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HomeMy WebLinkAbout020-1420-20-000ti~G~sconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Glen Johnson Construction, Inc., Glen E. John Hudson, Town of CST BM Elev Insp~'M~ lev: BM Description: ^ ~~ ~~ /~, !!/%c~~ ~ / TANK INFORMATION TYPE MANUFACTURER / CAPACITY Septic r F; ~ ~ 3 ~ ~~00 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L ~ S WELL BLDG Vent to Air Int ke ROAD o~ ... Septic ! ~ / ~~ ~ ~ ~ _ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ! Length DIMENSIONS 3 fj0_ SETBACK SYSTEM TO INFORMATION Type Of System: Gorwe~.~-~' a •~ o. Of Trenches County: St. Croix Sanitary Permit No: 515099 + State Plan ID No: Parcel Tax No: 020-1420-20-000 Section/Town/Range/Map No: 20.29.19.2670 ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~ ' ,S5 ~ y, t~ /av • ~~ Alt. BM ~~~.~,,. 95 ~a2..33 Bldg. Sewer SUHt Inlet ~• ~ ~ p, SUHt Outlet 9 , t ~~' Dt Inlet ~ Dt Bottom ~ ~ Header/Man. ia.s y~.~ Dist. Pipe /O.~ g~p. 3 Bot. System //~y g5.3B Final Grade v ~ l ~ 9G~ r D ~P St Co er ~~I ~ ~~~ ~! 95 /a Z . 3 PIT ~- LEACHING CHAMBER OR UNIT rca. Q : ~~'i,ti Inside Dj~. Liquid Depth ay`~ \ DrJ Manufacturer: ~ ~,~ ~~~ ~~/W~ Model Number: u ~ ~G1~ ~ T ;ing Vent to Ai~lntake P/L BLDG WELL LAKE/~~~RE 5 ~?~ S7 ' /",~i" DISTRIBUTION SYSTEM ,Q~ /~ Header/Manifolcj ~ Distribution x Hole Size x Hole Si ~~[[ Pipe(s) ~ ` `_ ~ Length Dia 'f' Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ . Bed/Trench Edges ~ Topsoil ~ ~Cl yes ~ No ~""~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 445 Cty. Rd. A~Hud(s~on, WI 54016 (SW 1/4 NE 1/4 20 T29N R19W) T'h/e Gle Lot 76 ParGcel No: 20.29.19.2670 1.) Alt BM Description = "~~ ~ "~ Go~e'~-~ /~~ C~~ T~ `J ~ ` r~ 2.) Bldg sewer length = a/Z C~.~..~,~~ , ~,~~ e~t~L -amount of cover = / CI aY w ~ / r ~~ N G~ ~ ~ 1JGC(C,Fi l~G o r t T ('o _ _ _ __ ~_ _ Plan revision Required? ^ Yes No xx 1 Use other side for additional information. _' V __ r ~___~_~ , i__ _ ___ ___ _ _ __- __-_- __ I I____ ___ __- L_ ___. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. PAID ~osrmn.tnse.tnn.~r satecy asul fi~diagR Division Z(11 w. waeltingloni Ave., r.o. liox ?lbx ~' GY,~ ~~ Madison, Wl 570?? 1b2 spry Arrmit Nambm~(Io ba fNbd in 6y ~u,) 5/5d5~ Sanitary Permit .AAplicatioa ~ ~ Number In atx~rdanue with s. Comm, A3.21(2k W~, Adm. Code, satxnission of this form, la tho apptt+priato gavertnaealal /U1~' emit is roqulsed prim to nbtaining a sanitary permit. Notn: Appiignion ltattw gur statewwned FOVY7'S sne pmt Addmsa (ifdilli+rart flam sailing address) submitted ~ tlw DetmrtmaM of Cnrnmace. Peroiatal iafarttrlion Ynn ptnvlde maY he used Ror aecandery ~ ~~~ ~ ^ in aooottlMioe with the Pt[va Law s. 15, 1 m Slats, a'c/ 1. A Iicatisa 2aforaaatlon -- Please Prht All I' Pmperry r' Names ~ pp~ it Pn-perty tNvner's IVlaifine Addtess PmpmtY ~ ~ ~~D \ ~~ _ d;t' ~Q 7 ZONING [3avt. Lot City, 9tste Zip Gods Ngmber ~~ '/+, ~ ~ ~ Nectien a2 ~>~.'~, pif'salwll~ {eltcek wll atat.f~~) ok ~ ~ T`?~ ~' ~ f ~ ~ e ~i ar 2 FBtnily nwdling ~ Numtxsr of ~ ~~ ~ Nmtte [~ Public/ConMnerciel - nescribe uaq ~ P ~ ~. gtate awned - rhscribe Use esM Numbcir Vilhgle of Z D : a ~. ~..~ /~ t!~ Gl~t..M.LQ.rS III, T~ ntF P+cnalt: {Chixk Daly sae bslr, ola liar A,. Colaplebn Iltaa B #~ ~) A, New System lteptso~nau TsatmdrHF#DldU1g Tank Replaeametu. ~I' Otba' irledificatitm to 13x 9yMRm (expUtm) 4y~gefn lust Fteviots PamilNtnnba' and pale Issdad R. f'ertnit __._ Permit Revision Change of Pern-it Trtadm~ to Ile~val Hetblre .