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HomeMy WebLinkAbout020-1412-50-000WiycOnsin Department of Commerce Safetyand Building Division PRIVATE SEWAGE SYSTEM INSPECTION~REP~RT 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 Turn uist, Tanner Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: (,v. v l ~ o,U T vtn ( vG TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic t ! ~ ~ ~ ~7 Dosing /` •~(,-. a (~ Aeration Holding ~Q TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ l~/ ~ 0 5~ ~ / ~ ~ Dosing ~ « Aeration Holding e PUMP/SIPHON INFORMATION Manufacturer errand (~~ GPM Model Number _ p -~ ~' ~,~ 1 ~~ I TDH Li Friction Loses System Head TDH _ Ft Forcemain Length ula. ~ Dist. to Weil , ~ ~ b Q~ SZ~ SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 430356 0 fate Plan ID No ` : ~ 8 7 2 _T~. /o Parcel Tax No: 020-1412-50-000 Section/Town/Range/Map No: 10.29.19.2597 STATION BS HI FS ELEV. Benchmark ~• (~~ ~ (a0 Alt. BM a.~- .2to 10 . Bldg. ewer u St/Ht Inlet SUHt Outlet / / / Dt Inlet Dt Bottom u u~~. . ~ 9~.~~ Header/Man. IbU.~O/ Dist. Pipe ~ ?~, ~ , ~ O t !7p • o Bot. System •~ q Final Grade /,fib ~ ~oo,~~{ St Cover ~. 3~~ ~OL ~ ~ 3~ 30 `1'9•S~ ~ ~,~,.# ~ ~y~la3 3, ~{ o l03~ qp, a ~ 1 BED/TRENCH DIMENSIONS Width ~~ Length )t-/~ No. Of'r2nCftes (~ ~~! I .J 1 PIT DIMENSIONS No. Of Pits Inside Dia. Li u' 1 / T ~S ~ ( f SETBACK SYSTEM TO P/L B LDG E L !_AKE/STREAM LEAC ufacturer: INFORMATION CHAMBER Type Of S ~tem: ~ ~ / ~ ~ A ~ j~ UyyY umber: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hote Size x Hole Spacing Vent to Air Intake ~ Di ~7 7 ~ ~ 7 Length a , Length Dia Spacing SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center rench Edges Tops ~ Yes ~ No No ~~ r/ •7. ~' ~c G}, - ILL d G 1~~ f ~~~^CQMMENTS: (Include code discrepencies, persons present, etc.) Inspection #~~~ ~ 3 ~~ spectio~ ~ 2:_ OC • s>j~, ~W~ Location: 637 Wild Flower Lane Hudson, WI 54016 (SE 1/4 SW 1/4 10 T29N R19W) Burkhardt Wr~ ie Lot 5 Parcel No: 29.19.2597 1.) Alt BM Description = ~ ~~ v - ~jww~.~z ~ ~ G ~ i.) ~-~/" ~ ~ r"' I ~°'~ ~'-'~~~. 2.) Bldg sewer length = ~ (A ~ 6~~(c,~;~-~-1 d ~,~ 1. Fv~ -amount of cover = ~ 2~l ~~V'~ tt; i ~~ Gtr,l~ r~ -Q Y~ Gu- t~11, Q - w~,,,p ,~.. ~-`fit a(D~'~ . ~~ r-- ~ --1- r ---~ --- --- -- ~ ~ ~ _ r _.._ - ~quired? ~ ~~ J Yes ~ No ~ O ~ ~ ~ ~'~ 1 2 9~ For additional information. ~_ ~_. _,____ ._____1_- __ Date Insepctor's Signature Cert. No. C Safety and Buildings Division County ~ ~ 201 W. Wasbingtou Ave.,sP.O. Bqx 7162 j~'°~nsn Madison, WI 53707 - 7162 Sanitary Permit Number (m be ft7led in by CoJ Department of Commerce 0)266-3151 ~s Sanitary Permit Application Stale Plan t.t,. Nnmbe; In accoid widt Comm 83.21, Wis. Adm. Cade. personal information you provide 9' .2.Z~ may be used for secondary purposes Privacy Prow.....__ _-- ~-- _ s) I. Application Information -Please Print All Information ~ !mod ~~ ~~ Propetrty Owtrer's Na me ~ Z ~ l~rcel if ~ Block !/ - /1'/ ~ ST. CR I .7D-/S~/2-.Sn S r Property Owner's M ailing Address ZONING OFFICE Prop~tY t.t>Vau..., , 07~~ B~- ~~54 Section S~ 54 , , City, State Zip Code Phone Number ~STZ'Gt! G!/i¢T '~~ f ,r~"G~ ~" (circle o ) ~ N R ~E T , - ~ II. Type of Building (check all that apply) '~' ~~`" Subdivision Name CSM Number „ ~~ 1~ or 2 Family Dwelling -Number of Bedrooms ~fl~d4 ^ Public/Commercial -Describe se ~ ~ iST ~ ' - ^ Stare Owned -Describe Use ^Ciry ^Village Township of ~ O III. Type of Permit: (Check only one bog on line A. Compl a if applicable) `~' ~New_ S~~ ^ Replacertxttt System ^ Treatment/Holding Tank Replxemecn Only ^ Other Modificatan to Facisting System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Ttaacfer m New List Previous Permit Number and Date Issued Before Expiration Phunber Owner IV. of POWTS em: (Check all that a 1 ) - ^ Non Pressurized Irt~iround ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil t-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized Io-Grouixl ^ Holding Tank ^ Peat Fiber ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Fiber ^ wing Chamber ^ Drip Line ^ Gravel-lest Pipe ^ Other (explain) V. D' t Area Information: m D___ - Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro (sf) System Elevation i . S d ~~) fib/ / t/~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Sine Steel Fiber plastic Gallons Gallons of Units Concrete Constructed Glass Tanks T z jIL ~/~ septic or EiddttgT~flt 2 -' d GJ,E,G1 v Aerobic Treatment Unit Dosing Chamber , ~ !