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HomeMy WebLinkAbout020-1413-50-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GE"";~~~-L INFORMATION y ""~ (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Sienna Cor Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: / 6 ~ ' U o p , o (~ yl,, ~/ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~-l ~~ Aeration Holding ~--~"~~ TANK SETBACK INFORMATION TANK TO P L WELL BLDG. Vent to Air Intake ROAD Septic MM ~ L r7T l r~ Dosing `~ Aeration ~r_, -- = r°`~ - -_-_~"~-~--- Holding PUMP/SIPHON INFORMATION -- ~' Manufacturer Demand GPM Model Nu r TDH Lift Frictio System Head TDH Ft Forcemain gth Dia. Dist. to well SOIL ABSORPTION SYSTEM p., f ELEVATION DATA county: St. Croix Sanitary Permit No: 430274 0 State Plan ID No: Parcel Tax No 020-1413-50-000 Section/Town/Range/Map No. 20.29.19.2603 STATION BS HI FS ELEV. Benchmark ~ ~ Z ~a~y ~Gb ` O Alt. BM .s'T • ~ Q Bldg. Sewer ~ /b/ St/Ht Inlet Z /pp_ 9~ St/Ht Outlet . ~, /OD• ~ Dt Inlet ~ ~~ Dt Bottom ~ Header/Man. ~ r_ CJ ~~ ~ 2 ` ~ Dist. Pipe G~~-d ~- ~ 3.2 2 . o Bot. System s~.~-- ,e~,v r~,D /. 2 Final Grade ~l ~~ ~~ • zs St Cover r l' ('~ S ~ BED/TRENCH DIMENSIONS Width 1 Length / ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~ _~ (J SETBACK INFORMATION SYSTEM TO P/L BLDG WE LAKE/STREAM LEACHING CHAMBER O MaRaf~Ctvr r/ / y Typ Of System: ~ i O t ~ ~ ,t/ d1Wi 1 ' UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold v Gl ~ Distribution Pipe(s) c~ / ~' / x Hole Size x Hole Spaci~ Len thy 'r ia ~ Len th Di i ~ S g g ng_ a pac SOIL COVER z Pressure Systems Only xx Mound Or At-Grade Systems Only t ~ ~ "~` Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched ~ Bed/Trench Center Bed/Trench Edges Topsoil Yes [~ No ~~ Yes [JA^N®®o~~ ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~~/ ~ Inspection #2: / / ~"2~i~ Location: 773 Martin AveCnue Hudsotn~, WI 54016 (NE 1/4 SE 1/4 20 T29N R19W) The Glen Lot ~"t ~ Parcel No: 20.29.19.2603 1.) Alt BM Description = J T' ~y ~~ I /~- ~/%~ ~ ~~ -~,hQ~ /J p.~/~ /,,~ /~~ 2.) Bldg sewer length = S~ _ >I ~R.n,,.LL f~[, / L `11 ~ 1 iow _ w/vr - amount of cover =~ 3 ~ /~ ~ .. ~^" _~, n ` G' ~ tj,(ti1 ~ /~Zr~ ~~ ~1.. ~~7~L~-~-- . ' Vent to Air Intake 9 ' ~formatio~ ~ j~ 2(O ~3_~ ~I ._- -- --Y ~,!<li~!~-.~ ~ ~jr~°~JI, ~f , Use otherls de for additional in Yes o II Date Insepctors Signat a Cert. No SBD-6710 (R.3/97) RECEIVED Saf ty and Buildings Division County ~ a N~V 2 2~~• ashington Ave., 1'.0. Box 7162 s'C GYd ~ i~, ' js~j®~ ~~ M icon, WI 537p7 - 7162 Sanitary Permit Nam r (to be filled in by Co.) Department of Corct erc~~• CROlX OUNTY (608) 266-3151 ~ 30 2 ~ SQ~~ Sant IlCat>iun State Plan T.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ' -~ may be used for sec;ondat-y purposes Privacy Law, s15.44(1}(m) Project Address (if different than mailing address) I. Application Information -Please Print Ail Information ~ ~ ~' 3 M A rJ~v ~~ . ~ _ Property Owner's Na me azc el # Lot Block # q' p ~ Property Owner's M ailing Address Propetry Location ~ 'y ~ Cit ,State Y Zip Code Phone Number k,Section ~Q -^ ~ +,.,~ ~,~/p_ ~ ,~ ~ II. T e of Baiidin (check all that a t (circle e} T .2g N; R~E ~1 or 2 Family Dwelling -Number of Bedrooms '7 Subdivision Name CSM Number ~ Public/Commercial -Describe Use _ __ _ ~ e. ~ ~~ ^ State Owrted -Describe Use _ - ^^ ^Ctty~^Village •~Township of ~dge~1/ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p2o - ~ ~! - S'o - 2 ~ 3 A• Ne ^ Re lacement S stem .