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HomeMy WebLinkAbout020-1420-60-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ~ INSPECTION REPORT 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 Glen Johnson Construction Hudson, Town of CST BM Elev: Insp. BM E v: BM Description: ~a~ am , TANK INFORMATION TYPE MANUFACTURER~~~~~t / CAPACITY Septic II ,,, ~,/~ 3 ~ ' Z e Q F,' 1 ~d , b Aeration Holding TANK SETBACK NNFORI~ATION TANK TO Pfd ~ ,~J LL BLDG. Vent to Air Intake ROAD Septic 7, ~! J ~~ ~~ / ~_ Dosing Aeration Holding G PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Hea TDH Ft Forcemain Len D' Dist. to Well Coll ARC(1RPTI(lN RVSTFM ELEVATION DATA County: St. Croix Sanitary Permit No: ~ 506146 State Plan ID No: Parcel Tax No: 020-1420-60-000 Section/Town/Range/Map No: 20.29.19.2674 STATION BS HI FS ELEV. Benchmark Z,yS ~a2• ~J Ddb Alt. B~ ~ .l ~ /b/. /~j Bldg. Sewer SUHt Inlet ~• S 9S, s~3 SUHt Outlet `~.$ 9 5 Dt Inlet Dt Bottom Header/Man. ~.~~ 9~• S~ Dist. Pipe ~ ~~1 9~~9~ Bot. System (~ D ( 3 . Final Grade 3 ~ $5 / , ~ StCover~l~ ~.Q ~~r• _~S BED/TRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits ` Inside Dia. `` Liquid Depth ~ DIMENSIONS ~ gl~d.. Qtr, ~ ~ l~t~G ~1 ''~- - ~' SETBACK SYSTEM TO P!L BLDG WELL LAKE/STREAM LEACHING Manufacture . ~~~ CHAMBER OR ~- ~ INFORMATION Type Of System: t! o~.~,a ^ ~T/ ' ~ l ~' ~ 4 ~! \ UNIT Model Numbe ~ ' 1 t11CTRIRI iTl(1N CYSTFM '~P Header/Manifold // Distribution x Hole Size x Hole Spac\ Ven ~~ir I ake f~ / ~1 'T ~ Pipe(s) \ i ~ S Q_ Dia Length pac ng Length .Dia C~lll rn\/FR ., n...~~.~.~ c..~+ew,~ n.. i.. vv Mniinrl Or ~t-RradP Svstams OnIV Depth Over ! Depth Over I xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 5~ t ~ Bed/Trench Edges Topsoil ~~ Yes No 'fes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / Inspection #2: / /_ Location: 471 Wren Lane Hud on, WI 54016 (SW 1/4 NE 1/4 20 T29N R19W) The Glen Lot 80 Parcel No: 20.29.19.2674 1.) Alt BM Description = ~ ` ~ G ~' ~,S ~ ~~ 2.) Bldg sewer length = Q - amount of cover = t~ y ~ /_ Plan revision Required? ',' Yes ~' No ~ ~ ` b~ Use other side for additional information. •7 Date SBD-6710 (R.3/97) 7 (0 3 Cert. No. ..._, f r ~ie~isi ~~ conltnet't:e.wl.gov Safety all Bt:iltlis~gs Division ~ ~tj~i W'. Washington Ave.,!' .Box 7162 1. ~ County ~~~~/~ , r~ ~'' ~`~ ~"' ~' n Madison, V+'i 5370 2 Depertrmm~t a/ *vomrr-erae ~ +~` Sanitary PerPpm~~it Number (to ba filled in by Co.) ~ ^, ~ __...__.._ - ~Sl ~ ~~ _ I Sanitary Permit Application ' ...._ . _ to Transaction Numixr ~~Vl~/'1r'" In acconiance with s. C alrrlnl. 83.21(2), Wis. Adnl. CoJr, sutsanisslon of this Ibnn to fire appropriate $C ntnutl umt is required prior to obtaining a sanitary permit. Note: Appticat.on loans I'or .stataowned POW .~ submitted to the L7epartnu;nt of Commerce. Personal Information you provide may be use for secuncla:y ~u Ises rn accnrdt»,ce with the Pti~~dcy i..aw, s. 1 s__. _a4(1~(m , _ Protect .Address (if dif/f'e9enIt thanrnailing dress) ,/~~ ~( W ~e~ ~~~ ' rY' / 7 f 14~~ L ~lrnlication Informatinn - Pltase Print cation _ Propel el's Name / ! _ Parcell a _ _ ~ ~~_ fo~~ s 6 4 2007 4~za ~ ~ ~ - ~~C~ pZa - / _ PropcrYy Owner's Mailing Address ~ t Y _ _ ~ Property i_ocatirnr 'l ~ Z~7T p ~~~~ ~~GG,, r ^ ~ -Lp-'7~~_-~ ST. CR _ (_ tty, State Lin Co i OIX COUN _ Ph j O C' Govt. Lot , 1 ~ l~D~~ ~L~l~.~<Jid ~ _ oriole one Z9' ~ ~ -` I I. Type of Building {chick all that apply} ~~ j ~i o,. , f il ' U ll u N b :.ut p ~~ T . E u N; R ~~ Subdivision Name am u y e sn um er o? 8edronms o ~~ t ' e 1 ut+lic/Contmercraf .. Utscrltae t?se !~ ~~ ^ City nl ____ __ _-__ ^ -~~ Q Clare (Awned -- Drscria; 1!se ~-__--_~ ~---•~ i - 4r_._.__. _ ___ CSM Nuinber a __ ^ Village of l.~ J~~ ~(.~ Town of__~~;CiC~.,~O-~ -~ ~ ill. T ype of Pet•tnit: (Ch eck only one bax on line A. Cotnlaiete li2te B if apyalicablej A. New System i Q Replacement System ^ TreatmentlHoiGtng'Fauk Replacement Only g y ( p ^ Other Modification to tixistin S stem ex lain) ~~ i I It' ` ~ _.~._~.. ~ Penltit Renewal Before Es tlrauun ~ ~ ~ ~ List Previous Perini Numb rand Date Isstxd ~ ~ g i ^ Permit Trrulsfer to New Permit Revision t.~ Cha» o of Plumber^•~~ ~ Z3 Q-~~` jj ,/ / -~f.~L `L~e _ ___ I Owner ,_„_---~ ~ `t tp ~ • r ['. rti•-,e of Pf.7~l"TS System/ConaPOnenUlJevfce: Check at{ that ap~~) _ _ _~ __ ____ _ ~1Voa-Pressurized ln-Ground i~ Pressurized ln-Ground ^ At•G~ade ~' Mound ? 