~------- Phmiber Mew QvYnar on fiV. of 1POWTb S dCo t/Devkc: Cheek all tltat NomFressuriaed tn-(~mur~d FRessurized fnd3round At~Qtade Mound>_?A in, of 1 quad ~ ~ tn. ~s ~l ^ Hokiing'1Ank t]iha'DlspersalCamponant(axptain) _ tksign Fk-w(gpct) Design sass nppttt~an RmeL16~1Ov •,•Pr....•.•..•..°•,__.,,_.,~,_., / ~ CQ / Vl. Tmak lain t:apacity in Total Not' ~ M,tariar Qp(lpps [lelletgt Unite 1 ttattTanka esiplne'Csatce ~ n ,a/L, G ,~ fiepNe or HoNfng Tmd~ pOd 1 ,` 3c., r' Go,u C v toting c]+amUer ~ a~ ptofae>atssnwaweana~d VIi. RespaeNilbiNiy BfateAa[AIt^ J. N,taiber Bnsiiws lhrwniVmabar Piumtier's Natrm tPriMl Pru a sip a ~ ~ 9' ~ ~ ?CS G- is / ,; l1,'ucJyl .5~ ~ u. ~7 x - Plnmher's Addrrs (3ttr~, City, glass, 7.ip Cndt) l d 70 5~~~ ,U a N ~ ' ~~'a VIII. Coua rtlaeat use 4 ~ matted laathig bt° . A1,~o~ed t . I ~ ~0 9 0~ ~ $'$ _. t~ 6"PSf~A~e 3~ ~~~~• l e~tlo ~ v, gei.J {~o+Meow~ tilt;. Cotsi)Il aostt+ for pbitp~rtwttl t>~ ' 1. Septic tank, effluent filter and' ~ ~ ~_ .~,~,,6 Vt7lC~.: +~~"ea`°'~"~ i ~ f ~~~a~ . dispersal cell must all be services !maintained ~ ~ n ` as per management plan provided by plumber. n(~p tJ'G°ol/~ Z, qp setback requirements must be maintained y aCQiWIG ~ ~~ ---------- _ - -- ,.~.otrt. r. s c...w ~b ee psi •~ les aao~ R tai l t udr. tRShe sill SAD-fi39R (R. 0#/b'n Va1id thnx 01109 ~- ~~.Z lid ~``o rrz o ~S.`G~•.u~/tea - '1 ~~ QJ`J ~d'~t c -~ ~y ~.,~.~ I i ~ ~4 s~.3 3 sC (''y may' ~,,v c f,~...~ ,302 ` l~Ge`Ge~ '~S 7~'oo`'et l PAID Wisconsin Department of Comr'~i r SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 2181 Page 1 of 3 A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8%Z x 11 inches in size. Plan must St. Croix indude, but not tirniied to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 0-1420-20-000 Please print all information. Date i Personal information you provide may be used for seconds u ivacy Law, s. 15.04 (1) (m)). v ewe ~L ` ~ ~ ^~' 'Y~_ Property Owner Property Location Glen Johnson Construction Govt. Lot SW 1/4 NE 114 S 20 T 29 N R 19 W Property Owner's Mailing Address s Lot # Block # Subd. Name or CSM# P.O. Box 809 tY 76 Plat Of The Glen City State Zi ~ o~IWGrt~ p C J City ~ Village ~ Town Nearest Road e ~.p , Hudson ~ WI 54016 715-386-2974(0) Hudson 445 Co. Hwy. A New Construction Use: i/ Residential / Number of bedrooms 3 Code derived design flow ra 450 GPD~ J Replacement _f Public or commercial -Describe: Jam'-Z ,~ . /~~ ,j / j Parent material Glacial Ouiwash ~ ood plain elevary n, ifapp rcabl Na General comments ~~~1,(;t.~ ,nQ ~~L,~. ~ ~Z..r and recommendations: Soil suitable for conventional POWTS with 0.7 gpd/sq/ft/ oa Ling ratre. Recommended sy em elev. _ 95.50" Boring # ~ Boring Y~ Pit Ground Surface elev. 100.65 ft. Depth to limiting factor > 114" in. Soli Applk~tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIftx in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0-10 10yr3/3 none Is/sl fill na na aw na na na 2 10-40 10yr2/1 none I 2fsbk mvfr gs 2f,1m 0.6 0.8 3 40-58 10yr3/6 none Ifs Osg dl cw 1 of 0.5 1.0 4 58-63 10yr4/4 none s 0 sg ml gs - 0.7 1.6 5 63-114 10y4/6 none s 0 sg dl - - 0.7 1.6 ~j 11 -' Boring # J Boring Pit Ground Surface elev. 99.95 ft. Depth to limiting factor > 105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-5 10yr3/3 none Is/sl fill na na as na na na 2 5-105 10yr5/4 none s Osg dl - - 0.7 1.6 rt r Site cut with 