~ p y i ~ ^ Trea[menc'i}Ioiding Taal; Replacement Only , ^ Other Modifi,:ation to Existing System j 8. ^ Permit Renew Permit Revision ~~ Change of~ ^ Permit Transfer [o New i List Previous Permit Number and Date Issued Before Expiratia r~~S Plumber Owner ~ ~ `~3aZ~~ g~Zs~ 3 ____~ IV T f . ype o PO WTS System: (Check all that apply) _ _ Lt9_.NOR -Pressurized In-Grou[ld ^ Mound > 24 in. of suitable soil (~ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized in-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter f LV Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less_Pipe ^ Other (explain) V. Dispersal/Treatment Area Information: _ (o,S-p Design Flow {gpd) Design Soit Application Rate(gpdsf? Dispersal Area Required {st) Dispersal Area Proposed (sf) Syste Elevation tfMt C~v ~ 7 8.-$'~ ~ 5 7 ~~`~ ~~d ~ VI. Tank Info Capacity in Total ~ Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons ~ of Units Concrete Constructed Glass New Existing F ~ Tanks Tanks Septic or Holding Tank -- - Aerobic TreaGnent Unit Dosing Chamber - ~~~~ _ VII. Responsibility Statement- I, the undersigned, assume responsibility for ' ~ allation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature I MPRS Number Business Phone Number Pl b um er s Addre ss (Street, City, State, Zip Code) 1 Q ~~ ,~a~~~~ GrJ~` C f VIII. Count /De artment Use Onl - ~, Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is uin Agent Signature ( o Stamps) Surcharge Fee) t,, ^ ~ - ~ Owner Given Reason for Denial '°`~ z S # IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3~ ~~~ ~S1e+~S ~ ~ ~~ ~ 1 Septic tank effluent filter and (~'~~ , ~~ f~ ~~~~ t d / i t di l ll ll b i i d spersa n ce mus a e serv ce ma a ne Q . as per management plan provided by plumber. y.p ~5 i~ ~ 0. d''C'/~~'tor ~) 1 t n, 2. All setback requirements must be maintained as per applicable code/ordinances.. ~~ ~-~- „ _ ~~ ~~~ / ~ /" 4ttach complete nlanc 6n fha f`nu.,~., n..t.,1 C . ,~.., ..,._,_....._ .. • • - -- --- -. ----- - r :-. ••-. •.~~ ..,..... oa,., w as mcuee m stze SBD-6398 (R. Q1/03) SEQ .~,-~ / ~ ~ Y~ / /~ '~G a D'G. d /~/ ~=- ~~~3 ~e~ c ppY ~~ ~ S r'e ~/./,~ G ati~ ,moo, ~ I T~ ~ A~.e~/ T rvrJ ~t ~ ~ ~s'D.r.~ 9 ~ ~~~ ~.~- /f1 ~ . ~~a c o'er. ° /1/ ~~ ~- t .. Wisconsin Departrnent of Commerce • ~pivision of Safety and BuNdings SOIL EVALUATION REPORT Page ~ ot~ in accordance with Comm 85, wrs. nom. ~.ooe Coup _- ~!`r~ ~ Attach complete site plan an paper not Tess than 9 i/2 x 11 indres in size. Plan must but not limited to: vertic~Pand horfmntal reference point (BM), direction and indude parcel I.D. , and location and distance to nearest road. north arrow scale or dimensions l , ope, percent s , ~ Date Please print tt tnt~~~VED Re ed by Z NbV Personal intortnation you provide maybe used / r secondary purposes (privacy Law, s. 5.04 (1) (m)). . PropertyDwner NOV 1 7 2003 P G petiyt.ocation U 114 SZ(h (~ vtLot ~ 114 T ~e(N R ~ E(or)~ On , . Property tier's Malting Address ST. CROIX COUNTY L t Block # Subd. Name or CSM# ////'' DD ~ O~ /'P'~o[Jo h ' ZONING OFFICE K. ~ l9 City State Zip Code Phone um r City ^ Yilage (Town Nearest Road ( ~ '~ New Construction Use: ~ Residentrai !Number of bedrooms _~.,~ Code derived design flow rate Z/~~l ~ ~ GPD ^ Replacement ^ Public or commercial -Describe: _ able li ii i -' -~~~ ft• __ c on app --- Fbod Plain elevat Parent material __~~S h _T~-- __. k General comments ~ ~f ~ ~ ~ ~ QU, ~V and recommendations; ~ / I [~ 8oring Boring # Pit Ground surface elev. 9~ ft. Depth to limiting factor ~~ in• Sod tca6on Rate Horizon Depth Dominent Color Redox Description Texture Swdure Consistence I Boundary Roots GPDIfR in. Munsel( flu. Sz. Cont. Cobr Gr. Sz. Sh. I 'Eft#1 'Eft#2 ~,ZO G / s m I i - - ~ .z i i o. 9 •9~ ~ 0 12 ~g 11 I w3 Boring # ~ Baring p Pit Ground surface elev. /~~ ft. Depth to limiting factor ~y~ in. Sob Ap iCation Rate Horizon Depth Dominant Color Redox Description Texture Structure CDRSistence (Boundary Roots GPDJ'fEr in. Mansell flu. Sz. Cont. Cobr Gr. Sz. Sh. I ~f ~E~1 ~~Z ~sa3 ~G r Y~ - , ~ ~~ ~ -- , l , ~ I .9p 9t•9o -' tz. I Efttuenl *t = BOD > 30 < 220 rngn-and TSS >30 <_ i50 mgll, ' tmuem ri"[ = csw, ~ au mgrs arw ~ ~~ = av ,,,y,~ CST N (P{ease Print} ~ Signature '~~ CST Number Q~ ,.