24 in. ofsuitabie soil ^ Mound < 24 is of suitable soil j C? Holding Tank 1 Outer Dispersal t:onlponent (exp:ain),_ _ 0 Pretrcauttent IJevice (explaur _ _ __.. n~,' (~~~ /, ~ ~ ~, \'. DispersalfTreatntent Area Inlortnatian: ~~ _ _ I Di;siKn flow (gpd) Design Soil Application Rate rQ t~lsl~ersal Arta Require) {s Llispersal Area Proposed (s f) System E:{ ttan ~ _V/ p-~r- / ^ I -- ~'1. Tank tnlo Capacity in----~--~ -- "Cora? ~ - M aC~ __~. _ -' Manufacturer ~ J = ~v Gallons_ Crallons Unns ~ r New 7an1.s Existing Tanks ,~ ~ ~ zy `~ ~ ~ ~ ,~ _ '-!~ ~, i o Sept c or H lding i ank I I _ _~ ..~~ ~ • ~ ~ r r Dosing Clranrber J ! Vli. Responsibility Statement- 1, the undersigned, assume responsi6iUty for installation oftite PpWT~own on the atwched plans. j i' JPl)umber's hame (Print! ~ Plumber's 5igt~ature ~/~ :c ~ a~ ' ~~~ ~ M !MFRS Numlxr Busntrss 3'hone Vumher ~t ~ ~ ~ ~ Y3L ~ ` ` l j Plumber's Address (Street, f_ its, State, Lip Cade) I ~/~ ~ ~ ~~ iL \'ll[ Count •!De artntent Use OtelY ~ Approved is ~~ ~'ermal Fce _ _ ~~ i .Date stmd Issuu:l: ent Signatu ~ i ~- rCriven Reason for nial,- gs '~~ ~ ~5 C77 -`_..i il. Condlrcasuns for Disapl.raval 1. septic ttmk,_tilHNtsrtt fNleranti disperssl cell must all be setvlces,( ras psi management plan provided hY pktttWer. 2 -All teZback 1'egWrements must be maitbkted 10 eorttpkle pla9ls ttl;' the 5YSiC111 3~ B ~ ~ l ~ ~ ~ eae.~ '~o (~a 1Zn, ne,,,J Q,~. IV t11C C'otlnry Oryty 9tt I1d11eY llOi lass 8112 x 11 inches in size SAD-630$ (R. O1i47'1 Valid ihru 0149 ~. , ~ :5 ~~ ~y r,. !~' l ~. `~ '~ ~n Jf"'" ~Mf lmlN~` ?tl9tllw~ . dr!ti1 7't~:;9c}. , ~ s'19'il~bhl filt7 :;?J 4 t:! 9.1 'lt .~.::.. , ~~.,,,,,•,~~(~ ~~ ~i ' / f~ '`_ .~ 1 \~ J/~ N ~ ~ ~ W T ~) ~ _ ~~ ~G ~> ~~. ~~ W~ ~~~~ ~. J !~f L~ ~~ U ~~~~U ~.~~~~ ~j.~1@r ~..~ f:, -` ~~_ N ~ ~~ z ~ ~dam~ C~ M ~c ~> !~ ~1 tti ~/ v r ~.1t ~'° ~~~ ~~~~~ ~,~ r 7~ ~F Wisconsin pepartment of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Com ,Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches i Ian must include, but not limited to: vertical and horizontal reference (BM), ion d parcel I.D. percent slope, scale or dimensions, north arrow, and location an 'lance res oad. Please print all i r Reviewed Personal information you provide may be used Property Owner Property Owner's Mailing Address ~U t3 ~~ c~ City State 'p Code or seco~~s~(~vip Law, s. AUG 1 4 2007 P ST. CROIX COUNTY L Phone Number 4 (t) (m)) openly Location u<. Lot ~ ~ va,~l;1/a s t # Block # Subd. me or D n City ^ Village ®Town oCS o,1 1 y~f ( ) c, Page ~ of .~ /$~v T//Zq N R ~~ E(or~N lR. ~ Nearest Road ~ ryit,~ Lr~ (aa] New Construction Use: ® Residential / Number of bedrooms 3 ' `~_ Code derived design flow rate ~O /~ ~d GPD ^ Replacement ^ Public or commercial -Describe: ______________ __._____ ,______ _, Parent material _~~-~aS~, Flood Plain elevation if applicable ~!//d~ ft. General comments ~ / and recommendations: S~.s~e wt ~t v ` ~' `~ (~~ ~ ra ~- ~G~'~'R j~ ,3 -~,j Sa ; ~ ~cc S ~ e ~ ,-~ rf h~LGt!`~o2 a Boring # ^ Boring 9~ ®Pit Ground surface elev. ~ (7~ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~ S- ~ 1b y ~~ ~rsbL m-~'r c ~ - , y + 3 ~t(m-I r ~' o ,.tom - ~ ~ /. 1 3 ,, Boring # ~ Boring qw ,.1 ® Pit Ground surface elev. / O ~ ~C/ ft. Depth to limiting factor ~ in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Efi#2 o - ~ lour 3/ -- ~ ~ 1( __ -- _ ~- .~ ,~ D Effltterrt #T =GODS > 30 < 220 mg/L and TSS'>30 < 150 mglL • Efliuent #2 = BODS < 30 mg/L and TSS < 30 mglL CST Name (Please Print) - - Signature CST Number Address / Date Evaluab dulled Telephone Number ~y (o C~t-;/ Q~ % /~/-~w~~mo.,~, a+,//, S`-`-/o/ ~ ~-G -y~ 7/S-7G4-az-~5 Property Owner lQ ~ r ~~~ N 5~ ~ Parcel ID # ' ~v-~_~~f~ ~ (a-~ .-~ Page _~ of,~ 3 Boring # ^ Boring ~ pit Ground surface elev. ~ ft. .-oeptn to limiting factor ~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description #'irxture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 -ly ~a y/ - S os I,t~ ( - -- , ~ /< Z ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 Q Bonng # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/ft? in. Munsell Qu. Sz. CoM. Color Gr. Sz. Sh. •Eff#1 •Eff#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mglL and TSS < 30 mglL 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 (8.6/00) Property Owner l2 ~c /~ ~Uyl (~ S~ n y~ Parcel ID # _f~ ~. ~ `f ~~ ~~ ,-~ a Boring # ~ Boring Cl [~ pit Ground surface elev. ~!, ~~ ft. •{Seoth to limiting factor ~~d ~n Page _~ of _`~ Horizon Depth Dominant Color Redox Description Teexture V Structure Consistence Boundary Roots Soil lication Rate GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 + o-~y ~~ ~~ - s os , ,~, ~ - -- , ~ ~, z ^ Boring # ~ Boring - n oaf Ground surfarp alev a ne..a .., r....:.:.... ~.....