5" of topsoil placed prior to soil 'on. Soil evaluation from 75" - 105" completed by use of hand auger due to collapsing soil pit walls. Effluent #1 = BODS> 30 <_ 220 mg/L a d TSS >30 < 1 0 mg/L 'Effluent #2 = BOD < 30 mg/Land TSS < 30 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson o+-•-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake lane, Osceola. WI 54020 8/31!2009 715-24&7767 ~E'L'~ Property Owner Glen Johnson Construction Parcel ID # 020-1420-20-000 Page 2 of 3 Boring # ~ Boring Pit Ground Surface elev. 99.27 ft. Depth to limiting factor >109" in• Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-20 10yr3J3 none Is/sl fill na na as na na na 2 20-109 10yr514 none s Osg dl - - 0.7 1.6 J' Site cut with 5" of topsoil placed prior to soil evaluation. Soil evaluation from 72" -109" completed by use of hand auger due to collapsing soil pit waits. ^ Boring # J 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 ^ Boring # J 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 = BODS> 30 < 220 mg/Land 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 (8.07100) A.C.E. Soil 8i SItE Evdluation5 So;/ eda/uav~vrP,~ Lac~al~~o~o, 5~ /e: - o ' (okn ~o~ nser, CanS~uci ,o~oP. ,4~rd. ~ S/~/s G. f<wy ,Lo~ 7G ~/a~ oF~e 6/e•~ 3w~hEl'~; Scc, zoT29~1 ~. c.n;~ Q., ~i ~~. ~~ ~, ~~~~~~~ ~uJ. /oCCorn~=/G1~ a9. Si,-d'ng ~oow'o a~cai'- ~~ e C/ ~ ~ ~ ' s ~ EX~sf~'ti c 3 "~, ~Y ~~ ~d~e 1 ~Q `~ 9e ~ ,- y ~. i _ ' ~ ~1 _ ~~i 99a~'_ ~ ~ ~;- ,zoo' ,, ~, g.®' -- 8 : T~ oF'/off st4~. P 3 ~3 ,¢ ssu reed e.l e<I,- = i~ ~.' c~' ^ ~V ~~,~ ~- s>„~ ~ ~ ni~-ision ~kEC ~~~~~ 201 W. We~ehingloea Ave. Medisoli, W~ 537 - Sanitary .P'ermit AAplication In aparrdettee with s. Comm. 83.21(2, Wls. Adm. [=oda, eubmiasion of this form to the sppr>ip~ COUNT unit is twqulrat l~r ro obtaining a sanitary permit. Nata: AppiiesNon lPnnma for sabmilted Iq tha ~+tmvate of Commefrop, Pasanel ieforttietinn am ~ wMh the Prtvnav I.4w s.15 Ot(A xml w,.r. ~ i~idA may 6e used for eecatWyy It A icatloq Iniortnatien Please PsiHtt A~ lafh-raoadiott P Owper'o Nano (hrner'a MaitJrgi Addrc.~ PAID ___~____ Stan Alna~ffon N ICE Project Addte~s (ift ~y~ ~mtxi sM OZ ~ ~h Loc~ion thsn mdtisa addriw) 2~ -av-c~~ ~o~ ..pry, ararc -- Zip taode ~~1f~~.. ~L~~r~ - r .~..~...~ Phane Namba ) '/,y ~~ y+, aa#iort ~~ 5~ , ~..tl ~J~.S /~'s (Cwelco~ al< ~,~ of aniWinlg c a!! chat w~rlb'} ~ rnfwn or 2 Pmnil il Lot Al ~r a 7 N; ~ ~ ~' ^ ~ ~w y a~eillag ^ NunnlnFr of Aodr Sabdivhion Name Pub1iGC:ommer~iei -1]as~ariba UsA F, ce- w~~ W~ P / /') ^~ ~ ~° _?~ G~O~ cay of 9ta6e Owned -- bcap'ibe Us; CSM Number vin.®e of ill. '1['ypc trElPsrnilt•. (Chock only mac baiR slt line . Cmalplela ifwa IB ~tWo) ~'' view 9yatean ltaplsmmpY T ~B Tsnk Reptacamemt Only t7d~ar 1-lodHiradoo m 113xhlbgt (a~rplsin) 8ywrem 1t. Permit Patmit hevisba Cha~{c of Permit TratuFer to List Pcsvims; Permit Nomba' and Dr6o Issued Renawsl Netbro Sx tlon Plumber Na1vOtYner rv. ofrowTS s ~ rma~: Cheat di mat Nnn-Pmsauriaad in-(3rormd PtsAteuriaed In~(3round At~iltaik hlwnd> 20 in. of admMe aoi! Magid <?A in. of aiuble soil Q Hnlding I nnk [~ Other Aialxraei ~Rm~+t (} (~lsin} ~ ~ ,~ I ~ 3Z ~ y. u VA't+sadae.t ~!~ ><nformtti~Otti a benign F#r-W (Bpd) Dasign 9a8 Applitsitian Rate(gpdsf? Aispersel Anil tie4uiteq (sib Diiipersai Arm Proposed (sQ Sit P1evMisn ~~~ ~~ CYO ~~ Sl. ~ ~. 3'~~~~J Cv V!. Tank. info Capaeily in Tatal f of hdawffst+ser Mat~erisl (laiiiuris [iellons thins Nair Taakr 13xirting Tieiks Seplieor Hn1AinR'fsa! lL~111~' l > i C',~ G t~ ~' U .