~t a .~-r ~ ~s33 0 q~T' S Date Evaluation Conduced Telephone Number t .. SO j•~ /~Sa r~ Pareel ID # Page Z- of _,~ . Property Owner _ [~ Boring Q ~Z in• ~ ication Rate a Bonng # [~ Pit Ground surface elev. // ~ d ft Depth b Gmi6ng fetXOr Horizon Depth Dominant Color Redox Description Texture G Wctus Consistence Boundary Roots .E~GPDfft?EB#2 in. Munsdi Qu. Sz. Cont Cobr ~_ 1 u L o o. i~/Z ~ ' ~ ~ ZM Y~1-~r G ~/° ~Z - .S ~ ~ / 9-/7a i.. _./// ~.~ ^ Boring # ^ Boring -- ^Pit Ground surface elev. ft. Depth to limiting factor in. Soo A olicatian Rate Horizon Depth Dominant Color Redox Descrfplion Texture Structure Consistence Boundary Roots ~E~GP) ~'Eff#2 in. Mansell t1u. Sz Cont Cobr Gr. Sz Sh. 8oring ^ 8oring # Ground surface elev. R. Depth to limi5ng ~c~r _ in. ^ Pit rSoli Aoolication Rate Horizon Depth Dominant Color Redox Oescriptbn Texture I Siructun: Consistencs+ Boundary i Roots GPDIt~ in. Mansell 11u. Sz_ Cont Cobr Gr. Sz Sh. ( 'Eif#1 ~ 'Eif#2 _ ~ i I i ' Effluent #1 = GODS > 30 <_ 220 mglt and TSS >30 < 150 mglL ` Effluent #2 = i30D5 < 30 mclL and TSS < 30 mgiL 7"he 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 608-2bb-3151 or TTY 608-264-8777. BBD-S3301R.07/00) /, r •. PAGE~,OF~ NAME:~~'~5O i~ LOT# LEGAL DESCRIPTION:.G4/I/4~yi I/4,S~T~,,N,R,~E(or~ SCALE: I"= ~U~ ,;>~. m\ ELEVATION: I dCJ• d "^4 1 ~~ ,d!'~~ BM 1 DESCRIPTION: c~D (~ a -~ ~ 0 Y L p ~ ~~ BM 2 ELEVATION: _ ,~;,:;. ~-- 1 BM 2 DESCRIPTION: ,;. c~ Q :~ SYSTEM ELEVATION: / ~ • [ r; SYSTEM TYPE: ~,n ~$ /~-I-,r ~ ^a-~ ~ ~ / .: ~/ DATE: ~/--~~ °~ SIGNATURE: i Safety and BuEEdings 1?ivision county r S~ GY ~ 20l W. Washington Ave., P.O. Box 7162 o ~ ~ /~~~~~~~ Madison, WI 53707 - 7162 Sanitary Perm't Number (to be filled in by Co.) Oe artment of Commerce (608) 266-3151 ~ ~"~ Sanitary Permit Application State Plan I.D. Number .NI yl ou~rovide ersonal information Code 21 Wis Adm In accord with Comm 83 , p , . . . may be used for secondary purposes Privacy ~ Law, ~~ ~„•, ~ Project Address (if tfferent than mailing address) I. Application Information -Please Print All Informati :, i ®~ , ~~ Property Owner's Na me Z ~ r Parcel k ,/~,, Block fl -~y13'~V t ~~.~ ~ aa ~.-~: ...~..- -- Property Owner's M ailing Address - Property Location o a /"~~ ~ N G f7 i ;(J Y S' " ~ O O ~~ ~4,~~4,Section a O City, State Zip Code Phone Number ,;vice~ .f~ ~5~3~ GJ~!'~_~'3~j-°~~0~' T ,~~~<''N, R ~~{CEo,~/) L~ 'V ~ ~ / l ) ll th t h k f B ll ' _ , _ --- i.. ~ ~,, e~, y a a app ec u (c II. Type o Subdivision Name CSM Numbet or 2 Family Dwelling Number of Bedrooms ~ _ s l i U l D ^ ~ ,.l/ se - escr PubliclCommercia ^ Suete Owned -Describe Use b -ST'~~-~--f W ~ -k-K-v~ ~9 ^City`^ViRage~Township of~ III. Type of Permit: (Check only orie. on lin A. Com ete line B if applicable) A' New System ^ Replacement System ^ TreatmenUHolding Tank Repiacemedt Only ^ Other Modification to Existing System l3. ^ Permit Renewal ^ Permit Revision a ^ Change of ^ Permit T!'ansfer to New List Previous Permit Number and Date Issued Before Expiration plumber ~. Owner ~` itV. T of POWTS S stems (Check all that a 1 } ' Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soiP-- ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass and Filter ^ Constructed Wetland ^ Pressurized In- und-^~ding Tank .~~ Peat Filter ^ Aerobic Treannent Unit ^ Recirculating St Filter ^ Recucttlating Synthetic Media Filter Leachin r ^ D ' ~I.t ^ Gravel-less Pi ^ Other (ex lei ) V. Dis ersal/Treatment Area Informs ~ ~ . -~ ~ ~ E Design Plow (gpd) Design Soil Application Ra Dispeysal Area Requird~(sf1 Disper al Area Proposed (sf) System Elevation ~ ~, ~ >> ' X7 ~ ~ ~ ~s ~ ~o~ a~7 ' ~., 0 ~ / Manufacturer ,~ Prefab Sit ee 'Fiber P stir VL Tank Info Capacity in Total Numbti'r Gallons Gallons of I3riits Concre nstru~ Glass New Existing Tanks Teaks Septic or Holding Tank ~ ~ a~'(J / ~ ~~ ~.