__ Horizon Depth Dominant Color Redox Description Texture Structure Consistence ~~~~ Boundary Roots Soil ication Rate GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 Q [1 p;r Ground surface elev. ft. Death to limiting factor 7~ ~°""~ # ° ~"~ Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots Soil i GP cation Rate D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 "Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent ff2 =GODS < 30 mglL 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. SBQ8330 (R.W00) ~PGAL~i 1" = G~~ r HMI HLEVA7lGN %(,~©• d p BM 1 Dr~$c~etr7l4N ~o ~-~ !1~ S.`ct' y~5~25f` (~ev-¢-1 BM 2 ELtVAT1ON `~~ $Y~TKM ELZVAT{OI~ / ' ~ r ~GC.J (a.. fiYOTtM YYi~~ i..G. ~.~ ~ ~l ~'vY~OC ~~~a _3 or 3 /s.SZ©~ZY,N,R 1 E Opt i ~~ !~ ~g_ 2 __ . ,~~`~" ; '- ~ -- , ;- _ _ ' g ~^ _ _ ~ ~. _~ .~ '' 1 4 - _... _. S$QNATlJ14~ commerce.wl.gov T ~ Safety and Buildings Division 201 bV Was'rin~ton Ave., A.O. Box 71G2 ~scan~~n Madison, WI 5,747-7162 Department of Cot»rneroe I Sanitary Permit APpYication In accrnrlance with s. Comm. 83.?t(?7, LVis. Adn,. Code, suLrnssro,~ of iktis form W the a crate governmental wut is reyuirtd prior to obtainhiK a sanitary permit _^:o;e: Applic«tion :i~rn~s for net PTybV"fS are sabinitted to the Department of Commerce. Personal m:ormation you provide atay se.ecrsdarY ~~)oxs in accordance with the Privacy Law, s. I5.(?4(t)(m), Slats. _ _ L .anntication tnl'ortnatio_n_--Please Print All Infor anan~~~ Property Owner's lvame ~// ___._ ~' - - - Property0wrrer'sMarlrne.Address - i~~~ V ~UU( - ) C'uy, State ~ Zip ode ~'fi'"`'~I~k .. ~ r -- - ~~r~~~ -_ IL Type of Building (check that apply} ~I o*? Family Dweltm~ . Nunti~r. Redron~ ^ PablicrCommercisl - Ge~c:nix Lse ^ Stab Oa°n~d -• f)escribe Use >~ ~i' /~ O G~ __ ck # d7 !*iiimuerT x -~~ (bounty S7 c rya <~__ Sanitary Permit lVUrctber (robe tilled ir: ~y C'o.) State Transaction Numbe~ Project Address (ik~/',,`"'i//fferent thanmailing addre: ~~ l ~~~v( Cj~~~ ~~'Pareei # y`iivc"~t _' ~~o-~~aa-~-~.v Property Lcx:ation~ i Govt. Lot _ ~ `~ ~~ ~~ !, ~- ~ s, SLt: tVR ~~ rg6tC One; ~ TAN; R1~~Eora~ Name C Village of _ _.._~.-.-.- own of_~LF~1 f ll. 'Ty~e.ai=Permit: heck only one box un iin~~tmplete line ~if Applicable} ~ ~ ~ ~~ ~! ~`--- --; .A. ~Neu'System C Replacement System ^ Treat ' nu[jctlding'I'aak Replacement EJn3•y~~-'!_] Jther Modification w Exist;ng System (expiarn) II R• ^ Permit kenewal ~ C Permit Raviaion ~ ,• ~ i,ist Previous Permit Number and Date kssued ~ C Cltan~dtuf Plumb ^ Permit Trans.er m Vew ~ 6efo,ecxpirauon '' )wort -^ ~~-T ------~ 1`'. Type of POW'TS SystenUC;ompoeendDevfce: ~Chce~i al! that ap~sfy~~- _~__ __ __ _ ~ ~~Non-Pt~ssurrzed !n-C;round ^ Pressurized Lt-Ground At-G~'ade C tvloand >~ 24 ~ of ~uitab!e soil ^ Mound <?4 in. ofsuitaiae soil ~ r~ ~, ~ I I__; klold,ng "Tank t_-) Utkt_r Ctispersal Component (etirlasn ~-` _ _- _ rea:mcnt Devi.e (ex^~ain) __ ; ~''. Dispersal/Freatment Area Information: , . y _ ~ ~ ~~___-~~~~-.!__.-_~ ~1e~ign Fiow (gpol f3esiKn Soil Applrcation Rate(gr. Y )ispersa! Area Required (t) ! Dispersa res N,mposed (atj SYStem Elevat:on~~p~~- ~~ 1' L- - --_r--- ~'1. Tauk Info Ca aciro i p i Focal tt of ~ Manufacture Gallons ~ GaKais I Umt5 ( ~ u ~ o ~ ~ ~~ i _ New Tanks E tnrg Tanks /-+ V t c ? ~ ~ ~ ~ Sepnc o: Hntding Tani- k~ ~-_ ''- ---.---- 9 ~ ~-___._._ I ~. ._._.~ i)nsn:g Chambrr , V 11. Responsibility Statement- t, the ndersfyned, assume responsibility far installation of the PON'TS _n on the at r -.._ Mp' 1PR5 Numbe Plumber's Name t Prinq --~~'~-- Plumber`s Stgnatu tachavl plans. r Business ne Nwnber ~ ` T~~ ~ ' Y~~ !lLl %l ~.1's-= 5 c' ~7 ..t h2 ~ % %~~---` - id L' ~ r'~ rs Z ___ i ~1 J - ~ c~lr ^ 3<~ r i _ -__ ____. Plumber's Atidfess (Scree;, Ctty, State, R p Code} Z i ~ ] [~/ /~ ~yA / ~ ~/~/( ~~ VIIL n'h`'"!~I'}e~artment Use Unly __-__ _ -~-- _T- Tilate Issued lssu g Agent Signa r '~ pptovcd ~ L Disapproved Pettitit Fee $ i ~ ^ Owner Given Reason forDeniat ALL ~`~v ' J ~/wr` j II es't-~ t o rovaulteasotta for ' •approv ~ s /_ r ~~" ~ ' i 1 Septic tank, effluent filter and ~~dY~~Yti~ ~C(/~2.