~t/~! D^ E: ct~ nnsiAg lumbar d ~~ f`P ~ ~ _:/~ C'~'3 ^/ ~Y ~ o: V~1<, Rlppoll~~lllNMty l~tate~nt- I, the ~- aennne ibR' ~ altlre Pt~IIV'!"S M tfMa attitdted Plnmber's Name (Printl Plumber's~ign LrJ: `l' !r ~i. Jy1 .5'~ ~u :~rr_t sCt _ ~~~!~v=._ ~1a~~ Nanber Sseinas7 Those Nwrtber -~ ? D ~L -3~~ - 9t~2 PUnnber's Address (Street, City, State, Zip Coda} v . coy nuc >!~t use ARId _-- Diaappa-val Parrtdt~~ ~ Hale isenad ! 8i ~. miner (liven for lleaial ~ ~ ~ i n D G~%~-~ 1~. CmadlUoiss of A.ppsava~uReasmita ll>I--t• Disspptrwvtr! SYSTEM OWNER: `~/~~_ (,~~~J /,a ~ d ~ ~ ~~~ 1 Septic tank, effluent filter and __ ~~// ~ _ `~. `~~~~ ~~ dispersal cell must all be serviced /maintained O~c~7" __ as per management plan provided by plumber. ~~ All setT~ac requK its raAisFrblrleCpwgaallMT~~ AsnBtfsxtttadrsM>fise as per applicable code/ordinances. SBD-638 (lt. Oi/0'n Vatid thru 01/09 vLd < <. ~Q~~f i~/~v c: ~ 66~ c~ ~r~~~~U G !d ~'r ~~ r 4~ 1 ~~ a 2~0' sue; ~~~ / `_- ~v 1: ~~/ y~~~- ~6~~ ,~i~iZ~l~ G !d d ~ °S 3~Y r" ~ 3 2~fo' ~~.~~--~.~~~.,~ ~/ ~l ~ y .tea T 9 ~'o s, ' Wisconsin Department of Commerce SOIL EVALUATION REP©RT Z' Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1114 page 1 of 3 Steel Sal Service Attach complete site plan on paper not less than 8~ x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. CroDc percent slope, scale or dimemsions, north arrow, and location and distance to nearest mad. Parcel I.D. (~~,~-~,)'Gi ~}~j P/ease print all infonr-atlian. R By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). ~ 13 Property Owner ;~ operty Location Sienna Corporation r ~ I°" ~ ~"' 6 ~~ ~ ~ .Lot SW 1 /4 NE 1 /4 S 20 T 29 N R 19 W Property Owner's Malting Address a # Block # Subd. Name or CSM# 7 4940 Vikin Dr, Suite 608 j ~'~ (. ~-~ r/ ~> g r ~ ~ 7Q~) 76 na The Glen City State p Code Phone Number City , Village ~ Tam Nearest Road ~~ ~7~'y i=~i~~i, MN 5435, ~ 1~ ~ Hudson ~./ ~ New Construction Use: i-r; Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial -Describe: Parent material Pitted outwash Flood plain elevation, "rf applicable na General comments and recommendations ~ ~ : System elevatiod 93.02ft~renches spaced and depth to code 4.58ft below grade ~ /~' ~~ a Boring # _ Boring 96 ~; Pit Ground Surface elev. 97.60 ft. in. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-32 10yr3/2 none sil 2msbk mfr cs 1vf .5 .8 2 3213 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 43-96 7.5yr4/6 none ms osg ml na na .7 12 I ~- q3. o Z S`F.9~go. 9rr Boring # Boring ±~ Pit Ground Surface elev. 97.60 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 6PD/ftZ *Eff#1 *Eff#2 1 0-8 10y-3/2 none sil 2msbk mfr cs 1f .5 .8 2 8-28 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 28-96 7.Syr4/6 none ms osg ml na na .7 1.2 cmuem ~ r = esuu 5> su < zzu mgiL and I ss >;io < 15o mg/L * Effluent #2 = BODS < 30 mglL and TSS < 30 mg/L SST Name (Please Print} Signature: CST Number 3av~ J. Steel 248956 address Steel Sal Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/10/2002 7?5-246-5085 Prop~eriy Owner Sienna Corporation J 3 ~ Boring # }Boring 1 1 M Pit 1 .8-2-- 10yr3/2 2 32-43 10yr4/4 3 43-96 7.5yr4/6 Parcel ID # Pending Ground Surtace elev. 94.00 fl. Depth to limding factor 96 in. Redox Description Texture Structure Consistence Boundary Root none sil 2msbk mfr gw 1f none scl 2msbk mfr cs na none ms osg ml na na 1 ~- ~t• ~z