~ t,, ~` ~~ Aerobic Treatment Unlt Dosirsg Chamber fi G{ ~ ~ ` ~ S' E' i VII. Responsibilit Statement- i, the` o ersigited, assume responsibility for ' at of the POWTS sh o the attached plans. Phumber's Na me {Print} Pl tier's Si gnature P/ umber usiness Phone Number ~~~ ~ Wf , ~ ~4 AK ~Gd7A. ~'~l~ ` f~ Plumber's Addre sa {Strcet, City, Stat ,Zip Code) ~ ~ so ~ ~ s V :Count /De artatent U e Onl Approved ^ Disappro Sanitary Permit Fee (includes Groundwater Da Issued 'ng Ag t Signature o tamps) Surcharge Fee) ~ ~ ~~ ~ ~ ~~ I Q 3 ~6~ ^ Owner Given Reason for Denial IX. Conditions of Approval/Reasons fQr Disapproval , ~~ ~ ~ k , ~~ S~ ~ ~ ~ ~o wNt~ p~Q~7w~- ~DL'~ S ~ G~'~~ `7 c~ ~~ ~~ ~ S ~ ~l~ ~.6-'t'~L~JG //i I/l~/I n ~m.K.G+~2 t%/,I/h~/l.~ ~/~U~t/1.~ ' `l~iliYri~2~2.IhK1z~ ~i(~h... ~(~~ ~'~~ ~~~~ li S D~9~(] pt-~~/C~ ~ (tom; ~ County onty} Ibr the ~'sy~st~ JQn_ ~apcr not ~~i!/K~7u/ltivlyt,~f J~/~L-LEit_~~%~(~ ~'vl~-~/h^~l .(/~ x 11, itches in slz . ~3 • ~3 -/ ~~1ao ° %~,r~o~ 1 em. 8D' ~Q/. S ~ sys~ 3' ~~'~ ~,~~J~ 0 'ly,~a~ /Od. d i uWC, v~ SEPTIC TANK ~ FL'MP CHAMBER CROSS SECTION AND SPECIFICATICNS 4" CI VENT PIPE 12" MIN. ABOVE GRADE ~ >_ 2S' FROM DOOR, WINDOW OR FRESH AIR INTAKE FINISHED GRADE 4" CI RISER --+ 18" iN. 6" MAX. INLET I (~~ f WATER TIGHT SEALS tPPROVED 'IPE 3' INTO SOLID 'OIL PUMP OFF ELEV . FT . MiEATH£RPROOF JUNCTION BOX APPROVED WITH CONDUIT MANHOLE COVER W/ PADLOCK ~ ~--- WARNING LABEL ~, ~"~ ~~_ k " MIN. . :; } ~~ '~ ~~ ~ '~ GAS- ~ ' TIGHTS `, A SEAL 8 e __f._ ' ALM B ~ ' ~ON , ~ C ~ ~~ --~-- ~ OFF ~D ~~ at JAPPROYED JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL ~* RISER EXIT PERMITTED OT1LY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK 1 CONCRETE PAD SPECIFICATIONS SEPTIC ! DOSE J) TANK MANUFACTURER: G/~'~BeY' NUMBER DOSES PER DAY: Z TANK SIZES: SEPTIC ~a~ d GAL. DOSE Sod GAL. ALARM MANUFACTURER: MODEL NUMBER: SWITCH TYPE: PUMP MANUFACTURER MODEL NUMBER: SWITCH TYPE: REQUIRED DISCHARGE ~~ ue.l Giy`1~ ,t7L U here Goy/mss ~~ RATE ~(J GPM DOSE VOLUME INCLUDING FLOWBACK: l5 ~l GAL. CAPACITIES: A = as INCHES = _ yG~ GAL. B = 2 INCHES C = ~ INCHES = D = ~ INCHES = GAL . l(8 GAL. 1°~ _GAL. PUMP ~ ALARM WIRING AS PER ILHR 1fi.23~ WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION FIPE l~ FEET + MINIMUM NETWORK SUPPLY PRESSURE . FEET + !'Q FEET FORCEMAIN X x.60 FT/140 FT. FRICTION FACTOR /,$-7 FEET TOTAL DYNAMIC HEAD = X3,3'7 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ~ DIAMETER LIQUID ~ 38'` al-~Ql~~v l " SIGNED: 1~~~~ _ LICENSE NUMBER: ~~'j9,~~ DATE: .~ t~~ ,~3 1l88 ~~ r n, PRGc' '~ '~F , Submersible Effluent Pump ~W~~~ 3871 E -- .., ~rkw-now ~'~ ~ X11 ~~ ~ ~~ • De+wtlOcMtO * +A~i tab; up ttx ~ OPM. ~~e; uR to 2~ tut, ~ iVl~i iql: c~IrboM ~~ .~ ! ~ aer~inuaus 14Q'P t~ 4crt~rNtbr~t, ~: $pQ 9eriN + Hof trxtnl~ ~y ~ dimiQe tO IrR ~ , • ~ m~lip plpibill~, ~ to 60 GRAS. a~tl t .' ~ ~ 3! fart, e a) settee + of running ~wi~J# dtmepe ~ ~, t ~ ~i 8in~N ~bees: 0.4 MP, !1~ ot?.~3V, 6q Hz, !~ RPM, butt in overbid with iutorntdtc~inest COQ HZp! 6Q RPM ~~ !lSV, b~ with + ~utard~t~rtpM i°~513 SJTO v~th tfxee P~nQ prourtdinp pit~p. Optiotui ~ foot ro~~ !d!S SJl'IN with three pprong Qroundir~p piuQ ;atiruiird on f:Pikij, ~. ~~ • i:uJly es~bmerpid M high pDrole tie oil (or iuon ~ effidar~t hilt tnnii~r. AvNttbfe br wtoa+irta ind N~tdi ~Mol~lo~1 Ptoa 1Wt~elt aauabl+~ end ptNtt d ~ ~oiotlt. Fi01'tfill~ ~ ~ IsnpllNt: Thermo- QIe~ Sattl~cpitt deildt- with Rump Out ~ #Or meohenipil ~ protection, ^ EPOb 1+A~~'t Thitmo~ irrrp~raWd plrtOrllftt~Oe.'