~GG~~'~-~/ ~ '~ f dis ersal cell must all be serviced /maintained {~Y~~n ~ _ as per management plan provided by plumber. ~,, Q ~/~~Q/n~- _ i - Z. All setback requirements must be maintained -~~~e ~-y ""~ ~~ as per appl3 b e of~o e_T~i "-' ~ot; ~rtE~Sus for the system and submit t~County Drib ~n papc~t test t~2 x~ncb~ ~~ vlil ~ I !~ l~n~ SL'tD-f,398 (R. 41147)Vafid thnt (71;09 ~(~Q Q_ ,i~dE~ ~~ ~~, G,(~6(G(X ,. 0 ,~ v \\j V .~ ~ ~- ~ .-y ~, Y ~ ,`~ ~ t~ L?r. ~ ~ ~ - y, •4 la- t; N' ~~ ~ (~' y w ~~ W W ~ ~ ~, ~ h `'~ vl ~- N ~~+ ~~ L -' `' ~ ' v `~' s ~ ~~ A ~ \~ ~_ ~, al N ~ ~. ~ 1I L~ ~ ~ i h ~ ,. ~ , .. ~. ~ , ~ .~, N w N W °C ~~ N ~ . ,. ~ ,.- _ ,~ u. ~, z:..~' ;P'`' ~ ~ '~ y ~'. . r -~ ~ ~.~ ~y ~ _ . o. ~ -, ~ ~ ~ ~... N '~ ~- ~ ~ ~ a_ Z "~' _~ ~ 6~ `L' ti H Q v~ ~ ~- N mar n ~_ ~ `~'' ~( ~\1 v n IN !' q ~ E. d ~- fi ~. ~.. ') ST. cRU1x cacriti~-jr SEPTIC TANi~. MAINTENANCE AGREEMENT AND owlvERSxrn c;ERr~cAT~oN 1~o~vt .~ ff , OwnerlBuyer ~ ~-~ ~/i~~' ~ -c1 . , ~ v ~ - I ._...~,... ,'vlailing Address (~,~ ~-(~-~~'~ ~~~1.1~~ Property Address __-.. `~~ ( ~~-e,~4 ~.t~'~.~ (Verification required from Planning & Zoning for new comsttvction.} City/State __Q~~...~.~.~- Parcel ldentification Ntrrrrber Q~~.~ a 0' _~~ ~. (~~ .i,EGAL DESC;~i~PTIO>,l property I.,ocation ~ (~ '/. , ~'/4 ,Sec. ~, T ~N R_ f~vV, Town of ~U~~~ Sulxiivision - t„_ G~ ~,.~ _ .. ...,~_> L,ol Certified Survey Map # Warranty Deed # ~ ~/~J>~ -„- - __ ,Volume 2~ ~ ~ , Pll~e # Spec house yes no Lot lints identifiahle yes nq SYSTEIN MA,Ih'TENANG''~D OWNER C>riRTIF CATi01~ p l ~Y ltnproper use and maintenance of your septic system cauld result in its premature failure to handle ~~tes. Proper maintenance consists of pumping out the septic tank c~vCry' three years or sooner, if needed, by a licensed pumper. What you put into the system can affoct the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance res~-utisibilities arc specified in §Comm. 83.52(1} and in (:hapter 12 - St. Croix County Sanifary t?rdinauce. 7'ha groperty owner agrees to submit w St. Croix County manning &Loi-iag T~epamnent s certification form, signed by lhr owner and by s uwstcr plumber, joumCyntati plurubcr, rastr~ctcd pluruber or a lieoruaed pumper vCrifyJtlg that (t) t}~ oei-site wastewatCr disposal system is in proper operating condition andior (2) after inspection and pumping (ifnecessary), t>ze septic tank is less than I /3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Uepartrnent of t:;omurcr~C and the l~patttxrcnt of Natural Resources, State of Vb'isconsin. C;ertif-ication staticr6 that your septic system has been maintained must be completed and retucnod to the St. Croix County Piatrnin$ & Zoning L7eparrttnent within 30 days of ttLe tltr®e year exriratior, date. I!we certify that all statements on this form are true to the best of tny! ottr knowledge. l/we am/are the owner(s) of the property described shore, by virtue of a warranty deed recorded in Register of Deeds Office. 2 f~,. Nttmhpr of hedronms _") 1 ~" ~a "" ~J SIGN l'~OF APPLICANT(S) _/ /_ DATE ~~*Any information that is misrepresented nuy result in the sanitary permit being revoked by the Planning & :[,oning Department. ;** Include with this application a recorded warranty deed from the Register of Deeds Uffiee and a copy of the certified survey msp if reference is made in the warranty deed. (REV. 08/0 • POWTS OWNER'$ NIANUAI. & MANAGEMENT PLAN Pegs ~ of?~ -~ n . J n 1 n -. Flf-E INFORMATION `fix- ~~0..-,~. ~-. ~ v Owner ~ _~.~ I Permit ~ ~ ~ ~ ~ ' `' hrn,w~, r riG,~7W1\ rMRfifY1C 1 CI't~l Number of Bedrooms "_'__.._. ~ ~tA ~ Number of Pukllic Facility Units _..~ (~ Nq Estimated ficw (average) _ ~V .~ al/da Design flodv (peak}.