~ / VII. Responsibility Statement- I, the undersigned, assume responsib' ' for installation of the POWYS shown on the attached plans. Plumber's Na me (Print) Pumber's Si gmature~ MP/MPRS Number Business Phone Number Plumber's Addre ss (Street, City, S ,Zip e)a ~~,~ `f~~ ty/p2 -.Z/D Fogerty Plumbing & Perk Testing s - - 3 . Co Appro il8~Qj ~>m'Y Permit (includes Groundwater. Snrt~arge Fee, ~ Issued ~~ z A Signature tNo Stamps) ^ Owner Given Reason for Denial , 35~ 2 o 1X. Conditions of Approval/Reasons for Disapproval N `_ _ I ~/G~~ f ~'C~ VtQR.c 'fb ~ OY~ SYSTEM OWNER: ~~ .S~-'~t:~~ ~~~ (.l 1 Septic tank, effluent filter and ~~ ~~~ G ersal cell must all be serviced /maintained dis U p as er m n ement Ian rovided b lumber. 2. setback requirements must be maintaine as per applicable code/ordinances. 3 ti / D/ L?-f n 3) ~ ~~ n (m ~1T y~y) for the on pa not less than 8111 x 11 inches in sFie Pgg~e 8 of 8 0 ~ ~ ~~~~a i tma - eo it Propasad IPjeser Conor+eta Coorbdea~ioa~ tm~k W/label A-100 Pll~er m P~apoeed 10'x 140'alt-grade Moiaid Cell Pn~pawo~2" Sch. ~/SF.Iev~akon~99.50' 1l,, ~ l[al~ ~~ `~ }~ i s~~ B~#1=Top of 2'PYC w/Zadie (dev.100) B~ ~ Tep alad Rledrrc Fake Past (elev. 9i8.~0j Site Plan For: Tanner Z~unquist Lot 5 of Burkhardt Prairie SEl/4-SWl/4 Sec. 10 T29N-R19W Hudson Tnsp. - St Croix Co. ~ Propaae+d f aedroouu Ea~ne /~~O/ % /~,/ Nate: Mamie Well aad Wahine Sdb~a per CoeaK 8~~3(8)(~ isconsin Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce.state.wi. us/s b www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary August 22, 2003 CUST ID No.224059 KEITH E STONER 23220 WOOD CREEK RD SIREN WI 54872 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/22/2005 SITE: Tanner Turnquist CTH A ATTN.• POWTS Inspector ZONING OFFICE 5T CROIX COUNTY SPIA ~ 1101 CARMICHAEL RD ~-e,~~hul1 HUDSON WI 54016 ~~ 3d 3~ Identification Numbers Transaction ID No. 896228 Site ID No. 663160 Please refer to-both identification numbers, above, in all correspondence with the agency. Town of Hudson St Croix County SE1/4, SW1/4, S10, T29N, R19W FOR: Description: New at grade, 600 GPD Object Type: POWT System Regulated Object ID No.: 915183 ~. ~ ~of~ c ~.: 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. GF ~~'~~ ~ o,v~ r . The following conditions shall be met during construction or installation and prior to occupancy or use: !~~ General Approval Conditions: ~ ~ C,G • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At Grade Component Manual , SBD-10570-P (R.6/99)" and SSWMP Publication 9.6, Design Of Pressurized Distribution Networks For Septic Tank- Soil Absorption Systems. ~• In the event this soil absorption system 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 the At Grade Component Manual are complied Key Item(s) • Deep and thoroueh rh;cPl ninw;nQ chars one to the absorption area to help break ur1 the Ulaty soil structure that was reported at the site. The county may, at their discretion, request verificatio riate lowing is accomplished prior to sand or aggrega e p acement. • The designer proposes to install an effluent filter to achieve the requirement of wastewater particle size. ~~ Maintenance information must be iven to the owner of the tank explainin that eriodic cleanin of the s tic tank outlet filter will be required. The outlet filter shall be insta a per product approval stipulations. Reminder • The orientation of the at grade system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual. KEITH E STONER Page 2 8/22/03 • Surface water drainage shall be diverted away from the system area. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(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 maybe made to me at the telephone number listed below, or at the address on this letterhead. ./~~ The above left addreq~ee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operati~ or maint ance of the POWTS. ~~ l~G~ ~~ ; Patricia L POWTS Plan Reviewer , • grated Services (715) 634-7810, Fax: (715) 634-5150 , M-f 7:45 am - 4:30 pm pshandorf@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 Fogerty Plumbing & Perk Testing, Inc. RESIDENTIAL AT-GRADE DESIGN Pressurized - Sioping Site INDEX AND TITLE SHEET Project Tanner Tumquist At-Grade Owner Tanner Tumauist Go 37 Address -f~z*~Wildflower Lane Hudson WI 54016 715) 549-5965 Legal Description SE1/4SW1/4 Sec. 10 T29N-R19W Township Hudson County St. Croix Subdivision Name Burkardt Prairie Lot No. 5 ~,T•S iOi1 Parcel ID Number Plan Transaction Number Rc .. ~~ DINGS ~ Index sheet Calculations At-grade drawings Laterals and dose tank Spec cations Management & contingency plan Pump Specifications Plot Plan 1 Page 4 Page 5 ( / Rage 6 /i~ G~ ~ ~ ~ n Page 7 b Page 8 Designer Keith E. Sto r Ww`;"'r.4j ',,Lirense Number Designer# 1575-007 Signature ~ ~ . ST NEE~• . • *I~one Number (715) 653-2324 -1515 e Date 07/15/03 s 81~"~ Mlls, piasuartt to: At-grade Component Manual for POWTS SBD-10570-P (R.6/99), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.11 (05!01) Page 1 of 8 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet -Sloping Site Flows and Site Data Entry. (r or c} r Residential or commercial? 465.0 Estimated wastewater flow (gpd) 697.5 Design wastewater flow (gpd) 2.50 % Site slope 99.50 Contour elev. below lateral (ft) 37.00 Depth to Limiting factor (in) ~/ __ _ 0.50 In-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 6.00 Linear loading rate gpd/ft 10.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 140.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) a Center or end lateral connection 1 Number of laterals 0.125 Orifice diameter (in) e.g. 0.188 Nat a final ca~ulation 1.83 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 3.24 Forcemain flow velocity (ft/sec) 100.00 Forcemain length (ft) 90.50 Pump tank elevation (ft) ~~ • (a 6.5 System head (ft) x 1.3 ~1 ~, C~ 8.75 Vertical lift (ft) `~~ `~i ~ .l5 2.15 Friction loss (ft) ~ ~ O 17.40 Total dynamic head (ft) ~,~~ Lateral Diameter Selection Designer must select one lateral diameter Pi a ~ameter Design options Design dwice 1 in 1.25 in 1.5 in 2 tt x x 3m X Gallons/lnch Calculator (optional) Total Tank Capacity (gal) Total Working Liquid Depth (in) Ga}>rn (enter result in cell G46) Treatment Tank Information 1250 Se tic tank capacity (gal) Wieser Concrete Manufacturer Effluent Filter Infon~nation Dose Tank Information Zabel _ Filter manufacturer 773.8 Dose tank capacity (gal) A100 Filter model number 16.1 Dose tank volume (gaUin) Wieser Concrete Manufacturer Note; This At-Grade is designee for a ~ bedroom residence. The estimated daily flow was increased to enlarge system design per the CST' s recommendation. ~ t'Y~'r''r ~J bh` _ ~ ~' , ~° V / (j U ~~ ~j~ fp,~ ~n ~~~~~ Q y or n Does Forcemain drain back? y or n Are laterals at highest point? NA '7 16.3 Forcemain drainback (gal) ' 112.0 5x Lateral void volume (galj 128.3 Minimum dose volume {gal) 31.7 System demand (gpm) Project: Tanner Tumquist At-Grade Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW ~D t) ~ i/6 B Observation Pipes (2 tin B 140. 