~t a tad QiM~ Rup~ea therms deiipn pror~die su~br ettOn~th and c~arroilan•rwfe~ce, ~ ~~.rtyo'~r~_lbtiN~{ Cut iron 1!1tiw~ ~ uf1~MV~Y izfet~th,' Ihd dUt'8b1U1Y• ~c oawr wbh inbprd h~die 'std t~rte~toi~ ~edartent p ^ 1bMAr' ~bN: $were duty ratrd op end wetir ntai~int ~ , (tpper~ iawsr ~~y ~y~bit! bu nor u~ilwo t~Ie~iMgddMtMeo~ilaa (C8A Ifitld ntode~ numbe{3 end ht "P" or "AC`. ~ ~ 5 I r ..~....i.~.... I1 ~ i ww ~ ~ w f ... ..+.~..~ N w~w« ~ i -~~..+..~.j ~ ~ 1t ~ ~ ~ E 6 ~,. I 0 ~ i ~ ~ ~ ~~~i 5 I III o ~ 4 rot Y r~.~~~ ~~~~~~ ' .`Y ..ee_...~.._ u.... .....r Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete she plan on paper not less than 8%: x 11 inches in size_ Plan mint County include, but not limited to: vertical and twrizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all informa>+~ -- Personal information you provide may be sed for '` t rw a Lerv, s. 5.04 (1) (m)). Property Owner roperty Location 1168 Page 1 of 3 Steel Soil Service St. Croix Date _ ~ Sienna Corporation t~~ ~:~ :~ ^) ~ ~ ~ Q~c vL t_ot NE 1/4 SW 1f4 S z0 T 2g N R 19 W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 4J40 Viking Dr, Suite 608 ~; r ~;~•cxx CoUrJT~ 9 na The Glen City State Z Code ~t6b~`al `-~~ '`" ~ City 'Village ~~,> Town Nearest Road ,~cf'i,pu, MN 55435 f.S.Z- 835-~~ Hudson Carmichael Rd. New Constntctiat DSe- / Residential /Number of bedrooms +/ 4 Code derived design flow rate 600 GPD __ Replacement Public or commercial -Describe: 2 ~~n b4'Y5 ~- Parent material Pitted ouiwash Flood plain elevation, if applicable na General corrtments ~ k "' .and recommendations: System elevation 91_45ft, trenches spaced and depth to code 3.50ft bebw gade , a Boring # _ Boring 102 Pit Ground Surface elev. 94.90 ft. in. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz *Eff#1 *Eff#2 1 0-12 10yr3/3 none sl 2msbk mfr gw 2f .5 .9 2 12-22 10yr4/4 none sicl ~ 2msbk mfr gw na .4 .6 ~' 3 22-32 7.5yr4/4 none tom-- osg mvfr cs na --~ ~7) L2 4 32-102 7.5yr4/4 none cos osg mvfr na na ~J 1.6 3 S, ~~~ : ~z~~ ~Z `,, v-.~r,~a(.e, ~o-~,~-,-.s -- _ S_' o-~~ - - 111,x,-,~ ~ Boring # .Boring ~ - - ~ / Pit Ground Surface elev. 94.90 ft. Depth to limiting factor 102 in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Stnreture Consistence Boundary Roots GPD/ttz *Eff#1 "Eff#2 1 0-7 10yr3/3 none sl 2msbk mfr gw 1f .5 .9 2 7-15 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 15-72 7.5yr4/4 none cos ,-- osg mvfr gw na ~ 1.6 - 4 72-84 7.5yr4/6 Wane ms osg ml cs na .7 1.2 5 84-102 7.5yr4/4 none cos osg mvfr na na .7 1.6 ~r ~i `f Z l02 * Effluent #1 = BOD > 30 < 220 ma/L and TSS >30 < 150 ma/L * Effluent #2 = BOD < 30 mo/L and TSS < 30 ma/L o ~ ~ - - - - -g- a-- - - .. CST Name (Pl~se Print) Signature: CST Number bavid J. Steel ~~ 248956 Address Steel Soi! Service ~ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W154017 9/16/2002 715-246-5085 Q~~$uy~ J ~ ~l1 /l~A W le ~Q ~'"Tl ~ pQWTS OWNER'S MANUAL & MANAGEMENT PLAN P>39~ ~ of ,~- FILE INIrOttMATION Owner ::~~1 ~ ~~: ~~r ~ ~~ Parmlt * ~~ DEStKiN PARAM@TEli~ Number of 8edroams *-~ 0 NA Number of Pubdo Fanitity Unlta A Estimated fiow taverapel 4/Q'd ailda Design #taW (peakl, (Eatimatad x 1.51 ~'~ 4 aUda SON Apptloatbn Elate a1/da /ft~ Standard InfhugttlEffiuent O~uafity Monthly avsraga• Fats, Oil 8t crease {FQG) 530 mg/L Biaohemioal Oxygen Demand {80D`? 520 mg!!. Q NA Total Suspended 5olida {TSSi s160 dtg/i. Pretreated Effksent Quality Monthly average Biochemioai Oxygen Demand Ii30D,1 s,:30 mg/l Total Suspended Solids (1'S81 s30 mgJi. O NA Feoal Coitform (geametrio mean) 510' efu/ZOOmI Maximum Effluent Partbla $iza Ya in die. DNA Other: DNA •Vslwe typlaal for danw~edo waetewatar and septic tank affluent. 