^{Estimated x 1.5} ry O ag l/d8y rJOii Application lists ~ elide /fix Standard influent/Effluent 11ualltY , Monthly avera~e• Fats, Oil & Grease IFOG) ; 530 mg/L Biochemical Oxygen Demand (130D~1 ' 5220 mgit Ln NA Total Suspended Solids iTSS) 5150 mglL Pretreated Effluent 4uality Monthly average 3iochemical Oxygen Demand {80D5) 534 mg/L Total Suspended Solids {TSSi 534 mpJl A Fecal Conform Igeametric mean) ~ s10" cful140m Maximum Effluent Particle Size ~ Y8 in die. ~(,~ NA Gther~ Q fVA °'laiues typical for domestic wastewater and septic tank effluent. MAINYENAIdCE SCI~iEDUIE SYSTEM SPECIFICATIONS S®ptio Tsnk Capacity ~~S' ~-j al ^ NA Septic Tank Manufacturer ~ ~ ~..Se..t ~ ^ NA Effluent Filter Manufacturer ~ Q,,,~ ~~ ^ NA Effluent Fiitar Mad91 Y ~ ~~D DNA Purrlp Tank Capacity g D i} _ -SEeI ^ NA Pump Tank Manufacturer ~ a ~ ~e.. S R., ^ NA Primp Manufactur®r ~ p ~, ~ _ _ ^ NA Pump Mudel Q NA Pretreatment Unit A Sengdt3rovel Filter ^ Peat Filter Q fvlephanical Aeration O Wetland A Disinfection ^ Other: DispersA ell{s} ~~~~ _ -ground Igravityi ^ In-Grou {pressurizedi Q At-Grade ^ Mound CA grip-Line ~~" ^ Other: Other. ~~~ _~ ^ NA Athlsr ~ ^ NA Other: ^ NA Sorvlce Event 8ervke Frequency Inspect condition of tankfs} At least once every: .,,~ month{g) (Maximum 3 years) C7 NA Pump out contents of tankfs) When t:ombineti sfudne end scum equals one-third {'/3! of tank volume ^ NA Inspect dispersal cell{sl --....w __ ~ At least e,nee every; _ ~ ^ month(s) IMaxtmum 3 yearsif ~ Year{si - C! NA (:lean effluent filter ~ -- _ At least onoe every ----._ _..._ _ - ^ manthlsl __ r _____.__~1!earlal _.._.._~~__. ___- __ ^ NA .._-._..._ inspect pump, pump controls & alarm __._._.__._._.._ __ YR~ 1 ~ ~ At !seat ance every: ~...,,, ^ manthis! ^ year(s) ~ ^ NA Flush laterals and pressure test _____~ ~At least once ev+try: ,..,,,. ^ month(st ©yearlsf Q NA ocher: At least pnca every: _ ^ months) - - -- ^ yearls) ^ NA ath6r: ""."" ^ NA MAI NTEN AN C I: I N 5 TRU C TIO MS Inspections of tanks and dispersal cells shall be made by an indlvlduel carrying ane of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector, FOWTS Maintainer; Septage Servicing Operator.. Tank inspections must include a visual inspection of the tankfs) to identify any missing or broken hardware, identify any cracks or leaks, measure the vol+.rme of combined sludge and scum and to chick for any back up or ponding of effluent on the ground surface, The dispersal cell{s! sha11 be visually inspected to check the affluent levels in the observation pipes and to check for any ponding at affluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory >authority. When the combined accumuiativn of sludge end scum in any tank equals Or~le-third iY3) or more of the tank ~~ofurne, the entire ccntents of the tank shall be removed by a Septag® Servicing Qperator a,nd disposed of in accordance with chaptor NR 113, Lv~sconsin Administrative Cods. All other bHryices, including but not limited to the servicing of effluent fibers, mechanical or pressurized components. pretreatment un'~t5, and artiy serviring at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within to days of completion of any service event. •ana~ en~ietisn„ulpV u~suaastM, 'IFf '9 !Z} '{ tfs9'lr8 ~e {)-~1{p}f tit4}1ZIw~'~$ wwo~ laideya yicnn aaue,~dwua ul peiJe~p Senn iuewnaop siM9. ___... „ Q~ ~ ~~ MUOt~ 1llOH1t1b- Aa01Vlt1tb9~1.7 JOl N suoyd • __ su~aiW fli3dWtldl li01'd1~3d0 E1NIalAl13S ~Jt/1d3S a3N1V1 1 W a371t/1$NI S1MOd S11V3W W OO ItINOlllggd '~181~$~dWl a0 i1A~ldsilQ 38 ~lta<W kNbl d dO 1i01>d~1N1 ~Hl WO>d~ NOSl13d d d0 3f1~S3k! '1'InS~a JIVW H1b~34 'SSaNM18W~1Qlp1l~ ,111tH. d~oN~1 SN~tl 1NSW11a!~adl a3H10 t!O dWnd 'Oild33 b kI~1N3 .tON Oa ' N~flAXO 1N~iOlddl~SN! k90/ONV SSSSIIl3 1MH1~''1 Iillb.Ll~tiyq AF/W SNNVI 1N3W1`0~3»1 tl3H10 qNt/ dWfld 'QI.Ld3S < { ON1Nl1bM > ~ 'a~u!3 2eyl is 10e;;a u{ saln~ eyi y3!M ,({duao5 lsnui sui~sisns vans ;o suollan~isuoaaa •aae;.ins an{leilll;ul ayi le leuaolq ayi ;o lenoulei 6wnAOllo; eaeld ui Pelan.rl~uoop~ eq itgul ewe3sAS uolid~osge lios ape~B-is pue punoy~ Q 'S.I,N1{3d p!1{~s; eyi eaelde~ of 3~osa~ ise! e s ollsi q ,~pw yuei 6uiploy a algeliene si ss~e iuaure:~eldaa au tl •trsxt iWWe;)sfr9o~ sigeilhs s aisool of pow~o;gad aq uolienlsne axis pue IloS a SiMOd oyi ;o ean}is; uodt7 •se~s i~ilauaeotrldlti eigsllhs Q it~ltuapi of poisnlens ua lou s .ails ayl ~~}~~ 'S1MOd pelis; syi eos)de~ bi isotre~ i&sl § av pspeisw oq ~cew ~luei 6uiploy a ~tRalouyaei S1Af1pd ul seauenpa l3uweg •suolleliwll floe :o/pue >l~egl~s of snp algtrlieng lou si eeav lueuleaeldai alg83lns ~ ~ •trwli leyl le lae};e ul seln~ eyi ylinn ~tidwoo lsrnu suiais,ts luaweaeldaa •e9.