation to be: 97.$0' /
3. Infiltrative capacity of native soil within 3'of infiltrative surface: 0.4 s .ft.
4. Absorption area required: 378.75 sq.ft.
5. Absorption area as proposed: 386.00 N.ft.(19 chambers total)
Infiltrator"Quick 4 Plus"=20.00 sq.ft.EISA per chamber,Infiltrator"Quick 4 Plus"end cap=3.0 sq.ft,EISA
378.75 sq.ft.-(2 endcaps)('3,O)=372.75 sq.ft./20.00sq.ft.EISA=18.63 chambers required
Number of trenches: 2 tie 1 @ 19 chambers,per trench
Trench width: 2.83'
Trench length: 79.00'
Trench spacing: Na
Total system area: 2.83'x 79.00'
SEPTIC TANK CAPACITY CALCULATIONS:
1. Proposed Septic Tank Capacity&Manufacturer: 700/300 gallon 2 chambered septic tank by Wieser Concrete
2. Design wastewater flow= 151.50 gpd
3. Minimum required capacity: 316.34 Gallons
(151.50)+(11.61 x 3*x 2.02)+(46.77 x 2.02)=316.34*(Requires a maximum 3 year maintenance cycle)
151.50gpd/75 gpd=2.02 gpd person equivalency
4. PolyLok PL-525 effluent filter to be installed at proposed septic tank outlet.
(151.50)(2.088"magic number')=316.34 gallon capacity required on 3 year maintenance cycle.
EFFLUENT DISTRIBUTION: Distribution valve to be installed in effluent line to accommodate installation of
future replacement dispersal cell.
Pg.3 of 10
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In-Ground POWTS Dispersal Cell Management Plan
Pursuant to Dep't. of Safety&Professional Services 383.54,Wis.Adm.Code
General
The In-Ground septic system shall be operated in accordance with Dep't.of Safety&Professional Services 382-384 Wis.
Adm.Code,and shall be maintained in accordance with component manual SBD-10706-P(N.01 101). All local and/or state
rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or
maintenance of the system should be directed to the installing plumber,Jim Thompson at(715)248-7767 or your County
Zoning Inspector at(715)386-4680.
Septic Tank
The operating condition of the septic tank and outlet filter shall be assessed at least once every year by inspection. The outlet
filter shall be cleaned as necessary to ensure proper operation. The septic tank contents shall be removed when the sludge
and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in
accordance with NR 113,Wis.Adm. Code,by an individual certified to service septic tanks under s.281.48,Stats. If the
contents of the tank are not removed at the time of the annual assessment,maintenance personnel shall advise the owner of
when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The addition of biological
additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for
septic tank use by the Dep't.of Safety&Professional Services,Safety and Buildings Division. No chemical additives should
be added to the system.
Septic tank manholes risers,access risers,and covers should be inspected for water tightness and soundness. Any opening
deemed unsound,defective,or subject to failure must be replaced. Exposed access openings shall be secured by an effective
locking device to prevent accidental or unauthorized entry into a tank or other component. No individual should ever enter a
septic tank as dangerous gases may be present that could cause death.
Dispersal Cell
Observation and vent pipes within the dispersal cell shall be checked for effluent ponding annually. Ponding levels shall be
reported to the owner. Persistent ponding of 3"or more will be deemed to indicate an impending hydraulic failure requiring
semiannually monitoring.
Effluent quality
The sewage effluent generated at this site may not exceed the high strength effluent concentration levels as established by the
Wisc.Dep't.of Safety&Professional Services. Influent quality entering the dispersal component of the POWTS may not
exceed 220mg/L BOD5, 150 MG/L TSS,and 30 mg/L FOG.
Contingency Plan:
If any portion of the system becomes defective,the defective component shall be immediately repaired or replaced with a
component of the same or equal performance to keep the system in proper operating condition. If the dispersal cell
component fails to accept wastewater,the existing dispersal trenches will be replaced by installation of a new dispersal
media.
Pg.5of10
r�s
Filters
N � P
PL-525 EFFLUENT FILTER
Polylok, Inc is pleased to add its
new commercial filter to its existing a
line of quality effluent filters.The
PL-525 is rated for over 10,000 GPD Alarm `
(gallons per day) making it one of accessibility------_.__, Accepts PVC
the largest commercial filters in its 4 extension handle
class. It has 525 linear feet of 1/16"
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed 525 linear feet
with every filter. When the filter is of 1/16°
removed for cleaning, the ball will filtration slots Rated for over
float up and temporarily shut off
10,000 GPD
the system so the effluent won't
leave the tank. No other filter on
the market can make that claim! Accepts 4"& 6°
SCHD.40 Pipe
PL-525 Maintenance:
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at least every three years. If the
installed filter contains an optional `
alarm, the owner will be notified "
by an alarm when the filter needs
servicing. Servicing should be c Gas deflector
done by a certified septic tank Automatic shut-off
pumper or installer. iM ball when filter
1. Locate the outlet of the U.S.Patent No#6,015,488 is removed
septic tank. 5,871,640
2. Remove tank cover and pump
tank if necessary. PL-525 Installation: 1. Locate the outlet of the
3. Do not use plumbing when septic tank.
filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the
tank. Make sure all solids fall 4 or 6 outlet pipe. If the
filter is not centered under the
back into septic tank. access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7. Replace septic tank cover. 5. Replace the septic tank cover.