8118TF.M BPECfFK+ATIVNisi Septic Tank Capacity ,? d al Q NA Septic Tank Manufacturer ~ r O NA ffflusnt FElter Manutectursr ~',~ O NA t?fflusnt FUter Modal d' d ~ Pump Tank Capacity at O NA Pump Tank Manufacturer re ~, 0 NA Pump Manufacturer ~,•.u / Q NA Pump Modei O NA Pretreatment Unit 0 SarrdlL3ravsl Fitter 0 Msottanicai Aeration a Dy~,fection O Peat Filter Q Wetland a other: O NA Dispersal CetltsJ O in-Ground {gravity) O At-t3rada D Drip-Uns DNA [~ tn-arourul {pressurized) Q Mound Q aher~ Others d NA Other. p NA Other: 0 NA t ANC scr~lwl.e 8ervise tEvent Service Frequatoy Inspect ao»dition of tank{al At 1eae4 once every: ~ ~, s e tMaxbttum 3 Years) O NA Pump out oontants of tanktei When oambined sludge and arum equals one-third tYs) of tank volume C1 NA lnapeat dispersal osllts) At )cast onus every: 3 morlthtsl (Maxbtturrt 9 years} sar(si DNA Clean affluent flksr At losat ones every: ~ rranth a? te! O NA month{el q NA Inspect pump, pump controls ~ alarm At least one every: ~-~- O aNrl Flush laterals and prsature teat At )oast ones every: ,--- to ;tea} al O NA other. At least once every: --- monthtsi Q ~artsl ©NA Other: Q NA MAINTENANCE INSTRUCTIONS Inspectione- of tanks and diaparsal calla =hall be made by an individual carrying one of the following iloenses or oertificationa Master Pkrmber; Master Plumber fiestricted Sewer; POWTS Inspector; POW'1'S Mainuinsr; Septage Servicing Operator, Tan inspections must lnolude a vieua! inspection of the tank{el to identify any missing or broken hardware, identify any cracks ar leak: measure the volume of aombir+ed sludge and scum and to cheek for any back up or ponding of affluent on the ground surfacr The dispersal o+aiitsl shall be visually irnpected to check the effluent levels in the observation plpss and to check for any pcndin of effluent on the ground surface. The pending of affluent an the ground surface may indicate a failing condition and requires th immediate notification of the local regulatory authority. When the combined accumulatlan of sludge and scum in any tank equals on8-third IY~1 or more of the tsnk volume, the antis contents of the tank shall be removed by a t3eptage Servicing Operator and disposed of in acaardsnoe with chapter NR 1 t; WieaoneM Adminlatrathro Code. Aii Other eeNlOee, lnoluding but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmer units, and any ssrvloing at Mtervals of S12 months, shall be parformad by s oertitad PCWTS Maintainer. A service report shalt be provided to the local regulatory authority within 10 days at compietlon of any service event, Pogo ~of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks} for tt+a presence iDf painting products or other'chemicais that may impede the treatment process and/ar damage the dispersal cf3iltsl. if high. aancentrations are detected have the contents of the tsnk(s} removed by a septage servicing operator prior to us®. System start up shall net oocur when soil conditions ors frozen at the infiltrative surface. Purina power outages pump tanks may fill above normal highwatar levels. When power is restored the excess wastewater will be discharged to the dispersal cells} in one large dose, o~reloa~d~g tankcreimoveddby a Septage Servicing Operatorfp ardtoc estoering effluent. To avoid this situation have the oontents of p p power to the effluent pump or contact a Plumber or POWTS Maintalnar to assist in manually operating the pump controls to restore nomtal levels within the pump tank. po net drive ar park vs'hicies aver tanks and dispersal cells. Da not drive ar park over, or otherwise disturb or compact, the area within 16 feet dawn slope of any mound or at-grade aaU absorption area. lieduatlon or elimination of the following from the wastewater stream may improve the performance and Prot d+sinfectantsf tat pdWTS: antibiotics; nabs wipes; cigarette butts; COndcma; cottons $ b~adg18°aSe/rharbic das;~meai