S{f, q(Q~9o •q!o Boring # -Boring Page 2 of 3 Sal APplicaUon Rate GPD/ft= 'Eff#1 'Eff#2 .5 .8 .4 .6 .7 12 ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS a 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 Borins~ # Boring _ _ __ ___ _ r Page 3 of 3 STEEL'S SAIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 SWl/4,NE1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715} 246-5085 The Glen lot 76 This. soil evaluation. was conducted. to satisfy a zoning. requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time. the. soil test was conducted.. Legend ~1" = 40' Benchmark EL 100.00Ft of '/2"pvc pipe ~- ,~ • Alt Benel~mark E1.100.p5Ft op of'h" pvc pipe --- ^ =Borings Boring Elevations n ~ -nom cnn. / {. ,, ~ ~. _ 1 ~. • ; { , / ~ ~ ~~ • •• `• i . ~ wry. ~: r:-.- ~ 1 x' - _... -C. It ~ ~' ; ,~ ~ $ ~I ~ }}}/// _,.. \ • L II . 2 _~ 1 ^\`j " 85 I 83 81 ~ ~~ •~ .. , i ,b ' , .. ~ I ' \ - :. - -- ` 1~ - ' - - -_ 79 c; j \, - _. ~• 1 , _ 1 _ .. .,• 1 •- 1 ~~~ ~~ ta, t It i _ '£r.° 4 t 1 ~'' Y~ R~ •• { r - , . 1 , .. a: _., , 1 I ,. • ! - _ _ zoa -- _ :. 39 ~ 1 ~i~ . _ - .,: _ __ _ • •1 w^ \~ ~ . -° a .._ i /, , ~. t ~ . ,. __-_ -..'~`~ '. .' ~. ,OIL. .\ \w 1 tl' - .: j~" - Vti ~ ` ' \ \ ' 22+~ I /I ;~: ~, a ,. ,V/-. •' i -..<'~ '~~ / / ~ ~ , tllt 1 i m \tt ~ ~. • r 233 ~ --_'I} I - 1 ,. ..~ .,,. i l ~ ~ ~~ / _ - is ; :\ / ~ + 1 r i '~, ~ t , 1 ~~~ %~'--.~. ryA7 :~Iy';+ :, '', I i-..w~wt ~ r ~ ! ~,..~`, ~ t, {. __ 1 4r t / 1 r 1 _~, _ ".....~~ 4 / I~ w•~ I 11~ ~1 .• ~ ' .~I II I, , 1 1 t:' ~, , I ~, 1w - ~ ~ F F~l.` .',.. l ~ 1 1' , ! II ! '' 1 { } {, 1 1 4 1: III ; ~ I_ ~ .-. / y ~. /: 1 ) , w` ! .I ' , I~ I t 1 tK -9• 2~v ~`T I ~ •\. 1, \\' t ~ ;. M1 ~ +1 , rI ., ,`,. r ~. • ' ~ ` 1 is i • ' /L/ it tJ. / .~ / ~.. 11~ ~ - ,t` ~ ; \l \,, \ \, 1, j ; . + / • ;1 1 1 ~1 111 111 j / 1 41 ' 1 1 , 1 1+ „~ ~(}ty) \l,t I ~ III 1 i~ I i i.'11: ~/ :a ^-• -~~~ II .-.. I:,.~ ,` 14 1~ ,; ~,. 1 i~ ' yl ._~ F ~- 11151 -- I I I _ 26 ; ; ~ - ,t ~, , I w ~, „~ , . 1 III I '~ '• -__ i I I I _ , ~ ~ ~' ~''. ' I ~ i ,' ,' 18 t ,F 1 1 1 I II 21' :I I _; ~ I 1 I ', III ,, ~ - ,I . , 1 I III f III 1 I 1 1 ~ ~ II ; I I SEp'~TC TANK ~__PGt'iP CHAN:B~.R CROSS 5~C:~.IU'~ AN7 5PE{:lrt~:~la~~~~ ~F' Ci' VENT'PIPE ~ T2"~ MfN. ~A~SOVE GRADE ~ WEAT4iERPRWr >_25' FRpM DQQR, WINDpW OR JUNCTION BOX AppgOVED FRESH AIR INTAKE WITH CONDUIT p~jLOCKV~R FINISHED GRADE ~7 WARNING LABEL I 4" CT RISER •-~-~ i-,4H MIN. 18" 'MIN. g" „~ • :; ~ ._r ' a ' IJL-ET ~ ', t, GAS, ; ' WATER TIGHT SEALS '~"" TIGHT ~ ~~ q SEAL ' PPROYED ~ B ~ ON IPA 3' _F"' ~ NTQ SnL IU C ~ + OIL PUMP OFF ELEV . ~,FT • --~-~' OFF D ~~ fAPAROYED JOIN'S WiTM APPROYEU PIPE 3' ONTO SOLIO SAIL ~~ RISER EXIT PERMITTER ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDxNG UNDER TANK CONCRETE FAD gPECIFICATIQNS aEPTIC / DOSE NUMBER DOSE5 PER DAY: ,,,,~,.~. TANK MANUFACTURER : l.J. `~5~~ - - , TANK_ SIZES : SEPTIC ,~_~, GAL. DQSE ,,, ee.,~,.• GAL. ALARM MANUFACTURER: ) r ~1 •~larr~~ __ MODEL NUMBER: •" t~ ~ SWITCH TYPE: 1r~~ rte- - PUMP MANUFACTURER : ~«' ~ ~ ,..,,.,,_... "`~""' MODEL N[JMBER : a SWITCH TYPE: ,~rr~.~~ REQUIRED DI SCFIARCsE RATE GPM pQSE V pI,uM£ CAPACITIES; PUMP ~ ALAP INC LUDxNG GAL • A :. INCHES = - ~~ GAL ~ s _ 2. INCHES = ~~„~.GAL, C ~ INCHES =~~,.,.GAL D ~ INCHES = _.._.92.~.-GAL ,M WIRING AS PER ILtiR 26.23• WA3 VERTICAL DIFFERENCE aETWEEI~ PUMP OFF AND DISTRIBUTION PIPE + MINIMUM FEETOFQRCEMAIN XR£S~ ~I`T11~Ga•F`T. •FRICTTCN FACTOR• , _• _.