+s luewaaslda~ algsi{ns a ytllgp;Qtr, of ttoptrnfsne ells pue liar nneu a ~o; paeu eyi ui llnsel II!nn seas luawsaelda: ayi loaload di einlled 'sIIaM Puy ~a~li lol ~s,niaru~s pesodoad pue 9ulislxe wa; siloeglas ps~int5a: +tq uodn pat3u{:;w aq lou p{Hoye pue uollasdwoo putr oou::gari;slp uab~d Ppicstrxad 8q plnoys ae~e luoweaslda, eyl •uaeis~(9 uolzd~osge ;los luawaaslda: a ;o uoileao{ ayi ~o; pexi~l~n Oq heut pue pei~r~lune ueeq sey ease luawaaelde~ eigeuns d wals~s euiaaeldea lue!iduioa apaa a apino~d of 'ue~lei aq isms} ~o 'u®sq ~nr;!y selnstrew ~ulnndipo; ayi paaledei eq louuea pue ells; ,~1MOd eyl ~; N111d AON3DN11N00 43i~'+ Pailil weds pion ay; pue 'lei~alew pgas i~sui ~eyloue jo lenei(3 yios penowa~ s~snoo ~ley2 ~o penowe~ pup pilib?nl?bxe aq Ile4s slid pue siluei It+~ 'Buidwnd :ai;y • •~olei©dp rtulain:gS eBeldeg a Aq ;o pasodap ~tjiprtoid pue P~tnouae~ aq lleys s3ld pue s~luei Ile la siueluoa a+a,2 s 'palees sBuluedo adid p®ubpuege eyl pule pe#3euuooslp aq lleys si{d pus sNuei of Bu,did liy • :$poQ enlie~islurwpd u{suoaaiM 'g~~gg uawo~ ~~a3dsyo yiln+~ ague{{dwoo ul Pauapuege ~({a;es pue AljAdo:d si u,aisns ayi leyi amsui of ue~lel eq pet's sdsls Bulnnoliq~ e43 69!hJeB to xno ua~lel ~ilusuewaad s{ ~o/pue ells; S1MOd a43 uayM 1N3WNOC1Nb8V •au-~q tpu~i}os ~trietin pug,;puoclu,~ai :sul~ldeu Aaeuues :saplalisad :slanpoid ~uiluier# :{,o :suoilealpaw :sde~as ieaw :sapia{gaey :esesaB letplpsa~ :&8u{{/lod e{geis8en pue 3!n~; :aeisnn {duand dwns} uleip uoilepunol 'te} `siueiaa;uisip :saedelp :ssal; leluep :s~sseei8ep 'sgtrn+~g uolldd tstuopiro~ :sling alieae8la :sed nn !~ e a4l ;o o;il eyi Suota:d pue reauew~o~ed ayi ano:du~ Aaui i.UltYtii! lelan,gtrisrann ayi wo1; Bwnnollo; eyi ;o uvlleuiw,;el :a uosonpep~ •sers uaicfaosge bias epe:8-la ~o punoua ~tue ;o adols uMOp if+6; S t ~~"yilnn sale ayi 'laeduloa ao ginisip aslAn~aylo Jo `nano Ted to en{2p lolu o(l °s{Ipo {ss,~adslp pue s~luei :eno saloiyan ~{aed ao anl~p lou off) of slaluoo duand ayi $uile~edo Allenueua ui is{see of ,~aU p u ® 'ilUei dwnd eyi u143iM s{anel leui~ou aloisa: 8uljolsaa of :oud aole~edp 6uralnieS eQeira e h ! 3 ! W S1.MOd '~ aagwnld a io83uoa to du.~nd 3uenl};e ayi of lennod o s6ae as! S q penawa~ ~ti>Rl ~iiUtld ~yl ;o elu®luoo ayi aney uolisniis siyi pions o.i. •luanl;;a y p aae}~ns ~o dn~loeq eyi ul ilnsa. Aedu pu13 {~lllsb tryi E3upubparo 'drop a®asi suo ur (•}Ilea lasJeds!P ayi of pa8~syas~p aq II?M te3eM•25P.M S58ax8 a4i paJ03$Q.1 5~ J6Mad UayM •Blonnl .iaipan 4WN I~uuou enoge {{l; ~tsw s~luei duand seBeino ~etinod 9ulanp •aae;ins en{itr~ilj;lul a4i ll: uazo~l ~.aP suoli!puoa pos uey,H anooo lau llsys cin l~els we1IIAg sius2uoa ei 1 ane 'fin bi ~ol~d as;eteda auialnaas e6etdes a I{q panocus: {sp~luel ayi;o # 4 pa3aeiap eis suorie.liueatroa yl3{y 11 '(s)If~o lss~od~!P tr43 eFlewsp io/pus sseoold luetUie9.13 eyi apadwl ,t,aw isyi sleaiwaya leylo as s2anpad ~uiluisn ;o aauoca,d eyi !c~ fap~up>l i4~W~erpji ~aeya S1MOd ayi;o esn a1 lol:d 'UOtian,~i&UO~ M9U !O~ jj Ja~ e6ed NUI1.1o~l13d0 ~1NV dll 1~IV1S Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8%2 x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), directron and parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest load: pending Please print all information. By 1136 Page 1 of 3 Steel Soil Service Date Personal information you provide may be used jpMip)s}~. 15.04 ) (m)). ` ~t t~ I ~ ~ Property Owner ~..I r ~ Pr LocaEtion CTS Sienna Corporation Govt. of SW 1/4 NE 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address 5 C t~ ~' ~ 2~o Lot # Block # Sutxf. Name or CSM# 494Q Vilking Dr. Suite 608 ~ ~ ~ ~., ~ ~ ~ . ; ~ 8 nor The Glen Cdy ~oC%~tR State Zip C PhO~g,A(,ilft~p~r~ ~~ (.~ ity Village Town Nearest Road .~..,_._._.-o . E.~, , MN 5543 35-2808 Hudson Dorwin Rd_ r_ '' New Construction Use: r Residential /Number of bedrooms 4 Cade derived design flaw rate 600 GPD _. Replacement __ Public or cornmercial -Describe: Parent material Pitted outwash Flood plain elevation, if applicable ~(p.o5'~ nor General comments and recommendations: System elevatio 96.75ft, renc a spaced and depth 5.75ft below grade ~our~~ ~ Z Boring# ~--; Boring " 105 y_,; Pit Ground Surtace elev. 101.80 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= *Eff#1 `Eff#2 1 0-21 10yr3/2 none sl 2msbk mfr gw 1f .5 .9 2 21-31 10yr4/4 none scl 2msbk mfr gw nor .4 .6 3 31-44 7.5yr4/4 none Is mvfr cs nor .7 1.2 4 44-105 7.5yr4/6 none ms osg ml nor nor .7 12 ~ (~ °~ 1 ~ ®• D goring # Boring 105 Pft Ground Surface elev. 101.80 ft. Depth to limiting factor in. Snit Applic~ion Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ftz *Eff#1 `Eff#2 1 0-36 10yr3/2 none sl 2msbk mfr gw 1f .5 .9 2 36-57 10yr4/4 none scl 2msbk mfr cs nor .4 .6 3 57- 05 7.5yr4/6 none ms osg ml nor nor .7 1 2 n 1 C-dL ~ ~0~-cC ~ ~6.0 - tnwem ~~ = esw 5> so < zzu mgrt_ ono i 55 >3l) < 750 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel ~~~~ e~ 248956 Address Steel Sal Service Date Evaluation Conducted Telephcee Number 1564 CR GG, Neuv Richmond, W 154017 9/12/2002 715-246-5085 ' Property Owner Sienna Corporation Parcel ID # Pending . a Boring # Boring 101 00 th to D ft limitin factor 0 Pit Ground Surtace elev. . ep . g 1 5 in. Horizon Depth Dominant Color Redox Description Textun: Structure Consistence Boundary Root 1 0-14 10yr3/2 none sl 2msbk mfr cs 1f 2 14-27 7.5yr4/4 none cos osg mvFr cs na 3 27-105 7.5yr4/6 none ms osg ml na na I ~- ~' S. is 6°1~ja~ Boring # Boring Page 2 of 3 Sorl Application Rate GPD/ft2 "Eff#1 *Efi#2 .5 .9 .7 1.6 .7 1.2 * Effluent #1 = BOD ~ 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 ^ Boring # - -) Boring i Pit Ground Surtace elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz 'Eff#1 "Eff#2 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 80 This sail e~aluatien was€ondueted to satisfy a zening requirement, it mad or may net 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 th€ seit Est was cenductedr Legend 1" = 40' Benchmark El: 100,00Ft ~qp of 'h" pvc pipe ('t~•~~ Alt Benehtnark E1:104:~OFt op of/2" pvc pipe ^ =Borings Boring Elevations B1 =141.80Ft B2 =101.80Ft B3 =101.pOFt B4 =OO.OOFt ., - .- - - • rte- . , ~` _ `~ t _- - - - - - r \~' 1 ~ ~ + ,: :: , , ~' + i a`t '~ ,..... •. .I' i ~vl ~.: ,• _ ., .ti - . .,. _ ,.. . , .. ,, • n .. .. • ._,:,._ ; • 1 A .. VJ W7 ~ QQ 1 ! _._ , ~. ~ __ ~ " VV „~ ,,... " \~ ~ i f T6T` , _ I ~ ~: w. , ~ ~ ~: , 1 - ! ;, ,:: _y..._.._ r - ~ 1 ,. 1 ,. • ~ ~.., ..... ..... ._. 1 ., 1 .. . _. ~. 5 ~,~ - ~ -- . __._ , . r ___ .., _ _ ,.. _ \ „, ~ W .' t / ' - ~,., • • ( _ ` ` - I. + ! .lam `• - s - ~ • ~"•• '~ 1 rr .'ah• 1 ... ',- .' s fr'~ ~ 67~ ~ n ,' , . V ' .. g` ~• . ,: ~ ; ~ 11.1 =. :. , 1 ' j.: .:;` 1 _ - - ,,~~ 1 + w `• ~' ; ~ r . - • ; 1 ~' Q i t /' 1 .~ r .. . ~. , .: -~ 39 - .. .~ ~ 1 ~. - --- ~p ." ~ 1 , '}J ~'' .. .. _ _. " . ` ., -. -.. .,~, a .' ,37,+" ~.',. ' ; - 6 . ~ _,. 1. n ... " ~ ! ' •..,,• '' ~-< ~ J ,~{( 1.'~.~ ~ r.~ •^'. 293'' ~ ..tom .,-~~,-- 11.x' ~:~ 1 ,, 1 i. .;~ _~ _ ~, 1. , , 11, .~ .. " _ a ~I. , , , 1 . . 1 •\ 1 ... .... r t1 I C f ~ " /" lid i 1 , ~ !~ • ti • -il • / ,, ,~ r .. I I + I' `I ,lat3 + ~:i 1 Ilf 1 ,1 1 ~ F 1 I ~ ~1 (yyy~/1 ! / 1 :/ r ,! i ~ fY I+t 1 .I /..i / . I ! t i l t ._._ `` ~ 1 __. f r ..-~`~~__ _-_ j t + 61 I .: N ! \ ~ ~~ II 1 I .+~ - 1 ~ n f' • li.l i t It I 26 66.E 1 ._~ .. 1 1 1 11, _ .I 1,. ~_ f ~ ~ ~~~ I I I I ~,'~ / -- , .- v , I r ~ + ~ N +I+ 17 / ~~, ! t 1 I ~" . t j t i ~~ ,j f R ~ 1 , - 1 t i I 2~ ,~.:, i 1 t ; ' 22 .~ u~a~ v. SEPTIC' TANK £. PUMP CHAi~iS~:R C~pSS wEC'TI4~1 AdJ S EC rr:'~uF.I'IO1tiS ~+" CI VEPJT PSPE 12°' MIN. ABGV:~ ~R~A~ ~ 4fEA1'HERPROOF 25` FROM DOflR, WIND.CW OR :TUNCTIflN BqX APPR04'ED RI;SY~ AIR INTAKE ------~--~ WITH CONDUIT MA~^S~iGLE COVER FINISHED GRADE Wf PADLOCK ~ ~+" cr RISER WARNING LABEL ~,„ ~T~~. 18" : IN. 6" MAX. ~ ~~+~ ~~ ~ i h L E T ~ ' ~` ~"~~ , ', WATER TTG HT S £ALS GAS- , ` ~ ti ' iGHT : ~ APPRCIUED ~ SEAL ~ +PPRt~VEO ~ ALM ~ RPP~OYED PIPE °I~~ 3' ~ ' ~ fl1J ~ 3 ° b~1T0 1NT0 St?L I D ' ~ S4i. I D 50I L ~~I~' UMP OFF ELEV . FT. °• -=-~--- ~ ~ OFF' ~`~ RISER EXIT D PERMITTED OtvLY IF TANK 9NUFACTURER M . HA5 APPRflVAi: 3" APPRt?VED B£I}~SN~ UND ER TANK CONCRETE PAD SPECIE: CAT~;ANS S~PT~C / %OSE T~iNR MAAPJFACTURER: ~~~;~,~..~ .~,.~K S+ZES: SEPTIC 1`'~;,~Q GAL. ~~~ D qS E ~ GA L . A LA ttM MA N'J fAC TU R ER : _..~t~.±r..~.~.T~, M MODEL R'UM9ER ~ 'D t...V swzTC~? TYPE: '~e.0.s, Pl.'MP MANUFACTURER : ~' MODEL t~'MBER : P th SWITCH TYPE: ~i~g,C ~.E'~C,'IRED DISCI-iARGE RATE ~~ GPM NUM~~R DpSES PER DAY: DGS~ VC3~iME IItiCLUDwNG FLOWBACK: J~ 9 GAL. CAPACITIES: A W ~'~ INCHES = ~0~;~ GAL. $ ~ x INCHES = `~a- GAL. ~~ C = a ZfvCi~ES = ~Ci`a GAL. :? _ _~ INCHE5 - ~.~ GAL. PUMP 8 ALARM WIRSNG AS PER irLHR 26.23 WAC EI~`aICA:. DIFFERENCE BETWEEN PUMP pF'F ANA DISTI~wBUTIgN PIPE .,,,.,,,/~- FEET * MINIMUM NETWC}RK SUPPLY PRESSURE 2.S FEET ~ _~ FEET FORCEMAIM X ~`0 FT/ 1~ 4 FT. FRICTI Oi~ FAC i nR ~- i EET T.QTA~ T~YNAMIC HEAD = ~~~~?~ FEET hi'£ItNA'~ DIMENSIONS OF PUM? TANK: LENaTH ,....~ ; WIDTH ~-•_•-• b:A!~iETER -- :~.IGI`3D: ~~.r.~.t~L-~~c=~~~ LICENSE N~~MBER~ s~~~~ DATE: ._.