0 ~}----~ 1 /6 B 23.33 C 12.00 W ~ D 5.00 { E 2.00 o L 150.00 B W 22.00 1 A x B 1395.00 L ~_ Cap Typical obi. pipe. = Total aggregate cell A x 6 Slotted in the lower l~ 6', and anchored = Plowed area L x W sec~xely. 6" AT-GRADE CROSS SECTION Synthetic fabric cover 101, Lateral . invert elev. 100.00 ft •---= . SurFace contour 99.50 ft i`A and system elevation ® = 12 in. topsoil and subsoil over aggregate and tapered to toes. = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: Tanner Tumquist At-Grade Transaction Number: Finished grade elevation f--- Observation pipe at aggregate toe 2.5 % Slope D --} Plowed la er Y below L x W Page 3 of 8 ' ~ PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram -End Connection E P last hale dkdled next to end oap ~E ~~~ Laterals & force main of PVC Sch 40 Holes driNed on the bottarn of the lateral [par COMM Table 8.30-5J equally spaced • =Turn-up+t~trallvalve orcleanoutplug Lateral Specifications C 'u A ~ 8 E C ~ 0 Totals 0.125 Orifice diameter (in) X 1.81 Orifice spacing (ft) 77 Orifices/lateral 31.7 Lat. discharge rate (gpm) 31.7 Sys. discharge rate (gpm) 17.4 TDH (ft) End Lateral connection point 1 Number laterals P 137.56 Lateral length (ft) 2.00 Lateral diameter (in) 2.00 Forcemain diameter (in) 100.00 Forcemain Length (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning Abel and ticking device junction box Final grade 4" disconnect Tank component is ~ Al6emate properly vented ~' ~` outlet ~~' location 18" mrc~. Electrical as per NEC 300 and Approved outlet joint Comm 16.28 WAC Inches Gallons 29.1 468.4 2.0 32.2 8.0 128.3 9.0 144.9 48.1 773.8 Tank full A Alarm on Pump on ~B 91.25 ft 1 " Pump off D 3" Bedding under tank ~ Goulds Pump manufacturer Model# 3871-EP05 Pump model number Project: Tanner Tumquist At-Grade Transaction Number: Provide 174" weep hole or antisiphon device. ~'~ 90.50 ft S.J. Electra Alarm manufacturer 101-01H Alarm model number Page 4 of 8 At-grade System Maintenance and Oaeraition Specifications Service Provider's Name Tri-County Sanitation Phone 715 386-0114 POWTS Regulator's Name [- St. Croix Co. ~onin~c Office Phone 715 386-4680 Svstem Flow and Load Parameters Design Flow -Peak 697.5 gpd Maximum Influent Particle Size 1 /8 in Estimated Flow -Average 465 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1395.0 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu1100 ml Service Freauency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for ndin and see a e once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. A11 other construction details are as per the at-grade component manual SBD-10570-P (R. 6/99). Lateral Tum-up Detail Finished •....••.......~ ............... Grade ~ ........ 6-8" Diameter lawn _~~ .: . • _ Threaded Cleanout Sprinkler Valve Box . • • . • .. • . • . - Plug or Ball Valve Distribution ~ , . ~ _ ~ _ _ ~ ' -' Lateral -------- Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Tanner Turnquist At-Grade Transaction Number: Page 5 of 8 Page '~ of 8 ~GOULDS PUMPS Submersible Effluent Pump 3871 E~5 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty wmp • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/a° maximum. • Capacities: up bo 60 GPM. • Total heads: up to 31 feet. • Dist~arge size: 1'/z" NPT. • Mectran~ai seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40`C) continuous 140°F (6090) intermittent. • fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Singte phase: 0.4 HP, 115 ~ 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Sin le phase: 0.5 HP, 115 V or~30V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord:10 foot standard length, 16/3 SAOW with three prong grounding plug. Optional 20 foot length,16/3 SJfW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil For lubrication and efficient heat vansfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP041mpeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical sal protection. METES ccer 10 9 s 0 7 x v_ 6 5 0 4 0 3 z 0 ^ EP05 Impeller: Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged themlopfastic design provides wperior strength and corrosion resistance. ^ Motor Housug: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplastic coves with integral handle and float switch attachment pants. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: upper and lower heavy duty ball bearing construction. AGENCY LISTING cartadiarl srarlderds assoaatwn (CSA fisted model numbers end in "C" or "F".) Galls Purlps is ~0 9001 farxjslrzred. ~ 2001 Goulds Pumps Effective May, 2001 83871 0 2 4 6 8 10 12 -rt'/h capAClTv Goulds Pumps ITT Industries ~0 10 20 30 40 50 GPM Page 8 af8 o zg so ee.>s (~J r morz - 6o n Site Plan For: Tamier'Itiunquist Lot 5 of Burkhardt Prairie SEl/4-SWl/4 Sec. 10 T29N-R19W Hudson Tnsp. - St. Croix Co. ~ Proposed 4 Be~droarrr Havre l~~~/7 P.d ~. corxa+aa: reoa+~ C.oseb0ramiorr tank iI/ZabelA-100 1~ m, Piapoeed 10'x 140'At g~deMorard Celt ~/3~x r of 99 S0' Maw Bbt#1= Tap ~'2"Pi'C w/I~e {s1ev.100) Its = Top aeoells7e~' Fewae Paist (elev. 940) /~,~ 3iait. Note: 1K~rArobr ~e.Aacrd Wa~e.Se~actx per Caerrre ~*3f0)t~1 - ~ .Ju1.12 03 07:50a FOGERTY PLUMBING 17156355286 Wisconsin Departr++e>lt of Commerce SOtL EVALUATION REPORT ' Division of Safety and 8trildings in aowrdanee with Comm 85. Wis. Adm. Code County Attach cwrlptete site plan an paper not Tess than 8 112 x 1 t indles in size. Plan must irldtrde. Out not limited to: vertical and tlorizontat reference point (BM?. direction and Parcel I.D. percent slope, stela of dtnr~nsiorls, nortll arrow, and logtion and distance teo nearest road. Please prltti aU Information. ~~ ~ Personal Ydonnation you pmNde may be used tar secandalY pWP~+ (Privacy t.aw.: t5.04 (t) (m)?. Property Govt Lot SE 1!4 s+w 7/d 'S Lot # Bloat # Strbd. Namo or S ~ ^ ~Y ^ ~~ ~~ p.2 r ~ ~ - Date ~I i v3 T,z ~ ~ N R %~ E (or~ P~t~ # Nearest Road [t3-New Construction Use: Q'Residential !Number of bedrooms ~.^._ C«1e derivl3d design tbw rate Gc'a GPC ^ Replacement ^ Public Or colrunerdal -Describe: Parent material ~ LT ~~ 7sGl Flood Plain elevation N applicable ~„/~ ~ General oorrwrlertts ~ (r~/~Dr CoNTJ~6fR ~ YY'S ~ CST~r /t~[oN-.w,eX.AS' L>i/~~~'v~ Pt.E'6p and recarrwrterldatiorts: ~j1P~t7 vNE To bi1~2'I1r6rLXTf~ dF 7~jrTist?~' S~ ~4 ~ STJ?N[jkRE. !'-~ ~C~CO.+'.wE~At ~tfrN~ [scv~sT CwvTel~~ _s ~ Boring i / l ~~ s 171 tilt Ground surface elev. tslo, o _ it. Depm >l0 6au'rr-9 F.~or 3 ~ in. ~ ~, Horizon pepth dominant Color Redox Description Texture Stivaure Consisterloe 8ourulary Roots GPO/ft: in. MunseN (hr. Sz_ Cant. Color Gr. Sz. Stl. 'Eff#t 'EfftF2 .. >r & © `.:: L /Q ^ •3'- SrL ~ ~ ~ ~ 3 ~ S ~ -- BSS L 7 , z - 3 ~ - ~ z. -- fG ' L - -- , ~ ~ s L 3 ~ c . ^ Bonrrg 2- ~ Pit Ground surface elev. Q~ S -- tL Depth to limmi4ng taclor 3~- ut• c„p-l Appdq~ Raft ~~ ~ tiot¢on Depth Dominant Coiar Redox Ot3saiQQan Texture Sttuctsrre Consistence Bolardary Roots GPDAP 'ES#1 'Ed#2 in. Muruep Qu. Sz. Cont Color Gr. Sz Sh. -,z sst /kF • ~ ~ -.rY ~ ~ -? J ~ F . L .ta[ ..2. 3 ,7~1-1 -~- --- o ~ 4 ~Z B - ~ 2- yt ~.~ r.-. .~ /. 1 /~ r./ ~fI ~ ~ rmK/.. 3 S .? 1. . ~e. ..._..,n ~ [inn ~ en .....A an,i TCC <?Ib rrldL ~iQlfertt ~ x BQDs ~ 30 < 2Z0 RI~IL ana 1.75 asv ~ +a, nyr.. ~~ Fogerty pl~lmbing & Perk Testipg' ~_ - p~F..zts~ T~s'-G~.. r6°' ?R9RR MrKPrnia RA ~ 6~~~3 G~LG 6S/-'Yys-?!OG Jul 12 03 07:50a FOGERTY PLUMBING 17156355286 properly C)watisr ~.[1.r/Xc.~ ,ill Q use Parcel 10 # - p.3 Page ~of~ .. ~ ^ goring gO~'g * [~ pg Ground surtrrce elev. __f_~ 2__ ft. ~ b ~0 b~ _._t__ ~ Solt Rabe Flaixorr geptl- Oorninarrt Redox pesoiplion 76xtun9 , Struct<re Corrsisbenee tY Raols ' ~ in. 1Aurrs~ f]u. Sx- CaM. Color tar Sz Sh. '!~1 o ., ~ -- s~'G ~ F S 2 ~• ~- ss-c ~ 3 7- - 3 ~r L 7 .1 3 F ~} F U tag ~~ # Grourd surface Elev. 11- ~ b ~'rD factor ei' Pit ~ Rate }boriton DepQ- DomirarK Redox Desuipt%orr Texture Strtx.'kre Cot~istence BowdarY Roots GF'QNf in, QbrxtseN Ck+. Sz. Cant. Color Gr. Sz. S7r. 