~~~---- TOTAL DYNAMIC HEAD ,~ FEET """~.~' FEET /~ FEET _1~~Z-FEET • WIDTH D~I/AMETEK _,~,.._ INTERNAL DIMENSIONS OF PUMP TANK LIQUID ~~~,::.._ ~'C.~!'~. ~,~~~' ~ ~~ SIGNED, ~ LiCENS~ Nc,~MaER: ,~?27~~'O DATE: ~ 1~8$ ~GOULDS PUMPS APPLICATIONS Spec'rfically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/0'"maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'h" NPT. • Mechanical seal: carbon- rota ry~ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: •EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatit reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, t6/3 SJTOW with three prong grounding plug. Optional 20 foot length, 1613 S1TW with three prong grounding plug (standard on EP05). ®2000 Goulds Pumps Effective February, 2000 63871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump aut vanes for mechanical seal protection. Submersible Effluent Pump „ EP04 3871 EP05 ^ EPOS Impeller: Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and wrrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplastic cover with integral handle and float switch attachment points. ^ Power table: Severe duty rated oil and water resistant. METERS FEET ._....._ ........................................... _ ~.........._... 10~ a ~ 7 x u 6 s 0 4 o 5 ..__.... _.. o' .......... o to zo 30 0 2 A 6 8 cAPACiTv ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' Canadian Standards AssorJation (CSA listed model numbers end in "F" or "C".) Goulds Pumps & Is0 9001 Registered. ao 10 12 m~/h Goulds Pumps ITT Industries ST. CROIx COUNTY,. - SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne ny~r ~ I~G-') Mailing Address ~ ~ / Property Address '1 o-/l~Xc °/~G~.vsdcJ t~°® ` (Verification iequired from Planning & Zoning Department for new construction.) City/State ~~ ~I,SaY1 t ~~~ Parcel Identification Number 020 ~' l ,~-O '-~ ~b° ~ ,Z67a LEGAL DESCRIPTION Property Location ~,(~'/a , ~'/a ,Sec. ,~Q~ T ~N R~W, Town of +~' ~~X~J~ a h Subdivision ~~,~ ~ ~-t..lrt ,Lot # ~. Certified Survey Map # .Volume .Page # Warranty Deed # // ~'~ ~ ~ _ , Volume~~, Page # Spec house yes no Lot lines identifiabl yes no SYSTEM NIAIIVTENANCE 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 §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County PLuuring & Zoning Department a certification form, signed by the owner and by a master phrmber, journeyman pltunber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with tbe standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County PLuu»ng & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are tree to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deal recorded in Register of Dceds Office. - Number of bedrooms SIGNATURE OF APPLICANT(S) 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. 08A5) POWTS OWNER'S MANUAL & M/aNAGEMENT Pi.AN Page ~ of ?/ FILE INFORMATION Owner a"/f yy~ ~,,~S~t e Permit # ~~" s~ DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units NA Estimated flow {average) al/da Desig~~ flow (peak}, (Estimated x 1.51 ~'~ gal/da Soil Application Rate 0 , ~ elide /ft2 Standard influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids ITSSi 5150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand (BODei 530 mgll_ Total Suspended Solids (TSS) 530 mg/L [~iA Fecal Coliform (geometric mean) a fu/100m1 / Maximum Effluent Particle Size YH in die. ^ NA Other: ^ NA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDIJtE SYSTEM SPECIFICATIONS ~5eptic Tank Capacity `j'®~S al ^ NA Septic Tank Manufacturer ~+CS~ ^ NA Effluent Filter Manufacturer ~L1/~ ~c4•~ ^ NA Effluent Filter Model Pump Tank Capacity .