~ __ a1~8 i, . ~~GOULDS PUMPS Submersibt~ Effluent Pump ,~ 3 V / I E 05 APPUCATIQNS Spec"rfically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATtON5 • Solids handling capability: '/," maximum. • Capadtres: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'h" NPT. • Mechanics! seal: carbon- rotary/ceramic-stationary, BUNA-N eiastomers. • Temperature: t04°f f40aC) continuous i 40°F {6O`C) intermittent. • Fasteners; 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EPi34 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EPOS Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 1613 S1TOW with three prong grounding plug. Optional 20 foot length,16/3 S1TW with three prang grounding plug (standard on EPOS). • Fully submerged in high grade turbine oil for lubr'Katdon and effkient heat transfer. Available for automatic and manual operation. Auto- maticmodels intiude Mechankai Float Switch assembled and preset at the factory. EEATUEtES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes far methanical seal protection. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' fanarYun Stand:uds Association (CSA listed model numbers end in "F" Or "~".~ Goulds pumps ~ no soot iteyisterad. EP05 0 2 4 b 8 caancirv ^ EP05 Impeller: Thermaplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat tran.~fer, strength, and durability. ^ Motor Cover: Thermoplastic cover with iMegrai handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ___5~ . GPM 10 12 mi/h Goulds Pumps ®zoo0 Goulds Pumps ~ ITT Industries Effective February, 2000 "''"'"'"~~~~ 83871 J_,29y5t'::~012 Document No. ~ STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED SIENNA CORPORATION, a Minnesota corporation, conveys and warrants to GLEN JOHNSON CONSTRUCTION, a Minnesota corporation, the following described real estate in St.-Croix County, State of Wisconsin. 8144.=,1 KATHLEEN N. MALSH REGZSTEk L1F DEEDS 5T. CkUIX CO. , MI RECEIVED FOk kEC.ORD 12J16/10H5 11:40Ali WARRANTY DEED X~MF~s. REC FEE• 11.00 TRANS FEE: 269.10 COPY FEE: t:~' FEE PAGES: 1 Tic R.;.ECP~...~_. $ti1tL`-69g- 2~Eo la-1~~ S•1 N ' ~~~ b~1o Tax Parcel No: Lot 80, Block 9, Plat of The Glen, the Town of Hudson, St. Croix County, Wisconsin This is not homestead property. Exceptions to Warranties: Easements, Dated this day of and restrictions of record. (SEAL) SIENNA CORPORATION, a Minnesota corporation By (SEAL) Catherine M. Thornhill Assistant Treasurer AUTHENTICATION Signature(s) authenticated this day of 20_ TITLE: MEMBER STATE BAR OF W15CONSIN (If not, authorized by § 706.06 Wis. Stats.) This instrument was drafted by: Sienna Corporation ACKNOWLEDGMENT STATE OF MINNESOTA Hennepin County } }ss. } Pe onal came before me this ~~ day of a..e~E~ , 2005, the above named Catherine M. Thornhill, the Assistant Treasurer of Sienna Corporation, a Minnesota corporation, on behalf of the corporation, to me known to be the person who executed the foregoing instrumerli,and acknp~wl~dge thg same. Ruth D~IVelson, Notary pu151ic 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 leflHD: f~~Oq necessary. NDiAA1-P11000-MNNEOOfrA MII Caonrnion F~ is ii. t0f0 Names of persons signing in any capacity should be typed or printed below their signatures. Visit our website at: www,glenjohnsonconstruction.rom GENERAL CONTRACTOR -~~~~ -~`O?i _ - - - - ~ `` ~~ ~~ i~ ~~ ~ 59 - ,~ 84 • e/i ~ r ~-=~~ 1 - 79 178 ~ 77 `~ 76~ ~5 ;y loll ~ 65 6 ~ _~_.-a 2 / ~~ ~ ~~` ~ ~ '-~i:----~~-"yam ~af - -- -°-- - -_ _ _ _ _ i~ ., ~. +t r_ • ----'`~ •,%~ ~~~ J ( / i~ • / , , 6 .~ i _- F. ~~\ Imo- _.._ ._ -..~-.._.~" 3 --'- ~ --~ - / ~C Tec ~ Y'• 7D ' 69 - =~ ~\ `fir /8 •~, ~;` ,; ~~ } 7 .~ ~~ ~, . ~, - - - - - - - - - - '~ ~ -----~'=- I~I I ~~ 27 ~,,~ ~: i to o' ~~~ ~t ~ t 26 _' i i ~ ~~ ~ ~ 15 ~~j 1 - 1 E ~; ~ g ..~:~:.~-;y a. sr"" ~~..-- ~\\ ~ f~,.s 21 , ~ ~// ~' ~. ' 23 ~ 22 ~. ---- '~ P.O. Box 809 Hudson, WI 54016 .7 ~. 5-386-2974 The Glen Hudson Township 1 54 ~ 55 ~ , . '~~..... y i ~ - --- 5 ~ 1 ~ 57 -. ... ~`~ f /' V 1 ~ _. ~ Ira ~ 1 e~ i ~~.~ ~ ~ .. ' ~. ~~__, _-- _ ~ L ~ ~ ~ ~ ~ ~ ~~ ,ice ~~' i~ .~ '~ ,,e' 1 ` 1 ` <, ~ % ~~ % ~ ,, ~i'~ /1 ~ ~ -~~- ~ ~ ~~ t ~~~ Y ' ~ ~. ,~ ~ j ~ r 1 ~ ~~ t!. I ~ ~' j' '~ ~ v ~ -----~---see ~" ~ / ~' . ` \ \ ~'<' 4 ,S: i. ,} ~ ~~ ~ _ r ~,. , x \ ~ _ ~- ~~ -- ~ ;~-~, 4 - `~ ._ ._ ~i iii ~ t ~` ~ ~ -o - -- _ F r \ . , , \ 41 1 r `,,. ` \ ti , VJ / 1 \ ~ \~ ~ _ \ ~' __1\ -~ v ~ v ~ ~ ~ ..' .. ~ 0.-; =,-'3