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fccnvr 47
SHEET r Od 3 SHEETS
i
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
V OWNERSHIP CERTIFICATION FORM
Owner/Buyer Blue Scooter, LLC - Tom Anderson, President
Mailing Address 579 Schommer Dr.
Property Address S e t �Jr�,i` � (��`✓ �..,
(Verification required from Planning&Zoning Department for new construction.)
City/State Hudson, WI Parcel Identification Number 020-1363-22-000
LEGAL DESCRIPTION
Property Location NE '/, SW 1 27 T 29 N R 19 W Town of Hudson
p rty /4, Sec. ,
Subdivision Plat: Exit 4 Business Park , Lot# 22
Certified Survey Map# Na Volume Na , Page# N a
Warranty Deed# (before 2007)Volume 2y'y l ,Page# 02-7
Spec house Qyes(✓lno Lot lines identifiable ayes(]no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&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 Safety And Professional Services 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 Planning&Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the
property described above,by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms Na
SIGNATURE OF APPLICANTS
( ) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV.04/12)
0
V 2 ���� ? ��� 744405
1 (
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 2-2000 REGISTER OF DEEDS
WARRANTY DEED ST. CROIK CO.. VI
Document Number RECEIVED FOR RECORD
This Deed,made between C.P.T.,LLC,a Wisconsin Limited 10/21/2003 11:30AK
Liability Company Grantor,and Graff Properties, LLC
WARRANTY DEED
Grantor,for a valuable consideration,conveys and warrants to Grantee the EXEMPT I
following described real estate in St.Croix County,State of Wisconsin(if more REC FEE: 11.00
space is needed,please attach addendum): TRANS FEE: 853.20
COPY FEE:
Lots 15 an 22 Plat of Exit Four Business Park in the Town of Hudson,St. CC FEE
PAGES: 1
Croix Coun ,Wisconsin.
Exceptions to warranties:Easements,restrictions and right-of-way of Recording Area
record,if any. Name and Return Address
Zor
02)1363-15-000-.020-1363-22-000
Parcel Identification Number(PIN)
This is not homestead property.
Dated this day of 2003.
C.P.T.,LLC
*
ACKNOWLEDGMENT
AUTHENTICATION STATE OF MINNESOTA )
)ss.
Signature(s) authenticated this day n County
of DG19f1tti
Personally came before me this 19 day o arvn,
2003, the above n ed C. .,LLC a Wisconsin Limited
* Liability Co rson who executed the
TITLE:MEMBER STATE BAR OF WISCONSIN foregoing i dimm me.
(If not, authorized by§ I�MM11��•fM�TA
706.06,Wis.Stats.) �
f
THIS INSTRUMENT WAS DRAFTED BY Notary Public,State of Wisconsin--
C.P.T.,LLC Donna M.Caywood 1809 Northwestern My Commission is permanent.(If not,state expiration date:
Ave.Stillwater,MN 55082
(Signatures may be authenticated or acknowledged.Both are not necessary.)
*Names of persons signing in any capacity must be typed orprinted below their signature.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2—2000
('�
3W-3
G
2358
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations
Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must County
St. Croix
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0201-131313-22-000
Please print all information. Revi By Date/ /
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Z-7� 1
Property Owner Property Location
Blue Scooter, LLC-Tom Halverson Govt.Lot NE 11 SW /4 27 T 29 N R 19 W
Property Owner's Mailing Address Lot Block# Subd.Na or CSM#
579 Schmmer Dr. 22 na It Exit 4 Businees Park
City State Zip Code Phone Number City ;j Village 16 Town Nearest Road
Hudson WI 1 54016 1 (715)690-2277 Hudson 647 Brakke Dr.
New Construction Use: Residential/Number of bedrooms Code derived design flow rate 151 GPD
IM Replacement Public or commercial-Describe:Office&equipment storage
Parent material Glacial Outwash Flood plain elevation,if applicable na
General comments
and recommendations: Site suitable for conventional POWTS dispersal cell with 0.5 gal./sq.ft./day loading rate. Recommended
infiltrative surface elev. =98.00'.