'Elglt •Etfirl ~'~ # Ground surface elev. d. t)epth b tb factor ~ U ~~ pit Sad Rate R t ~~ Depttr irr. Dominant WlutseR Redox Desuipdon Qu. Sz. Cats. Color Texture SUrudrre Qr. Sz. Sh. Consisfarce Bounrtary oo s ~~ ~~~ ' EfRuetd pt = li~D, > 30 _220 mgll. and •Tta'S. >30 <_ 150 mglt. ' Eflkient bt2 ~. QOl7~ = 30 mgll. and T•SS ~ 30 rtg~L The Dcpanment of Commerce is an equal opportunity service provider and employer. If you recd assistance to access services ar recd material in an ettertlatc format, please contact the dcpattmeal at 608>~t-~3t41 orTfY648-264-8777. aeca~ota~l ~,•Ju1.12 03 07:50a FOGERTY PLUMBING 17156355286 p.4 Foge 221 84biag 28288 McKenzie Rd. Spooner, W! 54841 ~ W,'D,yF LsT '~ S (715) 635-9 ~/~/.~ ,r1,F~ °B~, xr/ dF ,z"Pv~ ~ /~ ~,~R ~ft~i~+l/9Z=tST eve , d dzl " /KT ~t~ f0/ I F S/6~L G F,~c~ post, ts/- ~,w~, tl y ~ ~ ~ \ ~/ ~ \ _.: ~ ~yt ~ ~ , yov.~~ r ~ //w~` 1 ~ -. ~ _ 1 ~ ~ ~ ~ ~ 1 • ti ~, ~ ~ ~ ~ i ` , ` ~ . J' II a- ~ ~a ~• U ~ ~ s ~ t ~ -~ ! - ~ ~3 ~ ' ~ r ~ ~ • ~ ~ f ` X • d• ~ as - d dart' ~iYW ~ ~ - it' 1 Wi~cons)n Department of Commerce SOIL EVALUATION F2EPORT Page ~ of .3 Division of Safety and Buildings - in accordance with Cnmm R5 Wic nrlm r_r,.io _ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~ J+ ~ rL l include, but not limited to: verGpl and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel 1.D. f1 ~ ~ ~ ~~'~ ~2 U u Please print all information. Personal information you provide may be used for Privacy Law, s. 15.04 (1) (m)). viewed y oat ~ ~ Z7i /, 3 (J J Property Owner ,~„_ ~~ 1 (~ Prop rty Locatio Govt Lot SE 1/4Sw 1/4 S ~(~ T ~q N R IQ E (or W Property Owner's Mailing Address ~ 2 6 2002 City State Zip Code hone X C~;;; ~ , v~ t G (7 > Lot Block # Subd. Name or CSM# City ^ Village ~ Town Nearest Road ®-New Construction Use: [r~Residential /Number of bedrooms ~ Code derived design flow rate ~~ ~Conl) GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~. ~ 1 Flood Plain elevation if applicable /y~.g ft• General comments Sy~~r,,^ ~~~v. ~(10 , O ~,~- ~~, -- 11 ., and recommendations: /~ q c~ I'G~-~- Boring # ^ Boring I ®Pit Ground surface elev. 9 $ .qo ft. Depth to limiting factor _~_ in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 ~ b- lU r 3{2 ~- Si I ~ ~ 1~ rn~r ~S ~~ -~ - 5 . ~" 2 - l S+ I 2mSb r ~5 - ~ 3 Z2= 10 3l ~~ Zmsblc ,M~r LS - . Fj . 4 " -45 l rg I C3P ~.5 r y (~ vas Ua ~ -- . ~} Boring # ^ Boring n p ®pit Ground surface elev. `7 0 . ~ ft. Depth to limiting factor ~_ in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2 I o- ((~ x312 - S~ I l~r c S ~ v~ . 5 .3' Z - (~ ~4 - ~i 1 2•mS k r c-S - 3U- C2p~.5 ~y SL.. 2msbl~ ~' - -•••--••. ... - ..vvs - vv - u.v ,.,aye o~w ~ VV ~JV ~ IJV 111 L - = 5_ mg an < m CST Name (Please Print) $i/gn~ture / CST Number Address Date Evaluation Conducted Telephone Number / l ~- s ~ ~ -- SBD-8330 (R07l00) Property Owner Nt~[.`~'-'l Parcel ID # Page ~ of Boring" Boring # ~ , ~D ft. Depth to limitin factor L ~ in. pit Ground surface elev. g Soil Appliption Rate dox Description R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell e Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z (- l ~ 4~ gil 2 r,r~r cS _ _ ~ ~ I C t';7 v ~ OS m1 - ,~ -Cv Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. SAiI Appliption Rate tion Descri d R Texture Structure Consistence Boundary Roots GPD/fl2 Horizon Depth in. Dominant Color Munsell p ox e Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil Application Rate tion Descri d R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p ox e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 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) S PAGE~OF 3 r SCALE:1"= ~ O BM 1 ELEVATION /~ a , ~ BM 1 DESCRIPTION -(-o,p p -~ (~ D U'G fp ~ D ~ --~- BM 2 ELEVATION ~~~ Z ~ BM 2 DESCRIPTION ~ n n ~ (~ D,r~ ~,; n P SYSTEM ELEVATION !C:rO.O ~ SYSTEM TYPE~~Uy n r~ Sy S~e r/~ CONTOUR ELEVATION ~ q. Sd U ~~ k'~ ~, C~ ~~ ~U 0 G ' 1~~ .Z ~U q~ ,, ~~ ~ ~~ i ~~ 'e ~~ti ~~ eb SIGNATURE ,~ Sic, ~ f ~- - DATE /; ~ ,~ ~-- C~~ 1L U 2329 P 28.2 Document Number STATE BAR OF WISCONSIN FORM 2 - 1994 WARRANTY DEED This