~',,;~~,` ~ al ^ NA ^ NA Pump Tank Manufacturer icy. ^ NA Pump Manufacturer ,,dA ~ ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter O Wetland ^ Other: A Dispersal Cells} ~In-Ground (gravity) ^ At-Grade p Drip-Line ^ NA ^ ln-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: i:J NA Other: p NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ~ month(s) (Maximum 3 years) ear(s) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ^ NA Inspect dispersal cells} At least once every: ~ ~YeB (jls) (Maximum 3 years) ^ NA Clean affluent filter At least once every: monthls) year{s1 ^ NA p { j{s) ` ^ NA Inspect pump, pump controls & alarm At {east once every: ~e~ r- Y ' ^monthls! ^ NA Flush laterals and pressure test At least once every: ^yearls) Other: At least once every: ^ month(s) ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank{s1 to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check far any back up or ponding of effluent on the ground surface. The dispersal cellls} shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of affluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3i or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized gomponents, pretreatment units, and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory a+athority within 10 days of completion of any service event. z~ Page of START UP AND OPERATION roducts or other chemicals for new construction, prior to use of the POWTS check treatment tanklsl for the presence of painting p that may impede the treatment process andlor dami~le the dispersal cetHsl. if high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shah Hat occur when soil conditir.=ns are frozen at the infiltrative surface. During power outages pump tanks may fill ar,a doser overloadingt hie celll(sl andnm y eesuh in the~backupco surface dischargle of discharged to the dispersal cell(s) in one farg a e Servicing Operator prior to restoring effluent. To avoid this, situation have the contents of the pump lank removed by a Sept g power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore Harms) levels within the pump tank. Do not drive or ,park vehicles over tanks and dispersal cells. Do not drive or park aver, or otherwise disturb or compact, the- area within 15 feet down slope of any mound ar at-grade soil ab~rption area. Reduction or elimination of the following from the wastewater stream may'idm~feeasers, ae ta, fig; a 8i pars! d~snts# fat9 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails andlor is permanently take~au~~o Comm 83h33 oW ~~sisrtiAdminilslutbat+VekCode: insure that the system ~s properly and safely abandoned in compliance with p • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. * The contents of all tanks and pits shall be removed and propariy disposed of by a Septage Servicing Operator. • After pumping. all tanks and pits shall be excavated and removed or their covers removed and the void space filled witt soil, gravel or another inert solid material. CON'{INQENCY PLAN taken, to provide a code camplian if the POWTS fails and cannot be repaired the following measures have -been, or.must by replac t system: P" ~ suitable replacement area has been evaluated .and may be utilized for the location of a replacement