iscrsaps; mBdiCatiCns; ail; foundation drain (sump pump} water; fruit and vegetable peelings; S painting products; pesiicldes; sanitary napkins; tampons; and water softener brine. A~ANOONMairNT When the. POWT5 tails and/or is permanently taken out of service the following steps shall be taken tc insure that the sYStem ~s properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail piping to tanks and pits shall be dlscannected and the abandoned pipe openings sealed. s The contents of all tanks and pits shad be removed and properly disposed of by a Septage Serv~cine Operator. • After pumping, alt tanks and pits shall be exeavaisd and removed or their covers removed and the void space lilted with soil, gravel or anott+er inert solid material. CONTINGENCY PLAN if the POWTS falls and cannot be repaired the foltowing measuros have been, or must be taken, to provide a Dods camp/+am replaoement system: A suitable replacement area has been evaluated and may be uttiiied for the loaat'ron of a replacement sail absorptior system. Tho replacement area should ba protected tram disturbance and eornpaetiee to d otectt ha replscement araanwil required setbacks from existing and proposed structure, fat lines and wells. Fs p result In the need for a new soil and site evaluation io estabtlsh a suitable replacement area. Replacement systems mus oomply with the rules in effect at that time. Q A suitable replacement area is not avaitabte due to setback and/or sail timttations. Barring advances in PaWT; teohnotagy a holding tank may be inatatied ss a last resort to replace the failed ROWTS. sit ~~ p sit tan • D Mound and at-grade soil absorption systems may bo reconstructed M place fallowing removal of the blamat at th infittrative surface. Reconstructions of such systems must comply with the raise in effect at that time. < <WARAllNO> a SEPTIC:, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN L>:THAL BASSES AND/OR INSUFFICIENT GXYGEN. QQ NC ENTERN ~M~1'~}I~uNTPF.ROIROl01 OFFA AN MAY t3E D RFICVLT OR MPOSS BLE TANCES. OEATH MAY RESULT. RESCUE OF , pERSO ADDITIONAL COMMENTS POWT8 iNSTALLiER POWTB MAINTAINER Name `~f . ~ Noma ~ ~ s.-~ w Q L~ Phone ~ C -- ? ,w ~ „x Phone SEPTAGE S VICINl~ OPERATOR iPUMPER} LOCN$fieDUST GP H?CI ~~ ~ ~ _....----- Name Phone Phcne 3 ~ ~ ~~° ~~ This document wee drafted in aomplisnae with chapter Gamm 83.22i21tb}!t lldi&!fl end t33.5411t, (Zl >!< l3i~ Wisconsin Adr+itnistrative Cede. ~~ l~i ` ~ Stl'fiTE BAtF OF WISCONSIN FORM l - 1998 U66p$rID WARRANTY DEED KATHLEEN H. WALSH [R]~ry c kFGISTER 0!= DEEDS Oncument Ntrnoer YP'. ~ 7J I pA6[ 6~,3 ~ 5T. CkOIX c0. s WI '. _,_,... _ __ - RECEIVED FOA AECOk6 This Deed, made between Bane Corporation, ~_ 12-21-20@1 3010 PM a Minnesota corporation ~"-" WAAAfWTY DEED _.._ J ..~~____.._._ E%ENpi M .._.. __ _-_ _.___ ~~_~~ Grantor. CER1 CORY FEE: '' and S},gts„[ a~Co oorat phi. a Min~,gQta coroo_ration _ ,~ CDPY fEE: TRANSFER FEE: 9B63.S0 •---- -- ---- RECORDI!!O FEES 17.OD -~._ -..-... - -- RAOESs ~ __.._~ ..___._ ~.._~, Grantee. Grantor, For a vatuabie consideration. conveys to Grantee the following ''' ': described real estate in St. CroiX ~ V ~ County. State of Wisconsin , I (the uroperty) Necsicrn~q.aoa _. ,I See Attached Exhibit A ' Narrwand•aaumAdm~as l ~ llil~f~ ~ ~~~ S~~ 5 mei~r~i TX } ~ ~.l i v~~~ ~~n ka,... ~ ~ 553' _ - _... _ Q 20-104830-000 Parcel Itlentification Number {PIN) t is not his homestead property. (ls} (Is not) 20-1048-60-000 20-1048-90-000 20-1049-90-aao 20-1050-00-000 20-IO50~80-000 20-1052-20-000 20-1052-70-000 lo6ether with all appurtenant rights, title antl interesus. ~ Grantor warrants that the title to the Property is good, indefeasible in fee stmple and free and clear of encumbrances except See Attached Exhibit 8. !Dated this 20th day of December Bane r oration _„_,~ (SEAL) by ( _ ._._. Jo M. Nassef l,ts. C ief Executive. Offic (SEAL) AUTHENTICATION SiDnature(s) authenticated tfsls .day of ilTLF: MEMBEA STATE BAR OF WISCONSIN (tf not. authorised by §706.06. Wls. Slats.) 