Deed, made between James D. Henry and Allan C. Nyhagen a/k~a Al].al C. NyY~agert Grantor, and Patricia K. Hoeper and Tanner N. Turnquist , ga ~p i n t t:P.rlaIl't8 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 5, Plat of Burkhardt Prairie in the Town of Hudson, St. Croix County, Wisconsin. Recording Area 7 3 i 8S6 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , NI RECEIVED FOR RECORD 07!24/2003 09:30AM MARRANTY DEED Ey:Et~T # REC FEE: 11.00 TRANS FEE: 206.70 COPY FEE CC FEE: PAGES: 1 ~ame and Re~rn Address_ _. n ~~,,,,/~~ ~,Cuo..a~t , ~/~ S~ G D ~ - J~S6 fl . Part of 020-14 This is not Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this __~ day of July 2003 • July 2003 authorfsltal•byr~l}•4U6.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) * ames D. Henry Number (PIN) homestead property. Q~) (is not) 1~-- ~ V W~'"'4~ * Allan C. Nyhagen, a C. NyY~ya'1 __ __ ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. -~/Z?~ County ) Personally came before me this ,•N••••!•••••r.,. day of July 20~~t~• ;~bc~,trnatned James D. Henry P~.•' "~ ~ "•; ~. ~ ~ . b-.Q : ` - to me known to be the person(s~ex tdkl t~ fof~o g in$Ctr~um-~ent and ack wle ed tli~ ,~ .•' * - . o~.r+r.~. Notary Public, to of Wisconsin My Commission ' o ,state expiration date: ~~~ la/a~~~ ~~) * Names of persons signing in any capacity must be typed or printed below their signature. 1Mormation Froreaaronak company, Fond du t4" wi WARRANTY DEED STATE BAR OF WISCONSIN eao.65s-:az+ FORM No. 2 - 1999 AUTHENTICATION Signature(s) Allan C. Nyhagen ~a A11S1 C. NyI'Hyal MRY 27 2002 9:19PM HP LRSERJET 3200 p_5 t'P,^.-21-2®83 12=41 F.EMhX TEAM f. k'£ALTY ?35.361 $728. P. _~: ~r i~u~ ~ailaa f}» 9k (ir'~ •~+ty taWip aliea-pn1 U~. Ta.n.f B.na.n ~ . :. a..i - ... ~ .,,,, .. .~....-~' .. ~T • . w 3 ~ d~ •-•• ~ •~ if ~ ..... .eoo~o~srw~easr I fig. ~ ~~~ ~ ~ ~•• ~ • 8 ~ . w :. ~"~ • yd ~ ; ~` .. ~ , Q ~ I ;. ~• ~ 'G ~ ; ~ ~`~ ` ..... S ._ ~ , t ~- ~ Y J ~ ~ d_ ~ ~ '7y ' ~ ~ ~ if .. ~~ ~~~ ~ - .` ~~ f4 ~ II r +aN N tea O o4N - ~ ~~ ~ V nlbi r~ Z ~ _ ~ ;~ ~ ~ S'd S96S-6~S-SiG uost,~e0 umeyS d04~Zi EO TT unf ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ' AND OWNERSHIP CERTIFICATION FORM OwnerEBtrrcr ~T/!-A/.y~.e 7`u~i0i~s_tT Mailing Address Property Address City/State (Verification required from Planning Department for new LEGAL DESCRIPTION -~.~~~ Property Location ~ '/,, Su/ '/,, Sec. to , T~_N-Rf~\rir, Town of ~r~~SD~ Subdivision l~ ~¢,ct~z- ,~itt.E ,Lot # ~_. Certified Survey Map # '-'- ,Volume .._- ,Page # Warranty Deed # ~3 [,-~.~;6 , Voltune Z 3 z ? ,Page # .2-~z Spec house ^ yes Cta'no Lot lines identifiable ~C~3!yes ^ no SYSTIJM MAINTENANCE - Improper use and maintenance of your septic system could result in its premature failwe 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 alTect the function of the septic tank as a treatment stage in the waste disposal system. The property oamer agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undcrsigacd 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 ResowceS, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days~f the three v~ar PYn~r~/.n.. ~_~- t ~~' .~ t.-~,,.t_._.- SIGNATURE OF APPLICANT Q / aL/ ~3 DATE OWNER CERTIFICATION I (we) certify that all statements on this [orm~are true to the best of my (ow) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ' C.-+......-....... SIGNATURE OF APPLICANT DATE *"*'• Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. "*"' --` '• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed On.-.y~r ~... .~ . - - .