soil abaorptio act the replacement area w system. The replacement area should be protected from dattli eaAand wellsmFeitulre tonprot~ not be infringed upon required setbacks from existing,, and proposed structure, ernent systems mu result in the Head for a new sail and site evaluation to establish a suitable replacement area. Replan comply with the rules in effect at that time. _ ^ A suitable replacement area is not available due to rt to replacedthe failed POWTS s. Barring advances in POWI technology a holding tank may 4e installed as a fast reap sl to ~~ ^ e of the biomat at t ,' ^ Mound and at-grade soil absorption systems may be reconstructed in pleas following rom•val inf;ltratnre surface. Reconstructions of such systems must comply with the ruses in effect'at that time. < <WARNiNO> > AND OTHER TREATMENT TANKS MAY CONTAIN LETKACUMAS~TANCESD,O~.t.N ~' RESUL~ RESCUE OI SEPTIC, PUMP ENTER A ROM THE INTERIOR OiF A TAN M Y BE D FFICULT OR MPOSSiBLE. PERSON POWTS MAiNTA1NER P01AITS INSTALLER Name Name ~t~6lr~Gf ~'' sr•,~ !~Y' phone Phone 7 ~. _ ~ - .s' .~ LOCAL REt3ULA;ORY AUTHORITY SEPTAtiE SERVICIN{; OPERATOR (PUMPER) Name Name Phone ~1One Wisconsin Administrativ° Code, Tfiis docwnant was drafted M compliance with chapter Comm g3.22(2libil71id1&If) and 83.5M11, (2} & (3i, ,' U. 2732P y0s Document No. H STATE BAR OF WISCONSIN FORM 2 - 1982 N WARRANTY DEED SIENNA CORPORATION, a Minnesota corporation, conveys and warrants to GLEN .JOHNSON CONSTRUCTION, iNC, a Minnesota corporation, the following described real estate in St. Croix County, State of Wisconsin. 7 B S 1 7 4 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., MZ RECEIVED FOR RECORD 01/19/2005 09:15Ati 1dARRAHTY DEED EXEI~'7 iF REC FEE: 11.00 TRANS FEE: 407.40 COPY FEE: CC FEE: PAGES: 1 r, II Sienna Corporation Suite 608 4940 Viking Drive Minneapolis, MN 55435-5318 X Tax Parcel No: 020-1420-20-000 Lot 76, Block 7, Plat of The Glen in the Town of Hudson, St. Croix County, Wisconsin This is not homestead property. Exceptions to Warranties: Easements, reservations, and restrictions of record. Dated this day of , 2005. AUTHENTICATION Signature(s) ACKNOWLEDGMENT STATE OF MINNESOTA Hennepin County } }ss. } authenticated this day of 20 Personally came before me this l 7 day of • `halm.-..n~.~... , 2005, the above named Marsha A. TITLE: MEMBER STATE BAR OF WISCONSIN Pierce, the Assis ant Secretary of Sienna Corporation, a Minnesota corporation, on behalf of the corporation, to me (If not, known to be the person who executed the foregoing authorized by § 706.06 Wis. Stats.) instr ment and acknowledge th ame. YL j 1 ~ This instrument was drafted by: ~ ~ : .e ...~~... ~ Catherine M. Thornhill, Notary ublic Sienna Corporation 4940 Viking Drive, Suite 608 Notary Public of Hennepin County, Minnesota. Edina, MN 55435 My Commission expires January 31, 2010 Signatures may be authenticated or acknowledged. Both are not t:A7HEAtWE Wt. i1iORNFULL necessary. ~T~ ' Murc~ESOrA rb oumnrsgon r~,lm 81, 07t o Names of persons signing in any capacity should be typed or p rinted below their signatures. (SEAL) SIENNA CORPORATION, ~-<Ylinnesota corporation (SEAL) Marsha A. Pierce Assistant Secretary a .. ~~~n Las~r~:l ~~~~~ .~--~. -~~~ 1 7 ~ .,` l ~. \ ~' ,,, ~ ~ , ~ 9 ~ ~- ~ ~ ) :~ ` i 11`!!/ / =/ ! ~ .~ l/ '/ ~ i / %! ~ ~, ~1 ~_~ `1 ,\ ,`~ ~~~~, j, ~~r ~ ~~ t,.. ~ ~ • ,\\ \ •.1 .~ ~ ~~ . ~t /. '\ l~ ~ ~`\~ 1 ~ ~ \_ °; ~~ G ~~; - :.: ` / --_ f. ." i ,r' i~