❑Boring# jg Boring
Id Pit Ground Surface elev. 102.24 ft. Depth to limiting factor >9311 in. Sot Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu.Sz.Cont Color Gr.Sz.Sh. -Eff#1 *Eff#2
1 0-8 10yr2/2 none sit 2fgr mvfr as 3vf,f 0.6 0.8
2 8-17 1 Oyr4/6 none sicl 1 msbk mfr cw 2vf1 mf 0.2 0.3
3 17-32 7.5yr4/6 none cos[ 1 msbk mvfr cw 1 vf,f 0.4 0.7
4 32-52 1Oyr4/6 none Icos Osg ml gw - 0.7 1:6
5 52-72 10yr5/6 none s Osg ml ai - 0.7 1.6
6 72-93 1Oyr5/6 none Ifs&s Osg ml - - 0.5 1.0
H#6 consists of stratified layers of 10yr4/4 Ifs&10yr5 s too numerous to differentiate. Loading rate reflects most restrictive soil texture within
horizon. 11 1
L )Boring# Id Borings
u Depth to li ting ctor '96�� in. Soil Application Rate
Pit Ground Surface elev. 101.17 fl.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-10 1Oyr2/2 none sit 2fgr mvfr as 3vf,f 0.6 0.8
2 10-33 10yr416 none Ifs 1 msbk mvfr gw 2vf1 mf 0.5 1.0
3 33-48 10yr4/6 none Ifs&Is Osg ml cw 1vf,1f 0.5 1.0
4 48-63 1Oyr5/4 none s Osg ml gw - 0.7 1.6
5 63-96 10yr5/4 none Ifs&s Osg ml - - 0.5 1.0
1 11
u
Horizons#3&6 consist of stratified layers Is too numerous to differentiate. Loading rate reflects most restrictive sod texture within horizon.
"Effluent#1=BOD5>30<220 mg/L 4d TSS>30< 50 mg/L *Effluent#2=BOD <30 mg/L and TSS<_30 mg/L
CST Name(Please Print) Signat . CST Number
James K.Thompson 3602
Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane,Osceola,WI 54020 5/6/2014 715-248-7767
Property Owner Blue Scooter, LLC-Tom Parcel ID# 020-1363-22-000 Page 2 of 3
3] Boring# AJ Boring
Pit Ground Surface elev. 100.49 ft. Depth to limiting factor >92" in.
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
in. Munsell Qu.Sz.Cont.Color Gr,Sz.Sh. *Eff#1 *Eff#2
1 0-8 1Oyr2/2 none sil 2fgr mvfr as 3vf,f 0.6 0.8
2 8-22 1 Oyr4/6 none Ifs 1 msbk mvfr gw 2vf,1 f 0.5 1.0
3 22-34 1Oyr4/6 none Ifs&Is osg mk cw 1vf,f 0.5 1.0
4 34-66 1Oyr5/4 none s Osg ml gw - 0.7 1.6
5 66-92 1 Oyr5/4 none Ifs&s Osg ml - - 0.5 1.0
Horizons#3&6 consist of stratified layers of Ifs&Is too numerous to differentiate. Loading rate reflects most restrictive soil texture within horizon.
F-1 Boring# Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots QP
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
Boring#
Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
*Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<_30 mg/L and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format,please contact the department at 608-266.3151 or TTY 608-264-8777.
SBD-8330(R 07/00) A.C.E.soli&site Evaluations
mar Qlut_/QV. aSSu,nc� , los/7Qrr .(� Dom,!-cYC 2
��irnc..j/d�-sp�.s✓ca//��,�'x79.' /�J�,�;—A,C. Zr, 72.941 P. 9�,
/�",QC,o/QCe.nb.,� a(i5 f�r3a./�// � /rt.�fi/ud5�''>. •C!'aiX�,�(.
f • Br
1 � ' �opose.d d�rirswoy,Ya�✓r •�J
bernsWta n ef4'*-&-
11 CO-I/
11 �
6z
prspou cl Wiesi.,-de.
W',4/y,Z"x/,04-sAs B 2
me/ccml�t1%/4--a4 \
e.d bui/dry
"eo,.,e u-6. V O
133
unu wttl6l ntflptNll`.i .._ �_ '•'- �„���w��
Division of Safety and Buildings in accordance with Page ' of
^ l. 13:83.09,Wis.Adm. Code
'
Attach complete site plan on paper not less than 8 1/2 x 11 inches in sife�`Plan muR FR� d tt
include,but not limited to: vertical and horizontal reference point(BMk`dlr�ction and . QS T .ro
percent slope,scale or dimensions,north arrow,and location and distanbe to nest road.