~- Parcel Identification Number ~9.ZQ - /S/iZ -SDI At-grade System Management Plan Pursuant to Comm 83.54, ws. Adm. Code General This system shag be operated in accordance with Comm 824 Wis. Adm. Code, and shag ma~ined in accordance with its' component manuals [SBa10570.P (R. 06199) and SSWMP Imo. 9.6 (01/81)) and bcal or state odes perta'sring to system maintenance and maiMerrarrce reporting. No one should ever eater a septic or pump tank since dangerous gases maybe present that could cause death. Septic and pump tank abandonment shag be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to faqure must be replaced. Exposed access openings greater than 8-inches in diameter shah be secured by an effective lodcmg device to prevent acdderrtal or unauthorized entry krto a tank or component. Septic Tank The septic tank shag be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The cwrrterds of the septic tank shah be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic lank and outlet filter shah. be assessed at least once every 3 years by inspection. The outlet fQer shah be deaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisior>s are made to retab soNds in the tank that may slough off the titer when removed from its endostre. tf the iilter ~ erµdpped with an alarm, the tNter shah be serviced if the alarm is adivated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sk~dge and scum n the tank exceeds 1/3 the volume of fhe tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shah advise the owner of when the next service needs to be performed fA maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generagy not required. However, if such products are used they shat be approved for septic tank use by the Department of Commerce. Puma Tank The pump (dosing) tank shah be inspected at least once every 3 years. AN switches, alarms, and pumps shall be tested to verify proper operation. If an effkaent filter is ~staNed within the tank it shah be inspected and serviced as necessary. At~arsde and Pressure Distribution SvsUem No trees or shrubs should be planted on the at-grade. Plantings maybe made around the at-fade's perimeter, and the at-grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative mairrtenance) on the at-made is not recommended since soq compaction may hinder aeration of the intNdative sraface wifhb the mound and snow oompadion in the winter w~ promote frost penetration. Colo weather inst-aNations (October-February) dictate that the at-grade be heavily muld~ed as protection from freezkrg. Influent quakty into the at-grade system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank eifluerrt or 30 mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 10° cfu/100 mL for highly treated eliluent_ Influent flow may not exceed maximum design flow specified b the permit for the instaiation. The pressure distribution system ~ provided with a flushing point at the end of each lateral, and ft is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the it~al test when the system was instaged to determinerf orifice dogging has occurred and if orifice deaning is required to maintain equal distnbution within the dispersal ceN. Observation pipes within the dispersal ceq shah be dnedced for effluent ponding. Ponding levels shah be reported to the owner, and any levels above 4 indres considered as an impending hydraulic faikxe requiring additional, more frequent monitoring. Corrtirraerrcv Plan If the septic tank or any of its components become defective the tank or component shah be repaired or replaced to keep the system in proper operating condition. if the dosing tank, pump, pump controls, alarm or related waing becomes defective the defective component(s) shah be immed~tely repaced or replaced with a component of the same or equal performance. If the at-grade component fans to accept wastewater or begins to discharge wastewater to the ground surface, 8 wql be repaired or replaced in its' present location by creasing basal area if toe leakage occurs or by renovating the biobgicaNy dogged absorption and dispersal media, instaging new piping, and replacing other components as deemed necessary to bring the system irto proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Tanner Tumquist At-Grade Transaction Number: Page 6 of 8