2001 ACKNOWLEDGMENT (SEAL) (SEAL) Minnesota State of'i+b'f5L'KltB'!R- ss. ~ "r"te`'` `t Count . ^ Personally came~befo~re me this = ~~t ~ day of December 2001 ,the above named John M. Nasseff Chief Executive Officer of Bane Corporation, a Minnesota __ corporation - _ to me known to tm ~ie pers>ftS.1_.,:_~ who executed the foregoing lnstrurnenl and aq THIS INSTRUMENT WAS GRAFTED SY zr~ Lockridge Grindal Law Firm .~.-9.Q.a~las.laang,.ton...i1~v _ ' E. GALLAHER ~ . Minf}eapolis, MN 55401 IJojatgPub11c,5tateofWisconsin __ ,/R"fy tommisslan is permanent. (If not, state expiration date: (5lbnattares may be authenticated or acknowledged. Both are not JanuB~ 31 __, 2~( Q~~.) necessary.) _.. ... __ _._ _. ' Nmncs m arfcona >igning in any cspasiry moor he typed or prin,ad below ;heir s!gneuna- STAT6 6AR OF WISCONSIN w~sconai^ ispau 8tsnk Ca., inc. WAtIPANTY DEbD FORN No. 1 - 1998 MAw#uaea. Wu. 1 2059.E 616 STATE BAR OF WISCONSIN FORM 1 • 1998 r Document Ntunber WARRANTY DEED This Deed, [Wade between John Gies and Pearl Gies, husband and wife, Grantor, and Sienna Corporation, a corporation tinder the laws of Minnesota, Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in the Cotmty of St. Croix, State of Wisconsin: See Exhibit A, attached hereto o les Pearl Gles The parcel shown on this document is being added to the parcel shown on the document recorded in Volume 1797, Page 613, Document Number 666080, described as a parcel of land located: to create on parcel, and this transaction in thereby exempt from Chapter 18 of the ST. CROIX COUNTY LAND USE REGULATIONS pursuant to Section 18.05 {A)(3). Together with all apptutenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: restrictions, covenants, conditions and easements of record, if any. Dated this day of November, 2002. AUTHENTICATION Signature(s) authemicated this ,_ day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by§706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Fredrikson & Byron, P.A. (SMM) 4000 Pillsbury Centec 200 South Sixth Stteet Minneapolis, MN 55402 612-492-7000 2682096 (Signatures may be authetuicated or acknowledged. Both are not necessary.) 6`39gt~6 KATHLEEN H. YALSH REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD 11/25/2002 10:00Ari EIEMPT # REC FEE: ]3.00 TRAAS FEE: 87.90 COPY FEE: CERT COPY FEEL PAGES: 2 Fredrikson & Byron,P.A. 4000 Pillsbury Center 200 South Sixth Street Mimeapolis, MN 55402 Parcel Identification Number (PIN) 020.1049.30.000 This (is) (is not) homestead property. ACKNOWLEDGMENT STATE OF WISCONSIN ) COUNTY OF ST. CROIX ) Personally came before me this a.OrFt day of November, 2002, the above named John Gies and Pearl Gies, husband and wife, to me known to be the person who executed the foregoing instrument and acknowledge the same. C •Notar Public, State of t5C,b110,1Jw.~ _ M Commission is permanent. (If not, state expiration date: . ~) Michelle Beck Notary Public State of Wisconsin ,3 •Names of persons signing in any capacity should he typed oc primed hebw their s(;natures WARRANTY DFED SfA113 IfASl OP WLSCONSnN F~DRAI No. 1-1998 Inlorrrr0an ProfeasNOna~s Canoany Fond du Lec. Wisconsin 800-65b20T1 ~ ~ `~ f / \ ~ ! ~t ~ \ \ EiE i ~ \ ~i ~ i \ i~ \~ ~ rn \\~ ~ ~ \ \ ~' i ~~ l \\ ~'' ~'•, r, ~ ~ r t5 \ \ ~~ /' sp \ ~' '~ J \ .. ~- \/` ~ ~ t i V ~ ~ \\ \ ~ ~ ~~ ~~ b•~/~ , \ \ \\ \\ e ~ ~, \ \ \ \~ ~~i • • \ \ \ j ~ ~/ \ \ \ ~ ~' \\ \\ j / ~ ~ \\ \ ~~ ~ • ~ i\ ~ \ R ~ ~ ~~ \ \ ~ ~ \ \ t ~~ \ \ \` ~ \\ \\ E I \ \ \ ~~ ~ ~ , ,, ,\ o m ,, \ \ ~ \\ \~ \\ 7C \`~ `~ + l ~ \ ~~ N ~ ` \ \\ `~ Ht' 1 • \ \ r