D.#
APPLICANT INFORMATION-Please print all information:; �c rev, l3 J Date
Personal WOrnwtion you provide may be used for secondary purposes(Privacy Lavti,s,. U44t -'0FR'CE ,l
Property Owner Ptorerty Lrr Po rri
f .
T4,S l Z .N,R f."w
Property Owners Mailing Address Lot# Block# Subd.Name or CSM#
VL'r` cn. e- °5 X1i 44
City ` State Zip Code Phone Number ❑ City ❑ Village [ Town Nearest Road
21 New Construction Use: ❑Residential/Number of bedrooms Addition to existing building
❑ Replacement (Public or commercial-Describe:
Code derived daily flow INtiu^ ?gpd Recommended design loading rate r"? bed,
9Pd4e �'� trench,gpdli2
Absorption area required bed,ft2 trench,ft 2 Maximum design loading rate `/ bed,gpd/ft2 ° J trench,gpdJtt2
Recommended infiltration surface elevations) to fe ed to sit6 plan benchmark)
Additional design/siteyconsiderations
Parent material 16 S n )i!e' VA r' a e Flood plain elevation,if applicable #t
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tarn
U = Unsuitable for system ( S ❑ U W S ❑ U Rs ❑ U Us ❑ U I ❑S N1 U ❑S [X U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2
in. Munsell Qu.Sz.Cont_Color Texture Gr.Sz.Sh. Consistence Boundary Roots
Bed .Trench
V 6 1'4
Iq-2Z
Ground
elev. z a_y, 7,5 r 5 S 2 r a a1�`•' tom,v C r " c ^.
Depth to f 7, r S _ 3>7 +" ~- ' 7 Y €
limiting
tactor
in, F4-
Remarks: o/ e r >, y F 5 -7, if r
Boring#
1�- tayrt�i $6 r
<
5 0 S-1
Ground 435^i� 3,f rr 714 QS � ? � �---- -7 .�
elev.
Depth to
limiting
factor r
i t bin. Remarks: i,.l a F S ?. r ,
CST Name (Please Print) Signature Telephone No.
,`
Address i o I s E Date i CST Number
ily 4a� .14 _ x` 4,. a�n „ Sgol �i /! 2273
S7
~ C0r,s e- C_ SOIL DESCRIPTION REPORT
PROPERTY OWNER � Page Z'" of �
PARCEL t.D.#
Boring# [Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
z in. Munseti Du.Sz.Cont.Color Gr.Sz.Sh. Bed Trench
t 0-13 lb V, 2/1
Ground �
ewv 3 � - cz 7,5y r 5`'"
-!d 71 V r 7� ! S :
J.r1.5� � f'1vrr C5 r7i •�
Depth to 7j` — �'s ry 7:
limiting
factor
�?uin.
Remarks:
Boring#
t 5 f 1 r ars
2_41-71 7,5 yr i fS 2.#)s 1l v -fir �'.S
Depth to
limiting
factor
l 2 ct in. Remarks: CJf 1 c u fL
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P
in. Munseil Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench
Boring#
0mm0 (YI
� %0- Ito
11 e r V
Ground 4 3 ;: r _J"�_ O s
tom .
Depth to
limiting
factor
l2C in. Remarks:
Boring#
Ground
elev. w.—
ft.
[)ep�
Rrriting
factor
in.
Remarks:
QPMAI_000n,o nornck
tMVfRVMMtM I AL DY P0104
1432 12001 STREET,NEW RICHMOND, WISCONSIN
715-246-2454
Tom Nelson
Certified Soil TesW227387—RcgWeredSanitarian SP-00713
-------------0 10 4 13
a 105 ,52-
i b,4 . 72-
aq
yt
Vq 7 -T'-I-ct N -Z t9 LJ
0 C..) a cis Q
SCALE I'v 0
BM 1. TOT P.A. TOM Nelson
BM
Parcel #: 020-1363-22-000 02i27i2008 08:56 AM
PAGE 1 OF 1
Alt. Parcel#: 27.29.19.2159 020-TOWN OF HUDSON
Current X ST.CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
O-GRAFF PROPERTIES LLC
GRAFF PROPERTIES LLC
575 SCHOMMER DR
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description '647 BRAKKE DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.236 Plat: 07-072-EXIT FOUR BUSINESS PARK 020-99
SEC 27 T29N R19W PT NE SW EXIT 4 Block/Condo Bldg: LOT 22
BUSINESS PARK LOT 22 2.236AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
10/21/2003 744405 2441/027 WD
10/27/1999 612794 7/72 PLAT
2008 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 2.236 168,300 0 168,300 NO
Totals for 2008:
General Property 2.236 168,300 0 168,3000
Woodland 0.000 0
Totals for 2007:
General Property 2.236 168,300 0 168,3000
Woodland 0.000 0
Lottery Credit: Claim Count: 0 Certification Date: Batch#:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00